Nurses who work on the medical-surgical floors at OSF HealthCare Saint Francis Medical Center in Peoria say they would never want to go back to a time when they didn’t have the support of virtual nurses. In fact, nurses interviewed say they would eventually like virtual nurses to take on other aspects of comprehensive care, in addition to admissions and discharge.

Virtual nurses use technology to provide care and support to patients and their families remotely, often from a central location. This technology enables virtual nurses to access patient records, monitor vitals and communicate with patients and bedside nurses via video conferencing and other digital tools. 

OSF HealthCare is three years into an OSF Innovation pilot program using virtual nurses through OSF OnCall, the digital health arm of the Peoria, Illinois-based health system, to handle the admission and discharge of patients. Based on success and positive feedback from floor nurses and nursing supervisors, the pilot, designed by the OSF Innovation Performance Improvement team expanded virtual nursing to 141 beds at OSF HealthCare Saint Anthony Medical Center in Rockford, Illinois. That brings virtual nursing to a total of 217 beds through either tablets or in-room technology.

Nursing hadn’t significantly changed in 50 years and Jennifer Croland, vice president and chief nursing officer at OSF Saint Francis, said it was important to embrace technology and innovation to improve care and reduce burnout. In the beginning, she admits, there were communication challenges between bedside and virtual nurses.

“I think initially it was really adding another member to our care delivery team and how do we communicate with them. How do we let them know that we have an admission coming in? How do we let them know the patient is getting ready to be discharged and how do we let them know there’s something else the patient needs before they’re discharged?”

The virtual nurse for OSF Saint Francis Medical Center is based at the OSF OnCall command center, which is not located on the patient care unit. These nurses have access to the electronic health records of patients. Some patient rooms on the medical-surgical units at OSF Saint Francis are equipped with wall-mounted TVs and the virtual nurse and patient interact through this technology. More often at OSF Saint Francis and at OSF Saint Anthony, tablets are used for patients to communicate with the virtual nurses.

Croland says the virtual nurse is freeing up floor nurses for more direct, hands-on care and that’s resulting in fewer falls, pressure injuries and faster time for admissions and discharges.

“Regarding the discharge process, we're also seeing a shortened amount of time from the time that the physician writes the order till the time that the patient actually goes home. So, our baseline was around three hours when we started, and we're down to two now.”

When patients are admitted or discharged more efficiently this reduces wait times for incoming admissions and improves overall hospital flow. But virtual nursing also addresses nurse burnout and morale. Health systems have tried various options, but floor nurses interviewed for this story say virtual nursing has made the most significant impact.

Impact on floor nurses

Bedside nurses estimate they have been able to recover at least one hour a day that in turn can be spent on direct care and communicating with patients and families as a result of virtual nurses handling often complex, time-consuming tasks. Dalton Havens recently transitioned from a primary charge nurse who works a day shift to OSF OnCall Digital Hospital. But, when interviewed for this story about virtual nursing, Havens said he enjoyed having more time for direct care and communication.

“Since you do have more time with each patient, it just makes it a little bit easier to be able to spend the time to give them (patients) more detailed care than trying to rush around trying to get all these tasks done so you can get to the next thing and get to the next thing and the next thing.”

Primary charge nurse Hannah Tomblin helps coordinate communication between virtual nurses and those working bedside. She feels less stress on a daily basis because the OSF OnCall nurses are handling what can be complex admissions, discharges or patient transfers. For example, she responds differently now to learning about a new admission coming from the emergency department. Before virtual nursing, it was immediately stress-inducing.

“It was more of like awe (she frowns and shrugs her shoulders as other nurses listening laugh), because you had to go in and answer all the questions, you had to maybe call nursing homes, you have to call their pharmacy, you have to do all this, you have to do all that. But now that there’s a virtual admission and the mobile admission nurse, that’s all done for you so now when I have to say as a charge nurse, ‘You’re gonna get an ED admit,’ (floor nurses respond) ‘Oh, that’s OK, I have the virtual nurse now.”

Tomblin says nursing is stressful, not only because of workload, but because nurses make moral and ethical decisions daily so reducing documentation and logistical tasks goes a long way to improving work-life balance.

Alvin Baluyut (pronounced bal-you-yoot) used to work a night shift, and he would spend most of his time discharging patients. He recalls feeling as though his to-do list for patients who needed his help was never completed. He’s a champion of virtual nursing and in fact, would like to see OSF OnCall virtual nurses deployed more to help with educating patients about their condition or medication, so they understand why it’s important to take it as directed.

“If you have somebody who’s doing that regularly for patients to keep them informed, the rate of compliance would be more because the patient knows that ‘Hey, these are the benefits that I’m getting’ and then the plans and the indications for the medication for them are clearly communicated.”

OSF HealthCare. Brandi Clark, vice president of OSF OnCall Digital Care says planning will continue for expansion to other hospitals within the OSF Ministry. With that, there has been an evaluation of technology with a strong eye towards the future as Clark explains.

“As we think more broadly about this being about more than only nursing but about what does the technology-enabled hospital of the future look like? There are so many features and functions available through many of the technology platforms and so it’s really about how we redesign that total model of care and the experience that patient has using that technology in their hospital room.”

In the meantime, within the next 12 months, the virtual nursing program is set to expand its reach to an additional 350 beds across 12 units throughout OSF HealthCare.

Jennifer Croland and Brandi Clark

Nurses Dalton Havens, Heather Tomblin & Baluyut

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If you ask Ernest Cummings, a newer Peoria resident who found himself in the hospital for a diabetes-related condition, OSF HealthCare should continue using virtual nurses.

“It was better. Sometimes they (nurses) have other patients and sometimes it does take too long and sometimes I’m impatient,” Cummings says with a laugh. “But it was nice today,” he said after his hospital discharge discussion with OSF OnCall Virtual Nurse Laurice Domingo. 

Before his discharge from the medical surgical unit at OSF HealthCare Saint Francis Medical Center, Domingo touched base with a multidisciplinary team including his attending physician, social worker and anyone else who might have been part of Cummings’ care. Then Domingo popped onto the TV screen in the room, introduced herself and went through paperwork that had already been given to Cummings to look over before the video chat. Domingo makes sure to ask if Mr. Cummings is clear on next steps and if he has any other needs.

“How about transportation? “Yes. My brother is probably downstairs waiting for me,” Cummings shares. Domingo closes out the visit. “If there isn’t anything else I can help you with, I’ll let you go so you can go home!” 

OSF HealthCare is piloting virtual nursing on three medical surgical floors, covering about 75 patients at its flagship medical center, Saint Francis Medical Center in Peoria. The Performance Improvement division at OSF Innovation was tapped to design how virtual nurses through OSF OnCall Digital Health, can reduce the burden of bedside nurses and create a better patient experience leveraging the right technology. The pilot is testing two different approaches using installed technology on TVs in patient rooms that allow an audio-visual connection with the patient, and another that involves bringing in a tablet for the patient to use.

Domingo is already a pro at virtual nursing after having been part of the launch of the OSF OnCall Digital Hospital in August of 2022. She currently works from the OSF OnCall building in downtown Peoria but Vice President of Digital Care Brandi Clark says that could change in the future to help recruit and retain virtual nurses who might want to work from home.

OSF OnCall and nursing leaders haven’t yet settled on the technology platform that’ll be used but Clark says there is an advantage to hard-wired technology on television screens.

Patient feedback has been positive

“Patients certainly have expressed that they have had a good experience with the virtual nurse both with the tablet as well as with the installed technology in the room. A real benefit to the installed technology for the bedside nurses is that it requires no work from them to bring that technology into the room to the patient.” 

So far, OSF OnCall virtual nurses have mostly been involved in admissions and discharges which can be time-consuming and often leads to patients waiting for a bedside nurse to become available. OSF Saint Francis Medical Center Vice President-Chief Nursing Officer Jennifer Croland says they are also testing other ways to potentially use virtual nurses, including allowing the remote nurse to provide patient education.

“We've also looked at things like scribing patient assessments, doing regular rounding in the rooms to check on the patients, completing checklists and providing information on discharge appointments. And setting those up. So, there's been a fair amount that we've tried to do and we're really still trying to land on what is best for that virtual nurse to do.” 

The lessons learned to date include the importance of good communication between the virtual nurse and the bedside nurse.

Over a four-month period of the pilot, virtual nurses completed 93.4% of admissions and 87.7% of discharges, freeing up bedside nurse time. Completion of advanced care directive forms to document end-of-life wishes and patient education documentation increased from 60% to 100%.

Skeptical bedside nurses have come to appreciate the support a virtual nurse can provide in alleviating some timely tasks that take them from direct care. Brandi Clark says many hospital systems are testing options to see what works best and is cost neutral, while reducing nurse burnout.

“While there is not necessarily published, evidence-based literature out there to say, ‘this is how it should work,’ we are all learning together about how this will help optimize care for patients in the inpatient setting in the future.” 

While the pilot continues, the OSF Performance Improvement team is collaborating with frontline Mission Partners and leaders to continue to design the model and workflows to expand how OSF HealthCare can leverage virtual nursing care across its 16 hospitals. 

Patient Ernest Cummings and OSF OnCall virtual nurse Laurice Domingo

Brandi Clark and Jennifer Croland

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