Staffing, workflow, and operational models in virtual nursing and remote safety observation: A scoping review

Virtual nursing and remote safety observation have emerged as critical nurse-led workforce innovations, yet standardized evidence on staffing and operational models remains limited and inconsistently reported.

To identify the primary sources and types of evidence on staffing ratios for virtual nursing and remote safety observation, and to map evidence to inform implementation and future research.

A scoping review was conducted following PRISMA-ScR guidelines. Four databases from January 2020 to September 2025 were searched, identifying 6,356 records. After removing duplicates, two reviewers independently screened 3,436 records. Gray literature including vendor white papers and industry reports was supplemented to capture real-world implementation practices.

Twenty-one records met inclusion criteria (19 peer-reviewed, two gray literature implementation reports). Virtual nurse-to-patient ratios varied substantially by model type, operational scope, and coverage hours. Task-focused and team-integrated models demonstrated distinct staffing strategies aligned with different clinical roles and workflow demands. Remote safety observation staffing ratios were more consistent, ranging from 1:8 to 1:12 patients per observer, with artificial intelligence-augmented models supporting up to 1:16 patients with fewer inpatient falls. There is no single optimal staffing ratio for virtual nursing; effectiveness depends on strategic alignment with operational context rather than uniform application. Despite promising outcomes in workload relief and patient satisfaction, evidence remained predominantly descriptive with substantial heterogeneity.

Successful nurse-led virtual care requires deliberate redesigning of care processes and effective change management, supported by standardized metrics that integrate virtual and bedside nursing into evidence-based workforce practice.