Exploring the Critical Relationship Between Virtual and Bedside Nurses

Abstract

The COVID-19 pandemic has magnified the challenges faced by healthcare professionals; in particular, it exposed the highly stressful work environment the bedside nurse (BSRN) navigates while providing patient care. In response, virtual nursing (VNG) became an innovative solution to fill the gaps in healthcare delivery, and it continues to grow as a nursing discipline. The adoption of VNG, which facilitates real-time communication with BSRNs, presents challenges in maintaining trust and collaboration in a digital environment between the remote virtual nurse (RVN) and the BSRN. Barriers such as skepticism, misperceptions about the RVNs' role, and mistrust are discussed, alongside strategies to improve the working partnership between RVNs and BSRNs. The importance of gaining bedside leadership support, offering mentorship, offloading work from the BSRN, communication techniques, and practical interventions is suggested as potential steps the RVN can take to enhance their collaboration with the BSRN. This article proposes continued integration of VNG throughout diverse healthcare settings to potentially improve patient outcomes and expresses the urgent need for further research to improve the evolving RVN–BSRN partnership.

Introduction

The COVID-19 pandemic intensified an already stressful work environment, likely contributing to the unprecedented departure of nurses in 2021 (Auerbach et al., 2022, April 22). To alleviate the pressure, virtual nursing (VNG) became an innovative solution to fill the gaps in healthcare delivery, and it continues to grow as a nursing discipline (Ahmed, 2023). In general, the VNG model seeks to retain staff, provide experienced mentorship, decrease burnout/bedside workload, and improve patient outcomes (Perpetua et al., 2023; Roberson et al., 2023; Russell, 2023). Although various forms of VNGs were in place before COVID-19, the pandemic accelerated their use in the acute care setting (Ahmed, 2023; Perpetua et al., 2023).

There are many variations of VNG, but predominantly, it entails a two-way audio/video that enables communication between the remote virtual nurse (RVN), bedside nurse (BSRN), and the patient (Cloyd & Thompson, 2020). While this model can be applied across various settings, this article will focus on its use in acute care environments in US hospitals, such as medical/surgical, telemetry, or progressive care units, where the RVN collaborates closely with the BSRN to deliver patient care. Typically, many RVNs work from home or in a centralized off-site location (Sagastume & Peterson, 2023).

VNG offers several solutions to an increasingly demanding work environment; however, a major concern is maintaining the trusting relationships that are essential in nursing practice, particularly when in-person interaction is limited (Russell, 2023). This article aims to identify gaps in the literature about virtual and BSRN collaboration and suggest evidence-based as well as experience-based strategies for improving the working relationship between RVNs and BSRNs. The article's purpose is to support both VNG and BSRN as they navigate this new frontier, drawing on personal professional experience.

Brief Review

Acknowledging Barriers

Nurses who work together on a given shift are not simply colleagues; they function as each other's support system throughout the fluctuating demands of patient care. Whether it is through assisting a colleague in a medication pass or covering a break for a nurse who is grieving the loss of a patient, nurses forge bonds through helping one another. These moments of camaraderie foster trust and reliance based on shared experiences. However, what happens when the in-person shared experience changes to a virtual setting? What type of relationship is realistic, and how will the quality of such a relationship between the BSRN and RVN be affected? These are the questions that RVNs and the BSRNs who work with them face as they manage interpersonal relationships behind the computer.

The screen between the RVN and BSRN can create mistrust, doubt, hesitation, and overall skepticism from the BSRN. Roberson et al. (2023) touched on this in their VNG quality improvement initiative; their postimplementation surveys identified that some BSRNs had negative feelings toward the VNG intervention, citing they would have preferred additional in-person nursing support and expressing distress about short staffing. Furthermore, the RVN scope of practice/virtual capabilities were unclear to the BSRN (Roberson et al., 2023). This is just the tip of the skepticism iceberg expressed by the BSRNs. Based on observation within the workplace, other frequently expressed complaints include hesitation in utilizing technology, the notion that it is simpler for the BSRN to complete the task themselves, doubt in the RVN's ability to handle complex tasks, and lack of trust in the RVN's experience/professional background.

While integrating technology into healthcare is not a new concept, the accelerated implementation has contributed to the potential for valid skepticism, concerns, and biases from traditional in-person healthcare professionals (Roberson et al., 2023). To build stronger relationships between RVNs and BSRNs, further insight is needed to address common misconceptions, foster a better understanding of VNG, and ultimately improve patient care.

Current Insights

Agents of Change

It is important to recognize that the initiation of VNG typically occurs at the organizational level (Sagastume & Peterson, 2023). Consequently, cultivating supportive nursing leadership is a foundational aspect for both the successful integration and long-term sustainment of the RVN model (Cloyd & Thompson, 2020). The support from nursing leadership is critical to overcoming skepticism and building trust between RVNs and BSRNs in a digital environment. This aligns with Russell (2023), who noted that trust between all team members is a vital component to the success of VNG. Gaining buy-in from nursing leadership also assists in the utilization of VNG from BSRNs (Roberson et al., 2023). As a result, it can contribute to the positive partnership between the RVN and the BSRN. Anecdotally, skepticism on the part of formal or informal leaders can make rapport-building between RVNs and BSRNs more challenging. As a possible solution, nursing leadership should be skilled in facilitating change, actively supporting the VNG model, and the practice changes that RVNs will bring to the bedside (Cloyd & Thompson, 2020; Russell, 2023).

Healthcare professionals are more likely to support a new initiative and become invested in the changes occurring when they have input in its development (Nilsen et al., 2020). An opportunity to accomplish this is when nursing leadership incorporates the feedback or perspectives from the BSRN regarding how to utilize the RVN (Cloyd & Thompson, 2020). For example, if BSRNs express limited time to call nurse-to-nurse reports for skilled nursing facility discharges, nursing leadership can request that the RVN take ownership of this task. Adapting VNG workflow changes such as this affirms their positions as stakeholders in the VNG model.

How the RVN Assists

BSRNs may perceive any changes implemented by organizational leadership as an additional task toward their already busy workload, contributing to a general feeling of helplessness, negative bias, or even burnout toward change implementation (McMillan & Perron, 2020). Accordingly, nursing leadership should articulate the value VNG brings to the BSRN. Two plausible ways to express this are by providing RVN with the ability to mentor BSRNs and by offloading BSRNs' responsibilities (Roberson et al., 2023; Russell, 2023; Sagastume & Peterson, 2023). A positive work environment can boost staff retention (Press Ganey, 2024), and VNG support can play a key role in enhancing the bedside work environment.

There is a growing concern that newly graduated BSRNs are not prepared to meet the demands of nursing (Franqueiro, 2025). RVNs can play an integral role in mentorship, especially with novice nurses (Russell, 2023). With this practice model, an experienced RVN is readily available to lead them through unfamiliar interventions, offering support and potentially improving BSRN retention (Russell, 2023).

Post pandemic, 56% of nurses are still experiencing the effects of burnout (Doucette et al., 2023). Offloading tasks from the BSRN can contribute to reducing the effects of burnout by unburdening the BSRN (Sagastume & Peterson, 2023). RVNs can assume responsibility for time-consuming tasks such as discharging a newly diagnosed diabetic patient requiring a translator. While supporting the BSRN, the RVN can concurrently spend more time with the patient, completing hands-off tasks to potentially improve patient outcomes (Perpetua et al., 2023; Russell, 2023; Sagastume & Peterson, 2023). When RVNs are offloading work, it is seen as a valuable contribution that enhances the professional relationship (Roberson et al., 2023).

Exploring the Underpinnings of Virtual Communication and Practices

The Rationale VNG Practice Model was developed to improve the asynchronous HIV education patients receive from nurses virtually (Rouleau et al., 2023). This model could be incorporated to improve the RVN–BSRN relationship. One of the key components is “responsive communication,” or attentive communication; this can signify that the RVN is invested in their outcomes (Rouleau et al., 2023, p. 171). Therefore, responsive communication is a conversational tool that can assist in building trust with the BSRN because it can convey that the RVN behind the computer is reliable and readily available to meet the needs of both the BSRN as well as the patient. Additionally, Table 1 reveals more perspectives on the practices that the RVN can utilize to gain partnerships with the BSRN.

Table 1.

Practice Techniques for Strengthening the RVN–BSRN Partnership.

Tips, Tricks, and Traits for the Successful RVN

Be Transparent Communicate limitations: If the RVN is asked to assist in an unfamiliar area, they should communicate their limitations to the BSRN. However, it is equally important to convey that the RVN will actively seek solutions or resources to continue supporting the BSRN. If BSRN asks for assistance but the RVN is occupied with several other tasks, clearly inform the BSRN. Because the BSRN cannot visualize how busy the RVN is, it is often insightful for the BSRN for the RVN to list the current tasks at hand. For example, if the RVN simply states, “I am currently completing … at the moment, but I will be able to assist you when I am done!,” it allows the BSRN to recognize the work of the RVN and concurrently sets BSRN expectations for when the RVN will be available. The RVN should ask clarifying questions from the BSRN on unclear or critical interventions delegated to the BSRN.

Develop Thoughtful and Strategic Patient-Centered Interventions If RVNs can create and then implement personalized interventions/care plans, it enables the patient to have confidence in their treatment plan, the RVN (Rouleau et al., 2023), and the healthcare treatment team in general. The RVN is conveying an active investment in improving patient outcomes. As a result, the BSRN can further develop confidence, trust, and dependability in the RVN. Take the initiative to discover interventions and/or offloading tasks that will benefit both the patient and the BSRN. Examples include: ▪ If the RVN identifies a medication error, the RVN can call the pharmacy and/or the prescriber to initiate an order change. ▪ Increasing remote virtual patient rounding for disoriented and/or fall-risk patients. ▪ Thoroughly educating patients on their new medications, diet restrictions, any new or chronic diagnoses management, and more. ▪ Completing a chart review on high-risk sepsis patients. ▪ Reviewing lab results and contacting the provider if appropriate.

Utilize the Servant Leadership Lens The servant leader approach is founded on empathic, supportive, and nurturing characteristics directed to serving their team's growth (Erwin, 2023). The RVN can use this lens to build rapport with the BSRN. Acknowledge and verbally empathize with the challenging work/tough shifts that the BSRN experiences. Facilitate a sense of teamwork between the BSRN and RVNs by attentively responding to the requests of the BSRN and/or working together to accomplish complicated patient care interventions. Convey that supporting the BSRN is the top priority, which then benefits the patient and their outcomes. Anticipate the needs of the BSRN/patient and provide interventions accordingly.

Implement Proactive Practices and Enthusiastic Communication Participate in unit-based meetings and express interest in unit-based culture. While communicating through direct messaging, text messages, phone calls, etc., create dialogue that engages the BSRN. Occasionally, RVN should complete in-person rounding to maintain a physical presence and use this time to gain feedback from BSRNs. Ask if the BSRN received a break; if not, the RVN should proactively identify areas to assist to enable it. Become intentionally approachable through virtual communication by enthusiastic responses.

Note: The table reflects the author's professional experience and incorporates tools and insights used in their practice. RVN = remote virtual nurse; BSRN = bedside nurse.

Reflections for the Future

It is essential that organizations recognize the value of VNG as a necessary intervention to meet the evolving demands across various healthcare settings (Cloyd & Thompson, 2020; Russell, 2023). VNG can be expanded beyond the acute care setting to include areas such as community health, palliative/hospice, chronic disease management, surgical centers, substance abuse treatment, and so on. As previously mentioned, VNG can assist in retaining BSRNs by offering real-time support. Alternatively, VNG can also retain seasoned nurses who may be experiencing symptoms of burnout and leverage them into the RVN role (Cloyd & Thompson, 2020).

Conclusion

VNG is an innovative solution to meet the challenges faced by healthcare systems, particularly in the wake of COVID-19. It offers an opportunity to improve patient outcomes and support the BSRNs. However, the success of this model is likely dependent on maintaining and enhancing the relational components that enable effective collaboration. Further research is needed to better understand how to both cultivate and preserve the RVN–BSRN partnership over time. While this article offers meaningful insights and practical suggestions for fostering cohesive collaboration, it also highlights the ongoing need for evidence-based models to support a sustainable cross-functional practice.