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I have heard of sign on bonuses of $10,000-15,000 in Texas. These are in the Rio Grande Valley of Texas. They don't mention it in their advertisements but to survive you need a good handle on Spanish. Tu habla espanol? It is a very rural area, in the hottest part of the state because it is so far south and along the Mexico border. In addition, they are speciality areas like ICU, ER, and OR. Dallas and Houston are more than 8 hours away. San Antonio or Corpus Christi, more nationally recognized cities, are about 4 hours away. The best part is South Padre is about 1.5 hour drive from Mc Allen. I met a home health nurse who loves it there.

The way the original posting was listed I took the OP to mean it was an either/or answer. I didn't realize that the NCLEX has matching now. It has been a long time. A recent CVA patient's consuming food should be under the assessment of an RN. For this reason, I excluded it as my original either/or answer. If it is an ideal situtation where this has already occurred then the LVN would be assigned the CVA patient because she has the technical experience to feed patients with difficulty swallowing and has to perform to a higher standard than a UAP. The UAP assignment would remain unchanged.

Kileen would be the closest town for the programs listed in another posting. Ft Hood is very big. To me it is a great area of Texas. It is considered Texas Hill Country. A lot of different culture backgrounds there with a lot of farming. The area has grown considerably in the past 25 years. Gatesville, Texas is not far from Ft Hood. It is north of Ft Hood. I recall as a kid seeing tanks go across the highway. An in-law relative went to an LVN school there in the 80s but I do not know if it is still there. I know there is a hospital there. You might check out the cities Kileen and Gatesville because it will give you an idea of the communities and might have links. Try nursing+school+city in some searches. Best of luck!

i worked inpatient neurology for more years than i care to remember. licensed and non-licensed staff could do both of the things listed below. licensed and non-licensed staff were taught what they needed to know before doing either. for example, how much "thick-it" to mix with food and how much food to put on spoon.this was before the term "delegated tasks" became prominant in statues related to nursing practice. the patient suspected of tb wore a special mask and was transported to radiology. these mask have limited time of effectiveness. at the hospital i worked a licensed nurse, usually the primary care nurse, went down with these patients in case there were complications. more recently, i saw portable machines brought into a patient's room who was bed bound. the machine was left in the ante room after utilization for decontamination. to me, this is prioritization and nursing assessment. active tb indicates afb smears are positive with m. tuberculosis bacilli. the radiographic imagine will hopefully show cavitation in the chest. the sputum is the primary specimen used to determine effectiveness of treatment. the recent cva, cerebral vascular accident, leads me to believe this patient needs the r.n. the most for assessment regarding neurologic impact on patient's ability to consume food including how thick it needs to be, quantity of food bolus can tolerate, ability to use an extremity to participate in feeding self and establishing a plan of care which includes lpn and uap once the patient has stabilized. my answer is delegate to lpn or uap the transport active tb person to radiology.

This is directed to people who are already school nurses. To reply to this posting, after you click reply, please delete all words that do not apply to you. Insert your responses where appropriate. Have fun! Use color if you like. Comments are welcome, especially which educational level of students you prefer to work with and why. What is your level of education? 1. Non-licensed 2. LPN/LVN 3. RN (associate or diploma) 4. RN (BS/BSN) 5. RN (Master's not in nursing) 6. RN (Master's in nursing, not NP or CNS) 7. RN (Master's in nursing, NP/CNS) 8. RN (Doctorate not in nursing) 9. RN (Doctorate in nursing) Include years in any area and current location with number of years 1. Elementary 2. Middle School 3. High School 4. College 5. University What is your student population size? How many students do you see in an average day? How many people staff you school clinic and their educational level or role? What made you decide to stay in the educational level of students you work with? I just thought it might be fun to hear from each other before we jump back into the trenches again.

At least here, you can work in a school setting as a NP with prescriptive authority through a joint venture between the school district and the county hospital system. The salary market is based on the hospital because these nurses, NP, are employed by the Harris County Hospital District. They can be designated primary care practioners on their medicaid or CHIPS plans. They are overseen by a physician but there seems to be significant more autonomy and is away from the politics of the hospital. Some clinical experience might be useful before pursuing NP but it is truely a personal decision.

When I worked in the OR the hospital administration wanted our turnover times between cases to be 15-20 minutes. This was for major surgeries. The outpatient surgery area was supposed to turnover in 7-10 minutes. Of course, there was blame at each other all over as to causes in delay of turnover times. The result was the nurses in the Main OR came up with a data collection tool as to cause of delay in turn over time. The tool included surgery start time, stop time, surgeon's name, and procedure but no patient information . It made more paperwork for the circulating nurse but eventually helped identify the problem areas. Some of the choices were surgeon, anesthesia, instruments not available/ready (we did a lot of flashing of instruments), patient, prior case ran over, and delayed from pre-admitting. The form started in pre-admiting so they could document if the patient was late to the hospital. All the doctors were aware these forms were being used. They were still being used when I left the OR. Before I left the OR manager began giving incentives to those who, one circulating nurse and one scrub tech/nurse per month, had the best average turnover time. At the very least, the manager has something to go to administration with when they complain about turnover being too slow. One of the good things that came from this was they were considering down sizing non-licensed staff. The OR manager was able to show the difference in turnover times when a non-licensed staff was off for a week of vacation and not replaced to "normal staffing days". This resulted in no loss of non-licensed staff and now they replace them even using overtime staff. After this study, they tried to have two floating nurses to help turn rooms over and relieve staff for breaks and lunches. Good Luck!

I guess I am confused about the staffing in your OR and the patient status at end of case. The majority of the cases I had the patient was breathing on his/her own at the time of placement on the stretcher for transport. Once on the stretcher, anesthesia was almost always (95%) ready to take immediately to recovery/PACU. While the circulator was taking the patient to recovery, non-licensed staff cleaned the room. For 8 major ORs, 2 urology rooms and 1 lithotripsy room there were 3 non-licensed staff. In addition, there were two anesthesia non-licensed personal. One was designated for CVS. What was important to the hospital was having the operating rooms occupied the majority of the day because this increased revenue. The goal was 15-20 minutes turnover time. Depending on the case it ranged from 11 -23. Big neurosurgery cases usually took the longest. Our ORs, non-teaching hospital except LVNs and Scrub Tech schools, had scheduled cases from 7:30 a.m. to 6:00 p.m. There were frequent add ons so in addition to 7-3 staff for the 10+ rooms there were 2 teams scheduled to 11 p.m. and 1-2 teams scheduled 7a - 7p. The CVS team, 7-3, scheduling was independent of general surgery. During the turnover time, the scrub nurse/tech would take instruments to decontamination, get instruments for the next case, use the rest room if needed, and set up for the next case. Each case's supplies was in the room in seperate containers at the beginning of the day to expedite turnover. The circulating nurse would give report to PACU on post-op patient, interview and do consents for new patient, return to OR to confirm have supplies/instruments needed, help finish opening supplies/instruments, get missing supplies/instruments, confirm or do anesthesia turnover, do count with scrub nurse/tech, return to Pre-op to confirm patient has been seen by surgeon and anesthesia, and take to OR when surgeon/anesthesia ready. Keep in mind the above is based on good staffing days. There were times I mopped floors, took trash out, scrubbed in, counted with floaters while a scrub tech/nurse took a break. In addition, this turnover time between major surgeries was very stressful for a newbie. I dreamed of roller skates but even if I had them I knew I was proficient on them. A good scrub tech/nurse is GOLD! If you work together and help them you can be a great team. If they know their stuff then no instruments or supplies will be missing even in an emergency. If they don't or they want to make you miserable you will be running for stuff. Especially, in the beginning I had scrub techs (male) and a surgeon send me for things repeatedly. One was an OTIS. This was their OR joke. There is an elevator manufacturer called OTIS. Late, I think it was an orthopedic sales rep who told me the scrub tech and surgeon were wrong because there is an instrument called an OTIS. If you are not as busy as we were then I can see how you may not have non-licensed personal to help with turnovers. Good Luck to you!

During my period in the OR I never had a bad outcome regarding operative sites. During my periOperative course we were taught the surgeon is responsible for identifying the operative site. This was a sticking point with some surgeons and myself because they would not mark the site. If I could not get the physician to mark the site then I would ask the patient to mark the site. Everyone I asked, smiled. Many added, at least I know he will cut the right one. Within months of finishing the periOperative training, the hospital came up with a policy regarding operative site identification. We were told it was taken from a statute (state specific I am sure). The policy designated the physician as the medical person to mark the operative site with a permanent marker. Even with the policy there were many resistant surgeons. If the proper procedures are utilized then a wrong site operation should not occur. Of course, you have to have the right patient. You must confirm with the patient what the operative procedure will be including site. The consent must be consistent with the patient's understanding of the operative procedure. The surgeon confirms with the patient what operation is going to be done. This is all done prior to any medication. Once the patient gets into the operating room, the circulating nurse and scrub tech/nurse must confirm with the doctor and anesthesia the operative procedure including site. Where I worked there was an Expo Board for sponge counts etc. The operative procedure was also listed on this board. You incident is the exact reason why this area was a sticking point for me with surgeons. I had heard case law before where the surgeon and anesthesia were not assigned any blame. As one who does not want to put my nursing license at risk, I took a firm position regarding the surgeon identifying the surgery site. I tried to be present when the surgeon saw the patient to witness the confirmation between surgeon and patient but this was not always possible. This position will put you at odds with some surgeons so maybe someone else has better ideas. Do you have a periOperative nursing book? This is imperative because you are responsible for your nursing actions. Good Luck!

At the time I did my stent in the OR I had more than 19 years of experience in nursing. I thought I had stepped into the dark ages. As a nurse aide I remember being yanked from out of a doorway by the head nurse because Dr. ****** would be coming out of the room "any minute" and "nothing is to be in his path". I saw more hugging and kissing among my peers and some doctors than I had ever seen in a bar. Some surgeons and male scrub nurses would talk derogatory about women. Foul language was the norm. There were surgeons who got whatever they wanted and could treat you any way they wanted. Least I forget, answering an orthopedic surgeon's cell phone any time I was in his case because he "didn't want to miss any calls". I could understand if he had a patient that was going bad but that would be handled by medical. In addition, like you I had a physician, an anesthesiologist, slap me on my right scapula so hard it was stinging for 15 minutes. I deliberated as to what to do but by the end of the shift I did speak with the Head Nurse. She asked me what I wanted done. I said for it to never happen again! I never spoke with Risk Management. I didn't want to bring charges because I already felt uncomfortable with all these people, their behaviors and felt this would stir up more problems for me. Little did I realize, it would be shared with the other doctors and eventually down to my peers through the grapevine. Needless to say, I even had a surgeon say I don't want you to accuse me of hitting you. In contrast, I always saw the surgeons treat the PACU nurses professionally. My impression for what it is worth regarding some Surgeons/Anthesiologist: 1) tend to be narcasistic 2) boarder on hyper or mania Decide for you what you want! I can tell you from experience, grievance is just something on paper to be compliant with regulations. Even when you are right, the system, peers, and physicians can make your going to work extremely difficult and miserable. I wish you the best!

Looks resolved. The wonders of learning...

Looks like things have changed even from when I was in the hospital. I am only about 10 years your junior but I remember when a person's word meant something. Within 10 years of the oil bust I think the healthcare system became more deceptive like business systems. At this point, about 20 years since the oil bust, I think it has become as blatant deceptive. I feel your frustration, especially, since I would be in your shoes if I chose to return to an acute medical surgical hospital setting. Also, over prolonged periods of frustration I do mis-speak so I understand. Now that the NCLEX is over, my suggestion is for you focus on your goal of completing the refresher course and forget the age discrimination. It is not worth worrying over, especially, since it would be difficult to prove considering your history of not being in the active nursing force. We can all here recognize it for what it is. Consider the pleasure it can give you at the end of the refresher course to also (e.g.; like the young ones) leave this unit!!! HELLO??? No one wants a manager who is a blatant in your face LIAR! Of course, leave on good terms but secretly laugh as you walk out the door in December. BTW - I don't know if your area is like here but the job advertisements tend to drop after Thanksgiving and pick up again around February. There may be available jobs during that period but maybe not the one you want so don't be discouraged if that happens. Best of Luck!

Where I worked in psych they used plastic. I was new to psych so there were some clinical things I had not seen or considered. Now I am of the opinion whether it is metal or plastic utensils they should be counted. That was not the policy or practice of this facility. Amazingly, I had a young schziophrenic patient find a novel place to hide a plastic knife. She was also a self mutilator because the voices told her to do it. She would cut her arms, legs and stomach. After she was found to have cut herself a room search per doctor's order was done but nothing was found. It took us about 6 hours to figure out where she hid the utensil. Off topic - I had another schziophrenic patient who found comfort in having rock in her pockets. She would pick them up during smoking breaks. There was one psych tech for 14 PICU patients. Eventually, I saw her solution to our confiscating and redirecting her from putting in her pockets. Guess where she started carrying them? In both cases, they hid them in the lady parts. Good Luck!

Since this surgeon was of the opinion he was a god, it was directed to management who eventually took care of it.

I guess A&P may be weeding courses but I really think it is more likely the physiology portion. Anatomy is straight memorization. Physiology is understanding how things work. I saw many students complete the first semester of A&P but there was only about half the class after the mid-term of the second semester.

No I had the privilege (NOT) of holding to his ear.

good fitting shoes that comply with school policy. uniforms congruent with school policy. if you get cold easily get a lab coat or sweater you can where in clinical. i got a lab coat because you have pockets for more things. water resistant watch - i still use the dial type. it is simpler for me than fumbling with buttons on a digital. calculator (not fancy) black pens - (i have switched to gel because it is less tiring on my hand. i prefer the click style for obvious reasons) red ball point (if you will be learning to take off any orders) black marker (if you will be learning to set up charts) highlighters - colors of choice drug book - small enough it will not be a burden to carry to clinical. medical dictionary stethoscope (a reasonably priced one will do until you can afford better) dual tubing gives better acoustics, i am told. my cheap stethoscope i started school with still works. maybe i should sell on ebay. lol bandage scissors hemostat reflex hammer ( i had to have for assessment class but have not used since.) nclex books - i would not bother with until near the end of your program. spiral pocket size notebook -this is to write things down in clinical for reference later. you are learning so much this could be very helpful. i wish someone had suggested to me years ago. backpack (my preference is the one with wheels because you only have one spine your entire life.) whatever is required on your school supply list. whatever supplies you need to organize yourself to be the most successful. formal papers should be typed so access to computer with printer or typewriter is important. a pda certainly would be nice but if you are counting pennies i don't think it is necessary. good luck! we look forward to having you!

Without wavering I believe the answer is "B". The nurse's first reaction should be to address the behavior. Which answer meets this the best? A. Whatever the meaning of the patient's action it is not appropriate. Don't go there. B. "Offensive" may not be the adjective you would have chosen but this answer addresses the behavior. C. This can be done later. D. This can be done later.

In the psychiatric facility I worked this patient would be in intensive care because the behavior is not acceptable. Usually, this unit has less patients than a general psych floor and it is a locked unit. The doctors there knew how to work with these patients well. Frequently, they got them to voluntarily sign into the hospital and go to the PICU to keep them safe since they had been off their medication. The behavior was immediately addressed and the patient redirected with escort to his room and not left until dressed. If the patient would not go then the other patients were asked to return to their rooms. If these patients asked why then they were asked to give their group member an opportunity to deal with what was going on with him without an audience. If I was not able to get the patient to comply, then the supervisor would meet with the patient. Eventually, the patient would return to his room. The other bed was kept vacant, not blocked, as long as possible. If there was a roomate, because the unit was full, then there was a psych tech with the patient at all times for observation and redirecting, not restraining. In most cases the psychiatrist would prescribe ativan for agitation because when they came out naked they would be talking to themselves or others very rapidly. Clinically, their heart rates and B/P were usually elevated which was a concern. It is not good for a person to be tachycardic all the time. In addition, often they would have done things they did not remember prior to coming to the hospital. As you can see there are many safety concerns for such a patient. I would ask the patient if his mind was racing. If he had been able to sleep and evenutally ask if he would like something to take the edge off. At least 95% of the time they would agree. The medication was explained without too much detail, a medication handout would be given to the patient and then the medication consent signed before adminstration of the medication. The patient would be reminded by me that if his mind was racing again he could take the same medication to take the edge off. Unfortunately, it takes time for therapuetic blood levels to return. In some cases, the patient needs an acute intervention. It is sad. Some of these patients remember walking around on the unit naked after their blood levels return to therapuetic levels.

I agree with Tweety. I hate it in the store, at the post office, people driving and talking, etc. BTW yesterday on Netscape there was a highlight link that listed cell phones by how much radiation they emit. The following link about the controversy may be of interest: http://www.sciencenews.org/20000212/fob1.asp Recently, my PCP got a phone call on his cell while he was seeing me in an exam room. The phone was loud enough I heard the entire conversation! It was female. He asked if she had finished moving yet. She asked him about going to the club that night and so on... I personally like him and think he is knowledgeable but I am considering changing. In addition, during my period as a circulating nurse I encountered an orthopedic surgeon who thought the circulating nurse was the secretary for his cell phone. For weeks we were answering it, relaying personal messages while he operated, and taking business messages. Eventually, it was taken to management and stopped!

Your first position should be to follow whatever the policy is of the facility you have your clinical at the time. If the facility provides baby powder then they should have a policy. If they do not provide then ask your charge nurse what the practice is for that facility. In addition, find out what your instructor's position is for that rotation. As a registered nurse in places that did not provide baby powder and did not have a policy regarding baby powder I redirected the patient to have it brought in by a family member if they want it. Frequently, they would leave before anyone ever brought them any. My issue with baby powder has more to do with particles in the air. I would not encourage it but there are plenty of elderly ladies I have met that insist on it. In those cases, if they could not put it on then I would lightly tap some from the container into my hand and then rub that powder where they wanted it. In addition, you must keep the hallmark of "patient safety first". If you have a patient with acute or chronic lung problems (i.e.; asthma) in close proximity to the one who wants to use baby powder then you may have to take the position it can not be used. This position should involve the charge nurse and your instructor. In reference to skin breakdown I have met an ET nurse who was adamantly against baby powder because under some conditions it does facility skin breakdown. If the person is sweating then the areas that are powdered can become areas of caked powder and thus pressure areas in the folds of the skin. This was a private duty case. I am not certain why but she eventually agreed to baby powder with cornstarch. Since this was a one to one case there was never an issue of the patient being left for even two hours without the nurse's attention to her physical condition. joy

Hopefully, everyone realize life is not fair. Right? If not, some day you will. Weeding in colleges and universities occurs whether it is obvious to you or not. There are instructors who will just use the materials to be weed students out. Others will target students. It occurs in nursing and other curriculms. At my freshman biology department orientation the students numbered more than 300 in the auditorium. Each of the professors got up to speak. The one I remember was the one who stated "You all are here to get an education and then take my job. I am here to keep you from doing that!" I was mature enough to know life is not fair but this seemed outrageous. In my medical surgical rotation there was an LVN in our group that was going for her BSN. I remember when the instructor mentioned it to the group her face changed very negatively. I had been a nurse aide and blood collector for 5 years already and was fairly comfortable in the hospital setting. This LVN kept coming to me and asking me questions. Once she asked me to help her. I did. We were in her patient's room when the instructor came in and starting fussing at me. After that I could do no right. No matter what I turned in she would find nursing diagnoses I had not included. Then when I started including everything I could think of and the reports were thick she would say it was too much! Thankfully, I survived. As a generic student I took one class that was an RN-BSN class. In this class preferential treatment was blatant. Personally, I thought the tests were easier than any I had as a generic student. At the time I was furious but over the years I have come to understand this professor's position. These students were already nurses and would not be taking the nursing boards. Also, it furthers nursing as a profession the more nurses who get advanced degrees. Please, do not take this as a focus point to drum up the age old argument between the different levels of education in nursing. Those who want advanced degrees should get them and those who don't should not. My suggestion to students is to watch what others are getting in trouble for and don't do it. If you are a middle child you know what I am talking about. In addition, keep your mouth shut unless called on and do not gossip any where in clinical or school because this can be overheard and shared with your instructor. If you are the one under fire, your best weapon is to KNOW YOUR STUFF forwards and backwards! Best of luck to all students! joy

I am sorry, you have to take it again. I feel blessed to have only had to take it once. In contrast to the previous post, I say take hard candy with you just in case. Whether diabetic or not some people's blood sugar drops under stress. I put a lifesaver in my mouth right before time to start "just in case". lol I used several books with questions and looked up some things in lippincott to refresh my memory. In addition, there was one booklet that had questions like the exam that was to be taken timed. You mailed it to them and they sent you results that gave you an indication of your weak areas. I have always been a terrible test taker and get very nervous and anxious. Even when I know an answer I will try to convince myself I am wrong if there is one possible answer I can not rule out. As a result I took a review course that was 2 days a week for 4 weeks. Funny thing was, I didn't learn any thing new except to take candy to the test "just in case". The course did give me a since of comfort with what I already knew. The last thing I did before reading the first question was to give up all my worries to God. Once I let go of those worries I was able to focus on the test. If I came across a question with an answer I felt best fit and there was one I could not rule out I went with what I knew and moved on to the next question. One of the important things is knowing where the question fits in the nursing process. If you just skim the question then you may miss the question because you did not pay close enough attention to where it fit in the nursing process. For example, if the question ask what intervention should occur then it is presumed the assessment, nursing diagnosis, plan have all occurred. Of course you need to know you drugs related to nursing specialities. Remember, you have been studying for this for years and have the knowledge! Get plenty of rest days before the exam. Take some time off from work. The night before the exam I spent in a hotel to get away from other stress. Best of Luck! joy

This reply with be more legalistic with a possible technique for negative statements. Does your facility have a policy regarding personal email? If so, are you in compliance with that policy? Even if it does not have a policy, I suggest you develop the practice of not sending personal email/personal messages from work and ask people not to send it to you. It is not professional. In my first experience with email I did contact co-workers with personal email. The business did not have a policy regarding personal email and I was young, naive and stupid. I learned from an IT person at that business they can see EVERYTHING! This was in 1989. I don't know if my bosses saw my email because I never got in trouble. Since then I do not send personal email from work no matter what the business' or facility's policy is? As a mid-level supervisor I have seen employees terminated for first offense of personal email at work. The person over me and her boss did the termination. I did not agree with it but had no say. The hospital had a policy which included the statement "may result in termination". Everyone had to sign a copy when the policy came out. Texas is not a right to work state and most employees are not unionized. I mention this because your employer does not have to give you a second chance. One of the habits I have developed when people start talking to me negatively about other people is to tell them I am working on being more positive in my life so I would appreciate not hearing negative things about other people. I add that I am happier now than I was years ago and tell them about the technique I used to get where I am now. What I tell them is to come up with 5 positive things for every 1 negative thing they think of someone before they verbalize the one negative thing. The positive things don't have to be work related. Maybe that person is an excellent mother, spouse or has pretty eyes, is clean, etc. If one works at it they can come up with five things. Eventually, if they are open it will dawn on them they are focused on the negative instead of looking at the whole picture. I used this on a co-worker this past year. Within two weeks, she thanked me telling me how much it had helped her. Keep in mind if you want to be in the gossip loop this will stop their sharing with you. For me this is best because it waste my time and puts me behind in my work. If it is a work related issue she wants your opinion as to how to handle then I would tell her to write down 10 possible ways to handle it including the possible outcomes and effects and schedule a time to meet with her to discuss it. Essentially, this is busy work to keep her out of your hair and just maybe she will come up with her own decision. In addition, it should minimize her interruptions and put you in more control. Best of Luck! joy

There are groups who call themselves Christians who do illegal things just like there are terroist in the Muslem faith. Anyone who can rationale illegal behavior is not a true believer no matter what his/her faith is. These people have to suffer from a psychopathology, brainwashing or pure stupidity. The statement "Tom Cruise is not at fault for that anymore than eating Twinkies causes someone to kill" is not a valid comparison. TC can speak for one thing. Your reference to the mentally ill using his statement as "just another excuse" is valid and my position. Why give them another excuse? TC is not a physician and should keep his mouth shut regarding medications until he gets his M.D. Apparently, according to TC studying psychology make one more of any expert than physicians. I find your statement "Much like blaming the other woman for an affair, neglecting that the spouse had to want to commit the adultery and is primarily at fault for the action that they undertook" outrageous. What happened to right and wrong with American morals? If someone is married then that person is OFF LIMITS! The spouse who is feeling neglected needs to communicate with his/her spouse or divorce that spouse. I agree with Mr. Billy Graham. Men should not put themselves in a place where they might compromise themselves. In adultery, I blame the married person for making this "choice". In addition, your statement "If Christians were subjected to the treatment that is afforded Scientologists, there would be worldwide outrage" is an inaccurate generalization. To begin with the terroist who hate Christians would have a celebration. I don't know that scientologist have been murdered but I do know missionaries from my parent's church were and that never made the news. I have not seen scientologists treated negatively. In addition, I personally object to TC's egotistical public statements no matter what his religion. Your statement "As the sister of a bipolar with some paranoid schizophrenia" is interesting because I have never seen that combination. I have even asked a psychiatrist about it. We had a patient come with that combination by history but according to the psychiatrist the patient was bipolar with parnoid ideations and bipolar with schziophrenia does not occur. I understand how difficult this mental illness must have been for you and your family and ask God to bless you. I agree with your position of "CHOICE" because I tend to agree with the behaviorists theories. In biopolar people, you are right. They frequently go off their medications because they like the low grade mania stating they can accomplish more, sex is better, etc. Now, in their delusions god has spoken to them through TC telling them not to take their medications. In the psychiatric setting this is not a big leap. I have had patients tell me they have gotten messages from the tv on the unit. Since working psychiatric intensive care I have softened my "choice" position from 100% to about 95% when it comes to mental health. I have seen patients who are getting the upper recommended doses of their medications still have break through hallucinations. I even came to understand there were some who would leave the hospital still having them but hopefully less frequent. It is all theory as to etiologies for these variations but likely related to metabolism and uptake of the drug. Who knows what other variables may be influence those patients who can not find peace in medication from their biopolar or schziophrenia symptoms? joy