“Back in the day, we had plastic bins of medications on the counter. You would just grab them and put them in your pocket. Saline flushes, heparin, anything. It’s crazy to say it out loud, but we did it,” Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN reminisces. 

“In my unit, we had normal saline 5 mL with a green top. Right next to it was potassium—also 5 mL with a green top. I took it to my manager and said, ‘It feels like something bad could happen here…’” 

They told me there was a safety meeting the next month and they would address it then. 

Clipper had her “aha” moment: a month is too long. Something bad could happen between now and then. People should be empowered to fix safety risks like this now. 

Read on to learn more about how Clipper became a nurse leader and how she’s empowering other nurses and healthcare organizations to improve nursing care.

Q: What is your nursing background? 

A: I started as a staff nurse in med-surg, then moved into critical care. I realized I wanted to make a bigger impact, so I went back to school, got a couple more degrees, and moved into leadership. That's where it really began for me.

Q: Why did you want to become a nurse leader?

A: I really wanted to change systems and processes that felt clunky, awkward, or broken. I also have a passion for systems and operations.

Q: Did getting into leadership allow you to make changes faster?

A: No, I empowered the nurses to change those things. You don't need to go to a committee for everything.

Just fix them. That’s always been my mantra: if there's something that doesnt make sense that we do, fix it and make it better.

Q: How do we empower nurses?

A: It's about sharing the ownership. The units aren't mine; the hospital isn't mine. The units belong to the nurses. 

Shared leadership and shared governance are very powerful tools when people understand what they're for. Helping nurses understand what shared governance is for and how it can work in their favor is really important. It's about teaching them how to use that platform and then getting started on making things happen.

Q: How do we implement shared governance?

A: Empowering frontline nurses to impact their practice environment, patient care, safety, and so on. That means there needs to be a commitment to making things better and bringing forward their ideas to achieve that.

When you share the ownership of a unit or an organization, it makes more sense why you're asking people to invest a bit of their time and effort into creating something better for everyone.

Q: How did Virtual Nursing Academy come to be? 

A: Virtual Nursing Academy was really a response to a need. 

Over the past 25 years, we’ve seen three models of care: primary care nursing, team nursing, and patient-centered care. This is the fourth iteration, but many current leaders weren’t around for the previous models. There’s a significant need to build and operationalize this new care model when deploying virtual nursing in hospitals or health systems.

Q: Why should hospitals consider a virtual nursing solution?

A: The core need remains helping organizations build a care delivery model.

Consider the complexities. How do you create a transformative care model that spans this continuum and is leveraged by technology? How do you deploy nurses—the heartbeat of this model? There’s a huge gap in understanding how to do this.

We don’t sell technology; we educate and enable hospitals and health systems to build and launch the virtual nursing care model. We provide content such as short-form content, tools, assessments, and micro-learning videos, supplemented by live check-in sessions.

Q: How might virtual nursing look from a floor nurse’s perspective? 

A: Virtual nursing is a dual-sided care model. 

On one side, there are direct care nurses—those on the ground providing hands-on care. On the other side, there are virtual nurses working remotely. 

It is a collaborative team effort, and both sides need to work together effectively for a successful virtual nursing model. For floor nurses, virtual nurses are there to support, enable, streamline, and provide oversight and safety. 

Q: Is there virtual nursing education?

A: Some nurses reach out to learn more about virtual nursing, either because they want to become virtual nurses themselves or because their organization is deploying virtual nursing. We have many hospitals that sign up teams to learn more about virtual nursing since they are going to be deploying their own virtual nursing care model and want to move as fast as possible and avoid missteps in building the care model.

We provide 33.75 CEUs for them. These nurses often sign up for the program and seek reimbursement from their employers. 

Q: Do hospitals outsource virtual nurses or hire from within?

A: It’s both. I talk to hospitals who plan to use nurses from within the existing hospital or health system. 

Staffing a virtual nursing team is not always comprised of nurses just rotating through their home unit and their role as a virtual nurse—because virtual nursing isn’t for everyone and expertise is crucial. It’s not ideal to rotate everyone through, as this can disrupt continuity and expertise. 

Best practices are emerging, indicating that about three years of experience is ideal for practicing safely as a virtual nurse. 

Q: Why is there no virtual nurse association or organization?

A: Because it's a modality of nursing care. You're governed by your license, the state where your patients are located, and the state you are in. As of today, it falls under the American Nurses Association's scope and standards for nurses.

Regarding a given state’s nurse practice act, currently, I am not aware that any of these boards of nursing or Nurse Practice Acts differentiate based on the modality of care delivery.

Q: How will virtual nursing evolve over the next five to ten years?

A: I have no doubt that virtual nursing will become the preferred practice. 

The question is, how will organizations acquire the technology needed to implement it? I’m confident that in probably five years or less, it will be the standard practice.

In the meantime, we need to focus on training leaders to manage a potentially distributed workforce. We also need to train enough virtual nurses without pulling them away from direct care roles. This means thinking about recruitment—bringing nurses back into the profession who may have left for various reasons. We also need to educate nursing students, as they will graduate into a world where virtual care is the norm. These students will be looking for jobs in this new care model, and they won't be entirely ready for a few years as they develop their assessment and patient care skills, so we need to start those conversations now.

Q: What is your vision for Virtual Nursing Academy? 

A: At Virtual Nursing Academy, we support leaders and help them to launch their virtual nursing and care models. 

The nurse needs to be at the center of the virtual care community, ensuring effective coordination of care for patients. You can get a sense of our work at VirtualNursingAcademy.com.

Q: Would you rather work a day shift or night shift on the floor?

A: Night shift. 

Q: What's your favorite comfort food after a long day at work?

A: Pizza.

Q: What would be the coolest hospital therapy pet, besides a cat or dog, barring any allergy or disease risk?

A: A therapy pony.

What's your favorite medical TV show? 

A: Doc Martin, if that counts.

Final Thoughts

Though Clipper has come a long way from speaking out against normal saline hanging out with potassium, her core message remains the same: nurses are the heartbeat of healthcare and we can be empowered to make change. 

“Nursing has so much to offer, we need to take charge and lead this change ourselves rather than letting technology vendors and companies dictate it. This is our space,” she declares.

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