Nursing

January 31, 2025

Vanderbilt Health innovates with virtual nursing to enhance patient care

The primary responsibilities of a virtual nurse are admitting, discharging, conducting safety rounds, coaching on policy or procedure, and facilitating medication dual sign-off.

Monitor technician Dee Sawyers is part of Vanderbilt’s growing virtual nursing program. (photo by Susan Urmy) Monitor technician Dee Sawyers is part of Vanderbilt Health’s growing virtual nursing program. (photo by Susan Urmy)

In 2023, amid a national nursing shortage, nursing leadership at Vanderbilt Health knew they needed an innovative approach to properly support their current workforce and continue delivering quality care.

Virtual nursing, first conceptualized in early 2023 as part of a strategic plan to combat the shortage, was an essential part of the solution.

“Nursing leadership was brainstorming ideas, and we knew we needed to implement something different,” said Sandy Alexander, DNP, MSN, MBA, RN, associate nursing officer. “We brought leadership together with about 100 different front-line workers — nurses, care partners and medical receptionists — and collaborated. We knew our nursing shortage would continue, and we had to change the way we operated on our floors.”

In July 2023, after months of planning and coordination, the first virtual nurses went live on the VAD (Ventricular Assist Device) and Heart Transplant Stepdown Unit.

“We were very strategic about which units would go live first, and that sometimes meant tackling the tallest hurdles early. We made beneficial adjustments in the second phase based on our learning from the first rollout,” said Alexander.

Throughout 2023 and 2024, virtual nursing grew to a program currently active in 10 inpatient units throughout Vanderbilt University Hospital.

As innovators in the field of virtual nursing, Vanderbilt Health Nursing presented its model at the 2024 Magnet Pathway Conference. The Vanderbilt model uniquely developed workflow processes that tackled the largest implementation challenges first, enabling virtual nursing to continue expanding into clinical care and providing a crucial component that positively impacts regulatory reporting, unit discharge outputs and patient satisfaction.

Virtual nursing is now part of the virtual care department that formally opened in October 2024, led by Rhonda Day, MSN, RN, manager of Inpatient Patient Care Services. This new delineation will enable virtual nursing to develop as a unit and work to meet the growing needs of the patients it cares for. The virtual care department also encompasses virtual sitters and monitor technicians.

The primary responsibilities of a virtual nurse are admitting, discharging, conducting safety rounds, coaching on policy or procedure, facilitating medication dual sign-off, and managing other responsibilities as necessary.

Rooms equipped for virtual nursing have a camera and TV mounted across from the bed with the camera off and angled toward the ceiling. When a nurse requests entrance to the room, a chime rings, and they introduce themselves asking for permission to enter, as if a nurse were knocking on the patient’s door. Anyone in the room may grant permission. After the nurse has been allowed access, the camera rotates toward the patient, the nurse’s face appears on the screen, and patient care begins.

“There is no set guide for virtual nursing, so the Vanderbilt Health Nursing enterprise is pioneering it in our own way. That comes with its own unique challenges and opportunities. How do we take nurses who were working individually in separate units with different managers and now change their workflows to function as one cohesive department while best supporting the units we’re working in,” said Day.

Day’s current goals for the department include focusing on quality discharges to reduce readmission rates, aiming for 100% patient participation in all available virtual nursing rooms, and growing the virtual nursing workforce.

The program is expected to continue expanding, going live in approximately one new unit at the Main Campus every month throughout 2025 and 2026.

“It’s exciting to think about everything we’ve accomplished so far with this talented group of individuals and the synergy we’re developing. The work and dedication put into it has been immense, but I’m looking forward to the innovations of our team and the ways it’s going to set us apart as a virtual nursing program,” said Day.