Beyond the Bedside, Behind the Screen: Nursing Judgment Still Matters

I was reviewing a request for admission to a long-term acute care hospital on behalf of a payer. The patient was on a ventilator, and the coverage criteria required documentation of attempted ventilator weaning, including the results of the three most recent attempts. The record indicated that weaning had been attempted, but I could not initially locate those results. Without the required documentation, the request would have been denied. Rather than treating the gap as the whole story, I searched further in the electronic medical record. I found the missing results and could support the requested admission under the applicable criteria.

As part of my role, I followed long-term acute care (LTAC) patients through continued-stay reviews, so I was able to follow this patient’s progress after admission. Over the course of the stay, the patient was successfully weaned from mechanical ventilation and decannulated.

I had not examined the patient at the bedside, but I had recognized an incomplete clinical picture and kept looking. The clinical reasoning that led me to recognize the problem came from the same nursing foundation I had developed years earlier. The criteria mattered: I could not substitute a feeling for evidence. My experience mattered, too: it prompted me to ask whether the […]

2026-11-09T16:46:10-05:00November 6th, 2026|Nursing, nursing career|0 Comments
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The Discomfort of Trying to Create Change in Health Care and Beyond

In complex systems, change takes persistence.

Over the years, coworkers have often described me as “the dog with the bone.” Once I become invested in something, I tend not to let it go. That persistence has helped me create meaningful change within health care systems. It has also shown me how much organization, follow-up, patience, and emotional stamina meaningful change often requires.

I have also learned how often the answer is no. Sometimes the “no” is direct. Other times it comes through silence. Some ideas take longer to gain traction within large organizations than people initially expect. Creating change in any environment can be difficult. In health care systems, it can feel especially challenging.

Health care organizations are responsible for large numbers of patients, employees, regulations, budgets, and risks. Decisions that appear simple from the outside often involve layers of oversight, approvals, coordination, and competing priorities that most people never see. Still, understanding those realities does not necessarily make the process less discouraging.

The temptation to give up.

I have experienced this in clinical practice when advocating for patient education initiatives, operational changes, or workflow improvements that initially seemed straightforward. In health care, even small changes can require multiple approvals, coordination across departments, competing priorities, and months of […]

2026-07-06T11:31:12-04:00July 6th, 2026|career, Nursing, nursing advocacy, nursing career, Oncology nursing|0 Comments
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Rethinking Nurse Identity and Burnout Using Structured Coaching Spaces

Nurses have become fluent in the language of “burnout.” We use the word to describe a range of internal states such as exhaustion, disengagement, frustration, and compassion fatigue, states that are often attributed to staffing shortages and other systemic pressures. The term has become so embedded in our professional vernacular that it risks lumping distinctly different experiences into a single narrative.

Identity erosion as a framing device for understanding burnout.

In my coaching work with nurses, I have found that framing these experiences through the lens of professional identity adds a layer of clarity that is often missing from burnout conversations. Many nurses are beginning to see that their professional identity has been shaped over time by the environments in which they work, sometimes in ways that have lessened their sense of self.

Naming this as identity erosion does not separate it from burnout, but instead helps explain the deeper impact while opening the door to a greater sense of control. This shift in thinking explains why some nurses are asking deeper questions about their values, purpose, and how their work reflects who they are.

To be clear, health care systems deserve scrutiny. Nurses are working within environments that often demand increased productivity while constraining time, autonomy, and […]

2026-06-22T11:15:07-04:00June 22nd, 2026|nurse staffing, Nursing, nursing career|1 Comment
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From Care to Calling: How a Nurse’s Small Act Became a Lifelong Inspiration

Often, the simplest questions lead to the greatest moments of reflection and growth. While serving on a recent panel discussion, I was asked how I knew I wanted to be a nurse? The question offered me the opportunity to reflect on the butterfly effect of one nurse’s actions on the future of a teenage girl.

A mother’s sudden illness

I was 17 years old, a junior in high school, and growing increasingly excited about my first prom. The dress was picked out, the makeup decided, and my high school sweetheart (and current husband) had already asked me to be his date. Just prior to the big day, my mother began experiencing worsening headaches and increasingly noticeable vision changes. Though it was originally written off as stress or typical age-related vision changes, an eye appointment for a new prescription quickly led to a neurology consultation. With roughly 50% of my mother’s peripheral vision already gone, scans were ordered, and a craniopharyngioma was discovered.

Suddenly, prom was the last thing on my mind as my mother was admitted to a local cancer hospital for treatment of a large (noncancerous) brain tumor. Her surgery was scheduled for the day of the big dance. Her last words before being wheeled into surgery were, “When I wake up, the first thing I want to see are pictures of how beautiful you looked at the prom.”

2026-05-04T09:48:29-04:00April 2nd, 2026|career, family experience, Nursing, nursing career, Patients|0 Comments
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Workplace Safety as an Ethical Imperative in Nursing

“How do we honor the role of the nurse by building systems that reflect the same level of commitment they bring to patient care?”

Workplace violence (WPV) remains a persistent and serious challenge in health care. Nurses, bound by the American Nurses Association (ANA) Code of Ethics to provide compassionate care and prevent harm, experience assaults at significantly higher rates than other health care professionals—a trend that intensified during the COVID-19 pandemic. These experiences are not only harmful; they create a profound ethical conflict by directly undermining professional role obligations and disrupting the alignment between ethical expectations and workplace realities. This misalignment diminishes professional role clarity, fosters cognitive dissonance in nurses’ professional role identity, and ultimately strains their commitment to the nursing profession.

Nurses’ ability to uphold compassion and provide nursing care is compromised when their safety is not protected. The 2025 revision of the Code of Ethics, particularly Provision 5, directly addresses this concern. It affirms what we’ve long known to be true:

“The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence.”

This guidance reframes workplace safety—not as a matter of personal resilience or policy—but as an ethical obligation rooted in nursing values and woven into the nursing professional role. It highlights the responsibility of organizations, leaders, and the profession to ensure nurses can […]

2025-04-29T11:25:40-04:00April 29th, 2025|Ethics, Nursing, nursing career, violence against nurses|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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