Nursing and hospital staff shortages and associated costs persist. While nurse turnover dropped from 22.5% in 2022 to 18.4% in 2023, certified nursing assistant (CNA) turnover increased from 33.7% to 41.8%, according to the 2024 NSI National Health Care Retention and RN Staffing Report.

Rural health systems are particularly challenged to retain patients locally within their health system, rather than leaking patients to a tertiary center that can be hours away. Another major staffing issue is to meet increasing needs for safety sitters. Due to the high turnover in CNAs who serve as bedside one-to-one sitters, patient safety needs go unmet or the bedside care teams are forced to work short. Managing the one-to-one sitter pool is difficult and limits the number of patients that can be monitored. This article describes the journey taken by a rural health system as they began to take steps toward virtual nursing.

Improving Care, Beginning With Virtual Sitting

The COVID-19 pandemic made matters worse, so the health system had to come up with a workable plan that would allow it to augment its existing staff while keeping a larger volume of patients safe. 

It undertook a major initiative to improve patient safety, reduce fall risk, and increase access to specialty care by securing a grant through the Federal Communication Commission’s COVID-19 Telehealth Program to implement an inpatient virtual sitting solution.

With the aid of the grant, the health system implemented a virtual care technology to support virtual sitters, who watch over patients via video-and-audio connections to improve patient safety, such as reducing patient falls and elopement. The health system implemented 16 devices, including four ceiling-mounted monitors, 12 mobile devices, and a centralized monitoring center. The primary goal was to enable the use of virtual sitters, freeing up CNAs to perform other care activities.

They have seen consistent monitoring time well over 2,000 hours per month. The number of patients monitored per month is typically 30 to 40. While this may seem like a modest figure, it represents a significant improvement from the previous situation, where they could only monitor about 10 patients monthly with one-to-one sitters. This technology has enabled them to observe more patients who otherwise would not have been monitored. Notably, the care unit with the most total monitoring hours has seen a reduction in the overall fall rate.

After seeing the virtual sitting program’s success in saving costs, as well as improving patient and staff satisfaction, the health system progressed into virtual nursing using the same technology platform, which enables virtual sitting, virtual nursing, and specialty medical consults.

Progressing to Inpatient Virtual Nursing

When progressing from virtual sitting to virtual nursing, the health system followed one key principle: Structure the use of virtual sitters and nurses so that all staff works at the top of their skills and training. This enables a care model where nurses, nursing assistants, and virtual nurses perform the most appropriate patient care activities based on their skills and experience. Two of the mobile devices were redeployed for virtual consultations. One device was at the main campus and another at a critical access facility.

Using the virtual care platform, scarce specialists in neurology, nephrology, diabetes education, and wound care can serve more patients in both facilities. For example, one certified wound and ostomy nurse was better able to serve two facilities, located 30 miles apart.

Natalie Gardner BSN, RN, CWON, CFCS, described the benefits: “This has provided a way for me to do video consults with a remote facility, which saves precious time as well as mileage. The staff take the device to the patient’s room, remove their dressings, and position the patient so that I can see the wound. This leaves me more time to spend with all patients by eliminating the time it would take to drive to Jackson and back.”

Giving patients easier access to specialists improves care and facilitates early intervention to prevent transfers from the critical access hospital to the main facility. Plans are in place to support more providers to take advantage of this technology.

Honing the Virtual Nursing Program

For the foreseeable future, community health systems will face resource constraints. Moving from virtual sitting to virtual nursing frees up valuable resources to provide high-quality patient care while allowing all nursing professionals to perform to the best of their abilities and licenses. At every stage, virtual care can improve patient outcomes while enabling a care paradigm that allows nurses to spend more time doing what they enjoy most: providing direct patient care.