Nurses Know Safety Can’t Depend on Assumptions

In health care, we are trained not to rely on assumptions. We build systems that anticipate risk, standardize response, and make the next step clear before it is needed. When something goes wrong, we do not improvise. We follow a plan that already exists.

This is why it is so striking to encounter environments where safety depends almost entirely on assumption.

The tragic example of AED accessibility.

I began thinking about this outside of health care. I came to this through someone I know, John Ellsessar, whose life has been shaped by loss. His son, Michael, died at 16 after suffering sudden cardiac arrest on a high school football field where an AED was not immediately accessible.

That experience changed what he did next. It also changed how I think about a question that often goes unasked: What is the plan when something goes wrong?

Consider sudden cardiac arrest. It is one of the few situations in medicine where the response is both straightforward and time-dependent.

When John explained it to me, he put it simply: A heart attack is a plumbing problem, a blocked artery.
Sudden cardiac arrest is an electrical problem. The heart’s rhythm stops. […]

2026-05-15T13:18:43-04:00April 27th, 2026|Nursing, Public health|0 Comments
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What’s in the Air? Rethinking Airflow and Infection Risk in Health Care

Image generated using Google’s Nano Banana 2, 4/20/26.

For nurses, environmental infection prevention is often framed around visible conditions such as high-touch surfaces, shared equipment, and visible dirt. In my experience, airflow and ventilation are not topics that receive significant emphasis in nursing education or orientation. While this may vary by setting, many nurses are left to learn these concepts in practice rather than through formal training.

With the recent COVID-19 and measles outbreaks, there has been more focused attention placed on contaminated air as a risk to patient safety. In my work with health care teams across settings, I’ve found that while nurses are highly attuned to cleaning and disinfection practices, airflow and ventilation are often assumed to be “handled” by the facility operations staff. In reality, these systems depend heavily on how the environment is used at the bedside. Small, routine actions—like leaving a door open or introducing a fan—can unintentionally disrupt carefully designed controls.

This gap in awareness among clinical staff matters. While the Centers for Disease Control and Prevention continues to report progress in reducing health care-associated infections (HAIs), these infections remain at a persistent risk for patients. Expanding the nurse’s focus on the environment to […]

2026-04-22T12:32:28-04:00April 21st, 2026|infection control, infectious diseases, Nursing, Public health|0 Comments
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What’s Lurking in the Sink? Rethinking Water as an Infection Risk in Health Care

Image: Shutterstock

Nurses play a primary role in patient safety through direct care and through the environments in which care is delivered. While clinical responsibilities are well defined, the nurses’ role in promoting a health care environment that prevents health care–associated infections (HAIs) is not always clear.

A recent report from the Centers for Disease Control and Prevention (CDC) revealed that U.S. hospitals saw meaningful declines in several major HAIs in 2024, including Clostridioides difficile (C. diff) infections, catheter-associated urinary tract infections (CAUTIs), central line–associated bloodstream infections (CLABSIs), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Despite the obvious progress, each day, approximately one in 31 hospitalized patients and one in 43 nursing home residents contract at least one HAI in association with their health care. This alarming statistic underscores the need for frontline vigilance by nurses in every clinical setting.

When the Environment Works Against Us

Infection prevention is often framed around what we can see—dirty floors and high-touch surfaces, visibly soiled equipment, and stained linens. Some of the most consequential risks in health care are not visible. One emerging area of concern is the role of health care water systems as reservoirs for pathogens. Surprisingly, it’s not dirty water that’s being scrutinized, but clean […]

2026-04-08T10:03:07-04:00April 8th, 2026|infection control, Nursing|0 Comments
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When Nurses Mobilize: “Professional” Degree Programs

ANA grassroots advocacy manager Katherine Rowe

Few moments in recent history demonstrate the power of nurses as clearly as the fight over the definition of “professional” degree programs. Hundreds of thousands of nurses spoke out against the Department of Education’s proposed definition, loud enough for the issue to gain traction across social media channels and make an impact on Capitol Hill.

How Did We Get There?

We’ve known that the Department of Education (ED) was preparing to scale back support for unsubsidized federal graduate loans; last year’s One Big Beautiful Bill Act (OBBBA) tasked the ED to do so. The question was how. That’s why the American Nurses Association (ANA) pushed for nursing representation on the ED’s Reimagining and Improving Student Education (RISE) Committee and collaborated with partners on strong coalition letters when our calls for including the nurse voice went unheeded.

Despite these efforts, the RISE committee failed to recognize post-baccalaureate nursing programs’ strength and rigor, excluding them from the definition of “professional” degree programs.

Why does this matter? OBBBA eliminated the Grad PLUS Loans program while the RISE committee’s recommendations established two levels of federal student loan limits:

  1. Graduate caps: $20,500 annual / $100,000 total
  2. “Professional” caps: $50,000 annual / $200,000 total

In addition to […]

2026-05-04T09:51:06-04:00March 11th, 2026|Nursing, nursing advocacy, nursing students, Public health|0 Comments
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Multidrug Resistance: A Growing Threat of Carbapenem-Resistant Gram-Negative Organisms in Health Care

Nurses are well aware of the problems with multidrug-resistant organisms (MDROs) and their ubiquitous presence across health care settings. Care issues and outcomes among patients with MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and Clostridioides difficile (C. diff) have increased awareness, but MDROs remain a growing challenge in the provision of care in virtually all health care settings.

Carbapenem-resistant Gram-negative bacteria, another example of MDROs, have emerged as one of the most urgent public health challenges globally. Organisms such as carbapenem-resistant Enterobacterales (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Acinetobacter baumannii (CRAB) are associated with high morbidity, mortality, prolonged hospitalization, and limited treatment options. According to the World Health Organization (WHO), carbapenem-resistant A. baumannii and carbapenem-resistant Enterobacterales are among the highest-priority pathogens due to their rapid spread and severe clinical consequences (WHO, 2024).

Mechanisms of Carbapenem Resistance

Carbapenem resistance develops when bacteria change in ways that allow them to survive despite antibiotic treatment. Nurses and other health care personnel benefit from understanding these mechanisms because they directly relate to infection prevention activities, equipment cleaning and disinfection, and antimicrobial stewardship efforts.

Examples of how resistance develops are outlined below:

  1. Bacteria Produce Enzymes That Break Down the Antibiotic (Carbapenemase production)

Some bacteria create special enzymes that destroy carbapenem antibiotics before they can work. These are called carbapenemases. Common types of these enzymes include KPC (Klebsiella pneumoniae carbapenemase), NDM (New Delhi metallo-beta-lactamase), VIM (Verona integron-encoded metallo-beta-lactmase), IMP (Imipenemase metallo-beta-lactamases), and OXA-48 (Oxacillinase-48).  These enzyme abbreviations/names may be familiar, as they have been seen […]

2026-01-05T11:14:29-05:00January 5th, 2026|infectious diseases, Nursing, Public health|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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