Artificial intelligence in nursing: a systematic review of attitudes, literacy, readiness, and adoption intentions among nursing students and practicing nurses
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Background: Artificial intelligence (AI) could reshape healthcare delivery, but its adoption depends on nurses' attitudes, literacy, readiness, and intentions. Methods: Following PRISMA 2020, we searched six databases from inception to May 2025 and undertook thematic synthesis. A non-systematic horizon scan (June–August 2025) informed interpretation only. Results: Thirty-seven studies met inclusion: 28 analytical cross-sectional surveys, 8 qualitative studies, and 1 quasi-experimental trial. Nursing students generally held moderately positive attitudes towards AI; senior students were more enthusiastic than juniors, and men more than women. Students reported moderate literacy and readiness; prior AI training and stronger computer skills correlated with more favourable attitudes and greater adoption intentions, whereas anxiety dampened readiness. Many students doubted AI's ability to outperform humans in routine tasks and flagged integrity risks, underscoring the need for age-appropriate instruction and safeguards. Practising nurses expressed moderate safety and error concerns but showed greater optimism among younger staff; across studies, nurses consistently argued AI should augment—not replace—human empathy and judgement. Targeted training substantially improved, and largely maintained, AI knowledge; leadership endorsement and phased, user-centred roll-outs strengthened readiness, while outdated infrastructure, resource constraints, ethical/privacy concerns, and fear of deskilling impeded progress. Determinants of attitudes and intentions clustered around perceived usefulness/performance and effort expectancy, self-efficacy, digital literacy, and facilitating conditions. The horizon scan added signals of a preparedness–impact gap among nurse leaders, syllabus/policy language as a faculty readiness multiplier, role-specific adoption gaps (e.g., lower use among head nurses despite positive attitudes), and coexistence of high AI anxiety with positive attitudes in students. Conclusion: Global nursing exhibits guarded optimism grounded in moderate literacy and readiness yet constrained by infrastructural, ethical, and pedagogical barriers. Adoption is driven by perceived usefulness, self-efficacy, and enabling environments, with anxiety and demographics moderating engagement. Priorities include embedding longitudinal AI competencies in curricula, iterative hands-on training, robust governance/ethics, and modernised infrastructure. Evidence dominated by cross-sectional designs and a narrow set of countries should be strengthened through longitudinal and experimental studies that validate psychometrics cross-culturally and link self-reports to objective use and patient-safety outcomes.
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AI adoption is influenced by perceived usefulness, self-efficacy, infrastructure, and leadership support.
“AI adoption is influenced by perceived usefulness, self-efficacy, infrastructure, and leadership support [2,3].”
Nursing learners generally report more favorable responses when AI tools are clearly relevant to clinical practice and introduced with appropriate guidance and support.
“Nursing learners generally report more favorable responses when AI tools are clearly relevant to clinical practice and introduced with appropriate guidance and support [2,10,23].”
Nursing students and practicing nurses often report moderate levels of AI readiness.
“nursing students and practicing nurses often report moderate levels of AI readiness”
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- Authors
- El Arab, R. A., Alshakihs, A. H., Alabdulwahab, S. H., Almubarak, Y. S., Alkhalifah, S. S., Abdrbo, A., Hassanein, S., & Sagbakken, M.
- Affiliations
- OsloMet – Oslo Metropolitan University (NO)
- Corresponding author
- Sagbakken, Mette
- Venue
- Frontiers in Digital Health
- Publisher
- Frontiers Media SA
- Published
- 2025-09-25
- Volume
- 7
- Pages
- 1666005-1666005
- ISSN
- 2673-253X (ISSN-L)
- PMC
- PMC12507812
- OpenAlex
- W4414520430
- Cited by
- 113
- References
- 77
- Citations by year
- 2026: 112 · 2025: 1
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Digital Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Social Sciences › Decision Sciences › Information Systems and Management › Technology Adoption and User Behaviour
- Social Sciences › Safety Research › Ethics and Social Impacts of AI
- Keywords
- artificial intelligence in nursing, nursing students, attitudes toward AI, AI literacy, technology readiness, adoption intention, AI anxiety, AI training, perceived usefulness, self-efficacy, digital literacy, AI ethics and privacy, AI governance, nursing curriculum, AI adoption barriers, human-AI coexistence
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