Letter to the Editor by Kendra Williams to "Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care"

Who Does What in Health Care?

April 19, 2017

Response by Kendra Williams to "Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care" by Miriam Bowers Abbott and Peggy Shaw (August 15, 2016).

With Reply from Authors

Dear Editor:

I am writing in response to “Virtual Nursing Avatars: Nurse Roles and Evolving Concepts of Care” (Bowers Abbott & Shaw, 2016). While this article presented several different uses for avatars being introduced in the clinical setting, I do not support use of avatars to discharge patients. According to the North Carolina Board of Nursing RN Scope of Practice (2014), revised in 2010, “Teaching and counseling clients is the responsibility of the registered nurse and includes having the responsibility for assessing the client’s needs, developing the teaching plan, evaluating the effectiveness of teaching and counseling and making referrals to appropriate sources” (p. 3). An avatar simply cannot use judgment and assessment skills to determine effectiveness of communication or to individualize teaching instructions based on personalities and education level.

As a nurse in the NICU, I get the opportunity to select infants and their families and can serve as their primary nurse. It is privilege to follow these families through their NICU experience, with all the ups and downs that a premature infant can endure, all the way to celebrating with them on their discharge day. Discharge teaching is essential to ensure that my families know and understand exactly how to care for their child at home. Reddick and Holland (2015) stated that “Individualized education and planning needs should be developed based on the patient assessment, readiness to learn, and patient and family need” (p. 12). To think that a virtual nurse avatar would take my place and discharge my families makes me frustrated. After working so hard with my babies and their families, I want to be the one to have personal education time with them. As their primary nurse, I can customize their teaching, focusing more on where they have struggled and less on the concepts and care that they have mastered. No computer can understand the anxieties that my families might be experiencing with the fear of taking home a preterm baby that has medical needs. I feel that families will be much more open to discuss concerns prior to discharge with the nurse that has been there with them throughout the entire stay rather than a computer that comes in on the last day.

Computer technology is great, and will only continue to advance. With that advancement, changes are going to occur. I do think that there will be a place for avatars to help behind the scenes in nursing. However, having avatars perform the crucial discharge teaching is not that place. Reddick and Holland (2015) also stated, “Discharge education and planning are critical components of quality patient care” (p. 10). Adequate discharge teaching can prevent readmission to hospitals. Knowing that insurance companies are now reluctant to pay for readmissions, I will not be relying on an avatar to educate my patients. The personal relationship built with patients and their families during their hospital stay affects their overall experience. It is a privilege to work so closely with my families and see them through to the end.

I want the best for my patients. For me to provide discharge teaching to them personally ensures that, as a nurse, I have done my duty to serve my patients to the best of my capability.


Kendra Williams, RN


Abbott, M.B., & Shaw, P. (2016). Virtual nursing avatars: Nurse roles and evolving concepts of care. OJIN: The Online Journal of Issues in Nursing, 21(3). DOI: 10.3912/OJIN.Vol21No03PPT39,05. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No3-Sept-2016/Articles-Previous-Topics/Virtual-Nursing-Avatars.html

North Carolina Board of Nursing. (2014). RN scope of practice – Clarification. Retrieved from https://sph.unc.edu/files/2014/02/nciph-chrm-f15-rn-position-stmt.pdf

Reddick, B., & Holland, C. (2015). Reinforcing discharge education and planning. Nursing Management, 46(5), 10-14. doi:10.1097/01.numa.0000463887.70222.50