# Virtual Nursing Pilot in the Inpatient Setting: Qualitative Evaluation

## TL;DR

This study explores how virtual nursing can help with staffing shortages in hospitals by examining staff experiences and identifying best practices for implementation.

## Contribution

The study provides new insights into the adoption of virtual nursing through a qualitative evaluation of staff perspectives and operational adjustments.

## Key findings

- Staff attitudes toward virtual nursing shifted from resistance to acceptance over time.
- Direct communication between virtual and bedside nurses was critical for efficient care coordination.
- Adaptable staffing allocations were necessary to manage fluctuating patient census and unit demands.

## Abstract

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

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

We conducted a qualitative evaluation using individual semistructured interviews with virtual and bedside nurses, nurse executives, and IT project managers implementing a virtual nursing pilot program at a medical-surgical unit with 35 private and semiprivate beds at the Mount Sinai Hospital, a 1110-bed acute care hospital in New York, NY. 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.

Of 33 individuals approached, 16 (48.5%) consented to participate. Nine participants were clinical staff (virtual and bedside nurses and nurse managers), and 7 were executive leaders or managers in nursing and informatics. 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, and (4) adaptable staffing allocations were necessary to accommodate fluctuating patient census and unit demands.

The main beneficiaries of this intervention, bedside nurses, found their virtual counterparts helpful following a few adjustments. Participants reported a perceived reduction in administrative burden, uninterrupted completion of clinical tasks, and they felt their overtime was reduced, which all increased their buy-in for 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.