By Lisiane Pruinelli, PhD, MSc, RN, FAMIA, FAAN
Since FloGatorAI’s launch in 2024, we have talked a lot about what artificial intelligence (AI) can do to help nursing and health care. We have explored how it can potentially support clinical decision-making, reduce documentation burden and expand access to knowledge. We have discussed how to integrate AI into education, how to design and apply it responsibly and how to ensure it reflects nursing values.
But recently, I have found myself asking a different question.
Not what AI can do for us, but what might it be quietly changing in us?
As AI becomes increasingly embedded in how we write, summarize and communicate, I have started to notice something that concerns me. Written work and papers are often more polished than ever. They are clearer, cleaner and more professional. Whether in student assignments, clinical documentation, emails or reports, the language looks right.
But when we pause to ask where the reasoning behind the output came from, the answer is not always clear.
And that raises an important question: “As AI helps us produce better and more polished work, what is it doing to the human mind behind that work?”
Writing Is Not Just Writing
In nursing, writing is not just a communication skill. It is a thinking process.
We write to:
· Organize clinical reasoning
· Synthesize patient information
· Connect evidence to action
· Communicate clearly with other professionals
Documentation is not just a record; it is a reflection of how we understand the patient in front of us.
When writing becomes easier, faster and more polished, it can feel like progress. And in many ways, it is.
But writing has always served another purpose: it forces us to slow down, to clarify, to question and to make sense of complexity.
So, what happens when that friction disappears?
If AI generates the structure, the phrasing and even the argument, where does the human thinking happen?
The Cognitive Trade-Off
Emerging research is beginning to raise similar concerns. Studies suggest that heavy reliance on AI-assisted writing may reduce cognitive engagement, memory retention and critical thinking.
In some cases, individuals using AI were less able to recall what they had written and showed lower levels of mental effort during the task.
This is not limited to students. We are seeing similar patterns across professional environments where AI-generated summaries, documentation and communications are increasingly accepted at face value, without the same level of scrutiny or reflection.
Thinking, especially clinical thinking, is effortful. It requires uncertainty, iteration and sometimes discomfort. Writing is part of that process.
When that process is outsourced too early, or too completely, we risk skipping the very steps that build expertise.
And in nursing, expertise is not optional.
From Writing to Acting: The Next Step in Outsourcing
And this shift is not stopping at writing.
We are now seeing the rapid emergence of AI tools that take actions on our behalf. Some systems can autonomously navigate software, click through interfaces, populate forms and complete tasks by controlling a user’s computer screen or mouse. What once required human interaction is increasingly being delegated to AI.
On the surface, this feels like progress. It promises efficiency, speed and relief from repetitive tasks.
But it also raises an important question: If we begin to outsource not only how we write, but how we act, where does human judgment remain?
In health care, action is inseparable from responsibility. Clicking, documenting, ordering and responding are not neutral tasks. They are decisions embedded in workflow.
This evolution reflects the rise of what is often called agentic AI, which is a system that can generate information, plan and execute actions within workflows. Recent analyses of real-world deployments show that the true impact of these systems lies not in the technology itself, but in how they fundamentally reshape workflows and relegate decision-making to AI and not to humans. That shift matters in nursing, where action and accountability must remain tightly connected.
From Classroom to Clinical Practice
This is not just an educational concern. It is a professional one.
Across settings, including education, practice, administration and research, we are increasingly interacting with AI-generated outputs. And while these outputs may be correct, coherent and efficient, they can also create a subtle shift: From actively constructing knowledge to passively accepting it.
In clinical environments, this matters.
Nurses operate in systems where:
· Decisions must be made quickly but thoughtfully
· Communication must be precise
· Documentation must reflect real clinical judgment
A recent commentary highlighted how even small errors in AI-generated text, something as simple as a misplaced comma, can lead to significant misunderstandings in high-stakes contexts. In health care, where communication is tightly connected to safety, that margin for error matters.
But beyond punctuation, the deeper risk is this: If we rely on AI to articulate what we have not fully reasoned through, we create a gap between what is written and what is understood.
AI Is Not the Problem
Let’s be clear: AI is not the problem.
In fact, AI can be an incredibly powerful partner. It can:
· Help structure ideas
· Provide examples
· Support reflection
· Surface knowledge quickly
But like any tool, it is just a “tool,” and its impact depends on how we use it.
The goal is not to avoid AI. The goal is to use it in a way that augments thinking, not replaces it.
This means shifting how we engage with AI across all levels, not just in education.
Instead of asking: “Does this sound right?”
We may need to ask: “Do I understand this?” “Can I explain this without AI?” “Where could this be wrong?”
Reframing the Role of AI
If we are preparing an AI-enabled nursing workforce and practicing within AI-enabled systems, then writing and decision-making cannot be treated as final products.
They must remain processes.
We need to:
· Design learning and practice environments that require reasoning, not just responses
· Encourage critique of AI-generated outputs
· Maintain accountability for decisions, even when AI is involved
· Make the invisible cognitive work visible again
This is not about going backward. It is about evolving forward, intentionally.
The Question We Need to Ask
AI will continue to evolve from writing to reasoning to acting. Thus, we need to ask ourselves: “As AI writes more and begins to act more, are we still thinking enough?”
Because in nursing, thinking is not just an academic skill.
It is the foundation of safe, ethical and effective care.
And that is something we cannot afford to outsource.