Telehealth and virtual clinical hours: what counts

What the NP standards say about telehealth

The National Task Force on Quality Nurse Practitioner Education sets the national standards NP programs follow. Its 2022 edition requires at least 750 direct patient care hours and counts care delivered through telehealth as direct patient care. A video or telephone visit where you care for a real patient, under your preceptor, is therefore a clinical hour in the same way an in-person visit is.

The standards still expect those hours to prepare you for your role and population focus. A telehealth hour counts because of the care you provide in it, not because of the technology, so the usual expectations about patients, supervision and documentation all apply.

Your school sets the virtual share

Within the national standards, each school decides how many of your clinical hours may be completed through telehealth, and in which courses. Some courses suit virtual care well; others center on hands-on skills, such as the physical examination, and are planned around in-person time.

Counseling, social work and behavior analysis programs set their own rules for services delivered online, in line with their accreditation and certification standards. Before you agree to a telehealth placement in any program, check your handbook or ask your clinical coordinator:

• How many hours, or what share of a course, may be virtual.
• Which courses accept telehealth hours.
• Whether a telehealth site or preceptor needs any extra approval.
• How the school wants telehealth visits recorded in your log.

Specialties that suit telehealth

Telehealth fits best where much of the visit is conversation, history and observation, and planning care together. Specialties built on hands-on care, such as acute care, neonatal care and midwifery, are planned mainly around in-person hours.

Settings where virtual care works well include:

• Psychiatric-mental health: medication management visits, psychotherapy and follow-ups, often through telepsychiatry programs.
• Primary care follow-ups: chronic condition check-ins, reviewing results, adjusting medications and patient education.
• Counseling: individual and group sessions delivered online, where your program allows them toward direct service hours.
• DNP project work: meetings, data review and implementation with a practice whose project includes virtual care.

What makes a telehealth hour count

A telehealth hour counts when it has the same four parts as any clinical hour. The site and preceptor also need the same approvals as an in-person placement, including an affiliation agreement that covers the telehealth work, and the visits fall within your course dates.

HIPAA and privacy for telehealth

HHS guidance on HIPAA and telehealth asks providers to use telehealth platforms that meet HIPAA requirements. During the COVID-19 public health emergency, HHS used temporary enforcement discretion for some everyday video apps. That period has ended, so sites now use platforms that meet the HIPAA rules.

As a student, your part is simple and important:

• Use only the site’s telehealth platform and the account it gives you, never a personal video, phone or messaging app.
• Join from a private room where no one can see your screen or hear the visit.
• Wear a headset so the patient’s voice stays private.
• Record a visit or take screenshots only if the site’s policy permits it.
• Keep the same de-identified habits in your notes and log as you would in person.
• Close the platform and the EHR, and lock your device, when the session ends.

Your telehealth set-up checklist

Test everything before your first session, so the first visit is all about the patient:

1. 1Choose a private spaceA quiet room with a door, good light on your face and a plain background.
2. 2Use a headsetA headset with a microphone keeps the audio clear for you and private for the patient.
3. 3Check your connectionUse a stable, secure internet connection, and agree a backup plan with your preceptor in case a call drops.
4. 4Get platform and EHR accessLog in to the site’s telehealth platform and record system ahead of time, and complete any training the site asks for.
5. 5Learn the site’s ID verification stepsFollow the site’s process at the start of each visit, such as confirming the patient’s identity and where they are located during the visit.
6. 6Dress as you would on siteWear professional clothes and your school ID, and introduce yourself as a student working with your preceptor.

State licensure: care happens where the patient is

In telehealth, care is delivered in the state where the patient is located at the time of the visit. Your preceptor must be licensed to practice in the patient’s state, which matters when a practice serves patients in more than one state.

Your school may also have rules about where you are during a telehealth visit and about your own registered nurse license, so confirm the details with your clinical coordinator before your placement begins. Telehealth sites know which states their clinicians serve, which makes these questions quick to answer.

Simulation is not telehealth

Simulation and telehealth both happen away from a traditional clinic, so they are easy to mix up. Telehealth is real care for real patients, delivered by video or telephone. Simulation uses standardized patients, manikins or virtual cases to practice skills in a planned setting.

The National Task Force standards value simulation as part of NP education and count it separately from direct patient care. Simulation hours, including virtual simulation, do not count toward the 750 direct patient care hours, so plan those hours with real patients, in person or through telehealth.

Questions students ask