74% of Hospital Leaders Say Virtual Nurses Will Be Key To Future Care: A Day in the Life
Jessica Milhomme, (@jessthern) BSN, RN cares for between 24 and 27 patients a day, alternating between tasks like admissions, discharge education, medication plans, and pain management, along with overseeing the administration and monitoring of heparin and blood product transfusions. They're common nursing tasks, but Milhomme's execution of them comes with one major difference—
She does them all virtually.
During her 12-hour nursing shift, Milhomme calls into each of her patients' rooms, getting permission before broadcasting herself Zoom-style on an in-room 2-way screen, where she can see and talk directly with them. As a virtual nurse, Milhomme is based in Florida but cares for patients at a hospital system in an entirely different state. Milhomme represents a growing number of telehealth nurses changing the scope of how healthcare can be delivered in the U.S., a trend some experts say will only better serve the increasing needs of patients.
What is Telehealth Nursing?
Telehealth nursing encompasses any type of nursing care that is done remotely. Telehealth nursing includes everything from emergency triage to primary care, mental health, and chronic disease management. Telehealth services in general surged during the pandemic and while numbers have leveled off slightly, have continued to become more adopted and accepted by both healthcare providers and patients alike.
Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, is the CEO and Founder of Virtual Nursing Academy, a company that equips and empowers healthcare organizations to establish virtual nursing care models that best meet their unique patient and employee needs. Clipper is an expert in telehealth nursing and explains that a virtual model of nursing care will be a norm in nearly every aspect of healthcare, from long-term care to critical care to primary care.
"We're really seeing patterns continue to emerge across the country," Dr. Clipper says. "In my opinion, this is absolutely going to be the standard of care, in probably 5 to 7 years."
Hospital administrators seem to agree, with 74% of hospital leaders reporting in 2024 that they believe virtual nursing is or will become integral to care delivery models in acute inpatient care, an increase from 66% expressing the sentiments in a 2023 survey. The Virtual Nursing Academy alone has helped over two dozen hospitals set up their virtual nursing programs across the entire country, ranging from California to Texas to Kentucky to Tennessee to Ohio.
While many people may be more familiar with telehealth services like talking to a doctor over the phone or computer for a follow-up appointment or to discuss labwork, virtual nursing in a hospital setting may be more of a novel concept. But nurses like Milhomme are seeing patients every day in the hospital and making a big difference in easing some of the workload of floor nurses as well as for the patients they are caring for.
A Day in the Life of a Virtual Nurse
Dr. Clipper explains that there are typically two main care models that healthcare facilities can utilize to employ virtual nurses:
- A task-based approach, with virtual nurses "grabbing" tasks like documentation, admissions, or discharges from an ongoing queue, or
- A care partner approach, when a virtual nurse teams up with an in-person nurse or nurse group to help them complete their patient care throughout a shift
According to Dr. Clipper, both care models "have amazing outcomes" and which approach is used depends on a specific healthcare facility's needs and patient population. Sinai Hospital in Baltimore, MD, for instance, launched a virtual nurse program that focuses on "no-touch" patient care, especially admissions and discharges.
Milhomme's nursing care approach is a bit of a combination of the two care models—every shift, she is given a list of patients with certain tasks to complete. However, she also has access to communicate with the in-person nurses and doctors as needed. For instance, if a pain assessment reveals her patient needs a pain management intervention, Milhomme can virtually reach out to the floor nurse, who can administer the appropriate intervention.
She works on a unit with med/surg, telemetry, and oncology patients and the care she delivers is completely hands-free for the patients. Once she calls into a room, verbal consent is all that's needed for her to turn on the screen that video broadcasts her to a patient and when they are done speaking, she can virtually turn off the screen as well. At her particular unit, patients cannot call a virtual nurse (other hospitals have an on-demand virtual nurse call light system), so rounding is on her schedule. She is on day shift, but there's also a night shift virtual nurse that will finish whatever patients she is not able to round on during the day.
A typical shift for Milhomme is spent alternating between tasks like:
- Reviewing patient charts and taking notes on patients who may be discharged that day.
- Managing discharge care, such as contacting specialty providers on the care team for discharge approval
- Performing discharge education and paperwork directly with the patient
- Sending medications to the pharmacy.
- New patient admissions and history
- Signing off on heparin drips or blood transfusions, and "staying" with the patient for the first 15 minutes to monitor for any reactions.
- Rounding on as many patients as possible to check in, see if they have any questions or needs, and relay that information to the bedside nurse.
- Communicating with the bedside nurses via a messaging app to coordinate patient care and needs.
Milhomme also shares that her "nursing instincts" continue to play a vital role as a virtual nurse.
"I've been in situations where you because you've seen, you're accustomed to seeing when patients need help or when patients are in distress, and you know, okay, let's activate rapid response, or let's call someone in to help this patient," she says. "So those same instincts that you have as a floor nurse you can use when you're visiting a patient and knowing when to call for help for the most part."
The Benefits of Virtual Nurses
Milhomme clocks in and out for a typical 12-hour nursing shift, but she does it all from a computer in her home. She takes regular breaks and makes a point to ensure she takes walks and gets fresh air throughout her shift. Along with the flexibility and improvement in her work-life balance that virtual nursing offers, Milhomme explains that her role is rewarding because she feels she is providing vital services for both patients and her fellow nurses.
"I feel like I'm helping and making a difference because I can understand, from working as a floor nurse that you don't get to spend as much time as you'd like with your patients," she says. "You feel like you're just doing all these tasks, but you're not always able to build a relationship with your patient, because there's so much to do and so little time. My role is to work on those little tasks so that the bedside nurse can spend as much time as they can with their patients."
Dr. Clipper agrees, noting that the data backs up the benefits of the virtual nursing care model. "Across the country, we are certainly seeing reductions in length of stay, reductions in readmission, reductions in turnover, and improvements in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), she explains.
Dr. Clipper also points out the wide variety of tasks that virtual nurses can provide, such as assisting with sitters, documentation, admission, discharge, transfer, medication reconciliation, patient education, pain reassessment, dual nurse verification of high-risk medications, precepting on demand, and pre-op and pre-imaging checklists.
"We're seeing it being used as kind of a safety alert, where you could do a safe word activation if you have technology that's on in the rooms at all times," she adds. " There's really a plethora of use cases. And it's not just nursing. We are seeing virtual care teams evolve within the in-patient space as well."
Because of the current cost of many virtual care models, Dr. Clipper explains that many hospitals are predominantly utilizing the technology in acute care settings, but she adds that as price points start to come down, it will open the door for expanded use in settings like long term acute care, skilled care facilities, assisted living facilities. She points out that a virtual nursing model is an especially useful option for small, rural hospitals because it allows access to expert nurses that may not be available geographically.
While there are many benefits to virtual nursing, some skeptics worry that virtual nurses will replace in-person nurses—but Dr. Clipper is quick to allay those fears. "That could not be farther from the truth," she says. "Someone has to care for the patient. Somebody's got to lay hands on the patient, go to look at the patient."
Instead of looking at a virtual nursing care model as replacing one type of nurse, Dr. Clipper encourages seeing it as another layer of the teamwork approach all nurses know. "It's a dual-sided care model," she says. "It cannot happen with virtual people only."
"It's an exciting, fast-moving area for people to pay attention to in nursing," she says. "And I think it's really very exciting because this allows us to create nursing 2.0—it's a great opportunity for us to design and develop this and not let the technology companies do it. Rather, let's have this be nursing-LED".
How to Become a Virtual Nurse
It can help to look at virtual nursing as a specialty—anyone looking to work in telehealth should earn their RN and preferably BSN, gain experience as a floor nurse, and then specialize in virtual nursing. Nurses looking to take on a virtual role can make themselves more competitive by earning certification, such as becoming a Certified Acute Care Virtual Registered Nurse (CACVRN) through the Academy of Medical-Surgical Nurses.
Milhomme shares that to become a virtual nurse, she specifically searched for telehealth nursing roles. After working as a travel nurse during the COVID-19 pandemic, she knew she needed a break from a clinical role, but still wanted to work in the nursing field caring for patients. She was able to find a virtual nurse position at a hospital and applied—although she lives in a different state than the hospital where she is employed, her compact nursing license enables her to legally work in another state.
She shares that similar to floor nursing, being able to prioritize, manage your time, and know how to switch from different tasks rapidly are important skills for a role as a virtual nurse. Although she has future career aspirations to earn her Masters and even go to law school, Milhomme is very happy with her role as a virtual nurse right now. She encourages other nurses who are looking for a change or need a more flexible, remote position to look into virtual nursing.
"As nurses, we're trainable," she says. "There's so much that I feel we can do, there's so much that we've learned that we continue to learn every day, because it's science and it's always changing, and we're always learning. I think there's opportunity and room for growth and improvements, for anything."
Dr. Clipper also encourages nurses at every level to get involved in shaping the future of virtual nursing and its role in healthcare delivery.
If you have a nursing news story that deserves to be heard, we want to amplify it to our massive community of millions of nurses! Get your story in front of Nurse.org Editors now - click here to fill out our quick submission form today!
