Gamechanger: Virtual Nursing Model Creating Positive Outcomes for MercyOne

Virtual nursing model yields zero CAUTI levels, high patient engagement scores, and extra sets of hands for shift nurses.

MercyOne Des Moines' virtual nursing program was installed to offset nurse shortages and, when the pandemic hit, to protect staff and patients, but outcomes have yielded so much more: improved quality; decreased falls; decreased medication duplication; decreased missed care; and zero catheter-associated urinary tract infections (CAUTI) rates.

"What really was a welcome thing was our medical staff loved it," says Linda Goodwin, MSN, MBA, FACHE, senior vice president of clinical operations, integration, and innovation, who piloted the program in her former position as MercyOne's chief nursing executive (CNE).

Virtual nursing conveniently connects nurses, providers, specialists, and family members as needed; floor nurses receive extra help; physicians get fewer calls; patients receive quick, personalized service; the hospital earns high engagement scores; and nurse leaders are feeling less of the staffing shortage pinch, she says.

"It's speeding up care. It's preventing duplication of care," Goodwin says. "It's reducing time from order to care, and it's improving the quality patient-physician engagement."

Since the program started shortly before the 2020 pandemic hit, it has grown to 72 beds and eventually will broaden to the Iowa health system's rural affiliates and 44 hospitals.

How it works

Using videoconferencing technology and dedicated devices in each patient room, including a monitor, MercyOne's virtual nurses assist bedside nurses by monitoring the unit from a remote digital center.

The virtual nurse, who is responsible for 18 patients, participates in daily interdisciplinary rounds via teleconferencing, in which the patient's care team videoconferences into meetings, compares notes, and confers with each other, she says.

The virtual nurse then facilitates all care communications, such as calling for test or lab results, reviewing charts, handling discharge duties and anything else the care team needs, Goodwin says.

Dietary, care management, and pharmacy also are part of the growing virtual nursing program, she says.

"These pharmacists are taking medication reconciliation off the backs of nurses. They make sure there's no duplication of med orders, they stop a lot of errors, and they do all the patient education around new medications or diabetic education," Goodwin says. "They are a phenomenal piece of this team. It isn't just a nurse model anymore; it is a multidisciplinary model."

MercyOne's program also allows the patient's family to easily participate in care meetings with doctors and specialists as they explain the diagnosis and treatment, share test results, and discuss treatment options.

When it's time to discharge the patient, the family can log in to get discharge instructions and ask questions of a virtual pharmacist and other care team members to understand how to properly provide for the patient at home, she says.

Each patient's plan of care is top of mind in every round and every huddle, Goodwin says, which means if a patient wants something as simple as a chocolate malt, they immediately get a chocolate malt, ordered up by the virtual nurse.

"It's not delayed. It's not, "Oh, I'll put it on the list, and I'll call when I get back to the desk.' The virtual nurse can immediately deliver (on) those things, Goodwin says. "That's another reason it's so important to have them be free of any other responsibilities other than full focus on the patient."

Interestingly, the virtual nursing digital center is not onsite at MercyOne, but several miles away on the edge of downtown Des Moines, Goodwin says.

"One thing we learned," she says, "is to never place the unit close to the unit where virtual is being provided."

"You would think that's crazy, but what we found is nurses are who nurses are, and if they see that something's needed to be done quickly and the other nurse is too busy, they would leave the camera and go help," she says, "I said, 'No, we can't have that,' so we physically moved it off site and that has been very successful."

Why floor nurses like virtual help

While the virtual model is beneficial for units that may be short-staffed or have several newly graduated nurses, busy floor nurses taking care of five or six patients particularly welcome the assistance and support that virtual nurses provide because:

• They see less harm to patients—falls, for example—because the virtual nurse has a constant eye on each patient. "Because floor nurses have such sick patients, it oftentimes takes a lot of their time, but they can be comforted by the fact that a virtual nurse is overseeing their patients," Goodwin says.
• Virtual nurses can handle discharge duties. The virtual nurse knows the patient and the discharge plan of care. "They can arrange transportation with a social worker and never bother the nurse on the floor," Goodwin says.
• They can handle challenging family dynamics. "Do you know how much time it takes for a floor nurse when there are dysfunctional families?" Goodwin says. "The virtual nurse takes that off their hands."
• Floor nurses experience fewer interruptions. "Nurses get interrupted over and over and over and over and that causes them to miss many things they should be doing," she says.

Why patients like virtual nursing

Goodwin has queried MercyOne patients about their virtual nurse experience and most of them prefer it, she says.

"They will always say, 'I know what's happening; I'm not guessing why, and I don't have to delay and wait for the third or fourth consulting physician to give me the answers,'" she says.

Other feedback includes:

• Patients like having questions answered immediately.
• Patients find comfort and safety in knowing someone is right there if they need them.
• Family can visit virtually any time they want and can also have questions answered quickly.

Skyrocketing patient engagement scores

Goodwin credits the program's success to the forward thinking of Kathleen Sanford, DBA, RN, now executive vice president and chief nursing executive (CNO) of CommonSpirit Health, of which MercyOne is a part.

"Way back in 2011, Kathy made a prediction that the nursing shortage was not going to end, and we would have to adopt new innovative approaches to providing nursing care," Goodwin says.

Inspired by Sanford's virtual nursing care model, Goodwin, who worked with Sanford in Denver at the time, put together her own model and soon relished the same results that MercyOne has experienced.

"The most remarkable finding was we had the highest patient engagement scores I've ever seen," Goodwin says. "We went from an average percentile ranking in the 60s to several months where we got 100% patient satisfaction on 'Would you recommend?' I've never seen it. Never, never seen it."

When Goodwin was recruited in 2018 to MercyOne to be SVP/chief operations officer and CNE, she immediately got to work on a virtual nursing program, launching it shortly before the COVID-19 pandemic hit.

The virtual model has become so favored at MercyOne that more nurses are requesting it, Goodwin says.

"The only limiting factor is getting virtual nurses hired," she says, "and then being able to spread it as quickly as we want."