Joey Wahler (Host): The major nursing shortage is now being addressed using a team approach incorporating technology. So we're discussing Together Team Virtual Connected Care. Our guests, both from St. Joseph's Health, Yuri Pashchuk, he's Vice President and Chief Nursing Officer. And Karen Alsever is with us as well, a Registered Nurse now working as a virtual nurse. This is the St. Joseph's Health Medcast from St. Joseph's Hospital. Thanks for listening. I'm Joey Wahler. Hi there, Yuri and Karen. Thanks for joining us.

Yuri Pashchuk, MSN, RN, CCRN-K: Good afternoon. Thank you for having me.

Host: Sure.

Karen Alsever, RN: Good afternoon.

Host: Great to have you both.

So first for you, Yuri, just how serious is the nursing workforce crisis, would you say, from your standpoint? We've heard so much about it.

Yuri Pashchuk, MSN, RN, CCRN-K: Absolutely. It is very serious and I don't mean to minimize with my tone, but we knew this was coming. We had predictions that the nursing shortage was only going to be exacerbated. However, due to COVID, we really saw what we would call gasoline on the fire and it really ratcheted up the rate and pace of which this shortage has continued.

Many of our colleagues had to make some difficult choices in terms of working in the acute care setting in the hospital as well as impacting those that may be considering entering the nursing workforce, which has really created an extensive challenge for us when it comes to caring for our population, our community, and the resources we would need to do that.

Host: And so speaking of which, Karen, as the one in the trenches on a daily basis, so to speak, how would you say that impacts care, both for nurses like yourself and of course for patients as well?

Karen Alsever, RN: It's a more efficient with this triad of nurses focusing on patients' needs. Encouraging patients to get out of bed, increasing education to family and patients, preventing hospital acquired pneumonia, reducing patient falls; by frequently rounding on confused and at risk to fall patients, and increasing patient satisfaction with family and patients themselves. That's been a huge impact.

Host: So Yuri, to backtrack for just a moment. What exactly is Together Team Virtual Connected Care and what's so unique about it for the uninitiated?

Yuri Pashchuk, MSN, RN, CCRN-K: So one of the many challenges we face in this nursing crisis is certainly having the right number of staff with the right skill mix to care for the patients. What we discovered is that the mean age of nurses in the acute care setting was dropping. Meaning seasoned, trained nurses were exiting the profession, either taking retirement or looking for alternative employment options.

And there are certainly plenty of those. Newer nurses were entering the profession and we saw a gap between not only having lack of mentorship and seasoned, experienced nurses, but creating a safety net, allowing them to have questions answered, troubleshoot, or having a resource on the floor. And so this model addressed several factors.

It addressed that new nurses now have resources, such as Karen, who have at least eight years of experience. Many have significantly more. But it allows them to tap into a seasoned, trained nurse to be able to ask questions, leverage that experience that comes with years and years of knowledge to be able to walk them through different policies, different procedures that they may need to perform.

Or simply ask questions about a change in a patient's condition. It also allows nurses that may be considering leaving the profession or leaving the hospital to stay with us longer because it creates a virtual environment where they can still serve and support in the acute care setting at the hospital bedside, but not have to be on their feet for 12 hours or face some of the constraints that come with long nursing hours.

The third piece it has done is it allowed nurses to return back to the hospital, those that may have left, or sought different options based on their family needs. It created a more flexible work environment for nurses that would consider coming back based on their needs and their scheduled needs and family needs, allowing a lot of our nurses to reach back out and return to the hospital setting where before they would have had to look at alternative nursing employment options.

So the goal is, with these factors in place, we expect to see more of a stable workforce with a solid safety net for new nurses, mentorship for them, translate to reducing in turnover, as well as the patient satisfaction component that Karen spoke about, having that seasoned, trained nurse not only support direct patient care, but mentor those new nurses.

Host: And so speaking of workforce, back to you now for a moment, Karen. And when we talk about this new system, who is it exactly that makes up each of these care teams?

Karen Alsever, RN: So the care team is made up of a virtual nurse, a bedside nurse, and a care partner. So the virtual nurse has many years of experience. And for St. Joe's, we have former managers, directors, critical care nurse, emergency room nurse, med surg nurses, cardiac nurses, oncology nurses. For the bedside, it's a seasoned RN or it could be a new RN or even a graduate nurse. And the care partner could be an LPN a PCT or a nursing student.

Host: And so Yuri, when we talk about this still being relatively new, I believe about two years or so, what kind of feedback are you getting both from your staff and from patients as to how it's working so far?

Yuri Pashchuk, MSN, RN, CCRN-K: So it's new within Trinity Health in about two years. It's even newer for us. We've only had this in place for several months, but the feedback we've gotten was some of the original feedback coming out of our sister hospitals showed a tremendous impact on staff morale, support, resources, as well as patient satisfaction.

They were able to identify changes in patient condition, and seasoned nurses with years of experience can pick up on subtle changes and escalate them much sooner to a clinician or a physician to be able to intervene. And we really loved what that model stood for. And then obviously watching the staff turnover or how many nurses leave the profession, we saw that the units that implemented this model saw a reduction or had less nurses leave that unit as opposed to the units that didn't.

And so those were enough proof for us that we wanted to implement this. Now we will continue to measure and monitor this model for us and as any change, it took a little bit of work to get us there. There was some reluctance that this would actually land the way we wanted it to be.

But already we're seeing a very positive response. Our nursing students that are looking to join our profession are very curious about how this would be supportive for them, our physicians are sharing some of their feedback, and even patients have already reached out and shared their experience with interacting with a virtual nurse and how much that meant to them.

Host: I was going to ask you, oh by the way, how do the doctors feel about this, Yuri, right?

Karen Alsever, RN: Uh huh.

Yuri Pashchuk, MSN, RN, CCRN-K: Yeah, that was certainly on our list of colleagues that we wanted to be a part of this conversation. So even early on, I had conversations with our providers. Karen and I and others met with a group of our physician residents who are on one of those floors and had great conversation about what this means for them and how they partner with that virtual nurse and how do we leverage that resource to help them communicate better, communicate sooner and identify those changes for those patients.

Host: And so, Karen, just to be a little more specific from your standpoint, if I'm a patient under your care on a given day, and there's a virtual nurse in place for me as well, what does that mean for me? What's my interaction with that nurse and how do they do their job differently, beyond the obvious of course, than they would if they were there in person?

Karen Alsever, RN: I tell my patients that I can do everything, almost everything except bring them water or a warm blanket. So I, start my day with contacting the bedside nurse and the care partner and letting them know that I'm in the virtual nurse hub and how I can help them today. Because ultimately the bedside nurse is in control of the patient care. So then I visit, go through my list just like I would if I was on the floor and see who needs to be seen first. Maybe a patient that is at risk to fall, confused, even a comfort care patient that I know maybe the family is not with them. And for those that I can, I introduce myself as part of the team. I'm part of the care team that's taking care of you today.

And I let them know that I can call doctors for them. I can contact case management if they have concerns about discharge. I can just talk to them. I can give them a little bit more time than I could if I was on the floor. And I think that is huge for the patients as well. Just with the needs that our patients are bringing to us, that is huge to be able to just spend that little extra time.

Host: And so, if I'm in a hospital room, am I looking at a screen where I can see you sitting there? Or is it that you're always available to be there? If I call you, how do I connect?

Karen Alsever, RN: Yes. So, when I want to enter your room, I click on your room on my computer here, and then you hear a knock in your room, and I can hear that we've connected. And then I will ask, is it okay if I turn on my camera? I'm your virtual nurse, Joey. Is it okay if I turn on my camera? And you respond, yes.

Some people say no. Some people don't like this. But for the most part, people do. So you tell me, yes, go ahead. I turn on my camera. At that point, you can see me, and the camera is facing the wall. So then the camera turns around, and we can see each other.

Host: So there's obviously still privacy if the person wants it, right?

Karen Alsever, RN: Absolutely.

Host: Gotcha. So what do you like about this, Karen? What from your standpoint, having done it the traditional way is most helpful about this new approach.

Karen Alsever, RN: I absolutely love this care model. Like Yuri said, I was in a position where COVID kind of took its toll on me physically, and I just couldn't keep up physically with the demands on the floor. And with the shortage, all of that, it just, it took its toll. So, I'm happy with this care model because I'm back at the heart of why I became a nurse, and that's taking care of the patients, educating the patients, listening to their concerns. We never know what skill set we'll have to utilize in helping these, the patients, but that is one thing that I absolutely love about this. Like I said, I can spend a little bit extra time with the patient. And hopefully nursing satisfaction will turn around and increase by us being able to just spend that little extra time.

Host: Indeed, and you led me beautifully, Karen, with that last comment into my next question for Yuri. So, when we talk about this nursing shortage and the workforce, or lack thereof, Yuri, I guess St. Joseph's Health does currently have job openings in Connected Care, right?

Yuri Pashchuk, MSN, RN, CCRN-K: Absolutely. And we're positioned to continue to expand this. We're not done yet, and so we're already seeing the positive benefits of this. Our goal is to be able to expand this model on as many units as can support it. We also have trials going on where this is being evaluated in units such as the emergency room and women's and infant services to see how a virtual nurse can benefit that population.

We know that we have to do things differently. We've heard that health care is changing or health care will have to change, but we have to be an active participant in that change. And so our goal is to continue to be a leader in innovation in order to create an environment and a platform that allows us to provide that exceptional quality care for our patients; while leveraging some of the resources we have and combating some of the staffing challenges that everyone is facing these days.

Host: Something that was touched on earlier, Karen, the importance of nurses like yourself with experience mentoring and helping less experienced ones. Has this enabled you to do more of that or do it better?

Karen Alsever, RN: Absolutely. We still are in the grace period right now with this care model, but every day is a plus you know, cause all nurses, are very possessive of their patients, so sometimes, and I understand this totally, it's sometimes hard to give up that control over your patients. But moving forward, the new nurses are seeing that it's okay to ask us questions, it's okay to refer to us for guidance on how to handle a patient or how to handle a situation. And I think that is going to be the bonus here is it will all come together with grace. We did have one of our VRNs help a newer nurse, put a Foley catheter in. Not that she hasn't done it before, but sometimes that can be difficult. And she turned her camera on and guided this nurse through getting this catheter in, which is awesome.

Host: Well, actually, I was going to ask you, Karen, if you could share a story for us illustrating the benefits of this new system, but you just did that. And let me just wrap by asking you again, Yuri, if someone listening is interested in applying for one of the current job openings involving connected care, what do you suggest they do?

Yuri Pashchuk, MSN, RN, CCRN-K: Absolutely. I would suggest you go right to our website. You can see a link right to the job postings. You can reach out to our Talent Acquisition Department. We'll even let you come on site and do a tour, if you want a shadow, connect with folks like Karen and others, ask them questions to really understand and fully appreciate the benefit of this role.

I think we have something very special here and already we're seeing folks reaching out to us, other hospitals and health ministries reaching out to us asking those same questions because they know that we can't do this alone and what we've done in the past isn't working anymore. So we're really excited to be able to share some of these lessons learned and some of the success.

So please reach out, go to our website. We'll be happy to walk you through and get you connected with our team.

Host: Excellent. Thank you for that. And folks, we trust you're now more familiar with Together Team Virtual Connected Care. You heard Karen say that one of the very few things she can't do virtually is bring you a warm blanket, but Karen, I trust you're still capable of arranging for one, can't you?

Karen Alsever, RN: Absolutely. Yep.

Host: Those certainly come in handy when you're staying in the hospital. Well, Yuri and Karen, great information, continued success with the program, and thanks so much again.

Karen Alsever, RN: Thank you, Joey

Yuri Pashchuk, MSN, RN, CCRN-K: Thank you, Joey.

Host: And for more information, please visit sjhsyr.org. Again, sjhsyr.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks again for listening to the St. Joseph's Health Medcast from St. Joseph's Hospital.