Boundary Blueprint: Separating Work and Home to Protect Your Well-Being

Telehealth flexibility can hide a different kind of burnout, where the work never stops and the human connection feels harder to reach through screens. We talk through what drains us most in virtual care and the boundaries that help us stay present for patients without living at work. 
• provider burnout showing up differently in telehealth workflows 
• feeling pressure to move faster without room-to-room transitions 
• protecting the patient-provider connection when care feels transactional 
• setting a physical boundary between home life and work time 
• invisible work from inboxes, portals, labs, pharmacies, and staff messages 
• switching between platforms and EHRs raising cognitive load and error risk 
• unrealistic response expectations from patients across nights and weekends 
• tech failures, poor signal, and patients not prepared for virtual visits 
• refusing visits while patients are driving for safety and focus 
• normalizing stress and building a team to share coverage 

you can find us at hamiltontelehealth.com or you can email us at contact at myhamiltonhealth.com

Endorsement

Thanks for tuning in to today’s episode!

Ready to take the next step in your health journey? Visit HamiltonTelehealth.com — your healthcare oasis.
Get care when you need it, where you need it. Don't forget to subscribe!

Transcript

Burnout In The Telehealth Era

Nicole 0:25

Hi everyone, welcome to another episode of Tattoos and Telehealth. I'm Nicole Baldwin, and this is Kelly White, and we are both board certified nurse practitioners. We just like to come on and chat it up about whatever is on our mind for the day. Just to be mindful, this does not constitute a patient-provider relationship and is not to be construed as medical advice. We are just chatting it up, just in general. All right. So, Kelly, today we want to talk about burnout and different types of burnout. We're the the with the tech, it's like we're always on, always on the nature of telehealth. You know, is it helping or hurting provider mental health, you know, with the different different types of burnout?

Losing The Human Connection Online

Kelli 1:09

You know, I think this is a really good topic because, you know, we've talked before about burnout when you and I transitioned, right, from in-person care to at-home care. But I I think that in the telehealth space, it's really important to touch on the fact that provider burnout in the telehealth space is a real thing and it needs to also be given its space because we have the flexibility when we work in the telehealth space. But the things that people don't see is that oftentimes with that comes an expectation of one, being able to see patients faster, right? Because you're not physically going from room to room, and that can create a sense of urgency that causes a provider to feel a little more burned out. But then you also have to think about what does that do to the patient-provider human connection? So, you know, you and I are very, like, especially as nurses, we were trained as nurses first. We were very hands-on. Like we were hands-on at the bedside, being able to touch our patients physically and spend the time with them, spend the time with their families. And now we're down to videos, messaging, phone calls. It can feel transactional, right? And that can be hard to read, like nonverbal cues, building rapport can sometimes take a little bit more time or a little bit more intentional on our parts. And I think that with time, that can build a little bit of provider burnout with that overload, especially when you consider that every time you go into a new a new phone call or a new video, there's a certain piece that we have to carve out to build a rapport that maybe we didn't have to do if we were able to sit in front of our patient where those nonverbal cues we could kind of play off of. What do you think about like what are your thoughts on that?

Work From Home Or Live At Work

Invisible Work And Platform Switching

Nicole 2:58

Well, I think even today I had a new patient this morning and I I like to connect on video because for you to see me and me to see you, it builds that that report. Sure, I can call you or whatever, and and I can talk to you that way if your you know your state laws permit or whatever the case may be. But that always be mindful. But I feel like, especially with AI, you can make that connection when you can look at someone. And especially during COVID, all the doctor's offices were closed, right? So it was like you just had to figure it out. Like that's the way we had to do phone, video, chat, however we could, right? But I think it's important that making those those connections and and even a lot of patients are like, look, can we just do chat? Yes, but I want you to understand you're not talking to a robot, you're not, you're not talking to to a to AI. We don't use bots for our for for us. We we we just don't, because I never want patients to feel like you're talking to a bot. So it is, it definitely is burnout is a thing for sure, no different than it is in person, like you mentioned, because you're not going room to room. One of the struggles that I had initially, actually for a little while, was it was like, oh yeah, I'm working from home. Oh yeah, I'm working from home. No, it very quickly got to I live at work. I live at work. I don't work from home, I live at work. And so I actually years ago when I first started, I actually had a a like a she shed office built because I wanted to leave the house. I wanted to go to another I wanted it, it was in the backyard, but I wanted that line between can I carry my laptop in while I'm watching a movie to finish my charting. No, I need to make the line. And the line for me was walking across the yard. Work is out there, home is in here. And so, you know, things have evolved and changed, and and you know, I've created an you know a very nice office space to connect with patients in a manner that can be respectful and HIPAA compliant and all those things, but it was a struggle really going from working from home to very quickly living at work. And if you don't recognize that it's a slippery slope for providers, it definitely is a slippery slope. I have I have a friend who she will sit in bed with her laptop, and I'm like, you are nuts, you are nuts. And she and that she's just she's one of those. She's one of my good friends. She's a workaholic. Whether her medical assistants or nurses are on, she is on as well. She doesn't take any time to renew her mind. It's very, very rare. And but I think we all, for me anyway, working from home have really created a homebody. So COVID has created home bodies in itself. This is our safe space. Yeah. But then for those of us who have gone remote, not even medical, but work remote, it's created that additionally because now we're ordering groceries, we're like all those things, yeah, you know, and so it definitely is has its own set of burnout where I feel like some days I'm chained to the desk.

Kelli 6:27

Well, it really created a lot of invisible work, right? Like we have inboxes, portal, you know, patient portals, um, charts that we have to look over. There's real-time expectations from multiple digital channels, whether that's patients, our staff, pharmacies, labs, all the different things. Or it could even be for some of us different telehealth platforms. We're switching from one EHR to another all day long, constantly. And so there's a lot of invisible work involved there. So whether I'm in direct patient care on the line with a patient, I'm sitting here in front of my computer, hopping from one to the next all the time. And there's a lot of invisible work involved there. There's separate separate portals and apps, a lot of, you know, management tools, and it can really fragment your work. And I think that's where some burnout can lie because not only is that extra work and burden on you, there's an increased risk for error there because you are jumping around all the time. And so we have to be cognizant of the work that we're doing as we're jumping from platform to platform. It's no different than going from room to room. You can't take this patient's issue into that patient's room. You can't do the same thing jumping from platform to platform. And it I think it creates the same feeling, emotional feeling with your provider in a different context or in a different space. And so I think without without being able to appreciate that, it's like you said, you don't work from home, you live at work. And so there's a piece to that that maybe goes underappreciated by by providers, especially when they think, oh gosh, I'd love to work from home. It must be wonderful. I'm like, well, actually, you know, we suffer from a lot of the same issues just in a very different context.

Always-On Messaging And Boundaries

Nicole 8:14

You know, in a very, very different, different context. I mean, yeah, we're saving gas money, but as my telehealth career since you know 2019 has gone, my computer screen gets larger, right? Now it's like, you know, four feet wide because I'm gonna have inter-office communication here, I'm gonna have patient uh portal messages here, I'm gonna have scheduling over here, I'm gonna have emails over here. So I have all these tabs open and my mind is like, you know, like the old Rolodex, you know, it's just like a hundred to a hundred tabs are open at the same time. And and sometimes that's the way we feel in our mind, but that's the reality is like all these tabs are open and I'm ding ding ding ding ding. You know, in the ICU, it was like alarm fatigue, and we we get where we're we only hear the critical ones anymore, right? We only hear the we we hear the ones we know we need to hear, right? All the other ones, but you know, things that are less important, you know, they whatever. But uh definitely with all the dings and all of the, you know, and then we have, you know, we have texts from our staff, and then we have so there's so many modalities that it really is like just yeah, let me just take it down.

Kelli 9:28

And then I think that the the other piece to this is especially in our space from you and I, and and we have excellent staff, and I wonder how many providing platforms that don't use a bot, I'm gonna I'm gonna preface with don't use a bot, that have staff like you and I that take care of everything, what their response time expectations look like. Because I think that's different now with patients. They think, well, you're at home or this is telehealth, I can message you at 3 a.m. on a Sunday and you should answer me. Whereas in person, they know you work Monday through Thursday and your your clinic is probably closed at noon on Fridays. They understand they're not going to get a call back on Friday at 5 p.m. until Monday morning. Whereas with our patients, they expect a response at Sunday at 3 a.m. But it's not a it's not a reasonable expectation sometimes, you know, even though it is telehealth, it doesn't always mean it's 24-7, especially for platforms like ours where we use real people, we do the best we can to cover 24-7, but we don't use a bot. We do have that personal touch. And so I think that there's response time expectations there too, and how you, you know, how you handle those escalation paths with messaging and alerts and things like that.

Nicole 10:41

Yeah, absolutely. And and you know, we do have people that work on the weekends to kind of screen things to make sure we don't do emergencies. So we do have a little bit of more lax with that. But even on Easter, we have somebody that's going to check in just to make sure. I don't know why my that's so cool. I don't know what happened. I don't know why. I don't know why that happened, but we have uh a staff member that's just on just to kind of say, check in, you know, pharmacies aren't going to be open unless you're at a 24-hour pharmacy. And, you know, we we don't do emergencies, so the ER is open. So, you know, we do have a little bit more flexibility in that manner, but it is unrealistic, you know, especially that you know, coming up is Easter. And it's like, you know, we need, we need, we definitely need a break too. And, you know, when I was first doing telehealth, I was like, you know, I do need to work every holiday because people don't have their in-person, but we have to take time too. And that's something that I've really had to learn the hard way is, you know, as a human, I have my own family and I have my own priorities that I can't be chained to the dash 24-7 because I I will go crazy, be like working at the hospital 24-7. Like you're on, you're you're on all the time.

Kelli 11:58

So a little bit side note here, if you had to choose one pet peeve about connecting with the patient virtually, what what is your pet peeve?

Nicole 12:12

It would be having nothing to do with anyone's fault, but not getting when when tech doesn't work the way it's supposed to.

Kelli 12:22

Me every time. It is so aggravating. Like you get a patient on and they don't have Wi-Fi or they don't have a good signal or they don't have the connection you need them to have, or they don't know how to use their video, or they don't know how to click aggravating.

Nicole 12:35

Yeah. Like do a dry run before you connect. But like today, for some reason, the EMR video was not. I'm like, where's the button? There's no button for me to click. So I had to reach out to patient support or to our team, have them reach out to the patient to say, hey, I'm gonna send you a a different link because tech because the EMR is not, there's a glitch or it's down or whatever the case may be. And so it's frustrating for me because I look like I don't have my shit together. But really, I just like I can't do what I can't do. And if tech is not working, just because it's not working, yeah, then it becomes frustrating. And that's and that's a pet peeve. So sometimes it's half the time, well, more than half the time, the patients just aren't ready. And if you were going to a doctor's office, you would you would be ready. Yeah, you you would be ready, right? However, some of the times it is just tech in general. It is it is just a tech issue or people that live in rural states, and sometimes we have to call instead of video because that's just the way that we have to connect based on limitations, but that is, yes, that is it. Not being ready, not being prepared, not being prepared for the visit on the patient side and not tech not working the way it's supposed to.

Kelli 13:52

I think for me, it's the ones, it's the patients that you get them on the phone for a phone call and they have one bar and it's cutting out or very robotic, and their response is, yeah, I'm sorry, I just don't have good service here. And silence.

Nicole 14:07

How can I help you?

No Visits While Driving

Kelli 14:08

And I'm like, then you need to go somewhere you have good service because we can't do this. Like, I I can't help you if I can only hear every fifth or sixth word coming out of your mouth. Like, but they don't understand that that's not appropriate, you know. Like, I those are the those are the frustrations I think that I have the most. So I think if I had to pick a pet peeve in telehealth that I get frustrated with the most, it's those situations where I'm like, no, that's not okay.

Nicole 14:31

In the car, in the car, driving in the car.

Kelli 14:34

Yeah we don't all the all the racket of what's in the car or I will I will not let my patients drive. If if I hear that you're driving, I won't make you pull over. And I've had patients get angry with me. I'm like, well, then I'm gonna have to reschedule. I'm like, okay, that's okay. You just you can't be distracted and be driving because one, you're distracted because you're trying to talk to me. Two, you may or may not hear what I'm trying to tell you or absorb the information that I'm giving you, or be able to give me an accurate recounting of what's actually going on because you're partially paying attention to what's happening around you. But you should be. Yes, and less paying attention to what I'm trying to tell you. So we're not we're not connecting here like we need to be. So you're not gonna get a visit with me if you're driving, just putting that out there right now. So, guys, if anyone wants to have an appointment with me, you're not gonna get it if you're driving.

Nicole 15:18

You need to be 100% focused on driving or 100% focused on the visit. And both of those are super important. And so, either one, you need to focus on driving and this visit is a waste of time, or number two, you're 100% focused on me and driving is not safe. So you got, you know, not gonna happen. You gotta pick one.

Kelli 15:35

So I have a I have a dear, dear patient. He's been with me since the beginning of time, and he owns uh a string of barbecue restaurants. Um, and he often has to travel from joint to joint, you know, from restaurant to restaurant, checking his businesses. And I love him because he'll call me, he'll like, okay, I'm I'm still in the truck, but give me a minute. I'm pulling off right now, right now, I'm pulling over right now. Like he already knows he has to pull off before I'm gonna talk to him. He cracks me up. And and he will every single time. It's like, okay, I'm stopped. I put it in gear. Like I can hear him shift it into park. Okay, I'm ready. You have him trained. You have him have him trained. He's awesome.

Normalizing Burnout And Getting Support

Nicole 16:10

That's awesome. That's awesome.

Kelli 16:12

So, you know, I guess the point, the point of everything is to say that, you know, while working from home is fantastic, and I think that we have truly been able to fill a gap in healthcare and provide a service to patients that they otherwise wouldn't have, right? And it does its thing, and telehealth is a major is amazing. And being able to fill the gaps and the challenges of healthcare by bringing digital healthcare, there still needs to be some recognition for providers. And I hope that there are some telehealth providers listening to this that are able to, you know, say, yes, that's me. Yes, I have that burnout, yes, I feel that way, yes, this is how I'm feeling on a daily basis. For us to just say, guys, that's normal. That's okay. It's okay for you to feel that way. It's okay for you to be stressed and upset and anxious and aggravated. But also for y'all to hear Nicole and I say that it's all right to take a step back. It's all right to say, put you a team in place, put you people in place to take those calls. You know, like Nicole said, have it build a she shed or build you, build you a place where you don't live at work or or do some things that kind of take some of that demand off of you. But burnout is real in all aspects of healthcare, even if you do work from home.

Closing And How To Reach Us

Nicole 17:21

Yep, absolutely. All right, guys. Well, thanks for joining us. We're gonna wrap this up and hope you have a blessed rest of the week. And if you need anything, you can find us at hamiltontelehealth.com or you can email us at contact at myhamiltonhealth.com, and we'll be happy to uh happy to see how we can help you. Hope you guys have a great day. Take care. Bye.