Some health systems employ virtual nurses for administrative work and watching patients who are at a high risk of falling. Trinity Health is diving into virtual care with three-person hybrid nursing teams, according to Gay Landstrom, PhD, RN.
At the Livonia, Mich.-based system, a virtual registered nurse, a bedside RN, and either a licensed vocational nurse, licensed practical nurse, nursing assistant or certified nursing assistant work together to meet patients' needs by sharing the workload.
The three-person care model is already unique — most nurses are not used to working in teams — but adding a virtual nurse to the mix is "transformational," said Dr. Landstrom, senior vice president and chief nursing officer of Trinity.
Normally, if patients need a nurse, they have to hit a call bell that is picked up by the unit secretary, who would connect the message to a nurse, who might be busy with another task. If the patient needed medication because of pain in the incision site after surgery, for example, the nurse would contact the physician — who might also be busy — to make the order before they can pick it up.
With the hybrid nursing model, a virtual nurse can quickly work with the patient, make the order and contact the physician "without bothering the bedside nurse or the assistant," Dr. Landstrom said.
"By the time they call the bedside nurse and say, 'I've been talking to the patient in room 10, they are having pain in their incision site after their surgery. I've already determined that this is what they need, this is what I ordered; can you just go get them the medication?' The bedside nurse, all they need to actually do is draw the medication, go to the patient and administer it," she said. "It gets the patient's need met so much faster."
The model in action
While the in-person nurses engage in physical care, virtual RNs are conducting rounds to increase surveillance and meet patients' needs faster. If patients push a button to request their virtual RN, the team member can immediately appear.
"They actually have a 'knock,'" Dr. Landstrom said. "There's a 'knock' in our technology system that she can say, 'Hello, this is Mary, your virtual nurse. Do I have permission to enter your room?' It's very similar to if a bedside RN or a nursing assistant was knocking on the door and asking if it would be alright to come in."
Once the patient accepts, a camera installed on the wall across the bed turns on and swivels toward the bed; during off times, the camera is turned away for privacy and comfort. The room's TV and adjustable speakers broadcast the virtual nurse, who can zoom the camera to check the room and read IV pumps. If in-person care is needed, the virtual staff member can then connect with their team.
Dr. Landstrom said it was important the technology be unobtrusive. By having the camera and video screen permanently installed on the wall rather than on a cart the in-person nursing team has to roll in and out of rooms, there is less — not more — workload.
What inspired the hybrid team
With multiple reports pointing to an exodus of experienced nurses leaving within the next decade, Trinity wanted to ensure nurses worked at the top of their license and free up workers' time, she said. So, the system experimented with workforce models in about a dozen nursing units across the system. The trial and error method eventually found success in summer 2022, and by December, the system replicated the prototype in two hospitals.
Dr. Landstrom gave kudos to CommonSpirit, a Chicago-based system that has been experimenting with virtual nursing for years: "The virtual nursing part of our model, we definitely learned from CommonSpirit. I want to credit them with having done some good work that we learned from," she said.
The health system has been preparing to formally launch the hybrid teams for several months. On Sept. 25, Trinity ran a "dress rehearsal" before formally going live the next day. Currently, 38 hybrid nursing teams are assigned to 1,158 inpatient beds across eight states. The system trained 175 virtual RNs for this role.
The model helps retain older and more experienced nurses, Dr. Landstrom said, who naturally mentor younger team members while working virtually from a nearby campus.
"Nursing is really hard mental and physical work," she said. "Oftentimes, somewhere in the 40s, 50s, nurses will realize they physically don't want to continue doing the work. They might risk back injury, there's a lot of walking in these patient units, and they make a choice to leave bedside care."
The possibility of transitioning to virtual work can entice early career nurses to see a long future in nursing, too, and Trinity has succeeded in bringing experienced RNs back from non-clinical roles and nurses who retired early because of the job's physical demands.
"What happens now is really kind of beautiful," Dr. Landstrom said. "I knew we'd have great efficiencies, but it really has been wonderful to see."