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Virtual nurses may work from behind computer screens, but their impact is felt throughout healthcare as their expertise is increasingly integrated into patient care and nursing workflows.
Since the invention of the telephone in the modern digital age, healthcare providers have used telecommunication tools to bring clinical expertise and care to wherever patients need them. Regardless of the technology, nurses play essential roles throughout telemedicine, usually conveying or using insights or information.
Simply put, virtual nursing is the practice of nursing using telecommunication and telehealth tools and technologies.
Initially focused on increasing access to care in rural and remote areas and responding to the aftermath of natural disasters, telehealth, and virtual nurses have become part of the care provided to thousands of patients across the globe every day. They now support clinical teams throughout the patient care continuum to help ease the overwhelming demands and address serious healthcare issues.
During the COVID-19 pandemic, many care providers considered how telehealth tools could be used in innovative ways in the care of patients. The United States Government Accountability Office reported a 15-fold increase over the prepandemic level in telehealth use among Medicaid beneficiaries. Numbers skyrocketed from 2.1 million in the year before the pandemic to 32.5 million from March 2020 to February 2021.
Teresa Rincon, PhD, RN, FCCM, is a pioneer in virtual nursing. In 2003, she was one of the first nurses to practice from behind a camera as part of a teleICU. Today, she is an assistant professor at UMass Chan Medical School and its Tan Chingfen Graduate School of Nursing in Worcester, Massachusetts, and a senior telehealth consultant with Blue Cirrus Consulting, Greenville, South Carolina. She recently served as editor for a symposium of articles on virtual nursing for AACN Advanced Critical Care, a journal published by the American Association of Critical-Care Nurses (AACN).
When Rincon became a virtual nurse, there were fewer than 1,000 teleICU beds in the United States. Over 20 years, that number has grown 20x, with an estimated one in eight ICU patients now monitored remotely.
“The level of technology acceptance has created opportunities to apply the virtual nursing model to ‘virtually’ anywhere,” she said. “The ability to leverage clinical expertise across and despite geographical boundaries is an efficient and cost-effective way to ensure safe, timely, and effective care in critical situations and routine care delivery.”
Immediate Access to Clinical Support
Virtual nurses regularly assist with tasks that do not require physical proximity to the patient, such as patient-family education, completing admission and discharge tasks, and participating in two-person verification processes.
During a patient assessment, a remote nurse and an on-site nurse can efficiently work in tandem, with one managing tasks that require physical proximity to the patient and the other completing tasks such as clinical documentation, patient-family education, and expert nurse surveillance.
Virtual nurses provide an additional layer of clinical support to nurses at the bedside. At the push of a button, bedside clinicians have immediate access to additional nursing support.
This ease of access gives bedside nurses peace of mind, knowing that an experienced fellow nurse is not only assisting in monitoring for changes in a patient’s status but is available to collaborate and assist with care at a moment’s notice.
Virtual nurses serve as valuable mentors to novice nurses as they develop into competent and confident clinicians. They also may support travel or agency nurses to help bridge knowledge gaps caused by a lack of familiarity with specific facilities and policies. In addition, peer-to-peer collaboration can help on-site colleagues feel more supported.
Lisa-Mae Williams, PhD, RN, CCRN, is the chief nursing officer at Intercept Telehealth, Weston, Florida.
“In addition to caring for patients, virtual nurses are helping to address the experience gap by providing an extra layer of support and expertise to the on-site team,” Williams said. “Knowledge and expertise are precious commodities, especially when caring for critically ill patients.”
Beyond the ICU
Virtual nurses and tele-critical care (TCC) programs have become more pervasive, thanks to technological advances, modalities expansions, and the number of patients served.
“We’ve seen significant growth in the number of tele-critical care services, as they expand beyond traditional critical care areas, including to emergency departments, medical-surgical units, and even home-care settings,” said Fiona Winterbottom, DNP, MSN, APRN, ACNS-BC, ACHPN, CCRN, clinical nurse specialist, at Ochsner Health in New Orleans.
Advances in technology have led to increased use of mobile carts, which bring the expertise of intensivists and TCC nurses wherever they may be needed. In the emergency department, they can proactively manage patients waiting for hospital admission, providing earlier access to interventions and improving outcomes.
Remote clinicians can also support rapid response teams to help stabilize a patient with a deteriorating condition. The patient can often remain in their current unit and avoid transfer to an ICU. An added benefit is that the mobile cart can stay in the patient’s room, allowing the virtual nurse to continue monitoring them for a defined period.
There are also opportunities to create an observation space in the emergency department where patients who need short-term care for diabetic ketoacidosis, drug/alcohol overdose, allergic reactions, and other issues can get the expert care they need without being admitted to another unit.
Beyond the hospital, wearable devices and monitoring kits that link to an on-call automated system and a mobile app can help patients self-manage at home with a medical support system.
Unlimited Options
Ryan Morcrette, BSN, RN, CEN, is the director of virtual care and clinical communications at St. Luke’s University Health Network in Pennsylvania and New Jersey.
“The concept of virtual nursing will continue to mature along with the technology to support it, and we’re going to look back and wonder how we ever provided healthcare without this asset,” Morcrette said. “It will become second nature for patients, bedside nurses, and other clinicians.”
“As we look to the future, we have to think about how to harness the knowledge and skills we need to improve the care we provide to patients. We need innovative solutions to manage the impacts of the global nurse staffing shortages successfully,” Rincon said. “Thanks to telehealth technologies, an expert can be located anywhere in the world and connect with someone who needs their assistance.”
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Kristie Aylett is an Accredited public relations practitioner who provides strategic counsel and senior-level communication expertise to clients throughout the United States. During her 30+-year career, she has worked with multiple healthcare organizations, including medical schools, hospitals, nonprofit organizations, public health agencies, and professional associations such as the American Association of Critical-Care Nurses. She also teaches PR courses at Tulane University.
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