As a teen, Wendy Deibert experienced a near-death healthcare episode that resulted in an eight-week hospital stay punctuated by four surgeries. That harrowing experience became an enlightening window into what patients go through, igniting a fire in her to be on the other side of the bed taking care of those in need.
As a young adult, Wendy dove headfirst into nursing, specializing as a neurologist ICU nurse. She would go on to spend two decades at the bedside at Barnes-Jewish Hospital, eventually managing the ICU. Along the way, her exposure to the whirlwind of emotions surrounding patient care allowed her to see healthcare engagement from multiple angles. When personal experience saw her husband and father become patients, inefficiencies in the healthcare journey sparked a new mission in Wendy to help make care more accessible and easier to navigate for patients.
Determined to make a difference, Wendy took a leap of faith and transitioned into the realm of healthcare technology at St. Louis-based Mercy health system. From ensuring patient medication safety to learning the intricacies of interfacing and formulary building, her IT journey began. But it wasn’t just about incorporating new tools; it was about understanding how technology could serve patients better.
Wendy’s most transformative phase was a tele-ICU project where she oversaw the implementation of e-ICU across 350 beds. This venture brought together diverse care groups, introduced Wendy to the magic of virtual care, and showcased the technology’s potential to bridge the gap between remote areas and big cities. From there, Wendy played an integral role in rolling out more than 70 telehealth programs across six states with Mercy, ultimately culminating in the creation of Mercy Virtual – a mammoth hub of 160 virtual caregivers.
As an employee at Mercy, Wendy was a Caregility customer, using the company’s telehealth solutions to support several of the health system’s virtual care initiatives. After parting ways with Mercy to launch her own consulting business, Wendy eventually joined the Caregility team, where additional resources could support shared growth. She currently serves as Caregility’s Chief Nursing Officer, where she supports clinical integrity on behalf of the virtual care company and its hospital and health system customers.
“My passion is getting care into the home or as close to the home as possible instead of having patients travel. Virtual care is also a wonderful early warning system in inpatient settings like the ICU, enabling faster, more proactive care interventions.”
– Wendy Deibert
Wendy has learned through experience the importance of tailoring tech solutions to organizational needs, emphasizing that it’s not about replacing current processes but optimizing them. Integration, she believes, is vital. Separate systems, she’s found, tend to create bottlenecks, while a universal platform offers streamlined care.
“One patient, one record,” Wendy stresses. “No one wants to use a secondary system. Leverage EMR integration to embed processes and boost adoption. One thing I learned at Mercy is that telehealth programs grow organically. Disparate solutions for different units can be terrible for IT to manage and clinicians really prefer to live in one environment. Get onto one platform you can use across settings.” She encourages care teams to identify telehealth solutions that support broad use cases to simplify program growth and technology management.
“Make the technology, the clinician, and the process equal parts of the process,” Wendy also advises. “Collaboration between clinical and IT stakeholders establishes common ground and common language. If you just drop technology in without formally defining virtual care workflows, roles, and protocols, your program won’t be sustainable.”
Wendy’s unique position as someone with both clinical and technical expertise has given her a holistic view of the healthcare arena. Her journey from an eight-week hospital stay to her leadership role at Caregility has been nothing short of inspiring. Today, Wendy continues to leverage her expertise, advocating for best practices and pioneering the seamless integration of technology in patient care delivery to improve both patient and clinician experience.
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Hospital Leaders Weigh in on Virtual Nursing
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.
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.
HTLH 2021: Healthcare’s Future: Evolving to a Hybrid Model of Care
On-Demand Webinar
Healthcare’s Future: Evolving to a Hybrid Model of Care
In 2020, telehealth became a household word as an unprecedented number of providers and patients turned to virtual care as a vital component of healthcare delivery. At the same time, healthcare providers and hospital systems experienced rapid transformation, creating a hybrid delivery system of in-person and virtual care to best serve the needs of their patients.
This session explores clinical use cases from organizations and solution providers helping to move toward a hybrid model of care delivery, one that places the patient first – yet establishes equilibrium for the provider for better decisions in triaging.
Discussion Topics:
What is the pathway for healthcare organizations to grow?
How has hybrid care grown to include remote monitoring, acute care, shared services, and hospital at home?
What are lessons learned and potential opportunities ahead?
Featured Panelists:
Moderator: Kristi Henderson, SVP, Center for Digital Health, Optum Health, & Chair-Elect, ATA
Zenobia Brown, MD, VP & Medical Director, Population Health, Northwell Health
