Keeping Up With Clinical Risk Management: Transforming Healthcare Delivery Embracing Virtual Nursing for Staffing Challenges

A Quarterly Publication by Danielle Donovan
Volume Three 2023

According to a May 2023 survey from McKinsey & Company, 31% of nurses still say they may leave their direct patient care jobs in the next year. Healthcare facilities continue to struggle with significant nursing turnover, attempting to backfill and continue operations despite shortages. Some healthcare facilities are finding that pivoting to virtual nursing for certain aspects of patient care could be a potential solution.

However, as with any technology implementation, virtual nursing carries its own array of risks. In this article, we will explore some of these risks as well as discuss various risk mitigation strategies to protect your organization during nursing workforce shortages and ensure the effective utilization of virtual nurse solution.

What is Virtual Nursing?

Virtual nursing refers to the delivery of nursing care and services remotely using technology and telecommunications to free up the role of the bedside nurse. It involves the use of digital platforms, such as video conferencing, mobile applications, and remote monitoring devices, to provide healthcare services to patients. It can encompass a range of nursing services, including patient assessment, health education, medication management, and follow-up care.

Through virtual nursing, nurses can communicate with patients in real time, observe their symptoms, provide guidance and education, and collaborate with other healthcare professionals to develop treatment and admission plans.

However, it’s important to note that virtual nursing is not meant to replace traditional in-person care entirely. It is often used in conjunction with the bedside nursing team, especially for more complex or acute cases. Virtual nursing serves as a complementary tool in the healthcare system, providing an additional means of delivering care, streamlining emergency department throughput, alleviating the bedside team, and improving patient outcomes.

In the hospital setting, virtual nurses can assist with functions like:

• Patient admission, medication reconciliation, and discharge
  Gathering crucial information and going over follow-up care and discharge information
• Patient Education
  Providing real-time coaching and answering questions about treatment plans.
• Coordination of resources
  Connecting both internal and external resources for smoother transitions of care.
• Employee education and coaching
  Those more seasoned virtual nurses can act as preceptors to newer bedside nursing staff.
• Virtual meetings between patient caregivers and family members
  Family members who cannot be with their loved one in person can be connected with the virtual nurse and included in treatment planning.

Risk Exposures and Mitigation Strategies When Utilizing Virtual Nurses

Similar to telemedicine, the use of virtual nurses does not come without exposure to risk. Some of these exposures, and strategies to protect against them, include:

• Patient Privacy
  The virtual nurse may not have a complete view of the patient’s room to confirm patient privacy, thus putting the organization at risk of privacy breaches. Virtual nurses should follow a standard process of verifying privacy with the patient and be able to turn the camera and sound off when the patient prefers.
• Data security risks
  Virtual nursing involves the use of technology containing sensitive patient data, therefore exposing the organization to cyber breaches and ransomware attacks. Healthcare organizations should work closely with their IT teams to implement effective security programs, such as anti-malware software and intrusion detection/prevention solutions that can help to prevent, detect, and contain attacks.
• Insurance coverage
  The facility’s professional liability and cyber insurance may have some exclusions or limited coverage for virtual nursing. Discussing various coverages for this service with your carrier and broker will be imperative. The insurance carrier may also require the facility to have various risk mitigation strategies in place prior to offering coverage or pricing.
• Wireless connection, clarity, and sound
  There can be various “dead zones” in patient rooms or areas of the hospital. Without clear communication, care can be compromised and create barriers to virtual service. Again, healthcare organizations should work closely with their IT teams to test Wi-Fi connectivity and range within each patient care area of the facility.
• Scope of practice
  The scope of duties virtual nurses can provide to patients should be specified in an organizational policy. This policy should include items such as the range of services virtual nurses can provide and an escalation process for when virtual services end and in-person care is required.

Conclusion

Many hospitals have implemented virtual nursing programs, including Saint Luke’s Health System of Kansas City, which began planning in 2019 and launched its unit in 2021. An article by the American Nursing Association discusses how this journey did not happen overnight; however, when the virtual RN completed specific tasks, the bedside nurse was able to spend more time managing the physical needs of their patients, answering call lights sooner, and generally having more time with their patients.

If you are considering a virtual nursing program and have any questions regarding risk reduction strategies or insurance coverage, please reach out to the risk control team at Parker, Smith & Feek.

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Resources and References

1. Bell , J. (2022, July 1). Virtual nursing: What is it?. American Nursing Association: Innovation Site. www.nursingworld.org/practice-policy/innovation/blog/virtual-nursing-what-is-it/
2. Berlin, G., Essick, C., Lapointe, M., Murphy, M., & Burns, F. (2023, May 5). Nursing in 2023: How hospitals are confronting shortages. McKinsey & Company. www.mckinsey.com/industries/healthcare/our-insights/nursing-in-2023
3. Dyson, C. (2023, June 29). Stafford Hospital’s virtual program “a new frontier of Nursing.” www.fredericksburg.com/news/local/stafford-hospitals-virtual-program-a-new-frontier-of-nursing/

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