Retzloff’s experience mirrors that of other nurses across HCA Healthcare, the largest hospital chain in the US. Since 2023, HCA has rolled out an AI scheduling tool it co-developed with Palantir called Timpani at roughly 130 of its 190 locations. Retzloff’s hospital adopted it nearly two years ago.

“No one is happy with Timpani,” says Retzloff, echoing what five nurses at other locations reported in interviews with WIRED. “Everyone complains all the time.”Other purported HCA workers have expressed similar gripes about the tool on platforms like Reddit.

The nurses who spoke with WIRED allege that Timpani has potentially harmed patients by causing care teams to be understaffed, imbalanced, and exhausted. Operating with minimal oversight, they say the tool routinely schedules too few nurses or not enough experienced veterans during shifts, particularly on Sundays. It also frequently ignores nurses’ stated preferences for spacing out shifts, working nights and weekends, or taking specific days off.

As a result, nurses say they are being forced to waste more time trying to trade shifts or appeal their schedules than prior to the arrival of the software. They also believe colleagues are increasingly calling out, using paid or unpaid time to skip assignments, though doing so more than a few times annually puts them at risk of termination.

Retzloff, 34, a National Nurses United labor union leader with a decade of bedside experience, recalls recent shifts where all four of her colleagues were junior. Because she was the only senior nurse working, Retzloff says she had to delay care for the sickest patients to guide the novices through milder cases.

HCA is “letting AI dictate,” Retzloff says. “We are overriding clinical judgment and the human-to-human piece of health care with an app.”

Previously, managers handled scheduling manually and generally consulted nurses well in advance when overriding requests. With Timpani, nurses report needing to make alternative arrangements on shorter notice and an increase in temporary reassignments to different teams. “I can’t remember any issues before,” says a non-union nurse in Texas who asked to remain anonymous out of fear of retaliation from HCA. “Everything came out on time.”Harlow Sumerford, an HCA spokesperson, says that nursing leaders, not Timpani, make final scheduling decisions. Assertions that the tool “is designed to reduce staffing at the expense of patient care” are misrepresentative, he adds.

HCA’s goal is “to have the right caregivers, with the right skills and experience, available to meet the needs of our patients while also considering our colleagues’ scheduling preferences,” Sumerford says, noting that the company is continuing to improve Timpani based on nurses’ feedback. “Being Kicked”On average, Timpani schedules nurses for 1 percent of their requested days off, or what are known as red days, according to HCA. Lee Barker, an HCA nurse in Missouri, says while that number might appear relatively low, getting scheduled on red days was previously unheard of at their facility.

But less than a year after management introduced Timpani, Barker says now essentially every nurse has been assigned to work on a day they were supposed to be off. Barker delayed a long-planned doctor’s appointment for a chronic condition after struggling to trade an assigned red day. “It feels like we’re being kicked while we’re already down,” Barker says.

Complaints about Timpani have prompted HCA management to make minor updates to the software, but problems still persist, according to nurses across the US. Leaders of National Nurses United, the labor union representing about 10,000 of HCA’s 100,000 nurses, says the company has rejected their requests for information about the technology.

Some purported details emerged in July when a former HCA data science manager, Angelique Russell, sued the company for allegedly firing her in retaliation for raising concerns about Timpani. She accused HCA of routinely deleting data the tool uses to create schedules, which prevented auditing how well it worked and she claimed may have violated several healthcare laws. (HCA has yet to formally respond in court, and Russell declined to comment.)

Timpani was built on Palantir Foundry, a software platform for storing and analyzing different data from across a company’s operations. Named after the beat-keeping musical instrument, it uses algorithmic forecasts of patient volumes and staffing needs to automatically build nursing schedules. When Timpani launched in 2023, HCA’s top innovation executive Michael Schlosser told WIRED it would save time and money, as well as eliminate favoritism in assigning shifts.

Schlosser said in a paper this past July that Timpani has drastically reduced the number of hours managers spend on scheduling each month, lowered reliance on costly contract nurses to fill shifts, and increased retention. “The efficiency comes from AI generating stronger initial schedules,” he wrote, adding that over 98 percent “include a mix of skill and experiences.”HCA’s responsible AI policy emphasizes protecting individuals from “physical” or “emotional” harms, and executives have said they spoke to nurses and took an empathetic approach in developing Timpani.

In marketing materials, the company features nurses praising the tool for being easy to use and saving them time. Yet other HCA nurses say they feel ignored and disrespected, and they are not the only health care workers who have raised concerns about Palantir’s push into their industry.

Rayus Radiology, a large US imaging chain, began receiving complaints about scheduling errors earlier this year after it introduced a tool also built on Palantir Foundry, according to internal documents viewed by WIRED. The software is designed to populate scheduling fields from doctors’ orders. But in a number of cases, it linked the requests to the wrong patient profiles, listed tests or scans that didn’t match the orders, or made up personal details about patients. Schedulers who work at Rayus suspect that non-standard forms, illegible handwriting, and insufficient human review contributed to the issues.

Rayus spokesperson Kit Crancer says “the broad characterizations” do not fairly reflect its “processes, safeguards, or commitment to safe, accurate, and timely patient care.”He adds that Rayus uses technology “to support, not replace, appropriate human judgment and oversight.”A Palantir spokesperson declined to comment using their name, but the company has described its software as merely presenting information in a more helpful manner and emphasized that customers are responsible for the data, policies, and decisionmaking.

Palantir Anxiety Palantir’s sales have nearly doubled recently to almost $2 billion per quarter, as organizations seek its help analyzing data and automating tasks. Soaring costs and staffing shortages have made health care providers especially eager customers. Cleveland Clinic credited Palantir software with boosting patient capacity by forecasting ER discharges and replacing manual coordination.

But Palantir has also received pushback from civil rights activists over its defense and immigration work, as well as the stated political views of cofounders Peter Thiel and Alex Karp. In the UK, Palantir landed a $440 million contract with the National Health Service to try to cut appointment wait times, but nurses and activists have demanded it be canceled over privacy and security concerns.

At HCA, some nurses also want Palantir gone. While studies show AI-based scheduling holds promise, nurses say Timpani has become a source of anxiety. “Everyone checks immediately and every month you hear, ‘Man, why did it schedule me like that?’”Barker says.

Initially, some local managers could edit Timpani’s schedules. Now, nurses must flag problematic shifts to a centralized team at HCA headquarters in Nashville, which reviews appeals without direct communication or room for explanation, according to nurses. If denied, they try to swap shifts, but the chances of success are about only 50 percent, Barker and Retzloff claim.

Barker, who is a National Nurses United leader at an HCA psychiatric center, claims several colleagues quit over Timpani and that workplace injuries have climbed in the first 12 months with the tool. The center’s union of about 500 nurses filed a grievance over the software, arguing HCA is failing to sufficiently honor scheduling preferences. The matter is likely headed to arbitration.

In Timpani’s early days, HCA’s Schlosser acknowledged health care workers can be slow to adopt tech “because they have people’s lives in their hands.”But he envisioned a future where frontline nurses actively pushed for more tools: “Then it’ll be fun.”Three years later, some nurses see little reason to rejoice.