Virtual nursing refers to the delivery of patient care and services from a remote location. It is used to supplement care provided to patients and reduce the burden on bedside nurses.

Virtual nursing is used in acute care, ED triage, home health/hospital-at-home, mental health services, chronic care management and more. Virtual nurses can be centralized to a healthcare facility, distributed across locations, or a hybrid situation.

To connect virtual nurses to patients, as well as other members of the care team, organizations typically use an electronic healthcare platform and videoconferencing technology. Some telehealth vendors include Advanced ICU Care, Allm, AvaSure, Banyan Med, Caregility, Diagnotes, and RelyMD.

Virtual nurses also work collaboratively with bedside nurses to educate, round on and monitor patients, document care, and respond to patient and family questions.

Although virtual care technology has been around since the early 2000s, relatively few organizations used it with their patients until recently. During the pandemic, interest in virtual nursing and other remote care options surged as organizations faced growing patient care complexity and significant workforce shortages, which continue to this day.

Currently, healthcare workers are overloaded due to higher work volumes, longer hours, and persistent staff shortages. According to a May 2022 report from the American Nurses Foundation, 75% of acute care nurses reported feeling stressed, frustrated, and exhausted, and 60% reported feeling burned out. Virtual nursing may help reduce the burden on bedside nurses by offloading time-consuming administrative responsibilities to the virtual nurses.

In addition, there is a growing experience-complexity gap as patient intricacy increases and more experienced nurses leave the workforce. Some reasons for nurses leaving include early retirement, frustration with compensation and benefits, and burnout. As more experienced nurses leave, they are often replaced by newly graduated nurses, who are less prepared to deliver complex care. Virtual nursing can help retain clinical expertise and effectively scale it across an organization.

These issues, combined with other ongoing healthcare challenges, mean that the current nursing models need to transform. The status quo will no longer work. In the future, innovative care delivery models, augmented by virtual care, are needed to meet growing demands from both patients and staff.

Virtual nursing has several potential benefits for patients, nurses, and organizations, such as:

• Reducing RN workload, particularly for administrative tasks
• Mentorship and support for bedside RNs
• Oversight of newly graduated RNs
• More flexible work schedules
• Improving patient experience
• Improving quality of care and patient safety, including fewer adverse events and readmissions
• Reducing turnover costs, as well as potential staffing agency costs
• Improving nurse recruitment and retention

Health systems that currently have their own virtual nursing programs have already seen these benefits, saving millions in labor costs, improving patient safety, and more.

Case example: CHI Health

In 2014, CHI Health partnered with Banyan Medical Services to create a virtual expert nurse role. Since then, the program has saved CHI Health an estimated $12.8 million on labor costs as well as improved quality outcomes.

Case example: Houston Methodist

Over the last few years, Houston Methodist has scaled up its virtual programs significantly, including the introduction of a new virtual ICU just before the pandemic. Through these programs, the organization has achieved a 50% reduction in readmissions.

Case example: Guthrie Clinic

In 2022, Guthrie Clinic opened the Pulse Center, a virtual command center that offers bedside nurses around-the-clock support. The program helped Guthrie improve its Leapfrog Hospital Safety Grade from a "C" to a "B” and save $7 million per year in labor costs.

Virtual nursing is not without its challenges, and organizations must account for potential issues as they consider implementing their own virtual nursing programs.  

Organizational support and resources

Healthcare can be slow to change. There may be resistance to new ideas since many people prefer to stick with what they already know. Before implementing a virtual nursing program, organizations need to gain support and engagement from both leadership and nursing staff. Communicating with, and gaining support from the interprofessional team and provider groups is essential so that everyone has a common understanding of the objectives for utilizing virtual nursing. 

Support from nurses is particularly important. Some nurse unions have expressed concerns about virtual care, especially for remote patient monitoring and processes. Rather than having virtual nurses, the unions leaders contend that organizations should hire more bedside nurses. 

In addition, many hospitals have financial difficulties, which may limit the resources available for new programs. Start-up costs for a virtual nursing program can be high since organizations may need to invest in new technology and training for staff members.

Technological concerns

Aside from the cost of new virtual nursing technology, organizations will also need to ensure that it functions properly. Internet connection (Wi-Fi) issues or a lack of familiarity with certain software or hardware may make the care experience more challenging for both patients and nurses.

Organizations will need to ensure that any new tools implemented are compatible with their current technological infrastructure and that information can be integrated across systems. There are also potential security and privacy concerns when it comes to patients' health data, especially as cyberattacks against hospitals become more common.

Legal and regulatory issues

Patient consent, hospital policies and procedures, licensing across state lines, and other state and federal laws may impact the adoption of virtual nursing.  As nurse-to-patient ratios are adopted, it will be important to understand if virtual nursing has any influence over the legislated number of nurses.

In an August 2023 report, Joslin Insight, on behalf of AvaSure, surveyed 789 acute care professionals, 46% of whom were nurse leaders or organizational decision makers. The survey found that many CNOs (66%) believe that virtual nursing will become integral to acute care delivery models. In addition, 87%  of CNOs said they believe virtual nursing will help recruit or retain nurses who may be unable or unwilling to work at the bedside.

In the survey, 38% of respondents said they had either already implemented virtual nursing or are in the process of doing so, and an additional 26% said they are considering implementing a virtual nursing program. Some of the top use cases for virtual nursing identified by respondents include discharge, admissions, patient education, expert clinical oversight, and rounding.

As virtual nursing continues to grow, industry stakeholders are also formalizing competencies and potential certifications in the field.

In March 2023, the Academy of Medical-Surgical Nurses and the Medical-Surgical Nursing Certification Board convened a task force of 15 executives from 10 healthcare organizations to develop a virtual nursing certification program. Although the certification is still in the early stages, it will define the education and skill requirements for becoming a virtual nurse.

1. Pinpoint areas where virtual nursing could benefit your organization.
2. Evaluate potential organizational interest for virtual nursing.
3. Determine whether your organization has the capacity (workforce, technology, finances) to implement a virtual program and at what scale.
4. Consider how to measure and evaluate success of a virtual nursing program.

These conversations can help you determine whether a virtual nursing program would benefit your organization and how it could re-imagine your nursing model of care.