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PRACTICE
The Day in a Life of a Virtual Nurse and a Bedside Nurse

By Jessyca Gammel and Pauline Avila

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What is your nursing background?
Jessyca: I became a nurse in the summer of 2022. I was a nursing student during the COVID-19 pandemic and therefore did a lot of my clinicals, learning, and overall program online. I accepted a position at Houston Methodist on Walter Tower 17, which is a specialty floor for Neurology/Neurosurgery. We take care of any condition that involves the central nervous system and beyond, whether the patient has Alzheimer's, a stroke, or needs back or brain surgery. Pauline: My nursing career began in 2009 as an ICU nurse in New Jersey. 11 years ago, my family moved to the Houston area, and I have since worked at Houston Methodist Hospital for the past 10 years. I spent 8 years in the MICU department and eventually earned my graduate degree as a Nurse Practitioner (NP). After working briefly as a NP in the Infectious Diseases department, I transitioned to the TeleNursing department about a year ago.
What are your typical day-to-day responsibilities?
Jessyca: In the morning, our nursing team typically conducts bedside shift reports and greets all of our assigned patients. I try to start my morning around 8:15-8:30 AM so that I can read effectively through my patients’ charts and be prepared for our care coordination rounds (CCR). After CCR, I work on patient charts unless there are specific patient needs, responsibilities, and/or admissions. When we do have an admission or discharge on our floor, especially ones early in the day, this is the best opportunity to collaborate with the TeleNursing team. During admission, their team helps us navigate medication reconciliation, past medical history, adding phone numbers to the patient's chart, etc. During discharge, they help us go through the paperwork put together by the physician and answer any patient questions so that we can multitask with preparing the discharge or helping with other patient care on the floor. My day also includes wound care and patient mobility. When my day is complete, I hand off each patient to their assigned nurse and log out for the day.
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Pauline: As a TeleNurse, bedside nurses call us through a device in the patient’s room and we communicate with patients in real time through an audio-visual platform. In our role, we assist with completing each patient’s admission documentation as well as discharge instructions and education with patients and their family members. Each call typically lasts about 15-20 minutes, depending on the complexity. Some calls may take longer especially when involving an interpreter, patients requiring extensive education, and patients with comprehensive medication lists.
When you initially found out about the TeleNursing Program, what were your thoughts/opinions?
Jessyca: I was skeptical about the program because my floor was one of the first to test it out. I originally thought it was going to be something else that would be added to my day and workload. However, I have come to love the program as a whole, allowing for enhanced workflow throughout the day.  Pauline: I learned about the TeleNursing program through human resources. I became very intrigued and curious about what the role entailed and was interested to see if it would be a good fit for my career.
The program has successfully been operating for about 2 years. What are your thoughts/opinions on the program now?
Jessyca: I love how easy it is to get in touch with the TeleNursing team and that it helps alleviate a lot of the workload from us as floor nurses. Patients like to talk to people a lot, so the fact that these TeleNurses are available to talk to patients in real time is a huge bonus. Pauline: After 2 years of operation, the Telenursing program has demonstrated its effectiveness in enhancing patient care and accessibility. We receive positive feedback from our patients who appreciate the time we dedicate to thoroughly reviewing their discharge paperwork, answering their questions, and addressing any concerns. I believe this personalized attention enhances their overall experience and supports their recovery. I absolutely love working as a TeleNurse; I never imagined that I would be caring for patients virtually in my nursing career. It has been a fantastic experience, and I believe we are genuinely making a difference in delivering quality patient care.
What are some of the best aspects of the program?  Also, what are some the program’s challenges?
Jessyca: Sometimes, we experience long wait times to reach a TeleNurse when it is a busy discharge and admission day because the program is so popular. There are occasionally technical difficulties, but the team has been updating and revamping the in-room cameras, and it has been going great since then.  Pauline: Some of the best aspects of the program include easy accessibility, increased efficiency, effective collaboration among healthcare teams, and improved patient outcomes by allowing the bedside nurses to concentrate on complex clinical tasks. TeleNurses are available 24 hours a day, 7 days a week which helps reduce the workload of bedside staff. The flexibility in my work schedule has provided me with an ideal balance between work and home life. Also, we are able to work remotely on a monthly basis, with half of our team working from home and the other half in the office.  Some challenges to the program include technological glitches within the platform, software malfunctions, and connectivity issues. Additionally, as workflows are constantly changing, we must remain flexible, adaptable, and open to trying new approaches.
Do you have experience with any other Houston Methodist innovation technology in your current role?
Jessyca: Our floor is a pilot unit, so we have utilized many of the Houston Methodist innovation technology devices. We use the BioButtons for patient vital sign monitoring which has been a helpful tool. The in-room cameras have also been a great tool in monitoring patients. It helps us know if they are tugging at any of their IV lines, getting out of bed when they should not be, and helping them get back to baseline when we are not present.  Pauline: TeleNurses monitor the patient BioButtons, which are placed on patients designed to track vital signs such as respiration and heart rate continuously. This facilitates the early detection of potential acute events and helps prevent issues before they arise, so we can effectively communicate our findings with the patient’s care team.
How do you feel that Houston Methodist inspires innovation for its employees and patients?
Jessyca: Houston Methodist always puts the patient first and finds ways to help their employees do that in the fastest ways possible.  Pauline: Houston Methodist fosters innovation by creating a culture that encourages collaboration between the care team and opportunities for creative problem solving that ultimately leads to improved patient outcomes. They provide resources for employees to explore new ideas and prioritize patient centered care. I believe this empowers staff to contribute to advancements that directly benefit patients.