Artificial intelligence (AI) is being rapidly and broadly introduced into personal, public, commercial and health/medical practice settings. AI refers to a broad and evolving set of computational technologies, including machine learning, natural language processing, computer vision and generative AI ((Van Bulck et al. 2023; McGrow 2025). AI enables systems to learn from data to perform tasks that have traditionally required human intelligence, such as pattern recognition, clinical prediction, decision support and content generation (Bajwa et al. 2021; Rony et al. 2024; WHO 2021, 2025). Within healthcare, there is growing consensus that AI-informed tools are intended to augment – but not replace – the clinical judgement, ethical reasoning and relational care that are the hallmarks of nursing practice (ANA 2022; Rony et al. 2024). Findings from a recent survey of Canadian Academy of Nursing Fellows (n = 57) indicate that while many nurse leaders have encountered AI in practice, few feel confident with its use or governance. This gap suggests a leadership readiness challenge as well as a technology adoption challenge. Unlike earlier digital health tools, AI changes how information and knowledge are created and subsequently interpreted by clinicians, generating new risks as they become accountable for decisions shaped by systems they cannot fully evaluate (AAN 2026; McGrow 2025). The Canadian nursing informatics entry-to-practice competencies now include expectations that nurses assess AI outputs and safeguard equitable care, yet governance structures to support these responsibilities remain underdeveloped. Fellows also highlighted other concerns related to the use of AI, including the potential for algorithmic bias, ethical use and threats to equity and privacy. In this commentary, we posit that beyond supporting technological adoption, AI in nursing is fundamentally a leadership competency and governance issue. In this context, it is paramount that nurse leaders actively participate in establishing AI policies and evaluation standards, advance AI competency development and set boundaries for nursing judgement that ensure safe, ethical and accountable use of AI in healthcare.

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