Unit Consciousness, the Unseen Hands of Nursing, and the Environment of Care

One afternoon, in the first few years of my practice in the operating room, a spine surgeon asked me to tidy up the room in the middle of a major case.

Some spine surgeries require two or more stages. In this case, after the implantation of vertebral spacers, the patient would be repositioned from a side-lying position to a prone position so that decompression and posterior hardware implantation could be completed. The transition requires a great deal of work. Drapes come down, dressings are applied, and an anesthetized patient must be carefully moved. Many hands are needed and much care must be taken.

All of this work takes place in the aftermath of surgery. Anyone who has seen an operating room at the end of a procedure understands the challenge. There may be spills and splashes, wires, dropped instruments, packaging, and equipment arranged for the demands of the first stage of the case.

When the second surgery was underway, the surgeon asked me, as the circulator in charge of the room, to get the OR put back together.

Becoming aware of the environment of care.

At the time, I did not fully understand why he cared about this. But he understood something that I did not.

In those early years, […]

2026-10-06T09:38:36-04:00October 6th, 2026|Nursing, patient experience, patient safety|0 Comments
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Beyond Environmental Services: Common Cleaning Gaps in Patient Care

During rounds in an outpatient clinic, I noticed staff cleaning vaginal ultrasound probes between patients with a quaternary ammonium disinfectant wipe (a low-level disinfectant appropriate for use on devices that come in contact with intact skin).

When I asked about the process, the staff explained that because the probe was covered with a probe cover, they assumed a disinfectant wipe was sufficient. While probe covers provide an important layer of protection, they can leak or develop microscopic perforations. Because contamination can still occur, these probes should always be treated as if they have contacted mucous membranes and require a high-level disinfectant (appropriate for use on devices that come in contact with mucous membranes or non-intact skin) instead of a low-level disinfectant.

Gaps in knowledge and execution.

This type of misunderstanding is not uncommon in health care and illustrates a broader challenge: cleaning failures are often not caused by lack of effort but by gaps in knowledge and execution. Despite longstanding guidance, inconsistencies in cleaning and disinfection practices continue to be cited during regulatory and accrediting surveys.

The Spaulding classification system.

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2026-06-15T09:46:46-04:00June 9th, 2026|infection control, Nursing, patient safety, Public health|1 Comment
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Cost-Cutting and Nursing: Are We Solving the Wrong Problems?

Courtney Desy, BSN, RN, OCN

Across the country, hospitals are under sustained financial pressure. Margins are thin, reimbursement often fails to cover the cost of care, supply chains remain fragile, and administrative demands continue to grow. Leaders are asked to stabilize organizations while navigating forces largely outside their control.

Those pressures inevitably reach the clinical floor.

In staff meetings, nurses hear familiar refrains: we need to be more efficient, we need to tighten workflows, we need to reduce waste. These requests are rarely made casually or without reason. They reflect real financial strain and genuine concern about sustainability.

But in high-acuity clinical settings—especially oncology—the question isn’t whether efficiency matters. It does.

The question is whether we are starting in the right place.

The Problem with starting at cost-cutting

Nurses are trained to define the problem before proposing solutions. In clinical care, jumping to treatment without understanding the diagnosis is unsafe. Yet in operational decision-making, the process is often reversed.

The implicit starting question becomes:

How do we cut costs?

Once that question is accepted, the solutions are predictable: tighter schedules, compressed staffing, reduced flexibility at the bedside. These approaches may lower expenses in the short term, but they rarely address the forces actually driving financial instability.

From the nursing perspective, that misalignment […]

2026-01-16T15:00:23-05:00January 14th, 2026|nurse staffing, Nursing, patient safety, safe staffing|3 Comments
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Some Gentle Reminders for Ensuring Appropriate Language Interpretation for Patients

Photo by Ling App on Unsplash

When I began nursing school, I never could have imagined how quickly I would be thrust into the heart of health care, quite literally. During my first semester, I started clinical rotations on a cardiovascular unit, where I began to understand the phenomenal intricacies of the human heart. It was a time of discovery, as I learned to navigate the complexities of blood pressure readings, mean arterial pressures (MAP), electrocardiograms (ECGs), cardiac catheterizations, and even the life-changing left ventricular assistive devices (LVADs).

By the time I began my second semester, I found myself in a cardiovascular surgical intermediate care unit, a place that would push me further into the depths of cardiac care. There, under the watchful eye of my clinical preceptor, I had the responsibility of caring for patients who had undergone some of the most intricate and high-stakes procedures imaginable. It was during this semester that I encountered a powerful lesson that has stayed with me long after graduation and well into my early years as a registered nurse.

A lesson in why clear communication really matters.

A Spanish-speaking Hispanic woman with coronary artery disease was admitted to our cardiac unit. Her electronic medical record noted Spanish […]

2025-08-11T14:15:43-04:00August 11th, 2025|family, family experience, Nursing, patient engagement, patient experience, patient safety|0 Comments
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Nurses as Vital Partners in the Fight Against Antimicrobial Resistance

Photo: Shutterstock

Reducing the impact of antimicrobial therapy is a part of fundamental practice for health care providers, pharmacists, microbiologists, and public health professionals. Inclusion of nurses in the conversation regarding actions and implementation to achieve this end has often been an afterthought.

However, the number of nurses practicing across every health care setting makes us critical and active partners. What, specifically, are the roles and actions of nurses in addressing antimicrobial resistance, antimicrobial stewardship (AMS), and safe patient care and outcomes? Let’s first review the basics of the problem.

Nursing Activities Relevant to Antimicrobial Use and Stewardship

The approximately 5.77 million active nurses in the United States are widely trusted and well positioned to provide education on antibiotic use and influence behavior related to antimicrobial therapy. Their universal presence in health care settings empowers them to play a role as frontline actors in antimicrobial stewardship across inpatient, outpatient, and community settings. To make this happen, programs supporting appropriate use require commitment from health care leadership, available expertise in antimicrobial drug use, regular performance evaluation, […]

2025-07-14T10:38:24-04:00July 14th, 2025|Nursing, patient safety|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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