Care delivery models shifted to team models of care where one experienced RN oversaw the care being delivered by less experienced RNs, licensed practical nurses, and unlicensed assistive personnel. Post-pandemic, there are more less experienced RNs at the bedside than those with experience and the acuity of patient illness is higher than pre-pandemic levels, resulting in an experience-complexity gap. The experience-complexity gap puts new, graduate nurses at a disadvantage. There is a lack of experienced nurses available to precept new graduate nurses and nurses at the bedside continue to feel the nursing care shortage. How can the healthcare system support nurses at the bedside?
An innovative, new approach to a tried-and-true care model: virtual nursing
Virtual care is not a new concept. It’s been in place for years as telehealth and was most often used in outpatient and primary care settings by providers to have virtual patient encounters and by nurses to follow up and educate their patients. Telehealth became very popular during the COVID-19 pandemic and with mental health services. However, reimbursement for virtual care is changing and those who bill for services need to stay up to date on Centers for Medicare & Medicaid Services' changes regarding this type of encounter. Healthcare professionals are lobbying to continue these services since this type of encounter may be the only way some people can receive healthcare.
Virtual care has also been used in acute care for years as Tele-ICU where a group of nurses and providers monitor hospitalized patients remotely and then alert the clinicians if there appears to be an issue with a patient. The Tele-ICU model has worked well for hospitals that lack resources such as critical care intensivists or experienced critical care nurses. Telemonitoring in healthcare has used remote monitoring to monitor patient’s heart rhythms and if there was an anomaly, the technician would call the nurse. The difference with telemonitoring is the telemetry technician could not actually see the patient.
A new opportunity for virtual nursing
The post-pandemic era has made it clear that there are not enough experienced nurses left at the bedside to support new, graduate nurses. Bedside nurses find they are challenged with finding enough time in their day to do thorough patient admissions, discharges, and education, which leaves them feeling stressed. The virtual nurse care model is an opportunity to support new and experienced nurses.
Supporting new nurses…
The research is clear; new graduate nurses up through the first year or two of their practice leave their jobs because they don’t feel supported in their onboarding. New nurses possess beginner knowledge and competencies. They don’t possess the knowledge and experience to make complex clinical decisions and rely on experienced nurses to support, educate, and guide them in their decision making. Today with the shortage of experienced nurses at the bedside, this just can’t reliably happen.
Virtual nursing brings experienced nurse knowledge, expertise, and support to less experienced nurses at a push of a button. Experienced virtual nurses can see the electronic healthcare record and the patient via a video camera in the patient’s room. They are available at a click of a button to help nurses make bedside decisions, perform a procedure that the nurse at the bedside hasn’t ever done or hasn’t done recently, and be the support system for new nurses in the first few years after graduation. Think – nurse expert in your pocket.
Supporting nurses at the bedside…
Time is one of the biggest challenges facing nurses today. There simply isn’t enough time to do everything that needs to be done with patients. The work of nursing is time consuming, especially when it comes to completing admissions, discharges, patient education, and meeting with families. Experienced nurses often feel they don’t have time to provide the “quality care” that’s synonymous with being a good nurse.
Virtual nursing can be the answer. Virtual nurses can be used to support busy bedside nurses with doing admissions, discharges, and educating patients and their families. They can monitor vital signs, laboratory values, and diagnostic tests. They can also assess patients virtually, monitor other data trends, and alert the bedside nurse when there may be an issue. Often unlicensed personnel are providing direct care to the patient. Having the ability to push a button and have a virtual nurse remote into an encounter to assess a situation can be beneficial with identifying potential issues before they become problems.
Improving care quality through virtual surveillance and support…
Meeting accreditation standards and patient expectations for quality care is no easy feat. With the lack of experienced nurses at the bedside, no time to do real-time quality care and safety reviews and education, hospitals are struggling with monitoring and improving their quality outcomes. Having a team of virtual nurses who can monitor procedures, care, and provide education in real-time to correct care variation will only help improve quality and safety measures, especially for interventions that are high risk yet low frequency.
Where do we find virtual nurses?
During the pandemic and afterwards, experienced nurses opted to leave the bedside and move into non-bedside roles or to retire from the profession. This is an opportunity to bring experience back to the bedside as a virtual nurse; being able to practice nursing without the physical work required. Experienced nurses may be looking for the next opportunity in their career. If they don’t want to move into management, advanced practice, or education, there are limited opportunities available to them. Virtual nursing provides an opportunity to move laterally into a new role that they previously hadn’t considered. We talk about the importance of keeping talent within our organizations; offering a virtual nursing option gives nurses the ability to continue practicing while supporting and educating newer nurses and aiding experienced nurses who remain at the bedside.
It's time to embrace this new model of nursing care
Nursing has a problem; we don’t have enough experienced nurses at the bedside, and we don’t have the ability to adequately support new nurses as they begin practicing. Nursing needs to look at innovative models of care that leverage experience and support those who need it. Virtual nursing can be the answer. It brings experienced nurses back to the bedside, it keeps experienced nurses who are looking for something different in their career an opportunity to stay within their organization, and it supports our newer nurses so they don’t get frustrated and leave the profession. Organizations need to invest in virtual nursing, which provides experienced nurses the opportunity to continue to practice the art and science of our profession.
