To start, identify any areas where your organization may be struggling. Some areas of daily struggles that you could address with virtual nursing include:

• Gaps in care
• Safety incidents
• Documentation burden
• Low employee engagement or retention, especially from less experienced RNs

Based on your current needs, as well as the resources you have available, determine the potential scope and scale of your virtual nursing program. While some organizations will go all in and invest heavily in new virtual technology, others may choose to focus on smaller areas, such as documentation, first. 

Implementing a virtual nursing program can be challenging, from both an operational and people standpoint. Oftentimes healthcare can be slow to change, and many people may be resistant to trying new ideas. Without support from key stakeholders, including leadership and nurses, you will not be able to move forward with your ideas.

Sometimes people may not be resistant to the plan itself but rather how you present it to them. Rather than just explaining what virtual nursing entails, you should also explain why it's important, not only for your organization and staff, but also for patients and their care.

Identifying leaders, including RNs and those from other disciplines, who are supportive of virtual nursing can help convince others who may be more skeptical. Members of high-performing units will also likely be valuable advocates since they often have experience with successful projects and may be more willing to try new things. By targeting the areas of greatest concern, you will make a stronger case for why virtual nursing is both necessary and beneficial. 

Getting funding for a new program may be a major hurdle for some organizations. Start-up costs for virtual nursing programs can be expensive because new technology and training is usually required. Because of the time and resources needed to implement a virtual nursing program, it's important to show a return on your investment. You can focus on tangible benefits, such as labor or other cost savings, or intangible ones, such as reducing time spent on burdensome tasks.

There are also benefits for patients, such as reducing their risk of adverse events and increasing their satisfaction while in the hospital. Virtual nursing can help your organization address certain nurse sensitive indicators more easily, such as patient falls, hospital-acquired infections, and more. Quality and safety metrics can also impact value-based purchasing. 

The technology you’ll need will depend on the kind of virtual nursing program you want to implement. You'll also need to ensure that you have the appropriate IT infrastructure to support your virtual care goals, as well as robust privacy and security measures to protect patient data. Some organizations may want to work with their current resources, such as combining iPads with their existing EMR, while others may want to install newer, more robust technology.

Some common tools used in virtual nursing include remote patient monitoring devices, which allow nurses to assess patients without having to be in the same room, and videoconferencing technology to allow patients, bedside nurses, and virtual nurses to communicate easily.

If preferred, you can also partner with third-party vendors, such as Banyan Med, Caregility, and others, for the necessary virtual technology and/or training. 

Before you launch your virtual nursing program, be sure to have policies and procedures in place for virtual RNs, as well as a patient guide to help patients understand how the program works.

When you first deploy your program, it may be helpful to do a "staggered go-live" where virtual RNs initially start on-site before they eventually move their work outside the hospital.

Some example metrics of success you could share with stakeholders include:

• Nurse retention, including engagement and turnover
• Reduced labor costs
• Total admission and discharge numbers
• The cost savings related to increased bed turnover/decreased length of stay
• Patient call-light reduction
• Total medication education performed
• Improved nursing quality indicators
• Patient satisfaction and experience

Currently, much of the data on virtual nursing outcomes is in the early stages. Some organizations that have publicly shared their experiences with virtual nursing include Guthrie Clinic, Avera Health, Atrium Health (now part of Advocate Health), CHI Health, and CommonSpirit Health.

By openly sharing their findings, these organizations are promoting transparency and collaboration when it comes to virtual nursing. The success of these organizations will also help others implement their own programs.

After successfully deploying a virtual nursing program, you can begin scaling it up to other areas of your organization and implementing new technology as needed.

For example, Providence is expanding its Co-Caring hybrid nursing model to hospitals in Washington, Alaska, and Oregon, after a successful pilot at Texas-based Covenant Medical Center in 2021. At Covenant, the program helped reduce first-year turnover rates by 73% for RNs and 55% for all employees in the unit.

Over time, rapid adoption and expansion of new and innovative models of care will improve patient outcomes, staff experience and retention, and much more.