Providence forges a new path with a virtual nursing unit
Virtual nursing is gaining traction as an effective method to redesign and redistribute the workload in nursing. Virtual models reduce the burden on nurses who care for patients directly at the bedside and benefit nurses who wish to continue practicing but may not be able to practice at the bedside by extending their nursing career.
“The flexibility and variety of practice areas and care models may appeal to nurses who are considering leaving the profession and who may not be able to work in a traditional setting,” said Sylvain Trepanier, RN, chief nursing officer at Health System Providence . “Virtual nurses are becoming a new area of professional practice. The hope is that this will keep nurses in the profession, improve their careers and improve retention.”
Since 2004, Providence has leveraged a variety of telemedicine technologies and virtual care models, including Teladoc Health, to support safe, quality care across the organization.
“Based on our extensive experience in telemedicine, it made sense to use two-way audio/video technology to help our caregivers address some of the issues we were hoping to alleviate when piloting a new care model,” said Trepanier.
“The pilot development process was very collaborative between nursing and telehealth leadership and representatives from support services,” he continued. “We looked closely at all aspects of bedside care and had extensive discussions to determine what can be done virtually and what requires face-to-face care at the bedside.”
In interviews with bedside staff, they identified the overwhelming number of tasks they were responsible for that kept them from providing direct patient care, leading to dissatisfaction.
“The primary care model is no longer sustainable given the ongoing challenges in healthcare staffing and the aging of the population.”
Sylvain Trepanier, RN, Providence
“In personal feedback sessions, line-of-care nurses provided numerous examples of the various tasks they were responsible for in treating the patient and how there are numerous opportunities for an improved patient experience in trying to accomplish all of these tasks , improved operational throughput, fewer disruptions and an improved workload for our nurses,” explained Trepanier.
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TO ACCEPT THE CHALLENGE
Providence uses virtual care to complement or enhance patient care. While nurses continue to care for patients by providing direct hands-on care, virtual nurses can also participate and appear in real-time on their TV in the patient’s room to assist the patient.
“Two-way audio and video technology was installed and configured for each of the patient rooms and connected to the electronic medical record to allow the nurse to seamlessly video-confer with the patient,” explained Trepanier.
“The team developed specific roles and responsibilities for the nurses, virtual nurse and support staff,” he continued. “Communication tools such as secure chat and wearable two-way communication devices were also used to enhance live correspondence between the virtual team and the bedside team.”
Processes were developed to share the participating vendor’s contact information with the virtual team. Procedures for paperless documentation of downtime were created to support virtual nurses’ EHR workflows.
Training modules were then created in the organizational learning management system, customized for different roles (bed nurse, virtual nurse, all other caregivers and superuser). All employees were required to complete the modules and the training was supplemented with virtual and face-to-face skills testing.
In addition, as part of the virtual nurse onboarding, the nurse virtually accompanied the nurse to observe admission, discharge and training processes.
“The immediate results were incredibly promising,” noted Trepanier. “Within the first week, the virtual and bedside nursing teams were working on new use cases for the model. The virtual caregivers have also proven to be incredible advocates for their patients, creating an enhanced caregiving experience. We have received overwhelmingly positive patient feedback.
“The pilot also provides perspective and data to help us answer additional questions,” he continued. “We are using the data from this program to assess whether virtual care is helping to reduce mean length of stay. In addition, we are tracking how these changes in the skill mix may impact caregiver experience, patient experience, the cost of care delivery and other sensitive care quality indicators.”
The first pilot successes led to continuation and expansion plans.
ADVICE FOR OTHERS
“In addition to the technology that enables two-way communication, we have also optimized our EHR to better coordinate care between our virtual and bedside care teams,” said Trepanier. “We have also enabled and enhanced our use of live synchronous communication tools – such as personal devices and chat applications.”
But technology is only part of this work. He said the following is even more critical to the success of a virtual grooming program:
change management. Work with frontline caregivers to hear their concerns and ideas, and let them contribute to the project before you begin. Use these early conversations to inform and educate about the work. identify champions.
Outline the scope and vision. Be very clear about the result and the changes to be made. Communicate to employees what will change and how before implementing the workflow changes. That way, employees can be prepared to operationalize the various workflows and ensure their scope is maximized and everyone is working to the maximum of their licenses. This also leaves enough time to train staff and ensure proficiency with new skills.
Sponsoring/leadership by management. There must be a dedicated, present leader who represents the vision and emphasizes commitment to the program, staff and patient safety. They must be on the unit and present with their staff. You must respond to concerns, advocate for the program, and explain intent as to why the organization is going through the change.
“The primary care model is no longer viable given the ongoing challenges in healthcare staffing and the aging of the population,” Trepanier said. “We must do something to address the care shortage and we are choosing to do that by innovating and redesigning the way we deliver care.”
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