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Virtual Nursing during the pandemic was a necessity, now it begins to address the nursing shortage that health systems face. Today we sit down with Patricia Mook System VP of Nursing Operations and Kimberly Krakowski Assistant Vice President, Enterprise Nursing at Atrium Health. I hope you enjoy.


alright, here we are from HIMS 2022. And today we are taking a look at virtual nursing with a team from, , atrium health. And I'm gonna have you guys introduce yourself. Sure. My name is Patricia book and I'm the vice president of nursing operations for eight.

Fantastic. Hi, I'm Kimberly for Kelsey and I am with the enterprise. Also, I'm an atrium health as an assistant vice president of nursing operations and anything that is fun and exciting. Innovative. Yes. , well we just sat through a presentation on virtual nursing and behind us is, , is your presentation on virtual nursing?

What was what's the driver for? . So actually we were in the midst of the pandemic and very challenged with caring for our patients at a time when we had, , a lot of staffing challenges, , a lot of patients that were in isolation and we wanted to create a situation that, that brought better outcomes and a better experience for our patients.

And we had a lot of the nuts and bolts, all the pieces that, that we were doing in different areas of. The organization with respect to the technology. And we just had a big think tank and created this team nursing 2.0 virtual nurse. , and Kimberly was one of the people along with Melissa, Greg. So you see, you have all the, all the parts and pieces together. And it was just a matter of bringing the team together and saying, okay, how are we going to use all these things?

What are the parts and pieces to this? So we have cameras that are on cards that we were able to bring into the room. And we took, we kind of adapted that from our EIC concept. , we have nurses that were experienced that couldn't be at the bedside because they were unable to either do the, increased physical load of the patient in the room.

You know, the, the heavy lifting. , interactions with the patient. In that way, we had new grad nurses who were at the bedside who were really struggling with the care of the patient because their experiences in school were what they had been. We had patients who were isolated. You know, we, we had the things that we could put together to make a better experience.

There's a lot of drivers. Yeah. I think one thing to really point out is when we did this original pilot, it was in the progressive care unit. And so this is where your sickest of the sick COVID patients were that were not sick enough for the ICU because people were so critically ill, but they were down in the progressive care unit.

And this is going to require the nurses and anyone going in and out of. To put on full PPE. Remember this is a time when you're not able to have visitors. So there was a true isolation for the patient. So having that camera where you didn't just have the people coming in and out to care for you, but having someone that you could wave at the camera to come in and have a human face-to-face interaction, , was really, really important, not just to the patient, but then the patient's families being able to come in and see them, you know, cause we could put them in the room with them as well.

But also saying there's someone watching my loved one, because it was so scary to knowing they were that sick. So we, we hear from, , HCA, we hear from banner. So this is starting to take off elsewhere. As a result of the pandemic is really about safety. It was really about, , you know, bringing the right care professional to that bedside and not donning and doffing is, as you were talking about.

, hopefully exiting a pandemic and we're getting to a different stage. What does it look like coming out of the pandemic virtual nursing? So in a time when our, , nursing numbers are not enough and our staffing, , concerns are there, we, we have hired a lot of new grad nurses, and this is an opportunity to have an experienced nurse behind the.

He was always there to guide new grad nurses, which have doubled for us. Our numbers of new grad nurses have doubled. And so we're able to better precept retain nurses who are, who don't want to be at the bedside any longer. , use them as preceptors in the room. , from a safety perspective, we are seeing decrease medication errors were because he had got a double check.

We are seeing less falls. We're seeing. Potentially a decrease in length of stay and a lot of outcomes measures from the, from implementing a nurse behind the camera. And so even in a pandemic outside of a pandemic, , there, there are outcomes that we're looking to be, , really great quality outcome. But we're also at a time where the nursing shortage is pretty accused of getting worse.

So there's there's training aspects to it. There's, , there's retention aspects to it. The, , it's it's interesting. Or are you, you know, the ICU model used to be, we, we put everybody in a building. And then they were doing stuff remote. Is that how this works or is this essentially you have nurses out of their homes doing this kind of work.

So right now, because it is new, we have all of the nurses that worked in this area in a, you know, one room and they are also sitting next to people that are doing. , observation, which is more of a sitter fall prevention technology. , they're not sitting in the same place as the ICU because the ICU, they come in and consult, they review charts, but they are not instantly going to be on camera all times.

They have to be consulted. So in this, this is literally part of the care team. There's a sign at the head of the bed that says you have a virtual nurse. That's part of your. We explain it to them on the patient and the family. When they're admitted to the unit, they do have the right of refusal. If for some reason it's a problem for them to think that there's a camera at all times, but it's really, we have them together because we're trying to grow the team eventually.

Absolutely. I think that this could be virtual just as the EIC programs moved into that direction. As COVID hit you learn lessons that maybe everyone doesn't have to be in the same physical. So every time I turn around atrium is growing. Your, your CEO seems to, , seems to have plans for growth. , as you look at that growth, how do you take this program?

Or how are you planning to expand this? Is this, is this a pilot right now? Or so it was a pilot we're looking to utilize VNO at all across our enterprise, either at wake Baptist, down at Navicent or at Floyd, which in the last day. We have doubled in size. , and so we presently are doing all of that from a central bunker location, , in the Charlotte region.

And we actually do VPO virtual patient observation for Navicent and know getting ready to do that for weight now to, wow. The, , is there anything about across state lines that you have to. Yeah. You know, we, we do have to look at right now, , we're pretty good in the North Carolina area and with the hospitals that we have, certainly the state of Georgia has different state regulations.

, but our lives, many of the people that work in our states have that multi-state license replacing. Sure. So we're, we're, we're looking pretty good with that and we feel like we can, we, there aren't any major barriers for us. It's an easier for nursing because of the compact licensed. To be able to practice in multiple places.

Whereas when you think about your APS and your physicians, they actually have to be certified. And that's why it can be more difficult for them to provide telemedicine over a state line. Even if they're right there living on the border. , we haven't had that, or we don't anticipate that as we're moving forward, what is going to be the challenge to scale this up?

So capital dollars for the cameras, , which we're thinking about in terms of our future, , are these special cameras. So you can use there, their multitude of different vendors, obviously, that, that, , can be used for this purpose. We like to use a camera that integrates well with our EMR. , so you really have to really think about how do your cameras integrate with the EMR that you're using.

And we've had to make some changes because we were presently going through a change with that. , but we think that that. Camera's that we use today, , can be used multiple for multiple reasons. Our EIQ uses them. So we can flip into an AI CU circle circumstance. , we can flip rooms into EIQ if, if need be.

And in this pandemic, we've had two rooms that we, we never expected to be used for critical care, , are being used for critical care. The really great thing about this is we're expanding into using, using virtual nurse in our. , we've actually taken the virtual nurse into our rehab facilities, , special patients who had diaphragmatic, , stimulators that maybe you wanted to have a closer eye on.

And the ratios of that nurse rehab area was more higher. , we've been able to really move patients along from one, , one area to, to a less acute area, , in a much more easily, easily fashion. Integrated into your EHR. I'm sorry. I'm going back to the camera's. Yeah, my listeners are going to say, okay, that sounds like a great program.

We want to replicate that, but we want to be able to scale it, , outside of like pan tilt zoom. Is there anything else you're looking at for the cameras? So it is important to know. So we, we chose to use the same cameras that we were using for virtual patient observation and in the ICU. What you do have to buy from your camera.

Vendor is a different software that goes with it so that you can have multiple people to view back and forth. So you have like the camera, which is your hardware, then there's software different packages that will give you different areas of functionality. So that's definitely something I would say to keep in mind when you're looking at a camera, one camera does not fit all.

It needs to have the other bells and whistles that goes with it too. Fantastic. Reprogram. I want to 📍 thank you for your time. Thank you. All right. Thank you.

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