Characterizing the Telehealth Nursing Workforce

Abstract

Background: Before the COVID-19 pandemic, telehealth was limited by patient and provider skepticism, privacy concerns and regulations, and limited funding. However, during the pandemic, necessity led to sharp increases in telehealth practice and the easing of regulatory restrictions. Since the acute phases of COVID-19, telehealth use has waned but remains above prepandemic levels, and the patterns of practice appear to have changed. Purpose: This study aims to describe this new status quo by characterizing the workforce of registered nurses (RNs) in the United States who are providing telehealth services. Methods: This analysis was based on the National Council of State Boards of Nursing’s 2022 National Nursing Workforce Study. RNs were first separated into three bins based on the amount of telehealth they reported performing. Agglomerative hierarchical clustering was then used to develop an analysis of four general groups of RN professional profiles based on their use of different telehealth modalities. Results: Telehealth was more likely to be performed by female RNs and RNs of color. Rural RNs were more likely to perform telehealth than their urban peers, although urban RNs were more likely to participate in high levels of telehealth (>25% of their time). There were no major differences in salary, age, experience, or intent to leave nursing across the three levels of telehealth. Both rates of telehealth practice and modalities used tended to differ substantially based on RN professional profile (job title, primary specialty, and primary setting). RNs who hold multistate licenses were more likely to perform telehealth across state borders, particularly RNs who actively practice in more than three U.S. jurisdictions. Conclusion: Patterns of telehealth usage across the RN workforce were fairly heterogenous. Stakeholders in workforce planning and telehealth interventions must be cognizant of the distinct ways telehealth is employed across different types of professional profiles. Furthermore, as RNs with multistate licenses are more likely to perform interstate telehealth (and to present particular professional profiles), it may be that the National Licensure Compact facilitates nurse employment in particular types of roles.