JMIR Publications

ABSTRACT

Background:

Global nursing shortages require innovative care delivery models. Virtual nursing is a cutting-edge model being explored.

Objective:

To examine the perspectives of clinical and administrative staff involved in a virtual nursing pilot on a medical-surgical unit and identify best practices for future adoption.

Methods:

Design: A qualitative evaluation using individual semi-structured interviews with key stakeholders. Interviews took place in the spring of 2024 and were completed via phone or Zoom, audio recorded and professionally transcribed. Participants were selected using purposive sampling. The authors applied an iterative thematic analysis to transcripts using Dedoose. Claude.ai was used to generate code summaries for select codes. Setting: Medical-surgical unit with 35 private and semi-private beds at the Mount Sinai Hospital, a 1,110-bed acute care hospital in New York, NY. Participants: Virtual and bedside nurses, nurse executives, and IT project managers implementing a virtual nursing pilot program. We approached 33 individuals, 16 consented to the interview (49% response rate). Nine participants were clinical staff (virtual and bedside nurses and nurse managers) and seven were executive leaders or managers in nursing and informatics.

Results:

Our analysis identified the following themes: 1) staff attitudes toward virtual nursing shifted from resistance to acceptance over time; 2) direct communication channels between virtual and bedside nurses were critical for efficient care coordination and model adoption; 3) admission and discharge processes evolved throughout the pilot implementation; 4) adaptable staffing allocations were necessary to accommodate fluctuating patient census and unit demands.

Conclusions:

The main beneficiaries of this intervention, bedside nurses, found their virtual counterparts helpful following a few adjustments. They reported a reduction in administrative burden, uninterrupted completion of clinical tasks, reduced overtime, which all increased their buy-in in this care model. There are several opportunities for improvement such as real-time communication, unit-specific virtual nurse training, and flexible staffing for high-volume units. Our findings suggest that virtual nursing can address staffing challenges. Calculating the true return on investment for virtual nursing programs will require comprehensive mixed-methods evaluations of such outcomes as care team and patient satisfaction, length of stay, readmission prevention, completion of nursing tasks and reduction in overtime. Clinical Trial: N/A