From 'game-changer' to 'we all lose': 9 nurse leaders weigh in on virtual nursing

Several large health systems are turning to virtual nurses to fight workforce shortages and improve hospital efficiency, but not all leaders are onboard.

Some chief nursing officers embrace the incoming trend, noting it could improve patient satisfaction and staff morale while also reducing administrative work for in-person nurses. Others worry that virtual nurses can't provide the human element necessary to care.

More systems and hospitals are trying virtual nurses as staffing shortages continue. Trinity Health plans to roll out virtual nurses at its hospitals in Michigan and nationwide. Ardent Health Services also has plans to implement the company's virtual nursing platform at Albuquerque, N.M.-based Lovelace Medical Center. 

Becker's asked nine chief nursing officers where they stand on this trend and if it will, or should, stick around.

Note: Responses were lightly edited for length and clarity.

Vi-Anne Antrum, DNP, RN. Systemwide Chief Nursing Officer of Cone Health (Greensboro, N.C.): I believe that our future will continue to incorporate virtual nurses as a way to transfer knowledge from more seasoned nurses to our newer nursing workforce. It also provides an additional layer of support to decrease the burden our nurses experience on a day-to-day basis related to burnout. Leveraging and embracing this possibility can extend the career life of our most experienced nurses during a time of continued shortages while creating efficiencies in caring for patients in our hospitals. My prediction: If this trend continues, this model will become a standard part of the way we deliver care, and it will serve as a bridge to connect care across the continuum. Imagine if the same virtual nurse who cared for you in the hospital performed a virtual visit after discharge or was your hospital to home nurse and connected with your primary care provider for a warm handoff. This future helps us add tremendous value to those we serve. It moves nurses into the space of holistic care coordination as outlined in the IOM: Future of Nursing 2030.

Dianne Aroh, MSN, RN. Chief Nursing Officer of Virginia Mason Franciscan Health (Seattle): The rise in virtual nursing in hospitals and other patient care settings is a game changer. As nurses prepare to retire or seek more flexible scheduling options, we are implementing new opportunities for them to continue caring for patients without always needing to be physically present. Within our own health system, we are already seeing tremendous success with our virtual nursing program. Having a virtual nurse as a consistent member of the care team is another lever that we are pulling to provide additional support. As the healthcare industry continues to grapple with ongoing staffing challenges and high patient volumes, it is crucial that we continue innovating and leveraging technology to retain our workforce while maintaining high-quality and safe care for patients.

Gara Edelstein, RN. Chief Nursing Officer of Catholic Health (Rockville Centre, N.Y.): Moving to a hybrid model with virtual nurses can help create efficiencies for our nurses in a few ways. Virtual nurses can help with documentation related to admissions and discharges and educate the patients; this frees up the bedside nurse to provide more physical and emotional care. In addition, experienced virtual nurses can be used to support novice nurses by improving their clinical skills at the bedside.

Paula Fessler, MSN, RN. Chief Nursing Officer of University of North Carolina Hospitals (Chapel Hill, N.C.): The increasing use of virtual nurses in hospitals is a relatively new and innovative way to build teams to help bridge the current gap in our nursing workforce. Depending on the need, teams may utilize a virtual nurse in several different roles. A virtual nurse can respond quickly to call bells and alarms. They can complete the electronic medical record documentation while the on-site nurse completes the in-person assessment. A virtual nurse may teach or precept a nurse with less experience. 

I fully expect this trend to continue and grow. I believe it is a wonderful option when utilized to augment current resources.

Kelley Gonzalvo, DNP, RN. Vice President Patient Care Services and Chief Nursing Officer of Moffitt Cancer Center (Tampa, Fla.): Virtual nursing is a critical element of the way we now provide nursing care and expertise to a population that may not have been previously reached by the healthcare system. We are now bringing healthcare to our patients whenever possible, instead of our patients coming to us.

I am excited about how we will be adding a virtual element to harness the expertise of our more experienced nurses to support our novice nurses virtually.

Scott Jessie, MSN, RN. Chief Nursing Officer of SUNY Upstate University Hospital (Syracuse, N.Y.): The reality is the nursing workforce and the healthcare workforce in general will not return to pre-pandemic levels. We have to constantly adapt and innovate as we continue to build back from these dramatic changes in staffing resources. Virtual nursing is one tool that is likely to play a significant role moving forward. This technology can allow us to expand our workforce, bring experience to the bedside on demand, and support new staff to practiced staff when and where they need it. It can also reduce the workload at the bedside by having remote nurses do admissions, discharges, and answer questions virtually. We have had great success with virtual safety companions and are currently looking at options to add virtual nursing to our workforce now.

As this concept is more widely adopted, it has the potential to result in more satisfied patients, staff who feel more supported, and more opportunity to retain nurses who feel they can no longer work at the bedside.

Pidge Lohr, DNP, RN. Vice President Nursing Operations of Prisma Health (Greenville, S.C.): Virtual nursing is a practice innovation that supports bedside decision-making, leverages the use of technology, mitigates the growing nursing shortage, and allows for a practice setting that keeps expert nurse clinicians at the bedside. I do not see this as a trend that will go away. I see it as a critical element of staffing strategies hospitals must adopt now and optimize in the future to maintain the highest standards of safety, quality, and experience for patients, their families, and the nursing staff. A silver lining emerges from the dark cloud that was COVID-19.

At Prisma Health, we are proud of our robust, systemwide virtual sitter program. To complement that service, we are piloting virtual caregivers coming alongside the bedside nurses to help with time-consuming tasks of admissions and discharges, medication reconciliation, and expert clinical support for our newer practicing nurses. We also plan to use the technology to support and standardize virtual registered dietician visits in both the acute care and ambulatory settings. Initially we plan to use internal resource pool nurses to staff the pilot and existing clinical nutritionists (another hard to fill role in South Carolina). A hybrid model may attract nurses who are feeling they want to step away from the full-time clinical work to part time on a patient unit — and keeps them at a full-time status.

Catherine Mohr, DNP, RN. Chief Nursing Officer of J. Arthur Dosher Memorial Hospital (Southport, N.C.): The support will most likely be gradual based on the patient population. Virtual ICU care already serves as a platform to support bedside nurses that need support. Swing bed patients could be managed since the nursing care is less and coordinated around rehabilitation goals. Clearly there will be hospitals that pilot the technology and should be reporting patient outcomes.

Steve Polega, BSN, RN. Chief Nursing Officer of University of Michigan Health-West (Wyoming): As a nurse of 25 years, I believe that nursing is a calling and a gift. It is a huge responsibility to be trusted by our patients and families to be the eyes, ears and caring hands at the bedside. Nursing is all about connecting with people. To earn that trust, I believe that you need to be at the bedside. Nursing is about that kind touch, that smile, those reassuring things that we can do for patients and families. It is very challenging to have that real human connection through virtual care. I think we all lose if this trend continues. We have to optimize our technologies to make our nurses more efficient and effective, but at the end of the day, nurses put the humanity into care and need to be present and at the bedside.

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