How ChristianaCare is Expanding the Capabilities of Virtual Nursing

The next goal of this health system's virtual nursing program is to see how virtual care can impact other areas, says this nurse leader.

Health systems everywhere are experimenting with virtual nursing, and there are many key strategies that they can learn from each other.

Maria Brown, nursing excellence manager at ChristianaCare, outlined what ChristianaCare wants to accomplish with their virtual nursing model.

Brown is a part of the HealthLeaders Virtual Nursing Mastermind series, an exclusive, six-month series of calls and an in-person event where several health systems discuss the ins and outs of their virtual nursing programs.

Goals for the program

ChristianaCare launched a pilot of their virtual care program in 2022 with the primary goal of reducing burden at the bedside and giving time back to nurses to care for patients. The program then expanded to 500 beds in 2023, starting on med surg units and growing to include a postpartum unit and other specialty units, such as elderly, stroke, and cardiac step-down units.

According to Brown, the virtual acute care nurse program has had a significant impact on patient experience and on new nurses.

"Our experienced nurses function as clinical coaches," Brown said. "For those new nurses or novice nurses that are at the bedside providing hands-on patient care, if they have questions on clinical situations or need an experienced perspective, they're able to call the virtual nurse."

Brown says there is the possibility of using the virtual care program to keep tenured nurses in the workforce. ChristianaCare specifically uses experienced nurses in the program so they can provide the best care and guidance to other nurses.

"We definitely want to be able to keep our nurses practicing as nurses as long as they can, even if their bodies may not be able to physically do it, but they really want to continue as a nurse," Brown said.

Logistics

According to Brown, the nurses taking part in the program are pulled from practice areas to function as a virtual nurse—they are not being hired externally.

"We do have a few full-time nurses that have transitioned from those areas to a full-time virtual nurse role," Brown said.

The virtual nurses are housed in a remote location together and they are not allowed to work from home.

As for technology, ChristianaCare is leveraging a homegrown app paired with iPads at the bedside, which were initially used during the COVID-19 pandemic.

"They are in each patient's room purposely placed at each bedside—they don't come out," Brown said. "The only thing that comes out is the patients from admissions and discharges."

The health system created a dashboard to keep track of metrics such as length of stay, 30-day readmissions, and some harm metrics. Brown noted the significant impact on patient experience.

"We definitely think that's attributed to that nurse one-on-one time with the individual patient, and [the nurse] not being called [away] for a phone call or to help the patient in the next room, and those kinds of things," Brown said.

From present to future

According to Brown, both the nurses and the patients are positively reacting to the program. The nurses see the program as an opportunity to take a physical break from the bedside and connect with patients in a more focused manner.

"Culture change is hard, especially when you've been doing this for many, many years, and then we throw technology into the mix and then a different care delivery model into practice," Brown said. “Sometimes it takes a little bit of getting used to, but I think overall, nurses also support this new model."

Going forward, Brown believes that the health system's current staffing model may change from pulling nurses off of units to having a fully staffed virtual nursing model. The next goal is to expand further and see how virtual nursing can impact other areas.

"We hope to evolve to all other kinds of settings, meaning potential ICU type areas and EDs," Brown said. "We are doing some pilots in different types of areas, like an ambulatory space to kind of see how nurses could function that was as well."

As for technology, Brown expressed that the model is evolving, and due to the significant cost of switching technologies, some patience is necessary.

"I don't know if we've found that perfect technology that does everything, and so we wanted to wait and see what we can do with what we have," Brown said. "By the time we are able to decide on a technology, I think we would include things that have AI technology, maybe some ambient listening, [and] maybe some ways to use predictive analytics."

Advice for CNOs

For those CNOs and other nurse leaders who are attempting virtual nursing for the first time, Brown had several pearls of wisdom.

"I would say first and foremost, don't wait for the perfect scenario, because there never is a perfect scenario," Brown said. "If you're waiting for perfection in technology [or] staffing, you're going to be waiting a long time."

Brown also recommended getting stakeholders involved in the project as early on as possible, and ensuring that buy-in and support are present from all participating departments.

"You want to make sure that they're involved and have a stake in the process," Brown said, "and that everything is bought in, so that your program is successful."

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 into 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.