CHI Health redesigned the bedside team to create a team-based structure supporting the virtual RN. The virtual expert RN role allowed CHI Health to move from an RN/CNA paired model to a team-based model. In the new model, the virtual expert nurse oversees two bedside care teams made of an RN, LPN, and patient care technician who care for up to 12 patients each. The biggest change in the model was the addition of LPNs, which not only filled RN vacancies due to a local RN shortage, but also reduced labor costs. This reduction in labor costs offset the cost of the virtual RN technology.
The bedside care team is responsible for all in-person care, such as:
- Conducting physical assessments for patient admission
- Providing direct patient care
- Managing discharge processes and providing discharge instructions to patients and families
There is some overlap in the responsibilities of the virtual nurse and the bedside care team. Who performs certain tasks depends on the clinical situation. For example, the bedside care team provides most of the patient education, but the virtual nurse will step in for a high-risk medication or a new diagnosis. However, CHI Health leaders deliberately developed policies to make emergencies out of scope for the virtual nurse role because the virtual nurse may be involved with another patient and unable to hear the emergency codes.
In addition to on-demand communication via the two-way video platform, the virtual nurse and beside care team round daily. The team uses that time to coordinate care plans and prioritize high-risk patients that need additional attention from the expert nurse.