Solving a shortage with virtual nurses

For all the debate about artificial intelligence in healthcare, one quietly transformative shift is taking place not through machines, but through video calls.

A growing number of U.S. hospitals are now using virtual nurses (VNs) to handle admissions and discharges remotely.

The promise? Relief for burnt-out bedside nurses, better care coordination and fewer patients bouncing back to the hospital within weeks.

A new study by doctoral student Blair Liu (PhD ’26) and operations professors Yuqian Xu and Brad Staats at UNC Kenan-Flagler Business School offers a comprehensive evaluation of this model.

Their verdict is striking: Virtual nursing cuts average inpatient length of stay by more than 7% and reduces re-admission rates by around 2%. For overstretched U.S. health systems staring down a 300,000-nurse shortfall by 2027, this could mark an important inflection point.

“It started with curiosity and an operations lens,” says Liu. “During a hospital tour in a healthcare class, I saw a patient using an iPad. When I asked about it, the nursing director said it was for virtual nursing.”

What followed was an investigation into whether — and under what conditions — virtual nurses deliver measurable value.

Their model is relatively straightforward. Instead of relying solely on in-person staff, hospitals deploy experienced nurses from remote command centers or their homes to conduct high-volume, non-clinical work.

This includes patient intake, identity verification, education and discharge instructions — tasks that, while essential, often crowd the workloads of bedside teams.

The study used 28,000 inpatient encounters across two East Coast hospitals — one of which adopted the VN program. The setting allowed the authors to compare changes over time.

What they found made a real difference in how hospitals run, with reductions in length of stay and re-admission rates at both the 30- and 60-day marks.

“The VN program leverages very senior nurses with deep institutional and clinical knowledge,” Liu says. “That drives those care quality impacts,”

However, the study finds that the greatest returns emerge when VNs are used during admissions, rather than discharges. Getting things organized early, like checking patient history and timeliness of care, helps the hospital stay go more smoothly and leads to better outcomes.

But deploying VNs is not as simple as plugging in a webcam.

“Hospitals need reliable Wi-Fi since virtual nurses work over video,” Liu says. “During moments of poor internet connectivity at our partner hospital, virtual nurse services—such as admission or discharge—were interrupted, and bedside nurses had to step in to complete the process instead.”

Another challenge is recruitment. “Strong candidates are needed for virtual nurse roles,” she says. For retired nurses, those with physical limitations or clinicians seeking more flexible work, virtual positions offer a meaningful return to practice.

But for hospital leaders, creating a reliable remote workforce is far from simple. It means redesigning workflows, retraining staff and carefully selecting which patients are suitable for virtual care – typically those who can hear, speak, and communicate clearly.

The study goes further to identify the sweet spots where virtual nursing has the greatest payoff.

Departments that were moderately busy on a patient’s admission day— operating at 50% to 75% of capacity — saw the biggest improvements, with length of stay reduced by 11.8% and 30- and 60-day readmission rates dropping by 4.7% and 4.6%, respectively.

In contrast on a patient’s admission day, results were muted when units were either too quiet or too overwhelmed, with no statistically significant gains observed under low (below 50%) or high (above 75%) congestion.

Moreover, nurse experience matters. When virtual nurses had more years under their belt than their bedside counterparts, the length of patient stay dropped by 7.3% and 30-day re-admissions fell by 2.0%.

But when the virtual nurse was less experienced, there were no significant improvements. The takeaway: Virtual care appears to work best as a way to extend seasoned clinical expertise, not as a substitute for it. The researchers plan to explore this further.

The study points to a hybrid workforce in the future, one where knowledge can be decoupled from physical presence and redeployed at scale.

“Virtual nursing could be a good path forward,” Liu says. “New bedside nurses can really benefit from learning directly from senior virtual nurses with deep clinical and institutional knowledge.”

There are reasons for caution, though. The study’s findings, while compelling, come from a specific hospital system and implementation quality is likely to vary.

But as a growing number of facilities confront the nurse staffing crisis, the temptation to scale VN programs seems likely to grow.

“This study offers a clear message to nurse leaders,” Xu says. “Virtual nursing models can meaningfully improve hospital performance without compromising patient outcomes.”