Tag: Virtual Nursing

Breaking Free! Scaling Virtual Nursing Beyond Pilots

Posted on July 1, 2025 by - Featured, Uncategorized

Nurse doing virtual nurse call on laptop

Industry experts, healthcare leaders & the market have all agreed – virtual nursing is here to stay. In a 2024 study, 74% of hospital leaders reported that virtual nursing will become integral to care delivery models in acute inpatient care —up from 66% in 20231. However, only 10% of hospital leaders have reached a phase where virtual care is a standard part of care delivery, and nearly 30% of hospitals have no virtual care workflows at all1. 

Why the gap? 

Pilot or partial deployments of virtual nursing are where most institutions are getting stuck! 

How can we break through perpetual pilots and scale virtual nursing to be a standard part of care delivery? 

Let’s ask the experts. 

AvaSure, a leading provider of Intelligent Virtual Care Platforms, consulted with two leading healthcare institutions that have successfully moved beyond the pilot phase and fully integrated virtual nursing into their daily patient care. Together, they explored how these organizations made the transition and shared valuable insights and advice for other institutions just beginning their virtual nursing journey.

UCHealth logo

UCHealth, a nationally recognized healthcare system with $7.5 billion in operating revenue and over 33,000 employees, operates 14 Colorado hospitals, providing more than 2,500 inpatient beds, and over 200 clinics across Colorado, southern Wyoming, and western Nebraska. Their 2016 Virtual Health Center significantly enhances patient care through virtual deterioration monitoring, TeleICU, centralized telemetry, virtual admission & discharge support, virtual sitting, virtual consults & more. This Virtual Health Center has touched over 2.3 million patient lives, achieving remarkable outcomes like reducing code blue rates by up to 40%, increasing rapid response rates and improving patient safety through virtual sitting, yielding nearly $9 million in 1:1 sitter cost savings.  To support these expanded use-cases and future-proof the patient room for a hybrid patient care model, UCHealth implemented a ‘camera-in-every-room’ philosophy.

Amy Hassell, MSN, BSN, RN, CNO of Virtual Health Center, UCHealth

Tamera Dunseth Rosenbaum, DNP, RN, NE-BC, System CNO of UCHealth

As New Jersey’s largest and most comprehensive not-for-profit healthcare network, Hackensack Meridian Health (HMH) delivers a full spectrum of medical services, innovative research, and life-enhancing care through its 18 hospitals, 36,000+ team members, 7,000 physicians, and 500+ patient care sites.  HMH kicked off their virtual nursing journey in 2024 with the goal of improving outcomes and patient/provider satisfaction. With a virtual nursing pilot focused on virtual admission & discharge support, they successfully removed time-consuming task-based work from bedside teams. Following a year of successful implementation, the significant results prompted hospital leadership to expand virtual care by installing devices in every patient room. Pilot results after 1 year:

  • 11.6% reduction in length of stay 
  • 2-point reduction in falls/1000 pt days with injury 
  • 65% reduction in RN traveler hours and 26% reduction in RN overtime hours
  • 0.68% reduction in readmission rates

Marie Foley-Danecker, DNP, RN, CCRN, NE-BE, Vice President & Chief Nursing Office of Hackensack Meridian Health

Pilot sticking point: Lack of organizational alignment on program goal requires vision & change management

Lesson One: It requires both leadership support and buy-in from frontline staff to be successful.

The true blending of virtual and in-person clinical workflows is a technology investment, a change in nursing practice and a change in patient care – so “don’t underestimate the amount of cross-functional alignment it takes to get to one platform, one operating strategy across the network – it takes a village,” said Marie Foley-Danecker. HMH has 5 distinct project teams that stood up to help scale their pilot across the system: 

  • Tech Build Team (Both Network and Site Level) – make decisions around hardware, software, server, infrastructure, hosting and more – ensuring the system has not just the right technology, but the support infrastructure needed to support ongoing virtual care.
  • Clinical Workflow Team – help to ensure that bedside workflows are standardized and the virtual workflows fit seamlessly into them.  If you don’t start with standard work at the bedside, it will be nearly impossible to add a virtual care workflow.
  • Nursing Operations Team – help manage staffing, define roles & responsibilities between team members and drive collaboration 
  • Education Team – ensure the internal education of facility teams, as well as patients & family members so that they understand the role of the virtual care team members in their visit
  • Communications Team – tackle marketing and promotion of the program externally, helping to improve the hospital’s reputation as a cutting-edge, patient-experience oriented site of care. Robust virtual care programs can also act as great recruitment tools for future nurses who want to work at systems investing in the latest technology. 

Lesson Two: Prepare for and be willing to adapt quickly.

“Be nimble and understand that you might not get it right, right out of the gate. That’s why having a governance structure (like the teams at HMH or a steering committee approach at UCHealth) that can be quick to identify issues and change processes is really important” said Tamera Dunseth Rosenbaum. It’s essential to remember the primary reason why you’re doing this – to provide support to your bedside teams. So, listen to them! Be sure to take in their ideas of what may help and lean into those ideas. Example: HMH, at the suggestion of front-line teams and following suit of many facilities, chose to start with admission & discharge as their first virtual nursing use case. Bedside team members see a lot of value in the ability to offload task-based, administrative work to virtual teams in order to give them more time for hands-on patient care. Furthermore, virtual care team members who are focused specifically on admission & discharge – or other task-based nursing work – can be hyper focused, resulting in spending more time connecting with the patient and often seeing better results. A true win/win! Similarly, UCHealth chose to utilize the virtual nurse answer and triage call lights as a part of their first use case. However, it quickly became apparent that this was adding burden to the bedside with unnecessary steps and communication overload.  They took note, quickly changed course, and have since seen greater success. This willingness to adapt & change will be critical to the success of any virtual care program – and to winning the support of your team. 

Lesson Three: Build grassroots support.

The bedside team is critical for program success, so giving them a voice is essential. If you don’t know where to start, listen to your front-line nurses – and think about what would make their lives easier. Selecting a first use case that directly benefits them will help with long-term program success. As you get to more complex use cases, like TeleICU, virtual deterioration monitoring, TeleStroke and more, trust between virtual and bedside teams will be vital. You can build this trust through making front-line nurses feel a part of the implementation, ideation, and ongoing governance of the virtual nursing program.

Pilot sticking point: staffing the program

Many facilities are already struggling with the chronic staffing shortage, so how do you find the staff for a virtual nursing program? There are two main paths – utilize your existing talent pool to fill virtual roles or work with a staffing partner who can help provide the adequate staff for your program. Let’s discuss each model & the pros/cons of each. 

Utilizing your existing talent pool 

Tips & things to consider: 

  • Keep job descriptions consistent between on-site and virtual: This allows for flexibility for floating or job sharing between bedside and virtual roles, without creating unnecessary HR hurdles. Also, offering a virtual shift can be a nice benefit to bedside team members – facilities use this to reward seniority, help prevent burnout and improve staff satisfaction. 
  • Think outside your geography: The nursing shortage is more acute in certain regions. For example, HMH, located in New Jersey, knew that finding nurses in this expensive, metropolitan area would potentially prevent getting their program off the ground. In this instance, working with a partner based out of Tennessee with a richer talent pool, like Equum Medical, made sense for avoiding staffing restraints that would prevent them from getting their program started.
  • Evaluate the experience level of your current staff: If your facility is predominantly novice nurses, you’ll need your most experienced nurses at the bedside to make virtual care a success. Pulling these nurses into virtual roles could potentially increase travel nurse/overtime use, offsetting potential program ROI. In these cases, outsourcing with a staffing partner may be a better fit for your institution. 

Working with a virtual staffing provider

Tips & things to consider:

  • Speed to go-live: Outsourcing to a trusted provider of virtual nurse staffing may allow you to get started quicker, as they have teams ready to deploy immediately. You can always consider moving things in-house overtime once your program is scaled.
  • Add more use cases with supplemental staffing: Staffing doesn’t need to be all in-house or all partners! You can take a use case driven approach and use a staffing partner to fill gaps in your team’s experience. Outsource staffing for more complex use cases, like virtual patient deterioration or TeleICU.

Important insight: Marie Foley-Danecker said, “trust is earned—whether you choose to use a partner or have your own staff on the virtual team, the beside team will take time to trust them. Don’t assume that trust will be built immediately just because you use your own staff, or assume trust can’t be built if you outsource.”

Pilot sticking point: funding the program

One of the most talked about reasons for the lack of virtual nursing adoption is the funding. Like many things, leaders struggle to build the business case to pay for it. Some have a misconception that only affluent health systems, or those with a highly favorable payor mix, can afford it. However, HMH and UCHealth both have a challenging payor mix across their system and had to work hard to validate the business case to leadership. Some of their lessons learned include: 

Allocating virtual nurse resources to each department. 

UCHealth accomplishes this by allocating a small unit of service bump to each department that utilizes the virtual resource. At the care unit level, it can be as small as 0.1 – 0.2 hours per patient day, but UCHealth recommends this path for a few reasons:

  • Encourages use of the virtual team – if the department is “paying for it anyways”, they’re more likely to utilize the virtual team, helping to improve program utilization.
  • Helps to spread the cost and avoid constant justification to hospital leadership – When the entire virtual care program is consolidated under a single budget, it becomes a frequent target for scrutiny during budget reviews. Spreading the allocation makes it less likely to face ongoing questioning or review.
    • Tip: Be sure to have the virtual resource as a separate line item on each nurse manager’s budget to remind them that this is the FTE for the virtual team support. Otherwise, they may hire up to that amount, and the program will be over budget. 
  • Hits budgetary targets – With turnover and vacancy rates most departments can still hit their budgetary targets with this allocation.

Labor savings from virtual sitting can help fund investment in devices for other use cases – like virtual nursing.  

Both UCHealth and HMH began their inpatient virtual care programs with virtual sitting. The program was focused on reducing labor costs associated with 1:1 sitters and preventing patient falls. Virtual sitting is a mainstream nursing intervention proven to help facilities replace an average of 70% of 1:1 sitters while reducing falls rates by up to 60%. UCHealth has saved $9M in labor costs with virtual sitting achieving up to 6x ROI. Facilities can utilize these labor savings to help fund the investment in a virtual care device for every patient room. 

Pilot sticking point: sufficient infrastructure & technology

Medical quality audio and video devices are fundamental to enable virtual care workflows. Many pilots rely on mobile carts or tablets as a small proof of concept. However, this makes it challenging to scale as it creates additional workflow challenges that impact program success. Because of this, both UCHealth and HMH now standardize patient rooms with a device included and would recommend the same to anyone considering full-scale virtual nursing. This doesn’t mean you always need to add an additional vendor to your portfolio, as this can be a pain point for IT leaders constantly tasked with vendor consolidation.

Their recommendation: Consider your current technology stack. 

You may currently have a vendor in your hospital – like your EHR or virtual sitting provider – that can scale into virtual nursing. This can help to get more ROI out of an investment you’re already making. However, be sure they’re equipped to support you. When selecting a virtual nursing technology vendor, consider the following points: 

  • Platform ease of use: Be sure to select a vendor with a platform that supports multiple clinical use cases and is easy for nurses to use.
  • Support: There is a lot of clinical change & workflow management that comes with implementing a change to the care model, so select a vendor with expertise who will partner with your clinical teams throughout this process. IT teams also have a lot on their plates and shouldn’t be overburdened with implementing a new platform. Consider a vendor who provides robust technical and project management 24/7 support– not just at the time of deployment, but throughout the partnership.
  • Demonstrated outcomes: When technology advances, new vendors flood the market. In the clinical space, it’s more important than ever to select a partner with demonstrated experience in delivering outcomes for our patients.

Benefits of a fully integrated virtual nursing program

The promise of virtual care is to create a more sustainable, patient-centered healthcare system that leverages technology to deliver high-quality care anytime, anywhere with greater precision and efficiency. With virtual care workflows as a standard part of care delivery, facilities can meet the evolving needs of both patients & healthcare providers by expanding access to care, improving patient experience, reducing caregiver workload, and increasing the efficiency and scalability of staffing. The path to virtual care maturity requires more than just investing in new technology – it also requires organizational alignment, tight change management processes, and buy-in at all levels of the organization. Adopting an intelligent platform that seamlessly blends remote and in-person care with AI-powered virtual nursing is a critical step towards accelerating virtual care maturity.

Learn more about the AvaSure Platform’s ability to support your virtual nursing growth.

Resources

1 Joslin Insight Virtual Care Insight Study October 2024

7-Steps to Deploying Virtual Care and Virtual Nursing Platforms  

Posted on June 2, 2025 by - Featured

virtual nurse illustration

The healthcare landscape in the U.S. is undergoing a significant transformation, driven by challenges such as nursing shortages, increasing patient complexity, and cost constraints. As a result, nurses are feeling stretched thin, with many considering leaving the bedside — highlighting the urgent need for innovative solutions. Virtual care platforms are emerging as a powerful strategy to address these challenges, optimize care delivery, and enhance both patient outcomes and staff satisfaction. 

Hospitals are actively seeking ways to alleviate the burden on bedside staff and improve overall efficiency. 74% of hospital leaders believe virtual workflows will become integral to care delivery models in acute inpatient care, but only 10% of leaders have reached a phase where virtual care is a standard part of care delivery. This indicates a knowledge gap in how to start and scale virtual care programs.  

Based on AvaSure’s experience helping over 1,100 hospitals across the U.S. with their virtual sitting and virtual nursing programs, we’ve put together a 7-step roadmap to help you successfully launch your own virtual care program. 

1.  Identify your facility’s unique pain points 

It’s important to identify your biggest challenges within your organization. What’s unique about your facility and where should you focus your efforts? 

To help identify your top pain points, gather a group of cross-functional stakeholders, including bedside staff. Ask them to provide feedback on what they are struggling with on a day-to-day basis. 

Expect to hear things like: 

  1. Recruitment and retention of all levels of staff – from nursing assistants to nurses to highly specialized physicians. 
  2. Patient capacity challenges & bottlenecks 
  3. Loss of joy and fulfillment leading to burnout for all types of caregivers 
  4. Patients’ desire for an integrated experience, bringing consumer expectations to healthcare  
  5. Rise in patient complexity 
  6. Quality metric declines across key areas 

Once you’ve cataloged your challenges, you can get to prioritizing. 

2.  Prioritize the challenges with the greatest impact 

Once you understand the challenges across your facility, identify which is creating the biggest drain on the system. There are a number of use cases for virtual nursing platforms — each with its own potential impact.  

Some of the most prevalent use cases & outcomes they’ve been proven to impact include: 

Use Case Potential Outcomes 
Virtual Specialty Consults • Shorten response time for specialty consults  
• Decrease time to diagnosis and treatment  
• Improve ED-to-admission time  
• Retain higher-acuity patients in-network  
• Reduce unnecessary transfers  
• Decrease locum costs  
• Cut down windshield time for specialists 
TeleStroke • Decrease unnecessary transfers  
• Decrease stroke treatment response time  
• Reduce unnecessary transfers  
• Shorten stroke patients’ length of stay 
Virtual ICU • Improve evidence-based care compliance  
• Ensure 24/7 intensivist coverage  
• Prevent CLABSI, self-extubations  
• Reduce sepsis mortality  
• Lower malpractice expenses 
Patient Observation/Virtual Sitting • Reduce rate of falls and falls with injury  
• Reduce reliance on 1:1 sitters  
• Reduce labor costs  
• Prevent self-harm during behavioral health monitoring
• Improve patient and staff satisfaction ratings  
• Reduce elopements  
• Reduce incidents of harm to caregivers 
Virtual Nursing • Decrease bedside RN documentation time  
• Improve RN retention  
• Improve timeliness of admission and discharge from time of order  
• Reduce number of patients, and time spent, holding in the ED  
• Improved throughput and reduced overall LOS  
• Improved patient experience scores on HCAHPS including: Responsiveness, Nurse courtesy, Discharge information clarity 
Nurse Mentorship • Improve RN retention rates, especially new grad retention rates  
• Improve staff satisfaction  
• Improve speed to clinical readiness of new nurses  
• Improve preceptor-to-orientee ratio  
• Improve eNPS score  
• Reduce travel/agency spend  
• Improve response time for questions/escalations 
Patient Education • Improved patient experience scores on HCAHPS including: Responsiveness, Nurse courtesy, Discharge information clarity 
High-Acuity Patient Monitoring • Decrease 30-day readmission rates  
• Reduce adverse events and hospital acquired conditions such as: CLABSI, CAUTI, HAPI, falls, adverse drug events 
• Improve sepsis bundle compliance  
• Decrease code blues  
• Prevent unnecessary ICU transfers 
Pediatric Patient Monitoring • Reduce cost of monitoring eating disorder patients  
• Improve staff safety, preventing violence against caregivers  
• Reduce incidents of self-harm during behavioral health monitoring  
• Prevent non-accidental trauma 
Hospital Operations • Reduce RN turnover rates  
• Improve labor cost per unit of service  
• Improve room turnover times  
• Improved patient experience 

After identifying your facility’s unique pain points and prioritizing the most impactful ones to address, the ideal starting use case will become clearer. We recommend starting with one or two use cases: one use case that has a tangible financial ROI and one that has a positive impact on staff. This helps get staff on board and allows you to build a strong business case for leadership with clear, manageable goals. Once you’ve established a solid foundation, you can add more overtime.  

3.  Build your business case 

Building a strong business case is essential for ensuring a virtual nursing program’s long-term success. At this stage, collaboration between clinical, financial and IT leadership is crucial to demonstrate how the IT infrastructure can support clinical needs—both now and into the future.  

Once you’ve identified the virtual nursing platform use case with the most potential impact for your facility, begin to identify goals and benchmarks for your program.  

Business Case Highlight: One health system was struggling with high rates of ED boarding in their community.  A recent study published in Academics Emergency Medicine demonstrated that it costs $863 more per day to care for a patient in the ED than on a med/surg unit. Based on this alone, this facility was able to establish that decreasing their ED boarding by less than 5%, or 1.2-1.4 borders per day, would offset the costs of installing technology and staffing a virtual nursing program to expediate discharges.1

Best practice from AvaSure’s clinical team:  Be sure to include feedback from frontline staff and managers throughout the process—their buy-in is essential for long-term success. It’s important that care teams understand this program is designed to support them, not add extra work or replace jobs.  

4.  Select a vendor partner 

The final step in building your business case is selecting a virtual care partner who can help you achieve your long-term goals. Select a partner with both clinical and technical expertise—one who can not only meet your current needs but also help grow your program over time.  

When evaluating vendors, be sure to consider: 

  1. Platform ease of use & open architecture 
    Select a vendor with a virtual nursing platform that supports multiple clinical use cases and is easy for nurses to use. 
    No single vendor will be an expert in every use case, so it’s important to select a partner with an open ecosystem. This flexibility allows you to utilize specialty solutions—such as ambient documentation—when their expertise prevails. 
  1. Support 
    Implementing a new care model involves significant clinical change and workflow management, so it’s essential to choose a vendor with the expertise to actively partner with your clinical teams throughout the process. IT teams also have a lot on their plates and shouldn’t be overburdened with implementing a new platform. Consider a vendor who provides robust technical and project management with 24/7 support—not just at the time of deployment, but throughout the partnership. 
  1. Demonstrated outcomes 
    In any emerging area, many new solutions will become available with little real-world experience. In the clinical space, it’s more important than ever to select a partner with demonstrated experience in delivering outcomes for patients. 
  1. Current technology 
    Vendor consolidation is key for maximizing the impact of current spend and reducing technology duplicity. Before bringing on a new vendor, evaluate whether current solutions—such as your TeleSitter® solution—also offer a virtual nursing platform before investing in additional technology. 

5.  Roll out your first use case 

Now that you’ve identified the challenges, started formulating a business case with IT and secured leadership support, it’s time to start building your program. You can start with a single unit or department if preferred. 

Starting small is a smart approach, as it allows you to demonstrate early success. Consider launching during peak hours, such as 9 a.m. to 9 p.m., to ease staff into the program and ensure the virtual team is properly staffed. However, stay flexible—real-time feedback might show that this isn’t the most impactful area to address first. Be ready to adapt quickly. Achieving quick wins is crucial for securing buy-in from frontline staff and maintaining leadership support, so an agile approach will be key. 

When deciding what unit to start on, think about the following: 

  • Highest churn unit for admission & discharges – may be a high need for offload of documentation
  • Unit with highest amount of novice nursing staff – may benefit from virtual nursing & mentorship 
  • Unit with highest percentage of travel nurses – help to reduce agency spend and fuel a program ROI 
  • Virtual nursing for specialists that are low staffed – support nutritionists, diabetic management, wound care, social workers/case managers & more 
  • Units with residents using a virtual nurse – Assist with morning rounds and facilitate documentation to communicate with family 
  • High complexity patient unit – allows virtual nurse to do purposeful rounding and be a second set of eyes on patients 
  • Units with deterioration or sepsis protocols and/or wearable monitoring – helps reduce false alarms and identify early signs of adverse events 

Make sure to establish a feedback loop to hear directly from frontline staff about how the program is progressing and create a system to share successes both across the facility and with leadership. This positive word of mouth will be key to gaining broader support for the program.  

6.  Share results with stakeholders and spread the word 

After a few weeks or months, ensure you hold a forum with leadership and the cross functional teams involved to update them on your progress. Show how the pilot has driven change against your key goals or metrics. AvaSure’s clinical team will help you pull your data and showcase your progress. 

Tip from AvaSure’s Customer Success Team: It’s important to have a baseline before starting so you can demonstrate progress. Be sure to log all relevant metrics, including financials, before implementation. It’s also great to include great catches and stories from the front line leaders. Metric progress is great, but it’s the stories that will win the hearts of your teams. 

7.  Scale up your program – you’re really doing it! 

Now that you’ve demonstrated success (and it was easy!), consider expanding to additional units or use cases. However, be reasonable about what your team can handle at once. Take a slow and deliberate approach, ensuring that your teams have a venue to speak up if it gets overwhelming. 

Advice from the AvaSure team: If you’re going to fail, be ready to fail fast. Not every use case will be suitable for every facility. Sometimes, you may identify a need, but virtual care may not be the best solution. Ensure leadership is open to abandoning an idea if it’s adding more burden to teams instead of alleviating it. Your team will appreciate that you prioritize their work experience over forcing something that isn’t a good fit.   

Worried about staffing your program as it grows? Learn about hosted options if you are lacking adequate talent to pull from your area. 

A successful virtual care deployment can help address labor challenges by optimizing staff productivity, while also driving staff satisfaction and retention. Care teams will feel more supported, spend more time at the bedside, and leave each day feeling accomplished.  AvaSure is here to support you through every step of scoping, implementing, and scaling a virtual care and virtual nursing program. With 15% of our staff being RNs, we understand the unique challenges facing care systems today. Our robust clinical team is ready to help with business case development through implementation, metric tracking, and expansion. 

1 Canellas, M.M., et al (2024) Measurement of cost of boarding in the emergency department using time-driven activity-based costing. Annals of Emergency Medicine. 84(4);376-385

Virtual Care Solutions to Nurse Staffing Shortages

Posted on April 17, 2025 by - Featured, Uncategorized

Nurse Shortage Solutions

As hospitals and healthcare providers face increasing pressures to do more with less, nurses are feeling burnt out. A more novice nurse workforce, in addition to inadequate education and training, higher patient acuity, and rising nurse-to-patient ratios are amplifying this, ultimately leading to nurse staffing shortages. These problems not only affect the well-being of nurses but also impact the quality of patient care. 

To address these ongoing issues, hospital systems are reevaluating their workflows and looking at technology solutions to help support their staff. For example, many hospitals are adopting virtual care platforms and AI-enabled tools to help relieve administrative burden.  However, before making decisions on solutions, it’s important to really understand the root causes of nurse staffing issues. 

Top Reasons for Nursing Shortages: 

Nurse Burnout 

Nurse burnout is a common consequence of the overwhelming responsibility and pressure placed on nursing staff in hospital systems. Reduced resources and support lead to some nurses deciding to leave the healthcare industry all together.  Nurses play a vital role in ensuring that patients’ well-being remains a priority. RNs aren’t the only ones affected; when it comes to Patient Care Technicians (PCTs) and Certified Nursing Assistants (CNAs), health systems are seeing turnover rates in excess of 30%. So, what happens when nurses experience burnout and leave the profession? The remaining nurses within the hospital are stretched too thin with the number of patients they must care for. Job satisfaction begins to decrease, and turnover rates rise, leading to more resources and funds spent to replace and train new staff. As a result, trust in the hospital system starts to fade. 

Higher Patient Acuity and Reduced Resources 

Another key contributor to the nurse shortage is higher patient acuity and limited training and resources. Patient acuity refers to the level of care or monitoring a patient requires from hospital staff, particularly nurses. The higher the patient’s acuity, the more attention the patient needs. As the patient-to-nurse ratio increases, less attention is given to patients with less demanding issues and health concerns. This leads to diminished patient care, as nurses are unable to provide the attention each patient deserves. Inadequate resources and training leave nurses feeling overwhelmed, making it challenging to provide proper care for all their patients. More experienced nurses are retiring early, leaving junior nurses with a larger workload and less mentorship. This results in stressful situations and higher risk of incidents under the care of the hospital.  

Solutions to the Nurse Staffing Shortage 

One solution to this issue is to hire additional staff and nurses at the bedside. However, the high cost of hiring travel nurses makes it challenging for hospitals to support their existing nursing staff while meeting the demand for additional help. This is where virtual care can play a key role in providing support, helping optimize the staffing they have. It is crucial for hospital systems to address nurse staffing problems. By providing a better work environment for nurses and offering education and support to nurses’ journeys, hospitals can help the 52% of the nursing workforce who have considered leaving the bedside.  

Virtual Care: a Solution to Help the Staffing Crisis 

Virtual care is a resource used by healthcare providers and hospital systems to connect patients with  doctors, nurses, specialists, and virtual sitting staff remotely. This includes use-cases such as virtual sitting, virtual nursing, and virtual visits. This approach increases efficiency in managing workloads and can help patients receive care more quickly. Virtual care is becoming a prominent resource to help solve staffing issues. It allows nurses to return to the bedside and focus on direct patient care, working at the top of their license. Studies have proven that virtual care, specifically virtual sitting, reduces burnout and improves nurse well-being. A recent survey of 74 nurses from Renton, Washington-based Providence found virtual sitting improved their “emotional labor” and “emotional exhaustion” over in-person sitting. The survey illustrated that virtual sitting improves the well-being of nurses and helps maintain patient safety. Emily Anderson, MSN, RN, PCCN-K, nurse manager at Providence Medical Center in Anchorage, AK said, “Having insightful research into virtual sitting helps us alleviate burnout among our nursing staff and optimize the usage of all our resources to get the right care to the right patient at the right time.” As healthcare systems are evaluating ways to reduce nursing shortages, aid their teams, and deliver the best care possible, solutions like virtual sitting, virtual nursing, and AI need to be considered to support staff and ease the workload and pressure that has been causing the drop in workforce. 

What is Virtual Sitting? 

Virtual sitting, also referred to as virtual monitoring, is a resource for nurses at the bedside, reducing the need for one-to-one in-person sitting and helping to prevent adverse events for patients. Virtual sitting equips trained safety attendants to use video and audio connections to watch over multiple patients and improve overall safety. Virtual sitting has been used for preventing a variety of adverse events, such as falls, elopement, possible self-harm, suicide ideation, and staff abuse. By using this technology, events that once required 1:1 sitting can now be monitored by a virtual safety attendant, who can safely observe up to 36 patients at a time. This helps reduce the workload of nurses, allowing them to work at the top of their license and focus on higher-acuity patients.     

One hospital that successfully implemented virtual sitting amid nurse staffing shortages is St. Luke’s Duluth, a Minnesota-based health system. Like many health systems, St. Luke’s faced challenges such as a tightening labor market, increasing competition for experienced healthcare workers, and rising costs. To provide additional resources and support to their current patient care staff, St. Luke’s implemented a virtual sitting program. They utilize a two-person model: one staff member provides rounding services for patients and staff, while the other staff member observes patients via video monitors. Nursing leaders have found that this approach enhances patient and staff safety and helps support monitoring staff by providing adequate breaks to avoid monitor fatigue.  

Read more about St. Luke’s virtual sitting program. 

What is Virtual Nursing? 

Another way virtual care has emerged as a solution to nurse staffing problems is through virtual nursing. The American Nursing Association describes virtual nursing as a resource that “support(s) the team at the bedside to alleviate the workload and provide greater satisfaction for both the patients and the nursing staff.”1 Through virtual platforms, nurses and care managers can support teams at the bedside to educate patients, complete admissions and discharge paperwork, automate documentation, and mentor more novice nurses. This allows virtual nurses to have direct, uninterrupted time with patients, leading to less errors or gaps in documentation and freeing up floor nurses to care for their patients at the bedside. It enables a care model where RNs, CNAs, and VRNs (virtual nurses) perform the most appropriate patient care activities based on their skills and experience. 

Virtual nursing tools also connect hospital staff with external care providers in real time, ensuring smooth transitions and avoiding delays in securing post-discharge services. Holzer Health System is a recent example of this use case. Using the AvaSure virtual care platform, scarce specialists in neurology, nephrology, diabetes education, and wound care were able to serve patients in two facilities, located 30 miles apart. Natalie Gardner, BSN, RN, CWON, CFCS, describes the benefits: “This has provided a way for me to do video consults with the Jackson facility which saves precious time as well as mileage. The staff take the device to the patient’s room, remove their dressings, and position the patient so that I can see the wound. This leaves me more time to spend with all patients by eliminating the time it would take to drive to Jackson and back.” 

Additionally, virtual nurses can provide real-time mentorship, feedback, and confidence to recent graduates and novice bedside nurses, nurturing a nursing workforce for the future. 

What is Computer Vision and AI? 

While AI is advancing and gaining attention in the healthcare industry, hospital leaders must remember to use applications that can be easily used by their staff, enhance patient safety, and improve the overall hospital experience, all while ensuring that workflow is not disrupted.  

There are multiple types of AI currently being used in healthcare settings. Computer vision is a subset of AI that can vastly improve the way hospitals provide care without requiring care providers to compromise on safety and control. One application of computer vision is to help to prevent falls, elopement, and workplace violence by being able to detect factors that are potential warning signs. Following the detection, computer vision alerts a worker to address the issue that may be at hand. The technology is used to augment virtual sitting, helping care team members monitor patients more efficiently, identify patients in need, and make fast, informed decisions that keep them safe.  

To know you are using computer vision and AI correctly, keep an eye out for three positive indicators:  

  1. Data is used both to prevent immediate incidents and to drive proactive interventions based on insights over time 
  2. Real-time alerts are targeted enough to inform the right staff of risk without contributing to alarm fatigue 
  3. The program is scalable; AI isn’t just another expense but a way to reduce operational costs and drive savings that fund additional technology investments. 

AI in healthcare systems can be a tool but be sure to use the correct collaborative platforms, and track ROI from the start of the AI journey.  

A new example of AI in the healthcare space is AvaSure’s virtual care assistant, designed to bridge gaps in communication, prioritize urgent patient needs, and support healthcare teams in delivering timely, high-quality care. The Virtual Care Assistant appears as an avatar, helping triage requests, questions, or needs and assist within the nursing workflow. Requests are categorized into clinical and operational groups, and the assistant, named Vicky, ensures they are directed to the appropriate human personnel or team, helping healthcare systems integrate a reliable, trustworthy, and supportive system for healthcare workers. 

Implementing Virtual Care 

While there are many virtual care tools and technologies to help reduce the burden on nurses, what does implementation look like in practice? There are multiple phases of the virtual care journey; while it may feel like other hospitals are ahead of the curve, 29% of healthcare leaders established that they have no virtual care solutions, and 39% of hospitals are still in early exploration with virtual nursing. The 5-stage maturity model, developed with the input of 1,100 hospitals and 15+ clinical and hospital IT executives, represents a blueprint for care model redesign led by change-management oriented, outcome-focused leaders.  By making virtual care workflows a standard part of care delivery, facilities can meet the evolving needs of both patients and healthcare providers. It can help by expanding access to care, improving patient experience, reducing caregiver workload, and increasing the efficiency and scalability of staffing. 

Nurse staffing shortages are a real challenge in hospitals and create a chain reaction that impacts everything, from quality of patient care to the health and well-being of nurses. This issue contributes to burnout and stress, ultimately affecting the care that patients receive. It’s crucial that hospitals find solutions that support nurses and improve the entire healthcare system. 

AvaSure’s virtual care platform deploys AI-powered virtual sitting and virtual nursing solutions, meets the highest enterprise IT standards, and drives measurable outcomes with support from care experts. By offering our virtual care platform to monitor and support staff and patients, AvaSure can help reduce the burden on nurses, improve patient outcomes, and assist healthcare systems to better improve staff workflow and patient care.  

Resources

1Ball, J. (2022, July 1). Virtual nursing: What is it?. Innovation Site. https://www.nursingworld.org/practice-policy/innovation/blog/virtual-nursing-what-is-it/ 

How Holzer improved care while progressing from virtual sitting to virtual nursing

Posted on May 3, 2024 by - Featured, Uncategorized

By Lisbeth Votruba, MSN, RN, Chief Clinical Officer

The Goal:
• Improve patient safety
• Reduce fall risk
• Increase access to specialty care
• Free up CNA and bedside nurses for other activities

The Results:
1. Success of the virtual sitting program:
• Saved costs
• Improved patient and staff satisfaction
2. Progression into virtual nursing:
• Utilization of the same technology
• Further cost savings
• Enhanced patient and staff satisfaction

Nursing shortages and associated costs are not going away. While RN turnover has dropped from 22.5% in 2022 to 18.4% in 2023, the turnover rate for nursing assistants increased from 33.7% to 41.8% in the same period. And the ongoing costs as nurses continue to leave the profession are high. Each RN that leaves costs an average hospital $56,350, totaling roughly $4M – $6M per year, according to the 2024 NSI National Health Care Retention and RN Staffing Report. Bottom line: nurses need sustained support or the profession will continue to decline in well-being and in numbers.

These challenges hit particularly hard in smaller, community-based organizations. Holzer Health System is a not-for-profit, multi-disciplinary regional health system that provides the full continuum of care for its communities with locations throughout southeastern Ohio and western West Virginia. The system includes two hospital locations, including a rural critical access hospital, as well as multiple clinical locations, long-term care entities, and more than 180 providers in more than 30 medical specialties.

Matthew L. Hemphill MSN, RN, CNML, Director of Acute Care Nursing at Holzer Health System, described the problem: “We want to keep as many of our patients here rather than transferring them out to the nearest tertiary center two hours away. While we did have a small pool of one-to-one sitters, staffing was a challenge. Many needs were going unmet. There were numerous patients who required more monitoring than we could offer.”

Improving care, beginning with virtual sitting

The COVID-19 pandemic made matters worse, so Holzer had to come up with a workable plan that would allow it to augment its existing staff while keeping a larger volume of patients safe. 

Holzer undertook a major initiative to improve patient safety, reduce fall risk and increase access to specialty care by securing a grant through the FCC COVID-19 Telehealth Program to implement an inpatient virtual sitting solution.

With the aid of the grant, Holzer implemented AvaSure’s virtual care technology to support virtual sitters, who watch over patients via video-and-audio connections to enhance patient safety, such as reducing patient falls and elopement. The health system implemented 16 devices, including four ceiling-mounted devices, 12 mobile devices and a centralized monitoring station. The primary goal was to enable and expand the use of virtual sitters, freeing up CNAs and bedside nurses for other care activities.

After seeing the virtual sitting program’s success in saving costs, as well as improving patient and staff satisfaction, the health system progressed into virtual nursing using the same technology platform. AvaSure’s intelligent virtual care platform enables virtual sitting, virtual nursing and specialty medical consults.

Progressing to inpatient virtual nursing and realizing multiple improvements

When Holzer progressed from virtual sitting to virtual nursing, one key principle it followed was to structure the use of virtual sitters and nurses so that all nurses work at the top of their licenses. This enables a care model where RNs, CNAs, and VRNs perform the most-appropriate patient care activities based on their skills and experience.

Using the AvaSure platform, scarce specialists in neurology, nephrology, diabetes education and wound care can serve more patients in both facilities, the main Gallipolis Hospital and the rural critical access Jackson Hospital.  

For example, Holzer has one certified wound and ostomy nurse (CWON) serving both facilities, located 30 miles apart. Natalie Gardner BSN, RN, CWON, CFCS, described the benefits: “This has provided a way for me to do video consults with the Jackson facility which saves precious time as well as mileage. The staff take the device to the patient’s room, remove their dressings, and position the patient so that I can see the wound. This leaves me more time to spend with all patients by eliminating the time it would take to drive to Jackson and back.” Giving patients easier access to specialists improves care and facilitates early intervention to prevent transfers from the critical access hospital to the main facility.

Continuing to hone the virtual nursing program

For community health systems, the strain on resources will continue for the foreseeable future. Progressing on a path from virtual sitting to virtual nursing extends precious resources to enable high quality patient care, while allowing all nursing staff to work at the top of their skills and licenses. Holzer is continuing its path to expand its virtual nursing program to encompass more activities across more inpatient care units. At every stage, Holzer is delivering better patient outcomes while enabling a care model that gives nurses more time for their most satisfying work – spending time on direct patient care.

Virtual nursing: it’s a thing, but where to start?

Posted on November 15, 2022 by - Uncategorized

nurse smiling

Program overview:

  • 1 virtual nurse per 100 M/S beds that assists with 55-60% of patients
  • At admission complete the questionnaire & can scribe physical assessment of onsite nurse, work on care plans, virtual patient education, core measures, make follow up appointments and lead discharge process including compiling all discharge information, ensure follow up appointments are lined up & medication reconciliation

Early Outcomes:

  • On average, virtual nursing saves 12 minutes per admission and 15-29 minutes per discharge, giving time back to bedside teams for patient care
  • During first 6 months, 107 catches in discharge errors that could have been significant patient harm. The panelist noted, “while bedside nurses may have caught these errors prior to discharge, the virtual nurse can be laser focused on these specific tasks without the distractions of a typical floor nurse.”
    • Patient who was about to be discharged on 2 blood thinners
    • Diabetic patient being discharged without Insulin education
    • New CHF patient without proper medication prescription at discharge
  • Discharges completed by the virtual nurse currently have lower rates of readmission – this is an early trend; they’re waiting to see more results over time to consider it correlated
  • Increases in HCAHPS:
    • 7.6% increase in patient understanding of purpose of taking medication
    • 2.04% increase in top box score for transition of care
  • Qualitative feedback from patients that they enjoy seeing a nurse without a mask on, can smile & interact more genuinely and can assist with hearing impaired patients who read lips.

UCHealth: expert ICU nurse helping monitor high risk critical patients for sepsis, deterioration, and other adverse outcomes

Program Overview:

  • 3-4 virtual nurses monitor up to 1,800 patients within the system
  • Provide surveillance and early detection support aimed primarily at sepsis
  • Partner with novice bedside nurses providing help due to high turnover & lack of bedside experience
  • Work with other technologies that scan EHR and physiological monitors for triggers helping to identify patients in need of extra care
  • Monitor patients post rapid response to help detect rebounds

Early Outcomes:

  • Reduction in non-present on admission sepsis mortality & have seen compliance go up
  • Increase in rapid response calls
  • Unprecedented 25-70% code blue reduction in acute care areas, in combination with program on deterioration education
  • Bedside nurses have praised the program in making them feel more supported & secure in their roles

Great Catch: A post seizure patient was being monitored remotely and the virtual nurse (VN) could tell the patient was going to throw up. The expert VN was able to walk the bedside nurse through the steps to handle the situation – including fetching suction and calling the doctor. The doctor was able to help prevent the patient from aspirating. This gave peace of mind to the bedside nurse who was dealing with this situation for the first time.

Tips for getting started with virtual nursing

During the session, Virtual Nursing: It’s a Thing, but Where is it Going our panelists shared a number of best practices when it comes to building out your own virtual nursing program – but their biggest advice was to, “just do it!” While starting a program can be daunting, they both feel that the benefits have outweighed the work.

Some of their tips are:

  • Whatever process you’re designing for needs to make sense and solve a bedside need. It needs to make life easier for the end user and be integrated in a way that makes sense in building a team effort approach for care.
  • Be sure to clarify for the team what virtual nursing is – but more importantly what it is not to all team members involved
  • Building a virtual nursing program is an iterative process – be willing to adapt as you get feedback from the front-line teams
  • When staffing your virtual team, look for nurses with multiple years of experience who can bring a level of wisdom to the role and can take a wide-angle lens on the patient population allowing them to catch things the bedside team may not. In addition to experience, soft skills are key. Look for collaborators who love to teach, have high emotional intelligence, and want to mentor other nurses
  • Have courage to try! Start a program, build some buzz around it. There’s a lot of work in this, but it’s good work, so give it a shot.

What’s next for virtual nursing

As early innovators in this space, where do they see their programs going in the future? Unity Point is focused on scale and standardization. They’re currently focused on creating a standardized, sustainable structure across their enterprise when it comes to technology, job descriptions, and everything else operational that goes with virtual nursing, including creating a centralized leadership structure for the program. UCHealth is looking at expanding use cases of the program, including virtual specialist care for areas such as wound care and respiratory therapy where they currently lack adequate staff across the system. They’re also exploring how a virtual nurse could assist with dual sign off activities, such as checking blood & verifying high risk medications. Their ideal future state is one where an expert nurse is always a “call away” for a novice nurse who, for instance, is working night shift and has never placed an NG tube before, creating a culture of support and mentorship in all care settings.

Interested in your own virtual nursing program but not sure where to start? Our AvaSure RN’s can complete a free, on-site assessment of your facility and help in creating a business case based on your individual use cases.

Watch the full session below!