Three considerations about nursing and AI.

Lisiane Pruinelli

In my role as a nursing professor under the University of Florida Artificial Intelligence Initiative (ai.ufhealth.org) and in leading several national and international efforts, I apply what I’ve learned in years of clinical and educational experience to articulate the implications of AI for the nursing profession.

Doing so, I see three broad considerations that will affect the profession’s future. 1) The need to take into account the history of the nursing profession and the fact we are the most trusted profession in the US, 2) The question of how we can best incorporate new technologies and/or ideas into the care we deliver every day, and 3) The issue of how we can build the new generation of nurses while also training current nurses in order that they can play a role at the forefront of the AI/health care revolution while continuing to be strong advocates for safe and ethical care.

These three considerations are elaborated below:

  • Nursing is the most trusted profession in the United States. Since the early conception of nursing as a profession, nurses have been and still are the ones standing by every patient/client 24/7. Nurses go to war to care for people; nurses are in every hospital, clinic, school; nurses are the first ones present when good news arrives (a new baby is born) and when bad news is delivered (diagnosis, pain, death). We are there—for the good and the bad—standing by the patient to support them, support their caregivers, and most of all, to advocate for care that is safe and ethically sound for every individual.
  • That leads me to the second thought: How do we embrace new technology (and changes in general)? Nurses are at the front lines of care more than any other health care providers. Nurses are the first ones to identify needs and to lead change when doing so is the best strategy for delivering better care. With the rise of technology, there is no difference. Over recent years, we have embraced the transition from paper to electronic documentation, smart pumps (and all the list of smart devices directly or indirectly touching patients), virtual visits during the COVID-19 pandemic, apps that can provide better evidence and better resources for ourselves and patients, and so on. But how do we manage and prepare ourselves for these amazing—and challenging—opportunities to be agile practitioners? This leads me to my third thought.
  • The new AI-driven nursing generation. Here I would like to emphasize the need for us, as nurses, to take ownership of the tools and resources we use to mediate care delivery. How do we do that? And why?
    1. Nurses need to be involved in the entire process of technology development, from start to end. If we don’t understand the technology we use, how will we advocate for safe and ethical care delivery? That comes back to my first and second thoughts: how to guarantee that patients keep trusting us, and how we keep leading meaningful change. We need to take ownership of our actions, and that includes “owning” the technologies (that is, understanding they are there to serve nurses’ purposes) while providing care. For example, we nurses provide wound care and, based on that, we document our findings. How can we work with builders to develop a technology that can automatize this process? Could we work together to develop, for example, a wearable such as eyeglasses so that while we perform the dressing change, we can voice-activate pictures, measurements, and characteristics of this wound in a way that would be uploaded directly to the EHR? That technology would not just provide more precise documentation, but also help in decreasing the burden of documentation, a common problem faced by all. I’m sure you could come up with your own examples.
    2. All nurses and non-nurses concerned with the nursing profession need to acquire technology knowledge. When I say technology, it can be from a simple smart pump to a complex algorithm, such as AI, including decision-support tools, predictive models, ChatGPT–based models, and so on. We need to understand what these technologies mean, how we read them, how we interpret their outputs, how we translate these outputs to a patient-friendly language, and how we identify if the technology is not reading well. For example, when I worked at the bedside, when the blood pressure reading seemed not to reflect the patient’s state, I used to ask myself, “Does this blood pressure cuff need calibration?” That was a very common first question. Now, thinking about the current state of AI and technology a nurse might interact with every day, do we have enough knowledge to raise questions like: “Is this AI hallucinating?”; “Is this patient really not septic, even if the computerized clinical decision support tool is not flagging it while the patient has all the signs and symptoms for sepsis?” We need to build interdisciplinary collaborations to help us close that knowledge gap through developing and refining educational materials, mobile applications, workshops, and other means.
    3. I believe AI and technology can make our nursing profession better. But it’s up to us to make that happen. We need to take advantage of the state of technology development to release us from “heavy-lifting” tasks, such as lifting/moving/transporting patients from one location to other or keeping the nursing station storage filled, and use that time and effort to deliver better decision-making care to patients. We need to build a strong knowledge foundation that will make us feel comfortable in using these technologies and asking for more technological solutions to solve our nursing problems.

Keeping public trust depends on understanding technology.

Image: Christopher Burns/Unsplash

The nursing profession has built a strong presence over the decades and won widespread trust from our patients and the wider public. We need to come together to keep this trust inherent to us. With uses of AI already part of our current work and these uses likely to increase in the future, we need to build knowledge that can help us to understand enough of the technology to be able to advocate for patients regarding that technology. Starting this preparation during nursing school and throughout subsequent training, nurses will gradually acquire the foundational knowledge that will prepare them to interact with (and absorb) new AI knowledge all along the career path.

Resources and initiatives.

Several initiatives and publicly available resources are available (see below) for nurses to learn about the topic and get involved, and we need more. Several publications are also in preparation related to the use of generative AI. We need to build this AI-based knowledge in such a way that it brings the nursing profession together, because together we can go farther and faster.

AI-based knowledge resources to keep in the loop:

  1. Nursing and Artificial Intelligence Leadership (NAIL) Collaborative: This website provides information about past, current, and future efforts related to AI and nursing. This group has been continuously leading or involved with international efforts to discuss at firsthand the developments of AI and nursing.
  2. Nursing Knowledge Big Data Science (NKBDS) Initiative. This initiative “brings together nurse leaders and informaticists from public and private institutions and organizations . . . to utilize their unique knowledge to solve critical problems in health care.” Several efforts related to AI, raising the value of nursing, and building nursing data literacy are on the way.
  3. American Nurses Association (ANA) Position Statement; The Ethical Use of Artificial Intelligence in Nursing Practice.
  4. International Council of Nurses (ICN) position statement on the future of nursing and the use of digital health and AI.
  5. Just published: The ChatGPT Effect and Transforming Nursing Education with Generative AI: The authors conclude that “[u]sing . . . ChatGPT . . .  to educate nurses and support the documentation process is time-efficient, but it still requires a certain level of human critical-thinking and fact-checking.”
  6. LinkedIn: https://www.linkedin.com/in/lisianepruinelli/. My LinkedIn account is usually is a good resource for learning about new publications or about an ongoing discussion related to this topic.

Lisiane Pruinelli, PhD, MS, RN, FAMIA, is an associate professor and clinical informatics researcher at the University of Florida College of Nursing and College of Medicine. She is part of an inter-college network of experts in AI under the UF AIHealth Initiative.