Humanity is the heart of nursing

Replacing RN care with AI is unacceptable. Nurses are fighting back.

By Bonnie Castillo, RN

National Nurse magazine - Jan | Feb | March 2024 Issue

As workers, employers, the public, and elected officials grapple with the impact of artificial intelligence (AI) on a variety of industries, registered nurses know that for us and our patients, the discussion is not about some futuristic health care system we are still debating. AI is already insinuating itself into our work, from systems embedded in electronic health records that our employers use to try to automate our clinical decision making, to algorithms meant to predict how sick a patient will become so profit-driven corporations can decide how much care that patient should, or shouldn’t, receive.

Some employers are relying on AI to assess changes to our patients’ condition, to automate patient handoffs (with no human communication), to automatically summarize clinician-patient encounters, and to automate note-taking, all despite these systems’ tendency to make mistakes and miss important patient details. AI is being used to make staffing decisions, resulting in nurses being overwhelmed with far too many patients at once, or being sent home or called in for overtime with zero notice.

And our patients are already becoming the unwitting guinea pigs of scientifically unproven and unregulated AI that they often do not even realize is being used in decisions about their care without their consent.

Nurses are by no means anti-technology. Over the decades, new machines and devices have made our work easier and more efficient. But many of the new technologies deployed by our employers are never intended to help us be better nurses. Instead, they are intended to fragment, deskill, and replace our professional practice. In-person touch and assessment of our patients is fundamental to safe, therapeutic, and effective nursing care, but these technologies aim to remove us from our patients.

Ultimately, this is about our profit-driven employers boosting profits by replacing skilled nurses with technology. They’ll even claim AI helps solve the so-called “nursing shortage.” But we all know the United States is not experiencing a nursing shortage, only a shortage of nurses willing to risk our licenses and the safety of our patients by working in unsafe conditions.

There’s nothing inevitable about AI’s advancement into health care. Writers and actors showed us last year that union workers have the power to determine how AI is used in our economy and in our professions. Nurses were proud to stand with them on the strike lines.

And building on our track record of wins, NNU nurses will continue fighting back against unregulated and unproven technologies that put our patients and our profession at risk.

At Keck and Norris Hospitals in Los Angeles, the University of Southern California recently implemented an invasive AI scheduling platform. Nurses demanded USC bargain the impact of this new tech on patient care. They initially refused to budge, so nurses planned to picket. Just days before nurses would hold the hospital publicly accountable, USC met the union’s demands, including a statement that the employer does not intend to replace nursing staff expertise with AI, and commitments to center nurse judgment when determining the care patients need and safe staffing levels.

 Kaiser Permanente nurses also had big wins on AI recently. Kaiser uses an electronic medical record with an embedded staffing algorithm. When nurses chart on patients, it automatically calculates staffing levels according to the system’s assessment of how sick the patients are. This system, Epic Acuity, systematically lowballs the number of nurses that patients need. Through collective bargaining and organizing campaigns, union RNs forced Kaiser to create an oversight committee of nurses that pushes to make the system safer. Kaiser RNs also won a new "Acute Staffing Shortage" policy that forces Kaiser to take extra steps to add staff and reduce assignments when the system calls for more nurses than provided.

And NNU nurses are only going to get louder in our demand that tech developers and our employers prove that AI and other technologies are safe, effective, and equitable for patients and health care workers before they are deployed in care settings. NNU nurses at HCA Healthcare will be bargaining across the country in 2024, and they will be standing together to ensure strong contract language on tech and AI. NNU has also launched a national AI nurse survey to give us more data in our fight.

We’re also calling on Congress — including in October testimony that I gave to a U.S. Senate committee — to ground all AI statutes and regulations in the precautionary principle, which says that until something has been scientifically proven to be safe, we must use the greatest level of precaution, not the least. And we’re committed to protecting patient privacy, strengthening RNs’ right to bargain over AI in the workplace, and protecting workers from AI surveillance and data mining.

As nurses, our partnership is with our patients and with all working people. We are all about prevention, and that means shining a light on what’s already been happening and taking strong action to prevent future harm.

Bonnie Castillo, RN is executive director of National Nurses United.