POSITION STATEMENT

Artificial Intelligence
EXECUTIVE SUMMARY

The Australian College of Nursing (ACN) advocates for the of safe AI use such as considering when the dataset is not
patient-centred, ethical, and safe use of Artificial Intelligence large enough to allow the algorithm to work with safety and
(AI) to support and enhance nursing practice, education, accuracy.
and administration. The safe and ethical application of
This AI position statement is developed in keeping with the
AI in nursing relies on several principles and needs to
ACN mission of Shaping Health, Advancing Nursing. It is a
be supported by strong governance. AI has developed
starting guide for the nursing profession to ensure nursing
exponentially and is a key area of growth within digital health
remains at the forefront of Australian healthcare and to
and technology (Abuzaid et al., 2022). While AI has many
ensure improved patient outcomes. (Refer to Appendix 1 for
potential benefits in healthcare, appropriate regulations
definitions)
and safeguards must be embedded so that their use does
not compromise patient safety, nursing care delivery, or the
profession more broadly. This position statement outlines the Purpose
core principles that apply to using AI in healthcare. This position statement aims to provide nurses with an
AI is becoming increasingly more advanced, accurate, understanding of the core principles to safely navigate
practical, efficient, and effective (Pailaha, 2023). Nurses using AI, recognising the pivotal and important role of AI.
are uniquely placed to play a leadership role in developing, It acknowledges the role AI will play in the contemporary
testing, implementing, and evaluating AI in healthcare in a healthcare setting in the future.
nursing context. AI has the potential to significantly reduce
the often-repetitive tasks that nurses perform, as well Principles for safe use of AI by nurses
as assist in solving both our current and future workflow
Nursing informatics must be involved at all stages of
challenges. Nurses must understand and consider the
generative AI development and intrinsically involved in
implications of AI in clinical and non-clinical settings to
maintaining Australian nursing standards and practice.
ensure patient-centred care is uncompromised. Education
should be readily available to the profession to enhance Nurses must:
professional understanding of what constitutes an AI product
a. Continue to use their nursing knowledge and critical
and the role of AI’s algorithms in decision-making. To assist
thinking to ensure that AI is providing accurate and safe
the development of professional understanding, the National
solutions (AIDH, 2024). This will ensure patients and
Nursing and Midwifery Digital Health Capability Framework
the broader community are afforded the best care in
(Australian Digital Health Agency, 2020) and A National
line with AHPRA’s Shared Code of conduct principles
Policy Roadmap for Artificial Intelligence in Healthcare
(AHPRA, 2023).
(AAAiH, 2023) are resources that could be embedded into
the undergraduate nursing curriculum. It is important that b. Be cognisant when generative AI is used in nursing.
nurses know how to perform the tasks that increasingly AI Be cognisant of generative AI in digital tools used
is executing. Nurses must know when to question results to provide care, including applications with decision
provided by the AI tool and must understand the parameters support, predictive tools, and automation.

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POSITION STATEMENT Artificial Intelligence

c. Consider the ethical implications of data and algorithmic Clinical Decision Support Systems (CDSS): In Australia,
bias, which may embed gender, race, and other nurses increasingly use AI-powered CDSS to assist
inequalities and inequities due to the inherent limitations with evidence-based clinical decisions. These systems
of generative AI across various populations. analyse large volumes of patient data to provide treatment
recommendations, enhancing the precision and efficiency of
d. Engage in learning about different types of AI and
patient care (Jean, 2023).
how they can impact the provision of care: understand
generative AI’s safe and ethical applications. Virtual Nursing Assistants: AI-driven virtual assistants are
helping with tasks like scheduling patient appointments and
medication reminders, freeing up nurses for direct patient
BACKGROUND care.

Remote Patient Monitoring: With the integration of AI,

What is AI?
remote monitoring systems help nurses track patients’
The Australian Alliance for Artificial Intelligence in HealthCare health, in remote areas and in metropolitan areas. AI
(AAAiH) describes artificial intelligence as the simulation analyses data from wearables, alerting nurses to changes
of human intelligence processes by machines (AAAiH, in patients’ conditions for early intervention, such as Blood
2021). The goal of AI in healthcare is to automate tasks and Glucose Level monitoring applications. Virtual hospitals such
streamline decision-making, leading to better care delivery as Royal Prince Alfred Virtual Hospital (RPA Virtual, 2024) in
and patient outcomes (Abuzaid et al., 2022). Although the Sydney are providing expert patient care across virtual care
concept of AI was developed more than seventy years ago, services.
it has become increasingly well-known since the public
Predictive Analytics: AI-based predictive analytics are
arrival of large language models (LLMs) such as ChatGPT, a
employed to anticipate patient flow and potential health
generative pre-trained transformer (Haug & Drazen, 2023).
issues, helping nurses manage resources and prepare for
AI’s foundational element is its use of algorithmic processes
changes in patient care demands.
to automate and simulate intelligent behaviour, including
complex pattern recognition and problem-solving. AI learns Administrative Support: Generative AI tools attached to
from inputted data and thus improves its performance local healthcare networks can rapidly distil information and
over time via repetition, which can result in increasingly develop administrative documents such as memos, letters
independent action. and briefing papers or clinical documents such as discharge
summaries and care plans.
AI in Healthcare
AI’s role in healthcare is poised to expand exponentially
With the increasingly efficient application of AI across in the coming years (Jean, 2023). Nurses are faced with
various sectors, AI will become intrinsically embedded systems and tools increasingly reliant on various aspects
in the Australian healthcare system (Reddy, 2020). This of AI. As a human-centred profession, it is vital that nursing
includes but is not limited to clinical practice, management, matches the pace of development and implementation of AI
administration, informatics, education, and research for the whilst fully understanding the benefits, limitations, and risks
nursing profession. of its use. Innovations such as AI-driven surgical robotics,
computer vision, and more advanced electronic health
AI is widely used in the Australian healthcare sector.
records will transform the industry.
Examples include:
Patients can and will expect improved diagnostics, more
Robotics in Care: Robots are being introduced to assist
personalised care, and greater accessibility to healthcare
with logistical tasks and provide social interaction for
services. Considering these advances, the nursing
patients, reducing physical demands on nursing staff.
profession is well placed as the largest, most highly

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educated and skilled health workforce to take a leading role Planning and predicting by using knowledge about tasks,
in addressing current healthcare challenges and utilising this resources, goals, and potential trade-offs to create and
technology to ensure improved patient outcomes. dynamically update care plans or forecast required care and
resources (Pailaha, 2023).
AI is becoming more advanced, accurate, practical,
effective, efficient, and economical for nursing care. This Improving electronic medical records (EMRs) through
provides the nursing profession with opportunities but adds data organisation and analysis (Pailaha, 2023).
pressure to apply AI technology in patient care (Stokes
Improving collaboration, coordination, and
& Palmer, 2020). The requirement to provide ethical care
communication between healthcare disciplines (Pailaha,
and informed decision-making for patients shapes nurses’
2023).
roles in considered decision-making for patients. The use
of AI is not always inherently visible in systemic clinical or Providing increased levels of direct patient care:
informatics processes; patients must feel confident in all Robotics are increasingly used in nursing environments. An
decisions relating to their well-being. The risk of data bias is example of this is “Moxi”, a robot assistant used to give time
a reality in the use of AI, and there is evidence that AI models back to nurses by being programmed to run tasks such as
can embed and deploy human and social bias at scale. picking up medications from the pharmacy or transferring
Therefore, nurses require assurance that the information patients’ belongings (Diligent Robotics, 2024).
provided is based on algorithms utilising unbiased real-time
data. Streamlining real-time documentation with the use of
ambient listening algorithms. These can be programmed
The use of AI in health care is now critical to the knowledge to keep clinical-based nursing records at the time
base and skill set of the 21st-century nurse, and as such, of intervention. This can not only provide real-time
ACN supports its development as a core curriculum contemporaneousness documentation but also improve
component of undergraduate nursing education, plus a the accuracy of nursing documentation, and reduce the
fundamental element of continual professional development. administrative burden (Pailaha, 2023).
Furthermore, ACN recognises the need to identify the
evolving specialised digital and informatics nursing roles Increasing work satisfaction. AI can undertake some
that are critical in the development, governance, use, and professional tasks that do not require a highly skilled nurse to
assurance of patient safety within the current healthcare complete, allowing nurses to have more direct time to deliver
system. These roles may not be seen as ‘traditional’ nursing care to patients, supporting the nursing ability to work to full
roles but utilise nurses’ knowledge and skills in an advanced scope. This can bring an improved level of job satisfaction
contemporary nursing environment. and well-being to nurses’ working life, while positively
impacting patients and improving treatment outcomes. AI
may also reduce health problems associated with stress and
AI’s Role in Supporting Nurses
job dissatisfaction for the nurse (Robert, 2021).
ACN identifies the transformative potential AI brings and
notes some of these potential benefits for the nursing
profession, including:

Expanding access to high-quality care by reducing time-

consuming tasks that do not require specialised nursing
skills and knowledge, thus freeing nurses to concentrate
on high-quality care and allowing nurses to concentrate on
other tasks (Robert, 2019).

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Key Issues for Nursing Principles of the Ethical and Safe Use of AI for Nurses

The key issues for the nursing profession surrounding AI Solving ethical dilemmas, advocacy, privacy and data
emphasise the delicate balance between the transformative protection, closing social gaps (or inequities) enabling
potential of AI to improve patient care and the critical access to treatment, providing empathy and sympathy are
imperatives of data privacy, ethics, managing data bias but a small sample of the core skills nurses bring to patients
and equitable access, all of which must be thoughtfully and consumers in times of need. However, the nursing
addressed to ensure that AI truly advances healthcare for profession faces challenges when using AI and must ensure
everyone. As recommended in the AI in Healthcare Roadmap that the human contact or human touch (Pepito et al., 2023)
(AAAiH, 2023), there is a need for caution in adopting AI for that is so important to nursing care and patient well-being is
use in clinical settings. not lost with the health industry’s adoption of AI.

As the nursing field begins to reap the benefits of AI Nurses are often the final safeguard in ensuring treatment
implementation and advancement, it is crucial to proceed decisions are in keeping with an evidence base. To ensure
cautiously. Currently, there are no professional practice the nursing profession maintains the highest standards of
standards for AI use in nursing although the Australasian evidence-based care and human-centred individualised
Institute of Digital Health supports a shared code of care and treatment, ACN outlines the principles identified in
conduct for all healthcare professionals and organisations Appendix 3 to be considered by nurses when AI is included
and promotes profession-specific codes of practice for all in their healthcare interventions.
health professionals using AI in clinical use (AIDH, 2023). In
As AI is implemented within the nursing profession, its
Australia, only the Therapeutic Goods Administration can
ethical and safe use in critical decision-making situations is
approve AI for clinical use, subject to specific guidelines.
essential. The increasing prevalence of healthcare integrated
The nursing workforce lacks a structured, widespread AI
devices, data analytics, data driven projected outcomes and
education, and higher education is still in the early stages
robotics presents a growing safety challenge.
of incorporating digital health and AI into an already dense
undergraduate nursing curriculum (AAAiH, 2023). Incorporating AI into nursing practices, education, and
research requires careful planning, training, and ethical
Research by the Australian Institute of Health Innovation
considerations. By embracing AI technologies that focus on
at Macquarie University, Sydney, Australia, has raised
enhancing patient care and improving nursing workflows,
additional concerns. Their study of 266 safety reports related
the nursing profession can unlock the full potential of AI
to AI-enabled medical devices in real-world settings found
to deliver more efficient and intrinsically human-centred
that 16% were associated with patient harm, 66% were
healthcare services.
potential hazards, and 4% were near-miss events where
users intervened to prevent harm (Lyell et al., 2023). AI’s use of algorithms and predictive models to assess
data about patient populations will potentially lead to AI-
This underscores the need for nurses to be fully informed
developed personalised care solutions for individuals. These
about all aspects of AI development and use and actively
solutions will complement nurses’ own nursing knowledge
participate in incident reporting and review. Safety event
and practice, enriching and improving patient experiences.
reports highlight the need for a comprehensive system
approach to ensure the safety of AI-enabled medical
devices, which includes understanding how patients and
healthcare professionals interact with these systems.

Current considerations are outlined in Appendix 2, but this

list is not exhaustive.

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ACN Recommendations

ACN recognises the benefits AI represents and the 4. We advocate for the recommendations outlined in A
potential to improve further health outcomes for individual National Policy Roadmap for Artificial Intelligence in
patients, their communities and Australia as a whole. ACN Healthcare (AAAiH, 2023). We advocate for AI to be
recommends that nurses who specialise in informatics be developed within a robust safety framework, for the
included in those bodies managing AI in healthcare within implementation of accreditation to assess AI safety and
the healthcare system. quality practice standards and the integration of the
national AI ethical framework to support value-based
1. The nursing profession asserts its commitment to
healthcare.
staying abreast of healthcare advancements, particularly
in AI. We advocate for AI education at all levels of 5. Nursing should have a participatory role in the
nursing, from undergraduate to advanced CPD levels, to development of data governance models based
ensure a comprehensive understanding of AI products, on principles of integrity, transparency, auditability,
algorithmic decision-making, and the legal liabilities accountability, stewardship, checks and balances,
associated with automated decisions (Reddy et al., standardisation, and change management (The Data
2020). The National Nursing and Midwifery Digital Governance Institute, 2023).
Health Capability Framework (Australian Digital Health
Agency, 2020) and A National Policy Roadmap for
Artificial Intelligence in Healthcare (AAAiH, 2023) should
be integrated into nursing curricula to facilitate this
education effectively. The Australian College of Nursing
is currently offering a Graduate Certificate in Digital
Health (ACN, 2024).

2. Nursing informaticians must be integral to all aspects

of AI application, adhering to Australian standards
and management protocols. Healthcare organisations
must ensure nurses’ active involvement in governance
models, emphasising principles of fairness,
transparency, accountability, and trustworthiness.

3. Nurses must play a central role in the design,

implementation, and evaluation of AI applications,
ensuring that ethical and practical considerations
align with nursing requirements. AI should only be
integrated into nursing practice when ratified evidence
demonstrates improved patient outcomes. It is
imperative to emphasise that AI is a tool to enhance
nursing care and treatment, not a replacement for critical
thinking.

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APPENDIX 1

Current Definitions of Common Terminology Associated • Deep Learning: A type of machine learning that uses
with Artificial Intelligence neural networks with many layers to process and analyse
complex data (Jakhar et al., 2020). It is currently the most
• Artificial Intelligence (AI): A term coined by Stanford
successful ML approach, usable for all types of ML, with
Emeritus Professor John McCarthy in 1955. He
better generalisation from small data and better scaling
defined this as “the science and engineering of making
to big data. It has been applied in healthcare for image
intelligent machines”. We have programmed machines
recognition and natural language processing. Computer-
to behave cleverly, playing chess for example, but
aided diagnosis is an example of deep learning that
today, we concentrate on machines that can learn, at
assists radiologists and pathologists in interpreting
least somewhat like humans do, (HAI, 2020). AI can also
medical images and aiding in detecting diseases.
indicate a broad field that includes anything related to the
simulation of human cognitive abilities using machines • Generative Artificial Intelligence: Also known as
(O’Connor et al., 2022). generative pre-trained transformers, training data
generates new content in various mediums (for example,
• Automated decision-making: Technology assisting the
text, images, and code) (Massachusetts Institute of
judgement of human decision-makers (Commonwealth
Technology, 2023).
Ombudsman, 2019).
• ‘Hallucination’ effect: Where a LLM generates false
• Human-Centered Artificial Intelligence: AI that seeks
information (IBM, n.d.).
to augment the abilities of, address the societal needs,
and draw inspiration from human beings. It researches • Computer vision: Algorithms developed to analyse
and builds effective partners and tools for people, specific criteria in images and videos that are used to
such as a robot helper and companions for the elderly interpret, predict and assist with decision-making (IBM,
(Interaction Design Foundation, n.d.). n.d.).

• Large language model (LLM): Also referred to as • Predictive Analytics: AI-driven predictive analytics uses
natural language processing. Branch of AI that uses large historical data to forecast future health outcomes; this
data sets to teach machines to understand, interpret helps healthcare providers identify patients at risk and
and generate responses that mimic human language allocate resources more effectively (Reveal, 2024).
(Gartner, 2024).
• Narrow AI: Intelligent systems specifically designed for
• Machine learning (ML): Often referred to as neural one particular thing, e.g., speech or facial recognition
networks. Machine learning is a subset of AI that uses (Techopedia, 2023).
algorithms to enable computers to learn from and make
• Data Governance: Data Governance is a system of
predictions or decisions based on data. ML is used in
decision rights and accountabilities for information-
healthcare for tasks like disease prediction and image
related processes, executed according to agreed-upon
analysis (Reddy et al., 2019).
models that describe who can take what actions with
what information, and when, under what circumstances,
using what methods (The Data Governance Institute,
n.d.).

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APPENDIX 2

Issues for nursing consideration in the use of AI • Patient advocacy: Nurses have a significant
professional role as advocates for patients and their
• Governance: Currently, there is no professional practice
families in an increasingly complex healthcare system,
standard or code of ethics governing the use of AI in
now inclusive of AI.
Australia’s health care system. The Therapeutic Goods
Administration must approve AI in Australia for medical • Ethical use of AI: For example, personalisation, loss of
use, and it is required to meet specific guidelines. privacy, and anthropomorphisms use in healthcare, must
be considered to ensure we have the public’s trust and
• Limited education on the nature and uses of
acceptance in using intelligent healthcare devices and
AI within the nursing profession: The speed of
services (Liu & Tao, 2022).
AI adoption has required education providers to
continuously change course and education content • Incident reporting: All healthcare professionals must
within very tight timeframes. contribute to safety monitoring requirements to ensure
risk if harms are detected, reported and communicated
• Data Sharing: Consent, privacy and security concerns
(AAAiH, 2023).
about privacy breaches or unconsented use of patient
data need to be addressed.

• Confidentiality: How and where personal information

is stored and its secondary use in AI, as well as the
potential ability to resurface it by AI algorithms.

• Validity and reliability: There are still issues with

the validity of AI-generated data, as illustrated by the
‘hallucination’ effect defined above.

• Biases: As AI learns from inputted data and uncontrolled

datasets (e.g. the Internet), there is potential that AI will
perpetuate or systematically embed existing biases
into its outputs, which may lead to the potential for
suboptimal outcomes (Pailaha, 2023).

• Legal liability: Legal liability can become complex

when AI facilitates decisions. The legal responsibility is
still with the practitioner regardless of AI-recommended
actions.

• Informed consent: Ensuring patients and consumers

are aware of AI and consent to its use in their care.

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APPENDIX 3

Principles of the Ethical and Safe Use of AI for Nurses • Adherence to Standards: Follow industry and
regulatory standards and guidelines for AI use in
• Patient-Centred Care: AI should be used to enhance
healthcare to maintain consistency and quality in nursing
patient care and experiences. It is critical to ensure the
practice (AAAiH, 2021; AAAiH, 2023).
well-being and preferences of patients is at the forefront
of nursing practice. • Data Privacy and Security: Protect patient data and
ensure its confidentiality and security when using AI
• Nursing Autonomy: AI should support nurses in
systems. Comply with data protection regulations and
decision-making without undermining their professional
educate nurses on data handling best practices (AAAiH,
autonomy. Nurses should have the final say in patient
2021).
care decisions.
• Data Governance: Establish strong data governance
• Human Oversight: There must always be human
practices to ensure the quality and integrity of the data
oversight of AI systems. Nurses should critically
used by AI systems in nursing (O’Connor et al., 2023;
evaluate AI-generated recommendations and decisions,
Australian Digital Health Agency, 2020).
not simply rely on them, intervening when necessary
(Poalenlungi et al., 2023). • Ethical Decision-Making: Nurses should be trained
in ethical considerations related to AI use in healthcare.
• Clinical Expertise and Human Touch: Nursing
AI systems should adhere to ethical standards, and
care involves a combination of clinical expertise
nurses should have mechanisms for addressing ethical
and compassionate human interaction. AI should
dilemmas (Prakash et al., 2022).
complement these skills rather than replace them
(Aquino et al., 2023). • Ethical Frameworks: Apply ethical frameworks and
guidelines to AI in nursing. These frameworks help
• Critical Thinking: Nurses should always use critical
nurses and healthcare organisations make morally sound
thinking in their roles. This is particularly important
decisions using AI (AAAiH, 2021; AAAiH, 2023).
when using AI as accountability for all nursing decision-
making, which always sits with the nurse (Whende, 2019). • Monitoring and Evaluation: Implement processes for
monitoring and evaluating the performance and impact
• Transparency and Accountability: AI systems used
of AI systems in nursing care (O’Connor et al., 2023).
in nursing should be transparent and accountable,
Regularly assess their effectiveness and safety. This
and nurses should understand the decisions and
involves considering the following:
recommendations made by AI tools. (Robert N.2019)
- Bias Mitigation: Address bias in AI algorithms and
• Education and Continuous Training: It is data. Regularly audit and adjust AI systems to prevent
recommended that nurses receive undergraduate and discrimination in patient care. Ensure fairness and
postgraduate training and education in AI technologies. equity in the use of AI (Chen et al., 2023).
They must be prepared to work with AI tools effectively
- Resilience and Preparedness: Nurses should be
and adapt to evolving best practices (Buchanan et al.,
trained to handle situations when AI technologies fail or
2021; O’Connor et al., 2022).
make errors, and backup plans should be in place.
• Interdisciplinary Collaboration: Encourage - Clinical Validation: AI systems used in nursing must
collaboration between nursing professionals and AI undergo rigorous clinical testing and validation to
developers, clinicians, and other healthcare stakeholders ensure their accuracy and effectiveness in real-world
to ensure that AI tools are integrated effectively into healthcare settings, particularly in the Australian
nursing practice (Aquino et al., 2023). healthcare context.

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- Feedback Loops: Encourage feedback from nurses REFERENCES

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POSITION STATEMENT Artificial Intelligence

ACKNOWLEDGEMENTS

ACN would like to acknowledge the working

group from the Chief Nursing Informatics Officer
Faculty for developing this document:

• Adjunct Associate Professor Naomi Dobroff FACN, Chair,

Chief Nursing Informatics Officer Faculty

• Nathaniel Alexander MACN

• Sally Duncan MACN

• Simone Fitzgerald MACN – Policy Fellow 2023

• Janette Gogler MACN

• Rebecca Heland MACN

• Kerri Holzhauser MACN

• Dr Evelyn Hovenga AM FACN

• Adjunct Associate Professor Aaron Jones FACN

• Rebecca Lewin MACN

• Andrew McKelliget MACN

• Antonela Vogranic MACN

Acknowledgement is also extended to the following

people who were involved in the development
and review of this position statement:

• Karen Grace MACN – ACN National Director of

Professional Practice

• Peta Harbour MACN - Senior Nurse Advisor

• Siobhan Hooper MACN - Senior Nurse Advisor

• Dr Carolyn Stapleton FACN – ACN Director of Policy and

Advocacy

• Dr Penny Wilson - ACN Policy Strategist

Date developed June 2024
Review date June 2025

CITATION:

Australian College of Nursing (ACN). 2024, ‘ACN Position

Statement: Artificial Intelligence’, ACN, Canberra.

© ACN 2024

ISBN (print): 978-1-922720-43-6

ISBN (online): 978-1-922720-44-3

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