The health system’s use of telemedicine has saved more than 3,000 hours of bedside nurse time, supported by more than 16,000 virtual nursing sessions. The CNIO discusses this and other successes.
Johns Hopkins Health System recognized an opportunity to evolve how nursing care was delivered in response to mounting clinical and operational complexity – and without compromising quality or patient experience. Evolving workforce dynamics required ongoing attention to staffing consistency at the bedside, while patient acuity, regulatory requirements and documentation demands continued to rise.
THE CHALLENGE
In today’s healthcare environment, nurses often manage admissions, discharges, patient education, quality monitoring and hands-on care simultaneously – which can limit the flexibility to engage as deeply as desired in relationship‑based patient care.
“As part of our ongoing commitment to operational excellence, we continually evaluate opportunities to further streamline admission and discharge workflows,” said April Saathoff, DNP, RN, vice president and chief nursing information officer at the Johns Hopkins Health System and an adjunct faculty member at the University of Maryland School of Nursing. “Enhancing these processes supports smooth patient flow across the health system, improves care transitions, and helps ensure patients are well prepared to manage their healthcare decisions after leaving the hospital.
“At the same time, performance expectations around readmissions, patient experience and hospital‑acquired conditions remain high, requiring careful attention to education, coordination and compliance across every shift,” she continued. “We recognized that the inherent pace and demands of bedside nursing can contribute to interruptions during care delivery.”
Staff wanted to create a more intentional, less rushed model of care – one that allows experienced nurses to engage more fully with patients, address questions, reinforce education and support informed decision-making.
“As we looked ahead, we saw value in reimagining how nursing work is structured to proactively support staff wellbeing, reinforce consistent best practices and enable long‑term success across quality, experience and efficiency,” she added.
PROPOSAL
Virtual nursing was proposed as a care delivery redesign focused on strengthening – not replacing – the bedside nurse role. The model offered a way to redistribute time‑intensive and cognitively demanding tasks such as admission assessments, discharge education, care coordination, quality monitoring and mentoring to experienced nurses working remotely – allowing bedside nurses to focus more fully on physical assessment, interventions and other forms of direct patient care, Saathoff said.
“Technology‑enabled virtual nursing platforms made it possible for virtual nurses to engage patients in real time through secure audio‑visual connections while remaining fully integrated with the care team,” she explained.
“The intent was to create a continuous, visible nursing presence that could reliably support patients, families and staff during high‑impact moments of care such as admissions, discharges and education – factors strongly tied to outcomes like readmissions, patient satisfaction and safety,” she continued.
Staff saw virtual nursing as a scalable system that aligned workforce sustainability with patient‑centered care. It offered flexibility to retain highly experienced nurses, reinforce standardized workflows, improve throughput, and ensure consistent delivery of education and quality practices – all while preserving the human connection that is central to nursing, she added.
MEETING THE CHALLENGE
Virtual nursing was implemented as a collaborative model embedded directly into nursing workflows across multiple medical‑surgical units. Virtual nurses have taken on the roles of performing admission assessments, discharge planning and teaching, patient and family education, care plan updates, quality and regulatory monitoring, dual medication verification, and mentoring. Meanwhile, bedside nurses retain full responsibility for physical assessments, medication administration and hands‑on care.
“Virtual nurses work from dedicated on‑site hubs and interact with patients through Caregility cameras, speakers and monitors installed in patient rooms,” Saathoff explained. “Patients are introduced to virtual nurses as members of their care team, and sessions include education, safety checks, interpreter‑supported visits, and family/caregiver participation, as needed. Bedside nurses can easily request virtual support, creating real‑time relief during peak workload periods.
“Virtual nursing is tightly integrated into the electronic health record,” she continued. “Virtual nurses document directly in the EHR, use dashboards to prioritize work, communicate with bedside nurses via secure messaging applications, and leverage eligibility screening tools embedded into admission and discharge workflows.”
This integration ensures shared situational awareness, minimizes duplication, and reinforces virtual nursing as a seamless extension of bedside care rather than an add‑on, she added.
RESULTS
Throughput and efficiency: Virtual nursing drove measurable improvements in patient flow. Over this period, Johns Hopkins Health System saw measurable improvements in both admission readiness and discharge workflows, resulting in more timely patient movement and smoother care transitions across the health system, Saathoff reported.
“By handling admissions and discharges remotely, virtual nurses were able to complete these processes more quickly – yet still thoroughly – without the interruptions that routinely challenge bedside nurses, making these gains possible and helping to reduce average length of stay,” she said.
Quality and safety outcomes: The model contributed to meaningful improvements in patient safety and regulatory compliance, particularly in the areas of fall prevention and pressure injury reduction. Staff also observed improvements in regulatory documentation compliance, as virtual nurses consistently monitored, documented and reinforced quality practices – helping reduce variation and support bedside staff during busy shifts, she noted.
“In addition, virtual nurses routinely review care delivery to ensure quality bundle compliance and appropriate interventions are in place, while assuming administrative and documentation tasks that free bedside nurses to spend more time delivering direct, high‑quality and safety‑focused care with patients,” she added.
Patient and nurse experience: From the outset, nursing staff worked closely with their colleague Patient and Family Advisors, Patient Education and Patient Experience teams to co‑design a virtual nursing program that directly addressed patients’ needs, preferences and concerns.
“Many nursing‑related HCAHPS domains improved following implementation, specifically in categories like likelihood to recommend, nurse communication and discharge information,” Saathoff explained. “From a workforce perspective, virtual nurses rate their shift workload and satisfaction highly.”
Financial and workforce impact: Virtual nursing promoted nursing wellness by offloading cognitively intense and administrative tasks from the bedside nurse. The initiative allowed for greater workforce stability, with decreased dependence on premium labor and improved nursing vacancy rates, she reported.
“Since go‑live, virtual nurses have saved more than 3,000 hours of bedside nurse time, supported by more than 16,000 virtual nursing sessions,” she concluded. “These results demonstrate that virtual nursing is not only a technology investment, but a workforce and care delivery strategy that delivers sustainable value.”
This article was originally published by Bill Siwicki, Managing Editor, Healthcare IT News.
