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  • Mar 27 '10

    Quote from ruby vee
    in their rush to defend themselves, the business casual folks do send the message that they believe bedside nurses are a bunch of ignorant children to be treated like such.
    prior to entering nursing, i worked as a paramedic.

    i rose to the level of director of operations of a regional office for a large ambulance service.

    part of my job description was i had to be a licensed paramedic with appropriate acls, pals, etc.

    to maintain "medical command" priveleges, i had to have so many hours on the bus, as well as successful iv starts, intubations, etc.

    therefore, i spent time directly "walking the walk" and performing the same job duties of the staff i supervised.

    that gave me much more insight into how policies i enforced actually affected the staff's daily workflow, and helped avoid the "do it my way, or else" mentality so common in nursing.

    job satisfaction was high where i worked, even before i rose to the top. it remained so, despite challenges to the system that increased workload and operations procedures.

    nursing, on the other hand, is almost the exact opposite:

    the very minute someone gets promoted out of "the pool", they take off their scrubs and never want to get within arm's length of a patient again. then they have a bunch of "great ideas" that hinder my workload, often for no good purpose.

    ems has a much flatter hierarchy, and this creates more "street cred" for the managers when laying down the law or changing procedures. (ems is also more gender-balanced -- which may be another problem in nursing.)

    "chicken dropping" rules like "no drinks at the desk", wearing tracking tags, press-gainey surveys that measure little but the "waitress" side of nursing, or adding 5 more pages to a 20 page admission packet for "research purposes" all come from middle managers who have forgotten what it's like. (i resent it. greatly. i know featherbedding when i see it, versus proactive management they keep claiming.)

    the fact the so many of them have posted here during times that indicate "work day" surfing of the internet, speaks for itself.

  • Mar 27 '10

    i find it telling that everybody that has jumped on me about my satire automatically assumes i'm only talking about nurses or the nursing heirarchy.

    why does the hospital support an army of billing people, dutifully filling out forms, locked in mortal combat with another army of clerks at the insurance companies, dutifully denying claims or procrastinating on payment, negotiating reimbursement rates, preapprovals and god knows what else, until 270 days after the service is rendered, the provider (maybe) gets a check for 30% what was billed?

    how does all this busy work contribute anything to the end product?

    why, in the digital age, is it getting more complicated rather than less to get paid?

    how many assistant nurse managers does the manager of a unit need? if all 3 are on duty, is it unreasonable to ask for relief for a real lunch when short staffed?

    does an education department that simply leaves a video tape at the desk with a sign off sheet need 6 full time staffers? (how about one of them come take over so i can go put on my "business casual" clothes to sit in the conference room to watch a 45 minute manufacturer's video on how to prime an iv pump?)

    if the nurse manager has a fruit bowl, jelly beans and a coffee maker in her office, why is it such a big deal if i have a (covered) drink tucked out of sight at the nurse's desk? (especially when i frequently miss meal breaks due to short staffing?)

    if my nurse manager has so much empathy for me, why can't she look the other way and ignore the drink and save the intimidation game for something that means something?

    why do i have to carry a voip phone with me every minute of my shift? can i pee in peace rather than be told "room 6 wants a warm blanket" at that private moment?

    you folks that "did what you do for 20 years", did it 20 years ago. come out here now and be flogged for 12 hours and see how dark your "education-phobic, nitwit" mood becomes.

    then you'll have some "street cred" with the unwashed masses and every right to tell us "whiners" to suck it up.

    chances are, you'll see just how petty silliness impacts my ability to render safe, efficient care. oh, and maybe enjoy my job (like 15 years ago) rather than cringe everytime i see yet another memo posted telling me i'm not working hard enough.

    prove me wrong and we can transform the nursing part of healthcare together. continue in the status quo and watch the attrition rates continue to surge.

  • Mar 27 '10

    If, in your "healthcare job" you never touch anything but paper, or smell anything but coffee, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If your job description DOESN'T have an annual requirement to be on your knees, geting freaky with Resusci® Annie, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If your hospital department is closed on Christmas Day, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If the "alphabet soup" after your name on your employee badge is LONGER than your actual name, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If you have an assigned parking spot for your 9-5 job, while the 24/7 clinical staff walks from their assigned parking 1/2 mile away, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If, from your primary work area, you couldn't see an actual patient with binoculars, but earn twice as much as those who do, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If there is an "RN" after your name, and you NEVER, EVER wear anything but business clothes to work, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If "every other weekend" is NOT in your job description, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If you've ever written a memo that had the words "mandatory in-service", "self-education module" and "during employee's spare time" and distributed it via company-wide email, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If the trunk of your car is full of pens, post-it pads, pen holders (and other trinkets with a brand name drug on them) that you hand out by the thousands so you can bribe your way into spending 5 minutes shmoozing a physician, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    If you have NO IDEA why the blue thermometer tastes better than the red one, YOU ARE PART OF THE PROBLEM WITH HEALTHCARE TODAY!

    -- 360Joules
    (with kudos to Jeff Foxworthy)

  • Feb 22 '10

    The main thing I'm learning in nursing school is that while some of the alternative medicine has been proven helpful for some, very few approaches have held up in clinical trials.

    I think there are a number of reasons that people tend to hate on Western medicine.

    1. It's the status quo. Some people gain a sense of superiority by being non-conformist, and have this attitude of "enlightenment", thinking they know more than the thousands of qualified pharmacists, physicians and scientists who've run legitimate critical trials on these drugs and treatments. Some people have a real conspiracy theorist mentality and think they know more than the people who have dedicated years and years to studying and research.

    2. The controversial "business" aspect to the pharmaceutical industry. Some folks think if something makes money, it's inherently evil (i.e. socialists). They fail to realize that if a business is unprofitable, it will cease to exist. Naturally greed needs to be curbed, but money has to be made to fund R & D.

    3. The earthy / vegetarian / green / holistic approach is appealing to some.

    There are a million reasons to like Western medicine. For one, we have a longer life span thanks to Western medicine. So do all the non-Westerners that come here when they need it. People are coming here to get the care that their countries fail to deliver. Does that say anything at all? As usual, we Americans don't understand how good we have it. We're spoiled, plain and simple. We breed this culture of "Armchair Authorities".

    I'm not necessarily bagging on alternative medicine, just from what I've read in class, it's effectiveness is not always validated by evidence. Western medicine, while not always yielding the optimal results for every case, has evidence behind it.

  • Apr 22 '09

    Quote from ooottafvgvah

    I think my true problem was not so much the restraints itself (although it was extremely emotional to see it), but rather the lady being called, by multiple staff, a crazy old lady. She used to be someone's mother, sister, daughter, etc. I guess I just think it wouldn't be too stressful or take too much time out of the day to refer to someone as an actual human being.

    I definitely understand this now better today than I did yesterday. Thank you everyone for explaining this. I looked up some more information and i'm a little surprised we weren't taught that in school. We were pretty much only told that there were 'physical restraints, and then chemical restraints'.

    I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.

    I hope to continue learning like this (if maybe a little less emotionally ), and despite how terrible I felt yesterday, I think it was a good experience, because I definitely learned a lot about restraints and why they are used, and how people react to them. Thank you everyone for your help and encouragement.

    I've quoted several of your remarks out of context, not to address them in particular, but because I see in them a trend I would like to both commend and expand upon. I don't have much to add to the topic of restraints: I hate them, and I use them. They suck. They save lives. 'Bout sums it up. Also, a couple of recent posts stoled what I was about to say about compassion fatigue. It sometimes seems like the nurse who'll ask me, "Hey, when you get a minute, would you go see Mr. XXX and slap him around for me?" is the nurse who is least likely to crack up and actually slap him around. We all have negative emotions, from time to time, and those of us who aren't angels, or even saints, are at least spared the stress of pretending we are, for whatever that may be worth.

    But the point I really want to make, to the OP and anyone else willing to hear it, is that we all want to be treated like the caring, competent professionals we are, but if we can't extend that respect to each other, who on earth will? Now, clearly, not all nurses are equal, and a handful are downright bad, but I am arguing that when another nurse does something, our presumption should be that it was the right thing to do. I know some of my instructors taught that I should expect to see more experienced nurses using out-dated and/or sloppy practice, and not to fall into that, myself. A valid lesson, to be sure, but no more valid than what I've learned for myself, that pretty much every nurse I work with is a good nurse who cares as much as I do, is at least as smart as I am, and is probably a lot more experienced than I am. Now, it's always possible that if we disagree on some solution to a given issue, I could be right and they could be wrong. It's even more possible that we could both be right--that there are multiple right answers and the one we choose is a matter of style or personnal preference. But I find I've learned a lot just by recognizing that what I think, or even what I was taught, could be wrong.

    I think the OP has been shown, and grasps, that restraints are not an absolute evil. Clearly, they aren't an absolute good, either. They should never be used to punish a patient, or even for a nurse's convenience. But I would encourage us all to think that if a nurse and a doctor believe tying a patient's hands is in the patient's best interest, they probably have a good reason for thinking so. A facility with a No Restraints policy is saying, in effect, that the suits and bean-counters are better judges of patient care than the people in scrubs are, and if we work from the presumption that the other nurse is wrong, we're buying right into that. Again, I don't mean to bust the OP's chops, or anyone else's, but in the light of this experience and the comments in this thread, does it seem like a reasonable idea that when you see something you don't understand, or even don't agree with, you start by thinking, "A nurse did this, so it's probably right." Then try to figure out why it's right. Then, if you still have questions, ask them.

    "A nurse did this, so it's probably right." It's a huge leap of faith, and there will be situations where the evidence doesn't bear it out. Sometimes even good nurses are wrong, and some nurses are wrong a lot. But think about the converse: "A nurse did that, so it's probably wrong." Because every working nurse will eventually encounter that from someone. It's discouraging, degrading, and dangerous, but if you get through a shift without getting it from someone--a patient, a doctor, a patient's family--you're lucky. The smartest, most compassionate, best nurses I know have to put up with it. But how great would it be to at least know that you won't have to put up with it from a fellow nurse? So I'm asking the OP, and anyone else who'll listen, to take that leap--not blindly, to be sure, but not hesitantly, either. If we can do that, who knows? Maybe someday, others will, too.

  • Apr 14 '09

    Quote from kdcheermu
    Well, even though it is frustrating to us, we have to keep in mind... being in the hospital is a HUGE inconvenience to a patient. I mean, yes, it's an inconvenience when we have to "tip-toe" around the phone cord to get vitals, admin meds, etc... but it would suck even more if someone had to wake us up every 4 hours, constantly come in our room and disrupt us, give us no privacy and on top of all of that... being sick at the same time. We are nurses and nurses are "persons educated and trained to care for the sick". Part of our care is respecting patients and their privacy. When I find it difficult to deal with "rude" patients I try to look at it from the other side. What if it were my mom in the hospital (who is 6 hours away) and I didn't have any time off that would allow me to go see her... wouldn't I want her to be able to talk to me whenever I had the chance to talk to her? Would I really want her to be lonely and laying in a hospital bed with nurses who were frustrated at her because someone called to check on her? I would hope that whoever had the privilege of taking care of her would "respectfully" ask my mom to get off of the phone nicely if the procedure absolutely called for it. Otherwise, I'd want them to be happy that she had someone who cared about her enough to be on the phone with her for so long.

    I don't know... just my own thoughts.
    While I guess I can understand that being ill and in a hospital could be an 'inconvience' (odd word, since it's THEIR health afterall) to the patient and/or their families, it is my duty to provide the best nursing care that is needed for them AND all of my other patients to heal. Sorry if I sound mean, but my nursing priorities are more important than their personal telephone call. I would be polite, but really I do not have time to wait for personal phone calls to end to do my job. I think very logically about my time, the time I spend waiting for someone to finish a call is time I will not have to perform other duties. I am responsible for other patient's nursing care and also for my own time management. Personally, I consider it VERY rude for someone to continue a personal phone care when a nurse/tech/Dr. is their to provide them treatment. But I also find it rude for people to continue cell phone chit-chat at the bank teller, at a cashier, etc.

  • Apr 6 '09

    Dude, let me tell you -- you are ONE cranky old man. Yes, we "forgot" your breakfast, and for that, I apologized up and down and sideways, even ran to the basement to personally see to it you got a lunch tray. And how did you reward me? You lit into me about every single injustice done to you at this hospital, including, :HORRORS: having to be "last in line" in the x-ray line because YOU had a sepsis infection.

    I mean -- dude, you are getting out alive. Yes, little things were missed. There was probably a team of 100 or more taking care of you these last 3 weeks. Do you ever wonder that perhaps just everyday human error in a large organization COULD result in a few glitches in your care? Are YOU fricking perfect? You certainly expect everyone else to be.

    The truth is -- you were well taken care of in this hospital. People waited on you at your beck and call, every GD 15 minutes. You have been nothing but nasty to everyone, and now you take the LAST day out on me.

    Well, I hope people like you get what you deserve - whatever that may be. You are nasty and rotten to the core. You see people in service to you and you simply choose to demean them. I hope whereever you're going, that it's not someplace good. You are evil to the core. You live in the greatest country in the world, get what is STILL the greatest healthcare in the world, yet you continue to complain. Ugh. You make me SICK. Your last gripe was having to "wait" 2 additional hours for your private ambulance ride to the rehab place because you choose to be a louse over your bum knee. Seems to me you've got one good leg, so why dont' you use it? You've got enough dilaudid in you to kill a horse, yet you can't even seem to get up to sit on a commode!!

    Goodbye. Good riddance!!!!

  • Mar 27 '09

    Quote from ruby vee
    we often see threads with the title "fired for no reason," or "new grad harassed and fired" or something to that effect. and i always feel at least a little sympathy for the individual involved, if only because i can clearly see by reading between the lines of their self-justifying post that there was a reason for their termination, even if they just don't get it. (there are always a few posts every year from a new grad who is convinced that the reason she's not getting along with her co-workers is that she's just so beautiful they're all jealous, that crowds of mean people are following her around, that she's so wonderful she's going to rock the er or icu or nicu or or and no one sees her wonderfulness clearly, or that some mean, tired, old nurse who ought to retire and get out of the way is targeting her for no good reason.)

    i worked with a new grad who was recently terminated for, as she puts it, totally bogus reasons. evidently seeing mine as a sympathetic ear, she went on and on and on about how unfair it was that management expected her to get her act together and actually understand what was going on with her patients. "i've got the time management thing down pat," she said. "i don't know what else they want. they're just picking on me for no good reason." i liked sal, i really did. she was interesting and entertaining and really, really nice. she was also smart, hard-working (when she was at work) and well-educated. but she didn't study outside of work, and really didn't understand what was going on with her patients. i participated in several meetings with her in which it was pointed out that it's not enough to do the tasks, you have to understand why you're doing them. it's not enough to draw the labs. you have to understand what the results mean and then address them. for instance, if the inr is 9, it might explain the nosebleed, the cherry red urine and the fact that the hemoglobin is now 6. giving the coumadin at 6pm as scheduled is not a good thing, even if you gave it right on time and were able to explain to the patient that "it's a blood thinner." i could go on and on.

    i got a call from sal today, complaining that she knows she's blackballed for no good reason because she just can't get another job. she wanted me to give her a reference. did she just not get it?

    all you new grads out there who are convinced that you're being picked on for no reason, that your more experienced colleagues are just out to get you, and that you're being unfairly targeting, harassed, or picked on, hear this: it may be something you're doing (or not doing) and all those "mean people" are trying to explain it to you so you catch on, learn your job and succeed. we all tried over and over with sal, and she still doesn't get it. are you guilty of the same thing? if your preceptor says you lack critical thinking skills, do you take it to heart, think about it and learn from it? or are you convinced that the entire issue is that she's jealous of your extreme good looks? if your charge nurse charges you with a deficit in your time management skills do you spend time figuring out where you could speed things up a bit? or do you dismiss her as a tired old dog who can't learn a new trick and ought to retire anyway? are you taking to heart and benefitting from any negative feedback you're getting, however poorly given it is? or are you obsessing about how "mean" that nurse was to you and totally overlooking the message?

    i wish sal would have "gotten it." she would have been delightful to work with if she had. but right now she's focused on badmouthing her preceptors and the charge nurse, and she still doesn't understand what she did wrong. don't make the same mistakes.
    where to start?

    i remember once being on clinicals and we witnessed two nurses at change of shift argueing about what insuling a pt. was on. the nurse giving report said she gave reg. insulin, and the one getting report freaked out. the form filled out by physicians at this facility was complex to say the least, and they pulled it out and argued for awhile about what insulin the pt. should have been on. a student had that pt. too. after, oh, a good 15 minutes of going back and forth on the proper interpretation of the order sheet, it became clear the nurse giving report was right and all the other nurses had been giving the wrong insulin.

    my fellow students all hailed the nurse giving report........"what a great nurse, she read the order right. those other nurses are not up to snuff." i injected that who was right was not the issue at all. two rns argueing over what insulin was really ordered, people giving the wrong insulins.....seems to me the problem is the form is not reliable, and that is the problem. who cares who was "right" at the time about what insulin to give. lost in all the argueing and finger pointing was the fact that the form needed changed.

    my point is, like myself and my fellow students, people see the same thing and take different lessons from it. i read your story, and although i agree in principle that some gns have the wrong attitude, i have a different reaction than you.

    the first part i that a true, literal example of something your gn did or is that just something to make a point? scary if its true.

    as i read on, i noticed a trend in your thought process. notice the part afterward that i bolded. these statements do not convey to me a supportive preceptor who promotes learning. as experienced nurses, we must be mindfull of giving out constructive criticism that encourages learning from mistakes. "negative feedback", "charges you with a defecit" dont fall into this category.

    being a preceptor is not an easy task. hospitals give this responsibility to the wrong people for the wrong reasons. a good preceptor nurtures learning by being a leader and a teacher, not by failing or passing their gns. it is important to point out the mistake, but at the same time helping the gn realize.........yes, this is stressfull and mistakes will be made, but the bridge that we must cross to go from "nurse" to "good nurse" is not impossible to cross. make the changes we are suggesting, and you will have crossed said bridge.

    when i was new, i was very fortunate to have a preceptor who understood these things. she often chuckled at how stressed i'd get over nothing. often told me "you are not nearly as behind as you are acting". i had to be told about mistakes i made, told how to deal with difficult people from other departments who inturupted my work (i lost it on a housekeeping individual who was being a pest about fluids being left on the pole from a pt. who was d/c'd..........while i was trying to console/work with a woman who had just found out the mass on her pancreas was malignant) and all sorts of things. i never once felt attacked, targeted or picked on. is that because i am more mature, smarter or just a better person than the avg. gn? i doubt it.

    see, you tell your story and, the lesson some may take from it is that the quality of gns coming out of schools needs to improve, or that gns just need to buckle up and get with the program. me, i see gns like the one you describe failing and i take it as a loss, a missed opportunity for us experienced rns. yes, you are right, there are gns who "just dont get it". from my point of view, there are just as many preceptors who "just dont get it".

  • Mar 23 '09

    I don't know, but I am completely sick of hearing about patient satisfaction and having management lay it on MY shoulders. If management was truly concerned about patient satisfaction, they'd have a lower ration than 1 nurse to nine patients. They just want to work me like a mule and ALSO lay all the blame on my shoulders, when they put me in a situation that I will never succeed at. It's a bunch of crap.

  • Mar 23 '09

    Well, I am in trouble. I whipped off my nasty email and my manager has called me in for a "chat" on Monday at 2 pm. I know that I should not have been so nasty in my email and I wish I had talked to some of you before I sent it. You guys gave me some great ideas regarding the supervisors motives and how to respond to her, but I was angry and instead of sitting on my anger for 24 hour before taking any action, I let my anger overtake my logic. And you know, it always sounds worse when you send it in email instead of saying it in person. I don't think I am going to get fired, but I won't be surprised if I get suspended (this has never happened to me before). But I guess I deserve it. I shot my mouth off and I have to accept the consequences of my actions. I will send you guys an update. But I still don't like her and I don't want to work with her. And I WON'T be offering her an apology.

  • Mar 14 '09

    you pay 400,000 for only 1 bathroom and 1 1/2 bedrooms. the cost of living is horrrrible. im so sorry that you have to do that, but im sure you're making it just fine. i know where i live dallas, texas a 400,000 house could get you at least 3000 square feet 4-5 bedrooms. i hate how the cost of living is different all over. wouldnt it be great if it was unified all over?

  • Mar 14 '09

    I didn't necessarily want to drag up this whole thread but I wanted to add some thoughts to this discussion and comment broadly on some points posters brought up in the last spat of posts.

    1. Anesthesia and pain control. I agree with posters saying that this is the least of the concerns. Whether or not a procedure is painful doesn't factor into whether or not it is ethical to perform that procedure. The ethical practice of medicine generally says that doctors and nurses only perform medically therapeutic procedures this is waived a bit in many cases such as plastic surgeries but when done only for the sake of vanity they are generally done only on adults, so far as I am aware. In a proxy consent situation it is particularly important to only provide medically therapeutic interventions which either correct a current problem, fix a deformity, or sometimes provide a benefit that is necessary to the well being of the child (or other patient) but can't be achieved in any other, less invasive, reasonable way. Circumcision doesn't fit that category in any way and there is no objective reason to perform it.

    Whether we call it mutilation or not (I do) circumcision most definitely causes damage in every case. There is cutting, there is bleeding, there is a wound that must heal, scar tissue forms. Scar tissue is by definition damage. It's only a question of how much damage and how many get more damage than expected. I've known several people who had severe complications that are bad, noticeable, but they can 'live with it'. That isn't right, there was no objective reason they had to go through that or live with it. I'd venture to say there are probably more complications then we are aware of if only because when someone 'grows up' with a problem they may not notice that it is a problem. They may think that the skin on their penis is supposed to be so tight that it causes a bent erection for example or that the significant scar tissue is normal, they may not even know it's a scar.

    But as most of you are aware, most medical procedures do cause damage and wounding but those woundings are justified by the therapeutic aim of the procedure. This therapeutic aim is an essential justification under conditions of proxy consent, consent for those unable to consent to the wounding for themselves. The burden of proof of justification is on the person who causes (or wishes to cause) the wounding. Consequently, a physician (or parent) would need to show that infant male circumcision was medically necessary before it would be justified. If there is equal doubt as to whether or not it is medically necessary (which is by far the most favorable position that, at present, could be taken in favor of infant male circumcision), then the procedure must not be carried out. In other words, in situations of equal doubt, the person with the burden of proof (the physician or the parent) cannot proceed.

    That is not the world we currently live in though, unfortunately, though I think and hope we are moving in that direction. I think the problem is that male circumcision is given a cloak protecting it from ethical scrutiny because of its religious connections. I have little doubt it would be illegal to perform on minors today were it not tied to religion.

    2. How do boys or men feel and what does that mean? I think that unless they really think about it most don't feel anything one way or the other because that is just the way things are, why dwell on something you can't change (for circumcised guys). And until recently most people (in the US) thought it was necessary which colored opinion anyway. But that doesn't make it right. Whatever you believe about circumcision one objective fact can't be denied, the only boy/man who has any say in the matter are the intact boys/men who get to make his own decision about his most personal possession. Consider that there are two groups of men, intact and circumcised.

    Now of all the intact men, there will be some small group who are not happy with their state. It doesn't matter why they aren't that's just the way it is. And that is actually fine. They can get themselves circumcised. On the other side of the coin, there are going to be circumcised men who are not happy with their state. It makes no difference why they aren't happy, that's just the way it is. And that is also fine. The problem is there isn't anything they can practically do about it. So the point is leaving a boy intact puts him in the only group that always has an acceptable outcome.

    Now to illustrate this point further, I'll share with you a small survey on a large teen forum. The poster who wrote message #110 explains it quite well:

    "We've had poll after poll here on GovTeen. Regularly, at least 1/3 of cut guys would have preferred to have the choice. Sometimes, the number breaks 40% or approaches one-half. You can keep telling yourself that no one really minds -- but this is a personal choice that some people wish they had, for a logical reason. Why would you deny them that?"
    Here is one of their polls. You will notice that the poster doesn't lie. In this admittedly small sample, about half the 'cut' guys would have preferred the choice. But, they've run similar polls before and always get the same results. My guess is that most of those 'cut' respondents are American since it is very rare outside the US similarly, the uncut guys who wished they were cut, I'd bet many of them are American and are just a bit social conscious about it. Based on the fact that (secular) circumcision is very rare outside the US and few opt for it I'd guess that the as the numbers of intact boys in the US increases you might see more discontent but again circumcised guys can't really do anything about it practically speaking.

    I think that's says something very important and we should be listening. These are amongst the first group of kids to grow up with boundless information on this topic that could make an evaluation before their mind was really set. Previously, most people didn't think about it until they were about to become parents, not anymore. They can also talk to their cohorts in other countries and find out that all the myths they heard were not true and I think that is what really shapes opinion. I might add that 'foreskin restoration' is a very popular topic on those boards too.

    Now I am not saying that those 50% hate their parents but they would have preferred the choice and what's wrong with that? I'll add that I've seen similar polls about 'would you circumcise your son' and the numbers usually come out much higher on the no and that is very encouraging. So those who've asked there teen or adult kids they might be ok, they might not be. Are they going to tell you about it? If they're not ok, what real option do they have anyway?

    3. The issue of female circumcision came up and even the Seattle Compromise. In a nutshell, Somali immigrant parents requested their doctors to circumcise their daughters. The Somali's expressed how important it was to them for their religion, their culture, ect. The doctors resisted, the parents couldn't understand why the would circumcise boys but not girls [and neither can I]. The parents made clear that all they needed was a 'symbolic cut' a little nick, a little blood, if they couldn't get it they would go back to Somalia where it would be more extensive. The physicians acquiesce and agreed to perform this procedure. When word got out the s**t hit the fan and public pressure was so great that it was canceled. It isn't clear what happen with the children, they may have faced a worse fate in Somalia. So we protect girls from even a very simple, symbolic cut that from an objective prospective is less invasive than male circumcision but boys have no protection. How is that in any way reasonable?

    There were some who said female circumcision curtails female sexual pleasure. That isn't necessarily the case. A 2002 study found that circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women. The tradition may have started to try and curb female sexual arousal but so did male circumcision, particularly in Victorian America and Britain (the British have long since abandoned the procedure).

    "In cases of masturbation we must break the habit by inducing such a condition of the parts as will cause too much local suffering to allow the practice being continued.", On An Injurious Habit Occasionally Met with in Infancy and Early Childhood The Lancet 1860, Vol. 1, pp. 344-345
    "I refer to masturbation as one of the effects of a long prepuce [foreskin]."
    The Value of Circumcision as a Hygienic and Therapeutic Measure, New York Medical Journal 1871, Vol. 14, pp. 368-374.
    "[Circumcision] should be performed without anesthetic, as the pain will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." Treatment for self-abuse and its effects of 1888, Iowa, p. 295 By John Harvey Kellogg.
    Yep, the corn flake guy.

    In parlance of those times preventing self abuse was euphemistically referred to as being 'hygienic'. Of course the meaning changed but the word stuck and now you know where the circumcised boys are more hygienic came from.

    Does the fact that we think, know, that circumcision doesn't seem to impact male masturbation, actually I think it increases it, really change whether it is ethical? Does the fact that it seems, from the 2002 study, that female circumcision doesn't impact female sexual arousal or pleasure change anyones position of FGM? Is it now ok? What if we moved it into a hospital or Doctor's office, does that now make it ok? That is where most FGMs in Egypt are/were done. Here is the blog of a mother in Singapore praising her infant daughter's recent circumcision, again by a doctor. I am sure she did this out the best intentions cultural, social, religious perhaps they think it is more 'hygienic'. From an objective perspective, what is the difference between what she did and what many parents in the US did? What is the difference between these pictures and these pictures and here or here? Would your position on FGM change knowing that it doesn't impact female sexual pleasure, was done in a Drs office, and when the child was an infant? If not then why is male circumcision OK? I think the answer to that question lies in our cultural conditioning and blindness. Many people here might enjoy this article published in Australia's Medical Anthropology Quarterly, A Rose by Any Other Name? Rethinking the Similarities and Differences Between Male and Female Circumcision.

    4. The HIV, STD issue. This is just ridiculous. There is a WHO recommendation but the WHO recommendation applies only to countries with high prevalence and not to countries like the US. And let me just explain to you why especially in the US, and other first world countries, the HIV argument is pretty much BS. It's also a stupid policy in Africa and will almost certainly be a long term failure but for other reasons and as others have said would require a different thread.

    Anyway, to determine the probability of not becoming infected you can use the following formula:

    (1 - [chance of transmission from sex])^[sexual encounters]

    Now for the estimates, let's assume that there is a risk reduction of 50% for circumcised men. This is the number most often banted around by the popular media and those clowns at the UN and WHO in their reports from Africa. The probability of infection in any one encounter with an HIV positive partner varies depending on viral load, co-infection, and numerous other reasons. For example, people are most infectious soon after being infected. Infectiousness lessens after a few weeks which is one reason HIV spreads so fast in Africa, read The Invisible Cure: Africa, the West, and the Fight Against AIDS, by Helen Epstein, to find out why it's so infectious in Africa but not anywhere else.

    Anyway, I've seen numbers for women infecting men range from 1/700 - 1/2500 and interestingly enough, a recent publication in the Lancent of Infectious Diseases and reported at Aidsmap, put the risk of an HIV infected woman infecting her male partner at 0.04%.

    From Aidsmap:
    Researchers conducting a meta-analysis of studies of the risk of HIV transmission during heterosexual sex have found that, in high-income countries prior to the introduction of combination therapy, the risk per sexual act was 0.04% if the female partner was HIV-positive, and 0.08% when the male partner was HIV-positive. However these rates were considerably higher in lower-income countries, if the source partner was in either the very early or the late stage of HIV infection, or if one partner had genital ulcer disease, write the researchers in the February issue of The Lancet Infectious Diseases.
    They continue:

    Pooling the data from studies in high-income countries, the researchers calculated that the risk of transmission from an HIV-positive man to his female partner was 0.08% per sexual act: in other words, it was likely to occur once every 1250 sexual acts. When it was the female partner who was HIV-positive, the male partner's risk of acquiring HIV was 0.04% per sexual act - in other words, once every 2500 sexual acts.
    I bolded the last, though it isn't pertinent to the discussion, I might come back to it later. I'll only say that is so obvious I don't know why they made a point of it. It was been well known that people were more infectious in early and late stages or if they had genital ulcer diseases. Also note that they said prior to the introduction to therapy which means the true rate may actually be lower now but we'll go with it.

    So based on that, we'll start the estimate that the chance of infection is 0.06% a bit higher than published in the Lancet article. That means a male having unprotected sex with an HIV positive women has about a bit more than 1 in 1800 chance of being infected. Base line risk intact men vs circumcised men 1 random heterosexual contact with an HIV+ partner.

    [1 - 0.0006]^1 99.94% ~= 0.06%
    [1 - 0.0006 * 0.5]^1 ~=99.97% ~= 0.03%

    But the HIV distribution in the US population is about 5 in 1000 or 1/200 so, in general, there is only a 1 in 200 chance that I'll encounter someone who is HIV positive. Actually the risk is much lower but we'll discuss that in a bit. Given that as a fact, a closer estimate of the risk of becoming HIV infected after the 1 encounters is more like:

    The chance of event A (encountering an HIV positive individual in the general population) * the chance of event B the likely hood of getting infected during that encounter.

    1/200 * 0.0006 = 0.000003 --- 1 - 0.000003 = 99.9997% = 0.0003%
    1/200 * 0.0003 = 0.000006 --- 1 - 0.0000015 = 99.99985% = 0.00015%

    Of course, the number of sexual encounters is important too. For 1,000 encounters, the difference is 1.5 hundreths of a percent. That's is what circumcision bought you, big deal. Over the course of 1,000 random encounters an intact guy has 1.5 hundreths of a percent larger chance of becoming HIV positive. Circumcised guys, party on!

    Of course there are some caveats to this. First, your per-exposure risk might change based on other factors and the 1/200 is quite high since 75% of the HIV positive population are men. If women only account for about 1/4 of the total, this reduces the 1/200 to between say 1/700 or 1/1000. This is what it looks like when we adjust the prevelence among women:

    1/700 * 0.0006 = 0.0000008571 --- 1 - 0.0000008571 ~= 99.99992% = 0.00008%
    1/700 * 0.0003 = 0.0000004286 --- 1 - 0.0000004286 ~= 99.99996% = 0.00004%

    That's a whole order of magnitude. Now we're talking about a difference of 4 thousandths of a percent if we have 1,000 random partners. Party on.

    For Doctors, especially in the US, to entertain the notion that circumcision is going to in anyway impact a boys chances of acquiring HIV is very misleading, not truthful, or ethical. The commonly cited 50% has to be understood in context. Circumcision as a prophylaxis for any STD is, if it is even true, over stated especially in first world countries like the US. I find courious though that it keeps getting pushed, consider HPV. Now here is something that we've been vaccinating against for over three years yet people still try and tie circumcision to HPV, why?

    So yes, that was a long post but there was a lot to say. I liked what a lot of you had to say because it is really up to the medical community in general to end this. Rates are declining but we won't get to near 0 without your help. This is simply because circumcision is a pernicious practice whose myths seem to live on and on and on. No rational thinker can defend routine infant/child circumcision I just can't figure out why we are having such a problem turning it off in this country.

  • Mar 13 '09

    Quote from firstyearstudent
    Frankly, it sounds like you are just hurt and humiliated, so want her fired. Unless she has a history of flying off the handle or is not doing a good job or is repeatedly hostile toward you, you should just put it down to having a bad day.

    But does anyone who is trying to do their job have to be hurt and humilated? While I understand your point, I don't think that many people can wrap their brain around diminishing this experience to 'a bad day'. Does this happen on Wall Street? In the business/corporate world? Not the same way it does in the world of nursing. This is what makes people run for the hills on the first thing smoking.

  • Mar 7 '09

    Quote from firstyearstudent
    A $400,000 McMansion? Where did they live, Idaho? I live in L.A. and our hovel, well over $400,000 is less than 1,000 square feet, has one and half bedrooms, decrepit plumping and wiring dating from the '20s, one bathroom and a miniscule kitchen with no modern appliances. Plus it is in smack in the middle of gangland with schools so bad we have to drive your kids to a charter school in another school district! And plenty of folks who run in-home daycare around here make more than my salary and my husband's put together.
    I'm pretty sure this was in Ohio.

    Here in rural Illinois, $400,000 will get you a mansion as well.

    Why do you choose to live where you do?

  • Mar 6 '09

    Quote from Jaguar Boy
    Hello SubPrime crisis...(I know that not everyone who is affected was irresponsible, but I'm sure that many were...)
    I saw an interview on CNN with such a family. It was a husband and wife, no kids, who did in-home day care - that was all they did - and were going to lose their $400,000 McMansion. When I heard about the day care, I thought at first that maybe they owned a chain, but no, that was their sole source of income. When they were interviewed, it was obvious that both were mildly mentally retarded.

    How do the slime who exploit people like this get through the day?

    I know people who are very irresponsible with their money, and I have learned the hard way that telling people that their financial problems are their own fault usually goes over about as well as telling them that the problems they're having with their children are their own fault. As Twinkerrs knows, that isn't always the case, but usually it is.

    My before-taxes income has slipped over the 6-figure mark and I drive an 8-year-old car with 100,000 miles on it. Some people ask me why, and I just tell them it's none of their business, but the fact is, it still runs so why should I replace it? Granted, I spent 2 hours in the shop this morning and have to come back, but hey, if it ain't broke, don't fix or replace it. JMHO.

    Twinkerrs, most people can tell the difference between an undisciplined child and a child who really does have issues. You can usually tell by the way the parents react. If they don't think the behavior is funny or cute, it's the child's wiring. JMHO.