Thursday, January 31, 2008
Wednesday, January 30, 2008
The following is a brief description of a Signalman's (SM) duties:
SMs stand watches on signal bridges and send/receive messages by flashing light, semaphore and flights. They prepare headings and addresses for out-going messages; process messages; encode and decode message headings; operate voice radio; maintain visual signal equipment; render passing honors to ships and boats; and display ensigns and personal flags during salutes and colors. They perform duties of lookouts; send and receive visual recognition signals; repair signal flags, pennants and ensigns; take bearings, recognize visual navigational aids and serve as navigator's assistants.
The only reason I have this on here, is that this is my high school and that day when I saw it on the news I became numb, cried and left like I was there. Remembering is educating and sobering.
With much sorrow, respect and fellowship to my fellow Columbine Rebels.
Tuesday, January 29, 2008
You Might Be a Nurse If..
You believe that there is a special place in hell for the inventor of the call light.
You believe that not all patients are annoying....Some are dead.
You believe that the gene pool could use a little chlorine. You use the acronym FOS for constipated patients...(Full of shi*).
You have told a patient to "Get some rest now" and they die right there,
in front of you and their family
You believe that no matter how much you care some people are just assholes.
You believe PIA (Pain in the Ass) is an acceptable admitting diagnosis from ER.
You don't mention the name of a frequent flyer so as not to
invoke his spirit to bring him/her to the ER and then to your unit.
When asked..."What color is the patients diarrhea?"
...you show the doctor your shoes.
You can discuss dismemberment over a meal like it is normal.
You notice that you use more four letter words than before you became a nurse.
You look in your closet and you can't find anything non-medical to wear.
You can comfort anxious patients with..."I know just how you feel..It's my first IV too."
You can cover your mistakes with Versed.
When you get a call telling you the name of your next patient
and you do the care plan before they get to the floor...
When called for orders...the M.D. says..."Write them yourself..
you know the patient better than I do."
You believe all bleeding stops....eventually.
You believe everybody has to die sometime.
Ever told a confused patient you name was that of your co-worker
and to YELL really loud if they need help
You know its a full moon without having to look at the sky.
You've ever held a 14 gauge needle over a patients vein and said....
"okay..you are going to feel a little stick."
You shock someone with an unrecognizable rhythm
until you get one you do recognize.
You believe in the aerial spraying of Prozac.
You have encouraged obnoxious patients to sign out AMA.
You believe the government should require a permit to reproduce.
You believe every waiting room should have a valium salt lick.
You refer to vegetable and you don't mean the food group.
You believe the lab should have a "dumb shi*" profile on the requisition form.
You firmly believe that "too stupid to live"should be a diagnosis.
You have to leave the patient before you begin to laugh uncontrollably.
You believe a good tape job will fix anything.
You have your weekends off planned a year in advance.
You are totally astounded when someone from a nursing home is understandable.
You look at the veins of everybody you meet.
You think a referral to Dr. Kevorkian is perfectly appropriate in some cases.
You have ever restrained somebody...and it wasn't a sexual experience
SOME LIFE EXPERIENCES, both positive and negative, have so much impact that they change the course of one's life; just ask Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the department of nursing at Xavier University in Cincinnati, Ohio.
"I was a victim as a student nurse," McKoy says. "I was also victimized when I was working with a client. In fact, I received a concussion. Instead of me saying 'No' to the field, it made me want to be in the field even more."
McKoy's background includes psychiatric nursing with 19 years of forensic nursing experience. She was always interested in the area of human behavior and what motivates individuals. McKoy believes that other forces, and not just mental illness, drive people to hurt others.
"I was in shock initially when I realized that I was actually hurt that badly," McKoy says. "I didn't go through phases of detachment. I accepted what happened. I regrouped and said, 'I have to make some changes.'"
She adds, "Did it make me change how I went about my job? Yes, it did. I became more astute about my surroundings, not as trusting in my relationships with clients. When you've been hit (before), it puts you more on guard."
Becoming a forensic nurse because of personal or professional victimization may not be as uncommon as one thinks. McKoy mentions that she has a student who wishes to enter the field because of past negative experiences with teenagers. The student has already become nationally certified.
Julie Jervis, RN, MD, MBA, senior faculty and program director at Kaplan College, says she knows another forensic nurse who had been a former victim as well. "People who have been victimized, whether it is prior to them becoming a forensic nursing professional or not, I think might be motivated to help. It could be as a result of having a bad experience with the system and wanting to make it better, or having a good experience with the system and wanting to be another person who helps."
McKoy says that forensic nursing is an excellent area to go into for individuals who have been victimized. "It makes me want to be a better educator, researcher and practitioner because it really gives me more of a driving force not only to help myself, but help others," she says.
One study has explored how eight nurses experienced and evaluated the relation between their childhood adaptation to dysfunctional families and their nursing careers.1 The study's findings did not support the view that children of alcoholics sought careers in nursing to meet codependent needs, but rather some of them became competent nurses by finding positive application for the coping skills they learned in their families.
"Having been a victim, it places individuals in a perfect position to be empathetic toward other victims," Jervis says. "If the victim says, 'Has this happened to you?" It is OK to say 'Yes,' but it shouldn't become a war story. 'Oh yeah, when this happened to me, this happened,' or 'Well, it went this way for me."
Jervis suggests this response instead: "'That was in the past and we are here to concentrate on you and make you better.'"
Each individual enters nursing with varying degrees of motivation, values, beliefs and unresolved family-of-origin issues.2
However, circumstances that generate anxiety or strong emotion can interfere with objective, logical decision making.3 "A sexual assault is a critical incident," Jervis says. "Some people have problems with critical-incident stress and relive the incident when faced with something similar that reminds them of it. If the nurse is falling apart, that's not a good thing. If it's a tragic story and the nurse sheds a few tears and is empathetic ... there's a fine line of what's OK and not OK. The caring definitely has to be there, but complete detachment is just going to make the victim feel worse."
The literature suggests that negative reactions, biases, and stereotyping should be recognized and explored.4 Often, self-awareness begins unconsciously with the internal organization of life experiences.5 McKoy's students use case studies, journaling and discussions.
"How do they guide other people to explore these things if they have not explored these feelings themselves," McKoy says. "The best arena in which to do this is a safe environment where other people can give them different perspectives on how to look at things. Students often say 'I never thought about that. Sometimes it's good for people who aren't in forensics but who want to do this, to be in a safe place to talk about it, such as in a classroom setting. Don't let the first experience be the crime scene."
SAYING NO to Violence Against Nurses
By Tina Brooks
WORKPLACE VIOLENCE takes many forms such as aggression, harassment, bullying, intimidation and assault. Violent acts are perpetrated against nurses by patients, relatives, other nurses and other professional groups.7
Nurses experience workplace crime at a rate of 72 percent higher than medical technicians and at more than twice the rate of other medical fieldworkers, according to the Bureau of Justice statistics.
Yvonne McKoy, RN, PhD, CS, DABFN, associate professor in the Department of Nursing at Xavier University in Cincinnati, Ohio, would not be surprised by these numbing statistics. She has done extensive research in this area herself.
McKoy says, "I found that nurses thought this came with the territory. We thought and said for a long time that we were not willing to sue patients or to sue clients because this is a part of what we did. We accepted this."
Part of McKoy's research explored if nurses knew patients were in their right mind and why were nurses accepting of this behavior. "They thought that their colleagues would not understand and their employers would think that they were not doing their jobs. It must have been something about them that caused the behavior," she says.
McKoy, who was also victimized on the job several years ago, felt that the community where she worked did not understand her plight. "They saw it as part of what I did," she says. "When I was victimized, I was in the area of mental health."
Some of the injuries that McKoy received could have been life threatening, including a concussion, could have been life threatening.
Through her research, McKoy discovered that other nurses received physical injuries as well. Some individuals were able to go back to work in a couple of days, but in some instances the experience had lasting effects. Nurses changed areas where they worked or changed jobs. Others experienced nightmares, which lasted for some time. Some individuals had psychological problems while others had physiological problems such as nausea or vomiting. Other research suggests that consequences of violence also include the deterioration in the quality of patient care, low morale, high stress levels, and increased errors.
Violence against these nurses had implications for their families as well. "My family was most concerned about me being hurt," McKoy says. "They immediately wanted me to look at other employment, but I couldn't do that. My feelings were that I was called to do what I did."
When McKoy asks former victims if they would now prosecute the perpetrator, some of the individuals at this point say 'Yes.' They feel the person knew the difference between right and wrong. "So we stand on the edge of certain areas of the law where nurses are now saying 'If you know what you're doing to me I may not take it,'" she says.
Mental illness is one thing, but even in this area nurses are beginning to question patients' cognitive abilities. Do patients know what they are doing? Do patients know what they are doing when they hit a nurse? "Nurses are definitely fighting back differently now," McKoy says. "It doesn't mean that we're not compassionate."
As McKoy travels throughout the country presenting at different professional conferences, she is encouraging the profession to investigate this subject. The link between workplace violence, recruitment and retention and diminished job performance of nurses cannot be ignored.8 The Bureau of Health Professions' 2000 Survey revealed that too few young people are choosing careers in nursing, and the average age of registered nurses has increased substantially. In 1980, 52.9 percent of RNs were younger than age 40; in 2000, 31.7 percent were younger than 40. In 1980, 26 percent of RNs were under the age of 30, but by 2000, less than 10 percent were under age 30.
"Nurses are not willing to be victimized as much as they used to be and still stay on the job," McKoy says. "That is a critical issue to look at."
1. Biering P. Codependency. A disease or the root of nursing excellence. Journal of Holistic Nursing. 1998;16(3):320-337.
2. Jerome AM, Ferraro-McDuffie AR. Nurse self-awareness in therapeutic relationships. Pediatric Nurse. 1992;18(2):153-156.
3. Echroth-Bucher M. Philosophical basis and practice of self-awareness in psychiatric nursing. Journal of Psychosocial Nursing of Mental Health Service. 2001;39(2):32-39.
6. O'Keefe ME. Nursing Practice and the law. Philadelphia: F. A. Davis Co. 2001. p.403.
7. Jackson D, Clare J, Mannix J. Who would want to be a nurse? Violence in the workplace - A factor in recruitment and retention. Journal of Nursing Management. 2002;10:13-20.
"Recognizing moral distress is an important step toward resolution, yet many nurses are unaware of how it may be manifested. Examples from current literature along with vignettes from the author's experience are presented to illustrate the concept."
"Job satisfaction and moral distress. Bowles and Candela (2005) studied new nurses' perceptions of their job satisfaction. Nearly one-third of participants reported leaving their first nursing position within 1 year; 57% left by 2 years. When asked the reason for leaving their first job, nurses' answers predominantly fell into four theme areas: (a) patient care (acuity of patients, nurse-to-patient ratios, ability to provide safe care), (b) work environment (management issues, lack of support and guidance, too much responsibility), (c) location or nursing area move (moving to another area of nursing or physical relocation which included travel nurse positions), and (d) employment factors (salary, schedule, benefits). Participants felt the work was stressful, conditions were not conducive to safe patient care, staffing was inadequate, and there was not enough time to spend with patients. "Nurses do not speak of moral distress in terms of personal moral failure or inability to overcome in stitutional barriers. Nurses speak of anguish, sleeplessness, nausea, migraine headaches, gastrointestinal upset, tearfulness, a sense of isolation, or of knowing very early the immorality of a situation that others haven't grasped" (Hanna, 2004, p. 73)."
"Moral distress has recently been approved as a new nursing diagnosis and will be included in the 2007-2008 edition of Nursing Diagnoses: Definitions and Classi fication (L.M. Scroggins, personal communication, April 1, 2006). This will provide nurses a means to recognize and intervene with moral distress situations in their patients. For now, however, nurses often seem un aware of this experience in themselves. Feelings labeled as stress, burnout, emotional exhaustion, and job dissatisfaction may actually be symptomatic of moral distress. These symptoms may be the reason given by nurses for leaving a specific work environment or even for departure from the nursing profession (Elpern et al., 2005). As mentioned earlier, 15% of the nurses in one study reported resigning a position due to experiencing moral distress (Corley et al., 2001). Nearly 23% of nurses in another study plan to leave their current position within 1 year. When only nurses under 30 years of age are considered, this number increases to 33% (Aiken et al., 2001). The potential to influence the nursing shortage at an institutional level is clear. Facilities that identify and respond to the experience of moral distress could experience higher levels of staff satisfaction resulting in a decrease in staff turnover."
"Turnover of nursing staff is costly. Considering recruiting costs, training expenses, and termination costs, a Voluntary Hospital Asso ci a tion study by Kosel and Olivo (2002) counted the average cost to replace one medical/surgical nurse at $46,000. Replacing a specialty nurse such as a critical care nurse was estimated at $64,000. Adding additional personnel costs to cover the shortage created by turnover, costs increase to greater than $92,000 for a medical/surgical nurse and $145,000 for a specialty nurse (Hatcher et al., 2006). Though more difficult to quantify, turnover also impacts staff and patient satisfaction, quality of care, and patient outcomes. The Joint Commission on Accreditation of Healthcare Organi zations (2002) also recognizes the high cost of turnover, challenging nursing leaders to create a culture of retention for nursing staff.""The AACN has issued a position statement recognizing moral distress as a serious, but often ignored problem in nursing. Nurses are individually challenged to recognize and name the experience of moral distress and to commit to addressing the issue. At an institutional level, employers are charged with establishing processes supportive of increasing recognition of moral distress and decreasing its occurrence in the workplace."