There will be no human being in the loop, and both endpoints are autonomous Node.js applications operating as independent services.
Endpoint A is responsible for contacting Endpoint B via secure web socket, and maintaining that connection 24/7/365.
Both endpoints will initiate messages independently (without human intervention), and both endpoints will have an API (RESTful or otherwise) to receive and process messages. You might say that each endpoint is both a client of, and a server to, the other endpoint.
I am considering frameworks like Sails.js and LoopBack (implemented on both endpoints), as well as simply passing JSON messages over ws, but remain unclear what the most idiomatic approach would be.
Web Sockets have a lot of overhead for connecting to browsers and what not, since they try to remain compatible with HTTP. If you're just connecting a pair of servers, a simple TCP connection will suffice. You can use the net module for this.
Now, once you have that connection, how do you initiate communication? You could go through the trouble of making your own protocol, but I don't recommend it. I found that a simple RPC was easiest. You can use the rpc-stream package over any duplex stream (including your TCP socket).
For my own application, I actually installed socket.io-client and let my servers use it for RPC. Although if I were to do it again, I would use rpc-stream to skip all the overhead required for setting up a Web Socket connection.