Texas Children’s Hospital piloted virtual nursing in its 200-bed neonatal intensive care unit to improve nurse satisfaction and reduce burnout. Two virtual nurses staff the unit from 7 a.m. to 7 p.m. seven days per week. Virtual nurses continue to work 25% of their shifts at the bedside to maintain competencies.
The unit was chosen for the project due its operational readiness and unique needs:
- More time required to conduct discharge education with families.
- Large percentage of RNs with less than two years’ experience who could benefit from support.
- Anticipated integration with a live video system that would expand the functionality of virtual nursing program.
- Longer than average length of stay with discharge delays often attributed to family readiness.
Virtual nurse tasks
Nurses led the development of the model of care. A multidisciplinary kickoff event brought together 57 people, including bedside nurses, administration, information systems, care coordination, and family representatives. Ten bedside nurses who attended the kickoff meeting volunteered to develop the pilot project. The team prioritized tasks that alleviated the most administrative work from bedside nurses, reduced stress, and delivered enhanced patient care.
Tasks included:
- Conducted admissions and discharges.
- Provided patient and family education.
- Offered documentation support.
- Connected families with support services (e.g. lactation support, social work).
"I believe any changes that involve how nursing delivers care should always be nurse led and in close partnership with the health care team. If the goal is to ease the burdens that cause burnout and improve patient care, then the design should be that of those providing the care."
Technology
For the pilot, Texas Children’s did not employ new technology at the bedside. Rather, the hospital asked parents to use their smart phones to connect with a virtual nurse. The virtual nurse hub is located elsewhere in the hospital to capitalize on cybersecurity measures.
Early wins
In the first 30 days of the pilot, 78 NICU admissions had 177 encounters with a virtual nurse. That resulted in 49 hours returned to bedside nurses to focus on direct patient care and patient satisfaction scores increased.
Outcome measures
Texas Children’s is monitoring metrics like stay length and discharge times to gauge the initiative’s effectiveness. Initial outcomes tracked show:
- More than half of NICU admissions connected with a virtual nurse on the day of admission, 29% connected the next day, and 18% connected more than a day later.
- The average time from admission to completed admission orientation with a virtual nurse was 26.3 hours.
- Virtual nursing resulted in 25 minutes of uninterrupted care, per encounter.
Future plans
Texas Children’s will continue to use virtual nurses in NICUs at all of is campuses. The next steps include allowing expansion to other inpatient areas and optimization of current technologies post-pilot period. Long-term goals after this initial bedside care model redesign include evaluation of on-demand support for bedside nurses, care coordination optimization, safety rounds and chart checks, and remote patient monitoring.
"Conventional solutions are no longer sufficient, and as leaders in nursing, we need to start thinking differently and innovate. The problem is not going to fix itself, and we have an obligation to explore any and all potential solutions to provide relief and support to our care providers at the bedside and beyond."
Tips for success
- Select nurses with strong communication skills to serve in virtual roles.
- Make regular updates to standards of practice (SOP) to reflect process changes and staff expectations.
- Create enthusiasm among staff members by socializing the concept.
- Allow bedside nurses to drive the care and solicit their input early in the process.
- Stay apprised of information systems’ scheduled releases, upgrades, and ability to support virtual nursing tech.
