Virtual Nursing isn’t New — So Why Does it Feel That Way?

• Virtual nursing and telemedicine aren’t new concepts. They date back to the 1960s and have related uses in NASA.
• However, the COVID-19 pandemic brought the concept of virtual nursing to the forefront.
• Now, hospitals, individual nurses, and insurance providers are interested in increasing virtual nursing for myriad reasons.

NASA had health-monitoring sensors in spacesuits in the 1960s, so there’s nothing new about telemedicine or virtual care — despite perceptions that it burst onto the scene in a knee-jerk response to the COVID-19 pandemic’s lockdown protocols. 

But its growing popularity throughout the pandemic has brough more eyes to this version of nursing care, which now affects Medicare coverage, workforce shortages and how providers bill their patients. 

When Did Virtual Nursing Really Begin?

Psychiatric mental health care professionals used telemedicine in the ’60s to interact with each other, according to “Telehealth Nursing: Tools and Strategies for Optimal Patient Care.” But uses specifically for patient care weren’t established until later in the decade. 

“The first documented use of telemedicine to provide direct patient care occurred in 1967 at Boston’s Logan International Airport,” Dawna Martich, MSN, RN, wrote in “Telehealth Nursing.” “A medical station was created, linking the airport with Massachusetts General Hospital, in order to provide care 24 hours a day.”

But an official definition of telenursing wasn’t established until 1997 when the American Nurses Association took the lead and also created professional guidelines.  

“However, content to address the provision of patient care through this approach does not exist,” Martich wrote. 

Early iterations of the Virtual Integrated Care (VIC) Team Model had a virtual APRN with “six core roles: patient education, staff mentoring, patient safety surveillance, physician rounding, admissions, and discharge,” according to an August 2023 report from the Patient Safety Network. 

“In the initial VIC model, patient rooms in medical-surgical units at two different community hospitals were equipped with a wall-mounted camera, speakers, a large-screen video monitor, and tablet computers for bedside use,” the PSN report stated. “The virtual nurse and patient interacted through this technology.” 

Virtual Nursing Trends Resulted from COVID-19 Era

One of the biggest questions surrounding virtual care, according to a HealthCare Dive trend report, is whether or not “Washington will make COVID-19-era telehealth flexibilities permanent.” The move, the report stated, has bipartisan support and federal regulators are allowing providers to prescribe some medications virtually. 

Telehealth policies associated with Medicare that were instituted at the height of the COVID-19 pandemic remain in place through the end of 2024. 

Permanent Medicare changes, according to the U.S. Department of Health and Human Services, include:  

• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for behavioral/mental telehealth services. 
• Medicare patients can receive telehealth services for behavioral/mental health care in their home. 
• There are no geographic restrictions for originating site for behavioral/mental telehealth services. 
• Behavioral/mental telehealth services can be delivered using audio-only communication platforms. 
• Rural Emergency Hospitals (REHs) are eligible originating sites for telehealth. 

Virtual Care to Address Nursing Shortage?

Virtual nursing was at the forefront of the American Organization for Nursing Leadership conference last month in New Orleans. Two chief nurse executives estimated that a “fully integrated” care model that includes a virtual nurse and a robot would save more than $2 million annually. 

Bre Loughlin, a Wisconsin nurse, created Nurse Disrupted in 2020, providing virtual screenings to people in area shelters, according to a Spectrum News 1 report, but has expanded. She gives nurses the opportunity to work shorter shifts and complete work that doesn’t require them to interact with patients in person. More than 400 nurses are using Nurse Disrupted. 

Meanwhile, some hospitals are making the shift to virtual nursing directly, rather than working with an outside company. Last September, Trinity Health established its TogetherTeam Virtual Connected Care program, which “uses technology to support direct care staff and increase patient interaction,” according to a news release.

OSF HealthCare in Peoria, Illinois, also announced a virtual nursing pilot program in October. Nurses in that program, OSF OnCall, typically handle admissions and discharges. 

Where Else is Virtual Nursing Being Implemented?

Hospital systems throughout the country are launching pilot or full-fledged virtual nursing programs. Last August, Pennsylvania-based Jefferson Health unveiled its official virtual program, in which nurses work remotely to assist with patient check-ins and support tasks. The hospital had conducted a pilot program over the course of three months earlier in 2023. 

“Virtual nurses are not a replacement for bedside nurses, instead they serve as an additional member of the hospital care team. Bedside nurses and virtual nurses work together to ensure that patients continue to receive the safest and highest quality of care,” said Laura Gartner DNP, MS, RN, NEA-BC, Division Director, Clinical Informatics, Jefferson Health. 

The American Hospital Association offers five keys for success when incorporating virtual nursing into a healthcare system: 

1. Be inclusive from the start. 
2. Allow time for relationship building. 
3. Anticipate technological difficulties. 
4. Don’t be afraid to change workflows. 
5. Make sure buildings have adequate wireless bandwidth.

Billing for Virtual Care

Another aspect of virtual care relates to what healthcare providers consider billable. A January 2023 report in the Journal of the American Medical Association found “an association between implementation of clinician-initiated billing and an increase in e-visits, but adoption was low.” 

“Multiple factors likely contributed, including lack of awareness of e-visit workflow, perception that additional steps to complete e-visits were not worth the reimbursement, and concerns about negative patient perceptions of charging for messages,” the report stated.

Health insurance providers also have shown interest in telehealth as a way to lower patient costs and improve quality of care, according to the advocacy and trade organization AHIP. 

The Bottom Line

Virtual nursing has been around for decades but became more mainstream during the COVID-19 pandemic. With pandemic-era lockdowns a distant memory, the concept remains a part of the U.S. healthcare system. Nurses are creating their own virtual nursing companies, while hospitals are establishing pilot programs to help address the industry’s workforce shortage and insurance providers advocate for expanded telehealth services. 

As practitioners and patients grow accustomed to the virtual aspects of healthcare, the American Hospital Association offers reminders that can help make virtual nursing a success. 

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