Background: Virtual nursing is the “use of telecommunications and information technology to provide nursing services remotely…through long-distance information and communications technology” (Kim et. al, 2021, p.1007). It is a promising emerging model of care to aid with nursing staff shortages, varying experience levels, and complex patient needs. Despite virtual nursing’s growing prevalence, there is a significant gap in the evidence on how best to operationalize this model, including staff-level barriers and facilitators to success (Whalen, in press).
Aim: To assess barriers and facilitators to implementation of virtual nursing, including assessing staff perceptions of usefulness, acceptance, and appropriateness.
Methods: This mixed methods study was conducted at a large academic medical center among staff on all virtual nursing pilot units prior to implementation. All study participants provided basic demographic information via a Qualtrics survey. Quantitative data assessed perceptions in the domains of usefulness, acceptance, and appropriateness, using a validated survey (Marco-Franco, 2022 & 2023), with 18 five-point Likert scale (1-strongly disagree to 5-strongly agree), 3 yes-or-no, and 1 open-ended question. Quantitative data was summarized using descriptive analysis and included average scores for each domain. Study team members conducted qualitative semi-structured interviews; after transcription and cleaning, data underwent analysis using constant comparison and consensus coding to generate themes.
Results: Of approximately 183 staff, 85 provided quantitative responses. The average scores in each domain were usefulness 3.23, acceptance 3.42, and appropriateness 3.21. When asked a yes-or-no question, 82.4% found virtual nursing useful, 84.7% considered it acceptable, and 76.5% thought it was appropriate. Thematic coding of 12 interviews generated 16 codes reflecting both barriers and facilitators that were grouped into 3 themes: trust, clear roles and responsibilities, and communication.
Discussion: Participants viewed virtual nursing’s usefulness and appropriateness as neutral to somewhat positive, with acceptance rated slightly more favorably. Due to this ambivalence, successful implementation will be critical in shifting staff perceptions more positively. Virtual nursing has significant potential to be operationalized successfully when certain criteria are met. Healthcare leaders must communicate clearly to prevent confusion, provide clear role delineation, and foster a trustworthy environment before implementation. Virtual nursing must be executed skillfully to achieve the best results.