In 2024, hundreds of nurses gathered outside a Kaiser Permanente hospital in San Francisco, carrying signs that read: “Trust nurses, not AI.” As the nurses union started contract negotiations last year, the nonprofit health system’s adoption of artificial intelligence tools was one of the issues workers raised while picketing—and earlier this year, tens of thousands of Kaiser nurses went on strike alongside mental health professionals, largely to protest AI.
This has become a central issue for healthcare workers in California, and a report from Cal Matters this week reveals why they have pushed back on how they’re being asked to use AI on the job.
Former and current nurses at Kaiser revealed that their employer has started monitoring their performance closely with AI, evaluating them on how they responded to calls, and how long they spent on the phone with patients (which the company describes as “average handle time”). If their calls with patients crossed 15 minutes, nurses claimed they would be reprimanded or find that their monthly performance score was impacted.
Nurses said they were typically supposed to follow a script and offer only a few pieces of advice. Many were concerned that Kaiser’s approach to performance management would negatively affect patient care by forcing nurses to limit the length and scope of calls. They also noted that certain conversations—talking to new parents, for example, or patients who needed a translator—necessitated more time.
As one nurse told Cal Matters, citing a sensitive conversation with a patient that she felt required more care: “I had to ask myself: Am I going to get disciplined for going off script or saying more than what is necessary?”
According to Cal Matters, Kaiser also allegedly used AI to assess their tone or level of empathy. The tool was reportedly tested on nurses in 2024, but Kaiser stopped using it after nurses protested. Still, union representatives claimed that managers said they might eventually revive the program.
When reached for comment, a Kaiser spokesperson said the company “uses AI responsibly and with human oversight, always prioritizing patient safety, privacy, and equity. AI tools are designed to support our clinicians and care teams, not to replace them. Medical decisions remain in the hands of our clinicians.”
The spokesperson also denied that nurses were disciplined for taking calls that lasted longer than 15 minutes. “Kaiser Permanente does not use Average Handle Time to assess call response performance or enforce call time metrics. Any tools used in contact center settings support our quality assurance efforts and have human review and oversight. At Kaiser Permanente, our nurses are supported and empowered to take the time needed to deliver compassionate care and fully address each patient’s care needs. Our focus is always on ensuring we provide high-quality care through the use of evidence-based practices to achieve the best possible outcomes for our members.”
It’s not just nurses in California who are coming up against these AI systems. In a 2024 survey by National Nurses United—the largest union of registered nurses in the nation—half of workers said their employers were using algorithmic systems to analyze patient records. A notable number of them said their assessment of patients did not always line up with AI-generated guidance, and very often, they could not change the AI recommendations to reflect their opinion.
Healthcare workers in other states have expressed similar concerns over how AI is being used for performance management and in other ways that could potentially harm patients. In New York, the nurses’ union has repeatedly expressed concerns about the incursion of AI into healthcare. One hospital in New York City has been explicit about its alleged plans to replace nurses with AI-powered software. The widespread adoption of AI has also raised alarm bells in Tennessee, where a major for-profit health system—HCA Healthcare—has a controversial partnership with Palantir.
In other words, it’s not just office workers who are at risk of increased surveillance or likely to be impacted by AI’s growing role in performance management.
As one nurse put it to Cal Matters: “I’m not against the use of AI as long as it’s beneficial to the patient. But in this particular use, it’s to increase productivity and improve efficiency and cut costs. Kaiser is forgetting we aren’t just a call center for customer support. We’re nurses, and we’re there to take care of patients.”