Issue link: https://nnumagazine.uberflip.com/i/1521950
Besides EHRs, nurses also report new programs and initiatives such as Qventus, which is a software platform for automating discharge planning processes to reduce length of stay, and Desktop Medicine, where Kaiser uses an A.I.-powered system to categorize patient messages to "[assist] regional staff in resolving about a third of the messages so they never reached the inboxes of busy doctors," according to Kaiser's own website. Nurse members who work in areas where Desktop Medicine has been implemented, however, note that the messages that do not pass through to a physician get diverted to a medical assistant, who then determines whether the message should go to a registered nurse. Heather Aguirre, a charge RN who works in women's health at Kaiser Permanente in Napa, Calif., noted how this process was wrong on multiple levels. "So my number one concern: What is the algorithm looking for initially?" said Aguirre. "And then next, an MA should not be doing triage. They should not be looking at messages to decide if it goes to a doc or nurse; they are not trained to do that. Nurses triage. So there should be a layer of nurses who review messages at the start." But that's not what's happening. M organ, the new york city nurse, said it's so frustrating to watch our hospitals dump hundreds of millions of dollars into all this unproven technology when a very simple and scientifi- cally proven solution is and has always been immediately available: invest in safe staffing. "I feel like they are racing to put a man on the moon when we just need more nurses," said Morgan, who also teaches nursing. So NNU nurse members are ramping up the long-haul campaign to reframe the conversation on A.I.: The public, nurses and other pro- viders, and regulators need to hit pause on use of these technologies; question whether they are even needed and who benefits; and demand that the burden of proving A.I. and other data-driven tech are safe, effective, and equitable be placed on developers and employers before they are deployed in health care settings. In what perhaps may be the first public protest of A.I. tech by regis- tered nurses, hundreds of RNs rallied and marched on April 22 in San Francisco outside a Kaiser Permanente's International Inte- grated Care Experience conference that featured the system's use of advanced ana- lytics and A.I. "We're all for tech that enhances our skills and the patient care experience," said Bonnie Castillo, RN and executive director of NNU and CNA/NNOC to a boisterous crowd of nurses holding placards reading "Patients are not algorithms" and "Trust nurses, not A.I." "But we won't stand for employers devaluing nursing care—and breaking our solidarity with our patients and each other—to boost profits by replacing skilled nurses with technology." And on May 9, during Nurses Week, nurses from around the country held a briefing for media to warn about the dangers of A.I. for patient safety and the integrity of their profession. RNs shared stories about how A.I. hurts, not helps, their work and fundamen- tally questioned whether A.I. belongs in health care at all. "Rather than worrying or being focused on how we make A.I. work, is that we question the values," said Mahon during the briefing. "Why is A.I. here? Who is bringing it? What is behind this? Is it truly in the best interests of people? Is it providing human-centered care? Does it respect the values of dignity, human respect, and quality of life? This has in large part been overlooked by the hype that A.I. is inevitable." Along these lines, NNU will be urging Congress to institute a reg- ulatory process for ensuring that A.I. technologies are safe and effective, just as the Food and Drug Administration does for medi- cations and medical devices. And, of course, NNU nurses continue to challenge A.I. in their facilities. Many of our contracts include technology language provi- sions that give nurses tools to push back against harmful use of technologies, including A.I. The hard work is in educating and organizing nurses to take collective action. That is exactly what the nurses at Keck Medicine of USC did, though. When their employer announced that it would be instituting the Clairvia acuity system, the nurses were concerned that there was a lot less clarity and transparency over how patients were classified compared to their old system, which gave clear examples of where patients would fall in acuity and allowed nurses to add in reasons why they felt the patient should be designated at a higher acuity. "We demanded to bargain," said Shin, who is a professional prac- tice committee member. "We wanted a commitment from the hospital, in writing, that you are going to leave responsibility for patient classification and acuity up to the bedside nurse. We were not going to relinquish this responsibility or authority." The nurses stood firm on this language and were preparing to stage a picket of the hospital when management finally issued a memo stating that only a licensed registered nurse could make the final decision about nursing care hours needed. Now that the nurses have this strong language, it is up to them to enforce it and push back, said Shin. "If a situation comes up, we're going to have to say, 'No, we were told it is up to us to determine patient acuity and I am telling you this person needs to be one-on- one and not paired.' This is a way to empower nurses so that they know that, 'No, I have the right to say that this patient is a higher acuity than what Clairvia says it is.'" "Technology is going to be an ongoing issue for nurses," said Shin. "It's easy to get sucked into technology. I mean, I love my phone, my apps, but how much are you giving up in exchange for using tech- nology? That's the question." Lucia Hwang is editor of National Nurse magazine. Rachel Berger contributed reporting to this article. A P R I L | M AY | J U N E 2 0 2 4 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 N A T I O N A L N U R S E 23 "Everybody on my unit knows the sepsis warning system is not helpful. I've sent people to ICU and that thing never went off." Do you have a story about harmful A.I. or technology? Please email NationalNurse@ nationalnursesunited.org to share.