The 50 most-cited articles in AJN American Journal of Nursing, 2020

OBJECTIVE: As the number of Magnet hospitals continues to rise in the United States and abroad, the body of literature regarding various outcomes at Magnet hospitals is increasing also. A systematic review examining and compiling the most recent evidence would be invaluable to those seeking to pursue Magnet recognition for their facility. We conducted this systematic review to investigate how Magnet hospital status affects outcomes for nursing professionals, patients, and health care organizations. METHODS: In January 2018, the databases CINAHL, ProQuest, PubMed, and La Biblioteca Cochrane Plus were searched for relevant studies. The reference lists of selected articles were also examined to identify additional studies. The PRISMA statement was followed, and established methods for systematic review were used to produce a narrative summary. The quality of the reviewed studies was assessed according to the 22-item Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. RESULTS: Of the 163 studies identified, 21 met the…

Contraception is widely used in the United States, and nurses in all settings may encounter patients who are using or want to use contraceptives. Nurses may be called on to anticipate how family planning intersects with other health care services and provide patients with information based on the most current evidence. This article describes key characteristics of nonpermanent contraceptive methods, including mechanism of action, correct use, failure rates with perfect and typical use, contraindications, benefits, side effects, discontinuation procedures, and innovations in the field. We also discuss how contraceptive care is related to nursing ethics and health inequities.

Autism spectrum disorder (ASD) is a condition characterized by impaired social communication as well as restricted and repetitive behaviors. It is considered a neurodevelopmental disorder because it is associated with neurologic changes that may begin in prenatal or early postnatal life, alters the typical pattern of child development, and produces chronic signs and symptoms that usually manifest in early childhood and have potential long-term consequences. In past decades, autism was conceptualized as a strictly defined set of behaviors, usually accompanied by intellectual impairment. Today, it is recognized as a spectrum, ranging from mild to severe, in which behaviors vary substantially and the majority of children who fall on the spectrum have average to above average intellectual ability. Here, the authors discuss the risk factors for ASD, its epidemiology, common concurrent conditions, evaluation, diagnosis, treatments, and outcomes.

How politics is impeding the U.S. pandemic response.

Editor's note: This is the first article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.

Educational versions of interactive escape room games can be used to teach and reinforce knowledge and clinical skills. In this article, the authors describe their experience creating, piloting, implementing, and evaluating a safe medication educational escape room for first-year nursing students. They highlight the steps needed to develop an effective learning experience and provide insight into lessons they've learned throughout this process.

The purpose of this literature review was to investigate the major barriers nurses face when it is necessary to seek additional assistance and resources by calling the rapid response team (RRT) in order to manage and stabilize a clinically deteriorating patient. A total of 40 articles were reviewed. Eight barriers were identified as having an impact on RRT activation, either causing a delay in activation time or preventing activation altogether: a lack of consistent RRT education among nurses, the established hierarchy in the hospital, an uncertainty about when to call the RRT if clinical deterioration is subtle or gradual rather than abrupt, a perceived need to justify a decision to call the RRT, the increased workload for both the ICU nurse and the medical-surgical nurse, negative past experiences with RRTs, an unsupportive unit culture, and less nursing experience. Suggestions for overcoming these barriers include RRT education for nurses and physicians in addition to fostering a supportive unit culture.

BACKGROUND: Suicide is now the 10th leading cause of death in the United States. Suicide rates for health care providers are thought to be higher than for people in other occupations because of job strain and burnout. Despite the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience, which focuses on reducing stress and preventing suicide, a shortage of data limits our understanding of nurse suicide. Neither employers nor professional nursing associations track suicide data. PURPOSE: To determine the number of suicides and estimated rate of suicide among RNs, using data from the National Violent Death Reporting System (NVDRS). METHODS: We extracted data from the NVDRS, which is based on death certificates, coroner reports, and law enforcement reports, for the year 2015. The National Institute for Occupational Safety and Health's Industry and Occupation Computerized Coding System was used to code the data. Industry and occupation coding experts reviewed the coding for accuracy. RESULTS: Analysis of 2015 NVDRS data from 17 states showed that among…

According to this study: The antiviral remdesivir is superior to placebo in the treatment of patients hospitalized with COVID-19.A variety of therapeutic approaches are needed to continue to improve outcomes in COVID-19 patients.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article describes the interdependent relationship between SDGs 3 and 10. In addition, the authors focus on nurses' varied and increasingly essential roles in addressing health care inequities through such practices as care coordination and preventive care and education-work which will…

PURPOSE: To explore whether burnout is an independent predictor of career choice regret among nurses. METHODS: In November 2017 we invited a random sample of 89,995 members of the American Nurses Association to participate in an anonymous online survey. The survey collected demographic and professional information and included the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (known as the MBI-HSS [MP]), as well as several items exploring career choice regret. Of the 86,858 nurses who received the e-mail invitation, 8,638 (9.9%) responded. Multivariable logistic regression analysis was conducted for the final sample of 6,933 nurses who provided complete responses to the MBI-HSS (MP) and the career choice regret survey items. RESULTS: Fifteen percent of the 6,933 participating nurses had career choice regret. On multivariable analysis, experiencing burnout, working unplanned or mandatory overtime, being male, and having a higher academic degree related to nursing were independent predictors of career choice regret. Burnout was the strongest such predictor.…

OVERVIEW: In 2012, the Institute of Medicine Roundtable on Health Literacy established 10 attributes of a health literate health care organization that, if instated, would improve health information and empower patients to make more informed health decisions. Few studies have assessed how well organizations meet these attributes. PURPOSE: This study sought to describe the extent to which health care systems in North Texas were adopting policies and practices that address the 10 attributes of a health literate health care organization. More specifically, we sought to describe key organizational leaders' and clinicians' perceptions in this regard. STUDY DESIGN AND METHODS: This was a mixed-methods study, conducted with a convenience sample of 74 key informants from 13 hospitals across five health care systems. Informants provided demographic data, and their perceptions of the extent to which their hospital met the 10 attributes were measured via the Health Literate Health Care Organization 10-item questionnaire (HLHO-10) and semistructured interviews. RESULTS: Mean scores for HLHO-10…

BACKGROUND: Family presence during resuscitation (FPDR) upholds family-centered care principles and can result in better family member outcomes; yet it isn't routinely implemented by nurses. Prior studies have examined predictors of support for FPDR among nurses caring for high acuity patients, but limited research involves medical-surgical nurses. This is problematic because resuscitation occurs in all inpatient settings. PURPOSE: This study sought to examine the personal, professional, and workplace factors associated with medical-surgical nurses' perceptions, self-confidence, and use of invitations regarding FPDR. It also aimed to explore potential barriers to FPDR and nurses' educational preferences, in order to inform the design of interventions that might improve FPDR implementation in this practice setting. METHODS: A cross-sectional survey design was used to examine which factors are predictors of medical-surgical nurses' FPDR perceptions, self-confidence, and use of invitations. Data on nurses' perceptions of barriers and educational preferences were collected via survey as…

BACKGROUND: Food insecurity, which can be defined as having limited access to nutritional and safe foods as a result of a lack of financial resources, is believed to adversely influence health outcomes. Older adults, in particular, face rising health care costs and may be forced to choose between purchasing prescribed medications or using their limited financial resources for basic needs, such as food. PURPOSE: The purpose of this systematic review was to examine the relationship between food insecurity and cost-related medication nonadherence (CRN) in older adults living in a community setting. METHODS: A comprehensive electronic review of the literature was performed. Criteria for inclusion were original quantitative or qualitative research, written in English, involving community-dwelling U.S. adults 60 years of age and older. RESULTS: Six studies met all criteria and were included for analysis. Two studies reported a significant dose-response relationship between food insecurity and CRN, and a third reported an increased risk of CRN in subjects with persistent food insecurity.…

In this case study, we investigated the efficacy of mirror therapy and online counseling in the management of phantom limb pain. The patient was a 28-year-old woman who experienced phantom limb pain after a traumatic transhumeral amputation three and a half months before initiating therapy. After a 40-minute educational session with a nurse researcher experienced in pain management and surgical nursing, the patient practiced mirror therapy at home for four weeks and kept in contact with the nurse using a mobile chat application. The patient scored the intensity of her pain before and after each practice session on a 0-to-10 numeric pain scale. The first week was difficult for her because of tiredness and the pain. In the second week she experienced less pain during the day than at night but claimed to feel much better than before. In the fourth week, she reported having difficulty sleeping, but she stated that her pain had decreased. The intensity of the pain didn't change following mirror therapy in the first week; however, her average pain score was 1.15 points lower after mirror…

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.

BACKGROUND: Each year, 13,000 women in the United States are diagnosed with cervical cancer and 4,000 die from it. Moreover, 8 million women 21 to 65 years of age haven't had a Pap test in five years. Hispanic women have the highest incidence of cervical cancer and are less likely to be screened or return for care. Migrant women can face additional barriers to cervical cancer screening, including federal prohibitions against their participation in public health insurance exchanges and nonemergency Medicaid. PURPOSE: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management. METHODS: Four rapid plan-do-study-act…

Skilled nurses are critically important to an effective pandemic response.

Autism spectrum disorder (ASD) is the most common and fastest-growing developmental disability in the United States, affecting approximately one in 54 children nationwide. Early intervention for ASD produces the best outcomes-and developmental surveillance and screening are prerequisites to intervention. Although screening has been strongly recommended for two decades, the majority of U.S. children are not screened for ASD. Here, the authors discuss ASD epidemiology, screening, and diagnosis, as well as appropriate early actions nurses can take when ASD is suspected.

Remdesivir (Veklury) is the first antiviral drug approved to treat patients ages 12 and older who are hospitalized with COVID-19.The drug is administered via slow IV infusion.Elevated liver enzymes are common with treatment. Hypersensitivity reactions, including anaphylaxis, are possible.

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians. This article discusses the general principles underlying the pathophysiology and clinical management of trauma-related hemorrhagic shock and updates readers on nursing practices used in its management.

Since the 1960s, plastic has been used in the production of medical equipment and products that improve patient comfort, safety, and treatment. Yet an unwelcome challenge has emerged in the years since: how to safely dispose of this material without negatively affecting human health and the environment. Working with medical devices and supplies that are constructed using plastics, nurses are at the forefront of this issue and must identify solutions, collaborate with other health care workers, and lead efforts to establish more sustainable options. This series is in collaboration with the Alliance of Nurses for Healthy Environments (https://envirn.org).

BACKGROUND: Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care. METHODS: We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes. RESULTS: Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility. CONCLUSIONS:…

BACKGROUND: Critical illness survivors may develop posttraumatic stress disorder (PTSD) following critical illness and hospitalization. Left untreated, PTSD may result in poor health outcomes. PURPOSE: This study sought to examine the effects of a nurse-initiated diary intervention on PTSD development and symptom severity in critical illness survivors with varying levels of mentation. METHODS: The study used a pretest-posttest control group design. Patients who were hospitalized in a critical care unit for more than 24 hours were recruited at a single medical center with two such units. All participants completed a pretest on day 2 of critical care hospitalization; the intervention group participants also received a diary. All participants received a posttest one month after critical care discharge. The variables examined were PTSD severity and symptoms of avoidance, intrusion, and hyperarousal. Variables were measured using the Impact of Event Scale-Revised. Diaries were written by the patient, visitors, and interdisciplinary team members, and kept by the patient. RESULTS: A total…

This column is designed to help new nurses in their first year at the bedside-a time of insecurity, growth, and constant challenges-and to offer advice as they learn what it means to be a nurse. This article provides strategies and tips new nurses can use to improve their time management skills.

Without a nationwide strategy or infrastructure, we've missed a chance to control the pandemic.

PURPOSE: This project examined nurses' positive and negative perceptions of the technology used in language interpretation for patients who have limited English proficiency (LEP). The intervention was guided by the technology acceptance model, a framework that addresses users' acceptance or rejection of computer-based technology. METHODS: A sample of 47 nurses participated. Nurses' perceptions of an existing telephone-based remote interpretation technology were compared with their perceptions of a video remote interpretation (VRI) system. Instruments included a structured questionnaire to collect nurses' demographic and other characteristics and to measure their perceptions of the technology used in language interpretation; open-ended questions were added on how technology affected nursing care and nurses' rapport and communication with patients. Questionnaires on the telephone-based interpretation technology were administered, and after an eight-week trial of the VRI technology, questionnaires on the VRI system were administered. RESULTS: Overall, positive perceptions of VRI were…

Editor's note: This is the second article in a new series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice-from research design to data interpretation. The articles will also be accompanied by a podcast offering more insight and context from the author.

The number of orthopedic surgeries performed in the United States has increased substantially over the past several years. The most recent data available from the Agency for Healthcare Research and Quality indicate that five of the 10 operative procedures most commonly performed during inpatient stays involve the musculoskeletal system. Cigarette smoking is one of the most prevalent and preventable risk factors for musculoskeletal disorders and orthopedic surgery complications. This article discusses the effects of smoking on bone health, the importance of smoking cessation among patients scheduled for or recovering from orthopedic surgery, and the vital role nurses play in supporting patient efforts to lead a tobacco-free life.

In 1968, the criteria for brain death were established by the Harvard Ad Hoc Committee. Despite what may appear to be unambiguous definitions, clinicians, ethicists, and the public have grappled with the concept of brain death since its inception. In light of recent public discourse on the topic, Harvard Medical School convened a conference to examine research and ethical inquiry conducted over the past 50 years related to death as defined by neurologic criteria. Drawing on the report produced by this conference, this article provides an overview of the development of brain death criteria, describes recent controversies and updates, and discusses implications of these criteria for nurses.

COVID-19 exposes ongoing risks to residents.

The H2 blocker ranitidine (Zantac) has been withdrawn from the U.S. market because of concerns over levels of the contaminant N-nitrosodimethylamine, which can increase with time and temperature, posing a risk of cancer. Patients should be told to discard all products containing ranitidine.

Federal and state governments ease restrictions to increase NP availability.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN's Millennium Development Goals, which were in effect from 2000 to 2015.

A new initiative aims to reduce new infections by 75% within five years.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that provide an update on urinary incontinence and its management in older adults. It includes an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to…

PURPOSE: The aim of this quality improvement (QI) project was to increase the coprescription of naloxone kits at patient discharge as a harm reduction strategy to combat the opioid epidemic. An interdisciplinary team identified hospitalized medical patients who were at high risk for an opioid overdose or opioid-related adverse event. METHODS: Led by a physician champion, an interdisciplinary QI team composed of physicians (MDs and doctors of osteopathic medicine), advanced practice providers (NPs and physician assistants), RNs, care coordinators, social workers, and pharmacists developed and implemented a naloxone distribution program on one medical unit at an academic tertiary care center. The team developed and implemented criteria to identify high-risk patients, workflow for patient screening, staff and patient education programs, and processes for naloxone kit delivery to the patient's bedside. Data on naloxone kit distribution from the seven months prior to implementation (March 2018 to September 2018) and the seven months after implementation (October 2018 to April 2019) were…

Health care organizations should manage burnout from the top down.

BACKGROUND: Writing for publication in peer-reviewed journals is one of the most important types of writing that nurses engage in. It is essential for advancing the nursing profession, health care organizations, and individual nurses. Despite its importance, however, the rate of publication remains very low among nurses. At one large academic medical center, a baseline assessment of dissemination practices found a low publication rate. To address this, an evidence-based writing-for-publication program was designed to support professional dissemination of scholarly work. METHODS: A 12-week workshop was designed and writers were matched with a mentor. The workshop started with a four-hour kickoff session on the process of getting published, including choosing a journal, querying an editor, drafting a manuscript, and working with coauthors. Participants also began developing an outline for their manuscript. Drafts were due to the mentor every four weeks for editing and feedback. At the end of the 12 weeks a wrap-up session was held for participants to read each other's manuscripts and…

Nursing leaders continue to struggle with capacity issues in both clinical and academic settings-particularly those related to aging patient and nurse populations and the increasing complexity of health care in general. Programs and resources for formal mentoring have primarily focused on mid- and advanced-career RNs, but there is an imperative to develop methods of expertly mentoring "professionally younger" RNs across all settings and roles. In 2017, the American Nurses Association (ANA) conducted an extensive member needs assessment with more than 15,000 respondents. Three distinct career-stage categories were identified: early-career nurses, up-and-comers, and nursing leaders. The early-career nurses and up-and-comers listed "being mentored" among their top two member benefit requests. In response, the ANA launched a national virtual mentorship program in September 2018. The program aligned with criteria, recommendations, and charges from the American Nurses Credentialing Center's 2019 Magnet Recognition Program; the landmark 2010 report from the Institute of Medicine (IOM), The…

Opioid use disorder (OUD) is a chronic, relapsing disease. Genetic variability, dysregulated stress system response, and history of opioid experimentation or escalating exposure all contribute to the likelihood of developing OUD, which produces complex brain changes that make it difficult to stop opioid use. Understanding the neurobiology of OUD helps nurses anticipate the behaviors of patients with OUD and approach them with empathy. Here, the authors discuss the pathophysiology of OUD, available screening tools, medical treatments, and behavioral interventions that have demonstrated efficacy in reducing substance use.

Among adults ages 65 and older, dementia doubles the risk of hospitalization. Roughly one in four hospitalized patients has dementia, and the prevalence of dementia in the United States is rising rapidly. Patients with dementia have significantly higher rates of hospital-acquired complications, including urinary tract infections, pressure injuries, pneumonia, and delirium, which when unrecognized and untreated can accelerate physical and cognitive decline, precipitating nursing home placement and death. The authors discuss the unique needs of patients with dementia who require acute care, highlighting evidence-based strategies for nurses to incorporate into practice.

Surging rates of depression and anxiety are reported.

BACKGROUND: Inpatient falls are among the most common hospital incidents reported. Fall-related injuries have significant implications for patients, staff, and organizations. Adult behavioral health inpatients are responsible for higher rates of injurious falls and challenge traditional fall prevention methods. An inpatient behavioral health unit in an acute care hospital identified an increased rate of injury from falls per 1,000 patient-days in three months; three falls resulted in major injury. PURPOSE: The purpose of this quality improvement (QI) report is to describe the redesign of a fall prevention program for adult behavioral health inpatients using evidence-based practice (EBP) and QI methods. METHODS: Root cause analyses (RCAs) were conducted on all three fall-related major injuries. Concurrently, a literature review identified EBP recommendations for fall prevention on behavioral health units. A fall prevention action program was developed consisting of four elements: RN education to improve Morse Fall Scale scoring, individualized fall prevention patient plans, revised…

Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.

According to this study: Shift workers, especially women, are at increased risk for poor mental health, particularly regarding symptoms of depression.

Polypharmacy, the use by a patient of multiple medications, contributes to adverse drug events, hospitalizations, geriatric syndromes, and increased health care costs. In the United States, polypharmacy is increasingly widespread, particularly among community-dwelling adults over age 62. In 2005-2006, 31% of such adults used five or more prescription drugs and 8.4% used medication combinations associated with potential interactions. By 2010-2011, 36% used five or more prescription drugs and 15% used potentially problematic drug combinations. Reducing the dangers of polypharmacy, however, requires clinicians to broaden their focus, considering not only the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions. This article explores the factors that contribute to polypharmacy and discusses its negative physiological, psychological, and economic effects. It also describes strategies for reducing polypharmacy, including both "explicit" approaches, which are grounded in the findings of literature reviews…

BACKGROUND: Confusion about what a do-not-resuscitate (DNR) order means, including its misinterpretation as "do not treat," has been extensively documented in the literature. Yet there is a paucity of research concerning nurses' perspectives on DNR orders. PURPOSE AND DESIGN: This mixed-methods study was designed to explore nurses' perspectives on the meaning and interpretation of DNR orders in relation to caring for hospitalized adults with such orders. METHODS: Direct care nurses on three units in a large urban hospital were asked to respond online to a case study by indicating how they would prioritize care based on the patient's DNR designation. These nurses were then invited to participate in open-ended interviews with a nurse researcher. Interviews were audiotaped, transcribed, and analyzed. FINDINGS: A total of 35 nurses responded to the case study survey. The majority chose to prioritize palliative care, despite no indication that any plan of care was in place. Thirteen nurses also completed a one-on-one interview. Analysis of interview data revealed this overarching theme:…

The future of the profession is being forged under challenging circumstances.

The antiviral remdesivir has received Food and Drug Administration (FDA) Emergency Use Authorization to treat patients severely ill with COVID-19. The drug is still considered unapproved and under investigation. Nurses should review the Fact Sheet for Health Care Providers for full information regarding reconstitution and administration of remdesivir. Health care providers should report all adverse events and medication errors to the FDA MedWatch program and to Gilead, the drug's manufacturer.