Across the country, healthcare systems are balancing the same pressures: rising patient acuity, documentation demands that pull clinicians away from bedside care and a workforce that’s stretched thin. At Qualivis Roundtable 2025, two nursing leaders offered a grounded, practical view of what it looks like to respond by redesigning care models around real workflows, real teams and the realities of their communities.
One health system, Guthrie, spans rural counties across two states, where access gaps can be measured in hours and miles. The other, VHC Health, is an independent, high-performing teaching hospital in the Washington, DC region — growing quickly and intentionally designing for what comes next. Their approaches varied, yet both organizations chose to incorporate virtual nursing as part of the care team, paired with operational and workforce redesign intended to better support their clinicians day to day.
Guthrie: A rural care model built around teams, technology and access
When Deb Raupers, MSN, RN, CENP, Executive Vice President and Chief Nursing Officer, returned to Guthrie after the pandemic, she found a system under strain. Experienced nurses were leaving, turnover was high and critical care units relied heavily on travelers — an especially difficult challenge for a rural organization competing with urban markets. For many communities Guthrie serves, there is no alternative site of care nearby. The stakes were high.
Rather than treating virtual nursing as a point solution, Guthrie reimagined care delivery from the ground up — starting with how teams work together.
Redesigning the bedside team
One of Guthrie’s first moves was rebuilding team-based care so clinicians could practice at the top of their scope. Raupers recalled, “I literally went to every single care area and said, ‘How can we do it better here?’” RNs were paired with LPNs and CNAs, bringing LPNs back into acute care settings and restoring hands-on support at the bedside. This change reduced reliance on premium labor quickly and helped stabilize units that had struggled to retain staff.
The guiding question was simple: What work truly requires an RN and what doesn’t?
Virtual nursing embedded in daily care
Guthrie then established the Pulse Center, a centralized hub that integrates virtual nursing, AI-enabled surveillance and operational coordination. Virtual nurses are not a separate service; they are embedded into daily workflows — joining huddles, supporting documentation and providing real-time clinical backup.
The system began in critical care, where continuous monitoring and AI-based alerts help identify early signs of patient deterioration — often before a rapid response would traditionally be triggered. Virtual nurses and intensivists support bedside teams across facilities, helping rural hospitals manage higher-acuity patients safely and keep care closer to home.
Reducing friction at the bedside
One of the most immediate workflow benefits came from virtual “second nurse” support. Tasks such as blood administration and high-risk medication checks, which once required nurses to leave their unit in search of help, could now be completed almost instantly with virtual support. That shift reduced delays, interruptions and frustration.
Guthrie also centralized functions that often operate separately across hospitals, including sitters, telemetry monitoring, bed placement and transfers. This created more consistency, improved patient flow and reduced duplication across the system.
Outcomes that support access and sustainability
Guthrie’s redesigned care model delivered measurable gains:
- Reduced system nursing and agency utilization by 100 FTEs in one year
- Lowered system-wide vacancy rates from 26.9% to 22.3%
- Saved nurses 30 minutes per shift
- Reduced reportable falls with major harm from 10.15% to 1.75% in one year
- Improved patient flow and length of stay while enhancing early patient deterioration detection
VHC Health: Designing virtual nursing with intention and adoption in mind
Where Deb Raupers shared a scaled, systemwide model, Sarita Rhodes-Vivour—MSN, RN, CCRN-K, NEA-BC, Associate Vice President of Acute Care Nursing at VHC Health—shared insights into what it takes to design virtual nursing thoughtfully from the start.
VHC Health is a 537-bed independent, not-for-profit teaching hospital in Arlington, Virginia. As the organization expanded intermediate care capacity, leaders saw an opportunity to design new units with the future in mind — hardwiring rooms for virtual care and building workflows that could evolve over time.
Starting with clear pain points
VHC Health grounded its strategy in four priorities:
- improving fall prevention
- easing documentation burden on frontline nurses
- supporting nurse leaders with growing responsibilities
- retaining experienced clinicians by creating new ways to practice
Rather than pursuing every possible use case at once, VHC focused on where virtual care could make the most immediate impact.
Expanding collaboration across the care team
As planning progressed, VHC Health identified opportunities beyond nursing. Virtual admission assessments, enhanced case management collaboration and virtual provider rounding all emerged as ways to strengthen communication and continuity of care.
Rhodes-Vivour emphasized that virtual care isn’t about replacing in-person interactions. It’s about making sure patients and clinicians are connected at the right moments, even when geography or workflow makes that difficult.
Building for adoption, not just functionality
Vendor selection focused on partnership and scalability, with attention to nursing credibility, AI capability and long-term flexibility. Equally important was addressing fear and uncertainty among staff early.
VHC Health involved frontline clinicians in workflow design, created unit-based champions and revised job descriptions to reflect the realities of virtual nursing. Governance and metrics were established alongside implementation to guide growth and measure success.
Redefining return on investment
VHC Health is taking a measured, budget-conscious approach—starting small and scaling thoughtfully. Success is being defined not only in dollars, but in value: fewer falls, improved communication, stronger retention, and better experiences for patients, families, and staff.
Shared lessons from two different journeys
Though their environments differ, Guthrie and VHC Health shared a clear belief: virtual nursing delivers the most value when paired with care model redesign, operational alignment and strong clinician support.
Both leaders emphasized that technology alone does not solve workforce challenges. Lasting progress comes from integrating tools into daily care delivery so teams feel supported, workflows function better and patients receive safer, more connected care.
These insights reflect the purpose of Qualivis Roundtable. As planning begins for Roundtable 2026, we look forward to continuing these conversations and welcoming healthcare leaders committed to learning from peers and strengthening their systems together.