Virtual Nursing Case Studies

As pediatric nursing workloads increase, virtual nursing is taking on a more prominent role in the profession. The Society of Pediatric Nurses (SPN) is partnering with leading pediatric nursing units to strengthen understanding of emerging trends in virtual nursing by collecting and sharing data. If you want to start conversations about virtual nursing in your organization, click the link below to access our discussion guide. Continue the discussion around virtual nursing, by joining our virtual nursing community on The Hive, a free online community for pediatric nurses to connect. 

Implementing Virtual Nursing at Children's Hospital Los Angeles (CHLA)

Background

Children’s Hospital Los Angeles (CHLA) embarked on a virtual nursing initiative to address rising workload demands, high nurse turnover, and efficiency challenges in admissions and discharges. The program began on two high-turnover medical-surgical units and has gradually expanded in scope.

Key drivers for implementation included: 

  • Cost-effectiveness: Reduce overtime and delays in admissions/discharges.
  • Staff retention: Alleviate stress on bedside nurses, reducing turnover.
  • Workflow efficiency: Support nurses in managing documentation, charting, and patient education.

Program Design & Technology

  • Units Involved: Two medical-surgical units, including one with transplant patients.
  • Staffing: ~18 virtual nurses, Monday–Friday, 8 AM–8:30 PM.
  • Technology: Amwell platform integrated with Oracle Health EHR; iPads in patient rooms; communication via Teams, phone, and Google Drive.
  • Responsibilities: Admissions, discharges, education, chart reviews, care plans, post-discharge check-ins.

Implementation & Change Management

  • Staff engagement: Product managers shadowed nurses pre-launch.
  • Training & buy-in: Staff meetings, governance sessions, scripted scenarios, competitions.
  • Resistance: Addressed tech anxiety with role clarity, peer support, and reinforcement.

Outcomes & Impact

  • Efficiency: Faster admissions/discharges over time.
  • Bedside nurse relief: Reduced workload, more focus on direct care.
  • Retention: Early signs of reduced turnover.
  • Patient satisfaction: Improved scores; families appreciated uninterrupted attention.
  • Safety & quality: Virtual nurses caught documentation gaps and prevented errors.

Challenges & Lessons Learned

  • Technology: Connectivity, iPad misuse, charging issues; solved with secure stations and anti-theft cords.
  • Role clarity: Early confusion resolved with defined responsibilities.
  • Pilot limitations: Infrastructure differences across buildings posed challenges.

Unexpected Benefits

  • Collaboration: Improved communication across disciplines.
  • Continuity: Post-discharge follow-ups bridged care transitions.
  • Alternative staffing: Opportunities for nurses on light duty or unable to work bedside.

Future Directions

  • Expansion to more units and weekend coverage.
  • Creation of a dedicated cost center/unit with leadership.
  • Potential for fully remote virtual nurses.
  • Broader roles: parent equipment education, eating disorder monitoring, NICU car seat testing.

Key Takeaways

  • Engage frontline nurses early: Align with their workflows.
  • Prioritize role clarity: Define bedside vs. virtual nurse tasks.
  • Start small, scale thoughtfully: Pilot in one unit/building.
  • Support adoption: Use competitions, champions, and leadership visibility.
  • View virtual nursing as workforce innovation: Supports retention, satisfaction, and career pathways.