Virtual nursing is expanding beyond intensive care, pairing an in-person nurse with a remotely located colleague to support inpatient care through secure audio-visual technology. Evidence drawn from recent peer-reviewed work describes how these models are taking shape in noncritical hospital settings, what outcomes are being tracked and which operational choices influence success. The literature points to considerable variation in design, with many programmes assigning virtual nurses to focused tasks while others adopt broader co-caring roles. Patient experience and nurse satisfaction dominate reported outcomes, with hospital throughput and efficiency measures also used. Alongside reported benefits, the sources highlight gaps in standard definitions, role delineation and evaluation methods and call for clearer guidance, competency development and longer-term, multisite evidence.
Models and Core Components
Descriptions consistently identify three essentials: a virtual nurse (VN) working remotely, a bedside nurse (BN) and an enabling technology platform. Two broad approaches recur where details are provided. In task-oriented configurations, often framed around admissions, discharges and transfers, the VN concentrates on defined activities such as documentation support, medication reconciliation or patient education. In co-caring configurations, the VN’s scope is wider and may include mentoring, coaching and participation across multiple elements of care in partnership with BNs.
Reported VN-to-patient ratios vary markedly, from about 20 to 125 patients per VN, reflecting differences in scope, workflow and technology. Technology itself is heterogeneous. Some programmes use mobile devices brought to the bedside as needed, while others rely on in-room stationary systems. Interoperability with electronic records and other hospital systems is not consistently described, which makes it difficult to compare the operational burden across models.
Across informational, quality improvement and research reports, role clarity emerges as a recurring requirement. Several sources emphasise the need for explicit workflows, clearly delineated VN and BN responsibilities and agreed communication pathways, particularly where co-caring arrangements demand tight coordination. Nevertheless, despite the shared components, programme contexts differ.
Implementation Factors and Outcomes
Implementation reporting is uneven, yet common facilitators appear. Incorporating BN input during design helps align virtual roles with bedside realities. Structured team building between BNs and VNs supports trust and collaborative work. Ongoing bi-directional communication is cited as a practical necessity once programmes are live. Flexibility to iterate workflows, visible leadership support and adequate training feature as further enablers. Where organisational context is sparsely described, it becomes harder to generalise lessons, but the weight of experience points to change management and education as central to adoption.
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Evaluation focuses most frequently on patient experience and nurse satisfaction. Patient experience is often captured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, with several reports noting improvements in at least one category such as nurse communication, medication discussions or overall care. Qualitative feedback from patients is largely positive or neutral, though concerns about missed elements of care and privacy are noted. Nurse satisfaction measures use diverse tools, limiting comparability, yet many accounts describe favourable perceptions tied to fewer disruptions, more time for direct care, perceived workload relief, efficiency gains, coaching support, improved documentation practices or reduced vacancies. One report contrasts this pattern, describing significant BN concerns and low adoption.
Operational outcomes include hospital throughput and efficiency. Multiple sites report shorter time from discharge order to patient departure or reductions in average length of stay. Measures of efficiency such as reduced overtime, improved productivity or decreased labour costs are also described in several programmes. Although promising, the heterogeneity of measures complicates synthesis. Workforce outcomes, for example, are variously expressed as turnover rates, vacancy rates or satisfaction scores, sometimes using investigator-created instruments without reported validity or reliability. Patient experience measurement is more standardised, but HCAHPS does not distinguish between virtual and bedside contributions, which limits attribution.
Policy and Research Priorities
Literature flags unresolved implications for practice, policy and regulation. Dividing responsibilities between autonomous professionals raises questions about joint accountability, decision-making and the frequency and quality of professional communication. Some sources note the risk that novice BNs might have fewer opportunities to learn tasks transferred routinely to VNs, with possible effects on skill development. Maintaining BN competence for tasks handled virtually is highlighted as an operational and safety consideration, particularly during technology outages. Rotational exposure to virtual roles is suggested in one account, though evidence for this approach is not established.
Competency development for virtual care is a consistent theme. Beyond operating platforms and navigating multiple interoperable systems, VNs and BNs require skills for patient-centred communication in virtual encounters and for collaborating with families and multidisciplinary colleagues at a distance. As adoption grows, establishing scope and standards of practice for virtual nursing, alongside clear role descriptions and workflows, becomes more urgent. Professional bodies and leaders call for more elaborate operational definitions to underpin both implementation and evaluation.
Future evidence needs are clear. Most reported implementations are pilots with short measurement horizons in single organisations. Longitudinal designs are needed to assess sustainability, workforce effects and patient outcomes over time. Multisite studies would help test model performance across different contexts and support scalability assessments. Standardising definitions, selecting consistent outcome sets and using valid, reliable instruments would enable aggregation of results into an actionable evidence base. Comparative evaluations of task-based versus co-caring models across settings could clarify where each approach works best. Economic analyses are also needed to inform investment decisions in technology and staffing.
Virtual nursing in noncritical inpatient care shows promise for enhancing patient experience, supporting bedside teams and improving operational efficiency, yet programme designs and measurement approaches vary widely. Successful implementation is associated with bedside engagement in model design, strong team relationships, clear role delineation, effective communication and sustained training. To guide practice and regulation, the field now requires unified definitions, competency frameworks and robust longitudinal, multisite evaluations using standardised measures. With these foundations, health leaders can better judge where virtual nursing models fit, how they should be staffed and how to ensure safe, patient-centred care while supporting the nursing workforce.
Source: Journal of Nursing Regulation
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