From Definition to Governance: Examining Gaps in Nursing Regulatory Guidance on Artificial Intelligence

As Artificial Intelligence (AI) systems become embedded in healthcare delivery, nursing regulatory bodies face unprecedented challenges in developing guidance that protects public safety while enabling appropriate technology use. The College of Nurses of Ontario's (CNO) 2025 Virtual Care practice guideline represents one of the earliest efforts among Canadian nursing regulatory bodies to address AI. Our analysis examines this recently published guideline, identifying definitional limitations that situate AI within an outdated, anthropocentric paradigm - one that conflates AI’s formal logical processes with human-like reasoning despite their fundamental distinctions. Our analysis also identifies three critical gaps between contemporary understandings of AI systems and how they have been addressed within the guideline. First, the guideline’s privacy considerations treat AI as conventional healthcare technology, missing the privacy risks that are specific to AI systems. Second, the CNO inappropriately transfers complex technical assessment responsibilities from organizations to individual practitioners. Third, while the CNO acknowledges that algorithmic bias can affect equity-deserving populations, its guidelines do not recognize the operational frameworks needed for bias detection and remediation, again placing technical assessment burdens on individual nurses. To effectively address the implications of AI with regard to nursing regulation, interdisciplinary collaboration, clear organizational accountability frameworks, and evidence-based guidance reflecting technical realities are required. This analysis highlights the need for nurses, nursing regulatory bodies, and healthcare organizations to approach AI integration within nursing practice as a shared responsibility, and offers suggestions for how each can contribute to more technically informed and accountable AI governance in nursing practice.