National Nurses United

A s all registered nurses know, one of the most critical components of starting a shift off right is getting a good report at hand-off from your colleague. The previous shift's nurse will give you the inside scoop on how to best care for your patient: labs you are waiting on and which values to hone in on, whether medication got shifted back two hours because pharmacy screwed up the order, a special happy memory to make changing that wound dressing a little more bearable, or communicating potential workplace violence risks. But at University of Michigan Health-Sparrow in Lansing, Mich., where RN Jeff Breslin works as a float pool nurse, the hospital over the past few years has instituted automated hand-offs. With auto- mated hand-offs, the electronic health record (EHR) system in which nurses chart pulls together sections of the chart and high- lights certain data for the next shift's nurse; no human-to-human communication happens. Sparrow's EHR system, Epic, brags on its corporate website that "With Epic, Generative A.I. seamlessly inte- grates into your Electronic Health Record (EHR)… see how A.I. personalizes patient responses, streamlines handoff summaries, and provides up-to-date insights for your providers." Breslin is not impressed. He has seen that the automated hand-off reports often omit critical information or overstate the importance of other data. Usually, he intervenes first before any harm is done, such as when he hunted for info about an ordered medication for a patient that was charted in a different area than expected. "Documentation in the med record was missing, so if I would not have caught it else- 20 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G A P R I L | M AY | J U N E 2 0 2 4 where in the chart, I could have given a dose that could have been harmful," said Breslin, an experienced nurse who has worked at Spar- row for 29 years. "I did end up catching that because knowing what the patient was in for, and that the normal treatment would involve certain drugs, I dug deeper into the notes and saw that they had doc- umented it—just not in the proper place in the chart, and it was not contained in the electronic hand-off." The automated hand-offs, to Breslin, are not useful and cannot replace a nurse-to-nurse report. "It's better to have an actual conver- sation with someone who has taken care of the patient," he said. "It takes some of the guesswork out of receiving a new patient by having that face-to-face, human-to-human interaction." And that's exactly what the Sparrow nurses are fighting for, to restore in-person— whether face-to-face or by telephone—report as the norm. Automated hand-offs powered by A.I. algorithms are just one example of the flood of new technologies—hardware and software, programs, platforms, apps, cameras, screens, you name it—that our hospital employers are implementing in our workplaces. They claim they are doing so to "increase efficiency" and "help out" us busy nurses during a so-called "nursing shortage," but we know from experience that they have a less altruistic goal: to increase profits by cutting nursing staff, removing us from direct care, and deskilling and degrading our professional practice. As many of the nurses interviewed for this story point out, "efficiency" is a business goal, not a nursing goal. And we know the "nursing shortage" is a lie: 1.3 million actively licensed RNs are not working because they refuse to practice under the unsafe conditions hospitals are providing. Finally, we know A.I. has shown harmful biases against Black, Risky Business Hospitals are embracing artificial intelligence to replace us, but nurses know data points are not true nursing care. How we're fighting back for our patients and our profession. BY L U C I A H WA N G

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