Cover of Culture Breaks First, with Julie Tuel

Culture Breaks First, with Julie Tuel

Culture Breaks First, with Julie Tuel

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Virtual nursing gets sold to hospital boards as a staffing patch. Put a camera in the room, put an experienced nurse behind it, and the math on the slide works. Almost nobody in that boardroom asks the question that decides whether it works on the actual unit: what does this do to a shift in week three? Julie Tuel is System Vice President of Nursing Care Transformation and Clinical Digital Care at CommonSpirit Health, a system with more than 2,200 care sites across 24 states. As of CommonSpirit's March 2026 reporting the virtually integrated care model covered 1,075 beds, on the way to roughly 3,000. She is a critical care and stroke nurse by training, and she has spent this stretch of her career on the unglamorous part of the work: taking virtually integrated care from a concept that presents well to a care model that survives contact with a real med-surg floor and real nurses who did not ask for it. Dr. Sarah Matt asks for the first 90 days, not the strategic vision. Tuel's answer is that there is no system-level first 90 days at all. Every hospital and every unit is run as its own project, because the thing that breaks first when you scale a care model is not the technology and not the workflow. It is the culture, and a standard pushed out uniformly will hold for a quarter and then stop holding. On outcomes, Tuel gives numbers and then does something unusual with them. CommonSpirit has measured a 43 percent reduction in first-year RN voluntary turnover, and she immediately says it is not all attributable to virtually integrated care: it also reflects the nurse residency program and local and national nursing leadership. The program has also measured a 37 percent reduction in CAUTIs and CLABSIs and a 20 percent increase in nursing communication scores on HCAHPS. Other things covered: why CommonSpirit's model is deliberately not an admissions, discharges, and transfers model, and what changes when the virtual nurse is part of the care team instead

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The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.
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