High workloads and burnout during the COVID-19 pandemic have strained the nursing workforce resulting in high turnover and staffing shortages. The burden of documentation related to increased patient acuity and turnover became more apparent with the excessive work expected from nurses on a day-to-day basis. Our hospital experienced similar challenges expressed by nurses during employee forums and rounding. Documentation associated with the admission and discharge process was identified as the most time-consuming.

Virtual nursing (VN) is an up-and-coming innovative approach to decrease the workload of staff nurses. Our goal in implementing a VN program was to help address workload issues in the inpatient medical and surgical areas. With this program, our organization was able to drive efficiency and give back time to bedside nurses. The virtual nurses helped fill gaps, restoring balance to the staff-patient ratio.

Operational and clinical outcomes were measured to determine the efficacy of our VN program. Patients admitted or discharged by the virtual nurse were asked to take a survey of their overall satisfaction with the virtual visit. A report was also created to identify the total length of each visit, how many visits were conducted each month, and if the virtual visit was for admission or discharge. The length of each virtual visit, in minutes, correlates to the amount of time bedside nurses are saving. Additionally, nurses from our pilot unit participated in a post-implementation satisfaction survey to identify the impact the program had on their workflow.

The idea of virtual nursing was presented by our senior vice president of operations in January 2023. The interdisciplinary project team, consisting of nursing leadership, nursing informatics (NI), information technology (IT), and capital projects coordinators worked collaboratively to discuss the logistics of the project. The project team, led by NI, decided to pilot the program on one medical-surgical unit. NI, with the assistance of nursing leadership, developed the workflow for the bedside and virtual nurse while the IT analyst created the EMR build and assisted with the bedside tablet integration. NI provided training to the bedside nursing staff for the first virtual nurse.

With the accelerated implementation of just 6 weeks from planning, the project went live for the pilot unit on April 10, 2023. In addition, we were able to reach our 100th visit in just three months with one virtual nurse. With generally positive feedback from patients and nurses, the project team decided to incorporate additional inpatient units. By October 2023, the virtual nurse program was live in five inpatient units. The October 2023 data showed that the virtual nurse spent a total of 1,915 minutes conducting virtual admissions and discharges. Not only did the virtual nurse complete the necessary admission and discharge documentation, she also provided patient education. The 1,915 minutes spent correlate with the amount of time this program has saved bedside nurses. From October 2023 to March 2024, there was a 48% increase in the number of minutes given back to nurses!

Roshell Cabatingan MSN, RN, NI-BC

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