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A As the development of informa- tion and telecommunication technologies as well as medical expert and computerized physi- cian order entry (CPOE) sys- tems continue its rapid evolution, it is important that we understand their limi- tations to ensure they serve the individ- ual patient's needs. RNs must continue to play a major advocacy role in the delivery of safe, therapeutic and effective patient care, where the patient's health care needs, interests and wishes are protected. California RNs have a unique patient advocacy role in the health care delivery system, and technology can only be used to enhance and augment this unique role. In analyzing the safe, therapeutic and ef- fective values of any technology, RNs must explore the potential of technology replac- ing human interaction in the delivery of health care and the supplanting of critical thinking and independent clinical judg- ment with rigid critical/clinical pathways, RN displacement/override technology and other forms of artificial intelligence. A. Authority Under the Nursing Practice Act The use of informatics, telecommunication, computerized physician order entry, pa- tient observation, data collection, interven- tion, as well as documentation technology is not specifically mentioned in the Nursing Practice Act. Therefore, an understanding of the California Nursing Practice Act is essential in addressing the issues surround- ing the use of all forms of technology. Within the state of California, the statute provides clear recognition that nursing is a dynamic field, the practice of which is continually evolving to include more sophisticated patient care activities. The Act further provides clear legal au- thority for functions and procedures which have common acceptance and usage. It recognizes the existence of over- lapping functions between physicians and registered nurses, and permits additional sharing of collaborative functions within organized health care systems. The core of nursing is the assessing, managing and caring of human responses to health and illness which require a sub- stantial amount of scientific knowledge or technical skills. RN practice includes, but is not lim- ited to, data collection (subjective and objective); assessment; nursing diagnosis; planning; developing and evaluating care plans, protocols and programs; interven- tion and evaluation in the promotion and maintenance of health and wellness; pa- tient advocacy; triage; the case-finding and management of illness, injury or infir- mity; restoration of optimum functioning; or the achievement of a dignified death. As the practice of medicine evolved so did the practice of nursing. As medicine be- came more sophisticated, so did nursing. For example, critical care RNs have taken over the responsibility for carrying out several procedures that have been per- formed in the past solely by physicians. Critical care RNs now initiate and carry out cardiopulmonary resuscitation, defib- rillation, and in some instances, endotra- cheal intubation. RNs have clear legal authority to engage in sophisticated activities, so long as the activities are in the patient's best interest and the RN's competency has been validated. This means that RNs must have the knowledge, skill, expertise, and experience necessary to provide safe, therapeutic and effective patient care, including the aptitude to monitor and trouble-shoot equipment/hardware. RN legal standard of care: RNs have a duty to know the capabilities, limita- tions and hazard and safety features of many instruments/machines/hardware. The courts have ruled that defense of a machine malfunction will not protect RNs where the patients could have sur- vived with adequate manual support. The expectation is that RNs must exercise inde- pendent judgment at all times. B. Artificial Intelligence in Medicine and Nursing At issue here is will the professions (medi- cine and nursing) control technology or will technology control the professions? The study of artificial intelligence in medicine (AIM) is decades old. The alleged goal of AIM is to find ways of con- structing computers or creating programs that can diagnose and make therapeutic recommendations. Artificial Intelligence (AI) has been defined as the science of designing com- puters and machines to solve problems. AI is a multi-disciplinary field encompassing computer science, neuroscience, philos- ophy, psychology, robotics, and linguistics: devoted to the reproduction of the method or results of human reasoning and brain activity. Although AIM was originally not suc- cessful in making an impact on the prac- tice of medicine, with the emphasis of medicine shifting to the controversial notion of "evidence-based practice"— which tends to see only statistical data derived from clinical trials as legitimate evidence and comes perilously close to deriding professional judgment as mere opinion – the increasing reliance on com- puters, the increasing volume of informa- tion for clinicians to assimilate, and the many pressures to practice medicine more efficiently (cost containment) AIM proponents are convinced that those in the field of AIM will find themselves thrust in forefront of medicine, as they will be providing computer-based solutions for the ever-changing field of medicine. Nursing | Practice ■ ■ ■ Technology and Patient Advocacy RNs must exercise independent judgment at all times. Sponsored by the Joint Nursing Practice Commission Submitted by Hedy Dumpel, RN, JD, Chief Director of Nursing Practice and Patient Advocacy C A L I F O R N I A N U R S E M A Y 2 0 0 5 19