Hospitals across the nation are facing workforce challenges, and a nurse staffing shortage poses one of the biggest threats to care delivery.

More than 100,000 nurses exited the U.S. workforce from 2020 to 2021 due to a perfect storm of issues ranging from burnout and job dissatisfaction to competing family obligations and COVID-19-related illness. An aging nurse workforce nearing retirement and student capacity limits in nurse education programs are putting additional pressure on nurse staffing.

The American Nurses Association projects that the nursing shortage could reach up to 1.13 million additional nurses needed by 2028.

This has produced a domino effect of issues for health systems to address. High costs associated with travel nurses and staff recruitment have been a significant financial strain. Retained staff members often face increased workloads and less favorable nurse-to-patient ratios. Workforce deficits in additional lower-level roles often add tasks to nurses’ plates as well.

All of these challenges negatively impact clinician experience and patient care.

Wendy Deibert, RN, is senior vice president of clinical solutions at Caregility, a telehealth technology and services company. She has 34 years of nursing experience as a bedside critical care nurse, manager, senior consultant, operations manager and executive.

As vice president of telehealth services at Mercy Virtual, she played an integral role in building the world’s first “hospital with no patients,” which opened in August 2015, ultimately scaling to more than 160 clinicians caring for patients remotely 24/7.

We interviewed Deibert to talk about virtual nursing's role in helping tackle the nursing shortage.

Q. What is some of the evidence you see that virtual nursing is on the rise? What is attracting healthcare provider organizations to virtual nursing?

A. Virtual nursing is a new model that health systems are implementing to help address workforce issues. Supported by video-enabled telehealth engagement at the patient’s bedside, virtual nursing or telenursing programs use experienced nurses in remote roles to guide and support patient care from a centralized hub.

One of the things that makes this model attractive to health systems is that it allows them to expand their workforce to include nurses who may have retired due to physical limitations or those who may be considering retirement. In remote roles, these nurses can field tasks like virtual admissions and documentation so bedside nurses are free to focus on direct care.

Virtual nursing improves patient coverage by putting eyes and ears in every room. It empowers patients and care team members at the bedside to bring in clinical reinforcement, specialists, translators and patient family members virtually when needed. Virtual nurses can act as a second line of defense for new, less-experienced nurses, many of whom received limited hands-on training during the pandemic.

Using this model as an alternative to travel agency staffing solutions helps health systems rein in labor costs, which have blown budgets over the past two years. Hospitals avoid the discord that can exist between internal and travel nursing teams by instead opting for virtual care team support that becomes permanently integrated into the existing team.

Studies show there was a 34% growth in virtual nursing program adoption in 2022 and that momentum has certainly carried into 2023.

Q. Talk about hybrid nursing programs. What do they look like, and how do they operate?

A. Given the care model’s infancy, there is no gold standard on what virtual nursing entails, but best practices are emerging.

Programs are typically campus-based. That could be a single room in a hospital with a simple desktop computer setup or a virtual command center managing operations for multiple campuses.

Programs can be staffed internally, by third-party clinical services, or by a combination of the two. Some hospitals lean on outsourced virtual nurse support for a period while roles are filled internally, or during periods of high patient volume.

Depending on your available resources, funding and bandwidth, you can alternatively build and own virtual nursing programs in-house. Internal teams are typically paid rates that are more on par with floor staff.

Specific workflows vary from campus to campus. Some organizations use virtual nurses for patient admissions and assessments or discharge education. Others implement more comprehensive 24/7 patient surveillance and deterioration management programs.

Virtual nurses can operate as remote observers, scribes, patient and family resources, and staff trainers and mentors. A telenurse can even support patient physical assessments, with the help of sensors and connected care devices and a staff member, such as a technician or assistant, at the bedside.

The fact that there is no one universal approach is really the beauty of telenursing. Programs can and should be tailored depending on your health system’s specific needs.

Q. What are the benefits of hybrid nursing programs, and how can these benefits translate into help for workforce shortages?

A. One of the key benefits health systems see from virtual nursing programs is improved clinician experience, which directly impacts patient care.

Pandemic-era telehealth solutions focused on enhancing patient access and convenience. Current use cases for virtual care within inpatient settings similarly support caregiver empowerment by introducing new work modalities to understaffed and burned-out clinical teams.

By implementing virtual workflows for common tasks, health systems can drive efficiency and buy back time for floor staff. Virtual process enablement for things like admissions, care transition prep and ED assessments improves continuity of care and leads to faster time to treatment for the patient and earlier discharges.

Patients benefit from more frequent or continuous virtual nurse monitoring and support. We’re seeing higher patient experience ratings and improved clinical quality measures as a result.

The current workloads are simply untenable for many nursing teams. Virtual nurses help fill care gaps, restoring balance to staff-to-patient ratios. Embracing a hybrid nursing model supports staff recruitment and retention and enhances care team collaboration.

Virtual nursing also helps normalize nurse pay scales that have been overinflated by travel nurse wages over the past few years, leaving hospitals in a better financial position to grow their teams and modernize care models.

Q. What will it take for virtual nursing and hybrid nursing programs to really take off?

A. Because there are limited program examples to draw from, many healthcare organizations struggle with where to get started with virtual nursing. Scaling your virtual care infrastructure to support telenursing should be approached thoughtfully and is best tackled incrementally. Start small with one or two virtual workflows and then grow your program from there.

Virtual admissions are a common jumping-off point. We see health systems use that initial workflow to build buy-in and develop standardized processes that lead to fewer interruptions and more-focused work, improving patient throughput times. You can then parlay the best practices you establish with that workflow into additional areas.

Effective change management along the way is essential to success. Health systems can avoid animosity between virtual and floor staff by making it a true partnership with clearly defined roles and responsibilities. It is vital for virtual nurses to be seen as part of the team. Otherwise, floor staff will not trust or utilize them. Involve both teams in program development.

Ideal virtual nurse candidates possess technical fluency and direct care experience. Virtual nurses should receive a different level of training that specializes in looking at trend data to help prioritize patient needs and identify appropriate opportunities for care transition and clinical intervention.

Certifying bodies recognize that virtual RNs are something we need to put defined skills around. Organizations like the American Academy of Colleges of Nursing and the Academy of Medical-Surgical Nurses are actively working with stakeholders within the nursing community to develop virtual nurse certification programs. This will help establish standards, trust and support for programs going forward.

As adoption continues to grow, we’ll also see more validation studies assessing the impact of virtual nursing programs on care delivery. That emerging research will play an important role in advancing care model innovation as we look to better leverage virtual care to improve the experience for both patients and clinicians.

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Email the writer: bsiwicki@himss.org
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