In two years, Newark, Del.-based ChristianaCare has expanded virtual nursing to 41% of its beds without adding a single new staff member.
The first bed with virtual nursing launched in September 2022. By June 2023, virtual nursing was live across 17 units representing 510 beds at ChristianaCare’s Newark and Wilmington, Del., hospital campuses. By September 2024, the system plans to go live with approximately 400 more beds to the program on additional medical and surgical units as well as cardiac stepdowns, oncology, and women's health and pediatrics.
"I think we'll have nuanced learning coming from the additional types of work that virtual nurses can do in those patient populations other than the typical admissions, discharges and care coordination," Michelle Collins, DNP, APRN, vice president of nursing professional excellence at ChristianaCare, told Becker's.
ChristianaCare's strategy for virtual nurses allows it to leverage the staff it already has and reduce nurse burnout and stress, and potentially reducing call outs. Virtual nurses are selected by nurse managers using several criteria: the desire to be a change agent, the experience of being a preceptor and having years of clinical nursing experience. Targeting retiring nurses is not part of the health system's strategy.
"We left it in the hands of the nurse managers to identify those clinical nurses optimized to transition into this role," Dr. Collins said.
Once selected, virtual nurses are trained on the technology and asked to commit at least two shifts per pay period to virtual nursing. They work in the virtual nursing center across from the hospital's largest campus, which allows them to help each other as needed.
The program has not added any new staff or technology, instead leveraging the technology it acquired amid the COVID-19 pandemic and partnered to further develop our interactive platform, Dr. Collins said.
The effect
Since the program launched, nearly 24,000 patients have received virtual care and more than 87,000 calls have been exchanged between patients and nurses; the calls averaged 8 minutes. Virtual nurses improve patient experience, have caught potential errors and contribute to decreased length of stay and readmission rates.
Virtual nurses also relieve the burden on bedside nurses, act as coaches for new nurses and provide support to virtual and bedside colleagues.
One nurse told Dr. Collins she never wanted to work without a virtual nurse again. Bedside nurses leverage their virtualized partners for as many tasks as possible.
Dr. Collins added that she has heard nurses say they decided not to call out because they knew they would be working virtually.
What's next?
The system is considering putting virtual nursing in areas such as the emergency department. The expansions will come with a few changes, including more comprehensive training and orientation
"We need to figure out how to work very differently and how to be nimbler in how we utilize our experienced registered nurses," Dr. Collins said. "But we also need to leverage virtual technology for other roles, other clinicians and providers as well for healthcare overall."
Her advice for systems wanting to do something similar: "Make sure you know what you actually need, not the shiny dangling object that somebody wants to sell you and says it works in all these wonderful ways. Figure out some of your own workflows, determine what you have that you could leverage today. That is the spirit of innovation that we are looking to capture because it doesn't need to be perfect. Let's try it. Where did it go really well? Where did it go wrong? How could we make it better? What can we do? Leveraging the mindset of critical inquiry and creating this work as a standardized practice for virtual care is really important."