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Who’s ‘the Hospital’? Shared Governance Requires Transparent Organizational Decision-Making

When ‘the hospital’ speaks as a single, unified entity.

Many nurses working in hospitals do not know the decision-makers who affect their job. To patients, visitors, donors, accreditors, and other external constituents, hospital systems benefit from being personified as a single, unilateral-appearing brand.

Photo by Erik Mclean on Unsplash

However, when a decision is said to have been made by ‘the hospital,’ rather than by a specific person in the hospital, such language obscures who made the decision and why it was made. Lack of transparency around decision-making processes may be one reason some nurses feel shared governance models are more ‘lip service’ than genuine shared decision-making.

A common health care structure is a large system in which one main ‘flagship’ hospital serves as a central hub, with smaller branch hospitals/clinics with the same name and branding serving patients in other locations that may not be able to support a large hospital or multiple medical specialties.

For example, imagine a 20-bed rural hospital that is affiliated with Higher Education University, a hospital system with their main urban campus in a city one-hour away. The rural hospital’s affiliation with Higher Education University’s hospital system is important for external constituents. A patient may perceive that […]

2024-12-09T11:17:04-05:00December 9th, 2024|Nursing|0 Comments
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Recognizing Postnatal PTSD

After the birth of her son, pediatrician Tricia Pil struggled with post-traumatic stress disorder (PTSD). The delivery had been complicated by hemorrhaging, large blood clots, invasive emergency medical care, and fear that she and/or her infant might be dying.

“In the months after my son’s delivery,” she recalled, “it was as if a curtain had descended over my life. In addition to a terrible feeling of numbness, I was haunted by flashbacks and nightmares . . . . Billboards for the hospital where I’d delivered, people dressed in scrubs, pregnant women, . . . and worst of all, my own baby—the sight of any of these could trigger flashbacks and bouts of heart-stopping, sweat-drenched panic.”

Though we typically associate the birth of an infant with relief, joy, and adjustments to a new family member, in some cases the picture is complicated by postnatal PTSD (also referred to as postpartum or birth-related PTSD).

Some women are at higher risk for postpartum PTSD.

Photo by Alexander Grey on Unsplash

Research by Slade and Murphy found that “one-third of women experience giving birth as traumatic, and consequently 3-6% of all women giving birth develop postpartum post-traumatic stress disorder,” adding that many more are likely to have […]

2024-12-04T07:29:16-05:00December 2nd, 2024|Nursing|0 Comments
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The Critical Role of Nurses in Intravenous Fluid Conservation

Image credit: AHVAP.org (Association of Healthcare Value Analysis Professionals)

Baxter International’s North Cove Facility in North Carolina was severely damaged by Hurricane Helene on September 26, 2024. The temporary closure of that facility and production interruption has resulted in significant shortages in intravenous, dialysis, and irrigation fluids and supply disruption impacting health care facilities across the United States. The responsibility to effectively and responsibly manage these critical resources has fallen heavily on the shoulders of nursing teams and health care supply chain professionals.

The crucial role of nurses during shortages.

Nurses are responsible not only for administering IV fluids but also for monitoring fluid needs, assessing patient status, and adjusting plans of care accordingly. When these lifesaving fluids become scarce, nurses must ensure that every intravenous fluid or irrigation product is used wisely, balancing patient safety with resource availability.

Why conservation is essential.

The consequences of IV fluid shortages extend beyond inconvenience. Fluids such as 0.9% normal saline and Lactated Ringer’s are vital in stabilizing patients, hydrating those who cannot take fluids orally and serving as carriers for essential medications. Shortages can lead to critical delays in patient care, increased length of stay, and negative outcomes for patients […]

2024-11-18T13:53:43-05:00November 18th, 2024|climate change, disaster preparedness, environmental health, Nursing, Public health|0 Comments
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Pertussis Rates Have Been Rising: What Nurses Need to Know

Pertussis, or whooping cough, remains one of the leading causes of vaccine-preventable deaths worldwide, with most deaths occurring in young babies who are either unvaccinated or incompletely vaccinated.

During the COVID-19 pandemic, many of the infection prevention and control measures such as masking, social distancing, and remote learning for children resulted in decreases in reported cases of pertussis. However, in 2023 and 2024 a return to routine activities has resulted in an increase in pertussis cases. Preliminary data from the Centers for Disease Control and Prevention (CDC) show that more than five times as many cases of pertussis have been reported as of October 19, 2024, compared to the same time period in 2023. This is higher than was seen during the same time period in 2019, prior to the pandemic. Compounding this problem are the alarming trends showing lower rates of routine vaccination among adults and children, trends which indicate reduced vaccine confidence and increases in vaccine hesitancy in the U.S. population.

Key points of knowledge and action for nurses

Epidemiology of pertussis

Pertussis is caused by Bordetella pertussis, a gram-negative coccobacillus and is highly contagious and easily spread person-to-person via respiratory droplets or through direct contact […]

2024-11-11T11:32:08-05:00November 11th, 2024|infectious diseases, Nursing, pediatrics, Public health|0 Comments
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Blood Culture Bottle Shortage: Reducing ED Utilization in One Health System

Jonathan Nover, MBA, RN
Vice President of Nursing | Emergency Services
Mount Sinai Health System, New York City

The problem.

In early July 2024, a nationwide blood culture bottle shortage was announced. At the Mount Sinai Health System, specifically for our eight emergency departments (ED), naturally high utilizers, it was critical to devise contingency plans to reduce utilization and preserve supplies. Since it was evident early on that ED nursing would play a critical role in reducing utilization and waste, it was crucial to understand our current burn rates, utilization rates, contamination rates, and fill volume rates. We would need to recalibrate our blood culture stewardship and check in with our teams to understand workflows and their knowledge baseline about the nationwide shortage.

Discovering a gap in knowledge.

Through varying methods including huddles; “walking the GEMBA” with nursing leaders, epidemiologists, and infection preventionists; and eliciting transparent feedback we learned very quickly that our ED teams were not all aware of the top reasons for blood culture waste.

A nursing practice alert.

We created a nursing practice alert to highlight several key elements we’d learned . The areas of focus,

2024-09-12T10:31:16-04:00September 3rd, 2024|Nursing|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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