The Bedside Has Changed.
Your Strategy Needs to Catch Up.

We bridge the gap between Provincial policy and clinical reality. Specializing in the operational design of Inpatient Virtual Nursing Pilots and Centralized Provincial Float Pools.

Strategic Advisory Notice

ProRN Inc. provides the intellectual property, strategic roadmap, and operational design. Funding and implementation budgets are the sole responsibility of the Province or Hospital Corporation.

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Virtual nurse monitoring patient data on dual screens while conducting a video assessment, representing the ProRN Inc. Dyad Model

The "Paper Roadmap" is Insufficient Without Clinical Oversight.

Administrative strategy cannot see the "invisible workload" crushing nurses across the country. When generalist consultants implement workforce pilots, they often fail due to role confusion, union grievances, and cognitive fatigue.

"If you hand this to an IT vendor, the nurses will reject it as surveillance. If you hand it to a generalist, the union will grieve it. You need a translator who speaks 'bedside'."

The Implementation Risk

Without clinical calibration, pilots fail due to "Big Brother" syndrome and collective agreement non-compliance.

The ProRN Inc. Solution

Clinical workflow design that respects cognitive load limits and protects the collective agreement.

Scope of Work

Specialized Implementation Phases

We do not replace your internal teams. We lead the high-risk phases requiring clinical and regulatory precision.

(Note: Budgetary allocation for these programs is held by the Province/Hospital.)

Virtual Nursing Pilot Lead

Phase 1 & 2 Strategy

Design of the "Dyad Model" workflow. We define the specific Scope of Virtual Practice for admission/discharge to ensure the Virtual Nurse offloads 40% of administrative tasks without compromising safety.

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Float Pool Architect

Governance & Feasibility

Facilitation of the Provincial advisory table to define the "Provincial Float Nurse" classification. We handle the feasibility analysis to project costs vs. current private agency expenditures.

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Stakeholder Liaison

Union & Clinical Alignment

Bridging the gap between Provincial policy and union requirements. We mitigate "contracting out" risks by ensuring all pilot structures align with collective agreements from Day 1.

About the Lead Strategist

Andrea Gomez, RN

With over 25 years of high-acuity experience in ICU and Recovery, Andrea Gomez specializes in Clinical Translation—turning high-level healthcare policy into workable bedside reality.

As the author of Burnout to Balance: Your 8-Step Guide to Thriving in a Messy Workplace and the architect behind various Provincial Retention Strategy roadmaps, she helps organizations stop hemorrhaging talent by redesigning the work itself, not just the payroll. Her expertise lies in identifying the "friction points" in clinical workflows that cause pilots to fail.

Toronto, Ontario (Available Nationally) Registered Nurse
"You don't need just a plan; you need a translator who speaks 'bedside'."
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Official Documentation

Proposal for a Provincial Virtual Nursing Program

A formal, research-backed blueprint for enhancing patient care and nursing workforce sustainability through a government-funded virtual nursing model.

Note to Stakeholders

ProRN Inc. designs the program structure. Funding is derived from provincial health envelopes.

Introduction and Background

Healthcare systems across Canada face a severe nursing workforce challenge, with significant projected shortfalls by 2028. This shortage demands innovative models of care delivery to maximize the reach and impact of our experienced Registered Nurses (RNs). One such innovation is virtual nursing; this leverages technology to allow RNs to provide patient care remotely. Virtual nursing gained traction during the pandemic and is now being systematically scaled by many health systems as a strategy to support bedside teams and retain veteran nurses.

This report proposes a provincial, government-funded virtual nursing program that enables experienced RNs to work from home as “virtual nurses.” Unlike ad-hoc hospital or agency-run initiatives, a centrally administered program would ensure equitable access to virtual nursing services across the province. It would standardize quality and integrate strong guardrails to complement bedside care. The goal is a formal blueprint for Provincial Ministries of Health and Professional Practice Divisions to consider.

Government-Employer Model

A centralized approach promotes consistency, prevents competition between hospitals, and leverages economies of scale.

Rationale for a Provincial Model

A provincially funded and managed virtual RN program provides several advantages over individual hospital or private agency approaches. Centralized oversight and funding would promote consistency in standards, training, and technology. This ensures that smaller or rural hospitals can benefit equally from virtual nursing support. Various provinces have precedents for successful province-wide telehealth services.

From a workforce perspective, a government-employer model permits better coordination of virtual RN deployment to areas of greatest need. It prevents a patchwork of differing hospital programs that compete for staff or develop redundant infrastructure. A provincial program can also set uniform employment conditions and collaborate with nursing unions (e.g., ONA, BCNU). This ensures these remote roles support frontline staffing rather than undermine it.

Virtual RN Use Cases and Benefits

Discharge Education & Coordination

Virtual RNs can take charge of discharge planning and patient teaching. At Baptist Memorial Hospital, virtual nurses conduct discharge education for surgical patients, fill out paperwork, and arrange to print discharge instructions. This process typically takes 15 minutes and ensures patients receive thorough counseling on medications and follow-up care. Dedicated discharge teaching has reduced readmissions in multiple jurisdictions.

Admission Interview & Documentation

Admission assessments involve history-taking and documentation rather than hands-on care. Virtual RNs can guide patients through admission questions and enter data directly into the electronic health record (EHR). Henry Ford Health identified admissions as a primary task to shift to virtual care. This accelerates bed flow and maintains documentation accuracy.

Patient Education & Consults

Virtual RNs provide ongoing patient education during the hospital stay. They reinforce pre-surgery instructions and answer routine questions. Virtual nurses act as another approachable face of care, which increases patient satisfaction. They can also coordinate consults by arranging virtual family meetings or specialist consultations.

Safety Monitoring ("Virtual Sitter")

Hospitals often require 1:1 patient sitters for those at risk of falls or delirium. Virtual "tele-sitter" technology allows one staff member to remotely monitor multiple patients via cameras. Virtual RNs can oversee camera feeds for acute cases where an RN’s assessment skills might detect subtle signs of distress. This adds a layer of fall prevention without pulling bedside staff away.

Low-Contention Rollout Strategy with Guardrails

Introducing virtual nursing into the healthcare system requires careful planning to gain buy-in from frontline staff and unions. We propose a phased rollout starting with a pilot project under strict guardrails.

No Reduction in Bedside RN Positions

Participating hospitals must commit that virtual RNs will not result in any reduction of budgeted in-person RN staffing lines. The virtual program augments capacity; it does not replace it.

Clear Delineation of Tasks

The program must establish a defined scope of practice. Virtual RNs may document admission history but will not perform wound care or administer medications.

Mandated Reporting

Hospitals must transparently track virtual RN usage. Data on tasks performed and key outcomes will allow evaluation of the program’s impact.

Capped Pilot Scope

The initial rollout should be limited in size and duration. We recommend a 12-month pilot with roughly 50 RNs across volunteer hospitals.

Examples in Practice

Henry Ford Health (Michigan, USA)

Henry Ford launched a virtual acute care nursing program across its hospital system in 2025. Virtual RNs operate from a 24/7 command center and appear on patients’ in-room smart TVs via secure video. They perform admission interviews, discharge prep, safety rounds, and chart checks. In the first full month, virtual nurses logged 600+ hours on patient calls and completed approximately 24,700 tasks.

Baptist Memorial Health Care (Southern USA)

Baptist began implementing virtual nurses in 2022. They utilize telepresence robots that the remote nurse can drive to patient rooms. Virtual nurses focus on admissions and discharges. By 2024, Baptist Memphis had virtual nurses handle approximately 6,000 hours of admission and discharge assessments in a year.

Canadian Telehealth Nursing Services

Programs like Health811 and Telehomecare demonstrate that nurses can successfully deliver remote assessments and health education at scale. Telehome Monitoring programs have achieved major improvements in outcomes and cost savings, illustrating the potential impact of remote nursing care.

Technology Infrastructure and Tools

Operational Considerations

Scheduling and Shifts

We recommend starting with 8-hour shifts to maintain focus. Coverage will likely be needed 18–24 hours a day. Hospitals will book virtual RN time slots for predictable tasks and have the ability to call on them for urgent needs.

Workflow Integration

Each hospital unit needs protocols for engaging the virtual nurse. A regional hub or software platform will triage requests. Regular virtual huddles between on-duty virtual RNs and site liaisons will ensure smooth operations.

HR and Unions

Virtual RNs could be employed by the Health Authority or seconded from hospitals. Alignment with Collective Agreements (e.g. ONA, BCNU) is necessary to ensure parity in wages and benefits.

Quality Assurance

Continuous evaluation is required. Key performance indicators include patient satisfaction, nurse burnout levels, documentation accuracy, and clinical outcomes like readmission rates.

Conclusion and Recommendations

The Nursing and Professional Practice Divisions across the country have an opportunity to lead a transformative initiative. This proposal lays out the justification for a government-employer model that enables experienced RNs to provide virtual care. This is additive; it extends the reach of every nurse and relieves burden from on-site staff.

Key Recommendations

  1. Launch a Pilot in 2026: Convene a project team early in the year and select 3–5 diverse hospitals.
  2. Establish Governance: Create a steering committee and partner with technology providers.
  3. Develop Training: Conduct simulations and training for both virtual and unit staff.
  4. Monitor Rigorously: Define KPIs and produce a comprehensive evaluation after 12 months.
  5. Plan for Scale-Up: Draft an expansion strategy while maintaining core guardrails.

"It maximizes their impact by removing some physical barriers of location and allowing them to focus on their knowledge and therapeutic communication."

VN Proposal Sources Cited

Baptist Memorial Health Care – virtual nursing program overview.

Henry Ford Health – press release on virtual nursing launch.

Becker’s Hospital Review – report on Henry Ford’s pilot results.

Online Journal of Issues in Nursing – case study on community hospital programs.

Canadian Healthcare Technology – article on Health811 expansion.

Critical Care Services Ontario – description of Virtual Critical Care.

Ottawa Heart Institute – Telehome Monitoring program results.

American Hospital Association – notes on ambient AI documentation.

Chief Healthcare Executive – report on Nuance DAX AI tools.

Hospital News (Ontario) – nursing shortage projections.

Workforce Strategy

Provincial Nursing Pool and Scheduling Implementation

Introduction and Background on addressing staffing shortages through centralized solutions.

The Agency Challenge

Many provinces lack a health workforce strategy with regional solutions to address nursing staffing shortages. Canada's public healthcare systems have seen a surging reliance on private nursing agencies, which has strained hospital and long-term care (LTC) budgets. Between 2013 and 2023, real per-capita spending on private agency staff has skyrocketed, even as direct hospital spending remained relatively flat.

Hospitals have paid billions to private, for-profit staffing agencies in the last decade. This stopgap comes at a high price: agencies often charge double or even triple the normal hourly rate of in-house staff. For example, some LTC facilities have paid $88–$150/hour for agency RNs (versus about $43/hour in wages for a staff nurse) and even higher short-notice premiums. One small hospital reported rates up to $300/hour for agency nurses.

These practices have created a difficult cycle – higher pay and flexibility in agency work lure nurses from the public system, worsening staff shortages and forcing hospitals to rely even more on agencies. Now is the time for policymakers and stakeholders to explore a provincial nursing pool as a solution to reduce costs and stabilize the workforce by providing a centralized, public alternative to private agencies.

Financial Impact

Agency expenditures have skyrocketed since the COVID-19 pandemic. In 2022–23, total agency staffing costs in Ontario alone neared $953 million.

Financial Impact of Private Agency Nursing

Recent reports highlight the growing financial burden of agency nursing on healthcare budgets. A 2025 analysis revealed that public hospitals paid billions to private agencies over 10 years. Notably, agency-supplied staff often account for a small fraction of total worked hours but consume a disproportionate percentage of total nurse staffing costs, due to their premium rates.

Agency usage has roughly doubled year-over-year in many jurisdictions. This trend prompted warnings that “agency costs are crowding out the budgets for care” in core services. The current model is cost-inefficient, as private agencies charge 2–3 times the cost of hiring regular staff. Any plan for a Provincial nursing pool must address this financial imperative: rein in exorbitant agency fees and recapture budget capacity for public healthcare services.

Models of Centralized Nursing Staffing Pools

Other jurisdictions have created centralized or government-sponsored nursing pools to reduce agency dependence. Common success factors include maintaining more than union-level pay/benefits for pool nurses, centralized scheduling systems, and support for travel or training.

Jurisdiction Program Key Features
United Kingdom NHS Professionals National “bank” of temporary staff. 39M hours filled in 2021-22. Central recruitment and booking; self-funded via fees charged to hospitals.
British Columbia GoHealth BC Float pool of RNs who are regular health system employees. Nurses receive union wages, benefits, pension. Travel support provided.
Manitoba Provincial Travel Nurse Team Internal float pool for flexible deployments. Created via union agreement to offer an alternative to agency gigs.
Quebec Regional Float Pools Phasing out private agencies entirely by 2025. Expanded internal float pools ensure coverage. Law imposes fines for non-compliance.

Labor Relations and Legal Feasibility

Any Provincial nursing pool must navigate the labor relations context, particularly the union collective agreements. Central agreements often state the hospital “shall not contract out” bargaining unit nursing duties if it results in layoffs or loss of hours for union nurses. It carves out only a narrow exception for truly ad hoc, single-shift agency usage to cover unexpected absences.

The most feasible approach is to ensure the provincial pool operates within the public sector. For example, pool nurses could be employees of a new crown agency or of the Health Authority, with compensation aligned to collective agreements.

If pool nurses are not hospital employees or not covered by the union contract, the union may argue this violates no-contracting-out provisions. The safest path is treating the pool as an extension of hospital scheduling rather than a separate employer, which preserves union protection and removes contractor-misclassification risks.

Infrastructure Needs: Technology and Logistics

Centralized Scheduling

A central scheduling platform is critical for matching pool nurses to vacant shifts. This should function as a real-time marketplace where hospitals post staffing needs and nurses can sign up for available shifts via mobile app.

Credentialing Management

A centralized database should store and verify licenses, specialty certifications, and immunization status. Automating license verification speeds up onboarding new pool members.

Information Systems Compatibility

Pool nurses must navigate different EMR systems (Epic, Cerner, Meditech). The program needs to invest in standardized EMR training so nurses can quickly learn the essentials of different systems before an assignment.

Logistics and Support

Coordination of travel and housing is needed when nurses deploy outside their home area. A 24/7 support line ensures backup if a nurse has an issue finding a unit or if a shift changes last-minute.

Strategic Technology Approach

Most hospitals use legacy Workforce Management systems like UKG or Infor. Do not attempt to replace these immediately. Instead, implement a Marketplace Overlay.

BookJane

Toronto-based. Highly aligned with the "Uber-like" marketplace vision. Focuses on mobilizing internal float pools with excellent user experience.

Andgo Systems

Saskatoon-based. Specializes in "Intelligent Shift Fill Automation" for unionized environments. Excels at automating call-out rules required by agreements.

QGenda

Strong in credentialing and provider scheduling. Offers a "single source of truth" for credential management.

Implementation Roadmap

1. Feasibility & Consultation (Months 0–3)

Establish project team & advisory table (MOH, Health Authorities, Unions, Hospital Associations). Analyze agency spend. Address legal/HR feasibility. Secure stakeholder buy-in on the public-sector pool vision.

2. Governance & Framework (Months 3–6)

Decide host organization and secure funding. Draft enabling policy (e.g. require hospitals to use pool first). Design operational policies like travel reimbursement and nurse employment terms.

3. Recruitment & Onboarding (Months 4–9)

Launch recruitment targeting agency nurses. Process applications through centralized verification. Conduct training/orientation for first cohorts (EMR systems, clinical protocols).

4. Pilot Deployment (Months 9–15)

Go-live in pilot hospitals/LTC homes. Pool nurses begin filling assignments. Provide 24/7 support. Collect data on fill rates and costs. Produce evaluation report.

5. Scale-Up Rollout (Months 15–24)

Incorporate pilot learnings. Sequentially onboard remaining regions. Enforce policy shifts: hospitals now required to utilize pool for temps; begin phasing out existing agency contracts.

6. Full Implementation (Month 24+)

Pool fully operational province-wide. Comprehensive outcome evaluation. Formalize long-term governance. Consider legislative ban on agencies beyond this point if pool is meeting needs.

Conclusion

By following these implementation steps, the Province can create a centralized nursing pool that addresses the root causes behind the agency boom. This strategy shifts the solution to the public realm – offering nurses flexible work opportunities with the security and standards of the public system. Financially, redirecting funds from agencies to an in-house pool should yield significant savings and better value for money, while also improving workforce morale and retention.

A well-implemented Provincial Nursing Pool offers a feasible path to safeguarding the sustainability of the public healthcare budget.

Sources Cited

Canadian Health Coalition – “The use of agency nursing is exploding” (Aug 2023).

Global News / Canadian Press – “Ontario hospitals spent over $9B on agency staff over 10 years” (May 2025).

Policy Alternatives (CCPA) – “Hollowed Out: Ontario public hospitals and the rise of private staffing agencies” (Nov 2023).

BC Nurses’ Union – “For Patients, Not Profit – Update Magazine Spring 2025” (Mar 2025).

NHS England – “Guidance for developing a healthy nursing staff bank” (Apr 2025).

ONA Central Collective Agreement – Hospital Provincial Agreement (2018-2027).

ShiftMed Workforce Blog – “Streamline Nurse Onboarding: Centralized Credential Verification” (2025).

Healthcare Excellence Canada – “Optimizing the Use of Staffing Agencies” (Mar 2025).

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