The Exec: At Atrium Health, Virtual Nursing Increases Patient Satisfaction, Decreases Falls and Medication Errors

'It truly has proven to be an additional layer of support to enhance patient care and outcomes,' nurse executive says.

What began as an innovative way to monitor and care for COVID-19 patients at the height of the pandemic is evolving into a growing virtual nursing program at Atrium Health.

The North Carolina-based health system, now part of Advocate Health, launched its virtual nursing program in March 2021 when, like other health systems, nurses struggled to meet staffing demands.

Nurses loved it, patients loved it, and the health system noticed positive outcomes: decreased medication errors, decreased falls, increased patient satisfaction, and more, says Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL, vice president of nursing operations, professional development and practice.

Mook spoke with HealthLeaders about how Atrium Health’s virtual nursing program benefits both nurses and patients and how a care model prompted by COVID has become a permanent part of the health system.

This transcript has been lightly edited for brevity and clarity.

HealthLeaders: How did Atrium Health begin its virtual nursing program?

Patricia Mook: We began by gathering together some innovative nursing staff who had previous history with working with virtual patient observation and asked, “How can we support our nurses at the bedside at a time when we don't have enough nurses because of the pandemic and be able to virtually watch these patients?” We very quickly put up a pilot and it was absolutely fantastic.

We found lots of benefits. We were able to keep nurses who couldn't really function physically at the bedside but had great skill, so we put them behind the camera to be our virtual nurses. We were able to help new nurses do their work at the bedside with an experienced nurse behind the camera.

We saw staff engagement, a decrease in medication errors, a decrease in falls, and an increase in patient satisfaction. We also see this as a retention tool for nurses; it’s a reason for nurses to want to come to work at Atrium.

HL: What are the virtual nurses’ responsibilities?

Mook: The virtual nurse behind the camera observes about 10 patients and can do an admission assessment; they’re able to do hourly rounding; they can do RN/MD rounding with the medical doc when they come in the room; they can do medication teaching; discharge instructions; and work with families on family instruction.

They can monitor vital signs that are being taken in the room because the camera is so sensitive that they can zoom in on the technology in the room to monitor what's going on there. They have the ability to assist pharmacy with medication reconciliation. There are a lot of things that they're able to do.

In addition, sometimes nurses have medications or even administer blood that requires a second nurse check, and the nurse behind the camera can be that person and provide that check. There are so many ways that the nurse behind the camera can help the patient and help the nurse, physician, pharmacist, or any care provider who comes into the room.

HL: How does virtual nursing create efficiency for the floor nurse?

Mook: Every single time you go into the room of an infectious disease patient, you have to put on your gloves, your cap, your mask, and your paper gown, and that takes a good two minutes to get it all done. If you look at studies, the number of people who go in and out of the room is a lot.

When a nurse who's at the bedside doesn't have to go in and out of the room every hour, we  calculated that they saved probably two hours of going in and out of rooms. It saves a lot of time and it saves energy. It's more efficient.

Patricia Mook, MSN, RN, NEA-BC, CAHIMS, FAONL

HL: What benefits does virtual nursing offer patients? What do they like about it?

Mook: If they had a need, somebody was right there with them in an instant because the virtual nurse could zoom in to that patient, click on the button, and say, “How can I help you?” We were able to help them feel safer when they were alone in the room. During COVID, patients often weren't able to have visitors, so this was a person who was there to comfort them quickly.

One of the reasons we think we saw an improved patient satisfaction score was most of our patients during the pandemic were on isolation and the only face they saw was the nurse on the camera who didn't have to wear a mask. We were very encouraging of that nurse behind the camera to keep a smile on their face for their patients because that really was the only facial expression that patients would see the entire time they were in the hospital because everybody was masked. And that facial expression means so much to patients, so we saw a higher patient satisfaction score on the patients who were being seen with virtual nursing.

Finally, response time to call bells was a tremendous improvement for our patients, which also led to safety and patient satisfaction advances.

HL: What have been some of the outcomes that you’re seeing with virtual nursing care?

Mook: We are still collecting and analyzing data, so we don’t currently have specific information to share. The virtual nurse allows for early recognition of any changes in patient status, so attempting to get up would certainly be among those things we’re watching for. It has also provided us an earlier notification of when the rapid response team needs to engage, and in instances where the patient has coded.

The patients are truly winners here. We’ve seen a 56% reduction in the number of call bell responses and scores for patient experience have risen dramatically. It’s also useful in helping avoid mistakes; if you have a novice nurse on the floor, having an experienced nurse “in the room” with them via video can be a huge comfort and ensure that all elements of care are provided appropriately. It truly has proven to be an additional layer of support to enhance patient care and outcomes.

HL: How widespread is virtual nursing now across Atrium Health?

We’re currently covering 20 beds at Atrium Health Pineville Progressive Care unit and 30 beds at Atrium Health Cleveland. We’re looking at additional locations to expand, with a focus on med-surg and med-tele units.

We’re also working on electronic dashboards and other options to improve analytics and data collection.