The next challenge for virtual nursing will be growing to scale, says this virtual care leader.
Health systems have made significant strides in virtual nursing over the past few years as technology opens the door to new possibilities.
Stephanie Johnson, executive director of virtual care for UnityPoint Health, recently gave HealthLeaders an update on the health system's virtual nursing progress over the past year.
Johnson is part of the HealthLeaders Virtual Nursing Mastermind program, which brings together several health systems to discuss the ins and outs of their virtual nursing programs and what their goals are now and for the future.
What's changed?
Last year, according to Sarah Brown, UnityPoint's CNO, the goal of the virtual nursing program was to improve the nurses' experience by offloading burdens and giving them time back at the bedside.
In the past year, Johnson explained that the biggest evolution is the shift from a decentralized, market-based model to a centralized leadership structure, with standardized workflows.
"Standardization of workflows is happening in parallel with the centralization," Johnson said.
The biggest challenge going forward, according to Johnson, is the investment in growing to scale. In terms of equipment, UnityPoint is adding in-room technology this year.
"This is happening on a single unit as proof of concept, with the intent to scale the technology system-wide," Johnson said.
Currently, the health system uses a separate vendor solution for their software platform. However, as offerings evolve, Johnson expects that to shift to the EHR.
"We anticipate more collaboration with Epic as their service offerings continue to develop in the future," Johnson said.
UnityPoint is measuring outcomes using a virtual nursing dashboard to track several quality and process measures.
"Some of the data, such as first-year turnover, is yielding the results we anticipated," Johnson said.
Future of care delivery
In terms of the program's impact on staffing, Johnson said their strategy is still in the infancy stages as they continue to focus on building strong foundations.
"The future will focus on a growth strategy where we can continue to support the bedside and in-house nursing staff," Johnson said, "by assessing new opportunities across a variety of care settings including the ED, L&D, and transfer center."
As for what comes next, Johnson said there might be some opportunities for integration into care programs that extend beyond the hospital.
"[We are] starting to consider opportunities to collaborate with bed placement and care coordination," Johnson said.
Lastly, Johnson is most surprised by UnityPoint's progress in virtual nursing as measured by nurse and patient reactions.
"The patient and nursing adoption and satisfaction has been overwhelmingly positive once given the opportunity," Johnson said.
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Workforce, workflows, and work environment are all linked together in the journey to improve nursing, according to these nurse leaders.
Being a CNO in 2025 is more complex than ever, with higher patient acuity, different workforce expectations, and an onslaught of technological advancements that can make anyone's head spin.
However, a few workforce issues continue to rise to the surface as top priorities for many nurse leaders, including succession planning, workplace violence prevention, and leveraging technology to support bedside nurses.
The 2025 HealthLeaders CNO Exchange wrapped up on Wednesday after three days of enthusiastic idea-sharing and elevated discussion about these workforce concerns and more. Here are some of the CNOs' approaches.
Including non-acute spaces
There are many reasons why nurses come and go at the bedside, and many are choosing the option to work in the ambulatory space instead of the acute care space.
The Exchange members have noticed a migration from the inpatient to outpatient settings, even though there is typically less compensation. It's important that CNOs take a look at traditional models in the ambulatory space, and remember that many nurses are seeking better work-life balance.
The members also noted that many times, the nurses in ambulatory spaces often don't feel as included in the nursing team, even though they are a critical part of the workforce. CNOs must make an effort to extend awards and accolades to nurses in the ambulatory setting to celebrate the work they do for their health systems.
Addressing workplace violence
Workplace violence remains a top concern for CNOs, and the Exchange members shared many horror stories of what happens to their nurses because of violence from patients, other staff members, and even individuals from the nurses' personal lives.
There are major concerns about the lack of legislation regarding workplace violence towards healthcare workers. The members shared that they've heard many lawmakers say workplace violence is "expected" in nursing. CNOs need to be aware of what they can do to help advocate for policies and standards that provide protection and combat that stereotype.
The members recommended being proactive and implementing security measures such as weapons detection systems. CNOs should consider partnering with local law enforcement as well. For staff, nurse leaders should implement de-escalation training and encourage reporting when incidents do occur. Additionally, those protections should extend to the outpatient settings when possible.
Leveraging AI
The door is wide open for AI in healthcare, and as nurse leaders determine the best ways to utilize it, it's important to focus on the goal. According to the members, AI should exist in nursing to support the work that nurses already do, at the bedside and beyond. AI is capable of providing the whole picture in the EHR, which can lead to impactful workflow redesign.
Most importantly, staff must be involved in implementation. Technology integration is at its best when it happens with nurses at the helm, as they will likely be using the technology most frequently and are tuned in to workflow gaps.
Ethically, the members had some concerns about AI that are important for CNOs to consider. When bringing AI into nursing, CNOs must think about equity and disparities, information transparency, and data privacy and security. Patient safety must always remain top of mind and policies should be developed to ensure accountability and due diligence.
The goal is ultimately to reduce documentation burdens and time spent on administrative tasks, and CNOs have a major opportunity to improve their workforce through careful and intentional implementation.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Dogs provide a safe space for nurses to share how they're actually doing, says this nurse leader.
On this episode of HL Shorts, we hear from Beth Steinberg, associate director of research at the OSU Center for Integrative Health and program director for Buckeye Paws, about the benefits that therapy dogs have on nurse mental health and wellbeing. Tune in to hear her insights.
Nurses should be the ones advocating for nursing, say these CNOs.
Nurses across the country are faced with many challenges, such as workplace violence and staffing ratios, that have potential legislative components.
CNOs must be equipped with the skills to advocate for policies that will improve the lives of their nurses and help them deliver the best quality care to patients.
The HealthLeaders CNO Exchange is well on its way in Nashville as the participating members discuss everything from succession planning, leadership development, virtual nursing and AI, to workplace violence and nursing policy. On a panel about advocacy and policy, the participating CNOs had three areas of focus for nurse leaders wanting to get involved in the legislative process.
Issues to prioritize
According to the panelists, there are several key issues that CNOs should be prioritizing, with workplace violence policy at the top of the list. There has been a national push towards further penalizing those who assault healthcare workers, specifically with the Safety From Violence for Healthcare Employees Act, or the SAVE Act. Many have come to expect workplace violence in nursing, and CNOs need to counter that narrative and push for more legal protection for nurses.
The panelists made it clear that regardless of the viewpoint, mandated staffing ratio legislation is something CNOs must pay attention to. Reimbursement and full practice authority policies are also critical, especially for nurse practitioners, to demonstrate the value of nursing.
On a national level, nurse leaders now find themselves needing to defend Medicare and Medicaid, according to the panelists. There are several policies coming out of HHS that the panelists are concerned about and it's important that CNOs stay up to date with the newest proposals from legislative bodies at all levels.
Getting involved
The list of policies goes on and on, but the key takeaway from the panelists is that CNOs must be at the table during legislative discussions. Many policymakers do not understand the inner workings of the healthcare ecosystem, and by developing strong relationships with legislators, nurse leaders have the ability to make a real impact.
The panelists recommended that CNOs make appointments with local, state, and federal legislators outside of session, and make it clear that they can be a point of contact for when the legislator needs an expert. When the legislative bodies are in session, CNOs should make their presence known and engage as constituents.
CNOs should also develop relationships with their government relations teams at their organizations. Ultimately, the panelists emphasized that now is the time for nurses to advocate for nursing, rather than letting others do it for them.
Skills to employ
While advocacy might be new for some CNOs, it's necessary to take part in, and according to the panelists, there are a few key skills to work on that will improve advocacy efforts.
First, engage in storytelling. Everyone has been touched by a nurse or by the healthcare industry at some point in their lives, and by sharing those stories, CNOs can make nursing policies feel more personal to legislators who can prioritize them.
The panelists recommended following up with data to support the storytelling and emphasizing numbers that will stand out, such as vacancy rates. Nurse leaders should also get to know legislative aids and staffers who are doing a lot of the heavy lifting for the legislators as part of their team. Despite the overwhelming nature of politics and the constant change, CNOs should try to stay educated and be selective about where they can affect the most change.
The CNO Exchange continues, so stay tuned for more coverage.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
CNOs are coming together to face three challenges that are heavily impacting the nursing industry.
This year started off with a bang for healthcare and the chaos has continued. From the ever-changing landscape of technology to the uncertainty surrounding healthcare policy, CNOs have a lot to consider when thinking about the future of the nursing industry.
Many nurse leaders are nervous about AI implementation and how to move forward with diversity, equity, and inclusion (DEI) policies, all while addressing the typical staffing and wellbeing concerns.
From April 14-16, the members of the HealthLeaders CNO Exchange will meet in Nashville, Tennessee, to talk about how to meet these challenges head-on.
Virtual nursing and AI
To fill in workforce gaps, health systems everywhere have been implementing virtual nursing and AI technologies.
Virtual nursing allows nurses to spend more time at the bedside while alleviating administrative and documentation burdens, such as admissions and discharges. As virtual nursing becomes the standard of care across the industry, the Exchange participants will discuss what comes next for virtual nursing, how to measure outcomes, and how to overcome implementation barriers.
AI is still a nebulous concept for many, with endless possibilities and opportunities for use. However, there are some serious concerns among nurse leaders about documentation errors, lack of transparency, and deskilling among the workforce. The Exchange members will also discuss how to properly implement AI into nursing workflows and how it should be controlled and regulated.
Policy and advocacy
Many CNOs are unsure how to proceed with policy as the Trump administration continues to throw executive orders at the wall to see which ones stick. As of right now, nothing regarding DEI policy has been made illegal, but with so much public scrutiny of the term, health systems are already taking steps to comply with what might happen.
At the Exchange, the participants will discuss how nurses and nurse leaders can get involved with policy and lawmakers to advocate for the nursing profession. For instance, CNOs must connect with their representatives and build those relationships so that legislators have nursing experts that they can turn to when making policy decisions.
Succession planning
Lastly, CNOs are struggling to build the next generation of leaders due to labor shortages, retention challenges, and the aging workforce.
The Exchange participants will discuss how to find and encourage nurses to go into leadership and how to incorporate mentorship and training time into staff schedules. They will brainstorm ways to find diverse, highly-qualified candidates, and ways to partner with nursing programs to present leadership as a desirable career path.
Lastly, the members will share how they are funding succession planning initiatives and getting buy-in from CFOs, CEOs, and HR leadership. There's lots more to come from this year's CNO Exchange, so stay tuned for more coverage.
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
For innovative CNOs who want to crack the code for nurse wellbeing, there might be a hairy solution.
HealthLeaders spoke to Beth Steinberg, associate director of research at the OSU Center for Integrative Health and founder of the Buckeye Paws program, about the Buckeye Paws program and how dogs can be a powerful tool for nurse wellbeing. Tune in to hear her insights.
In 2025, CNOs need to begin leveraging social media as a tool for connection with their workforce and the public.
According to Rebecca Love, chief nursing officer and nurse influencer, and Dr. Marion Leary, nurse innovator and also a nurse advocate, there are several steps that CNOs can take to begin getting comfortable with posting online.
First and foremost, Leary recommended understanding what point of view you want to post from. Leary also suggested starting with a buddy, or someone you can run posts by before hitting 'send' or 'schedule.'
Leary and Love's third tip is to distinguish between your personal and professional social media, and to decide which you're going to post as. Love also recommended leaning into your nursing expertise and into the subject matters that you're most passionate about. The most important part as well is to actually engage with the audience.
To stay on top of the nursing narrative, CNOs must jump at the opportunity to connect with the public and with their own staff through social media.
In the realm of social media, many CNOs are late to the game.
The narrative surrounding nursing has run away from nurse leaders, and while there isn't a way to completely own a narrative on social media, it's not too late for CNOs to jump into the conversation.
According to Rebecca Love, chief nursing officer and nurse influencer, and Dr. Marion Leary, nurse innovator and also a nurse advocate, it's important for CNOs to be on social media themselves.
"[CNOs] have this knowledge and leadership skillset that really needs to be seen by nurses across platforms," Leary said at the AONL 2025 conference.
Why CNOs should post
According to Leary, partnering with influencers is one way to enter the narrative, but the more effective method is to join social media directly. CNOs across the country are all trying to address similar issues, so forming relationships on social media and collaborating is a great way to help solve problems.
"Make sure you're on LinkedIn especially," Leary said. "Create a profile and just document what you do on a day to day, like what the struggles are that you're seeing at your institutions and then making sure that you're engaging with other CNOs across the country."
Love referenced the Woodhull Study on Nursing and the Media, which found that nurses were cited as sources in only 4% of health news stories 20 years ago. The revisited study in 2018 stated that nurses are the source of only 2% of quotes in articles, and were never sourced in stories on health policy.
"So, what that's telling you is 98% of relevant news stories go to others to speak on behalf of nursing," Love said. "CNOs must participate because other people are writing the narrative about nursing without nursing."
Love explained that traditionally, nurses were told they couldn't speak about the profession because of HIPAA, which Love identified as incorrect.
"Most people are getting their news now from social media and the older traditional ways of journals and publishing are not the ways to engage with the population and scale," Love said. "If we are going to advance our profession, we need to move forward by doing that on the platforms that are engaging with the front line of humanity, which is social media."
Many reporters will also use social media as a way to find industry voices and experts, which is another reason why CNOs must engage on those platforms.
"The truth is that the power of social media to drive change and drive good on behalf of the work we do is exactly what is necessary, because fundamentally, that is our goal, is to alleviate suffering and to fight for humanity," Love said.
Shifting the narrative
While the publicity surrounding nursing can be quite negative, it's important that CNOs and other nurse leaders try to pivot the narrative to show the broader impacts of the nursing profession.
"Nursing is a wealth of different experiences and knowledge, we're not just one thing," Leary said. "Yes, we work at the bedside, but we work in policy, we work in research, we do innovation and startups, all these things that are attributed to other fields and professions, nurses are doing those things and leading in those spaces."
To Love, CNOs need to provide a counternarrative to the negativity coming from many frontline nurses on social media. Both CNOs and frontline nurses want the same things for nursing, like better outcomes, conditions, pay, and a future for the profession.
"The truth is that bridge is only going to get wider, that gap is going to get wider until [CNOs] get on social media and start creating an open, honest dialogue that creates a counternarrative to what these nurses are experiencing, but also transcending where we want nurses to go because I think that there is shared mission and vision," Love said.
Getting started
Love and Leary both provided posting tips for CNOs who are just getting started. First and foremost, Leary recommended understanding what point of view you want to post from.
"You have to understand and create your own persona for social media," Leary said. "What I am on social media is not necessarily what I am off of social media, and you have to be okay with creating that persona and leaning into it."
Leary also suggested starting with a buddy, or someone you can run posts by before hitting 'send' or 'schedule.'
"For CNOs, having a buddy within their health system would be helpful so that you're always keeping your health system's priorities in mind," Leary said.
Leary and Love's third tip is to distinguish between your personal and professional social media, and to decide which you're going to post as.
"You've got to pick your persona on social media, either you're representing the institution you are, or you're representing the person you are," Love said. "I would strongly suggest you represent the person you are."
Love also recommended leaning into your nursing expertise and into the subject matters that you're most passionate about. The most important part as well is to actually engage with the audience.
"You get what you put out and what you give," Love said. "If you just post and don't engage with others, people aren't going to engage with you. Social media is a two-way street."
Lastly, Learn emphasized the importance of being kind online.
"Be nice," Leary said. "Don't engage with trolls and negativity, it just never works out."
CNOs should consider looking to unexpected sources for strategies to improve nurse wellbeing — including dogs.
CNOs everywhere have come up with innovative solutions for nurse wellbeing and retention.
But none quite like the one Beth Steinberg has implemented.
In her 43 years as a nurse, Steinberg, who serves as the associate director of research at the OSU Center for Integrative Health, noticed that stress and burnout were reaching all-time highs, especially after the COVID-19 pandemic. Lower work engagement and burnout were causing more turnover and nurses were rapidly leaving the bedside to follow different career paths.
"We lost a lot of our healthcare staff during the COVID pandemic," Steinberg said, "and then afterwards, people found that they just weren't able to come back to the bedside…[or] the hospital environment."
The healthcare exodus has since slowed, but stress and burnout continue to be top concerns for CNOs and healthcare providers in many inpatient and ambulatory settings, Steinberg explained.
One the biggest hurdles with previous wellness programs for staff that Steinberg implemented was that nurses are too busy during their shifts to access the provided resources.
"They had to register, they had to schedule, maybe take some time off," Steinberg said. "It's not easy to step away when you're taking care of patients."
Inspiration struck Steinberg when she and her colleague in the nursing department both got new puppies and began training them to be therapy dogs. The goal for the Buckeye Paws program, which was launched in 2020, is to bring a wellness program to the nurses and to meet them where they're at.
"As we were training our dogs to become therapy dogs, we talked about how we might bring a program into the hospital, not for patients, but for staff," Steinberg said. "We wanted to make it a program that was so accessible that we would go to where staff were working."
According to Steinberg, the program is run with stringent policies and procedures. At first, they thought they would only need eight to 10 dogs for the academic medical center, but they realized quickly during the program's pilot that they would need many more.
"We had a lot of excitement about the program," Steinberg said. "There are a lot of therapy dog programs out there, but the American Kennel Club has recognized Buckeye Paws as singular in the nation as a therapy dog program because it is a peer support program."
Currently, there are about 30 handlers, who are all medical center or university employees who volunteer their time to be part of the handler team. The handlers are trained in trauma informed care and mental health first aid before they are allowed to provide support.
"We have physicians, nurse practitioners, nurses, administrative staff, physical therapists, [just] a wide variety of handlers with varying amounts of time," Steinberg said. "They might do it on the weekends [or] the holidays when they're not in the office."
There are 20 more dogs set to join the program, which will bring the total to about 50 dogs, which is how many are needed to meet the needs of the organization, Steinberg explained.
"We have a canine master trainer that has oversight of our program that puts dogs through all the testing," Steinberg said. "We also have temperament testing and canine good citizen requirements as well as their health requirements and things like that."
A paws-itive impact
According to Steinberg, the Buckeye Paws dogs have a massive positive impact on the staff. They get called in for traumatic events, and they are available for staff to speak to with a nonjudgemental attitude.
"Dogs are nonjudgemental," Steinberg said, "so the staff readily talk to the dogs about what's going on with their day [and] what's going on with their personal lives."
Nurses and other staff members tend to be more honest with the dogs about how they are actually doing, Steinberg explained.
"There's a dynamic that changes things with the presence of a dog that provides that nonjudgemental support for people to feel comfortable and to be vulnerable," Steinberg said. "It doesn't always happen with humans."
The nurses' reaction has also been incredible, according to Steinberg.
"So many times we'll see people down the hall, and you'll see their face change," Steinberg said. "They start to light up, [and] they start running down the hall towards the dogs."
However, the handlers are also trained to recognize when people are afraid of dogs or don't want to interact with them. Those who don't want to interact with the dogs can still get the benefits of seeing their coworkers' moods lifted, Steinberg explained.
"There are people that are fearful, there are people that have allergies, and there are also people [who] culturally don't believe in dogs as pets," Steinberg said. "We recognize that and we're very aware of the behaviors and reactions of people when we come to the unit, whether they welcome that dog or not."
Tips for CNOs
For CNOs and other nurse leaders who might want to try this approach in their organizations, Steinberg emphasized that innovation is key.
"Hospitals have had therapy dog programs for [many] years, but usually they're for patients and families," Steinberg said. "Having something just specific to our staff, they've been so grateful and appreciative that when they see Buckeye Paws on the unit, they know we're not there to see a patient, we are there for them."
There is also research being done through the program that aims to measure the impact of the program on staff, the handlers, and the dogs. While this kind of program is not a fix for system-wide issues, Steinberg explained that the program has value as something that can help nurses get through their day.
"There are big picture things that still need to be worked on," Steinberg said, "but when you introduce something that can just for a few minutes offer support and maybe help improve mood, there are some downstream effects to that, [such as peer support], collaboration, patient care, and things like that."
Steinberg says Buckeye Paws can provide support to other health systems by helping them develop similar programs and working with them on policy, recruiting, and finding a canine master trainer.
"Not every hospital is suited or accepting of this kind of program," Steinberg said, "but if you can pull it off, it's so beneficial for the staff."
The nurse leaders at AONL 2025 are looking to revolutionize nursing education and promote nursing advocacy.
The 2025 AONL Conference wrapped up on Wednesday this week in Boston after four days of learning, idea sharing, high wind chill, and clam chowder.
This year, technology was the main superstar as leaders brainstormed the pros and cons of AI and the best use cases for virtual nursing. However, there was an undercurrent of tension and worry regarding the future of healthcare policy, the ethics surrounding AI, and other new nursing practices.
Despite these concerns, the nurse leaders in attendance are looking to push past boundaries and step into the future with highly effective strategies to keep nursing sustainable. Here are two of those innovative ideas.
Revolutionizing nursing education
With the nursing shortage in full swing, it's been difficult for nurse leaders everywhere to find new nurses and create pipelines into the industry. To help bring more nurses into the profession, the nursing leadership at WVU Medicine and Beebe Healthcare created hospital-based RN diploma programs.
According to Tanya Rogers, AVP of nursing education at WVU Medicine, and Karen Pickard, director of the Margaret H. Rollins School of Nursing and Clinical Professional Development at Beebe Healthcare, the goal of those diploma programs is to address staffing issues while having a program that can scale and change with the workforce.
According to Rogers and Pickard, this program is scalable for other health systems, and if CNOs want to try this program at their own health systems, they should customize it to fit their organizations.
At WVU, the students receive one credit for every five clinical hours, and their NCLEX pass rates are comparable to more traditional degree programs. They also receive free tuition as long as they commit to working in the health system for three years following the completion of the program. WVU partnered with Beebe to focus on outcomes, and there are four ROI metrics that the program focuses on: GME reimbursement, traveler savings, bed closure mitigation, and student tuition assistance.
Promoting nursing advocacy
Despite the wave of anti-DEI executive orders from the Trump administration, the nurse leaders at AONL came to discuss policy and how to get involved in the decision-making process at the local, state, and federal level.
Torrey Trzcienski, Jennifer Boutelle, and Kelly Haeckel from Middlesex Health created a policy advocacy coalition called the Healthcare Policy Awareness and Advocacy Coalition (HPAAC) to help get nurses more involved in policy. They collected data through a cross-sectional research study to see how knowledgeable and involved the nurses and nurse leaders are in political spheres.
For CNOs who want to attempt a program like this, Trzcienski, Boutelle, and Haeckel recommend starting locally to effect change that one can see in their community. Nurses can advocate in one of four different areas:
Public health
Patient care
Nursing practice
Fiscal sustainability
They also recommended gathering data to know where nurses are now, and then trying to prioritize policy and participating in the legislative process through voting and/or public comment. They also recommended inviting legislators to come into a health system to get a sense of what the industry is really like. That way, the nurse or nurse leader can build relationships with those legislators, and give them a person to call when they have questions about nursing.
