CommonSpirit Health: Integrating virtual and bedside nurses

Nurses can use more support on the floor, and patients in the hospital want to have more time with their nurses.

CommonSpirit Health is aiming to improve nurse and patient satisfaction with its virtually integrated care model. Like other health systems, CommonSpirit is utilizing nurses in virtual roles to help guide patients in the hospital and take some of the load off of nurses at the bedside.

Julie Tuel, vice president of nursing care transformation and clinical digital care at CommonSpirit, says the integrated model is seeing good results. CommonSpirit has the model in place across more than 1,000 beds, and the plan is to roll out the model gradually across the system.

Tuel tells Chief Healthcare Executive® that the integration of the virtual nurses with the bedside nurses is “what’s really made us successful.”

“We are intertwined within that care team,” Tuel says. “So we're introduced upon admission, we are there for daily rounds, education to the patient on many fronts. We also help with admissions and discharges and transfers, help with care coordination, making sure the plan of care stays on task as well with that perspective, and then really help with the discharge piece as well. So really we're there for the whole continuum and supporting that patient along the way.”

The virtually integrated care model began in acute care, but has also expanded into critical care and the emergency department. Tuel says the system is looking at ways to provide better care across the care continuum.

How is the model helping nurses?

One of the main goals of the virtually integrated model is to improve the retention of newer nurses, which is a thorny problem for many health systems.

The virtual nurses can answer questions from less experienced nurses at the bedside and help guide them.

“The largest focus we really want to focus on with our care team is around how do we support and mentor the bedside care team, so we can make sure that we stabilize the workforce,” Tuel says. “We all know in healthcare that is the most challenging piece for healthcare organizations, so being able to stabilize that, provide support, so that we keep the nurses at the bedside, make sure they're highly skilled, they feel supported, so they'll stay.”

CommonSpirit has seen a reduction in turnover of first-year nurses by more than 40%, and Tuel says the virtually integrated model is contributing to that success.

“We do know statistically the first-year nurses are the ones that usually turn over the fastest,” Tuel says. “So if we can stabilize that and really provide that mentorship and support, not only do they stay in the organization, which is our main desire, they will end up providing higher quality care as well throughout the organization.”

What’s the impact on patients?

CommonSpirit’s virtually integrated care model is also contributing to reduced infections, Tuel says. The health system is seeing fewer central line-associated bloodstream infections and catheter-associated urinary tract infections.

“We've been able to see some great improvement,” Tuel says.

The virtually integrated care model also emphasizes strong guidance to help prepare patients for when they leave the hospital, and Tuel says that education doesn’t come just at the end of the hospital stay.

“Discharge starts at admission, so we've really seen that if we provide discharge teaching, education, support all the way through their stay, instead of providing it at the end, we're having better outcomes for our patients,” she says. “And we're able to spend more time with the patient doing that as we free up that nurse from doing that task, so they can do more hands-on tasks at the bedside.”

CommonSpirit has also seen a 25% increase in nurse communication with the virtual nurses supporting the bedside nurses.

“Our virtual nurses have time to spend with them, answer their questions, be readily available,” Tuel says. “It's not that the bedside nurses aren't, they definitely are, but being able to be at the touch of a button and being able to answer their questions and spend that quality time with them has been what's been able to drive those results in collaboration with the bedside.”

What are keys to success?

Health systems looking to integrate virtual nurses and nurses on the floor should engage their nurses at the outset.

“Bring in the staff members that are going to be part of this care team, make sure their voice is heard,” Tuel says. “Shared governance is so important, I can't stress that enough.”

Health systems also need to continue to support nurses throughout the process of bringing virtual nurses and bedside nurses together.

Tuel stresses the importance of helping nurses adjust to change.

“What has been really successful for us is making sure that the people who are going to be involved in the process, and what I mean by that is the bedside care team, that they're engaged every step of the way of the project, and we still continue to do that every site we go to,” she says.

The nurses in those teams develop the workflows, and Tuel says that nurses are able to ask questions and bring up concerns.

“It's so important that they're engaged in that throughout the process, and their voice is heard through the process,” Tuel says.