Using Implementation Science to Evaluate a Virtual Nursing Care Model in a Medical and Surgical Acute Care Setting

Virtual nurses, experienced nurses who use technology to remotely direct patient care, are rapidly being introduced into acute care settings as part of the strategy to mitigate nursing shortages and burnout. We used an implementation science approach to evaluate the implementation outcomes of a pilot virtual nursing model in a 40-bed medical/surgical unit. Using Proctor's implementation outcomes of acceptability, adoption, appropriateness, fidelity, and feasibility, this mixed-methods study included observations, focus groups with virtual nurses, surveys on direct care staff, and additional quantitative analysis. Virtual nurses, who became integral members of the care team, engaged in admissions, discharges, patient education, remote monitoring, and staff mentoring. Virtual nurses reported high satisfaction due to greater patient interaction and supporting colleagues. Bedside care staff reported that the virtual nurse support not only was useful, but also increased time to provide direct patient care. The study highlights the learnings related to implementation outcomes of integrating a team-based virtual care model. The model, which introduced teamwork between bedside and virtual nurses, improved workflow, created a meaningful role for experienced nurses, and supported nursing practice for bedside nurses. Implications for standardizing training and the challenge in creating meaningful teamwork and efficient workflows are discussed.