While some nurses recognize the potential of artificial intelligence to minimize documentation burden and improve patient monitoring – and see a future with broader AI-enabled nursing – others are concerned about AI replacing empathetic human assessment of patients, cutting nursing jobs, risking protected patient data to compromise and more.

In this spirit, the California Nurses Association organized a protest against Kaiser Permanente's use of artificial intelligence on April 22 at San Francisco Medical Center in Oakland, accusing the health system – and the hospital industry at large – of rushing to implement untested and unregulated artificial intelligence to displace nurses and at a risk patient safety. 

Nurses want a say in AI deployments

"It is deeply troubling to see Kaiser promote itself as a leader in AI in healthcare, when we know their use of these technologies comes at the expense of patient care, all in service of boosting profits," said Michelle Gutierrez Vo, a nurse at Kaiser's San Francisco Hospital and a CNA president, in a statement about the protest. 

"Nurses are all for tech that enhances our skills and the patient care experience, but what we are witnessing in our hospitals is the degradation and devaluation of our nursing practice through the use of these untested technologies," she said.

At the San Francisco protest, some of the nurses held signs that read "Trust Nurses, Not AI," according to coverage from local news KQED. 

Gutierrez Vo also said CNA demands that workers and unions be involved "at every step of the development of data-driven technologies and be empowered to decide whether and how AI is deployed in the workplace."

In a National Nurses United FAQ about AI's impact on nursing and healthcare, the organization said patient acuity measurements "result in inappropriate nurse-to-patient ratios and unpredictable scheduling."

Instead, patient acuity measurements, which may be based on incomplete charting, should be based on an RN's holistic assessment, said NNU, the parent organization of CNA. The group also said that clinical prediction tends to be "excessive, if not faulty," adding that AI often misses patient deterioration risks. 

The organization said it doesn't support models of care that remove RNs from direct patient interactions, such as when remote patient monitoring sensors collect data offsite and push care decisions onto "less-skilled medical workers."

Kaiser Permanente has a different view of AI and its potential benefits to patient care.

An article posted to its website last month said the health system is highly focused on developing responsible AI in healthcare, and that it values the need for key guardrails to protect patient safety. 

While the article's author, Dr. Daniel Yang, Kaiser Permanente's vice president of artificial Intelligence and emerging technologies, advised on considerations for policymaking, he didn't provide insight into the involvement of staff feedback in "testing and validating the accuracy of AI tools" and continuous monitoring of "outcomes to ensure it is working as intended."

But Yang explained, for example, that a study of the Advance Alert Monitor program in use across 21 Kaiser hospitals across Northern California found that it saved approximately 500 patient lives each year. The program uses predictive analytics and automates an hourly analysis of hospital patients' electronic health data.

If the AI identifies a hospital patient at risk of serious decline, it alerts a "specialized virtual quality nursing team" to determine the level of on-site intervention needed.

Healthcare IT News reached out to Kaiser last week, nationally and in California, to ask how nurses are involved in the use of AI in patient care. We will update this story if there is a response.

Addressing AI reservations

Regardless of a healthcare organization's goals, delivering AI at scale will require the buy-in of physicians, nurses and other medical professionals.

A new report on the future of nursing – released April 25 by Florida Atlantic University's Christine E. Lynn College of Nursing and Cross Country Healthcare, a technology and workforce advisory firm – showed that most nurses are uncomfortable using AI and have deep concerns about its safety and efficacy. 

According to the survey of more than 1,100 nursing professionals and students, 38% question AI's potential benefits for the nursing field. 

Nurse respondents' top five concerns about using AI in healthcare were lack of empathy and patient connection, job replacement, data security, regulation of emerging technologies and upskilling.

However, while two-thirds of nursing students said they are unfamiliar with current AI applications in healthcare, more than half said they were optimistic about its impact.

To encourage nurse adoption and appreciation of AI, healthcare organizations should prioritize transparency, training, communication and feedback, researchers advised.

"Engaging nurses in AI implementation is vital to acceptance and adoption," they said. "By soliciting and incorporating nurses' feedback, healthcare organizations can tailor AI solutions to address specific pain points and enhance the nursing experience."

Further, prioritizing that feedback and emphasizing AI's positive impact on nursing practice, can go a long way to fostering the culture of innovation and collaboration a future of AI-enabled nursing will require.

Toward that goal, three years ago Florida Atlantic University launched two new combined programs in nursing and artificial intelligence and biomedical engineering. The combined degree programs provide FAU bachelor's in nursing graduates with early experience with AI – helping them understand how "algorithms, pattern matching, deep learning and cognitive computing to learn how to understand complex data," according to FAU. 

"We are at the forefront of training future nurses to embrace the many opportunities that technology offers to improve patient outcomes and streamline time consuming day-to-day administrative tasks," said Safiya George, dean and professor at FAU's Christine E. Lynn College of Nursing, in a statement about the new report.

"As AI rapidly evolves in the delivery of healthcare, nothing will replace the human touch, empathy and compassion that is at the core of the nursing profession," she added. "Ultimately, current and future nurses will find a synergistic balance between technology, innovation, patient trust and the human connection."

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.