Co-Caring and Virtual Nursing

Co-Caring shifts the patient care delivery model and incorporates virtual (remote) nurses into the care team. Previously, nurses on these units followed a primary care model. Under this model, one nurse was responsible for most of the care and tasks for a cohort of patients. Going forward, caregivers on these units will follow a team-based model. Under this new model, work is re-distributed between multiple caregivers, with each responsible for certain elements of patient care. Team members include:

• Bedside Nurse: Provides hands-on care such as administering medication, responding to emergencies and performing nursing procedures that require a physical presence.
• Virtual nurse: Responsible for support of administrative tasks such as discharge planning, medication management, providing loved ones with updates and patient education.
• Nursing assistant: Provides basic patient care such as helping patients use the toilet, taking vital signs and monitoring a patient’s condition.

Co-Caring is designed to foster collaboration among bedside nurses, nursing assistants and virtual nurses, who work together to provide patient care both onsite and remotely. This approach redistributes the workload, allowing each team member to practice at the top of their scope and focus on their individual strengths.

The redistribution of work on the care team also means the bedside nurse can focus their attention on the tasks that require them to be physically present, allowing for greater emphasis on quality of care and patient safety. The virtual nurse and nursing assistant are accountable for tasks that were previously handled by bedside nurses, but don’t require a physical presence to complete.

Virtual nurses work remotely and interact with the patient via a large television screen in the patient room. These nurses are real people — they are not computer-generated — and are licensed by the Alaska Board of Nursing, ensuring they meet the same standards and expectations as their bedside counterparts.

Virtual nurses will never appear on screen or view the patient’s room unless the patient first approves it. The camera is turned off and pointed away from the patient’s bed. The virtual nurse will alert the patient by a knock sound and request to come onscreen and will only do so if the patient approves the request, maintaining the patient’s right to privacy.

The virtual nurse is not the only nurse a patient will interact with. They’re part of the care team, collaborating with the bedside nurse and nursing assistants to ensure all aspects of patient care is thoroughly covered.

One thing that’s important to know is that Co-Caring is safe for patients. The addition of the virtual nurse to the care team means more comprehensive care. The virtual nurse is an additional caregiver for each patient.

Patients have indicated they appreciate the model because they feel more attended to. They like the fact they can quickly connect with their virtual nurse anytime.

Patient families have also expressed appreciation of the model. Family members who cannot be in the hospital with their loved one can access the virtual nurse anytime to get status updates, communicate information about their loved one and even join a virtual visit with the patient via video.

Co-Caring and Virtual Nursing have also shown positive health and safety outcomes. Across the Providence family of organizations, Co-caring has resulted in:

• A 50% reduction in patient falls with moderate to severe injury
• A 20% reduction in average patient discharge time
• A 5% reduction in hospital-acquired infections

With Co-Caring, each patient has three caregivers — bedside nurse, virtual nurse and nursing assistant — who are ready to provide care. If the bedside nurse is unavailable to provide immediate care, the virtual nurse and nursing assistant can alert other members of the unit to assist in providing urgent care to a patient.

This is like the care that was delivered under the primary care model. However, unlike the primary care model where one bedside nurse is primarily responsible for the care of four or five patients, the team-based model shares patient care responsibilities between a bedside nurse, virtual nurse and nursing assistant.

The goal of Co-Caring is to meet the growing demand for care and help address caregiver burnout. Created by nurses for nurses, Co-Caring is an innovative solution to one of health care’s most pressing problems – the shortage of nurses. Any cost savings will come from improvements in nurse retention. According to one study, it costs $61,110 to replace just one bedside nurse including the costs for recruitment and orientation. Based on the 16.4% turnover rate nationally, for every one-in-six nurses that leave a 200-bed hospital, that’s a loss of at least $3.9 million.

The redistribution of work in the team-based Co-Caring model relieves the bedside nurse of administrative burden, helping reduce burnout and improve job satisfaction. More than 30 studies show nurse satisfaction improves overall retention.

There is a nationwide shortage of nurses that is projected to continue. According to the American Hospital Association the U.S. will need more than 200,000 new registered nurses each year to meet the increasing health care needs.

A 2024 analysis by the Alaska Hospital & Healthcare Association reported that more than 1,400 new nurses are needed in Alaska each year to keep up with staffing needs. This study also reported that Alaska hospitals had an average nurse vacancy rate of 22% and it took an average 138 days to fill a vacant position.

Additionally, a study by the National Center for Health Workforce Analysis in 2022 projected Alaska will have the highest nurse vacancy rate in the nation by 2030 with 23% unfilled positions — a shortage of 5,400 registered nurses.

Yes, nurses who provide care virtually have the same job description and requirements as other nurses working in the unit and are licensed by the Alaska Board of Nursing.

The video cameras used in patient rooms are on the Providence’s secure network, which is the same HIPAA-compliant network that is used to protect access to patient records.

Health care facilities in the U.S. must comply with the HIPAA Security Rule, which establishes national standards to protect individuals' electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.

Additionally, when the virtual nurse is not on screen visiting a patient, the camera is pointed away from the patient toward the wall, ensuring the patient has privacy.

The Co-Caring model of care has been in use since November 2023 and is currently being used at 12 inpatient units and eight hospitals within the Providence family of organizations, including here at Providence Alaska Medical Center. The units where Co-Caring is used include several medical-surgical units, a dialysis and nephrology unit, and an emergency department.