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The rollout of so-called virtual nurses in hospitals remains a mixed bag, University of Pennsylvania researchers have found in the largest survey to date on nursing care delivered remotely through a screen.

One hospital staffer said virtual nurses are a huge help getting patients checked in.

Another said they worry hospitals are trying to cut corners by keeping floors fully staffed by using virtual nurses.

And sometimes, patients think the virtual nurse is a television advertisement and try to press fast forward, researchers were told.

A new study out of University of Pennsylvania School of Nursing surveyed 880 registered nurses in 10 states, including Pennsylvania, about the virtual nursing programs that have sprung up at health systems across the country.

About half — 57% — of the nurses surveyed said virtual nurse programs did not reduce their workload, with some saying they felt virtual nurses created more work.

But similar numbers also said they thought virtual nurse programs improved the quality of care patients received.

Others said they didn’t think the technology had any impact — positive or negative — on quality of care, according to a study of results published online in December in JAMA Open Network.

“It can be beneficial or a headache,” one nurse interviewed by Penn researchers summed up.

Virtual nursing programs became more widespread during the COVID-19 pandemic, when health systems needed to limit physical interaction to protect patients and medical staff, and have continued to expand in Philadelphia and across the country. Administrators embracing technology and artificial intelligence say they can help streamline administrative responsibilities that can burden staff, provide extra patient oversight, and improve how quickly clinicians can respond to emergencies.

Local examples include Penn Medicine’s use of virtual nurses to monitor patients at risk of falling or pulling out tubes and wires. Jefferson Health assigns a virtual nurse to patients who doctors have decided need to be monitored around the clock.

And virtual nurses handle administrative work, like reviewing medications and giving discharge instructions at Virtua Health hospitals in New Jersey.

The new study from Penn is among the largest to date to evaluate how well the programs are meeting goals, and the mixed results should be a warning to hospital administrators to proceed cautiously, researchers say.

“Virtual nursing programs have been heralded as an innovative silver bullet to hospitals’ nurse staffing challenges, but our findings show that most bedside nurses are not experiencing major benefits,” said lead author K. Jane Muir, an assistant professor of nursing in the university’s Department of Family and Community Health.

Virtual nursing on the rise

Virtual nursing refers to patient-care responsibilities managed by a team of nurses stationed at a remote hub, where they monitor screens and electronic information feeds.

They are not intended to replace bedside care, but rather to serve as an extra set of eyes to monitor patients.

If a patient who is known to be unsteady on their feet moves as if to get up from bed, a virtual nurse could speak through a screen or sound system asking if they need something and call a nurse on the floor to help them. If the patient falls, a virtual nurse can quickly alert medical staff.

Virtua Health officially launched its program last year.

Virtual nurses make sure patients have the appropriate medications before going home, know their discharge instructions, and have a follow-up appointment scheduled. They work in partnership with the bedside nurse, who focuses on the physical tasks in caring for a patient, while the virtual nurse handles the majority of the discussion.

“It’s something that our patients are requesting and they’ve come to expect,” said Kristin Bloom, a nurse by training who serves as assistant vice president of clinical operations for Virtua’s Hospital at Home program.

Virtua also uses virtual nurses in its intensive care units to help monitor and identify early signs of deterioration. These nurses have access to bedside cameras and can view the patient’s heart rhythms, lab results, and vital signs.

Participants in the Penn survey, conducted in late 2023 and early 2024, did not include nurses working in New Jersey, where Virtua’s hospitals are based.

Virtual nursing challenges

Nurses surveyed by Penn’s researchers said they appreciated the extra set of eyes on patients, but not all were convinced that the virtual monitor was any more effective than bed alerts that can sound when they sense a patient leaving, according to the study.

Karen Lasater, an associate professor of nursing and co-author of the study, urged health systems to include in-hospital nurses when shaping their virtual care programs.

She said including bedside nurses in the conversation about what’s working and not working is “imperative.”

“It’s important that nurses have a seat at the table,” Lasater said.

Nurses surveyed also expressed concern that health systems were using virtual workers to avoid hiring more on-site staff.

Bedside nurses questioned why they were being asked to take on more responsibility because administrators said they couldn’t afford to hire more staff, yet still found funding to build virtual programs.

“They felt like investments in virtual nursing was a workaround,” Lasater said. “Why did they have money to invest in virtual nurses who couldn’t do all the work of the bedside nurses, but couldn’t invest in more bedside nurses?”

At Virtua, administrators have turned to veteran bedside nurses to staff their virtual nursing program.

“It’s an avenue to retain our experienced nursing staff,” Bloom said.

Philadelphia-area hospitals have seen some virtual nursing challenges. In 2024, for instance, Jefferson Abington Hospital was cited by the Pennsylvania Department of Health after inspectors said the power cords attached to the monitors for virtual nursing created a strangulation risk for behavioral health patients.

The hospital treated the incident as a learning experience, adjusting how the mobile monitors are used.

The technology can also be confusing for some patients, who may not grasp the concept of a virtual nurse or may get conflicting instructions from their virtual and bedside nurses, Lasater said.

Penn initially planned to use virtual nurses to help monitor behavioral health patients, who often require one-on-one monitoring around the clock.

But staff found that patients who were experiencing behavioral or mental health challenges were too often confused or unsettled by virtual nurses, and unable to follow their instructions, Bill Hanson, Penn’s chief medical information officer, told The Inquirer in 2024.

“We’re all learning as we go,” he said at the time.