By Cathryn Domrose
January 24, 2000
Illustration: William Jacoby/Corbis

After 23 years of working in nursing homes and home health care, Marian Eure, RN, decided to put her expertise online. As an Internet "guide" for About.com, a network of general interest Internet sites, she helps elderly clients navigate the Web, runs online forums for seniors, and writes short articles on topics such as violent crime and aging.

For the past six months, the San Antonio nurse has worked 10 to 15 hours a week as the About.com guide to senior health, in addition to her full-time job at an insurance company. "The part of nursing that I really love is getting the information out," Eure said. "I think nurses are on the front line for giving health information to people."

For specialists and generalists

As it has for every other profession, the Internet has opened up new opportunities for nurses. Nurses are working as consultants to online healthcare companies, answering questions in chat rooms, helping design Web pages, and even offering information on their own Web sites. They are doing what many say nurses have always done best: giving out good health information in ways the average person can understand. In the meantime, healthcare observers and regulators are trying to figure out how the Internet will shape the future of nursing, as well as how to apply age-old regulations to a new medium.

Some Net nurses have salaries or long-term contracts with Internet health companies while others work as consultants for several different companies. Most work at home—one of the Internet's biggest perks. Pay varies from $100 to run a chat room for an hour to salaries that nurses say are comparable to hospital positions. Many work online to supplement teaching or clinical practice. Job descriptions vary from day to day and week to week.

"I really don't have a set job description," said Ann Marie Giusto, RN. The Walnut Creek, Calif., nurse is chronicling her pregnancy on Helios Health's pregnancy and infant care Web site and working as a liaison between Helios and medical centers. "I really can make the position what I want."

Regulations fuzzy

Giusto had little computer experience when Helios hired her a few months ago. She could surf the Net and use a basic word-processing program. But the company liked the fact that she had set up an air emergency flight program when she lived in New Mexico. They liked the idea that she was pregnant and open to sharing her day-to-day experiences with other expectant mothers.

"Nurses understand the holistic approach," said Gina Wade, MS, RN, an assistant clinical professor at the University of San Francisco School of Nursing, who teaches consumer informatics, a new field in nursing. "We are the domain experts. It's an obviously natural place for us on the Internet."

Nurses say they are careful about what they say on the Internet. It's illegal for them to practice any form of nursing in states where they are not licensed. But they can give out general information the way that health columnists do in magazines and newspapers. Most online companies have disclaimers saying information on their sites should not be considered medical advice. If patients need medical advice, Wade said, nurses refer them back to their primary care providers. But an online nurse can suggest ways for patients to talk to the primary care provider so that both understand, she said.

The undeniable future

Internet nursing isn't for everyone. Wade, who has worked as a consultant for several online companies, said she loves it, but would be bored doing nothing else. Others say they miss the face-to-face patient contact. A nurse who wants an Internet job needs to be a bit of an entrepreneur, said Leslie Nicoll, PhD, RN, an associate research professor at the University of Maine College of Nursing in Portland, and editor of Computers in Nursing.

"You need to be more into the business mentality, which is difficult for many nurses," she said. "Kind of blowing your own horn."

The concept of health care on the Internet is growing fast and constantly changing. Issues like licensing, ownership of information, and patient privacy will loom larger as more hospitals and clinics begin communicating directly with patients through computers.

"The patients will start to use the Internet as a component of interacting with their healthcare provider," said Nicoll. "I really think we're getting to the point where computers are less of a novelty and they're just there."