As artificial intelligence (AI) becomes more widespread in healthcare, nurses are pushing for health systems to be more open with how they plan to use the technology and to include nurses in their decision-making processes for new AI tools.   

Nurses push for more input on AI use at their organizations

According to Cathy Kennedy, president of the California Nurses Association/National Nurses Organizing Committee, AI can be useful, but health systems need to get input from nurses before they roll out AI tools to ensure that they don't negatively impact clinical practice. 

Last month, members of the California Nurses Association raised concerns about Kaiser Permanente's San Francisco Medical Center using AI algorithms to help assess patients and set staffing levels. According to Kennedy, the tool is largely reliant on nursing charting and patient data, which could be incomplete due to staffing shortages. By using incomplete data, the tool could set inadequate nurse-to-patient ratios and limit nurses' ability to provide care.

Nurses have also expressed concerns about using remote monitoring technology as patient sitters since it could complicate staffing. Jessica Early, a patient advocacy coordinator for the National Union of Healthcare Workers, said remote monitoring technologies are often unable to detect subtle changes in patients' conditions that bedside clinicians can more easily identify.

"If you don't have someone there laying eyes on the patient to provide that data, these algorithms could be making erroneous determinations about a patient's status and spit out staffing decisions that are inappropriate and would compromise care," Early said.

Currently, healthcare unions are pushing health systems to include language in their contracts that provides guardrails for AI use. They have also asked that nurses be included in the decision-making process when it comes to the technology.

How healthcare organizations are addressing these concerns

For its part, Kaiser Permanente said clinicians remain at the center of patient care decisions. The health system is also working with unions to monitor how new technologies may impact jobs and to avoid displacing employees. 

"We have consistently invested in and embraced technology that enables nurses to work more effectively, resulting in improved patient outcomes and nurse satisfaction," Kaiser Permanente said. "We ensure the results from AI tools are correct and unbiased."

The National Union of Healthcare Workers has also said that its members have been bargaining for language in their contracts that ensures job protections and prevents organizations from implementing technology initiatives to cut costs. Some nurses have also asked to be included before an organization fully introduces new AI technology.

For example, Maimonides Medical Center limits untested and unregulated AI use in its contract with nurses. During a trial of an AI-powered thermometer, nurses found that the tool incorrectly listed 30 ICU patients as having the same temperature. When nurses returned to using old-fashioned thermometers, they discovered that several patients actually had high fevers.

According to Nancy Hagans, president of the New York State Nurses Association and an RN at Maimonides, allowing nurses to assess how the technology affected patient care helped the facility avoid serious outcomes. 

Although some caution around the use of AI is warranted, most of nurses' concerns could be addressed by understanding how the technology works and how it will be implemented, said Richard Kenny, healthcare executive advisor at SAS Institute. 

Kenny recommends health systems establish a culture of trust and transparency, ask clinicians for feedback, and include them in AI implementation decisions. They should also avoid using terms like "AI doctor" or "AI nurse" that could be confusing or exaggerate the technology's use in clinical care. 

Separately, John Martins, president and CEO of Cross Country Healthcare, said that the more AI is used in research and clinical documentation, the less fearful nurses will be about its use. 

"Over time, I believe clinicians and nurses in particular will come to embrace the technology because they'll see that the outcomes are the same if not better," Martins said. "If you program the algorithms right, you may actually take away biases that actually happen with human nature." 

In general, Kenny said health systems try to be responsible with how they use AI, with the best systems using it to optimize operational processes and reduce administrative burden. "The truth of the matter is, AI cannot replace the nurse," he said. "More than anything, it gives us an opportunity to go back to practicing at top of license, which is what every nurse wants." (Devereaux, Modern Healthcare, 5/10)

3 ways to boost nurse involvement in your AI strategy 

By Ali Knight  

Many organizations are adopting technology solutions, such as AI tools, to address long-standing problems like workflow inefficiencies and administrative burden. Faced with a workforce that suffers from ongoing shortages and burnout, healthcare leaders must take an intentional approach to implementing new technology solutions that will impact their staff's day-to-day work.  

Nurses at all levels — from the C-suite to the front line — should play an active role in deciding what AI tools to adopt. You can leverage an existing shared governance model or develop a targeted technology-selection and implementation task force to ensure that nurses' voices are heard. Here are three strategies you can use to increase nurse involvement in AI decision-making and implementation.  

1. Proactively address nurses' concerns about AI. 

An effective change management strategy is essential to gain employee buy-in and avoid disengagement. Proactively identify and address nurses' concerns about any AI tools you are considering.  

Start by listening to your staff. Your nurses likely have different levels of understanding about AI and are working in different roles in care delivery. Remember to stress that technology is there to enhance — not replace — the role of clinicians. The following resources will get you started with these conversations:   

• The top 3 concerns staff have about AI — and how to address them 

• What technology can't (or shouldn't) do for clinicians  

2. Engage nurses in identifying opportunities for AI impact. 

Enlist the help of nurses in building the case for change. Engage frontline nurses in identifying pain points by using our field guide on taking a problem-first approach to AI. Employees who understand that technology will be solving a problem they currently struggle with are more to support change efforts.  

Helping your staff see how AI supports the organization's mission and goals, while at the same time helping to ease their burdens and enhance patient care, will increase buy-in. For additional questions to consider with your team, check out the following resource: 

• 12 technologies to address your clinical workforce challenges 

3. Include nurses in evaluating and implementing potential AI solutions.  

Nurses should be involved in decisions about AI tools, from selection to implementation. Nurses may consider new technology to be an added burden if they aren't part of the decision-making process. Frontline nurses can provide the best assessment of technology's usability. And having a seat at the table can fosters feelings of engagement and ownership among nurses. Nurses should also be included in evaluating and redesigning workflows post-AI implementation.  

Organizations that invest in technology, including AI tools, to improve work processes will have a competitive advantage in recruiting and retaining nurses. Here are some additional resources on how to leverage technology to support your clinical workforce and lead your organization through the change: 

• Clinical workforce technology 

• AI pulse survey: Are healthcare leaders ready for AI?