NIs

Read each story and comment separately. do not compare both stories. Story 1 One issue that has ethical, legal, and accreditation implications for my practice as an Informatics Nurse Specialist (INS) is telehealth neurological assessments for suspected stroke patients in the emergency department (ED), especially when workflow gaps occur. In a busy ED, neuro carts are sometimes misplaced, not charged, or stored in another pod, which delays connection with the remote neurologist and slows NIH Stroke Scale completion. Those minutes matter when determining eligibility for thrombolytic therapy such as tenecteplase, and delays directly affect door to implementation times of stroke certification standards from The Joint Commission and clinical guidance from the American Heart Association. Compounding this, my hospital still relies on paper documentation for TNK administration. Paper forms increase the risk of incomplete time capture, missing contraindication checks, scanning delays, and documentation that is not immediately visible to the interdisciplinary team. From an informatics perspective, this creates legal exposure and quality reporting challenges because time stamps, dosing verification, and eligibility criteria are not structured or easily retrievable for audit. In practice, I would standardize cart placement, explore real time location tracking, embed structured NIHSS and TNK eligibility tools directly into the EHR, and transition from paper to electronic stroke documentation with mandatory fields and automated time stamps. I would also partner with ED leadership to review door to intervention metrics and reinforce rapid stroke alert activation processes. Aligning technology, workflow, and documentation strengthens patient safety, supports accreditation compliance, and reduces organizational risk. Story 2 Since the end of 2020, many rural hospitals have either stopped delivering babies or announced they will do so before the end of 2026. This represents a 10% reduction in rural labor and delivery units. The accreditation issue in rural areas is a significant concern given the high costs of labor and delivery services. Rural hospitals often face financial challenges, including high fixed labor and delivery unit costs, which can lead to the closure of these services. To build a collective response, it is crucial to prioritize workforce training and education. Preparing physicians, advanced practice providers, nurses, dentists, and other healthcare professionals to work in rural settings can strengthen maternal health services. Strategies such as Grow Your Own and Career Ladder Programs, along with investments in rural healthcare education, can support recruitment and retention efforts. Interprofessional education and telehealth training are vital tools for addressing staffing challenges faced by providers and hospitals operating in isolation, thereby encouraging collaborative solutions