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sirI, MSN, APRN, NP Admin 72,649 Views

Joined Jun 24, '05. Posts: 100,259 (17% Liked) Likes: 26,214

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  • Jun 16
  • Jun 14

    The Survey

    In January 2015, invited members and readers holding an active nursing license via the allnurses site as well as newsletters, emails and facebook to participate in a 10-minute online survey about nursing salaries. Respondents were asked 20 questions to characterize their educational background (degree, license), main roles as nurses, employer type, experience level, geographic location, etc……. After just 2 weeks from January 22 through February 3, more than 18,800 responses were received.

    After reviewing the results, feel free to post your questions and comments. We can all learn from each other's input.

    Respondent Profile

    As shown in Figure 1, the majority of the respondents have a Bachelor’s or Associate’s Degree in Nursing(39.23% and 38.89% respectively), followed by Diploma (14.81%), Master’s Degree in Nursing (6.38%), PhD (0.29%), Doctor of Nursing Practice(0.29%), and Doctor of Nursing Science(0.10%). With the difference in the number of BSN (6,891) and Associate (6,831) respondents so slim, it will be interesting to see what effect the mandates of some health systems requiring BSN or higher will have on these numbers in future surveys. To see what allnurses readers are already saying about this, go to BSN and Associate Nurses are Neck and Neck. Will this change?

    FIGURE 1

    Figure 2 shows that the majority of respondents were overwhelmingly RNs (82.39%). A couple of questions this brings to mind: are fewer nurses beginning their career as LPNs/LVNs (14.84%), and will the number of APRNs (2.09%) increase fast enough to help meet the needs of a rapidly growing population in need of more autonomous healthcare providers.

    FIGURE 2

    When asked, “Are you a manager or supervisor?” 17.58% (3,316) responded YES, while 82.42% (15,542) answered NO.

    In response to the question, "What percentage of time is spent in direct patient care?", half of the respondents(51.85%) spend 75-100% of their time in direct patient care while 8.79% spend less than 5% in direct patient care. (Figure 3)

    FIGURE 3

    It's not any surprise that the survey revealed that 92.26% of respondents are female and 7.74% are male.

    FIGURE 4

    FIGURE 5

    Experience: Figure 6 show that 62% of the respondents have 10 years or less experience.

    FIGURE 6

    Additional demographic of our respondents:

    • 82% work full-time; 11% part time; 7% other
    • 55% work at a Not-for-Profit facility
    • Facility Size: 25.47% less than 100; 21.45% = 100-300; 15.93% = 300-800; 11.94% = 800 - 1500; 11.54% = 1500 - 3000; 13.67% = more than 3000
    • Population Setting: 45.38% Urban; 32.15% Suburban; 22.47% Rural
    • 56% of nurses work in a hospital. To see the other places that top the list, read Where Do Most Nurses Work?

    FIGURE 7

    FIGURE 8

    FIGURE 9 - Total Number of Respondents by Primary Specialty


    The interactive charts below will allow you to customize your view to include various filters that will affect the range of figures shown. You can do this by selecting items in the drop down menus at the top of the charts. Be sure to hover your cursor over the chart for more details.

    These salary figures do account for cost of living indexes, which can greatly affect the value of salaries. Generally, the cost of living is highest on the West Coast and in the Northeast. The states in the South, Midwest, and sections of the Mountain West have the lowest cost of living. For more discussion about this, please read What States Pay the Highest and Lowest Nursing Salaries?

    Although women dominate the nursing profession, do men make more money? - Read what our readers have said. Look at interactive graphs below and see what you think.

    FIGURE 10 - Annual Salary Base Pay by Gender

    FIGURE 11 - HourlyBase Pay by Gender

    FIGURE 12

    FIGURE 13

    FIGURE 14

    FIGURE 15 - Avg Salary by Degree/State

    FIGURE 16 - Annual Salary by Degree/State

    FIGURE 17 - Avg Annual Salary + Hourly Pay by Degree/State

    FIGURE 18 - Annual Salary + Hourly Pay by Degree/State

  • Jun 8

    When I was a young graduate, I remember I had a pediatric patient and his mom was deaf. She was trying to tell me that something was happening in the room of her son, but I was very frustrated because I was not able to understand her hand movements. I thought she was upset or angry with me. I went to the room and the IV pump alarm was flashing (the line has air). That was an awkward moment for me because I did not know how to understand deaf people. And that broke my heart.

    I've been a Registered Nurse for about 14 years. I have cared for many patients. Maybe I have forgotten some of them, others are still in my heart as they were the first time I met them.

    I remember this little baby. She weighed 5 pounds 7 ounces and was very tiny. She had Thrombocytopenia and received Garamycin for awhile in NICU. When she was 3 months, her mother was in shock when the audiologist told to her that her daughter was deaf. OMG! Nobody in the family was deaf so they were all scared about all the typical questions about her health and future.

    In that moment, I confirmed what I always had in my mind! I have to learn American Sign Language (ASL). What will happen if I have another deaf patient again? ASL it’s so important for the Health Professionals. So I decided to enroll in ASL course. I learned at a very fast pace how to sign my name, and the basic words I need to communicate. I am still practicing and learning, but I know more signs that I knew before.

    The mother of the little girl looked all over Puerto Rico to see what she could do to help her daughter. Not only pray for a miracle at nights, she looked for a specialist in Puerto Rico that might help her girl. Finally, she found an ENT who accepted her in order to perform the surgery for cochlear implant (a new procedure in the Island). She was one and a half years old... When I recently saw the pictures of that moment, two tears came from my eyes! The surgery took about three hours. Her mom was very anxious and worried. But the girl was so strong, stronger than the family. She was discharged from the hospital the next day and had her processor a few months later. The first time she could hear, she just cried. Her mom cried too!

    Since that time, I encouraged the nurses and other health professionals how important it is to know at least the basics of ASL. Being deaf in a speaking society is like being in another country where the people cannot understand you and speak another language. Even worse, because being deaf is a limitation that is not easily recognized until you speak to the person and the person does not answer you.

    Unfortunately more than 38,225,590 have hearing problems in United States. (1)
    And the question we have to ask as a nurse is…Do I know ASL?

    Once I took the ASL course, I learned another way of speech, another way to love, and another way to communication.

    • I not only can sign (I AM YOUR NURSE) I also can sign I LOVE YOU and (CAN I HELP YOU?)
    • I not only understand (THIS HURTS!) And (I HAVE HEADACHE!)
    • I also understand (MOM, I LOVE YOU) when my daughter was signing back to me.

    That little princess is my baby and now I know ASL because of her.

    Ten years later she speaks and hears almost perfect. She is an honor student, she speaks and also knows ASL. I am still learning that you do not have to wait until a family member has a situation to do something for others. Do it now!

  • Jun 4

    allnurses conducted its first annual Salary Survey to find how various variables such as education level, licensure, experience, geographic location, and even gender affect nursing salary. More than 18,800 respondents provided some very interesting and credible data. Thanks to all of you who participated. We are happy to tell you that the results to the survey will be published in 2 weeks. Since much of the data will be displayed using interactive charts, you will be able to customize the data to help you find things that are pertinent to you.

    The attached infographic gives a glimpse of some of our findings. We will be releasing some of the general data during the next couple of weeks. Feel free to ask questions and add your input.

    What do you think the average nurse is making?
    What do you think is the most popular incentive for nurses?
    What's the average BSN salary in your state?
    Where's the highest nursing salary for my specialty in the US?
    Is it worth getting an MSN?

    Here is a list of related articles with some of the general data from the 2015 Salary Survey:

    Although women dominate the nursing profession, do men make more money?

    BSN and Associate Nurses are Neck and Neck. Will this change?

    Where Do Most Nurses Work?

  • Jun 4

    Craig's list. Call visiting nurse association. Call local hospital home health division. Most states do not permit LPNs to work independently and mandate RN oversight

  • Jun 4

    That's really not the purpose of this website. Have you spoken with his health care provider about a potential referral for home care?

  • Jun 3

    The poll is now closed for voting. Thanks to all who participated in submitting the articles and voting.

    Because there were so many great articles to choose from, it was a close race.

    And the winners are...


    And a big thank you to all who participated. Remember, the Spring Article Contest is going on now, so submit your article for a chance of winning $150.

  • Jun 2

    Personally, I would let it slide, cont to do my best, learn from your mistakes and go on.

    I respectfully disagree with above poster who (if you read his/her posting history) is extremely unhappy in general with their chosen career path.

    You can't always be in a warm and fuzzy environment - being an NP is not always a supportive role. However, sometimes we just have to roll up our sleeves and wade right in. I've been an APN for 10 years now and my practice is big (21 MDs now) and many varied personalities. And yes...they gossip sometimes. Here's some tips I've learned when I've goofed:

    1. Admit my mistake up front. No crying, no hysterics, just the facts.
    2 Come up with a plan to remedy it. In my worst mistake, I made a prescribing error which was exceedingly costly. I enrolled in an extra pharm course, took an additional 30 hours CME in pharm, sought additional advice from some trusted NPs I know (thank you Siri) and moved on.
    3. Don't participate in gossip. Be known as someone who might be aware of mistakes other providers' make but who doesn't repeat them.
    4. Sit in on exams of the MDs who are questioning you - even if it means you have to do so on your own time. This shows a commitment to the job and profession.
    5. Find a mentor - another NP who you admire and trust who can help you navigate the ropes of the practice. Consider joining your states' APRN organization.

    Being an APN is different than being an RN - the role is similar but the expectations and responsibilities are far greater.

  • Jun 1
  • May 30

    Case Study #1 - Miss TB and Ecstasy

    TB, age 15, attended a wedding in a small rural community about an hour's drive from a children's hospital. She and 8 other wedding-goers were given some pills by a family member, with the aim of making the party more fun. Late in the evening the Emergency Response Team was called to the scene for reports of a fight. Once there, the focus of the call shifted when TB was noted to be stuporous and vomiting. Her GS on scene was 5 (1 for eye opening, 2 for vocalization and 2 for movement) so she was intubated by the paramedics and readied for transfer to the city. By report, she had taken 3 Ecstasy pills over the space of 45 minutes. She was directly admitted to the PICU early on Sunday morning. Her admission vital signs and labs were as follows:

    HR 146, BP 156/94/110, sats 92% on 50 % FiO2 ventilated SIMV R16, T 38.9°C
    pH 7.16, PaO2 74, PaCO2 61, NA++ 129, K+ 3.9, Cl- 109, Ca++ 2.16 Gluc 4.6, Lactate 3.1, HCO3- 22
    HGB 12.4, Hct .26, WBC 4.9, Plt 279
    BUN 34, Cr 3.1, CK 1500, Troponin 0.7
    PTT 40, INR 2.0

    She had been given a 20 ml/kg crystalloid bolus en route to the hospital and received a second 20 mL/kg bolus on arrival. Ventilation for normal gases was ordered. Active cooling was initiated with a cooling blanket placed under her, ice packs to both axillae, groin and head. Sodium nitroprusside was started to maintain SBP 90-100. CT scan demonstrated diffuse cerebral edema.

    4 hours later

    Despite active cooling her temperature remained 39.1. HR remained in the 140s, but now her BP was 78/40/51. The nitroprusside had been stopped and norepinephrine started, escalated to 0.08 then to 0.1 mcg/kg/min with poor response. Hypertonic saline was infusing at 1 mL/kg/hr on an estimated weight of 80 kg. Sats were now in the 88-90 range on 75% FiO2. Her urine output was minimal, the urine cloudy and pale orange. Repeat labs were sent as follows:

    pH 7.01, PaO2 68, PaCO2 78, Na++ 118, K+ 4.8, Cl-- 105, Ca++ 2.2, Glu 8.1, Lactate 5.1, HCO3- 26.4
    HGB 10.1, Hct 0.19, WBC 7.1, Plt 177
    BUN 63, Cr 7.1, CK 3850, Troponin 1.3
    PT 61, INR 3.4

    Over the following 24 hours, the staff struggled to bring her temperature, HR and lactate down and her BP, sodium and sats up. She received a total of 80 mL/kg of a combination of crystalloid and colloid, which rapidly third-spaced. She became hemodiluted and was given 5 mL/kg of PRBC to improve her oxygenation, with poor effect.

    5 am Monday - calling the surgeon

    By this time she was in difficult straits. Her SBP was in the low 70s on 0.25 mcg/kg/min norepinephrine, 0.1 mcg/kg/min epinephrine and 0.009 units/kg/min vasopressin. Her lactate had continued to rise to 9.4 and her GCS was 3. The decision was made to cannulate her electively and put her on ECMO. The cannulation was VERY difficult: she was obese, fluid overloaded and coagulopathic. Eventually she went on pump, but flows were a serious issue. Most of the time the best flow achieved was about 50 mL/kg/min, which was not enough. She was bleeding from everywhere; an attempt to run CRRT was made, which only served to impede ECLS flows. Her DIC was so severe that the regional blood bank was completely depleted of type-specific and O negative blood products. The hematology tech eventually told the unit there would be NO MORE blood products allocated for this patient. Period. Late Tuesday afternoon, her pupils were noted to be fixed and dilated. After a discussion with her family, the decision was made to withdraw life sustaining treatment;the family was given time to say their goodbyes and she passed away peacefully once the pump was stopped.

    Of the other 7 party-goers who also received pills from the 16 year old boy, 3 were admitted to hospital. All were girls; one was treated in the ED and discharged within a few hours. One girl was admitted for ongoing monitoring and treatment; she recovered and was discharged on the Tuesday. The third girl, also 15, followed a similar course to TB. ECMO was attempted but she progressed to brain death on Wednesday.

    The 16 year old was charged with trafficking and entered a plea of not guilty. He believed that because he hadn't sold them the drugs, he wasn't engaged in trafficking. Halfway through the trial, as evidence of the suffering these two girls endured was read into the record, he changed his plea and received a sentence of 4 months in custody.

    A few weeks after the two deaths, yet another girl, aged 12, was admitted following ingestion of "several" Ecstasy pills at an organized event promoted by a local attraction. These dance parties had been occurring several times a year for five years without incident. Admission was ticketed, once the doors closed no one was permitted in or out until the event ended and bags were searched for contraband. Parents were required to pick up their teens or arrange pick-up with written authorization. Security was provided by the event staff and the parties were very popular. Following the death of this little girl and the publicity surrounding it, the events were discontinued completely. Her course in hospital differed from the first two in that ECMO was not offered, since it proved to be ineffective. Although more attention was paid to her hyponatremia than had been in the first two cases, she succumbed to profound cerebral edema after 3 days in PICU. Her mother has become an ardent activist to raise awareness of the dangers of MDMA. The boy who sold her the drugs was 17 years old at the time of the offence and was tried as a juvenile. He received two years' probation.

    Case Study #2 - SG and GHB

    This young lady grew up in a dysfunctional setting. She was exposed to drug culture early on. On the day of her PICU admission she had consumed an unknown amount of her mother's "recreational" GHB before going to a party. She was found unresponsive on the side of a heavily travelled main route through the city and was transported to the children's hospital. In the ED she was noted to have severe blunt force trauma to her head, consistent with a fall or collision. Witnessed later stated she had been thrown from a moving vehicle. A sexual assault assessment was performed; she had vaginal and rectal tears and abrasions with multiple semen donors. Following decompressive craniotomy and Codman placement, she was admitted to PICU in critical condition.

    Over the first week post-admission she received large volumes of mannitol; she was placed in an induced coma, neuromuscular blockade was initiated to allow active cooling to control her ICP. She was tested for sexually transmitted infections and prophylaxis given for them. She did not become pregnant as a result of her assaults. Normal ICP was finally achieved on PICU day 9. Her bone flap was replaced on PICU day 11. She was slow to wake up once her sedation was weaned and remained unresponsive until PICU day 13 when she began to respond first to pain then to voice. She was unable to sit unsupported or even to hold up her head. By PICU day 18 she had identifiable sleep-wake cycles but was not verbal. She was extubated to BiPAP on PICU day 19 and moved to nasal cannula on PICU day 21. After 4 weeks in PICU she was transferred for rehabilitation.

    Four months following her discharge from PICU, she returned for a visit; she was walking unaided and talking. She has no memory of the events leading to her injury or for the time she spent on the PICU. She has not been able to return to school due to cognitive impairment and her Facebook page has not been updated since the day before her injury. Her mother received treatment for her substance abuse and remains clean and sober. She provides around-the-clock care for SG, who is now an adult. Their lives were totally changed in less than a heartbeat.

    Lessons Learned

    In the ensuing months and years following the three Ecstasy deaths, several teenagers - mostly girls - have been admitted to the PICU described in these scenarios for overdoses, often of several agents including Ecstasy. Treatment has evolved based on these three deaths and the focus is on supporting vital signs while aggressively treating hyponatremia. Hypertonic saline is initiated on admission and run at higher doses than in previous situations. By correcting the hyponatremia early (and gradually), cerebral edema is minimized. There have been no further Ecstasy related deaths on this unit. PICU staff are always ready for the unexpected. But no longer are the evils seen in the adult world something abstract. Hazards unheard of even 5 years ago are now appearing in our children's lives and they're not safe from them. Having some awareness of what they might be doing - and what that might be doing to them - is an advantage we all need, both as parents and as health care providers. Experience is the best teacher but it isn't written anywhere that the experience must be first-hand. Perhaps this series of articles may save a life. Or several. That is my hope.

    To read Acts 1 and 2 in this series, please go to:

    The Agony of Ecstasy in PICU and Other Tales… a Play in 3 Acts - NTI 2016 Session

    The Agony of Ecstasy, Act 2 - NTI 2016 Session

  • May 30

    Um. Siri... How could you forget me?? I'm crushed. I'll have to send you a great big bottle of Sambuca for that.

    I've been to NTI 9 times now. The only one I've missed since 2007 was Denver in 2014. I had to choose between NTI and a bucket-list trip to Ireland. (I struggled with that one. Just a bit.)

    In 2012 I stopped at a booth in the Expo to compliment a speaker I'd listened to earlier in the day; her topic was one of great interest to me, Munnchausen's Syndrome by Proxy. We talked a bit about her presentation as I stood there and then came that moment. The one when she asked me if I was certified in my specialty. I felt almost embarrassed to say no and felt like my reasons for NOT being certified sounded a lot more like excuses. I tucked my tail between my legs and sneaked away. When I went to NTI the next year in Boston, I had written the exam and was waiting to hear if I passed. I've often wanted to tell her how much that conversation influenced me, and I'm proud to say I AM certified in pediatric critical care nursing.

    I've learned so much, walked hundreds of miles and met some of the most amazing nurses along the way. I spent my 50th birthday in Chicago with the staff from Allnurses, which made it a very special occasion. When I spoke at NTI in 2011 on a most serious and difficult topic, I found myself looking out into the room at the very same staff from AN... wearing clown wigs. It was an unforgettable moment. I'd like to give a shout-out right now to tnbutterfly and traumaRUs for attending my 0730 session this year and providing me with moral support. Luv ya! I'd also like to mention how special it was to spend a whole day with madwife2002 and her daughter in San Diego last year. We had such a lovely day.

    I look forward to May from the second NTI ends each year and can't wait to walk into the Resource Center, go to the bag pick-up and get started. See you all next year!

  • May 30

    Quote from avengingspirit1
    It's a Landmark lie. The data pool for the study on BSN staffing and mortality rates was used for an earlier study about staffing levels and mortality generally. The information was simply copied onto another template for the study. The authors then said they would simply factor out the results from first study for the subsequent study. Then they only included data that was given the green light by the very people backing and supporting this fabrication.
    It's a study that you don't believe not a lie. A study published and vetted by one of the most respected peer-reviewed publications in the world. If you don't like the methods, get involved in research and repeat the study and move the profession forward rather than calling everything you don't like a lie and a shill.

  • May 28

    And just as an aside...the new Medicare rules under ACA actually now allows CNM's to charge 100% of the physician billing fee.

  • May 28

    On the other hand, I think this is a legitimate question unlike the one the OP posted before in another thread.

    Consider the following scenario:

    A family practice physician sees a new patient to establish routine care of a healthy middle aged male with no prior histories. He performs a physical exam, checks vital signs, orders labs, and determines that screening diagnostic tests are required. He writes up a note on the patient and bills the insurance company for $100.

    An FNP sees another middle aged male with the exact same profile as the one the physician saw and performs the exact same procedure as the physician but can only charge the insurance company $85 or 85% of what a physician can charge because that's what the CMS rules state.

    If you look at it, both providers did the exact same thing. The argument against making reimbursement equal between physicians and NP's is that NP's offer a more cost-effective alternative to the care physicians offer by charging insurance companies less. That disparity, however, is also preventing NP's from having a level playing field with physicians.

    In some institutions and practice settings, physicians insist on billing services alone and not having the NP's on their team bill in order to capture the 100% reimbursement. This devalues the NP in states where a collaborative practice is required. There are good arguments on both ends of the debate.

    This is not about NP's asking to be allowed to perform the full scope of physician and surgeon practice. What it is is asking if NP's should be paid the same as physicians if they bill for the exact same CPT code. I'm also not excluding PA's in this argument.

  • May 26

    There may be a few people reading this who have never experienced bullying. But, I'm pretty sure every organization of every type, has had to address the subject on some level. Just read or watch the news and you'll see where victims of bullying act out as a last resort, sometimes, resulting in extreme cases of violence.

    As a nation we had to fight to get where we are today, and we still employ the willingness to fight to stay there. Fighting is not new. However, in the workplace it has apparently become so prevalent that policies have, and are being developed to deal with this issue. As a nurse, I've heard the phrase "eating our young" in so many leadership classes that it almost feels superfluous. I've been a nurse for 27 years and I ask myself 'how are we changing and growing as a profession if we're still discussing the same issues?' We identify it as an issue, but are we any closer to dealing with it? Does bullying play any part in job satisfaction or employee turnover? Do we owe it to our profession to look at these questions closer?

    I would like to direct myself today in a slightly different direction...instead of looking at how to stop it; i want to simply try to understand what it is.

    Can a person think they are always right? Do adults have bad moments and have adult temper tantrums? Does having a difficult personal situation cause someone to act out? I think the answer to all of these is quite simply, yes. But does feeling your always right, or having a bad day, or an occasional crying spell at work make you a bully? No.

    I have worked with many people who thought they were always right. Some of those people were very eloquent at explaining themselves, and I respect them for taking the time to explain. Does that make them a bully, no. In the ever growing field of healthcare, change is inevitable. We all get frustrated at times, and we try to navigate the safest and most effective options for our clients. This frustration sometimes bleeds into their interactions with one another. Does that make them a bully, no. A quick I'm sorry or 'I get it' has fixed those hurt feelings easily. I myself have shed tears at work as I have a mother with Alzheimer's Disease. There have been times where the drive was too short from home to work, or my mom hadn't eaten for days without choking, that triggered those feelings of sadness, loss, and feeling overwhelmed. I'm fortunate because these are the moments my coworkers are my family and take care of me by offering me a hug, allowing me a crying spell in the bathroom, or just listening for a few minutes as I vent. Does that make me a bully, I certainly hope not.

    So what is a bully? Bully: a cruel and brutal fellow; be bossy towards; discourage or frighten with threats or a domineering manner; intimidate.

    I see the key words here being cruel and intimidate. Because bossy, really, I can live with; bossy: offensively self-assured or given to exercising usually unwarranted power. A person can easily be bossy without being a bully, it may be aggravating to deal with that on a daily basis but it is not something I personally would go home upset about. But cruel: able or disposed to inflict pain or suffering; and intimidate: to compel or deter if by threats. Wow! Those are powerful words! What drives a person to want to inflict pain or suffering in a threatening manner? Like seriously, who does that? And can you tell in an interview that they're like that? Or, if they're not 'like' that then, how do they become that? If we identify them, is there a potential to get them into classes about appropriate interactions and dealings with people. I think we need to recognize that there are people with great skill sets and poor people skills. How do we appropriately verbalize our concerns, or report bullying to a manager without coming across too 'soft' or too 'sensitive'?

    One time, I witnessed a coworker call another coworker an idiot, in a group, in a mental health facility, in front of patients. Talk about cruel, it totally undermined this persons authority as a healer. I have personally experienced bullying in my past, by a leader. As a leader she was put in a position by our direct supervisor to mentor me and guide me. All of which she did none of! Actually, she did the opposite, she would set me up for failure, not speak to me, and physically separate me from the person I was to be directly shadowing. And when I did speak to my manager about it, my concerns were dismissed, saying I wasn't there long enough to to have any "concerns". I quit that job.

    We've all read the research articles in our professional nursing journals stating being a victim of bullying can lead to depression, job dissatisfaction, psychosomatic and psychological concerns. When are we going to change our thinking from defensive to offensive? What can we do to foster a more supportive and nurturing environment for victims to speak up? As a profession, I feel we need to rethink how we deal with bullying. I feel we need to cast a wider net, not just look at how to handle the end result, but also how to identify it, how to report it, and most importantly, how to support its victims. We need our playgrounds back.