Arrow-right Camera
The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Virtual nurses pilot launches at Deaconess among multiple steps to offset worker shortages

MultiCare Deaconess Chief Executive Nurse Jennifer Graham, center, and Alex Bare, RN, right, connect by video with Courtney Fields of Banyan Virtual Nursing during a demonstration in a patient's room on the ninth floor, Wednesday, July 12, 2023, in Spokane.  (DAN PELLE/THE SPOKESMAN-REVIEW)

In a patient’s room at MultiCare Deaconess Hospital, a big-screen TV streams a regular broadcast. After a voice prompt, the show stops, and the face of nurse Courtney Fields appears.

She is a virtual nurse who talks to patients via the TV to handle some of the more mundane administrative tasks rather than direct patient care.

And Fields is doing this from Tampa, Florida.

The virtual nurse initiative is an effort by Deaconess to offset the nursing shortage plaguing hospitals across the United States. Translated locally, there are 500 open nurse jobs for Deaconess and Valley hospitals, said Jennifer Graham, MultiCare’s chief executive of nursing.

Virtual nurses such as Fields work with patients on admissions, medicine list collections, diagnosis instruction and discharge details – all easing the workload among fewer on-site nurses.

Deaconess launched this virtual nurse pilot May 9. It’s now in 30 rooms on a medical-surgical unit, but set to expand to a total 94 rooms by fall.

“The virtual nurses provide support in the virtual realm for tasks that require a nurse, but not a nurse in-person,” Graham said. “It’s not a robot. It’s not AI. It’s an actual nurse, a real person who is on the care team.”

By August, the virtual nurse model is set for Deaconess’ medical oncology unit. Then it will be introduced into a complicated surgery unit by October. Licensed for 372 beds, Deaconess serves an average of about 200 patients a day.

The virtual nurses are under contract with MultiCare and trained in its policies, similar to a travel nurse, Graham said. The virtual nurses work for Banyan Medical Systems and are licensed in Washington state so they can practice on a local care team.

Deaconess is the first MultiCare facility to use the virtual nurses. MultiCare took the step after holding more than 50 sessions in 2022 to listen to about 1,000 nurses.

Graham said current estimates are that the U.S. will be short by 1.5 million registered nurses by the end of this decade, while hospitals expect increasing patient demand.

“About 500,000 nurses left the profession during the pandemic, and some of that is the result of the age of the nursing workforce,” Graham added.

“The baby boomers were a large part of the nursing profession, and they’re starting to retire. There are also about 80,000 people who apply to nursing programs every year who are qualified and aren’t admitted because we lack adequate faculty.

“So between the retirements and the nurses who left because of moral injury and the stress of being in the nursing profession during the pandemic, and our inability to train nurses fast enough, the gap continues to grow.”

Graham said multiple strategies are underway to support MultiCare’s on-site nurses – including technology upgrades that report on patients’ conditions in beds, hospital delivery robots called Moxi and the recent hiring of 60 licensed practical nurses to join hospital care teams.

Trained regionally at North Idaho College, LPNs haven’t been hired by the hospital to help with patient care for decades, she said, after most hospitals by the 1980s turned to a RN primary care model.

“We will be using an integrated nursing model, which will be nursing assistants, LPNs, registered nurses and virtual nurses.”

MultiCare spokesman Kevin Maloney said the hospital can’t disclose the cost of virtual nurses pilot because of contractual constraints.

The Banyan virtual nurses ask for patients’ permission verbally before they enter the screen-time sessions. Eventually, via the camera system and technology installed with the TVs, they can do routine skin checks, check pupils or read medication labels.

Graham said administrators hope to bring virtual nurses to Valley Hospital next year. At Deaconess, it now has six Moxi units that are self-propelled robots to do tasks such as deliver gowns and lab samples, as directed by nurses.

“Moxi came because we needed support for the nursing team to stop running around the hospital doing things we could give Moxi – delivery work,” Graham added. “The second phase of that work was a big technology upgrade that we needed for the safety of our patients in the call-system technology.”

The hospital is rolling out technology upgrades for its room call system and communications platform, she said. When a patient presses a button to call a nurse, that system will be integrated, Graham said.

“The updated call system is not yet in every room. We started it about three years ago. Not only does the bed tell us if someone is in the bed, but also how much they weigh, how fast they’re breathing, how fast their heart is beating, whether they need our help, whether they get out of bed unassisted.”

The technology is integrated with the hospital’s electronic medical record, and the system can activate alarms and speak to nurses’ iPhones about issues via text messaging. The telecommunications platform allows providers to share protected health information, Graham said.

“As we implement these technologies, we’re trying to keep our eyes on the looming nursing crisis,” she said “It’s not even looming – the nursing crisis is here.”

Patient Joy Kelley of Spokane got a virtual nurse visit after she checked into Deaconess for hip surgery. She’d never seen a provider over a screen before, but she described it as easy for her admission process.

“I liked the fact it was without a lot of chaos,” Kelley said. “I answered all the questions, and the nurse was very respectful.”

The virtual nurses don’t take away jobs but rather bring relief to on-site nurses who can focus more on primary care, Graham said.

“What nurses said to us is they want to be treated like knowledge workers, valued for their integrated thinking that they bring,” Graham said. “Because of the number of patients who need quality care, and the dwindling numbers in the nursing workforce, this primary care model isn’t going to get them the time with patients they need.”