The (Virtual) Nurse Will See You Now

From ER to inpatient: Where you’ll meet virtual nurses

Hospital systems integrate virtual nurses differently. Some require them to work at the bedside for some shifts, while other nurses work exclusively virtually. And even in systems that have widely adopted them —like Trinity, which employs virtual nurses across 82 units in 27 hospitals in 11 states — they’re not in every unit.

How a patient encounters a virtual nurse also varies. At hospitals run by Trinity Health, patients see a virtual nurse on a TV screen and can call the virtual nurse by pressing a button at their bedside. Other institutions use iPads, some equipped with external speakers.

Despite these differences, there are a few common models for how virtual nurses work. Take, for example, hospital admissions. Patients admitted through the emergency room (ER) might see a virtual nurse to complete paperwork while waiting for a bed, explains Devika S. Kandhai, nurse manager at University of Maryland Baltimore Washington Medical Center (UMBWMC), in Glen Burnie, Maryland. 

And that, nurse leaders say, can reduce bedside nurses’ workload. The virtual nurses complete the time-consuming labor of documentation needed to comply with state regulations, leaving on-site nurses with “more time back at the bedside with the patient,” says Amy Hassell, chief nursing officer with the UCHealth Virtual Health Center. 

But not all nurses agree that virtual nurses alleviate their work, particularly in hospitals where staffing ratios rise or remain untenable for nurses working a brick-and-mortar shift. In fact, some say that implementing virtual nursing along with higher patient-to-nurse ratios introduces safety concerns due to the hands-on attention that critical care patients need, according to an article published in Cardiology Advisor.

How virtual nursing can benefit patients

In patient rooms, virtual nurses take on various tasks, including assessing patients’ pain. At Trinity’s hospitals, a virtual nurse can zoom in to examine a surgical site and monitor for a potential infection. Virtual nurses can then pull up the patient’s chart, and if they don’t have an order for what the patient needs — say, pain medication — they can reach out to the physician, get the order and then contact the bedside nurse to say, “This is what I’ve assessed. I think you need to give the patient this much medication, and I’ve got the orders, and you’re cleared to go,” explains Landstrom.

Such assessments are also an opportunity for mentorship. Kandhai says that more experienced virtual nurses “can be the second pair of eyes” that a junior nurse needs.

At some institutions, such as UMBWMC, virtual nurses can discharge patients and review instructions for home care. Like a Zoom meeting, multiple people can join these discharge meetings — patients’ children, spouses, interpreters — no matter where they’re located, says Iskra Gillis, director of UMBWMC’s Acute Care Services. And because everyone is part of the same conversation, they’re all “hearing the same thing,” she says, rather than relaying instructions secondhand, which can lead to missed information or misunderstandings. “That makes the patients safer, too,” Gillis adds.

Several studies have found that improving the hospital discharge process can lead to better patient outcomes, which is especially important for older adults, who are more likely to be rehospitalized soon after discharge than their younger peers. In one study, researchers found that patients who clearly understood their post-hospital care instructions were 30 percent less likely to be readmitted to the hospital or the emergency room than patients who lacked a clear understanding of their discharge instructions. 

The focused attention on patient education that virtual nurses provide can be rare in a hospital, where bedside nurses are interrupted an average of 13 times an hour. “It’s like, my phone goes off, my other patients call me. ‘I'll be right back. Hang on,’” says Hassell, who started her career as an ICU nurse. And patients pick up on that and may be reluctant to “bother” their nurses because they are so busy.

Some health care leaders, however, haven’t noted any reluctance from patients to reach out to virtual nurses; in fact, patients sometimes ask questions they’d never asked other providers, or they share their emotional struggles. That attention and care is “so important to healing and well-being,” says Landstrom.

UCHealth's Hassell also considers virtual nursing an important tool for improving health equity. It ensures that “experts are available for everybody at our health care system, for all our patients, all our nurses,” rather than solely at larger academic medical centers, which tend to have more resources than rural or community hospitals.

The future of nursing

Because virtual nursing is still emerging, data about how well it works — for patients and nurses — is also still emerging. But its potential has already attracted substantial philanthropic support. In May, Mother Cabrini Health Foundation, a New York–based philanthropy that advances the health care of underserved New Yorkers, will award 10 to 13 high-need hospitals $5 million each to support nursing workforce initiatives, including piloting and expanding virtual nursing.

The organization decided to include virtual nursing in this program based on research with nurses and hospitals that showed its potential to improve patient safety and “the well-being of nurses,” says Daniel Ferrara, chief programs and grants officer for Mother Cabrini. Taken together, that leads “to improved patient care.”

And though implementing virtual nursing — from staff training, upgrading technology and identifying the most effective models — will take years, it’s important to recognize that one aspect of virtual nursing is already deeply familiar: From their training to their skill set, says Kandhai, a virtual nurse “is still a nurse.”