SheaTab

"mine seem bright and able." This seemed inflammatory and stereotypical. You probably didn't mean it that way, but that is how it read. Last time I checked, weight doesn't correlate with IQ. My observations have been that students with weight issues tend to overcompensate in other areas -- academia being one.

This is excellent! I'll never forget one particular lecture during my first nursing program (2003). My instructor was a middle-aged ex-military woman who was teaching psych. We were going through various chapters in the book and when we reached the small section on the GLBT community she said, "we all know how we feel about this so let's move on." and, that was the end of that. I was particularly insulted and made my concerns known to all involved. I hope they have since chosen to include some education since many nurses don't seem to work well with that population. THe fact is, it really doesn't matter how we "feel" about it. It isn't just nurses as I've seen it from physicians in the emergency room as well. I've worked in L&D and I've heard nurses call lesbian patients dykes and have seen more than my fair share of eye-rolling. I have seen a lesbian OB run (essentially) out of an OB unit because the nurses created a hostile environment for her. I can't count the times that I heard, "I wouldn't want a lesbian delivering my baby!" Why? But you wouldn't mind a male OB? It's as if many just can't see past the sexuality and see the person. Since then, I have completed master's and have had the great pleasure of teaching ADN nurses myself. It never ceases to amaze me when I hear students make comments about patients based on weight, race, gender-identity, etc. I always ALWAYS include a heartfelt message to them about this. We are here to provide you with the very best possible care ... Whatever package you come in and whatever your needs may be. All of us would hate to think that our medical providers were making jokes about our habitus or lifestyle. How were you thinking of designing your study?

Attached. The only thing I would add are important teaching for antibiotics ... for example - Metronidazole - No ETOH during treatment, dark urine. Vancomycin - nephro, red man, slow, etc. Quinolones (avelox, levaquin, cipro, etc.) Adults only. Black box - tendon rupture. Small risk of cross-sensitivity with PCN and cephalosporins. etc etc etc. Important Drugs to Remember.doc

This is an enormous soapbox for me! I have worked with all levels of students and have had them come to me in their final semester still not having a solid grasp on the basics of safely administering meds (rights of med admin) or even a general feel for the most commonly administered meds. Most of my students have felt like this is one of their most significant weaknesses. I don't know about other programs, but the ADN program I taught at has threaded pharm throughout the curriculum instead of having a dedicated class. This was a big mistake in my opinion. I start by having them memorize this ... in fact, I want them to know it like the back of their hand and require them to check it prior to administering meds. PADRRT! Pronounced, Pa-Dirt! Patient, allergy, drug, dose, route, time. So many nurses in practice have let these few simple rules slide and our students are watching. So before we even start administering, my students need to use two identifiers to ID the patient. Then are to check allergies against each med they are to admin. Then drug, dose, route, time. In that order without any variance. I teach them to be methodical and watch for them to do it the same way, time after time. They spend so little time in the lab practicing. I think about it like this ... would you rather have your 13-year-old attend a sex education class or a sex practice course? The answer is obvious. There seems to be more of an emphasis on the didactics than on the practice in nursing school these days and I'm afraid we will continue to see more adverse events in practice if we don't change our emphasis. There are many things I am very flexible about. They can add their own flare or style to teaching or making a bed, for example, but they can not vary from this. When I start clinical, I will borrow a MAR or computer and make up fake drugs on alcohol swabs or something. I will let one student be a pretend patient and then let each student run through the process over and over and over (ad infinitum) until they are confident in the process of PADDRT! ;o) At the bedside, I also look for them to be able to tell me about the drug and any nursing implications. I also want them to tell the patient each drug they are about to take and what it is for. For example, "this is lisinopril 20 mg and it is for your blood pressure." This gives the patient the opportunity to say, "No, I usually take 40 mg" or "I can't take that, it makes me cough like a smoker!" It also helps them learn the indications for the meds and gain comfort in educating and talking with patients. I also provide them with a list of must know meds with implications at the start of clinical. This is something we go over during admin and in post-conference. I start from first semester up. One problem I have seen is that students just don't take it seriously unless they are tested on it. You know, if they are going to be tested, they will learn it! If not, they will casually look at it if they have time. I have considered making up mini tests and having them take one each clinical day. Any thoughts? I'd be happy to share the list of meds if anyone is interested and you are more than welcome to alter it for your own personal needs. Additionally, in terms of comfort with the patients and gaining skill in teaching and promoting well-being and safety in patient care, I require students to teach each of their patients 4 things each day. I verify it when I check them off on assessments and also when I observe their care of the patient. I look for them to be able to show the patient how to do it (Not just educate! Practice!) and for them to be able to get the patient to return demo. If they forget and don't ask the patient to return-demo, I will gently ask for the return demo myself. They are often shocked and surprised how often the patient has NO IDEA how to do what they have been told. Actually, the patients most often don't remember what the students have said at all. This is a really great reality check for them. I approach it like this - some of the most significant risks of hospitalization include skin breakdown, pnemonia, DVT, and infection. Teaching your patients these few things can save their life! AND, I also tell them that what the patient can't do for themselves, you must do for them or ensure than it gets done by delegating and following up. 1. Pneumonia & skin-breakdown prevention - T, C, DB at least every two hours while in bed and get up an walk as often as you can (of course, if they are safely able to) & drink plenty of fluids (barring any fluid restrictions or NPO status). 2. DVT Prevention - Walk and pump your legs (like gas pedals) at least everey couple of hours. 3. Infection Prevention - Encourage patients and their families to wash their hands or use hand sanitizer and to remind each healthcare staff to do the same before they provide any care. This helps the students to learn to teach and also to encourage patients to take active part in their own care. I call these topics "THE BIG 3!" Last, I require them to learn "THE BIG 5!" For patient safety always check the following 5 things before you leave the room! Check your patient, the bed, the table, the wall, the floor!" (patient, table, bed, wall, floor) Patient in a position of comfort, breathing, and CALL LIGHT IN HANDS OR WITHIN REACH. Bed in lowest position and HOB in appropriate position. Table right next to bed so patient does not fall out when reaching for phone or glasses. The wall is equipped with whatever you might need in the event that you need to save the patient's life including (per facility protocol) O2, ambu or CPR device, suction, etc. The floor is clear of garbage and obstacles that the patient may trip or slip on. I want them to become methodical and second-nature about these things so that they will continue these things in practice. I also teach them to tell patients why they are doing certain things so that the patients are able to connect intention with action. For example, "I am lowering the bed to the lowest position for your safety. I am pulling the table to your bedside so that you can safely reach it," etc. etc. This helps the student to teach and also the patient to advocate for their own safety. So often patients have no idea why we do the things we do and may rate us poorly in terms of protecting their safety and privacy even though we are constantly (but quietly) doing so all the time. For example, we close the door and curtain to protect privacy but the patients don't always see it that way. Thoughts? Good luck! Tabitha

There is a much more significant problem than the "bottom-line." With all the lateral violence we presently have in our profession, we really can't afford to admit one more disrespectful nurse into practice! There is no room for disengagement and ugly attitudes in nursing school or in practice. I am of the mindset that if a student can't conduct themselves in a professional manner while in school, then they are almost definitely going to be a problem when they graduate. These same students will most likely have challenges with their colleagues and also with their patients. Like you, I wouldn't want such a student to represent our profession. Student apathy will likely manifest itself later as nursing apathy. YIKES! This reflects poorly on your educational institution and also on nursing as a whole. We have an ethical obligation to promote the professionalism in nursing practice and when we graduate students such as the one you described, we are failing that mission in a monumental way. Just my thoughts. I don't envy your position. Good Luck, Tabitha

Dakovich: As a RN and Nursing Educator, I'd actually like to encourage you to continue to challenge the status quo, much as you have in this post. It is absolutely acceptable to expect to be treated professionally by all those you encounter in your nursing education and in the field once you graduate. I am saddened that you had such a disappointing experience during your orientation. I am well aware of the fact that this happens in schools and hospitals across the U.S. I have some thoughts if I may share them with you and my nursing colleagues. First, attitudes are contagious and as such, I'd like you to consider the importance of not adopting these eye-rolling negative ways of relating to others. It is woefully unfortunate that we are modeling such behavioral to our neophytes before they even cut their first tooth. You are the future of nursing! I have a challenge to issue to you and all would-be nurses and that is-- Be the Change we so desperately need in our profession. YOU adopt and model the attitudes of kindness, fairness, and respect. However inappropriate the attitudes, I am of the opinion that we have come by them honestly. Nursing has endured centuries of disenfranchisement, that is, years of not being invited to the healthcare decision-making table. If you take a look at the social repercussions of the disenfranschisement of other groups such as African Americans and women, for example, you might note similar patterns throughout history. It wasn't until a great number of folks got together (a critical mass) and demanded a change, that real evolution occurred. YOU, the future of nursing are a distinctive part of that critical mass. I'm so excited that you are able to recognize the importance of professionalism. Never settle for anything less than the very best for yourself and your patients. And, you just let me know if I can personally do anything to support you. Just because we have always done things a certain way, doesn't mean that we should. Be the Change, Tabitha

Thanks SunnyCalifRN! Hey, I am right there with you and have heard similar analogies at safety conferences. I love this one, "If you knew that 40,000 people were harmed everyday by flipping a light switch, would you ever flip the switch or would you revert to lanterns or other sources of light?" http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1 How many of you know beyond the shadow of a doubt that GE would be working night and day to find a solution to such a danger? How much harder should we be working as a healthcare community to put an end to the appalling fact that 40,000 patients are harmed in healthcare access points across the U.S. daily? I like system-focused fixes as well and believe they contribute to the fair and just culture we are seeking to create in our healthcare system. It is a fact, as many are finally willing to admit, that the folks who do the work are also some of the most qualified to fix the problems. The only problem I have noted is that when we nurses propose solutions, they are rarely heard and implemented if they involve significant capital investment and increases in nurse staffing. Our ideas are wonderful and valued often only to the extent to which the proposed solutions also lend a commensurate increase in efficiencies to be gained. The problem with this line of thinking is that efficiencies need to be measured and so much of professional Nursing care is immeasurable. Additionally, this idea of Kaizen and Lean Manufacturing principles does a great job of building on what we already have; however, clearly the system that we've created has failed in terms of Nurse satisfaction and patient safety. My greatest fear is that what has worked so well on the assembly line might result in the systematic decay of the last bit of flesh we have left on our weary bones. Much Respect and Admiration, Tabitha

Do you work in small hospital or academia/large hospital? You know what, I can empathize with why you'd be worried; but I'd bet any amount of money that the doc would be at least as understanding as your nursing colleagues. More than ever before, docs and nurses alike are receiving education regarding the fact that errors rarely occur because of absolute human stupidity. That is not to say that they don't, however, in most all cases there are identifiable extenuating circumstances. You can bet your derrière that the MD in question has made one or more mistakes in the past and I can almost guarantee that he will not hold a grudge for your error. If it were me, I might pull him aside and perhaps voice my concerns. I bet you will walk away feeling much better. Remember, even the most skilled and experienced surgeon is human at the end of the day. There is a degree of risk to the work he or she does and the only way the human element of risk can be removed is by using robots and I'm sure that robotics is not without risk altogether as they are operated by--you guessed it--humans! A surgeon with the steadiest hand in the industry can and will have one slip and damage an artery and, in the end, it does not make him any less of a surgeon. But that's just my opinion. Also, there is literature coming out to support that 12 hour shifts are too long to be fully competent in the care we humans give. How about that?! Most of us work 12 hour shifts performing some of the most important work there is, that is, caring for the life of another human being! Take for example the U.S. trucking industry, which allows for a operator to drive for no longer than 11 hours without a rest break of at least 8 hours and there are many who think that 11 hours is too long. See: http://www.saferoads.org/statement-fmcsa-hours-service-rule-truck-drivers. According to Wikipedia (a highly reputable source ... haha), Australian truck drivers must rest 30 minutes for every five hours they drive. In Europe, total driving time cannot exceed 9 hours and a rest time of 45 minutes must be taken every 4.5 hours (time can be divided). http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32006R0561:EN:HTML Now, unless these truck driver associations and regulatory bodies are merely trying to prevent DVT in their industry professionals, I suspect another motive. I believe, and I could be wrong, that the primary motive of such strict measures are to ensure the safety of both the truck driver and the other motorists on the road. How is it that our Nurses can be expected to perform at peak levels of mental acuity at the tail end of a 12-hour shift? How many of you have stayed over and worked 16 hours? I know I have! How many of you do it without a sip of water or a break and with an achingly FULL bladder. But I digress ... So, Sister Nurse of mine, don't be so quick to take all of the blame. There were UNDOUBTEDLY other factors involved. And, that's all I have to say about that. Best! Tabitha

Dearest Gardengal1: I would like to start by encouraging you. Every one of us has made a mistake to one extent or another. Consider that errors can be acts of commission and omission. I have forgotten antibiotics on a particularly busy shift in both the ED and L&D. Who's to say that this act of omission is any less devastating to the patient than whatever happened to you. Antibiotics can have a serious impact on patient prognosis in terms of their length of stay, morbidity, and mortality. The main thing is that you own this mistake in the exact manner that you are doing. You reconcile with yourself that you are human and as such, you will err. Unfortunately, there is no way around that. It is really important that you look closely at what happened and determine if this was a failure in the system or if it was a simple human error. For example, if certain "hard-stops" were in place, could the error have been prevented? I have several thoughts around this. If the error was in programming the right rate on the pump, could a "smart pump" have prevented the error by taking the flawed human mathematician out of the equation? If labeling was an issue, could we place the labels in a locale that would make them more accessible? Think long and hard about the exact path you took that led to the error and consider if the system had anything to do with it. You have been a nurse for a great number of years and have practiced safely so I sincerely doubt you have a lot of "bad habits." However, this is worth definitely considering. I certainly mean no disrespect, but if you have any habits that you know are not in our patients best interests, this may have been your wake-up call. We all have them and it takes courage and a humble attitude to admit them and move forward. I like to give you an example from my own experience if I may. I have recently moved from practice (though I still work PRN in the ED) to nursing academia. I am uber-passionate about patient safety and healthcare quality and tend to weave that into all my interactions with my students. I once told my students that in our present healthcare environment, it was imperative that items that fall on the floor be thoroughly sanitized or discarded if unable to sanitize. I was working as Team Leader during a typically hectic ED shift and was cleaning one side of a “double room.” The patient in the other room was an elderly confused patient who kept pulling her leads off. Her daughter asked me if I could reconnect her leads. Well, as you already know, the leads were laying on the floor. I picked them up and as I was about to reconnect them, it occurred to me that I was about to do the exact thing that I had told my students they must never do. I sucked it up, pulled out a couple of sanitizing wipes and cleaned the leads prior to replacing them on the patient. Did it take more time, sure, but was it in the patient’s best interest? Absolutely. We carry around funk-factors all over the bottom of our shoes from isolation room to isolation room. We do not wear shoe covers and bacteria like c. diff can survive for months. I have a lot of reservation around ever reusing anything in the patient care environment that cannot be properly sanitized because you cannot “see” many of the bugs that can wreak havoc on the imunnosupressed patient or any hospitalized patient for that manner. IMHO, this is one of the factors that play a significant role in our rampant rate of hospital-acquired infections which have risen to the millions per year! This example may seem small in the grand scheme of things, but we should all remember this one thing, to our patients, every little thing matters. Being a patient advocate is so difficult, if not impossible, in our present healthcare delivery environment. It means being 100% accountable for what you do and also 100% accountable for what you see other folks doing. Even more challenging is being 100% accountable for doing the right thing every time when we don’t have the time to do it! Seeing a wrong about to happen and not saying something is nearly as negligent as committing the wrong yourself. Another example, how many of you have ever witnessed a nurse push an IV medication through a port that hasn’t first been swabbed with alcohol? I don’t know about you guys, but I see it all the time. IV tubing has the potential of being some of the most germ ridden stuff in the hospital. Patients drag it around everywhere. Bathrooms, outside, etc. We never ever have any business pushing anything through a port unless we have thoroughly “scrubbed the hub.” That doesn’t mean a quick swipe … SCRUB! I have taken to carrying around a pocketful of alcohol wipes and have stopped many-a-nurse dead in their tracks by handing them one. Yes, I have gotten a number of “Well aren’t you Nancy Nurse” looks. However, if we are honest, people DIE from infections they are given in the hospital. Scrubbing the hub can make a difference between life and death for the patient. You’d want it for yourself and for any member of your family so why would we do any less for our patients? I think I know … I may seem to have digressed a little from the original main idea of the posting but I like to circle back. OP, your offense is NO WORSE than picking something up off the floor and reusing is, failing to scrub the hub, or neglecting to use isolation garb in a patient’s room who has a case of diarrhea which has not yet been diagnosed. I’d like to offer you the opportunity to look at this through global lenses and take a gander at all the ways nurses have fallen short of doing the right thing for their patients. Take for example that my mother had a recent 11-day admission to an oncology floor. During only one shift assessment did a nurse pull out her stethoscope and listen to my mother’s lungs and bowel. My mother was septic and had renal impairment as a result. I’ve never felt more helpless as a family member or nurse. As they began to fluid resuscitate her, her UOP was negligible. She complained of DIB at one point and I had to ask a nurse to listen to her lungs. Help me understand what has happened to our profession? This posting is not meant to bash nurses because I can’t imagine any profession for which I have a greater respect and affinity. I only mean to draw attention to the fact that we all need a wake-up call to the fact that one offense is no greater than another. We have all been set up for failure in the very system that is supposed to support and champion safe patient care. It is nearly impossible to not make an error in our present system and it is a miracle that you have gone this long without one! We are all asked to do more than we are humanly capable of doing with little back-up support to assist during the times that we are struggling or busy with another patient. Even in locales that have addressed the nurse-to-patient ratio, which are few and far between, have experienced less than satisfactory quality outcomes because, and this is merely my personal hypothesis, they have been remiss to address the fall-out of the burnout syndrome. We can fix the ratios through legislative action (if we will all get onboard); however, we will need to heal a very wounded profession through a variety of creative methodologies if we are to rid our profession of all the bad habits and attitudes that have resulted from centuries of disenfranchisement. OP! If I were in your presence, I would squeeze the life out of you with a big old hug. I know one thing for certain, you will absolutely learn from this mistake and I can almost guarantee that you will never make it again. I hope that you will use this experience to help prevent other nurses from making this exact same mistake. You can bet that if you made it, a number of others have too and also a number of others will make it in the future. Use this experience as an opportunity to reach out to your nursing peers in the interest of protecting our vulnerable patients. Warm Regards, Tabitha

kat nurse: What an excellent point you make. I am proud to say that I would be willing to take a pay cut to support our profession and patients. What a mess we are ALL in! Most all quality indicators are "nurse sensitive" to some degree or another. Even those not directly nurse driven--antibiotics prior to some surgeries, for example--require a nurse to administer the medication even though the physician has written the order. This is a partnership. Nurses are at the heart of safe and quality healthcare in the United States and this is where United States Nurses must collectively advocate for the rights of their patients. As a Georgia Nurse, I am very concerned for the patients and Nurses in Texas, Nebraska, Maine, and every other state. I have every reason to be energized by the opportunity to leave my profession in better condition than I found it. Best!

I have one thing to say ... But for the grace of God go I. We are all vulnerable to errors like this and worse as long as we continue to allow hospitals to: critically understaff nursing units, push for greater "efficiencies" and removal of so-called waste, and allow our brothers and sisters to continue along the path of burnout. I can easily see how something like this would happen. Perhaps the nurse pulled two meds up in syringes and failed to label them. In practice and also when family members have been hospitalized, I have noticed that labeling syringes is a rarity. I don't know if this is a phenomenon specific to my locale, but it is quite pervasive. I believe that this is a symptom of burnout to some degree. Many of us have felt pressure to perform more than we were physically and emotionally capable of doing in a given shift. This had led to cutting of corners in as many places as possible in the effort to survive what can be an extremely unpleasant and undoable work-a-day career. I long for the day where nurses will/can stand up and declare that best practices will be the only way they are willing to deliver care. The day where we can say that we don't care how much longer it will take to provide excellent care, because we refuse to give anything less than that. Nurses, isn't it about time that we take our profession back and refuse to have the administrative masterminds dictate the quality of care we deliver? My heart goes out to the family of this patient and also to the nurse who made this mistake. I can only imagine how devastated she must feel right now. We have all made errors in terms of medication administration ... it could happen to any one of us and if it hasn't yet, it is only a matter of time.

I agree with the previous poster. You owe her your honesty. Definitely start by sharing with her how wonderful she is with the patients but you have to be very forthright with your concerns about her prioritization and pace. How long has she been orienting?

No driver present? No meds until one is. I will be happy to give Motrin or Toradol until such time as a driver arrives. It isn't worth the risk. Tabitha

Take a moment and give yourself a break. You did the best you could with the resources and experience you had. Yes, this patient should have had an IV before AROM. In the future, I might approach it like this, "Dr. Doe, the patient has just arrived and I will be happy to assist you with AROM once her IV is established." Period, end of discussion. One of the most difficult things for new nurses is learning to effectively and passionately advocate for their patients. This is even difficult for experienced nurses. I'd like to give you an example, if I may. I was charge nurse in a L&D unit a couple of years ago. One of the nurses was taking care of a 38 week fetal demise. I knew the MD had started pushing the patient and this particular MD didn't have the best reputation among his nursing and medical colleagues. He would often push patients who were 8 cm and he also extensively manipulated the perineum as a matter of course. Anyway, the nurse caring for the patient came out of the room to get forceps and the residents. I immediately questioned this since this was a fetal demise and they had only just started pushing. I knew the MD was looking at this birth as a teaching opportunity on how to use forceps since there was no risk to the baby. Make sense? So, I asked the MD to come into the hall for a "time out." I told him that I was "concerned" about his decision to use forceps on this patient since both the patient and infant were not in any distress. He gave me a long story about how good he is at using forceps and asked for my support. I told him that I would not support him, but at the time, I just didn't have the experience or guts to take the issue further. He delivered the infant with forceps and, to my knowledge, there were no repercussions. However, I ask you to consider a few things I learned from the situation. One, forceps can cause cervical and lady partsl lacerations that can lead to a infection in the postpartum period. Is it worth the risk? A cervical lac can lead to an incompetent cervix in future pregnancies. Is it worth the risk? We should always ask ourselves these questions when we care for our patients. Many of our interventions have a degree of risk involved which is unavoidable. However, the benefit MUST outweigh the risk or we are being negligent in the care of our vulnerable patients who unknowingly assume that we always have their best interests in mind. In this case, this MD did not. Did the benefit of AROM with this patient outweigh the risk? Definitely not. After thinking long and hard about this birth, a few things came to mind. We had no idea how long that infant had been dead. Her skin could have very well been extremely friable and using forceps on her head could have easily caused unneeded damage. Additionally, we neglected the emotional aspects of this patients care because we further traumatized what was already one of the most difficult days of her life. Last, this was a life-altering experience for me. I decided on that day that I would always consider my patients from the following point-of-view. If she had been my daughter or loved one, having the knowledge that I do as a healthcare provider, would I allow the intervention in question to be performed? I know good and well that I would have never allowed that MD to use forceps on my daughter under similar circumstances. Everyone deserves the same level of care that you'd want for yourself and your loved ones. Would you have allowed the doc to break your water without a IV in place? Of course not, because you'd want to have IV access in case you had to run to the OR with a cord prolapse. OP, I'm not judging you in the least and I have actually had the exact same thing happen to me early in my career as an L&D nurse. I made the same decision you did and was bullied into it. It won't happen to me again though, I assure you. I am only trying to help you with examples of how you might respond differently in the future. In the future my actions will bee different as I know yours will as well. I would have told the MD in the example above that I was not going to support forceps use and that we would either have to wait for her to labor down a bit or involve the powers that be. I know that much worse things happen in healthcare but the truth is that every little thing matters. I make it my business to ensure that not one little hair on each of my patients head is unnecessarily harmed if I can prevent it. Thank you for sharing your story. You are not alone and sadly, we all have to learn these lessons. Be strong and know that we are here to support you through the good and bad. No matter what! Tabitha

With the intent of advancing the professionalism of nursing practice, I agree that a conversation is in order. I wouldn't tolerate another nurse being disrespectful to me, although, it happens more than I'd like to admit. I generally say something like, "gee, are you having a bad shift? Is there anything I can do to help? Have I said something that has upset you?" If you didn't lie, then yes, this is defamation and there is legal recourse. Making a statement like this can have an impact on your career because there will be some who might question your veracity and credibility in the future. Before taking legal action, I would probably take the "one up" and professional approach and meet with this nurse one-on-one. Tell her how her statement made you feel and ask for clarification. She may have the details of the situation confused. Alternatively, you might have missed some important details. With this in mind, go into the conversation with an open mind. However, be assertive in your right to a respectful and professional work environment. If you are unable to come to a truce or understanding, you deserve the right to maintain your professional credibility. These are just my thoughts. Wishing you luck. Please let us know how it goes. Best Always, Tabitha