*NOT FOR EXTERNAL DISTRIBUTION*
Source: Tennessean
Author: Hadley Hitson
Date: August 8, 2024
A patient sits in her hospital bed, nervously waiting to talk with medical professionals about what led her to HCA Healthcare's TriStar Skyline Medical Center on a recent afternoon.
After a few minutes, the voice of nurse Brittany Piro comes from a speaker on the wall.
“Knock, knock. This is Brittany," Piro said. "May I turn on the TV and the camera so I’m able to see you?”
When the patient agrees, a camera that had been pointed at the ceiling swivels down to focus on her. A smiling face pops onto the black screen, ready to ask all the necessary admission questions and take down her list of medications.
She’s not artificial intelligence or a virtual assistant. This is Brittany Piro, one of TriStar’s skilled nurses with nearly two decades of experience caring for patients.
TriStar Skyline was the first HCA hospital in the country to implement a full-scale virtual nursing program with over 100 cameras across the med-surge and progressive care units, plus a few portable screens for use in the emergency room.
Like telehealth doctor visits, virtual nursing programs are rising in popularity nationwide. Certain jobs previously completed by a bedside nurse taking over an hour per patient can now be done via nurses working from home.
At TriStar, a network of contracted virtual nurses call in from their homes to do all admission and discharge paperwork for each patient, from 6 a.m. to 2 a.m. seven days a week.
Beyond easing the nationwide nursing staffing shortage, it allows nurses to work remotely from home.
“I made the change for work-life balance,” Piro said. “I think this is the way of the future.”
While TriStar Skyline remains the only HCA hospital in Tennessee with the virtual nursing program in place, Skyline Director of Advanced Clinicals Rhonda Blackwell said she hears from plenty of other hospitals in the area who want to implement similar programs.
Vanderbilt University Medical Center piloted a “teleconference nursing” program in its 36-bed Ventricular Assist Device and Transplant Unit last year, and Ascension Saint Thomas has been exploring telemedicine in its own way with virtual urgent-care visits.
Combatting the nursing shortage: 'It helped me stay'
HCA Chief Nursing Informatics Officer Sherri Hess said the idea was a response to pressures in the medical world, from the rising impacts of the national nurse shortage to an increased competition across hospital systems when it comes to nurse recruitment and retention.
Since the COVID-19 pandemic, hospitals have struggled to combat burnout and stress among nurses. A 2023 study from the National Council of State Boards of Nursing found that approximately 100,000 registered nurses left the workforce between the start of the pandemic and 2023, and another 610,000 planned to leave by 2027.
“We're looking at opportunities of how our technology can help,” Hess said. “How we can utilize very experienced nurses as they are aging. It gets tougher to work 12-hour shifts, weekends and have that patient load.”
Since TriStar Skyline launched its virtual nursing program in October 2023 as a partial solution to those issues, Skyline Chief Nursing Officer Amy Higgins said she’s seen a noticeable difference in recruitment and retention, especially for young nurses just graduating from nursing school.
“This makes us different,” Higgins said. “You can never replace the caring touch of a nurse, but this is absolutely imperative to improving our care.”
Registered Nurse Rachel Taylor, who started working at Skyline a year before the hospital implemented virtual nursing, said it immediately improved her daily schedule. She remembers regularly staying at work up to two hours late after already long shifts to finish admissions and discharge paperwork.
Since the virtual nurses arrived, the extended shifts have become far more rare.
“I will be the biggest advocate for it,” Taylor said. “It helped me stay here.”
She estimated that each discharge would take her around 15 to 30 minutes, and her floor sends anywhere from 10 to 20 patients home each day. Now, in-person discharge nurses simply arrive when needed to physically escort the patient out of the hospital.
Meanwhile, the 45-minute-long admissions process is completed entirely by the virtual nurse by the time the bedside nurse arrives.
Making new connections
Virtual nursing isn't for everyone.
If someone has hearing loss, is confused or blatantly doesn’t want to deal with a virtual nurse, the hospital will make accommodations.
Taylor said she occasionally meets older patients who are bothered by the idea of talking to a medical professional through the TV, but most of the time, they come around.
Piro has been part of TriStar Skyline’s virtual nursing program from the start.
“She’s one of my favorites,” Taylor said, looking up at Piro on the TV.
Piro spent 17 years working the typical 12-hour shifts of an emergency room nurse before moving into the virtual sphere, and she said it’s been a great transition for her and her family.
She said she’s thankful to still make a difference in the lives of patients and other nurses alike — even if she isn’t able to handle the hands-on patient care like she used to.
Piro’s favorite story is the time she added a patient’s daughter to their video-call, and his grandchildren rushed over to say goodnight to him. She remembers the man’s spirits immediately lifting.
In the last year, she’s been able to identify uncharted changes in patient medications and even quickly diagnose a patient with a life-threatening bacterial infection based on his medical history and symptoms. She can also patch in other medical professionals and translators when necessary.
“Not that I catch a lot of things, but we do catch things because we are able to take more time in the chart,” Piro said. “We're able to get a more thorough history with the patient. I can even call in family on the screen.”