I enjoy working with students and residents, so I was excited to be asked to present on the topic of virtual nursing. I asked who would be co-presenting from the nursing side, and I was met with a blank stare.
I have experience with virtual nursing technology and implementation, but I’m not seeing hospitalized patients at the moment. I haven’t seen it through that particular lens. I also can’t provide the nursing point of view. I was eager to bring one of my nursing colleagues on board.
As with any presentation, we wanted to come up with a catchy title that would make people want to attend, especially given the scheduling constraints for our anticipated audience. My proposed title of “Virtual Nursing: A Promising Fix or an Expensive Band-Aid” was probably sassier than the organization would have liked, so we toned it down a bit. After creating just enough of an abstract to be able to start advertising the talk, we split up to start creating content.
If you have recently spent time scrolling through healthcare tech sites, you probably noticed that virtual nursing is having a moment. Every few weeks, a new health system announces a pilot program, a vendor rolls out a freshly branded platform, and a press release lands in my inbox proclaiming that the future of inpatient care has arrived.
I understand the appeal, given the genuine staffing crisis that continues to grind down nurses across this country. However, the literature is starting to show that virtual nursing isn’t going to be the ultimate solution to a problem that has been building for decades. A recent study published in JAMA Network Open might give hospital leaders a reason to pump the brakes.
Before we dive into the data, we need to note that “virtual nursing” has become one of those terms that gets used in so many different ways that it risks losing all meaning.
At its core, virtual nursing refers to registered nurses who deliver care to hospitalized patients remotely, using video and/or messaging platforms instead of being physically present on the unit. The virtual nurse is stationed offsite, sometimes in a central hub within the same health system, sometimes even at home. They interact with patients and bedside staff through a screen.
Workflows might be active, such as assisting in tasks related to patient admissions. This could include reconciling medication lists, performing screening instruments, and helping educate the patient and family about what to expect. Similar tasks might be performed before or during discharge.
Another common use case involves virtual nursing teams that function as high-tech sitters. Sometimes they monitor multiple patients on a split screen, while at other times they might use AI-powered tools to determine whether a patient is at risk of fall or injury.
Less common but growing applications include triage support, documentation assistance, mentoring of newer bedside nurses, specialty consultations, preoperative screenings, interpreter services, and even serving as a second witness for high-alert medication administration.
Intensive care units have historically been early adopters of using virtual nursing for rapid response oversight. What is newer is the expansion of virtual nursing onto medical / surgical floors of the hospital. Most of the current conversation and controversy is playing out there.
Virtual nursing is often seen as the solution for nursing shortages. Some quick web searches reveal turnover rates of registered nurses to be greater than 15%, with large numbers of nurses leaving the workforce or planning to do so within the next five years.
One of my best friends is a nurse. She is constantly being floated to other units in the hospital that are outside of her specialty. She is sometimes assigned to be a sitter, which although important for patient safety, is a misuse of her time and skills since she is 1:1 in a lower-skill environment rather than performing her usual duties with multiple patients. For her, it’s not an easy shift, but is professionally unsatisfying.
Her particular specialty is hands-on. We haven’t really talked about virtual nursing, but I will get her thoughts as I pull this presentation together.
Virtual nursing is also touted as a way to retain nurses who have musculoskeletal issues or other reasons to move away from bedside nursing. Moving to virtual lets them bring their clinical judgment to the game in new ways, including the uncanny ability of seasoned nurses to spot the patient who is about to go sideways before the numbers change.
Virtual nursing can also free up time and attention for nurses who are physically at the bedside. It distributes some of the administrative burdens to a remote nurse.
This brings us back to the study, which was a cross-sectional, mixed-methods study drawing on the 2024 Nurses4All survey. The final analytic sample included 880 registered nurses working on medical, surgical, and intermediate care units across 418 hospitals in 10 states. These nurses had reported that virtual nursing was being used by their hospital, which made them well positioned to comment on whether it was actually helping.
In addition to answering questions about virtual nursing’s impact, respondents were also invited to provide a free text response to the question, “Please share any positive or negative experiences you have had working with virtual nurses.”
The short version of the findings is that virtual nursing is producing mixed results, and the mixed results lean toward unimpressive.
The majority of nurses in the study (57%) reported that the use of virtual nurses did not reduce their workload at all. Of that group, 10% said that virtual nursing actually increased their workload. Of the 43% who reported workload reduction, only 8% said the reduction was meaningful.
The quality-of-care findings were more favorable, but still underwhelming. A little over half of respondents cited a positive impact on care quality, but only 11% said that the improvement was substantial. Nearly half of the nurses reported no impact on quality, and 4% said that virtual nursing negatively impacted quality. As the authors said in their conclusions, these are decidedly mixed findings.
The free text responses fell into six themes: virtual nursing as a staffing workaround, virtual nursing as an extra pair of eyes, safety risks and time delays, added work, patient distrust, and administrative help or hindrance.
The staffing workaround theme is the one that should give hospital leaders the most pause. Nurses described a pattern in which virtual nursing was being used not as a supplement to adequate bedside staffing, but as a substitute for it. Multiple respondents noted that management was counting virtual nurses in the staffing ratio, which effectively reduced the number of physical bodies on the floor.
One nurse made the point as directly as possible. She would rather give up the virtual nurse entirely in exchange for having another person on the unit who could physically intervene when a patient needs it. That is not a ringing endorsement.
Nurses described the added work component through examples, such as having to correct documentation errors introduced by virtual nurses who lacked familiarity with the specific patient or the unit’s workflow. Others noted that by the time they had exchanged messages back and forth with a virtual nurse to address a concern, they could have simply handled it themselves in the first place. The overhead of coordination was, in some cases, consuming more time than the task being delegated.
The patient distrust findings deserve particular attention, because they highlight a reality that technology enthusiasts often underestimate. The patients who populate medical and surgical units are not usually digitally engaged, younger adults who are comfortable navigating a video interface while also managing acute illness, pain, and anxiety. They are frequently elderly, cognitively impaired, hard of hearing, or simply overwhelmed.
One nurse commented that patients treat virtual nurses like a commercial during their favorite show, ignoring them or trying to fast-forward them. That is blunt, but probably accurate in a meaningful subset of cases.
Another noted that virtual nursing only works well for patients who are cooperative, not in pain, and have all of their immediate needs met. That is a fairly narrow slice of the typical med-surg census.
To be fair to the technology, the study also identifies areas where virtual nursing provides genuine value, such as when a virtual nurse acts as a scribe for a bedside nurse who is performing physical tasks.
The authors ultimately concluded that virtual nursing might not be as much of a big win as hospitals expect, and using it to subvert staffing requirements is likely to create more problems than it solves. Virtual nursing is most beneficial when it is implemented purposefully with clear workflow definitions and adequate training for all involved.
I also see potential for work on the technology side. Nurses reported delays in messaging between virtual and bedside nurses, equipment failures, and camera and sound issues. These are examples of failures in workflow design, equipment selection, and testing. Vendors in this space should be doubling down on creating tools that actually fit into the hospital unit rather than those that look great in a demo.
As all good study authors do, the team noted the need for additional research, including analysis of the technology in units that were not part of the study, or analysis of variation across hospitals.
For hospitals that are deploying virtual nursing, it’s a prime opportunity to involve nursing informatics and clinical informatics experts to ensure that solutions drive value through improved outcomes and staff satisfaction. If implemented thoughtfully, virtual nursing has real promise. But gaps exist between the promise and reality. Closing them will require more than buying a platform and pointing a camera at the patient’s hospital bed.
Is your organization using virtual nursing? Has it lived up to the sales pitch or caused more problems than it has solved? Leave a comment or email me.
Email Dr. Jayne.
When I read Mr. HISTalk's pondering, my thought process went more towards availbiltiy for non-urgent appointments than urgent / 24-7…