Providence nurses say Anchorage hospital’s plans for ‘virtual nursing’ teams put patients in danger

Anchorage nurses say a new staffing model recently launched at Providence hospital will put patients in danger.

Last week, Providence Alaska Medical Center announced it had implemented what it calls a “co-caring model” of nursing at two units of its flagship hospital in Anchorage. Instead of being attended to by a registered nurse, patients in two units will have their care shared by a virtual nurse via camera and video in the patient’s room, a certified nursing assistant and a registered nurse.

Hospital officials say the idea is meant to address an increasing staffing shortage of registered nurses by spreading the workload between more caregivers.

But a group of Providence nurses says it will do the opposite by increasing the patient-nurse ratio for registered nurses, stretching already overburdened bedside nurses beyond what’s safe.

Madison Eckhart has worked as a nurse in the hospital’s progressive care unit, a step-down unit from intensive care, for years.

“The work it takes to care for our assigned four patients on this unit amounts to hundreds of tasks a day,” Eckhart said at a rally Wednesday near Providence that drew about 65 nurses and several elected officials to protest the change.

Starting next week, nurses in her unit will have to take on a fifth patient, she said.

“We sacrifice ourselves and for our patients in countless and unseen ways,” Eckhart said. “Providence has decided to abuse this sacrifice they sold to us the idea of a quote, ‘improved patient experience,’ but initiated changes that reduced the involvement of nurses at the bedside.”

The union representing nurses has filed an unfair labor practice charge with the National Labor Relations Board.

Sean Foreman, a night nurse with 20 years of experience, said at the rally that the patients he cares for are sicker than ever. Many have drug or alcohol withdrawal, psychiatric issues or are recovering from major surgeries and illnesses. The added virtual nurse presence won’t relieve the pressures of caring for very sick patients in person, he said.

“The majority of the work that we do at the bedside, it requires us to be at the bedside,” he said.

More patients inevitably means less time a nurse spends with each individual, said Terra Colegrove, the local president of the Alaska Nurses Association.

“Each additional patient will increase the likelihood of something missed or a bad patient outcome,” she said.

Providence nursing executives describe the plan as a solution to a nationwide shortage of registered nurses that is particularly acute in Alaska. The hospital cited a study by the National Center for Health Workforce Analysis that found Alaska is projected to lead the country in nursing job vacancies, with 23% of openings unfilled by 2030.

The “team nursing model” is new to Providence’s Alaska hospitals but has been in practice at some of the organization’s other hospitals with promising results, said chief nursing officer Carrie Peluso. Providence officials point to other hospitals that have embraced the model, such as a pilot program at a Providence hospital in Texas that saw a 74% reduction in turnover of nurses.

The idea is to redistribute the work of the bedside nurse, Peluso said. Virtual nurses, who work from home and have to be registered nurses licensed to practice in Alaska, can take care of bureaucratic or paperwork-related nursing tasks, and nursing assistants can perform other work in their scope of practice, leaving the registered nurses with more time to spend on each patient. Some patients have already reported better communication and care with the new model, she said.

“The model is to actually increase the number of caregivers available to the patient,” she said.

Some states have mandated nurse-to-patient ratios, but Alaska does not.

Peluso said she expects registered nurses to warm to the new staffing scenario in time.

“We think once they get used to the model, they will find there’s a lot of benefits,” she said.

Eckhart said she expects the change to work in the other direction, with more nurses burned out and ready to leave hospital work altogether.

“Their increase to our workload will manufacture a shortage of well-trained, experienced nurses on my unit,” she said. “Patients will suffer for it.”