Virtual Nursing Programs Need to Balance Growth With Value

Jefferson Health, a participant in the HealthLeaders Virtual Nursing Mastermind program, is strategically expanding its program as it looks for sustainability

Jefferson Health launched its virtual nursing program in 2023, and is expanding its strategy to broaden the virtual observation footprint and include inpatient provider consults. They’re also exploring opportunities to integrate other care team connections, such as diabetes educators.

“For nursing specifically, we completed a second pilot, applied key learnings, and officially launched a formal program with a dedicated, permanent team,” Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, the health system’s Nursing Informatics Officer and a second-year participant in the HealthLeaders Virtual Nursing Mastermind program, said in an e-mail Q&A. “We have refined the virtual nurse’s core tasks and workflows to enhance support for bedside teams and have collaborated closely with our vendor to optimize the technology. In addition, we have identified other areas across our system where virtual care can further improve patient support and clinical workflows. As we continue to expand, our goal is to integrate virtual care more seamlessly into inpatient operations to enhance efficiency and patient outcomes.”

This includes using the virtual platform for more care team functions. Beyond the first use cases for provider consults, Gartner says they want to expand inpatient consults to help hospitals access specialists in other locations and reduce the need for transfers, which can be stressful and time-consuming. They’re also working to integrate this and other virtual functions into their EHR platform, so that virtual nursing isn’t an added function that complicates nursing workflows.

These additional services cost time and money, though, which is a tough sell in this economy.

Laura Gartner, AVP and Nursing Informatics Officer at Jefferson Health. Photo courtesy Jefferson Health.

“One of the biggest challenges we’ve faced with the virtual nursing program is securing sustainable funding,” says Gartner. “There is strong interest in implementing virtual nursing across various units, as the benefits—such as improved workflow efficiency and enhanced patient support—are widely recognized. However, integrating a virtual nurse into staffing models requires a financial investment, and identifying consistent funding sources has been a barrier. Aligning financial priorities with program expansion remains a key focus.”

To prove that ROI, Gartner says they’re tracking process metrics such as average number of virtual nursing sessions per shift, overall number of sessions, time per session and overall, and the reason for accessing a virtual nurse. They’re also tracking outcomes, including the 30-day readmission rate, falls, falls with injury, HCAHPS scores, voluntary nurse turnover, discharge times, LOS, and incidental overtime, among others. To date, she says, they’ve seen improved HCAHPS scores, shorter LOS times, a decrease in incidental overtime and reduced discharge times.

They’re also on track, she says, to double the use of their meds to beds program, which aims to improve patient education and medication management.

The program also has value that can’t be measured in a metric. Gartner says virtual nursing has had a positive effect on the nurse-patient relationship.

“One of the best parts [of the program] has been hearing the virtual nurses connect with patients,” she says. “These are truly incredible nurses, and through this program, they’re able to spend more focused time with patients than they often could at the bedside. It’s been rewarding for both the nurses and the patients, and a great reminder of the value of meaningful interactions in care.”

Gartner says she was surprised by how nurses were initially apprehensive about the program.

“Even though virtual nursing has a benefit of reducing bedside staff workload, it’s still a big change from how things have traditionally been done,” she says. “Some nurses were worried that we were taking a nurse away from the unit, rather than adding support.”

In fact, the health system has changed its staffing strategy as the program evolves. Where Jefferson Health first used two enterprise resource nurses on temporary assignment, Gartner says, they’ve now switched to two permanent staff members and have plans to add more.

“I’ve found that building trust and understanding takes time, and that’s been a valuable reminder of the importance of clear communication, collaboration, and involving frontline nurses early and often,” she added. “What’s been most encouraging is that, as nurses see the impact firsthand and hear positive feedback from peers, acceptance and enthusiasm grow organically. It’s a journey, but one that’s already showing great promise.”