Works2xs

I beleive that the poll question was couched in the following terms: "... occupations rated for their honesty and ethical standards" I don't want to get off on a rant here... .. but I don't think there's any real linkage between being hightly honest and/or ethical with being highly skilled. Not that I don't think that this is a laudable accomplishment. As a consumer, it's great when we find a professional where these two traits coincide. However, when it comes down to people voting with their wallet, they seem to look for skill first. I'd even go so far as to say that the public's perception of our profession is based on an ideal that "caring" is more of an innate character trait than any "real" skill. To push the envelope a bit further, since "caring" is looked on as a virtue, and since our profession seems defined in those terms, people's response to us is along those lines - much like they'd admire someone who gives generously to charity. It's not a skill to be paid for, but rather a character trait to be admired. In just the short time that I've been a nurse, it's been pretty clear to me that while we, as a profession, can't come to grips with how to define ourselves, there's precious little chance that we'll be able to communicate our true skills to anybody outside of the profession. ... to borrow a phrase from Dennis Miller... "that's just my opinion.. I could be wrong."

Because there are large sales of these drugs, it's somehow "proof" of a negative impact on sensitivity, etc. in circ'd men? "Intact" men don't use these drugs? Was there a study showing a distribution of use among these groups?

Good point, and good info. I'm in some definate need for spending a bit of shoe leather figuring who relates to whom and what political influences are at play in the workplace. Thanks.

Well, I'm in that Thanks for your feedback!

I'm currently struggling with a bit of a dilemma. There's a particular doctor (I work in the OR) who seems to think it's perfectly acceptable for him to walk up to various female nurses and kiss them. I'm not talking about the cheek-to-cheek air smooch some folks/cultures do as a matter of greeting. This is more of the lingering type that an intimate couple would engage in. I've witnessed this on two occasions so far, and each time, the nurse on the receiving end walked away with the squinched-up face of someone who's just eaten something that they've found to be disgusting. The first time I saw this, I asked my preceptor about it. She explained that this was par for the course with this particular person, and that he'd been known to do this for some time. She didn't have any answer as to why the behavior was put up with and noted that she'd also been a recipient of the rougue kiss. I saw it happen again the other day. This time, it was the nurse anesthetist that was assigned to the OR that I was working. The kiss took place in pre-op holding and when she turned around, she had the afore mentioned look on her face. I later asked her about it to see if it bothered her. She noted that she'd known the guy for a long time, and that he'd taken care of her kids. "So you don't mind?" I asked. To which she said "no." However, her body language, tone, and expression during her explanation indicated that it was more of an action she tolerates rather than one of any shared enthusiasm. (By the way, the times I've seen him do this have been right out in front of the nurse's station, surrounded by people and in some cases patients. Apparently, nobody has been bothered enough to say anything - at least not to my knowledge). So here's what's bugging me... During my previous career, such an action would be a firing offense. In fact, I have seen people given their walking papers for much, much less. Having been a corporate manager, I am sensitive to actions and behaviors that could be construed as something that creates a "hostile work environment." Standing by and watching this behavior goes against my instincts to do otherwise. On the other hand, the people this particular person is kissing (assaulting?) are adults and as such, are more than capable of stepping up to their own defense. While I feel that it would be a cop-out for me to use that fact as a reason for inaction, I don't want to usurp anyone's right to self-determination. Another concern is that as a new person in the field, I really don't have a good feeling for what sort of retaliation this particular doctor could bring against any nurse he might think had "narc'ed" on him. I'm not concerned for my own sake as I could return to my previous career. However, I obviously can't assume the same degree of freedom for my coworkers. So I don't want to be cavalier about taking any action. I don't know what sort of feedback I'm looking for here. I know the channels to work through should I choose to pursue the matter. I guess I'm just a bit stunned at the blatant nature of this guy's actions as well as the seeming reluctance (even general acceptance) the people on the receiving end seem to have regarding this guy's activity. The fact that he's so blatant about it coupled with the fact that it's right out in the open, in front of scads of witnesses, makes me wonder if I'm just being overly sensitive. If so many have been affected, and if so many have seen it and not sought to do anything about it, perhaps my impressions of the matter are skewed in some manner. Am I just missing something? (I'm also weirded out by this guy being an OB and showing such obvious ignorance of how it might be received.) Anyways, I was curious about whether anyone else has seen this sort of thing and what the repercussions were, if any, resulting from any complaint.

In a "General" forum, any post is an invitation to others to make comments. Perhaps there should be a "vent" forum for folks to empty their proverbial spleens with some expectation of NOT soliciting opposing views. [sidebar: I really don't advocate that approach, but thought it was an idea worth expressing. A text forum is a notoriously difficult medium to convey feelings... especially negative ones. I think it would be better if folks just understood that whatever they put in these threads will garner opposing opinions and not get so wrapped around the axle when it occurs. Sometimes, folks approach these forums like a ringing phone: it holds some strange power to compel them to answer, even though they'd rather not.] Regarding the "only the experienced need reply" type of comments - It's an exclusionary tactic that seeks to eliminate dissent without the messy business of actually addressing the point made in the "rookie's" post. It always strikes me as something just about one "click" above name-calling on the "irrelevant argument" scale.

Yes, folks get on here to vent. However, there are many "vent" threads that are humansituations that just happen to occur in a nurse setting. Even though the setting brings a definite context, it doesn't necessarily lock every other point of view out. For example, I'm sure there are scads of folks who take their "vent" home and discuss it with a significant other, who just might not also be a nurse. In my experience, that "unqualified" person can sometimes provide a moment of needed clarity. Yes, it's irritating when someone chimes in with some high-horse sounding retort. But before breaking out a can of whoop-orifice on some newbie, remember that it's just as irritating to be told your opinion doesn't count by some experienced person using an equal dose of sanctimony in their response. Experience can be a double-edged sword. The longer you are in a particular setting, the narrower your worldview becomes. Someone else mentioned "perspective" brought by others. Often times, that's just what is missing from the "venters" post.

I'm afraid that you've made an incorrect assumption. I wasn't endorsing any of the inventions to which you refer. I was responding to the OP's question regarding the use of "customer" in place of "patient." Interesting point of view. I thought that those in our care had full autonomy. For example, consent for treatment is required. As I understand it, we're supposed to provide information for the individual to use in making a decision. Which sort of brings us back to the question of "patient" or "customer". The term "patient" is often used to denote someone who is in somebody else's care - a dependent to somebody in a superior or authoratative position. While it's true that individuals often make decisions contrary to their own health, that is their right. Someone who is in a dependent position might be seen as someone who can have decisions made for them, or as you say, for their own good. This approach strips the individual of their autonomy which is arguably anathema to today's healthcare model (and legal right). The use of the term "customer" usually denotes someone who's in an independent position with respect to making decisions on their own behalf. It also usually denotes someone to whom we are dependent on for our own livelihood. In today's healthcare model, it looks (to me at least) to be consistent with what organizations advertise in things like "Client Bill of Rights" as well as protections provided to every individual as part of the law (and if we fail to provide those rights, they can adversely affect our livelihood). Collectively, we (nurses, etc.) might not like what the "customer" decides. But that's entirely beside the point. It's not our "right" to "make" anybody do anything against their own will. One could argue that knowing that certain decisions, approaches, whatever, are of more value than another then we should work all the harder to present those options in the best terms that a particular individual can understand. Looking at someone as a dependent, incapable "patient" lends itself to bypassing all that extra effort. However, if they can grasp all the context and/or background of all the choices, then the "customer" can make the best choice that fits within their own interests. Yeah, perhaps it's all semantics. However, as we see in nearly every political movement, words can frame perceptions. Looking at those in our care as a "customer" can frame how we approach them within the context of what ensures individual autonomy, facilitates outcomes that more closely match individual expectations, and ultimately protect us from making choices that will end up putting us in a courtroom somewhere. But then again, that's just my opinion. I could be wrong.

Sorry, I don't know what assumption you think that I've made. I know that management of any organization can be boneheaded. I know that such boneheadedness is often expressed by poorly implemented "solutions" to problems that are really just symptoms of crappy management. I also know that it's entirely possible that a management principle can be valid and still be subject to poor use or implementation. I'm also aware that while the above statements are fairly accurate, none of them have any real bearing on the question of whether it's appropriate to look at those in our care as being a "customer" or "client".

There are 2 fundamental flaws with the resistance to looking at patients as customers. 1. People who end up sick and in the hospital aren't there because it's a good time. It's not like they are there to do us a favor. Many, many people have to pay substantial sums of money to have the privilege of being cared for by people with years of education and experience. Often times, this cost is second only to their mortgage. For that level of burden, there's an expectation of something more than just sitting there and taking whatever is dished out. About the only thing worse than being sick enough to require hospitalization is having to endure it while surrounded by a bunch of surly, out of sorts people who seem to act as though I should just shut up and accept whatever they deign to throw my way. While I might have to put up with some MW teenager tossing a sandwich to me at a drive-thru, you can bet that for the money I'm spending on my hospital stay, I expect to be treated with some degree of dignity and respect. 2. And while my years of experience and educaction might not be in the field of medicine, it was certainly as difficult to come by. And as a result of that time and effort, I'm not just some blithering idiot. If you'd just stop long enough to explain a thing or two to me, rather than treating me with less attention than you'd give your house plants, I might just accept your ministrations with a level of understanding that you'd find surprising. I realize that there are people just down the hall or around the corner that may be more acutely sick/injured than myself. I'm more than willing to put up with some suffering while you treat those who are more ill than me. On the other hand, I don't want to end up on the bottom of the priority list simply because I'm not a "squeaky wheel." ---------------------------------- Ok... before you blow your top at the veiws above, let me explain a little. I understand that the nurses in this thread are tired of bad patients treating them like serving wenches. However, there are also nurses who treat their charges as a nuisance regardless of how understanding and patient they are with the lack of attention they might be receiving. So let's at least try not to throw the baby out with the bathwater here. Just as there are unreasonable patients, there are also unreasonable nurses. Regardless of how great you might be, they need a readjustment to their approach. Here's another view... Is it possible that you can provide the same level of care to your patients and still tune your approach to make their stay any more endurable? These people are sick and feel a near complete loss of control. Often times, their irritability is just a function of their illness and nothing at all to do with how they are being treated. Part of the skill of a nurse is their ability to reduce their fear and anxiety. Those skills aren't just measured in how many IV's you can start with one stick. They are also measured in how well you can communicate with those receiving your care. Perhaps it's just me, but having had the unfortunate need to be parked in a hospital bed a fair number of times in my lifetime, I've had the opportunity to see both sides of the coin. One of the reasons that I chose nursing was the fact that the people who often had the most profound impact on my stay were those with whom I spent the most time - the nurses. Most of the time, it wasn't that the care given was any better. Rather, it was the manner in which it was provided. You may be the most skilled and educated practitioner on your unit. However, if your people skills aren't any better than some turnkey at the local prison, then unfortunately nobody will ever know it. And if they do, they'll be too bent out of shape with the other part of your care package to make any difference. If you already practice the arts I'm speaking of, then good for you. However, I'd bet that you know of some member(s) of your peers that don't. It's these folks that management's aiming at. It's too bad that some small minority can bring customer and management ire to all of us. Perhaps when you sit in the driver's seat, you can instill your skills in your charges so that such measures won't be necessary in the future. Oh.. btw... I recognize the fact that management is often really lousy at implementing these sorts of initiatives. That doesn't make the need for the initiative any less important. It just illustrates the need for tons of work at that particular part of the business. But that's a subject for a different thread.

Perhaps having chronic pain all her life, she's learned coping mechanisms that allow her to function at something near normal levels. Maybe, even though she masks the outward signs, she's still continually suffering on the inside. It might even be possible that the only thing that empowers her to continue on in that manner is that she knows that in "x" number of hours, she'll be granted some respite from her pain so that she can build up enough stamina to bully herself through for the next little while. Wouldn't it be a shame if some outside observer misinterpreted her ability to endure as an absence of discomfort? Perhaps because this has happened enough in the past, she's learned that if she doesn't behave in some "socially acceptable" way of demonstrating "real pain" then she'll be damned to having to endure even more. It's almost too much to contemplate that a person who has the guts and determination to actually live a life in that sort of condition would still have to "prove" her pain on a regular basis.

What enrages me is a prevailing culture that has created an atmosphere where you feel criminal just for asking for pain relief. It has done a wonderful job in creating an environment where some patients feel obligated to lay in bed white-knuckling the bed rail out of fear that they'll end up in some "reefer madness"-type drug induced haze. It's just needless, pointless suffering. In a world where there's already enough health-induced misery that we CAN'T do anything about, why on earth would anyone allow someone to endure pain when a treatment is so close at hand? /rant off

It's an attempt to get an IT professional at a nursing salary.

Started when I was 44. Best danged thing I ever did!

And that's the weakest argument against. It's amazing that you actually believe there's a comparison between a circ and a loss of a limb. That's right up there with the great "foreskin industrial complex" brought up elsewhere in this thread.

Hmmm. Just in the short span of time that I've worked in the OR, I've had several occasions to witness patient concern regarding modesty. This has ranged from the Muslim woman asking for an all female surgical team to the middle-aged housewife who just didn't like the idea of being exposed. Guarding someone's modesty just seems the decent thing to do, even if they are completely unconscious and unaware. I know that I'd appreciate the consideration if in their position, so the Golden Rule applies. And speaking of rules, protecting the patient's privacy in this manner is included in our intraoperative care plan. Kind of surprised anyone would take issue with someone voicing these sorts of concerns... Am I missing something?

The idea of having circumcision as an item in the orificenal for fending off HIV infection rates in high rate areas is tempting. However, I think some fairly big problems would have to be wrestled with before getting aggressive about putting this out there in those areas. First one, as others have mentioned, is the potential health risks associated with doing the circumcisions in the first place. While reading a completely unrelated article in "Fast Company" (Nov 2006), I came across this tidbit: "Tanzania has only one physician for every 20,511 people, a ratio typical of sub-Saharan Africa. Ipuli's [village in central Tanzania] women in labor have been trundled 37 miles by wheelbarrow to reach the nearest clinic." (Ok, I can't vouch for the scientific accuracy of the author's statement.. but it does illustrate a point). If this procedure were to become more standardized in these areas, would it be done with the edge of a rusty razor blade or hunting knife? How much would such conditions contribute to other mortality and morbidity issues for these children? Would they just trade adult deaths for childhood deaths? Second, I get a bit nervous at suggesting such measures for poor populations. We've seen just in this thread the level of emotion associated with circumcision. I'd imagine similar objections would arise in the heavily affected areas. There'd be numerous moral implications associated with "marketing" this idea, regardless of any practical considerations. I'm sure a Nobel Prize awaits anyone who could overcome those sorts of issues. Of course, doing nothing is equally steeped in moral damnation as well. Interesting discussion.

Seems odd that the most vociferous voices against circumcision seem to ignore these non-trivial health impacts. Having undergone the procedure in my infancy, I can say that just for the reasons noted above, I'm glad it was done. Also, since these issues do have potential impacts to the health and well being of my kids, I don't have a problem "making the decision" for them. I'd go as far as to say that it's less of an impact on my kids that the battery of injections I ensured they received to fend off numerous maladies. Speaking of mental impacts... Before anyone asks...I have seen circ's done. And what struck me the most was that the child protested the most during the process of putting them in the restraint. When it came to the procedure itself, they couldn't seem to care less. As far as "passing out" - I don't doubt the veracity of the poster's observation. I've also seen kids get quite agitated at the Vitamin K or Hep injections they got. Are you suggesting that we stop these sorts of procedures based on the same criteria? I'd have to agree with Timothy in that these illustrations are more of a play on emotion as well as a being a "red herring" than any meaningful argument against totally stopping the practice. Regarding any notion that "I was robbed" of some meaningful piece of my anatomy. I can't say as I've ever heard of a man suffering from "phantom foreskin pain" as a result of a childhood circumcision. I don't put this on any trauma level above having ears pierced. Equating the loss of this small piece of skin to the loss of a limb is just silly hyperbole. Regarding sensitivity - Ok, I won't argue. However, for me at least it's a big "so what." As I noted to the ladies in one of my nursing classes a little while ago, it's like saying my 90 ft tsunami is somehow less of an event than a 100 ft one. To the people living on the coast, they're equally affected. I also seem to remember numerous discussions during the "sexual revolution" about how to stave off the big moment so your partner can reach hers. So I'll just say the sacrifice of my small skin fragment was done to help in the fight to help women realize their unlimited capacity for reaching the big moment. ... back to our regularly scheduled programming....

Why would you want to approve the use of a drug that can be grown for free when you can force suffering people to pay thousands of dollars a year for an alternative? It certainly would be a shame to reduce a cost burden for someone already coping with the considerable expense of drugs to treat little things like AIDS or cancer. It really is more humane and sensible to insist that they choose more expensive, albeit legal, alternatives.

"H.R.6420 Title: To amend the Internal Revenue Code of 1986 to impose an excise tax on certain medical care providers that fail to provide a minimum level of charity medical care, and for other purposes." I think that without the full text of the proposal, it's really impossible to draw any real conclusion. For example... .. What are "certain medical care providers" defined as? I know that as it stands now, certain not-for-profit organizations are required to provide charitable care for a defined percentage of cases in order to maintain their tax-exempt status. If you read the above statement, it would seem that the legislation is targeted at defining what amounts to a penalty to those providers that fail to meet the required number of charitable cases. .. what is meant by "for other purposes"? .. how is "charity medical care" defined in this case? So, at first blush anyways, I'd say the proposed legislation is more of a "big stick" to wield at providers who claim tax exemption but fail to meet the defined parameters to gain that exemption. Which seems reasonable, to me at least. I also don't think that this has anything to do with the establishment of "socialized medicine". But, like I said, without the full text of the proposed bill, and an indepth knowledge of this particular portion of the tax code, I could be wrong.

Change the question. Imagine for a moment that nursing was a male-dominant profession. What benefit would there be in bringing in more females? Broader insight to the people being served? Different priorities? Different approaches to interpersonal relations? Etc. Etc.... The same benefits apply regardless of whether the equation adds more men, women, or any other type of cultural context. So, bringing in more men to the profession will broaden the diversity of the how the service is provided. Nursing is also having issues with filling positions, be it as instructors, bedside, or whatever. Certainly, making an effort to tap into nearly half of a population not currently involved in nursing would help meet those particular needs. So it's not that there's some magic bullet in adding more men to the profession. It's more that it provides greater opportunity to tap into the entire spectrum of the human potential needed to get the best and brightest to the bedside.

Every time I see this sort of thread open up, there is always opinion on what amounts to two different subjects. Subject one: What the patient wants - yea, verily. If a patient is more comfortable with a nurse of the same sex, then by all means, accommodete the patient's needs. I don't think that I've seen too many responses that say that the patient doesn't get what they want in terms of the gender of the provider. Subject two: Management's response to assignment of staff to patients based solely on gender. This is the area that is going to generate some issues. Unlike "subject one" this proclivity to single out men for perfroming (or not performing) a particular task in nursing based on their chromosomes would, in any other career field, would be grounds for a discrimination suit. I think we can agree that the patient's desires come out on top regardless of how reasonable we (the nursing staff) might view that request. Even if it bucks the current zeit geist for gender relations, we are bound by "patient bill of rights" to respond accordingly to their request. Anyone disagree? Where I get rubbed the wrong way is when coworkers, supervisors, managers make assignments, changes, etc. based solely on the gender of the people providing the care and nothing at all on what the stated preferences of the patient might be. Don't shut me out of L&D for no other reason than I'm a man. And don't send all your heavy lifts either. It only takes about 50 lbs to blow a disk (according to my friends at OSHA) so don't think you can simply substitutes me for a lifting job that would otherwise take 2 lady nurses. Guess what.. the same lift would require 2 guys as well. Making allowances for stated patient preferences is one thing. Making assignments or job offers based on hospital admin/unit manager/supervisor preferences is quite another. As with any discriminatory practice, it is incumbent on those who are in a position to propagate such injustice to recognize and respond accordingly to any workplace practice that might be in error. It has really been an eye-opener for me, a person from a former male-dominated career field to watch how the "other half" reacts to the same pressures and preconceived notions that pervade the nursing profession. It is my fervent hope that the ladies, in this sense, prove to be the better half.

First time I had an MRI, it didn't bother me. However, a few years ago I had to have one and I was totally freaked. Had to reschedule and have it done under sedation. Don't know if I was more embarassed about having to be gorked out to have the test or the stuff I said while I was in happy land (which I only know because my wife told me about it sometime afterwards).

Nursing school was hard. Demanding. And ultimately a great experience. If it were easy, then completing it wouldn't have been much of an accomplishment. Add to that the great people that I met while in school and still have the blessings of their continued friendship and I'd say that all in all, it was a pretty good deal. Hard does not equal hell. I've seen hell and nursing school aint it. ... I now return you to your regularly scheduled venting....

What I've noticed about "critical thinking" is that it's a skill most adults have been using in one capacity or another for some time. What throws people is putting putting a name to it. For some reason, it freaks people out. Equally strange is the way instructors approach the idea. They seem to treat it like it is a totally new concept that's not to be experienced outside of nursing. (Ok, ok... there ARE people for whom this is a totally new concept.. but that's a subject for a different thread...) Basically, all that's being asked is that you look beyond the obvious first impressions. For example: If you are a parent, you've undoubtedly found that certain situations are indicators that something is not/potentially isn't right. "Hmmm. It's been too quiet for the last 10 minutes." A non-critical thinking approach would just stop at the "quiet" part and figure all is well. The experienced parent will realize that the quiet is often assocaiated with your kid getting into something that they really shouldn't be messing with (or worse, have come to some harm that prevents them from making any noise). So based on your experience, you've put together a set of conclusions and/or possibilities that may be at play. Based on those conclusions, you then take action, collect more data, etc. So the skill shouldn't be all that foreign to you. The "new" part is that you'll be pulling from what you're learning in nursing-specific course work. What you're being asked to do is to make the mental connections between the patho, pharm, psych, etc. etc. As for testing, my experience has been that the test that you get in your typical college exam doesn't require anything more than simple recall from rote learning - decidedly uncritical thinking. (Of course, that's totally contingent upon the skill of your instructor, quality of the institution, etc.) So getting study guides for NCLEX are helpful in exposing you to the sort of questions that you're likely to encounter. Most of these guides also include the rationale in how the answer was arrived at. Do the question, run through the rationale in your own mind, and then compare it to the rationale that the test developer used. Then... do a truck-load of those questions to get used to thinking of questions in the terms you are likely to see on the test. It's not easy. But neither is it impossible.