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Virtual nursing jobs on the rise to help eliminate burnout, turnover for in-person workers

By Stephanie Stahl

Updated on: March 25, 2024 / 9:28 PM EDT / CBS Philadelphia

PHILADELPHIA (CBS) -- The virtual universe is expanding, even now in our post-COVID world.  A growing number of hospitals are using virtual nurses to help reduce burnout and turnover.

After four deployments as an Air Force nurse and more than 20 years on the job, Charissa Jackson needed a change.

She traded scrubs for a screen and now works as a virtual nurse

"It doesn't require you to be doing a 12-hour shift. It doesn't require you giving shots or passing out pills," Jackson said.  

The new role helped her combat burnout.

"It was essential for my mental health to find a way to still use my expertise after I left the military," she said. 

A recent survey finds burnout for physicians and nurses remains above pre-pandemic levels. Staffing shortages have been noted as a key contributing factor, along with too many bureaucratic tasks. 

"Virtual nurses have taken off significant administrative burden to our floor nurses," Chief Nursing Officer Crystal Beckford said. 

Virtual nurses generally focus on areas such as patient outreach and education, admissions and discharge instructions allowing their counterparts to be more hands-on at the bedside.

"I'd say anywhere from an hour, to 90 minutes, an hour and a half, it's giving back to that floor nurse," Beckford said. "It could save a life and it can also save a nurse from turnover." 

Patient Jannel Jackson, experiencing a virtual nurse for the first time during her hospital stay, appreciated the extra attention.

"The regular nurses may not always be able to get to you," Jackson said. 

Innovation improves outcomes for all sides. Some virtual nurses work remotely from call centers and a few hospitals are experimenting with them working from home.

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Stephanie Stahl is an Emmy Award-winning health reporter. She can be seen daily on CBS News Philadelphia and Philly57.

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Exceptional nursing careers begin with access to growing health systems

The profession of nursing – and the ways aspiring nurses are prepared for their careers – will see profound change over the next few years. By 2030, the profession of nursing will look very different , as will the landscape of health care. At every level, leadership is needed to provide clear, strategic and sustained direction and to ensure health equity is a priority. And technology continues to take on an ever-more important role.

At Thomas Jefferson University College of Nursing , the challenges presented by the changing health care landscape are inspiring unique opportunities to transform nursing education. 

With over 130 years of educating nurses, Jefferson College of Nursing is a model for graduating nurses who provide exceptional patient care that drives high-quality outcomes. Jefferson-educated nurses serve as health care innovators, leading from day one.

A forward-looking approach to health care

The College’s Dixon campus is an example of a forward-looking approach to health care. Located in Philadelphia’s northern suburbs in Horsham, PA, near the Pennsylvania Turnpike, the facility provides easier access for students from that area who might find it difficult to reach the College’s Center City Campus .

The Dixon Campus accommodates several hundred nursing students and offers small class sizes, free parking, and access to public transportation hubs. Notably, clinical rotations include the growing Jefferson Health system. In 2020, thanks to  Edith R. Dixon, the campus made its new home in this 42,000-square-foot high-tech complex named for its chief benefactor.

Multiple scholarship opportunities are available

In addition to providing more convenient physical access to nursing education through its suburban Dixon campus, Jefferson College of Nursing offers a wide range of scholarship opportunities for prospective students, including the Raynier Scholarship for up to $5,000 per year and the Diversity in Education & Nursing Excellence Scholarship for up to $15,000 per year.

Three BSN program options to balance school-life schedules

To accommodate career goals while balancing the complexities of school-life schedules, students have three Bachelor of Science in Nursing (BSN) program options, including a traditional BSN targeted toward students pursuing their first baccalaureate degree and an accelerated option for second-degree students. The accelerated option is offered on a one-year or two-year pathway. The starting salary range for BSN graduates is $62,000 to $86,000.

Thomas Jefferson University BSN students have opportunities to gain health care experience while immersed in the BSN through externships with our partner health system, Jefferson Health. Upon graduation, Jefferson graduates can avail themselves of an early-hire program with one of the largest health systems in the Philadelphia region, Jefferson Health. The Jefferson Health nurse community is 9,600 strong with full-time and part-time nursing employees.

Experience clinical technologies of tomorrow

At the Jefferson College of Nursing, technology isn’t just used as part of nursing student education; it is fully integrated. Technology is driving everything – from academics to patient engagement and everything in between.

In 2021, Jefferson was the first college of nursing in the state of Pennsylvania to become an Apple Distinguished School . Apple Distinguished Schools use technology at the highest levels, preparing learners to excel in sophisticated technological environments. The College incorporated Apple technologies into all classrooms and simulation rooms so students can get firsthand experience with the clinical tech of tomorrow.

The Raynier Institute & Foundation Center for Advanced Education, Simulation, & Innovation Center

Jefferson College of Nursing’s Dixon campus features the large-scale, state-of-the-art Raynier Institute & Foundation Center for Advanced Education, Simulation, & Innovation Center, where students engage in complex clinical scenarios that parallel, anticipate and amplify real-life situations at the next level. This Center enables expert simulation faculty to create engaging and realistic experiences that accentuate what students learn in the classroom and are exemplars of the curriculum.

Applying the latest technology to transform the educational process

Virtual reality and 3D printing simulate specific nurse experiences in the field in a safe and secure learning environment. Artificial intelligence is used so nursing education remains dynamic throughout a student’s academic career at the College.

While other learning institutions use virtual reality simulation, the College’s Dixon campus uses the technology as a bridge to competency-based learning. Students can hone their clinical skills by first interacting with patients and health care scenarios in a virtual reality environment and then in our simulation center before moving into the real-world clinical environment. Virtual reality also enables nursing students to safely experience today’s growing health care issues, including workplace violence.

In keeping with Jefferson College of Nursing’s commitment to applying the latest technology to transform the educational process, the Dixon campus is equipped with state-of-the-art 3D printers that produce a wide range of sophisticated learning tools used to practice invasive skills in the safe environment of a lab. 3D technology creates simulated body parts and other materials that make the learning experience more realistic.

Practice clinical skills through a capstone program in Italy

The Jefferson College of Nursing offers students an innovative opportunity to be part of improving education and health care on a global scale through a four-week undergraduate clinical capstone program in Italy .

Students work with the staff of Fondazione Policlinico Universitario Agostino Gemelli Hospital/Università Cattolica del Sacro Cuore . This initiative is a regular offering for undergraduate students, functioning as a bridge between the end of school and the beginning of a career. It allows nursing students to put what they've learned into practice. There is no better way to offer experiential learning than to immerse students in an environment that challenges their thinking and enhances their nursing skills. This year, nurse practitioner students can engage in this global experience.

Graduates prepared for what the real world demands

The difference at the Thomas Jefferson University College of Nursing is that students don’t just leave school with a great education.  They graduate prepared for what the real world will demand of them. And for making a real difference in the communities they will serve.

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Why were so many metro stations in Moscow renamed?

Okhotny Ryad station in Soviet times and today.

Okhotny Ryad station in Soviet times and today.

The Moscow metro system has 275 stations, and 28 of them have been renamed at some point or other—and several times in some cases. Most of these are the oldest stations, which opened in 1935.

The politics of place names

The first station to change its name was Ulitsa Kominterna (Comintern Street). The Comintern was an international communist organization that ceased to exist in 1943, and after the war Moscow authorities decided to call the street named after it something else. In 1946, the station was renamed Kalininskaya. Then for several days in 1990, the station was called Vozdvizhenka, before eventually settling on Aleksandrovsky Sad, which is what it is called today.

The banner on the entraince reads:

The banner on the entraince reads: "Kalininskaya station." Now it's Alexandrovsky Sad.

Until 1957, Kropotkinskaya station was called Dvorets Sovetov ( Palace of Soviets ). There were plans to build a monumental Stalinist high-rise on the site of the nearby Cathedral of Christ the Saviour , which had been demolished. However, the project never got off the ground, and after Stalin's death the station was named after Kropotkinskaya Street, which passes above it.

Dvorets Sovetov station, 1935. Letters on the entrance:

Dvorets Sovetov station, 1935. Letters on the entrance: "Metro after Kaganovich."

Of course, politics was the main reason for changing station names. Initially, the Moscow Metro itself was named after Lazar Kaganovich, Joseph Stalin’s right-hand man. Kaganovich supervised the construction of the first metro line and was in charge of drawing up a master plan for reconstructing Moscow as the "capital of the proletariat."

In 1955, under Nikita Khrushchev's rule and during the denunciation of Stalin's personality cult, the Moscow Metro was named in honor of Vladimir Lenin.

Kropotkinskaya station, our days. Letters on the entrance:

Kropotkinskaya station, our days. Letters on the entrance: "Metropolitan after Lenin."

New Metro stations that have been opened since the collapse of the Soviet Union simply say "Moscow Metro," although the metro's affiliation with Vladimir Lenin has never officially been dropped.

Zyablikovo station. On the entrance, there are no more signs that the metro is named after Lenin.

Zyablikovo station. On the entrance, there are no more signs that the metro is named after Lenin.

Stations that bore the names of Stalin's associates were also renamed under Khrushchev. Additionally, some stations were named after a neighborhood or street and if these underwent name changes, the stations themselves had to be renamed as well.

Until 1961 the Moscow Metro had a Stalinskaya station that was adorned by a five-meter statue of the supreme leader. It is now called Semyonovskaya station.

Left: Stalinskaya station. Right: Now it's Semyonovskaya.

Left: Stalinskaya station. Right: Now it's Semyonovskaya.

The biggest wholesale renaming of stations took place in 1990, when Moscow’s government decided to get rid of Soviet names. Overnight, 11 metro stations named after revolutionaries were given new names. Shcherbakovskaya became Alekseyevskaya, Gorkovskaya became Tverskaya, Ploshchad Nogina became Kitay-Gorod and Kirovskaya turned into Chistye Prudy. This seriously confused passengers, to put it mildly, and some older Muscovites still call Lubyanka station Dzerzhinskaya for old times' sake.

At the same time, certain stations have held onto their Soviet names. Marksistskaya and Kropotkinskaya, for instance, although there were plans to rename them too at one point.

"I still sometimes mix up Teatralnaya and Tverskaya stations,” one Moscow resident recalls .

 “Both have been renamed and both start with a ‘T.’ Vykhino still grates on the ear and, when in 1991 on the last day of my final year at school, we went to Kitay-Gorod to go on the river cruise boats, my classmates couldn’t believe that a station with that name existed."

The city government submitted a station name change for public discussion for the first time in 2015. The station in question was Voykovskaya, whose name derives from the revolutionary figure Pyotr Voykov. In the end, city residents voted against the name change, evidently not out of any affection for Voykov personally, but mainly because that was the name they were used to.

What stations changed their name most frequently?

Some stations have changed names three times. Apart from the above-mentioned Aleksandrovsky Sad (Ulitsa Kominterna->Kalininskaya->Vozdvizhenka->Aleksandrovsky Sad), a similar fate befell Partizanskaya station in the east of Moscow. Opened in 1944, it initially bore the ridiculously long name Izmaylovsky PKiO im. Stalina (Izmaylovsky Park of Culture and Rest Named After Stalin). In 1947, the station was renamed and simplified for convenience to Izmaylovskaya. Then in 1963 it was renamed yet again—this time to Izmaylovsky Park, having "donated" its previous name to the next station on the line. And in 2005 it was rechristened Partizanskaya to mark the 60th anniversary of victory in World War II. 

Partizanskaya metro station, nowadays.

Partizanskaya metro station, nowadays.

Another interesting story involves Alekseyevskaya metro station. This name was originally proposed for the station, which opened in 1958, since a village with this name had been located here. It was then decided to call the station Shcherbakovskaya in honor of Aleksandr Shcherbakov, a politician who had been an associate of Stalin. Nikita Khrushchev had strained relations with Shcherbakov, however, and when he got word of it literally a few days before the station opening the builders had to hastily change all the signs. It ended up with the concise and politically correct name of Mir (Peace).

The name Shcherbakovskaya was restored in 1966 after Khrushchev's fall from power. It then became Alekseyevskaya in 1990.

Alekseyevskaya metro station.

Alekseyevskaya metro station.

But the station that holds the record for the most name changes is Okhotny Ryad, which opened in 1935 on the site of a cluster of market shops. When the metro system was renamed in honor of Lenin in 1955, this station was renamed after Kaganovich by way of compensation. The name lasted just two years though because in 1957 Kaganovich fell out of favor with Khrushchev, and the previous name was returned. But in 1961 it was rechristened yet again, this time in honor of Prospekt Marksa, which had just been built nearby.

Okhotny Ryad station in 1954 and Prospekt Marksa in 1986.

Okhotny Ryad station in 1954 and Prospekt Marksa in 1986.

In 1990, two historical street names—Teatralny Proyezd and Mokhovaya Street—were revived to replace Prospekt Marksa, and the station once again became Okhotny Ryad.

Okhotny Ryad in 2020.

Okhotny Ryad in 2020.

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Nursing Home Basics: Who Qualifies, Who Pays, and Other Helpful Facts

Why it matters.

Understanding how nursing homes work can be confusing because standards for eligibility, insurance coverage, etc. vary from state to state in the US.

In this second article in our series on nursing homes ( read Part I here ), we answer some commonly asked questions about nursing home structures and functions.

Who Is Eligible to Enter a Nursing Home?

People qualify for nursing home/facility level of care (NFLOC) if they are unable to live alone safely in the community. There is no federal definition of NFLOC and the exact rules governing level of care vary from state to state. Despite this lack of consistency, the following four areas are commonly considered when a state determines a person’s level of care need: physical functional ability; health issues/medical needs; cognitive impairment; and behavioral issues. In many states, there has been significant rebalancing toward home and community-based services and away from nursing home care. Check state websites for updated information on specific eligibility requirements.

Who Pays for Nursing Home Care?

Medicare is the federal health insurance program for people in the US who are 65 or older, some younger people with disabilities, people with End-Stage Renal Disease. A common misconception is that Medicare will pay for all nursing home costs. This is not true.

Post-acute care (PAC) or skilled nursing facility (SNF) care is usually covered by Medicare or private insurance up to 100 days (100 percent for 20 days and then 80 percent for 80 days based on certain criteria). Long-term care (meals, room and board, and basic health services) is often paid for privately until funds are spent down. A “ spend down ” is how someone with Medicare may qualify for Medicaid — a joint federal and state program that provides health coverage to some people with limited income and resources — even if their income is higher than a state's Medicaid limit. Under a spend down, a state lets the person subtract their non-covered medical expenses and cost sharing (like Medicare premiums and deductibles) from their available income. Each state’s Medicaid program covers approximately 70 percent of nursing home care.  Long-term care insurance can also pay for nursing home care, but relatively few people have it.

The average cost of a nursing home is over $90,000 per year but this varies state to state. Multiple organizations provide information about nursing home costs and Medicaid daily rates online, including the  American Council on Aging .

Who Oversees and Regulates Nursing Home Quality and Safety?

The Centers for Medicare and Medicaid Services (CMS) oversees nursing home quality and safety at the federal level. Several divisions have regulations that pertain to nursing homes. 

The CMS Division of Nursing Homes develops and oversees most nursing home regulations. CMS delegates nursing home surveys and inspections to a designated organization in each state, usually the State Survey Agency (SSA). SSAs conduct annual, recertification, and complaint surveys and assess compliance with regulations. There is also a Special Focus Facility program for a small number of low-performing nursing homes that receive more intensive oversight and guidance on quality improvement in each state.

How Do We Measure Nursing Home Quality?

Because definitions of quality may vary, there are different methods used by federal, state, or private organizations to collect and analyze quality data. Here are a few examples:

  • Minimum Data Set (MDS) is a standardized assessment tool required by CMS that measures health status in nursing home residents. All nursing homes that accept Medicare or Medicaid must submit the MDS regularly for each resident to receive payment.
  • National Healthcare Safety Network is an electronic system for infection reporting, including COVID and other data that goes to CDC.
  • CMS Five Star Quality Rating System gathers information from inspections (surveys), quality measures, and staffing from each nursing home and makes this information publicly available on the CMS website.
  • Medicare’s Care Compare   allows users to locate and compare data from nursing homes.

What are Quality Innovation Networks-Quality Improvement Organizations (QIN-QIOs)?

QIN-QIOs focus on working with nursing homes, states, and regions to improve quality of life and quality of care across settings, including nursing homes. QIN-QIOs have their own separate line item in the US federal budget to support the national program which covers  all 50 states and US territories . QIN-QIOs are not part of state survey agencies or the survey process. Their focus is on quality improvement, support, education, and training, which are often provided free or at very low cost.

Who Works in Nursing Homes?

Women make up most of the nursing home workforce, particularly direct care workers such as certified nursing assistants (CNAs). ( Almost 90 percent of nursing assistants are female). Many are single parents.  People of color comprise most of the US nursing assistant workforce.

Most nursing assistants are low-income wage earners. Many live at or near the federal poverty level and almost half receive some type of public assistance. Nursing homes typically pay CNAs the minimum wage, but this is not necessarily a livable wage depending on where they live. For this reason, CNAs often work in multiple settings and have multiple jobs. For many CNAs, English is not their first language, and they may have limited English proficiency. Many are immigrants.

What Are Some Challenges Faced by the Nursing Home Workforce?

There are many issues facing nursing home CNAs today and some new opportunities. The National Association of Health Care Assistants (NAHCA) conducted a survey of 1,420 CNAs in July 2023. When asked about their jobs, many CNAs reported that low wages and benefits would be the primary reasons they intend to seek another type of employment. They also cited unstable or inadequate hours, lack of supervisor’s/manager’s support, lack of career advancement or professional development, and feeling under-valued.

High rates of turnover (in some cases over 100 percent in a year) and the need for stronger, stable leadership are important reasons to better support CNAs and other direct care workers. Creating and testing standardized career ladders or lattices and providing more training and education on topics of interest to CNAs represent opportunities to promote better retention and reduce turnover. Another way to respond to CNA concerns is by becoming an  Age-Friendly Health Systems Nursing Home .

Alice Bonner, PhD, RN, is IHI’s Senior Advisor for Aging. Amanda Meier, BSW, MA, is IHI’s Project Manager, Age-Friendly Health Systems. If you have any questions or ideas about nursing homes or related policy issues, please feel free to reach out to Alice Bonner ( [email protected] ) or Amanda Meier ( [email protected] ).

You may also be interested in:

The Basics We (and Policymakers) Should Know about Nursing Homes

Centering What Matters: The Core of Age-Friendly Care

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UPSC ESIC Nursing Officer Recruitment 2024: Application window closes today for 1930 posts, direct link to apply

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