Nurses are setting rules about AI in their contracts

We’re talking about AI again. But wait! Don’t leave. This isn’t about another tech company.

This time we’re focusing on nurses. Around the country, as AI implementation grows in hospitals, so do RNs’ concerns about new technology encroaching on their ability to deliver care.

While AI tools have promised saved time, better illness detection, and burnout reduction, the National Nurses United (NNU), a union representing 225,000+ RNs nationwide, insists “hands-on work of caring for other people cannot and should not ever be automated,” according to its Nurses and Patients’ Bill of Rights.

So they’re fighting back the way nurses do best: through contract negotiations. Nurses in California and North Carolina spoke with Healthcare Brew about how they’re using their bargaining power to help regulate AI in the hospitals they work in.

“We needed to have strong language in our collective bargaining agreement that allowed the staff nurses to have a say in any kind of technology that came through the front doors of the hospital,” Cathy Kennedy, president of California Nurses Association and the NNU, told us.

Contract concerns. In 2024, NNU published a survey of 2,300 members and found 60% of respondents said they didn’t trust their employers to implement AI with patient safety prioritized. Respondents also claimed automated reports often didn’t match their assessments (48%) and they couldn’t override the AI with their own clinical judgement (29%). Scheduling tools have also put nurses on the wrong shifts, nurses told us.

That’s where the contracts come in.

“We want to ensure that nurses’ skills are at the top of the list and not being undermined by a computer program,” Hannah Drummond, chief nurse representative and RN at Mission Hospital in Asheville, North Carolina, told us.

In Mission Hospital’s most recent contract in 2024, nurses added language to improve protections against AI, ensuring it wouldn’t be used without union approval, according to NNU. They settled the agreement in the middle of Hurricane Helene, when the hospital was without power for several days and clinicians were left papercharting and relying on generators, Drummond said.

An August study from multiple countries found that AI is linked to clinician deskilling.

“These are the times where you really see that the skills that only humans possess are super, super important and keeping up those skills is really important,” Drummond said. “Had we been reliant on generative AI in that situation, we would have been absolutely screwed.”

Humans vs. robots. Kennedy is focused on maintaining human interaction in nursing.

“We recognize technology is here to stay, and it can be helpful in some instances, but when it’s trying to replace the activities that we do as nurses and as ancillary support staff, you can never automate that,” she said. “That human touch is what is needed in the work that we do.”

In a Morning Brew Inc. survey of 277 healthcare workers, 83% said AI needs to be more regulated.

But electronic health records company Epic, which has information on 325 million patients, has already implemented AI in the background of its programs. An estimated 65% of hospitals are using AI-assisted predictive models.

Though, there is an option to opt out of the AI in Epic, Drummond said. In negotiating with the hospital, she said it wasn’t easy, but the union had a lot of support from the nursing staff to create guardrails.

“It definitely wasn’t something the hospital wanted to hand us, but we fought for it and forced their hand through our collective power,” Drummond said.

Mission Hospital did not respond to a request for comment, and the American Hospital Association declined to comment.

Increased AI use in hospitals has raised privacy concerns from nurses as well as tech experts who previously told Healthcare Brew that AI tools are susceptible to hacking. Drummond questioned whether health information is also at risk of being sold now that third parties are involved.

“All of these are concerning because the way that this plays out affects actual life-and-death situations because we’re caring for human beings,” Drummond said.