When virtual nursing first gained traction during the pandemic, hospitals saw it as a lifeline — a way to maximize staff members time when stretched thin, keep patients connected and maintain safety during a crisis.

Three years later, the screens are still on. But the question facing health systems now is not whether to have virtual nurses, it is how to make their programs distinct, durable and indispensable.

At Duluth, Minn.-based Essentia Health, the idea began modestly: a handful of nurses experimenting with iPads and Zoom calls.

“We really took this grassroots approach,” said Adrienne Radovich, BSN, RN, a nursing director who helped lead the rollout. “We used the technology we had and made it work.”

Essentia’s pilot launched in 2023, with nurses testing a basic model for virtual admissions and discharges. By early 2024, it had grown into a full program spanning 22 units across Duluth, Superior, Wis., Detroit Lakes, Minn., and Fargo, N.D.

What makes Essentia’s approach stand out is its focus on people, not hardware. Virtual nurses are not remote; they work on site, supporting colleagues they know by name.

“Our success comes from the staff themselves,” Ms. Radovich said. “They’re engaged, they love it and they keep finding new ways to use it.”

Beyond admissions and discharges, virtual nurses now mentor new graduates — “newly experienced RNs,” as Essentia calls them — walking them through strong admission interviews and discharge education. The results have been positive: Patients say they have never had so much time with a nurse, and staff report leaving on time more often.

“It’s about augmenting the bedside nurse,” said Melissa Fritz, DNP, RN, who oversees the program for Essentia’s West market. “We’re helping them spend more time with patients, and the patients can feel that.”

If Essentia represents the grassroots end of innovation, Cleveland-based University Hospitals is scaling in the opposite direction: whole-hospital transformation. Its Connected Care Team program, housed under the Veale Healthcare Transformation Institute, has wired every inpatient bed at UH Lake West Medical Center in Willoughby, Ohio, with cameras, microphones and AI-enabled sensors.

“We started with the problem: limited nursing capacity leading to inefficiency and frustration,” said program leader Brian Nelson, BSN, RN. “Could we put a solution in place that acts as a force multiplier for our nursing teams?”

From there, the team built a hybrid staffing model unlike most others in the country: Nurses split their time evenly between the bedside and the virtual hub.

“A nurse might be a virtual nurse one day and on that same floor the next,” Mr. Nelson said. “Patients see them on the screen one day, then in person the next. It builds trust.”

That structure, he said, has been key to keeping communication seamless and staff invested. His colleague and platform lead Lauren Yanus, MSN, RN, added that the flexibility has allowed nurses to innovate.

“We give them the space to ask, ‘What else can this technology do?’” That freedom has already led to unexpected breakthroughs, such as virtual triage in the emergency department, where remote nurses now help assess and direct incoming patients before medics even leave the room. At Lake West, early results show higher patient experience scores and improved staff engagement. The hospital is now studying how the technology affects falls, length of stay and discharge times.

At Baltimore-based Johns Hopkins Medicine, virtual nursing was co-designed. When the idea surfaced, Deborah Sherman, RN, director of virtual nursing, convened more than 200 people across six hospitals for a two-day design session.

“It was incredible,” she said. “We had bedside nurses, legal, pharmacy, IT, educators, even members of our patient family advisory councils — everyone in one room, in person, talking about what this should look like.”

From those sessions came a deeply collaborative model. Virtual nurses at Johns Hopkins rotate between the bedside and the screen, balancing direct care with virtual admissions, discharges and education sessions. They also help train new nurses and lead patient education calls that can include family members dialing in from home.

In its first seven units, the program has shown improved throughput, faster discharge times and higher HCAHPS scores among patients who interacted with virtual nurses. Ms. Sherman said what differentiates Johns Hopkins’ approach is its inclusiveness.

“We designed our model together, not from the top down,” she said. “It’s multidisciplinary, it’s evidence-based and it has heart. That engagement is what made it work.”

While Johns Hopkins focused on collaboration, Norfolk, Va.-based Sentara Health has doubled down on infrastructure. The system spent the past year hardwiring cameras and televisions into every inpatient medical-surgical and intermediate care room across all 12 of its hospitals, a level of standardization few other systems have achieved. That decision allowed Sentara to scale quickly, rolling out its program across 73 units in one year.

“This ensures seamless, user-friendly communication in every room,” said Jaime Carroll, RN, vice president of clinical support services and chief nursing officer. In less than 10 months, Sentara’s virtual nurses completed more than 35,000 patient sessions, totaling more than 8,600 hours of care. Patients report feeling more informed at discharge, and staff cite faster workflows and stronger teamwork.

Sentara’s next step is to consolidate systems: transitioning its legacy eICU program to the same platform, eliminating mobile carts and adding virtual sitter services. The goal, Ms. Carroll said, is a single, integrated network for remote care across the enterprise.

“The technology is only part of it,” she said. “It’s about making the experience cohesive for patients and clinicians: one system, one approach.”

Virtual nursing may have started as an emergency measure, but hospitals are turning it into an advantage — a tool to retain nurses, strengthen patient relationships and redefine care in the digital era. As Ms. Sherman put it: “Virtual nursing doesn’t take nurses away from the bedside. It gives them new ways to be there.”

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