We’re in a period of tech advancement that the World Economic Forum has dubbed the Fourth Industrial Revolution. Characterized by physical, digital, and biological worlds coming together, this period is one where tech enablement is a given, allowing us to shift our focus to finetuning the application of converging technologies.
In the Forward of “Nursing Satisfaction: What Matters Most at Work,” Ascom North America Managing Director Kelly Feist points to healthcare as a key market where you can see this revolution unfolding. Comfort with technology in healthcare picked up significantly after the pandemic, leading providers to rethink traditional care models through a new lens of digital empowerment. Today, the integration of connected devices, remote support, and AI into clinical workflows is forever changing how medical teams deliver care.
As Feist sees it, intelligent workflow technologies are more essential than ever in healthcare, due in large part to rising pressure on bedside nurses. In the Ascom nursing satisfaction survey, nurses cited increased patient loads, having to care for sicker patients, and working longer hours as drawbacks driving them away from the profession.
So, what can hospitals and health systems do to improve nurse satisfaction and retention?
Ascom notes that nurses are looking for value-adds that make the job worth doing. “This expectation can come in the form of traditional benefits like higher compensation as well as softer benefits, like greater flexibility in working hours and having mechanisms in place to make their job easier by delivering care more intelligently, efficiently, and collaboratively.”
Naturally, nurses want to be paid more for intensifying workloads, but technology is also influential in the fight for nurse talent. Almost 60% of nurses surveyed said that a hospital’s suite of technology tools was an important factor in deciding whether to take a job. Nurses want technologies to drive efficiency, give them more time with patients, and automate the capture of information into a centralized source.
Source: Ascom, Nursing Satisfaction: What Matters Most at Work
Feist highlights three takeaways from the report:
1 –Technology designed for clinical workflows consistently ranks high for addressing some of the key challenges nurses identify as negatives in their jobs. Nurses’ number one desire for workflow solutions was to eliminate redundant steps.
“Ascom identified that nurses, nurse assistants, or technicians manually measure as many as four to six vital signs per round, record each result on a chart, and then enter all of the data into the electronic health record (EHR), which could take up to three hours per shift.”
Thus the rising popularity of aware rooms and Virtual Nursing. These next-generation solutions allow bedside RNs to shift routine tasks like admissions and vitals capture to integrated devices and remote team members.
2 – Technology is increasing the time nurses directly spend with patients. The automation and remote redistribution of routine tasks are freeing up time for bedside nurses to focus on what matters to them – patient engagement.
Interestingly, virtual patient engagement channels are also offering nurses new ways to build uninterrupted relationships with patients, and supporting career extension for older, experienced nurses to continue providing patient and staff support.
3 – Technology can aid in proactive care, giving clinicians a practice “safety net” to anticipate, recognize, and intervene before a sentinel event occurs. By augmenting patient coverage with virtual eyes, ears, and sensors, care teams are alerted to potential health threats earlier, improving downstream outcomes.
The ability to manage alerts to mitigate alarm fatigue and highlight actionable cues in the ocean of new information that providers are inheriting is becoming more important.
Today, technology plays a crucial role in supporting caregivers’ ability to provide the best patient care possible. With sicker patients seeking care, limited clinician pools, and a pending surge in elderly patient populations, empowering nurses with intelligent workflow solutions not only improves nurse satisfaction today, it also modernizes care models to ensure success in the future landscape of care delivery.
Staffing shortages, clinician burnout, and overwhelmed new hires – sound familiar? The same challenges hindering hospitals across the nation prompted the team at OhioHealth to create Virtual Nursing “smart rooms” to help stem the tides of nurse attrition. Executives from the health system and their technology partners recently shared their experience getting the emerging care model off the ground in the webinar “Clinical Workflow Optimization: The Role of Virtual Nursing.”
Arika Thomas, MBA, BSN, RN, Director of Nursing for Inpatient Services at OhioHealth’s new Pickerington Methodist Hospital; Erica Braun, MFA, User Experience and Product Design Advisor for OhioHealth; and Tom Gutman, MBA, Senior Consultant of Simulation Technology for OhioHealth, joined eVideon Clinical Implementation Director Erin Pangallo, MS, BSN, RN, and Caregility Clinical Program Manager Ben Cassidy, MBA, MSN, RN, CCRN, to discuss the health system’s approach.
Each “smart room” is powered by the Vibe Health by eVideon smart room platform, which includes the Insight digital whiteboard, Aware digital door sign, Companion bedside tablet, and interactive Engage TV solution. These solutions elevate the inpatient experience with personalized communication, tailored education, and self-service tools that improve patient satisfaction, loyalty, and outcomes while alleviating non-clinical responsibilities for bedside nurses.
Integration with the Caregility Cloud™ virtual care platform allows the OhioHealth team to seamlessly facilitate bedside Virtual Nursing and Virtual Patient Observation sessions via the footwall TV. Together, the platforms create a digital health hub in every patient room that allows hybrid care teams (virtual and in-person) to work together seamlessly to provide patients with the highest level of care and meaningful interaction throughout their care journey.
A Co-Caring Approach to Nursing
OhioHealth’s Virtual Nursing journey was methodical and collaborative, beginning with a co-design phase that involved an in-depth review of internal workflows alongside floor nurses. This phase aimed to identify and eliminate “pebbles in the shoe” of RNs, as Thomas puts it – small, yet significant inefficiencies in workflows and routines. Following a nine-month pilot at two sister site units, the program was refined and launched at Pickerington, with the hospital now reaping the benefits of this innovative approach to nursing.
The co-caring model, a cornerstone of OhioHealth’s program, blends traditional and virtual nursing roles to create a hybrid care team. This model includes bedside RNs and LPNs handling direct patient care, patient support assistants (PSAs) managing daily living activities, and virtual nurses focusing on administrative tasks, patient education, and care coordination. Virtual nurses support 15 to 20 patients assigned to their nursing team.
Just two months into the program, OhioHealth’s collaborative approach has led to significant improvements in patient and nurse satisfaction, with nurses reporting reduced stress and more time for bedside care. Patients appreciate the added care provided by virtual nurses.
“Something that we've noticed is now that nurses have support with that admission, our dead-bed time has shrunk.”
Erica Braun
User Experience and Product Design Advisor, OhioHealth
“We’re also looking at usability and frequency metrics,” said Braun. “Caregility has a great backend dashboard we’re monitoring to see how many calls our virtual nurses are taking in a day, on certain days, and at certain times of day. Right now, we have two virtual nurses per shift. We’re trying to assess, as we grow at Pickerington and beyond, is this enough? Are they covering too many or too few patients? We’re really trying to understand their productivity to inform how we could scale.”
How to Start and Scale Virtual Nursing
During the discussion, speakers offered advice to other health systems looking to get started with or scale Virtual Nursing.
“Our recommendation is to start with a big win that’s easy to implement,” said Cassidy. “Once you have that one device set up in one patient’s room and one virtual nurse, you can carry out simple workflows. Think about admissions and discharges as well as hourly rounding and assessments. Those are where you’ll see the biggest time savings. You may also see some reduction in incremental overtime by taking some of that heavy documentation off the bedside.”
“Then you can move over to more complex workflows,” Cassidy continued. “You can have multiple use cases using the same device in that patient’s room at the same time. You can have a wound care nurse go in to do their assessment and on top of that, you can have someone virtually observing the patient in a sitter format. Expanding that model is a big lift but it’s also needed. Making that “room of the future” allows you to impact care throughout the entire organization, not just one unit or facility.”
Elevating the Standard of Care
The success of Pickerington Methodist Hospital’s Virtual Nursing program is a testament to the power of innovation and collaboration in healthcare. The hospital has set a new standard for nursing care that better addresses staffing shortages, enhances nurse and patient satisfaction, and improves overall care quality. As the program scales, its impact is expected to grow, offering a blueprint for other institutions seeking to embrace virtual nursing “smart room” technology.
OhioHealth’s journey from conceptualization to successful implementation highlights the transformative potential of technology in healthcare. By prioritizing co-design, embracing technological solutions, and fostering a collaborative care model, the health system has not only enhanced care delivery but also positioned itself as a leader in healthcare innovation.
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Virtual Nursing’s Reach Within Hospitals
In a recent HealthLeaders article, “Hospitals are Looking for Hard ROI in Virtual Nursing,” author Eric Wicklund confers with healthcare executives on the difficult task of pinning down value for the nascent care model. Given the multitude of ways that Virtual Nursing can be deployed, one of the most challenging aspects of rolling out a program is identifying where virtual nurse resources can make the most impact. This will inevitably vary from facility to facility.
“Each hospital is approaching the issue from a different direction, ranging from basic [virtual] sitter programs targeting patient monitoring and fall prevention to platforms that support new nurses to more complex telenursing platforms that combine monitoring with administrative functions,” Wicklund observes.
Although determining where virtual nurse resources can deliver the most significant benefits can be a complex task, one of virtual nursing’s most remarkable attributes is its adaptability and versatility, enabling its deployment across various units within the hospital. Here are several illustrative examples of how virtual nurses can be leveraged to improve patient care across the inpatient enterprise.
Tele-ICU Support: One of the most well-known applications of virtual nursing is in the intensive care unit (ICU), where virtual nurses provide round-the-clock monitoring, early intervention, and clinical support to high-risk patients. They work in conjunction with intensivists and on-site staff to enhance patient care and safety, assisting with real-time data analysis and intervention.
Emergency Department (ED) Assistance:Virtual nurses can play a crucial role in the ED, supporting triage, patient assessment, and timely decision-making. By providing remote guidance and expertise, they help alleviate the pressure on ED staff, ensuring efficient care delivery, especially during high-demand periods.
Cardiology Care Coordination: In cardiology units, virtual nurses can assist in monitoring and managing care for patients with heart conditions, including angioplasty and stent procedure recovery. They help ensure timely detection of patient deterioration, medication adherence, and ongoing patient education, promoting better outcomes for cardiac patients.
Sepsis Care: Virtual nurses are well-suited to monitor patients at risk of sepsis. They can continuously assess vital signs and clinical data, identify early warning signs, and alert care teams to intervene promptly, potentially preventing this life-threatening condition.
Neurological Care: Patients in neurology units, such as those recovering from strokes or traumatic brain injuries, often require close monitoring and frequent interventions due to memory impairment. Virtual nurses can provide consistent support, reminding patients about instructions and interventions, and helping reduce the burden on in-person staff.
Skilled Nursing Facilities (SNFs): Beyond the hospital, virtual nurses can extend their reach to post-acute care settings like SNFs. They assist with patient assessments, medication management, and rehabilitation programs, ensuring that patients continue to receive high-quality care even after discharge.
This diverse landscape of use cases underscores the flexibility of Virtual Nursing. Healthcare organizations can tailor their adoption journey to meet specific goals, introducing virtual nurse resources to units most in need of additional support and units most likely to correlate to patient outcome improvements.
When expanding virtual nursing programs to additional units, it’s essential to start small and grow incrementally. As you implement your initial program, you’ll likely find that clinical staff closest to patient care delivery will generate new ideas and identify opportunities for improvement. Their feedback and insights can drive innovation, unlock additional ROI, and shape the future of virtual nursing within your organization.
Many see Virtual Nursing as a natural next step in the evolution of patient care models, proposing that there will come a time in the not-too-distant future when virtual nurses are an essential part of every hospital care team. In addition to helping health systems offset chronic staffing problems, looking ahead, Virtual Nursing models can introduce new pathways for providers to extend care into patients’ homes to support chronic care management and preventive medicine on a broader scale.
Healthcare delivery is undergoing a transformation and virtual nursing is at the forefront. In a recent webinar co-hosted by Caregility and the American Telemedicine Association (ATA), healthcare leaders from institutions at various stages of implementing Virtual Nursing programs gathered to discuss their experiences.
Virtual care pioneer and Caregility CNO Wendy Deibert led the illuminating panel discussion featuring Tracey Kopenhaver, Operations Manager, Geisinger Inpatient Virtual Care; Christine Coriell, Director of Nursing Operations, OhioHealth Resource Center; and Debra Marinari, Associate Vice President, Hospital Operations, Mary Washington Healthcare.
All panelists pointed to nursing workforce challenges as key motivators to pursue Virtual Nursing, but technology and ROI had to line up.
Addressing Nursing Shortages and Burnout
The virtual nursing model allows healthcare organizations to tackle staffing shortages and burnout by distributing the workload more evenly.
“We were motivated by a few things – primarily the nursing shortage, nurse turnover, nurse burnout, and really looking at our care team redesign. Looking at current state, where we don’t have quite enough nurses to go around, and our nurses are overworked and busy and can’t get to all the things that they need to do in a day… How can we try to future-proof or buffer that?” – Tracey Kopenhaver
Technology Aligns with Strategic Goals
By leveraging existing technology that supports remote patient observation teams and tele-ICU programs, Virtual Nursing programs align well with strategic goals to centralize and scale virtual care.
“When we think about our Nursing strategic goals at OhioHealth, one is having a flexible workforce and second is maximizing the technology we have at OhioHealh. So, this was just a natural next step into the virtual world.” – Christine Coriell
Demonstrated ROI
Panelists addressed the importance of justifying costs, typically vetted through pilot programs.
“It had to be cost neutral – that’s the model that we took. So, we had to make sure that whatever we brought in was going to have a good return on investment – not just the quality metrics, but [improving] satisfaction and decreasing turnover.” – Debra Marinari
Strategy
While there is variation in how Virtual Nursing workloads are assigned within each organization, some standard practices emerged. Each panelist’s healthcare organization uses Epic’s EHR in different capacities for streamlining workflows. Each organization also staffs virtual nurses onsite, with Geisinger employing a hybrid model that also includes nurses working from home.
Getting Started
“The number one recommendation I would give to anybody who is thinking about starting a virtual nurse program is don’t let perfection get in the way of progress. We started very low budget. We repurposed carts. We hired per-diem staff to start with and borrowed some staff from our virtual ICU program. We really went in on a shoestring to get it off the ground. We’ve been able to demonstrate the return and we have the financial support to move ahead with a more permanent solution.” – Tracey Kopenhaver
Staffing Models
Virtual nurse staffing models varied across panelists. Coriell noted that, in their current phase, OhioHealth virtual nurses work Monday through Friday from 7 a.m. to 7 p.m., with plans to extend to 24/7 coverage.
“The virtual nurse will be assigned to patients that all will roll up to the many nurses overseeing that care at the bedside. We’re utilizing a flex team of nurses with knowledge across different care sites for now. A future focus is on having dedicated full-time employees (FTEs) for the program.” – Christine Coriell
Geisinger takes a slightly different approach, with Virtual Nursing overseeing specific tasks.
“There are no specific patient assignments for virtual nurses since they currently focus mainly on admissions and discharges.” – Tracey Kopenhaver
Meanwhile, Marinari and the Mary Washington Healthcare team elected to bring on additional FTEs for virtual nursing from the very beginning.
“The model had to be really such that the nurses at the bedside did not feel like they had less resources, but actually more. We had to balance the FTEs for each of the departments, and what that workload was going to be [in terms of] patient ratios. The virtual nurses are assigned to patients, currently managing around 15 to 16 patients during the day and up to 20 at night.” – Debra Marinari
Goals and Results
Positively impacting nurse and patient experience are core objectives for each organization.
KPIs
“Key outcomes that we really want from this program [include] retention of nurses, decreasing that workload and stress at the bedside, increasing time for the bedside nurses to be able to provide care for their patients, improving nurse satisfaction [and] patient satisfaction, and then some cost savings. Ultimately, we would look at time saved with length of stay and a few other metrics as well.” – Christine Coriell
“We’re looking at our HCAHPS – nurse responsiveness and communication with the nurse scores in particular.” – Tracey Kopenhaver
Time Management & Efficiency
All panelists agreed that virtual nursing significantly improves time management, reducing the workload of bedside nurses.
“The thing that we’ve been able to measure the most is the time saved for the bedside nurses.” – Tracey Kopenhaver
Marinari and the Mary Washington Healthcare team conducted time studies to demonstrate time savings, assessing the time from when the discharge order is written to the time the patient leaves as a metric. Coriell highlighted the role of existing relationships between virtual nurses and unit staff in speeding up tasks and improving efficiency.
Conclusion
Virtual Nursing programs are not just a trend; they are a substantial step toward enhancing healthcare delivery. These programs alleviate staff burnout, improve patient experience, and provide financial returns. With insights from leaders in the field mounting, it’s clear that Virtual Nursing is a viable and vital part of the future of healthcare.
What Nurse Unions, CNIOs, and Virtual Care Have in Common
Workforce challenges continue to be a chief obstacle for healthcare provider organizations. Nurse burnout and attrition reached a fever pitch during the pandemic, leading to a surge in nursing strikes nationwide. Nursing unions are at the forefront, championing better staff-to-patient ratios, safety measures, wages, and working conditions for their members.
2023 research from the Health Management Academy sheds light on some of the ways hospital clinical leadership is working to tackle nursing concerns. Developing more sustainable documentation protocols to reduce the burden on nursing teams and leveraging technology to reduce workplace violence were among the top priorities cited by Chief Nursing Information Officers (CNIOs) in leading health systems.
Integrating virtual nursing into care offerings, monitoring technology’s influence on nursing labor cost trends, and streamlining tech stacks to improve clinical efficiency were also cited as key focus areas. CNIOs are keenly attuned to technology’s impact on clinical workflows and experience, and rightfully so.
Many of the tasks the McKinsey research highlights as being ripe for tech enablement – documentation, hunting and gathering, and interdisciplinary communication – align with virtual nursing objectives.
Given the fair share of turmoil and turnover in the nursing profession in recent years, it’s unsurprising that the concept of virtual nursing has encountered naysayers. Clinical resistance to the hybrid care model largely centers on the misconception that virtual nurses will replace bedside RNs. Virtual nurses are intended to augment and support existing teams, not supersede them, by taking tasks off of overburdened nurses’ plates.
“It’s about alleviating [nurses’] pain points and making the job more satisfying,” says Caregility Clinical Program Manager Irene Goliash, RN. “You can significantly improve patient, family, and staff satisfaction just by shifting clinical workload to someone who has time to devote to the specific activity.”
Virtual nursing introduces remote resources floor nurses can tap for patient care support and staff safety monitoring. It also introduces a succession plan that allows hospitals to move experienced nurses who age out of bedside care into virtual roles to preserve institutional knowledge.
Selecting the right virtual care platform can also impact the perception of virtual nursing. To appeal to clinicians, solutions should offer a consistent, simple interface and include things like training components that reduce total onboarding time for new nurses. Identifying a solution that is agile enough to be leveraged enterprise-wide can help health systems achieve goals related to clinical resource consolidation.
Nursing unions, hospital clinical leadership, and virtual nursing programs all have one thing in common: They support a shared mission to address nursing pain points to improve clinician experience, reduce burnout, drive efficiency, and positively impact patient care.
The challenges faced by the nursing workforce are multi-faceted and require a comprehensive approach to address them effectively. Integrating virtual nursing into comprehensive care offerings is one way to alleviate some of the pressures faced by bedside RNs, without replacing them. Leveraging technology, healthcare organizations can ultimately improve the experience for clinicians and, in turn, patient outcomes.
How Virtual Nurses Improve Patient Satisfaction and Outcomes
Patients frequently need help understanding health information to navigate care in our complex medical system. Healthcare encounters – especially those in acute care settings – can be emotionally charged and intimidating experiences for patients, oftentimes leaving them with questions they may be too apprehensive or distracted to ask during their stay.
The lack of understanding of health education can put anyone, regardless of health literacy level, at risk of misunderstanding or missing important information about their follow-up care, leaving patients and hospitals more likely to suffer poorer outcomes, higher readmissions, and longer lengths of stay (LOS).
Overcoming Patient Education Challenges with Virtual Nursing
Properly educating patients about their condition and how to care for themselves after discharge can transform patient outcomes and improve the patient experience. Few clinicians would argue the importance of patient education but providing it in the hospital setting is a challenge for care teams as well as patients. Finding the time to educate patients and families, among all the other tasks nurses must juggle, can be daunting, particularly as workforce shortages persist.
That’s where virtual nurses come in.
In today’s telehealth-enabled world, an experienced remote nurse can perform patient education and discharge preparation, accomplishing many of the tasks that typically fall to floor nurses to support, including:
Accurately collecting the home medication list
Providing follow-up care instructions
Reviewing signs and symptoms to look out for
How it Works: Virtual nurses work with care managers to obtain the patient discharge list. The remote RN cameras into the patient room via a hardwired A/V solution or a cart-based telehealth endpoint. The virtual nurse, with the patient, performs a review of the patient’s medications, post-discharge activity, and when to next follow up with their doctor. The virtual nurse can also include the patient’s family or caregivers in the discharge education session.
For post-surgical patients, this process might include dressing change instructions. For a patient with a respiratory condition, discharge prep might consist of training on how to use a new inhaler properly. For a diabetes patient, patient education could entail how to administer insulin and basic dietary recommendations. In each case, the virtual nurse can perform teach or talk-back education with the patient to ensure they understand the information they’ve been given.
The Clinical and Financial Impact of Virtual Nursing
Virtual nurse workflows related to patient education and communication can have a measurable impact on patient outcomes and experience.
Reduce Readmissions
Hospitals can lose up to 3% of each Medicare payment for a year due to higher-than-anticipated readmission rates. Hospitals saw $320M in Medicare payment reductions due to readmissions for 2022. Hospitals can reduce the potential for readmissions by using virtual nurses to empower patients and in-home caregivers through quality health education that supports discharge readiness. Armed with accurate information presented at the right time, patients can make better decisions and take a more active role in their care, which improves outcomes and helps reduce rehospitalizations.
Half of HCAHPS patient satisfaction measures – directly impacting hospital and provider reimbursements – focus on communication between the patient and healthcare team. Low HCAHPS scores can hurt the hospital’s reputation and limit funding received from Medicare. Providing patients access to virtual nurse support and personalized education can restore their sense of control over their health. Patients feel valued when the care team communicates with them in a way they can understand and are more likely to recommend the hospital as a result. Informed patients are also more engaged in their care and see better long-term outcomes.
Deploying Virtual Nurses to Support Patient Education
Here are a few guidelines to help you build an effective virtual nursing program designed to support patient education:
To close communication gaps, get the virtual nurse in early to get the plan of care going and keep the care team in step. Virtual nurses should engage RNs, care managers, patients, therapists, providers, and families as appropriate.
The education process should start at admission and be consistent rather than a hurried one-off task at the end of an acute care stay. Initiating conversations around follow-up care early on gives patients time to ask questions prior to discharge.
Identify the learner, whether an in-home caregiver, hired help, or another resource, and include them in patient education when possible.
Implement train-the-trainer programs to support and standardize patient education and communication practices.
Ensure you have resources in place to overcome language barriers. Language accessibility is vital to equitably empowering all patients, and its accommodation is required by law. When considering language access solutions, assess how easily the virtual nurse can bring an interpreter into virtual calls.
Use teach-back methods to ensure patients understand the information provided at discharge. Ask patients to explain in their own words the necessary steps to support their health and the next steps in their care journey.
Show-me methods allow care team members to verify that patients understand how to operate any medical devices that may be part of their follow-up care.
Incorporate best practices to overcome low health literacy into patient communications. These include avoiding medical terms, limiting information to three to five key points, and using education written at a fifth-grade reading level.
While many of these concepts are familiar to healthcare teams, introducing virtual nurse resources into workflows lays the foundation for more empowered patients, improved clinician experience, and greater financial solvency. These hybrid care models are rapidly evolving to play a pivotal role in strengthening patient communication, care processes, and outcomes.
Chaisson and the Central Maine Healthcare team recently launched a Virtual Nursing Program on the healthcare organization’s three hospital campuses. In a recent panel discussion co-hosted by nursing leaders from Caregility, Hicuity Health, and Blue Cirrus Consulting, Chaisson shared insight into her team’s experience with the new nursing model.
You recently launched a virtual nursing program at Central Maine Healthcare. Can you walk us through the impetus for going the route of virtual nursing, which workflows you selected for the initial program, and why?
Kris Chaisson, RN, BSN, MS, CCRN-K, NEA-BC, Chief Nursing Officer, Central Maine Healthcare
I think everybody can appreciate this nursing shortage and needing to find ways to help the bedside nurse, especially when 35% of our nurses have three years of experience or less. We were finding that they needed a little bit more support from experienced nurses so we decided to look at this route.
We initially engaged Hicuity Health in looking at this right at the height of the pandemic when we were taking care of critical care patients outside of the critical care area. We were having critical care patients in our ED, our critical care units were full, our PACUs were full, and we were wondering how we were going to do this with the expertise we needed. Once the pandemic sort of leveled out a little bit, we really shifted our focus and decided to look at how we could support the bedside nurse.
Most of the workflows we’ve used are really helping us with admission histories, medical histories in terms of medications, looking at discharge teaching, discharge education, and education throughout the patient’s stay. We recently started talking about using the virtual nurse to document for codes. That’s the next workflow we are going to look for, especially in our critical access hospitals.
You have a lot of novice nurses due to some of the turnover. How are you seeing this program assist the novice nurse?
I think they’re more comfortable with the technology and they haven’t had this established practice that they have to do everything by themselves. So, they’ve actually adopted it a little bit more readily than a more tenured nurse.
When a patient is boarding in the ED for a little bit and comes up to the floor and all their admission history and medication history is done, it’s a sense of relief that now they can spend time just meeting the patient, talking to them, doing their physical assessment, and developing that relationship instead of worrying about the tasks that need to happen. So, they’ve embraced it.
How did you work to establish trust between the staff on the floor and the nurses that are supporting them virtually?
We really worked at that. The implementation team did a little team building and orientation with the virtual nurses, just to get to know them a little bit and really be inspired by how much experience they have to bring to the bedside. And then we really worked hard on the handoff, sort of scripting an introduction of the virtual nurse to the patient. So, there was trying to manage learning who they are, what they can do, and then have [bedside staff] really treat [virtual nurses] as an extension of our team. And I think that really helped the nurses see that they were really helping and not something to fear.
We eased into this with the virtual nurse. We were comfortable with the camera because we do have a virtual patient safety assistant program. They were kind of used to the traveling video camera, going from room to room to help care for patients in that way. So that was less of a hurdle for us because we had that foundation.
Getting folks engaged really early on was really important. We also launched a survey to the nurses before we started, asking them what would help them. What do they find takes the most time out of their day? And then we wanted to make sure we didn’t just put a cookie-cutter sort of solution on top of a problem we thought we were fixing, but really didn’t need to. So that was really helpful.
What are best practices around insourcing versus outsourcing the virtual nursing staff?
What was most helpful working with Hicuity is we asked to talk to a few clients who had already been there, done that, and got to learn from them and ask, “If you had to do it all over again – what wouldn’t you do?” That way, we wouldn’t step in those potholes that they did. That was very helpful.
We did entertain whether or not this was something we could take on ourselves and we quickly came to the decision that we don’t have the nursing supply here in Maine. We rely heavily on purchased labor. This was cheaper than purchased labor, so we were excited about that.
Now I would be lying if I didn’t admit I thought, “Wouldn’t this be awesome in the future as the nurses here age and can’t be at the bedside anymore? Is this an opportunity for us to build in some retention for our tenured nurses to be able to do this remotely at home?” And that’s crossed our minds, of course, because I do need to have a long-term strategy for that game.
What are some of the things that you’re going to measure for success in your program?
We’re going to resurvey the team. We’re also looking at our nurse-sensitive indicators to see if they’ve helped. We have a dashboard on our portal page where we track all the assignments that the virtual nurse has done through Cerner. So, we have a tally of how productive we are in that realm.
We’re also looking at our quality metrics and then any event that they sort of head off at the pass. So, if they notice somebody that’s not doing very well and they cue in the nurse and we save a code from happening or, say, help with a rapid call, we’re going to track that too on our risk-tracking system.
If there was one thing about the perceptions of virtual tools and virtual nursing at your organization that you could change, what would it be?
I would try to take the fear out that we are replacing nurses with this. I think there was a fear there when we first started talking about it because our scope was big – like adding maybe a virtual nurse on every floor and maybe we could downsize a nurse but add more CNAs. And then we quickly learned that wasn’t going to be right for our organization or culture. We had to really shift gears and think, “How do we support them?” It’s supportive and it’s not replacing a nurse. And I think that went a long way.
We also started very small. We have 24 hours of nursing care coverage by a virtual nurse. We have a nurse coming in at 7:00 in the morning and leaving at 7:00 at night and one coming in from 11:00 AM to 11:00 PM. That’s 24 hours of care. We picked those hours because that’s when you ramp up in your admissions throughout the day. We’re going to start there, and we want to see how that goes and whether we need to expand or cut back or adjust hours a little bit. But we started slow and small to get people used to it and it is going really well.
What advice would you give anyone who is trying to implement a virtual nursing program?
I wish I had somebody to tell me how to do it. You really need to know your data. You need to know your nurse turnover. You need to know the experience of your nurses. You need to know what the skills and the pain points are for them.
And then you need to put that proposal together and get real support from your executive team because there is a financial investment you have to put in upfront. There is some technology. We had to sign a service agreement with the company to get the nurses. And we had to say, “Okay, if we do this, we’ll get this.” So, we put together a very robust business proposal to get buy-in from them. That was really the first step.
I had already kind of circulated it through the nursing leadership team… but getting the senior team to really buy in as being a partner with nursing to support this [was vital]. I needed every member from finance to HR to understand. Because, as you can imagine, HR was going to get questions like, “What’s going to happen with my job? Do I still have a job?” Those sorts of things. So, getting support from those stakeholders was really key.
And then really engaging your key stakeholders. We had a plethora of different services from patient experience to infection prevention, transport, and environmental services all engaged in this process to make sure that we went through all the steps you need to in change management. IT had their own project manager. We had Kaitlyn Smith, who helped manage the project from the nursing clinical side. So that was a great partnership. And then we had both Caregility and Hicuity Health facilitating those meetings as well and it was a great partnership to get this launched.
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How to Get Started with Virtual Nursing
The use of telehealth in inpatient settings first gained momentum in the early 2000s when teleICU units were introduced to help clinical teams deliver quality care to high-acuity patients. The concept emerged in response to a shortage of critical care specialists and the need to improve patient outcomes in the intensive care setting.
A similar scenario is playing out today. Widespread nursing workforce shortages are impacting healthcare organizations across the nation, leading many to examine ways telehealth tools can be used to recreate teleICU-like success in lower acuity units.
That’s where virtual nursing comes in.
Virtual Nursing: From Concept to Impact
Forward-thinking hospitals are turning to virtual nursing to augment and support burned-out bedside staff and improve patient coverage and safety. Attention to virtual nursing has risen significantly in recent years and real-world examples of the nascent care model are beginning to emerge.
To help shed light on the topic, Caregility recently hosted a panel discussion that brought together four nurse leaders who have successfully implemented virtual nursing programs to discuss their experience.
Central Maine Healthcare’s Senior Vice President and Chief Nursing Officer Kris Chaisson, RN, BSN, MS, CCRN-K, NEA-BC, recently helped launch the health system’s first virtual nursing program. Chaisson credits her team’s prior exposure to inpatient telehealth for making the project less intimidating. “We were comfortable with the camera because we do have a virtual patient safety assistant program,” says Chaisson. “They were used to the traveling video camera, going from room to room to help care for patients in that way. So that was less of a hurdle for us because we had that foundation.”
From the teleICU to the COVID-19 response, most healthcare organizations have similar experiences with inpatient telehealth to draw from.
“We did a lot of things with teleICU, and I think we learned a lot of lessons,” notes Wendy Deibert, EMBA, BSN, RN, Chief Nursing Officer at Caregility. “Trying to take that concept and move it down to the acute care space was [initially] a challenge because everybody thought it was really expensive. I think the difference with virtual nursing is that it can be as simple as using a cart or an iPad to begin that process. You start very small, and you grow.”
So, what is the first step?
Engage your bedside nurses. “For the nurses, you really have to look at their pain points,” Deibert says. “What is it that we can take off you so that you can do the real direct care?”
To capture that intelligence, Teresa Rincon, Ph.D., RN, Senior Telehealth Consultant at Blue Cirrus Consulting, recommends conducting surveys with frontline staff to identify the problems they’re seeing.
Chaisson and the Central Maine Healthcare team surveyed the health system’s nursing staff to identify what takes the most time out of their day. “We wanted to make sure we didn’t just put a cookie-cutter solution on top of a problem we thought we were fixing, but really didn’t need to,” Chaisson shares.
“You have to have utilization of your program and you have to have buy-in from the people using it,” echoes Marcia Murphy, RN, AGACNP-BC, ANP-BC, CCRN-K, NE-BC, Vice President of Clinical Operations and Nursing at Hicuity Health. “Every idea they have might not get implemented exactly into your program, but what is the problem that they’re trying to solve? Listening to that and then working together to solve that problem is important.”
Build your business case. Chaisson encourages those considering virtual nursing to understand current clinical performance benchmarks and time constraints. Weak performance areas can reveal ideal places to introduce virtual nursing support.
“You need to know your nurse turnover,” Chaisson says. “And then you need to put that proposal together and get real support from your executive team because there is a financial investment you have to put in upfront. We had to say, ‘Okay, if we do this, we’ll get this.’ So, we put together a very robust business proposal to get buy-in from them.”
The business case should clearly identify “the problems we’re going to try to solve first,” says Rincon. “Do a time and motion study to look at how long would it take to do the tasks associated with solving that problem.” Outline technical and staff needs. Where will virtual nurses work from? Will roles be staffed internally or outsourced?
Collaborate for change management. The importance of true partnership with key stakeholders throughout the organization was championed by all panelists.
“We had a plethora of different services from patient experience to infection prevention, transport, and environmental services all engaged in this process to make sure that we went through all the steps you need to in change management,” shares Chaisson. “IT had their own project manager. Kaitlyn Smith helped manage the project from the clinical side. Then we had both Caregility and Hicuity Health facilitating those meetings as well and it was a great partnership to get this launched.”
Set your team up for technical success. Enabling technologies used to support virtual nursing should help, not hurt staff. “It can’t put more impact on them than it already is today,” says Deibert. “It has to be simple and easy to manage. We know carts, iPads – all those things are hard to manage overall. So, you’ve got to work that into their daily practice. Make sure that it’s there and available, that they’re not having to run three floors down and four floors over to get the one device that they need.”
After the team establishes core workflows, consider scaling the program to incorporate new areas or new tasks. “Maybe it’s supporting a whole floor,” says Deibert. “Maybe it’s mentoring and coaching because you have a younger nurse in this space. Then you can go to what everybody’s looking for – that hospital room of the future where we wire every room so you can do anything, whether it’s virtual nursing, virtual observation, or a tele-stroke consult because I need a doctor right now.”
Meanwhile, what care teams can field remotely is changing fast. “If you think about natural language processing and the use of AI, it definitely is going to enhance what virtual nurses can do, what they can see, and what they can hear from a distance,” says Deibert. “There’s a lot to come with this. As everybody tries different processes and different workflows, we’re going to really branch out the whole role of virtual nursing in the future.”
Moving Virtual Nursing from Concept to Practical Application
Virtual nursing is moving from concept to real-world implementation as health systems look for new solutions to address workforce challenges and better support patient care.
Together, these issues build a compelling case for adopting virtual nursing. Made possible by the rapid evolution of inpatient telehealth over the past few years, this hybrid care model brings virtual engagement and workflows to bedside care to improve patient safety and buy back time for floor nurses.
Virtual nurses can support many tasks that don’t require hands-on patient care, including virtual admissions and discharges, remote documentation, telerounding, blood and medication verification, virtual observation, patient education, and on-demand coaching and support.
Virtual Nursing’s Impact on Patients, Clinicians, and Health Systems
Virtual clinical workflows can have a tremendous positive impact on patient and clinician experiences.
Patients benefit from improved nurse-to-patient ratios, faster clinical intervention, and a second layer of care team support.
Virtual roles extend the careers of seasoned nurses who might otherwise leave or retire. New nurses gain access to virtual nurse mentors during onboarding and when they need help. And floor nurses can enjoy more focused work with fewer interruptions.
Operationally, virtual nursing can improve efficiency and patient satisfaction. It also offers health systems a more permanent solution for workforce reinforcement, reducing reliance on travel nurses by introducing new recruitment and retention tactics. Telenursing also lays some groundwork for next-generation hospital rooms and home-based acute care models.
Technical Considerations When Implementing Virtual Nursing
Given how new the model is, the challenge for most healthcare teams is knowing where to get started with virtual nursing. A cornerstone of all telenursing programs is the availability of synchronous audio and video at each patient’s bedside, using either mounted or mobile telehealth endpoints.
Subscription-based, pay-as-you-go service models can help reduce upfront installation costs. To maximize resources and manage solution sprawl, look to centralize siloed telehealth programs onto platform solutions that are integrated with the electronic health record (EHR) system and flexible enough to work with innovative digital health devices entering the market.
As you formulate a program strategy, identify clinical and technical needs first. Conduct a network assessment to make sure infrastructure is optimized to support concurrent virtual sessions. Are there coverage gaps in Wi-Fi that need to be addressed before implementation? Be mindful of standard security protocols that can disrupt virtual care.
Once you know which clinical processes you’ll be transitioning to a hybrid model, consider the telehealth capabilities you’ll need to support your workflows. Do you need advanced zoom functionality to read medications and IV bags remotely? Will virtual nurses need night vision to access dimly lit patient rooms? Is there a bedside button nurses and patients can use to bring in the virtual nurse?
Beyond the EHR, identify which peripherals will apply to your use cases. As programs evolve to include more advanced workflows, you may consider adding remote physical assessment devices, such as digital stethoscopes.
Clinical decision support integration can allow virtual nurses to bring patient stratification into telenursing workflows. Translation services should also be part of your virtual engagement strategy to meet language access requirements and ensure that health equity is baked into your program.
Driving Care Model Innovation with Virtual Nursing
Telehealth and virtual care solutions are redefining care, and the healthcare industry is just scratching the surface of what’s possible with virtual nursing. By taking a strategic approach to implementation, health systems can build telenursing programs that support patient and clinician well-being and add a secondary line of defense to patient care.
About the Author: Wendy Deibert is Chief Nursing Officer atCaregility. She has 34 years of experience as a bedside critical care nurse and telehealth consultant, launching hundreds of virtual care programs nationwide. This article originally appeared in HealthTech Magazine.
How Virtual Nursing Helps Address Nursing Shortages
The following guest blog features commentary from Marcia Murphy, VP of Clinical Operations and Nursing at Hicuity Health.
Concerns about clinician staffing and the future availability of highly trained physicians and nurses have been on the strategic dashboard of every attentive health system and healthcare leader for years.
Workforce shortages have been predicted repeatedly and consistently, as healthcare leaders modeled the anticipated impact of long-term trends such as increasing healthcare demands due to an aging patient population, the projected rate of clinician retirement, increasing turnover, and the slow rate at which new providers and nurses are being trained.
Recent Trends Fueling the Need for Virtual Nursing
In recent years, a range of potent forces added velocity to the growing shortage of nurses nationwide. The widely reported Great Resignation during the COVID-19 pandemic and ongoing burnout and turnover issues have created increased urgency around the issue of nurse staffing.
According to the Medscape Nurse Career Satisfaction Report 2022, 52% of RN respondents reported that the pandemic decreased their career satisfaction. Roughly one-third of all nursing respondents indicated feeling either “burned out” or “very burned out”. The 2023 NSI National Health Care Retention & RN Staffing Report, based on data gathered from hospital executives during the first quarter of 2023, revealed that 75.4% of hospitals reported an RN vacancy rate above 10%.
As a result, hospitals have been forced to create both short-term and longer-term solutions to the trio of staffing issues: shortages, burnout, and turnover. Whereas authorization to simply hire more nurses might have addressed similar situations in the past, recruiting efforts have proven to be increasingly difficult as the national need for RNs has led to more competition for scarce clinical resources.
Many hospitals turned to travel nurses in an attempt to bolster their staffing, typically at a high cost and with mixed results. Some hospitals were compelled to increase nurse-patient ratios or to engage additional non-nursing support, when available, which nominally addressed staffing shortages but risked intensifying nursing burnout.
Virtual Nursing: A New Way Forward
Against this backdrop, virtual nursing services have emerged to offer hope to short-staffed hospitals and their beleaguered frontline nurses. Technology-enabled virtual nursing ensures that the work that needs to be done gets done, while bedside nurses maintain a priority focus on those nursing elements that can only be done in person and at the bedside.
The nursing tasks that can be effectively performed by a virtual nurse are numerous. Examples include admission and discharge documentation, patient and family education, medication reconciliation, patient monitoring, precepting, and many others. The goal is not simply to relocate the workload but to enable, hospitals to improve patient care, staff support, and clinical outcomes.
The impact of adding virtual nursing care is multi-dimensional.
Virtual nursing allows the bedside nursing team to focus on hands-on patient care. Studies have found resulting increases in patient satisfaction scores.
Virtual nursing provides real-time support for the bedside team, helping to reduce stress and burnout and improve clinician experience and retention.
Virtual nursing enables the hospital to add staff without finding candidates locally, relocating them, or relying on travel nurses, which can materially improve the hospital’s nursing costs. The NSI study found that the average hospital could save more than $3M annually for every 20 travel nurses eliminated.
Virtual nursing can also allow hospitals to lean on virtual services providers to take on the responsibility for hiring, retaining, and seamlessly augmenting staff.
By fielding services such as continuous patient observation, hourly rounding, admission history, and documentation of activities of daily living (ADL) via a virtual nursing program, health systems can immediately offset nursing shortages while also ensuring that bedside nurses feel well-supported and better able to focus on hands-on patient care.
The hybrid care model also lays the groundwork that will help health systems modernize care models and capitalize on digital health innovation in the years to come. With technology enablement in place, virtual nursing equips care teams to leverage seasoned, remote telemedicine nurses to anticipate staff and patient needs, customize care programs and related workflows, and continue to ensure the highest levels of patient care throughout the hospital.
