2024
2024
Leaders agree virtual nursing is the next step in care delivery. Here’s what they’re doing.
Leaders agree virtual nursing is the future of care delivery. Here’s what they’re doing.
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What are the goals?
One key element of nearly every virtual nursing program is the goal of improving the nurse’s experience, in both workflow and wellness.
All healthcare organizations are dealing with a nurse workforce shortage, a result of increasing rates of stress and burnout and workflows that can best be described as overwhelming. In that light, a virtual nursing program aims to reduce that burden by siphoning off administrative tasks and other duties that take the nurse away from bedside care.
“We think of it in terms of really opening up the workforce by creating… a new role for nurses to consider, especially later in their career. Those who maybe have left, now have options to come back.”
—Janet Tomcavage, executive vice president and CNE, Geisinger
From a human resources perspective, a virtual nursing position could be attractive to veteran nurses who would like to ease their way off of the floor but don’t want to retire just yet. They also give an organization the opportunity to use veteran nurses as virtual mentors for new nurses. Some health systems use virtual nursing as a marketing tool to attract new nurses.
One caveat: Mentoring may not be enough to sustain a virtual nursing program on its own.
The ROI is difficult to define, particularly at a time when health system leadership is focused on saving money and improving efficiency. Mentoring is often added to a virtual nursing program that is focused on other goals.
Administrative tasks, also known as time spent on a computer or in the EHR, also figure prominently in another key ROI: Administrative efficiency and data entry.
Virtual nurses can handle those tasks more easily than a floor nurse who’s also in front of the patient, and in many cases those nurses are more efficient, resulting in time saved and more accurate records. Health systems have been known to hire virtual nurses with those qualifications in mind, or to use nursing assistants or technicians to fill that role.
Which brings us to staffing. Many healthcare organizations begin a virtual nursing program with their current corps of nurses, usually assigning floor nurses to certain days on the floor and certain days at the virtual desk.
Janet Tomcavage
Executive Vice President and CNE, Geisinger
Becky Fox
Chief Clinical Information Officer, Intermountain Health
The idea here is to acclimate the nurses to the virtual platform while giving floor nurses and patients a familiar voice at the other end. This also plays into the strategy of having an interchangeable nursing force, with nurses who can be deployed either to the floor or the virtual platform.
Not every health system embraces that strategy.
Some are creating a separate workforce for the virtual platform, one with specific skills that differ from bedside care. They may also hire advanced nurse practitioners or even non-nurses for those roles, with the idea that the virtual nurse is focused on administrative tasks and perhaps observation but does not need the clinical care skills of the bedside nurse. This might also play into a much larger telemedicine platform that serves multiple departments and programs, from the ED to an acute care at home service.
Staffing strategy plays a crucial part of any virtual nursing program, as most programs are launched with the idea of improving or at least stabilizing staffing shortages. Some health systems are marketing their virtual nursing programs to entice potential nurses, while others are using the platform to curb costs like time off and overtime, and even to eliminate the need to employ travel nurses.
72%
of our participating health systems
report being in the early (36%) to mid-stages (36%) of their virtual nursing journeys, with only 27 percent reporting being in the mature stage.
What The Numbers Say
The program began with a survey to gauge where each participating health system was in their respective programs.
According to the survey, 72 percent of the health systems reporting being in the early (36%) to mid-stages (36%) of their virtual nursing journeys, with only 27 percent reporting being in the mature stage. The early stage is when a program is still in ideation and testing, the mid-stage is when there is some adoption and promising outcomes, and program maturity is reached when a program is becoming systemwide.
By far the largest area that virtual nursing has an impact on is the medical surgical department, according to 91 percent of our participants. The ICU is in second place (64%), followed by behavioral (18%) and chronic care (18%) departments, then outpatient (9%), rehab (9%), and ED/follow up (9%).
In terms of staff acceptance of the virtual nursing programs, the response is overwhelmingly positive, with 60 percent reporting a very positive response and 40 percent reporting a somewhat positive response. No negative responses were recorded in the survey.
The same goes for executive team support for virtual nursing programs. Most of the participants reported a very positive response (80%) and the rest reported a somewhat positive response (20%).
The participants unanimously agreed that virtual nursing's ability to improve quality and patient experience would appeal to the executive team. Most strongly agreed that the expansion of services, increased care access, and the attraction of new nurses would also be appealing.
When it comes to budget allocation, at the time of the survey, 89 percent of survey participants reported that less than five percent of their nursing budget is attributed to virtual nursing. Only 11 percent said the attribution was between five and 10 percent.
In the next three years, 80 percent of participants reported they expect their health systems’ virtual nursing labor budget to increase between 10 and 25 percent, offering executives the chance to advance their programs even more.
Sarah Pletcher, MD, MHCDS
System VP and Executive Medical Director for Strategic Innovation, Houston Methodist
Areas where virtual nursing has the most impact on our participants
Medical surgical department
ICU department
Behavioral and chronic care departments
18%
What Are The Key Challenges Systems Are Facing?
Healthcare executives need to include nurses in the planning and development stages not only to make sure the new platform meets a nurse’s needs, but to develop nurse champions who can help introduce the platform to others in the department.
This process works best with a clear definition of roles for floor nurses, virtual nurses, and anyone else involved in the program. Nurses need to know their expectations, and they need to understand which tasks they take on and which are assigned to someone else. These tasks should be rigid during the early stages of the program, as nurses learn their routines and responsibilities, but should be flexible later on as nurses learn their strengths and capabilities.
“What is the patient experience in this? They do feel connected regardless of the fact that the nurse is on a laptop, a mobile cart, or whether we have the telemetry in the room on a big monitor. They feel like they’re being supported, educated, and know how to care for themselves when they go home.”
—Becky Fox, Chief Clinical Information Officer, Intermountain Health
Some nurse leaders have seen their nurses develop a smooth rapport with each other, with each nurse knowing what task to undertake without asking and some trading off and helping others when things get busy, or someone needs help. With that familiarity comes efficiency and a heightened sense of nurse well-being.
Another challenge? Patient buy-in.
Nurse leaders need to remember that they not only need to get their nurses on board with a new endeavor, but the patients as well. Creating patient education resources will help streamline the process and make the patient feel more comfortable and confident in their care.
Kay Burke
Kay Burke, Chief Nursing Informatics Officer, UCSF Health
Where Do You Even Start With Technology?
Each of the participating health systems began at different technological starting points. Some gathered or developed the technology in-house, while others outsourced to third party vendors. The important thing for many systems was to just get started, with the intention of upgrading the technology as the programs mature.
The basic starting point for many systems involved iPads or other tablets or basic cameras on carts or stands, while others already had wall mounted TVs in place, so they began by using those.
Now, many systems are upgrading to smart TVs, with fixed screens and sensor-enabled bidirectional cameras. The ultimate goal for many is to implement ambient listening and other algorithmic technologies to improve documentation and patient monitoring.
One of the biggest challenges is integrating the technologies together and making sure that they fit well into nurse workflows. If the nurses dislike the technology, then they will not use it, and the resources spent to acquire and implement the technology will have gone to waste.
“An organization that wants to implement nursing technologies should start by evaluating its current needs, challenges, and opportunities to ensure that they can adequately take on and deploy a new solution. The new technology should augment, not replace, nursing workflows and aid in streamlining their documentation. The organization should plan and execute a pilot group with clear goals, metrics, and a feedback loop to ascertain the impact and value of the technology.”
—Duncan Salt, VP of Sales, Microsoft-Nuance
Duncan Salt
VP of Sales, Microsoft-Nuance
How Should Systems Measure ROI?
An efficient virtual nursing platform will reduce admission and discharge times, but one has to remember that these processes contain a lot of moving parts, and the nurse affects only part of the whole routine. Nursing leaders and executives need to be careful not to overstate the ROI.
“We really focus heavily on time durations of each activity that we do.”
—Steve Klahn, System Clinical Director for Virtual Medicine, Houston Methodist
Other metrics focus on what is called soft ROI, or value that doesn’t always show up as a savings of time or money. Nurse and patient satisfaction surveys, the latter in HCAHPS scores, are crucial in measuring nurse well-being and patient engagement.
Steve Klahn
System Clinical Director for Virtual Medicine, Houston Methodist
Nurse satisfaction does have a direct impact on stress and burnout and can lead to reduced turnover, as well as less personal time off and more enthusiasm (which, in turn, might lead to improved efficiency). Patient engagement can lead to improvements in adherence to care plans and medication, through the idea that a more engaged patient will be more likely to follow care routines and take their prescribed medications.
Ideally, a virtual nursing platform can eventually lead to improved clinical outcomes, though that may take some time to measure. An efficient care team and care plan will mean fewer errors, both in care and data entry; this, combined with better patient engagement and medication adherence, will reduce the percentage of adverse events and rehospitalizations.
One area in which virtual care has shown a defined value is in falls prevention. Telesitting or virtual sitting programs have in the past been launched on their own, separate from a virtual nursing platform, with the sole purpose of keeping an eye on patients at risk of getting out of their beds, falling, or doing harm to themselves. Many of these programs use non-nurses in that role to save money and staff, and studies have shown that they reduce adverse events, improve clinical outcomes and save money.
With that in mind some health systems are integrating virtual sitting into their virtual nursing platform to give the program a hard ROI and early value and give the other benefits time to show themselves.
“It’s not just adding on new staffing or thinking about how [to] increase the ratios on the nurses. It’s really about a return on investment based on those other metrics [and] hopefully quality of care improvements as well.”
—Jason Atkins, Vice President and Chief Clinical Informatics Officer, Emory Healthcare
What Does The Future Hold?
As for what the future holds in store for virtual nursing, the general consensus is that this platform is here to stay—and it will grow.
Most health system executives in charge of virtual nursing see this as part of a much larger reinvention of in-patient care, with nurses sharing the virtual space with doctors, specialists, the patient’s family, even counselors and others capable of addressing social determinants of health. The idea is that the virtual care platform in every patient room will be able to offer a wide range of resources for both the patient and the in-person provider.
This goes hand-in-hand with the evolution of virtual nursing technology. Smart TV systems enable organizations to integrate virtual care tools with patient entertainment and engagement platforms. The goal is to create the "hospital room of the future," where health systems can integrate nursing and technology together to improve outcomes in a cost-effective way.
Some of the more advanced programs are also exploring the use of virtual nurses outside the hospital setting. As healthcare organizations look to shift more services from the hospital to the home, a virtual nursing platform can be an important link to care coordination for remote patient monitoring and hospital at home programs, or to help newly discharged patients connect to providers for follow-up visits and rehab sessions.
“The future of virtual nursing is promising as technology advances and enables more innovative and effective ways of providing care to patients across different settings and situations. I look for virtual nursing to aid and complement the necessary skills and expertise of nurses, through access to real-time data, insights, and decision support tools to ultimately free up more time to focus on patient care.”
—Duncan Salt, VP of Sales, Microsoft-Nuance
Lastly, a goal for many health systems is to incorporate mentorship for new graduate nurses. As previously mentioned, the idea is to use the virtual platforms to have tenured nurses provide guidance to the bedside nurses. This has the potential to address the generational knowledge gap facing the nursing workforce, and it will help keep tenured nurses on the job for longer.
Virtual nursing programs are rapidly evolving, and we will be keeping up with the trends. Stay tuned for more from this Virtual Nursing Mastermind in 2025.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives focusing on pain points that matter most to you. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at anorris@healthleadersmedia.com.
Jason Atkins
Vice President and Chief Clinical Informatics Officer, Emory Healthcare
Looking for even more on what our HealthLeaders Mastermind participants achieved?
Looking for even more on what our HealthLeaders Mastermind participants achieved?
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