Table 3 Overview of themes, subthemes, and supportive quotations

 Measure value

“We recently started a new program in a couple of the ICUs… the big question that the nurses have over there, because I round and talk to them, is what are we bringing to them? They don’t really see that there’s a benefit on their end.” TeleICU9

 Partnerships

“They asked, ‘could a teleICU nurse provide a second signature?’ I said, ‘yeah, as long as we can visualize and double-check everything that you do at the bedside through the camera.’ A couple of other ideas have come from the bedside staff and we explore them.” TeleICU5

“Extubation in less than 24 h is an important metric… the [teleICU nurse] has a collaborative conversation ‘your patient is still intubated at the 18-h mark, what can be do over the next six hours to get this patient extubated?’… That’s something we’re currently utilizing [teleICU] for, which has been very helpful.” ICU1

 Specialized skills

“Having been an ICU nurse for 20+ years, your focus has to shift from being very detail-oriented for a few patients to being more generalized for a large amount of patients… I have to know a little bit about everybody and a little bit more about certain patients... you have to step back and change your approach to how you look at your patients.” TeleICU1

 Execution

“We really have been able to thwart disasters at times… We visualize patients and if something is amiss, if a patient has problems with their mentation, if they’re delirious, confused, we keep an extra eye on them, and we’ll alert the staff if something is not right.” TeleICU5

“I camera’d in when the pressure was low, and I said ‘do you have access? Somebody needs to bring the cart.’ Then the doc came, and he directed the code. I was helping the nurse that was on the chest because they weren’t going fast enough. I’m like ‘you need to be 100′.” TeleICU3

“There were a few times when I wasn’t sure about something, or whether or not I should wake up the provider at night… I would call them [teleICU] and see what they thought about the situation. I maybe did that two or three times while I was working night shift.” ICU16

 Tools for effective collaboration

“We have to be careful on our end when we’re talking to the staff, how we modulate our voice and what words we choose to not sound condescending or fault finding. It’s an art and some people are much better at it than others.” TeleICU2

“I’ll see the camera flipped around and they’re looking at stuff, but they’re never telling me what they’re looking at or why they’re in my room. I want to know why you’re looking at my patient because if I missed something I want to know.” ICU13

“I don’t know if they don’t document it, so I’ve run into that where I’ve called and said, ‘did you do this?’ and they’re like, ‘yeah, but it’s not documented.’ So it’s frustrating on our end, but it’s frustrating on their end also.” TeleICU11

 Mutual respect

“As a new nurse, it felt strange, because it felt like you were always being watched. If you change your mindset to think that it’s for helpful reasons, then it just is what it is.” ICU12

“When we have providers [in teleICU] that we know, we’re more likely to use it. It could be a big thing to know who is working over there. There are some of our former nurses who went there, so sometimes they’ll pop in and just say ‘hello’, which is nice.” ICU16

 Collaborative leadership

“I feel like our [teleICU] services aren’t always advertised much. I think we need to be present on the unit more, we actually need to go to the units and do things with the nurses… it’s just that they have a different perception of us.” TeleICU3

“We monitor so many different ICUs. Each ICU has their own culture. It’s different. [Unit] was one of the first to come on board. Their physicians really started this program. They were much more receptive. Having that relationship helped a lot, where other places are not very receptive.” TeleICU7