Readers Write: Virtual Nursing Thrives When Thoughtful Design Guides Implementation

Virtual Nursing Thrives When Thoughtful Design Guides Implementation
By Christine Gall, RN, DrPH

Christine Gall, RN, DrPH, MS is chief nursing officer of Collette Health.

Virtual nursing has quickly evolved as a force multiplier that is capable of addressing top pain points that are impacting care delivery, operations, quality, and patient experience. But as more health systems explore this model, outcomes have varied widely. Some organizations report measurable improvements in documentation time, throughput, retention, and workload relief. Others struggle to see benefits or encounter frustration at the bedside.

The difference rarely comes down to technology alone. It comes down to design. Successful virtual nursing programs begin with clear-eyed assessment. What problem are we trying to solve first? Throughput congestion? Night shift support? Documentation burden? The strongest programs anchor the initial design to a significant operational issue that is specific, measurable, achievable, and relevant.

Of equal impact is the identification of a leader and team that are ready for the responsibility of substantial workflow redesign. Virtual nursing models are more likely to succeed and scale when both factors are addressed and when the initial focus is narrow and well defined, setting up an iterative strategy that supports program expansion and scale over time.

Virtual nursing is also capable of delivering powerful, longer-term benefits like improved staff resilience and nurse retention, but those gains require longer timeframes to see improvement. Programs that try to solve multiple issues initially at launch often struggle, while those that sequence thoughtfully and use data-driven rapid cycle improvement to continually monitor success and iterative improvement are better positioned to scale successfully.

When organizations run into difficulty, it generally involves a failure to define attainable goals, a gap in stakeholder perception that creates barriers to acceptance and adoption of new workflows, and/or a failure of the new work processes to address the areas of concern without creating new burdens. In my experience, three design choices consistently determine whether virtual nursing lightens workload or adds friction:

Task Clarity and Workload Optimization

For bedside nurses, the value of virtual nursing is measured in minutes of administrative burden reduced and the expansion of impactful time spent with their patients. Programs succeed when they clearly define which tasks are moving from bedside to virtual roles. That may include time-intensive admission, discharge, and patient education activities, care coordination, and focused clinical oversight. But decisions regarding role and scope of the virtual nurse must be explicit.

When the virtual nurse’s role is not well defined and understood by the entire team, bedside teams experience little relief, and sometimes more duplication. A symptom of poor task clarity is an increase in the need for communication between the virtual and bedside staff. Well-run virtual nursing initiatives build in automated methods of communication directly into the workflows rather than requiring one-off, manual communication activities. Real value comes from task transfer, not task shadowing.

When programs invest in this level of clarity, bedside nurses increasingly recognize the impact, and barriers to adoption are mitigated.

Workflow Integration, Not Overlay

Many early virtual nursing implementations struggled because the virtual workflows were created as parallel processes rather than developing novel, integrated workflows. If virtual nurses document in separate systems, communicate through separate channels, or escalate through ad-hoc pathways, the bedside becomes the bridge between worlds, an experience that likely creates additional burden.

Integration, by contrast, means shared communication pathways, aligned documentation practices, clear escalation rules, and participation in unit workflows rather than operating in parallel but separate processes. When virtual nurses are embedded operationally, lines of workflow delineation are crisp and do not create new burdens for communication, coordination, or clarification.

Shared Governance and Co-Design with the Bedside

Virtual nursing is as much a cultural change as an operational one. How it is introduced matters. When bedside nurses are asked to adopt a model that they did not help shape, skepticism is a rational response. The programs that thrive invest in shared governance, inviting bedside teams into discussions and decisions about workflow redesign, task allocation, communication norms, and measurement. This transparent approach may not only produce more realistic workflows, but can also establish trust between virtual and bedside roles from the start.

Trust and shared responsibility for iteratively creating a robust care delivery model is the foundation for program stability, refinement, and scale. Connecting leaders and teams with the “what” and “why” before defining “how” a virtual care program will evolve is crucial to buy-in, acceptance, adoption, and ultimately ownership of the new processes.

Virtual Nursing as a Near-Term Workforce Solution

Unlike conventional software deployment, the success of virtual nursing cannot be measured by technical readiness alone. Integrations, reliability, and usability matter, but they are only one part of the equation.

Virtual nursing changes how work is distributed, how handoffs occur, and how clinicians collaborate. It is a care model that is built on an agile technology platform, not a rigid technology solution in search of a problem to solve. Successful virtual care models mature through continuous evaluation of outcomes and success metrics, data-driven iteration, and widespread dissemination of shared learnings.

It may be easy to forget that the workflows, staffing models, and best practices we consider routine took years to stabilize. This is an important perspective to remember as virtual nursing practice and integrations evolve. The nursing workforce has carried extraordinary strain for more than a decade, and many traditional solutions focus on long-horizon strategies, such as expanding education pipelines, addressing retention, or modernizing licensure. Those efforts matter, but will also require the full redesign of the model of clinical care delivery to effectively address the looming issues of the day.

Virtual nursing is one of the most promising and actionable models that can reduce burden, increase capacity, and improve care in the near future, provided the foundational elements are fully embraced and executed. If we allow early friction and avoidable barriers to eclipse that potential, we risk discarding an approach that could meaningfully support nurses when eloquent solutions are urgently needed.

The opportunity is not merely to deploy technology, but to build a sustainable clinical workforce that is properly resourced and supported to deliver world-class care and elevate the patient experience of care.