How Virtual Nursing Can Help Fortify a Workforce in Crisis

The COVID-19 pandemic hit an already beleaguered nursing workforce hard, driving stress, burnout, and resignations among nurses to record highs. The urgent need to address nurse workflow issues and better support them has sparked fresh interest in the virtual nursing model among healthcare provider organizations.

Though the model itself is not new — the first recorded use of ‘telenursing’ was in 1974 — its popularity grew during and after the COVID-19 public health emergency (PHE). According to data from the National Council of State Boards of Nursing, the United States nursing workforce lost 100,000 registered nurses during the pandemic and is on track to lose an additional 900,000 workers by 2027. The research also shows that nurses reported feeling used up (56.4 percent), emotionally drained (50.8 percent), fatigued (49.7 percent), and burned out (45.1 percent) a few times a week or every day.

This dire situation has led healthcare provider organizations to deploy various strategies to bolster the workforce, including virtual nursing. About 38 percent of 789 healthcare professionals surveyed last April said their organization had already implemented virtual nursing or was in the process of doing so, and another 26 percent said their organization was considering implementing the services.

Furthermore, 75 percent of survey respondents said virtual nursing is a recruitment opportunity to hire nurses who cannot or will not work at the bedside.

Numerous health systems have launched or are in the process of launching virtual nursing models. While they can help alleviate the stress on the nursing workforce and improve patient experience, there are some challenges to deploying the model.

WHAT VIRTUAL NURSING LOOKS LIKE

Virtual nursing models offer a new and unique way for nursing team members to work in the clinical arena without having to be physically present at the bedside, according to Kasey Paulus, senior vice president and chief nursing executive at WellSpan Health. Tasks virtual nurses can complete include patient education, patient safety surveillance, admissions and discharge protocols, and rounding.

At WellSpan Health, virtual nursing began as a pilot at its specialty surgery and rehabilitation hospital. The health system launched both a virtual nursing program, wherein virtual nurses act as an extension of physically present bedside nurses, partnering with them on admissions, discharges, and patient education, and a virtual sitting program, wherein a virtual sitter monitors up to 16 patients at risk of falls or self-harm using the artificial intelligence.

“This is a really important strategy for us as we think about innovative care models and how we can continue to provide high-quality, safe care for our patients as we navigate ongoing workforce challenges,” said Paulus in an interview with mHealthIntelligence.

The health system is using Artisignt’s virtual nursing platform, which includes a camera and microphone and connects to televisions in the patient rooms. WellSpan initially opted for the hardwire installation for the pilot program in the rehab hospital. In the intermediate phase of the rollout, it will bring mobile carts with the virtual nursing platform to three of its hospitals, Paulus said.

Similarly, virtual nurses at OSF HealthCare support patient admissions and discharges. The OSF Virtual Nursing program operates through a partnership between OSF HealthCare Saint Francis Medical Center and OSF OnCall, a digital health entity within the health system that leverages technology to enable virtual care.

The health system is in the first phase of its virtual nursing implementation, said OSF OnCall’s Vice President of Digital Care Brandi Clark in an interview with mHealthIntelligence. The virtual nurses work from the health system’s digital health center, completing admissions and discharge documentation for medical surgery patients in three units at OSF Saint Francis Medical Center. This documentation is completed in the patient’s EHR via audio-visual teleconferencing technology. 

“We started the program with tablets utilizing a video platform to support the audio/video connection with the patient, and we are now piloting in-room installed technology that allows for the audio-video connection to run through the patient’s television,” she said.

Texas Children’s Hospital, which is also in the early phases of deploying virtual nursing, is taking a more multidisciplinary team approach to the model.

“We have representatives from social work physicians, advanced practitioners, patient and family services, and bedside staff from nursing as well as nursing leaders [involved in the model],” said Ashley Simms, the hospital’s assistant vice president of nursing, in an interview with mHealthIntelligence. “So, I think it's really important to talk about the inclusion and the scope of people that we have involved in the building and planning of virtual nursing.”

The hospital is launching its virtual nursing pilot in the neonatal intensive care unit (NICU) in the coming months. Simms explained that virtual nursing will encompass three buckets of work: alleviating the administrative burden on bedside staff members, real-time patient surveillance, and supporting those at the bedside with on-demand consultations.

“Like a phone-a-friend approach,” Simms said. “We have a lot of nurses that are coming out of nursing school that are just not at that same level of readiness as what they had been pre-COVID. And so, right now, they are leaning a lot on their fellow nurses at the bedside that are also still trying to take care of their own patients. So, how do we provide a support system that is someone who’s not also trying to take care of their own patient?”

Another focus of the Texas Children’s virtual nursing approach will be providing education for families to help prepare them to care for their babies once they get home from the NICU, Simms added.

IMPROVING PATIENT AND CLINICIAN EXPERIENCE

As healthcare provider organizations pilot their virtual nursing models, the benefits are becoming increasingly apparent, especially with respect to tackling nursing shortage challenges.

“We've all seen the headlines, we know what we've experienced…And we know we continue to have a generation of baby boomers who will retire and leave our workforce and, more than likely, require care in the healthcare sector,” Paulus said. “And given the challenges in healthcare right now, unfortunately, if we don't make changes, we'll continue to lose members of the workforce…So, our commitment is to create a positive, supportive work environment where nurses and healthcare workers want to continue to stay and provide great care to our patients in our community. And different initiatives like this are a really great way for us to deliver on that.”

Jennifer Croland, vice president and chief nursing officer at OSF Saint Francis Medical Center, echoed this point, stating that the hospital explored virtual nursing as a strategy to alleviate the burden on bedside nurses staffing acute care units, which are some of the busiest nurses caring for some of the most medically complex patients.

Data from a four-month period of the pilot reveals that virtual nurses completed 93.4 percent of admissions and 87.7 percent of discharges. Completion rates for advanced care directive forms to document end-of-life wishes and patient education documentation increased from 60 percent to 100 percent.

Not only does virtual nursing add a layer of support for acute care nurses, but Croland also noted that it offers additional role opportunities for those same nurses, where they can use their expertise and skills rather than be assigned to time-consuming activities that don’t involve hands-on care.

“We are hoping to extend the tenure of nurses working at the bedside by offering them a shared role of doing both virtual and bedside care,” she said in an interview with mHealthIntelligence.

Further, virtual nursing has helped OSF Saint Francis Medical Center manage capacity constraints. Croland said that virtual nurses are facilitating quicker and earlier-in-the-day discharges, thereby shortening wait times for patients in the emergency department (ED) awaiting a bed.

OSF Saint Francis Medical Center has experienced a decrease in time taken from order to discharge in phase one. The hospital expects to see an impact on ED throughput metrics in phase two.

“Getting patients from ED and procedural areas admitted to the acute care units should also reduce the number of patients who are leaving without being seen and keep our surgery/procedure areas functioning without delays,” she added.

According to Clark, early data collection during the first phase of the virtual nursing implementation showed that both virtual and bedside nurses and patients rated their experience at approximately 4.2 on a five-point scale.

In addition to enhancing nurse and patient experience, virtual nursing positively impacts clinical outcomes. For instance, Paulus said that WellSpan has experienced a 39 percent reduction in patient falls since implementing the new virtual approach.

OVERCOMING IMPLEMENTATION CHALLENGES

While the virtual nursing model is growing increasingly popular among healthcare provider organizations, there are several potential hurdles to implementation, such as technology readiness.

“There are many technical and networking implications that should not be underestimated when putting in place this type of solution,” said Clark. “We have a team from the performance improvement division of OSF Innovation that has helped to ensure all issues are logged, tracked, and addressed by the appropriate parties.”

Since the challenges are primarily related to the technology and workflow to support an efficient communication process between teams, the health system focused on training bedside and virtual nurses in these areas.

Virtual nursing implementation requires “a strong partnership between bedside and virtual nurses, including frontline nurses and from executive nursing leaders,” Croland added. “Start by engaging your team early in the design and expand into subsequent phases when seeing and hearing positive trajectory of processes and outcomes.”

Texas Children’s also believes in a frontline-up, and not a top-down, approach when implementing virtual nursing models. According to Simms, a group of nurses has been tasked with determining schedules, workflows, and the education and training needed to implement virtual nursing.

“They’re not being dictated to what it should look like,” she said. “And I think that is going to be really pivotal when you come to change management and adoption and really getting to what the bedside nurse actually needs.”

Similarly, WellSpan Health brought together an interdisciplinary team to develop the virtual nursing program. This team included all key stakeholders, including nursing, IT, and performance improvement team members, who worked together to decide the workflow for the virtual nursing model.

Paulus noted the nursing team played a critical role in technology selection, assessing various vendor solutions before deciding on Artisight. One of the main reasons Artisight was selected was the different use cases the platform could support in addition to virtual nursing, like peer consultations with specialists in patient rooms.

The health system also connected with other provider organizations that had already implemented virtual nursing to anticipate potential pitfalls and understand strategies for success.

As WellSpan rolled out the virtual nursing program, leaders kept in touch with nurse staff through daily and weekly huddles and touchpoints to ensure they felt supported, Paulus said. The nurses were also provided with resources and clear escalation pathways.

The nurses’ reaction to virtual nursing models across the provider organizations interviewed has been overwhelmingly positive, with nurses sharing how the programs are helping improve their work lives.

“One of our nurses that shared with me, it has brought joy back to her practice,” Paulus said. “She just loves and appreciates the opportunity to spend this uninterrupted time with the patient and really get to know them and do a thorough job as she's admitting or discharging, making sure she can answer all those questions. One of the beautiful things about this new process is you don't have all of the other interruptions that come if you're the bedside nurse trying to do an admission or a discharge. And so, it's been a really positive experience for the nurses.”