What is virtual nursing, and why is it on the rise?

What is the virtual nursing model?

The virtual nursing model is not new. The first documented use of telenursing dates back to 1974, when a registered nurse from Boston Hospital provided care remotely to patients at Logan Airport.

Virtual nursing today, like nursing overall, varies from one healthcare organization to another. Virtual nurses can be tasked with completing admissions and discharge processes, providing patient education, medication reconciliation, rounding and more. For instance, in an ANA Innovation blog, Jennifer Ball, RN, program manager for digital and virtual care at Saint Luke's Health System of Kansas City, explains that the goal is to support on-site registered nurses (RNs) using virtual care, "We looked at what could be taken off the plate of the bedside RN and completed by a nurse on camera in the patient room."

In addition to patient-facing care, experienced nurses can mentor and guide newer bedside nurses through virtual nursing models.

Various virtual care tools facilitate virtual nursing, including synchronous and asynchronous telehealth platforms, remote patient monitoring tools and generative artificial intelligence. The tools enable the virtual nurse to interact with patients, families and other healthcare professionals in the rooms, as well as track patients' vital signs and, in some cases, movements in the rooms, like falls. They can alert on-site staff to major changes in the patient's health metrics, prompting timely interventions. The virtual nurse also has access to patients' EHRs and medical histories, allowing them to support bedside clinical decision-making along with other tasks.

Understanding the benefits and challenges of virtual nursing

The nursing shortages plaguing the healthcare industry are among the top reasons for virtual nursing's rising popularity.

In 2022, the National Council of State Boards of Nursing released data showing that the nursing workforce lost 100,000 RNs during the COVID-19 pandemic and is expected to lose an additional 900,000 workers by 2027. Shortages are simultaneously a contributor to and result of burnout. A majority of nurses said that their workloads had increased during the pandemic, and more than half reported feeling used up (56.4%). About half said they felt emotionally drained (50.8%), and a little less than half said they felt fatigued (49.7%) and burned out (45.1%).

Virtual nursing has emerged as a tool to combat these shortages and concurrent burnout. A 2023 KLAS report revealed that virtual nursing and sitting solutions are helping healthcare organizations address staffing shortages. For the report, researchers surveyed 43 healthcare professionals, 98% of whom said their current virtual nursing and virtual sitting solution is part of their long-term plans.

Of the 39 respondents who answered the question regarding their solution's impact on staffing shortages, 59% said their solution had a very positive effect, and 28% said it had a moderately positive impact.

Healthcare providers also see virtual nursing as a potential recruitment tool. A survey of 789 healthcare professionals -- conducted in April 2023 on behalf of virtual care platform provider AvaSure -- shows that most (75%) believe that virtual nursing offers the opportunity to recruit nurses who are either unable or unwilling to work at the bedside.

Survey results also show that 59% of respondents cited patient discharge as the top use case for virtual nursing, followed by admissions (53%), patient education (51%) and expert clinical oversight (35%).

In previous interviews, health system leaders echoed this, confirming that they implemented virtual nursing to alleviate the administrative burden on bedside nurses, particularly those caring for medically complex patients. The virtual nurses take on tasks like admissions and discharge and patient education documentation, giving the bedside nurses more time to invest in hands-on care.

They also noted that virtual nursing has helped reduce inpatient capacity constraints, facilitating quicker discharges and shortening wait times for emergency department patients who need to be admitted.

However, the success of the virtual nursing model depends on health systems' ability to successfully tackle numerous challenges. Leaders have noted a wide range of hurdles to implementing the model, including creating and deploying new workflows, mitigating patient concerns regarding virtual nurses and establishing shared governance models. They also shared various strategies for overcoming these challenges, such as conducting listening sessions with nurses to understand the challenges of the new protocols and creating patient focus groups to explain the virtual nursing care model and address patient concerns.

Further, at a session on virtual nursing at the American Telemedicine Association's annual Nexus conference in May 2024, nursing leaders highlighted the importance of building trust between the bedside and virtual nurses. To foster this trust, nursing leaders suggested giving the nurses opportunities to meet and get to know each other, making sure the nursing workforce understands both sides of the model and reassuring on-site nurses that they will not be replaced.

Exploring the strong interest in virtual nursing

Healthcare organizations are displaying a marked interest in implementing virtual nursing models.

For instance, the abovementioned AvaSure survey found that 66% of 789 healthcare professionals believe virtual nursing will become integral to acute care delivery models. More than one-third (38%) of respondents said their organization had already implemented virtual nursing or is in the process of doing so, and another 26% said their organization is considering implementing the services.

Additionally, a May 2024 KLAS report revealed that virtual nursing is among the top use cases for virtual care among large healthcare organizations with more than 500 beds.

The popularity of virtual nursing is further evidenced by the rising number of healthcare provider organizations that have announced plans to implement the care model.

In August 2023, Vanderbilt University Medical Center in Nashville, Tennessee, and Jefferson Health in Philadelphia both launched virtual nursing programs, citing improving care protocols and reducing administrative burdens as the main goals of their programs.

Earlier, in April 2023, Kentucky-based CHI Saint Joseph Health became one of the first hospitals to implement a virtual nursing model using technology developed by its parent health system, CommonSpirit Health. The organization's primary goal is to curb workforce challenges related to nursing shortages.

Some health systems are beginning to assess the impact of virtual nursing, publishing their findings in scientific journals. Researchers from BayCare Health System in Clearwater, Florida, found that the virtual nurse pilot increased patient and nurse satisfaction and reduced turnover and adverse events. Similarly, New York City-based NewYork-Presbyterian studied its virtual nursing program, finding that it had "achieved measurable improvements in both patient and staff experience metrics."

Virtual nursing can offer much-needed support to the nursing workforce and shows significant potential in improving the nursing experience. Its popularity suggests that it will continue to be integrated into hospitals and other healthcare facilities. However, as with all things digital, virtual nursing is only as successful as the people and processes behind it.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.