How Virtual Nurses Improve Patient Satisfaction and Outcomes
By Heidi Steiner, Product Manager, Caregility
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.
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.
Buzz around virtual nursing is building. As telehealth sheds its COVID skin, the virtual care technology is entering a new phase of growth helping health systems advance acute care models to mitigate hospital workforce challenges.
In a recent interview with Commercial Integrator editor-in-chief Dan Ferrisi, Caregility President and COO Mike Brandofino addressed the rise of inpatient virtual care and, more specifically, virtual nursing.
“We lost a lot of nurses during COVID who retired, can no longer work, or just decided they didn’t want to [do it] anymore and we don’t have enough nurses coming in so there’s a huge shortage,” said Brandofino. “Virtual care is being used now to augment that.”
Nursing shortages during the pandemic led to labor cost inflation as hospitals battled for scarce resources. Recent CNBC coverage revealed that the “average pay for travel nurses was $150 an hour in early 2022, which analysts say tempted more nurses to leave staff jobs, increasing turnover and exacerbating shortages.”
That pay rate is three times higher than the national average for full-time staff nurses.
Virtual nursing offers health systems an alternative to expensive contract nurses that not only acts as a force multiplier for care teams but also enhances care collaboration and improves patient and clinician experience.
How Virtual Nursing Can Help Solve Many Workforce Shortage Woes
Healthcare IT News
Virtual care pioneer and Caregility Chief Nursing Officer Wendy Deibert, EMBA, BSN, RN, recently sat down with Healthcare IT News editor Bill Siwicki to offer a deep dive into the benefits of a hybrid approach to nursing that employs telehealth.
Virtual nursing programs are typically campus-based and staffed internally but can also be supported by third-party clinical services or a combination of the two. Workflows vary from campus to campus.
“Some organizations use virtual nurses for patient admissions and assessments or discharge education,” shared Deibert. “Others implement more comprehensive 24/7 patient surveillance and deterioration management programs. The fact that there is no one universal approach is really the beauty of telenursing. Programs can and should be tailored depending on your health system’s specific needs.”
Deibert noted that multiple organizations are actively working with stakeholders within the nursing community to develop virtual nurse certification programs to help establish standards for programs.
Virtual Nursing Programs Adapting to Organizational Needs
HealthTech Magazine
Meanwhile, organizations like Mary Washington Healthcare are forging their own path as early adopters of virtual nursing.
HealthTech Magazine editor Teta Alim highlighted the health system’s journey into virtual nursing in coverage of the 2023 American Telemedicine Association conference. Debra Marinari, Associate Vice President of Hospital Operations at Mary Washington Healthcare’s Stafford Hospital, and Heidi Steiner, MD, Clinical Program Manager at Caregility, were on site to share insight into the nursing workflows the hospital is working to virtualize, including admission assessment, plan of care, patient education, and discharge, to name a few.
Mary Washington Healthcare deployed an Inpatient Virtual Engagement solution to support its new virtual nursing program. According to Marinari, the leadership team will assess nurse engagement, patient satisfaction, the rate of nurse turnover, quality and safety metrics, and readmissions to measure program success.
Experts Weigh in on the Joys and Woes of Virtual Nursing
The Atlanta-Journal Constitution
Given the elevated rates of nurse attrition during and since the pandemic, many care teams are onboarding new hires who have limited field experience. As Atlanta Journal-Constitution writer Hunter Boyce shared, another benefit of virtual nursing is its ability to connect new nurses with experienced remote nurse resources who can help guide and mentor them. That secondary line of clinical reinforcement boots confidence for care team members, improving clinician experience and increasing the likelihood of retention.
As Walsh University nicely sums it up:
“The impact of technology on nursing practice cannot be overstated. When nursing technology takes over time-consuming routine processes, streamlining communication and delivering accurate diagnoses and personalized treatment plans, NPs are freed up to do the work that only humans can: providing one-on-one, compassionate care.”
Virtual Nursing for Post-Acute and Transitional Care
Virtual nursing programs continue to make headway as health systems look for new solutions to the ongoing staffing crisis. Many of the virtual workflows sprouting up in inpatient departments have applicability in post-acute and transitional care, as well, where the impact of workforce shortages is also being felt.
Here is a look into how virtual nursing can support transitional care management, home care, population health, post-acute care, and hospital-at-home models.
Transitional Care Management
A patient’s discharge signals the start of a 30-day period where Medicare pays for services to help the patient transition from inpatient services to a community-based setting. Patients are typically moved to either a home, long-term care, or assisted living facility.
Many of the processes to prepare patients for care transitions can be fielded virtually. Providers are required to contact the patient within two business days of discharge, followed by a face-to-face visit within 14 calendar days of discharge for moderate-complexity patients and within 7 days for high-complexity patients. Supportive services provided by a virtual nurse can include:
Coordinate follow-up visits, durable medical equipment delivery, etc.
Educate the patient and/or caregiver on self-care, activities of daily living, etc.
Support adherence to the treatment plan, including medication management
Provide access to community resources and assist with care navigation
Home Health
Traditionally, care has been delivered in person when patients transition to a home setting.
Hybrid “tele-home” care models are emerging where a home care nurse may see a patient in person on the first visit and then virtually after that unless hands-on nursing care is required (i.e., dressing changes, wound vac care, etc.) or in-person visits are deemed necessary.
If practitioner-ordered virtual visits are incorporated as part of the patient’s Plan of Care (POC), the virtual visit must address specific patient needs identified in the comprehensive assessment and incorporate interventions and measurable outcomes identified in the POC.
Many home health agencies provide patients with Bluetooth or wireless devices such as pulse oximeters, blood pressure cuffs, glucose monitors, and scales connected to a tablet. This allows virtual nurses to track patients more frequently, between formal visits, to catch trends and head off deterioration before resulting in an ED visit. A home care aide acting as a telepresenter for the virtual nurse can also be used for virtual nurse visits.
In a study of nearly 1,400 patients with 314 patients belonging to a hybrid model, there was a significant reduction in hospitalizations in both the 30- and 60-day time period for those in the hybrid model. This patient group also demonstrated better clinical outcomes across a variety of measures.
Population Health & Chronic Disease Management
Chronic diseases continue to plague approximately 46% of Americans, with almost 30 million people living with five or more chronic diseases. Leveraging virtual care can dramatically improve outcomes for patients living with difficult-to-manage chronic illnesses.
Employing virtual nursing to support chronic disease management increases patient adherence to their POC. It also provides a quick and easy way to connect with their care team more often for early intervention to prevent unnecessary trips to the ED or hospital.
Remote Patient Monitoring
Remote patient monitoring (RPM) helps achieve chronic disease management goals while reducing patient travel costs and infection risk. Conditions that are appropriate for RMP include hypertension, diabetes, cardiovascular heart disease, COPD, and asthma. RPM tools are sent to the patient’s home and may include scales, digital stethoscopes, blood pressure monitors, pulse oximeters, blood glucose meters, and questionnaires.
Use cases reimbursed by Medicare include remote monitoring of physiologic parameters such as weight, blood pressure, pulse oximetry, and respiratory flow rate, set-up and patient education for equipment use, and treatment management services.
Knowing how to manage risk alerts is a key to success and guides the actions and interventions of the virtual nurse. In this way, patients are informed of self-care interventions, thus improving and reinforcing what they need to know the next time. In addition, alerts from remote monitoring devices help the virtual nurse monitor the maximum number of patients.
Skilled Nursing Facility & Long-Term Post-Acute Care
Telehealth can address over 50% of resident cases typically sent to the hospital, potentially avoiding readmission. To qualify for Medicare coverage, there must be a “qualifying event” that includes a three-night hospital stay that requires skilled nursing or rehabilitation for at least one hour daily, five days a week. Medicare SNF benefits last 100 days without a new qualifying event.
Post-acute workflows that can be performed virtually include:
Provider virtual visits: SNF patients are typically seen by a nursing home provider on admission, then monthly for the first 90 days and every 60 days after, or as concerns present.
Specialty virtual visits: Specialists can be brought in virtually, avoiding patient transport needs.
Ancillary visits: Virtual visits with pastoral care, hospice, family, and friends.
Continuous virtual observation or tele-sitting: Patients at high risk for falls or other safety concerns can be observed continuously and redirected.
Virtual Nursing: Admission, discharge, care planning, chart review, and assessment can be fielded virtually to offset some of the administrative burdens of bedside nursing staff.
Long-term care (LTC) facilities can utilize the same workflows, albeit at a lower frequency given lower patient acuity. LTC facilities provide long-term custodial care that is typically paid for byeither Medicaid, personal finances, or long-term care insurance.The use of a telepresenter is especially helpful within both populations.
Long-Term Acute Care Hospitals
Patients moving to a Long-Term Acute Care Hospital (LTACH) require direct skilled nursing care and have complex medical needs such as ventilator weaning and or complex wound care that can’t be met at a lower level of care. Patients are typically transferred from a hospital’s ICU to an LTACH.
LTACHs must maintain an average length of stay greater than 25 days. For optimal reimbursement, it’s imperative that the acute care hospital discharge patients to the LTACH as soon as feasibly appropriate. Every extra day spent in an ICU instead of the LTACH hinders LTACH reimbursement by minimizing LTACH length-of-stay (LOS), increasing costs and LOS for the acute care hospital.
Like other post-acute inpatient facilities, virtual workflows can support a multitude of use cases. Virtual observation can be more broadly used to support workflows beyond fall and safety monitoring by unlicensed personnel. Ventilator-dependent and other complex patients at high risk for deterioration or readmission can be observed continuously or rounded on more frequently by a virtual nurse.
These workflows can help to interrupt deterioration requiring hospital readmission, decrease adverse events, and keep the LTACH’s LOS intact by treating patients in place.
Hospital at Home
The Hospital at Home (HaH) care model has shown promise for reducing cost, improving outcomes, and enhancing the patient experience. HaH offers hospitals more flexibility to care for patients in the comfort of their own home.
Programs vary based on hospital capacity and patient population needs, but may include:
Medium-acuity patients who need hospital care but are considered stable enough for home
Patients with defined treatment protocols such as pneumonia, COPD, diabetes, etc.
A combination of in-person visits, virtual visits, and continuous biometric monitoring
Diagnostic studies (electrocardiograms, echocardiograms, X-rays), treatments (oxygen therapy, IV fluids, IV antibiotics, and other medications) and services (respiratory therapy, pharmacy, virtual nursing)
The combination of in-person and virtual nursing visits provides patients with 24/7 access to care. If necessary, the patient can visit the acute hospital for treatments that cannot be provided in the home (i.e., CT scan, MRI, etc.). The patient is discharged when stable.
Conclusion
When we think about keeping patients out of high-cost care settings and preventing unnecessary use of the ED and inpatient settings, virtual nurses are key players. They can advise multiple patients during their shift, provide timely care, perform competent assessments, document results in the EMR, and guide patients to the most appropriate level of care.
Nurse triage and advanced practice nurses do what they can to alleviate the pressure on providers who are in short supply and overtaxed. By providing sound care advice to patients on-demand, any time of the day or night, virtual nurses enable physicians to direct their expertise to patients who are high-risk, have chronic diseases, or are in the most fragile condition.
As health systems seek to meet the new demands of today’s healthcare environment, virtual nursing has become a hot topic. Here we address some of the most frequently asked questions about telenursing.
What is virtual nursing?
Virtual nursing is a hybrid care model that partners bedside staff with an experienced virtual nurse resource who works from a centralized hub and helps guide and support care for assigned patients.
Should virtual nursing be staffed internally or outsourced?
Virtual nursing programs are typically staffed internally, but hybrid or outsourced models can provide relief when clinical team resources are limited. Virtual nursing programs seek to support bedside staff, not replace them. In any staffing model, building trust between bedside and virtual staff is one of the most important factors in the success of virtual nursing programs.
What makes a good virtual nurse?
Seasoned nurses with extensive bedside experience are ideal candidates for virtual nursing. Virtual nurses should be assertive yet personable, good at multi-tasking, and comfortable with technology. They should also be good problem-solvers with high emotional intelligence who are adept at picking up on nonverbal cues. Prior experience at the health system or facility will likely be more important than telehealth experience, which is one reason unit managers may encourage bedside nurses who are burned out, seeking a change, or considering retirement to consider a telenursing role.
What virtual nursing programs do most hospitals begin with?
Hospitals and health systems typically start with virtual nursing programs that take time-consuming work off the plate of bedside nurses, such as admissions and discharges. Providing relief to bedside staff early on helps to establish trust and buy-in around hybrid care models. Medication second signature and blood product verification are also relatively easy programs to stand up. Tele-sitting is another workflow many health systems begin with, as it often poses the most immediate ROI.
What staffing ratio is recommended for a virtual nursing program?
Ratios will vary depending on the responsibilities being fielded by the virtual nurse. If the virtual nurse is only doing admissions and discharges, they could take over an entire facility or multiple facilities. When telemonitoring with a clinical decision support tool, virtual nurses may monitor hundreds of patients. 30 to 50 patient beds per virtual nurse is typical of other programs. Time studies can help you determine the average time needed to complete specific tasks and inform your strategy. Consider peak usage times when evaluating staffing ratios, as needs can vary greatly from shift to shift.
What KPIs help assess the value of virtual nursing programs?
Efficiency gains are typically assessed to quantify the impact of virtual nursing programs. Conduct time studies pre- and post-implementation to determine time saved by transitioning processes to virtual workflows and the subsequent labor cost savings. Improvements to clinical measures such as patient falls, patient falls with injury, and average length of stay are other metrics to assess program value.
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The U.S. will grapple with a critical nursing shortage for at least the remainder of the decade. Thus, health systems are now looking for ways to more efficiently ensure that patient needs are met, while recruiting and retaining qualified clinical staff. Many successful health systems are turning to telenursing to supplement and enhance traditional bedside care.
Across the country, healthcare organizations are experiencing difficulty recruiting, higher labor costs, and increased staff burnout. In a 2021 letter to HHS Secretary Xavier Becerra, the American Nurses Association noted that states were challenged by unfilled positions and failure to recruit enough replacements. Louisiana reported 6,000 unfilled positions even prior to the Delta variant, Tennessee had 1,000 fewer nurses than when the pandemic started, Mississippi lost 2,000 nurses between January and August that year, and Texas recruited 2,500 nurses outside the state but still did not meet its staffing need. These shortages feed on themselves, since working in a chronically-understaffed setting takes its toll.
In the first quarter of 2021, 36% of hospitals experienced an RN vacancy rate above 10%, according to the NSI National Health Care Retention & RN Staffing Report. RN turnover in 2020 was 19%, about three points higher than in 2019. Unsurprisingly, burnout is a big reason that almost half of nurses are changing roles, reducing hours, becoming “travelers,” and retiring. Conservatively, one-third of nurses reported being “burned out” or “very burned out” in 2021. This shortage of nurses and other qualified staff is increasing hospital and health system costs by $24 billion per year, averaging $17 million in additional costs for a 500-bed facility.
Approaching the shortage: a series of stop-gaps
Some health systems use travel nurses as a stop-gap to help staff more shifts. This does not actually solve the problem, though, as added expenses limit the long-term sustainability of this approach. Other hospitals are increasing their patient-to-nurse ratios, with some facilities relying on patient care techs and nursing aides to ease the burden. Unfortunately, thousands of qualified would-be nurses have been turned away from nursing schools due to shortages of faculty, clinical sites, classroom space, preceptors, and financial support.
While schools implement strategies that enable them to add student capacity, health systems must find ways to do more with less, without sacrificing care quality. With declining margins due to the pandemic, it is all the more difficult to simply hire more aides, even presuming they are available.
Besides actual procedures and hands-on care, bedside nursing includes charting, consulting with team members, accessing supplies, coordinating with other departments, and speaking with family members and friends. However, given the understaffing on many floors and unit, patients often interact with a variety of care team members on each shift. This fragmentation in turn makes it more difficult for patients and their visitors to decipher “who’s who,” and to bring forward important concerns.
Dividing to conquer
The pandemic accelerated acceptance of telehealth, along with more comfort with wearables, Bluetooth-enabled physical assessment, and virtual monitoring from patients, clinicians, and healthcare systems.
Incorporating telehealth programs within acute care facilities allows floor nurses to cover more ground. Virtual patient observation, for example, can support a number of goals, from greater patient safety to an improved patient experience.
Patients have long complained about the sleep deprivation caused by clinicians entering the room, along with the background noise from nurses’ stations and hallways. In addition to the discomfort and disorientation that interrupted rest entails, when a series of staff intrusions occur with no prior warning nor way to ask questions, the patient can easily feel like an “object,” with little control over the situation — not an ideal environment for healing.
With on-demand access to nurses and supporting care team members, patients can have their questions answered remotely, allowing floor staff to be notified and physically intervene only when needed; thus systems have seen their room entry needs, often with attendant needs for PPE or other precautions, significantly reduced.
With some basic concerns addressed by virtual nurses, the floor nurses can also cultivate an improved relationship with patients, providing more concentrated time for in-person care to focus on their needs. This is obviously a more desirable situation for a high-performing bedside nurse.
The best solutions are those that address a number of pain points, and virtual patient observation is gaining traction as a core workflow. Facilities have learned that consistent monitoring and early intervention, as is facilitated by virtual observers, can reduce wandering, falls, self-harm, and visitor security incidents.
Health systems can also reduce labor expenses by leveraging virtual infrastructure. For example, one 900-bed hospital reported a $3 million annual unbudgeted expense for bedside sitters alone. Furthermore, just one hospital-related fall injury can cost up to $30,000 (not to mention legal and reputational exposure).
Telenursing: more efficient delegation and workflows
Collaboration among virtual and on-site nurses can enable floor staff to spend more value-added time with patients at the bedside. Telenurses with “eyes on the patient” can address tasks such as admission and discharge planning, medication reconciliation, patient and family education, and some student/trainee preceptorship. Meanwhile, floor nurses can focus on the tasks requiring hands-on skills and in-person availability, including supervision of aides and less experienced staff.
Tele-nurses can train, mentor, back up and otherwise support bedside nurses, coaching them through unfamiliar tasks or procedures, while also being available for advice and counsel. Of course, they can also coordinate communication in urgent and emergent situations, and can instantly activate alarms on the floor.
Thus, telenursing does not solve the nursing shortage, but it can support optimal outcomes of care, staff development, retention, and morale — with fewer RN FTEs.
Download Caregility’s latest eBook to discover how virtual workflows can streamline bedside care and improve patient and clinician experience. The eBook includes tele-nursing use case examples, staffing model best practices, and guidelines for implementation.
Spotlight on National Nurses Month: Caregility Supports ANF’s “Reimagining Nursing Initiative”
Nurses are an indispensable part of U.S. healthcare delivery. Standing on the front line of patient engagement and at the crux of care coordination, RNs have long served as the backbone of the medical industry, helping to keep healthcare consumers, their loved ones, and clinical staff in step in their shared pursuit of improved patient health.
During National Nurses Month each May, these care team members are formally recognized and celebrated for their ongoing commitment and contributions. The hardship experienced by many nurses during the COVID-19 response over the past two years serves as a particularly salient reminder of the sacrifices that are frequently required of these vital resources. As our nation emerges from the pandemic to confront a national nursing shortage and unprecedented rates of clinician burnout, many organizations aligned to the field of healthcare are amplifying efforts to identify new ways to better support our RNs.
It is in the spirit of that mission that Caregility has teamed up with the American Nurses Foundation (ANF). As the philanthropic arm of the American Nurses Association (ANA), ANF’s vision is to “achieve a healthy world through the power of nursing.” Relying on the generosity of donors to help achieve and expand this mission, the Foundation funds “bold thinkers to pilot and evaluate new ideas that accelerate widespread transformation in nursing.” The ANF’s Reimagining Nursing Initiative focuses on three core pilot program areas:
Practice-Ready Nurse Graduates
Technology-Enabled Nursing Practice
Direct-Reimbursement Nursing Practice Models
To support the ANF’s cause and honor National Nurses Month 2022, Caregility donated $3,000 to the Foundation’s Technology-Enabled Nursing Practice program, which supports the design and implementation of technology-based tactics and tools that meaningfully enhance the practice of nursing. The program’s emphasis on nurses as key drivers of effective healthcare IT design echoes Caregility’s core development principles for telehealth.
“Like the ANF, we recognize the fundamental role that nurses play in successfully reimagining healthcare,” said Caregility SVP of Clinical Solutions Wendy Deibert. “We’ve seen first-hand the tremendous positive impact that our own clinical leadership team has had on virtual care program design, so we see tremendous value in ANF’s efforts to similarly advance nurse involvement in digital transformation.”
Donations from Caregility and others will fund as many as 11 innovative pilot programs that will receive three-year grants totaling a combined $15 million.
“The American Nurses Foundation is extremely grateful for Caregility’s recent contribution to The Reimagining Nursing Initiative in honor of National Nurses Month,” said a spokesperson on behalf of ANF. “This gift will enable the Foundation to fund innovative pilot programs designed to create and implement cutting-edge, technology-based tools and strategies that will significantly enhance the practice of nursing.”
The donation was made as part of the Caregility Cares program, honoring members of the medical community who go above and beyond to bring relief to others. Learn more about the Caregility Cares Essential Worker Scholarship and Frontline Worker Recognition Programs here.
Looking for virtual workflow relief to reduce pressure on your nursing staff? Contact us today to see how Caregility can help.
