Introduction
Artificial intelligence has been on the rise in the healthcare industry. It has been of great value in areas such as nursing, where it can enhance the efficiency of care provision and decrease the resistance quotient. In the broader health industry, the AI market has been projected to reach $45.2 billion by 2026, a year-on-year growth rate of 44.9% as it seeps into the clinical and operational spheres [
1]. Now, AI is used in nursing to diagnose, monitor, and administer medications to patients. According to Sommer et al. [
2], 25.2% of the nurses can be classified as AI expert nurses, while the results from Atalla et al. study [
3] show that it is the nurses’ attitudes toward AI which significantly influence their innovative work behaviors, suggesting that favorable attitudes towards AI should help fostering integration of AI into nursing practice. It relieves the human nurses from handling everyday tasks that can be delegated to the AI so that the human nurses can concentrate on attending to the complicated patient needs [
4].
However, incorporating AI in nursing has challenges. This paper sought to highlight, especially in poor-resourced settings such as Jordan. The healthcare system is burdened by a nurse-to-patient ratio far below the World Health Organization’s recommendation (1:14 vs. 1:6) [
5]. In such contexts, nurses engage AI to reduce the burden on them; however, they raise issues of data protection, patient secrets, and automation of nursing jobs. More so, studies show that about 41% of the healthcare staff, including the nurses, needed more time to integrate artificial intelligence because of a lack of training and inadequate Artificial Intelligence machines [
6,
7].
Artificial intelligence integration into nursing practice poses several challenges, including concerns about privacy of data because of requirements of health records, potential biases in the artificial intelligence algorithms that may lead to disparities in patient care, nurses need to get trained in a comprehensive way to serve new skills, and these new skill sets will require nurses to be trained intensively in order to develop them, and finally incorporation of artificial intelligence may demand heavy investment in technology and human resources [
8]. Such challenges in part can be addressed by establishment or a re-instatement of robust data governance policies, development of ethical AI framework(s), targeted education and training of nursing professionals for implementing implementation of ethical AI framework(s) and moreover should adhere to clear guidelines of AI accountability and integration in health care system [
9,
10].
The constraints due to ethical issues are further discussed as a major barrier to adopting AI in nursing, there is a considerable emphasis on algorithmic decision-making, increasing concerns about the role of analytics and human intelligence in highly charged care settings. For example, AI systems do not have human empathy as is the core of the nursing profession, thus, patient care is put at risk [
11,
12]. Consequently, although the implementation of AI might bring benefits, it can only be introduced to the nursing work environment by handling the identified ethical, training, and cultural issues [
13].
Building on these ethical and cultural challenges, understanding how nurses perceive and comprehend AI in their daily practice is critical for its successful integration. AI has the potential to support a workforce increasingly strained by demographic shifts and shortages of skilled professionals. However, as highlighted by a recent cross-sectional survey conducted among 114 nurses in Bavaria, Germany (67.5% female, 32.5% male), there is a significant knowledge gap. The survey revealed that only 25.2% of participants identified as AI experts, with many perceiving AI as merely computers (30%), programming-based software (25%), database tools (20%), learning systems (15%), or decision-making aids (10%). Despite 66.7% viewing AI as an opportunity, concerns about its uncontrollability and potential risks underscore the need for comprehensive training [
14]. Addressing these knowledge gaps and apprehensions through targeted education is essential to empower nurses and foster confidence in leveraging AI responsibly within the ethical framework of patient-centered care.
For this research, Jordanian nurses’ attitudes towards AI are explored, focusing on the perceived advantages and disadvantages of the application in their workplace. The study encompassed a diverse cohort of nursing professionals, including registered nurses (RNs), licensed practical nurses (LPNs), certified nursing assistants (CNAs), critical care nurses, emergency room nurses, and nurse practitioners (NPs). This comprehensive inclusion aimed to capture a wide range of perspectives on artificial intelligence integration across various nursing roles.
The primary objectives of this study are as follows:
1.
To assess Jordanian nurses’ attitudes toward AI integration in nursing.
2.
To explore how AI can enhance nursing effectiveness by reducing administrative tasks and improving patient monitoring while addressing ethical concerns like patient privacy and job automation.
3.
To evaluate nurses’ current knowledge of AI technologies and identify gaps in their training.
4.
To propose practical strategies for healthcare organizations to implement AI as a supportive tool, maintaining the human element in nursing care.
Results
The results of this study are presented in three sections, corresponding to the techniques outlined in the methodology: They rely on semi-structured interviews, focus groups, and thematic analysis. This section presents findings of nurses’ perceptions of Artificial Intelligence (AI) integration in nursing practice in both public and private healthcare institutions in Jordan.
Semi-structured interviews
Twenty-five nurses were interviewed semi-structured between September 2023 and May 2024. The interviews took about 50 to 60 min each, giving a total picture of what the nurses experienced, worried about, and recommended for AI in nursing. The results showed a mixture of optimism and concern about AI integration.
Understanding of AI
Almost all participants were familiar with AI, describing it as a technology for administrative tasks, data analysis, and patient monitoring. However, nurses in private institutions demonstrated greater awareness of AI applications compared to those in public healthcare settings. Among the 25 participants, 18 had direct experience with AI systems in their workplace. Table
4 illustrates the participants’ understanding provided varied descriptions of AI, reflecting a range of familiarity and usage in their roles.
Table 4
Participants’ understanding of AI
NP1 | “AI is mainly for automating tasks like patient data entry.” |
NP2 | “AI helps with diagnosis, but I am unfamiliar with its use in nursing.” |
NP7 | “We use AI to monitor ICU patients, but I am still learning how it works.” |
NP10 | “AI is a tool that helps reduce our workload, especially with data handling.” |
Participants from private institutions, such as NP7, were more familiar with AI in critical care environments. In contrast, participants from public institutions, such as NP1, were more familiar with AI as an administrative tool. This difference marks the variation in exposure to AI technologies, which reflects institutional resource and technology adoption.
Perceived benefits of AI
As shown in Table
5, Participants widely recognized that AI would reduce nurses’ workloads, particularly in administrative and repetitive tasks. Twenty-one 25 participants applauded that AI freed them up to spend more time on direct patient care.
For example, NP5 stated:
“AI takes over the tedious data entry tasks so that we can focus on the patients’ needs.” — NP5.
Nurses said using AI-assisted monitoring systems, especially in critical care, yielded positive patient outcomes because real-time data analytics were provided. AI tools also helped many intensive care unit participants track patient data and glean insights, enabling more rapid, better-informed emergency decisions.
“AI helps us track patient data in real-time, and we can make decisions faster, especially in emergencies.” — NP9.
Although these benefits were well known, several participants pointed out that AI’s effectiveness hinges on how well it fits into their workflows. It was often mentioned that there was potential to reduce administrative burden and improve patient care quality.
To what extent should challenges be recognized? And confront the difficult ethical questions that emerge from it.
The semi-structured interviews also revealed great concerns about AI, especially ethical aspects. For example, 15 participants were concerned about patient privacy and data security, and 12 were worried that AI could cause job displacement.
Table 5
Participants’ challenges and ethical concerns
NP3 | “AI might affect patient privacy, especially with sensitive data.” |
NP6 | “We need more transparency in how AI systems make decisions.” |
NP9 | “AI could take over parts of our job, leading to fewer nursing positions.” |
NP12 | “AI may improve efficiency but cannot replace human empathy.” |
Many participants also raised AI algorithm transparency. For instance, NP6 noted that AI systems need more clarity in making decisions, a common concern that AI may sidestep human judgment in critical care.
Participants also expressed concern about job displacement. NP9 commented that more tasks could be automated, and the fear is that AI could decrease the number of nursing positions. Participants spoke of AI’s potential but also pointed out the inability of AI to replace human empathy and emotional intelligence during patient care.
“AI may improve efficiency, but it cannot replace human empathy.” — NP12.
The semi-structured interviews showed that nurses in Jordan generally believed that AI could improve the efficiency of nursing tasks through automation and real-time data analysis. But the findings also raised serious questions about patient privacy, job displacement, and training and transparency of AI systems. Participants recognized that AI was not so much an enabler of more efficient workflows as it was an aid to getting things done (and perhaps less human things). However, it also confirmed that the human element of patient care cannot be eliminated and that AI technologies must be used ethically.
Focus groups
Further, three focus groups of 7–8 nurses were conducted to broaden insights regarding nurses’ collective perspectives on integrating AI into nursing practices. The group dynamics in these sessions provided a richer discussion of shared concerns, insights, and experiences that might not have come out in individual interviews. The group discussions identified consensus on the potential benefits of AI and a great deal of concern over training, implementation, and ethical implications.
Consensus on AI benefits
Individual interviews and focus group discussions were consistent with each other in that they recognized the possibility of using AI to improve efficiency in nursing. Repetitive tasks such as patient monitoring or data entry became one of the most frequently mentioned advantages. The participants agreed that AI could free up valuable time to allow nurses to spend more time on direct patient care, which they considered their first responsibility.
In all three focus groups, participants said that AI systems, particularly those used in ICUs and general wards, dramatically reduced the time spent on documentation. In describing how AI-assisted monitoring systems could alert nurses to critical patient changes and enable faster interventions, nurses described.
One participant from Focus Group 1 said:
“AI helps us focus more on patient care, our primary role. Instead of filling out forms, we get alerts when something critical happens with a patient, which helps us respond faster.”
Another participant from Focus Group 2 elaborated on the real-time advantages AI provides in emergency care settings:
“We use AI in our emergency department to track vitals and notify us of a significant change. It reduces human error and lets us act quickly when time is of the essence.”
Focus groups agreed that AI systems were practical, especially for reducing manual and time-consuming tasks. However, the discussions also made clear that the way AI is being used today is very much supplementary to human judgment, not replacing it. Nurses were generally satisfied with AI’s role in accelerating their efficiency in critical care and data management tasks.
Concerns about training and implementation
While focus groups recognized AI’s potential benefits, a common theme remained in all focus groups: there needs to be more training and preparation for using AI technologies. However, participants thought AI could enhance healthcare practices with adequate education and hands-on experience. Many participants stated they needed to be adequately trained to use AI systems and were frequently unsure about what they could and could not do with these technologies.
Of the 25 nurses who participated in the focus groups, 19 mentioned insufficient training they received in their institutions. They called for more structured workshops and practical training sessions to help these nurses grasp what AI meant in their everyday work. Training programs, they said, should extend beyond theoretical knowledge to the practical use of AI in real-time clinical settings.
For example, one participant from Focus Group 3 stated:
“We need hands-on training to understand how AI fits into our daily work. Right now, it feels like an abstract concept. We’re using it without fully knowing how it works or how it can help us.”
Another participant from Focus Group 2 echoed similar concerns:
“AI systems are great, but I’ve never had a formal training session. I feel like I’m just figuring it out on the job, which isn’t ideal when dealing with patients’ lives.”
Several participants mentioned that AI technologies are growing rapidly, and we need to keep learning and taking refresher courses. They were concerned that their institutions’ training programs were not keeping up with technological advancement. They said ongoing professional development would be needed to keep up with AI’s role in healthcare on an ever-evolving basis.
Implementation barriers and ethical concerns
A second key discussion area across the focus groups was how to make AI systems work. Some AI tools described by nurses promised some good things but needed to be completely integrated into existing workflows, causing inefficiencies and frustration. They pointed to cases in which AI systems were used in concert with manual processes, sometimes adding to rather than decreasing the work.
Participants in Focus Group 1 provided an example of an AI-based patient monitoring system that generated alerts but required manual data entry for updates:
“We get alerts from the AI system, but we still have to enter the data manually into the hospital’s main system. It feels like we’re doing double the work.”
In addition, these discussions raised ethical concerns about AI, particularly patient privacy and the accuracy of AI-driven decisions. Many nurses suggested they were uncomfortable relying too much on AI and that they found it uncomfortable when the system’s decision-making processes weren’t fully transparent. Everyone worried that AI would make mistakes in diagnosing or monitoring patients, which would be very dangerous.
A participant from Focus Group 3 commented on this issue:
“AI can help us a lot, but we don’t always know how it’s making decisions. If it flags something as urgent and wrong, we could treat patients unnecessarily.”
The discussions also highlighted a significant gap in understanding how AI handles sensitive patient data. Nurses expressed concerns that AI systems might compromise patient confidentiality, particularly if the systems were connected to broader hospital networks or cloud-based platforms.
“We need more information on how patient data is stored and who can access it. With AI systems, there’s always a risk that sensitive information could be exposed.” — Participant from Focus Group 2.
Summary of focus group
The focus groups provided a collective perspective on AI integration in nursing, reinforcing many themes from the semi-structured interviews. Participants across all groups acknowledged the potential benefits of AI in improving efficiency and reducing workload but emphasized the need for comprehensive training to maximize these benefits. Concerns about implementing AI technologies, particularly regarding workflow integration and ethical considerations, were also prevalent.
Table 6
Key insights from focus group discussions
Focus Group 1 | AI improves efficiency but needs to be better integrated with manual systems to avoid doubling the workload. |
Focus Group 2 | Nurses require structured, hands-on training to fully understand AI’s potential and how it fits into their daily responsibilities. |
Focus Group 3 | There are significant concerns about the ethical implications of AI, particularly regarding patient privacy and decision-making transparency. |
Table
6 summarizes these insights, highlighting the unique contributions of each focus group while reflecting shared concerns. For instance, Focus Group 1 emphasized the importance of seamlessly integrating AI with manual systems to avoid doubling the workload. Focus Group 2 stressed the need for structured, hands-on training to help nurses fully understand AI’s potential and its fit into daily responsibilities. Meanwhile, Focus Group 3 raised significant concerns about ethical implications, particularly related to patient privacy and decision-making transparency. Overall, the focus groups agreed that AI needed proper education and implementation strategies to truly live up to everyone’s hopes for it by being used by nursing. The nurses expressed optimism and caution and spoke of AI opportunities, but all said AI needed to be embedded in a way that enhances their work while ensuring the safety of their patients.
Interviews and focus group thematic analysis
Through thematic analysis, recurring patterns across semi-structured interviews and focus groups were identified. This process revealed three prominent themes: Efficiency, Ethical and Practical Challenges, and the Need for Training and Education—AI as an Enabler. These themes capture the ambiguities of nurses’ attitudes and encounters with Artificial Intelligence (AI) as it integrates into their daily work. Table
7 presents these main themes, sub-themes, participants’ quotes, and codes, which highlight both the benefits and concerns related to AI integration in nursing practice.
Table 7
Main themes, sub-themes, participants’ quotes, and codes
AI as an Enabler of Efficiency | Administrative task reduction | “AI helps reduce the time spent on paperwork so that we can focus on patient care.” (NP5) | Efficiency |
Ethical and Practical Challenges | Privacy and job displacement | “I worry about AI taking over some of our roles, and also about how patient data is handled.” (NP9) | Ethical concerns |
Need for Training and Education | Lack of AI training | “We need structured training to understand how to use AI in nursing.” (Focus Group 2) | Training gaps |
Theme 1: AI as an enabler of efficiency
The analysis revealed that overall, nurses considered AI a major tool to boost the efficiency of nursing tasks. As a theme, it was found in both interviews and focus groups. People also pointed out that AI has cut down the time required for doing mundane robotic administrative work like entering patient data, creating reports, and how to track a patient’s progress. In turn, it has enabled nurses to spend more time focusing on direct patient care, which is the essence of their job. In critical care units where real-time monitoring is necessary, AI helps many nurses streamline their workflow.
AI-enabled manual data handling errors sped up tasks such as processing patient vitals and staff alerting to critical changes and reduced manual data handling errors. However, the literature lacks insights from intensive care unit (ICU) nurses on how AI use in patient monitoring systems improved the time to detect abnormal trends in vital signs, which may avert critical incidents. With AI implemented consistently in routine monitoring, there was a smoother workflow and faster response time.
However, there was a feeling that AI systems needed to be fully leveraged throughout all departments. Public institution nurses said AI had a lot of potential, but the systems needed to be developed or integrated better to take advantage of it. Many participants said that if AI were more widely and cohesively adopted, it would enable them to manage time and resources better and, in turn, improve patient outcomes.
Theme 2: ethical and practical challenges
Participants acknowledged AI’s role in improving efficiency but repeatedly raised ethical and practical challenges. Among the greatest concerns raised were the privacy of the patient and how sensitive AI systems handle data. Participants were worried about the security protocols for AI systems, worrying that patient data could be breached. Nurses were worried about how data is stored and accessed, and they all wanted to know more about how algorithms and processes work behind AI’s decision-making.
They worried that nurses working in settings where AI was more commonplace could be displaced. They were aware that AI could help with many of their jobs, but they were also very worried that as AI gets smarter, it will replace humans in making decisions. Participants insisted that AI should supplement, but not substitute, human judgment and care. Across different settings, there was the fear that AI would take over the personal, empathetic nature of nursing.
But many nurses also said that despite its support for diagnostic processes and patient monitoring, AI simply didn’t have the emotional intelligence or human empathy needed for patient care. It was found that for nursing to be much more than clinical care, the work includes the emotional needs of the patients. Everyone agreed that AI could not replace this most basic aspect of nursing and should not be programmed to do so.
Theme 3: need for training and education
Another recurring theme in the interviews and focus groups was the need for structured, comprehensive training. Nurses said they needed to prepare to use AI effectively, lacking formal training and educational resources. While AI was being used in their institutions, most participants believed they needed to be sufficiently guided on using these tools daily. Nurses were given limited training and often had to learn how to use AI applications through trial and error.
Participants wanted hands-on training sessions where they could learn more about AI systems. They said that understanding their capabilities, limits, and inner workings would make them more efficient and safer for patients. A popular and clear need was for ongoing professional development programs meant to update nurses on the latest advances in AI and ensure their confidence in using these systems.
Several also pointed out that AI technology is rapidly evolving, and training is ongoing rather than a one-time event. Nurses hoped that with regular refresher courses, they might fall asleep and be behind AI systems as they continue to develop, compromising the quality of the care nurses provide.
Summary of thematic analysis
The thematic analysis results suggested the nature of this complex relationship between nurses and AI in clinical practice. However, AI was well recognized as a means to make nurses more efficient by automating their administrative tasks and boosting data management accuracy. Yet it’s far from settled, regarding data security and ethics of AI, and the fear that AI will replace nurses in roles. The urgent need to train more comprehensively and continuously became a key factor in successfully integrating AI into nursing practice. Thematic analysis of nurses’ relationships with artificial intelligence (AI) in clinical settings indicates a complex relationship. AI is generally acknowledged to be something that will help make nurses more efficient by automating administrative tasks and improving data management accuracy. But there are fears that there isn’t enough thought being given to the security of the data, ethical implications and whether or not AI will usurp nursing roles. Because of these issues, successful incorporation of AI into nursing care requires comprehensive and continuous ongoing training. In this study, we underscore that ethical standards in nursing need to be upheld while technological advances that enhance nurse’s capabilities, rather than stand in its place.
Research techniques comparative analysis
This study employed three qualitative research techniques: focus groups, semi-structured interviews, and thematic analysis. Each method was unique in its contribution to understanding nurses’ perspectives on AI integration in nursing practice. The following sections compare these techniques in detail and highlight their strengths, limitations, and contributions to the research. Table
8 presents a comparative analysis of the research techniques, emphasizing their respective strengths, limitations, and key contributions to the study.
Table 8
Comparative Analysis of Research Techniques
Semi-Structured Interviews | - Captured rich, in-depth, and personalized responses. - Allowed follow-up questions to delve deeper into specific areas. - Facilitated detailed exploration of individual experiences, both positive and negative. | - Time-intensive, requiring significant effort for conducting interviews and transcribing responses. - Limited to individualized perspectives, lacking the broader group dynamics that provide a collective understanding. | Provided detailed insights into personal experiences and individualized concerns, including nuanced perspectives on AI’s impact in nursing practice. |
Focus Groups | - Fostered interactive discussions and group dynamics, enabling participants to build on each other’s responses. - Facilitated the identification of collective concerns, such as training gaps and job security. - Highlighted consensus on AI’s perceived benefits. | - Group settings may inhibit some participants from fully expressing their views, particularly if they feel overshadowed by dominant voices. - Risk of groupthink or bias influenced by more vocal participants. | Offered insights into shared challenges and collective attitudes toward AI, highlighting the importance of consensus-building and group-oriented strategies. |
Thematic Analysis | - Synthesized data from both interviews and focus groups, ensuring a holistic view. - Provided a systematic approach to identifying recurring patterns and generating comprehensive themes. | - Dependent on the richness and quality of collected data. - Coding and categorization processes were time-intensive and required meticulous attention to detail. | Enabled the creation of overarching themes like efficiency, ethical concerns, and training needs, contributing to a structured understanding of nurses’ perspectives on AI. |
Combining semi structured interviews and focus groups enabled a thorough exploration of nurses’ attitudes to AI. Interviews gave us deep individual insights, focus groups made us share collective sentiment and bring us diverse perspectives. These qualitative data were effectively synthesized by thematic analysis with themes circling around efficiency improvements, ethical considerations, and were required to have comprehensive training. While the methods are time intensive and require participant openness, careful planning and skilled moderation are required to limit the potential biases and to obtain rich, reliable data collection.
The integration of AI in nursing practice from the nurses’ point of view was explored using a combination of semi-structured interviews, focus groups, and thematic analysis. Semi-structured interviews provided detailed personal insights about individual experiences, while the focus groups helped bring out the group dynamics and shared challenges and perspectives. The thematic analysis synthesized findings from both techniques to elicit key themes that included the role of AI in increasing efficiency, ethical and practical issues, and the overall need for comprehensive training.
While each method had strengths and weaknesses, they offered a multi-faceted approach. A deeper exploration of personal views was possible through semi-structured interviews, group consensus, and shared challenges were emphasized through focus groups, and thematic analysis provided a structured framework to understand overarching patterns across all data sources. Combining this approach allowed the study to reflect on individual and collective insights. It helped deliver a balanced and all-inclusive picture of how AI is being integrated into nursing practice.