Gina Ellerbee (left), Administrative Director of Nursing Practice, and Summer Blackerby, Chief Nursing Information Officer, stand in CoxHealth’s virtual nursing command center.

May 23 2024

Nursing Leadership Is Crucial to Using Virtual Care Effectively

Artificial intelligence can also help providers retain experienced nurses and increase support for bedside care teams.

The pandemic may have spotlighted nurses as unsung heroes, but it also led to a mass exodus of senior nursing staff, exacerbating the existing staffing shortage. To fill these gaps, providers are using virtual care and artificial intelligence to support bedside teams, reduce burnout and give veteran nurses a new way to continue the work they love.

In Springfield, Mo., the pandemic left CoxHealth in need of experienced nurses to mentor younger colleagues. With six hospitals and 80 clinics to support, Chief Nursing Information Officer Summer Blackerby and Administrative Director of Nursing Practice Gina Ellerbee saw virtual nursing as a promising solution.

In 2022, as CoxHealth was about to start its annual budget planning, Blackerby and Ellerbee seized the opportunity to begin a virtual nursing pilot as a proof of concept before requesting funding for a virtual care program. They launched the pilot on two acute care floors at Cox Medical Center South, later expanding to a third floor in a community hospital in Branson.

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They had just enough staff to run a virtual team three days a week, but they moved forward with a 90-day pilot, tracking metrics that they had identified at the outset. Using both in-room cameras and a cart model, they wanted to connect bedside nurses with virtual nurses who could provide an extra set of eyes. The pilot went so well that CoxHealth extended it for a year before embarking on a phased rollout across the system.

Nurses’ input was integral to the process and helped to secure buy-in. “Our nurses came up with a lot of the plans, and they came up with the workflows,” Ellerbee says. 

Changing Clinical Workflows for the Better

Today, a 5,000-square-foot virtual command center provides support for nearly 650 medical-surgical and intensive care unit (ICU) rooms. To join the virtual team, nurses must demonstrate excellent communication, clinical judgment and critical thinking skills. “It really is an elite place for them to be,” Ellerbee says.

IT solutions include Philips eCareManager enterprise telehealth software, Capsule Surveillance software, the Caregility platform and a centralized database of patient information.

LEARN MORE: Why integrating AI with virtual care transforms workflows and care delivery.

Electronic health record (EHR) system integration and AI predictive models in the Philips software pull in data that helps virtual nurses prioritize tasks. The command center provides early warnings so that nurses can attend to patient needs sooner. That has paid off with a reduction in falls, hospital-acquired infections and other issues.

Virtual care has been equally powerful for nurses, Blackerby says. “It’s great to see them excited about nursing again,” she says. “It’s really revived their overall outlook.”

Collaboration is the heart of the program. For example, if a medical-surgical nurse identifies a patient who needs extra attention, they can pull in an ICU virtual nurse, who may also tap an early intervention team on the floor. All work together to determine the best course of action.



“I knew it would happen a little bit, but it has surprised me how much they collaborate,” Ellerbee says.

For CoxHealth, the program has been transformative. The command center is located in the tower where nurses spent two years caring for COVID-19 patients. After the crisis, the space held painful memories for many nurses. Today, it represents a positive new chapter.

“When they walk out the door at the end of the day, they feel good about what they did,” Ellerbee says. “They feel like, ‘I did everything I was supposed to do for my patients. I did a great job today.’”

Adapting to Staffing Challenges and New Technologies

Guthrie Clinic also struggled after the pandemic to recruit enough nurses for its 10,000-square-mile service area in Pennsylvania and New York. It adopted telesitting in 2022, but paying nonlicensed staff to sit with patients was costly and still didn’t meet the need, says Terri Couts, senior vice president and chief digital information officer.

The next iteration – a telesitting platform with built-in AI – had an immediate ROI, enabling one telesitter to monitor 16 people.

DIVE DEEPER: Remote patient monitoring enhances nurse workflows.

“That was the introduction of our virtual care model redesign,” Couts says. “We started thinking, ‘How can we do this differently, and what are the avenues we can impact?’”

Increasing senior nursing support was a priority, especially in the ICU. In early 2023, Guthrie began to expand its virtual care capabilities. First, it data-mined the safety event system to identify focus areas and success measures.

Guthrie then designed a program to support those metrics and began hiring nurses. Virtual care nurses need a different skill set to sit on the other side of the camera, Couts says — not only a substantial amount of experience, but also the ability to teach and mentor.

Source:, “Surveyed Nurses Consider Leaving Direct Patient Care at Elevated Rates,” Feb. 17, 2022

Today, more than 500 of Guthrie’s medical-surgical and ICU rooms are equipped with cameras and two-way speakers. Virtual nurses attend rounds, advise on certain procedures and provide double-checks for high-risk medications.

That means that instead of having to leave the bedside to ask for a double-check — a process that used to take about 33 minutes — an ICU nurse can call a virtual nurse, who can complete the process in about 90 seconds.

READ MORE: Learn three keys to success with a generative AI platform.

Retaining nurses and nursing expertise is one of the most significant workforce outcomes of virtual care, says Oriana Beaudet, vice president of nursing innovation for the American Nurses Association. “Some nurses who were educated during the pandemic had to supplement traditional clinical experiences with simulated care. To have a highly experienced nurse resource, even if virtual, for newer nurses to learn from— as a care resource, to discuss coordination, to impart knowledge around techniques and procedures, or to navigate organizational nuances— is absolutely priceless,” she adds.

Building the Role of AI in Workflows

SSM Health, which serves Illinois, Missouri, Oklahoma and Wisconsin, is easing clinicians’ burdens by leveraging AI to prevent burnout. SSM Health has used Nuance for natural language processing since 2020, adapting its use over time as the technology has improved, says Chief Medical Information Officer Ann Cappellari.

When the pandemic resulted in a significant staffing shortage, the need for efficiencies became even more pressing. Patient documentation was an obvious place to start, Cappellari says. At first, SSM Health used NLP to record patient visits so that the recordings could be transcribed, but the process was clunky and required a good deal of training.

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All of that changed when the most recent versions of generative AI arrived, particularly in the form of Nuance DAX (Dragon Ambient eXperience) Copilot, amplified by Microsoft Cloud for Healthcare. Integrating this technology with SSM Health’s EHR system enables clinicians to fire up the app to capture conversations and document patient visits automatically.

DISCOVER: How can healthcare balance the reward and risk of AI?

“Almost overnight, the output of the solution changed,” Cappellari says. “We don’t need to do any training at all, and this works 50 times better.”

Humans still review the final product, but the overall impact has been significant, she says. Patients like the increased face time with their clinicians, who no longer have to spend visits typing notes on the computer.

For now, SSM Health is using Nuance DAX with physicians, but Cappellari says that Chief Nursing Informatics Officer Cheryl Hager is developing workflows that will enable nurses to adopt the technology in the future. “It’s an absolute game changer for providers,” she says.

Photography by Mark Katzman

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