# AI in nursing practice: safe, lawful and accountable use *What these tools get wrong, what the NMC Code asks of you when you use them, and what to check before you sign.* ## Production summary - Modules to record: 3 - Total script: 2019 words, about 13 minutes of finished audio - Voices: Emma (host) and George (practice educator) - Level: Registered nurses, nursing associates, student nurses and nursing support staff ## Accreditation wording that must appear in the description - **The CPD Certification Service** (planned): Application scheduled. - **NMC Code (2018)** (aligned): Written against the published Code, which is the standard every NMC registrant is held to. The NMC does not approve or accredit training providers or CPD, and this is our own mapping with no endorsement implied. The NMC is consulting on a new Code in 2026. - **NHS England guidance on AI-enabled ambient scribing products** (aligned): Written against the published guidance as updated on 29 July 2026. Our own mapping, with no endorsement from NHS England implied. > Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved. --- ## What AI actually is on your ward, and how it gets things wrong **Runtime** about 5 minutes. **Words** 715. **Starts at** 00:00 in the full course recording. ### Learning outcomes to state on camera - Distinguish a prediction tool from a generative AI tool and say how each fails - Explain why a generative tool can be fluent, confident and wrong - Name the four failure modes that matter most in clinical documentation - Recognise automation bias and describe how to counter it - State what the NMC Code asks of you when you use an AI tool ### Script `[CUE 1]` *A prediction tool and a generative tool side by side, each with its typical failure* **EMMA** [00:00] George, I'll be honest. Every second email at work now is about AI, and I still couldn't tell you what the thing is actually doing. Can you? **GEORGE** [00:10] I can, and it takes about a minute. First, there isn't one thing. On a ward there are at least two kinds, and they fail differently. One predicts, taking measurements already in the record and giving you a score or an alert. The other generates, taking words in and producing new words out. **EMMA** [00:32] Give me an example of each. **GEORGE** [00:34] A deterioration risk score is the first kind. A scribe that listens to a consultation and drafts the note is the second. The first can be miscalibrated, wrong about a kind of patient it saw too little of. The second can invent. **EMMA** [00:51] Invent. That's a strong word. `[CUE 2]` *A fluent paragraph with three highlighted claims, one of which is invented* **GEORGE** [00:53] It's the right one. A generative tool has learned from a huge amount of text which words tend to follow which. When it answers, it produces the most plausible continuation. It doesn't look anything up, and it has no idea whether what it produced is true. **EMMA** [01:11] But it sounds so sure. **GEORGE** [01:13] Because sounding sure is what it's built to do. Smooth, confident prose is its whole output. It doesn't hesitate when it's guessing. A wrong sentence and a right sentence look identical on the screen. **EMMA** [01:27] So how do I know which is which? **GEORGE** [01:30] You don't, from the text alone. You know from what you saw and heard. Which is why I want you to carry four failure modes in your head. Invention, a detail nobody said. Omission, something said that's missing. Distortion, the detail's there but changed. And misattribution, the wrong person said it. `[CUE 3]` *Four failure modes as four short clinical examples: invention, omission, distortion, misattribution* **EMMA** [01:50] Which is the worst? **GEORGE** [01:52] Omission, because you can't see a gap by reading what's on the page. You only catch it if you remember what was said in the room. A missed allergy is invisible in a note that looks complete. **EMMA** [02:07] And distortion? **GEORGE** [02:07] Numbers, sides and negatives. A dose that's slightly off. Left for right. No chest pain turning into chest pain. Those three get a second look from me, every time, whoever wrote the draft. **EMMA** [02:21] Here's what bothers me. If it's right nearly every time, I'm going to stop checking. I know I will. `[CUE 4]` *A tired clinician at the end of a shift reading a draft, with the unread last paragraph fading* **GEORGE** [02:28] Everybody does. It has a name, automation bias, and it isn't carelessness. It's what happens to a tired person given a draft that's ninety-five per cent right. The five per cent hides in the bit you stopped reading. And the better the tool, the worse it gets. **EMMA** [02:47] That's a strange thing to teach. The better it is, the more dangerous it is. **GEORGE** [02:53] Not more dangerous, harder to supervise. So you use a habit. Read it as though a very fast, very confident junior had written it, someone who has never met the patient. You wouldn't sign their note unread. **EMMA** [03:08] Fair. Now the part everyone worries about. The NMC. What does the Code actually say about this? **GEORGE** [03:15] Nothing about the technology, and it doesn't need to. Clause 10.4 says attribute your entries to yourself. 10.3, complete records accurately and without falsification. 6.2, keep the knowledge and skills you need for safe practice. And 19.1 and 19.2, reduce the likelihood of mistakes and allow for human factors and system failures. `[CUE 5]` *Code clauses 10.3, 10.4, 6.2 and 19.1 with a draft note in the middle and an arrow to the registrant* **EMMA** [03:36] So if the tool wrote it and I accepted it... **GEORGE** [03:40] It's your entry. You adopted it. You also have to know enough about the tool to use it safely. Not how it's built. How it fails. **EMMA** [03:50] Is the Code about to change? **GEORGE** [03:52] The NMC has said it will consult on a new Code from September to December 2026, and that digital and AI technologies are one of its areas. I'd be surprised if the duties got lighter. This course teaches what stands today and tells you when that might move. **EMMA** [04:12] What about my employer? If they bring the tool in, doesn't some of this land on them? **GEORGE** [04:18] Some does. They share responsibility for how it's introduced, tested and supported. But your accountability to the NMC is yours. It doesn't transfer. So you want to be someone who can ask good questions about the tool, which is where we go next. **EMMA** [04:36] So the one thing to take away? **GEORGE** [04:38] Two. It writes fluent text whether or not it's true. And once you accept it, it's your record. ### Sources for the on screen credit - The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (clauses 6.2, 10.3, 10.4, 19.1, 19.2), Nursing and Midwifery Council - NMC to launch landmark consultation on new Code and Revalidation process, Nursing and Midwifery Council - 500,000 NHS staff to get new artificial intelligence tools to help free up more time for patients (June 2026), NHS England --- ## AI scribes and drafted records: what to check, and what to tell patients **Runtime** about 4 minutes. **Words** 658. **Starts at** 04:46 in the full course recording. ### Learning outcomes to state on camera - Explain what NHS England's guidance requires of organisations and of clinicians - Explain when an ambient voice product is and is not a medical device - Check an AI-drafted record using a repeatable routine - Tell a patient clearly and honestly that a scribe is in use - Correct and report an error in an AI-drafted record ### Script `[CUE 1]` *A scribe listening to a consultation and producing a draft, with the clock showing time saved* **EMMA** [04:46] George, scribes. Half my friends in the NHS say they're a miracle and the other half say they're a lawsuit waiting to happen. Who's right? **GEORGE** [04:56] Both, depending on whether the note gets checked. Let me start with what one actually does. It listens to a consultation or a handover, with permission, and drafts the note or the letter. **EMMA** [05:09] And the benefit is real? **GEORGE** [05:11] Yes. Typing is time away from the patient, and trials have reported documentation time coming down. I'm not going to pretend that isn't valuable. But everything from the last module still applies. It can invent, omit, distort and misattribute, and it reads beautifully while it does. **EMMA** [05:29] Is there actual guidance on this, or is everyone making it up? `[CUE 2]` *A checklist of what an organisation should have: safety officer, hazard log, impact assessment, device check, privacy notice* **GEORGE** [05:34] There's actual guidance. NHS England published it in April 2025 and updated it in July 2026. It's written for the organisations adopting these products, which is useful for you, because it tells you what to ask of yours. **EMMA** [05:49] What should my organisation have done? **GEORGE** [05:52] Appointed a Clinical Safety Officer. Identified the risks and kept a safety case and hazard log, which is what the standard called DCB0160 asks of a deploying organisation. Done a data protection impact assessment. Checked whether the product counts as a medical device. And updated its privacy information before any recording started. **EMMA** [06:12] That's a lot. Would I know if they hadn't? **GEORGE** [06:16] You can ask. Who's our Clinical Safety Officer? Is there a hazard log for this? Where does the recording go? If nobody can answer, that's information. It doesn't mean stop. It means ask your manager or your information governance team before you rely on it. `[CUE 3]` *Two columns showing the organisation's responsibility and the clinician's, meeting at the signed entry* **EMMA** [06:34] And what does the guidance ask of me personally? **GEORGE** [06:38] Review and approve every output before it's acted on. You keep an ongoing responsibility to review and revise. And it says plainly that NHS organisations can still be liable for claims. So the organisation answers for the tool, you answer for the entry. **EMMA** [06:55] I've also heard people argue these aren't medical devices at all. **GEORGE** [06:59] The MHRA clarified that on 29 July 2026. In summary, a product that supports diagnosis or treatment, or acts automatically without a clinician reviewing it, is a medical device. One that only transcribes, summarises, drafts letters or suggests codes for a clinician to review falls outside. Read their statement for the exact words, because this is a summary and positions get updated. **EMMA** [07:24] So the line is a human reviewing it. `[CUE 4]` *A line dividing products that only draft for review from products that act or support diagnosis, with a clinician standing on the line* **GEORGE** [07:27] Exactly. And you're the human. That's the design. Which is why I get nervous when people treat the review as a formality. **EMMA** [07:36] Okay, give me the routine. I want something I can do in two minutes. **GEORGE** [07:42] Same order every time. Numbers first, doses and frequencies. Then negatives, denied and no and absent. Then sides and sites. Then medicines and allergies. Then who said what. And last, close your eyes and ask what was said that isn't there. **EMMA** [07:58] And if I can't verify something? **GEORGE** [08:00] Don't sign it. Edit it or remove it. A shorter true note beats a fuller uncertain one. `[CUE 5]` *The six-step checking routine as numbered cards, then a patient conversation in plain words, then an amend-not-delete audit trail* **EMMA** [08:07] What do I say to the patient? I feel awkward. **GEORGE** [08:11] Keep it ordinary. A tool is going to listen and help me write the note. I'll check it. This is where the recording goes. You can say no. Clause 5.2 asks you to make sure people know how and why their information is used. If they say no, follow local policy and write it yourself. **EMMA** [08:33] Last one. I find a mistake two days later. What do I do? **GEORGE** [08:38] Correct it through the proper route so the history is kept. Don't delete and rewrite. Report it as a patient safety event. And if it touched their care, be open and candid with them under clause 14. **EMMA** [08:53] I think I'd be tempted to quietly fix it. **GEORGE** [08:57] I know. But a quiet fix looks like falsification later, and clause 10.3 is clear. An error that's caught and reported means the system works. That's the outcome you want. ### Sources for the on screen credit - Guidance on the use of AI-enabled ambient scribing products in health and care settings (published 27 April 2025, updated 29 July 2026), NHS England - MHRA clarifies regulatory status of ambient voice technologies used in the NHS (29 July 2026), Medicines and Healthcare products Regulatory Agency - The Code (clauses 5.2, 10.3, 10.4 and 14), Nursing and Midwifery Council - National review of clinical risk management standards DCB0129 and DCB0160: supporting information, NHS England --- ## Confidentiality, bias and speaking up: using AI without breaking trust **Runtime** about 4 minutes. **Words** 646. **Starts at** 09:09 in the full course recording. ### Learning outcomes to state on camera - Say what counts as identifiable information and why a name is not the only thing - Explain why an unapproved tool is not covered by your organisation's data protection - Describe what to do if you have already shared identifiable information with a tool - Give two ways bias can enter an AI tool and an example from clinical practice - Know how and why to speak up, and how to use this learning for revalidation ### Script `[CUE 1]` *An approved tool with its assessment, contract and safety case, beside an unapproved one with none* **EMMA** [09:09] George, I'll confess something. Last month I pasted a messy handover into a free AI tool to tidy it up. No names. Is that all right? **GEORGE** [09:19] I'm glad you said it, because you're far from alone. And no, probably not. Two questions. Had your organisation approved that tool for that use? And was it really anonymous? **EMMA** [09:31] Not approved, as far as I know. And I took the name out. **GEORGE** [09:36] Take the first one. An approved tool has been assessed. There's an impact assessment, a contract saying what the supplier may do with the information, a safety case. A free tool you found yourself has none of that, and its terms may allow your input to be kept or used. Your organisation's data protection doesn't extend to it. `[CUE 2]` *A list of identifiers building up on a person until they can be recognised* **EMMA** [10:00] People call that shadow AI, don't they? **GEORGE** [10:02] They do, and it's the risk that's growing fastest, mostly because the people doing it are conscientious, trying to save time, not careless. **EMMA** [10:12] And the second question? I took the name out. **GEORGE** [10:15] A name is the obvious identifier, and far from the only one. Initials, a date of birth, an NHS number, an address, a ward plus an admission date, a rare diagnosis in a small community. Several together almost always identify someone. `[CUE 3]` *A 72 hour clock starting when the organisation becomes aware, with the learner's report speeding it up* **EMMA** [10:32] So taking the name out isn't enough. **GEORGE** [10:34] No. The test is whether somebody who knows the person, or has other information, could work out who it is. If they could, it's still personal data, the UK GDPR still applies, and so does clause 5 of the Code. **EMMA** [10:50] Right. So what should I do about last month? **GEORGE** [10:54] Tell your manager and your information governance team now. Don't wait and don't quietly fix it. They have to assess whether it's reportable to the Information Commissioner, and where it is, the deadline is 72 hours from when the organisation became aware. `[CUE 4]` *A tool being tested on a narrow group and then used on a wider one, with the gap marked* **EMMA** [11:11] So the clock starts when they know, not when I did it. **GEORGE** [11:16] Yes, which is exactly why telling them early matters. Every hour you wait comes off theirs. And prompt reporting is treated completely differently from concealment. If you're worried about the reaction, Freedom to Speak Up exists for that. **EMMA** [11:31] Okay. Moving on, because I want to ask about bias. Isn't that a bit abstract? **GEORGE** [11:37] It can be, so let me give you a concrete one. The independent review of equity in medical devices, published in March 2024, found that pulse oximeters can overestimate oxygen levels in people with darker skin. And it warned AI-enabled devices carry a similar risk if they're built and tested on unrepresentative data. `[CUE 5]` *A concern moving from a clinician to a manager, a report and a speaking up guardian, then a reflective account* **EMMA** [11:58] That's not an AI tool, though. **GEORGE** [12:00] No, which is why it's useful. It shows the mechanism. If a group was thin in the data, the tool works less well for them, and nobody has to have intended it. A tool that reassures you about a patient it measured badly is worse than no tool. **EMMA** [12:20] Does it apply to scribes? **GEORGE** [12:22] Directly. If a scribe handles an accent or a second language less well, the notes for those patients will be worse and look just as confident. So ask of any tool who it was built and tested on, and whether it works as well for the patient in front of you. **EMMA** [12:42] And if I think something's wrong? **GEORGE** [12:44] Say so. The Code asks you to raise concerns where people may be at risk. Tell your manager, report it as a patient safety event, or go to your Freedom to Speak Up Guardian. A concern raised early is the cheapest safety control an organisation has. **EMMA** [13:03] And can I use all this for revalidation? **GEORGE** [13:06] Yes, carefully. This course alone is non-participatory CPD. If you then discuss it at a team meeting or journal club, that discussion is participatory. A reflective account might describe a draft that was wrong, what you changed in how you check, and the Code clause it links to. With no patient identifiable, ever. ### Sources for the on screen credit - The Code (clause 5 on confidentiality, and clause 16 on raising concerns), Nursing and Midwifery Council - Equity in medical devices: independent review (March 2024), UK Government - Data protection and personal data breaches, Information Commissioner's Office - Guidance on the use of AI-enabled ambient scribing products in health and care settings, NHS England --- *Copyright WAJD Group. Built by WAJD AI.*