According to our analysis, RNs seemed concerned that their organizations are prioritizing technology investments over hiring additional staff, which is crucial for the hands-on support they need to effectively manage their workloads. From the RN perspective, the new technology seems misplaced given the acute need for essential personnel. The quotes below underscore nurses’ strong desire for a reallocation of resources toward recruiting more staff to meet the pressing demands of patient care:

"My hospital is apparently hiring virtual nurses instead of staffing physical on-floor nurses appropriately. No idea how that could possibly help."

"Another big waste of money that won’t work that could have gone to staffing."

While RNs do see the benefit of virtual nurses handling administrative tasks, the limitations of virtual nursing stand out to bedside RNs. One nurse voiced this opinion:

“We have ‘virtual nursing’ at our hospital… It's been a complete waste of time and money. The only thing they are allowed to do is chart your vitals, which automatically fills it for you when you click the time, but they don't even do that correctly, they will chart respirations as zero without changing it. Useless.”

Echoing this sentiment, other nurses question the practicality of virtual assistance:

“Which one does compressions?”

“I wonder if they can help me reposition my patient…”

Leaders should emphasize that virtual nursing is intended as a supplemental support for nursing staff amidst workforce shortages, not a standalone solution. It is also crucial to demonstrate a continued commitment to recruiting and retaining bedside staff.  Addressing these concerns directly helps build a culture where technology is seen as a support for bedside RNs, working in tandem with proper staffing to enhance patient care. Ensure frontline nurses are aligned and informed about the strategic investments and staffing decisions by:

• Being upfront with staff as to the way in which virtual nursing fits into the broader staffing strategy. Nurses want transparency, and may hear any promises that virtual nursing will not reduce the organization’s focus on in-person staffing as hollow or dishonest.  Provide as much context as possible on how virtual nursing will impact staffing plans in the short- and long-term, along with relevant cost-benefit analyses.
• Reinforcing your recruitment and retention strategy: Collaborate with nursing staff to review and refine the organization’s recruitment and retention strategy, ensuring transparency in staffing investments. Furthermore, boost the visibility and accessibility of key stakeholders, including human resources, who are instrumental in steering recruitment and retention efforts.

Nurses shared concerns that their organizations might use virtual nurses to reduce the number of bedside RNs and justify an increase in bedside nurse-to-patient assignments. This sentiment likely stems from nurses perceiving that organizations are attempting to reduce costs by cutting staffing dollars.

“These [virtual nurses] would be great if they were used in addition to current staff to free up more time for care. But we all know they will be used to replace current staff and ratios will go through the roof because your virtual nurse now counts.”

“You know this is exactly what will happen…higher patient ratios because someone on a screen will replace in person nurses.”

Some RNs shared they have considered leaving their organization if virtual nursing replaces, rather than supports, bedside staff, due to the potential for increased patient ratios as a cost-savings measure:

“I heard my hospital will be adding the ‘benefit’ of having virtual nurses watch patients in their rooms so that the floor nurses will have the ‘opportunity’ to go up to 8-9 patients as compared to the regular 5 on our card[iology] tele[metry] floor… I for one will no longer be working for this organization if they implement this."

Leaders must clearly communicate how virtual nursing will affect staffing ratios and workload. If virtual nursing will not impact staffing levels, leaders should clarify that its purpose is to cut down on administrative tasks and prevent additional patient assignments, allowing nurses to dedicate more time to direct patient care. However, if virtual nursing is part of a strategy that affects staffing ratios, leaders must be candid about these changes, highlighting how they will benefit both the frontline staff and patient care. Leaders should explain the expected changes to headcount and ratios, and how they plan to support nursing staff through these strategic adjustments. Address the impact of virtual nursing on staffing ratios by:

• Collaborating on staffing model revisions: Collaborate with frontline staff, human resources, and staffing specialists to update current staffing models to incorporate virtual nursing roles. Ensure these revised models reflect a mix of virtual and bedside nursing roles that optimizes patient care and staff well-being.
• Monitoring and adjusting staffing plans in response to staff feedback: Continuously assess nurse workloads and patient assignments to effectively accommodate the integration of virtual nursing. Use staff feedback and key performance metrics to make any necessary adjustments to ensure nurses can focus on direct patient care without being stretched too thin.

Nurses worry that managing virtual nursing technology could become yet another item on their already extensive checklist of responsibilities, potentially slowing down processes they have efficiently executed without technology. Overall, nurses are concerned that the adoption of virtual nursing technology could inadvertently add to their workload rather than alleviate it, as they grapple with technical issues and unreliable equipment.

"This sounds like one more task that I would constantly be having to worry about managing when I could do all that faster without it."

Additionally, our findings indicated that the potential for technology failures heightens apprehension among nursing staff. They fear frequent technical issues could compromise patient care and predict that the equipment might easily malfunction or face connectivity problems. Nurses anticipate that when technical issues inevitably arise, the expectation will be that nurses function as IT support, straining their already stretched capacity.

"Who's going to fix them when they shut down? Because you know they're going to call the actual nurses to help."

"Pretty sure like any other hospital equipment 4 of them will be down in under a month, 2 won't connect in certain rooms, and patient z destroyed 1...nice try though."

"Those things will be in a closet with a Post-it note on them in less than a month. 'Broke!'"

Leaders should collaborate with the frontline to ensure virtual nursing enhances workflow efficiency. Continuous feedback and process adjustments, coupled with robust support and training on the new technology, will help demonstrate a commitment to ensuring that virtual nursing genuinely supports nursing staff. Achieve this goal by:

• Assessing workflow design: Involve nursing staff in the design and implementation of new workflows to help seamlessly integrate virtual nursing. Organize cross-functional teams that include IT specialists, nurse educators, and frontline nurses to map out how workflows are impacted and enhanced by technology.
• Creating specialized support roles: Establish dedicated roles or teams responsible for virtual nursing technology support to ensure technical issues are addressed promptly without overburdening nursing staff. Learn how UCHealth's patient technology technician serves as a vital link between clinical staff and IT support in our detailed case study.

¹ Siwicki B. 74% of hospital leaders say virtual nursing will become integral to acute care. Healthcare IT News. December 10, 2024.

² Reddit. r/nursing. Reddit.com. Published 2025.