Exploring health systems' virtual nursing staffing strategies
Health system leaders note that successfully implementing virtual nursing requires effective staffing strategies, such as identifying nurses with the right skills and experience.
Among healthcare's most intractable problems is the nurse staffing crisis plaguing hospitals and health systems nationwide. Nurses are vital to a healthcare system tasked with caring for an aging and ailing U.S. population; however, declining nursing program enrollment, high levels of burnout and insufficient recruitment and retention strategies are driving a worrying shortage of nurses. To address this issue, health systems are increasingly turning to virtual nursing.
The virtual nursing model involves a nurse remotely completing various tasks, including admissions and discharge, patient education and medication reconciliation. Multiple tools support the model, such as synchronous and asynchronous telehealth platforms, remote patient monitoring devices and generative AI solutions.
Healthcare professionals view virtual nursing as a strategy to reduce burnout and enhance recruitment. However, the implementation approach requires careful consideration, and health systems must address several challenges, particularly with respect to staffing.
Here, health system leaders detail key strategies for staffing virtual nursing programs.
GAIN NURSE BUY-IN
Though virtual nursing has numerous benefits, the model changes nursing workflows, which could be met with resistance from nurses who are used to certain processes and protocols. Thus, gaining staff buy-in and engagement is crucial.
"This is a totally new role, it's a new type of delivering patient care, and we knew that getting our bedside nursing teams engaged in understanding the potential for this role and the opportunities it brings for patients and staff was going to be critical," said Andrew Thum, DNP, RN, director of health system nursing workforce operations at Jefferson Health.
The Philadelphia-based health system launched its virtual nursing pilot in July 2024. Through the pilot, two virtual nurses support 46 patient beds across two units. They focus primarily on admissions and discharges, patient education, rounding, scribing for bedside staff and bedside nurse support and mentorship, Thum said.
This is a totally new role, it's a new type of delivering patient care, and we knew that getting our bedside nursing teams engaged in understanding the potential for this role and the opportunities it brings for patients and staff was going to be critical.
Andrew Thum, DNP, RNDirector of health system nursing workforce operations at Jefferson Health
One strategy that helped Jefferson leaders gain buy-in was selecting nurses from the units to serve as virtual nurses.
"They were working with their colleagues at the bedside virtually, but they knew each other," Thum said. "So, there was already that kind of built-in trust that was there from a colleague-to-colleague standpoint."
IDENTIFY THE NEEDED SKILLS
Virtual nursing requires a unique skill set that combines in-person, bedside nursing with virtual care delivery competencies. When selecting virtual nursing staff, program leaders should look for experienced and agile nurses.
At New Orleans-based Ochsner Health, flexibility is a key skill for virtual nurses who manage admissions and discharges.
"We need to be flexible because today we know what our staffing model looks like, what our hours are, but tomorrow they may be different, and then next year they may be different," Dallas DeVore, RN, Ochsner's virtual nurse supervisor, explained. "So that's one of our biggest things, and we tell everyone, 'It's okay, no harm, no foul, if you're not a flexible person.' It doesn't mean that you're not a good nurse. It doesn't mean that you're not a virtual nurse; it just means that right now, this may not be a good fit."
Interviewing can help health system leaders identify nurses who have the necessary flexibility. DeVore noted that one question asked during virtual nursing interviews at Ochsner is, "Why did you become a nurse?"
The nurses whose answers were focused on patient care and helping people have typically been more successful in virtual nursing roles than those who wanted specific hours or case types, DeVore said.
Additionally, prior nursing experience is essential to success as a virtual nurse. At Jefferson, for instance, virtual nurses must have at least five years of in-person nursing experience.
"We felt that that was really important because we wanted to position this virtual nurse to not be just completing tasks that arguably a nurse of a lesser experience could accomplish just as efficiently, such as admission documentation or history, but there were pieces of the role around mentorship of new staff, scribing for staff and patient education that we felt like a nurse with more seasoned experience would be more valuable in this role," Thum said.
Further, filling virtual nursing positions with more experienced nurses offers a new career pathway for older nurses who find bedside care too physically taxing.
Another key skill for virtual nursing staff is good therapeutic communication skills. Thum pointed out that communicating with patients and bedside staff through technology adds a layer of complexity, which means virtual nurses need to be excellent communicators in person and be able to transfer that skill to virtual setting.
CONDUCT COMPREHENSIVE TRAINING
Even though health systems are searching for experienced nurses with a specific skillset to fill virtual nursing positions, training is still an essential aspect of their staffing strategies.
We're not teaching them how to be a nurse. The most important thing is we're getting nurses with experience, so we're teaching them how to be a virtual nurse.
Dallas DeVore, RNVirtual nurse supervisor at Ochsner Health
At Ochsner Health, virtual nurses undergo step-by-step training for their new tasks. For example, they are trained on the virtual discharge process and how it differs from the in-person discharge.
"We're not teaching them how to be a nurse," DeVore noted. "The most important thing is we're getting nurses with experience, so we're teaching them how to be a virtual nurse. All we're teaching them is how to go through our workflow and then how to use the equipment and how to troubleshoot the equipment at the bedside if the iPad is off or the monitor's not working."
Program leaders are also mindful of differing digital competencies, and hence, training for the technological side of virtual nursing is tailored to each new staff member.
"[If] we have somebody who is tech savvy, loves Epic and knows how to do everything in Epic, then we just need to teach them how to use video and how to be able to use the two-way audio with the patient and then how to charge it," DeVore said.
Thum also highlighted the importance of having virtual nurses who are comfortable with technology and have experience with different kinds of technology.
This isn't as much of a limitation as it used to be. With the ongoing digital transformation of healthcare, most nurses are using technology in their day-to-day work.
"Bedside nurses use all different kinds of technology every day, whether it be the electronic health record, whether it be different patient point of care equipment that they use to do patient testing, et cetera… many of them, of course, are used to using tech," he said. "It's whether or not they're comfortable with using tech as a primary tool of their job."
Additionally, Thum said, Jefferson Health includes communication strategies in virtual nursing training to ensure the nurses can effectively educate patients and assess their understanding of the information.
BE MINDFUL ABOUT STAFFING AS YOU SCALE
Health systems with virtual nursing programs are eager to expand them; however, they must proceed carefully to avoid inadvertently burdening nurses or jeopardizing patient care.
Thum explained that as Jefferson Health works on expanding its virtual nursing program to approximately 200 beds by 2026, program leaders are trying to ascertain how many beds one virtual nurse can support at a time.
"I think what we're interested in evaluating as we expand is more so the workload or task burden," he said.
The health system plans to begin with one virtual nurse supporting 50 to 75 beds. But as the expansion solidifies and workload data becomes available, the health system may make adjustments.
For example, Thum explained that med-surg telemetry units tend to have a high turnover rate, higher admissions and discharge volumes and higher transfer activity. Virtual nurses could be especially helpful in supporting the bedside nurses in these units. However, that one-to-75 ratio may not be the right mix in these units with high activity, and leaders would need to reevaluate that ratio.
Another way to approach virtual nursing workload could be having a task queue for a set of virtual nurses rather than assigning the nurses a certain number of beds. Thum noted that many health systems they spoke to have organized their virtual nursing units this way.
The work to identify the best practices for virtual nursing is ongoing. Still, Thum and DeVore both emphasized that it behooves health systems to determine how to best implement and staff these programs as virtual nursing's popularity rises.
"Virtual nursing is here to stay, and it's just going to keep growing and growing," DeVore said.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
