As health systems tinker with various virtual nursing models, cases for and against on-site programs are emerging.
"Virtual nursing" is an umbrella term for several organizational designs, use cases and tasks for remote nurses.
For example, Trinity Health, a 96-hospital system based in Livonia, Mich., has a bedside registered nurse and nursing aide work in tandem with a virtual nurse. While Guthrie Clinic, a six-hospital system in Sayre, Pa., employs nurses to monitor and communicate with patients from a command hub. And at University Hospitals, a 21-hospital system in Cleveland, nurses can work a hybrid schedule, with some days at the bedside and others at a remote hub in an administrative building.
As pilots turn into common practice, systems fine tune what works best — and discover what does not work at all.
At Becker's 2024 Health IT + Digital Health + RCM conference, some nurse leaders described a "cannibalization" risk with programs that are situated in-house.
Nurse leaders experiencing short-term staffing issues might feel compelled to yank nearby virtual nurses — say, ones working in a nearby center or on a different hospital floor — to the bedside. Or, when practicing bedside nurses are feeling burnt out, their boss might consider transitioning an entire unit to remote positions.
Both of these scenarios cannibalize the workforce, according to Cynthia Salisbury, MSN, RN.
"If you include, in your virtual RN cohort, nurses that worked on that floor before — you don't want to cannibalize the team on the bed at the bedside, right? You don't want to do that to a unit. That's definitely not your [best] approach," said Ms. Salisbury, Providence's executive director of nursing operations.
Transferring bedside nurses to a remote role could be optimal in some cases, such as for an experienced nurse who wants to continue working but cannot keep up with the job's physical demands. But placing too many practicing nurses in remote positions could result in a more severe shortage at the bedside.
During the conference, Walker Dupre, Ochsner Health's telemedicine director of virtual nursing services, agreed with Ms. Salisbury. New Orleans-based Ochsner, which has used virtual nursing since 2012, has some nurses work from a virtual care center, their homes or out of state.
Nashville, Tenn.-based HCA Healthcare, the largest health system in the U.S., with 186 hospitals, also employs nurses to work from home. The system's chief nursing information officer, Sherri Hess, said the costs for building centralized command centers are unnecessary.
Besides the costs associated with brick-and-mortar facilities, another downside to planting virtual nurses in a command center or hiring out-of-state nurses is a lack of personal knowledge of the hospital.
Jane Dus, DNP, RN, chief nursing officer of Advocate's Midwest region, told Becker's that the system is testing three models. One program has cameras for virtual nurses to monitor patients 24/7, another has nurses work a hybrid role, and the last one uses a central location staffed with virtual nurses to fulfill each hospital's specific needs.
Although each model has merits, Dr. Dus said she prefers the first two since the on-site nurses show more trust with off-site nurses they already know.
"What's nice about that model is that they know that population, and they know those nurses, because they're part of that team," she said. "I personally like that model, but we'll just see how we continue to progress."