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Valley Health finds early success with virtual nursing


The Virginia health system began its program in 2023. Theresa Trivette of Valley Health talks about the program and keys to success.

A little more than a year ago, Valley Health launched its virtual nursing program.

Image: Valley Health

Theresa Trivette, chief nursing executive at Valley Health, says the system's virtual nursing program has had encouraging success.

Valley Health, a system operating six hospitals and serving patients in Virginia, West Virginia and Maryland, deployed the program at Warren Memorial Hospital, based in Front Royal, Va.

With virtual nursing programs, nurses communicate with patients through their television and help them with issues such as documentation, answering questions on medication, and preparing for discharge. Some hospitals have turned to virtual nursing programs due to staffing shortages and a desire to reduce the load on nurses caring for patients at the bedside.

Theresa Trivette, chief nursing executive at Valley Health, says the virtual nursing program has delivered encouraging results since launching in May 2023. Patients and staff have given the virtual nursing program high marks, and bedside nurses are getting more time with patients, she tells Chief Healthcare Executive®.

Trivette says Valley Health wanted to “take some of the administrative burden off of our frontline team, so that they can be better focused on the care delivery at the bedside.”

Valley Health tapped Teladoc Health, the virtual care company, for the technology in the system’s virtual nursing program. So far, Trivette says each bedside nursing unit at Warren Memorial is saving about three hours per day, and that’s translating to giving each bedside nurse an hour back each day.

“In nursing time, that’s a lot,” Trivette says.

“It may give them more time to be able to walk a patient around the unit where before, sometimes, that was something that they didn't have a lot of time for,” she says. “And having them more available to get into the bathroom quicker when they want to … all of the reasons why we would want them more available to our patients.”

Aiding with discharge

Valley Health’s virtual nurses initially focused on helping patients with the admission process and getting oriented to the hospital, Trivette says.

Soon after, virtual nurses began preparing patients to be discharged.

“From a nursing workload perspective, the process of discharging a patient is a very time-consuming activity,” she says. “There's lots of education … that takes a lot of time from the bedside team that we felt could be done by somebody from behind the screen. That would enable more time given back to the bedside, again to do those things that require a nurse to physically do at the bedside.”

The virtual nurses can spend more time preparing patients for discharge and making sure they understand about their medications when they leave the hospital.

Plus, the virtual nurses can have other family members dial in for patients who are older or may need more assistance.

“We don't always get the benefit of doing that when we're just physically at the bedside and the family's not there,” Trivette says. “And so that's been very beneficial.”

Virtual nurses also participate in “multidisciplinary rounds,” Trivette says. When bedside nurses check in on a patient and go over a plan for the day, the virtual nurse also joins the visit.

Patient and employee satisfaction

So far, patients say they welcome working with virtual nurses. Valley Health has done some public education, including working with local media to report stories on the new virtual nursing program, so patients won’t be surprised that they will see some nurses on screen, and some at the bedside.

Patients are giving good reviews in their comments after their stay at Warren Memorial. “They value having that extra time and attention from a virtual nurse,” Trivette says.

Plus, Trivette says the virtual nursing program appears to be contributing to a drop in the length of time patients are spending in the hospital. She says that may be linked to more meaningful conversations to prepare patients for discharge.

Employees, including nurses and doctors, also say they are welcoming the addition of the virtual nursing program, she says.

“They are verbally recognizing that this is giving them back time in their day and it's supporting them well,” Trivette says.

Palliative care doctors and team members have embraced the virtual nursing program, which enables families to participate in discussions if they can’t be there in person.

“Having the family and the patient together to have those really difficult conversations has been a big win,” Trivette says.

Trivette says the virtual nursing program appears to be having an impact in recruiting and retention.

“We definitely attribute a lot of that to not only the virtual nursing program, but just the investment in listening to what gets in their way every day … and the virtual platform has solved a lot of those issues that they've identified by giving them time back in their day.”

Keys to success

Nurses played a key role in the design of Valley Health’s virtual nursing program, and she says that’s been a key part of the program’s success.

Nurses offered their thoughts on the placement of televisions for virtual visits, and when virtual nurses should - and should not - check in with patients. Bedside nurses also offered suggestions on where virtual nurses could offer assistance and lighten their load.

“The health profession in general, particularly nursing, they don't like anything being done to them,” Trivette says. “They want to be an active voice. They're highly educated folks who want to know that they're making a difference.”

Once the program was up and running, nurses offered suggestions for modifications, and some of those were adopted.

But Trivette also stresses the importance of sticking with the virtual nursing program and not making too many changes right away. Trivette says she and other leaders talked with nurses about pain points, but also studied how other hospitals with virtual nursing programs dealt with some of the same issues.

“I think the biggest lesson is give it time, and don't try and change or add or modify too quickly,” Trivette says.

If hospitals don’t allow time for the virtual nursing program to succeed, Trivette says, “You can't get the return on the investment. You can't get stabilization for your team, which will actually make them angrier than happier.”

Trivette recalls talking with nurses early in the program, and some had some concerns. But as the conversations progressed, much of the discomfort stemmed from the fact that it was new and different, she says. Valley Health stuck with the program, but also gave time for nurses to share their feelings.

“They want to know that they were heard at the end of the day, and they were part of the design,” Trivette says.

“A year later, they're thrilled that we're telling our story everywhere, that it's making a difference for others, because now they get it,” she adds. “But change is hard … And recognizing that and leaning into it is important.”

In the future, Valley Health expects to expand the virtual nursing program to other facilities, including its critical access hospitals. Hopefully, that will lead to fewer transfers of patients.

“We'll see fewer patients having to be placed in ambulances to go up the road and away from their communities,” Trivette says.

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