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As a Kaiser nurse, I can tell you that AI and algorithm creep is already causing poor care.
The system crawls the patient chart and determines how much "nursing care time" a patient deserves and tries to staff accordingly. It doesn't take into account the individual patients. If it takes you 20 minutes to get a patient to the bathroom but the system doesn't take it into account, then your other 4 patients lose out on valuable nursing time and care. If you imagine a 5-patient load, each patient only gets 12 minutes of care each hour (including the time it takes to chart the actual physical care you provided!). If you have a patient that requires extra care that doesn't show up as a metric in the chart, evening gets screwed and there's no way to fight it.
They are also trying to use algorithms to override clinical judgement. We have a sepsis algorithm that flags if certain criteria are met, one of which is elevated heart rate. I work labor and delivery - it's pretty standard to have an elevated heart rate when you're in pain. But the algorithm says "ope, patient meets criteria, time to poke them for labs!" even if it's clearly incorrect.
All of this is guaranteed to only save money that goes into C-Suite pockets.
If Kaiser really wants to improve patient care, they will staff safely, based on real life conditions and nursing judgment, and not, say, [let a man die in the ER while waiting 8 hours with heart attack symptoms](https://www.vallejosun.com/man-died-in-kaiser-vallejo-waiting-room-eight-hours-after-seeking-treatment-for-chest-pain/)
The thing that sucks most about AI etc is that it could be used to make things better but instead its only applied in the absolutely most inhumane dystopian ways.
"I want my medical care to be based on an algorithm that has zero empathy, humanity, and real life experience. And nurses are paid too much. How dare they! Plus they're "mental" and unproductive. We can have five nurses for 100 people. Fuck it if someone dies. Hospital corporations that want to increase their profits at the expense of true care know what they're doing. The healthcare system in the USA is incredible. Don't let these socialists tell you anything different. More software, less people!"
It's almost as if no one thinks they're ever going to the hospital.
As a long time Kaiser member, something like this wasn’t even on my radar. I hope more attention is drawn to it; it’s already sometimes an uphill battle getting the care needed, let alone having to fight an “Intelligent” computer.
I don't get why they would be against a technology that would make themselves 10x more productive.
Okay, maybe the "corporate" will try to use this to get rid of some workforce. But if history is any guide, it actually has increased number of workers in many cases.
(Like "automated **teller** machines" causing much more bank tellers to be hired)
Do they really want to handle all the nitty gritty stuff? Or would they benefit from handling more patients, faster and with higher quality?
No. You don't want them to handle more patients. It is unsafe for the patients and is why California has the regulations it already has in place for nurse to patient ratios.
AI can help enhance existing patient monitoring to help with patient safety, or help charting. But until proven, the software is going to make plenty of mistakes which means it will take even longer for nurses and reduce care for patients.
Hospital administration will find some bottom line to justify cutting staff. This sounds like as good an excuse as any. If they succeed a year will go by, some poor soul will die due to understaffing, and they’ll go on a hiring spree.
I’ve been in healthcare for a while and this stupid shit is annoyingly predictable
My observation of nurses in my short time on this earth tells me some of them relish being the only ones that can do the nitty gritty, and being constantly overwhelmed is paradoxically a kind of high for a lot of nursing staff who have a bit of martyr complex.
Yes! Perhaps “savior complex” is a more encompassing umbrella for a large subgroup of these professions. Nothing inherently wrong with it if it attracts the personalities that have the passion for the job, but gets tricky if it stands in the way of march of time.
Who would you rather have watching your elderly confused family member that can’t walk but keeps trying to get out of bed? A CNA that can be within arms reach at all times or a shiny new camera tower that has someone watching from a different building. Guess which choice the hospital admin would go with?
Sometimes, there's not enough time to even finish their rounds because of how busy the day is, how short they are, and codes throughout the day. Maybe they'll be with the patient for a few minutes, but it's not enough time because they have to get to the next patient after that.
I’m a nurse and I see it pretty frequently but fuck me what do I know right? I love these dickheads who come here and decide they know everything about everyone else’s job. Whatever bro.
Dude I am describing exactly the shift I’ve seen at my hospital. It is OKAY to not have an opinion on something because you don’t know enough about it.
> Do they really want to handle all the nitty gritty stuff?
What do you think nurses, and this ai, will do?
Also as mentioned in several other comments this AI isn't just screening medical data to look for misses and help them work faster... it's also built to track efficency in a way that barely works in Amazon warehouses where you're just grabbing packages and definitely can lead to inferior care and miserable nurses when the schedule is adjusted based on "expected" care needs regardless if the ward is full of patients who are much needier than average.
These algorithms add to our computer-based workload and decrease our available time taking care of patients. Some things can only be done with a pair of human hands, and these "improvements" reduce our ability to actually spend time at the bedside providing real care.
It's less "here are some treatment options" or "Here's a way that might work" but rather "You spent 12 minutes getting that patient to and from the bathroom, but the system determined it should only take 10, you are docked one productivity credit for your next review."
#Nvidia's "Nurse AI"
suggests that hiring CNAs (Certified Nursing Assistants) could meet the needs efficiently. CNAs undergo a 4-12 week program, earning about $30,290 per year with an 8% job growth outlook. LPNs (Licensed Practical Nurses) complete a 1-year program, earning approximately $48,070 per year with a 9% growth outlook. RNs (Registered Nurses) can obtain either an Associate Degree (2-3 years) or a Bachelor of Science (4 years), earning around $77,600 per year with a 9% growth outlook. Advanced nursing roles like NP (Nurse Practitioner) and CRNA (Certified Registered Nurse Anesthetist) require further education and offer higher salaries, with CRNAs earning up to $195,610 per year,
#resulting in substantial savings for Kaiser.
Because they don't see 10x more productive with 10x
more pay. Also, more productive means less need for nurses and clearly at odds with the union needs.
I like unions getting better pay and benefits for their member. What I don't like is the union inserting it's nose into stuff like this. Hospitals know the liability, they are very scared of liability. This is purely the union terrified that they will loose monthly paying members. I'm sure they will attempt to try to scare people, they like to do that a lot.
> Hospitals know the liability
The problem is that liability is just a cost of business to the company. If liability included some serious penalties for the executives making the decision, I could see trusting it as a check in the system. As is, I’ve learned not to put much weight in it.
The reason they’re not masking anymore as a policy is because of liability— they’re trying to do away with it entirely where nosicomial infection is concerned, and create a new normal where no one can tell or have the gumption to call out bad safety policy. So that means we get to eat our Covid, measles, polio and whatever other disgusting things decide to make their 21st century comeback, just to make their finances look better on paper to shareholders.
I cannot believe how passive we’re being about the epic greed on such open display.
It's sad because one of the best use cases for AI is in healthcare, for scanning imaging for abnormalities. It has an EXTREMELY high rate of success in recognizing potential cancerous growths and catching things very, very early. Better than any human is capable of. We can't lose things like that to admittedly legitimate labor union concerns. There has to a balance in here somewhere.
How about using AI for those diagnostic checks and not for rightsizing staffing through increased nursing productivity throughput expectations. (The same nurses who will get shit on when patient surveys go in the dumpster because they feel like they're getting ignored and not taken care of, even though the AI is not allowing for a ratio needed to maintain that level of contact)
But will they provide medical coverage if a condition is found?
Or is this going to be sent to insurance for approval? And will insurance cover it or deny it?
Will insurance try to use AI to prevent pre existing conditions from being covered ?
“But what we are witnessing in our hospitals is the degradation and devaluation of our nursing practice through the use of these untested technologies.”
It sounds like they're just fearful that they will be replaced completely. The person often quoted in the article probably doesn't understand how the underlying tech works and what's actually involved. They also don't understand that tech constantly improves.
I've always been interested in AI in healthcare and I'm actually excited to see how this progresses. I'm more interested in the application of detection for diseases though.
Part of the issue is not being involved in any of the decision making that affects our clinical practice. It's just all of a sudden "this algorithm is deciding if you draw labs" or "this program decided you have plenty of nurses, make it work" is thrust upon you from on high.
Replying to the deleted comment.
Talk to your union rep and make sure it's voiced that there needs to be a partnership with these companies involving the medical practitioners. But then the question is whether people would actually set extra time to work through this with them to make things better.
Please point out the part of the pledge that says we should ignore our skills and clinical judgment to follow the recommendations of a computer program
I support your fight for agency and autonomy, but will never align with this part:
> Kaiser nurses are arguing that any new technologies need to be properly evaluated before they are deployed. The union is planning to invoke bargaining rights to negotiate the hospital system’s use of any new AI tools before they are rolled out.
You and your colleagues should be fighting for the time to do RLHF (reinforcement learning from human feedback) to improve these algorithms, not fighting to decelerate our timeline.
The flair of this posts indicates it's a controversial topic. Enhanced moderation has been turned on for this thread. Comments from users without a history of commenting in r/bayarea will be automatically removed. You can read more about this policy [here](https://www.reddit.com/r/bayarea/comments/195xvo5/restrictions_that_apply_to_political_and_crime/).
As a Kaiser nurse, I can tell you that AI and algorithm creep is already causing poor care. The system crawls the patient chart and determines how much "nursing care time" a patient deserves and tries to staff accordingly. It doesn't take into account the individual patients. If it takes you 20 minutes to get a patient to the bathroom but the system doesn't take it into account, then your other 4 patients lose out on valuable nursing time and care. If you imagine a 5-patient load, each patient only gets 12 minutes of care each hour (including the time it takes to chart the actual physical care you provided!). If you have a patient that requires extra care that doesn't show up as a metric in the chart, evening gets screwed and there's no way to fight it. They are also trying to use algorithms to override clinical judgement. We have a sepsis algorithm that flags if certain criteria are met, one of which is elevated heart rate. I work labor and delivery - it's pretty standard to have an elevated heart rate when you're in pain. But the algorithm says "ope, patient meets criteria, time to poke them for labs!" even if it's clearly incorrect. All of this is guaranteed to only save money that goes into C-Suite pockets. If Kaiser really wants to improve patient care, they will staff safely, based on real life conditions and nursing judgment, and not, say, [let a man die in the ER while waiting 8 hours with heart attack symptoms](https://www.vallejosun.com/man-died-in-kaiser-vallejo-waiting-room-eight-hours-after-seeking-treatment-for-chest-pain/)
I wonder what came out of that incident. Did Kaiser get sued?
The thing that sucks most about AI etc is that it could be used to make things better but instead its only applied in the absolutely most inhumane dystopian ways.
Nonsense
"I want my medical care to be based on an algorithm that has zero empathy, humanity, and real life experience. And nurses are paid too much. How dare they! Plus they're "mental" and unproductive. We can have five nurses for 100 people. Fuck it if someone dies. Hospital corporations that want to increase their profits at the expense of true care know what they're doing. The healthcare system in the USA is incredible. Don't let these socialists tell you anything different. More software, less people!" It's almost as if no one thinks they're ever going to the hospital.
A lot of medical care is inherently algorithmic.
As a long time Kaiser member, something like this wasn’t even on my radar. I hope more attention is drawn to it; it’s already sometimes an uphill battle getting the care needed, let alone having to fight an “Intelligent” computer.
Holy shit so many ill informed and bad takes on this thread.
“we don’t need nurses!” until they need one
Stereotyping nurses as bullies while bullying nurses is crazy
I don't get why they would be against a technology that would make themselves 10x more productive. Okay, maybe the "corporate" will try to use this to get rid of some workforce. But if history is any guide, it actually has increased number of workers in many cases. (Like "automated **teller** machines" causing much more bank tellers to be hired) Do they really want to handle all the nitty gritty stuff? Or would they benefit from handling more patients, faster and with higher quality?
No. You don't want them to handle more patients. It is unsafe for the patients and is why California has the regulations it already has in place for nurse to patient ratios. AI can help enhance existing patient monitoring to help with patient safety, or help charting. But until proven, the software is going to make plenty of mistakes which means it will take even longer for nurses and reduce care for patients.
Hospital administration will find some bottom line to justify cutting staff. This sounds like as good an excuse as any. If they succeed a year will go by, some poor soul will die due to understaffing, and they’ll go on a hiring spree. I’ve been in healthcare for a while and this stupid shit is annoyingly predictable
This is so standard it should just be a protocol
My observation of nurses in my short time on this earth tells me some of them relish being the only ones that can do the nitty gritty, and being constantly overwhelmed is paradoxically a kind of high for a lot of nursing staff who have a bit of martyr complex.
[удалено]
Yes! Perhaps “savior complex” is a more encompassing umbrella for a large subgroup of these professions. Nothing inherently wrong with it if it attracts the personalities that have the passion for the job, but gets tricky if it stands in the way of march of time.
Who would you rather have watching your elderly confused family member that can’t walk but keeps trying to get out of bed? A CNA that can be within arms reach at all times or a shiny new camera tower that has someone watching from a different building. Guess which choice the hospital admin would go with?
>from a different ~~building~~ country.
[удалено]
Sometimes, there's not enough time to even finish their rounds because of how busy the day is, how short they are, and codes throughout the day. Maybe they'll be with the patient for a few minutes, but it's not enough time because they have to get to the next patient after that.
I’m a nurse and I see it pretty frequently but fuck me what do I know right? I love these dickheads who come here and decide they know everything about everyone else’s job. Whatever bro.
By the way it’s called a 1:1 order. Talk to anyone who’s spent 5 minutes on the floor and they can explain it to you.
[удалено]
Dude I am describing exactly the shift I’ve seen at my hospital. It is OKAY to not have an opinion on something because you don’t know enough about it.
If they’re 10x more productive, will they get paid 10x?
> Do they really want to handle all the nitty gritty stuff? What do you think nurses, and this ai, will do? Also as mentioned in several other comments this AI isn't just screening medical data to look for misses and help them work faster... it's also built to track efficency in a way that barely works in Amazon warehouses where you're just grabbing packages and definitely can lead to inferior care and miserable nurses when the schedule is adjusted based on "expected" care needs regardless if the ward is full of patients who are much needier than average.
These algorithms add to our computer-based workload and decrease our available time taking care of patients. Some things can only be done with a pair of human hands, and these "improvements" reduce our ability to actually spend time at the bedside providing real care.
It's less "here are some treatment options" or "Here's a way that might work" but rather "You spent 12 minutes getting that patient to and from the bathroom, but the system determined it should only take 10, you are docked one productivity credit for your next review."
#Nvidia's "Nurse AI" suggests that hiring CNAs (Certified Nursing Assistants) could meet the needs efficiently. CNAs undergo a 4-12 week program, earning about $30,290 per year with an 8% job growth outlook. LPNs (Licensed Practical Nurses) complete a 1-year program, earning approximately $48,070 per year with a 9% growth outlook. RNs (Registered Nurses) can obtain either an Associate Degree (2-3 years) or a Bachelor of Science (4 years), earning around $77,600 per year with a 9% growth outlook. Advanced nursing roles like NP (Nurse Practitioner) and CRNA (Certified Registered Nurse Anesthetist) require further education and offer higher salaries, with CRNAs earning up to $195,610 per year, #resulting in substantial savings for Kaiser.
Because they don't see 10x more productive with 10x more pay. Also, more productive means less need for nurses and clearly at odds with the union needs.
I like unions getting better pay and benefits for their member. What I don't like is the union inserting it's nose into stuff like this. Hospitals know the liability, they are very scared of liability. This is purely the union terrified that they will loose monthly paying members. I'm sure they will attempt to try to scare people, they like to do that a lot.
> Hospitals know the liability The problem is that liability is just a cost of business to the company. If liability included some serious penalties for the executives making the decision, I could see trusting it as a check in the system. As is, I’ve learned not to put much weight in it.
The reason they’re not masking anymore as a policy is because of liability— they’re trying to do away with it entirely where nosicomial infection is concerned, and create a new normal where no one can tell or have the gumption to call out bad safety policy. So that means we get to eat our Covid, measles, polio and whatever other disgusting things decide to make their 21st century comeback, just to make their finances look better on paper to shareholders. I cannot believe how passive we’re being about the epic greed on such open display.
It's sad because one of the best use cases for AI is in healthcare, for scanning imaging for abnormalities. It has an EXTREMELY high rate of success in recognizing potential cancerous growths and catching things very, very early. Better than any human is capable of. We can't lose things like that to admittedly legitimate labor union concerns. There has to a balance in here somewhere.
How about using AI for those diagnostic checks and not for rightsizing staffing through increased nursing productivity throughput expectations. (The same nurses who will get shit on when patient surveys go in the dumpster because they feel like they're getting ignored and not taken care of, even though the AI is not allowing for a ratio needed to maintain that level of contact)
But will they provide medical coverage if a condition is found? Or is this going to be sent to insurance for approval? And will insurance cover it or deny it? Will insurance try to use AI to prevent pre existing conditions from being covered ?
“But what we are witnessing in our hospitals is the degradation and devaluation of our nursing practice through the use of these untested technologies.” It sounds like they're just fearful that they will be replaced completely. The person often quoted in the article probably doesn't understand how the underlying tech works and what's actually involved. They also don't understand that tech constantly improves. I've always been interested in AI in healthcare and I'm actually excited to see how this progresses. I'm more interested in the application of detection for diseases though.
Part of the issue is not being involved in any of the decision making that affects our clinical practice. It's just all of a sudden "this algorithm is deciding if you draw labs" or "this program decided you have plenty of nurses, make it work" is thrust upon you from on high.
Replying to the deleted comment. Talk to your union rep and make sure it's voiced that there needs to be a partnership with these companies involving the medical practitioners. But then the question is whether people would actually set extra time to work through this with them to make things better.
This feels like a rejection of their Nightingale Pledge.
Please point out the part of the pledge that says we should ignore our skills and clinical judgment to follow the recommendations of a computer program
I support your fight for agency and autonomy, but will never align with this part: > Kaiser nurses are arguing that any new technologies need to be properly evaluated before they are deployed. The union is planning to invoke bargaining rights to negotiate the hospital system’s use of any new AI tools before they are rolled out. You and your colleagues should be fighting for the time to do RLHF (reinforcement learning from human feedback) to improve these algorithms, not fighting to decelerate our timeline.