Becker's Hospital Review

53 CMO / CARE DELIVERY University Hospitals' spin on virtual nursing By Erica Carbajal M any virtual nursing models involve separate teams where nurses work as either a bedside nurse or a virtual nurse. But Cleveland-based University Hospitals is taking a different approach. In May, the health system introduced a model in which nurses can work a hybrid schedule, with several days spent at the bedside and the remainder of their schedule at a remote care hub as a virtual nurse. e model is in place across five hospital units, with 23 staff nurses on these units working some of their weekly shis at the remote hub in an administrative building, health system leaders told Becker's. "We have hardwired all patient rooms in five hospital units with the technology for remote nursing," Michelle Hereford, MSHA, RN, FACHE, chief nurse executive at University Hospitals and the Ethel Morikis Endowed Chair in Nursing Leadership, told Becker's. "Each day, a nurse from each of the five units works in the remote hub in collaboration with their home units and each other." e approach has been a way to deliver on nurses' flexibility demands and allow members of the same team to continue working together. When working a remote shi, nurses are oen caring for the same patients with whom they established a connection during a bedside shi at the hospital, making patients more comfortable when a nurse dials in virtually. "We had much less hesitancy from patients than expected," said Jennifer Carpenter, DNP, RN, CENP, chief nursing informatics officer for the health system. During the pilot period, the health system engaged members of its family advisory council to get patients' perspectives and learned increased familiarity with virtual care made them more receptive to the virtual nursing program. In response to patients' privacy concerns that popped up in the first few weeks of the hybrid virtual nursing model, leaders tweaked the standard orientation to ensure staff communicate to patients that they are not being recorded, and to limit sensitive conversations to in- person interactions, said Dr. Carpenter, who is also vice president and chief nursing officer at UH MacDonald Women's & Rainbow Babies and Children's Hospitals. Initially, bedside nurses also shared concerns about having heavier workloads if a remote nurse was supporting them, but leaders have found "the trusting relationship between nurses from within the same team has helped with this hesitancy," she said. An established working relationship has enhanced the level of collaboration between the teams, who divide work based on the level of patient acuity and care needs that day. "e remote nurse has been especially beneficial in work such as dual verification of medications, safety monitoring, shared nurse worklists, and coordination between hospital and post-acute care facilities," Dr. Carpenter said. Based on the program's success so far, Ms. Hereford and Dr. Carpenter said University Hospitals plans to expand the hybrid model to night shis and introduce remote access for other healthcare team members. n The risk of publicly reporting clinician well- being: Viewpoint By Kristin Kuchno W hile addressing clinician well-being is important, publicly reporting measures of burnout could be counterproductive, according to two physicians. Measuring clinician well-being is crucial for identifying contributing factors and understanding how they have changed over time, wrote Jonathan Ripp, MD, of Icahn School of Medicine at Mount Sinai in New York and Tait Shanafelt, MD, of Palo Alto, Calif.-based Stanford Medicine in an Aug. 8 article published in JAMA. Some also suggest that using this data to rank hospitals for their clinical well-being could encourage other systems to prioritize well-being. However, negative effects could arise if the measurements are shared publicly in an effort to be transparent, the authors said. For one, it could be harmful to psychological safety, as "public reporting is likely to rely on shame as a primary motivator for organizations," according to the article. It could also motivate leaders to collect favorable, rather than honest and accurate, feedback. Similarly, it could motivate clinicians to provide more favorable feedback, as their livelihoods are tied to the success of their organization, the authors said. To collect and use well-being data most effectively, the authors recommend organizations: • Collect data anonymously to ensure psychological safety • Share the data throughout the organization transparently • Use the data to inform and advance efforts to improve work environment n

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