How 6 systems are tackling virtual nursing's growing pains
Erica Carbajal and Paige Twenter – Becker’s Clinical Leadership
As hospitals and health systems take virtual nursing models from pilot stages to full-scale rollouts, common challenges are emerging.
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While virtual nursing is seen as a key strategy to enhance care delivery, improve patient experience, and support bedside nurses, expanding these programs systemwide presents significant logistical and operational hurdles. From retrofitting patient rooms to managing installations without disrupting care, nurse executives are navigating a range of challenges.
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Becker's recently connected with six nursing leaders to unpack the complexities of scaling virtual nursing across facilities — what is working, what is proving difficult and how health systems are adapting.
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Note: Responses have been lightly edited for length and clarity.
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Jaime Carroll, RN. Vice President of Clinical Support Services at Sentara Health (Norfolk, Va.): Scaling virtual nursing indeed presents a multifaceted challenge, requiring comprehensive coordination among various stakeholders. The integration of technology into the physical infrastructure of the hospitals necessitates detailed planning and execution, particularly when adapting existing spaces to support virtual care capabilities. For instance, the decision to hardwire each room illustrates a meticulous approach toward ensuring stable and reliable connectivity, but it introduces the complexity of accommodating diverse room layouts across different hospitals. This necessitates an individual evaluation of each room to determine the maximum TV size, ensuring that the equipment seamlessly fits both the physical space and the functional requirements for patient care and interaction.
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The initial phase of cabling, which involves running cables from network switches to patient rooms, is a foundational step that sets the stage for subsequent tasks. Once the cabling is completed, successful implementation relies on the synchronized efforts of multiple parties: TV and camera installation vendors bring the physical hardware into place, while the virtual nursing company ensures that software systems are compatible and optimized for use. Meanwhile, nurse call experts, IT personnel, facilities directors and clinical leaders must collaborate to fine-tune the integration process, addressing any technical or operational issues that may arise.
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A significant logistical challenge is the need to vacate 12 rooms per day according to a predetermined schedule, allowing uninterrupted installation and testing without disrupting hospital operations. This requires careful planning to ensure patient care continues smoothly, highlighting the importance of communication and coordination across departments. The intricate dance of preparing each room for virtual nursing, involving both physical modifications and digital integrations, underscores the demanding yet rewarding task of establishing a robust virtual care environment.
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Jennifer Carpenter, DNP, RN. Chief Nursing Informatics Officer at University Hospitals Health System (Cleveland): At University Hospitals, the complexity we're seeing that has emerged in scaling virtual nursing is the high demand. Every hospital wants to put a virtual nursing program into place, but it's complex and can be expensive. There are not yet standard metrics and measures of how to allocate the costs of the program across the system, so we continue to focus on more traditional hospital worked hours-per-patient metrics. Another complexity we've seen is having to be adaptive in our implementations while new technologies and innovations develop in this space. It's important that we move fast, but with purpose.
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We are not only studying how other health systems are scaling virtual nursing, but also focusing on what care model will work best for our health system. We developed a two-year strategic plan that focuses on the importance of our own objectives. It is our priority to provide the opportunity for virtual nursing expertise to our own direct care nurses as part of their role, rather than build exclusively remote teams or outsource.
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We wanted to assemble a team that could perform clinical, patient care at the bedside as well as participate in care virtually. We're using our own staff to innovate this care model. It's important to us that our nurses are embedded in our health system, understand our mission, and that we retain them both in traditional direct care and virtually. It's also our priority to move the virtual model beyond nursing and include our providers, rehab specialists, patient observers and other care team members into the changing model of care.
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Trish Celano, MSN, RN. Chief Nurse Executive and Associate Chief Clinical Officer at AdventHealth (Altamonte Springs, Fla.): Virtual care offers us many opportunities to improve care delivery both from a clinical and experience perspective for patients, families and team members. While there are several challenges around launching virtual nursing, one of the more significant is scaling the technology and infrastructure across a larger footprint.
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Thinking about the acute care side of healthcare, the opportunity to maximize an organizational ROI is for targeted use cases to be deployed across an entire facility. This requires significant organizational commitment as well as capital investments.
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Deploying a hybrid model with nurses and providers who can engage in a facility strategy offers the best opportunity when there is capability across the entire facility, supporting the scaling of resources. We have virtual nursing in several areas at different facilities but not across an entire facility for nursing. This is the work ahead that we need to address.
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Trish Shucoski, DNP, RN. Chief Nurse Executive of BayCare Health System (Clearwater, Fla.): BayCare continually seeks new ways to use innovation to improve patient care and support our nurses. With 16 hospitals and hundreds of locations serving West Central Florida, implementing change takes tremendous planning and preparation. The good news is that we have seen challenges become opportunities to make positive change. BayCare began virtual nursing in 2015, when a virtual nursing unit was created to monitor ICU patients and improve patient outcomes through standardization. In 2022, we started using the virtual space for administrative tasks in the acute care setting. Our goal is to reduce the time nurses spend on documentation.
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Adoption of virtual nurses includes the need for appropriate staffing, expensive hardware and reliable internet connectivity. We have learned virtual nursing works better when we rotate in nurses who work on the floors and have a trusting relationship with the bedside nurse. This also promotes retention of nurses with years of experience and knowledge to share. We're still working on labor expenses as we determine the best staffing model to support the added technology, which can also come with connectivity issues. The cost of the hardware itself limits how quickly we can scale.
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BayCare continues to evaluate the most effective role and functions of the virtual nurse. In addition to ICU monitoring, virtual nurses assist with admission, discharge and patient education in medical and surgical areas. As we scale across the system, we are considering additional responsibilities focused on quality and patient safety indicators, as well as precepting and mentoring. We also are looking for other ways the virtual nurse can continue to lighten the workload of the bedside nurse. With virtual nursing coming to the forefront of conversation, BayCare expects multiple models and iterations of what the virtual nurse can and will do. Lessening the burden of balancing time constraints with providing the best care possible will allow nurses to get back to the art of caring and connecting with patients.
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Janet Tomcavage, MSN, RN. Chief Nursing Executive of Geisinger (Danville, Pa.): Virtual nursing brings an exciting opportunity to transform how we care for patients and offer solutions to support nursing. Geisinger has been providing virtual services for several years and has a full suite of virtual nursing services including Virtual ICU, Virtual Observation, Virtual Telemetry, Virtual Sepsis and Virtual Nursing. But as with any new approach, there are challenges. One of the first things we had to address was infrastructure upgrades (data lines, power sources, etc.) to support the new technology. Then, the cost of the equipment to support this technology — and the fact that this market is rapidly evolving, therefore organizations must carefully scrutinize the market offerings to make the best decisions for their organization and the future. Another consideration is assuring compatibility and integration with our hospitals' current systems, such as the EHR. Equally important is reliability of the equipment in the "real world." Equipment often works in a test environment, but hospital systems need platforms that have no delays and deliver 24/7 reliably so teams can count on the technology for patient care.
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Geisinger is committed to its virtual platform to support patient care. More than three years ago we selected a product already in use with our Virtual Observer model to get several hundred beds supported by virtual nursing and test our approach. We introduced the concept of virtual nursing to our teams, learned valuable lessons and evolved our model. This gave us the time to carefully review the market, evaluate what other organizations have used and engage in careful review of what tools are available. We've also completed focused pilots with more advanced technology to test in busy nursing units throughout our system. To offset costs, we have secured some grants to allow us to expand these services and started to think through how other departments could leverage the platform for their work as well.
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Gail Vozzella, DNP, RN. Senior Vice President and System Chief Nurse Executive at Houston Methodist: Virtual nursing is a strategy to combat the nursing shortage now and in the future. Embarking on implementation of virtual is an organizational investment in infrastructure, resources, financial, capital and workforce. A workplan must include scaling up not only the units covered, but also the tasks completed by the virtual team. The good news is several hospital organizations, including Houston Methodist, have embedded virtual nursing into our model of care. We can now share findings on how to optimize virtual, including a scalability plan.
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Houston Methodist started virtual acute care nursing under the same infrastructure of virtual intensive care. The scope of the virtual nursing program was initially built to support admission and discharge questions and documentation. Four pilot units in one campus allowed nurses and leadership to hear immediate positive feedback and challenges which allowed for swift adjustments required to optimize utilization. From that pilot, we quickly spread across most acute care units across the organization. Additionally, sharing success stories of both patient experience with the virtual team and the results showing a reduction of documentation burden for our nurses helped build adoption across the system.
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At Houston Methodist, we know that the role of virtual nursing will continue to evolve as we strive to give high quality care to our patients all while making sure nurses are able to deliver compassionate care. As technology improves, virtual nurses have the ability to provide enhanced support to bedside nurses with double checks of medications, patient education, mentoring of new nurses and virtual rounding of patients. We know healthcare is best when we are one team with the patient at the center of everything we do. And virtual nursing is one way we are able to do that now and in the future.
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Editor's note: This article was updated post-publication to include insights from an additional health system.