Virtual Observation And Team Nursing


The beginning of 2020 introduced numerous challenges that would spark indefinite change in the healthcare landscape for clinicians and patients alike. While the pandemic may have placed a microscope over well-established cracks in healthcare systems, there’s no denying the many new obstacles that resulted from a significant increase in the need for medical care and the halting of daily operations for months in the U.S.

The COVID-19 Impact on Clinicians

Decline In Nursing Staff

Supply and staff shortages, increased care costs and government regulations, over-populated hospital beds, and more, combined with the aging of the nation’s largest generation, create adverse outcomes for patients and clinicians. Of a large sample of RNs and LPNs surveyed in 2022, 62% said their workload increased during the pandemic, while approximately half reported feeling “used up,” burned out, and fatigued, and even “at the end of their rope” on a near-daily basis, particularly for younger and less-experienced RNs.[i]

Many clinicians leaving the healthcare workforce resulted in a significant nursing shortage. The physical and emotional fatigue within the nation’s healthcare organizations led to a 95.7% increase in RN turnover in the past 5 years.[ii]

Increase In Nursing Challenges

In addition to the more recognizable obstacles clinicians face, COVID-19 introduced a seemingly endless list of obscure and often dangerous symptoms—many respiratory-related, as well as further complexities for patients with pre-existing conditions, and it created an influx of high acuity patients with respiratory distresses. This resulted in many patients requiring high levels of ventilation and oxygen care, multi-organ system intervention, and other support that called for the accommodation of more specially trained nursing staff that was just not available. In some healthcare organizations, ICU nurses were reported to have supplemented their staff by training medical and surgical personnel to deliver primary care to patients, allowing them to tend to individuals requiring specialized treatment. The situation presented a model of team-driven care that could be carried over for future use once the pandemic crisis diminished.[iii]

The pandemic-driven decline in the clinical workforce has impacted care and cost the healthcare industry millions. The average U.S. hospital lost $7.1 million in 2021 alone and continues to lose up to $9 million annually from RN turnover.[iv]

A Need For Solutions

Retention And Leverage

Though healthcare organizations faced an overall decline in staff (including physicians, support and IT personnel, and leaders) in the wake of the pandemic, they’ve found that nurses have become the most challenging roles to fill. Therefore, the focus has shifted with fervor from hiring to simply streamlining and augmenting current staff with new solutions. Two primary solutions being widely discussed by healthcare system leaders are improving the current workload and employing technology in every step of patient care.[v]

Virtual Observation

Virtual care is crucial for addressing clinician workload and retention and ensuring efficient use of incoming staff as the RN workforce reinvigorates in the coming decades. The number of RNs expected to enter the healthcare labor force is expected to grow 9%—to 3.3 million by 2031.[vi]

Virtual Observation as a form of staff supplementation can improve organization productivity and capabilities by supporting several processes and tasks:

  • Remote patient observation
  • Medication monitoring, records, verification, and integration with patient records
  • EHR (electronic health records), screening, data collection, admission, and discharge
  • Wound care
  • Patient-clinician communication
  • Telehealth

By allowing virtual assistance, healthcare systems can benefit from having their nursing staff’s essential responsibilities lightened so that they can focus on better and more narrowed patient care. The Virtual Observation care model supports onsite staff and helps decrease nurse turnover, patient ICU transfers, readmission, length of stay, and adverse events like falls.[vii]

Patient Falls occur every year in U.S. hospitals at a rate of 700,000 to 1,000,000, with roughly 250,000 leading to injury. Injuries occur in up to 35% of patients who’ve suffered falls and can add more than 6 days to a hospital stay. The average cost of a fall with injury is more than $14,000 per patient.[viii]

The Team-Based Nursing Model and Virtual Observation

“The team nursing model of care [first developed in the 1950s during WWII nursing shortages] involves pairing nurses who work as a team to deliver patient care. This model utilizes the entire staff’s diversity of skills, education, and qualification levels. Team members work collaboratively and share responsibility. Nurse satisfaction increases when team nursing is used because nurses feel supported, the environment is collaborative, and team communication improves. Research shows that team nursing can improve quality and patient safety.”[ix]

Data has shown that the team-based model drives higher patient and clinician satisfaction levels while increasing patient safety and quality of care. The model can also be easily modified to patients, clinicians, and organization needs, therefore being adaptable by most care facilities.

“Because the model accommodates staffing agility, hospitals can quickly train support staff such as unlicensed assistive personnel, physical therapists, respiratory therapists, and others to assist with patient care. This interdisciplinary team-based approach facilitates the rapid deployment of staff to areas most in need.”[x]

Some hospitals and health systems already leverage team nursing models, augmented with virtual care, often called “the hybrid model” of team nursing. A “virtual intensive care unit (ICU)” can entail a team of remote critical care nurses for additional narrowed Observation of essential patients with technology that features dual AV equipment and higher resolution cameras. These nurses use advanced knowledge of specific illnesses to integrate “real-time physiological monitoring data with predictive analytic tools to quickly identify patient deterioration and partner with clinical teams to initiate early interventions.” [xi]

“In acute care areas, clinical nurses can access virtual telenursing services to facilitate admission and discharge procedures for qualified patients. Using encrypted video conferencing software on a bedside smart tablet, the Tele nurse connects with the patient to virtually complete the admission or discharge process, providing in-depth teaching, anticipatory guidance, or care coordination, all while documenting the encounter in the electronic health record. This gives clinical nurses more time to focus on hands-on skills like physical assessment, all while patients receive dedicated, uninterrupted contact with an experienced virtual nurse who can answer questions and address any concerns.”[xii]

The team model looks to individual members for their chief discipline and skillset in types of care to come together to offer each patient the most specialized treatment possible. Virtual Observation lends itself to a true team-based model by optimizing current staff to collaborate on patient care. The model allows fewer RNs and increased support staff when caring for more high-acuity patients.