The Hospital as a Site of Struggle: Recovering the Autonomy of Nurses Through a Labor-Oriented Implementation of Artificial Intelligence

Introduction

When questioned on the rising labor shortages in rural healthcare during his Senate confirmation hearing in January 2025, Secretary of Health and Human Services Robert F. Kennedy Jr. responded buoyantly, “Our nation made a commitment over 100 years ago to put a hospital within 30 miles of every American . . . It’s absolutely critical. It’s life saving, and rural hospitals are closing at an extraordinary rate right now” (Finnegan 2025). Kennedy then declared that President Donald Trump had tasked him with a critical objective—stemming the “hemorrhaging” of hospital staff by introducing artificial intelligence (AI) and telemedicine into rural healthcare. Cleveland Clinic “has developed an AI nurse you cannot distinguish from a human being that has diagnosed as good as any doctor,” he claimed, going on to say that it would now be possible to provide “concierge care to every American in this country, even the remote parts of Wyoming, Montana, and Alaska” (Finnegan 2025). On the face of it, RFK Jr.’s vision of an AI nurse delivering care “just as good” as a human nurse appears to be a compelling solution to fragmented care systems. However, the drive to create a quick profit out of a public health crisis is indicative of the very market-driven motivations that have pushed industry toward collapse.

While Kennedy’s claims of Cleveland Clinic’s newly developed AI nurse were later proven false, his vision of solving the healthcare labor shortage crisis through automation also fails to mention an often overlooked detail: Out of the roughly 5.6 million licensed registered nurses in the United States, only 2.3 million nurses are employed (Smiley et al. 2025; DOL 2025). In other words, the lack of working nurses in hospitals is not a problem that needs to be “innovated” through the invention of an AI nurse. Rather, it is a power struggle between the profit motives of corporate actors and nurses who are fighting to maintain autonomy over their working conditions as emerging technologies threaten to take them away.

Furthermore, the implication that AI is the new frontier of healthcare points to a worrying future, wherein the solution to the collapse of hospitals is not to consider building new clinics, subsidizing healthcare, regulating medical costs, or allowing health professionals greater autonomy over their work lives. This is particularly problematic for nurses, who exhibit some of the highest levels of burnout compared to other medical professionals (Galanis et al. 2023), because AI implementation has been justified by hospital management as a means to cut down on high workloads. Through corporate management, biometrics will be monitored remotely, electronic medical records will be extracted and mined for data, and AI chatbots will answer patient’s questions, all with the ultimate goal of cutting down on labor costs by automating healthcare workers out of their own field.

However, the introduction of AI into nursing has manifested itself as an added stressor rather than a mitigator of burnout. Hospital management has incorporated AI software into clinical settings as a tool for staffing and scheduling, measuring “speediness” of care, conducting surveillance, and automating vital tasks like charting and intake (National Nurses United n.d.). These tactics, meant to improve the “efficiency” of nursing, erode the ability of nurses to engage in what they find most meaningful: providing direct care to patients. While AI innovations have the potential to enhance medical devices, the application of AI in an already fragmented, corporatized healthcare industry acts as a temporary solution to the systematic deprioritization of the rights and autonomy of nurses.

As healthcare becomes increasingly mechanized in the name of profits, it is increasingly necessary for nurses to have control over their workplace and to be able to apply their medical expertise in clinical settings. Putting AI implementation in the hands of nurses is a matter of allowing nurses to have greater ownership over their labor conditions, which can improve patient care and ensure that new technologies can be smoothly integrated into healthcare. This brief will discuss AI implementation in nursing as an opportunity to reassess the corporatization of healthcare, consider the risks of integrating emerging technologies into such a fragmented field, and offer legislative solutions that can put the power of care back in the hands of nurses.

Background and Context

Prior to the current corporatized healthcare landscape, medical professionals had greater autonomy over their working conditions. Throughout much of the 20th century, the dominant model of healthcare ownership was the physician-owned independent practice. Doctors had greater control over treatment plans, management of schedules, and the direction of clinical care. In turn, patients were able to have personal relationships with doctors that allowed more individualized care and time. Nurses, however, have had a different trajectory. As hospitals were transformed into social institutions through modernization in the late 19th and early 20th century, the majority of the waged hospital workforce were working-class female nurses, who began to resist their roles as “hand-maidens” meant to serve doctors (Salmon and Thompson 2021). Nursing as a profession was elevated through the advancement of schools of nursing at hospitals, as well as the establishment of the Registered Nurse certification following the completion of accredited schooling (Salmon and Thompson 2021). While workplace structures in healthcare may not have been the most equitable for nurses, the value and legitimacy of their care grew due to growing credentials and greater time spent with patients than doctors, allowing them to exercise their medical expertise collaboratively.

Unfortunately, such strides were short-lived—beginning in the Reagan administration, hospitals began to behave like businesses due to measures to deregulate the healthcare industry. Prior to 1983, Medicare and other insurers’ payments were tied to costs, wherein hospitals were paid for the price of an operation or service, and given a reasonable additional amount to make a profit (Frakt 2018). However, in a move to significantly cut down on the cost of Medicare, the Reagan administration passed a law that shifted Medicare to a prospective payment system—Medicare would now pay hospitals a fixed price per visit or service (Reagan 1983). This meant that regardless of how much the procedure actually cost, hospitals would have to make do with the payment they received. Thus, financial risk was shifted to providers. To account for this change, a major restructuring of healthcare operations had to occur. Because providers could only earn a greater profit by keeping the costs of procedures down, hospitals began to seek revenue by offering new programs and growing in scale to absorb greater levels of financial risk (Frakt 2018). In short, hospitals and medical clinics began to behave more like businesses than providers of care.

These deregulatory developments have caused the healthcare industry’s position as a profit-making venture to balloon. In the 1980s, 11 percent of hospitals were owned by companies controlling three or more hospitals. Today, that number is up to 56.1 percent (Fuse Brown 2025). Nine megahospital chains in the US each own more than 50 hospitals, and while three-quarters of physicians owned their practice in the 1980s, a similar proportion of doctors work for hospitals or corporate entities as of 2023 (Fuse Brown 2025). This trend toward for-profit ownership has led to the prioritization of shareholders over a model of quality patient care. For the healthcare professionals, the industry has become fragmented by the rise of administrative arms of hospitals and the lack of autonomy over care plans and scheduling.

In recent years, private equity firms have maintained a dangerous grip on healthcare. In 2012, 816 physician practices were owned by private equity firms. As of 2021, that number is up to 5,779 (Abdelhadi et al. 2024). And as of February 2024, almost 460 hospitals in the US are owned by private equity firms (Brownstein 2024). Private equity firms can have devastating results on the quality of patient care and the longevity of medical facilities. In Pennsylvania, Steward Health Care, one of the largest private for-profit hospital systems, was forced to shut down two of its hospitals after the private equity firm that managed them extracted profits through “sale-leaseback” agreements. Hospital capacity was then pushed dangerously past its limits, exacerbating poor health outcomes (More Perfect Union 2025). In Illinois, for-profit hospitals have been proven to invest less in nursing services than nonprofit hospitals, leading to poorer staffing levels, less care for patients, and significantly higher burnout among nurses (Meline 2025).

The devaluation of worker autonomy in this era of corporatized healthcare has had destructive consequences; burnout among nurses experiencing constantly under-staffed, high-stress working conditions has pushed them into eventual departure from the industry. The COVID-19 pandemic was a significant breaking point for the nursing industry due to the restructuring it faced from corporatization—as many as 100,000 nurses left the profession altogether in the first two years of the pandemic, and surveys estimate that as many as 600,000 more intend to leave by 2027 (Levins 2023).

This is the landscape that AI implementation is entering into—a profit-driven healthcare system that would be happy to rid itself of the people and professionals that matter most to its ability to function. Privatized medicine is willing to take away the ability for nurses to find value in their work no matter the cost, as long as corporate executives and CEOs can continue to line their pockets and appear to “cut down” on nursing tasks (Collier 2025). Thus, AI implementation is increasingly a site of struggle for maintaining the dwindling autonomy that nurses have over their working conditions, and can serve as an opportunity for nurses to practice medical care as they see fit instead of pushing them toward burnout and eventual departure from the field (Campos 2025).

Policy Analysis and Illinois

While attempts of regulate the use of AI in healthcare are still nascent, a number of laws have cropped up at the state level in regard to AI and employment practices; New York, Colorado, and California were among the first states to create safeguards around AI hiring tools to prevent “algorithmic discrimination” (Beck, Lamb, and Woodard. 2025). In Illinois, similar measures have been taken to address the potential for discriminatory biases in AI tools as they are increasingly applied toward employment practices. In August 2024, Governor JB Pritzker signed H.B. 3773, an amendment to the Employment Article of the Illinois Human Rights Act, which took effect on January 1, 2026. H.B. 3773 states that it is a civil rights violation for an employer to use AI that “has the effect of subjecting employees to discrimination on the basis of protected classes” or “to use zip codes as a proxy for protected classes” with respect to “recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment” (Ill. 2024). The second provision of this amendment adds that an employer’s failure to “provide notice to an employee that the employer is using artificial intelligence” is also a civil rights violation (Ill. 2024).

This amendment to the Illinois Human Rights Act applies broadly to different employment sectors, and speaks to the priorities of the Pritzker administration to allow the “AI revolution” to enter Illinois without replicating harmful hierarchies of race, gender, and class in these employment tools. The particular attention to the use of zip codes as a “proxy for protected classes” forces employers to ensure that the AI tools they may use for recruitment, for example, are not inconspicuously imbued with racially discriminatory categorizations of applicants. While this amendment may be improved by ensuring that employers perform regular bias audits of the analytic software, the first provision builds a foundation toward regulating the potentially discriminatory applications of AI.

The second provision, however, is of particular concern, especially for healthcare workers. The employer’s responsibility to notify employees of the use of AI in employment practices is not made entirely clear—there is no guidance on whether employers must specify whether generative software was involved in writing performance reviews or disciplinary practices. Additionally, there is a lack of clarity on when and how notifications of AI usage must be provided (Sweitzer and Shine 2024). For nurses, surveillance mechanisms and charting paperwork is increasingly being encroached upon by algorithmic software and generative AI. Because these applications are not considered a discriminatory application of AI against “protected classes,” the second provision allows employers to continue to automate and surveil these nurses’ care so long as they notify them before doing so. In other words, the second provision has the potential to codify the surveillance and micromanagement of nurses, and strengthen the administrative arms of hospitals as they automate nurses out of patient interactions without consequence. In the case of nursing, H.B. 3773 is another dimension of the site of struggle between nurses and corporate motives because its efforts to protect medical workers have the potential to harm them further.

Beyond the potential impact of the Illinois Human Rights Act’s amendment, other mechanisms are in place in Illinois to confront the structural forces behind this problem, including the corporatization of healthcare. To combat the unregulated mergers and consolidation of hospital groups, Public Act 103-0526 was passed in 2024 to give the Illinois attorney general greater oversight over healthcare acquisitions (Levins 2025). This amendment to the Illinois Antitrust Act requires that the state be notified at least 30 days in advance to allow the Illinois Health Facilities and Service Review Board the ability to investigate and evaluate whether to prohibit the transaction (Levins 2025). Of the voting members of the Illinois Health Facilities and Service Review Board appointed by Governor Pritzker, only two are representatives of community advocacy organizations (HFSRB n.d.).

This top-down process of regulating hospital mergers, which lacks input from current nurses and healthcare workers, points to the need to put power back in the hands of nurses by having them take charge of the policymaking process. Nursing unions in Illinois are already on the frontlines of the fight against mergers, as seen in the most recent fight by the Illinois Nurses Association’s against Prime Healthcare (WJOL 2025). These acquisition reviews can only be strengthened by hearing directly from how nurses are experiencing them on the ground. Although Illinois’s policies regulating AI implementation and healthcare corporatization indicate a desire to speak to the priorities of nurses and patients, they remain substandard because they do not follow the initiative of nurses. Thus, nurses must be at the forefront of the fight for creating equitable care systems and healthcare labor protections that push back against the corrosivity of corporatized medicine.

Policy Recommendations

The inadequacies of existing legislation in Illinois point to the need not only to amend current policies but also to create new regulatory measures that are specific to the needs of the healthcare field and strengthen the autonomy of nurses. Hospitals act as a microcosm of the broader conflict between workers and corporations, and nursing unions play the crucial role of tipping the balance toward labor justice. To rebalance power at this site of struggle toward workers, I suggest the following policy proposals.

Codifying Bargaining Power

The amendment to the Illinois Human Rights Act, H.B. 3773, requires that employers notify their employees if AI is implemented for the use of employment practices. However, a simple notification does not provide any means for employees to push back against these measures if they choose to do so. H.B. 3773 must be expanded to require that employers must give advance notice to nursing unions and medical unions before AI integration to allow them ample time to bargain over its implementation.

Protections Against Surveillance and the Automation of Medical Expertise

AI applications in diagnostics, designing care plans, and monitoring biometrics are just a few of the ways generative and algorithmic software has the potential to displace the medical expertise of healthcare workers. Additionally, staff scheduling and measuring the “efficacy” of care is increasingly falling within the purview of AI software. Thus, there must be greater regulation of AI as a medical and surveillance tool.

New legislation that regulates AI’s application in healthcare must include the following provisions:

• Healthcare workers have the right to refuse the use of AI in their healthcare practice. Hospital management cannot force the use of AI as a consultation tool while treating patients, and healthcare workers can ultimately reject the suggestions made by these tools.
• AI must be a complement, not a substitute, for medical work. As an example, the intake process must be conducted by a medical professional, such as a medical assistant or nurse, not an AI chatbot. AI chatbots may support the work of intake staff, but they cannot be forced upon them.
• AI cannot be used to calculate ideal, “efficient” staffing levels or efficacy measures.
• AI should not be used as a tool of surveillance. Removing human oversight from medical care, despite all the difficulties that come with the administrator-healthworker relationship, has the potential to create errors and flag certain behaviors as “inefficient” or “slow” when they are actually responding to an emergency call or a sudden change in patient health.

Compensation and Discipline

Nursing and healthcare jobs will undoubtedly be changed, or at least affected, by AI implementation through medical advancements that will rely on emerging technologies. Thus, all nurses whose roles are restructured by AI, like using new medical devices or software, must be trained and receive compensation for such training.

If AI use is forced on nurses for the use of charting, particularly for those who are in nonunionized workplaces or were not able to reach a collective bargaining agreement, they should not be punished or have their licenses revoked if AI is found to have created errors in transcriptions of their charting.

Strengthening Antitrust Measures

Although the Health Facilities and Service Review Board investigates and evaluates healthcare acquisitions, there is potential to expand this board to a new committee. An additional board composed of representatives from nursing and doctor’s unions would allow them to oversee these mergers as a collective. An added component to this board may be the ability for nurses and doctors who currently work at the hospitals that are pending review to submit public comments and discuss opposition or favor toward the transaction.

Conclusion

RFK Jr.’s vision of substituting automated medical workers with human nurses, instead of improving the working conditions of existing healthcare workers, points to the corporate capture of public health crises and the overriding motivation to make a profit out of a flatlining field. In reality, AI implementation has the potential to be a site for nurses to reclaim power over their working conditions and reorient the medical industry toward a worker-centered structure. The crisis of a nursing “shortage” cannot be innovated out of a technological stand-in, and framing the issue in such a way indicates a fundamental misunderstanding of what is driving nurses out of the profession. This is the culmination of a decades-long erosion of the autonomy of healthcare professionals, and the devaluation of the labor nurses provide combined with the overvaluation of administrative and corporate arms of hospitals. AI implementation in healthcare is a flashpoint for understanding why healthcare must be restructured to center the rights of nurses—botched implementation has the power to drive out an even greater number of nurses as they become progressively distanced from the ability to interact with and treat patients the way they desire.

Above all, healthcare is an industry that deals in people’s lives. Creating safe working conditions wherein nurses are valued is not just a protective measure for individual nurses, but a safeguard for the entire healthcare system. Implementing AI through a labor-oriented approach gives nurses greater agency over how they treat their patients, and is essential to reorienting the hospital back to its primary duty of care. Transforming healthcare does not rest on the creation of an AI nurse—it rests on empowering the nurses we already have.