Background: Rural communities in Osmanabad district face restricted healthcare facilities due to the geographical distance, fewer staffed centres, and inadequate specialists' assistance. Telehealth, especially nurse-driven virtual consultations, offers a potential solution to fill this gap, but its performance will be determined by the existing infrastructure and workforce readiness of the local context, as well as patient acceptability. Objectives: To evaluate the digital readiness of rural nurses and to report infrastructure and experiential barriers to telehealth adoption, and to determine the impact of teleconsultations on patient travel time, follow-up compliance, and satisfaction in rural PHCs and CHCs of Osmanabad. Methods: A convergent mixed-methods approach was used from January to April 2020. A structured questionnaire with a focus on digital literacy, availability of devices, connectivity, and frequency of teleconsultation use was administered to 60 registered nurses in five PHCs and three CHCs. Quantitative data were analysed descriptively. The same respondents were interviewed again using semi-structured interviews about technical challenges, training requirements, and coordination problems, and the data were analysed thematically using Braun and Clarke’s approach. Results: Eighty-seven percent of the nurses self-reported basic smartphone competence, and 30% had undergone formal telehealth training. Fifty-seven percent of sites had reliable internet, and 47% had a dedicated telehealth device. Nurses performed 14.2 teleconsultations per month on average. Patient results were an average2.3±0.8 hours saved in travel time and 28.5±9.4% more likely to fulfil follow-ups and scored a 4.1±0.6 out of 5 in satisfaction. Primary qualitative themes were intermittent connectivity and power outages, device shortages, the need to train hands-on, caregiver support for the elderly and frail, and the importance of streamlining IT–public health department coordination. Conclusion: Rural nursing practice in Osmanabad is an important example of how telehealth has clear benefits in terms of travel burden and quality of care continuity. Sustainable scale-up will involve investment in a reliable connectivity option, standardization of telehealth equipment, immersive telenursing training, and the establishment of communication links between nursing and IT staff in order to achieve equitable delivery of healthcare.