Advocate Health has been aiming to take cognitive and documentation load off its nursing staff by implementing AI and virtual nursing.
The Charlotte, N.C.-based health system recently launched Project Nursing, an ambient AI documentation tool from Microsoft for nurses, at a North Carolina hospital and has continued to expand virtual nursing across the enterprise.
Becker’s talked with Betty Jo Rocchio, DNP, CRNA, executive vice president and chief nurse executive of the 69-hospital system, about how these and other technologies are giving bedside nurses more time for patient care. This conversation has been lightly edited for clarity and brevity.
Question: How and why did Advocate get involved with Microsoft on Project Nursing, and what do you expect some of the benefits to be?
Betty Jo Rocchio: Advocate Health has been involved with DAX Copilot, Microsoft’s documentation tool for physicians. It’s probably noteworthy that we had the first physician in the world to use the technology in a clinic. We’re early adopters, and Microsoft has been our partner in this space for a long time. Our physicians use it daily, have published research on it, and continue to refine it through regular use.
It made perfect sense for nursing to get involved in the private preview of [Project Nursing]. Physicians jump in and out of specific episodes with patients, but nursing is more continuous — we’re with patients 24/7, 365. There’s more interaction and a greater challenge in getting that documentation into the right place in the EHR.
Microsoft took some time to enter the nursing side because it’s trickier. But the potential benefits for nurses are significant. Our current options are to either remember everything, jot notes on paper, or try to document while building a relationship with the patient.
Ambient voice technology allows us to capture the essential aspects of nursing documentation in real time. That way, we can focus on the interaction with the patient. It’s groundbreaking. It will take effort to fully implement, but we’re excited. It integrates well with our virtual nursing program.
Q: Where are you now with virtual nursing at Advocate Health, and are there plans to expand?
BJR: We’re in 29 hospitals right now. We have plans to expand to 13 more this year — maybe more.
Q: What tasks are the virtual nurses helping with?
BJR: We’re using two different models. One is for admissions, discharges and transfers. These virtual nurses remote in to handle those pieces. For example, if a patient moves from an ICU to a step-down unit, the virtual nurse completes the transfer documentation.
The second model is more inclusive. These virtual nurses remote in via cameras and are part of the care team throughout the patient’s stay. A bedside nurse might have five or six patients, while a virtual nurse could manage up to 12, collaborating closely with the bedside nurse all day.
Virtual nurses use their computers and document in real time. With ambient voice technology, bedside nurses can do the same. The goal is combined real-time documentation, where the voices of both nurses feed into the EHR.
Q: We’ve talked about this previously — the importance of involving nurses in tech rollouts. How is Advocate involving nurses in developing these technologies?
BJR: We have strong professional governance that includes frontline nurses. These nurses still work at the bedside but dedicate part of their week to helping us make decisions.
We’ve created a technology and analytics unit council focused on projects like this. Members understand the workflows of both virtual and bedside nurses and ensure the technology fits their needs. They’re actively involved with Microsoft, working alongside them on Project Nursing.
Q: We’ve also discussed nurses being concerned about AI. How do you address those anxieties?
BJR: By having frontline nurses design the care delivery model, they know the tech was developed by nurses, for nurses.
Also, we emphasize that AI isn’t replacing nurses — it’s giving them time back to spend with patients. When they don’t have to worry about documentation at the end of a shift, they feel more supported.
It’s also important to have innovation units where change can be piloted and refined before rolling out more broadly. Once a model works, we want to move quickly.
Q: How do you measure ROI on these projects?
BJR: We’re focused on reducing nurses’ cognitive workload — specifically the hours spent documenting. That’s time not spent with patients.
In 2024, with virtual nursing, we reduced cognitive workload by about 43,000 hours — and we’re not even live across all our hospitals yet.
We’re also tracking recruitment and retention. With better support — virtual or in person — nurses are staying longer. New nurses even ask about virtual nursing during the hiring process.
We’ve started including virtual nursing in nursing school rotations. New grads are saying they wouldn’t accept a job without virtual nursing as part of their orientation. We also see benefits when experienced nurses change specialties — it gives them added support.
The ROI isn’t necessarily in cost savings. We’re not cutting staff. We’re realigning the care model. The returns are in reduced workload, better retention, and improved recruitment.
Q: Are there any other technologies you’re using or planning to use to support bedside nurses?
BJR: We’re putting technology into three key areas:
— Workforce: Giving nurses more flexibility to work across units using tech that fills shifts.
— Workflows: Using AI and ambient voice for transitions of care, especially during handoffs.
— Work environment: We’re adding tech to screen visitors, similar to TSA screening, and buttons on nurse badges to call for help. It’s about making sure our workplaces are safe for all teammates.
Q: Anything else you’d like to add?
BJR: Just that this technology isn’t being added piecemeal. It’s part of our overall strategy at Advocate. Our frontline nurses, through professional governance, are helping guide these decisions. We’re redesigning the care delivery model to provide compassionate, effective care.
