{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/registered-nurses/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Registered Nurses", "soc_code": "29-1141", "category": "Healthcare", "us_employment": 3379720, "median_annual_wage": 97550 }, "verdict": "SAFE", "risk_resistance": 80, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 14, "embodiment": 19, "liability_shield": 16, "trust_premium": 17, "judgment_accountability": 14 }, "reasoning": { "task_resistance": "At 14 the score credits that hanging a piggyback, titrating pressors to a MAP target, doing a neuro check q1h, and de-escalating a confused post-op patient at 3am cannot be done through a screen — but it stops short of 18 because charting, care-plan generation, SBAR handoff drafts, discharge instructions, and acuity/triage scoring are genuinely automatable and can eat 20-30% of a shift.", "embodiment": "19 reflects that the work happens in rooms with vomit, code carts, combative patients, and bariatric transfers — you cannot start a 20-gauge in a dehydrated 88-year-old, palpate a rigid abdomen, or feel a thready radial pulse remotely, and the physical unpredictability of a med-surg floor is why this sits at the ceiling rather than in the 13-15 range of clinic-based roles.", "liability_shield": "State board licensure with a personal NPI, a named signature on every MAR entry, and the reality that a wrong-patient insulin dose goes to the Board of Nursing under your license — not the hospital's — puts this at 16, held below 19 only because RNs practice under physician orders and protocols rather than holding independent prescriptive authority.", "trust_premium": "17 because the patient's willingness to admit they haven't taken their metformin in three weeks, or the family's decision to accept comfort care, turns on the nurse who has been in the room for twelve hours — though unlike a primary care panel the relationship is usually shift-length, not years-long, which is what separates this from 20.", "judgment_accountability": "Deciding whether the drop in urine output warrants waking the intensivist, whether to hold a beta blocker at a borderline pressure, or whether this patient is septic before the lactate returns are ambiguous calls with defined consequences — 14 rather than 18 because much of that discretion runs through standing orders, rapid-response criteria, and escalation to a physician who owns the final diagnostic decision." }, "rationale": "The bulk of an RN's shift is physical and interpersonal: starting IVs, assessing wounds, repositioning patients, administering meds, catching the subtle change in color or breathing that precedes a crash. AI is already eating the documentation layer — charting, discharge summaries, care-plan drafts, triage protocols, insurance paperwork — which is real time savings but not the job. State licensure, personal accountability for medication errors, and the fact that patients and families want a human at the bedside keep this occupation firmly intact; the near-term risk is not replacement but higher patient ratios justified by 'AI efficiency'.", "outlook": "Demand keeps rising with an aging population; AI will strip out documentation hours, and the fight over the next decade is whether that time returns to patients or becomes justification for heavier assignments.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "State safe-staffing laws with hard numeric RN-to-patient ratios that explicitly bar counting AI monitoring or documentation tools toward staffing compliance — California Title 22 already sets ratios; Oregon HB 2697 (2023) and pending bills in NY/MI/PA extend the model. A ratio statute that names AI acuity-scoring as non-substitutable would block the 'AI efficiency = higher ratios' pathway that is the actual near-term risk.", "plausibility": "already happening", "would_add": 3 }, { "dimension": "liability_shield", "change": "Board of Nursing rules (or NCSBN model language) declaring that an RN who accepts an AI early-warning score, sepsis alert, or AI-drafted assessment without independent verification is practicing below standard of care — making the nurse the required verifying signer on algorithmic output rather than a downstream consumer of it. Malpractice insurers writing this into policy conditions has the same effect.", "plausibility": "plausible", "would_add": 2 }, { "dimension": "judgment_accountability", "change": "Task-mix shift: this occupation genuinely has two tiers. As charting, discharge summaries, care-plan drafts and insurance documentation are absorbed by ambient scribes (Epic/Nuance DAX deployments already live at Kaiser, HCA), the residual shift concentrates in escalation decisions, rapid-response calls, titration under ambiguous vitals, and family goals-of-care conversations — the parts that own consequences. No law required.", "plausibility": "already happening", "would_add": 3 }, { "dimension": "judgment_accountability", "change": "Expansion of formal RN authority under protocol — nurse-driven sepsis bundles, RN-initiated Foley removal, standing-order titration, and independent triage disposition authority in EDs. Where hospitals codify these, the RN owns a consequential call previously made by a physician.", "plausibility": "already happening", "would_add": 2 }, { "dimension": "task_resistance", "change": "If bedside AI absorbs the routine tier faster than staffing shrinks — i.e., ratio laws hold — the remaining hour-by-hour work is unstructured physical assessment and de-escalation, which current systems cannot do at usable quality. Rises only conditional on the staffing floor; without it, saved documentation time is reclaimed as more patients, not more judgment.", "plausibility": "plausible", "would_add": 2 }, { "dimension": "trust_premium", "change": "Growth of segments where the human presence IS the product and is separately billed: hospice/palliative bedside care, private-duty and concierge nursing, doula-adjacent perinatal nursing, and home-based hospital-at-home programs (CMS Acute Hospital Care at Home waiver) that require an in-person RN visit per day by rule.", "plausibility": "plausible", "would_add": 1 } ], "ceiling_note": "Already 80/100 with embodiment at 19 — very little headroom. The realistic fight is defensive: preventing task_resistance erosion via staffing floors, not raising the score. A single-payer-style cost squeeze or repeal/preemption of ratio laws moves this down faster than any lever moves it up." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 2906840, "wage": 70000 }, { "y": 2018, "emp": 2951960, "wage": 71730 }, { "y": 2019, "emp": 2982280, "wage": 73300 }, { "y": 2020, "emp": 2986500, "wage": 75330 }, { "y": 2021, "emp": 3047530, "wage": 77600 }, { "y": 2022, "emp": 3072700, "wage": 81220 }, { "y": 2023, "emp": 3175390, "wage": 86070 }, { "y": 2024, "emp": 3282010, "wage": 93600 }, { "y": 2025, "emp": 3379720, "wage": 97550 } ], "from": 2017, "to": 2025, "change_pct": 16.3, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [], "license": "https://cookedindex.com/terms" }