DRTCBear

Do Good, Essentially correct except that to assess whether a hospital loses you have to know what the break-even point actually is. In all likelihood the break-even point is months, not years. All industries employ people that may not work out, and these costs are well understood, so nursing is no different. If hospitals feel that their turnover rates are excessively high they have the same options as any employer: Make their working environments more attractive: Higher pay, career ladders, better benefits, better patient care, modern equipment, educational programs, sign-on and/or retention benefits, loyalty. Hospitals, like most employers, would like an endless supply of high quality, low cost, compliant nurses. They would like to be able to keep salaries down, benefits low, and the ability to move patients through their facilities like slaughterhouses move cattle. Committed, caring, and professional nurses tend to interfere with such plans because they have higher expectations than disinterested, uncaring, and unprofessional nurses. But hospitals use RNs, regardless of whether they are new or experienced, to meet minimal staffing standards. So even nurses that do not work out help hospitals meet regulatory requirements, so it isn't as though there are no benefits from day 1...

simple answer No. If hospitals incurred a net loss on orienting nurses, hospitals would be failing right and left because they were losing money every year. Instead, the costs of training new nurses are one, among hundreds of factors affecting the profitability of hospitals, including: overall staffing costs, reimbursement rates, costs of equipment, supplies, and staffing, executive perqs, stockholder dividends, taxes, licenses, fees, inspections, certifications, regulatory compliance... We might as well ask whether hospitals lose money on buy equipment and supplies until they have been fully utilized, or if they lose money courting investors, administrators, physicians, public relations personnel..I. Does it cost money? Sure. But if hospitals invest nothing in developing future capacity, they won't survive to reap profits in the future. If you want to focus on something that really affects hospitals - figure out how becoming health insurers affects the financial characteristics of hospitals: http:www.afn.org/~mathstat

I want to take a strong position - but not a harsh position. It was inappropriate to do what you did. The very first step to take is to graciously and sincerely apologize for having done this at all. Second, a review of significant aspects of patient condition, such as long-standing 'dementia' should be part of orienting to a new patient. If 'dementia' is a correct diagnosis I would think that it should have been pretty obvious in an assessment of 'orientation'. Altering the appearance of people, whether it would mean cutting off or unraveling dredlocks, beehive hairdos, shaving someone's pubic hair, removing jewelry, ought to be done only after considerable deliberation. It isn't just inattentive to an individual patient, it is also a question of compassionate and culturally sensitive care and interdiscioplinary practice. Asking other nurses or supevisory personnel before taking such measures is not just good defensive behavior - it is the essence of collaborative practice. It is really easy to be culturally insensitive - just assume that what we think is ok will be okay with everyone else. at the same time - you made a mistake - you didn't kill the patient - even if the family were to sue you - what would they be suing for? I think most attorneys would laugh them out the door... Thinking ahead too - we should all, always be aware, that family's often disagree on care - no one person speaks for a family - not even the patient - tho the patient's wishes should be pre-eminent... but there is a very great difference between a patient initiating a request for something - like being shaved - and 'appearing' to consent to it when it is suggested by a caregiver. people often accept suggestions from caregivers even though they don't really want it. bear

I must be confused here. She was 'on break'. She told her staff where she was and what she was doing. There is nothing in your story to suggest that she was there longer than her break. If this was an intern or resident would you be contemplating punitive action? If she was playing a video game on her break would you be considering punitive action? It's not like she hid away in a closet somewhere and nobody knew where she was and she rolled in fifteen minutes after shift transition began. I think the environment you would be creating by taking punitive action is a far greater threat to staff and patient well-being than anything this nurse appears to have done. Personally, I wish I could do 30 minute catnaps. In fact, when I was in grad school in statistics the chairman of the department had a cot in his office for power naps. he was quite prolific and got everything done that he needed to get done. being 'awake' isn't all it is cracked up to be if it is barely sentient - and being aslessp isn't so bad if it makes the rest of the shift smoother... Also, has she asked to move to days? You offered no explanation for why yhy are you considering changing her schedule - leaving it unclear whether this is at all appropriate. bear

Hi Krissy, Sorry to hear of your past problems but it is great that you found your way to a way of healing. I am color blind - so there are things I will never appreciate or 'know' that involve colors - e.g. I will never, ever see what non red-green color blind people see when presented with a standardized test. Instead, I see what red-green color blind people see. The rub is that normally sighted people will never see what we see so if you were a skeptic who was normally sighted - you would never be able to get evidence that there were red green color blind people who were accurately reporting what they saw rather than delusion. Pretty much the same with skeptics and holism - they just do not get it and it runs counter to their beliefs that modern science has explained all there is to know about health, healing, and illness. They are as wrong as they were when they stood by the shore and laughed at robert fulton (steamboat), the Wright brothers at kitty hawk (airplanes), and Edison in his lab (electric lightbulb.) The less well informed skepts exhibit the typical response patterns or religious fundamentals and fanatics - they 'believe' they know science the way some believe they know 'god'. on the other hand, it is pretty inexpensive to find out for yourself, as you have. based on your past knowledge you know that surgery cause as many problems, if not more, that it solves. if skeptics looked at modern surgery, pharmacology, and vaccination programs with the same degree of blind, ill-informed, doubt, they would close down the entire health care system. What has always been most curious to me is that skeptics rarely, if ever, address the shift from physicians and hospitals assuming the roles of insurers by entering capitation agreements, propsective payment systems, and managed care agreements. Under such systems, health care providers make more money when they provide less service - banking more of the difference between what they are paid and what it costs for them to provide service. Yet skeptics are unifromly silent with regard to "professional caregiver insurance risk" even though it represents one of the greatest threats to health and our system of health care delivery. Go figure. Enjoy the healing experiences - sadly, most skeptics will never experience them...

Zenman, Yep. But despite all this there are still people out there who feel qualified to do research on TT without ever having conducted a full literature review. They read reviews of reviews of literature, ignore anything that calls into question their biases, suggest research designs that are guaranteed to prove their null hypotheses instead of research designs that give a fair chance to their alternative hypotheses, and apparently cannot grasp why the probability of a TT practitioner passing the Rosa Test was less than 0.10 (0.30) for skills levels of 2 out of 3 or 3 out of 4 correct. Do a web search on "emily rosa", TT, and "skeptic" and you will get hundreds of websites run by people who are either too dumb to remove their accolades, or too lacking in integrity to admit the truth as you have described it. In hundreds of exchanges with skeptics on another LS the pattern was fairly uniform. First they come on spouting nonsense. Then when questioned they suggest that you don't know what you are talking about. Then they move into the phase where they start wondering if maybe there is something to the suggestion that they open an intro to statistics book and look up how to calculate binomial probabilities, to which they have previously responded that it is unnecessary because they 'know' that TT is bunk. Then, after months they finally agree to work it out themselves and with only two exceptions, you never heard from them again - not even an apology for their arrogance and errors of the past. Larry Sarner (another of the flub four authors) actually threatened to sue me if I continued to expose their work for what it was. Real science I guess. Now, going back to the original question - is there a place for alternative and complementary practices in nursing? Of course there is. It is what nursing has always been about. The non-alternative and non-complementary aspects of nursing can be done by robots and semi-skilled workers - the bringing of one's whole self to the encounter in behalf of a patient: The tenderness, empathy, healing presence, ability to put oneself in the shoes of the other and care for them is the non-rational but traditional core of nursing. TT practices as do many other alternative and complementary practices bring a sense of wholeness and healing to nursing encounters that could, in some people's opinions, in efforts to constrain costs, be eliminated from 'nursing' practice. We could, of course, hook patients up to telemetry, sedate them, and warehouse them in cubicles like items in a Walmart supply depot, to be picked up and delivered to stationary nurses for the few procedures that couldn't more efficiently be provided by robots - and we may yet get there, but I don't think of that as 'nursing' care. Alternative and complementary care practices are add-ons for nurses - not substitutes for core nursing skills, yet skeptics tend to fantasize that they are routinely used instead of core nursing skills. I have certainly seen the difference between the two different modalities of practice - but skeptics see something very different than I see even when viewing the same situation. bear

Sorry Charlie, I am not a TT practitioner, I am a nurse-statistician. Invitations to Randi style challenges are responded to appropriately - with gales of laughter... It strikes me as quite odd that a post that derogates TT practitioners and extols the virtues of what was clearly an unscientific, even fraudulent article in JAMA, is perfectly acceptable, but a post that points out that endorsing such an article is misguided is not. Pseudoscience at its worst. bear

And another student who proved that Emily Rosa's research on TT was scientific misconduct, a publishing fraud, and that poor little Emily is still clueless - years later, about research, design of experiments, and data analysis. You really ought to do your research homework before spouting off... Research is not for the weak and simpleminded! bear It was a student who proved that "theraputic touch" was hooey. She showed that 21 professional practitioners of TT could not even detect the supposed "human energy field" they claimed they could feel and manipulate to cure and comfort patients. The only special equipment she used was a cardboard screen and a towel. If they could not see her they scored no better than chance on guessing if she was holding her hand near them or not. Best of all her results were recently duplicated by rresearchers in France.