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.
Access the recording: Virtual Nursing – From Concept to Impact
Here is what they had to say.
Where to Begin with Virtual Nursing
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.”
Want to learn more about how you can move virtual nursing from concept to impact? Watch the full virtual nursing panel discussion on-demand here.