Taking nursing into the digital frontier

Among the nurse clinicians on the Virtual Care team, (clockwise, from top left): Sandeep Swan, Marianne Villamor, Michelle Kosikowski and Zeenat Ashrafi. Inset (bottom right): Lara-Eloisa Marfa, Assistant Head Nurse.
Among the nurse clinicians on the Virtual Care team, (clockwise, from top left): Sandeep Swan, Marianne Villamor, Michelle Kosikowski and Zeenat Ashrafi. Inset (bottom right): Lara-Eloisa Marfa, Assistant Head Nurse.

Nurses play leading role in success of cutting-edge Virtual Care program

Nurse Marianne Villamor assesses her patients with meticulous care: She checks their vital signs, asks how they slept, and takes a look at their incision if they’ve had surgery. It’s a routine she perfected as a JGH bedside nurse—but there’s a notable difference now.

Ms. Villamor sees her patients on a screen, while they’re at home.

Members of the team of transfer nurses who screen and select JGH patients for the Virtual Ward. From left: Katie Chan, Chandhi Bhatnagar and Sara Sabbah.
Members of the team of transfer nurses who screen and select JGH patients for the Virtual Ward. From left: Katie Chan, Chandhi Bhatnagar and Sara Sabbah.

“It’s a different way of doing my job,” says Ms. Villamor, a Nurse Clinician, “and I love it.”

Ms. Villamor is a member of the Virtual Care nursing team, the backbone of our CIUSSS’s initiative to extend the reach of health care by turning some patients’ homes into virtual hospital wards. Every day, using technology and clinical expertise, these nurses deliver top-tier care that has become key to the success of the widely lauded program.

The Virtual Ward, which includes the award-winning Hospital@Home program, is an essential part of the CIUSSS’s vision of delivering care in whichever location is most comfortable and appropriate for the patient—an approach known as Care Everywhere. For nurses like Ms. Villamor, this means providing the same quality of care to patients at home as they get inside the bricks-and-mortar hospital.

During a typical virtual visit with her patients, Ms. Villamor might watch them take their blood pressure or ask them to point the camera of their electronic device at their leg so she can see how a wound is healing. Patients who go into the Virtual Ward are provided with an iPad or smartphone to ensure they remain digitally connected to the healthcare team.

Additionally, she might ask someone to walk around with their iPad, so she can see how their home looks, or what’s inside their fridge.

“We get a more comprehensive look at the patient.”

Nurse Marianne Villamor

Before making the switch in 2022 from bedside nursing to virtual care, Ms. Villamor worried she would have less time for patient interaction, she says. Yet the opposite has been true. “I find that I’m even more focused than at the bedside, and I can have even more time to speak to patients and address their concerns.”

Feedback has been overwhelmingly positive. Patients say they feel closely supervised by healthcare staff, all the while enjoying time with family at home. Some have kept up their life routines: among our CIUSSS’s Virtual Ward patients, one was going to university classes and another attended her book club, while one patient, David Shashoua, even continued to work at his textile import company (see related article).

“Some patients feel they’re healing faster when they’re surrounded by loved ones and eating familiar food, in an environment where they’re comfortable,” Ms. Villamor says. What’s more, the program frees up hospital beds for those who really need them, she adds.

“It’s win-win for everyone.”

Nurse Marianne Villamor

Before patients are approved for the Virtual Ward, they’re screened by Nurse Clinicians like Sara Sabbah, another member of the Virtual Care team. Based at the JGH, she and her transfer nurse colleagues work in collaboration with doctors and other healthcare professionals to evaluate candidates.

Ms. Sabbah works in the Emergency Department and other units, where she discusses cases with healthcare staff and meets patients to evaluate their suitability for the program. Candidates must meet a strict list of criteria: Among them, they must know how to handle technology, have adequate support at home, and be able to walk independently. Before they leave hospital, Ms. Sabbah prepares them for their virtual hospital stay by reviewing the program, discussing their medication and supplying instruments such as thermometers and pulse oxymeters.

Ms. Sabbah says the work feels like the leading edge of health care. “There’s no script or playbook to refer to. It’s all new—and that’s very cool. The policies being created have our influence behind them. We’re integral to the process.”

Her colleague, Nurse Clinician Chandhi Bhatnagar, agrees.

“It’s an opportunity to be part of change. We feel we have a voice in making decisions.”

Nurse Clinician Chandhi Bhatnagar

Erin Cook, Director of Virtual Care for our CIUSSS, says the dedication of these nurses has been vital to the program’s success.

Erin Cook, Director of Virtual Care
Erin Cook, Director of Virtual Care

“Their passion for delivering high-quality, patient-centred care, and for learning about new techniques and technology, have been key,” says Ms. Cook, whose full responsibilities also include Quality, Transformation, Evaluation, Value, and Clinical and Organizational Ethics. “As the program has evolved, they’ve always stayed focused on doing what is best for the patient. They’ve continued to learn and adapt to new ways of working and have always been up for the challenge.”

Nurses have also ensured a smooth transition for patients and other professionals as they integrate new technologies into the program, she adds. And, Ms. Cook notes, technology has proven to be no impediment to providing “compassionate, patient-centred care.”

The Virtual Care nursing team, which began with five nurses during the COVID-19 pandemic, has since grown to 19, including 13 nurse clinicians like Ms. Villamor who work remotely from home.

“Nurses are moving it forward and keeping it running,” says Assistant Head Nurse Tracy Heramchuk. “That’s always been our job—looking at the needs of the patient and meeting those needs, wherever the patients are.”

Among the Virtual Ward’s strengths is an interdisciplinary approach that involves collaboration among several teams. Dr. Lawrence Rudski, Medical Director of Virtual Care and Director of the Azrieli Heart Centre at the JGH, praises the teamwork among nurses from various CIUSSS directorates.

“It’s been eye opening to see the collaboration across the network among the nursing teams—the Virtual Ward, SAPA, and even Rehabilitation,” he says. “This model has shown us what’s possible when we create an integrated team within an integrated healthcare network. And it gives us a model moving forward.”

And it relies on nurses like Ms. Villamor, who sees the benefits of Virtual Care both for herself and her patients. “Telehealth is part of the future,” she says, “and I’m so glad to find a team that’s open to the innovation.”