Core principles to guide dissemination of this practice model
Virtual nursing—a new and steadily growing practice model that enables nurses to connect with and provide care to patients through technology—has the potential to further transform care delivery. With more organizations adopting virtual nursing, there’s a clear need for standards to safely and effectively implement this technology and tool. Virtual nursing has shown promise for improving access, efficiency, and satisfaction among nurses and patients, and it could expand access to care, improve nurse well-being, and strengthen patient engagement and empowerment, according to the American Academy of Nursing.
“Virtual care will become the standard of care across the continuum within the next couple of years,” said Bonnie Clipper, DNP, MA, MBA, RN, CENP, FAAN, CEO of Innovation Advantage and founder of Virtual Nursing Academy, which has provided services to several American Nurses Association (ANA) constituent and state nurses associations. “This model is more than just nursing and technology. It’s a new patient care model that leverages the care team through technology. Nursing is perfectly positioned to redesign its practice.” A Texas Nurses Association member, Clipper was one of 29 subject matter experts who served on an ANA professional issues panel on virtual nursing.
Implementation imperatives
A study by Khairat and colleagues indicated that key aspects for implementing a virtual nursing program should address available virtual nurses per shift, the availability of virtual nursing equipment, the physical layout of virtual nursing workspaces, and training of virtual nurses on best practices for virtual encounters and on policies and procedures. They should include when to escalate technical issues, simultaneous use of electronic health records, and available support resources for problem resolution. Virtual nursing’s growth has widened concerns about standards of practice related to staffing ratios and matrices, license portability, regulations, and reimbursement. A recent survey from AvaSure indicated that 74% of hospital leaders say that virtual nursing will become integral to acute care.
In June 2023, the ANA Membership Assembly, the association’s governing and official voting body, indicated that establishing principles for virtual nursing was a priority given the practice model’s increased adoption and the need for clarity around best practices for its use.
The 2023 Membership Assembly approved the following recommendations:
- Develop a national policy that addresses standardization of virtual nursing practice as a modality and consider funding and reimbursement models, as well as implications associated with licensure, regulation, and liability.
- Advocate for technology that meets nurses’ and patients’ needs.
- Support data collection on virtual nursing to understand its impact on nurse and patient satisfaction, as well as patient outcomes.
- Recognize virtual nursing as a source of support for nurses at the point of care. Virtual nurses should support, but not supplant, nurse staffing in nursing ratios, matrices, or other measures of staffing levels.
Professional issues panel actions
In May 2024, ANA published a call for members to participate in a professional issues panel for virtual nursing with a focus on developing principles and guidelines to implement and incorporate virtual nursing into nursing practice, irrespective of the technology used to deliver virtual nursing care. Expected outcomes for the panel included crafting a definition of virtual nursing and developing guidance for using virtual nursing that speaks to:
- Funding and reimbursement models
- Impact on nurse and patient outcomes
- Impact on portability, licensure, and other regulations governing nursing practice, including nurse liability
- Impact on nurse staffing
- Ethical implications of virtual nursing
The panel met over 5 months from July to December 2024 to determine and agree on the ideological approach, scope of work, and key components of this report. The 2019 ANA Core Principles on Connected Health provided a foundation for an update to create the new virtual nursing principles. The 2019 principles—an update to the 1998 ANA Core Principles on Telehealth, which considered the advances in technology and nursing care that evolved into virtual nursing—will be retired upon publication of the ANA Core Principles for Virtual Nursing.
The initial steps of the professional issues panel involved determining what to include and consider when delivering virtual care. The panel’s responses are reflected in the word cloud below.
After several meetings, discussions, voting, and vetting, the professional issues panel developed and finalized a definition of virtual nursing (right).
Virtual nursing principles
The panel also developed 13 principles that address the implications of virtual nursing related to quality and safety, ethics, staffing, access, research, license portability, and patient and family centered care, to name a few. Once approved by the ANA Board of Directors, these principles will be published on nursingworld.org.
These draft principles consider nurses’ accountability in providing virtual care consistent with standards of professional practice and that virtual nursing care should be grounded in the Code of Ethics for Nurses. The principles also indicate that nurses performing virtual care should
do so within their scope of practice and knowledge and in accordance with oversight and laws comparable to in-person care.
Virtual nursing care should improve access to quality care while complying with standards of safety, privacy, and security. The principles also call for leveraging evidence from research to advance virtual nursing care guidelines and best practices.
“Amid the promise of virtual nursing care models lies our sacrosanct obligation to not only do no harm, but also to proactively identify and mitigate the risks for harm through the intentional design of virtual care delivery systems,” said the professional issues panel co-chair Patricia McGaffigan, MS, RN, CPPS, president of the Certification Board for Professionals in Patient Safety and vice president of safety at the Institute for Healthcare Improvement. “Our shared goal for these guiding principles is to protect patients, families, and the workforce in the receipt and delivery of virtual care to ensure this innovative approach delivers reliable, person-centered, compassionate, and trusted care and caring.” McGaffigan is an ANA-Massachusetts member.
Virtual nursing holds tremendous promise to address challenges such as increasing patient acuity, staffing shortages, nurse and patient satisfaction, access and equity for recipients of care, and the increasing knowledge complexity gap. Robust research is essential to fully reap this promise, according to Laurie A. Huryk, MSN, RN, NI-BC, a member of both the professional issues panel and the New Jersey State Nurses Association, who is nurse informatics manager at CentraState Healthcare System and an adjunct instructor at Rutgers School of Nursing. “If we are to retain our virtual nursing programs, we have to prove their value to those who make financial decisions in healthcare,” she said. “Future research must convert the intangible benefit felt by bedside staff and patients into dollars saved by adding a virtual nurse to the team.”
—Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Enterprise, served as co-chair of the ANA professional issues panel on virtual nursing.
What is virtual nursing?
“Virtual nursing is leveraging remote technology and tools to provide safe and quality patient care through application of the nursing process by emphasizing communication, compassion, and collaboration throughout the continuum of care.”
— ANA Professional Issues Panel on Virtual Nursing
Resources
American Academy of Nursing. Meeting’s proceedings: Addressing the challenges and policy implications of virtual nursing. December 2024. aannet.org/page/virtual-nursing-2024
American Nurses Association. Gun violence, virtual nursing, reducing nursing documentation burden, top issues at the ANA Membership Assembly. June 17, 2023. nursingworld.org/news/news-releases/2023/ana-membership-assembly-endorses-actions-against-gun-violence/
Khairat S, Morelli J, Edson BS, Aucoin J, Jones CB. Needs assessment of virtual nursing implementation using the Donabedian framework. Comput Inform Nurs. 2025;43(3):e01229. doi:10.1097/CIN.0000000000001229 avasure.com/news/survey-despite-progress-in-virtual-nursing-adoption-most-providers-remain-in-early-stages/
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