During the pandemic, LDI Senior Fellow K. Jane Muir noted the rise of a curious new technology —virtual nursing—in which remote registered nurses helped deliver care through video or messaging apps. Her hospital tested an early version of the system, and Muir, an Assistant Professor at Penn Nursing and the Perelman School of Medicine, watched the technology spread across the country, performing duties like patient monitoring, record-keeping, and arranging discharges.

Muir, who studies emerging models of nursing care, was intrigued enough to lead one of the largest studies to date on virtual nursing in hospitals.

Her team’s findings were mixed: More than half of nurses said virtual nursing failed to reduce their workload. However, more than half also said the system improved care, though only 11 percent described the improvement as substantial.  

Many nurses viewed virtual nursing as a short-term fix rather than a complete solution to understaffing. Nurses, she said, preferred having another colleague performing direct care at the bedside instead of adding virtual nurses who cannot touch patients.  

At the same time, nurses said the technology helped with administrative tasks such as admissions.

Muir acknowledged that her team—including LDI Fellows Alexandra Maye, Matthew McHugh, Linda Aiken, and Karen Lasater—could not yet link virtual nursing to patient outcomes. A future project will examine more closely the experiences of virtual nurses and assess their effects on how patients fare.

She doesn’t think virtual nursing can replace bedside nurses anytime soon.

Hospitals should also be cautious when using artificial intelligence (AI)-driven care models without strong evidence of their safety and effectiveness.

For more from Muir, see her answers below.

What is the state of nursing at this moment for burnout, job satisfaction, and retention?

Muir: Nurse burnout and turnover have reached crisis levels. Nearly half (47%) of hospital-based registered nurses report high burnout, one in five report job dissatisfaction, and 40% intend to leave their employer in the next year if possible. Nurses cite high burnout and unsafe nurse staffing ratios as top factors driving them from health care jobs. Chronic nurse understaffing contributes to unsafe workloads and poor working conditions that perpetuate this cycle.

What are virtual nurses and what problem are they trying to solve?

Muir: Virtual nurses in hospitals are registered nurses who deliver care to hospitalized patients remotely using video and/or messaging platforms. The goal is to support bedside nurses by offsetting certain care tasks to the virtual nurse. Implementation varies widely across hospitals, but virtual nurses typically handle tasks such as patient monitoring, documenting in the electronic health record (EHR), and conducting admission and discharge procedures.

Why did you take on this virtual nursing project?

Muir: I study emerging nursing models of care that affect patient outcomes and nurse well-being, including virtual nursing. I became interested in studying the issue because I worked as a nurse during the COVID-19 pandemic, and an early form of virtual nursing was piloted in my workplace. Although it was necessary to help nurses assess and monitor patients in the emergency department during the crisis conditions of the pandemic, I’ve watched it expand across the U.S. as a more permanent model. It is critical to gather evidence about care models like virtual nursing and its impact on nurses’ work and patient care, prior to widespread hospital adoption.

What are your most important findings on virtual nursing in your JAMA Network Open paper?

Muir: Our study is one of the largest to date on virtual nursing in hospital settings. Among the 880 hospital nurses in our sample, we observed mixed reviews. More than half (57%) of nurses said that virtual nursing programs did not reduce their workload, and 10% said that they worsened their workload. Most nurses (53%) said that working with virtual nurses improved patient care quality, but only a small percentage (11%) characterized that improvement as substantial.

You quote several nurses about virtual nursing. How would you summarize their comments?

Muir: Hospital nurses in our study described their experiences working with virtual nurses. A significant theme from our qualitative analysis was concern that virtual nursing was a nurse staffing workaround rather than a meaningful solution to chronic understaffing. Nurses said they would prefer an additional nurse at the bedside performing direct patient care over adding virtual nurses who cannot physically interact with patients. Bedside nurses reported being pulled away from patient care to address calls from virtual nurses about concerns they had already addressed. Others described having to correct documentation errors because virtual nurses lacked familiarity with the patient’s course of care. However, nurses did find virtual nurses to be helpful for administrative tasks such as admissions and discharges, and for serving as a second witness when administering medications.

What limitations does your virtual nursing study have?

Muir: This was a descriptive study, so we cannot establish linkages between virtual nursing and nurse or patient outcomes. We also lacked detailed information about how virtual nursing programs were implemented within individual hospitals, which may be important for understanding the variation in bedside nurses’ experiences.

Does your experience with virtual nurses suggest anything about how AI should land in hospitals?

Muir: Our findings suggest that health care organizations ought to proceed cautiously when implementing virtual nursing or AI-driven care models without empirical evidence of their safety and efficacy. As we analyzed our results, we were struck by how these care models risk falling prey to the “Doorman Fallacy” — the problematic assumption that complex human roles can be reduced to discrete tasks and safely replaced with virtual or AI alternatives.

What recommendations do you have for policymakers?

Muir: Our findings demonstrate that virtual nursing is not a replacement or substitute for the bedside nurse. If policymakers are seeking evidence-based solutions to protect the public’s health, they should look to the decades of rigorous research showing that increasing the number of in-person nurses at the patient’s bedside is associated with better patient and nurse outcomes.

Where are you going next with your research?

Muir: Our next step is to study the experiences of virtual nurses themselves and determine the variation in virtual nursing implementation across U.S. hospitals. This will help us determine the relationship between virtual nursing and patient safety outcomes, as well as nurse job outcomes such as burnout, intent to leave, and job satisfaction.

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The article, “Virtual Nursing for the Care of Hospitalized Patients,” was published on December 5, 2025 in JAMA Network Open. Authors include K. Jane Muir, Alexandra Maye, Matthew D. McHugh, Linda H. Aiken, Vicky Vo, and Karen B. Lasater.

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