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Bridgid Joseph BSN, MSN, APRN, CNS

Surgery,Critical Care,Transplant,Neuro
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Bridgid Joseph is a BSN, MSN, APRN, CNS and specializes in Surgery,Critical Care,Transplant,Neuro.

I am a CNS for Emergency Cardiovascular Care, I have been a SICU/Trauma SICU RN for 10 years prior to this role, and have a lot of experience with Neuro and Solid Organ Transplant patients.

Bridgid Joseph's Latest Activity

  1. The ballot question 1 in Massachusetts (Nurse Patient Assignments Limit Initiative) which will be voted upon November 2018 was designed to establish patient assignment limits for registered nurses working in hospitals, with limits determined by the type of unit or patient with whom a nurse is working, and the maximum numbers of patients assigned would apply at all times. Massachusetts is a hub for medical advancement. In Boston specifically, there are 6 major medical centers within a few feet of one another. Most are teaching hospitals of Harvard University, so staffing, technology, and innovation to support patients and safety are at the forefront of care. Despite that, there has been a push by the Massachusetts Nurses Association (a union) to enact a similar law for over 20 years. It was brought as a ballot question in 2014 but tabled after allowing for a change in ICU staffing ratios (which showed no change in patient mortality or complications, in a study from Beth Israel Deaconess Medical Center). Now it's more stringent and on the ballot for November 2018. Why does this ballot question face so much opposition? It seems like more nurses is a good thing, right? No one disagrees that nurses are good, and its beneficial for us to take care of our patients. That being said, attached to this proposed bill is not only tighter staffing ratios than California, a 37-day window to comply (to which California had five years), but there is also a $25,000 fine for each time there is not that exact nursing ratio on the unit. The fine doesn't seem like a big deal: staff appropriately or get a fine, right? What happens when staff call out because they are sick? If you can't find coverage to make a 1:4 ratio on the Med Surg floor, hospitals get hit with a fine, and many of them, especially the smaller hospitals, do not have the money to pay. What about leaving the unit for a lunch break, or getting coffee? Not if it means the nursing ratio will be off for any period of time. Shared governance or interdisciplinary meetings? Sorry, you will have to schedule those on your days off. Because of the quick turnaround time to become compliant, and the few numbers of nurses in MA, any resource staff, unit based educators, and/or clinical nurse specialists will be pulled into staffing. There will not be anyone extra to help and "cover" a patient for a quick break. In California, the law allowed for Licensed Practicing Nurses (LPNs) to be hired to assist with upstaffing, but not in MA; RNs only. Differences also include that MA law has higher RN numbers to start and the bill in MA has a prohibition against reducing levels of other healthcare workers (CA did not). MA does not allow any exemptions, whereas in CA 25 hospitals sought and obtained an exemption from the law. These fines, threats of fines, and immediate need to upstaff is going to cause numerous hospitals outside of the metro Boston area to close. This will limit access to care, longer drives for patients from the suburbs, and longer wait times to get care (fewer hospitals and services,) shunting everyone into the city. Those hospitals will have the same patient ratio limitations and will be unable to open and further ambulatory services. Currently, according to the 2017's Best & Worst States for Healthcare Massachusetts is ranked #9 overall for Best hospitals (#1 being the best), with California ranked at #25, despite these ratio laws being fully compliant since 2009. Furthermore, Massachusetts has a current ranking of #3 for access to care, meaning access to healthcare is readily available throughout the state. California is ranked #48, meaning the public has less access to healthcare. It's pretty telling that despite making nursing ratios legally required, the state of California has not improved the patients access to care and their overall satisfaction with care. On top of the other concerns with this bill, the "at all times" language, which requires ratios to be the exact same, day and night, doesn't allow for nurses to use their clinical judgment at all when taking care of patients throughout the day. If I have 4 patients, 3 of which are ready for discharge, I cannot take a new PACU admission to help out the unit. A nurse who may have three heavy patients, one requiring a Rapid Response and eventual transfer to the unit, may have to take that patient, or it negatively impacts throughput and the patient has to sit and back up the PACU waiting until someone can admit them. That scenario may seem extreme, but it is something staff face every day, and if I am willing to take that extra patient to support my colleagues and support patient care, my hospital can be fined $25,000? That makes no sense. However, it is the reality of this bill. 4 patients in a Boston hospital at night, is a very different assignment from one of the community hospitals, yet they require the same exact staffing? That doesn't add up. The general population of MA is being asked to vote on a bill without any knowledge of how healthcare works as whole. This is not to say lay people don't understand good care, they are our customers and they deserve the safest and best care possible and their input is invaluable. However, they do not know how to run a hospital, how it is budgeted, how we currently run staffing matrix, and what this bill means not only to their care but the state of Massachusetts. It has been estimated it will cost the state $1.3billion to become compliant with the thousands of new RN positions (most Boston hospitals only hire BSN level nurses, which will no longer be possible). It is an estimated $900million annually to maintain these new staffing ratios, without any revenue to the state, and more headaches and difficulty for the public to access care. No other field asks laypeople to make a decision on how they guide their business/care (think Medicine). It is bad policy-making for nurses to do the same; we all believe that highly trained nurses at the bedside, with an appropriate number of patients, benefits not only patients but the work/life balance of our staff. This bill is not the way to do it. We don't want hospitals to close, and patients to have to search for care. We want the best care possible for all of the residents of Massachusetts, and eventually, all patients in all states, as this will set a precedence for mandated ratios in all states in the future!
  2. Bridgid Joseph

    Our Current Reality: Are You Going to Work Scared?

    I think it's great that so many of us are not impacted by mass casualties. For those of us who have been impacted (for me it was the Boston Marathon bombing and one of our MDs shot in a clinic by an enraged family member at an adjacent hospital and I've had family members and loved ones that have barely escaped) that may have a different perspective. I am fearful sometimes that this will happen again in my city,and I might not get home to my family, or that some of my close friends and colleagues may be injured. Tragedies happen every day in different ways and mass casualties is just one of them, and it's reassuring to know that maybe it's only the folks who have had a mass casualty in their city, and responded to them, are the ones that may be feeling PTSD. And, it's important to support our colleagues and loved ones who may need help.
  3. Every time there is some horrible mass casualty that happens anywhere in the world, we see immediate and intense video, usually raw footage, streamed live to our computers, TVs, and smartphones. All at once we are not only processing that something horrible has happened/is happening, but we are also visualizing the hysteria, loss, and destruction simultaneously. As nurses, we are not only seeing these things happen, but as soon as we realize it's either happening (or not) in our town, many of us are wanting to go right out and help. How often have you seen something horrible happen, like the Las Vegas shooting, Texas church massacre, or any other mass tragedy, and thought "It's not in my city, but what if it was?" According to the National Institute of Mental Health, 7 or 8 out of every 100 people will experience Post Traumatic Stress Disorder (PTSD), which can be brought on after surviving a dangerous event, having a friend or loved one involved in a dangerous event, or after the unexpected loss of life of a loved one. Less than half of these people will seek help for treatment of their PTSD. The VA National Center for PTSD reports rates of PTSD after bombings around 34% and mass shootings 28%, which are high numbers, considering the volumes of people impacted by each event. With all of these mass casualties happening annually and all of the visualizations of these acts of terror, I wonder if these numbers might start to jump even higher with the increase of mass casualty events, especially with healthcare workers? There are some people that are now afraid to fly after 9/11, afraid to go to concerts after the Manchester bombing and the Las Vegas shooting, afraid to send their kids to school after the Columbine and Sandy Hook shootings...need I go on? There are a lot of regular activities that people of all ages are afraid for their lives to do, because of possible bombings, shootings, etc. And then there are nurses and other healthcare workers that leave their homes every single day to go take care of other people, and when these mass casualties happen, we are expected to perform at the top of our abilities...and somehow not be focused on what might be going on with our families, letting them know we are OK, are they? What about the staff that suffers PTSD and have to go to work every day? Do you feel that way or know any colleagues that do? At most, if not all, hospitals, there are Employee Assistance Programs (EAPs) that can help anyone who may be suffering from PTSD related to these mass casualties. I think that as much as our job is to care for our patients, we also owe it to each other to look for these signs in our colleagues and either speak to them personally to try to get them some help, or talk to their manager to make sure that they speak to them and offer assistance. I had to do this just last week, and I really wasn't sure how the conversation would be received by a colleagues manager, but they had actually seen some changes in their employee's behavior and appreciated my feedback and the employee got the help they needed. According to the National Institute of Mental Health, the signs and symptoms of PTSD are: Flashbacks (reliving recent trauma) Frightening thoughts Avoiding talking about the event(s) that caused trauma Easily startled On edge/tense/short-tempered Difficulty sleeping Angry outbursts Negative thoughts about oneself or the world Distorted feelings of guilt or blame Loss of interest in normally enjoyable activities Displaying even one or two of these signs can mean that you/your colleague may have PTSD. You don't have to have every single sign for a diagnosis, so if you notice these changes, especially noticing a change in temper or other behaviors, please speak up. Talk to your manager, a friend, a colleague, if you notice any of these symptoms in yourself, and get the help you need to get back to feeling yourself! We are on the frontline of saving people's lives when these are mass casualties, so let's make sure that we are all looking out for one another, taking into account our own mental health and our colleagues as we navigate through these scary times.
  4. Bridgid Joseph

    We are getting a therapy dog!

    This is great! I love to hear of therapy pets being used and appreciated!!
  5. Bridgid Joseph

    Job Stagnation: How to recognize and what to do about it!

    I hope it helps! I think we have all felt this way at some time in our careers.
  6. Job stagnation is when you are no longer challenged at a job, but stay with the position because of the paycheck, the benefits, or possibly relationships with co-workers. How do you know that what you are facing is job stagnation? To be clear, almost everyone has a day or week at work when we just want to throw in the towel, either because work is insane (based upon population or demand) or our own life stresses are impacting our work life; for some reason, work just seems horrible. But, when this feeling is every day and lasts for a month or more, and you've even tried to take a vacation (which can sometimes recharge your batteries and give you a whole new outlook), maybe you realize you have hit a wall with your career, and you are just in the wrong job right now. Job stagnation is a bigger realization that you need a permanent change. Boredom You go into work and just do not feel excited for the day; the days meld together and feel monotonous. Why would you want to go in? Some people are really happy doing the same thing every single day, but if you don't feel that way, then it may be time for a change of pace for you. Lack of Learning Not only do you feel bored, and a lack of challenge at work, but you don't feel like you are offered any education to learn new skills...which you can eventually master. Your job should be offering to support you by sending you to courses off the unit to learn more about your current patient population, and the current and most up to date standards of care. If there is a lack of funding for off unit education, education should be brought to you. You may be an expert in your patient care area, but there is always something new to learn, and you should be excited to learn! Overwhelmed at Work So the opposite of feeling bored is that you are constantly feeling overwhelmed at work by your workload and completely under-supported by your nursing leadership team. Just as much as no one should dread going to work because they are so bored, you shouldn't feel like you are so overworked and under-supported that you are anxious and stressed about going to work. Not only is that not good for your mental and physical health, but no job is worth that. Opportunities for Growth If you verbalize to your manager that you are interested in furthering your career, and they are unable to support you, either because there are no actual opportunities, or they choose to not support your opportunity for growth, your career is truly stagnant where you are. Whether you have a skill set that can be supported by a current open position in your unit/area or elsewhere in the hospital, and you have been overlooked, or there just aren't any available, it may be time for you to move on to a different hospital or unit. Sometimes people are scared to make a huge change in their lives and to jump into a new career, perhaps a different nursing unit, or hospital, or a different career altogether, like moving from adult med surg to pediatric oncology, or making the decision to go back to school for a Bachelors, Masters, or Doctorate degree. I have heard people say that it is a luxury to move jobs, and I am not sure that it is a luxury. It is most definitely a HUGE decision that impacts your family, your life, and it can be stressful to change insurance, pay processes, etc (if you change physical places of work), but the benefits on your emotional and physical well being can be so immense. If you feel like you may be stagnant in your job, do yourself a favor and just look at other jobs in the field/area that you've thought about, and just see what is out there for you. If you really feel the pull for one of the positions, just apply! There is no harm in applying for a job, going for an interview, and seeing what the other job might be like. Maybe take a day to shadow in this new position; it may be right for you, or it may not be, but sometimes just challenging yourself and looking at a new position, may give you some new perspective. You may decide that you want to take the leap into this new job because you just loved the staff, and you had a great feeling about the institution and administration, or you might see some red flags, like a lack of ability to grow in the role or a lack of support for continued education (something that you may have found as a dead end in your previous job), and maybe realize that it isn't the right job for you. And if it isn't? Keep looking! Network with other nurses that may love their jobs and look into all options; start a thread on allnurses.com to get some opinions from other nurses on what they love about their jobs. And, most importantly, keep an open mind. Don't give up hope that a better job is out there for you, that will make you feel fulfilled. You may find that your dream job, where you can look forward to more than a paycheck every week, is out there waiting for you!
  7. Bridgid Joseph

    Emergency Calls- How long do we wait?

    As the parent of an asthmatic child (and an APRN).....YES! If they cannot speak, call 911 and let me know which hospital they are heading to!!
  8. Bridgid Joseph

    Emergency Calls- How long do we wait?

    As the parent of an asthmatic child (and an APRN).....YES! If they cannot speak, call 911 and let me know which hospital they are heading to!!
  9. Bridgid Joseph

    Animal Cuddles at the Hospital? Yes Please!

    I am sorry you had a bad experience with both therapy cats and dogs (in general)! For sure staff and patients are able to opt out and both are notified well before the furry visitors arrive- they are scheduled and also the staff is reminded in huddles so that they can touch base with each patient before the pets arrive.
  10. Bridgid Joseph

    Animal Cuddles at the Hospital? Yes Please!

    Thank you- they are AMAZING especially with the pedi population :) Glad you had a good experience!
  11. Bridgid Joseph

    Animal Cuddles at the Hospital? Yes Please!

    There have been lots of articles about animals at Nursing Homes and long-term care facilities, but there isn't a lot out there about animals brought to the in-patient setting. Animals are almost always allowed when they are working service animals, which are animals trained to perform a specific duty task for a person in need of assistance (like a seeing eye dog, seizure alert dogs, etc.) as part of maintaining Americans with Disabilities (ADA) requirements. However allowing therapy pets, is a little more controversial. Therapy pets are personal pets that, along with their owners, provide supervised goal-directed interventions to patients in hospital. Usually therapy animals are required to have some sort of certification showing that they are non-aggressive and able to consistently follow simple commands. The American Kennel Club offers a Canine Good Citizen (CGC) exam that more than covers these requirements, including the dog's responses to people in wheelchairs and on crutches, and is usually a requirement for a therapy pet. It's a pretty good requirement to know that animals coming into the hospital to visit ill patients won't be aggressive to staff, patients, etc. right? On a personal note, my dogs both passed the CGC as they are therapy animals, but the biggest hurdle for one of them was people in wheelchairs; he absolutely would lose his mind with anyone on wheels (i.e. skateboards, rollerblades, and wheelchairs) which was not only embarrassing, but a lot of work to correct! When our hospital first started offering therapy pet visits, I heard some staff concerned about the 'diseases' that animals might bring to their already sick patients. My first thought was, let's not forget that hospitals are filled with a lot of germs, despite insane amounts of cleaning! That being said, there are 39 diseases that are known as zoonosis diseases, in that they spread from animal to humans, however the transmission is infrequent with most diseases now due to vaccines and preventative care for animals. Some of the most well known are rabies and roundworm, however all dogs that work as therapy animals must have their vaccinations for rabies and be on preventative monthly treatment for parasites (such as worms), and there are a lot of rules in place by hospitals to make sure that pets are only in places that they should be in hospitals. One big rule? Pets can only visit with patients who are interested in seeing them. So, people are not just walking around with their animals and going room to room. Patients are made aware when pet therapy visiting hours are, well in advance, and they are allowed to request or decline a visit. Sometimes the dogs are brought to the solarium/family room to allow for group visits for patients who are ambulatory, but for those who are bed bound, or with limited mobility, the dogs are brought right to their rooms. Also, the therapy pets are not allowed to visit patients on neutropenic precautions, or patients who are severely immunocompromised, and they are not allowed in the PACU, ORs, Critical Care Units, Labor and Delivery, and other procedural areas where sterility is maintained. in addition, staff who come in contact with the animals, who should be groomed the day of their visit, are required to wash their hands both before and after touching the animals, if they choose to do so. Patients are also encouraged to wash their hands (or use sanitizer) before and after contact, and it is offered to them via the human handler of the dogs. Between good hand hygiene, and preventative healthcare requirements for the animals, most zoonosis diseases are removed as a risk for patients. When you see the faces of visitors, staff, and patients as the animals walk onto the unit, or walk throughout the halls of the medical center, there is no thought of transmittable disease, because people's faces light up and they are so excited to have a furry visitor. Whether you are an animal person, or not, and whether you think that therapy dogs help, or not, the energy and happiness that follows these furry friends around the hospital is amazing, and I like to think that a visit from these uplifting creatures helps to heal these patients and get home sooner! Have you ever had experience with therapy animals in your hospital? Do you wish that your hospital had this program? I couldn't imagine not having this option for patients, after seeing patients responses.
  12. Bridgid Joseph

    Peer Support: How much do I really need it?

    It is a great start and was a pilot, and has flourished into a true program at my hospital, however I know that other hospitals are struggling with their programs. We have CISD after true critical events and that is usually activated by a staff member escalating to the director or at the directors request. This peer support is more for every day frustrations that can occur...and if anything is too much for the trained volunteers, it quickly gets escalated tot eh experts :)
  13. Bridgid Joseph

    Peer Support: How much do I really need it?

    Due to the burnout rates of our profession, and because administrators are starting to realize the impact of the everyday physical, emotional, and ethical issues that we deal with daily, some hospitals are trying different methods to support staff nurses' emotional health and well being. The good news is that the hard work that we do is noticed and being appreciated, and that administrators are trying to help and assist with some of the stress that we endure due to our jobs. I know that most people think, if we get more staff, that will decrease our stress, and maybe it would, but shy of reimbursement costs changing, and staffing ratios dramatically increasing, what are some things that your hospital can do to help support you? Some hospitals have created anonymous peer support systems, which staff have reported finding really helpful and decreasing stress. So how does it work? Staff that are looked at as leaders, professionals, and generally well-liked and considered approachable, are tapped by their managers, Clinical Nurse Specialists, etc. to be asked if they would like to volunteer as part of the Peer Support Network. If they agree to this position, they get training on how to support and speak with other staff that have been in stressful situations, similar to laymen who volunteer on various support hotlines who do not have psych backgrounds, however are trained to empathize with others and lend support, and offer outlets for frustrations within the hospital system, if needed. If the peers coming for support have bigger issues than the peer supporter feels that they can handle themselves, they can consult the Employee Assistance Program to allow for a fully trained MD/RN/Social Worker to offer more intensive anonymous support. The Peer Support Networks are created to support staff who have worked a really difficult shift and need to debrief/unload, but instead of speaking to a friend or family member who might not understand the intricacies of hospital life, speak to a colleague who can understand. Someone who understands losing a patient that you've been taking care of for the past few months, they were ready to go home, but coded instead. Someone who understands that you had a patient whose family could not have been more difficult to deal with due to disagreements about care and disrespect to the nursing staff. Someone who understands working with a staff of varying personalities, yet you all depend on each other to get through a shift, and it seems like family at times....and families can have some serious disagreements, especially in stressful situations. The Peer Supporters are staff that are willing to volunteer to speak with another staff member who needs to talk on a break, after a shift, or via email, and they know that the conversations will go no further (unless there are concerns about mental disease, plans to hurt self, others, etc.) but the guidelines of the program are outlined and reiterated when staff first contact a Peer Supporter. Essentially, it allows you a friend (an ally) that can be from any area of the hospital, not even your unit, that you can speak to, and who will offer advice if you want it, and just listen to you, if that is all you need. When I first heard of programs such as this, I thought it was a good idea, but wondered if many staff would utilize the program? Sure enough, the support is there and being used. Not only are the staff that go for support reporting an increase in job satisfaction because they feel more supported, but the Peer Supporters actually have reported feeling good about what they are doing for their peers. I also wasn't sure that a lot of staff would agree to becoming a Peer Supporter; I knew that some would, and obviously as nurses we are all healers, but we've been healing all shift and we all need a break right? But there seem to be many volunteers in these programs, with minimal drop-outs. It's actually a pretty simple premise, that is easily implemented and recreated, and despite some possible extra pay for Peer Supporters that may stay after a shift to converse with colleagues needing help, this program is pretty cost neutral for hospitals to run, and the staff that utilize the programs seem to feel that they are useful and help to decrease their stress. Would you utilize a Peer Support Network to help you deal with stressful situations at work? Do you think this would be a helpful program at your hospital? It's surprising how some simple ideas can help to decrease staff stress and improve morale in the workplace, and it's nice to see that some hospitals are truly trying to help their staff deal with everyday stressors.
  14. Bridgid Joseph

    Forced to resign after 7 weeks

    I am an experienced RN- now an APRN, but my first job as an APRN, I resigned during orientation knowing that it was not the right fit. I have never put it on a resume because I didn't actually work there, but I have certainly spoken to it when I got my next job as an APRN a few months later. I feel like honesty is the best method with interviews, but you can just say that the personalities did not match and it was not a structured orientation which made you feel unsupported by administration. To me, from what you've described, is all true! And, as someone who interviews and hires folks, I would find that to be a mature and insightful look at a job position- you didn't just stick with it for the paycheck, you want to work somewhere that you can thrive and grow professionally.
  15. I hear too often in the nursing world that we "eat our young". This is not OK on quite a few levels, but the biggest concern is how often this happens and, despite the fact that so many of us disagree with this behavior and this sentiment, it still occurs frequently. The fancy term for the behavior of "eating our young" is lateral violence. I have been thinking about this a lot lately: Is that mentality different from other professions where people will clamor all over each other to get ahead? Not entirely, but it seems totally out of character for nurses, who give care to others and are healers for a living, to be laterally violent to each other. There may be times where we may, perhaps, be a bit short with an MD when we disagree upon a plan/intervention for a patient, or not be best friends with one of our coworkers, that is part of human nature, especially when working in a stressful environment. Who hasn't been under a lot of stress in the middle of an insanely busy shift, and maybe come across as less than pleasant to a co-worker? Saving lives can be stressful business, but that doesn't mean that we should demean one another. Lateral violence refers to a person of higher "power" or status on a unit, bullying or demeaning a co-worker, either through verbal or non-verbally aggressive acts. Usually, if you snap at someone because you are stressed, you will address it and apologize, or make some sort of note that you didn't intend to come across as you did. Lateral violence is a continued trend of behavior that makes others feel uncomfortable, demeaned, and of less value. The thing about lateral violence is that some of the acts that constitute it, are so subtle. While any administration for any hospital or other healthcare arena would tell you that they take a stance on anti-bullying and/or lateral violence, the behavior and actions can be really tough to nail down, and it has been so long accepted in our culture that it goes under-reported. It's not just the senior nurse on your unit that might get snappy or yell at a newer nurse for not being able to read their mind during an emergent situation, it could be the resource nurse that doesn't schedule a break/lunch time any time that you work with them, or doesn't offer you help when you are drowning in your assignment, but seems to offer to help everyone else out. It's the charge nurse that gives you the heaviest assignment every single shift. It's the person who runs the schedule and they put you on every single shift that you request off. It's the co-worker that ignores you, or rolls their eyes at you, when you ask for help. If you have ever been in a situation at work where you've felt distressed by how you have been treated, you may have been the victim of lateral violence. These actions are what create a toxic environment that leads to a high turnover of nurses, and severely unhappy nurses on the unit in their short time there. And not only do the clinical staff suffer, but the patients suffer as well. When clinical staff are not working as a team, helping each other when they need it, and giving unequal patient assignments, it can be hard to meet the needs of our patients. If I can't find a co-worker willing to help me reposition my bed bound patients, they are at a higher risk of pressure ulcers, right? And if my assignment is so heavy I don't have time to change out that IV that was due to be changed at the beginning of my shift, that patient is at a much higher risk for phlebitis. What can we, as a culture of nurses, do about lateral violence? Just saying we won't tolerate it isn't enough. One of the biggest ways to prevent it is to educate staff on what lateral violence actually is; once behaviors are pointed out, and it becomes a part of the culture that those behaviors will be scrutinized and not tolerated, people tend to have more self awareness of their actions. We also need to speak out when we see it occur to others, or experience it directly, and report it. Nurse leaders on units should lead by example and set the tone for their unit, not only that they don't bully their own staff or colleagues, but that they are supported by the policies set forth by their institution, and enforce a culture of anti-lateral violence. And when staff report lateral violence to their managers/directors, they need to feel comfortable and that there will be no repercussions for their actions, and that the person reported will actually be dealt with. None of us should feel uncomfortable or scared going to work, for any reason, and if you do, you need to speak out about it, and report it higher and higher in your institution until someone listens! Feel empowered to stand up for yourself, your colleagues, and our community.
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