Tipton Health interviews Michelle Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, FAAN, Vice President, Nursing Professional Excellence at ChristianaCare. Dr. Collins developed the Virtual Acute Care Network(TM) in December 2023. Michelle Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, FAAN, Vice President, Nursing Professional Excellence at ChristianaCare. Dr. Collins developed the Virtual Acute Care Network(TM) in December 2023.
As hospitals seek innovative ways to address staffing shortages, maximize efficiency, and improve patient outcomes, virtual nursing offers some of the answers. However, hospitals must approach virtual nursing strategically to avoid common pitfalls.
Michelle Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, FAAN is Vice President, Nursing Professional Excellence at ChristianaCare. She developed the Virtual Acute Care Network(TM) in December 2023, bringing together virtual nursing planners from across the country to share ideas. She shared with us some of the challenges hospitals may encounter (in no particular order), and how to avoid them while planning and executing a virtual acute care nursing program.
Pitfall #1: Focusing Only On Nursing’s Needs
Although virtual acute care nursing programs affect nursing teams, it’s important to use a multidisciplinary team approach to develop the program. This includes having clinical nurses involved in decision-making. Developing a virtual nursing program can’t be just an executive decision, but rather needs the engagement of bedside nurses, nurse educators, nurse leaders, and even patient educators.
Including patients and families in program development helps identify areas that caregivers may not consider. Collins shared that ChristianaCare also included the Patient Family Advisory Council of past patients and families to learn how to make the technology and its in-room use more patient-friendly. It’s also important to include other medical professionals who might be interested in utilizing the technology in the future.
“This is not a nursing-only kind of function. Hospitalists, physical therapists, case managers, social workers, and dietitians could also use it, especially in a larger healthcare system,” Collins explained. “Preparing and planning for these potential future events helps streamline development, improve patient experience, and address workforce efficiency opportunities.”
Pitfall #2: Shopping Before Planning
There are many types of technology for virtual acute care nursing, each with different nuances, that can help healthcare systems implement virtual care. However, it’s critical to first determine what’s most important to the organization before shopping for software and technology.
Collins advises organizations that want to implement virtual care to first define how the technology will be used, what it should measure, and if the potential improvements justify the cost. Considering your metrics helps you choose the software that best meets the organization’s needs.
“You need a roadmap that’s been endorsed by your executive leadership,” Collins cautioned. “You need to know what you are measuring for improvement and what you are monitoring from day one. That plan should be in place before going live. Given the potential expenses, this isn’t necessarily a ‘let’s figure it out as we go’ type of project.”
Pitfall #3: Adopting One Staffing Plan for All Units
Consider how the virtual nursing program will be staffed—are you using existing full-time equivalent (FTE) nurses, or does the organization plan to hire additional nurses? If existing FTEs are used, how will that impact the nurse-to-patient ratio?
Expediting care by managing admissions, discharges, patient education, or reviewing lab values can reduce the task burden on bedside nurses. However, increasing the staffing ratio from 1:4 to 1:5 means the bedside nurse has one more patient to assess, give medications, do wound care, or hang IVs.
Collins cautions that the impact of implementing virtual nursing on the staffing plan of one unit will differ significantly from a program implemented across the system. Knowing staffing patterns across units and thinking outside the box can help protect patient outcomes, staffing ratios, and efficiency.
Pitfall #4: Executing Without Understanding Workflows
An integral part of the planning process for a virtual nursing program is understanding the workflow. There must be a defined expectation of what the virtual nurses will accomplish each day and a means of measuring the outcomes.
Collins gave the example of the variety of electronic health records (EHRs), some of which don’t have a way of identifying different nursing personas, namely virtual nurses. Another opportunity is to involve unit managers in self-selecting which of their staff nurses will participate in the program, allowing nurses to work both at the bedside and in the virtual program.
“Virtual nursing happens one patient at a time without interruption,” Collins explained. “Our nurses have told us, ‘This is why I went into nursing, because I can have a relationship with this patient, make time, and make a difference in their care.’ Therein lies the sacredness of the relationship.“
Pitfall #5: Assuming Virtual Staffing Levels Will Be Consistent
While designing your virtual care model, consider what the most important items are in your workflow and how they will change based on staffing. For example, what’s the plan when there are changes to the number of virtual nurses that are available on a given day?
It’s crucial to not only understand what the workflow should be but also identify how to pivot when things do not go as planned.
Pitfall #6: Failing to Prepare for Language Concerns
Depending on your patient population, your virtual nurses may need to partner with the organization’s translation team to provide seamless and culturally competent patient care. Virtual nurses may need to collaborate with a translator for each interaction with the patient or family.
Pitfall #7: Assuming Your Organization is Ready for Change
Collins advises nursing leaders to consider, “Are enough of your leaders aware, interested, and bought in? Because this is not work for the lighthearted.”
It’s not just readiness in the organization for change. Instead, virtual nursing programs and outcome measurements require the readiness for sustained change and evolution, improvement, and attention to data. Virtual nursing programs demand the engagement of the nursing leadership team, clinical managers, and bedside nurses.
Collins concluded, noting that nursing staff appreciate working with virtual nurses when they are educated on how a virtual team can free them up to complete the required tasks and still have time for meals and breaks. Virtual nursing must also demonstrate productivity, which might include the number of admissions, discharges, patient education, or consults that were completed.
Each of these pitfalls could result in implementation failure and must be addressed during the planning process to reduce the potential risk that your program may not succeed. When you have questions about implementing new nursing programs or want help improving your nursing excellence data, call Tipton Health. We are excited to help you improve patient care, patient experience, and nursing satisfaction.
Tipton Health can help you avoid the pitfalls! Learn more about how our expert nursing consultants can assess and refine your current virtual nursing program or help you develop a flawless new virtual nursing program. Contact Tipton Health.