Dissertation
Virtual Nursing Care: Centralization and Change Management
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: Health systems across the United States are increasingly adopting virtual nursing (VN) to address persistent workforce shortages, rising patient acuity, and documentation burden; however, national implementation remains fragmented, with most programs operating in decentralized structures and lacking standardized workflows or outcome metrics. Locally, the project site’s VN model functioned as a siloed regional program with inconsistent processes, unclear role delineation, and limited scalability. A synthesis of 1,280 screened articles identified 29 relevant sources across two domains: change management and centralization. Evidence emphasizes structured, iterative frameworks (e.g., PDSA, Kotter), interdisciplinary collaboration, clear vision, and leadership-driven communication to support adoption, while the centralization literature highlights the need for standardized processes and system-level alignment to reduce variability and strengthen reliability. Purpose: This quality improvement project aimed to develop a structured change management toolkit and evaluate early operational outcomes associated with transitioning from a decentralized VN model to a centralized systemwide structure. Methods: The project was implemented on Unit 4A, a 34 bed surgical oncology unit, including all eligible adult inpatients from April to September 2025. Practice change objectives included standardizing VN workflows, improving order completion efficiency, and enhancing the patient experience. Guided by the Knowledge to Action Framework, a multidisciplinary workgroup met monthly from October 2025 to February 2026 to identify knowledge gaps, tailor interventions, and develop a centralization toolkit to promote adoption. Data included HCAHPS scores, length of stay (LOS), and VN order completion times. Normality was assessed using Shapiro–Wilk tests, followed by a t-test (p < .05). Findings: Patient experience improved from 74.51% to 91.67%. LOS decreased by 24–32% in five of six months. Admission order completion times showed early improvement and late stabilization, while discharge completion times improved consistently. Discussion: Early operational gains suggest that structured change management strategies supported workflow stabilization and strengthened adoption of the centralized VN model.
Details
- Title: Subtitle
- Virtual Nursing Care: Centralization and Change Management
- Creators
- Kayla Piplani - University of Iowa
- Contributors
- Maria Joseph (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Health Systems/Administration
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Kayla Piplani
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217821502771
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