ATA2023: Virtual Nursing Programs Adapting to Organizational Needs

A Virginia Health System Prepares for Its Virtual Nursing Rollout

Mary Washington Healthcare, headquartered in Fredericksburg, Va., and virtual care company Caregility announced last month the deployment of an in-patient virtual engagement solution as part of the health system’s upcoming virtual nursing program.

“It’s definitely exciting to be starting this new phase of care for our nursing staff and, of course, get safer outcomes for our patients,” Debra Marinari, associate vice president of hospital operations at Mary Washington Healthcare’s Stafford Hospital, said in her ATA2023 session.

Marinari did her research and proposed forging ahead with in-patient virtual support. In response, the two-hospital regional system turned to virtual nursing to mitigate the impact of a high nurse turnover rate, a lack of staff engagement and high labor costs.

The organization then tried a proof of concept for one nursing unit, using already-available Apple iPad devices from a previous initiative to save costs. At first, Marinari said, nurses were frustrated with workflows and buy-in was not there. But, as the proof of concept drew to a close, “toward the end, the nurses were like, ‘Wait a minute, where did all the virtual nurses go? We could use them,’ because they did see the benefits,” she said. The bedside nurses finally recognized that with a virtual nurse, they were free to focus on more immediate tasks and didn’t have to stay moored to discharge or admission.

Remembering her nurses’ initial frustrations, Marinari also decided to go with a solution to put cameras in patient rooms as a simpler measure for workflow purposes.

Heidi Steiner, Clinical Program Manager for Caregility, speaks at a day-three ATA2023 session while Debra Marinari, Associate Vice President of Hospital Operations at Mary Washington Healthcare’s Stafford Hospital, looks on.

“Technology is only as good as the workflows that we have,” added Heidi Steiner, clinical program manager for Caregility. She shared a slide listing the first set of workflows, starting  with virtual nursing at Mary Washington.

Marinari also said that the organization will use a virtual command center that a dedicated team of virtual nurses will work from. To measure what works and what doesn’t, they’ll keep an eye on nurse engagement, patient satisfaction, the rate of nurse turnover, quality and safety metrics, and readmissions.

“There’s so many more we want to do. Rounding, for example, is another one on my list,” Marinari said. “I’m getting a lot of interest from other disciplinaries, of course, that want to use this technology.”

Heidi Steiner, Clinical Program Manager for Caregility, shows a slide of Mary Washington Healthcare’s virtual nursing workflows at her ATA2023 session.

Because Mary Washington follows a triad discharge — where the patient, nurse and physician are all in the same room at the time of discharge — having a virtual nurse coordinate the process can reduce delays if the in-person clinician is late or unavailable. “With the help of the virtual nurse doing the discharge, they can all be together, they can all plan ahead so that nurse won’t be pulled into another room. The virtual nurse can plan ahead and make sure she or he is ready to do the discharge with the physician in the room,” Marinari added.

EXPLORE: How virtual monitoring is evolving in healthcare.

Stay Creative with New Virtual Nursing Programs

In the following ATA2023 session, some of the panelists challenged the thinking that a virtual nursing solution worked best with a centralized command center rather than the nurses being able to work completely remotely from their homes.

“Why can other practices have people work from home and provide virtual care, but our nurses have to be in a physical center somewhere to provide care?” asked Sarah Bell, the nurse administrator for virtual nursing, remote patient monitoring and advanced care at home for Mayo Clinic.

Bell added that healthcare organizations can and should put guardrails in place to ensure virtual nurses are delivering high-quality care remotely, and that allowing virtual nurses that flexibility will increase an organization’s recruitment capability and workforce retention. For instance, health systems can require that virtual nurses work from a private room or home office and provide the necessary equipment with the right security and the ability to track productivity.

“We’re so early in this, why are we boxing ourselves in?” Bell said. “You’re going to be able to retain the best, keep the best, even if they’re going through a life circumstance that’s going to move them across the country. I want my good nurses to stay.” 

Healthcare leaders discuss solutions to retain their nurses. From left to right: Moderator Tearsanee Davis, Director of Clinical Programs and Strategy for the University of Mississippi Medical Center’s Center for Telehealth; Pamela Ograbisz, Associate Vice President of Telehealth, LocumTenens.com and LT Telehealth; Ashley VonNida, Chief Nursing Officer, Equum Medical; Sarah Bell, Nurse Administrator for Virtual Nursing, Remote Patient Monitoring, and Advanced Care at Home, Mayo Clinic; and Dr. Troy Leo, Senior Medical Director for Virtual Health, Atrium Health.

Dr. Troy Leo, senior medical director of virtual health at Atrium Health, also said that virtual nursing should be viewed not as a way to change nursing ratios but as a tool to offload the heavy burdens on those bedside nurses’ plates. “Don’t try to sell virtual nursing as a way to lessen your ratios and lessen the number of physical nurses. It’s the wrong answer,” he said.

As a lesson for other healthcare leaders, Leo described a failure his team experienced when trying to spread virtual nursing beyond the initial COVID-19 medical surge unit. Because it had worked so well there — with patient and staff satisfaction scores increasing — Leo said the team thought they could just replicate the processes for different unit. However, because they didn’t consider the particular needs of the other unit, the virtual nurses weren’t used as much initially. So, he said, they adapted and communicated what support they could give based on the needs of that unit. “Make sure you’re really communicating what you can offer,” he said.

Tracking the key performance indicators of staff satisfaction, staff retention and the cost of labor will help keep a healthcare organization’s virtual nursing program relevant to the workers they want to support. It’s imperative to be “really data-driven and always evaluating and looking at how we’re doing it and where we need to go,” Bell said.

“That’s the beauty of virtual nursing, that it can always be changed. It’s malleable to whatever your needs are.”

WATCH: How Atrium Health’s virtual nursing observation program mitigates clinician burnout.

Houston Methodist Shares Lessons Learned from Fast Implementation

In less than a year, Houston Methodist rolled out a virtual nursing solution to some 20 units and has already notched about 20,000 patient encounters.

Because the large health system was experiencing many of the same workforce stresses as its peers, leaders knew they had to try something innovative to immediately help bedside teams, said Steve Klahn, the inpatient clinical director for virtual medicine at Houston Methodist.

Aroub Khleif, the organization’s administrative director of innovation, ambulatory and clinical systems, said a unified, team-based approach to break down siloes, coupled with reliance on the tech tools that were already available and recognized as secure, helped them stay agile.

“Your main focus when you’re initially launching should be to look and evaluate your existing technology stack, instead of trying to find a new solution,” Khleif said. “We opted into the path of, let’s use what we have. Do we have buy-in? Does this work? If so, we’ll go from there.”

Houston Methodist leaders discuss lessons learned from setting up their virtual nursing program. From left to right: Steve Klahn, Inpatient Clinical Director for Virtual Medicine; Aroub Khleif, Administrative Director of Innovation, Ambulatory and Clinical Systems; and Dr. Sarah Pletcher, System Vice President and Executive Medical Director for Strategic Innovation.

One element that Houston Methodist soon realized it was missing was the ability to make virtual nursing available for multilingual needs. “We quickly recognized that we missed something, and that was integration with a language service vendor. We want to be able to provide all of our services and be inclusive of all of our patients,” Khleif added.

Because that technology was already available in an ambulatory setting, Khleif said it was a two-day turnaround to make it available for virtual nursing. That was an important lesson in centering care inclusivity and meeting all of a patient’s needs.

Dr. Sarah Pletcher, the system vice president and executive medical director for strategic innovation at Houston Methodist, closed out the virtual nursing session with this insight: “Healthcare innovation really is a contact sport. You’re going to succeed. You’re going to fail. Both of those are important to do. Both are exhausting. Things like this, discussions where you can celebrate wins and the knocks we took along the way, are important.”

Keep this page bookmarked for our ongoing coverage of ATA2023. Follow us on Twitter at @HealthTechMag and join the conversation at #ATA2023.