Nurses’ Perceptions of How Telemedicine Has No Effect on Burnout

Though many nurses who participated in study interviews discussed the ways in which ICU telemedicine can decrease burnout, a number of respondents simply told the study team that they did not know what effect telemedicine could have on burnout.

Of the nurses who held this belief, a number discussed the provision of emotional support via telemedicine. Most of these respondents felt that emotional support offered in person was more effective that that provided over a camera or telephone. Some nurses worked in ICUs that already had support services for ICU staff proved by a chaplain or social worker. One respondent described what was available in the ICU where she worked and noted the difference between “venting” and needing support for the ethical dilemmas that are common for nurses. She felt that a person who had been trained to assist with these dilemmas would be more effective than a person who had not been trained.

Nurses are nurses. They’re great to vent to. However, if you’re really having an ethical dilemma, [we have a] chaplain who is readily available, who makes himself—like he makes himself readily available, and I know who he is, he’s super cool… Now, I don’t think every hospital has that…So if you’re

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everyone—and that’s just me as a nurse, I couldn’t do that. That's not me…It’s different with my colleagues. (Site 01, ICU)

Other nurses preferred to share concerns with and receive reassurance from their colleagues in the ICU. They noted that they felt more comfortable with other nurses whom they knew and trusted than with people with whom they did not often interact. One respondent stated that she did not think that emotional support delivered via telemedicine would even be well received.

I don’t think it would be well-received. I think nursing—we so support one another, we even support our doctors. When something goes wrong, we kind of band together, and support one another, and I—like I said before, I don’t think we know [the staff in the telemedicine unit] well enough to ever get any kind of support—how do you get support when—see, I feel a big part of support is touch, and it’s contact, it’s maybe seeing tears, or feeling somebody’s pain. You can’t do that through a screen. I’m sorry, I just can’t even—no. Maybe they could say to a nurse, you did a great job, you know, I’m sorry this

happened, and okay, you didn’t do anything wrong, and that might make her— but when she walks out of that room, if something went wrong and the patient died, her support, if she was really involved with that patient for a long time, is going to come from her coworkers, the people that are there, that are going to touch her, hold her hand, see her tears, or cry with her. You know. That kind of thing. I don’t see that happening through a screen. No. (Site 02, ICU 2)

When discussions during interviews turned to the potential ways that ICU telemedicine could provide instrumental support for the bedside nurses, some respondents stated that they did not believe that the staff in the telemedicine unit could provide enough assistance to affect burnout. Some respondents believed that telemedicine services were too remote to be effective. One reason is the importance of nonverbal communication, which is not always conveyed via telemedicine. In the words of one respondent:

You know, there’s so much more to…social interaction, and…conversation and understanding of people…just by expressions and gestures and…a lot of nonverbal communication. (Site 07, ICU)

Another reason why respondents did not feel that telemedicine could not meaningfully affect burnout was that the staff in the telemedicine unit could not assist with tasks that they felt

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caused them the most stress and pressure, such as charting or being physically present with patients.

I guess I don’t really feel like they’re involved. I guess I’m not sure how, ‘cause usually burnout’s just…I’m not sure how they would really be able to assist in that. I mean, they help with orders and things like that by all means in patient care, but they can’t physically step in the room and be like, all right you need a break, and let you go. That’s not really something they’re capable of, so. I don’t, I guess, to me, I don’t know if they really help with burnout at all. I mean, they can help make the process smoother, which decreases frustration of burnout, but it’s not like they can walk in and be like, all right, you’re having a shitty night, just go [Laughs] and take five minutes, I’ll watch the crazy guy that won’t stay in bed. (Site 04, ICU 1)

Other respondents alluded to the relationship between their infrequent use of telemedicine and its lack of effect on their workloads. One nurse from ICU 1 at Site 05 recognized that she did not interact with the staff at the telemedicine unit enough to know them, noting, “[T]his is a team, and you only know how good your team is until you interact with them.” Another nurse from a different site mentioned that the ICU where she works is not consistently busy, and thus she does not need assistance from the ICU on a regular basis.

I mean, it may make their workload a little harder where you have to call, but…On most nights, we don’t have to call the doctor. It’s only those

temporary nights when there’s like a really sick patient, which is probably like once every two weeks there’s probably a night where it’s just horrible. (Site 04, ICU 2)