Virtual Nursing: How Technology is Supporting Patient Care

Think of a typical scene in an Indian hospital at night, with just one nurse on duty, many patients to attend to, and insufficient time for even one complete round. The nurse-to-population ratio in India is far lower than the recommended international standard, and smaller city hospitals have to contend with this challenge to a greater extent than larger metropolitan hospitals. In such a scenario, virtual nursing has been a way out, whereby the use of video conferencing, sensor technology, and patient monitoring has enabled fewer but more experienced nurses to monitor more patients as well as wards. In this article, I will discuss virtual nursing in detail, its status of adoption in India, and its challenges.

What is Virtual Nursing?

Virtual Nursing describes a care model in which a nurse virtually supports the needs of patients and the bedside nurses by way of video calls, monitoring dashboards, and interconnected devices, but does not necessarily have to be physically present by the bedside of all patients for all tasks. A virtual nurse may help complete the admission process paperwork, give discharge education, or act as the second pair of eyes looking at the patient's vitals, while leaving the bedside nurse free to do the practical work.

Telemedicine in general, on the other hand, involves connecting the patient to a physician for an online consultation. In this case, virtual nursing specifically involves extending the nursing care processes and observation from a remote location, and it is usually connected with remote patient monitoring - continuous data collection from bedside machines and wearables monitored by a virtual nurse.

Some hospitals use the approach to establish a special virtual care centre, in which a small team of more experienced nurses monitor several wards or even several hospital facilities from their computers rather than relying solely on the nursing team at each ward for all tasks.

Where India's Adoption Currently Stands

Nursing shortages make this technology especially relevant to India. According to the Indian Institute of Technology Madras, the current nurse-patient ratio in the country is estimated at less than 2 out of 1,000 people, compared to the WHO-recommended three per 1,000, with industry estimates suggesting a shortage of around 2 million nurses in 2030 if the trend persists. It is believed that nurse shortages occur especially in tier-2 and tier-3 cities where hospitals might have state-of-the-art infrastructure but lack qualified nursing personnel.

The development of virtual infrastructure in India has been rather fast in recent years with the help of national telemedicine platforms that have managed to complete several crore consultations. The infrastructure was not created to serve the purpose of virtual nursing; rather, the creation of such infrastructure has helped develop necessary digital habits and capabilities that make it easier to implement virtual nursing models.

The implementation of virtual nursing models in individual hospitals lags behind that of remote consultation models with doctors. Large hospital chains are known to be trying out virtual monitoring and ICU models more frequently compared to small or publicly owned hospitals that have less capital available to support camera, sensors, and dashboard software required for the models.

The Ways Virtual Nursing is Already Supporting Care

Remote patient monitoring of vital signs is one of the well-developed applications, with connected devices measuring such parameters of a patient as heart rate, blood saturation, or blood pressure constantly, while a virtual nurse analyses the received data stream to detect any alarming signs instead of regular in-person assessments.

Supporting admission and discharge processes is another popular application. Such administrative functions as giving instructions for discharge and checking a patient’s comprehension of the necessary medications, as well as completing admission documents, may be done remotely by a nurse.

A virtual ICU or high-dependency unit is the third advanced application of telemedicine technology. This type of nursing involves the monitoring of ICU beds by a team of experienced critical care nurses through video feeds and live data from different locations within one hospital or several hospitals.

Why Virtual Nursing is Gaining Ground

First, the obvious benefit here is that of extended reach of the workforce. It is possible to have one experienced nurse doing their job remotely to cover several wards or even several hospital locations depending on a particular approach, thereby expanding the reach of the nursing workforce without proportionally increasing the size of the actual physical workforce for each bed added.

The second benefit is continuous monitoring. Since remote patient monitoring systems are capable of monitoring patient health continuously and not just during scheduled visits, any changes in the condition of patients can be detected faster. It is especially important to do so in those wards where there is already a lack of staff available to care for the number of patients present.

Another advantage is that of role flexibility for the nursing professionals themselves. The roles of virtual nurses may be less stressful both in terms of physical demands and scheduling than those of bedside nurses, and this is viewed as a means by some hospitals of retaining their more experienced nursing professionals.

Where Virtual Nursing Still Faces Resistance

Cost of infrastructure poses another obstacle. The creation of virtual care centres requires costs incurred in purchasing the camera, connected devices, dashboard and connectivity, which can be more readily managed by large, well-financed hospital groups as opposed to small and publicly owned hospitals struggling with the most severe nurse staffing shortages.

Issues with workflow and training pose another potential problem. Virtual nurses require a skill set that bedside nurses do not. A skill set that bedside nurses do not require, such as the ability to use monitoring tools and communicate remotely, and the hospital will require designing a workflow on how the virtual nurse should refer an issue that needs immediate attention to the on-site nursing staff, instead of expecting the technology to solve the coordination problems.

Trust and acceptance pose yet another challenge. Both patients and nursing staff need to accept the fact that their care will be partly provided through virtual nurses, and some research conducted on the matter in other countries has shown that certain workload and responsibilities of the virtual nurses remain unclear as opposed to standardised and established.

Where Virtual Nursing Goes from Here

Considering the magnitude of the nursing shortage India is expected to face in the future, it seems inevitable that virtual nursing will continue to grow as yet another measure hospitals use to get the most out of their nursing staff without having to hire or retain more nurses. Today, virtual nursing is largely practised by the most advanced hospital chains, but the pace at which it will move beyond those hospitals and into smaller and public hospitals will be determined mostly by cost.

The way forward for the development of this practice will largely involve integrating virtual nursing with AI-powered monitoring systems to identify early warning signs in patient data without requiring constant monitoring by the virtual nursing team.

The way in which virtual nursing will address the nursing shortage in India, or will be largely practised by some well-endowed hospitals, will largely depend on how fast hospitals practising it receive adequate training and funding.

Considering the magnitude of nursing shortage expected in India, virtual nursing can be said to play an increasing role as one of several ways for hospitals to use their already strained resources – but whether this actually solves the problem for the whole nation, or remains confined only to some well-endowed hospitals, would have more to do with how quickly these hospitals train their employees than the actual availability of this technology.

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