Hospitals Are Looking for Hard ROI in Virtual Nursing

Health systems across the country are launching telemedicine programs aimed at improving the nurse's workload, but both value and sustainability are hard to pin down.

Editor's note: This article appears in the October-December 2023 edition of HealthLeaders magazine.

Virtual nursing is all the rage these days, with health systems across the country launching telemedicine-based programs aimed at helping their beleaguered nurses. But with no clear-cut path to ROI, executives are uncertain whether the programs can be sustainable.

Each hospital is approaching the issue from a different direction, ranging from basic telesitter programs targeting patient monitoring and fall prevention to platforms that support new nurses to more complex telenursing platforms that combine monitoring with administrative functions.

At the Medical University of South Carolina (MUSC) in Charleston, officials tested a virtual nursing service about a year ago, says Emily Warr, MSN, RN, administrator for the health system's Center for Telehealth. That program was geared toward helping new nurses learn the ropes.

Not long afterward, the program was shut down.

"We learned from that endeavor that it's not enough," Warr says. "It has to be much more complex and bring more value."

So MUSC pivoted, creating a platform designed not only to remotely monitor patients in their rooms but help with administrative tasks, from charting in the EMR to onboarding and discharges. That program will debut soon in four of the health system's rural hospitals, where the nursing ranks are especially strained.

"Bedside nurses spend way too much time in documentation," Warr says. The new program, she says, assigns those tasks to the virtual nurse, who can sit in a room in another part of the hospital and handle EMR documentation for several patients. It adds another set of expert eyes to the details that make up the patient record, while freeing up the bedside nurse to focus on hands-on duties and interactions that improve care management.

Warr says a virtual nursing program will only succeed if it addresses multiple pain points.

"This program can't just focus on workforce economics or quality [of care]," she says. "One is not enough. There has to be a quality component. We've got to impact patient care."

Warr says the biggest challenge to standing up a telenursing program is the CEO.

"They see this as an additional expense until proven otherwise," she says.

That's a common refrain in many health systems, as health system decision-makers struggle to balance new ideas and technology against a perilous bottom line.

'Things Are Changing Too Fast'

At a recent HealthLeaders Teams Exchange in Nashville, clinical and financial executives from several health systems across the country came together to discuss the challenges they face in sustaining a workforce. Virtual nursing was one of the hot topics of conversation, with nearly everyone agreeing they'll have fewer nurses in five years and nearly three quarters saying they've launched such programs to address that problem.

But they aren't going to wait long to see value.

"Things are changing too fast," says Meg Scheaffel, BSN, RN, MBA, MHA, NEA-BC, vice president and chief nurse officer at Baptist Health Louisville. "Anything beyond 18 months [is now considered] long-term planning."

[See also: Can Virtual Nursing Help Hospitals Address Workforce Challenges?]

Telesitting, telenursing, and virtual nursing programs saw a dramatic increase during the pandemic, when hospital leadership sought to reduce contact between infected patients and their staff to curb the spread of the virus. In time, those hospitals using the platform saw benefits ranging from reduced stress on nurses to improved clinical outcomes through more consistent monitoring, resulting in more efficient room turnover, improved patient discharge rates, and better patient satisfaction scores.

And they're seeing a lot of potential in the platform, especially as health systems look to address the changing nature of the hospital stay.

"With inpatient virtual care, it opens up a lot of doors," says Colleen Mallozzi, MBA, RN, senior vice president and chief nursing informatics officer at Jefferson Health, which recently launched its Virtual Nursing Program after a trial run earlier this year involving nearly 400 patients.

"The virtual nurse can do anything except physical touch," adds Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, an associate chief nursing information officer and division director of clinical informatics at the Philadelphia health system.

Jefferson Health is launching its virtual nursing program after a four-month pilot in two units and will be watching a wide range of benchmarks that include patient length of stay, patient satisfaction, patient flow (including transfers), nurse turnover and overtime, and documentation compliance. The program will be incorporated into the wall-mounted television unit in each room, a familiar form factor for many in-patient telehealth programs.

"We want our nurses to be doing what they should be doing, which is caring for patients," says Gartner.

But a nurse can't physically be in a patient's room at all times, and with fewer nurses that time spent in the room is even smaller. Jefferson Health's program puts a nurse virtually in each room at all times, accessible through the wall-mounted TV, giving patients the comfort of knowing there's someone looking in on them and answering their questions when needed.

"It's an evolving landscape," says Mallozzi, noting the program is separate from Jefferson's 10-year-old telesitting program, which focuses solely on monitoring and safety care and has shown value in reducing patient falls.

Starting Small and Scaling Up

To be fair, telesitting, whose roots trace back to the practice of using volunteers (sometimes retired nurses) to sit with patients with behavioral health concerns or at risk of falling, has proven its value, with studies finding it reduces patient falls and self-harm and can save hospitals hundreds of thousands of dollars a year in associated costs. But those programs don't address nursing workflow or stress issues. Telesitting can be incorporated into a virtual nursing program, but it can't be stood up as a telenursing service.

Farther south, Valley Health went live with its virtual nursing program in May. The six-hospital network, serving parts of Virginia, West Virginia, and Maryland, partnered with Teladoc Health to launch a pilot in one hospital, with plans to expand soon.

"We started this way, beginning with a traditional med-surg unit, so that we would have lots of options," says Theresa Trivette, DNP, RN, CENP, the health system's chief nursing officer. "Each unit is going to have its own culture and needs … so we need to begin slowly and let our nurses [help us to] build out this model together."

Trivette says the health system saw the value of an inpatient telemedicine platform during the pandemic, and officials wanted to find a way to keep that going after COVID. Not surprisingly, executives jumped on the idea of using the platform to support nurses.

"They're getting tired, and many are considering retirement," she says. "We thought about how we could keep them in care delivery longer."

Trivette says the program focuses more on care management, with administrators inviting nurses to map out the platform and prioritize what they do in the patient's room. And while some nurses initially saw this as an intrusion that affected their job responsibilities, she says, the attitudes turned positive as the program was fleshed out to address their stresses.

She says the platform has become popular with patients (especially seniors) who just want someone to chat with each day and has led to a 20% jump in patient experience scores. In addition, it has boosted staff morale and engagement, which in turn will improve care management and coordination.

"We're focusing on supporting the whole care team, not necessarily plugging a pain point," Trivette says. "How do we help our nurses in all aspects of care delivery?

At the HealthLeaders Exchange, much of the focus around virtual nursing was on hard results, such as clinical and administrative outcomes that translate into savings. At Mount Sinai South Nassau, for example, Senior Vice President and Chief Nursing Officer Stacey Conklin, MSN, RN-BC, MHCDS, NE-BC, is working side-by-side with John Pohlman, CPA, the hospital's chief financial officer and senior vice president of finance, to make sure virtual nursing outcomes align with financial considerations.

That might include reduced patient length of stay, which improves patient satisfaction scores as well as the room turnover rate. Or the extra pair of eyes on the EMR could not only cut down on documentation time but reduce errors, improving not only the coding and billing process but clinical outcomes.

"You have to have your CFO at the table," noted Helene Burns, DNP, RN, NEA-BC, senior vice president and chief nursing officer at Jefferson Health New Jersey. "We have to think about where we invest our dollars."

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