Virtual nursing has swept the country as a key strategy to support unresolved workforce challenges.  In addition, an increasing number of healthcare organizations are looking to virtual nursing as a key strategy to assist with various financial, quality, safety and patient experience goals as well. 

My name is Carol Boston-Fleischhauer. I am the Chief Clinical Officer of Banyan Medical Solutions; the first firm to bring virtual nursing to the market almost a decade ago; offering a  full range of virtual nursing services to ensure model optimization and achieve  sustainable results.

Let me highlight four areas for you to consider:

  1.  The current state of Virtual Nursing, including its present value proposition
  2. Key market forces other than workforce challenges that should be kept in mind when committing to care model change
  3. Why a broader value proposition for virtual nursing should be considered
  4. What that proposition looks like, expanded opportunities, and key building blocks

Current State

There are many virtual nursing models and definitions; but at Banyan, we view virtual nursing as a care model innovation; rather than a technical set of devices to support existing care.  Over the past several years, virtual nursing has swept the industry; with hundreds of organizations now reporting some level of virtual nursing support.

So, one thing we know is that virtual nursing is alive and well. What we do not know is the type and scope of the models that are being implemented or how they are being deployed because no national, publicly available data set about virtual nursing exists.

We also know virtual nursing’s current value proposition is linked to workforce challenges that have been present for several years, and are still unresolved. In fact, The pandemic demonstrated  an inversely proportional relationship between nursing workforce destabilization and the dramatic increase in virtual nursing.

Market Forces

Newly released  data reflects a  growing RN workforce that continues to gravitate away from  bedside hospital-based employment. This is predictable given the range of employment opportunities that are available and being pursued.  So, despite overall RN growth across the country, RN interest in hospital employment continues to decline. In addition, the time it takes to fill a vacant hospital RN position ranges anywhere from 85 to over 100 days; because both the market and academic pipelines are declining.

When thinking about how to effectively staff acute care, factors beyond the workforce that must be kept front of mind include:

  1. Hospital margins have not stabilized; with a month-to-month downward trend of about 11% and national margins as of January now standing at 5.1%
  2. Public/private payer imbalances continue; impacting shrinking revenue received to cover growing operating expenses
  3. Inpatient acuity and LOS are increasing
  4. Growth in market share strategies have been prioritized; in part to offset the financial landscape as well as maintain a competitive edge

Broader Value Proposition

Should Virtual Nursing be a part of an organization’s continued solution set to support unresolved workforce challenges, or should this care model be considered within the broader context of financial, quality, safety and patient experience goals as well. 

We propose an expansion of virtual nursing (VN), that when optimized, will not only serve to impact an organization’s ongoing efforts to maintain a healthy/highly supportive work environment for your clinical workforce, but it will also pay dividends to address other key organizational pressures that must be addressed as well.

Expand the value proposition of  virtual nursing in the following ways:

Expand the VN Role. While data reflects leaders dominantly utilizing virtual nurses to take over certain administrative work; like admissions and discharges, the opportunity to virtualize other time-consuming work critical to care, but not requiring in the room presence to complete, is clearly there. In so doing, direct care nurses get “time” back during the shift correlated to how expansive of a VN role you support;  allowing direct care nurses to redirect their time to other activities that address outcome metrics.

Virtual Nurses are also high experienced. That experience can be leveraged to formally coach, precept, and provide targeted clinical guidance to increased numbers of inexperienced RNs as well.

Move beyond pilot programs. While pilots are important, don’t fall prey to organizational inertia and analysis paralysis. Conduct pilots but consider the pilot virtual nursing program within the purview of the intended organizational outcome. Treat the pilot as a use case intended to prove or disprove broader implementation of a care model for the entire organization.

Move beyond Med/Surg.  Medical surgical units are typically piloted first; which makes sense, however, virtual nursing has applicability across the entire organization. For example, emergency services is one area with a long list of use cases. There are clinical, operational, financial, and service positive impacts noted when the ED model integrated virtual nursing.  Also, consider expanding virtual nursing  to advance cross-continuum care, transitional support and behavioral health.

Key Building Blocks and Non-Negotiables to Scaling Virtual Nursing Across the Organization

  1. C-Suite commitment to this care model is essential
  2. RN staff buy-in.  A thoughtful approach to change management will be required in order to gain and maintain clinician support for this care model change.
  3. The organization’s capacity in driving innovation must be in place. Care transformation requires a unique skill set and bandwidth to sustain over the long term.
  4. To support this care model, a critical mass of highly experienced RN to deploy 24/7 is required.
  5. Solid mechanisms to support communication between direct and virtual clinicians is essential.
  6. Standard clinical processes to ensure model consistency and reliability are required
  7. Centralized coordination of virtual services will be needed.
  8. Data analytics to monitor model productivity and outcomes is critical.
  9. Continuous improvement mechanisms are necessary.

In light of continued, unresolved workforce challenges and broader financial and market pressures, care model innovation is non-negotiable.  When effectively designed and implemented, virtual nursing is a highly sustainable approach to delivery patient care.

Carol Boston-Fleischhauer, JD, MS, RN, SVP/Chief Clinical Officer, Banyan Medical