What Is the ROI of Virtual Nursing, and Where Does the Workflow Value Show Up?

Virtual nursing is usually justified on labor, however the measured evidence points somewhere else. In a 2025 observational study, virtual nurses completed discharge education in 79.2% of encounters compared with 27.2% for bedside nurses, and took nearly three times as long doing it (Khairat et al., SAGE Open Nursing, 2025). The return comes from the work happening consistently rather than quickly, which makes the workflow around the program the thing worth designing.

When virtual nursing entered the conversation, most of the focus was on staffing. Could virtual nurses help with shortages, reduce burnout, and keep experienced nurses practicing? Those questions still matter, and the business case usually gets built on them.

The research published since points somewhere slightly different. The clearest measured effects are not about how many hours a program saves, they are about how consistently important work gets done.

What is the ROI of virtual nursing?

Labor is one component, and the published evidence for it is less than the evidence for completeness of clinical work.

The workforce math is real enough. The 2026 NSI National Health Care Retention and RN Staffing Report put the national RN turnover rate at 17.6% for 2025, the average cost of replacing one staff registered nurse at $60,090, and the average time to recruit an experienced RN at 78 days (NSI, 2026). Any program that helps a hospital keep experienced nurses has a defensible financial argument. It is simply not the only place the value lands.

Does virtual nursing reduce the bedside nurse's workload?

Often not directly, according to the nurses themselves, and that finding is more useful than it first appears.

In a study of 880 hospital nurses published in JAMA Network Open in December 2025, 57% reported that virtual nursing did not reduce their workload and 10% reported it made their workload worse. In the same study, 53% reported that it improved the quality of patient care (Muir et al., JAMA Network Open, 2025). The authors describe the work as descriptive and note it could not establish causal links to patient outcomes.

Those two numbers only look contradictory if the goal was saving time. Most nurses in that sample did not experience virtual nursing as fewer tasks, and about half experienced it as better care. A program evaluated purely on hours returned can look like a disappointment while it is improving something else.

What does virtual nursing measurably change?

Completeness. Work that competes with everything else on a busy unit gets done far more often when somebody has protected time for it.

An observational study of 111 encounters at a large Southeastern US hospital compared virtual and in-person nursing on task completion. Discharge education was completed in 79.2% of virtual encounters versus 27.2% of bedside encounters. Home medication review was completed in 78.8% versus 25%. Admission documentation reached 80.2% versus 58.8%, and social determinants of health assessment reached 96.9% versus 37.5% (Khairat et al., SAGE Open Nursing, 2025).

The same study found virtual discharges averaged 19 minutes and 7 seconds against 6 minutes and 55 seconds in person. That is the finding people skip, and it is the honest one. Virtual nurses were not faster. They were more thorough, because thoroughness was the entire assignment. This is a single-site study of 111 encounters that did not control for patient severity, so treat it as a strong signal rather than a settled number.

Does a dedicated discharge process change patient outcomes?

One large multi-site study points that way, and it needs to be quoted carefully.

A retrospective study across nine hospitals in one Southeastern US health system matched 4,662 virtual-nurse-assisted discharge encounters to 4,662 in-person discharges and found a 30-day emergency department readmission rate of 3.7% for the virtual group against 13.3% for the in-person group, a risk ratio of 0.28 (Khairat et al., npj Digital Medicine, 2026). Similar reductions appeared in both urban and rural hospitals.

Two qualifications belong with that number every time it is used. The outcome measured was an emergency department revisit rather than an inpatient readmission, and the authors state that the observational design cannot prove causation. A difference that large in a discharge process is worth taking seriously and worth holding loosely until someone replicates it.

What is happening to the experienced nursing workforce?

Less an exodus than a reallocation, which is what makes virtual roles interesting. The National Council of State Boards of Nursing found the median age of registered nurses rose from 46 in 2022 to 50 in 2024, while the share of RNs employed in hospitals fell to 53% (NCSBN, 2025). In AONL's 2025 Nursing Leadership Insight Study of 3,128 respondents, 23% of nurse leaders said they might leave their current position, but of those only 8% planned to leave the profession (AONL, 2025). Experienced clinicians are moving between roles more than they are walking away, and a virtual role keeps that expertise in the building.

"Virtual nursing is an incredible way to use nurses who have a wealth of knowledge but maybe not the stamina to work 12-hour physical shifts anymore," said Sue Schuelke, PhD, RN-BC, Assistant Professor at the University of Nebraska Medical Center College of Nursing.

What happens to coordination as a virtual nursing program scales?

The hard part stops being the video connection and becomes knowing who owns the next step.

Most programs begin with discharge. As they mature, virtual nurses often pick up admissions, medication reconciliation, patient education, family communication, and care coordination. Each addition raises the value of the program and also the number of open questions on any given shift. Which patients need virtual support today? Has the admission been completed? Is discharge education finished? Does the bedside nurse know the virtual visit is done?

The invited commentary accompanying the JAMA Network Open study makes this point from the research side, warning that "technology without workflow redesign and user-centered design risks adding burden" (Khairat and Clipper, JAMA Network Open, 2025). Nurse leaders describe the same thing operationally.

"It's not about the technology. It's about a new model of care and the technology enables it," said Kathleen Sanford, DBA, RN, Executive Vice President and Chief Nursing Officer at CommonSpirit Health, speaking to AHRQ PSNet.

This is where configurable workflows earn a place in a virtual nursing business case. When every admission, discharge, and education task has a named owner and a visible status, teams spend less time asking where things stand. Backline helps organizations give the handoffs between bedside and virtual teams a defined owner, a status, and an escalation path. 

How should hospitals measure virtual nursing success?

Increasingly on clinical and workforce outcomes rather than financial ones, which matches where the evidence is strongest.

In an April 2026 Wolters Kluwer survey of chief nursing officers, patient outcomes and nurse competencies tied as the top measures of care model success at 87% each, while financial management ranked eighth out of nine at 81% (Wolters Kluwer, 2026).

Questions worth putting alongside the staffing model: Are discharge workflows becoming more consistent? Are bedside nurses spending more of their time on direct care? Are patients receiving more standardized education? Are teams spending less time tracking the status of routine work? A peer-reviewed pilot at BayCare Health System reported roughly two hours of administrative work returned per shift and voluntary RN turnover falling from 17.8% to 12.2% (Journal of Nursing Administration, 2024), which is one site and a reasonable shape for what to track.

It also helps to be clear with nurses about what the program is not. Amber Price, DNP, RN, Senior Vice President and Enterprise Chief Nursing Officer at Sentara Health, told Chief Healthcare Executive: "One of the things that I've guaranteed to our nurses is that we will not change our ratios" (Chief Healthcare Executive, 2026).

The so-what

The evidence on virtual nursing is young and mixed, and the mixed parts are the informative ones. They fit together if the value of the model is consistency rather than speed.

That carries a practical implication. The organizations getting the most from virtual nursing are likely to be the ones that redesign the workflow around it, rather than the ones that only install the technology. If you are thinking about what comes next for your program, we would be glad to share how health systems are using configurable workflows to support admissions, discharges, medication reconciliation, and other nursing processes. Explore Backline or connect with our team with a Workflow Assessment to learn how we support your initiatives. 

References

1. Khairat, S., Morelli, J., Aucoin, J., Edson, B. S., Jones, C. B., & Shea, C. M. (2025). Association of virtual nursing and task completeness: An observational study. SAGE Open Nursing, 11, 23779608251363667. https://doi.org/10.1177/23779608251363667

2. Muir, K. J., Maye, A., McHugh, M. D., Aiken, L. H., Vo, V., & Lasater, K. B. (2025). Virtual nursing for the care of hospitalized patients. JAMA Network Open, 8(12), e2545597. https://doi.org/10.1001/jamanetworkopen.2025.45597

3. Khairat, S., Zhou, Z., Morelli, J., Anstrom, K. J., & Jones, C. B. (2026). Virtual nursing implementation and 30-day patient readmissions: A multi-site study. npj Digital Medicine. Advance online publication. https://doi.org/10.1038/s41746-026-02881-2

4. Khairat, S., & Clipper, B. (2025). Virtual nursing and the future of workforce sustainability. JAMA Network Open, 8(12), e2545603. https://doi.org/10.1001/jamanetworkopen.2025.45603

5. NSI Nursing Solutions. (2026). 2026 NSI national health care retention and RN staffing report. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf

6. National Council of State Boards of Nursing. (2025, April). 2024 national nursing workforce study. https://www.ncsbn.org/research/recent-research/workforce/2024-workforce-rn.page

7. American Organization for Nursing Leadership. (2025, March). AONL nursing leadership insight study 2025. https://www.aonl.org/system/files/media/file/2025/03/AONL-Nursing-Leadership-Insight-Study-2025.pdf

8. Wolters Kluwer. (2026, April 8). Wolters Kluwer survey: Chief nursing officers rank patient outcomes and nurse competency as top care model success KPIs [Press release]. Business Wire. https://businesswire.com/news/home/20260408066963/en/Wolters-Kluwer-survey-Chief-Nursing-Officers-rank-patient-outcomes-and-nurse-competency-as-top-care-model-success-KPIs

9. Agency for Healthcare Research and Quality. (2023, August 30). In conversation with Kathleen Sanford and Sue Schuelke about virtual nursing. PSNet. https://psnet.ahrq.gov/perspective/conversation-kathleen-sanford-and-sue-schuelke-about-virtual-nursing

10. Ransford, J., Tidwell, T., Johnson, L., Gitney, N., Morgan, A., & Hauch, R. (2024). Implementing a virtual discharge nurse pilot: Utilizing the Pathway to Excellence framework. JONA: The Journal of Nursing Administration, 54(11), 605-611. https://doi.org/10.1097/NNA.0000000000001498

11. Southwick, R. (2026, May 15). Sentara Health embraces virtual nursing and AI. Chief Healthcare Executive. https://www.chiefhealthcareexecutive.com/view/sentara-health-embraces-virtual-nursing-and-ai

12. Carbajal, E., & Twenter, P. (2025, February 21). How 5 systems are tackling virtual nursing's growing pains. Becker's Hospital Review. https://www.beckershospitalreview.com/nursing/how-5-systems-are-tackling-virtual-nursings-growing-pains/