Daqueengene

I cannot imagine WHY A NURSE WOULD REQUIRE YOU TO SIGN A PERMIT THAT YOU INDICATED WAS NOT CORRECT!!!!!!!! Having said that I am appalled and embarrassed by the lack of professionalism and disregard of patient safety and the WHO, Joint Commission, AORN ,ect... emphasis on correct site surgery. I cannot imagine this happening! I would bring this up to the management of the hospital or surgery center where you had your procedure. I would caution that you should never sign a permit that is incorrect EVER no matter what anyone tells you.

It is so hard these days to find the balance in Nursing. It is true that times have changed and there are many different responsibilities and pressures to handle. I feel bad for nursing right now but I feel worse for the patients we serve. We are loosing the focus of patient first. I have fallen in the abyss of more computer entry, more responsibilities, and less time for actual patient care at times. I have been burned out and crispy over the years but have always found my way back by concentrating on the care that I can give. If there are questions or things that I need to know I have sought them out through study, research of standards, clinical practice articles, books and professional certification in my specialties. This gives you more credibility and helps develop a stronger sense of professionalism. It also gives you a credible and factual platform from which to affect change in your work place. You are still so new to the profession and are really in the place where it is the hardest. Give yourself some time and focus on the people you are charged to care for. I have been a working RN for 29 years now. There have been many times that I have thought of giving up and walking away from the profession. I have stayed because I know that through my actions I can help someone in there time of need. I can make there stressful and scary time of illness or physical change easier. I have a professional responsibility to be practicing from a place of true knowledge and care. Be the best you can be. We have a grand opportunity now to merge the highly technical side of nursing with the softer and very important side of caring. When we can do that we elevate our profession. Don't give up on yourself. Remember each person you touch you give them a part of yourself but they also give you a part of them selves too. We are so lucky to be able to actually take the hands, the heart and the knowledge we have and use it for healing.

Isn't it interesting that so many places have so many different ways of doing things. It just says to me that standards are so general and varied there is such a wide interpretation that no really knows what is the best and safest way to do anything! I am constantly floored by our varied practices. Why are there so many different recommendations and practices? Shouldn't it be the same everywhere? How are we to know when we go to a different hospital, outpatient service provider, Dr office or what ever if what they are doing is really an accepted way to do things? No one intentionally provides poor service ( well maybe ) but with that in mind everywhere I have ever worked someone in charge has made the decision about how something is to be done and most of those decisions are made with reccomendations from some other supposidly knowledgable source.(Questioning those decisions in very unpopular and will make your life miserable most of the time so many just don't, and go on to do what everyone else is doing.) We cannot know everything. We have to have some faith in those who have set up the policies that we function under. So many times though we find out that those policies are woefully inadaquate and sometimes dangerous. Why cant we have national standards that directly spell out what is to be done and how it is to be done so everyone who comes to us for help will be getting the same level of safety and care from Maine to California Ie.. this bronchoscope is processed tha same way every bronchoscope is processed throughout the U.S. Then it wouldn't matter where you go the process would be the same and there would be less room for interpretation and a decrease in the level of care. You work someplace and do things the way you are taught to do them and feel that you know what is to be done and how it is to be done. Then you go someplace else and find they do things very differently and it is confusing, who is right, and what is the best way to do something? Sometimes this doesnt matter and the level of care is not in jepordy but other times you find out that the way you were doing things was wrong or you find out the way things are being done now are wrong. How are we to know when there is so much ambiguity and wide latitude for instituting institutional policy and procedure. We all know there is a watering down of standards as they are translated from place to place and person to person. So many of us look down on and scoff at them that they become a joke or a just a pain in our @##. What about the people who are placing their faith in us as professionals to take the very best care of them or their loved one. Sorry to go on. Thanks for letting me vent!

Isn't it interesting that so many places have so many different ways of doing things. It just says to me that standards are so general and varied there is such a wide interpretation that no really knows what is the best and safest way to do anything! I am constantly floored by our varied practices. Why are there so many different recommendations and practices? Shouldn't it be the same everywhere? How are we to know when we go to a different hospital, outpatient service provider, Dr office or what ever if what they are doing is really an accepted way to do things? No one intentionally provides poor service ( well maybe ) but with that in mind everywhere I have ever worked someone in charge has made the decision about how something is to be done and most of those decisions are made with reccomendations from some other supposidly knowledgable source.(Questioning those decisions in very unpopular and will make your life miserable most of the time so many just don't, and go on to do what everyone else is doing.) We cannot know everything. We have to have some faith in those who have set up the policies that we function under. So many times though we find out that those policies are woefully inadaquate and sometimes dangerous. Why cant we have national standards that directly spell out what is to be done and how it is to be done so everyone who comes to us for help will be getting the same level of safety and care from Maine to California Ie.. this bronchoscope is processed tha same way every bronchoscope is processed throughout the U.S. Then it wouldn't matter where you go the process would be the same and there would be less room for interpretation and a decrease in the level of care. You work someplace and do things the way you are taught to do them and feel that you know what is to be done and how it is to be done. Then you go someplace else and find they do things very differently and it is confusing, who is right, and what is the best way to do something? Sometimes this doesnt matter and the level of care is not in jepordy but other times you find out that the way you were doing things was wrong or you find out the way things are being done now are wrong. How are we to know when there is so much ambiguity and wide latitude for instituting institutional policy and procedure. We all know there is a watering down of standards as they are translated from place to place and person to person. So many of us look down on and scoff at them that they become a joke or a just a pain in our @##. What about the people who are placing their faith in us as professionals to take the very best care of them or their loved one. Sorry to go on. Thanks for letting me vent!

Labor down Labor down Labor down:coollook:

I Listened to a news story this morning about Grady Memorial Hosp in Atlanta going back to all white uniforms for Nurses. The overall feeling is that we are indistinguishable from anyone else in the hospital. Other reports discuss the overall lack of a professional image with all the cutsy scrubs and or tired wrinkled scrubs that look like we slept in them then came to work. I have to agree with the assesment that we all look the same from environmental services to nurses. It is confusing to patients and visitors who we are and what we do (all of us ). They may think "do I ask that person a question about my illness or is that the tray lady." Some of the scrubs have gotten out of hand too...at times it is more than my eyes can take. I see this problem comming from Physician staff as well and this is confusing for patients. I work with Physicians who hire office personel and even surgical assistants to work with them who have no formal training, who may at best be a CNA or ORT at worst someone with little or no medical background and a high school diploma, and they introduce them to their patients as their "Nurse". I have been in rooms with physicians who place all of us RNs, ORTs, CORTs, LPNs, CNAs ect and say "I never can keep up with all you Nurses" around here. They dont even seem to know or care to make a distinction between any of us and to them we all are Nurses. So how can we expect the general public to know or even care when the Hospitals and the Physicians dont seem to care. I cannot imagine what would happen if a PA, RNP or RN who had been mistaken for a Dr. by a patient didn't correct that error in perception. I cannot imagine knowingly introducing someone as a nurse to a patient who is not a nurse. I cannot imagine standing there smiling and letting that person think I am something I am not. I am not sure all white uniforms are going to restore our identity. How did we lose it in the first place? What is the general feeling out there on this issue? rainbows and blue skies J

In our hospital we do share eye drops for pre-op cataract clients. The drops are instilled by the holding room RNs and the tips arent allowed to touch the eye at all. The drops are then discarded after their use for that day. All the patients for that day share the charge. This may sound crazy to some but when I started there in the eye room pts shared phaco irrigation from case to case just changing tubing and eye meds instilled during the case and after the case before going to recovery were kept and used day to day patient to patient never dated and it was gross. I still think that everyone should get their own drops but in the age of cost containment it is often the patient that gets placed on the chopping block.

Congratulations! You will do fine if you don't try to be super woman. Listen to your body it will tell you when to slow down take a break order out instead of cook and get the LB (lover boy) to help with the daily chores if living. I have had three children working full time with all three pregnencies. The last one was the hardest but I was working a very busy labor and delivery unit and some days I would go home and collapse. Try and work as long as you can if you don't have any problems because you will need the time after to be with the baby. It was worth it to me to work up until labor to have the extra time off after. Keep your feet up when you can ,rest your mind, dream about the wonderful gift you have been given and hold on for the ride because it is the BEST! keep smilin rainbows and butterflies J

Ours are the same and ENDORNs we use the olympus scope washer for all our endoscopes. The Colon and EGD scopes are on one setting and the bronch is a different setting about a 70 minute cycle (bronch)vs a 40 min cycle (endoscopes). The scopes are leak tested under water then hand cleaned in a sink with kleenzyme and brushes that go down the channels then hooked up in the washer and processed on the cycle that is set for each scope. The washer uses a detergent cycle, metracide cycle ,alcohol cycle and then water cycle. They are then dried and hung in the scope closets that house all of our endoscopes. Bronchoscopes are processed on a longer cycle due to the difficulty with AFB and other Lung bugs that are difficult to kill and since it goes into the lung a higher level of processing is used. Steris is fine as well and I have heard of many places that use steris processing of their scopes.

I work in a small hospital and after our pacu facilitators became certified in pacu nursing the tide changed indicating that two RNs needed to be available for all recovery patients. We work it out during the day easily due to the number of staff that are around all the time but on call and late at night the RN on call for OR has to stay in the pacu until the patient is recovered and off to the floor. It is a good idea especially late a night or on the weekends. If we have back to back cases on the weekends there is a second PACU RN on call that has to come in until the OR is not working and then can go home while the OR RN stays until the patients are out to the floor. It can make for a long call especially if you as the OR RN have been there for hours before the PACU RN comes in, which is the case sometimes. But I dont mind staying it makes sense to me to be there for the dreaded What If. We all know that post operative patients can be tricky and can turn on you in a second. I sure wouldnt want to be there alone trying to take care of a patient who is taking a turn for the worst. It is hard getting patients to the floor alone too so we help each other transport to the floor.

I agree with many of you in that demanding patients and families can be a definate strain on the daily work load and time management for pt care. I am somehwhat troubled though by many of the negative remarks regarding pts and their families. (burn out!:angryfire ) I think that this reinforces that nurses are over worked underpaid and expected to be everything to all people, professional expert clinician, johnny or joannie on the spot at all times, caretaker, care giver, fluffer, puffer, beautician, therapist, babysitter, secret code breaker ( physician hand writting decoder), communications expert, expert orafice cleaner, toenail clipper, linnen changer, coffee giver and generally professional door mat for Dr.s, Patients, families, administrations and each other. As long as we continue to work this way we will be worked this way. We have become part of the problem and not part of the solution.:uhoh21: Families need care too when they have a loved in the hospital. We cannot look at them as the enemy. We have to find a way to work with them and to help them help themselves. We cannot be smart mouthed and terse with them. There will always be families that we cannot get through to. There will always be problem patients but these are some of the challenges of nursing. I know each and everyone of you out there give 100% of yourselves. I know much of this thread is blowing off steam which is something we all need to do to stay sane and to keep getting up and going into work when we know that we are going to walk out feeling used abused and unable to give the kind of care we really want to give. But remember that you DO MAKE A DIFFERENCE in the lives of the people you care for and their families. When you can take the time to do something for someone dont look at it as demeaning or not part of your job but look at it as a kindness that you have the power to give and maybe someday that person will see it as that and then understand just how great you were. Keep up the good work, speak out for nurses rights make a difference in the lives of other nurses and their patients. :balloons:

Demerol has fallen out of favor in pain management due to the breakdown of demerol in the body produces nor-meperidine. With prolonged use as in chronic pain management this build up can cause dangerous and uncomfortable S/Es. As nor-meperidine builds up in the body it can cause confustion, combative behavior and can lower the seisure threshold. Demerol more specifically nor-meperidine is metabolised in the kidney thus anyone with kidney disease of dysfunction should not recieve it. Elderly people who are more prone to confusion (sun downers) ect should not recieve it. Demerol is fine for short lived acute pain in young healthy people although most Dr.s don't prescribe it correctly since in young healthy individuals with good kidney function will clear the drug quicker than the usual q 4 hrs it is prescribed Q2 to Q3 is more in line with the drugs bioavaliability. Demerol works well in post op especially for the patient who is having post operative shakes. Long term pain management is not the correct clinicle application of demerol. While I am on it Phenergan doesn't potentiate anything except sedation. Phenergan has been shown to actually increase pain perception in patients. We think we controll their pain we just knock them out with sedation and do nothing for their pain. FYI I learned most of this during a short stint as a hsopice nurse and through a chronic pain management seminar.

nurses today are rushed and pushed through programs to be dumped into acute care hospitals. newly graduated rns are becoming the new face of specialty nursing units such as icus ers ors and the like. these new rns come out of school with a totally different attitude and demeanor than ever before. i have worked with some new nurses who have flat out refused to take anything home for review or study. i was even told by one new nurse that she had finished school and was done with studying and that if i had anything for her to read i would have to make time at work for her to do it. when i graduated nursing school and started my first job i was scared to death because it was then that i realized that i was so unprepared for the real world of nursing. i had many late nights before work reviewing material pertinent to the area i was working in. i requested information to take home so that i would be more prepared and able to care for the people who depended upon me. i see new rns who have never done any real patient care except for clinical in school going to icus to care for critically ill patients with out basic bedside nursing experience. we train them to nurse the monitors and the bells and whistles and they don't even know there is a real live person attached to those monitors. we are so caught up in paper work that we nurse the chart instead of the patient. with techs giving baths, doing vs and answering pt call bells when is the nurse in the room. when does the nurse place her hands on the patient, observe their skin, interactions, eye contact and generally get o know them. i get patients from units with infiltrated and phlebotic ivs, swollen arms and the documentation reflects that the iv was fine or there is no documentation at all addressing the iv site. patients are sent to me for surgery or endoscopy covered in stool so bad that it is dried and caked onto their skin. they are sent down with their mouths dry caked with thick salvia the tongues to dry and cracked that they bleed. ivs may be documented to be in the same place for 7, 8 or 9 days with out any supporting documentation as to why. reports have to be coaxed out of transferring units. sometimes all i get is that she is just really sick. i have to ask about age, medical hx, admitting diag, allergies, pertinent labs, p.o. intake, loc, vs, ect... then i am met with exasperation from the rn because she has to look the info up in the chart and she is just too busy to get that info for me... and.. no one else asks for report! i get patients that have documentation of med taken that were not taken and pts who received meds that just weren't charted. when i have to call for all this information before a procedure it slows the process and then everyone gets his or her panties in a wad. the problem and excuses i get is that everyone is to stressed, too busy, have too many patients ect... i believe that is all true. i know i am stressed everyday. i know that there are more and more days now after 21 years of nursing that i think of walking away from it all. i know that i am encouraged by my peers, my supervisors, the hospital administration, and the doctors to hurry hurry hurry and that i don't need to take time to do the things that i need to do to take proper care of the patients entrusted to my care. i also know that if i take short cuts and try and please the higher ups that when an incident occurs as it inevitable will then they will hide behind their policies and say they had no idea i was not following the written policy. we so often teach the short cut and so new rns never learn the right way to do things. they think the short cut is the way and we all know that short cuts get shorter when learned as the proper way to do something. too many of the new nurses are not given a solid and stable foundation of do it right take your time and always think of the patient first speed comes after a skill is mastered. we are taught to slap a band-aid on the artery and move on. we all are paying the price of this lack of proper training. msn rn, bsn rn, adn rn, lpn we all have a personal and professional responsibility to the people we serve. no matter how much education you have care and responsibility to the patient are the cornerstones of our professions. i have worked with msn rns who were worthless in the pt care area. i have worked with techs who have been better and more observant that the rn or lpn. it really isn't the level of education that brings about good patient care it is the personal dedication and drive to be the best, do the best for the patient and continue to grow and learn all through your career. we can argue about entry level of practice but that is a moot point as long as associate programs and lpn programs are out there and being promoted. msn, bsn and adn all take the same licensing exam to become an rn. all have to maintain the same number of ceus per licensing cycle. all are able to provide the same care. we need to change our way of thinking and demand of each other professional support and care. we need to make sure that all new rns get a good foundation and that those providing mentorship are truly mentors with the dedication to properly train new rns.

Just wanted some feed back on benifits out there. The Hospital where I work has just cut benifits this year by taking our accured sick time and changed it to what they are calling short term disability. All the hours we had accured as regular sick time were changed into this short term disability. In doing this they cut the pay to 60%. We have a punitive sick policy anyway that doesnt allow you to take sick time until you have used 3 days of PTO first. Then said that we could suppliment the 60% with a short term disability policy( pay roll deducted) that they had arranged from an insurance carrier to offer to the staff. By doing this then you could get your pay up to the 100% that most people need to survive. They then said that we could carry more hours in our bank now in a half a**ed attempt to make it sound good. Well to make a sick story sicker many of us older nurses that have had our bodies and our minds used and abused by our profession:crying2: cannot get the short term disability due to the long list of preexsiting disqualifiers. To add insult to injury the CEO of the hospital when announcing this policy change accused all of us of obtaining false Dr. notes and excuses to miss work to go hunting or what ever since he knew that any of us could get one of the Dr.s to write us out of work. I was insulted and flabbergasted to say the least. Not only did he insuinate that we were unethical but that the Dr.s were too. This is the Same CEO who six monthes earlier wanted to know what to do to help retention and then after no raises for 1 yr we got a 1% raise! Insult again! What do you all think about changing sick policies and taking hours accured at 100% pay and changing them to 60%. Do other hospitals do this? You would think that people who work in and run hospitals would understand disease transmission and physical injury enough to know that we as the employees who come into contact with highly infectious patients, have to pull, push, twist ,turn, and do cartwheels to get things done even with proper body mechanics some time you will have a muscle pull strain back problem, joint problem ect... I feel like they just want to use us up then throw us out. On top of all that just for me personally I had changed from full time to part time due to some family problems and concerns and when I did that I had too many hours in my sick bank for a part time employee to I lost sick hours that I had accrued and havent gotten them back even when the number was inceased with the 60% change. Oh well I will stop complaining just wanted some feedback. thanks

Weezie Sorry Girl but I know of no place that allows family to be in attendance when surgery is going on. The scrub sinks usually serve more that one room and others may be scrubbing for another procedure in another room. Pt privacy is a big issue since doors may have windows that would allow a person to view other procedures as well. The hall must be clear of traffic and extra personel to facilitate the flow of patients equipment ect... and think about it if everyone had a person with them then it would get so out of hand sterility would be compromised. That is why no one not even regular hospital staff are encourage to come in and wonder around. I don't even like it when other OR staff come in and out of my room while I have a patient on the table traffic controll is important to patient safety. I wish I had better news for you but I dont. I hope you find a way to have your nodule taken care of but I really think you will have to give up the idea of having your husband in the OR with you sorry.

I believe that there is almost always a place for family in the care of a loved one. We have, for too many years, shut out families who then felt pushed out and began to think WE HAD Something TO HIDE. I believe in close contact and frank discussion with family members I have been in nursing for 21 yrs Surgical and Obstetric mainly but some good ole med surg in my infancy in nursing. In OB you get used to having families watching everything you do and you get real used to explaining everything over and over. I believe by facilitating a holistic and inclusive partnership with patients and families you give the best care. When families see how hard we work and how much we care while being knowledgabe and competant (sp) I feel that does so much in fostering a good relationship that there are less law suites and accusations of malpractice and negligence. I currently split my time between a regular OR and L&D at two different hospitals. While I do not agree with letting family members into the operating room during regular surgery for infection controll issues and no real staff to monitor the person and make sure they are alright because it can be overwhelming to see the person you love put to sleep tubed draped and cut on. I do believe that fathers that get to go into the surgical area for the birth of their child is common and appropriate. Sounds like a double standard yes but there are differences. There are people who can monitor the support person in the OB OR should he or she have to leave the room. The person is brought back after induction of anesthesia or placement of spinal or epidural and after prepping and draping. In a regular OR there usually is no one but the circulator that could take care of the visitor and then he or she would be taken away from the task of surgery and that would be a step down in care especially in the case of an emergency. If God forbid there were a code in the OR and the persons significant other was there it would be very difficult to get the job done and take care of the visitor. In C-Sections as I said before the father or support person leaves when the baby goes to the nursery and isn't allowed back in the room no matter what. C-sections are considered dirty cases and most women will recieve antibiotics routinely. IN the regular OR many of the cases are not dirty and adding extra personel just increases the risk of infection. Giving all patients antibiotics just so husbands and wives can be in the room isn't cost effective and increases the risk of more drug resistant strains of bacteria. I call out during surgery to waiting families and give regular updates about what is going on and how the patient is doing. This makes the wait so much easier for families and they dont feel left out or pushed to the side. They feel their being taken care of too. They relax, worry and anger are kept to a minimum. We all know that many malpractice cases are brought forth by people who have felt that care simply was not provided or that they were treated rudely, not spoken too, or that their concerns were minimized and not taken into consideration. As far as being under a microscope I say bring it on because I think people need to see how hard we work how great we are and then maybe they will begin to understand that a nurse is alot more than a bedpan fetcher and or Dr's handmaiden. People in OB have often said that they wish they could get rid of video cameras in the delivery room and some Dr's will not allow it. Again I say bring it on because that tape is going to be my best defense it will show what was done and that things were done right. blue skies and butterflies

The cleaning of surgical insturments should be done in the central processing area and all instruments should go through similar processes to ensure uniformity of care and uniform levels of practice. All patients should be treated with the same level of care, processing some instruments in central processing then others in the sink in the OR represents two different levels of care and can come back to haunt you during inspections and surveys. Surgical instruments have many small moveing parts, rough and grooved surfaces, hinges and cannulas. These instruments are very difficult if not impossible to clean adaquately by hand even with brushes. Just eyeballing it you cannot ensure that all biological material is removed. ultrasonic cleaners utilize enzymatic solutions that penetrate protien molecules and break them apart, they use agitation and heat to continue the clean and remove particles from even hinged and cannulated surfaces. If istruments are being cleaned in the OR they must be cleaned in an area that is considered dirty they cannot be cleaned in scrub sinks, substeril rooms ect.. dirty instruments must go to a dirty area for decontamination then move on to the sterilizing area then on to the steril storage and or the operative field. Occasionally instruments must be flashed for another case but they should be properly decontamed and cleaned then sent back for flashing in the OR. It is always best to use instruments that are processed in CS but if you have to flash instrument sets they must be cooked on a 10 min cycle for trays of instruments and any with cannulas must be done on a 10 min cycle. Single instruments can be flashed on a three minute cycle as long as metal is not touching metal and all clamps are open wide. Standards of care are well deliniated in AORN standards and in the standards set out by the steril processing professional organizations. Cs can be taught how to handle special instruments safely and with out causeing damage to them. We aren't the only people who can clean delicate things we must be involved in the training of the people who will be cleaning then. I have seen many OR RNs and ORTs break and or tear up many different instruments and equipment themselves so it can happen to the best of us and we need to learn to let others take the role they have been given and rise to the higest level of preformance and know we all are human and can make mistakes.

As A OR Rn I must say that having more people in a room during surgery just increases the risk of problems. Infection rates increase with increased personel in an active OR. Many people think they are ready and able to view procedures on loved ones only to find out too late they are not and end up on the floor passed out then to the ER for treatment or in need of assistance to get out of the OR and there is no one who can take care of them. I have worked in places where a family member is allowed to be in the room for a cesarean section and this is a routine practice, but they are allowed only after anesthesia has been safely induced ie. spinal or epidural, the patient has been prepped and draped, they leave with the infant and are not in the room for the remainder of the procedure. I suggest you find a Physician who you can trust and who can help your husband work through his distrust of medical personel and hospitals. I would make sure that you are able to discuss your concerns with your anesthesia provider and I would canvass friends co-workers who ever to give you recommendations for both and don't be afraid to request. If you have friends who are OR nurses see if you can request them for your care then maybe your husband would be less anxious for you to be away from him during your surgery. Surgery is scary for us all even those of us who work in it every day. Rest assured that there are many dedicated and professional people who are there to make sure that you get the very best care but you have to be an active informed and knowledgable consumer it is like buying anything you must look around test drive and the first place you go may not be the right place for you to have your surgery. Good luck. from an OR nurse dedicated to each Patient I come in contact with each day.

in this day and age it is so very sad that the only way a nurse can rise to a level of financial security is to leave patient care and go into management or administration. why is it that so many people think because we are nurses we are happy to work long, hard, holiday, weekend, 12hr shifts ,with out breaks ,and or lunch because we are kind and caring angels of mercy who somehow don't need to make the monthly mortgage ,pay for college tuition for our children ect... and that we don't do it for the money because anyone with any sense knows that is insane. why is it that we don't ensure that the best of the best stay at the bed side in clinicle practice by paying them an appropriate half way liveable salery. why is it that we eat our young and discard our older nurses like an old pair of shoes. if we would just look at the research that indicates that nurses make the difference in how well patients respond to treatments, nurses make the difference in how satisfied patients are with their hospitilization. we have to change before the rest of the world will change. we have to demand the professional respect we deserve and we have to live and work up to the standards that are set by our many professional organizations. poeples lives depend on it and our professional survival depends on it. stand up be counted.