The RoboAPRN program gives APRN students experience in telehealth and mental healthcare.
As telehealth becomes increasingly more common in healthcare, the need to train providers in this technology and care delivery is also rising. So how can nursing school educators train their APRN students about telehealth in an effective way?
Use robots.
Last November, the University of Texas at Austin did just that. It introduced a new project to the School of Nursing’s Simulation & Skills Center—RoboAPRN: Telepresence Robots in Healthcare Education.
RoboAPRN is a robot with a screen for the head, a long pole for a body, and it sits on wheels. The robot is moved around, or "driven" via computer or app by nurse practitioner students. Nurses can control the robot from any location, and navigate the robot around the hospital to see patients. This allows nurses to address patients' needs without being physically present in the same room.
The goal of using the robot is twofold: to familiarize students with telehealth and to improve patient access to mental healthcare, especially for patients who live in remote areas and may not have access to a mental healthcare provider.
Achieving this goal is particularly important for states such as Texas where there is a significant shortage of mental health professionals. According to the Hogg Foundation’sMental Health Guide: Understanding Systems and Services in Texas, 206 out of 254 counties in Texas were designated as full or partial mental health professional shortage areas. Of those 206 counties, 185 counties did not have a single psychiatrist or mental health provider in the area.
Providing better patient access through telehealth services could help with this issue.
"In a rural state like this, where there is such a lack of mental health providers, I think we have to be innovative and creative and figure out what we can do without being face-to-face,” says Donna Rolin, PhD, APRN, PMHCNS-BC, PMHNP-BC, director of the psychiatric nurse practitioner program at UT Austin.
The project trains both undergraduate nursing students and psychiatric nurse practitioner students on the use of telehealth with a strong emphasis on mental health services.
“Once our NP graduates become licensed, many of them are hired into telehealth positions and this [program] helps train them before they are out in the real world,” explains Rolin.
Introducing new technology
Rolin's department received nearly $10,000 in grant money for the project. The UT Austin team, including Valerie Danesh, PhD, RN, CCRP, assistant professor; Scott Hudson, director of simulation and skills labs; and Sean White, instructional technology specialist, researched robots to figure out which one to use while Rolin tweaked the existing curriculum to include telehealth content and determine which simulation to use for the pilot.
Rolin chose the substance abuse disorder and detox assessment and treatment, with the alcohol detox simulation as the starting point using the robot.
The testing period of the technology itself was relatively brief; it took the staff and student testers less than a week to feel comfortable with the RoboAPRN before they used it into the simulation lab. As part of the pilot, Rolin test drove the robot remotely via her computer and iPhone app both from her home office and a different building on campus.
How It Works
The RoboAPRN allows the patient to see and communicate with the nurse who appears on the robot's screen, creating an environment as though the nurse and patient were in the same room.
The NP psychiatric students act as on-call remote providers for a simulated hospital with the UT Austin Simulations Lab. They must respond to a nurse role-playing as a patient going through detox, handle undergraduate RN-level students calling them for orders, as well as respond and direct other issues that might arise from patients undergoing alcohol detox.
In this simulation, the robot is the facilitator of communication between the NP psych students, the undergraduate students, as well as the “patients” in the simulation lab.
During the simulation, the psych NP students drive the RoboAPRN into the examination room. Via live video conferencing through the robot's screen, the NPs interact with the patient. The nurses can see what the patient is experiencing, speak with him or her to complete the assessment, and make healthcare decisions as if they were in the same room with the patient.
The students used the robot three times a month for a six-and-a-half-month period, and were required to provide qualitative feedback to the team throughout the semester. This enabled them to make immediate adjustments to the simulation when necessary.
The undergraduate RN-level student response has been positive with 27 of 36 students saying there has been strong value in adding telehealth to the simulation, Rolin says.
The psych NP students were required to provide qualitative reflections and said they felt more confident because of the hands-on training they received in the simulation lab before graduation, Rolin says.
Future Possibilities
The team at UT Austin is exploring a variety of other possible uses for RoboAPRN. There is consideration to bring other disciplines in remotely, but those are still in the early stages, Rolin says.
“We’re thinking about using the robot in a more physical assessment context as well, but we’re not sure how soon it’s going to happen,” Rolin says. “We’re going to try different things to see what works best.”
One nurse leader created a millennial nurse mentor role to help her address the needs of younger nurses and improve retention rates.
When thinking about mentoring, it's usually assumed a nurse with years of experience will be coaching and guiding a newer, less experienced nurse.
But in an effort to understand the needs of millennial nurses to improve their retention rates at the healthcare organization, one CNO flipped that traditional relationship on its head.
While the overall nurse turnover at her hospital is 13%, the turnover rate for nurses with zero to three years of experience is closer to 18%. The organization hires 150 to 200 new graduate RNs every summer, and it has a nurse residency program that is being fine-tuned.
Clements first learned about the concept of a millennial mentor at a CNO meeting a few years ago.
"Somebody presented this idea and it piqued my interest because about 60% of my staff are nurses with less than two years of experience," she says. "I came back from the meeting and reached out to my nurse managers and asked them to find a new graduate who would be willing to be my mentor."
The search for a millennial mentor wasn’t a lengthy process. Once Clements identified what she was looking for, her nurse managers made a suggestion for a match.
"In my hospital, I have five generations of nurses working for me, and I want to make sure I’m meeting the communication needs, the recruitment and retention needs, [and] the development needs of our nurses," Clements says.
Before meeting with the mentor, Clements outlined the scope of the mentorship, which would be quarterly meetings that allowed the two to touch base on meeting the needs of millennial RNs on issues such as:
Professional development
Recruitment and retention
Scheduling
Work-life balance
Work environment
The meetings are casual, either in the cafeteria over coffee or in Clements' office. There is no standing agenda and they talk about the current hot topics in the hospital.
At their first meeting, Clements' mentor brought a notebook with lists of questions and ideas, she says.
The topics of discussion can range anywhere from improving technological communications to exploring ways to increase social interactions outside of the hospital. One conversation revolved around how the millennial generation is very tech savvy and due to Dartmouth-Hitchcock’s remote location, they’re still using pagers because the phone signal is not completely reliable, says Clements.
As a result of one of the conversations with her mentor, Clements explained, the organization is looking to move to a cellular communication platform.
They’ve also discussed the lack of social opportunities outside of the hospital and ways to increase those. The hope is that the increased opportunities for socialization will encourage the nurses to remain at Dartmouth-Hitchcock longer than three years.
Currently, each unit is trying different tactics such as hiking as team building, says Clements.
Additionally, the mentor has suggested a social event specifically for nurses, and they are exploring the best way to do that, which can be a challenge because nurses work long shifts and the average commute time is around an hour each way, Clements says.
Advice for other CNOs
When asked to reflect on her experience with the millennial mentor, Clements says, “I think it’s important to stay on top of the issues of the nurses coming in and managing the different generations, [and] to be able to provide opportunities for growth, preceptorship, and communication methods.”
"I think all of us need to figure out how to communicate with these different generations [about] the work ethic and the schedules and everything that goes along with that," she says.
Clements' advice for CNOs considering a millennial mentor?
"Besides, do it? I think I might tell CNOs, if you’re not connected with your millennials and what their needs are, then you’re going to miss the boat for recruitment and retention."