Best Practices for Implementing Hospital-Based Virtual Nursing: An Integrative Review

There are currently unprecedented threats to the nursing workforce, including burnout and stress, which contribute to low job satisfaction, inadequate staffing, and decreasing retention rates. Virtual nursing is a possible solution to address many of these issues. Although this is a well-established staffing model in the ICU, it is newer to other hospital-based settings, and there are no current best practices for implementing virtual nursing in the non-ICU setting.

The purpose of this integrative review was to address the following question: What are best practices for implementing virtual nursing in the inpatient, non-ICU setting?

An evidence-based practice team at The Johns Hopkins Health System in Baltimore, Maryland, performed a systematic review of the available research and nonresearch literature, guided by the Johns Hopkins Evidence-Based Practice model. Reviewers searched PubMed, CINAHL, Embase, and Cochrane using search terms related to "virtual nursing" and "inpatient." All evidence underwent an independent screening and appraisal process to generate a synthesis of existing information and create best-evidence recommendations.

The initial search yielded 327 unique records, six of which were included in the final review (one quasi-experimental study and five quality improvement projects). The evidence was limited but provided some guidance on the scope and skills of the virtual nurse, such as concrete clinical skills and soft skills (such as communication and interpersonal skills); the needs of the bedside nurse and patients, such as education and communication norms; and operational concerns for leadership and other health care providers, such as creating standardized workflows and establishing metrics for success.

Despite the growing prevalence of virtual nursing, there is limited information on its use in the non-ICU hospital setting. Although there is some evidence to inform the skills and scope of the virtual nurse, the impact of virtual nursing on the bedside nurse, patient priorities, leadership implications, and considerations for all staff, more information is needed. Rigorous implementation science research should be conducted in parallel with the development of virtual nursing programs to contribute to the state of the evidence and provide much-needed guidance on this quickly developing technology.