Health systems are brainstorming new ideas for how to build and improve virtual nursing programs.

The Virtual Nursing Mastermind program participants are meeting in Atlanta, Georgia, to discuss the ins and outs of implementing virtual nursing programs.

The program consists of CNOs and other nurse and technology leaders from 12 health systems across the country who are all at various stages in their virtual nursing journeys, and who are innovating with new technologies and solutions.

Implementation

One of the biggest hurdles for virtual nursing is program adoption and implementation. The participants discussed how to gain buy-in from the other C-suite members, particularly the CFO and CIO, and how to introduce the program to the nursing workforce.

There's also a call for defining terms, which the participants say will help with buy-in. The participants were clear that "nursing" needs to come out of "virtual nursing." The tasks being done virtually, like certain documentation functions, do not necessarily need to be completed by a nurse. Health systems should be looking at other departments or positions who can complete those types of processes. This new technology will also enable many other departments in the health systems to also use the platforms for their various needs.

The participants also shared how they have operationally set up their virtual nursing programs. Many have centralized hubs with dedicated buildings where their virtual nurses are based, and others have virtual nurses working from home. The participants noted that they believe virtual nurses need to be at least technologically proficient to take on the position and that those working from home have a private space they can use with a reliable internet connection.

Lessons learned

ROI and improved clinical outcomes are a crucial piece of the puzzle. The participants spoke about what outcomes and efficiencies they are seeing so far and the metrics they are using to track progress. Some of the top metrics include timely discharges, turnover rates, incremental overtime, HCAHPS, and other nurse sensitive quality indicators.

Every health system is going to have different needs and different ways to measure ROI, so according to the participants, it is important to start with a metric like timely discharges. Leaders should look at traditionally "soft" ROI metrics and assign dollars to them so that the rest of the C-suite will get on board with implementing virtual care programs. Additionally, if a system is going to launch a virtual care pilot, it should directly address the chosen ROI metric that will solve the problems that the health system is focusing on.

The participants said the possibilities are endless with virtual nursing technology. The programs are set to expand well beyond just documentation and more into patient monitoring, nurse mentorship, and into more forms of digital care. The ultimate goal is to leverage virtual technology to create sustainable care models of the future.

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.

The new simulation lab will use new technologies and interactive labs to train healthcare workers on care management for pregnant women and their children

Stanford Medicine Children’s Health is launching a new innovation lab aimed at improving care for pregnant women and their children.

The Stanford Medicine Children’s Health Simulation Innovation Center will use AR, digital health-enabled mannequins, and other tools and technology to give healthcare workers a more hands-on education on a wide variety of health concerns, from difficult births to neonatal care.

“The Innovation Center is … a tool for enhancing care delivery, research, and quality improvement initiatives,” Kristine Taylor, DNP, executive director of the Innovation Center and Center for Professional Excellence and Inquiry, said in a press release. “By analyzing simulation data and outcomes, healthcare teams can identify areas for improvement and implement evidence-based practices to enhance patient care.”

The 4,900-square-foot center is one of several innovative projects being launched across the country to address the nation’s high maternal mortality rate and significant care gaps in children’s health. The maternal mortality rate in 2022 was 22.3 deaths per 100,000 live births, according to the U.S. Centers for Disease Control and Prevention; that’s down compared with 32.9 per 100,000 in 2021, during the height of the pandemic, but still high compared to other developed nations.

[Also read: NYC Targets Maternal Health Care Gap With Mobile Program.]

Healthcare leaders at Stanford Children’s say the new center and technology will help train healthcare workers of all levels, even social workers, in an interactive learning environment that includes debriefing rooms, where they can go over what they’ve learned and discuss new ways of delivering care.

“We are able to enhance our critical thinking, decision-making, and communication skills, ultimately improving patient care outcomes without putting actual patients at risk,” Emily Tomich, RN, a triage nurse and labor and delivery nurse educator, said in the press release. “This is especially important in high-stress situations where clear communication is critical, from basic procedures to complex surgical techniques.”

Gerard Phillips, the health system’s Senior Director of Nursing, explains in this week’s HealthLeaders podcast how UCSD Health is improving patient safety--and where they expect to use the technology next

UC San Diego Health has avoided more than $10 million in healthcare costs since adding remote video monitoring to its telesitting program in 2012.

In this week’s HealthLeaders podcast, Gerard Phillips, DNP, MBA, RN, the health system’s Senior Director of Nursing, says the bidirectional cameras placed in patient rooms enable specially trained video monitoring technicians to monitor patients and communicate with them around the clock.

The 24/7 monitoring program is designed for patients deemed at risk of falling, wandering, or causing harm to themselves by pulling out attached lines and tubes. The health system now has 30 cart-based cameras stationed across five healthcare sites, monitored by three technicians, who are trained CNAs, at a central video monitoring hub.

Phillips says the program not only has allowed UCSD to “maintain a higher level of safety [for] our patients,” but enabled the health system to use those savings to invest in other areas of the organization.

He also says UCSD envisions using remote video monitoring in a number of areas, including virtual nursing, staff safety and home-based care management. And they’re embedding AI technology into the cameras to help monitors spot visual cues of signs of concern with patients.

Listen to Phillips and learn how the health system is making the most out of its virtual telesiting program here.

CNOs and CFOs must learn to speak each other's language, says this nurse leader.

On this episode of HL Shorts, we hear from Katie Boston-Leary, director of nursing programs at the American Nurses Association, about how CNOs and CFOs can better communicate with each other. Tune in to hear her insights.

A new report shows that lowering nurse manager span of control improves clinical and financial outcomes.

Amid high burnout and turnover rates, nurse leaders should take a closer look at a key piece of the workforce puzzle: nurse managers.

Nurse managers need time and support from leadership to complete their tasks. According to a report published by the American Organization for Nursing Leadership (AONL) and Laudio, this could be accomplished by lowering span of control.

Span of control refers to the number of employees that nurse managers are in charge of supervising. According to the report, the median span of control for nurse managers is 46 employees, but 25% of all inpatient nurse managers have spans of control higher than 78.

The problem

According to Rudy Jackson, senior vice president and CNE at UW Health and a HealthLeaders Exchange member, nurse managers often have to perform many different duties. As a result, they’re often stretched thin.

"We put so much incredible pressure on our nurse managers to manage finances, culture, patient experience, quality, [and] keep turnover rates [and] length of stay down," Jackson said. "Yet we have all of these things that we put on their shoulders before they're able to get those things done."

Jackson said UW Health is making a significant investment in reducing span of control for nurse leaders. They’re looking at metrics like total headcount per nurse manager vs. how many pilots they are working on, as well as workforce diversity.

Jackson said a recent study has helped the health system understand what “we can eliminate off their plate” to make their jobs easier.

High spans of control also impact turnover rates.

According to the report, managers with higher spans of control face more turnover costs and incremental overtime.

Nurse managers are often swamped with busy work, leaving little time for job development. Jackson said that with more time, nurse managers could develop relationships with their teams, improve quality outcomes, improve the patient experience, and ultimately reduce costs, turnover and vacancy rates.

"What I need are leaders," Jackson said, "and reducing that span of control is going to allow us to move those individuals into a leadership role where they're truly able to guide their teams." 

The solution

The ultimate goal of lowering span of control is to give time back to nurse managers while also keeping costs down.

The report says that a financial case can be made for reducing span of control, when possible, even if it means splitting larger departments into smaller ones. According to the report, leaders should consider reducing or reallocating administrative tasks to offload the nurse manager's burden, while leveraging technology.

Additionally, the report says that giving more time to nurse managers to meaningfully interact with staff lowers RN turnover rates, which in turn lowers hiring costs.  

To Jackson, the answer to this issue will vary depending on the size of a health system and its resources.

"When you look at the control data for an organization like UW Health and you compare us to others, we do have a lot of resources that support our managers," Jackson said.

"It's a matter of trying to understand what exactly are those individual things that are impacting our leaders," Jackson continued, "and how can I leverage technology to offset some of that burden?"

UW Health developed a nurse manager council so that nurse managers have a venue to voice innovative solutions, questions, problems, and concerns. Jackson said UW Health will soon be conducting time studies with managers across the health system to better understand where nurse managers are spending their time.

"One of the solutions I heard recently from a CNE was [that they] give [their] managers a day off once a week, and … in theory, that would work pretty well," Jackson said. "The reality is that the work doesn't stop."

"As CNEs, we need to start thinking about innovative solutions, leveraging technology, offering the appropriate support," Jackson said, "but [doing] so in a manner that doesn't add additional cost to organizations that already exist on razor thin margins."

What about assistant nurse managers?

According to the report, the assistant nurse manager plays a critical role in this strategy.

The study found that 56% of nurse managers are supported by at least one nurse manager. Of that number, 4% of nurse managers have all team members reporting to the assistant nurse manager and 18% share the direct reports, while 78% have all team members as their direct reports, without including the assistant nurse manager.

The report says that RN turnover is lower when assistant nurse managers are part of high span of control teams, which ultimately reduces costs. However, the data also shows that too many assistant managers can become counterproductive and lead to high turnover, possibly because roles are less clear.

Jackson has experienced working in environments with and without assistant nurse managers, and UW Health is now trying something new.

"What we've challenged our team with is start looking within," Jackson said. "What resources do we have internally that can allow us to start to decrease that administrative burden to those managers so that we can get them out of their office and elevate the roles of some of the others?"

UW Health deploys full-time charge nurses called care team leaders (CTLs). Jackson said they are looking at how CTLs can help offload the burden from nurse managers.

UW Health is also leveraging technology to help with administrative burdens.

"We're looking at technology to remove the burden of scheduling," Jackson said. "We've got to be able to put pressure on our IT departments to find those solutions that help nurses and help the organization make our leaders more efficient, [and] support our nurses even better."

In health systems where creating new roles is not possible, Jackson recommended making existing roles more supportive to the nurse managers.

"I think there's a lot of different ways to utilize the assistant manager role," Jackson said, "but I don’t think we need to be stuck with the solution that the assistant manager is the only way we're going to fix the manager span of control."

A new survey highlights the importance of being prepared to deal with a cyberattack and data breach.

With cyberattacks in healthcare on the rise, it’s vital that practices have security measures in place to protect patient data.

Yet, only 63% of organizations have a cybersecurity plan in place, according to a survey by Software Advice, which means many are vulnerable to potentially crippling attacks that can be costly and damaging to patient trust.

The survey fielded answers from 296 respondents with IT management, data security, data management, security training or audit responsibilities at healthcare organizations around the country.

The data revealed that half of organizations have experienced a data breach, with 32% dealing with one in the past three years.

More than one in four practices (42%) has experienced a ransomware attack, with nearly half (48%) reporting the attack impacted customer data, while 27% said it impacted patient care.

After a ransomware attack has taken place, a third of respondents (34%) failed to recover patient data from their attackers.

With 55% of practices allowing access to more data than employees need to their job, it introduces greater human error into the mix.

To counter the increase in threats, CEOs at both provider and payer organizations must take a proactive approach to cybersecurity.

That includes putting preventative measures in place, such as more training for employees handling data to help them identify scams and attacks, as well as limiting certain data to the employees that need it.

Preventative measures, however, aren’t effective for attacks that have already happened, which is why it’s crucial for CEOs to implement a response plan “that includes defined roles and responsibilities, communication protocols, and a prioritization list,” the report said.

Not every organization that is prepared to prevent and respond to a cyberattack will be safe though.

Banner Health’s next CEO, Amy Perry, recently told HealthLeaders that it’s difficult to protect yourself again bad actors that are coming at you from all different angles.

"Do I see a solution? Not an easy solution,” Perry said. “All of the health systems, including Banner, have multiple, multiple investments in protection. But again, moving at the speed that the people that are working on the other side of this in the dark corners of the world, I think we've got a long way to go before we figure out how we keep ourselves safer every day.”

One of the biggest challenges when implementing virtual nursing programs is determining which metrics to use to measure ROI.

Jason Atkins, vice president and chief clinical informatics officer at Emory Healthcare, outlined how the Atlanta-based health system is implementing virtual nursing and the five metrics they use to measure the success of their program.

Atkins is a part of the HealthLeaders Virtual Nursing Mastermind program, in which several health systems are discussing the ins and outs of their virtual nursing programs and what their goals are for implementing this new strategy.

Metrics

The first metric, according to Atkins, is nurse satisfaction and nurse engagement. This data is collected via surveys that go out to the nurses.

"We do pulse surveys to make sure that we're asking questions around, 'Do you have the tools you need for your work?’ and, ’'Do you have the staffing and resources that you need for your work?'" Atkins said.

The second is patient satisfaction. Patients must be made aware of the cameras and what their interactions will be with the virtual nurse.

Atkins said that explaining the virtual nursing process to the patients will gain their trust and engagement.

"We really want to make sure that we're explaining the why behind this to our patients," Atkins said, "because they're going to see a camera in their room and that could certainly give someone a sense of privacy invasion."

Length of stay is the third metric. The virtual nurses are completing discharge planning, education, and facilitation, and according to Atkins, they are the link to the interdisciplinary rounding process to make sure that milestones and barriers are worked before discharge day.

"Making sure we've got prescriptions set up, we've got their med reconciliation done, we've got all their discharge milestones such as transport or subacute care." Atkins said. "All of that stuff should help decrease our length of stay."

The fourth metric is readmission rates, which are often dependent on discharges, education, and follow-up planning.

"Making sure that the patients who are discharged have their follow-up appointments before they ever leave the hospital," Atkins said, "so they can get that good continuity of care and not get readmitted to the hospital."

The fifth and final metric is cost and productivity. Atkins explained that the goal is to offload the burden of care from the bedside nurse, while making sure that there is a return on investment.

"It's not just adding on new staffing or thinking about how [to] increase the ratios on the nurses," Atkins said. "It's really about a return on investment based on those other metrics [and] hopefully quality of care improvements 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.

Automakers are applying the smart home concept to the automobile, with plans to include sensors that can track a driver’s physical and mental health

The next healthcare access point for providers could be the car.

General Motors is seeking a patent for technology inside the automobile that tracks a driver’s behavior and health through sensors, according to Autoblog.com. The technology could help to identify drivers who are impaired or affected by a wide range of health concerns, ranging from drugs and alcohol to issues with mental acuity, breathing, blood pressure, or blood sugar.

The company’s plans, which have been ongoing since at least 2022, are to create a tech platform inside the car that establishes a profile of the driver’s habits, called a “vehicle occupant mental well-being assessment.” The platform would then identify any trends that fall outside the norm and use “counter-measure deployment,” which would range from asking the driver to perform a “mental health exercise,” calling family members or a trained professional, or even taking control of the car.

The idea isn’t exactly new. Automotive displays at CES in Las Vegas have for many years hinted at or even featured prototype sensors and technology aimed at tracking the driver’s health. Cars can now be fitted with technology that prevents a driver under the influence of alcohol from starting the car.

The effort has ties to the remote patient monitoring movement, in which healthcare providers are looking to track patients and provide on-demand services outside the hospital, clinic or doctor’s office. And with programs like Lake Nona’s WHIT House in Florida targeting smart home concepts, automakers are aiming to do the same thing with their newest vehicles.

Aside from tracking people with substance abuse issues, healthcare providers and public health advocates say the technology could address accidents each year linked to driver distress, such as mental health issues, blood pressure, diabetes, cardiac issues, even allergic reactions. While those accidents only represent about 2% of all crashes in the U.S. each year, according to data compiled by the U.S. Department of Transportation, 84% of those are caused by medical emergencies that could potentially be detected and prevented.

Ideally, the technology might someday be used to identify hazards to drivers, like smog or high pollen counts for people with respiratory issues, or direct (or even steer) drivers to a nearby healthcare site in an emergency.

Several carmakers are giving health and wellness tools a serious look. In the past few years Mazda, Audi, and Toyota have said they are working on next-generation cars armed with a wide variety of sensors, including ECG sensors in the steering wheel and earpieces designed to measure a driver’s impairment.

And back in 2011, the Ford Motor Company announced partnerships with digital health companies WellDoc, Medtronic, and SDI Health to include health and wellness connectivity solutions on the Ford SYNC platform.

“We want to broaden the paradigm, transforming SYNC into a tool that can improve people’s lives as well as the driving experience,” Paul Mascarenas, chief technology and vice president of Ford Research and Innovation, said in a May 2011 press release.

The company also announced plans to embed sensors in the seats to monitor a person’s heart rate, though by 2015 the company had ditched those plans. And while the latest SYNC platform offers integration with apps, no mention is made of health and wellness monitoring.

In many cases, automakers have abandoned these plans on the idea that wearables would do a much better job monitoring drivers, as well as passengers. But the fact that GM is taking an active look at the technology means they haven’t given up on the idea.

The old ways of growing the nursing workforce are no longer working, so it’s time for some new strategies.

The greatest challenge facing nursing leaders today is workforce development. Health systems are in dire need of solutions that improve both recruitment and retention.

These challenges come at a time when workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover. Virtual nursing and other new technologies like AI have also had an impact on the workforce and need to be considered when strategizing.

Here are four ways CNOs can move forward and build a strong, healthy, and happy workforce.

Click here to read the accompanying cover story.