Virtual nurses will assist in hospital admissions, discharges

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Upstate is beginning a virtual nursing program, and it will impact patients who are admitted to the hospital. Here to tell us about it is Nurse Kathy Berardi. She's an assistant director of nursing at Upstate. Welcome to "The Informed Patient," Ms. Berardi.

Kathy Berardi, RN: Hi. Thanks so much for having me. I'm really excited to have the opportunity today to discuss this new initiative and the way that nurses are providing care to our patients admitted to Upstate.

Host Amber Smith: Well, we started hearing more about virtual health care through telemedicine during the pandemic. Is that where the concept of virtual nursing began?

Kathy Berardi, RN: Yes, it is actually. I'm sure many of us listening have experienced a virtual visit with a provider. Maybe it's a checkup or a phone call with your primary care provider as a follow up. The concept of virtual nursing is really similar, and many organizations really began using this workflow to provide virtual nursing to patients really during Covid when we were all in isolation.

So this might've looked like the nurse was outside the room and called into the patient's room to check on them before kind of gowning up and getting ready to go in that room to provide care, to see if they needed anything in that room. And then, really, it advanced from there, where the nurse could call into the room with an iPad, maybe to ask screening questions, thinking of admission questionnaires or even discharge teaching, and it was really great because the nurse could actually connect with family outside of the hospital as well when those visitor restrictions were really tight. So we could have the patient and the family participating in those questionnaires or in the discharge teaching. And it really helped everyone to come together.

And so, really, it was helpful because the virtual visit allowed the nurse and patient, and even family to see each other and really could help gauge the understanding of everyone throughout that discharge process.

Host Amber Smith: So it sounds like that worked out really well during the pandemic, and we learned from that, and now we think there are ways we can put this into play regularly.

Kathy Berardi, RN: Yes, absolutely. And I think overall the real goal of virtual nursing is to really take some of that workload off of that bedside nurse that's working in person with the patient. And so there's many different applications that you might use for virtual nursing.

Host Amber Smith: Many hospitals are facing a shortage of bedside nurses. How will a virtual nursing program help with that?

Kathy Berardi, RN: So virtual nursing workflows we have in place have really started to help with the nursing shortage that was happening during the pandemic. And as nursing staffing has recovered, it's also turned into helping some of those newer-to-practice nurses who have just come out of nursing school to really focus on that care that they want to provide to the patient at the bedside, in person, when the patients really need it.

And that virtual nurse can help them to feel more confident, knowing that their other patients are being cared for virtually and really taking away some of the tasks from the bedside so those nurses can catch up at the bedside.

And so about a year ago we started the virtual nursing program, and we've been doing discharges on a few units. And the patients listening may have experienced that somewhat so far. And now we're working toward expansion of the program to the entire hospital and working with patients on both admission and discharge to the hospital.

Host Amber Smith: It sounds like the virtual nurses are experienced nurses. What are the qualifications to be a virtual nurse?

Kathy Berardi, RN: The nurses that we're really looking for to fill the virtual nursing role have about three to five years of nursing experience, and that really helps to make that bedside nurse feel a little bit more confident. And the patients will have the ability to work with a nurse who's had a lot more experiences under her belt. And typically they've also worked in multiple different fields within nursing and many different areas.

Host Amber Smith: What is the goal of the virtual nursing program at Upstate?

Kathy Berardi, RN: The goal is really to take some of that workload off of the bedside nurse that's working with the patient in person. And by saving some time in the bedside nurse's workday, we're really hoping that it helps the nurse have more time to do more holistic and patient-centered care with their patients.

An example I like to use when I'm talking to nurses about virtual nursing is if you had a four patient assignment as a nurse and one patient is going home that day, that nurse might spend 30 or 40 minutes really going over the discharge planning and all the discharge paperwork and teaching with the patient. And if the virtual nurse were to spend that 30 or 40 minutes with the patient instead, think of all the time that that bedside nurse can put those minutes back to provide care to the three other patients that they're caring for.

And as a nurse, what I like to think about is maybe it's taking one of your patients on a longer walk down the hall to look out a window. Or maybe it looks like a little extra TLC, like a person that's been in the hospital a little bit longer, maybe having their nails painted or their hair washed with a special shampoo from home. And so those minutes that are saved with virtual nursing really add up and I think contribute to the end goal, which is to improve the care to the patients that we're providing.

Host Amber Smith: At hospitals where programs like this are already in operation, what have been their experiences?

Kathy Berardi, RN: From what I've seen in (health care) literature, patients are really enjoying virtual nursing. Patients who have participated in broader virtual nursing programs across the country have really reported increased patient satisfaction. And I think virtual nurses being added to the nursing team and collaborating with patients and families in a way that bedside nurse might not have the time to really allows the patients to experience better physical care and better teaching for discharge from the hospital.

And that virtual nurse really fills in the gaps for patient education, patient advocacy, and really overall, I think it's leading to increased patient safety at those times when patients are most vulnerable, which would be admission and discharge into our organization. And the ultimate goal is really to get patients in to receive the care that they need and get patients home safely to continue their recovery.

Host Amber Smith: This is Upstate's "The Informed Patient" Podcast. I'm your host, Amber Smith. I'm talking with nurse Kathy Berardi, an assistant director of nursing at Upstate.

You describing the duties that a virtual nurse does, it sounds like this is really making a nurse team that's going to be responsible for these patients that the nurse is going to be working closely with the virtual nurse, and vice versa. But let's talk about how this works in practicality. Does the patient have a way to reach the virtual nurse, or does the virtual nurse contact the patient?

Kathy Berardi, RN: So right now at our organization, the process really looks like the virtual nurse will receive a request for a virtual visit from the bedside nurse to say that this patient is ready for admission or discharge. And that virtual nurse will review the chart and get ready for that visit, get familiar with the patient's care and what the plan is moving forward.

And then the virtual nurse will send a request to the patient. The patient will use their own personal video enabled device, such as a phone or an iPad. And the nurse will send a secure text message to that patient's own personal device, and the message will say something like, "this is your virtual nurse, and I'd like to connect for a virtual visit." And there'll be a link, and that will bring you to a secure web browser for the video visit. And this link comes right from our electronic medical record, so it's safe from a privacy standpoint.

Host Amber Smith: So they'll meet the virtual nurse at admission, it sounds like, or once they're in their room?

Kathy Berardi, RN: Yes. So at admission you might engage with a virtual nurse, and that virtual nurse would be able to see and hear the patient, and the patient would be able to see and hear that virtual nurse. And what's really nice is, especially at discharge, if the nurse needs to provide visuals for discharge education or planning, the nurse can also share her screen from in the medical record to provide some educational materials for the patient to look at and then provide copies for the patient to take home as well.

Host Amber Smith: So where are the virtual nurses located?

Kathy Berardi, RN: The virtual nurses are located at an upstate building, which is our throughput operations center. And it's a really great place for them to be located because that location really provides a variety of throughput related activities for our organization. So our bed management staff is there, transfer center staff, environmental services, and throughput, and patient transport dispatch staff. So by having all of those disciplines together in one location, any barrier to moving patients throughout our organization can hopefully be discussed and worked through, to get that ultimate goal of having our patients receive the care that they need timely and then discharge home timely to continue their healing process.

Host Amber Smith: So these are Upstate nurses. They're just not in the hospital. They're at the throughput operation center.

Kathy Berardi, RN: Yes. Yep. They work remotely from the throughput operations center, where they have their computers that are able to connect to anywhere on a patient's own cell phone.

Host Amber Smith: Now, are the virtual nurses available around the clock?

Right now they're available during peak admission and discharge times, and that's typically from 7:00 AM to 11:00 PM, and throughout our expansion of this program, we'll definitely be continuing to evaluate these hours and hopefully get the virtual nurses scheduled when we need them the most.

Do patients on all units at the hospital, are they going to receive virtual nurses, or are you rolling this out on certain floors first?

Kathy Berardi, RN: In June, we'll be fully functional with admissions to all areas of the organization if the patient is able to, and that would be if a patient has their own device that's able to be video connected. And for discharges, it will be a rolling process to expand to all units in the hospital. But hopefully within the next six months or so, we will be able to service all areas of the organization.

Host Amber Smith: Do you have plans for expanding this in the future?

Kathy Berardi, RN: Absolutely. At this time we are expanding from just doing discharges to include admissions and discharges at the whole organization.

But other organizations across the country who've been involved in virtual nursing for a longer period of time are doing much, much more -- things like answering call bells, rounding to check in on patients and families, answering questions, doing patient teaching, monitoring vital signs, and even training and teaching newer nurses at the bedside. And overall, really just filling in the gaps of patient care as they exist as a whole. And this has really decreased the rate of missed opportunities for nurses across the whole country, which is beneficial to patients and staff.

Host Amber Smith: You said that patients like this at other hospitals that already have this in operation. What about the nurses at those institutions? Are they liking this as well?

Kathy Berardi, RN: Yes, absolutely. I think that having another nurse as a part of the care team for the patient really is helping those nurses get back to the bedside, connect with their patients again, and providing holistic and patient-centered care the way that nursing should be performed.

Host Amber Smith: Well, this is exciting, and I appreciate you making time for this interview to tell us about it. Thank you.

Kathy Berardi, RN: Thanks so much for having me.

Host Amber Smith: My guest has been assistant director of nursing, Kathy Berardi from Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron. Find our archive of previous episodes at upstate.edu/informed. If you enjoyed this episode, please invite a friend to listen. You can also rate and review "The Informed Patient" podcast on Spotify, Apple Podcasts, YouTube, or wherever you tune in. This is your host, Amber Smith, thanking you for listening.