UnityPoint's CNO discusses the future of the health system's virtual nursing program.

The potential of virtual nursing seems promising as many health systems begin to brainstorm and implement programs of their own.

Sarah Brown, CNO at UnityPoint Health, laid out how the Iowa-based health system has set up their virtual nursing program and what their four goals are for the future.

Brown is a part of the HealthLeaders Virtual Nursing Mastermind panel, where several health systems will discuss the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.

Starting goals

Many health systems are using virtual nursing to offload work and give time back to nurses to be at the bedside. And at UnityPoint it's no different.

"Our goals with it initially, and I would say they have morphed a bit over time," Brown said, "[were] really to redesign the work so that we could remove some work from our nurses that were at the bedside to try to make their experience while they were at work better."

Brown said UnityPoint wanted to set up the program in a way that did not sacrifice quality or patient experience. The main focus was on improving the bedside nurse experience, and that remains a priority, along with efficiency and quality goals.

"I think the efficiency piece comes when we’re getting high, 90%, maybe even 100% of our admissions on our med surg inpatient united completed within the first four hours," Brown said. "That's not something we could have said before."

Brown attributed that success to how they resourced differently. There is now more focus and consistency with the people doing the admission and discharge processes, and so they are able to do more of them. Brown said they are heading toward a retention goal with the program as well.

"With that experience, they catch more things," Brown said. "I think where we want to go is then more focused on our new-to-practice nurses that really need more of a mentor [or] coach sort of role."

What's next

Brown sees UnityPoint going through four evolutionary phases with the virtual nursing program.

Phase one includes the admission and discharge processes and other documentation needs, along with some care planning and patient education.

Phase two will focus on operations and implementing in-room technology. This would enable the virtual nurse to help check medications, blood draws and other processes with the bedside nurse in the room. They could also help assist with documentation during a rapid response situation, and help with virtual rounding.

"I think we are a bit hampered with moving forward in the other phases without the in-room technology," Brown said, "so that piece will be really important to us."

The third phase is expanding the program to allow for monitoring on a broader scale. Virtual nurses could then act as eyes in the sky, to look for deterioration, sepsis, or other patient conditions.

At that point, the health system could move to the fourth phase and use virtual nursing for mentorship of new-to- practice nurses.

Brown said that three years into the program they have really matured the first phase, but they still have a long way to go to get to the long-term goals.

Additionally, Brown is hopeful that UnityPoint can implement virtual care in the EICU.

"Like many organizations, we are at max capacity in many of our hospitals on a daily basis," Brown said. "I have this idea that there has to be a way we can incorporate virtual waiting room monitoring or virtual nursing in our emergency departments as well."

The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.

To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.

CNOs must take a look at how they introduce new nurses into the workforce, says this nurse leader.

On this week’s episode of HL Shorts, we hear from April Prunty, director of nursing professional development at Allina Health, about how CNOs can prepare new nurses for the difficulties they will face on the job. Tune in to hear her insights.

Nurse wellbeing makes the rest of the healthcare team succeed, says this nurse leader.

Nurse wellbeing is essential to the success of a health system, and it is the CNO's job to make sure they are providing programs and support to help keep their staff safe and well.

April Prunty, director of nursing professional development at Allina Health, spoke to HealthLeaders about how CNOs can be visible and provide support, and redesign workflows to give nurses time to prioritize their mental health. Tune in to hear her insights.

Click here to read the accompanying article. 

Nurse wellbeing is critical to positive patient outcomes and the overall success of a health system.

Being a nurse is difficult.

The job entails long hours, substantial workloads, and the heavy emotional burden of guiding patients through some of the toughest moments of their lives.

Nurse wellbeing is essential to the success of a health system, and it is the CNO's job to make sure they are providing programs and support to help keep their staff safe and well.

According to April Prunty, director of nursing professional development at Allina Health, more than half of the healthcare workforce is made up of nurses or nurse-related positions, so the wellbeing and success of nurses affects everyone. If nurses are not in top shape, Prunty explained, that causes a decline in patient outcomes.

"If our nurses and our nursing team members aren't doing well, they are not in a good position to provide that excellent patient care," Prunty said. "There is also some evidence to suggest that if nurses are doing well, the rest of the healthcare team is doing well."

Understanding wellbeing

Wellbeing looks different for each nurse. Some might prioritize flexible scheduling and better work-life balance, while others might want more opportunities to connect with others or time to process events.

" One of the key tenets of nurse wellbeing is really understanding what wellbeing means for the individual nurse," Prunty said. " It does look different for everybody, but there's some key principles that can be woven throughout to support wellbeing."

CNOs need to show their support and learn about their staff to understand what those needs are.

"One of the things that we often hear from nursing staff is that they really appreciate visibility," Prunty said. 

Nurse leaders should take time to informally round on units and connect with staff, Prunty recommended. CNOs can take that opportunity to listen to what the nurses are telling them, so they can provide the correct support and continue to advocate for them.

"Continuing to advocate for staff [at] whatever table they're sitting at to make sure that staff have the resources that they need to continue providing excellent patient care is always important," Prunty said.

Changing the environment

The next step is to make the work environment healthier and safer. Prunty referenced the uptick in workplace violence as one of the key challenges in the healthcare industry, as well as the increased levels of care required by patients.

"We're seeing a lot of changes in some of our healthcare settings," Prunty said, "and we need to make sure that our staff feel safe coming to work, and that they're adequately prepared to care for the complexity of patients that we're seeing."

Prunty recommends that CNOs allow for adequate breaks throughout the day so that nurses can take a breather, while feeling empowered to do so.

Prunty said there are a few different phases to supporting staff who have experienced a traumatic event or high-stress situation.

The first is to provide support in the moment allow the nurse to take a step back, and reassure them that a colleague or a nurse manager has their back. The second is to make sure that the nurse has time to process what happened.

Prunty said Allina Health implemented both employee assistance programs and a spiritual care team that can support staff in real time.

"We need to be attuned to the impact of the experiences that our nurses are feeling," Prunty said. "I think the importance is having the support and resources in the right place at the right time."

Leaders also need to ensure that nurses feel like their tasks are a value add, and that they are giving nurses back time at the bedside.

"It's really important for executive nursing leaders to think about what [our workflows are] and what [our processes are], and how [we can] improve efficiency," Prunty said, "so that we are maximizing the time that we have with our patientsand making sure that we're promoting a healthy work environment."

Supplying resources

Prunty suggested that CNOs try something creative when providing resources to support nurse wellbeing. In addition to the standard employee assistance programs, a few of the sites across the Allina Health system have calming rooms, where nurses can go to take a break.

"It's a space [where] you can listen to calming music [or] meditate and take a deep breath," Prunty said. "A space where you can physically close the door and sort of separate yourself from what's happening on your unity during your clinic."

Allina Health also has robust employee well-being programs through the Penny George Institute for Health and Healing. The programs allow staff to receive coaching on a variety of different topics through online asynchronous learning.

"I think this is really our opportunity to say OK, what's working, [and] what's not working," Prunty said, "and it's OK, we can try something else."

It's critical that CNOs communicate the existence of resources as well, so that nurses can find and use them. Prunty emphasized the difficulty of communicating with nurses, since nurses do not have time to frequently check their e-mails.

Allina Health has tiered huddles that are focused on safety issues, and a communications team that disseminates all the necessary information on a weekly basis to staff. Prunty said they are also looking at ways to integrate resources into the EHR, including a button that can be pressed if nurses need resources during the documentation process.

Prunty also explained that they are leveraging social media and signage to provide even more avenues of communication.

"As our health system continues to grow in complexity and expand in geographic areas," Prunty said, "we really need to think about how [we can] reach all of our staff, because that's part of feeling included . Knowing what’s going on and not feeling left out of messaging."

Preparing new nurses

CNOs need to find innovative ways to build resiliency among new nurses. According to Prunty, the disruption to academic programming by the COVID-19 pandemic caused many new nurses to enter the industry with less clinical experience.

"I think it really is an opportunity for us to think differently about how we bring people in and help them through that transition," Prunty said.

Allina Health has implemented a strong nurse residency program that Prunty says is addressing the needs of the new generation of nurses. The program gives nurses the opportunity to build community with those going through similar experiences.

"We're talking a lot about moral distress, moral injury, processing grief and loss, [and] having crucial conversations," Prunty said. " Things that are really challenging for folks as they enter the nursing workforce."

There is also an opportunity to revamp academic programs and partnerships sto support nurses in their transition to the workforce.

Prunty emphasized the need for leaders to stay flexible.

"I would say the agility and curiosity in approaching the new needs of this workforce are going to be critical," Prunty said, "to make sure that they have what they need to take care of patients."

Leading by example

There are a few things CNOs can do to positively influence the work environment and keep spirits high, and visibility is a key component.

"I think rounding and making sure people see you as a person," Prunty said, "and you [making] that connection with your teams is critically important."

CNOs need to keep advocating for nurses in as many spaces as possible, and to help people outside the nursing realm understand the role of a nurse.

It's difficult to explain to others the invisible labor that is associated with providing excellent patient care, Prunty stated, and it's important that that's recognized and acknowledged as a critical part of providing care.

"I think any opportunity to just be curious and help people understand," Prunty said, "and tell our story as nurses, I think is really important."