Harmonizing Bedside & Virtual Nursing: Introducing Polarity Thinking

Night or day. Hot or cold. Right or left.  Our descriptions of the world around us are often infused with language that divides, separates, and polarizes. Given such descriptions, we often feel compelled to choose between one choice or the other, that is, to adopt an “either-or” mindset. According to Barry Johnson, either-or thinking is an ideal orientation when solving problems (Johnson, 2020).

However, in some situations, it is advantageous to embrace the inherent contradictions presented by polarities by adopting a “both-and” mindset. “Both-and” thinking embraces the paradox and avoids seeing the situation as a problem to be solved or a false choice between two poles (Johnson, 2020). From this perspective, the tension between two seemingly opposing or contradictory perspectives is leveraged to identify paths and solutions that ultimately improve decisions, choices, and outcomes (Johnson, 2020).

The fast-changing and operational landscapes of nursing practice, in general, and the quickly emerging virtual nursing constitute arenas where consideration of how the polarity-infused language of the profession might benefit from adopting a “both-and” mindset. Applying a Polarity Thinking™ mindset to a healthcare organizational framework has been noted as essential to achieve healthcare transformation (Christopherson, Troseth & Wesorick, 2021).

Traditional nursing care requires physical presence. In the “bedside” paradigm, the nurse fulfills or executes disparate roles and functions for the patient, including expert assessment and monitoring, the delivery of therapeutics, nursing interventions, healthcare communication, care coordination between disciplines, discharge planning, and the provision of critical educational and emotional support.  Notably, the patient is not the sole recipient of nursing attention. Family and friends must be appropriately apprised of the patient’s status and included as part of the care team. In addition, in this paradigm, nurses are the principal party responsible for documenting care and ensuring continuity of care for the duration of the patient’s stay in a healthcare setting.

While the bedside paradigm has proven historically successful, several aspects of this paradigm are creating tensions or unsustainable challenges for nurses delivering patient care. For example, the complexity of data collected and information available about patients has exponentially increased over the past half-century. This fact has introduced a substantial cognitive burden to primary healthcare providers, including nurses (Collins, 2020)  (Ebright, 2010). At the same time, the numbers and percentages of novice nurses in hospitals have been steadily increasing. Thus, less experienced professionals are expected to manage highly complex and large volumes of medical and patient information (Collins, 2020). In addition, the COVID-19 pandemic has exacerbated training and onboarding challenges for nurses. In March 2022, the American Nurses Foundation and the American Nurses Association released the results of its COVID-19 Impact Assessment Survey, which found that 52% of nurses are considering leaving their current position due primarily to insufficient staffing, work negatively affecting their health and well-being, and their perceived inability to deliver quality care (American Nurse’s Association, 2022). Moreover, 60% of acute care nurses reported feeling burnt out, and 75% reported feeling stressed, frustrated, and exhausted (American Nurse’s Association, 2022). Finally, baby boom RNs started retiring in 2010, creating gaps in difficult-to-replace nursing expertise (Auerbach et al., 2015). This changing nursing landscape raises various questions about how to meet present and future patient care needs. How can we reduce care variation and cognitive load on nurses? How can we increase the quality of care and, at the same, reduce cost? How can we create a work environment that reduces nursing stress and burnout?

Virtual nursing has emerged as a solution that addresses the challenges faced in current bedside nursing practice. In contrast to the “bedside” nursing paradigm, the “virtual nursing” paradigm envisions a healthcare setting where key aspects of the healthcare experience are delivered to patients through or in collaboration with computer-aided tools and/or interfaces. Virtual technologies can perform various functions that support the bedside nurse including remote patient monitoring, decision-support algorithms, ambient clinical intelligence, predictive analytics, 2-way video, and hospital-at-home care.  These technologies provide support to bedside nurses and patients by offering additional clinical expertise, reducing cognitive load, and reducing nurse’s workloads by completing time consuming tasks that can be managed virtually.

Despite the compelling vision of the virtual nursing paradigm, several potential challenges in implementing this vision have been suggested. For example, from the perspective of the bedside nurse, virtual technology must be implemented to amplify capabilities instead of adding additional work for them (Collins, 2020) . However, many current technologies and information management tools have increased the workload for nurses and physicians, becoming simply “something else to manage.”  How can we embrace technology to support care providers while avoiding the dehumanization of care? How can we effectively use technology to bring people together?

Embracing a “both-and” mindset creates opportunities for leveraging the tensions inherent in the polarity-oriented view (Johnson, 2020). This calls for us to challenge our “problem solving mindset” so we can apply Polarity Intelligence™ as healthcare leaders (Christopherson & Troseth, 2021) and reframe to ‘Bedside Nursing and Virtual Nursing’ as the future paradigm and with the skills to apply it. We often see technology as substitution or replacement for a process. We fear technology will dehumanize care. Using a polarity lens, we must clearly identify ways technology can amplify bedside nurses’ capabilities.  Gaining a better understanding of these polarities and ways of bridging them may provide a means for advancing the patient’s needs, goals, and aspirations by synergistic engagement of compelling aspects of both the bedside and virtual nursing paradigms.