Nationwide, healthcare leaders are recognizing the value of incorporating virtual nursing into service lines that have historically followed direct care models. Virtual nursing is a logical response to widespread health system challenges, such as high vacancy and turnover rates among registered nurses, hospital capacity shortages, the untenable cost of hiring agency workers, and unresolved RN burnout.
Nationwide, healthcare leaders are recognizing the value of incorporating virtual nursing into service lines that have historically followed direct care models. Virtual nursing is a logical response to widespread health system challenges, such as high vacancy and turnover rates among registered nurses, hospital capacity shortages, the untenable cost of hiring agency workers, and unresolved RN burnout.
To learn more about the benefits of virtual nursing and how to deploy this innovative care model effectively, Becker’s Healthcare recently spoke with two experts from Banyan Medical Solutions: Tony Buda, founder and CEO, and Carol Boston-Fleischhauer, MSN, RN, senior vice president and chief clinical officer.
Reducing workload intensity for direct-care staff, while improving patient throughput
During the COVID-19 pandemic and beyond, many healthcare organizations turned to virtual nursing as a strategy to keep beds open, stabilize their permanent workforce, mitigate the unsustainable cost of agency and travel nurses, and address stressful working conditions.
According to Ms. Boston-Fleischhauer, the clinical workforce challenges that emerged during the pandemic are starting to stabilize; in particular, some turnover reduction. Still, the inpatient work environment remains extremely stressful. Key contributors include higher patient acuity levels, continued staffing shortages in many markets, and time consuming care needs that aggravate RN burnout.
“In 2024, there are more registered nurses in the workforce; but fewer of them want to work in acute care,” Ms. Boston-Fleischhauer said. “We’ve had a 10-year decline in registered nurses interested in inpatient employment. Virtual nursing can support the work environment for permanent registered nurses by reducing their workload intensity and providing them the support they need.”
In the post-COVID era, both patient volumes and lengths of stay are on the rise. As a result, capacity at hospitals and health systems is at a premium and emergency department boarding has become a significant problem. “Many health systems are embracing virtual nursing as a primary strategy for improving throughput and decreasing length of stay; creating more capacity and revenue potential” Ms. Boston- Fleischhauer said.
Virtual nursing is also a market differentiator for organizations looking to recruit direct-care clinical staff; in particular, novice RNs looking for additional organizational support as they transition from academia into practice. “Working at the top of licenses is a big deal for registered nurses, but it can be elusive,” Ms. Boston Fleischhauer said. “Organizations use virtual nurses to assume time-consuming work that does not require direct patient contact; this provides direct care RNs the time they need to practice at the top of their license. The result? An improved work environment and dramatically decreased RN turnover levels.”
Traditionally, most healthcare organizations have looked to virtual nurses to take on documentation-heavy responsibilities such as admissions and discharges. Now, hospitals and health systems are getting excited about other clinical work that could be optimized with virtual nursing. Examples include patient rounding, focused patient education, 24-hour chart checks, structured mentorship of novice nursing staff and more.
“Another area where virtual nursing is exploding outside of the acute care setting is in the emergency department,” Ms. Boston-Fleischhauer said. “Opportunities exist for virtual staff to initiate select care for ED patients being admitted; including admissions and rounding, while waiting for an inpatient bed to become available. The result? ED RNs rely on the virtual nurses to assume that work, while the ED nurses prioritize their time with patients requiring ED RN skills and expertise. Decreases in inpatient LOS and associated operational costs also occur. Virtual nurses can support accelerated discharges as well.”
Looking ahead, Ms. Boston-Fleischhauer noted it’s only a matter of time before organizations use virtual nurses as they move patients to transitional care services; including skilled nursing facilities or home health, as well as the growing trend of organizations offering the hospital-at-home model.
More than a technology solution to workforce challenges
Although interest in virtual nursing is growing fast, no clear industry standard or defi nition exists for how to deliver care in this way.
“I would still call virtual nursing the Wild Wild West — we haven’t yet landed on the gold standard,” Ms. Boston-Fleischhauer said. “As a result, organizations across the country are trying to fi gure out how to leverage virtual care for patients and families, but they don’t have a lot of clarity about how it is defi ned, let alone how to design the model to achieve the outcomes that are needed; be they workforce quality, safety, patient experience, or financial.”
Based on nearly a decade of experience in virtual nursing, Banyan Medical Solutions takes a fundamentally different approach to optimize model design and sustainability. “From the start, we understood that successful virtual nursing involves more than just technology. It’s about overcoming the roadblocks in staffing and implementation to make it truly sustainable,” Mr. Buda said.
Ms. Boston-Fleischhauer reiterated this point, noting the role of technology in Banyan’s broader strategy and aims. “We view virtual nursing as a care model innovation that optimizes virtual communication technology,” Ms. Boston-Fleischhauer said. This approach, she said, requires a service strategy based on three core components.
Banyan Medical Solutions leverages a comprehensive, virtual communication technology platform to connect direct-care staff, virtual staff, and patients and families in the patient room. This platform is intentionally designed to support the appropriate types of communication and visual capabilities needed for virtual care.
Care Connect is another key tool that rounds out Banyan’s technology platform. This proprietary tool is integrated with a healthcare organization’s admission, discharge and transfer (ADT) feed and automates all scheduled workflow notifications. Care Connect also populates each virtual nurse’s work list and provides direct care nurses with full transparency into the status of virtual work on different units.
“Banyan Medical Solutions is the only organization in the country with a tool like this, which eliminates the need for direct-care staff to call virtual nurses to notify them of virtual work needs.” Ms. Boston-Fleischhauer said. “This increases the efficiency of our virtual nursing model, and provides assurance that virtual nurses are handling the care tasks delegated to them. As charge nurses and nurse managers manage throughput, they can also see that the virtual work needed to move patients through the system is occurring.”
The second key element for a virtual nursing care model is access to a critical mass of highly experienced registered nurses. If an organization already has elevated turnover rates or increased turnover rates, it’s not practical to transfer direct care nurses into virtual roles. That would further disrupt the stability of the direct care workforce, aggravating the very problem that virtual nursing is intended to solve.
“Banyan Medical Solutions employs hundreds of highly experienced registered nurses that assume virtual roles on behalf of our clients 24/7,” Ms. Boston-Fleischhauer said. “Direct care nurses need help and support 24 hours a day. Virtual nursing isn’t a part-time solution to a part-time problem. It requires 24/7 access to qualified and competent registered nurses that can consistently provide virtual care.”
Change management is the third component of a successful virtual nursing program. This is extremely important for sustaining virtual nursing over the long term, but it’s often overlooked. Virtual nursing requires direct-care nurses to function in different ways and become comfortable with working in a team environment. It can be difficult for nurses to shift gears if they have practiced for decades in one model of care, such as primary or total patient care.
“When we partner with clients, we invest heavily in a comprehensive change management strategy,” Ms. Boston-Fleischhauer said. “This helps staff at all levels understand and support the model, as well as its benefits for them personally. Skill building and coaching for direct care staff is essential.”
Driving sustainability with organizational preparedness at all levels
When an organization commits to virtual nursing, the whole organization must be ready and committed, and understand how to make the model sustainable over the long term.
“Unfortunately, many technology firms provide little assistance with care model change, let alone ensuring that registered nurses at all levels become comfortable with the virtual nursing model that their technology is intended to facilitate,” Ms. Boston-Fleischhauer said.
When Banyan Medical Solutions partners with a healthcare organization to design and implement a virtual nursing model, it works with key stakeholders at all levels. Initially, Banyan partners with the executive team to establish clear goals and objectives, as well as an understanding of what will be required to move to a new model of care.
Banyan also works closely with unit managers to develop comprehensive work plans that reflect the needs of the unit. “While an organization is transitioning to a virtual nursing model, units can’t close down,” Ms. Boston Fleischhauer said. “We help to create work plans that support care model changes and work in sync with the operational challenges that units face.”
Providing managers with the skill building and training needed to drive care model innovation is equally important. Chief nursing officers can’t achieve the desired outcomes from virtual nursing unless nurse managers at the operating level possess the necessary skills to lead care model change.
Over time, ongoing coaching is also essential, because virtual nursing isn’t a “one and done” conversation. Staff need periodic reassurance even after a virtual nursing model is deployed.
“One of Banyan Medical Solutions’ key differentiators is that we work with clients over the long term. We are partners from the day the contract is signed,” Ms. Boston-Fleischhauer said. “Once organizations become comfortable with the virtual nursing model, they often identify new areas that could be virtualized. We love to be thought partners with clients to determine what else can be virtual in the acute care space and beyond.”
Best practices for deploying a virtual nursing care model
Ms. Boston-Fleischhauer acknowledged it tends to be easier to embrace virtual nursing as a care support to a legacy model than it is to adopt virtual nursing as a care model innovation. As a result, organizations must ask a key question: How do they define virtual nursing? This decision must be made at the executive level.
Once leadership teams agree on the goals and objectives for a virtual nursing program, they need to analyze the return on investment. Banyan Medical Solutions partners with clients on this work and helps to determine what is required for measuring and monitoring the model’s impact.
“We determine on a monthly basis where organizations are with the return on investment. We’re proud of our data-driven approach to evaluating the productivity of the model and outcomes,” Ms. Boston- Fleischhauer said. “Our disciplined approach to tracking and trending agreed-upon metrics provides executive teams with real-time data to confirm positive model trends as well as identify and implement course corrections if data suggests the need for adjustment.”
Banyan Medical Solutions, the first company in the U.S. to introduce virtual nursing to the industry, started implementing best-practice virtual nursing solutions long before the COVID-19 pandemic. Leveraging its deep experience in this space, the company has developed a playbook for implementing, scaling, sustaining and maximizing the results from a virtual nursing care model.
“A true integration of technology, consulting, change management, staffing and ongoing support sets us apart from competitors who merely sell technology,” Mr. Buda said. “Our goal is clear: Demonstrate value realization to ensure our clients achieve measurable outcomes and expand their capabilities seamlessly. This proven, turn key process provides clientele the ability to scale. Our experience and dedication enable us to handle the details, so our clients can focus on what matters most — patient care.”