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Curbside Consult with Dr. Jayne 5/19/25
One of the hospitals where I am on staff has decided to take a dip into the waters of virtual nursing, at least according to a buzzword-filled newsletter that came out last week. Apparently, the project is going to be transformative, innovative, and cooperative, although having all those words in the same opening paragraph made me wonder if hospital administration was having fun with a thesaurus app while writing it. They left out some of the adjectives that we sometimes associate with technology projects, including disruptive, aggressive, and intrusive.
At no point in the newsletter did they actually explain what type of virtual nursing workflows they planned to implement, or what the timeline might look like. I’ve done plenty of work in this space and know that if you’ve seen a virtual nursing project at one organization you’ve seen one project and that rarely do two of them look alike. There are so many variables, including which EHR will be incorporated, what kind of equipment will be used, and which of the many problems the organization is trying to solve with the solution. There was also no mention of the timeline, the holding of stakeholder sessions, or any contact information about the project other than to contact the director of nursing for questions. I don’t envy the volume that her inbox is likely to see with all the questions I heard thrown about in the physician lounge.
I thought the timing of the newsletter was particularly interesting, since we just had our quarterly medical staff meeting last week and that would have been a fantastic opportunity for socializing the concept with the majority of physicians who are on staff at our facility. Of course, that begs the question of whether administrators actually want to have a dialogue about the project, leading my more conspiracy-minded colleagues to think the lack of information was part of a well-orchestrated plan to cut physicians out of the process. Having watched a number of technology projects unfold here, I’m not sure that I would give some of our leaders credit for being organized enough to intentionally alienate us. More likely than not, it’s just the usual confusion and lack of communication and coordination that we see most of the time.
One of my colleagues asked me what I thought about virtual nursing and which variety of the solution we should adopt. In thinking through current needs and what I hear from the floors, I think a quick win would be to adopt a solution that enables virtual sitters. Right now, the hospital is so short staffed for sitters that they’re floating registered nurses to do the job, which creates an incredible cost burden every time a physician orders a sitter for their patient’s safety. There’s a lot of pushback when the order is placed, which isn’t a good look for any healthcare facility. It’s also a dissatisfier to the nurses who are floated, since they end up working far below the level of their licenses. Although implementing a virtual sitter program would create some operational savings, it’s a huge capital investment, as it would require adding cameras and technical infrastructure throughout the facility.
Having that kind of technology in patient rooms could also be used as a stepping stone to implementation of AI-powered fall prevention programs, which I think are going to be increasingly important as the average age of hospitalized patients continues to increase. Due to the technology lift, organizations that employ these kinds of solutions usually do so on a unit-by-unit basis, which makes sense to reduce disruption. Still, I could see the neurology unit duking it out with orthopedics and the general medical service to see who gets to go first. I suppose if hospital leaders wanted to get creative they could throw in some teambuilding and elements of competition and turn it into a formal challenge to see who can earn the right to go first. Personally, I think it would be more entertaining than the usual teambuilding they try to do, which usually leads to worsening resentment by the lunch break, if not before.
While we were talking about it, someone asked whether I thought it would be better for the staff of such a program to be employed by the hospital or by a third party. There are certainly pros and cons with either approach. Making the virtual sitters part of our hospital would have the potential to build collegiality and trust, and might allow us to tap a larger candidate pool due to the virtual nature of the work. On the other hand, having them work for a third party might lead to culture issues if there is a perception of difference as to how those sitters are treated versus in-person employees. It certainly changes the appearance of the balance sheet, which is more important to some administrative types than others.
When it comes to virtual nursing of the registered nursing variety, I think it’s critically important that the nurses be employed by the hospital so that there is a single cohesive nursing workforce. Virtual nursing has enormous potential when it comes to creating longevity in the staffing pool – allowing nurses to float to virtual roles when they need to because of illness, injury, or disability. There’s potential for hybrid roles where nurses work both virtually and in person, which helps keep skill sets sharp for future role changes. Such an arrangement also prevents the feelings of “us versus them” that I’ve seen in other virtual projects, where the virtual staffers may be in another state or otherwise never set foot within the facility.
I’ve seen so many different kinds of projects, though; I think it would be challenging to figure out where to start first in our facility. Would we want to have virtual nurses primarily for admission, discharge, or both? Or would we use a more hybrid model where several less experienced bedside nurses might be paired with a more experienced virtual nurse who serves as a supportive mentor to the group? Of course, one of the first things we should be doing is having conversations with our stakeholders, which don’t seem to have happened yet based on how the newsletter sounds.
For the projects on which I’ve worked, usually I become involved after the decisions are made and I’m working on implementation and training, so it would be great to understand the thought process of organizations who have tried the different solutions in different combinations. Is there one way that’s more foolproof than others to implement in a mid-tier community hospital as compared to the academic medical centers that many vendors seem to have worked with? Is there enough consistent experience in the field that pitfalls have been identified for organizations to avoid?
What are your thoughts with virtual sitters or virtual nursing? Did it do all that you expected or did the efforts fall flat? Leave a comment or email me.
Email Dr. Jayne.
Whether virtual nursing or virtual MDs, they need to understand the importance of EMPATHY. I have experienced a few virtual nursing encounters in the past couple of years where the virtual nurses were as cold as a block of ice. Perhaps that’s where the hospital sent its burnt out nurses for some R&R, but some accompanying counseling would have been in order.
Re: Virtual Nursing Initiative
A thought occurred to me, although this may be giving too much credit.
What if the idea was to get out in front of the grapevine, by announcing early? And, there is no detail because that work hasn’t been done yet? IOW, it’s an honest attempt at communicating.
In general, every employee subgroup wants early access to this kind of information. There is a lot of status and ego on the line. Most will watch other excluded subgroups fumble around in the dark with varying degrees of satisfaction or concern.
Curiously though, attempts to curtail organizational rumours usually fail. There is always more detail to speculate on. Increasing the size of consultation groups only enhances decision-making if those groups were too small to begin with. And larger engagement groups leads to slower decision making.
Again, I’m probably giving too much credit to the process here.
“Sitters” either virtual or in person would be a great job for nurses who are on light duty to fill. Hospitals often pay nurses to do jobs that are well below their licenses when they could utilize them for things as being sitters (you are not then taking a nurse ‘out of the count’) or being mentors to new nurses which would allow the light duty nurse to use her skills and her experience to help to precept a new employee.
Virtual nursing can absolutely be a game changer for the nursing world but like any technology enabled transformation, you have to understand what problem you are trying to solve (the sitter one makes perfect sense) and how you are going to solve it with people, process and technology. None of these work on their own. Many organizations pilot something and then never scale it (too many competing priorities) to truly leverage the benefits it can bring. And engaging the nursing staff in the planning and solutioning is imperative. Like any project – it needs discussions about workflows and outcomes. It truly can be a game changer with both nursing and patients if its done in a way that addresses your challenges, and you have the right technology in place to support and scale.