Virtual care team credited for nurse retention

Gina Ellerbee: Virtual care can provide another option for staff with physical limitations.

More than a year after the rollout of its virtual care team, CoxHealth reports progress with worker satisfaction and retention as a result.

In June 2023, CoxHealth announced a $10 million investment in technology that would allow patients in the hospital to be monitored remotely by a virtual care team comprising nurses, hospitalists, pharmacists and respiratory therapists. At the time, equipment, including high-definition cameras, were connected to 157 patient beds, and the hospital system has since exceeded its goal to provide virtual care to 700 patient beds, with 704 cameras functioning on all six of its campuses.

In the first year, CoxHealth had over 95,000 video sessions with patients and assisted 120,000 with the technology, officials report. Among positive patient outcomes are reductions in central line infections, falls and catheter-associated urinary tract infections.

According to past Springfield Business Journal reporting, virtual care is available for intensive care and medical-surgical patient rooms across the system.

Cary Lynn Nabors, manager of public relations at CoxHealth, said improved patient outcomes have resulted from the investment, but some of the most pronounced gains have been in the area of employee satisfaction and retention.

Across the system, Nabors said, frontline retention of registered nurses has improved by just under 50% since the establishment of the virtual care team.

CoxHealth employed 3,460 nurses in 2023, according to the most recent list data published by SBJ in August. It recorded 44,996 inpatients in 2023. In 2022, CoxHealth employed 2,891 nurses and had 43,142 inpatients.

Additionally, an in-house survey found 73% of the virtual care team indicated that they either agree or strongly agree that they leave work feeling more satisfied and positive.

A national study by nursing analytics firm Professional Research Consultants reveals that this level of satisfaction is not the norm. The 2023 National Nursing Engagement Report found 41% of U.S. nurses report feeling unengaged by their work.

CoxHealth’s results are getting noticed, Nabors noted.

“Our leadership has spoken at nationally renowned conferences in the industry,” she said, citing the 2024 Healthcare Information and Management Systems Society conference, held in March, as one example.

In their presentation at that conference, Gina Ellerbee, administrative director of nursing practice and professional development, and Summer Blackerby, chief nursing information officer, described the virtual care team as a collaborative effort across disciplines to serve patients.

Nabors added that CoxHealth regularly fields requests from other health systems, including one from as far away as Japan, to visit and learn about the technology.

Extra sets of eyes
Hanna De La Cuesta is a hybrid nurse at Cox South Hospital, and in that role, she divides her time between a cardiovascular unit and the virtual care team, which occupies a large area that was formerly the COVID-19 care unit on the hospital’s fifth floor.

In a recent interview at the virtual care headquarters, she said she has seen the benefits of the technology, both for patient care and for the professional experience of nurses. Notably, the virtual care team can help the charge nurse with admissions and discharges – freeing them from some of the time-consuming processes so that they can focus on patient care.

Additionally, the virtual care team can remotely monitor telemetry and vital signs and alert floor staff to any change in a patient’s condition. They can also alert nursing staff quickly to updates to a physician’s orders.

When a concerning indicator pops up, members of the virtual care team can camera in to a patient’s bed for observation while keeping an eye on vital data.

Communication with the floor nurse happens via phone or a texting app, De La Cuesta said, and as that person moves from bed to bed providing patient care, attention can be drawn to particular areas of urgent need as they arise. De La Cuesta noted she is surrounded by medical-surgical and intensive-care professionals with the virtual care team.

“It’s a win-win,” she said. “When I have a patient there that doesn’t really look good, I always ask their opinion – ‘Hey, what do you think about this patient?’ That means there’s a third or fourth pair of eyes to look at the picture.”

Saving time
Like De La Cuesta, Ellerbee said the virtual care team saves time for the nursing staff on medical floors. When a virtual care team member wants to speak to a patient, a chime similar to a doorbell rings, and the virtual care team can communicate with the patient via cameras and microphones.

“Maybe the patient just has a question or they want to get an update or they need something,” she said. “Our virtual nurse can text the bedside nurse.”

Patient education can also be provided by the virtual team, thus allowing the bedside nurse to focus on tasks that require in-person care.

Virtual team members can provide a second set of eyes for medications that require a witness, Ellerbee said. That way, nursing staff do not have to be pulled away from patient care to watch an IV being administered, and patients do not have to wait for the availability of a second-floor nurse.

“Our cameras are so good that they can literally zoom in and look at the oxygen meter on the wall,” she said. “They can look at a patient’s pupils. The cameras are amazing, what they can see and what they can do.”

According to past SBJ reporting, the equipment is manufactured by Dutch electronics and medical equipment maker Philips, which partnered with CoxHealth to provide the technology.

Ellerbee noted the virtual care team can even communicate with a patient’s family members by text or email.

“Let’s say it’s a family member who lives out of town and they want to get an update,” she said. “They can send them a link that they can camera into the room to see their loved one and get an update from the virtual nurse to tell them the plan or what to expect.”

Staff retention
Ellerbee said nursing retention has improved by almost 50% across the CoxHealth system since the virtual care team was established.

“It’s hard to ever say that this one thing is making all the difference, but it is one piece of it for sure,” she said.

One advantage is the hybrid staffing model that allows nurses to divide their time between nursing floors and the virtual care desks, Ellerbee said, adding the variety has proved appealing to many of them.

Additionally, the difficult physical work of nursing sometimes calls for other options.

“Some of our nurses are virtual only,” Ellerbee said. “Many of them used to work the bedside and either can’t anymore or just needed something different.”

Ellerbee said that flexibility is important for workers.

“We have bedside staff that have worked here for years and years, and there comes a point in life where you can’t physically do that work anymore,” she said. “We don’t want that knowledge walking out the door.”

Ellerbee said for some, virtual care is a pre-retirement position.

“So, then the next generation of nurses, with the push of a button in the room, they can get the expert nurse who’s been there, done that, to help them and to answer questions and to guide them through,” she said.

Ellerbee said nursing is very physical work.

“To be on your feet 12 hours a day, running, it’s not an overestimation that it’s more than 20,000 steps a shift,” she said. “And the lifting that you have to do, the mobilizing patients – it’s hard on your body, and there comes a point where pounding that pavement for 12 hours gets to be too much for some.”