grv68

i really enjoyed bbqvegan statement above. i don't have any answers but continue to be inspired by what i have read of dr. paul farmer and his work in haiti and with pih. most folks may have heard of tracy kidder's book, mountains beyond mountains, but farmer's "pathologies of power" offers numerous case studies across many cultures and countries, including the us. in contrast to michael moore's film which i think is his least sensationalistic by comparison i recommend salud for another perspective. yes there has to be way because ultimately we all pay the price as a society. trailer here http://www.saludthefilm.net/ns/synopsis.html

Ive read through this thread and my two cents for contributions are: 1. Moore may start off with right intentions but tends to be over the top in most cases. In this film had he simply presented the criteria the WHO uses in ranking health care then the movie would indeed be damning. 2. That said no health care system is perfect and "ours" is certainly held hostage by pharmaceutical and lobbying groups. What do you expect when a society has no social net? The Euros have high taxes to fund their system, perfect or imperfect as they may seem, but suggest to most Americans to pay 40% in taxes out of each check you will see a public lynching. The cultural divide continues in that we have more debt and more consumerism and our states vary in where monies are allocated: for example one town may choose to spend tax money on their education system which makes their town have higher SAT scores, college placements, etc. Research economic data and tell me if you can compare the state of NY to the state of MS (no disrespect to MS). Northern industrial to agrarian economy that appears on paper to still be in Reconstruction. 3. I suspect Castro pulled out all the stops to "shame" the US when Moore did this film. I have distant relatives in Cuba that are doctors (cardiologists in fact) and they make $18/month. Confounding, no? So yes you may have socialized medicine but if you have to wait six months and hope you dont die in the meantime what is the point? If you dont have insurance and cant get help as is the case here at times then what is the point? Results are the same. 4. Separate health care from military politics. Apples and oranges. You might be surprised to know many folks around the world respect and like Americans but despise our government. We are a generous people. I am waiting for someone to do an expose on the VA system where returning vets are denied mental health because of "pre-existing personality issues." That is worth a film and an ounce of outrage. In matters of politics I will defend anyone's right to say what they want no matter how much I disagree with it. Open discourse is better than people disappearing in the night. Orwell wasn't too far off the mark at times -speaking of all governments and imperial practices. Cultural politics are complicated matters, living and dying is straightforward. 5. I walked away from "Sicko" contemplating more of what it means to have a "society" and if we are any closer to a functional one. What does it mean to be a "citizen of the world" and get away from dichotomous "us vs them" thinking. If people are angry then why are they angry? Simple "they are jealous" is childish reductionist thinking. There is a distinction to be made between "Society" and "Civilization". We treat our pets better than we treat each other. 6. The poorest and most abject case of neglect here does not merit comparison with someone who lives in sub-Saharan Africa and other underdeveloped countries. We have a "system" and they have nothing. Something to contemplate. Does not matter if you are "left" "right" or whatever, go and look at Africa or Bombay and tell me that the sights, conditions, and smells dont move you to tears. My point is in terms of dollar and cents one is left to infer human life doesn't amount to much. As nurses we may be treated just as poorly as people in Moore's film. Perverse irony that we are the first face of "health care" people will encounter. Ive said it in previous posts: Treating the body and spirit are ultimately outside of the black and red margins of profit. We all lose if everything is predicated on dollars and cents. My only bias is my belief that in this country where there is so much wealth there should be no child that goes without food or an education, and no adult should be homeless. In every society there are those who cant work (physical or mental impairment) but every human being wants to feel useful and connected to something. Call me an optimist.

PTSD and depression. Origins of which i rather not discuss publicly but will offline from this forum. Meds helped to a point but cognitive therapy and knowing "triggers" are what helped me most. I think "best coping mechanisms" vary from person to person.

ok i am back to be a little more annoying summary of nursing shortage here http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm BTW this link above has data on national faculty shortages and nursing student enrollments Please be patient a second so you can see where I am going with all the data below after I explain data sources i went over to the MA BORN site (Board of Nursing) There I found the statistics about active RN licenses in MA. The last data point is for Fiscal Year 2005. Location: ttp://www.mass.gov/?pageID=eohhs2terminal&L=7&L0=Home&L1=Provider&L2=Certification%2c+Licensure%2c+and+Registration&L3=Occupational+and+Professional&L4=Nursing&L5=Licensing&L6=Statistics+About+Licensees&sid=Eeohhs2&b=terminalcontent&f=dph_quality_boards_nursing_p_stats_register_nurse_licensees&csid=Eeohhs2 Then I went over to the MA gov site and tracked down population data for MA. http://lmi2.detma.org/Lmi/lmicensus.asp I then went and did the same deal for national data. # of active RN licenses against national (near current ) census data Census data (national) http://factfinder.census.gov/servlet/ACSSAFFFacts?_event=&geo_id=01000US&_geoContext=01000US&_street=&_county=&_cityTown=&_state=&_zip=&_lang=en&_sse=on&ActiveGeoDiv=&_useEV=&pctxt=fph&pgsl=010&_submenuId=factsheet_1&ds_name=null&_ci_nbr=null&qr_name=null&reg=null%3Anull&_keyword=&_industry= # of active RN licenses in the US http://bhpr.hrsa.gov/healthworkforce/rnsurvey04/2.htm =============================== My summary (and please point out problems with my logic) NATIONAL The national population is 288,378,137 The # of Active RN licenses nationally is 2,909,357 Ratio of RN to US population is 1:10 =============================== LOCAL in my state (MA) The # of Active RN licenses (FY 2005 last data): 103,222 MA population (rounded up): 6,000,000 Ratio of MA RN to MA resident is 1:58 CAVEATS This isnt telling you where nurses are because the data is diffuse throughout the US. An article somewhere on allnurses pointed out the top cities for nurses, like San Fran Census data is based on Year 2000 MA census data is more recent as are Active RN licenses nationally, while MA Active Licenses stops at 2005

Hi All, I have included some links for reading. I am in MA and I can tell you there is a shortage of nursing faculty, combined with schools struggling to have sites agreeing to have clinical rotations, that has exacerbated the nursing situation. Some schools, like my program, have managed to get waivers to have ASN nurses do clinical instead of MSN instructors. A good friend is an instructor at a well known school here and she is constantly worried about how class sizes have increased and "getting to the students". Large class size often mean larger clinical groups, although there is a limit to clinical group size a full group is stressful for an instructor. Of course I have issues with "shortage" in MA with respect to jobs because all my friends and I are struggling to find jobs. Some facilities are downright rude and unprofessional with our inquiries, or simply dont do us the courtesy of acknowledging our applications. I didnt realize until after I graduated how saturated my area was with RNs. The MA Board of Nursing (BORN) gives stats on # of nurses out there. Where are the jobs in MA? I cant find the one article I had that said 34,000 students were turned away nationally because of faculty shortage. I hope these articles, local and national nursing organizations, are helpful. http://www.nursingfacultyjobs.com/shortage.html http://seattlepi.nwsource.com/local/98060_nursing02.shtml http://nursing.about.com/od/nursingshortage/a/enrollmentup.htm http://www.raconline.org/news/news_details.php?news_id=816 http://findarticles.com/p/articles/mi_qa4102/is_200402/ai_n9357913 http://www.aacn.nche.edu/Media/NewsReleases/2005/Enrollments05.htm http://nursing.about.com/od/becomeanurse/a/gettingin.htm

Suzanne Gordon provides an interesting interpretation for this image of nurses in "Nursing Against Odds." The book is surprisingly accessible and a good read, although I have heard fellow students say they would have thought twice entering the profession had they read this book first. I am sure that was not Gordon's intention. I cant summarize her complex and multidisciplinary interpretation but it is all tied more into labor history and exploitation of women who had no viable skills or support (ie, girls who were homeless, unemployed, or formerly prostitutes). I recall one section where Gordon discusses how many young girls were promised training at what I guess we would call diploma houses and essentially did everything from laundry, meals - hence the literal image and stereotype of nurses as scullery maids and serving wenches. These women were indentured servants until released. They had very few options. Some women were given approval to nurse and some were kept on servants. As I mentioned in one other post that nursing is one of the few unreformed professions that still has working hours left over from the 19th century. We reformed child labor laws but not health care hours. You will be surprised as I was that nursing originally began with men. Religious orders ran most of the charitable care and then with the Industrial Revolution and Protestant reformation for-profit hospitals arose and displaced free care. There are in-depth reviews of the book at Amazon.

jess "I rely the whole time on lip reading and although the person talking needs to be looking at me, not everyone does." The reality is most people do not look at you when talking because it is considered confrontational. I found in my experience most people mumble. It isn't intentional but frustrating nonetheless. Yes you will get the screaming loon when they are told you are HOH. Sigh. Ask someone to repeat themselves and you sometimes get impatience and aggression. Breathe and count to ten and most often they will calm down too. I had a few people along the course of life who saw both hearing aids assume I was also retarded or mentally slow. Why? I dont know. Don't allow the hearing loss to be a handicap or others perceive it as such. Earn what you have by merit and not handout. I found schools do nothing to accomodate the HOH so let the prof know and sit in the front. You owe it yourself to have the hearing loss diagnosed and assessed so you can enable yourself best with the appropriate technology. Avoid anyone that suggests corrective surgery. If you made it this far you likely dont need it. Many people have undetected hearing loss. Don't deprive yourself of what you could be missing out. Of course turning down hearing aids is a nice feature for selective hearing. Proper detection of the loss does help. If you let it go the loss might increase. It does happen. My loss stemmed from the auditoy nerve so my loss has not fluctuated much over my life. Hearing aids if properly fitted should not squelch or have feedback. Unfortunately our ears keep growing so the aids have to be replaced. Sadly insurance does not cover it. The over the ear models are not very attractive but last the longest. I know they make girls self conscious but if you have long hair it shouldn't be a problem. Analog aids are the most common and digital are still pricey. I don't know much about the invisible in the ear models but I was told they are moody and prone to breakage. Repairs are expensive. Research around for someone who does hearing aids wholesale and attached to a licensed audiologist. You will save tons of money. Have a sense of humor. Kids will ask what they are and its a conversation opener with the peds crowd. I have had some great misunderstandings over the year. One time I was suffering bad calf pains and limping around, and my cat was also quite ill. While I was in a bar with classmates one asked me how my calf was feeling. I thought she said my cat so I said it was ok but it didnt like the fact it got shaved. I received a weird look and then I realized she said "calf" and not "cat". The words sounded alike to me and the background noise didnt help. A great laugh was had by all and I relaxed after I stopped blushing like an eggplant.

Ive read this with interest. Logically I believe there is a need for balance, and self-control because we are in control of how we choose to react. Nursing school was not pleasant for me. It was not pleasant for my classmates. Was it hell or the hardest thing to do? No. I would think being a single mom with kids, scrambling to make ends meet with no support structure is accurately Hell. Ive had life experiences that far exceed nursing school as trauma. In my program which consisted of mature students and second career people. We were belittled, mocked, insulted, and at one point one student was practically physically assaulted by a screaming instructor in front of the class. Clinical instructors would comment out loud who they were going to get rid of. There was gender and racial issues. I had one instructor tell she did not believe males should be nurses. I smiled and didnt respond. This instructor most likely had mental issues. I wont go into details as to how but the class stood up. That instructor was removed, there was an investigation, lawyers consulted and in the end a Dean was asked to leave, contracts for clinical instructors were not renewed and there was restructuring of the department. Is this the norm? I would say No. There is clinical documentation in journals in history about mass psychosis. The best example I can give here is to look at a lobster tank. When it gets overcrowded and turbid and the environmental stressors increase the lobsters become cannibals. Go look in a tank sometime and you will find a lobster with one claw. I'm sure the lobsters know they are destined for the dinner plate. The rubber bands on their claws are not for your protection, it is to prevent the product from killing each other. I have two good friends who are nurse educators so I have heard the other side of the debate. Students who are not prepared, who are dangerous, and don't seem to care. I have also heard how the internal academic politics like the corporate crap in offices drove them to tears and banging their heads against the walls. They stay because they love to teach and that one great student that comes along once in a while makes a difference to them. They remain active on the floor nurses in addition to teaching because they are there for the patients. They know some of their peers are Harpies who have no life or outlet and who sharpen their claws daily. The nursing student environment does get toxic. Fall below a GPA and you are out. Think to transfer to another program to finish out, then think again. You start from scratch. I know because I left one school after one semester (nasty environment where I was one of three males) and went to another program and told I had to repeat first semester despite solid 'A' work in pre-reqs and Fundamentals. Why? "We emphasize cultural competency and each school has a different emphasis." Overall my class was supportive of each other. Maybe that was not the norm from what I read here. I saw the rage, the tears, the doubts, the frustration, the 'I don't dare talk and just go with the flow' among students. I'm not bitter. Would I do it again? No. It was a traumatic two years I wouldn't wish it on anybody; and frankly if I were in my early twenties I would have bailed and knowing my disposition then I would not have responded so nicely. I am in my late 30s. The drama and trauma is behind me. It remains to be seen what the job will bring. I will do my best. I read somewhere 34,000 students were turned away from nursing programs nationally last year because the schools were flooded with apps and short of nurse educators. I know of folks on waiting lists so I have mixed opinions on the "nursing shortage". I believe the American south, poor populated, and rural areas are hurting for nurses. I am convinced if the American public truly knew the working conditions and why nurses don't stay they would be on the front lawns of the state houses wondering why administrators, big insurance, and pharm companies are making obscene amounts and perks and we work hours that belong to the 19th century. It is (my opinion) OBSCENE that in a country of extraordinary wealth we have homeless and uninsured. Children and the elderly are our most vulnerable populations. The public knows we will all at one time or another be in a hospital bed. I digress. I am an RN now. Nobody will take that away from me. I know and choose NEVER to subject a student to the behavior. That said nurses show through behavior that they belong to a profession. It is a profession with a history stretching back to medieval times. No place, job or school is perfect but there should be reforms and standardization on programs so we dont have this ASN vs BSN debate and no 'horizontal violence' in the schools or workplaces. There is a lot work to be done in recruiting men into nursing. We should not act like caught crabs in a pail who pull down the one crab trying to climb out of the pail. We are not lobsters and we aren't crabs. In closing I have told others and I remind myself with the adversities in Life, "Living well is the best revenge." You can decide what that means to you.

Thought I infuse some history here on a seldom discussed part of nursing...few people realize that both female and male RNs have served with distinction in the military in our country. I admit my own ignorance about the role of military nurses in other countries but I am sure those nurses exist. Below is a link to an article on Cpt. Maria Ortiz KIA in Iraq http://www.baltimoresun.com/news/local/harford/bal-md.ha.memorial19jul19,0,4204922.story?track=rss We know Florence Nightengale tended aid to soldiers of the Crimean War and was recognized by the British public for her efforts. The American poet Walt Whitman served as a nurse tending to the wounded in the Civil War while searching for his brother. Male nurses have an equally long and proud tradition. The Civil War remains our most costly conflict in terms of human loss: 620,000 to 700,000 died, mostly of infection, starvation and shock. There are a few books on the role of nurses serving in the World Wars, Vietnam and Korea. I list some related to WW2 but there are others for other conflicts. Sorry for the unintentional bolding. Emphasis in not intentional. They Call Them Angels: Military Nurses of Military Nurses in World War II, Kathi Jackson No Time to Fear: the Voices of American Military Nurses in World War II, by Diane Burke Fessler And If I Perish: Frontline US Army Nurses in World War 2 by Evelyn Monahan who also wrote "All This Hell: US Nurses Imprisoned by the Japanese" We Band of Angels: The Untold Story of American Nurses Trapped on Bataan by the Japanese by Elizabeth Norman There is a memorial to these nurses in DC. Note that these nurses were unarmed and tended to both American and foreign wounded and were subjected to rape, torture, sniper fire, and other horrors. Many received military decorations, full burial honors, and the support and petitions from the men in the many units during and after their respective wars when they came home. The image that crosses my mind is cross fire that shatters those old glass IV bottles.

I met up with the Nurse Recruiter at a facility north of a major city. I am reminded how much the job hunt sucks and why I refer to Human Resources as Inhuman Resources. Many of my classmates are struggling to find jobs. We are all ASN nurses and the reasons vary from timing of the next orientation (please come back later), or not accepting new grads (we are full), or you need a BSN (you need a BSN or a year of experience before applying here). Many of us are discouraged but we keep trying, and as you read you will see I try to have a sense of humor about it all. I don't know if it is my city but the hospitals we have encountered are for the most part indifferent to us, and in some cases downright rude and dismissive. Outside the state many of us are receiving interest and the red carpets and one of my classmates took a position outside the state (an option for the single and unattached). I understand folks are busy and have job stress but the rudeness is uncalled for. My handler was this ruddy faced guy who had to clear piles of paperwork from a chair so I could take a seat. The rest of the office look like it belonged to a government clerk with unprocessed stacks of triplicate forms, although he had two nice amateur photographer Italian scenes on the wall that hinted some sense of civilization and culture, or a momentary enthusiasm of a hobby long dead. I am not sure why he wanted to see me because when I had applied for a med-surg position I was told by him and his colleague at an affiliated location that all their new grad positions were full and possibly not opening up again until October. He invites me anyway and I look at this as an opportunity for interviewing with a chance I could be placed on a future incoming list. I should preface this by saying I am a career changer and have dealt with HR before. My approach with HR types is to smile, keep my answers short and concise, and simply let them run their charm since they usually have a scripted line or two of how wonderful their place is to work for and how you are so fortunate to be selected because of your numerous skills and talents. I always research the facility's mission statement and history and try to ask important questions. A good "fit" is important to me. I park it in the chair and the phone rings. He answers. He is fifteen minutes on the phone with intervals of his mouthing "Sorry" several times to me like he is a goldfish deprived of air. He then explains to me that their orientation is 8-12 weeks, run during the days, and it is a union hospital so I would have to join the union. No problem for me. He informs me that he has no openings at the moment except some odd night positions, and the facility runs orientation every other week. He is glad that I am interested in full-time because the facility has a strict policy that new grads work days and 40hrs weekly because that makes them a good nurse. He also says new grads are not allowed to work twelves. I uttered one sentence that I am indeed interested in full time. He says he is happy because he is exasperated by new grads that only want to work 24hrs weekly. Phone rings again. Another few minutes but not as long. I am thinking of the slain gladiators that probably were on the floor of the Coliseum looking out to the Palatine Hill in his wall photograph. Ave cæsar! Morituri te saltamus! (Hail Caesar! Those of us about to die, salute you). He returns to his captive. I ask about ratios and retention. He responds that ratio is all dependent on acuity. Fair enough. As for retention, he adds that nurses are so happy that they stay forever and a day (his words). Phone rings. It is clear from the conversation that a nurse had given notice and the nurse manager is hyperventilating on the phone for a replacement. Lets put this way if I can hear it from three feet away she was hyperventilating. I am smiling and looking pleasant. He asks me if I am interested in an oncology floor position on Floor X. Uh, (thinking to myself) this must be the nurse leaving. I mentioned I had some modest oncology experience (200hrs as a Student Nurse). I asked about the ratio and how many OCNs are on the floor. He tells me it is a heavy floor with 6-7 patients sometimes 7-9 per nurse and that I would still have orientation on days and they can work (just for special me) an orientation at nights with an experienced nurse. I continue smiling. He adds that the floor sometimes has psych and med-surg overflow. I nod in understanding. The position is nights: two twelves and two eights. Phone rings again. 3 minutes. Starting rate is mid twenty per hour and change that goes up a dollar at the end of next month per union contract and then there is the shift differential for nights (11-7) and every other holiday/weekend requirement adding another small increase. Phone rings again. 5 minutes. He said he will talk to the nurse manager about an interview with her and let me know some time next week. Whatever. I was polite and civil but certainly didn't feel the love. There were too many contradictions between the "corporate line" and the reality l can infer between the lines. My gut instinct tells me orientation would be a mixed bag from days to getting used to a regular night shift. 5 phone calls him, two to three sentences, me.

I was working as a Student Nurse on an Oncology/BMT floor. There was a male patient who was fighting hard and riding the roller coaster with his labs and emotions. He was down and back from MICU a few times that summer. He was a crusty ex-Marine who had definite opinions (he named his urinals after Bill and Hillary Clinton), but he was a nice once you got to know him. There were times when other nurses didn't know what to do with him because he could be so difficult. There were times he was not compliant and simply an irascible codger. He was estranged from one daughter, his son was abroad so his wife was his sole visitor. Against all odds, I managed to get along with him. One night he was extremely depressed and delirious from a fever and had quite a bit of meds on board. I had changed his sheets several times during my shift to keep comfortable and from shivering. That evening was fairly light so I had the time to spend with him. I sat at his bedside and he looked at me in obvious misery and asked me "if it was ok to die" but he was so afraid that his wife would be angry at him for not fighting anymore. Needless to say I was stunned but I said to him that he had to do what was best for him and he knew deep down his wife loved him. I recalled several incidents and times I was in the room with her and how she joked with him, inquired about his progress with the team outside the room, how she hunted down videos throughout the hospital so he could watch them on his TV. I think every nurse on that floor saw or heard John Wayne single-handedly win World War II. I held his hand that night as he cried and then he cheered up, and asked if I would visit him tomorrow. I said yes. He went into a deep sleep. I had to unloosen his grip on my hand. Next day I came into the room. It happened to be my day off. We talked, joked, and he was a completely different person. His wife was there and smiling. You would never know he had a dark, difficult night. As I was leaving he called out to me and said, "Thanks, for keeping your promise. It means a lot to me." I genuinely thought he forgot everything because his condition was vastly improved. Outside his room I was approached by a nurse, who I knew well and respected, but she was rather nervous about approaching me. Three other nurses had put her up to approaching me and asking why I came in to see a patient on my day off. What passed through my mind I couldn't type here. The tone behind the question was clearly snarky. Rather than answer her directly I looked at three who were within earshot and replied "I keep my promises." The patient died a few weeks later. His wife had taken a picture of the two of us together. There he was in his precautions gown, bald and looking like a bad version of Yoda in mask with his arm on my shoulder. I still have that photo and when I feel down or incompetent I think of him knowing I made a difference. I couldn't stand his politics, his humor was more than a little off and he was definitely opinionated, but I saw a scared man trying to maintain his dignity. If I had his illness and prognosis I would be terrified. The patient is what matters. I keep telling myself that. I began to understand that in this profession your presence, your technical knowledge, and the relationships you have with families, which I don't think doctors have as in depth as nurses, are what matters. I was a Student Nurse then and I am an RN now.

Yes. I am HOH, and wear bilateral hearing aids. I have used a special stethoscope, but found I can hear with a Littmann Cardio III. Yes I can take the hearing aids out and put it in my cargo scrub pockets. Cardiotronics makes the E-scope II which may help you. It is helpful to me but I did find feedback and external sounds can be distracting. The electronics are great but sometimes overly sensitive. I assume you had an MOS in Infantry. You didn't state the decibel range of your loss. It can make a difference. As a child (long before the loss was detected) I learned how to read lips, discern body language, and figure out a lot from context. My loss originated from antibiotics in infancy. I did well in school, no speech pathology and never considered myself "impaired". If it is any inspiration Dr. Helen Taussig, a pioneer in pediatric cardiology was severely hearing impaired and did auscultation using her fingertips. There was a film "Something the Lord Made" although it doesnt focus on her. Best of luck. PS: janfrn -amazed by your posts. You are an amazing source of knowledge!

Hi While I have not done an IM, but I have completed several triathlons and long endurance events. Without bragging I am an experienced athlete with a long competition history in triathlon, locally and nationally. There is no indication in your post your current level of fitness, or if you have done other types of tri, like Sprint, Olympic, or Half Iron events. There are many factors you need to consider: diet, flexibility, your current fitness base and building an aerobic base and phasing your training up to race date. Swimming, biking and running are individual components that require time and technique. Oh and don't forget living a LIFE including family and work. With the right preparation the IM becomes a mental event to test your resolve, and your spirit. It is amazing what you can put your body through. Some would argue if you made it through nursing school you can do a triathlon :-) As for resources I would recommend Don Fink's book Be Iron Fit. I would be happy to answer your questions off-line at my email which should be on my profile. Doing triathlon is addictive: bragging rights are forever and you will look at the world in a different way. You will do more in one morning than some folks do all week. GRV