To say that virtual nursing has captured the imagination of healthcare leaders across the country is an understatement.

On a daily basis, the trade and professional press are replete with articles highlighting various organizations attempts to introduce virtual nursing into their systems. More recently, professional organizations have called for standards, policies, and even regulations to influence the scope and extent of what and how virtual nursing should evolve. To be clear, the overarching goal of virtual nursing is to specifically combat the excessive work burden that acute care RNs face amidst continued workforce shortages, unresolved RN burnout, excessive vacancies, and over-reliance on expensive agency labor. Additionally, virtual nursing can provide structured mentorship and coaching support to the increasing number of novice nurses being hired amidst continued outmigration of experienced RNs to other employment settings. However, virtual nursing models vary in terms of goals, model design, as well as results.

So, what does an organization need to have in place to get this “right”? Here are the non-negotiables for nurse leaders to consider:

1. Be clear as to how you define your virtual nursing model.

Are you seeking part time support or extra coaching for your RNs on certain shifts or are you looking to advance an innovative care model that that includes clearly defined virtual RN roles with 24/7 accountability to work in tandem with direct care nurses? At this time, models vary widely; there is no one-size-fits-all option.

2. On day one, establish the goals that you seek to achieve.

Are you looking for virtual nursing to decrease workload intensity of your direct care RNs, or improve their mental health and well-being? Do you need to decrease turnover, overtime, over-reliance on expensive agency labor, and overall labor costs? Do you want to inflect length of stay? The virtual model you select will directly influence the type of results that you can achieve.

3. Choose your technology platform carefully.

While many organizations and systems improvised various types of technology support during COVID, for example: iPads on carts and cellphones to support communication between providers, those types of short-term solutions will not be sufficient to optimize the level of virtual care support that can be created. When leveraging the expertise of a virtual RN assuming 24/7 responsibility for care in collaboration with direct care RNs, it is essential to utilize the right technology, including permanently fixated cameras, TV screens, and two-way audio.

4. A critical mass of highly experienced, credentialed RNs must be in place 24/7.

In most markets, inability to fill RN vacancies continues. In addition, increased numbers of novice RNs are approaching acute care organizations for employment while mid-late career nurses are leaving direct care for alternative opportunities or retirement. For virtual nursing to be a part of an organization’s care model, part-time virtual nursing support will be insufficient. A permanent supply of virtual nurses who are highly experienced must be integrated into staffing 24/7 in order to achieve the goals that have been established.

5. Change management is key

Virtual nursing is a care model innovation and is disruptive to status quo nursing practice. As is the case with any major initiative, attention to the professional, cultural, and organizational challenges inherent in changing a care model is key. Sufficient staff preparation for understanding the role of the virtual nurse and how a virtual nurse can serve to support the role of the direct care nurse is as important as ongoing monitoring of role, process, and practice changes that will occur after virtual nursing is fully implemented. Resistance to this type of care model change can be predicted.

6. The role of the CNO as executive sponsor cannot be overstated.

Changing a care model is extremely challenging, and the need for senior executive support during model design and implementation will make or break front line staff understanding, support, and enthusiasm with embracing virtual nursing, versus viewing it with any degree of hesitation or resistance. While project management to drive model design and implementation is essential, the CNO must be seen as the ultimate executive sponsor on behalf of the entire nursing enterprise.

7. Measure, measure, measure.

The goals you select related to workforce, quality, finance, or patient satisfaction should be baselined at the start of your initiative, and routinely measured. Scorecards at the unit and organizational level should be widely distributed so all stakeholders are clear as to progress being made, and where metrics indicate difficulty, mitigation plans quickly put in place. Without a solid measurement strategy, a nurse leader may be unable to “defend” a virtual nursing investment because metrics were either not clear at the start of the initiative, or metric monitoring was insufficient at best.

8. You are in this for the long haul.

As is the case with any major change initiative, results take time. Be clear with all stakeholders, including your C-suite, that the results you are committed to accomplishing will not become evident within 30 days of the model being put in place. Short term qualitative wins may be more immediately apparent and should be recognized. However, the true impact of changing a care model through virtual nursing will take time to demonstrate. Trending monthly and quarterly progress is essential to demonstrating that your targeted return on investment will be realized.

The supply/demand imbalance for an adequate supply of RNs to assume direct care roles in acute care, especially med-surg, is getting worse. Healthcare organizations and systems cannot hire their way out of this shortage and continue to implement legacy staffing models. Care model innovation that embraces the fundamental redesign of “work” is non-negotiable.

Virtual nursing is here to stay. 

By Carol Boston-Fleischhauer, JD, MS, BSN, RN

Carol Boston-Fleischauer joined Banyan Medical in May, 2023 as the Senior Vice President, Chief Clinical Officer. Carol’s primary role is to lead Banyan’s clinical strategy. In this role, she partners with healthcare organizations and systems to advance virtual nursing as a comprehensive care model innovation optimized by technology as well as directly influence emerging virtual nurse policy, practice, and regulatory discussions at the national level. A licensed attorney and masters’ prepared registered nurse, Carol has held numerous practice, advocacy, education, and leadership positions; most recently as the Chief Nursing Officer of the Advisory Board.