Volume 18│Issue 2│Summer 2026
We wish to remind our readers that Within REACH submissions are accepted on a rolling basis and that we accept stories and articles related to article critiques, human interest stories, literature reviews, evidence analysis, research, quality improvement, and proposed state or national legislation. Any story that aligns with our REACH professional model of practice is appropriate for peer review and publication. We would especially like to hear from those of you who have a potential Magnet story for our next certification! We want to share all the good work you do for your patients and colleagues. By publishing in Within REACH, we have a recorded source of studies with outcomes and contact information, and there is the potential to collect other stories for our next Magnet survey! Publishing in the Within REACH may also be an option for the Clinical Advancement Program (CAP).
Carilion Clinic Roanoke Campus
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TABLE
OF CONTENTS
1 Editorial — Chris Fish-Huson, PhD, RN, CNE—Editor-in-Chief 4 National Legislation, The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023, Jasmine M. Shorter, BSN, RN 9 Tying our Nursing Reach Model to ANCC's Magnet & Pathway to Excellence, submitted by: Alicia Mcallister, MSN, RN, CPN, NE-BC 14 Article Critique, Tackling Telemetry: A Resident-Led Initiative to Reduce Unnecessary Telemetry Use, Jasmine M. Shorter, BSN, RN 18 Article Critique, Evaluating Sepsis, Tia T. O'Dell, MSN, RN 21 Legislation, A Summary of Bill- S. 921: Tyler's Law, Alexandria H. Gilmore, ADN, RN 24 Proposed National Legislation, Workplace Violence Prevention for Health Care and Social Service Workers Act, Tia T. O'Dell, MSN, RN
RECOGNITION/EVENTS 3 Nursing Research Classes
12 Presentations, Awards & Recognitions
7 WOW Wall—Curiosity, Commitment
28 Carilion Nursing Research Conference Flyer
8 WOW Wall—Collaboration, Compassion
29 Where Our Nurses Have Presented
11 2026 People's Choice Award Winners
30 Nursing Research Conferences
Carilion Nursing Research Editorial Board: Chris Fish-Huson, PhD, RN, CNE - Editor-in-Chief Reviewers
Nancy Altice, DNP, RN, CCNS Desiree Beasley, MSN, RN, CCNS, CCRN Sarah Browning, DNP, RN-BC Charles Bullins, DNP, RN, AGACNP-BC
Carilion Clinic Roanoke Campus
Troy Evans, MSN, RN, CCRN, NHDP-BC, NEABC Laura Reiter, DNP, RN, CRN, CNRN Cindy Ward, DNP, APRNCNS, RN-BC, CMSRN, ACNS-BC
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Basic Nursing Research for Frontline Nurses Finding Answers to Burning Clinical Questions!
This class focuses on evidence-based practice and how to find and use research findings to improve nursing care. It is a single 4 hour class. Prior to attending this class, please consider an area of nursing focus/patient care you would like to explore and bring your ideas to class. You can register in Workday. The dates and locations for classes are: July 23, 2026
8:00am - 12:00pm
CRMH Seay Center Classroom E
September 17, 2026
12:00pm - 4:00pm
CRMH Seay Center Classroom E
November 12, 2026
8:00am - 12:00pm
CRMH Seay Center Classroom E
December 17, 2026
4:00pm - 8:00pm
Virtual Class
Objectives- At the completion of the class, participants will be able to: • • • • •
Define the clinical question Find and analyze the literature Discuss roles and responsibilities in human subject research Communicate findings for making changes in practice Identify resources for supporting nursing research
Space is limited for these informative events. Please register to attend by logging into Workday. If you have any questions, please contact Nursing Research by phone at 266-6216 (76216) or by e-mail nursingresearch@carilionclinic.org. Check out the Nursing Research web page that can be accessed through InsideCarilion.org. If you enroll within 12 hours of the class start time, please email cdhuson@carilionclinic.org to ensure you receive the class invite to Teams. Carilion Clinic is an approved provider of continuing nursing education by the Virginia Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Contact hours provided: 3 For successful completion of the program nurses are required to sign in at the registration table then complete and submit an evaluation form to the activity coordinator at the end of the program. Nurses will receive a certificate of completion for (3) contact hour(s) from the coordinator.
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The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023 By: Jasmine M. Shorter, BSN, RN A current proposed national legislation is "The Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act (of 2023)." This bill was introduced in Senate on March 30, 2023, and is sponsored by Senator Sherrod Brown.1 The bill was then introduced to the House of Representatives on April 26, 2023, and is sponsored by Representative Jan Schakowsky.2 This bill has many different components, but most impactful are the components that would require hospitals to create staffing plans, establish a safe nurse-to-patient ratio, and protect nurses who refuse assignments deemed unsafe due to specific specified criteria, including an unsafe nurseto-patient ratio. Staffing plans would be submitted to the Department of Health and Human Services, also referred to as the HHS. The bill would require a visual post somewhere in each unit regarding the appropriate ratios, and would require each unit to keep records of what the actual ratios are during each shift.1 This is important because it would hold hospitals accountable to their staffing plans, and provide evidence if the hospital was not following the determined nurse-topatient ratios. To determine what ratio is considered safe and acceptable, hospitals would have to follow specific protocols or guidelines which would be outlined to determine the specified safe nurse-to-patient ratio for each unit. The ratios could vary from unit to unit, but once in place, would not be able to be changed by the unit manager or unit staffing director just to suit their preferences for the day. The bill later outlines that a nurse may “object to, or refuse to participate in, an assignment if it would violate minimum ratios or if they are not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing the nurse’s license.”1 This is a phenomenal addition to the proposed bill in order to protect nurses and their licenses. When nurses have too heavy a patient load, the risk of nursing errors increases, which can potentially place the nurse’s license at risk. Nurses work very hard to go through nursing school, obtain their degrees, and pass their licensing exam. It is unfair to knowingly put a nurse in an assignment that jeopardizes all the hard work they put into obtaining their license. I appreciate that this bill offers that protection to nurses and outlines that if a nurse was to refuse an unsafe
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assignment for the aforementioned reasons, the hospital cannot take disciplinary action or any other type of adverse action against that nurse. The bill also states that the "HHS may impose civil monetary penalties on hospitals violating the ratio requirements and must publish the names of such hospitals.”1 This is an important addition to the bill because it would encourage hospitals to be compliant with their staffing ratios to avoid fines. This bill differs from current law because currently, there is no federal law requiring safe minimum nurse-to-patient ratios. Staffing rules vary by state and hospital. For example, Virginia does not currently have a legally mandated nurse-to-patient staffing ratio for hospitals.3 In fact, California and Massachusetts are the only two states that have legally mandated nurse-to-patient ratios, though California is the only state that has a comprehensive legally mandated nurse-topatient ratio for every hospital unit, while Massachusetts only has a law specific for ICU nurse-topatient ratios (1:1).4 This new proposed federal legislation would be huge, creating national minimum staffing standards which would apply to every individual state. It would offer both job protection and license protection to nurses who refuse unsafe assignments. I am hopeful that this bill will eventually pass and become law. Per the congress.gov website, this proposed bill’s latest action was being referred to the Subcommittee on Health on 12/17/2024.2 It seems like this bill has been pending for a long time, having originally been introduced to the Senate and House of Representatives in early 2023. However, many bills take months to years of reviewing, discussion and adjustments depending on their complexity prior to being passed and signed into law. This is especially true with federal legislation, as the impact spreads across all 50 U.S. states. Even the nurse-to-patient staffing ratio law for California alone reportedly took five years to be enforced from the time that it was initially introduced.4 The impact of this law would be substantial. The law mandating minimum nurse-to-patient ratios would in turn lead to safer patient care, due to a more appropriate workload for the nurse. For the same reason, it would reduce nurse burnout by making their jobs more manageable, and likely lead to lower nurse turnover due to improved working conditions. With safer assignments, there would potentially be fewer nursing and medical errors as well. While this bill would be phenomenal for nurses, I think it would be more of an issue for hospitals and staffing directors, as they cannot always control the number of incoming patients and these patients still require care, Continued on next page
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regardless of what the ratio mandates. Further discussion may need to be carried out to come up with a safety net plan for these incidences. All in all, I think that this is a great bill that supports nurses and should be signed into law. I am hopeful for myself and every nurse across the U.S. that one day soon, it will!
Citations: 1. Library of Congress. S.1113 - 118th Congress (2023-2024): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023. Congress.gov. Published 2023. https:// www.congress.gov/bill/118th-congress/senate-bill/1113
2. Library of Congress. H.R.2530 - 118th Congress (2023-2024): Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2023. Congress.gov. Published 2023. https:// www.congress.gov/bill/118th-congress/house-bill/2530
3. Legislative Information System. 12VAC5-371-210. Nurse staffing. Virginia.gov. Published 2023. https://law.lis.virginia.gov/admincode/title12/agency5/chapter371/section210/
4. Davidson A. Nurse-to-Patient staffing ratio laws and regulations by state. nursejournal.org. Published March 21, 2023. https://nursejournal.org/articles/nurse-to-patient-staffing-ratio-lawsby-state/
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On Friday, June 12th, Amy Matthews, NRV Rehab Manager, was eating lunch at her desk and talking on the phone when she began to choke. She realized that she needed help, but she couldn’t speak, so she stepped out of her office. Sheena Gum, NRV Rehab CTL poked her head out of her office to ask Amy if she was okay, but all Amy could do was shake her head “no” and give the universal “hands around the throat” choking sign.
Courage!
Amy said that Sheena immediately kicked into action and started the Heimlich maneuver. Amy has no idea the number of abdominal thrusts performed, but during this time she could not get any air at all. She remembers thinking, “They’re going to have to do CPR” because she sensed that she was about to stop breathing. Finally, she felt something in the back of her throat. Although hesitant to do a “blind finger sweep”, she thought it was worth the risk. After the sweep, the object dislodged on the next thrust! She immediately could breath, the crisis was over! Amy said that Sheena "is constantly doing something to help me, and I often tell her she's a 'lifesaver'... but now she literally is MY Lifesaver!!" Amy also credits her co-workers for being there the whole time, ready to take over or help. Amy said, "I'm very thankful and blessed!"
Commitment As part of nurses week, the Nursing Recognition Council celebrated with Nursing Superlative Awards! This year we are pleased to announce our winner of "Nurse of the Year" is Kyleigh Bradley! Kyleigh is a Clinical Professional Development Coordinator who works on 9MICU/10MICU. Congratulations Kyleigh!
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Collaboration!
We proudly welcome 72 S.O.A.R. (Seeking Opportunities, Aspirations, & Results) Nurse Externs to Carilion, representing 20 nursing programs. This incredible group includes 35 rising seniors participating in our 8-week summer pathway and 37 students in our flex pathway.
Compassion! Congratulations to Jeremy Howard, RN Case Manager with Carilion Clinic Hospice - Roanoke. Jeremy is this month's recipient of the Oakey's Caregiver Award. This honor is awarded to hospice clinicians who provide exceptional care, comfort, and compassion to patients and their families. Congratulations, Jeremy for reflecting the best in hospice care!
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Tying our Nursing REACH model to ANCC's Magnet & Pathway to Excellence
Submitted by: Alicia Mcallister, MSN, RN, CPN, NE-BC Carilion’s Nursing Professional Practice Model, REACH, closely aligns with the principles of both the Magnet Recognition Program and the Pathway to Excellence Program. These prestigious designations foster a culture of nursing excellence where team members feel supported, valued, and empowered to provide exceptional care while achieving exemplary patient outcomes. The five components of the REACH model guide nursing practice and help drive strong empirical outcomes for patients and their families while sustaining healthy and positive work environments for all staff.
Research Through research and innovation, bedside nurses leverage advanced real-time documentation and reporting tools to accurately collect, analyze, and evaluate data. This information helps identify unit goals, opportunities for improvement, and strategies that advance professional nursing practice. Nurses are encouraged to share best practices, ask questions, and incorporate evidence-based care into their daily practice. Access to resources such as the Carilion Institute for Research and Development, the Health Sciences Library, the Simulation Center, and Elsevier’s Clinical Skills supports ongoing learning, innovation, and the translation of evidence into practice.
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Education Carilion promotes transformational leadership and professional growth at every level of nursing practice. Through comprehensive onboarding, transition-to-practice programs, nurse residency, mentorship, continuing education, certification support, the CAP Clinical Ladder, and the Institute for Leadership and Effectiveness, nurses are provided opportunities to develop their skills, advance their careers, and prepare for future leadership roles through intentional succession planning.
Advocacy Nurses play a vital role in identifying gaps in patient care and the overall patient experience. They are empowered to advocate for patients and implement personalized care initiatives that promote safety, quality, and outcomes that exceed expectations. Advocacy extends beyond the bedside, encouraging nurses to influence positive change within the organization and the communities they serve.
Clinical Decisions Carilion fosters a culture of nursing voice, shared decision-making, and professional governance at all levels. Nurses are empowered to actively participate in decisions that influence their practice and improve the health and well-being of the community. Collaboration with interprofessional team members ensures that plans of care reflect the best interests of patients while also supporting staff safety, engagement, and well-being.
Human Touch Compassionate, individualized care begins with caring for those who provide it. By integrating wellness initiatives, recognition programs, mindfulness activities, and debriefing opportunities following stressful events, Carilion supports the emotional and professional well-being of its team members. These efforts help staff maintain resilience, refill their cups, and continue delivering exceptional care with empathy and compassion. These distinguished nursing designations serve as beacons to our community, demonstrating Carilion’s commitment to nursing excellence and professional empowerment. Through the REACH Professional Practice Model, nurses are encouraged to embrace innovative, evidencebased practice; empowered to lead and advocate for patients; supported in providing safe, compassionate care; included in decisions that shape their practice and well-being; and recognized for their contributions and achievements. Together, these principles create an environment where nurses thrive and patients receive the highest quality care.
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2026 People's Choice Award Winners
Congratulations to our 1st place winners: Taylor Basham, Thomas Leen, Britney Meurer, Cody Peery, & Brittany Hendricks
This year with the votes being so close we have an honorable second place: Congratulations to Micheline Brunner
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January - March 2026 PRESENTATIONS Bath, J. (2026, February 4). Traumatic brain injury [invited presentation]. Virginia Tech bioengineering & neuroscience students. Blacksburg, VA.
Bath, J. (2026, March 21-24). Standardized critical care training improves paramedic confidence in Critical care management. Society of Critical Care Medicine- 2026 Critical Care Congress, Chicago, IL. Beels, S. (2026, March 29-April 1). Building skills: How simulation training shapes CRRT nurses at the bedside. AKI & CRRT 2026 Conference. San Diego, CA. Gillenwater, A. (2026, March 23-26). Unlock. Turn. Transform: Making learning come alive. Vizient/AACN Nurse Residency Program Conference 2026. Phoenix, AZ.
PUBLICATIONS Price, L., Harvey, E., Carter, K.F. (2026) An innovative online approach to certification success. Journal of Emergency Nursing, S0099-1767 (25)00470-2. Advance online publication. http:// doi.org/10.1016/j.jen.2025.11.015 Bath J, Boone S., Faulks E., Bernier C., Rose-Inman H., Harvey E., Bean S., Lamb G., Collier B., Hamill M. (2026). 617: Standardized critical care training improves paramedic confidence in critical care management. Critical Care Medicine 54(3S). DOI: 10.1097/01.ccm.0001184464.41617.b7
Nicely S., Bath J., Boone S., Faulks E., Lamb G., Hamill B., Harvey E., Collier B., Hamill M., (2026). 618: Physician assistant confidence improvement in critical care management after standardized training. Critical Care Medicine 54(3S). DOI: 10.1097/01.ccm.0001184468.51601c3
April - June 2026 Presentations
Adkins, A. (2026, April 17). Challenges and opportunities in pediatric and neonatal vascular access: Can we move the needle on venous depletion. Arizona Vascular Access Network (AzVAN) conference, Phoenix AZ. Adkins, A., Perry, M. (2026, May 1). Into to NPD: Supporting clinical nurses transitioning to NPD practice. 2026 Pathways to Knowledge Nursing Education Conference, Richmond, VA. CRMH Research Day April 21, 2026 Oral: Maimuna Jatta. Impact of alcohol-based hand rub (ABHR) on the bacterial bioburden of gloves used during direct patient care Posters: Jessie Rose, Sandra Andrews, & Ellen Lockhart. Increasing NICU and wellborn staff knowledge and confidence in caring for cleft lip and palate patients Melissa Goad, Cindy Ward, Maribeth Greenway, & Hayley Andrews. Using the AHRQ CUSP method to decrease CLABSI on a hybrid PCU/ICU Arts & Science of Nursing Showcase Virtual Posters May 6-15, 2026 Suzanne Beels & Sarah Stover. Building skills: How simulation training shapes CRRT nurses at the bedside. Melissa Goad, Cindy Ward, Maribeth Greenway, Haley Andrews, & Ruth Ndolo. Using the AHRQ CUSP method to decrease CLABSI on a hybrid combined PCU/ICU. Thomas May, Sara Brown, Daniel Myers, Robert Dingus, & Phyllis Whitehead. Integration of pallliative care triggers during IDR's in an ICU. Rachel Altizer & Robin Woody. Collaborative rounding with bedside clinicians: Focus on proactivity not reactivity. Marisa Doran, Carter Colwell, Bernard Boalang, Lamiere Downing, Ashish Raju, Michelle Martin, Erin Sydenstricker, & Suzanne Beels. TCAR utilization and access: Comparing community and tertiary hospitals. M. Colette Carver, Nicole Hosey, Dedria Sowder, & Jocelyn Venable. Increasing depression screening through data transparency and workflow alignment. Amy Lucas & Kathleen Manchin. Piloting objective criteria for nurse driven indwelling urethral catheter removal protocol. Continue to the next page
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PRESENTATIONS, AWARDS & RECOGNITIONS April - June 2026 (Continued) Arts & Science of Nursing Showcase Virtual Posters, May 6 - 15, 2026 Jessie Rose. Increasing NICU and wellborn staff knowledge and confidence in caring for cleft lip and palate patients. Rachel Altizer & Wendy Davis. B.R.U.S.H. campaign: Improving nursing documentation and engagement surrounding oral care. Kaleigh Schmucker, Amy Lucas, & Robert Dingus. Decreased falls after intensive intervention. Taylor Basham, Thomas Leen, Britney Meurer, Cody Peery, & Brittany Hendricks. Empowering frontline nurses: Implementation of a unit-based quality council to improve ICU quality metrics. Micheline Brunner. Closing the documentation gap: Improving nursing EHR efficiency through analytics-driven initiative. Amy Lucas. Ticket to test for urine cultures. Tonya Kelly. Medication barcode scanning: Enhancing safety & efficiency in healthcare. Peer-Reviewed Publications Jatta, M., McDaniel, L., Nowak, E., Harvey, E.M. (2026). Infection prevention and control in the intensive care unit: Preventing the spread of multi-drugresistant organisms. Critical Care Nursing Clinics of North America. Advance online publication available June 22, 2026. Bailey, B., Garrity, B., Jones, B., Carter, K. F. (2026). Implementing an admission-discharge nurse program to improve patient and nurse outcomes: A quasi-experimental study. Nursing, 56(6), 54-61. https://doi.org/10.1097/NSG.0000000000000401
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Article Critique "Tackling Telemetry: A Resident-Led Initiative to Reduce Unnecessary Telemetry Use" by: Jasmine Shorter, BSN, RN Overall study question: This quality-improvement initiative study was developed to help determine a method to improve telemetry ordering practices. The background of this study points out that "the overuse of telemetry without indication leads to alarm fatigue, unnecessary costs, and reduced patient satisfaction"1 without necessarily improving their outcomes. The methods used to answer the question: In this study, education sessions were held for the providers responsible for placing admission and telemetry orders. The education was based off the AHA Best Practice guidelines. It is unclear if these sessions were mandatory for the providers to attend or not. In addition to education sessions, physical reminders were posted around the provider work areas to help remind them of the new guidelines for ordering versus not ordering telemetry monitoring. Upon admission, two separate physicians to review the need for the telemetry order 48 hours later. A pre-post analysis following AHA Best Practice guidelines was used to determine if the patients ordered to be on telemetry monitoring met the appropriate criteria to have those orders in place.1 1. General information a. Was the design appropriate to answer the study question and clearly identified? The design was clearly identified in the study, where it states "we designed a qualityimprovement study using a pre-post analysis to measure the effect of education on appropriate telemetry ordering. Telemetry orders upon admission to a tertiary care center were analyzed by 2 physicians based on the 2017 AHA Best Practice guidelines. The same orders were then reevaluated at 48 hours to assess whether telemetry remained indicated or was appropriately discontinued."1 The design was adequate but could have been more detailed in regard to what specific measurements or criteria were being evaluated for telemetry monitoring appropriateness. Without much concrete evidence to go off of in this study, the design seems rather broad and potentially leaves a lot open to various interpretations.
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b. Was the sample size adequate (how did authors determine sample size)? The sample size was determined by using the number of admissions in the local authors1 hospital over a two-week period. 156 admissions were analyzed prior to the intervention, and 110 admissions were analyzed after implementing the intervention.1 I would not consider this sample size to be adequate to deem the effectiveness of the interventions. According to the statistics found on the American Hospital Association website, almost 100,000 patients are admitted to the hospital on a daily basis across the United States.2 A much larger sample size, spanning across more than one hospital, would be much more appropriate to accurately deem the effectiveness of the interventions performed. c. What was the intervention, instruments/measures used? Were these appropriate? "Interventions included an educational lecture given to the teaching hospitalists and internal medicine residents regarding the AHA Best Practice guidelines. In addition, physical reminders were posted near telemetry stations in the hospital. After the educational intervention, telemetry orders were analyzed in the same fashion over a 2-week period. Results were analyzed for signif-icance with a chisquare test using a P value of significance set to 0.05. Charts of patients who did not have a telemetry order on admission or had telemetry appropriately discontinued were not re-visited during the study."1 Using AHA Best Practice guidelines was an appropriate benchmark to determine the need for telemetry monitoring in admitted patients. Providing educational sessions to the doctors was appropriate to ensure everybody received the same training pertaining to the recommended guidelines. Posting physical reminders is overall very helpful when implementing new changes, because people often revert to their old "habits" without adequate reminders. Measurements for these study results would be more accurate if they had been taken for longer than a 2-week period, and conducted through a larger number of hospitals. d. What were the outcomes of the study? "The proportion of appropriate telemetry orders on admission significantly increased from 60.9% to 73.6%. No significant change was observed in appropriateness at 48 hours with 37.9% and 39% of orders deemed appropriate pre- and post-education, respectively."1 e. Are the results clinically significant? Are the results relevant to practice?
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The results have potential to change the current ways that telemetry monitoring is ordered and continued versus discontinued during inpatient admission stays. There was a 13.4% change in the proportion of appropriate telemetry orders upon admission, which I would consider to be significant. There was not much change at all in the observed appropriateness at 48 hours. The results are very relevant to practice as almost every U.S. hospital uses telemetry monitoring, and the inappropriate overuse of telemetry monitoring contributes to alarm fatigue, increased costs to the organization and patients, and often causes frustration for hospital staff and patients dealing with extra lines getting tangled and in the way. 2. Conclusions a. How can the results be applied to my patient care? I can be more mindful about the telemetry orders I see placed on my patients. I have been nursing for almost 5 years in the Emergency Department, and most of the time can predict if a patient will require telemetry monitoring or not based on their chief complaint and/or current symptoms. If I see a patient that does not seem like they need telemetry monitoring even though it's ordered, I can at least speak with my provider to verify that the orders are indeed appropriate. Working in the Emergency Department, patients are often automatically placed on the monitor simply for convenience. When we get EMS squads, it is like second nature to most of us to go ahead and connect the patient to telemetry monitoring. This study is a good reminder that not all patients require telemetry monitoring, and by placing patients on the monitor unnecessarily, it can easily do more harm than good. b. Will the results help me in caring for my patients? I do believe the results will help me in caring for my patients, by reminding me to be more proactive in evaluating the appropriateness of telemetry monitoring orders. 3. Overall Assessment a. Take-home message—how (or not) were the findings of this study relevant to practice? The findings of this study are relevant to practice because many patients are inappropriately placed on telemetry monitoring, which as aforementioned, increases alarm fatigue,
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patient frustration, and can even unnecessarily increase safety risks and fall risks due to the many extra lines present for telemetry monitoring. The study points out that with better practices and guidelines; there are ways to reduce the amount of patients placed on telemetry unnecessarily. b. What would you like your colleagues to know from this article? I would like my colleagues, particularly the providers, to understand that though telemetry monitoring may seem like a simple, harmless "why not?" order to put in, the unnecessary use of telemetry increases alarm fatigue, patient frustration, and unnecessary costs to the organization. The appropriateness of telemetry monitoring orders helps to improve patient safety, contributes to a smoother workflow, and decreases alarm fatigue. c. Would you recommend this article to your colleagues? Yes. Even though the study could have been much more detailed and accurate in some areas, I do think it brings attention to the high rate of unnecessary telemetry orders in hospitals and this study naturally urges the reader to be more mindful about telemetry orders on their patients.
Citations:
1. Jamal H, LaLoggia M, Boggarapu S, et al. Tackling Telemetry: A Resident-led Initiative to Reduce Unnecessary Telemetry Use. JACC: Case Reports. Published November 3, 2025. Accessed May 11, 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC12714514/
2. American Hospital Association. Fast Facts on U.S. Hospitals, 2025. American Hospital Association. Published January 2025. Accessed May 11, 2026. https://www.aha.org/statistics/fast-facts-us-hospitals
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Article Critique, Evaluating Sepsis By: Tia O'Dell, MSN, RN Overall Study Question Sepsis continues to be a major cause of illness and death and is something we deal with every day in the emergency department. Because of this, hospitals place a strong emphasis on compliance with the Centers for Medicare and Medicaid Services (CMS) Early Management Bundle for Severe Sepsis and Septic Shock (SEP-1). The purpose of this study was to determine whether meeting SEP-1 bundle requirements actually translated into better outcomes for patients with severe sepsis and septic shock. Specifically, the authors looked at whether bundle compliance affected mortality, hospital length of stay, and ICU length of stay. Methods The authors performed a retrospective study at a community hospital and reviewed two years of patient records. During that time, 577 adult patients met the study’s inclusion criteria for severe sepsis or septic shock and qualified for SEP-1 review. The authors noted that a higher percentage of patients who presented with sepsis on admission were in the group that was compliant with the SEP-1 bundle. Patients were divided into groups based on whether they received care that met SEP-1 bundle requirements. The authors then examined mortality, hospital length of stay, and ICU length of stay to determine whether compliance with the bundle was associated with improved outcomes. Critique General Information The retrospective design was appropriate for the study question. Since the goal was to determine whether bundle compliance was associated with patient outcomes, reviewing existing records provided a practical and ethical approach. It would not be reasonable to intentionally withhold recommended treatment from patients in order to compare outcomes. The sample size of 577 patients who met the study’s inclusion criteria from two years of patient data provided a reasonable amount of information for a single-center study. Although a larger multicenter study would strengthen the findings, the authors acknowledged that the study may not have had sufficient statistical power in the multivariable analysis to detect a significant relationship between SEP-1 compliance and patient outcomes. continue on the next page
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The intervention studied was compliance with the CMS SEP-1 bundle. The outcomes measured included mortality, hospital length of stay, and ICU length of stay. These outcomes were appropriate because they represent outcomes that matter to both patents and healthcare providers. Interestingly, the study found that bundle compliance was not a statistically significant predictor of mortality or length of stay. Despite maintaining high compliance with SEP-1 measures, the hospital did not demonstrate improved outcomes based on compliance alone. The authors suggested that one possible explanation was that some patients arrived after sepsis had already progressed to a critical stage. Although they received timely antibiotics and appropriate treatment after arriving at the hospital, the severity of their illness may have limited the impact of meeting the SEP-1 bundle on patient outcomes. I found these results clinically significant because they support something many nurses and providers recognize in practice. Meeting quality measures is important, but patient care is more than checking boxes. Early recognition, timely interventions, reassessment, and clinical judgment still matter. Conclusions This article was particularly relevant to my practice as an emergency department nurse. In our department, every patient is screened for sepsis during triage. If sepsis markers are present, a sepsis alert is initiated automatically to help ensure timely interventions. Early recognition is a priority, and this process allows treatment to begin quickly. What stood out to me was that although protocols are bundle compliance are important, they are only one piece of the picture. In the ED, some septic patients are obvious and some are much more subtle. I've seen patients come in with vague complaints or abnormal vital signs that didn't initially look impressive but turned out to be very sick. Those patients require nursing assessment, experience, and frequent reassessment. This article reinforced the importance of maintaining a high index of suspicion and continuing to use critical thinking. Timely labs, blood cultures, antibiotics, fluids when appropriate, communication with providers, and reassessment all play an important role in caring for these patients. Having protocols in place helps, but they do not replace bedside nursing judgment. Overall Assessment The biggest takeaway from this article is that SEP-1 compliance alone may not improve mortality or length of stay. Protocols provide an important framework, but they should support clinical judgment rather than replace it.
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I think this article would be valuable for emergency department and critical care staff because it highlights the importance of balancing evidence-based guidelines with individualized patient care. In our emergency department, every patient is screened for sepsis during triage, and sepsis alerts are initiated whenever criteria are met. This standardized approach promotes early recognition, but the patient's presentation and response to treatment still require ongoing assessment and critical thinking. As Ed nurses, we are often the first people to recognize when something just doesn't seem right. Sometimes that instinct comes before the lab work or before a patient clearly meets criteria. This article reinforced that while protocols are important, our assessments, communication, and reassessments remain essential to getting septic patients identified and treated quickly. I would recommend this article to colleagues because it serves as a good reminder that quality care involves more than meeting metrics-it involves recognizing the patient in front of us and responding accordingly.
Reference Lawrence JR, Lee BS, Fadahunsi AI, Mowery BD. Evaluating sepsis bundle compliance as a predictor for patient outcomes at a community hospital: a retrospective study. J Nurse Care Qual. 2024;39(3):252-258. Dot:10.1097/NCQ.0000000000000767
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A Summary of Bill- S. 921: Tyler’s Law By: Alexandria H. Gilmore, ADN, RN “Tyler’s Law” was proposed when Tyler Shamash of California died in 2018 from a fentanyl overdose. Detection was missed due to the test not being sensitive to fentanyl. His family did not find out the death was due to fentanyl until his family received the autopsy report five months after his death. Tyler was only nineteen at his time of death. Tyler’s Law was proposed by Tyler’s mother, Juli Shamash, to try to save other families from the heartbreak she and her family have endured this tragedy. Tyler’s Law was originally passed in California in 2022. Tyler’s Law was then passed in the Senate on March 23, 2026, and will be moving up to the House for consideration next. The bill’s sponsor is Jim Banks. He is a republican Junior Senator for Indiana. This bill has a 70% chance of being enacted and has thirteen cosponsors. The bill outlines further testing in the emergency room setting that includes detection of fentanyl. According to a fentanyl research page, “In 2021 alone, over 107,000 Americans died of overdoses— the highest total ever recorded. Nearly 71,00 of those 2021 overdose deaths involved synthetic opioids, primarily fentanyl. This means fentanyl is now linked to roughly two-thirds of all fatal drug overdoses in the U.S.” We also know that addiction has no stereotype. Addiction does not care about your age, race, sex, religious beliefs or financial status. Addiction, especially fentanyl, has no discrimination. With an epidemic this ramped, why is this drug not on a standard test? Could a dose of Narcan saved Tyler’s life had the test been done? In California when this event occurred, fentanyl was obviously not in the current law to be mandated to test during a routine emergency room drug test. Some hospitals had made it their own policy to test, but it was not a mandated law. After Tyler’s mom fought for this testing to be put in place, four years after her son’s death, her wish became a reality. In 2022, the governor of California, Gavin Newsome passed the bill for fentanyl to be included in testing in the state of California. In California when this event occurred, fentanyl was obviously not in the current law to be mandated to test during a routine emergency room drug test. Some hospitals had made it their own policy to test, but it was not a mandated law. After Tyler’s mom fought for this testing to be put in place, four years after her son’s death, her wish became a reality. In 2022, the governor of California, Gavin Newsome passed the bill for fentanyl to be included in testing in the state of California.
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Unfortunately, at that time California was the only state that had pushed this bill through. In 2023, a similar bill was passed in Maryland after the tragic death of 31-year-old Josh Siems. Josh’s girlfriend fought for better testing to be put in place, and Tyler’s mother attended the hearing while also testifying with her own personal story. Since then, the states of Virginia, Pennsylvania, and Florida have enacted similar laws in place. Virginia and Florida have also named their bills after young men that have died due to fentanyl overdose. In 2023, Tyler’s mother was ready to take this to the federal level. While legislation at the state level can mandate, laws must be put into place differently at the federal level. The 10th Amendment is in place so that the federal government remains an umbrella to the states to keep them sovereign in their own power. Therefore, the bill had to be tweaked if it was going to make it through the federal court. Finally, in 2026 the bill passed through with the verbiage of the U.S. department of Health and Human Services to guide hospitals towards the standard of care to have full screenings nationwide. This would create more of a guidance from the federal level with the intention of it becoming a national standard. The date for the bill to be heard at the House has not been set yet but should be sometime in 2026. I personally think implementing full drug panels nationwide is extremely important. As healthcare workers we are always evolving and doing our best to keep our patients safe even when they are not always able to keep themselves safe. This legislation would impact healthcare in a positive way. Unfortunately, there are so many street medications, even if they are labeled as one thing can and sometimes are laced. When a patient comes through a hospital emergency department, we have the duty to find out what exactly is in the patient’s system. Patients can be unconscious or not even realize that what they thought they took was in fact something else, and family members may or may not be present or know the whole story either. It is a tragedy that the world has already lost countless lives to the epidemic of addiction, but hopefully through these tragedies we can save more lives by working towards better safeguards in our healthcare system.
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References Tyler’s Law: After losing her 19-year-old son to a fentanyl overdose, Juli Shamash is lobbying for legislation in his name - GovTrack.us. (2025). GovTrack.us.https://www.govtrack.us/posts/499/2025-05-07_tylers-law-after-losingher-19-year-old-son-to-a-fentanyl-overdose-juli-shamash-is-lobbying-for-legislationin his-name Tyler’s Law (S. 921). (2025). GovTrack.us. https://www.govtrack.us/congress/bills/119/s921 1 Sugue, M. (2024, March 19). Fentanyl Statistics 2024: Latest Overdose & Addiction Data, Addiction Group. https://www.addictiongroup.org/resources/fentanylstatistics/
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Proposed National Legislation Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2531) By: Tia O’Dell, MSN, RN Bill Sponsor The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 2531) was introduced by Representative Joe Courtney of Connecticut. The purpose of the bill is to direct the Occupational Safety and Health Administration (OSHA) to establish enforceable standards designed to prevent workplace violence in healthcare and social service settings. Current Law Currently, there is no federal law requiring healthcare facilities to have comprehensive workplace violence prevention programs. OSHA provides recommendations and guidance regarding workplace violence, but these recommendations are largely voluntary. Because of this, healthcare organizations are responsible for developing their own policies and procedures. Some facilities have extensive safety measures and reporting systems, while others may have limited resources or inconsistent processes. This variation creates differences in how workplace violence is prevented, managed, and reported throughout healthcare settings. How the Proposed Legislation Differs from Current Law The Workplace Violence Prevention for Health Care and Social Service Workers Act would require OSHA to establish national standards for healthcare and social service employers. Healthcare organizations would be required to develop workplace violence prevention plans, provide ongoing education and training, maintain logs of violent incidents, and establish procedures for reporting and responding to workplace violence. Frontline staff would also be involved in identifying risks and developing prevention strategies.
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Unlike the current recommendations, these standards would become mandatory rather than voluntary. The goal of the legislation is to create a more consistent and proactive approach to preventing workplace violence and protecting healthcare workers. How the Proposed Legislation Would Impact Nursing and Healthcare Workplace violence affects every area of healthcare. Nurses, physicians, technicians, and support staff are exposed to verbal abuse, threats, and physical violence far more often than should be considered acceptable. Unfortunately, many healthcare workers have come to view these situations as simply part of the job, but they shouldn’t be. As an emergency department nurse, this legislation is particularly meaningful to me because I know how quickly situations can escalate. Patients and families are often experiencing fear, stress, grief, frustration, or mental health crises, and emotions can run high. However, workplace violence is not just an emergency department issue. It affects healthcare workers throughout the hospital. One way our organization has tried to address safety is by focusing on prevention. Every person entering the hospital, including employees, goes through a metal detector. Patients arriving by ambulance are also searched by staff before entering the facility to identify weapons or potentially dangerous items. These measures have helped create a safer environment, but they don’t eliminate the problem. Verbal abuse, threats, and aggressive behavior still occur, and they affect healthcare workers in every department. What I appreciate about this legislation is that it focuses on prevention instead of waiting until something happens and then reacting to it. Requiring healthcare organizations to develop prevention plans, educate staff, tract incidents, and involve frontline workers in safety planning would create a more consistent approach throughout healthcare. More importantly, it reinforces the idea that violence against healthcare workers should never be accepted as part of the job.
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As a clinical instructor, I think this legislation also sends an important message to nursing students and new nurses entering the profession. We spend a lot of time teaching students assessment skills, communication, patient advocacy, and clinical judgment. We should also teach them that being cursed at, threatened, or assaulted is not something they should simply expect because they chose healthcare. Creating a culture of safety starts early and benefits everyone. Most nurses can probably think of at least one situation that stayed with them long after the shift ended. Whether it involved verbal threats, physical aggression, or a situation that escalated unexpectedly, those experiences are not easily forgotten. They contribute to stress, burnout, and even nurses leaving the profession altogether. Supporting healthcare workers and creating safer environments is important not only for staff, but also for the patients we care for every day. Overall Assessment The biggest takeaway from this legislation is that healthcare workers deserve the same expectation of safety that we provide to our patients. While many organizations have implemented security measures and policies, approaches vary from one facility to another. Establishing national standards would create more consistency and place a greater emphasis on prevention instead of simply responding after an incident occurs. Working in healthcare, I've seen how quickly situations can change and how important it is to have systems in place that protect both patients and staff. While no policy can eliminate workplace violence, having prevention plans, education, and reporting systems can help reduce risk and support healthcare workers after an incident occurs. As nurses, we spend our careers advocating for others. This legislation is a reminder that healthcare workers deserve that same commitment to safety. I believe this bill would have a positive impact on healthcare by promoting safer work environments, improving staff retention, and reducing burnout. Most importantly, it sends the message that violence should never be accepted as simply part of being a nurse. I would support this legislation and encourage my colleagues to become familiar with its goals and the positive impact it could have on healthcare workers across all settings.
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Reference Workplace Violence Prevention for Health Care and Social Service Workers Act, H.R. 2531,119th Cong (2025-2026). Accessed June 20, 2026: https://www.congress.gov/bill/119th-congress/house-bill/2531/text
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“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom
Nottingham
Natl. Harbor, MD
Aurora
Williamsburg
Palm
Anaheim
Greenville
Lake Buena Vista
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Thursday, November 12 to Saturday, November 14, 2026 Hilton Garden Inn, Troy NY The 2026 ANA-NY Annual Conference is your opportunity to elevate the essential skills that shape exceptional nurses: communication, leadership, emotional intelligence, and more.
10th Edition of Nursing World Conference October 22 - 24, 2026 Boston, Massachusetts (accessible both online & virtually)
Poster Abstracts are due 10/26/2026
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