From the Guidelines
In California, telehealth nursing practice requires full licensure with the California Board of Registered Nursing, with no separate telehealth license needed, as emphasized by the need for awareness of laws and regulations around providing services via telehealth, including understanding licensure requirements across states 1. Nurses must practice within their scope while adhering to the same standards as in-person care. The ethical principles of autonomy, beneficence, nonmaleficence, and justice are fundamental to telehealth nursing.
- Autonomy is maintained by ensuring informed consent and patient privacy through HIPAA-compliant platforms.
- Beneficence and nonmaleficence require nurses to provide quality care while minimizing harm, which includes recognizing when telehealth is inappropriate for certain patients.
- Justice demands equitable access to telehealth services, addressing the digital divide affecting rural and low-income populations. Legal considerations include proper documentation, maintaining confidentiality, and understanding cross-state practice limitations, as states have the authority to regulate the practice of medicine and other health professions within their boundaries, with most states requiring out-of-state clinicians providing telehealth services to be licensed in the patient’s state 1. Telehealth contributes to cost-effectiveness by reducing hospital readmissions, decreasing transportation costs, and enabling earlier interventions, as seen in the use of telehealth in cardiovascular and stroke care, which can increase access to care, improve patient safety, and enhance patient engagement 1. However, challenges remain in reimbursement policies and technology infrastructure. Population health policy development should focus on expanding broadband access, standardizing reimbursement, and creating clear practice guidelines to ensure telehealth services are accessible, accountable, and maintain high-quality care standards while controlling healthcare costs, with increased federal funding needed to promote high-quality research in these areas 1.
From the Research
Telehealth Nursing Licensure Requirements
- The telehealth nursing licensure requirements vary by state, and it is essential for nurses to be aware of the specific regulations in their state 2.
- The COVID-19 pandemic led to emergency declarations and policy changes, resulting in telehealth flexibilities, including changes to provider licensing requirements and cross-state practice 2.
Ethical and Legal Nursing Issues
- Nurse practitioners using telehealth must work within their scope of practice and follow discipline-specific guidance to avoid potential malpractice 2.
- Understanding legal and regulatory requirements is crucial for nurses engaging in telemedicine 3.
- Telehealth raises concerns about patient privacy and security, and nurses must ensure that they are following proper protocols to protect patient data 4, 5.
Quality Care, Accountability, and Cost-Effectiveness
- Telehealth has been shown to be generally equivalent to in-person care in terms of efficacy, and it can improve access and timeliness of care 6, 5.
- Telehealth can be a cost-effective mode of healthcare delivery, but it also poses challenges, such as the potential for overutilization of care and widening of public health disparities among minority groups 5.
- Policy makers and practitioners must carefully consider the evidence of telehealth's efficacy, including modality, evidence quality, population demographics, and point-in-time measurement of outcomes, when weighing the benefits and challenges of telehealth 6.
Population Health Policy Development
- Recent legislative initiatives have advocated for further telehealth advancements, especially with the rapid implementation of telehealth during the COVID-19 pandemic 4.
- As telehealth continues to evolve, it is essential to draft policies that ensure telehealth narrows, rather than widens, the existing disparities in access to healthcare 5.