National Nurses United

National Nurses United (NNU) is the largest union and professional association of registered nurses in the United States, representing more than 225,000 members and affiliated with the AFL–CIO. Founded in 2009 through the merger of three major state nursing organisations, NNU has emerged as the country's most prominent institutional voice demanding enforceable worker and patient safeguards against the rapid, often unregulated deployment of artificial intelligence in hospital settings.

Founding and structure

NNU was formally established in December 2009 through the merger of the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), the United American Nurses (UAN), and the Massachusetts Nurses Association (MNA). The CNA/NNOC — the largest and most politically active state nursing association in the country — drove the consolidation, creating the first nationwide single-union structure for direct-care registered nurses capable of carrying national campaigns on staffing ratios, healthcare financing, and worker conditions. The union is governed by co-presidents — as of 2025, Nancy Hagans, Jamie Brown, Cathy Kennedy, and Mary Turner — and an executive director, currently Puneet Maharaj.

Membership grew to approximately 225,000 following the October 2022 affiliation of the New York State Nurses Association (NYSNA), which brought approximately 42,000 New York unionised nurses into the NNU structure. Affiliates today span California, Michigan, Minnesota, New York, the District of Columbia, and more than twenty additional states through the NNOC organising arm. The union affiliates with the AFL–CIO and describes its mission as organising all direct-care RNs into a structure capable of exercising influence over the healthcare industry, employers, and government.

AI opposition — core position

NNU has positioned itself as the principal organised opponent of unregulated AI deployment in US hospital settings, arguing that algorithmic tools currently deployed — or under active consideration — undermine the holistic nursing assessment that safe patient care requires. The union's position is not a categorical technology refusal: NNU acknowledges that technology can support nursing practice. Its objection is specific to AI tools that quantify, predict, or automate clinical decisions without worker oversight in hospital procurement, and without validation against the nursing judgment they are designed to replace or supplement.

The categories of AI deployment NNU challenges most actively include: algorithmic patient-acuity and staffing-ratio tools that determine nurse-to-patient assignments from incomplete real-time EHR data; AI-generated shift-handoff notes that omit clinical nuance; predictive-deterioration monitors whose alert volumes displace active bedside assessment; and remote-patient-monitoring infrastructures that shift care to off-site personnel with reduced clinical training. The union further argues that current AI deployments enable employer surveillance of nursing practice, shift clinical liability to individual nurses for recommendations they did not make, and erode the professional judgment that makes nursing a skilled occupation.

Nurses and Patients' Bill of Rights

In 2024, NNU published the Nurses and Patients' Bill of Rights: Guiding Principles for A.I. Justice in Nursing and Health Care, asserting seven AI-specific rights: the right to high-quality, person-to-person nursing care; the right to safety; the right to privacy; the right to transparency; the right to exercise professional judgment; the right to autonomy; and the right to collective advocacy for workers and patients. The document serves as NNU's primary framing instrument for evaluating proposed AI legislation and for anchoring AI-guardrail demands in contract negotiations across the union's affiliate bargaining units.

Survey evidence

NNU's approach combines direct action with systematic documentation. The union surveyed more than 2,300 registered nurses between 18 January and 4 March 2024 — one of the largest nurse-side assessments of AI deployment in US hospitals on public record. Key findings: 60 per cent of respondents did not trust their employer to implement AI with patient safety as the first priority; of the approximately half whose employers used algorithmic acuity tools, 69 per cent said AI assessments did not match their own clinical judgment; of the 12 per cent whose employers used AI-generated shift-handoffs, 48 per cent reported automated handoffs missed critical clinical information; 29 per cent said they could not override AI assessments in imaging and sound systems. The survey provided the evidentiary base for NNU's legislative and bargaining demands throughout 2024 and 2025.

Direct action

The union has coordinated public actions across its affiliates. On 22 April 2024, hundreds of registered nurses from the California Nurses Association held a protest outside Kaiser Permanente's San Francisco Medical Center, timed to coincide with Kaiser's hosting of the 2024 Integrated Care Experience conference. Nurses carried signs reading "Trust nurses, not AI," demanding that CNA's 24,000 Kaiser-represented nurses be included in decisions about AI deployment in patient care.

On 16 January 2025, NNU organised nationwide marches and rallies in Washington D.C., El Paso, and across California. More than 100,000 NNU members were simultaneously entering contract negotiations with major healthcare employers including UCHealth and Dignity Health, and the marches were framed explicitly as connecting safe-staffing demands to patient protections against AI. NNU president Nancy Hagans stated: "Patient advocacy is at the core of what we do as nurses. That's why we're demanding safe staffing and protections against untested technologies such as A.I."

Legislative and contract work

NNU's state-level legislative channel runs primarily through CNA. As of April 2026, CNA-sponsored legislation establishing patient-safety and nursing-practice guardrails for AI had advanced through committee in California. The union's contract strategy — embedding AI-specific provisions in collective-bargaining agreements as a condition of new technology deployment — is the primary mechanism through which NNU intends to operationalise the Nurses and Patients' Bill of Rights standards across its 2025–2026 contract cycle.