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 […]

2026-10-06T09:38:36-04:00October 6th, 2026|Nursing, patient experience, patient safety|0 Comments
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Nurse Voting, New Grad Bullying: And Other October Issue Highlights

The October issue of AJN is now live.

Here are some highlights. Some articles are open access or temporarily free; others will require log-in for access.

On this month’s cover is Flag, a work by California-based fiber artists Deb Cashatt and Kris Sazaki. See On the Cover to learn how they painstakingly created this piece.

“In a political climate marked by uncertainty and profound challenges, the nursing voice remains one of the nation’s most trusted. Democracy is stronger when nurses vote,” writes AJN editor-in-chief Carl Kirton in this month’s editorial.

With Election Day approaching, voting is the focus of an open-access CE article, “Nurse Voting in Ohio Primary Elections: A Cohort Study.” Ruth Ludwick and colleagues examine the voting behavior of LPNs, RNs, and advanced practice registered nurses in three recent Ohio primaries, and how licensure type and age were related to voting. Their findings suggest that the nursing profession has unrealized political power.

An additional CE article, “Immune Thrombotic Thrombocytopenic Purpura: Diagnosis and Management,” outlines the pathophysiology and clinical presentation of iTTP—a rare, life-threatening hematologic disorder—plus criteria for diagnosis and current treatment strategies.

The latest installment in our Strip Savvy ECG interpretation series, “The Impacts of Hypocalcemia on QT Interval Duration,” presents […]

2026-09-28T10:09:51-04:00September 28th, 2026|Nursing|0 Comments
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The Personalities of Veins: What Thousands of IV Starts Have Taught Me

The grape.

“I have rolling veins.”

I’ve heard some version of this warning hundreds of times before placing an IV. When a patient tells me their veins roll, I picture a grape sitting on an empty plate.

Imagine trying to pick up that grape with a fork. If you approach it gingerly, trying to delicately pierce the skin, the grape is likely to slide to one side. Instead, you have to commit. You need a quick, deliberate motion—enough force to pierce the grape, but controlled enough that the fork doesn’t go straight through it.

Some veins are like that.

When I find a firm vein that wants to move away from me, I anchor the vein as well as I can, knowing that doing so may flatten the very spot that initially looked so promising. Then I approach it with measured force—a controlled jab. Enough commitment to enter the vein before it can escape, without so much force that I go through the other side.

Sometimes I explain the grape analogy to patients after they’ve warned me about their rolling veins. It often makes them smile, but it also gives them a way to understand what I’m doing. I may tell them, “It might feel a […]

2026-09-22T09:45:09-04:00September 22nd, 2026|Nursing, nursing roles|1 Comment
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Community Hospital Closures: Raise Your Voice

In my Ohio county, two of our three hospitals have closed since 2025. Here’s what happens when first responders are stretched beyond their limits. In June, 2025, I may have lost a good friend because of delay of care after he was stung by paper wasps in his backyard. He made it into the house where his wife gave him an EpiPen injection, called 911, and gave him two Benadryl tabs. When she went for a glass of water, he lost consciousness.

Minutes passed. She called 911 again and asked where they were. “Oh, we patched that over to the next township,” she was told. “Both of our squads are out on other runs.” His wife is a small woman and did not know CPR. His breathing slowed, his color became dusky, and then he quit breathing. More time passed. When the squad finally arrived, they assessed, quickly put him on the floor, intubated, started a line, CPR, AED, all of that. He was in pulseless electrical activity and never regained consciousness.

They transported him to the now closest hospital, which was nearly 16 miles away. His wife called me when they were en route and said, “I think he’s already dead.” We were […]

2026-09-08T11:18:48-04:00September 8th, 2026|Nursing|0 Comments
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One Question That Can Change the Diagnosis: Why Travel History Matters

A college student presents to the emergency department with fever, nausea, vomiting, and diarrhea after returning from a spring break humanitarian mission trip to Haiti. During the nursing assessment, the patient reports having brushed their teeth with water that might have been untreated and recalls receiving multiple mosquito bites. What might at first appear to be a routine case of gastroenteritis comes in this case with concern for dengue, malaria, typhoid fever, or cholera. The patient’s travel history changes not only the differential diagnosis but also the urgency of testing, treatment, and infection-control decisions.

One simple question can change a patient’s outcome: Have you traveled recently? According to the CDC, nearly half of travelers to low- and middle-income countries become ill during or after travel. Although many illnesses are mild, some require hospitalization, and others may not become apparent until weeks or even months after returning home. Some syndromes can present years after travel.

Why travel matters.

According to the WHO, international travel is on the rise. Millions of people are traveling for professional, personal, and humanitarian reasons. International travel exposes people to infectious diseases that may be uncommon in the United States. Contaminated food and water, insect bites, animal exposures, health care […]

2026-08-28T09:50:45-04:00August 28th, 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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