Virtual supervision ends, but virtual nurses remain at end of PHE

Brianna Zink, RN, MSN, is senior director of Healthcare Product Strategy for Infor. 

Photo: Courtesy Infor

At the end of the public health emergency on Thursday, virtual supervision by doctors and clinical staff is going away, to be replaced by a return to traditional care of having a physician in the room. 

Another type of virtual care that increased dramatically during the COVID-19 pandemic is expected to remain. This is the use of virtual nurses who work within a hospital like a dispatch service for patient needs.

Patients use a TV screen or computer provided by the hospital to communicate with a registered nurse who is located within the hospital, according to Brianna Zink, RN, MSN and senior director of healthcare product strategy for cloud computing company Infor. 

The TV screen or iPad is integrated with a call light system. When the call light goes on, it is answered immediately by the virtual nurse and the patient request is directed to the appropriate person, Zink said. In some cases, this could be to a certified nursing assistant, rather than the RN who is working in the inpatient unit. For instance, a CNA is able to help walk a patient to the bathroom.

Chief nursing officers are excited about virtual nursing, Zink said. The result has been an increase in patient satisfaction scores and also a huge increase in nurse satisfaction. 

Most of the estimated 60 chief nursing officers Zink spoke to at a recent Health Management Academy CNO forum said their hospitals and health systems were using virtual nurses and had come to depend on the program as a way to counteract workforce shortages and burnout.

"I didn't talk to a single one who wasn't already using it," Zink said. "Everyone was looking at standing up virtual nursing programs. [They're] looking at the huge nursing shortage – a lot of them have a virtual nurse ratio 1 to 15-18 patients – it was able to take work off of the bedside nurse. Nurses at the bedside are less bogged down with administrative work, there's less near misses on medication reconciliation. The next step is looking at furthering the technology."

Hospitals spend a lot of money to get the program rolling, she said. Some did pilots and then rolled out the program.

"It's a huge investment, money-wise to buy equipment," Zink said. "It was a big lift for hospitals to set up technology-wise." 

Virtual nursing began before the start of the pandemic, but it was COVID-19 that drove the innovation. 

The CNOs she spoke to weren't fearful about losing the virtual service at the end of the PHE, because it all takes place within the walls of a hospital, Zink said.

"The resounding response," Zink said, "is they're excited to see how innovations that happened during the pandemic will continue on."

During the pandemic, the Centers for Medicare and Medicaid Services enabled a number of ways virtual supervision could suffice, according to Brian Scarpelli, executive director of Connected Health Initiative. Virtual supervision by doctors and clinical staff is going away at the end of the PHE on May 11, Scarpelli has said.

CMS, responding to a request for comment said, "As described, the practice does not appear to be reliant on any waiver or flexibility implemented by CMS during the COVID-19 public health emergency (PHE)."

Lisbeth Votruba, MSN, RN, chief clinical officer of AvaSure, which implements virtual care inside of hospitals for acute patients said, "Virtual nursing in the acute care setting will not end when the public health emergency (PHE) ends. The major changes that affect telehealth are unrelated to virtual nursing, largely because registered nursing care in the hospital setting is not a directly billable service. However, OCR's (Office of Civil Rights) announcement that they will resume enforcing compliance with HIPAA rules for telehealth after a 90-day grace period is an important change to protect the privacy and dignity of patients who are hospitalized and at their most vulnerable."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org