The future of health care is virtual: a nurse’s perspective


This time, it’s my family.

My work takes me all over the U.S., consulting on the implementation of virtual care to get the most appropriate level of care to the patients who need it. I work with teams to develop better workflows and to get more experienced eyes on patients. It’s the kind of care anyone would want for their own family.

I was flying to Utah to assist a hospital system when I got the call: My brother had an intense asthma attack and was intubated in a critical care unit in California. I immediately rerouted, hoping to get there as quickly as I could. When I arrived at the ICU, I asked what the last 12 hours of data from his cardiac monitor showed. No one knew. The staff had to print them out for me. With all the tools of today, we live in a state of printed paper?! The data had not been stored, either, until I asked them to print it out.

The next day I came back to the hospital and noticed his cardiac rhythm changed. He was having PVCs and PACs. I asked the nurse if she noticed it. She stated, “no.” She did not get a report from the night shift of the change in rhythms. I explained it’s the little changes that occur that lead to bigger problems later. I requested lab work to check electrolytes and those were pending. I also noticed from the printouts that they had extubated him too soon.

The staff heeded my warnings and took labs, where they found out he was dangerously low on potassium. They gave him the medication and the rhythm returned to normal. Had these rhythm changes not been noticed – had the potassium levels not been checked – had I not been there as an experienced nurse – there is a good chance that my brother would have gone into cardiac arrest and might not have made it. I can’t even wrap my head around that possibility, but it’s unfortunately real – for my brother and for the many patient families whose loved one suffers a traumatic event that might have been prevented.

My 32 years of nursing experience in critical care, ED, trauma, organ procurement, and executive roles have taught me that seconds count and information is everything. As one of the first virtual ICU nurses in the country over ten years ago, I also know that virtual coverage isn’t about big brother; it’s about getting another set of eyes on patients to help get ahead of patient deterioration, especially when there is a code. It’s about helping out with documentation or consulting with providers. It’s about providing another lifeline to the patients or families, and being able to answer their questions. It’s about empowering bedside teams to get back to what they went into health care to do – deliver 1:1 bedside care.

However, there is still resistance to the implementation of virtual care models because of these misconceptions, the traditionally high costs to implement, and questions around reimbursement. I believe one of the silver linings of COVID is that it is helping to change that perception because there is no other way. The pandemic spotlighted virtual care’s benefits because of the risk of infection and the bed and staff capacity shortage. We had the largest number of ICU patients with no available beds. We had the largest number of patients on ventilators than ever before but had to put cameras on nurses’ heads to get the data out of the room. And now, after two years of the pandemic, we have an even greater fallout related to staff shortages.

At the beginning of 2022, it was estimated that 30 percent of nurses were looking to retire. Those numbers have turned out to be much larger. We have burnout as we have never seen before. Last month, many facilities were seeing 60 percent turnover. We have had the largest number of travelers and new grads than ever before, with up to 80 percent of staff having less than two years of experience at the bedside. And let’s not even go to financial solvency. The challenges couldn’t be more real – from staff illnesses to furloughs to living the challenges of providing bedside care when you don’t have the tools you really need to do your job the way you know it can be done!

Do I blame nurses and other care team members for wanting to quit? No! It’s time to arm these healers with the tools they need to get back to 1:1 patient care. It’s time to deliver care differently, and I believe that we have reached that tipping point where health care knows we have to change.

Virtual nursing and virtual care could be the answer. Back in my day as a virtual RN, the program showed amazing benefits and a direct impact on care and outcomes. Still, it was pretty rigid in design, and we only had access to cardiac monitoring data and video. Now, we have so much more data at our fingertips that could make that virtual care even more impactful. We have analytics and AI to help us stratify patient risk and get ahead of deterioration. We have access to the EMR that virtual staff can use to help populate, reduce the manual load on bedside teams, or do dual sign-off to expedite intervention.

Because no two hospitals are the same, for hospitals to realize the benefits of virtual care and accelerate adoption, flexibility in the design of the virtual care workflows is key. That’s what excites me most about my new role and the future of health care. I think if hospital leaders, unit managers, frontline workers, and vendors all work together to break down the silos and build solutions together we will be able to solve the challenges facing us today. Suppose we can find new and novel ways to leverage technology and virtual care to support bedside staff. In that case, we can reduce burnout, support staff on the floor, expedite intervention, improve efficiencies, stratify patient risk and ultimately get more eyes on patients.

I’ve been in nursing and nurse leadership for decades, and this is the most exciting time in our profession: We have more data, we have AI, and we can provide even better informed secondary support to bedside teams to get more eyes on the patient and reinvent the way we deliver patient care. In a time where we have been living in fear and chaos, I believe there is hope. Hope for a new era in clinical care. For a new way to deliver superior patient care to all patients. For patients like my brother.

Pamela Miles is a nurse and health care consultant.


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