MADISON, Wis. – A new virtual nursing program in the neonatal intensive care unit, or NICU, at American Family Children’s Hospital is effectively helping new nurses adjust to the challenging environment of bedside care for the tiniest patients.
The NICU at the children’s hospital is a Level IV, which is the highest level, where the most seriously ill and medically complex patients are cared for.
The turnover rate for new nurses is high nationwide, approximately 32% in the first year, according to a 2025 Nursing Solutions report. Before the program started, American Family Children’s Hospital NICU had a 38% new-to-practice nursing turnover rate from 2021 to 2023.
Neonatal intensive care nursing is particularly demanding, and high turnover is caused by the medical complexities of the patient population as well as the emotionally difficult nature of the job, according to Morgan Kuhl, NICU nurse, UW Health Kids.
To help address the turnover rate, UW Health Kids launched a virtual nursing program in July 2024, led by three UW Health Kids NICU bedside nurses, Kuhl, Grace Long and Hailey Madson, who together have nearly 20 years of NICU experience.
Since implementing the virtual nursing program, no new-to-practice NICU nurses have left during their first year, Kuhl said.
“We are extremely proud of the early success of the program because coming out of nursing school, it can be overwhelming to care for this precious and incredibly vulnerable population,” she said. “Everything you do as a nurse at the NICU must be done with such precision, and the treatments given to these babies will impact the rest of their lives.”
Each nurse works two six-hour virtual shifts per week. The program aims to support nurses in their first year by answering questions and reviewing challenging cases. Virtual nurses use a secure laptop from home, while new bedside nurses communicate via a tablet computer on the unit. The virtual nurses also work in-person shifts as bedside nurses on the unit. There are approximately 70 nurses in the NICU, with 12 nurses assigned to each shift. The virtual team is currently mentoring approximately 15 nurses, but any nurse on the unit, regardless of experience, can check in with the team.
The virtual nurses are available during busy times on the unit when it might be hard to find a nurse in person to answer questions, as well as to create a safe space to ask those questions and provide emotional support, according to Long.
“Oftentimes, families are not expecting to be in the NICU, and this is their first major interaction with the health care system, which can be traumatic and frightening,” Long said. “With these virtual check-ins, we can take the time to talk with new nurses about how to handle that, or we can simply listen if they’ve had a tough day.”
The hospital’s NICU opened 11 years ago, initially utilizing only half of the unit with a small number of patients, according to Madson.
The patient population has grown, with a higher average daily census each year, she said.
“I have been here for eight of the 11 years, so I’ve seen the growth firsthand,” Madson said. “Patients are also getting more and more complex, so the nurse team needs to be even more prepared to meet the challenge.”
Since the program started, it has expanded several times. The virtual team can now communicate with families remotely, having more detailed discussions about admissions, including what to expect during the stay.
Each new nurse also has a preceptor, or mentor, who works with them to provide guidance and support. The preceptors have the resources to complete the orientation toolkits with new nurses. However, sometimes when the unit is busy, they cannot cover educational topics as thoroughly.
The virtual nurses meet with new nurses without a patient assignment, allowing for in-depth virtual discussions of issues like changing dressings or specific details of mechanical ventilation. They have created PowerPoint presentations to supplement the content of the toolkits, giving new nurses more time to process the information.
September is NICU Awareness Month, which recognizes the experience and resilience of babies and families, and also honors the dedicated NICU staff who provide specialized care. In recognition of this awareness month, last week the virtual nursing team presented about the program at a national conference in Washington, with the hope of helping other organizations.
For the virtual nursing team, overcoming the many challenges is the best part of the job.
“Watching a parent hold their baby for the first time, or seeing a baby go home thriving after we weren’t sure if they were going to make it, is rewarding,” Long said.
