From the nursing professional development (NPD) practitioner lens of environmental scanning, nursing is on the precipice of a major paradigm shift in the way we provide care, how we interact with the care team, and how we engage in the environment of care. Rapidly evolving technology elevates prior remote telehealth models—which gained popularity during the COVID-19 pandemic—by integrating artificial intelligence (AI) with the use of ambient room sensors, wearable technologies, AI chatbot capabilities, and more.

Training staff to use new technology and equipment has long been within the wheelhouse of competency management for the NPD practitioner. For those whose nursing practice predates computer charting, who can forget the transition to electronic medical records (EMR)? Like the major workflow and competency shift with EMRs, these changes far exceed the use of new technology and equipment alone. Many of these new technologies are being piloted or adopted for use across the country with little to no data to support the required competencies needed. When piloting a new technology, a team needs to both successfully implement the change and identify how it will impact the workflows of the care team, communication and team building among the clinicians, and documentation requirements in the EMR. 

Piloting AI at Ardent Health Services

A year ago, Ardent Health Services, which consists of 30 hospitals and spans six states, embarked on this journey by launching a pilot program at one facility struggling with emergency room staffing. In partnership with an AI tech company, the program implemented virtual care nursing (VCN) in the emergency room. The program hired experienced emergency room nurses to provide VCN with the use of telemonitors, providing task relief to bedside nurses through admission intake, discharge instructions, rounding, referrals, and teaching.

The success of the program led to another pilot in a different market. This pilot introduced VCN on a medical-surgical floor with the addition of AI-driven patient room sensors which collect ambient data. The sensors monitored patient activities and behaviors with the intent of fall prevention by notifying the VCN of a potential patient safety threat, thereby triggering actions such as a virtual check-in and/or communication by the VCN to the onsite care team for further intervention. Concurrently, another site piloted wearable biotechnology on non-ICU patients that provided continuous biometric monitoring (including most vital signs) intended to detect patient deterioration early.

Drawing on NPD Processes for Success

As we piloted these AI programs, I knew I had to apply the NPD process, and utilized the NPD Scope and Standards as a guide. I collaborated with all learners and other involved partners to develop competencies applicable to standard work in this uncharted practice environment.

Beginning with Standard 1: Assessment, a few months into the pilots I was tasked with drafting the standard work and orientation competencies for the VCN, primary nurse, and interactions with the providers. To achieve this goal, I pulled together a task force of relevant employees to better understand current virtual care workflows being utilized in the pilots, review any currently available competencies, evaluate the suggested virtual care workflows provided by the product vendors, and explore education and training options from third parties. The task force consisted of virtual care nurses, nurse managers and directors of the units, chief nursing officers from the facilities and the system, NPD practitioners at the facility level, and EMR analysts. One of the virtual care nurses had recently transitioned into their role from being a floor nurse and could provide input from their perspective.

Any good assessment starts with data. To build competencies for standard work, NPD practitioners must determine the expectations of the role and how to operationalize them. After reviewing currently available competency data with the stakeholders, the next course of action was to determine in detail the current workflow of each virtual care nurse by mapping out their daily work, step-by-step. This included how they:

• Currently performed their job;
• Determined their workload and assignments;
• Interacted with the technology and with the patients and providers;
• Communicated with the bedside nurse and unlicensed personnel;
• Documented their work;
• Built trust with the team;
• And what their pain points and barriers were.

Plus, a myriad of hypotheticals, such as:

• What if the equipment needs troubleshooting—who is responsible?
• What if family declines virtual care, where is this documented?
• What if the patient no longer wishes to participate—how is this communicated to bedside staff?
• What if the virtual care nurse cannot complete all elements of their assignment—how is the communicated to the bedside nurse?
• What if the patient is hearing impaired or speaks another language—how are these needs addressed?

Then, the task force reviewed every workflow in detail to dig deeper into understanding how the workflows are operationalized. Utilizing Standard 2: Diagnosis, the task force analyzed current processes, found practice gaps to address, and opportunities for improvement and standardization of the workflows.

In alignment with Standard 3: Outcomes Identification, the task force also identified several outcomes to address. Changes needed included:

• Optimizing the EMR to improve communication and documentation practices;
• Establishing unified standards for patient selection;
• Creating scalable standardized workflows to promote high reliability;
• Developing competencies for both the virtual care nurse role and beside care team members and providers;
• Integrating the competencies in the orientation program;
• Identifying key performance indicators (KPIs) to measure performance and outcomes;
• And promoting seamless patient care among team members through deeper integration of the new technologies. For example, integrating the communication process within Rover devices, or combining technologies to include both biosensors for the patient and ambient room sensors to the patient rooms where these technologies were separate in the pilots.

To accomplish these outcomes, Standard 4: Planning became essential. Additional relevant people joined the taskforce to help optimize technology, improving communication between the virtual care nurse, the care team, and patient.

To prepare for Standard 5: Implementation, the EMR team developed training materials for the documentation changes and presented a plan to the taskforce to socialize the care team to the upcoming changes. These changes would fundamentally change the workflows for both the VCN and the bedside nurse by introducing new documentation to promote communication and create the ability to track KPIs related to hours of care, type of care provided, and more. Implementation will drive the standard work for the roles as well as competencies needed to be successful in a virtual care team setting.

As for Standard 6: Evaluation, outcomes from the implementation of these technologies have garnered positive feedback from both patients and the care team. VCNs on the taskforce shared the positive feedback they’ve received from patients, who have expressed how much they appreciate having someone readily available to answer questions and consistently check in on them. VCNs also shared positive feedback they have received from the bedside nurses by being able to alleviate some of their tasks and free up the bedside nurses time. Measurement of the KPIs will require more data in the long term.

What’s Next for NPDs and AI?

As this technology rapidly evolves, NPD practitioners play a key role in leading the development, change management, and implementation of new competencies staff require to provide high quality care. We must continually be vigilant of the changing health care landscape and anticipate more advances in the near future.

To help guide nursing practice through this wave of technological advances, the American Nurses Association (ANA) has a webpage dedicated to the use of telehealth in nursing and has issued ANA core principles on connected health. These resources will prove beneficial to all NPD practitioners as we navigate to align these technological advances with standards of professional performance for NPD.