Virtual Nursing: What is it?

You might be asking: why do we need “virtual” nurses when we don’t even have enough physical nurses at the bedside?  That’s exactly why we do need them.  Virtual RNs can support the team at the bedside to alleviate the workload and provide greater satisfaction for both the patients and the nursing staff.  We are all aware of the current and future staffing challenges in healthcare, and this is one way to address it.  It also provides opportunities for nurses that are not wanting to leave the workforce but have years of great experience and knowledge to continue their career in a less physical role.

The concept isn’t anything new…. telemedicine has been around for many years and the pandemic helped us to see how this kind of care model can be used in many different ways to supplement the bedside team.  Saint Luke’s Health System of Kansas City began their journey to implement virtual nursing before the pandemic, in 2019.  We had a wonderful opportunity with the construction of a new 33 bed nursing unit at one of our facilities.  This would allow us to design the care model, workflows, roles and implement the technology needed to open the unit in early 2021.

It was important that the model had an impact for both the nursing staff and the patient experience.  We looked at what could be taken off the plate of the bedside RN and completed by a nurse on camera in the patient room.  We included tasks such as admission database, discharge teaching, medication reconciliation, completing procedure checklists, second nurse sign off for meds/skin checks, general education/teaching for the patients, contacting families, answering questions, and the list goes on.  When these items are completed by the virtual RN, that frees up the time of the bedside RN to have more time to manage physical needs of the patents, answer call lights sooner, and generally have more time with the patients.

Patients love the model, because if they just need information, have a question, can’t work their TV, the virtual RN is just a button push away.  Our unit has modified the call light to have a special button for the patient to hail the virtual nurse directly.  It is answered quickly, and the patient likes knowing they will get their virtual RN. They get assistance from someone that is familiar with their condition and can meet their needs quickly.

This didn’t happen overnight: we had a team of staff that worked on the roles and responsibilities, as well as the workflows of the virtual RNs.  There were opportunities to spin up some temporary teams during the peak of the pandemic in 2020, and this allowed us to try out our plan before the unit actually opened.  It provided great insight into how this role could benefit everyone.  We hired staff before the unit opened and had them spend some time at the hospital to get to know our technology and how we provide care in our system.  They got experience being an admit or discharge nurse and learning our EMR.

Communication and teambuilding are important and can’t be stressed enough.  We had a day of team building and scenario walkthroughs, so each side of the care model understood what the priorities were for their partners.  We are all one big staff and have joint staff meetings and education.

After almost 2 years of preparation and planning, the unit opened in February 2021.  There was allot of learning that took place and staff needed to be flexible as we changed things on the fly to improve processes and support of the workflows.  Experience is definitely the best teacher! The unit has now been open for over a year, and we are expanding the model to other units.  We have changed the workflows several times and have learned allot from our staff and patients.  We are grateful to everyone who has helped us along this journey.

Lessons learned you ask?

• You can never have too much education, training, and information shared
• Staff have to be flexible, like change, and be willing to try new things
• Start your planning early, be wiling to adjust things, and figure out your technology early on
• Get everyone involved from the beginning: other disciplines and staff that will be interacting with the new care model

My last words of wisdom…..Have fun!  This is an adventure, and you will be paving the way for not only nursing, but other disciplines that will want to use this model of care.  And if you have staff displaying on a 55-inch TV in the patient rooms, you might want to think about adding hair and makeup in your budget 😉

– Jennifer Ball RN, BSN, MBA, Director of Virtual Care

(This story originally appeared in Nursing World.)