Raquel Alvarez Sanchez has been a Kaiser Permanente advice nurse in Vallejo since 2010. Her job is to answer patient calls, assess symptoms, give medical advice, and triage the most serious cases to emergency care. It's clinical work. It's emotional work. And increasingly, it's being measured by algorithms.
Last year, she was on a call with a suicidal patient that stretched past an hour. She stayed on the line, talking the man down, waiting for police to arrive before hanging up. She knew the call would wreck her average handle time for weeks and might trigger questions from management. She did it anyway.
"I think at some point all of the nurses have been talked to about their average handle time," she says. "The only thing I can think of is they're doing it for profit."
Charlotte Capulong, who has worked in nurse call centers for 22 years and helped organize Kaiser nurses against an AI tone-of-voice tool, is blunter: "You aren't calling Comcast. We're dealing with life here."
Seven current and former nurses told CalMatters that those who spend more than 15 minutes on a call routinely face criticism or get called into performance evaluation meetings. Call time factors into monthly performance scores. Software tries to predict daily whether nurses are being unproductive or failing to answer calls quickly enough.
In summer 2024, Kaiser began testing an AI tool that attempts to assess empathy and tone in the voices of nurses and patients. Nurses circulated a petition against it: "Trust nurses, not AI." The AI tests ended in November 2024, but union representatives were told managers may bring the program back in the future.
One nurse, speaking anonymously for fear of retaliation, described a call with an elderly woman who'd just received a terminal cancer diagnosis. The woman was in shock. She really just needed someone to talk to. The nurse wanted to stay on the line and show compassion — but stopped herself, fearing it would hurt her monthly performance score and lead to a reprimand.
"I had to ask myself: Am I going to get disciplined for going off script or saying more than what is necessary?"
The California Nurses Association is bargaining for 25,000 nurses, including 1,000 in call centers, and AI is expected to be a central issue. The union filed charges over what it says is unlawful surveillance. State lawmakers are considering bills that would protect healthcare workers who override automated care recommendations.
Kaiser defended its practices, saying it deploys technology with patient safety in mind and doesn't use "average handle time" to assess performance. But nurses on the phones say the pressure is unmistakable.
Capulong puts it simply: "The amount of time that Kaiser is giving us to complete a call is sometimes not safe. People can get hurt."