Virtual Nursing

Opportunity

In the aftermath of the COVID-19 pandemic, nursing shortages and increased administrative burdens posed a significant challenge to hospital care delivery. Bedside nurses felt burnt out as they struggled to give their patients the time and attention they deserved. Many tasks unrelated to direct patient care take a lot of time and coordination, which left bedside nurses feeling stressed and overworked as they juggled those tasks with direct patient care.

Solution

A Performance Improvement team from OSF Innovation and a Digital Care team from OSF OnCall, the digital arm of OSF HealthCare, set out to find a solution that would relieve bedside nurses of tasks that could be handled remotely, allowing them to dedicate their energy to hands-on patient care. They reviewed virtual care methods that were used during the pandemic as a possible solution. Tablets were often used as a communication tool between patients and their families, doctors and nurses. The team determined that using a virtual nurse, someone communicating with the patient remotely, for admission and discharge could save significant time for bedside nurses and offer a better patient experience.

Impact

Saves patients time

Using the virtual nursing team has reduced the overall time it takes to discharge patients. For example, hospital discharge with a virtual nurse takes about 20 minutes. Before virtual nursing was introduced, nearly half of patients at OSF HealthCare Saint Francis Medical Center experienced discharge times of two hours or more. With virtual nurses now completing some inpatient discharges, only 33% of patients face these longer discharge times. When patients are admitted or discharged more efficiently this reduces wait times for incoming admissions and improves overall hospital flow.

Frees up time for bedside care

There is a lot of behind-the-scenes work that goes into admitting and discharging a patient. There is often coordination of care between providers, ordering prescriptions, setting follow-up appointments and patient education. All these tasks pull bedside nurses away from direct patient care. It can also be challenging for a bedside nurse to properly complete all these tasks or educate a patient thoroughly when being pulled away to take care of other patients. The introduction of virtual nursing into the aspect of care allows bedside nurses to focus on building stronger connections with their patients, enhancing both care and job satisfaction.

Better record keeping

The demands on bedside nurses during a patient’s hospital stay can sometimes make it challenging to ensure all necessary forms are completed or that patients receive comprehensive education about their care. Virtual nurses, with their flexibility and availability, can help manage these important details. During the pilot, the completion rate for advanced care directive forms to document end-of-life wishes and patient education documentation increased from 60% to 100%.

More positive patient experiences

Anecdotal evidence indicates that patients value the virtual nursing experience. They often note quicker discharge times and appreciate the full attention of their virtual nurse. Post-hospital surveys include comments like, “They were very accommodating and nice. Always concerned about my health and well-being,” and “She was quick and helpful.”

Less burnout for nurses

Bedside nurses on the floors using virtual nursing report feeling less stressed now that they have the ability to hand off admission and discharge tasks. They appreciate having more time to spend on patient care.

“It’s one of the best things that’s raised bedside nurses’ morale, and that’s huge. I think that a lot of hospital systems could learn from that,” says Amanda Gordon, RN.

Pilot Details

Scope

The idea was first tested on two floors at OSF HealthCare Saint Francis Medical Center in Peoria, Illinois. It has since expanded to all adult surgical floors at OSF Saint Francis and OSF HealthCare Saint Anthony Medical Center in Rockford, Illinois, covering over 500 beds. In December 2024, the pilot expanded again to include the emergency department at OSF Saint Francis, bringing on another 72 beds.

Technology

Virtual nurses use two-way audio-video communication for patient interactions, mostly using tablets. Some rooms at OSF Saint Francis have TVs that offer the same functionality. Tablets are an interim solution while exploring in-room equipment, which would require infrastructure investments. Bedside nurses have expressed a preference for in-room equipment to alleviate the need to bring the tablet to the patient.

Scheduling

The pilot has tested two different models for staffing virtual nurses.

At OSF Saint Francis, the pilot uses a centralized model with dedicated virtual nurses working remotely from OSF OnCall. OSF Saint Anthony uses a decentralized approach where floor nurses alternate between in-person and virtual shifts.

“There are pros and cons with each. The ones that are on the floor (decentralized model) already know the culture of the floor and they understand the workload. It also gives them a variation on the kind of work they do and offers a nice change of pace,” says Suzanne Hinderliter, director of digital care development at OSF OnCall. “The benefit of the centralized model is that the OSF OnCall virtual nurses become the experts at it. They’re doing it all the time, so there’s more efficiency and consistency there.”

Suzanne says they will continue to refine their data gathering to determine which model makes the most sense at a larger scale.

Future of virtual nursing

By using technology to meet the needs of both patients and caregivers, OSF HealthCare is pioneering a smarter, more sustainable approach to hospital care. The virtual nursing pilot helped leaders at OSF understand what was needed to scale the program across the Ministry to provide an even greater impact.