Virtual nursing was introduced a couple of decades ago, but it’s getting a fresh look thanks in large part to its successful use during the height of the pandemic. Today, leaders at many health systems are piloting technologies and expanding programs as they work to systematically scale this model.
Sylvain Trepanier, R.N., chief nursing officer at Providence, summed up the situation in a recent interview, noting that the primary nursing model is no longer sustainable due to continued staffing challenges and the aging population. With the World Health Organization projecting that 6 million more nurses will be needed worldwide by 2030, the need for sustainable solutions is apparent.
Expanding the Hybrid Care Model
Virginia-based Mary Washington Healthcare recently partnered with Caregility to deploy the company’s Inpatient Virtual Engagement telehealth program at the health system’s 100-bed Stafford Hospital. Clinicians will use synchronous, video-enabled technology to care for patients who do not require hands-on access.
The solution includes telehealth, observation, consultation and fleet-management capabilities. The technology integrates with the Epic electronic health record (EHR) system, enabling staff to launch virtual visits within the EHR.
Virtual nursing programs, whether through partnerships with telehealth providers or by using homegrown solutions, enable nurses to work in remote locations. They can observe and answer patients’ questions, speak with family members and ease the burden on bedside nurses by performing tasks that don’t require physical proximity such as handling admissions interviews, discharge instructions and explaining medication instructions.
An Unprecedented Partnership for Care
Ochsner Medical Center in Kenner, La., began an integrated and innovative virtual nurse pilot in 2017 that has continued to deliver benefits, including improved outcomes, notes Ruth Sagastume, R.N., chief nursing officer, in a recent American Organization for Nursing Leadership article.
The program’s platform allows an unprecedented partnership for care between bedside and virtual nurses who share responsibilities for medical-surgical and telemetry units.
The initiative grew out of a need for a nursing model to address the gap between the patients’ acuity and the expertise level of the nurses working in med-surg and telemetry, Sagastume notes. Instead of a consultant-based approach commonly used in electronic intensive care unit models, the virtual nurses are assigned a group of patients for whom they provide care for their shift duration.
The virtual nurse leads communication efforts across all team members and consistently evaluates the patient’s progress, responses, clinical data and other aspects of care.
Benefits and Successes
Sagastume says the program has delivered numerous benefits, including:
- Improvements in the way staff manage bed capacity and patient acuity, particularly during the pandemic.
- Greater flexibility in bed placement optimization while protecting bed capacity for highly acute critical care patients.
- More direct oversight and patient monitoring, which can result in early detection of rapid changes in patient conditions.
Providence has been using various telemedicine technologies and virtual care models since 2004. It partners with Teladoc and provides bidirectional audio and video technology installed and configured for patient rooms, and interfaces with the EHR, enabling the virtual nurse to seamlessly interface with the patient, Trepanier told HealthcareIT News.
The team developed specific roles and responsibilities for bedside and virtual nurses and ancillary staff. Tools such as secure chat and wearable two-way communication devices are used to enhance live communication between the virtual and bedside teams.
5 Keys for Successful Virtual Nursing Programs
1 | Be inclusive from the start.
Engage clinical staff, information technology (IT), quality assurance and other leaders and invite input throughout program development and implementation.
2 | Allow time for relationship building.
Virtual models require different ways to care for patients and shifts in overall nursing responsibility. Information sharing and building trust among participants is vital and will take time to develop.
3 | Anticipate technological difficulties.
Unplanned occurrences like equipment overloads and shutdowns can happen even with careful IT coordination. Determine early on how you will deal with hiccups.
4 | Don’t be afraid to change workflows.
The best ideas on paper don’t always work in real life, notes Jennifer Ball, director of virtual care at Saint Luke’s Health System of Kansas City, Mo., in a recent CDW HealthTech report.
5 | Make sure buildings have adequate wireless bandwidth.
Otherwise, you may end up continually expanding capacity and building in redundancy to keep up.