Understanding impact of inpatient telemedicine on nurses in a rural hospital environment

<h2>Abstract</h2><h3>Background</h3> Virtual health care has increased equity for those living in rural locations. Whilst this care delivery modality has improved access, it remains important to understand the impact on rural nurses who are on-site and support the delivery of virtual patient care. <h3>Question</h3> What are the impacts on nurses when introducing a virtual doctor model of care for the inpatient wards at three sites of a rural health service in Victoria, Australia? <h3>Methods</h3> A purposive sample of nurses (n = 21) from inpatient settings completed surveys at two time points, at model preparation and at implementation. Semistructured interviews with nurses (n = 13) provided in-depth information. Survey data are presented descriptively. Interview transcripts, analysed using the Qualitative Framework Approach, were coded, grouped, and themes interpreted. <h3>Findings</h3> Survey results at preparation showed that 93% felt informed about the introduction of the model of care. At implementation, very good/excellent ratings were given for policy and procedure development (84%), staff communication (83%), and education and training (50%). Themes from interviews on impact for nurses pertained to rural relationships, adapting the inpatient ‘usual' model, systems and processes, and nurse recognition and identity. <h3>Discussion and conclusion</h3> The impacts on nurse professional practice and their patient care delivery models need early consideration when introducing virtual care in rural health services. Rural nurses are adept at problem solving real-time issues; they value knowledge acquisition and being listened to as professionals. This vital workforce must be fully involved at the planning phase of new rural virtual models.