Boston Children’s Hospital’s journey into virtual nursing started when a small group of nurses decided to test how the concept would work within their single inpatient medical unit in 2022. The nurse-led initiative was conducted over the winter holidays during a period of lower census and received support from the hospital's innovation and digital health team.
The success of this first “test of change” positioned the hospital to be selected as one of five health care delivery systems in the Institute for Healthcare Improvement (IHI) and Johnson & Johnson Center for Health Worker Innovation Learning and Action Network in June 2023. The network was created to support nurse-led innovation in the design of care delivery solutions and to foster nurse thriving through care process change. Boston Children’s introduced “remote resource nurses” on one medical and one surgical unit for 10-day PDSA (Plan Do Study Act) cycles as one of many small tests of change.
"Our nurses noted many benefits of integrating virtual nurses within our staffing model. Our aim is to sustain and further optimize care quality, patient and family experience, staffing effectiveness, and to evolve care models that support the well-being of our nursing and interprofessional team members."
Virtual nurse tasks
An experienced nurse served as a remote resource nurse from 7-11 p.m. seven days a week. Focused assignments included:
- Completing admission histories.
- Conducting chart reviews to synthesize complex patient histories.
- Coordinating discharge teaching and safe care transitions.
- Guiding new-to-practice RNs following their initial orientation.
- Providing detailed patient and family education.
- Completing high-risk medication two-RN checks.
"It was nice to have someone to ask questions and bounce ideas off. If an admission was coming, it was helpful that the virtual nurse was already looking into the chart, looking at the vitals, looking at past documents to help us know what’s going on with the patient. For nurses to have that person look into these things while they’re taking care of other patients was helpful."
Technology
Boston Children’s avoided new capital expenditures by redeploying electronic tablets that had served as patient-family and team communication devices during the pandemic. The on-demand video capability allowed families and bedside nurses to connect quicky with a remote nurse. The nursing team worked with information technology to link the tablets to the Epic EHR. Small tests of change included nurses working from home as well as within the hospital.
“Having those couple of shifts at home was an eye opener. Mentally, it helped me reset and be able to come back the next shift. I think it helps people start seeing nursing in a different way. You’re doing the same thing, but this pulls you out of the middle of the chaos.” Marisol Hernandez, BSN, RN, CPN, staff nurse who served as a remote resource nurse.
Wins and outcomes
As part of the IHI Learning & Action Network, Boston Children’s conducted 55 PDSA cycles and saved 27.4 hours of direct care time using remote resource nurses.
- 18 potential errors were prevented.
- 84.2% of staff said they would like to see the remote resource nurse role continued.
- 100% of nurses interacted with a remote resource nurse during their shifts.
"I was able to send off a policy. I was able to print things for nurses. I did insulin math with a nurse. She showed me the syringe and how much insulin she was going to give so I could co-sign it."
Tips for success
- Trial small tests of change without over-planning to drive innovation.
- Measure the impact of change to engage stakeholders.
- Engage frontline teams to design, evaluate, and manage change.
- Listen and act on staff feedback.
