News
Clinical Voices September 2026
Sep 30, 2026
Predicting Falls: Staffing Measures Show Mixed Impact
The findings suggest that appropriate staffing requires speaking with nurses more than relying solely on quantitative reports.
A study finds mixed results in how nurse staffing relates to patient falls, revealing that nurse reported perceptions more accurately predict falls on medical-surgical units, while objective metrics such as RN hours-per-patient-day (RNHPPD) are more closely tied to fall risk in critical care.
“Association of Objective and Subjective Nurse Staffing Metrics With Patient Fall Rate by Unit Type,” in Nursing Outlook, explains that real time judgments align with patient needs on medical-surgical units, where acuity and workload change quickly. But in critical care, consistently high acuity makes objective RN staffing levels a stronger indicator of the care intensity required to prevent falls.
The 2024 analysis of 1,269 adult hospital units shows the strongest staffing effect in stepdown units, where each additional RNHPPD was linked to a 0.36 decrease in falls per 1,000 patient days. This impact reflects the mix of patient mobility and acuity in these transitional units, where fall rates are 2.6 times higher than in critical care. But the study also highlights that metrics alone don’t fully capture all staffing realities.
“Ultimately, our findings suggest that determining appropriate staffing levels requires engaging nurses in dialog about staffing needs more than relying solely on quantitative staffing reports,” the study adds. “The findings linking staffing to falls, while not novel, reinforce the importance of nurses’ voice in determining adequate nurse staffing to reduce the risk of this perennial adverse event.”
A related article in Medical Xpress expands on this idea, emphasizing that nurses’ real time judgment on workload and patient complexity can offer an important safety signal that complements the objective staffing metrics that hospitals typically report.
AACN offers staffing standards for specific patient populations, including adult critical care, adult progressive care and pediatric critical care. These resources give nurses unit specific expectations for safe staffing and provide practical tools to support patient safety across diverse care settings.
What Factors Lead to IV Smart Pump Errors?
Improved understanding of IV medication administration errors is fundamental to patient safety.
Using eye-tracking technology, novice nurses participated in a study to rate four intravenous (IV) smart pumps and determine the one that produced the fewest medication errors and the least cognitive workload during programming testing.
“Usability, Workload, and Error Rates Across Four IV Smart Pumps: A Comparative Study With Novice Nurses,” in Advancing Medical-Surgical Nursing, notes that the Ivenix infusion system produced no observed errors, had the shortest programming times, and generated the lowest perceived workload for the users.
“These findings highlight the critical role of interface design in clinical performance and underscore the importance of integrating human factors engineering into medical device development and procurement decisions,” the study adds.
The study included 31 senior undergraduate nursing students with some clinical experience, averaging 5.34 clinical rotations; 83.9% had previously worked with smart pumps. The Ivenix system produced no errors, compared with 14 errors each with Baxter Sigma Spectrum and ICU Medical Plum 360, and 26 with Becton Dickinson Alaris.
The users also ranked the pumps for preference, with 26 selecting the Ivenix system, which also performed best in every measure of cognitive workload – overall, mental demand, physical demand, temporal demand, performance, effort and frustration. The users corrected errors thanks to system feedback in most cases, but the 12 errors that went uncorrected (compared with 32 corrected) demonstrate a risk to patients.
“This striking variability underscores the complexity of the problem and highlights the need for continued investigation,” the study notes. “Improving our understanding of IV medication administration errors, regardless of experience level, is fundamental to building a stronger foundation for patient safety.”
AACN resources on IV smart pumps include a continuing education webinar series and blog posts on nurses’ role in smart pump safety, secondary infusion and IV pump alarms. AACN Advanced Critical Care include related articles on optimizing patient safety and alarm fatigue.
Protecting Yourself in an Era of Nurse Scrutiny
Nurses who know their rights and responsibilities are better prepared to advocate for patients and communicate clearly.
Nurses are encountering broader legal scrutiny, with malpractice concerns now intersecting with criminal, administrative and workplace reviews in ways that can turn routine decisions and documentation into lasting professional consequences.
“A Primer for Legal Literacy: Beyond Malpractice,” in Advancing Medical Surgical Nursing, looks at what can happen if a clinical event draws legal attention, often in ways nurses don’t anticipate. It explains that everyday charting and quick exchanges may be interpreted differently, shaping how an incident is understood long after it occurs.
The article breaks down four legal systems that can act on nursing practice — civil, criminal, administrative and workplace — noting that each operates under different rules, timelines and evidentiary standards. These systems can also overlap, creating complex situations for nurses to navigate.
Nurses who understand their rights and responsibilities are better prepared to advocate for patients, communicate clearly and respond with confidence when challenges arise. The article emphasizes clear, factual and patient specific charting, noting that documentation should be objective and able to withstand later review.
Common workplace communication, including texts and email updates, can surface in legal reviews, highlighting the growing importance of legal literacy in safe and confident practice. “Incomplete, delayed, inconsistent or copied documentation can raise questions about care, while clear, factual and patient-specific entries support professional credibility,” the article explains.
Workplace behavior can also carry legal and professional consequences, especially when patterns of incivility, bullying or gossip create a hostile environment or raise questions about a colleague’s competence. Social media activity and internal investigations add further risk, making awareness of conduct an important part of protecting practice.
AACN offers an NTI recorded session that explores these issues and gives practical strategies to recognize legal risk in everyday practice. Nurses can access “Rising Together: Know Your Legal Limitations and Risks“ to review recent cases and strengthen documentation and communication habits.
Individualized, Multifaceted Treatment for Trauma Patients With ARDS
The review covers an array of treatment modalities for ARDS.
A review of current evidence supporting treatment of trauma patients with acute respiratory distress syndrome (ARDS) emphasizes taking an integrated approach to provide the best chance for successful outcomes.
“Acute Respiratory Distress Syndrome in Trauma Patients – Treatment Interventions and Risks,” in Injury, notes that “although reported incidence rates vary considerably, research consistently shows that trauma is among the most powerful triggers for developing ARDS.” The many risk factors and variability in patients’ clinical presentations call for individualized approaches to ARDS management.
“Optimal outcome requires individualized mechanical ventilation strategies, careful fluid management, coherent use of transfusions and consideration of advanced therapies such as prone positioning or ECMO in refractory cases, all within a framework of vigilant hemodynamic monitoring,” the review adds.
A condition with a range of definitions and severities and a pathophysiology that’s not completely understood, ARDS defies simple diagnosis or uniform treatment. “Its development in trauma patients reflects a complex interaction of factors, from the direct impact of the injuries themselves to systemic inflammatory responses, transfusions, infections and secondary complications.”
The review covers an array of treatment modalities for ARDS – mechanical ventilation, positive end-expiratory pressure (PEEP), extracorporeal membrane oxygenation (ECMO), veno-venous ECMO (VV-ECMO), prone positioning, fluid management, transfusion, glucocorticoids and pulmonary vasodilators. “While foundational principles of management are established, the field still lacks robust, trauma-specific algorithms that translate physiologic insight into truly personalized treatment strategies.”
The necessity of a multifaceted treatment approach includes precise planning for airway and ventilation management, the review adds, because physiological factors can vary based on trauma type and “potential anatomical distortions.” Suggested future research includes trauma-specific ventilation strategies and clinical trials on pharmacological therapies.
AACN continuing education on ARDS includes an NTI recorded session, “From Distress to De-Stress: Navigating the Updated ARDS Guidelines.” The session helps critical care nurses stay informed on current research and practice for managing ARDS.
Recommendations for Treating Patients With IAP
The review includes detailed pathophysiology on how IAH and ACS affect cardiovascular systems.
A review of recent evidence on how intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) impact cardiovascular health notes that early recognition and individualized treatment approaches led to the best patient outcomes.
“Cardiovascular Effects of Intra-abdominal Hypertension: Current Perspectives,” in Anaesthesiology Intensive Therapy, offers 23 recommendations to manage intra-abdominal pressure (IAP) as a basis for developing a set of consensus strategies. “Clinical management should be cognizant of intravascular volume and potential effects of IAP on venous return, and the necessity for clinical management to be guided by careful haemodynamic assessment and phenotyping of the patient’s haemodynamic profile using clinical, ultrasonographic and other haemodynamic monitoring tools,” the review notes.
Key elements of a multifaceted treatment strategy include improving abdominal wall compliance, reducing fluid accumulation, using early vasoactive drugs and employing surgical decompression in selected cases, the review notes. “Early intervention is crucial to prevent the progression of organ dysfunction associated with elevated IAP.”
The review includes detailed pathophysiology on how IAH and ACS affect patients’ cardiovascular systems and can ultimately lead to multiple organ failures. Clinical guidance covers hemodynamics, both traditional (preload, contractility and afterload) and functional (stroke volume variation and pulse pressure variation), and how elevated IAP impacts them adversely.
Many charts and graphics help clinicians understand some of the challenges related to measuring pressures accurately. “Haemodynamic monitoring can only benefit patient management when clinicians are well versed in both the appropriate use and the inherent limitations of these measurements,” the review adds.
The review notes that the Abdominal Compartment Society plans to release updated guidelines that emphasize early recognition and management to help prevent organ failure.
AACN continuing education resources include “When the Pressure Is on: Intra-Abdominal Hypertension and Abdominal Compartment Syndrome,” an NTI recorded session that can help identify patients at risk of developing IAH and ACS.
Ultrasound Device Offers Heart Pacing Potential
While research is in the early stages, the MIT group is optimistic about this new pacemaker’s potential.
An ultrasound device under development uses targeted soundwaves to pace the heart with submillimeter precision, revealing a noninvasive alternative to implanted pacemakers that carry surgical risks and long term complications.
“A Wearable Non Invasive Sonogenetic Pacemaker,” in Nature Biomedical Engineering, explains that the device relies on engineered ion channels activated by targeted ultrasound, enabling precise electrical activity in heart cells. Early testing shows that engineered human cardiomyocytes responded to the focused soundwaves with synchronized, controlled activity.
In addition, testing in rats reveals noninvasive pacing with submillimeter precision and rate control up to 9 Hz across different heart chambers, restoring sinus rhythm in arrhythmic models. Subsequent work confirmed safety over eight months of daily activity and demonstrated reliable pacing in porcine hearts similar in size to a human’s, indicating the device can function in human like anatomy and may be ready for expanded preclinical testing.
A related article in Cardiovascular Business describes the noninvasive device, developed by Massachusetts Institute of Technology (MIT) engineers, as a thin sticker placed on a patient’s chest. Before using the sticker, a patient would receive a one time injection to increase cardiac cell sensitivity, allowing the stamp sized device to deliver pacing effects as soon as it is applied.
While research is in the early stages, the group at MIT is optimistic about this new look pacemaker’s potential. They envision combining this pacing work with earlier sticker based imaging research, which has been used to visualize other internal organs, to create a single ultrasound sticker that can both monitor and regulate the heart.
“We believe you could one day have stickers on the body that could do long-term imaging deep in the body and also do stimulation for therapeutic effects, in a noninvasive closed-loop way,” Xuanhe Zhao, MIT engineering professor and study co-author, adds in the article.
President’s Column: Pull Up a Chair: Offering and Accepting a Seat at the Mentorship Table
In her latest article, AACN President Tonka Williams shares that nursing requires both the science of what we do and the humanity of how we do it, which is an important lesson she passes on as a mentor. “Mentorship can happen at the bedside, in the hallway, over coffee or after a difficult shift. Mentorship can help someone find their voice and ensure they have a seat at the table.”
Taking Critical Care to New Heights
For one North Carolina Life Flight nurse, a winning raffle ticket led to a helicopter ride-along and sparked a lifelong passion for critical care transport. In this nurse Q&A, Duke Life Flight nurse Anna Sapp tells us, “I was captivated by the ability to bring advanced, lifesaving care directly to patients when and where they needed it most.”