Marilyn Shuler first walked into Montefiore Medical Center in the Bronx when Jimmy Carter was president. She was a young nurse, bright-eyed and ready to make a difference. Thirty-nine years later, she got a letter dated May 28, 2026: her position would be eliminated in 45 days.
The job she'd held for nearly four decades was utilization review — the quiet, essential work that stands between patients and denied insurance claims. Shuler read charts, assessed medical necessity, caught gaps in documentation, and argued with insurers when they tried to refuse coverage for care doctors had already ordered. It was clinical knowledge meeting bureaucratic warfare, and she was good at it.
What made the layoff sting even harder was timing. Shuler had been on the picket line just months earlier, during the 41-day New York nurses' strike that began January 12, 2026. She'd walked in the cold, chanted with her colleagues, and voted to ratify a contract that union leadership had hailed as landmark — with, among other things, safeguards against artificial intelligence replacing nurses.
"We won those protections," Shuler said at a July 1 virtual town hall. "And then they turned around and did it anyway."
Twelve utilization review nurses across Montefiore's Moses, Einstein, and Weiler campuses were eliminated. The New York State Nurses Association (NYSNA) identified the replacement as software from Datavant, a health data company. Montefiore called the union's characterization "inaccurate and misleading" and described the tool as a "nonclinical program that helps facilitate the paperwork process."
The bitter irony wasn't lost on anyone. The contract language nurses had won required management to consult the union if AI caused "diminishment" of jobs. Instead, nurses said they noticed their workflows shifting quietly in February, right after they returned from the strike, with no consultation at all.
"What we want from Montefiore is simple," Shuler said. "Stop the layoffs, keep a licensed nurse on final review, use AI to support us instead of replacing us, and sit down with the nurses who actually do this work."
NYSNA filed a class-action grievance on June 1. The case is being closely watched as one of the first known instances in the U.S. where licensed nursing roles were explicitly eliminated and replaced with AI-driven workflows.
Shuler doesn't know what she'll do next. Thirty-nine years in one hospital, in one profession, doesn't make for an easy pivot. But she's clear on one thing: patients will suffer if algorithms replace clinical judgment on the cases that don't fit neatly into a template.
"The algorithm sees data points," she said. "We see people."