Thinking inside the box: the tele-intensive care unit as a new clinical site.

The tele-intensive care unit (ICU) offers students an opportunity to observe the decision-making process of nurses working in consultative teams in a high-acuity environment, providing a unique opportunity for novices to "see" into the thinking and the communication of expert nurses. Students are often overwhelmed by the physical environment of an ICU--specifically, its noise, technology, and pace--and often are relegated to the sidelines when a patient becomes unstable. Clinical education in the tele-ICU allows students to participate safely in the care of complex, unstable patients. Nurse educators, as experienced tele-ICU nurses, can help students to process complex information and can model intradisciplinary and interdisciplinary communication about patient concerns. The experience moves the students from engagement in tasks and a linear process of thinking to engagement in decision making and a more complex understanding of the nurse's role in patient care.