Virtual nursing implementation and workflow integration: A qualitative study of challenges and effective strategies

Nursing shortages in the United States have worsened in recent years, with a decline of more than 100,000 registered nurses between 2020 and 2021. These shortages strain health systems, increasing nurse workloads and negatively impacting patient care. The rise of telehealth solutions, accelerated by the COVID-19 pandemic, has increased the use of virtual nursing (VN) as a potential solution to support bedside nurses and reduce burnout. However, there is limited research on VN's implementation and integration into existing nursing workflows. This study examined the challenges and effective strategies perceived by stakeholders for the implementation and integration of VN, providing insights for health systems planning to adopt or scale VN services.

This qualitative study was conducted with 18 stakeholders of a VN program at a large urban hospital in the southeastern United States: six virtual nurses, nine bedside nurses who utilized VN in their patient care workflow, and three members of the program's VN leadership. Participants completed a 30-min semi-structured interview about their experience with implementation of the VN program.

Four themes emerged related to VN implementation and integration. (1) Training: Bedside and virtual nurses described the need for formal and hands-on training. Virtual nurses cited ongoing group sharing as beneficial. (2) Technology challenges and benefits: Bedside nurses experienced some challenges related to functioning of the tablets and the need for live technical support. Confidentiality was maintained through virtual nurses' use of private space and headphones. (3) Communication and collaboration: The secure chat system was seen as integral to bedside and virtual nurses' ability to collaborate and coordinate patient care. (4) Leveraging experienced nurses: VN leadership and bedside nurses perceived the hiring of experienced bedside nurses for the role of virtual nurses as beneficial for mentoring and supporting bedside nurses.

The perceptions of VN program implementation from nurse and leadership perspectives as identified in this qualitative study informed recommendations for effective strategies for addressing challenges and facilitating VN implementation. The findings and recommendations can be used by health systems as they plan to integrate or scale VN.