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Advances in technology offer additional health care tools to improve the health of patients and efficiencies for our clinicians in innovative ways. These technologies cover a huge variety of therapeutics, ranging from wearable devices, such as insulin pumps, to robotic-assisted surgeries. Nursing informatics is firmly embedded in the use of technology to improve nursing care and science. One of the most recent developments in nursing is the exploration of virtual nursing. This paper will present the past, current, and future projections for this unique blend of nursing art and science with cutting-edge technology.

Keywords: nursing informatics, informatics, telemedicine, technology, virtual nursing, nursing shortage

We are nearly a quarter of the way through the 21st century, and technology is firmly grounded throughout almost all elements of health care as a requisite and ubiquitous tool for improving patient outcomes and driving new care models. Wearable health monitors, tracking apps, and even robotic surgeries are commonplace uses of technology in patient care that most of us recognize and take for granted. A lesser-known source of technology in health care—and one that is arguably among the most important in the field of nursing—is nursing informatics. Much of the behind-the-scenes technical infrastructure that allows hospitals to function seamlessly is informed by nurse informaticists, who create systems that support clinical workflows and decision-making around documentation, communication, and patient care. Nursing informatics is a vital part of the health care landscape that offers unique solutions, such as virtual nursing, to address a variety of emerging needs and challenges in the nursing space.

The Unique Vantage Point of Nursing Informatics

The American Nursing Association defines the field of nursing informatics as the integration of nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.1 In other words, nursing informaticists translate both nursing and technical jargon, effectively communicating between clinical staff, technical staff, and administrative leadership to advance efficient patient care through the use of technology. Nurses who choose this field hone their unique skill set, which includes the compassionate application of nursing science, knowledge of the patient experience, technical savvy, and effective communication. A classic example of a tool at the heart of nursing informatics development is the electronic health record and its single-practice cousin, the electronic medical record (EMR). Electronic health records and EMRs are so pervasive and indispensable that a contemporary hospital without them might be unrecognizable. These electronic systems carry with them the signature of nursing informatics. They contain relevant clinical information, IT system implementation, and wide accessibility to multiple users, all working in harmony to support patients, frontline caregivers, administrators, and the entire care team.

A deeper dive into the world of nursing informatics reveals why this field is so unique and important. The busy health care environment moves fast, and while patient experience, nursing care, and quality are always priority one, quality improvement initiatives and ideas for implementation can compete or conflict, especially when different hospital stakeholders speak different “l(fā)anguages.” A nursing informaticist’s job is to translate between 3 different “l(fā)anguages”: “nurse,” “information technology,” and “hospital administrator/business analyst.” Using data from a multi-pronged approach, their unique vantage point allows them to seek creative technological solutions by, for example, updating existing practices to implement more efficient workflows or by designing tools to address a particular challenge. Another vital function of nurse informaticists is to improve patient care and nursing experience through implementation of technological evidence-based practice (EBP).2 When we consider EBP in nursing, we often think of clinical care and practice more related to bedside nursing or infection prevention. But EBP is important in nursing informatics, too. In fact, many nurse informaticists conduct their own research to learn the most effective ways to use technology to improve patient care.3 In addition, their communication expertise makes them the perfect fit for disseminating new initiatives to clinical staff or for designing an eLearning program for clinical training distribution.2 If you are currently using a technological tool in the health care system, thank a nurse informaticist.

Virtual Nursing: A Use Case

The field of nursing informatics is uniquely qualified to help solve some of today’s most pressing nursing challenges and does so with a creative technological spin. It is no secret the nursing profession is facing a workforce shortage that will only worsen in the coming years.4 While reasons vary and speculation abounds, the proof is in the data: one measure estimated that the year 2021 saw a decrease of around 100 000 registered nurses (RNs),5 representing the largest single departure of nurses from the profession in the past 40 years.6 The Health Resources and Services Administration estimated that by 2025 there will be a shortage of 78 610 full-time RNs.7 Furthermore, the workforce is aging. With an average age of 52, an estimated 200 000 of today’s RNs will retire each year until 2031,8 on top of an aging population that will likely require more, not fewer, care providers in the years to come. This trend, while troublesome, presents an opportunity for innovation.

We advocate tackling this challenge head-on through the use of virtual nursing, which is championed by a hospital’s nursing informatics team. Although the origins of nursing telehealth date back to the 1970s, virtual nursing has evolved over the past 50 years and exploded out of necessity during the COVID-19 pandemic. 9 Virtual nursing merges together clinical, technical, and administrative functions—the quintessential nursing informatics fingerprint—to create innovative strategies to approach the nursing shortage and improve patient care. Virtual nurses support and enhance the care delivered by frontline nurses; this technology does not replace nurses, but rather supplements the care team. Using real-time, 2-way communication through video-conferencing, virtual nurses are able to provide all the same non-physical examination duties as an in-person traditional nurse. For example, a virtual nurse might conduct admission or discharge sessions, process medical histories, answer patient questions, or provide vital patient education and care instructions, allowing the bedside nurse more time in-person with patients.

In addition to its help with the workforce shortage, virtual nursing should be implemented widely because of its great benefits and potential for improving patient care, which includes uninterrupted nursing attention, seamless assistance, and increased access to specialists and visitors.10 For example, floor nurses who may need 30 to 45 uninterrupted minutes to conduct a discharge discussion with one patient may also need to respond simultaneously to other urgent needs of another. Interrupted discharge instructions and multiple competing priorities can lead to lower-quality care.11 However, virtual nurses, who are equally knowledgeable professionals, have more uninterrupted time to spend with each patient, allowing floor nurses the freedom to respond to in-person emergencies. In one pilot program of virtual discharge nurses, both patients and nurses reported high satisfaction with the interaction, and patients maintained a low re-admission rate, suggesting this virtual program was both popular and effective.11 In some hospitals, at the literal touch of a button, a patient can ask a question to a qualified virtual nurse and get instant information in real-time without having to wait or fear burdening or interrupting their busy, in-person nurse.12 Similarly, patients who are waiting to see the doctor in an outpatient environment can easily receive education or personalized advice in the exam room, saving time. Furthermore, patients who live in rural areas without specialists can more easily visit one-on-one with varying health care professionals, such as nutritionists, advanced practice practitioners, behavioral health therapists or very specialized experts whose in-person visitations may have otherwise required travel.

Furthermore, virtual nursing can increase patient satisfaction and engagement.10 Video-conferencing offers the patient and nurse a more comprehensive avenue for dialogue versus the telephone alone, and technology enables family members, social workers, and even medical interpreters to more seamlessly support multiple aspects of patient care and well-being.13 In a limited pilot program, involving over 900 cameras in the hospital rooms of another health care system, patients “unmuted” themselves to give rave reviews of virtual nursing. One survey provided 100% positive feedback from patients on their virtual nursing experience, suggesting that this technology is here to stay.10

While patient satisfaction is paramount, let us revisit the challenge at hand. We know that in order to address the nursing shortage, we want to encourage new nurses to join and stay in the field, and we want to improve nurse retention and job satisfaction at all levels of tenure. Virtual nursing is attacking the workforce shortage by creating a new model of care that addresses both issues while supporting both patients and nurses. First, new nurses need support and guidance from more experienced colleagues in order to maximize their confidence, satisfaction, and success.14 Nurse leaders, as much as they want to provide mentorship, are often overburdened with administrative tasks, preventing them from working with newer nurses at the bedside. Virtual nurses can easily take on administrative tasks, such as patient intake and medication review, thereby freeing in-person nurse leaders to devote more time to new nurse support and mentorship. Notably, mentorship is not unique to in-person nursing; one nurse informaticist argues that always-available virtual nurses can provide excellent mentorship as well. For example, the new nurse who has a question and struggles to find help in the lower-staffed, wee hours of the night can get advice from a virtual nurse.15 Thus, virtual nurses’ contribution improves the workflow of the entire unit and team.10

Second, the option of virtual nursing provides a new choice for nurses who may prefer to use their expertise in a virtual environment for any reason or who simply want to try something different. For example, experienced nurses who have limitations that prevent them from working bedside can continue to practice and improve patient outcomes. In many cases, nurses who gravitate to this new and growing virtual field thrive in communicating and interacting with patients. Flexibility is also an attractive perk; virtual nurses may complete up to 2 patient tasks per hour as they work from home 3 to 4 days a week with shifts varying between 4 to 12 hours, offering a schedule that fits around nurses’ competing priorities while elevating quality care and safety for countless individuals.

When nurses have more agency over their working environment, they report higher job satisfaction and less burnout, which leads to happier workplaces, higher retention, and less turnover.16 In 2023, one 68-hospital health system that implemented virtual nursing in 12 of its facilities has already seen an improvement in nursing turnover by 60% and a decrease in nursing vacancy by 46%.15 Virtual nursing, which synthesizes clinical care, technology, and administrative functions, has incredible potential to not only improve the workforce shortage and patient satisfaction but also modernize care models in innovative ways.

While virtual nursing offers promising solutions for a number of issues, its implementation can bring challenges. Particularly in large enterprises, rolling out new technology requires great collaboration between departments and executive agreement on the goal of virtual care. For example, creating virtual nursing roles requires a strong business case to define the return on investment. In addition, virtual roles may be filled by existing in-person nurses, which shuffle resources that may affect nursing ratios and introduce questions about remote work arrangements. Virtual nurse implementation is no easy endeavor, but we argue that it is not only worthwhile but also vital to the future of nursing care delivery. We urge you to stay tuned for future developments in this exciting field.