Topic: Virtual Nursing

Improve Patient Engagement Scores

AvaSure logo

Improve Patient Engagement Scores

Sarah Brown MSN, RN, CMPE, NEA-BC at UnityPoint Health, discusses the challenges her nursing staff faced during the pandemic and how this caused massive burnout throughout their system. Quality of care was being compromised, so leadership agreed to make innovative changes and identified the use of AvaSure TeleNurse™ solutions as a potential solve. Sarah noted, “Virtual Nursing in the med-surg area immediately helped our nurses at bedside and has grown astronomically quickly.”

Early results of TeleNurse™ Programs:

  • 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
  • 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

AvaSure Introduces Virtual Classroom Webinar Series on Virtual Nursing

AvaSure virtual classroom series

Hosted by Chief Clinical Officer Lisbeth Votruba, series will detail how nursing leaders can launch and implement virtual nursing programs

BELMONT, Mich., March 21, 2023 /PRNewswire/ — AvaSure, the inventor of the TeleSitter® solution and the market leader in acute virtual care and remote safety monitoring, announced today that it will kick off a virtual classroom series on March 23, “Virtual Nursing 101,” which will detail how nursing leaders can launch and implement virtual nursing programs.

The virtual classroom series is hosted by AvaSure Chief Clinical Officer Lisbeth Votruba, MSN, RN, who will be joined by special guests and experts to cover pressing industry topics, such as the role of the virtual nurse and how to build a virtual nursing business case, as well as lessons learned from ongoing programs.

“Nursing leaders across the nation understand the numerous benefits that virtual nursing could deliver to their health systems but often have questions about how to get started and what it takes to create a successful virtual nursing program,” said Votruba. “We are delighted to launch this series to help spread awareness of how virtual nursing represents a new model of care that can help health systems improve patient safety, reduce labor costs, and protect staff from caregiver violence, while reducing documentation burden on staff and increasing staff satisfaction.”

Votruba is a pioneering nurse executive committed to continuous improvement of healthcare and the diffusion of new technologies to drive patient and staff safety. She is a member of the Medical Surgical Nursing Certification Board (MSNCB) Virtual Nursing Job Analysis Task Force as a subject matter expert for the creation of a medical-surgical virtual nurse certification, and for nearly 15 years, she has worked extensively with over 1,000 hospitals in standing up their virtual care platforms.

The free, six-part series will take place on the last Thursday of each month and feature Votruba along with special guests and experts. The first session, scheduled for March 23 at 12 p.m. EST, will feature Terri Hinkley, EdD, MBA, BScN, RN, CAE, CEO of Academy of Medical-Surgical Nurses.

In this session, Votruba and Hinkley will discuss the role of the virtual nurse and what was involved in the creation of the MSNCB Professional Certification, the competencies to look for when hiring virtual nurses, and how to recruit for the role without exacerbating existing staffing challenges.

Virtual Nurse Webinar Schedule

March 23: The Role of The Virtual Nurse

April 27: Introducing The Clinical Resource TeleNurse Model: What Is It And How Can It Help?

May 25: Building A Virtual Nursing Business Case

June 22: Introducing The Expert Oversight TeleNurse Model: What Is It And How Can It Help?

July 27: Selecting The Right Technology Partner For Virtual Nursing

August 24: Starting & Scaling Your Virtual Nurse Program

To learn more about “Virtual Nursing 101” and register to attend, click here.

About AvaSure
AvaSure provides the leading hospital virtual care platform to systems with nursing and staffing shortages that are challenged to significantly reduce labor costs without sacrificing patient health outcomes. Recently recognized by KLAS Research as the leader in reducing the cost of patient care, AvaSure is the pioneer in providing best-in-class, video-based AvaSure TeleSitter® and TeleNurse™ solutions. As a trusted partner of more than 1000 hospitals, AvaSure combines remote patient monitors, virtual nurses and other providers on a single platform to enhance clinical care without placing any additional burdens on existing staff. To learn more about AvaSure visit www.avasure.com.

Media Contact:
Marcia Rhodes
Amendola Communications
mrhodes@acmarketingpr.com

AvaSure Virtual Classroom Series: Virtual Nursing 101

nurse writing in notebook

Are you thinking about implementing virtual nursing but are not sure where to start? Or have you tried out things that don’t quite meet your objectives? You aren’t alone!

Join AvaSure’s Chief Clinical Officer, Lisbeth Votruba, MSN, RN as she navigates you through your program and how to get started in a 6-part educational series. Lisbeth is a pioneering nurse executive committed to continuous improvement of healthcare and the diffusion of new technologies to drive patient and staff safety. She was selected as a participant at the recent Medical Surgical Nursing Certification Board task force meeting to develop a certification for the virtual nursing position and for nearly 15 years, she has worked extensively with over 1,100 hospitals in standing up their virtual care platforms to help optimize labor forces, improve the quality of patient care and drive staff satisfaction & retention.

This free, six-part series features Lisbeth along with special guests and experts who will cover key topics and lessons learned from ongoing programs.


Session 1: The Role of the Virtual Nurse

Featuring Terri Hinkley, EdD, MBA, BScN, RN, CAE, CEO of Academy of Medical-Surgical Nurses

  1. Learn about the role of the virtual nurse and what was involved in the creation of the MSNCB Role Certification from two task force members.
  2. Understanding competencies to look for when hiring a virtual nurse and how to recruit for this role without taking away from bedside staff or further exacerbating staffing challenges.

Session 2: Introducing the Clinical Resource TeleNurse™ Model – What is it and How Can it Help?

Featuring Wayde Batt, MSN, NEA-BC, BC-RN, Patient Services Manager, NSICU / Virtual Nursing, UNC Health Rex & Laura Gartner DNP, MS, RN, RN-BC, NEA-BC , Director Clinical Informatics, Jefferson Health

  1. This model of virtual nursing focuses on offloading documentation and administrative burden from bedside teams, helping to optimize your labor force and deliver elevated patient care
  2. In this session, learn what’s driving the need for this nursing model, areas of focus and hear best practices from those who’ve already piloted
  3. Discover early outcomes from those already using this model to help reduce discharge time, increase patient & staff satisfaction and optimize outcomes

Session 3: Building a Virtual Nursing Business Case

  1. Learn how to partner clinical and IT resources to build a business case for virtual nursing
  2. Identify key metrics to use as goals & benchmarks for your program
  3. Get best practices for setting up an initial pilot & how to sell your leadership team on starting a program

Watch On-Demand


Session 4: Introducing The Expert Oversight TeleNurse™ Model: What Is It & How Can It Help?

  1. This model of virtual nursing focuses on retaining an experienced nurse to oversee a cohort of complex patients, monitoring for early signs of adverse patient events, mentoring novice nurses and providing support to bedside care teams
  2. In this session, learn what’s driving the need for this nursing model, areas of focus and hear best practices from those who’ve already piloted
  3. Discover early outcomes from those already using this model to help detect adverse events sooner and drive satisfaction in nursing staff, especially novice team members

Watch On-Demand


Session 5: Selecting The Right Technology Partner For Virtual Nursing

  1. Once you’ve sold your teams on virtual nursing, picking the right partner is essential
  2. Learn criteria to use to select the right partner for program success & what requirements should guide your decision
  3. Understand how technology will impact your program and details around emerging trends towards AI/Machine Learning, Camera-in-every-room and more

Watch On-Demand


Session 6: Starting & Scaling Your Virtual Nurse Program

  1. Once you’ve decided to kickoff, learn best practices around developing your initial pilot and kickstarting your program
  2. Learn how to scale and grow your program over time

Watch On-Demand


Discover everything you need to know to start your virtual nursing program, no matter what stage you’re at. To learn more, check out our 7 step roadmap to developing a virtual nursing program.

Want to learn more about our virtual nursing solutions? Explore here.

Virtual nursing: 7 step roadmap for getting started

virtual nurse illustration

Including Virtual Nursing Best Practices from AvaSure’s Experienced Clinical Support Team

Hospitals across the U.S. are challenged with nursing shortages, a rise in patient complexity and unprecedented cost challenges. Nurses are being stretched too thin, constantly asked to do more with less. This environment is causing 52% of nurses to consider leaving the bedside at a time when labor is already a challenge. Hospital leadership is being forced to think differently about how technology can help create a new model of care delivery.

89% of hospital leaders say they’re considering some form of virtual nursing, but only 2% have implemented a program – why the gap? Many don’t know where to start.

Are you in the 2% that have already started their virtual nursing journey? We can help no matter what phase you’re at! Schedule a complementary on-site assessment to get started with AvaSure.

For those still concepting, with our extensive experience helping over 1,000 hospitals across the U.S. with their virtual sitting and virtual nursing programs – we’ve put together a 7-step roadmap for starting your virtual nursing program.

1. Identify your facilities 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 efforts?

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

Expect to hear things like:

  1. Retirement vacancies causing a lack of highly experienced staff
  2. Burnout & exhaustion of staff members of all types – from nurses to CNAs to physicians
  3. Novice nurses feeling overwhelmed and unsure if they’re doing a good job
  4. A rise in patient complexity
  5. Quality metric declines across key areas
  6. Patient throughput challenges & bottlenecks

Once you’ve cataloged what your staff is dealing with, you can get to prioritizing.

2. Prioritize the challenges with the greatest impact

Once you understand challenges across the facility, work to identify which is creating the biggest drain on the system.

We see two models of virtual nursing that customers are starting with first to address their top challenges – based on ease and the biggest impact:

  1. Clinical Resource TeleNurse™ Model: a virtual nurse offloads documentation burden, giving bedside teams more time for direct, hands-on patient care
    • Admission & discharge support
    • Medication reconciliation
    • Patient & family education
    • 2-nurse sign-off
    • Expert consultation
  2. Expert Oversight TeleNurse™ Model: a virtual nurse oversees a cohort of complex patients providing clinical insight & nurse mentorship
    • Review & respond to clinical triggers from EHR and/or physiological monitoring
    • Expert nurses provide guidance and mentorship to novice nurses on the unit
    • Proactive patient rounding
    • Support satellite facilities with expert interventionists/specialists

We are confident one of these virtual nurse models would be a great place to start and to solve your greatest challenges.

3. Build your business case

Building a business case to sell your organization on starting a virtual nursing program is essential to ongoing success. The collaboration between clinical and IT leadership is key in this stage and to document how an IT infrastructure can help support clinical needs, not just today but for the future.

Once you’ve identified the model of virtual nursing with the most impact for your facility, begin to identify goals and benchmarks for your program. 

Examples include:

  • HCAHPS Patient Experience Scores
  • 30-day readmission rates
  • Staff satisfaction
  • Rapid response & code blue rates
  • Time to discharge

Still not sure where to start? You’re not alone. Hear from our customers who’ve kicked off their programs and have already seen early results to help get you thinking.

Best practice from AvaSure’s clinical team: Be sure to include feedback from front line staff and managers, bringing them along in the process. Their buy in will be essential long-term. Make sure your care teams understand this program is designed to help them, not add more work to their plate or eliminate jobs.

4. Select a vendor partner

The final piece of your business case will be to choose a virtual care partner that can help you achieve your long-term goals. It’s important to select a partner that has both clinical & technical expertise and will help grow your program over time.

When evaluating vendors, be sure to consider:

  1. Platform ease of use
    • Be sure to select a vendor that offers a platform that supports multiple clinical use cases that is easy for nurses to use.
  2. Support
    • There is a lot of clinical change & workflow management when implementing a change to the care model, 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 support including project management and 24/7 support – not just at the time of deployment, but throughout the partnership.
  3. Demonstrated outcomes
    • In any emerging area, a lot a new solutions will become available with little experience. In the clinical space, it’s more important than ever to select a partner with demonstrated experience in delivering outcomes for our patients.
  4. Current technology
    • Vendor consolidation is key for maximizing the impact of current spend and reducing technology duplicity. Before adding a new vendor, consider if any current solutions – such as your TeleSitter® solution – also offer virtual nursing solutions 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 have leadership on board it’s time to start building your program. You can start with a single unit or department if you’d like.

It’s good to start small, helping to demonstrate early success. Consider perhaps starting with peak hours – such as only between 9 a.m. – 9 p.m. to help ease staff into the program and staff the virtual team successfully.

But be flexible, consider that you may identify in real time that this isn’t the most impactful area to be addressed. Be willing to adapt and change quickly. It’s imperative that you get some quick wins under your belt to gain buy in from front line staff and garner continued support from leadership, so an agile approach can help.

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 expert oversight & mentorship
  • Unit with highest percentage of travel nurses – may benefit from expert oversight or clinical resource
  • Considering using virtual nursing for specialists that low staffed – nutritionists, diabetic management, wound care, social workers/case managers & more
  • Assist with morning rounds on units with residents using virtual nurse to facilitate documentation to communicate with family
  • Units with high complexity patients allowing virtual nurse to do purposeful rounding being a second set of eyes on patients
  • In conjunction with units that have deterioration or sepsis protocols and/or wearable monitoring to help reduce false alarms and identify early signs of adverse events

Be sure to build in a feedback loop to hear directly from front line staff on how the program is going and have a way to share wins across the facility and with leadership. This positive word of mouth is what will really sell 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 in the early discussions 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 change, be sure to log all metrics before implementation in addition to any financials.

Best practice from AvaSure’s clinical team: Include great catches & stories from front line leaders. While metric moving is great, 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!) identify additional units to cover or consider expanding to a second model of virtual nursing. But be reasonable about what your team can take on at once. Go slowly & deliberately, making sure your teams have a venue to speak up if it’s too much.

Worried about staffing your virtual nurse program? Learn about hosted options if you don’t have adequate talent to pull from in your area.

A successful virtual nursing program can not only help with labor challenges, helping to optimize the productivity of your staff but it can also help to drive nurse satisfaction & retention. Nurses will feel more supported, get more time at the bedside, and leave feeling accomplished. AvaSure can help support you through every step of scoping, implementing, and scaling a virtual nursing program. With 15% of our staff being RNs, we understand the unique challenges of care systems today and have a robust clinical team to help from business case development through implementation, metric tracking, expansion.

AvaPrize 2022 Winners

VA staff holding AvaPrize

VA Health System

VA North Texas

Path-To-Zero Award

ShorePoint

Safety Net Award

MaineHealth

Super Star Monitor Staff Member

Diane Norris, Providence

Program distinguishes those who have advanced patient safety and achieved new efficiencies in care delivery.

BELMONT, Mich., Jan. 25, 2023 — AvaSure, the inventor of the TeleSitter® solution and the market leader in acute virtual care and patient safety monitoring, today announced the winners of the 2022 AvaPrize awards.

The AvaPrize awards honor individuals and organizations who have advanced patient and staff safety, eased the working lives of nurses, and achieved new efficiencies in care delivery. Winners demonstrate the ever-evolving role of virtual care as it becomes a vital tool in patient care and staff augmentation throughout a healthcare organization.

“Every day across the nation, healthcare organizations rely on AvaSure’s solutions to enhance patient safety, augment bedside care, and improve the efficiency of care delivery,” said Adam McMullin, CEO, AvaSure. “We are proud to recognize these distinguished organizations and individuals – out of more than 1,000 of our hospital customers – who have demonstrated their commitment to advancing clinical quality and patient outcomes.”

The honors include:

  • The Safety Net Award for the organization that demonstrates the most complete AvaSure TeleSitter program. The award went to MaineHealth, which has improved patient safety through fall prevention and increased nursing job satisfaction through its TeleSitter program. In addition to fall prevention, Maine Health has monitored 1,928 patients who were at low to moderate suicide risk, helping these vulnerable patients continue their journey of emotional and physical health.
  • The Path to Zero Award for the organization with the most impressive fall reduction program centered around the TeleSitter program. The award went to ShorePoint Health for significantly reducing fall rates across multiple locations by up to 46% in their first year of implementation.
  • The Super Star Monitor Staff Member Award for the individual who consistently goes above and beyond to help measure success and uphold effective use of the AvaSure TeleSitter. The award went to Diane Norris of the remote visual monitoring team at Providence Health & Services-Oregon Region. Norris prioritizes building relationships with patients and delivering exceptional bedside care. She was a Providence caregiver for nearly 26 years before joining the remote visual monitoring team over a year ago. For Norris, it’s about connecting with patients in a whole new way. Many just want someone to talk to, especially during COVID, when capacity was limited for guests.
  • The VA Healthcare System Award for the U.S. Department of Veterans Affairs hospital that optimizes use of the AvaSure TeleSitter solution. The award went to VA North Texas Health Care System, which has monitored more than 2,500 patients through its TeleSitter program, increasing the utilization rate from 45% to 78%, greatly improving safety and efficiency measures.

During National Nurses Month in May, VA North Texas Health Care System nurse Juliet Aninye, LVN, Lead for the AvaSure TeleSitter Program, was honored with the Department of Veterans Affairs 2022 Secretary’s Award for Excellence in Nursing and Advancement of Nursing Programs.

Aninye was recognized for her leadership in the delivery of patient care through the utilization of the AvaSure program. The VA National Nursing Awards reflect the high-level of professionalism and excellence in service VA nursing represents.

See the press release here.

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

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

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

So, 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. Request an assessment here and we will be in touch. We look forward to helping you transition to this exciting new model of supporting nurses through virtual care.

Watch the recorded session.

Virtual Nursing – It’s a Thing, But Where to Start?

A few years ago, it was estimated that by 2030 the U.S. would experience a shortfall of more than half a million nurses, with a huge loss in quality and availability of care.

The pandemic sped up the timeline.

The greatest concern was the potential loss of specialized expertise; two-thirds of 6,000 critical care nurses surveyed in August 2021 said they were considering leaving the field from burnout.

Solutions have been hard to find, but Houston’s Memorial Hermann Health System has tried something new:

  • As the COVID-19 delta variant spread, critical care nurses were detailed to an existing central video monitoring facility. There, these “virtual nurses” can care for COVID-19 patients across the system, supporting less experienced bedside nurses and improving patient quality and safety.

Key learning objectives of this on-demand webinar:

  • Discover the basics of virtual care, including the technology and the art of video and audio interactions with patients and bedside staff
  • Learn about policies and workflows Memorial Hermann established for virtual nursing
  • Find out how virtual nurses can make the highest use of specialized care resources

Presenters:

  • Scott Shaver, MSN, LP, RN, CPHIMS, Director of Hospital Information Systems, Memorial Hermann
  • Mary Ellen Carrillo, MSN, MBA, RN, CVRN, FABC, Chief Nursing Officer, Vice President of Nursing, Memorial Hermann
  • Jennifer McGuire, Manager, Staffing, Memorial Hermann
  • Lisbeth Votruba, MSN, RN, Chief Clinical Innovation Officer, AvaSure

Disrupting the Nursing Shortage: Meet the “Virtual Nurse”

webinar graphic

A few years ago, it was estimated that by 2030 the U.S. would experience a shortfall of more than half a million nurses, with a huge loss in quality and availability of care.

The pandemic sped up the timeline.

The greatest concern was the potential loss of specialized expertise; two-thirds of 6,000 critical care nurses surveyed in August 2021 said they were considering leaving the field from burnout.

Solutions have been hard to find, but Houston’s Memorial Hermann Health System has tried something new:

  • As the COVID-19 delta variant spread, critical care nurses were detailed to an existing central video monitoring facility. There, these “virtual nurses” can care for COVID-19 patients across the system, supporting less experienced bedside nurses and improving patient quality and safety.

Key learning objectives of this on-demand webinar:

  • Discover the basics of virtual care, including the technology and the art of video and audio interactions with patients and bedside staff
  • Learn about policies and workflows Memorial Hermann established for virtual nursing
  • Find out how virtual nurses can make the highest use of specialized care resources

Presenters:

  • Scott Shaver, MSN, LP, RN, CPHIMS, Director of Hospital Information Systems, Memorial Hermann
  • Mary Ellen Carrillo, MSN, MBA, RN, CVRN, FABC, Chief Nursing Officer, Vice President of Nursing, Memorial Hermann
  • Jennifer McGuire, Manager, Staffing, Memorial Hermann
  • Lisbeth Votruba, MSN, RN, Chief Clinical Innovation Officer, AvaSure

Virtual Nursing Emerged as Solution to Workforce Shortage in Texas During Pandemic Surges

AvaSure Guardian Mobile Device

On July 30th, 2020, as hospitalizations from COVID-19 were hitting new peaks across the country, Memorial Hermann Health System initiated a pilot virtual nursing program at 3 of its hospitals in Texas during its COVID-19 hospitalization surge.

ICUs at Memorial Hermann have large windows that allow nurses to monitor and check-in on patients without physically entering the room. As patients filled hospital beds outside these ICU locations, nurses had to physically enter rooms in full personal protective equipment (PPE) to periodically check in on the critically ill.

The program utilized mobile monitoring devices in rooms so nurses could monitor patients virtually, and soon the virtual program covered 14 ICUs during the summer surge through September. The program was designed to maximize shift efficiency, protect staff and patients from COVID exposure, and centralize protocols based on nursing qualifications.

As the COVID-19 delta variant spread, experienced critical care nurses were sent to a central video monitoring station that managed the health system’s 100 mobile monitoring devices, which allowed communication between less experienced staff to effectively monitor and care for COVID patients in the 2 subsequent surges that followed.

The system also allowed nurses at Memorial Hermann to safely and effectively monitor up to 8 patients from remote (at-home) locations if needed.

Memorial Hermann’s protocols included revamping its staff and nurse practices to accommodate for the high demand created by COVID-19 hospitalization surges and ongoing workforce shortages.

“We also in the future could use [the virtual program] for nurses who may not be physically able to work more than 3 shifts,” said Director of Hospital Information Systems at Memorial Hermann Scott Shaver, MSN and registered nurse. “I have full disclosure, I guarantee you if I was a nurse on the floor right now, I would do 3 shifts and that would be it. I am too old to do more than that.

My body doesn’t work that way [anymore]. But I can guarantee you that I can do 3 shifts in the ER and then do a shift at home using this. I could definitely do that. And so we actually have that availability as well not just for COVID but for really anything in the future. This can be applied to really anything that we can think of in the future where we can use virtual nursing to take care of patients.”

The company AvaSure provided the virtual nursing platform used by Memorial Hermann. The company sells evidence-based virtual care solutions, an innovative set of software and hardware aimed at inpatient telehealth care and utilized in nearly 1,000 hospitals across North America.

Juliet Aninye, a VA North Texas Health Care System nurse and LVN Lead for AvaSure’s TeleSitter® Program, was the winner of the Department of Veterans Affairs (VA) 2022 Secretary’s Award for Excellence in Nursing and Advancement of Nursing Programs.

The AvaSure TeleSitter® solution allows one trained hospital employee to monitor up to 16 patients simultaneously, preventing not only falls but elopement, violence against caregivers, and other adverse events.

“The bedside nurse will select which patients are most at risk for some kind of adverse events,” said Lisbeth Votruba, Chief Clinical Innovation Officer at AvaSure and herself a registered nurse. “[Falling] is a very common one. A frail elderly person who’s disoriented in a hospital setting—if they fall it can be really catastrophic. Those types of patients or a traumatic brain injury patient who’s impulsive and aggressive … or a patient who is in isolation with COVID, is delirious, their oxygen level is dropping, they’ve got to keep a mask on and they keep pulling it off. [It is important] to have the ability to monitor those higher risk patients, which is about 10% of the [in-patient] setting.”

Votruba said the virtual nursing models that have emerged improve efficiencies in patient admission and discharge, virtual preceptor mentoring, and critical care support that leverages nursing expertise across a health system in a centralized manner.

AvaSure’s video platforms that enable physicians and other clinicians to have instant telehealth check-ins with patients and their families are part of a $12 billion global telehealth market that exploded in growth during the pandemic.

Texas plans to invest $600 million over the next several years to expand broadband statewide and improve telehealth access for the 2nd largest rural population in the US. Nearly 2.8 million Texas households, or 7 million people, lack broadband access, according to the US Census Bureau.

According to the Texas Rural Health Association and Rural Health Hub, there are 64 counties in the state without a hospital, 25 counties without a physician, and 75% of counties are designated as Health Professional Shortage Areas (HPSA).

Virtual nursing advocates say the shortage of trained health care professionals in rural areas was an existing problem that was exacerbated by the pandemic and highlighted the state’s current health care system’s inability to reach these vulnerable communities.

The University of Texas Medical Branch (UTMB) School of Nursing will be launching a nursing certificate program in January of 2023 that aims to improve care for patients in rural areas where there are not enough professionals to care for these communities.

“For telehealth to be a widely adopted solution across Texas, providers need resources, education, and support to eliminate barriers and successfully implement telehealth tools into modern health care practice,” said Dr. Kristen Starnes-Ott, Vice Dean for Academic Affairs and Professor at UTMB School of Nursing.

She pointed out that many health care institutions shifted to a telehealth model as an emergency measure when the pandemic began, but much of it was done without adequate training.

With proper preparation, training, and implementation, she said that telehealth has great potential to help Texans receive needed care in areas with a shortage of providers.

Source: Boram, K (August 1, 2022). “Virtual nurse emerged as solution workforce shortage in Texas during pandemic surges”. State of Reform Texas