Nurses Protest Untested AI Technology In Nursing Care (Video)

Article posted with permission from the author, Suzanne Hamner

As a long-ago graduate of the dinosaur school of nursing, whose hourly wage upon graduation was $12.00 per hour, many changes have been witnessed over the decades – some good, some not so good, and some just downright bad.  The worst that has been witnessed is the increasing reliance on technology while rejecting the observational skills using all five senses and the development of “intuition” or “following your gut” when it comes to providing care.  This dinosaur graduate earned the designation of “technology averse” – a designation meant to disparage, but one taken up like a badge of honor. Today, it is rare to see an oral thermometer used that isn’t attached to some piece of electronic measurement device, a manual blood pressure cuff, or paper charts that the nurse hand writes findings from assessments.  In fact, it has become rare to see a nurse even perform a full head-to-toe assessment each shift in an acute care setting – a skill that was once expected.

The changes to blood pressure machines, electronic charts, and “forehead” thermometers were accepted without question as a means to make the job of nursing easier.  Debate on both sides of the argument can be compelling.  However, once technology enters the sphere of providing care to humans, increasing that technology is almost always inevitable to eventually seek to replace that which is irreplaceable – those who provide hands-on care.

Recently, Becker’s Health It, at beckerhospitalreview.com, featured an article regarding nurses protesting AI (artificial intelligence).  As more and more hospitals go to AI protocols regarding the diagnosis and treatment of patients, nurses are protesting AI that could potentially pose a risk to patient safety.

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Nurses took to the streets of San Francisco this week to protest the use of artificial intelligence in healthcare. But what were their specific complaints?

In general, they said they were demonstrating against the “untested” technology and the risk it poses to patient safety, and how AI should not replace nurses.

The hundreds of nurses who protested April 22 in front of Kaiser Permanente’s San Francisco Medical Center also told local media outlets which programs in particular concerned them.

Some nurses objected to a platform in the Epic EHR that determines nurse staffing based on real-time charting. Cathy Kennedy, RN, neonatal intensive care nurse at Kaiser’s Roseville (Calif.) Medical Center and a nursing union leader, told the San Francisco Standard that if nurses don’t log charts right away the next shift could be short-staffed. Other nurses said it might not account for their time-sensitive work that can’t easily be measured, such as educating patient family members or preparing for chemotherapy treatments before a patient arrives, the San Francisco Chronicle reported.

“We are the providers at the bedside, we know how to take care of patients best,” Amy Grewal, RN, an oncology nurse at Kaiser Permanente Fresno (Calif.) Medical Center, told the Chronicle. “No algorithm can tell us.”

The original article highlighted the protest and the position of the nurses.

Hundreds of nurses gathered April 22 to protest the use of artificial intelligence at Oakland, Calif.-based Kaiser Permanente.

The California Nurses Association held the demonstration at Kaiser Permanente’s San Francisco Medical Center to coincide with the beginning of KP International’s Integrated Care Experience conference.

“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, BSN, RN, a president of the California Nursing Association and registered nurse at Kaiser Permanente Fremont (Calif.) Medical Center, in a statement. “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.”

“AI has got to go!” nurses chanted as they held signs that read “Trust Nurses Not AI,” according to an April 22 video posted to X by the San Francisco Chronicle.

The association is asking that nurses and union members be involved in “every step” of the decision-making process for the deployment of AI and other data-driven technologies at Kaiser Permanente and other health systems.

“Human expertise and clinical judgment are the only ways to ensure safe, effective, and equitable nursing care,” stated Cathy Kennedy, RN, a nurse at Kaiser Permanente Roseville (Calif.) Medical Center and a president of the state nursing association. “We know there is nothing inevitable about AI’s advancement into healthcare. No patient should be a guinea pig and no nurse should be replaced by a robot.”

After calling the AI “untested technology”, chanting “AI has got to go”, and proclaiming “Trust Nurses Not AI”, the nursing association is “asking that nurses and union workers be involved” in all steps of the AI deployment decision-making process.  Ironic that a president of the state nursing association would say, “Human expertise and clinical judgment are the only ways to ensure safe, effective, and equitable nursing care” and “No patient should be a guinea pig and no nurse should be replaced by a robot.”

Why is it ironic?  Nurses, in some cases, were pushing “untested technology” when it came to the use of masks to prevent “respiratory” disease and transmission despite scientific studies to the contrary, enforcing an arbitrary six-foot social distancing policy with no basis in science, and receiving the CONvid-1984 never before tested in human mRNA injections while recommending and giving those injections to patients.  While some technology may enhance a nurse’s skill and a patient’s care experience, the reliance upon technology to the almost exclusion of human-acquired skills opened the door to increasing the use of technology to decrease the number of nurses required to provide patient care – a winning scenario for bottom line money driven hospital authorities/conglomerates.

Becker’s Health It reported some nurses concerns over technology in patient care.

Another nurse complained about an AI chatbot at Kaiser Permanente that patients can talk to instead of a nurse, according to the Standard. But what if a patient is having a heart attack and the chatbot doesn’t understand — because it wasn’t trained on the correct medical terminology — when a nurse would have? “The AI might direct them to the pharmacy, not to a doctor,” Michelle Gutierrez Vo, BSN, RN, a president of the California Nursing Association and registered nurse at Kaiser Permanente Fremont (Calif.) Medical Center, told the news outlet.

Melissa Beebe, RN, an oncology nurse at UC Davis Medical Center in Sacramento, Calif., lamented to the Standard that an AI tool that monitors patient vital signs often issues false alarms. A hospital spokesperson told the news outlet she was “fear-mongering,” noting that the platform has been in place since May 2022. “The concern is that this [technology] will take jobs — it will not,” the spokesperson said. “It will make their jobs easier.”

Kaiser Permanente has an Advance Alert Monitor in place at 21 Northern California hospitals that analyzes EHR data to detect patient deterioration. The Oakland, Calif.-based health system says the tool saves about 500 lives a year, but nurses told KQED it can produce erroneous notifications or miss patients who are in decline. “There’s just so much buzz right now that this is the future of healthcare. These healthcare corporations are using this as a shortcut, as a way to handle patient load. And we’re saying ‘No. You cannot do that without making sure these systems are safe,’” Ms. Gutierrez Vo told the news outlet. “Our patients are not lab rats.”

Of course, a hospital spokesman would dismiss the concern of nurses. The ruling dogma is the monetary bottom line.  And, if this spokesman is not a nurse, he cannot declare what technology would make any nurse’s job easier, nor can he guarantee that technology will not cost jobs.

It’s no secret in the nursing world that “technology” makes mistakes or often gives false readings and alarms.  The problem comes when nurses do not recognize the fallibility of technology. Many times, it has been witnessed that automated blood pressure machines give false readings.  The reaction of the nurses was witnessed to take that machine reading as absolute without ever verifying the reading through manual blood pressure – using one’s own ears to hear the systolic and diastolic values.  This failure has resulted in many patients being overloaded with fluid or treated for increased blood pressure when the patient’s blood pressure was within the normal range.  The forehead thermometer has technological failure issues – giving erroneous readings due to environmental, physical, and patient variables.  Granted, these machines are right more often than not; however, when a nurse solely relies on that technology to the exclusion of other skills, the nurse may not recognize an erroneous reading.

Case in point. A family member was almost overloaded with fluid due to an erroneous automated blood pressure machine reading taken by a “technician”, not a nurse.  The family member had a blood pressure within normal range during the entire hospital stay. But, for that afternoon blood pressure measurement, the reading was far below the normal range.  The nurse failed to verify the reading or the technician. The family member was given fluids to help raise the blood pressure.  A few hours later, a retake of the blood pressure using the same machine resulted in no change in the below-normal range reading.  This prompted a call to this dinosaur. The family member was instructed to have the nurse retake the blood pressure manually – using a stethoscope and blood pressure cuff.  The family member reported the nurse gave her a “deer in the headlight look” and stated to this dinosaur, “I don’t think they know what I am talking about.”  At that point, the family member was instructed to ask the nurse to use a different machine, not the same one.  The use of a different machine produced a blood pressure reading above the normal range.  As you can see, if that nurse had continued to act on an erroneous reading, the family member would have been overloaded with fluid resulting in higher blood pressure and possible cardiac involvement resulting in injury.

But, the use of these machines is not the only issue.  The use of electronic healthcare records poses a risk as well. The use of electronic healthcare records (EHR) encourages copy-and-paste charting; foregoing checking documentation of other disciplines involved in the care of the patient; foregoing chart reviews; and promotes inaccurate documentation of patient condition.

Case in point.  A family member was continually evaluated for dysphagia (difficulty swallowing) by all disciplines in the hospital because a surgeon used that diagnosis for Medicare to pay for a gastric tube.  It resulted in staff ignoring other conditions and family input disputing the diagnosis.  The EHR had automatically placed “dysphagia” into the diagnosis field on the main record page.  In another incident involving the same family member, respiratory therapists evaluated the family member for oxygen use, determining the value needed to maintain proper oxygenation at 10 liters per minute.  This value was due to another error committed by hospital staff in failure to properly document patient history given by the family.  Continually, nurses charted the wrong value in the chart and continually decreased the oxygen flow as established by respiratory therapists.  The respiratory therapists who cared for this family member continually adjusted the oxygen level to the proper value, documented it in their disciplinary notes, and “supposedly” communicated it to the nursing staff.  Those staying with the patient reiterated to the nurses the proper oxygen level when staff would “adjust” the flow based on the value in the notes entered by other nurses.  This resulted in the family member experiencing improper oxygenation levels.

As a “dinosaur” respiratory therapist once said to this “dinosaur” nurse, “Treat the patient, not the monitor”, recognizing that the monitor can be wrong.

So, while commending these nurses for speaking up against AI now, these same nurses were embracing technology that many “dinosaurs” saw as a danger when first introduced.  While they gesture about protecting patients from being guinea pigs for untested technology, many embraced untested technology, being guinea pigs themselves, for the mRNA CONvid-1984 injections and allowed patients to be guinea pigs as well.  The danger in the technology comes from increasingly relying on that technology to the exclusion of time-honored traditions of care that truly ensure patient safety.  It is the abandonment of critical thinking, assessment, and evaluation to the “trust of technology” that endangers the safety of patients.  And, it is the love of the bottom line of the hospital entities/conglomerates that produces the insatiable desire for more technology to trim the cost of the human equation.

If all of this wasn’t bad enough, the pervasiveness of “assumption, presumption, and supposition” into healthcare, especially where technology accuracy is concerned, has led to decreased patient safety and proper care.  It is this embrace of technology that is now pushing the “jump” to AI involving nursing care. Acute care facilities have already embraced AI technological protocols for the diagnosis and treatment of patients, almost replacing the knowledge, skill, and critical thinking processes of physicians – to the great detriment of the patient.  Hospitalists are now replacing family physicians in providing care in acute care settings with mixed results.  Now, the acute care setting is targeting nurses.

For those of us who saw this coming decades ago, it is no consolation to be right.  In fact, it brings much shame that we could not stem the tide.  While no system is ever infallible, the push for AI technology into an arena that has solely been the responsibility of humans – caring for the sick – brings plenty of danger to us all.  Ultimately, it is patients who will bear the brunt of it all. And, at some point, we will all be patients.

Article posted with permission from Sons of Liberty Media