More health systems are developing virtual nursing teams to augment their workforce and close care gaps.
Nurses in remote positions tend to take on many administrative responsibilities, freeing up their in-person colleagues to provide hands-on care and spend more time with patients.
Health systems are experimenting to determine which technology solutions and workflows are most effective, while unions raise concerns about patient safety and push for in-person hiring instead.
Several provider organizations have announced virtual nursing programs over the past year, largely in acute-care settings. Trinity Health, based in Livonia, Michigan, announced in January it plans to launch a virtual nursing model across 88 hospitals in 26 states following a year of pilot programs. In June, Renton, Washington-headquartered Providence announced it was implementing the model at eight hospitals in Texas.
Such programs require upfront expenses for recruitment and technology. When hiring, health systems often look for nurses with years of in-person experience to work exclusively in a virtual capacity. After being trained on telehealth technology, the clinicians are typically stationed at an on-site “command center” to handle admissions documentation, discharge planning and transfers, medical histories and assessment of current symptoms, though some work from their homes. The nurses also monitor patients from afar, educate them on medications and treatment, coordinate care with and advise the in-person clinical team and schedule calls with family members.
Patient rooms are equipped with cameras, video screens, electronic alert buttons and telemetry devices that monitor their vitals and send data to care teams and the healthcare organization’s electronic health record. Patients and in-person clinicians can use screens set up in the room to interact with a virtual nurse.
At Stafford Hospital in Virginia, part of Mary Washington Healthcare, Associate Vice President of Hospital Operations Debra Marinari proposed virtual nursing as a way to augment care and address loss of clinical expertise after three years of the COVID-19 pandemic. The program began in May after six months of preparation.
“It was quickly recognized that we were not going to be able to continue nursing and the model of care that we had,” Marinari said. “Something had to change. What we were doing was not sustainable.”
The hospital tracks nurse turnover rates, infection and readmission rates and patient experience metrics to determine the program’s success, Marinari said. In-person and virtual team members provide feedback to nursing leadership about workflows and collaborative processes.
Having virtual nurses handle more of the administrative work boosts capacity, Marinari said. Because the virtual nurses tend to have more experience, Stafford Hospital set their pay at a slightly higher level than regular staff nurses working with critical-care patients.
The organization hopes to hire enough virtual nurses to remotely monitor patients 24/7, with Mary Washington aiming to expand the program to other facilities, Marinari said.
Provider organizations say that virtual nurses can effectively act as a support team for bedside nurses, potentially reducing burnout. The programs are also being used as an employee engagement tool to retain and attract clinicians. Having a remote option allowed Lexington, Kentucky-based CHI Saint Joseph Health to keep an employee on staff even after they moved hundreds of miles away, said CEO Anthony Houston.
“We didn’t have to backfill that person with, perhaps, an expensive temporary nurse while we searched for someone,” Houston said.
CHI Saint Joseph, which started an integrated virtual nursing program in 2022 using technology developed and patented by its parent company CommonSpirit Health, sees the clinicians as leaders in the front-line care process, who usually take on more responsibilities than their bedside counterparts, said Chief Operating Officer and Chief Nursing Executive Melissa Bennett. They need to be familiar with all the pieces that go into care, from how nutrition trays are delivered to where patients should be placed, she said.