Bill Klaproth (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2023 conference. With me is Emily Cornelius. She is a Nurse Manager. We also have Patricia Mook, Vice President of Nursing Operations, both from Atrium Health. Their session, Virtual Nursing, the Future of Compassionate Care is Here. And this podcast is brought to you by Teladoc Health. Teladoc Health was an early innovator of comprehensive virtual care within the hospital, including a state-of-the-art inpatient virtual nursing solution. It's powerful platform, provides staff immediate contact with patients, helping improve operational efficiencies, patient access, staff satisfaction and clinical outcomes. Discover the power of virtual nursing at teladochealth.com/virtualnursing. This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Emily and Patricia welcome.

Emily Cornelius, MSN, RN, NE-BC: Hi. Thanks for having us.

Patricia Mook, MSN, RN, NEA-BC, FAONL: We're so glad to be here.

Host: I'm glad that you're here. So let's talk about this. Patricia, I'm going to start with you. What is the compelling leadership issue or problem that your session addresses?

Patricia Mook, MSN, RN, NEA-BC, FAONL: So today, and for the last three years, we've just been really challenged with taking care of patients, not enough nurses. And we have brought together technology and compassionate care to take care of our patients, just augmenting staffing in a very new and innovative way.

Host: And Emily, for a nurse leader listening to this, obviously we have this nursing shortage. There's a staffing issue. Why was this important for you to look at and what is it important for a nurse leader when trying to address an issue like this, like you two have done?

Emily Cornelius, MSN, RN, NE-BC: So you want to make sure that you're advancing the care of the patients. So that's our number one priority is patient safety. And this is a way that we can supplement the nurses at the bedside. We're not replacing them but we can help them. We can take some things off their plate. Anything that we can do virtually for them, that is our goal to do that. And so for a new leader or a leader looking to do this, my advice would be for them to study their units. Look and see where they can make the most impact and start there.

Host: Yeah. That's excellent. I love how you said that and Patricia then, so understanding that, what Emily just said, what are the policies or programs or what did you do to change this? Give us the specifics.

Patricia Mook, MSN, RN, NEA-BC, FAONL: Sure. We were challenged with, in particular, a Pulmonary unit during our COVID environment where we didn't have enough nurses to care for our patients the way we wanted to care for them. And so we sat down as a group of nurses and informaticists and in one week we were able to put a process together, a team nursing concept where we had a nurse behind a camera who could take care of and review and assess 10 patients in conjunction, and in partnership, with the nurse at the bedside. And we found you know we came to some really wonderful just opportunities where our patients were being taken care of in a safer and in a way, in a safer way, and in a way that our patients felt really good about their care. We saw great results with patient satisfaction and quality. And Emily, you can speak a little bit about that.

Emily Cornelius, MSN, RN, NE-BC: Yes So I can speak to the results we saw. One of the biggest things is we saw, um overall patient satisfaction went from like 14% to the 80th percentile. Our call light study yes, Call lights, the number of patients using their call light to call the nurse for something that decreased by 57%. And that was because they were able to directly work with the virtual nurse to get their questions answered or get their needs taken care of.

Host: That's amazing. So how does the virtual nurse work? Patricia, you mentioned team nursing and you put a nurse in front of a camera. How do you do that? How does that work?

Patricia Mook, MSN, RN, NEA-BC, FAONL: We, we actually put a nurse in what we call a bunker. It's a space, where they're offsite and they're monitoring through a camera, which is two way. Where the patient in the room can see the nurse when she comes into the room on the camera, and they can converse back and forth. And this virtual nurse can support patient education, family education. They can assess the patient. The camera has the capability to go down to your watch and see very detailed things on medications. The nurse behind the camera can be a second check nurse for the nurse in the room. They're documenting, they're really assisting in partnership with the care provider at the bedside. And this allowed a lot of flexibility during a time when we don't have enough nurses to take care of our patients across our nation.

Host: Yeah. So this allows that nurse really to cover more ground, see more patients in shorter amount of time. So, Emily, give us your thoughts on this.

Emily Cornelius, MSN, RN, NE-BC: So I think one of the keys is to remember we are not replacing that bedside nurse. We are a compliment to them. We're there to help them with their care and this frees them up so it includes satisfaction for them. Because, they're able to typically, before this, they would have to stay 30 minutes to an hour afterwards to chart, to do those things that they couldn't get to because they were caring for patients. The virtual nurse is able to help with that. So they're able to get out on time, so they're satisfied. You know, a lot of them work three, and four days in a row, so they're able to get home, get to bed, have time with their family. So it's a big satisfier there. But bottom line is there's care that's not being left undone. All the care is being done so the patients are being taken care of and versus before there was things that you just couldn't get to.

Host: So has the patient reaction been to this?

Emily Cornelius, MSN, RN, NE-BC: Patients have been very receptive to it. Initially, they were kind of worried like you're going to be listening and watching to me at all times. So it was education, letting them know that we have a privacy mode that we can give them privacy. We're not listening to all their conversations, and I've had patients and families, we actually had a patient that initially refused and her daughter, as she learned about it it's like, no, no, no, no, I want this. And she was able to go home versus she would've stayed with her mother. Just because not that she didn't think, that we wouldn't care for her but just she said I know my mom. She's going to try to get up and do things on her own and she knew with virtual that it gave her security to be able to go home at night and leave her mom.

Host: So does each room have a camera and a screen in it?

Patricia Mook, MSN, RN, NEA-BC, FAONL: So the way we're working right now, we use both ceiling cameras in our new rooms, in our new hospital rooms that are wired for that. And we also use cameras on a pole, like an IV pole, a sturdy hi, bigger pole. It's like an iPad that is on a pole and it gets put at the side of the bed of the patient and when the patient needs somebody or has reason for a call, um, they can call the nurse into the room is what we say, call the nurse into the room and you'll see the nurse's face on the camera or on the big TV in our wired rooms. And it's really interesting, they can do you know, RN MD rounding together.

In addition to, that, we are doing a study. We are doing it on a floor that has I think a dozen or so 15 new grads and the new grads are brand new nurses who are coming to work. And their reaction their like of this new innovative care model has been tremendous. They love the fact that they have a preceptor, an experienced nurse behind the camera who they can call on if they have a question in taking care of the patient. And so it's really been helpful to onboarding new nurses.

Host: Talking about new nurses, young nurses coming into the profession, they grew up with technology. For them, they must love this.

Patricia Mook, MSN, RN, NEA-BC, FAONL: It's like

Host: right?

Emily Cornelius, MSN, RN, NE-BC: Yeah

Host: It's like, oh yeah. An iPad.

Oh, yeah. We'll do

Patricia Mook, MSN, RN, NEA-BC, FAONL: that.

They love it They do love it.

Host: They they get this. They love it and they get it, right.

You were going to say, Emily.

Emily Cornelius, MSN, RN, NE-BC: I was just going to say, um, we've had multiple new nurses that have just talked about coming out of school, and especially the last couple years, their clinicals. They have, not been what they were before COVID. A lot of their clinicals were cut in half and stuff, so they didn't, they've come on board with without some of the knowledge that they typically would have. So for them, they're coming into a field nervous and they're what I consistently hear is it's nice to know they're someone that's got my back. I've got an extra set of eyes, and ears, and the virtual nurses have been able to, chime in and help them the first time they started a new drip. The first time they did X, Y, or Z and everybody on the unit was tied up. So they were able, the virtual nurse was able, to help them. They didn't have to delay the care and it didn't take away from the nurses at the bedside.

Host: It's almost like having a mentor right on board sort of. Yes. Is

Emily Cornelius, MSN, RN, NE-BC: Yes it's beautiful.

Yes

Host: A good thought? And, and the results have been amazing from what you said. I mean, you guys got to be so proud.

Patricia Mook, MSN, RN, NEA-BC, FAONL: Yes we are very

Host: And excited about, Hey, we're onto something here.

Patricia Mook, MSN, RN, NEA-BC, FAONL: Yeah. We were just in a room with, there must have been 300 nurses and nurse leaders in the room. And I would just share that a lot of people are dabbling in this. It's not super wide but there are enough. And what I shared with them is virtual nursing can happen in a lot of different ways. You can use it as an admissions nurse, as a discharge nurse, 24/7 care model like we have. But what I would say is be open to the possibilities of the different places that you could use this that would really amplify care for the patient. There are so many possibilities. And just as a leader, you have to listen to your staff, and listen to the needs in order to bring the right technologies together for the patient.

Host: It's a great adoption of technology, great use for that. And I'm struck still by when you said patient experience scores increased from 14% to 80%.

That's amazing.

Emily Cornelius, MSN, RN, NE-BC: Yes.

Patricia Mook, MSN, RN, NEA-BC, FAONL: It is. It is amazing. And we, were, and that is a huge plus for us.

Host: Yeah yeah for sure. Thank you for bringing your case study and how it's worked for you to this podcast. As we wrap up, if I could just get a final thought from each of you on virtual nursing. Anything else you want to say about this?

Patricia Mook, MSN, RN, NEA-BC, FAONL: Yeah. I would say don't be afraid of it. And be open to the possibilities and know that there are financial there, there is financial good reasons to do this. And don't see that as a barrier, right? Because the technology costs money. But when you look at decreasing length of stay, improving safety, improving quality, improving your onboarding of new grad nurses which you all need to do, and retaining that nurse who cannot do the physical work at the bedside but can be an experienced nurse behind the camera. Emily?

Emily Cornelius, MSN, RN, NE-BC: I would just add that when you're looking at that, think outside the box. Don't just be boxed in to, oh, this is the way we need to do it. Get your nurses at the bedside involved. Get your virtual team involved and get feedback from them. Ask them if we could help you, what are some things that we could help you with and kind of build your program from that. Have the that bedside nurse involved in it because they're the best ones to help make those decisions on what they feel like are their biggest needs.

Host: Yeah, that makes a lot of sense. And hearing you both talk just the job satisfaction for the nurses too. Last year at this conference we talked a lot about nursing burnout.

Patricia Mook, MSN, RN, NEA-BC, FAONL: Yes

Host: And how something like this can help with job satisfaction. Taking the weight off of their shoulders, not spending a half hour afterwards doing paperwork, having somebody they can ask a question to right there virtually. So this all this helps everything it seems like.

Emily Cornelius, MSN, RN, NE-BC: Yes

Host: Yeah. Well, thank you both for your time today. This has been great.

Patricia Mook, MSN, RN, NEA-BC, FAONL: Thank you for having us.

Host: Yeah, this has been great talking with you. So once again, Emily and Patricia, thank you so much. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing leadership.

Thanks for listening.