Kaiser nurses say surveillance of them is undermining healthcare – The Markup

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Kaiser Permanente nurses say technology is making their jobs — and patient care — worse

By Khari Johnson

July 9, 2026 8:00 a.m. UTC

Viewable online at<br>https://themarkup.org/artificial-intelligence/2026/07/09/kaiser-permanente-nurses-say-technology-is-making-their-jobs-and-patient-care-worse

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Kaiser Permanente nurses who answer advice and triage calls say their duty of care for patients is being increasingly threatened by workplace surveillance.

Seven current and former nurses told The Markup that those who spend more than 15 minutes on a call with a patient routinely face criticism from Kaiser management or get called into performance evaluation meetings. Call time, they said, factors into monthly performance scores they receive.

In addition to tracking call length, they said Kaiser uses software that tries to predict on a daily basis whether they’re being unproductive or failing to answer calls quickly. Artificial intelligence systems have also been used to rate their empathy and tone of voice.

Their comments come as the California Nurses Association begins negotiating a new contract with Kaiser this month with AI a likely issue. Kaiser nurses went on strike against AI for one day in March and picketed against AI last fall. The CNA is bargaining for 25,000 nurses, including 1,000 in call centers.

At the same time, California lawmakers are considering several bills regulating AI in the workplace, including one that would protect from retaliation doctors and nurses who override automated care recommendations.

Kaiser defended its use of AI, saying it deploys the technology with human oversight and with patient safety in mind. It said it does not use “average handle time” to assess performance.

Kaiser Permanente is the largest private employer in California, providing healthcare services to more than 9 million people in the state and to 3 million other Americans. That means the company’s use of artificial intelligence could set important precedents for managing workers with AI. It could also have a big impact on patient care, providing an early example of how the healthcare sector balances cost-cutting automation with human presence or touch.

Raquel Alvarez Sanchez, a Kaiser Permanente advice nurse in Vallejo since 2010, said she was on a call with a patient who was suicidal last year that took more than an hour because she had to wait for police to arrive before hanging up. She tried to make the man feel cared for, even though she was cognizant that staying on the call that long would throw off her average call time for weeks and could lead to questions from management. Sanchez, a union steward, said she’s accompanied colleagues to performance evaluation meetings, where they were found to have done everything right on a call — except staying on the line for more than 15 minutes. She said she hasn’t seen nurses get fired for doing that, but she fears that continued pressure can lead nurses to quit or retire early.

“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 spoke with The Markup on condition of anonymity due to fear of retribution described how that surveillance affected a call with a patient last year. Initially she thought her patient, an elderly woman who just received a terminal cancer diagnosis, was suicidal, but quickly came to understand that she was in shock and really needed somebody to talk to.

The nurse wanted to take time to show compassion or comfort to the woman, who acts as a caretaker for her daughter, but she stopped herself out of fear it would hurt her monthly performance score and lead to a reprimand from her manager. She became a nurse to provide people with compassionate care, but “I had to ask myself: Am I going to get disciplined for going off script or saying more than what is necessary?”

Caption:<br>Kaiser Permanente advice nurse Raquel Alvarez Sanchez works from her home office in Santa Rosa on April 6, 2026. Kaiser Permanente nurses have raised concerns about the growing use of AI to monitor their work ahead of upcoming contract negotiations.<br>Credit:Photo by Chad Surmick for CalMatters

Kaiser Permanente says its performance evaluations help improve patient outcomes. A company spokesperson said, “Kaiser Permanente does not use Average Handle Time to assess agent performance or enforce call time metrics. Any tools used in contact center settings support our quality assurance efforts and have human review and oversight.” In a statement provided to...