Build vs. Buy: Should Your Digital Health Company Hire Virtual Nurses In-House?
By Ava Bethea, BSN, RN — Chief Executive Officer of NursiConnect, and Chair of the North Carolina Nurses Association Council on Virtual Nursing
You raised the round. You built the platform. The technology works. And then you hit the wall almost every digital health and RPM company hits at the same moment: you need nurses on the other end of it — and finding, hiring, and keeping them has quietly become your bottleneck.
Here’s a question worth sitting with. When your device installs stopped scaling, you probably didn’t build an in-house installation department. You partnered with a company that installs nationally, so your team could stay focused on the product. Most digital health companies make that call without blinking.
So why are you still trying to build your own nurse-recruiting operation?
The moment nursing becomes your problem
It usually shows up as a step function. You’re steady today, and then a payer deal or a new practice lands and suddenly there are 100, 200, 300 patients coming on fast — and, as one RPM founder put it, “that is basically an entire new full-time person.” Except a full-time clinical hire isn’t a person you can post-and-fill in two weeks. And planning for demand that spikes and dips is, in his words, “really complicated.”
That’s the trap. Your enrollment can move at the speed of sales. Your in-house clinical hiring can’t. The gap between the two is where programs stall, boards get nervous, and patients end up under-monitored.
Why building the nurse layer in-house is the wrong instinct
Not because you can’t. Because it pulls you away from the thing only you can do — and it’s a fundamentally different operation than the hiring you already know.
Clinical hiring is nothing like tech hiring. Engineers don’t need multi-state licensure, credentialing, or compliance clearance before they can touch the work. Virtual nurses do. Multi-state and compact licensing, background and drug screening, credential verification, and virtual-care competency all sit between “signed offer” and “monitoring a patient.” Teams that assume clinical onboarding moves at tech speed discover it doesn’t — after they’ve already promised the board a ramp.
The employment burden is heavier than it looks. As one founder said plainly, “we can’t make them W2 employees — it’s too complicated. Can’t provide health benefits and sick pay.” Carrying nurses as employees means benefits, workers’ comp, and legally required sick pay — real cost and real administrative weight that has nothing to do with your product.
There’s no bench, so a single resignation becomes a coverage gap. The fear every clinical leader named: “a nurse leaves and we don’t have the ability to cover our other patients. We can’t interrupt our patient [care].” When you carry your own small team, one departure or one leave of absence opens a hole immediately — and the patients don’t wait.
It’s not your core competency, and pretending it is costs you. “Our team, our skill set and strength is not recruiting and hiring nurses.” Every hour your leadership spends sourcing nurses is an hour not spent on the platform, the payer relationships, and the roadmap that actually differentiates you.
What “buying” the nurse layer actually looks like
Buying doesn’t mean handing over control. It means contracting a partner who already carries the clinical workforce so you don’t have to build one. In practice that’s:
- Flexibility and stability. Scale up when a step function hits, flex back down when it passes — without the whiplash of hiring and laying off clinical staff yourself. As one founder framed his own need: “flexibility but also stability.”
- The employment burden, absorbed. The partner carries the nurses — benefits, workers’ comp, sick pay, the compliance overhead — and you contract the coverage.
- Multi-state licensing and credentialing handled as infrastructure. Including the hard-to-fill, investor-mandated geographies you can’t easily recruit into on your own.
- A bench behind every seat, so a resignation is the partner’s problem to backfill, not a hole in your patient coverage.
- Nurses who already understand virtual care — telehealth workflows, remote monitoring, and clean documentation —
The result is that your clinical capacity moves at the speed of your enrollment, and your team goes back to building the product.
When it actually makes sense to build
To be fair: building in-house can be the right call in specific cases. If nursing is your core product — if you’re a clinical services company whose entire value is the care team — owning that workforce is strategic, not a distraction. If your volume is small, flat, and predictable, a couple of employed nurses may be all you ever need. And if you have deep clinical-operations leadership already on staff with the bandwidth to run recruiting, licensing, and compliance, you may have the machine to do it well.
Outside those cases, though, most digital health and RPM companies are better served treating the nurse layer the way they treat every other non-core function that stopped scaling: partner for it, and stay focused on what makes you, you.
The bottom line
The technology was never the hard part. The nurse layer is — and it’s the piece most companies try to build exactly when they can least afford the distraction. You already made this call once, when you stopped installing your own devices. The nurse layer deserves the same clear-eyed decision.
If you’re staring at a staffing ramp you’re not sure you can hire against, that’s the conversation worth having before the board asks about it.
Want to run the decision yourself first? Grab the Build vs. Buy guide — a 6-question scorecard that lands you on a clear build-or-buy answer, plus a side-by-side of what each path really costs. Get the guide →
Or if you’d rather just talk it through:
Ava Bethea, BSN, RN — Founder & Chief Executive Officer of NursiConnect, and Chair of the North Carolina Nurses Association Council on Virtual Nursing. NursiConnect is the certified virtual-nurse workforce behind virtual care. Nurse-founded, built from years inside virtual nursing, Hospital at Home, RPM, and virtual triage.