Implementation of a Virtual Nurse Program: Reducing the Bedside Burden

Purpose: The goal of the VRN was to support the nursing team at the bedside, reduce workload, create a healthier work environment, and implement an innovative care model utilizing existing technology to improve patient satisfaction. The program was created in response to nursing workforce shortages with a strategic focus on utilizing an innovative model of care to improve nursing engagement. Rapid implementation leveraged current telehealth RNs and utilized advanced technology and equipment, all while maintaining budget neutrality. The program created an integrated care model that enhanced patient and RN satisfaction, throughput, turnover, vacancy, and demonstrated a financial impact.

Description: Applying principles of telehealth, the team was guided by a core set of principles: remaining budget neutral, technology neutral, and initial focus on completion nursing task-based work (admission/discharge). We would like to share the steps taken during implementation of the program, challenges faced, solutions developed, and outcomes achieved. Utilizing EHR functionality such as secure chat, streamlined navigators, treatment team, shared patient lists, and required documentation proved beneficial to support both admission and discharge workflows and proved scalable through repeated, rapid implementation. Standardized tools for education, socialization, and go-live virtual huddles promoted consistency and efficiency. The VRN partnered with bedside teammates to identify clinical practice gaps resulting in improvements in site-level care and documentation. Virtual nursing complements the healthcare ecosystem by alleviating bedside burden and promoting workforce sustainment. Sites of care have demonstrated eagerness to expand, integrate, and optimize the support for the bedside nurse beyond admissions and discharges.

Evaluation/outcome: Outcome metrics included patient engagement, throughput, vacancy and turnover, and total patients served. Patient experience top box performance, improved 13.4 to 23% points in nursing communication, discharge, and likelihood to recommend. Patient throughput improved with a 4% increase in discharges by noon and 17% increase in discharges by 2pm. Voluntary turnover decreased in three of five hospital sites and vacancies decreased at four of five sites. A post-pilot survey indicated positive perceptions of the program. Patient encounters totaled 464 discharges and 2420 admissions for a total of 2884 patients. This returned 86,520 hours to the bedside clinical teammates over the five-month pilot. Pilot sites yielded a decrease in RN staff turnover of 143 RNs from 2022 to 2023 annualized. Projected annualized turnover savings year over year is $6.3 million when considering the average cost of turnover for a bedside RN as $44,000 according to the 2020 NSI National Health Centre Retention & RN Staffing Report. Reduction in RN turnover is multifactorial; however, three of five VRN pilot sites outperformed the 27-hospital region.