Virtual Observation Is Live. Why Is Bedside Sitter Demand Still High?

By Nicole Shields, BSN, RN

How nursing leaders can evaluate patient selection, frontline adoption, and the workflows behind appropriate virtual observation use.

Virtual Observation Is Live. Why Is Bedside Sitter Demand Still High?

Your virtual observation program is operational. Equipment is installed, initial training is complete, and monitoring is available.

Yet bedside sitter demand remains high.

For nursing leaders, the question is not simply how to increase virtual observation use. It is whether the organization is matching patients with the appropriate level of supervision—and giving clinical teams the support to make that decision confidently.

Some patients require continuous bedside presence. For others, uncertainty about eligibility, communication, or response coverage may limit appropriate use of virtual observation.

Understanding the difference is the starting point for a useful program review.

Why Can Bedside Sitter Demand Remain High After Virtual Observation Launches?

Continued sitter demand may reflect patient needs, workflow barriers, or a combination of both. A program review should distinguish clinically necessary bedside supervision from situations where eligible patients are not being considered for virtual observation.

Questions worth exploring include:

• Are eligibility criteria clear and consistently applied?
• Can staff initiate monitoring through an understood, approved process?
• Do bedside teams trust the communication and response workflow?
• Is support available across units and shifts?
• Are leaders evaluating safety and patient needs alongside utilization?

The goal is appropriate use, not the highest possible virtual observation census.

What Does the Research Say About Sitters and Video Monitoring?

A 2020 systematic review in Annals of Internal Medicine examined 20 studies of bedside sitters and alternatives in adult acute-care wards. Two studies provided very-low-certainty evidence about whether adding sitters reduced falls. Eight studies provided moderate-certainty evidence that interventions including video monitoring reduced sitter use while falls decreased or did not change (Greeley et al., 2020).

The findings require context. The review included no randomized trials, and none of the studies had a low risk of bias. It evaluated falls—not every clinical reason a patient might require direct supervision (Greeley et al., 2020).

For nursing leaders, the takeaway is not that bedside sitters are ineffective or that virtual observation is suitable for every patient. It is that observation practices deserve evaluation rather than an assumption that one approach is always preferable.

Local patient needs, clinical judgment, approved policies, and the ability to respond remain central to that evaluation.

Balance Individual Observation Needs With Unit-Wide Support

When a patient needs additional supervision, a bedside sitter may be the appropriate choice.

That decision also sits within the unit’s broader staffing plan. If a nursing assistant is reassigned from unit coverage to continuous observation, other patients still need help with toileting, mobility, call lights, and routine care.

The question is not whether one patient deserves that attention. It is which observation model meets the patient’s needs and how the unit will provide the hands-on support that remains necessary.

For eligible patients, virtual observation may provide monitoring and verbal redirection while bedside staff remain responsible for physical assistance and clinical response.

Those responsibilities must be planned together. Virtual observation is not a substitute for hands-on care, and available monitoring capacity is not the same as available response capacity.

Understand What Bedside Teams Need

Before interpreting low use as resistance, ask staff where the workflow becomes difficult or uncertain.

Can they identify eligible patients? Do they know how to request monitoring? Are they confident that concerns will reach the right person? Have previous communication or response problems been resolved?

Published implementation experience illustrates the importance of these questions. At one academic medical center, lack of process clarity emerged as a barrier. The organization incorporated nursing input, decision pathways, nurse champions, follow-up education, and leadership review into its implementation approach (Abbe & O’Keeffe, 2021).

Use frontline conversations to examine:

• Patient eligibility and exclusions.
• Activation and discontinuation steps.
• Observer responsibilities and limitations.
• Bedside response expectations.
• Handoffs and reassessment.
• Access to help when the process is unclear.

Include night and weekend staff, agency nurses, float staff, and new employees. A workflow familiar to the implementation team may be less familiar to someone who uses it occasionally.

The purpose is not to test staff willingness to adopt the technology. It is to understand what they need to use it appropriately.

Make Communication and Bedside Response Reliable

A bedside nurse may worry about frequent notifications that interrupt other care. An observer may worry about whether a concern will receive a timely response.

Both perspectives matter.

Review whether approved workflows clearly address:

• When verbal redirection is appropriate.
• Which situations require immediate notification.
• How urgent and nonurgent information is communicated.
• Who receives notifications and provides backup.
• What happens when the first contact cannot respond.
• How relevant information transfers between shifts.

Communication expectations must reflect patient-specific risks and hospital policy. They should never discourage observers from reporting clinically significant concerns.

Ask both groups how the process functions in practice. Are messages actionable? Is responsibility clear? Where do delays or misunderstandings occur?

A process-evaluation study in the Journal of Nursing Care Quality used feedback from patients, nursing staff, and monitor technicians to identify improvements and inform standardization of a hospital’s video-monitoring process. It provides a practical example of using the experiences of those involved to improve the service (Sand-Jecklin et al., 2019).

The objective is not simply fewer calls. It is useful communication followed by an appropriate response.

Integrate Virtual Observation Into Existing Nursing Workflows

Virtual observation should be an understood option within approved care processes—not an unfamiliar resource considered only when bedside sitters are unavailable.

Review where eligibility assessment, initiation, and reassessment fit into existing work. Look for unnecessary duplication or uncertainty without removing safeguards.

Where consistent with hospital policy and applicable requirements, nursing leaders can evaluate whether a nursing-driven initiation pathway would help eligible patients access the service without avoidable delays.

The pathway should clarify:

• Inclusion and exclusion criteria.
• Circumstances requiring direct bedside supervision.
• Who can initiate, modify, and discontinue monitoring.
• Reassessment expectations.
• Documentation and handoff requirements.
• Clinical accountability and escalation.

As the program matures, review whether these criteria remain appropriate, clearly understood, and consistently applied. Experience should prompt evaluation—not automatic expansion of eligibility.

Support the People Leading the Program

Clinical champions can connect program leadership with the realities of bedside care. Their role should include listening, troubleshooting, and bringing unresolved issues forward—not simply encouraging greater use.

Whether that responsibility sits with a coordinator, educator, manager, or bedside nurse, clarify:

• What the person is accountable for.
• What time and support are available.
• Which decisions they can influence.
• How concerns move beyond the unit.
• Who provides coverage when they are unavailable.

Champions need a workable role, not just another assignment.

Executive sponsorship should be equally practical. Establish who can resolve staffing, technology, education, or cross-departmental barriers that unit-level teams cannot address alone.

The aim is a reliable support structure across participating units and shifts.

Five Questions to Guide a Nursing Leadership Review

1. Are patients receiving the appropriate level of observation?

Examine eligibility, exclusions, reassessment, and the documented reasons for bedside supervision. Consider differences in patient needs before interpreting variation between units.

2. Is the approved workflow clear and workable?

Ask staff to walk through how they initiate, use, and discontinue monitoring. Identify uncertainty, unnecessary delays, and education gaps.

3. Can bedside teams respond when observers raise concerns?

Review notification pathways, backup coverage, handoffs, and the practical availability of hands-on assistance.

4. Do program leads have the support to address barriers?

Clarify ownership, available capacity, decision-making authority, and escalation routes.

5. Are we evaluating more than utilization?

Review patient eligibility, reasons for sitter assignments, safety outcomes, communication and response concerns, and staff feedback alongside virtual observation use.

A higher utilization rate does not, by itself, demonstrate safer care. Continued sitter use does not necessarily indicate failed adoption.

Turn Program Review Into a Focused Improvement Plan

A useful review should end with a specific next step—not a general request to use virtual observation more.

Choose a clearly defined barrier, such as uncertainty about eligibility or an inconsistent notification pathway. Bring the relevant bedside staff, observers, and clinical leaders together to understand it.

Agree on an approved change, identify who owns it, and determine what information will show whether it is helping. Review the results before extending the change more broadly.

This keeps improvement focused on the workflow rather than treating adoption as a staff-compliance problem.

Where VIDICI® Fits

VIDICI® is Altus’s turnkey hardware-and-software platform for virtual care, including virtual observation.

The technology is one part of the program. Hospitals define patient-selection criteria, clinical protocols, staffing responsibilities, and escalation processes.

The research discussed here can inform program planning, but it does not establish outcomes for VIDICI specifically. The systematic review identified limitations in the evidence, while the implementation and process-evaluation papers describe individual organizations’ experiences (Greeley et al., 2020; Abbe & O’Keeffe, 2021; Sand-Jecklin et al., 2019).

A sustainable observation program depends on more than available equipment. It depends on clinical teams understanding when to use the service, how it fits their work, and what support is available when a patient needs help.

Explore VIDICI to learn how its hardware and software can support your hospital-defined virtual observation workflows.

VIDICI® Virtual Care. Your Way.

Research cited

• Sitters as a Patient Safety Strategy to Reduce Hospital Falls: A Systematic Review — Greeley et al., Annals of Internal Medicine, 2020.
• Continuous Video Monitoring: Implementation Strategies for Safe Patient Care and Identified Best Practices — Abbe & O’Keeffe, Journal of Nursing Care Quality, 2021.
• Video Monitoring for Fall Prevention and Patient Safety: Process Evaluation and Improvement — Sand-Jecklin et al., Journal of Nursing Care Quality, 2019.