In 2024, just 10% of hospital leaders and 14% of hospital IT leaders have reached the phase where virtual nursing is a standard part of care delivery – in both groups, 30% reported no virtual nursing, according to a new study, "The Virtual Care Insight Survey," from AvaSure, a virtual nursing technology and services company.

At the same time, despite the slow march toward virtual nursing maturity, 74% of hospital leaders believe virtual nursing is or will become integral to care delivery models in acute inpatient care, up from 66% in last year's survey.

"The Virtual Care Insight Survey" was conducted online by Joslin Insight in collaboration with the American Organization for Nursing Leadership on behalf of AvaSure. This survey was a follow-up from a survey 18 months ago, creating a longitudinal view on how perceptions and strategies are quickly evolving in virtual nursing.

The surveys combined received responses from more than 1,000 healthcare professionals (789 in 2023 and 340 in 2024) primarily working in acute care settings.

At least 30% were nurse leaders or key decision makers, collectively referred to as "hospital leaders." To complement the nurse survey, AvaSure gathered insights from 29 hospital IT leaders (mostly CIOs) regarding inpatient virtual care adoption.

Key features of inpatient virtual care include virtual sitting, virtual nursing, episodic consults, ambient listening and generative AI.

We spoke with Lisbeth Votruba, RN, chief clinical officer at AvaSure, to dig into the survey results.

Q: This year, just 10% of hospital leaders and 14% of hospital IT leaders have reached the phase where virtual nursing is a standard part of care delivery. In both groups of leaders, 30% reported no virtual nursing. What are the challenges in getting virtual nursing to become a standard way of delivering care?

A. Health systems face significant and ongoing workforce challenges, particularly in attracting and retaining qualified clinical staff. These create significant financial difficulties for hospitals, which limits the time and budget to adopt and innovate with new technologies. While paradoxically, it is the new technologies that will support a transformation in care delivery that is needed to address these workforce challenges.

Although the nursing shortage has transitioned from acute to more chronic in 2024, nearly 900,000 more nurses, or roughly one fifth of the 4.5 million registered nurses nationwide, plan to leave due to stress, burnout and retirement by 2027. When you're faced with these types of deficits, projects like launching virtual care – despite its ability to lower burdens on staff – are deemed cumbersome.

Many stakeholders acknowledge the importance of nurses working at the top of license, yet few address the issue of the acute shortage of unlicensed support staff, part and parcel to achieving this goal. Nursing assistants' turn-over rate continues to climb year over year, sitting currently at 42%.

Given these financial constraints, hospital CIOs must quickly demonstrate return on investment for new technology initiatives. Fortunately, virtual care is conducive to this. Hospitals can begin with virtual sitting safety observation, which can then lead to rapid improvement in reducing falls and other adverse incidents, shorter patient stays, and reduced risk.

Over the long term, investment in virtual nursing has the power to generate substantive growth in critical metrics relating to patient and staff satisfaction.

Q. This year, 46% of hospital leaders are piloting or have implemented virtual nursing. That number has grown from 38% a year ago. Nearly half is fairly sizable for an area of virtual care that is fairly new. What factors are driving these hospitals and health systems?

A. There are several stages on the road to virtual care maturity. Virtual care is far from an all-or-nothing or one-size-fits-all model. The providers that have the most success in the realm of virtual care view it as a phased process that begins with select deployments of virtual sitting or virtual nursing solutions.

Most organizations that launch virtual care programs start with virtual sitting, which enables virtual safety attendants to watch over patients with video and audio connections, thereby improving patient safety. Moreover, a typical 250-bed hospital can save more than $2.5 million in costs annually by replacing up to 75% of one-on-one sitters with continuous monitoring.

After the virtual sitting phase, organizations often progress to virtual nursing. This may take the form of either of two effective models. First, the clinical resource model uses virtual nurses to handle documentation and provide frontline staff more time for direct patient care.

Second, the expert oversight model leverages experienced virtual nurses to oversee a group of complex patients while also delivering clinical insight and mentorship to nursing staff. At each phase, virtual nursing can remain cost-neutral by rolling ROI over from one phase to the next.

Q. 74% of hospital leaders believe virtual care is or will become integral to care delivery models in acute inpatient care, up from 66% in last year's survey. 74% is much larger than the 46% with programs running. What do these other executives see that is so promising to them?

A. Healthcare executives across the spectrum understand the promise of virtual nursing revolves around transforming the way care is delivered to make it more accessible, efficient and patient-centered. These leaders see virtual care as a catalyst to expand access to specialty care, decrease staffing costs, improve nurse well-being and improve patient safety.

Here are two real-world examples.

Virtual sitting saved St. Luke's Duluth $1.5 million in 2023, maintained fall reduction goals, and decreased staffing costs. The program helps the hospital optimize staff efficiency by offloading routine observational tasks to virtual sitters to enable clinical workers to focus on other critical aspects of patient care.

And, researchers surveyed 74 nurses from Renton, Washington-based Providence and found virtual sitting improved their "emotional labor" and "emotional exhaustion" over in-person sitting. The survey illustrated virtual sitting improves the well-being of nurses and helps maintain patient safety.

Q. What does your survey reveal leaders consider to be the leading use cases for virtual nursing? And why do you think these are the top areas?

A. Our survey revealed that providers use virtual care to solve their most pressing problems. As such, the top use cases for virtual care are virtual sitting (39%) and offloading documentation, especially patient discharge and admissions.

First off, it's no surprise virtual sitting is the top use case. It equips trained, non-licensed safety attendants to use video and audio connections to watch over multiple patients and improve overall safety, which makes it a natural starting point.

Virtual safety observation is proven to drive better patient outcomes – often a 50% reduction in falls across the organization. In addition to reducing patient falls, the solution reduces tube/line interferences and ensures staff safety from potential patient aggression. Virtual sitting has been proven to drive immediate and measurable ROI for hospitals.

Second, virtual technology plays a significant role in expediting patient discharge in hospitals; this is achieved through streamlining processes, enhancing communication and improving access to care. Nurses and care managers can use virtual platforms to educate patients and caregivers on discharge instructions, reducing the need for in-person meetings and allowing for more flexibility.

Virtual tools connect hospital staff with external care providers in real time, ensuring smooth transitions and avoiding delays in securing post-discharge services. Virtual technology automates documentation and discharge paperwork to enable faster processing of necessary forms.

Lastly, expert virtual nurses can provide clinical surveillance of high-acuity patients, both in the ICUs and in med/surg settings. They can respond to triggers from their electronic health record and oversee patients during the critical few hours after a rapid response call, ensuring expert care is provided in a comprehensive and timely manner.

At the same time, virtual nurses may provide real-time mentorship and confidence to more novice bedside nurses, thereby nurturing a nursing workforce for the future.

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