AI has the potential to transform nursing

7 Comments

1. Nurses care for all people. Machines do not. Having just been saddled with so much extra work because of the global computer outage I am old school and do not put much faith in AI.
   Will AI be able to do the paperwork. I think not. I want to care for people not substitute this with AI.
   Nursing now is not what it once was 30 years ago and I don’t mean the technology. Often the big picture wholistic care gets missed. Too much paper work. Not enough care.

2. Way beyond the scope of a Position Statement, more of an existential challenge.

   The advent of AI will be a very interesting development in nursing and its utility, reliability and ethical implications will vary considerably across specialties and present fundamental challenges for the wider profession and health care. We will need more than a position statement to govern for all the pitfalls, and some of these will not be new to nursing practice.

   There are some very real concerns in how AI may be implemented given that nurses and the nursing profession do not have full control, professional autonomy and governance over their practice, which is often significantly determined, proscribed and directed by the medical profession, health service employers/providers, overarching policies and policy directives, executive and operational management structures, human resources, funding and of course politics. These are very real existential and sociological threats to the integrity of the nursing profession and in my experience cause many of the clinical and ethical conflicts in provision and standards of care often outside the control of nursing. For example, when funding, human resources, employment practices, education, recruitment and retention are scarce, we have already seen how less qualified and fewer nurses are engaged in the workforce, particularly in aged care, nursing homes, disability care and NGOs, and severe shortages across the whole spectrum of our public health care system. The advent of AI will present the same challenge again, where employers and service providers will be tempted to plunge for the lowest common denominator, expecting nurses to follow AI generated directives, algorithms and clinical pathways in much the same way as already deployed through existing models of care, policies and procedures, regardless of the codes and principles advocated by the profession, in this case – the first principle cited, ‘Nurses must always remain the decision maker and continue to use their nursing knowledge and critical thinking in the care they provide to their patients and the broader community’. How is this possible if the employer, often driven by profit, funding demands, power inequities, executive egos and the politics of health care seek to impose the AI agenda and infrastructure and employ cheaper less educated, qualified and experienced professional carers in their institution? How will a competent or professionally qualified nurse fair in a system which has deployed AI when faced with clinical and ethical decision making? There have been many failures to address this over the years that have compromised nursing care and punished those who stand up or raise such concerns.

   A fundamental problem with AI is that it has no human consciousness, conscience, moral or ethical integrity. AI is totally dependent on its programming, and arguably the more liberal its sources and tendrils, gathering information and knowledge, and crunching the numbers, which of course it can do far more substantially, systematically and timely than a human brain (one of its major capabilities), the greater the risk it could be way off beam ethically, socially, clinically, professionally and legally, and we have seen already how AI can crunch entirely incorrect and inappropriate data.

   And of course AI could be deployed to manage digital systems and patient care technology such as IVs, infusion pumps, heart monitors and surgical equipment. Would the nurse become a technician for the AI system, its legs as opposed to the critical thinking brain we expect to rely on? It is all very well to advocate that first principle, but how exactly would that work when these kinds of issues have not been very well dealt with before? How exactly can AI even be considered to replace the actions involved in the most basic of nursing care, where would the patient’s rights sit if the mechanics of it were possible?

   Notwithstanding the above, I can see how nursing practice may be augmented and improved with AI, but I seriously do not believe it will stop there when employers, institutions, service providers and politicians control the purse strings, and such systems compete with the need for human resources and provide opportunity to cut corners. AI might work in more concrete black and white clinical situations, but nursing is rarely that simple, it is a deeply personal, intrusive, complex, intuitive, empathic, compassionate, hands on, emotional, relational, transactional, critical, human interface, not one that AI can be allowed to replace or compromise. As for mental health and the less defined and equally critical therapeutic, evidence based practices and transformational impact, I see a very different set of applications and challenges.

   I don’t see any evidence that the Australian College of Nursing and its position statement will even scratch the surface of addressing this complex domain, other than serve as a very basic code or principles of practice, a mere prerequisite to the main event where much remains to be seen.

3. Thank you John you have expressed very elegantly exactly my thoughts.
   Yes we nurses do not have any control in the operations of a health care facility. Already computers dictate the paperwork. even when medications can be given. I am fortunate to now work in community nursing with a high degree of autonomy and a supportive team of nurses and allied health professionals.
   Hospitals because of a lack of experienced staff rely more and more on documentation and algorithms to deliver care. But there is no substitute for experience, compassion and empathy.

4. with AI errors are ‘instant’ and ‘repetitive’

5. wam, yes, AI is as error-laden as the people ordering the programming of the algorthims.
   Garbage in, garbage out.

   I feel for nurses with their wealth of experience who are now on the chopping block. They are subject to the whims of over-paid HR Dept bean-counters tasked with replacing nurses with AI protocols.

   Look no further than the history of Remdesivir (Veklury in Australia) to see why protocols designed with no oversight of the precautionary principle can be a disaster. The New England Journal of Medicine published a paper ‘Randomized, Controlled Trial of Ebola Virus Disease Therapeutics’ in Nov 2019, a few months before covid hysteria began. (DOI: 10.1056/NEJMoa1910993 – VOL. 381 NO. 24)

   The paper has lots of blah, blah, but to see why Remdesivir was removed from the trial check Figure 1.
   Fauci, Director of NIAID, was at the center of the Ebola trial and knew all about Remdesivir. He pushed the FDA for approval and got it. By 2021 nurses quietly nicknamed remdesivir as ‘run, death is near’.

   Missing in this story is the application of the precautionary principle. Aussie nurses, doctors and specialists have been effectively gagged by AHPRA since 2021. Unless the dictators running amok in AHPRA are brought to heel, the general public is in danger. Unless the doctor-patient relationship sits above bureacratic interference, what’s the point of a health system if it is run by algos guided by ‘health’ adjudicators who almost to a person have no medical qualification?

6. Thanks, BK.
   I was injured in 72 and a stroke in 2007 so I have been in and out of Darwin and Adelaide hospitals for the last 52 years.
   As a slow learner I, twice, accepted the surgeon’s advice to shift to a private hospital.
   The first was a disaster and I ended up back in the public hospital emergency ward where they called my darling back from Tassie because I was nearly gone. Then in the kidney ward, fortunately my nephrons grew back.
   The standard of nursing was, as the difference between permanent and temporary ie high in the public and low in the private. The adelaide private was touted as an excellent heart hospital sp I agreed but again the nurses were scarce and I ended up covered in bed sores and back in the public.
   During that time, I have spoken to many nurses and, with the addition of observation as a patient and a visitor, have concluded that the quality of nurses depends on experience and those nurses who trained on the job starting at 15 were invariably excellent but less paid than the, markedly, poorer those who went to uni at 19 and started working and learning at 23.
   In the public system you are unlucky to be treated poorly but in the private system, beyond the level of ingrown toenails or there basic proven practice of childbirth, (even there if anything goes wrong, in darwin, there is a corridor under the basement which leads directly to the emergeny ward lifts.)you are lucky not to be treated poorly.
   There are few practically trained nurse left as they are old but there are overseas nurses who pop up currently are great.
   ps
   The family took me to a lawyer who was frightingly so eager to check if my story was true that I didn’t follow up. But I wrote to the director who came and talked with me on my verandah and I never received a bill???
   Sadly the universities have usurped the nursing and teaching systems to a bums on seats level with 20% drop out and 5000 graduates with 6500 nurses leaving hospitals per annum??? Looks like Mobius again??

7. Hi Wam
   Yes the private system leaves alot to be desired. I have been a nurse for 35 years. I was University trained. The quality of nursing training varies considerably. In Victoria Latrobe and the Australian Catholic University offer the best training.. 35 years ago you could sit the enrolled nurses exam after 18 months of Registered Nurse training. This allowed me to work part time in a nursing home. Back when nursing homes were staffed by enrolled and registered nurses. The public system has more permanent nurses. In Victoria training registered nurses can work as assistants in nursing. This helps gaining more experience. I have mentored some excellent student nurses.
   Some of the problem now is once you start working we have so much paperwork and algorithms that determine timeliness for paperwork regardless of what is happening with the care your patients need. Computers can not look at skill mix on a shift. Acuity of patients. There are far too many managers in most hospitals. Alot of us older nurses are tired and just want to do the best for patients. Managers make the decisions nurses have to live with or fight for better outcomes. We don’t get consulted which could make changes so much better.. But we keep on doing our best.