Kaiser Permanente nurses who staff the health system’s telephone advice and triage lines say they are under mounting pressure from workplace monitoring tools and artificial intelligence software that they believe puts speed and cost savings ahead of patient safety.
Seven current and former nurses told CalMatters that spending more than 15 minutes on a call routinely draws criticism from supervisors or triggers formal performance reviews. Call length, they said, feeds directly into monthly evaluation scores. Beyond simply tracking how long calls last, nurses said Kaiser has deployed software that forecasts, on a daily basis, whether a worker appears unproductive or slow to pick up calls. At one point, the company even tested AI designed to grade nurses on their tone of voice and apparent empathy.
The complaints surface as the California Nurses Association opens contract talks with Kaiser this month, with artificial intelligence expected to be a central sticking point. Kaiser nurses staged a one-day strike over AI in March and picketed the issue last fall. The union represents roughly 25,000 nurses systemwide, including about 1,000 who work in call centers.
Meanwhile, state lawmakers are weighing several bills aimed at regulating AI in health care workplaces, including one that would shield doctors and nurses from retaliation if they override computer-generated care recommendations.
Kaiser disputes that it manages nurses by the clock. A company spokesperson said the health system does not use “average handle time” to judge performance and that any technology used in its call centers is meant to support quality assurance, with human oversight built in.
Still, the stakes are significant. Kaiser is California’s largest private employer and serves more than 9 million people in the state, along with roughly 3 million patients elsewhere in the country. How it handles AI in the workplace could set a template for other health systems grappling with the same tension between automation and hands-on patient care.
Raquel Alvarez Sanchez, an advice nurse based in Vallejo since 2010, recalled a call last year with a suicidal patient that stretched past an hour because she stayed on the line until police arrived. Even as she tried to comfort the man, she knew the extended call would skew her average handle time for weeks and could invite scrutiny from management. As a union steward, Sanchez said she has sat in on performance reviews where colleagues did everything right clinically but were still flagged for going over 15 minutes. She hasn’t seen anyone fired over it, but she worries the constant pressure is pushing nurses toward burnout, early retirement or resignation.
“I think at some point all of the nurses have been talked to about their average handle time,” she said. “The only thing I can think of is they’re doing it for profit.”
Another nurse, who asked not to be named for fear of retaliation, described a call last year with an elderly woman who had just received a terminal cancer diagnosis. The nurse initially suspected the patient was suicidal but soon realized she was simply in shock and needed someone to talk to — a woman who also serves as caregiver for her own daughter. The nurse wanted to linger and offer comfort but held back, worried it would hurt her monthly score and draw a reprimand. She had become a nurse to provide compassionate care, she said, but found herself asking, “Am I going to get disciplined for going off script or saying more than what is necessary?”
Kaiser maintains its performance reviews are meant to improve outcomes, not punish nurses for spending time with patients. “Kaiser Permanente does not use Average Handle Time to assess agent performance or enforce call time metrics,” spokesperson Vincent Staupe said, adding that any tools used in its contact centers are subject to human review. Staupe said Kaiser deploys AI responsibly, with attention to patient safety, privacy and equity, but declined to detail its internal systems, citing security and operational concerns.
Whether the pressure nurses describe translates into harm for patients is difficult to measure. Nurses say their contact with patients typically ends once they hang up the phone, making it hard to track downstream effects. A 2024 records request by CalMatters to the state Department of Managed Health Care turned up no formal patient complaints tied specifically to call times. Still, nurses insist the risk to care quality is real.
Michele Ramos, a patient advocate with Consumer Watchdog, said many Kaiser members’ first contact with the health system comes through the advice line, and complaints she later hears about problems inside Kaiser facilities may often trace back to what happens on those calls. She sees the time pressure as consistent with a broader pattern at Kaiser of prioritizing costs over care. The health system was fined a record $50 million in a settlement with the state’s managed health care regulator over delayed behavioral health appointments and overuse of group therapy instead of individual sessions. It also reached a settlement with the U.S. Department of Labor following investigations into its substance abuse and mental health services. In 2002, Kaiser faced criticism for paying bonuses to non-nurse call center staff who kept calls short — though nurses who spoke with CalMatters said they’ve seen no similar incentive structure today.
“Kaiser’s been known through the years to manage dollars over managing care, and I think this would be a contributor to that, which is only going to fail patients,” Ramos said.
Nurses say the 15-minute benchmark is especially difficult to meet on calls that inherently take longer — patients with multiple symptoms or chronic conditions, new parents seeking reassurance, people processing devastating diagnoses, or callers who need an interpreter, which can add 30 minutes or more to a conversation. Nearly four in 10 Californians speak a language other than English at home, and roughly half of them are not fluent in English, according to state data.
“The amount of time that Kaiser is giving us to complete a call is sometimes not safe,” said one nurse who spoke on condition of anonymity.
Charlotte Capulong, who has worked in nurse call centers for 22 years and helped organize opposition to the AI tone-monitoring tool, said she has watched colleagues get pulled into meetings and criticized even when they did everything else correctly except finish a call within the allotted time. “People can get hurt,” she said. “You aren’t calling Comcast. We’re dealing with life here.”
In the summer of 2024, Kaiser began piloting an AI system designed to evaluate empathy and tone in conversations between nurses and patients, according to several nurses interviewed by CalMatters. Workers responded by circulating a petition demanding more transparency, protection of patient privacy and respect for nurses’ clinical judgment, echoing the “Trust nurses, not AI” slogan used at protests outside San Francisco hospitals earlier that year. The pilot ended in November 2024, though union representatives say management has indicated it could return.
“That was intensified when they said we’re going to use AI to evaluate our calls and grade us,” Sanchez said. Another nurse, speaking anonymously, said flatly: “AI did not understand our job and would grade us wrong all the time.”
Kaiser declined to answer questions from CalMatters about the tone-monitoring tool or how AI and other automated systems are used to evaluate nurses, including whether patients were told their calls might be analyzed for empathy and tone.
Nurses also described shrinking breaks between calls — even after conversations involving suicidal patients, mental health crises or dying patients. Where nurses once had roughly 10 minutes to finish notes or simply regroup after a difficult call, they say they now often get 30 seconds or less during busy periods, though more time may be available late at night or with a supervisor’s approval following an especially hard case. That pace, they say, increases the odds of missing important warning signs about a patient’s condition.
Union representatives declined to detail specific AI-related demands ahead of this summer’s bargaining sessions with Kaiser.
Researchers who study workplace surveillance say the concerns raised by Kaiser nurses reflect a much broader trend. Annette Bernhardt, who directs the Technology and Work program at the UC Berkeley Labor Center, has warned that algorithmic management can strip workers of autonomy and reduce them to mere extensions of the systems monitoring them. A 2023 academic study of call centers in four countries found that AI-driven monitoring left workers with less recovery time between calls and higher rates of emotional exhaustion; nearly half of respondents said AI tools made their jobs more stressful.
Virginia Doellgast of Cornell University, who co-authored that research, said what Kaiser nurses describe fits a pattern seen across industries where constant monitoring adds strain to work that is already emotionally demanding. “Stress and burnout can lead to more mistakes across a range of areas, and in the health care setting that is much higher risk because you’re dealing with people’s lives and their health,” she said. Conversely, research shows workers given more control over their pace tend to report higher job satisfaction and fewer absences.
The concerns extend beyond Kaiser. A 2024 survey by National Nurses United found that half of more than 2,000 nurses said their employers use algorithmic systems to analyze patient records, including predicting how much care a patient will need. Two-thirds said their own clinical judgment had, at some point, conflicted with an algorithm’s recommendation, and 60% said they didn’t trust their employer to prioritize patient safety when deploying AI.
Pa Vue, who has worked in call centers for nearly a decade, said she has had her performance score docked for repeating advice to a patient she worried might be having heart problems. As a union representative, she has watched managers question the length of calls and seen nurses penalized for exercising professional judgment that ran counter to software recommendations, or for scheduling appointments without first consulting a doctor. She says the emphasis on efficiency undercuts the quality of care patients are paying for.
“I’m not against the use of AI as long as it’s beneficial to the patient, but in this particular use [empathy and tone monitoring] it’s to increase productivity and improve efficiency and cut costs,” Vue said. “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.”
AI is also a flashpoint in separate negotiations covering roughly 2,400 mental health workers at Kaiser facilities in Northern California, who have raised concerns about therapy session transcripts potentially being used to train AI models, and about automation threatening their jobs altogether. A spokesperson for the National Union of Healthcare Workers said those talks are ongoing.
Kaiser’s use of artificial intelligence extends well beyond call centers. The health system uses AI to flag hospitalized patients at risk of complications by analyzing electronic health records, and an AI tool called Preventus helps determine discharge timing. Doctors and therapists use a program called Abridge to transcribe in-person visits instead of taking handwritten notes. Nurses say Kaiser has also tested AI-based remote monitoring for higher-need patients at some Bay Area facilities.
California Nurses Association President Cathy Kennedy, who also leads National Nurses United, sees the tone-detection experiment as part of a broader effort by Kaiser to squeeze more efficiency out of nursing staff at the expense of professional autonomy. She argues AI systems should be proven effective and fair before they’re rolled out on real patients and workers.
Under its existing contract, Kaiser is supposed to notify the nurses’ union before deploying new technology, though the union says that doesn’t always happen. As a result, CNA has been trying to compile its own inventory of AI tools in use across the system, asking members to flag anything unfamiliar. That grassroots tracking helped the union push back against the empathy-tone AI last year and stop a separate pilot that would have replaced in-person nurse monitoring of confused patients with cameras.
Debru Carthan, a Kaiser radiologist and member of the Service Employees International Union, sits on a labor-management committee examining AI use across the company as part of the Coalition of Kaiser Permanente Unions. The coalition runs a “see something, say something” campaign encouraging frontline workers to report AI tools introduced without notice. Carthan said she worries the tone-detection technology could disadvantage nurses from different cultural backgrounds, and she has grown increasingly convinced that AI adoption in health care is driven more by cost-cutting than by improving patient outcomes.
State lawmakers have taken notice, though efforts to pass new protections have stalled repeatedly. Assembly Bill 1018 and Senate Bill 7 — both backed by the nurses’ union — would have required employers to notify workers before using automated systems to make decisions about hiring, discipline or performance evaluation. Gov. Gavin Newsom vetoed SB 7, and AB 1018 failed for a third straight year amid opposition from major employers, including Kaiser.
Lawmakers have since revived the effort with a new version of the bill, now numbered Senate Bill 947. Another proposal would bar employers from using AI to predict employees’ emotional states, while a separate bill would protect doctors and nurses from retaliation for overriding AI-generated recommendations and require health care employers to give staff an annual inventory of the automated systems in use. Kaiser declined to provide CalMatters with such a list.
In total, the nurses’ union and the California Labor Federation are backing roughly half a dozen bills aimed at regulating workplace AI. Earlier this year, labor leaders — framing AI regulation as a defining issue heading into the next presidential election — held a Sacramento news conference urging Newsom to strengthen worker protections if he hopes to pursue national office. “It’s an ongoing fight, and it’s a fight well worth having,” Kennedy said. “Whenever there are other unions in discussion about artificial intelligence, we are in solidarity with them.”
The nurse who held back compassion from the cancer patient she feared was suicidal said she believes the monitoring and scoring systems are turning nurses into box-checkers rather than caregivers.
“I used to use humor as a way to help patients heal, and I don’t feel comfortable doing that here because I know the calls are being recorded,” she said. “You can always tell when a patient appreciates the humor or your personal compassion, but I don’t feel like call centers have tolerance for that because that’s not part of the script. That really takes away from the whole point of being a nurse and what patients come to know from nurses.”
Original source: CalMatters
