Owney

My boss got tired of my complaints about the corners I had to cut trying to give nursing care that I could live with. She retired me (AKA found somebody to lie about me, fire me, contest my 6 months unemployment, and challenge my license). After three years of extreme poverty the stress of 23 years of hospital work (mostly in the busiest ERs in town) I became physically disabled. My wife got SSI but even with our SSD it would not cover our predatorily overpriced mortgage and all the other expenses of living in a dying rust belt city. February this year, we moved to the Southwest and absolutely love it. Gorgeous weather, no crime, polite neighbors, wide open spaces and much lower cost-of-living makes us wonder why it took so long to get away from the hell hole that our nice neighborhood in Detroit had become. At first I missed giving nursing care, but the more I think about it, the more foolish it seems that I spent so many years destroying my body (and my mind) trying to work in spite of the nurse managers and bean counters of hospital administration. Whenever I think I miss nursing, all I have to do is read about the experiences of working nurses on this board. The latest is "nurses struggling with mental illness" where nurses are expected to disclose their medications to their employers. Have none of them heard of HIPPA? Wouldn't the hospital help a nurse get sued for disclosing health information to a third party? So nurses must treat everybody else's health information (except their own) in the world as priveleged? Whatever happened to privacy? Yes, I do miss my patients, but the horse's behinds that "run" our "health care system?" Not at all. Owney:typing:

Heaverboo, When I was in nursing school, way back in the 1980's, we were required to write 3X5 index cards for every drug each of our patients were given. It listed generic &/or trade name(s), indications, dosage, side effects, precautions and nursing considerations. I went to work in the emergency room of a major trauma center directly from school (nearly unheard of then). I remember at my first code, a pharmacist handed me a syringe and said, "push this." Remembering my education that said, "NEVER give a drug unless you know all about it", I made it a point to ask the pharmacist about each drug given in ACLS. She was very helpful in giving me print-outs of the ACLS hospital formulary to study in preparation for the next course. I made it a point never to give a drug, especially IVP without someone (pharmacist, physician or experienced nurse) telling me something about it. I do not believe anyone ever treated my questions as stupid ones. During my last days in E.R. I still had another nurse check my pediatric dosages and other "brain fart" math problems, and never hesitated to call the pharmacy if I could not find out what I needed to know before giving a med of which I was unsure. I worked in the emergency rooms of over a dozen hospitals in Southeastern Michigan; sometimes as staff, and more frequently for an agency. Although not always complete with nursing implications, every hospital I worked in was required to have a medication formulary which must list every drug stocked by the hospital. Some hospitals go so far as to require testing on each medication before a nurse can administer it. Hope this helps, Owney:loveya:

Babs, From my first day in the ER of a major trauma center, I knew I was putting myself at risk for PTSD. In 1981 I don't think it even had a name yet, and I had no idea how much I was paying until I was retired from nursing. One day my boss decided she no longer loved me and I was fired, black-balled, blocked my six-months' unemployment and questioned my license. It took about six months to realize what "at will" meant, and another six before I began to learn what PTSD is. I learned more from the Viet Nam Veterans Against the War (without whom I question whether PTSD would ever be added to the medical diagnosis manual) website than from any other source. What I learned about PTSD is that it gets worse before it gets better. I also learned that one can seldom attribute it to a single episode, and that it did not begin on my first day in ER, but from the day I was sworn into the Navy. I filed for a veteran's pension, and after nearly a year the V.A. told me, "You must be wounded in combat. You cannot get PTSD by being stabbed by your boss, surviving a typhoon nor from witnessing the carnage of combat." I took two leaves of absence from the trauma center. On both occasions I saw my internist and my psychiatrist. I kept copies of my visits and only recently read that my employee health record contained documentation that, "Illness not related to employment." Evidently this prevented my family from suing the hospital if I were to commit suicide. The most important thing I have learned about it is that, although there is no cure, one can learn to live with it. Like you, I tried PACU and it did not work out for me. When I had same-day surgery, I saw the way my nurse was pressured by her supervisor. I decided that their was no chance of finding any RN position that does not demand life-or-death responsibility and a constant demand for superhuman perfection. Isn't it amazing that I could work in a major teaching hospital that had a "trauma victims counseling program" and they could completely disregard my emotional needs? I looked into the impaired nurses programs in my state and found that their only help was mandated for nurses who were addicted to alcohol or other drugs. I did get help (group and individual therapy) at my community mental health program, but again, most of it was directed at drug dependence. I had stopped drinking as soon as I realized that with no income, it was a hobby that I could no longer afford. Most of my fellow group members were mandated by their parole/probation officers, and after "how to avoid relapse" for the umpteenth time in eighteen months I stopped attending group sessions. I did continue bi-weekly individual therapy sessions until I relocated to a much smaller city with a much more affordable cost-of-living. I renewed my license in my former state and considered transferring it to my new home. After talking to other nurses I found out that there are only two hospitals in town, and both treat employees even worse than in the big city. Our family dollar goes much further here, so I hope I will never have to earn a nickel by nursing. I intend to volunteer at the senior citizens' and poor peoples centers for blood pressure, glucose, visual, nutritional and general health screening. I love nursing too much to ever abandon it completely, but even "paperwork" nursing jobs eventually have pressures (quotas, increasing case-loads). I am at a loss to recommend a field of nursing that is pressure-free. I would guess that the State of New York may have on-line PTSD resources. Have you checked with Albany? If you have insurance, can you see a therapist? After a thirty-two months' battle I qualified for social security disability retirement for Crohn's ulcerative colitis, degenerative arthritis secondary to (and exacerbated by) stress and anxiety. My symptoms diminished considerably when I began getting checks and nearly disappeared when I walked away from my predatory mortgage and relocated to more comfortable, affordable (and crime-free) housing. If you have insurance, can you see a therapist? Does the State of New York have on-line resources for PTSD? You might find out by checking with Albany? Hospitals are too busy chasing the almighty dollar to care about nurses. Fifty percent of the cost of each hospital admission goes to nurses' pay. The boardroom suits consider us nothing more than expenses (like a cart of linen or IV fluids). Almost every day I pray for nurses who care too much to survive in the hostile American "sickness care industry." I will surely remember you in tonight's prayers. Love, Owney

Dear readytolive, zoeboboey gave you a good answer. My therapist thought I might be ready to work after a year, so she gave me a referral to the "rehab counselor." After speaking with her nurse-to-nurse we decided that I was not, but she gave me good advice about keeping my license as long a I can. In '05 I began to collect SSD (physical disability) checks but they became less and less sufficient for my wife and myself to live on. We relocated to an area which has a much lower cost of living, I applied for my hospital pension, and my wife turned 62 so she filed for SSI. I am reasonably certain that I will never return to the bedside, but have not ruled out every possible nursing specialty, if only an occasional consultant job, private duty or volunteer work. In March of this year I renewed the license in my old state for the second time since my boss "retired" me in '03. Both 2-yr. renewals required $50 to the state and $20-30 for on-line continuing education, so it costs me $35-40 a year for the privilege of signing "RN" after my name. The Social Security administration allows us to earn some income. I am sure that a rehab counselor could advise you how much you can earn without jeopardizing your SSD. Once upon a time there were plenty of low-stress nursing jobs, but as with other fields, low stress employment is increasingly an "endangered species." There seem to be fewer employers who will pay us for "sitting around." Have you contacted your state/provincial board of nursing? They should advise you what you would have to do to reinstate your license. All of the states I have lived in have "reciprocity", meaning that I could get practicing privileges in as many as I can afford. Unfortunately my new home town has only two hospitals and from what I have heard on this site, they are both stuck in the 20th century in terms of pay and nursing autonomy. California is the only state I know of which has patient-load limits established in law, and I doubt that I would (like the ten years I did so) ever want to live there again. A competent rehab counselor would help you inventory your skills, abilities and interests to help you find work which complies with your stress tolerance and which you enjoy. I would jump at the chance to care for 6 or fewer (healthy) newborns, but I doubt any mother-baby unit would pay RN wages for doing only that. They would more likely "float" me to NICU which is the scariest place I ever saw. Welcome to allnurses. I wish you well in your quest for the perfect job. Sincerely, Owney :typing

Dear 123sunnid, It sounds as though you should explore your career issues with a disinterested third-party such as your mentor, therapist or pastor. I know next to nothing about floral design, but I do know that one should always pursue (within practical limits) any art that feels good. I began dabbling with music in my teens and if not for my singing in choirs and my instruments, I think that when my department director "retired" me from nursing would have been my last day on this planet. You might feel out your employer and see if you can hold onto some kind of school nurse position, part-time if possible. In any event, do not let your nursing license expire. Without it, you close all doors in nursing after working so hard to get into the noble calling. There so many countless specialties that you can almost count on the dream job coming along as soon as you let your license go. Your husband should be happy that "his career is his hobby", but he should pray that it will continue as long as he needs it. I would ask him, "What would you do if you went to work tomorrow and your workplace no longer existed? What do you intend to do with your life after you retire?" I loved my last nursing job so much that I told everyone that I intended to retire from there in another ten years. Big mistake! I always got the heaviest work-load and the worst EMTs or LPNs to work "with." Owney:typing

My Dear Colleagues, I have seen computers move into hospitals throughout my career. Before the internet (yes, there really was such a time) we had some PCs that were supposedly dedicated to printing out patient discharge instructions. The first time the deputy emergency medicine chief saw two medical students playing chess from a floppy drive, he had the IT folks install locks that kept the "patient instruction" floppies locked into place. Were these folks abusing their privileges? Most likely--but if they were third year students, they probably signed up for ER elective in order to learn. Evidently they felt they learned more by playing chess--since most of the staff (except us nurses) treated them like useless furniture, especially when the ER got really busy. I heard about another large hospital system that had nursing documentation software written by folks who were brilliant software authors. They never sought input from nurses, just put it on the system and hospital administrators issued an imperial decree that it be used. Needless to say, it failed miserably. God knows how much nursing documentation and patient needs suffered during the failed trial. I have heard that there are good nursing documentation systems in place these days. I should consider myself fortunate to have retired during the last days of pen-and-paper documentation. I worked in a huge medical center whose entire university computer system was in the basement of the hospital. The IT folks were so helpful that if you brought them a box of floppies, they would give you software to access the system from your home. (I know they could not do this today without blocking access to medical records.) One day a fun-loving colleague told me about a web site, which I keyed up on the computer in the middle of the treatment area. I should have known that as soon as I answered "are you at least 18 years of age?" in the affirmative, I would be bombarded with Mediaographic photographs so quickly that the only way to stop it was to unplug the computer. I later heard another nurse tell a resident physician that "...if you use any of our computers to access anything other than medical information, they will fire you. They have already done it to more than one person." Bear in mind, however, this hospital had the nearly limitless resources of a HUGE university IT department to police its system. At another hospital I saw more than one physician who used hospital telephones and the internet to trade stocks (after all, how could she/he give good ER care if he/she cannot afford to fill the tank of the Jaguar or make the next medical conference/cruise). Administration looked the other way since she/he was more than "just some nurse." At other hospitals, every time I suggested that we should have nurse-to-nurse department mail, (so that we could trade days off) the response was, "If we do that, our nurses will spend all their time chatting and ignore their patients." When I worked for the pool I worked with a physician who kept all of his patients' ER records on his laptop. Imagine today how poor he would be after the lawyers got finished with his HIPA cases. A few years ago, I got a letter from the VA about a mislaid laptop with millions of medical records. The letter said that if I suspected any of my records had been "mined" by commercial entities, I should contact the VA immediately. If any of my records had been accessed, I would hope the third-parties were my federal legislators, so that they could see what a sorry sitcom my "treatment" by the VA was. What I have learned from my computer experience is: 1. Surf as much as I like, but cross-check all information that I dispense. 2. Never open unsolicited emails from an address that I do not recognize. 3. Never answer the question, "Are you at least 18 years of age?" 4. Never post anything that could lead to a court summons. 5. Never post anything that I would not want my mother to read. The internet is a marvelous resource. I was breathless when I first surfed with my HSC, and was told, "YOU HAVE JUST ACCESSED 2.4 MILLION WEBSITES IN 1.2 SECONDS." What I have learned in the years since was that a large portion of that information would help me most by raking it into my tomato garden. Over my lifetime I have seen newspapers, radio, television and internet resources evolve into entities that are best handled by two approaches: 1. Pay attention to only half of what one sees and hears. 2. Ignore the rest. Best Regards, Owney:typing

My Dear Colleagues, In 1976 I obtained a bachelor of arts degree from San Diego State University, with emphases in developmental, personality, abnormal, and industrial psychology. When I studied psychology at State, manic-depressive disorder was characterized as either neurosis or psychosis, the difference being either the knowledge of reality in the former, and the absence of such knowledge in the latter. Electing not to attend graduate school, and finding a soft employment market in San Diego, I relocated to my home town where my mother and sister both had administrative positions in the state mental health system. I was soon working on a locked adolescent and children's ward of an inpatient mental health facility. I attended Wayne County Community College and obtained an Associate of Science in Nursing in 1981, and went to work in the emergency department at Detroit Receiving Hospital. Since we were also the psychiatric crisis center for all of the city, I had many encounters with that department, as all incoming patients with medical problems had to be cleared by us prior to evaluation by them. On the day I graduated from State I realized that my psychology education began to become obsolete. Correct me if I am mistaken. It appears that manic-depressive disorder is now called bi-polar, and my psychiatric social worker friends tell me that bi-polar always means psychotic (not aware of reality) rather than mood swings which are more profound than "normal", but of which the sufferer is aware of reality at all times. To me, such a widely held belief is further evidence of propaganda foisted upon psychiatrists by the drug companies (incidentally, when was the last time your psychiatrist suggested the trial of a new medication without handing you many "free" samples, which the "pusher" put in her/his closet?) I heard a report on the radio the other day (it may have been quoting last week's New England Journal of Medicine) citing a recent study suggesting that each new generation of psychotropic drugs is no more efficacious, has more side effects, and (surprise, surprise) costs many times more. I recall that at our "capping" (completion of first year, 1980) and at our graduation, (1981), ceremonies someone read the fact that "nursing licensure in the State of Michigan may be impossible for anyone with a history of psychosis." I have known nurse colleagues who practiced on a "limited license" while rehabilitating from alcohol or other substance abuse. I knew another colleague who took herself away from bedside nursing after a traumatic brain injury. Unlike the government and the insurance industry, I believe everyone should be entitled to affordable, effective, professional mental health. As soon as my boss "retired" me, years before I was ready, resulting in instant poverty and near-homelessness, I went to the closest community mental health facility that would take medicaid. Naturally when I told the intake social worker that I was drinking two 30-packs a week, I was labelled "alcoholic." Before I saw the psychiatrist I looked at my income (zero) and my beer tab ($2,000/year for the cheapest slop I could find) and stopping (cold turkey with no effects other than a clearer head and improved nutrition) was a no-brainer. As soon as the medical doctor read in my two-week old chart that I had a substance problem, what did he prescribe? More drugs! I really did give six different SSRIs and a "mood stabilizer" the honest try. Each time it was the same crap. I would reach a plateau for a week or so, and then it was right back to the same anxiety/depression. The only help for me was group sessions (if only to see that I was much better off than those crack-heads and drunks), and two-years' individual bi-weekly sessions with a clinical social worker. Other than temporary chemical easement of disabling symptoms, anxiety, depression and bi-polar neurosis are only treatable by resolving the underlying cause, i.e. difficult adaptation to an adjustment disorder--loss of home, income, profession, loved-one, marriage, ect. The only mental illnesses in which drugs are essential are unreasoning psychoses, such as schizophrenia. and once these are chemically stabilized, adjunct talk therapy is absolutely essential. As the holder of a college degree in psychology and years working with the mentally ill, I think I am in the position to know when "I ain't right!" Owney:typing

Like some of you I retired early (57) and live on disability (SSD). Unlike most of you my boss woke up one morning and decided she no longer loved me so she suspended me and gave the chief of hospital security several months to develop a pack of lies about me. After over seventeen years faithful employment at the largest private employer in the city, he spent several months painting a picture of me as a dangerous psychopath. It took me six months to realize that in an "at will" state my boss could "retire" me at any time with no notice and no reason. I think she only gave me a "reinstatement (AKA Kangaroo Court:bugeyes:) hearing" was so that I could spend six months (with no income) thinking I might be allowed to resign. Those stinkers even contested my six-months unemployment, dragging it out in court for eighteen months by delays, and then failing to show up for the hearing--so I did eventually get my "money.":bowingpur I tried the EEOC. the state civil rights commission and several dozen lawyers, all of whom told me that I definitely had a case, but as soon as they found out with whom they would be dealing, they refused to take it (unless, of course I could give them $10,000 cash). Four months after my "reinstatement hearing" (at which they neglected to follow their own "disciplinary procedures" and fired me on the spot), I had to go downtown and talk to a representative from the state to answer my former employer's allegations that I should no longer keep my license. Of course I have the letter from the state capitol which speaks to how unfounded their allegations were. The stress of having a career which I loved taken away from me and the near homelessness of NO INCOME for nearly three years exacerbated enough physical and emotional illness to render me totally disabled my doctor said so immediately and after almost three years, the judge finally said so too. The minute we could, we abandoned our "predatory mortgaged" (not for a big screen TV, but just to keep going) house, moved nearly two thousand miles away to a small, friendly town with a beautiful climate and a much lower cost-of-living (our rent is 1/3 of our former mortgage; our utilities are 1/4 and insurances are 1/5 of what they were). In four days driving, we went from twelve degrees, with falling snow, to t-shirts, shorts, sandals and three hundred days of sunshine.:wink2: My wife, my son (36) two cats and dog have only been here two months but we loved it when we got here, and we love it more each day. My son got the first job in his life that he really likes. I recently renewed my license in my former state and will soon convert it to this one. As soon as I do, I will volunteer at the city volunteer corps, and at the senior citizens' center (where my wife and I already joined a writers' group and are soon to take art, craft, birdwatching and conditioning classes, and I may teach beginning guitar). I will be glad to do B/P, glucose and vision screening, and dispense nursing advice, (which will always end with, "Be sure to see your physician.") I worked in mental hospitals for five years, emergency trauma centers for twenty-two, and had NO IDEA how stressful it was until I stopped:banghead:. I also had no idea how stressful living in a dying, crowded. nasty city in a state whose terrible climate is only eclipsed by its government debt, unemployment, foreclosure, crime and out-migration WAS until I started living here:wink2:. At least once a day, I thank God (I am often driven to tears) for my deliverance from the forced labor that constituted my last years of practice in the busiest ER in town. Conventional wisdom says, "once you work in a large urban trauma center you can work anywhere." HA! My boss always needed me to work a shift that should have had ten RNs with only one or two others. Whenever I applied for a job elsewhere she would see to it (by "blackballing" me) that I could not leave. I am hoping to keep up my license long enough to have "RN" on my tombstone. I know that when I stand before Saint Peter:saint:, I will be proud of my contributions to the profession of nursing:heartbeat:. Although I have already forgiven them, I doubt that old Saint Pete will not expect some explaining by those who wrecked my profession and drove me from my home. What am I doing in retirement? I am spending a lot more time singing:yawn: in choirs, open-mikes (twice a month in a nursing home), watching birds, stars and planets, rock-hunting, playing with my pets, my musical instruments, reading, writing. socializing and making music with my new-found friends than I ever thought possible.:wink2: If anyone who reads this is curious where I now live, send me a P-Mail and if you tell me who and where you are, I may tell you--as long as you promise not to move here. Owney:typing

I read "Critical Care" and "Tending Lives." Heron's career is very much like mine. She worked for 17 years and I worked for 22, mostly ER. In "Tending Lives" each chapter is the story of nurses working in different specialties. The most telling chapter is "Echo Heron", a minute-by-minute of her last bedside shift. She taught me that the longer I stayed at the bedside the more certain I would be when the moment arrived that I could no longer do it. Echo's moment came in 1994, when she ended her shift and NEVER looked back. My moment came last year when my boss decided it was less trouble to suspend, fire, and blackball me, and then file a complaint on my license than to address my written complaints of harassment. Anyone thinking about entering the profession, and everyone having second thoughts about it should read her non-fiction books. Talk to nurses who have five years' experience, since 85 per cent leave the profession by then. The more we know about quality care, the more frustrated we are with the virtual impossibilty of providing it. Like Heron, I intend to keep up my license and ACLS. Like her, I pray every day that I will never again have to use them.

Dixiedi, Are you prepared to withold your care to fellow humans and watch them die because they cannot afford to pay it? Why should the greatest country, with the greatest medical care in history have such an inequitable and rediculous system to pay for it? I interpret your post to mean that if you have no money, you should "simply" die, and quit whining.

mkue, How can you say FINALLY if you read the date, 27 February? How can you say that Kerry "sings with a different choir every day" if you look at Junior's flip-flops, especially his flip-flop on Homeland Security? 'Steadfast' Bush's amazing flip-flops By Dan Payne | June 5, 2004 BUSH-CHENEY team likes to say president is "steadfast." And John Kerry is "flip-flopper." But Senator Kerry is bolted to floor compared to Bush. President Bush is no more steadfast than Tony Soprano is faithful. Never burdened by reality, Bush says departing CIA chief George Tenet did "superb job." That assumes Tenet's job was to fail miserably to anticipate 9/11 and to goad Bush into going to war under false pretenses. Bush doublespeak is matched only by his amazing flip-flops, which are underreported. Armchair Strategist aims to fix this, with help from Center for American Progress, liberal (There, I said it!) think tank. Bush can't get enough of Chalabi. Chalabi cons Bush's neocons into toppling Saddam; sits behind Laura Bush at State of Union speech; always looks marvelous in custom-made $1,000 suits. US paid him $335,000 a month for "intelligence." US troops raid Chalabi's house. US soldiers raided Chalabi's home and seized documents and computers. (Hope they didn't wrinkle his suits.) While on US payroll, told Iran that US had cracked code for Iran's secret communications. Time magazine says, "The US's abandonment of Chalabi may prove to be the most head-snapping reversal of all." Bush called Osama number one priority. "There's an old poster out West that says, `Wanted: Dead or Alive.' . . . The most important thing is to find Osama bin Laden. It's our Number One priority. We will not rest until we have found him." (Sept. 13 and 16, 2001.) Now Bush doesn't care about him. "I don't know where he is. I have no idea and I really don't care. It's not that important." (March 13, 2002.) Cheney: We will be greeted as liberators. On "Face the Nation" Cheney predicts war in Iraq will "go relatively quickly." On "Meet the Press," says "things have gotten so bad inside Iraq, from the standpoint of the Iraqi people, my belief is we will, in fact, be greeted as liberators." (March 16, 2003.) Bush: That's Cheney's story, and I'm sticking with it. On Feb. 7, 2004, Tim Russert asks: "It's now nearly a year, and we are in a very difficult situation. Did we miscalculate how we would be treated and received in Iraq?" Bush: "Well, I think we are welcomed in Iraq." (Pentagon reports 820 US troops killed in Iraq and 4,682 injured, June 3, 2004.) Bush opposes Department of Homeland Security. Former press secretary Ari Fleischer says Bush told Congress, "There does not need to be a Cabinet-level Office of Homeland Security." (White House press briefing, Oct. 24, 2001.) Bush supports Department of Homeland Security. "So tonight, I ask the Congress to join me in creating a single, permanent department with an overriding and urgent mission: securing the homeland of America." (June 6, 2002.) Bush: Al Qaeda and Saddam same. "You can't distinguish between Al Qaeda and Saddam when you talk about the war on terror." (Sept. 25, 2002.) Bush: Saddam had no role in 9/11. "We've had no evidence that Saddam Hussein was involved in Sept. 11." (Sept. 17, 2003.) Bush acrobatics on 9/11 commission. Bush was against creating commission, then for it. Against National Security Adviser Condoleezza Rice testifying, then for it. Against testifying himself, then for it. Said he'd testify only for one hour. Then said no time limit but had to have Cheney along -- to keep their stories straight. Bush says president should talk OPEC into lower prices. "The president ought to get on the phone with the OPEC cartel and say we expect you to open your spigots . . . The president of the United States must jawbone OPEC members to lower the price." (Jan. 26, 2000.) But not this president. With gas prices soaring, President Bush refuses to "personally lobby oil cartel leaders to change their minds." (Miami Herald, April 1, 2004.) Bush then: gay marriage is state issue. "The states can do what they want to do. Don't try to trap me in this state's issue like you're trying to get me into." ("Larry King Live," Feb. 15, 2000.) Bush now: for constitutional amendment banning gay marriage. "Today I call upon the Congress to promptly pass, and to send to the states for ratification, an amendment to our Constitution defining and protecting marriage as a union of man and woman as husband and wife." (Feb. 24, 2004.) Flip-flops, ad nauseam. Against nation-building, then for it. Found WMD, then lost them. Against McCain-Feingold campaign finance reform, then signed it into law. Tariffs? Not gonna have 'em; puts 'em on steel, then lifts 'em. Mocks Al Gore's idea for hybrid fuel car; calls for $1.3 billion to develop one. For extending ban on assault weapons in 2001; now against it. Fashion idea for DNC conventioneers: Bush flip-flop shoes. If it flips, wear it. Dan Payne is a Boston-based media consultant who worked on John Kerry's Senate campaigns and for Michael Dukakis during the 1988 presidential primaries. His column appears regularly in the Globe. © Copyright 2004 The New York Times Company :rotfl:

"Fighting a Comprehensive War on Terrorism" Remarks by Senator John Kerry at the Ronald W. Burkle Center for International Relations February 27, 2004--University of California at Los Angeles--As Prepared for Delivery It's an honor to be here today at the Burkle Center - named in honor of a good friend and one of America's outstanding business leaders. Day in and day out, George W. Bush reminds us that he is a war President and that he wants to make national security the central issue of this election. I am ready to have this debate. I welcome it. I am convinced that we can prove to the American people that we know how to make them safer and more secure - with a stronger, more comprehensive, and more effective strategy for winning the War on Terror than the Bush Administration has ever envisioned. As we speak, night has settled on the mountains of the border between Afghanistan and Pakistan. If Osama bin Laden is sleeping, it is the restless slumber of someone who knows his days are numbered. I don't know if the latest reports - saying that he is surrounded - are true or not. We've heard this news before. We had him in our grasp more than two years ago at Tora Bora but George Bush held U.S. forces back and instead, called on Afghan warlords with no loyalty to our cause to finish the job. We all hope the outcome will be different this time and we all know America cannot rest until Osama bin Laden is captured or killed. And when that day comes, it will be a great step forward but we will still have far more to do. It will be a victory in the War on Terror, but it will not be the end of the War on Terror. This war isn't just a manhunt - a checklist of names from a deck of cards. In it, we do not face just one man or one terrorist group. We face a global jihadist movement of many groups, from different sources, with separate agendas, but all committed to assaulting the United States and free and open societies around the globe. As CIA Director George Tenet recently testified: "They are not all creatures of bin Laden, and so their fate is not tied to his. They have autonomous leadership, they pick their own targets, they plan their own attacks." At the core of this conflict is a fundamental struggle of ideas. Of democracy and tolerance against those who would use any means and attack any target to impose their narrow views. The War on Terror is not a clash of civilizations. It is a clash of civilization against chaos; of the best hopes of humanity against dogmatic fears of progress and the future. Like all Americans, I responded to President Bush's reassuring words in the days after September 11th. But since then, his actions have fallen short. I do not fault George Bush for doing too much in the War on Terror; I believe he's done too little. Where he's acted, his doctrine of unilateral preemption has driven away our allies and cost us the support of other nations. Iraq is in disarray, with American troops still bogged down in a deadly guerrilla war with no exit in sight. In Afghanistan, the area outside Kabul is sliding back into the hands of a resurgent Taliban and emboldened warlords. In other areas, the Administration has done nothing or been too little and too late. The Mideast Peace process disdained for 14 months by the Bush Administration is paralyzed. North Korea and Iran continue their quest for nuclear weapons - weapons which one day could land in the hands of terrorists. And as Defense Secretary Don Rumsfeld has admitted, the Administration is still searching for an effective plan to drain the swamps of terrorist recruitment. The President's budget for the National Endowment for Democracy's efforts around the world, including the entire Islamic world, is less than three percent of what this Administration gives Halliburton - hardly a way to win the contest of ideas. Finally, by virtually every measure, we still have a homeland security strategy that falls far short of the vulnerabilities we have and the threats we face. George Bush has no comprehensive strategy for victory in the War on Terror - only an ad hoc strategy to keep our enemies at bay. If I am Commander-in-Chief, I would wage that war by putting in place a strategy to win it. We cannot win the War on Terror through military power alone. If I am President, I will be prepared to use military force to protect our security, our people, and our vital interests. But the fight requires us to use every tool at our disposal. Not only a strong military - but renewed alliances, vigorous law enforcement, reliable intelligence, and unremitting effort to shut down the flow of terrorist funds. To do all this, and to do our best, demands that we work with other countries instead of walking alone. For today the agents of terrorism work and lurk in the shadows of 60 nations on every continent. In this entangled world, we need to build real and enduring alliances. Allies give us more hands in the struggle, but no President would ever let them tie our hands and prevent us from doing what must be done. As President, I will not wait for a green light from abroad when our safety is at stake. But I will not push away those who can and should share the burden. Working with other countries in the War on Terror is something we do for our sake - not theirs. We can't wipe out terrorist cells in places like Sweden, Canada, Spain, the Philippines, or Italy just by dropping in Green Berets. It was local law enforcement working with our intelligence services which caught Khalid Shaikh Mohammed and Ramsi Bin al Shibh in Pakistan and the murderer known as Hambali in Thailand. Joining with local police forces didn't mean serving these terrorists with legal papers; it meant throwing them behind bars. None of the progress we have made would have been possible without cooperation - and much more would be possible if we had a President who didn't alienate long-time friends and fuel anti-American anger around the world. We need a comprehensive approach for prevailing against terror - an approach that recognizes the many facets of this mortal challenge and relies on all the tools at our disposal to do it. First, if I am President I will not hesitate to order direct military action when needed to capture and destroy terrorist groups and their leaders. George Bush inherited the strongest military in the world - and he has weakened it. What George Bush and his armchair hawks have never understood is that our military is about more than moving pins on a map or buying expensive new weapons systems. America's greatest military strength has always been the courageous, talented men and women whose love of country and devotion to service lead them to attempt and achieve the impossible everyday. But today, far too often troops are going into harm's way without the weapons and equipment they depend on to do their jobs safely. National Guard helicopters are flying missions in dangerous territory without the best available ground-fire protection systems. Un-armored Humvees are falling victim to road-side bombs and small-arms fire. And families across America have had to collect funds from their neighbors to buy body armor for their loved ones in uniform because George Bush failed to provide it The next President must ensure that our forces are structured for maximum effectiveness and provided with all that they need to succeed in their missions. We must better prepare our forces for post-conflict operations and the task of building stability by adding more engineers, military police, psychological warfare personnel, and civil affairs teams. And to replenish our overextended military, as President, I will add 40,000 active-duty Army troops, a temporary increase likely to last the remainder of the decade. Second, if I am President I will strengthen the capacity of intelligence and law enforcement at home and forge stronger international coalitions to provide better information and the best chance to target and capture terrorists even before they act. But the challenge for us is not to cooperate abroad; it is to coordinate here at home. Whether it was September 11th or Iraq's supposed weapons of mass destruction, we have endured unprecedented intelligence failures. We must do what George Bush has refused to do - reform our intelligence system by making the next Director of the CIA a true Director of National Intelligence with real control of intelligence personnel and budgets. We must train more analysts in languages like Arabic. And we must break down the old barriers between national intelligence and local law enforcement. In the months leading up to September 11th, two of the hijackers were arrested for drunk driving - and another was stopped for speeding and then let go, although he was already the subject of an arrest warrant in a neighboring county and was on a federal terrorist watch list. We need to simplify and streamline the multiple national terrorist watch lists and make sure the right information is available to the right people on the frontlines of preventing the next attack. But we can't take any of those steps effectively if we are stuck with an Administration that continues to stonewall those who are trying to get to the bottom of our September 11th intelligence failures. Two days ago, the Republican Speaker of the House Dennis Hastert refused the request of the bipartisan 9-11 commission for just a little more time just to complete their mission. This after the Commission has had to deal with an Administration that opposed its very creation and has stonewalled its efforts. He didn't hesitate to pick up the phone and call Denny Hastert to ram through his Medicare drug company benefit or to replace a real Patients Bill of Rights with an HMO Bill of Goods. This President told a Republican fundraiser that it was in the "nation's interest" that Denny Hastert remain Speaker of the House. I believe it's in America's interest to know the truth about 9-11. Mr. President, stop stonewalling the commission and stop hiding behind excuses. Pick up the phone, call your friend Denny Hastert and tell him to let the commission finish its job so we can make America safer. Third, we must cut off the flow of terrorist funds. In the case of Saudi Arabia, the Bush Administration has adopted a kid-glove approach to the supply and laundering of terrorist money. If I am President, we will impose tough financial sanctions against nations or banks that engage in money laundering or fail to act against it. We will launch a "name and shame" campaign against those that are financing terror. And if they do not respond, they will be shut out of the U.S. financial system. Fourth, because finding and defeating terrorist groups is a long-term effort, we must act immediately to prevent terrorists from acquiring nuclear, chemical, or biological weapons. I propose to appoint a high-level Presidential envoy empowered to bring other nations together to secure and stop the spread of these weapons. We must develop common standards to make sure dangerous materials and armaments are tracked, accounted for, and secured. Today, parts of Russia's vast nuclear orificenal are easy prey for those offering cash to scientists and security forces who too often are under-employed and under-paid. If I am President, I will expand the Nunn/Lugar program to buy up and destroy the loose nuclear materials of the former Soviet Union and to ensure that all of Russia's nuclear weapons and materials are out of the reach of terrorists and off the black market. Next, whatever we thought of the Bush Administration's decisions and mistakes - especially in Iraq - we now have a solemn obligation to complete the mission, in that country and in Afghanistan. Iraq is now a major magnet and center for terror. Our forces in Iraq are paying the price everyday. And our safety at home may someday soon be endangered as Iraq becomes a training ground for the next generation of terrorists. It is time to return to the United Nations and return America to the community of nations to share both authority and responsibility in Iraq, and take the target off the back of our troops. This also requires a genuine Iraqi security force. The Bush Administration simply signs up recruits and gives them rudimentary training. In a Kerry Administration, we will create and train an Iraqi security force equal to the task of safeguarding itself and the people it is supposed to protect. We must offer the UN the lead role in assisting Iraq with the development of new political institutions. And we must stay in Iraq until the job is finished. In Afghanistan, we have some NATO involvement, but the training of the Afghan Army is insufficient to disarm the warlord militias or to bring the billion dollar drug trade under control. This Administration has all but turned away from Afghanistan. Two years ago, President Bush promised a Marshall Plan to rebuild that country. His latest budget scorns that commitment. We must - and if I am President, I will - apply the wisdom Franklin Roosevelt shared with the American people in a fireside chat in 1942, "it is useless to win battles if the cause for which we fight these battles is lost. It is useless to win a war unless it stays won." This Administration has not met that challenge; a Kerry Administration will. But nothing else will matter unless we win the war of ideas. In failed states from South Asia to the Middle East to Central Africa, the combined weight of harsh political repression, economic stagnation, lack of education, and rapid population growth presents the potential for explosive violence and the enlistment of entire new legions of terrorists. In Saudi Arabia and Egypt, almost sixty percent of the population is under the age of 30, unemployed and unemployable, in a breeding ground for present and future hostility. And according to a Pew Center poll, fifty percent or more of Indonesians, Jordanians, Pakistanis, and Palestinians have confidence in bin Laden to "do the right thing regarding world affairs" We need a major initiative in public diplomacy to bridge the divide between Islam and the rest of the world. For the education of the next generation of Islamic youth, we need an international effort to compete with radical Madrassas. We have seen what happens when Palestinian youth have been fed a diet of anti-Israel propaganda. And we must support human rights groups, independent media and labor unions dedicated to building a democratic culture from the grass-roots up. Democracy won't come overnight, but America should speed that day by sustaining the forces of democracy against repressive regimes and by rewarding governments which take genuine steps towards change. We cannot be deterred by letting America be held hostage by energy from the Middle East. If I am President, we will embark on a historic effort to create alternative fuels and the vehicles of the future - to make this country energy independent of Mideast oil within ten years. So our sons and daughters will never have to fight and die for it. Finally, if we are going to be serious about the War on Terror, we need to be much more serious about homeland security. Today, fire departments only have enough radios for half their firefighters and almost two-thirds of firehouses are short-staffed. We should not be opening firehouses in Baghdad and closing them down in New York City. We need to put 100,000 more firefighters on duty and we need to restore the 100,000 police on our streets which I fought for and won in 1994 but which the Bush Administration has cut in budget after budget. We need to provide public health labs with the basic expertise they need but now lack to respond to chemical or biological attack. We need new safeguards for our chemical and nuclear facilities. And our ports - like the Port of Los Angeles - need new technology to screen the 95 percent of containers that now enter this country without any inspection at all. And we should accelerate the action plans agreed to in US-Canada and US-Mexico "smart border" accords while implementing new security measures for cross border bridges. President Bush says we can't afford to fund homeland security. I say we can't afford not to. The safety of our people, the security of our country, the memory of our brothers and sisters, mothers and fathers, neighbors and heroes we lost on September 11th call on us to win this war we did not seek. And our children's future demands that we also do everything in our power to prevent the creation of tomorrow's terrorists today. Maybe there's no going back to the days before baggage checks and orange alerts. Maybe they're with us forever. But I don't believe they have to be. I grew up at a time of bomb shelters and air raid drills. But America had leaders of vision and courage in both parties. And today, the Cold War is memory, not reality. I believe we can bring a real victory in the War on Terror. I believe we must, not only for ourselves but for all who look to America as "the last best hope of earth." I believe we can meet that ideal - and that's why I'm running for President.

Yeah, I read, "Nurse", by Peggy Anderson, RN when I was a senior nursing student. For a heart-rending story of a Viet Nam Nurse's experience read, "Home Before Morning." I forget the author's name. But by all means, read all three of the books by Echo Heron, RN. The last one of hers I read was "Tending Lives." Each chapter is about a nurse working in a different specialty. VERRY interesting! The chapter I found most meaningful was "Echo Heron." It is the account of her last shift at the bedside. What I learned from it, is that when the time comes, every nurse will know to turn on her heel, keep walking, and NEVER look back. After over 25 years in hospitals, that moment came for me last year. Read, enjoy, and know that you are not alone. Love :kiss

Sadie04, I hope you archived your message to yourself. If you have not, go back to your post and down load it into your word processor. Whenever your patients care is compromised, you should write a memo to administration, if only to cover your behind in the event of a lawsuit. Your anecdotal notes *could* act in your defense in the event that your leukemia patient sues for getting a disease while under your care. You should always complain, preferably in writing, whenever your patients are compromised due to unfair staffing. If this becomes a pattern, you may have to find another job before you find yourself in the middle of a REAL disaster. Love, :kiss

I recently saw a discussion on allnurses about getting started in Legal Nurse Consulting. The best advice was to visit the American Association of Legal Nurse Consultants. They publish the "bible" for LNCs, titled, "Principles and Practices for the Legal Nurse Consultant." I would guess the textbook must give some history. They have a website, and there is an [email protected]. One of those two should give you answers if not other places to look. LOL :)