Innovative Approaches Maximize Impact of Virtual Nurses

Jan 23, 2024

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Symposium in AACN Advanced Critical Care describes how telehealth and virtual nursing continue to adapt to issues facing the profession and challenge the status quo.

ALISO VIEJO, Calif. - Jan. 23, 2024 – Virtual nursing presents opportunities for novel solutions to the overwhelming demands and serious issues facing healthcare, according to an article published in AACN Advanced Critical Care.

Rise of the Virtual Nurse” reviews the evolution of virtual nursing and describes practical and real-world examples of how health systems are finding innovative ways to integrate virtual nursing into patient care and nursing workflows.

The authors are tele-critical care (TCC) nursing leaders Mary Tibbe, MSN, RN, CCRN-E, AGCNS-BC; Sandy Arneson, MSN, RN, CCRN; and Cindy Welsh, MBA, RN, FACHE. Tibbe is manager of the virtual ICU, virtual nursing, Cardiac Monitoring Center and Telesitting programs at Corewell Health West, Grand Rapids, Michigan. Arneson is director of nursing services, Capacity Command Center, Physician Connection Line and Patient Placement at Charlotte, North Carolina-based Atrium Health, part of Advocate Health. Welsh is the Oakbrook Terrace, Illinois-based vice president of tele-acute and respiratory care at Advocate Health Care and Aurora Health Care, which are part of Advocate Health.

“Nursing leaders have an opportunity to think creatively about how virtual nurses can support their colleagues from afar more efficiently and effectively,” Tibbe said. “Virtual nurses offer untapped potential to shape the way the nursing profession functions in the future.”

Inpatient virtual nursing has traditionally focused on early recognition of clinical decline, disease prevention and reduction of healthcare costs. The disruption of the COVID-19 pandemic led to accelerated innovation, with TCC units supporting their colleagues on the front lines in a variety of new ways.

Advances in technology have led to increased use of mobile carts, which bring the expertise of intensivists and TCC nurses wherever they may be needed. In the emergency department, they can provide proactive management of patients who are waiting for admission to the hospital, providing earlier access to interventions and improving outcomes.

TCC clinicians can also support rapid response teams to facilitate stabilization of a patient with a deteriorating condition. In many cases, the patient is able to remain in their current unit and avoid an ICU transfer. An added benefit is that the mobile cart can remain in the patient’s room, allowing the TCC nurse to continue monitoring them for a defined period.

Virtual nurses also serve as valuable mentors to novice nurses as they develop into competent and confident clinicians with the critical thinking skills required in today’s acute, high-technology environment. They also may support travel or agency nurses to help bridge gaps caused by lack of familiarity with specific facilities and policies.

“Having virtual nurses as part of the team can assist with recruitment and retention of nurses and contribute to increased patient and nurse satisfaction,” Welsh said.

Throughout the article, the authors share examples from their health systems and others that underscore the potential contributions of virtual nurses.

For instance, Corewell is developing an innovative platform in collaboration with an electronic medical record company to integrate TCC nursing workflow into the patient record, with new tools and outcome measures.

At Atrium, TCC nurses and their colleagues at the bedside collaborated to address an alarming trend in fluid overload in patients’ volume status. With increased monitoring by TCC nurses, the project and subsequent interventions led to a 67% decrease in the average 24-hour fluid balance of patients.

“Despite their inability to physically touch a patient, TCC nurses can play a meaningful role in the patient’s care team,” Arneson said. “A culture of collaboration between direct care and virtual nurses can contribute to more efficient workflows, standardization of best practices and improved patient outcomes.”

The authors include a list of specific factors health systems and organizational leaders should consider for starting a virtual nursing program.

The article is part of a symposium in the journal’s winter 2023 issue about ways that telehealth and virtual nursing are challenging the status quo. Other articles address:

  • Innovations in TCC nursing during the COVID-19 pandemic
  • Implementation of a TCC nurse program to address staffing in a pediatric cardiac intensive care unit
  • Acute care advanced practice providers’ use of telehealth during the COVID-19 pandemic
  • The importance of healthy work environment standards in TCC nursing

AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue also includes a topic-based symposium, feature articles and columns of interest to critical care and progressive care clinicians.

Access the issue by visiting the AACN Advanced Critical Care website at

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses (AACN), the journal has a circulation of 1,500 and can be accessed at

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000;;;