Why Providence had to 'blow up' the old way of providing care with virtual nursing

To deal with nursing shortages, Renton, Wash.-based Providence had to "blow up" the old model of hospital care, the health system's chief nursing officer told Becker's.

Providence recently brought virtual nursing to 10 sites across nine hospitals in four states. With the so-called Co-Caring model, the virtual nurses, working from home, support bedside nurses and technicians by helping with administrative tasks like admissions, discharges, preprocedural checklists, and medication reconciliation.

"What was very clear to us at the onset is that it doesn't matter how good we are at recruiting nurses. It doesn't matter how good we are at retaining nurses. We are never going to have enough if we keep on doing things the way we do them today," Syl Trepanier, DNP, RN, chief nursing officer of Providence. "That was the impetus for us to change. Nibbling on the edges is not going to take us there. We really have to blow this model up and look at things very differently. And that's been our driving force."

Dr. Trepanier noted that Providence didn't just add a virtual nurse to the team; it adjusted all the providers' roles to give them more time to focus on what's most important.

"We're changing the entire model to include a virtual nurse," he said. "But at the end of the day, we are spreading the work so that we can better meet the needs of our patients."

He said he "wouldn't be surprised" if there came a day in the near future where this program or some virtual nursing component existed at all of Providence's 51 hospitals, but added that it will depend on what the health system learns this year from its initial 10 sites. It now operates in medical-surgical and telemetry units but could one day expand to places like the emergency room or critical care. He could also envision virtual case managers, wound assessments, pharmacists and even advanced practice nurses being added to the mix.

"There really is an entire healthcare team that could latch on virtually," he said. "We just have to make sure that someone stays by the bedside of the patient, that not everyone disappears. So that's why I think it's always going to be a hybrid of sorts. At least initially."

The early results of the program have been positive, Dr. Trepanier said. Patients have sent thank-you letters after being discharged. At Lubbock, Texas-based Covenant Medical Center, which piloted the program, first-year turnover rates fell by 73 percent for registered nurses and 55 percent overall.

"We've realized we were really not putting the nurses in a position where they could practice at the top of their license, at the top of their competency," he said. "So now we've elevated their role, by extending the role of the technicians … and making sure that everyone feels they're part of the team. What was really appealing to us is we could leverage a team that could be there virtually but that could be there also physically and then elevate all of the roles."

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