Hospitals are zeroing in on alternative care models to improve the nursing work experience and patient outcomes while lowering costs.
Eight in 10 nurse leaders are piloting new care models in their organizations, ranging from virtual nursing to home health, according to a recent study by healthcare solutions company Wolters Kluwer.
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The report identified five main strategies that more leaders are looking to implement — home healthcare, internal float pools, virtual nursing, telehealth nursing and multi-disciplinary care. Driving the innovation are some of the industry's most pressing problems such as staffing shortages, higher acuity patients, time management issues and nurse-to-patient ratios. The survey included responses from 157 chief nursing officers, vice presidents of nursing, directors of clinical practice and directors of nursing education.
Almost three-quarters of nursing leaders said they planned to implement home health nursing models, which could work well with an industry shift toward value-based care, according to Bethany Robertson, an author of the report and a clinical executive for Wolters Kluwer's health learning, research & practice division.
"The most expensive care rendered is inside an acute care facility and there's the propensity to have hospital-acquired conditions and infections and things like that, so we are trying to move care outside of the acute care environment from a cost perspective," Robertson said. "Also, we haven't really demonstrated that it's the most valuable. If you think about value-based care, it's more optimal to have people in their own surroundings, assuming they don't have housing insecurities and food insecurities and things of that nature."
Exploring some of those alternative care models for nurses is underway at Advocate Health.
"With some of the places where care is being delivered outside of the four walls of the hospital, [like] hospital-at-home, home health, even outpatient, we are starting to look at where the care delivery model can change in those areas, too," said Betty Jo Rocchio, chief nurse executive at the Charlotte, North Carolina-based system. "You can see that virtual nursing could be a big help outside of the four walls of the hospital as well...It is something that we have on our map to address."
Advocate has rolled out a virtual nursing program at 29 of its 69 hospitals. It plans to expand the program to 13 more facilities by December.
The model pairs bedside nurses and virtual nurses, who answer call lights and patient questions and assist with charting. The model gives bedside nurses more time for in-person care.
"They know the patients," Rocchio said. "They know everything about the unit. They're not just somebody sitting in a remote location trying to help. They're very well ingrained into the care model, because we call it a co-care model. They are actually at the bedside for a couple days and do virtual for a couple days.”
Rocchio said the model has been well received by staff, particularly early career nurses.
"Our newer nurses that come into the profession get help from the virtual nurse as well," Rocchio said. "I rounded the other day in one of our first hospitals that's probably the most robust with virtual care, and I talked to some of the frontline nurses and it's amazing how much they love this model... Many of them said they're going to start making decisions out of school on whether somebody has a virtual model in place or not."
In a separate report, the 2024 National Nursing Workforce Survey released this month, 26% of registered nurses and 21% of licensed practical or vocational nurses said they used some form of remote communication to provide patient care last year.
St.Louis-based Mercy, which began piloting ambient artificial intelligence nearly three years ago, has seen a significant change in documentation times for nurses, said Tracy Breece, the system's executive director of nursing informatics.
When ambient AI was introduced to the nurses, they were spending an average of 167 minutes per 12-hour shift on documentation, Breece said. That task is down to about 133 minutes.
"We are constantly looking at what's the next workflow to continue to move us into a balanced state where technology alleviates a cognitive burden, reduces time spent with technology interaction and [and gives] the nurse the time back for patient family interactions," Breece said.
Both systems emphasized nurses who would be involved in using these ambient AI programs would also be included in deciding how they will be incorporated into their workflow.
"We are not doing this to nurses," Rocchio said. "We are doing it with nurses. They're designing what this looks like in the workflows. The last thing you want is people that aren't involved in the patient care every day designing it, so we have a very robust professional governance structure that has frontline nurses on it, and they are taking the lead in designing this in the workforce for us."
