Caring Through Virtual Nursing

Sep 06, 2023

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I think the concept of virtual nursing will continue to mature along with the technology to support it, and we're going to look back and really wonder how we ever provided healthcare without this asset

Ryan Morcrette

Virtual nursing is a transformative approach that leverages advanced technology to enhance patient care and optimize healthcare services. By integrating digital communications and platforms, virtual nursing supplements the continuity of care by enabling regular check-ins and continuous communication between patients and nurses.

Ryan Morcrette, BSN, RN, CEN, is director of virtual care & clinical communications at St. Luke's University Health Network in Pennsylvania and New Jersey. His interest in healthcare came somewhat unexpectedly after he was diagnosed with cancer and unable to follow his path of serving in the U.S. Navy. However, his personal experience allowed Morcrette to see first-hand how impactful nursing is on the healthcare system.

Ryan Morcette

First, can you give an overview of virtual nursing and how it differs from telehealth?

I wouldn't say there is a difference but rather an expansion of the use of technology to deliver care across the continuum. I would say telehealth has been focused on replicating an in-person transactional encounter between clinician and patient. It is generally leveraged for specific specialists to provide care to a specific patient with a specific problem. Virtual nursing broadens that out to support all patients and our nurses in a centralized delivery mechanism.

Can you give an example of how virtual nursing was implemented at your health system?

When the pandemic hit, just like every other organization across the entire industry, we pivoted our strategies. We rapidly adopted new workflows on the use of traditional telehealth technology, and we created a department that was originally focused on remote patient monitoring, again in response to COVID.

Then we leveraged these nurses in a very valuable and meaningful use case, focused on sepsis, and eventually we were able to evolve this concept into a virtual nursing department that participates in the care of patients across our entire network.

We then began to see that this approach would fit into strategies we had before the pandemic. Those were about streamlining and centralizing some nursing care using data analytics, in partnering with some of our thought-leading colleagues and networking through the American Telehealth Association and Avia.

We're now asking broad questions like what can virtual nursing do? How can we contribute to our network's response to the nursing shortage that we're facing? How can we leverage experienced nurses and broaden their reach in the hospitals? How can we redesign the care model and evaluate how technology can help us help that bedside nurse? This could include alleviating administrative work duties or bringing expertise to the room.

Could you talk more about the use case with sepsis and how virtual nursing played a part?

Our director of medical informatics/ACMIO worked with the data science team to build a sepsis time-zero model to more proactively detect patients who are likely to have sepsis, severe sepsis or septic shock. Using those analytics, we're able to deliver real-time predictive scoring models and participate in the proactive care of patients with sepsis.

So, that tool and other workflows in our electronic health record bring the virtual nurse into the care of the sepsis patient at the very early stages. Essentially, we've developed a core group of subject matter experts who can communicate with the bedside nurse or the treating physician about the SEP-1 compliance bundle, which are the compliance measures for treating sepsis patients. They essentially do a concurrent chart audit and escalate clinical issues that can be addressed within the timeframes required by the core measures.

That sounds like an amazing use of technology. On a personal level, what piqued your interest to go into nursing?

I was a volunteer for my local fire department and ambulance in high school. I always looked up to the paramedics, the flight team members and the ER staff, and I really connected with somebody who drove me toward emergency medicine as a nurse.

I had every intention of going through my undergraduate naval ROTC program and going into the United States Navy, thinking that there'd be a wonderful opportunity in terms of life experience and just technical experience. I ended up in college diagnosed with Hodgkin's lymphoma. So, I found myself as a young adult in college with cancer. I lost that opportunity to serve the country, but I became much more aware of what nursing really was about and much more acutely aware of the patient experience. So, I went into nursing after that experience with all the tools I needed to be both a competent nurse, but an empathetic person as well.

How did your experience being a patient impact your practice as a nurse and now as a nurse leader?

It really helped me understand the broader healthcare picture, and the patient experience has been with me since day one. I have always tried to demonstrate the utmost degree of empathy for my own patients.

When I have the opportunity to mentor new nurses or nursing students, I make sure they understand the concept that, yes, it might just be a sprained ankle or a runny nose, but you don't know what else is going on in that person's life, and you don't walk in their shoes. So to them, they're in the emergency department because today's a really awful day in their life. Nobody wakes up and says, "Oh, I want to go to the emergency department."

So, I think that was definitely meaningful for me in being able to help mentor other folks. As I progressed through leadership, it became a core tenant of mine in terms of my leadership style. Even now, for the work we do with virtual care, fortunately we're paired very closely with the patient experience department. We're constantly evaluating how we can leverage technology to improve not only the clinician experience, not only the network quality and efficiency, but also the patient experience when we design our programs.

What's on the horizon for virtual nursing in the next few years?

It's developing so rapidly, and virtual nursing has become one of the top buzzwords in the industry. It's really hard to filter out some of the noise. I think as long as we continue to focus on improving quality and experience - that's both internal employee experience as well as patient experience - and driving efficiency, the options really become limitless. I think people should really start to think outside the box about what's possible.

The challenge is that we have a nursing shortage and it's not going away. Every hospital is doing everything they possibly can to recruit and retain every single nurse they can. So, it's difficult to see the value in a program that may have to capitalize on those human resources that are very limited to begin with, right? So executive education is very important, and having support from executive leadership so that you can drive a top-down change is super important. That's something at St. Luke's that we very much have, that top-down executive steering committee level of support and commitment.

If we keep focusing on those three aspects, I think the concept of virtual nursing will continue to mature along with the technology to support it, and we're going to look back and really wonder how we ever provided healthcare without this asset. It's going to become second nature for patients, bedside nurses and other clinicians.

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