The initial results are showing promise at ChristianaCare, a multi-campus health system with three acute care hospitals in Delaware and Maryland (1,200 beds) and outpatient offices in Delaware, Pennsylvania, and New Jersey, according to Dr. Michelle L. Collins, DNP, APRN, CNS, ACNS-BC, NPD-BC, NEA-BC, LSSBB, vice president, nursing professional excellence at ChristianaCare.
Hospital readmissions are down for patients who used the virtual nurse service. Patients have been pleased with the experience and bedside nurses have less patient documentation to complete. In fact, one clinical nurse told Collins that she liked virtual care nursing so much that she did not want to practice nursing without it. “She told me ‘I am much less stressed, and I feel happier being with my patients.’”
Collins discussed the implementation of virtual nursing at ChristianaCare during a recent Tipton Health Nursing Leadership Webinar titled “How Remote Care Delivery is Changing Nursing.”
ChristianaCare began exploring virtual nursing to offset nurse recruiting challenges that had forced the system to turn to travel nurses to augment its staff. “We couldn’t sustain using purchased labor into the hundreds of millions of dollars.”
After looking at alternatives, ChristianaCare first tested virtual acute care nursing in two units in September 2022. Clinical nurses joined interprofessional partners to develop the test model. The test went so well that the system quickly expanded the program to 15 units.
“As of October 23rd (2023), we’ve had over 10,000 patients participate in this since May of 2023,” Collins said of the virtual acute care nursing program. “We average between 500 and 600 calls a day.”
Virtual Nursing Program Design at ChristianaCare
ChristianaCare is using already available iPads that were added during the COVID-19 pandemic for the hospital’s care at-home program, explained Collins. The iPads allow patients to communicate with a nurse from their bed quickly. In addition, Collins said, bedside nurses can work with a virtual nurse to help with documentation, ordering lab work, and other administrative tasks.
No additional nurses were hired by ChristianaCare to staff the program. “We looked at our current staffing and where there were adjustments that could be made,” Collins said. “The virtual nurses are experienced nurses on the unit they support. They are the go-to nurses for when people have questions. We wanted someone willing to be a change agent because this is a significant change.”
Virtual nurses rotate back to bedside care periodically, Collins said. “They still report to the nurse manager of the unit because our virtual nurses rotate back, so they rotate back to the clinical bedside from their virtual nurse role/”.
Virtual acute care nurses are available to anyone in the patient’s room, including the patient or their family, bedside nurses, providers, or other caregivers, Collins said, adding that the virtual nurses are available from 7:00 AM to 7:30 PM, Monday through Friday.
Workflows in Three Buckets
Collins said that during the pilot, the work done by virtual nurses fell into three buckets:
- Patient quality and safety. Virtual nurses can participate in head-to-toe patient assessments with clinical bedside nurses via an iPad and document the process. Virtual nurses can also complete intermittent pain reassessments, look at provider notes and lab results, and let the clinical nurses know which patients should receive more attention.
- Patient experience. Virtual nurses can complete shift reports and do hourly rounding with patients. They can update, review, and revise interdisciplinary plans of care. They can connect with the patient’s family members or any interdisciplinary team member. They prepare and review discharge and education instructions.
- Nurse productivity. Virtual nurses can complete many time-consuming tasks that bedside nurses typically have to do. For example, ChristianaCare no longer does ED call reports, so the virtual nurse gathers the information a bedside nurse needs to receive the patient and complete the admission. Virtual nurses can also preview orders, order tests, and leave notes within the hospital’s system.
ChristianaCare surveyed patients who used virtual nursing during the trial period. Of the respondents who used virtual nursing, 78% said they were very or somewhat satisfied with the service, Collins said, adding that convenience and ease of use were what patients liked the most.
“It’s one tap on the front of the iPad to engage a virtual nurse, Collins said. “The patient can call the virtual nurse, and the nurse comes immediately.”
ChristianaCare has also seen a reduction in readmission rates since it started using virtual nursing. “We think that is aligned to patients more fully understanding their discharge plan and medications,” Collins said. Virtual nurses can spend more time with patients explaining their discharge instructions without interruption.