Virtual nursing: 7 step roadmap for getting started

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.