Welcome to ACNL in Action, brought to you by the Association of California Nurse Leaders. I'm your host, Charlene Platon. Our guest today is Dr. Bonnie Clipper, founder of the Virtual Nursing Academy, a self-directed online program designed to help organizations build, launch, and optimize their virtual care delivery models. Dr. Clipper is a nurse futurist and was among the first to recognize the usefulness and importance of virtual nursing as a care model. And before we get started, just a reminder that if you like today's episode, please remember to share it with a colleague or drop a review on Apple Podcasts. It really helps us out and it helps other nurses find our show. And back to our guest. Thank you so much, Bonnie, for being here. We are so excited to have you here today.

I'm really looking forward to this, Shirlene.

Yes, and we have such an interesting topic to discuss today, and that is the topic of virtual nursing. And I want to get started there because a lot of people might not know what that is. And so first things first, what is virtual nursing and how does it differ from traditional nursing practice?

Yeah, that's a great question. So virtual nursing, if you can imagine it, we operationalize this through a dual-sided care model or a hybrid care model. So there are direct care nurses that are at the bedside, providing care to the patient, giving patients medications, hands-on assessments, touching the patients, interacting and engaging the patients. And then on the other side of this equation, there is actually a nurse that is a virtual nurse. That means they work remote, but in fact, they are a nurse. Generally speaking, we see these to be registered nurses. However, there certainly are things that virtual nurses can do in a LVN or LPN capacity as well. So in this dual-sided care model, this really kind of frames up what is virtual nursing. When you think about the virtual nurse, that's actually the noun or the person that's sort of practicing nursing in a remote capacity. A lot of times we see these command centers be on campus, in an office building, or maybe down the street from a hospital or a medical center. However, it doesn't have to be that way. It can also be even out of state with the right compacts and licensure. Uh, we see programs of that nature as well.

That is so exciting. And it's really great to hear your perspective and to hear your expertise on it because it is such a timely topic. And I know that a lot of organizations across the country are looking into this as a model uh for their organizations. And on that topic, what are the potential benefits and maybe even challenges of implementing virtual nursing programs?

All right, that's that's sort of a good one for us to kind of double-click on. So I would say we would think about this in terms of what is it that the hospital wants to do or what problem is the hospital trying to solve? Because coming at it from that vantage point and then understanding what technology they're using allows us to really focus on the outcomes. So, from a technology perspective, there's really amazing technology out there, and it's everything from a what's called BYOD or bring your own device. That's where you might send a patient a direct link to do an admission or a discharge or patient education, and the patient would literally do it on their phone or their own tablet or their own laptop. If you move across that technology continuum, you have tablets and iPads that are excellent at virtual nursing. We have carts on wheels that do an incredible job on virtual nursing. And we can continue to move to the right of this continuum and really start to think about rooms that are wired with camera speakers and microphones, or even the most kind of complex and sophisticated technology, which is really ambient computer vision, room-mounted sensors, things that are listening and observing at all times. So, depending on those technologies, that's going to drive your outcomes. So we see virtual nursing helping with reducing falls, reducing sitter hours. We see virtual nursing being used in a lot of organizations to expedite discharges, assist with admissions, with patient education. Depending on your technology, it can also help you with dual nurse verification of high-risk medications. Maybe it's chemo, maybe it's heparin, maybe it's insulin, you know, that we can actually zoom in with the good technology and look at a patient's armband or literally read the labels on medication vials. We're seeing organizations use virtual nursing for precepting on demand. If they have a lot of nurses with less than a year or two of experience, it's literally a great way to sort of dial, you know, dial a friend, and your friend happens to be a registered nurse that can assist you with your questions or verifying things. So we're really seeing it start to show up in a whole lot of different use cases. And of course, following the use case, um, we're seeing outcomes improve. So HCAPS improvements uh around communicating with the nurse, um, transition of care, understanding, understanding your medications. Patients feel like they've had a much more focused discharge than even when the nurse is standing in front of them in the room, because it could literally be us looking through the screen at the patient, and that's incredibly focused. And I'm not being disrupted just like the nurse at the bedside might be with calls or texts or people coming into the room. So we're definitely beginning to see outcomes start to emerge that are demonstrating a pattern, and the pattern is saying there's something to this care model.

That is incredibly exciting, and I'm so looking forward to seeing more of those outcomes become, you know, come to fruition and become published even. And we know just from our experience, how much of an impact that can make to nurses that are practicing at the bedside. And it's really interesting to see the diversity of applications that virtual nursing has and all the all the different use cases. I'm really curious too about the settings that you can use virtual nursing, because I think mostly we hear about it from an inpatient context. What is probably other, I'm just curious, what other interesting settings have you seen virtual nursing applied?

Well, think about it as a tool that can be used across the continuum, right? So we're having conversations with organizations right now that are interested in pre-admission testing that would be done through a virtual nurse. Um, in addition to inpatient care for acute care hospitals, certainly from a post-acute care perspective, whether it's rehab or assisted living skilled care, there is interest continuing to emerge from those areas of healthcare as well. Hospital at home or home care is a great application for what a virtual nurse could do to assist. So we're certainly seeing growth in that area. And then if you think about it, even from within the acute care hospital, we tend to work with a lot of hospitals that are really trying to build and leverage this in medical, surgical, or telemetry units. However, virtual nursing is also incredible in ICU's, IMC's critical care areas as well. And we're starting to see, you know, really applicability in things like women's services. So if you think about it, when you're sending a mom home with a newborn, those conversations can really be supported and bolstered through a virtual nurse as well. So every time there's an opportunity for that interaction, it's really a chance for the organization to say, how can we use this tool to improve things or make them more efficient for the boots on the ground for the direct care staff?

Yes, that's great. And there is something to be said about all the different ways that you could use virtual nursing and the different settings that it can be applied to. And with all those different types of pieces in mind, I'm curious about what skills and training do nurses need to have in virtual nursing roles.

Yeah, this is a great question. In fact, I just uh was on a call with the CNO previous to this, and we talked about um job descriptions, competencies, um skills, things of that nature. What we've really been seeing is that it takes a minimum of three years to develop the skill set that's necessary to really be a virtual nurse. So what's good and bad at that about that is that young nurses really get very excited and want to graduate and go jump in the box or the command center or be the virtual nurse. I love the enthusiasm. However, they're not ready yet. You really have to build expertise as being a direct care nurse. That means providing hands-on patient care, being with patients, interacting with patients, using your critical thinking, your problem solving, your communication skills human to human. And after you mastered that, three years is generally when we seem to see that you know, there's a strong enough set of competencies that they can transition into virtual nursing. And that seems to be kind of a sweet spot. We also see organizations that get saturated with applicants for virtual nursing so they can continue to increase the tenure that they're looking for because the more experience and expertise you have in nursing, and as we train you to be a virtual nurse, the better outcomes the patients are going to have. So it benefits all of us to have the most expert, trustworthy nurses in the Virtual Nurse Command Center. And part of that is we really do have to help keep our younger nurses so that they are engaged enough to eventually move into those virtual nursing roles and leverage the expertise of the nurses that have been at the bedside for a very long time. We're seeing this be a retention tool for nurses that might be thinking about retirement because they can practice very differently and in still such an incredibly impactful way as a virtual nurse. So it's a little bit kind of across the board. I will also tell you that from a competency perspective, virtual nursing is very unique in that it's a specialty and a modality all at the same time. So the Academy of Med Surge Nursing has the exam for certification called the Cavern, the Certified Acute Registered Virtual Nurse. It's a very good and rigorous exam. So I think that's helping us really to establish the specialty area of virtual nursing. And we are also seeing some skills arise that are very, very important. So, for example, communication and what we call web adequate is very important for a virtual nurse. So the conversation through a screen is slightly different than the conversation you would be having when you're standing next to someone. So, depending on the organization, some do a really good job calling out competencies and job descriptions to meet those needs.

Yes, and it's so interesting to consider what competency would look like, right, for a role like this because of all these different uh settings, applications, the fact that it is behind a screen. But it's also very cool to see that this type of a role would require that expertise and that, you know, that level of uh, you know, that level of expertise that you would see in someone who's been a nurse for a longer period of time, that has been in the profession for uh a while and has seen a lot. So I like how you pointed out as well that it's a tool for retention, and that's such a hot topic today. And in speaking of retention, we know that virtual nursing is just one of many new care models that are out there that the nursing profession is really starting to explore. And as a nurse futurist, you probably have had your eye on several other models. And we are just wondering if you could tell us about some of those innovative care models that are really reshaping how nursing care is delivered right now.

Yeah, this is always such a really intriguing question because I think some of it is like, you know, moving the pieces around a chessboard. And some of it is really going to look very, very different based on the technology that we have available to us. So when you when you think about the rapid growth of virtual nursing, we know that 66% of hospitals right now are exploring how they can bake in a virtual nursing care model into their organization. Now that means they're across the continuum. Some are actually trying to modify or change their care team in planning for technology adoption. Some of them are all in on virtual nursing platforms and going through all of this transformation at the same time. So we're really kind of all across the board in terms of this approach. From my vantage point, I have no doubt that virtual nursing is not only here to stay, it's going to continue to grow and it will literally be the standard of care. You know, probably three, five, might it be seven years. I I think it will be very unique and rare to find an organization that does not have virtual nursing in some way, shape, or form. And some of that is because you think about the utility. So imagine how you could assist rural hospitals in bringing in an expert nurse in whether it's critical care, pulmonology, or a you know, women's or pediatric nurse expert virtually through technology. That's incredible value to them and their patients. So I think we're gonna continue to see more evolution in that space that really is gonna help a whole lot. I also see that artificial intelligence, while it's everywhere, in fact, it's in too many conversations. I think we have to figure out in nursing what do we want it to do for us? And we're gonna have to start foundationally. And you can't just go for sort of the sexy, shiny objects, like, you know, embodied AI through humanoids, that's not gonna be a thing in the next couple years. We first got to figure out how the heck do we use our automated scheduling and staffing tools and leverage the AI that's built into those before we can lean towards, you know, embodied AI. So I think the answer is yes, and this is gonna be forward-facing, really being very strategic because everything is so expensive. Thinking about what problem are you trying to solve, how might you change your care model, whether that is looking at roles that perhaps you're missing today or you need to add or swap out, and then also thinking about how do you integrate technology that can support you on whatever your pain points are. And all of this is literally just going to continually be compounding. So there is no fast way to go from the Flintstones to the Jetsons. It takes a while. So I think we have to be very mindful about that. We also have to make sure that everything we do in nursing as nurse leaders, that we can build a business case and figure out what are we measuring, how are we demonstrating value and going through things very thoughtfully.

Absolutely. And I do like how you phrased it in terms of a yes and, because we know that virtual nursing is not going to go away at this point. It's it's become, it's become really embedded and integrated into many of the ways that we deliver care now and that we're exploring, especially with those outcomes that you were speaking to. And I am curious about that as well, because there are a lot of challenges that we're facing in healthcare delivery today, one of them being turnover, you know, you mentioned retention. I am curious how this model of virtual nursing and these other models that people that we're all exploring, and you know, AI, technology, all these different things. How are all these different models really addressing these major challenges that we're facing in healthcare delivery today?

Yeah, you know, fantastic question. So I'll give you an example. Um, there's a really unique technology on the market that I think is very good. And it allows us, it's an agnostic way to integrate all of your hardwired monitors into one platform. That doesn't sound amazing, but that's what it does. You also can then integrate all of your ventilators into the same platform. So if you think about this, this is integrated into some of the top-tier virtual nursing platforms. So it does a couple of different things. It puts all the patient information in one place so that from a monitor tech perspective, right? So follow me on this, but from a monitor tech perspective, generally speaking, the rule of thumb that so many organizations still use today is one to one to 18 to 24 per monitor tech. So in this technology, because there's AI that is integrated in it, you can go up to one to 60 to 1 to 80. So now I've just helped you on the labor side by extending your monitor techs. Okay, so so that's kind of like make a note of that, because that's a potential savings. And also those monitor techs, let's train them to be nurses. The other thing it does is that it allows us to integrate all the ventilator settings. So now we've added a VRT, a virtual RT, to our care team as well. That person can help us because RTs, it's really tough retaining RTs because they're such amazing people, such a complex role, and we have a hard time recruiting or retaining RTs. Now, if we have the ability to do some of that monitoring, that can really help us ensure patient safety, early weaning, those kinds of things with RTs. So you think about those components, now also build that into the high-tier virtual nursing platform. Now we've just given virtual nurses a plethora of information that actually gives them insight into these patients as well. The beauty of the AI that's integrated into these platforms is that it amplifies our work as human beings and makes us so much safer and so much more efficient because it will go right to the bad things. So as we cue in and start to train the AI what to watch for, instead of my human eyes scanning across 24 patient rhythms all the time, watching for the bad blips, this picks it up way faster and in fact can start to predict it. So I think the adoption of this technology is really gonna be a force multiplier for us in a variety of disciplines. However, I'm gonna say, Charlene, the important thing is that we cannot be replaced. So if I have one more tech CEO reach out to me or one more tech company talk about how they are going to replace nurses, it's gonna make me scream. We cannot be replaced. We can have things that allow us to expand potentially our scope and help us be smarter, faster, and more efficient. But there is no thing today that is actually going to touch the patient and interact with the patient other than a human being.

Right. And I just want to first say that as someone who is formerly a telemetry nurse at the bedside, I just want to say that what you're what you're sharing about these new models is just absolutely incredible. And it's music to my ears, right? Because I used to be one of those nurses that was watching all those 24 strips go by and I'm like hunting and I'm like getting paranoid about missing something. So something like this could really absolutely be a nice way to complement the care that a nurse is able to provide. And that's the important piece, right? The and the the fact that we cannot be replaced as nurses in the current state, of course, because there is no one thing that has the ability to take all the expertise and all the years of experience and all the ways that we know how to interact with humans and put that into a technology today. That that is not what we're talking about. We are talking about how nurses are able to utilize these models to support their expertise, in addition to. So I really appreciate that you're sharing that. And um, there can be a lot of talk in terms of the possibilities of AI and technology. And I think that this is where a lot of nurses really need to come to the table to share that and to share their expertise and be part of these conversations. Otherwise, there will be a lot of confusion and misper you know, misperceptions, misconceptions in terms of what nurses are, what they can do, and what can replace the care of a nurse. So I do really appreciate.

Yeah, absolutely. And I think for those people that follow me on LinkedIn, last week I had a CEO reach out to me on LinkedIn and said, he said, Hey, I know you're going to health. I'd like to show you our AI nurse. And I replied, there is no such thing. And he messaged me again and he said, No, I want to show you ours. It's the best on the market. So that made me promptly put a post out on LinkedIn that has like 41,000 views, because there is no such thing as an AI nurse, right? There are AI agents that can help nurses, but there is no such thing as an AI nurse. So let's just be clear and not make up terms about what the technology can and can't do for us.

Right. And I I think that is a slippery slope as well, right? When we have other companies that might be button that might be stating what a nurse is in that context of AI, and they might not have the the context or the background expertise as a nurse to be able to understand that and grasp that fully. So that is a really important distinction to make. And I did read the LinkedIn post as well. I love it. And I'm glad that that conversation is happening because we can't just make assumptions about what nurses are, what they can do, and say, oh, this AI nurse can do XYZ because it can also lead down a path of maybe the wrong path in terms of what we think about for care delivery. And so thank you for sharing that and for for um making that uh clarification. And I want to speak to the future as well, because looking ahead, there, you know, beyond some of these newer models, I want to ask, how do you think about what the role of nurses is going to look like and how it's going to evolve over the next several years, given all of these different things that are developing?

Yeah, I sure wish I had a crystal ball. There's there's a real part of me that thinks that we're gonna have to because of the of the shortage and also the opportunity of technology, I think that we are going to move into the problem solver, critical thinker, facilitator, orchestrator, conductor role. And that means that we potentially could be leveraging more technology to assist us in making the best decisions. Um, and that might be whether it's, hey, we got some new lab results and don't give that med or give that one instead. I think it's gonna help us in terms of how we care for our patients. I also could see, and I again, Charlene, I don't have the crystal ball, but is there a way that we start to amplify ourselves to make sure we keep pulling us up to the top of our license and hand off the jobs that we don't have to do? So I'm always relieved when I hear of organizations that have moved away from drawing labs and starting IVs. You don't have to be a nurse to do that, give that away. I would even argue there's a lot of medication administration that you don't have to do anymore. As a nurse, we can go back to, if necessary, utilizing kind of that medication tech, medication aid model with the appropriate training. However, it's the nurse that's really doing that upskilled work of thinking about what was the impact of that medication, or, you know, hey, I assessed the patient for pain, I gave them med. What's the impact of that? So I think that we're gonna continue to wrestle with ourselves to pull back up to the top of license. The other thing is that we need to be the ones that design and determine technology based on our needs, not the way it is today, where technology is created and then they try to sell it to us. So I think we really have to go get much more articulate and clear on what our needs are. And I think technology companies are gonna have to become a lot more savvy about working with us way back at the pencil drawings and the ideation stages to figure out what we need instead of just continually creating things that get sold to our CIOs, our COOs, our CEOs, and instead focus on what our real needs are so we can provide the care that patients need.

Absolutely. And I do want to point out how uh impactful what you shared is, especially when it comes to the conversation of scope of practice. I know that a lot of people have been looking at different care team models where we really evaluate who is the appropriate person to do the appropriate task. And that absolutely includes nursing. And given how much they have evolved in their expertise and their role over the years, that is a question that organizations can really ask themselves, you know, who is the appropriate person to do this task? Does it really need to be the nurse? Because I know that historically nurses have been kind of the gatekeeper of all things, right? To be the ones to resolve all problems. But there are other models out there that we can do to really elevate our scope and to really maximize the expertise that nurses have. And so, so really great to think about that in the next few years, in addition to having nurses really be part of these conversations and really thinking about how to be the ones to uh to share their expertise on technologies like AI and everything else that's out there. And so I know that we're wrapping up our conversation soon, but I do want to give you final, you know, opportunity to share any comments that you think that our listeners should know about when it comes to virtual nursing or anything that's related to the topic.

Ah, thanks for that. You know, I think we're at a really incredible point in time. Um, we are in the infancy of what virtual care and virtual nursing is gonna look like. I think we're in the infancy of what smart hospitals are gonna look like. It's important for nursing to participate in that. And, you know, to me, it's sort of silly and cliche. It's not, you know, lean in and get to the table. The heck with that. I think if if there's work going on in your organization, you email the CEO, the CIO, the COO, and say, hey, I saw that we're doing some work there. I'd like to volunteer to be a nurse on that committee or on that council. So I think it's really going to be incumbent on us to continue to push our way in and get involved. And the the same is true on the reverse. I think as you're out at conferences and learning more about technologies, demos, talking to vendors, ask them if they have nurses on their team. Ask them if they have a CNO. So often when I ask that, they'll say, we have a chief clinical officer, and guess what? It's a physician, right? That's not the same. So I think we also have to start to put pressure in a good way back on technology vendors to ask about that. And I think we just have to continue to realize that we have so much in common from a nursing and a medicine and a therapy and an RT perspective. We all have very common interests, and that is all of us want to make sure that we are literally not outsourced and replaced by this technology that, in some cases, isn't going to be able to deliver the care that's needed. So we probably have a lot more common ground with other disciplines than we like to believe.

Right. And thank you so much for sharing that, uh, Bonnie. We really appreciate having you on our call for today. And can you also share with our listeners how they can find you and learn more about your work with the Virtual Nursing Academy?

Yeah, absolutely. So I am the top nurse influencer globally on LinkedIn. So please feel free to reach out to me, Bonnie Clipper, uh, on LinkedIn. And also uh the Virtual Nursing Academy, real simple, virtual nursingacademy.com. You'll be able to find us online. And on LinkedIn, we also have a Virtual Nursing Academy page. Feel free to join that as well because we share tons of free content, tools, and assessments just because we want to see virtual nursing really proliferate in more organizations.

Wonderful. Thank you so much for sharing that, Bonnie. And we are so appreciative to have you on our podcast today. Thank you for joining us. Our guest today was Dr. Bonnie Clipper, founder of the Virtual Nursing Academy. We would love to hear your feedback. Email us at socialmedia atacnl.org and connect with us on LinkedIn and Facebook at ACNLNurse. And as always, if you like the show, please remember to rate, review, and share. ACNL in Action is presented by the Association of California Nurse Leaders with new episodes on the first Friday of every month. To learn more about the show or ACNL in general, visit us at acnl.org. Thank you for listening.