Virtual exchange (VE) refers to the practices in which groups of learners are engaged in online intercultural interaction and collaboration with partners from other cultural contexts or geographical locations as an integrated part of course work under the guidance of instructors (Jager, Nissen, Helm, Baroni & Rousset, 2019; O’Dowd, 2018; O’Dowd & Lewis, 2016). This study presents how a VE course was developed by engaging students in two EFL countries, Taiwan and Czech, via the pedagogical approach of English as a Lingua Franca (ELF) to observe whether and how the nursing junior college students in Taiwan benefited from VE course in improving their communicative competence in English and integrating the key concepts of nursing EMPATHY in the English expressions. Forty-eight senior nurse students, who have had theoretical background in nursing practice, participated in the course. Consecutive oral and written learning activities lasting for 18 weeks were conducted, including (1) reading and role-playing regarding nursing workplace conversational text, (2) online platform-based oral self-monitoring exercises, (3) collaborative team-based script writing on nursing workplace conversation, (4) action drama contest on nursing workplace and with intercultural reviews, (5) group discussions via google meet on nursing workplace topics, and (6) face-to-face online live Q&A interaction with ELF partners. The course purpose is to bridge nursing-majored EFL learners to ESP in nursing profession. A qualitative content analysis of reported learning outcomes was conducted, based on the 48 learners’ live conference interaction recording texts. Several key themes were identified via a post course questionnaire, which provides insight into the type of learning that VE course can contribute to ESP-for-Nursing classrooms. These included how virtual exchange contributed to forcing students to use linguistic strategy as a communicator in their ELF communication, and to conceptualize English as a tool for communication instead of as an abstract academic activity. Moreover, how the nurse students embedded two core elements: empathy and caring of nursing EMPATHY into the VE tasks is discussed.