Brenda F. Johnson BSN

I’ve been a GI nurse for about 25 of my 27 years of nursing and I have seen a multitude of changes take place. The proficiency of a colonoscopy has improved as scopes have become more flexible with high definition cameras that lead to an increased adenoma detection rate. Now that screening colonoscopy is paid for by insurance, more people are getting one and lives are being saved. But there still remains a societal imputation around the test that hopefully over time will disappear with education and awareness. March 24 - 28 is GI nurses week this year, so if you know a GI nurse, please celebrate with them. SGNA is the national organization for GI nurses that sets the guidelines for standards of practice and provides many services with the most important being education about gastroenterology. There are many opportunities in your community to serve as a volunteer or participant at a colon cancer awareness event. Here in Chattanooga, we have the Rump Run on March 9th. It is a run or walk event with a bouncy house and face painting for the kids, and a large colon to walk through that exhibits different types of colon polyps and cancers. Colon cancer survivors are the highlighted guests of the day as they share their stories to help spread awareness. It is a fun way to spend a Saturday morning. The reason a colon screening is so important is that very often there are no symptoms when a person has colon cancer. There may not be any visible bleeding or pain and therefore some cases of colon cancer are not detected until there is an occluding tumor or metastasis. Educate your circle of friends and family to talk to their doctor about when they should get a colonoscopy. The first time screening is at age 50 except for African Americans who should get one at 45, and of course those with a family history. Some of you may have read or heard that colon cancer is on the increase in younger people. The highest increase has been seen in the age group of 20s. Although the exact cause is not known, genetics and environmental factors are thought to play a role. These younger patients are more likely to die from the diagnosis than older patients (Priedt, 2018). Some signs and symptoms that we can tell our patients to watch for is blood in the stool, diarrhea and constipation, abdominal cramps, and the feeling that aren’t empty after a bowel movement. If one of your patients, friends or family has unexplained weight loss, fatigue, and jaundice, make sure they make an appointment to see their doctor right away. These are signs of advanced colon cancer and they need to be addressed. Most of us have known someone affected by colon cancer, and the fright that diagnosis can bring. We lift up those going through the trenches of surgery, chemo and radiation in our prayers. Also, we celebrate the survivors, those who have been in the pit and are now on the other side. Many survivors give back by telling their story and educating their community. March is the month to highlight these wonderful people and one by one, save a life. I am proud to be a GI nurse and I learn something all the time. I have come to respect the GI system and how important it is to our bodies. Research is continually realizing all that the GI system does for us and how we treat it is so important. What we eat and drink really does matter. Celebrate Colon Cancer awareness month in your unit or office this year and make it an annual event. Participate or volunteer in a local event, it is rewarding and not to mention a lot of fun! Are you a colon cancer survivor? If so, please share your story with us. Reference Preidt, R. Colon Cancer Hits Younger Adults Especially Hard, 1 Oct, 2108. Healthday Reporter. Retrieved from https://www.webmd.com/colorectal-cancer/news/20131001/colon-cancer-hits-younger-adults-especially-hard-study-finds#1

I have not personally been fired for being sick, but I have witnessed other nurses suffering that fate. I felt bad for them and I can’t imagine what they must have gone through. We want things to be fair and just, and to be able to trust the company that we work for to do the right thing. However, employers aren’t always fair. I’m sure many of you reading this will be able to relate to the story highlighted in this article. A nurse from Nolensville, Tennessee, Chrissy Ballard was fired this summer after being off from work to begin treatment for her stage 2 hormone-receptor negative (can’t be treated with hormones because it doesn’t have hormone receptors), and HER2+ breast cancer (tests positive for the protein human epidermal growth factor receptor 2 which encourages the growth of cancer cells). Chrissy worked with dying patients in Hospice care for a company called Caris Healthcare. This past March, Chrissy was diagnosed with the terrifying diagnosis of breast cancer. She must now face her own truth of mortality, after helping patients do the very same thing. Caris Healthcare fired her in the middle of her cancer treatment. Her termination letter states that the reason for her firing was due to “health reasons”, but that she was eligible for rehire. Caris Healthcare’s mission statement is to “Hospice with Compassion and Hospice with Grace”. Their actions towards Chrissy does not line up with their mission statement. Not one person on earth is immune to being diagnosed with cancer, or some other diagnosis that threatens our life and well being. If the day comes that we need to take time off from work for an illness, we hope to be able to take the needed time off to have surgery and other treatments without retribution from our employer. The Family and Medical Leave Act of 1993 (FMLA) that was initiated by President Bill Clinton, allows employees to take 12 unpaid weeks off from work for qualified reasons while their jobs remain secure. The employee must have been at the institution for 12 months in order to qualify and have worked 1250 hours during that time. Chrissy was fired just before the 12-month deadline. While Chrissy’s case is being fought in the legal arena, Chrissy and her husband say that they regret not putting her request in writing. Lawyers suggest that when you are going to be out for qualified reasons, put it in writing as to why you are asking for time off. After reading about Chrissy’s situation, I pulled up the policy for attendance at my facility. The policy stated that an “Absence”, in which the employee must take an unscheduled absence over 4 days be referred to FMLA with a written note from a physician. Under the “organizational rights” in the policy, it tells us that the business has the right to authorize or refuse the request to be off, and are able to investigate absences to determine whether the reason is justifiable. In the employee handbook at my place of employment, it gives the following reasons an employee can use FMLA for pregnancy-related issues such as complications, birth, and care after birth or adoption, care of a family member with a serious illness, and a serious health condition that inhibits the employee from doing their job. FMLA is also granted for military reasons including allowing the employee to take off 26 weeks for a special leave related to care for a covered service member. FMLA allows the employee to come back to work to an original or equivalent position, same pay and benefits. In a perfect world, we would be able to take off the amount of time that we need and be able to keep the same job. However, employers have to protect themselves as well. Some employers engage in shady practices that put their employees in jeopardy. It is our job to know the law and our employers’ policies regarding time away from work. We should never assume anything. When applying for a job, make sure to check into whether they provide short term disability, long term disability, insurance, and that they fit the qualifiers to provide FMLA. Chrissy’s surgery was successful, and now she is in the middle of her radiation treatments. The Equal Employment Opportunity Commission is investigating her case for improper firing. Her case can and will set a precedent for nurses in the United States. Like I stated earlier, I’m sure there are nurses reading this who have experienced good and bad issues regarding their employer when faced with a life-changing event. Share your experience if you wish, or give advice to those who may be facing this in their lives right now. Below is the link to the article about Chrissy Ballard if you would like to read more about her. A Hospice Nurse Started Chemo. Then Her Employer Fired Her.

Medical Advances Whether we like it or not, the future has caught up with us. Old school nurses like me who have been practicing for thirty years or more have witnessed many changes. Just a couple of examples are needleless methods of administering medications and the multitude of other safety measures initiated that decrease medical and medication errors. Electronics have improved surgical, endoscopy, and X-Ray equipment by increasing accuracy. Oh, and let’s not forget electronic charting. When electronic charting first came, we nurses often complained. The common complaint was that we felt the computer took us away from the patient. Paper charting allowed us to chart at a later time and was much less complicated. However, computer charting has decreased mistakes with hard stops and standardization of the nursing language. Each step of medical advancement has increased the quality of patient care and decreased complications. And here we are on the cusp of improving the world in medicine even more. Telehealth has been around for a bit actually, but it is getting ready to be a large part of the healthcare system. What is Telehealth? What is Telehealth? It is the use of electronic information to transmit patient information and providing healthcare services. As mentioned earlier, this method of care has been used in the United States since 1964 when they used closed-circuit television (Nelson & Staggers, 2017). It has been used in medical teaching for a long time as well, beginning with live video. Benefits There are many benefits to using telehealth, such as decreasing or removing travel barriers for the poor, rural, and disabled. Telehealth will provide more immediate care which can lead to earlier detection of disease or health issues. By putting the power back into the patient’s hands, they become empowered, more independent, and therefore more compliant. Telenursing allows nursing and technology to combine in order to give care to those who may have trouble accessing medical care for a myriad of reasons. As we know, rural patients have difficulty with transportation due to geographic conditions, and less access to practitioners. Medical compliance is lower in rural patients, making chronic conditions harder to manage. Veterans are another group of patients that need assistance to connect with providers. Veterans with disabilities may have trouble traveling to appointments for services that are not offered locally. There are several successful programs that use telehealth in order to better provide care. The one we will focus on is The Department of Defense. Real-time appointments are conducted via video between the patient and the provider. The patients may include active service members, retirees, or dependents. Some of the services that are provided include mental health, dermatology, pulmonary disease, and cardiology care through telehealth. For more information, here is their website. Technology allows doctors to monitor vital signs, blood sugar levels, temperature, bi-pap readings, and much more. This eliminates the need to go to the doctor's office so often in the case of chronic conditions, homebound patients, and handicapped patients. Biometric data can help to not only monitor conditions but also to diagnose issues. Loop recorders are a good example. When patients have short periods of heart arrhythmias, it is often hard to record, and therefore diagnose and treat. Loop recorders are small devices implanted in the upper chest that record heart activity. They activate and begin recording when the heart rhythm becomes abnormal. This information helps the cardiologist to diagnose the patient. The question may arise asking if telehealth is equal to a face-to-face visit. Studies have shown that telehealth is just as effective (Nelson & Staggers, 2017). Another concern when using telehealth is privacy. The same rules and laws apply to these situations that apply to any other HIPAA related issue. Another consideration is the patient’s media/computer and health literacy. These factors must be considered as medicine moves forward using telehealth. Telehealth is becoming more sophisticated and applicable with each passing year. There is much to contemplate as we move forward using telehealth in the United States. What are your thoughts on the future of healthcare using telehealth? Share your thoughts and experiences with the allnurses community. https://youtu.be/cC88besDEDc

Yes, one thing is for sure. . . change is constant. Medicine's evolution over the years has built on previous knowledge and has expanded on it. EPB is used in everything now, from charting to dispensing medications. It improves the quality of patient care, which is what we all want!

In our country, and specifically in healthcare, we are leadership deprived. It is difficult to lure good leaders into management positions due to the increased stress that they will have to deal with. Adding to that, younger nurses don’t want it either. There are other fields of nursing that they can invest education and experience in that will yield them more money. Some nurse managers are promoted out of convenience or because they are great nurses. However, Good clinicians don’t always make effective managers because they may not have any leadership skills. Over 70% of nurse staff turnover is because of bad managers (Roussal, 2016). When a nurse leaves a position, it can cost around $75,000 to replace that person (Roussal, 2016). This includes the recruitment of the new staff person, replacement, and possibly temporary staff until the position is filled. Included in that number is the overtime paid to the present staff and the orientation of the new person. When there is a high turnover, the core staff become burned out and unhappy leading to the potential of additional turnover. Personally, I have had some fantastic nurse managers, and some not so fantastic. But my recent experience tops the not so fantastic scale by epic proportions. I kept waiting for the lies to catch up to this person, or the emotional bullying to escalate until someone finally reported the problem. For years, I had begged for help from the manager’s superior, but to no avail. Nothing happened. I felt trapped, frustrated, and angry. Was there no one who cared that the whole department was stressed and unhappy? A part of my frustration was that my co-workers would not stand up for themselves and report the manager. A culture of co-dependency and toxic circumstances had festered for so many years, that I guess they accepted it as status quo. Recently, my manager did something that was so egregious that this person is now forced to step down from their position. What I have realized from this experience is that some of my co-workers who would not have reported this incident. The manager would have gotten by with it, and gone on to commit other intentional errors. Now that there is some exposure to the bad management, my co-workers are more willing to speak up. The people who were brave enough to speak up in the first place did so with much consideration and purpose. There are incidents that are reportable, that must be reported by those with knowledge of what happened. Of course, there are incidents that aren’t harmful but still need to be reported. This allows for a review of the system and root cause analysis that improves how we do things and prevent future incidents. There are a few leadership qualities that lead to failure; lack of vision is one of them. Leaders must be able to articulate their vision so that the staff can relate and understand. This will help staff know that they are a vital part of fulfilling that vision. If a leader has no connection to the larger picture, the staff feel disconnected and unimportant. When a manager has no empathy, the staff don’t feel cared for. Part of having empathy is being able to listen and hear them when they have concerns. No motivation can kill a department’s ability to thrive. Having an environment that helps to create energy and purpose will allow the staff to enjoy their workplace. Also, when a leader has no eye on the future, the staff feel stifled and are unable to learn and grow. Good leaders create trust between themselves and the staff. If the staff has trust, then they will feel comfortable bringing to you issues that they have. They will also know that the manager has their back in difficult situations. A nurturing environment will grow empowerment amongst the staff. A good leader accepts responsibility for things that are their responsibility. They don’t deflect blame onto the staff, or elsewhere but instead are mature enough to self evaluate and use situations to improve their leadership skills. Being an advocate and liaison between the staff and upper management, other departments, and ancillary is an important part of being a good manager. Being open and approachable will go a long way in human relationships. Having a good emotional IQ helps as well. Communication is extremely vital in maintaining any relationship, and especially important with management. Being able to effectively communicate and have crucial conversations will make all the difference in how staff respond to changes. Not every good leader can be excellent in all aspects, but they can continue to try and learn. As for those bad leaders. . . I have no idea! Tell us about your good leader, or bad one. Give us the reasons they are either good or bad.

Wow is all I have to say. Hard to believe some of the absentee rules out there.

How is it not a HIPPA violation for the hematologist to notify your employer? That alone seems illegal

Herbal supplements are popular, as are street drugs in modern America. Both are misused. Then there are those that fall into both categories. Salvia (Salvia officinalis - known better as Sage) is an herb that can season your stuffing, and help with your digestive issues, while a different type of Salvia (Salvia divinorum) can be used as an hallucinogenic. We will look at the Salvia divinorum in detail, it's history, describe hallucinogens and how salvia is subject to that definition, and its reaction in the human brain. What is Salvia used for? Herbs are plants in which any part or parts can be used in food, perfume, or medicine. Herbs have been used since the beginning of time, just their smell can soothe the soul and their taste can evince joy. Being part of the mint, sage family, Salvia is used as a medicinal herb to help aid people with diarrhea and regulating bowel habits. It is an easy to grow annual with pretty purple blue blooms. The Black and Blue variety attracts hummingbirds if you are a bird lover. The stems, flowers and leaves are used for their medicinal, aromatherapy, and culinary uses. Salvia is also used as a deodorizer and disinfectant. Herbs have multiple purposes, making them a delight to grow and use. However, when using herbs for medicinal reasons, always check with your doctor. As of now, there are no approved medical uses for Salvia in the United States. History of Salvia Salvia is native to Mexico, for hundreds of years, the Mazatec Indians ( Sierra Mazateca, Oaxaca Southern Mexico) have used salvia for medical practices, shamanism (practitioner reaching altered states of consciousness to interact with spirit world), and divination (gaining insight through ritual) according to the article, "What Are the Effects of Using Salvia" by Kathleen Davis FNP. The Indians would brew a tea from the Salvia leaves, or roll fresh leaves to chew without swallowing so it is absorbed into the bloodstream and not be deactivated in the gastric juices. Because of Salvia's fast action and low addictive and side effects, it is popularly used as an hallucinogenic among young people. Chewing on the leaves, inhaling, and extracts under the tongue are ways that Salvia is used as a recreational drug. Being legal in most states, it can be purchased in smoke shops and on the internet. Tennessee, Oklahoma, Delaware, Louisiana, Maine, and Missouri have declared Salvia illegal according to the article on WebMd, "Salvia Divinorum Overview Information." Salvia as an Hallucinogen According to Davis, Salvia's hallucinogenic effects are similar to LSD. Salvia is popular because it produces visual hallucinations quickly with low side effects. Also, due to the fact that Saliva has little potential for addiction makes it popular. Salvia is not just grown in Mexico, but parts of the United States. Users can experience time and space distortions with its most "potent naturally occurring hallucinogen". It can cause slurred speech along with loss of coordination. Delaware took action after a teen committed suicide in 2007 while using Salvia passing "Brett's Law," putting Salvia in the class of schedule 1 controlled substance. The same year the DEA put salvia on the list of drugs that they were concerned about, calling it a risk to its users. Salvia possesses an active ingredient called "Salvinorin A, a kappa opiate receptor (KOR) agonist". The agonist stimulates some central nervous system receptors in the brain. This is where much of the human perception is located. Effects of Salvia are felt within two minutes and can last up to 30 minutes when smoking such as in a hookah, but when taken orally the effects are lessened but can last from 1 to 3 hours. Those most likely to use Salvia are wealthy, white males between the age of 18 and 25 according to Davis. In the survey, "2015 Monitoring the Future Survey," showed that just below 2% of 12th graders had used Salvia in the past year, with over half expressing no desire to use it again. In certain vulnerable people the space and time disturbances can last hours after the effects are gone when the dose is 500mg or above. Health risks listed in Davis' article when using Salvia Sweating Dizziness Lack of coordination Confusion Slurred speech Difficulty concentrating How Does Salvia work in the brain? In the article, "Brain's Reaction to Potential Hallucinogen Salvia Explored" a chemist named Jacob Hooker is one of the first to study the effects of Salvia on the brain in- primates using PET scans. The purpose of the study was to track how salvia travels through the brain to see its relevance for medicinal purposes and understand why it is used as a recreational drug. Salvia's peak concentration was found to be 10 times greater than that of cocaine at the fast rate of 40 seconds. The most concentrations of the drugs were found in the cerebellum and the visual cortex which makes sense that the effects are felt in motor and visual function of the brain. Hooker concluded that as little as 10 mcg is needed for a psychoactive response in humans. Because it does not give people a euphoric sense, it can be studied for pain control and mood disorders. They plan to do more research on Salvia in the future. Conclusion Salvia can be dangerous, even deadly. Because it can easily be bought, the thought may be that is not harmful. For those touched by drug abuse, this can be scary. Hopefully as research comes in, more regulations will be put into place making it illegal to buy as a recreational drug. Keep enjoying it in your food and grow it in your garden for its beauty. If you know someone who has tried Salvia as an hallucinogen, please share your story with us. References Davis, Kathleen FNP. "What Are The Effects Of Using Salvia?" May 2, 2016. MedicalNewsToday. 2 May, 2016. Web. DOE/Brookhaven National Library. "Brain's Reaction To Potent Hallucinogen Salvia Explored." April 28, 2008. ScienceDaily. 2 May, 2016. Web. "Salvia Divinorum." WebMD. Nd. 2 May, 2016. Web.

Whether it is a family member, friend, or you, mental illness can be devastating, especially when it goes untreated. When a person with mental illness reaches out to someone they feel safe with and then receive negative feedback, they can be devastated. People who don't understand, will often say something that hurts the person reaching out. As a result, that person may not tell another person, ever. People who are suffering with a disease need help, support and treatment. Mental illness is no different than any other disease but it is one that often gets hidden until something tragic happens. Sometimes all a person needs is for someone to listen. Caring enough to actively listen can mean a lot. We know as healthcare workers how much listening can change a situation. The National Alliance on Mental Illness is an organization here to help change America's perception of mental illness. They advance their cause through education, support, and patient advocacy. Their website tells us that eating disorders are the most harmful. Eating disorders can start young, so being able to detect a child with one could save their lives. The National Institute for Mental Health reported a study from 2015 that tells us that one in five people (43.8 million) adults have a mental illness. America's young people age 13-18 have a high number of those affected as well. In fact 21.4% will deal with some form of mental illness in their life. These numbers are high, and that isn't including those who do not discuss their problems with their doctors and go undiagnosed. Whenever we have a problem, no matter what it is, having someone who understands, helps us to feel better about the situation. We share our stories because we know that the other person relates on a gut level. As a person with a mental illness, finding a support group, or someone they can talk to, can make a huge difference in their treatment. Knowing that they are not alone can be the difference between life and death. Having family members who have mental illnesses, I see how ignoring the issue can make it so much worse. These people often mask their feelings with alcohol or drugs, leading to other physical illness. Many people refuse treatment while others take medication and once they feel better, they stop taking it. This cycle can be dangerous for the patient. Talking to our loved ones can be tricky. Staying nonjudgemental and open to what they say is essential. Having real conversations helps everyone involved. Connect with Someone The helpline for the National Eating Disorders Association is 800-931-2237 Text NEDA to 741741 to get connected to a volunteer National Suicide Prevention Lifeline 800-273-TALK (8255) The more we share information and talk about mental illness, the more the stigma will dissolve. We can be part of the movement to educate ourselves and others about mental illness. As nurses, we can talk to our patients openly and honestly helping them to get the correct treatment. Involving their families will also decrease the stigma that surrounds mental illness. Allowing both the patient and the family to ask questions of us and the doctors will help one by one getting past learned prejudices about mental illness. We as nurses can also be the voice of reason among our peers. A person who is mentally ill can cause their caretaker to fear them due to not knowing how to properly approach their care. When we coach our co-workers and lead by example we will improve the patient's experience along with educating each other. Understanding the dynamics of their illness will help us in treating them. Speak to the patient about their illness as you would their other physical issues. They will appreciate the openness and honesty. I know there are a lot of nurses out there that work in the field of mental illness. Share with us your experience to help us educate each other and the patient.

Yes, she was known by her attacker. I didn't put much about him. He worked as a parking valet at the garage and had recently been fired.

I don’t remember hearing anything about Carlie’s murder last January, but her community of nurses did. On January 25, 2019, in the parking garage of a Wisconsin hospital, Carlie was kicked in the head over 40 times and then left to die under a car in the early hours of the morning on January 25, 2019 (O’Reilly, 2019). It was so cold that her skin froze to the concrete (Harris, 2019). She left work at 1:00am, was found at 3:43am by a snow plow driver, and tragically died at 4:21am. Carlie died a slow, torturous death - Alone (O’Reilly, 2019). As I read Carlie’s story, and how she died, it weighed heavy on my heart. I pictured someone I know falling victim to such a brutal death and my stomach squeezed so hard that it hurt. Was Carlie conscience, did she lie there thinking about her husband and family. How much pain did she suffer while her tears went unheard. With any act of violence, we try to rationalize it - we try to make sense of it. But the circle of thoughts that we continually play in our minds about something irrational cannot be rationalized. Nurses often are on the receiving end of abuse, and those feelings and memories stick with us forever. Not to mention our individual histories and personal experiences with abuse that we bring with us everyday. The ones that have shaped us and have developed how we respond to abuse. Any abuse - verbal, sexual, physical, or mental is immensely personal, it touches and shapes our souls. The abuser tries to steal our joy and our sense of safety, but it’s time we as nurses stop putting up with workplace violence. According to Bankole K. Fasanya and Emmanuel A. Dada, in their article, “Workplace Violence and Safety Issues in Long-Term Medical Care Facilities: Nurses’ Perspectives”, that on a daily basis, two people are killed as a result of workplace violence, and 87 are injured (2016). This statistic covers any field of work, however, the healthcare field takes credit for a large majority of those numbers. In fact, in the article, “Educational and Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study”, it tells that we as healthcare workers are victim of almost 74% of the abuse inflicted in the workplace (Hemati-Esmaeili, Heshmati-Nabavi, Pouresmail, Mazlom, & Reihani, 2018). Workplace violence can be verbal, emotional, sexual, or physical and most nurses have experienced one or more forms in the span of their career. Abuse can come from a peer, superior, doctor, patient, or family. Certain fields of nursing suffer higher incidents of abuse such as the Emergency Department, Long Term Care, and the Psychiatric wards. A large percentage of these events are not reported. The reason may be that there is a feeling that nothing can or will be done, or that there will be retribution for reporting. How can we, as nurses advocate for ourselves? We need to empower ourselves and our fellow nurses and learn what our choices are and what is being done about workplace violence. A bill was introduced February 19 this year by Representative Joe Courtney. He represents Connecticut in the House of Representatives since 2007. This bill - H.R. 1309 will require the Department of Labor to look into violence in the healthcare field. It is asking that requirements be set to educate healthcare workers on how to de-escalate violent situations, and recognize the signs of impending violence. Also, it asks that each incident be investigated as soon as possible in order to get the most accurate information. Nurses often do not feel comfortable or safe reporting incidents of workplace violence. They fear retribution, prejudice, or even losing their jobs. This bill will allow them to report concerns and events privately and without punishment. What can we do? Contact your state Representatives and Congressmen/women and ask them to support this bill. Tell them that is is essential that something be done to protect us. If this becomes mandatory, turnover will decrease, morale will increase, and the culture of the healthcare field will greatly improve. The perception that nurses are expected to endure a certain amount of violence needs to be eliminated (Fasanya, 2016). Thank goodness the majority of workplace violence cases are nonfatal. But one fatal incident is too many. Share your stories with the allnurses community. References Fasanya, B., & Dada, E. (2016). Workplace Violence and Safety Issues in Long Term Medical Care Facilities: Nurses’ Perspectives. Safety and Health at Work, 7(2), 97-101. doi: 10.1016/j.shaw.2015.11.002 Harris, C. (2019). Dying Wisconsin Nurse Found Frozen to Ground was Allegedly Targeted by Former Parking Valet. People. Retrieved from https://people.com/crime/slain-wisconsin-nurse-was-allegedly-targeted-by-valet/ Hemati-Esmaeili, F., Heshmati-Nabavi, F., Pouresmail, Z., Mazlom, S., & Reihani, H. (2018). Educational ad Managerial Policy Making to Reduce Workplace Violence Against Nurses: An Action Research Study. Iranian Journal of Nursing and Midwifery Research, 23(6), 478-485. doi: 10.4103/ijnmr.IJMNR_77_17 O’Reilly, M. (2019). Murder and Me. Medscape Nurses. Retrieved from https://www.medscape.com/viewarticle/917203

This has been going on for decades. About 10 years ago, I asked an Anesthesiologist why on their pre-surgical orders have different guidelines for men than women in regards to EKG. She told me that is is just how it is. The criteria was different regarding ages for routine EKGs preop. Men got one at a younger age than women. Made no sense to me. Very good article, thank you!

That is so cool!

The second World War drained the hospitals, health agencies, and schools of nurses by about 30% according to Liz Eberlain in her article, “Making a Difference: The U.S. Cadet Nurse Corps”. This created a nursing shortage that threatened the future of the country as well as the war. After the war was over, nurses would be needed for the continued treatment of the soldiers and their families. Labor - Federal Security Appropriations Act, 1942 The House of Representatives and Congress put together a Code, addressing the labor and other needs of the United States due to World War II called “Labor - Federal Security Appropriations Act, 1942”. Among this Code was a law that communicated how federal money would be used to recruit nurses. The demand for nurses had become critical and the medical community would have collapsed under the great need for nurses during and after the war. This code also dropped discriminatory practices by allowing any race, color, or creed to apply (An Act Making Appropriations for the Department of Labor the Federal Security, 1942). The code focused on High School graduates between the ages of 17 and 35. These students could be trainees, student nurses, or post-graduate nurses; it even offered refresher courses for nurses who had not been working due to retirement or having children. Recruitment Recruitment efforts were widespread using leaflets, posters, newspapers, parades, even Hollywood made short films and advertisements to encourage enlistment. (Below is a link to one of these short films) High schools hung the posters in their hallways to encourage new graduates to enlist, and parents were promised that their daughters would be safe and taken care of. These young women would receive a monthly stipend along with free tuition to nursing school. The nursing program was pushed from 36 months to 30 months in order to expedite their graduation (Eberlein, 2019). However, the $5 million allocated to get the program going was not enough. The forward thinking congresswoman, Frances P. Bolton initiated the bill called the “Bolton Act” that asked for the establishment of a governmental program that would give grants to nursing schools to enable the training of nurses (Eberlein, 2019). Her bill passed on July 1, 1943, giving $65 million in the first year to nursing schools across the country (Eberlein, 2019). Several things happened that year to further the nursing profession. One was that the cadet program was put under the Public Health Services who answered to the Surgeon General (Eberlein, 2019). The Surgeon General at that time was Tomas Parran who appointed Lucille Petry, RN over the new Division of Nurse Education (Eberlein, 2019). The birth of return demonstration teaching began during this time, changing how nurses are taught forever. Altogether, the U.S. Cadet Nurse Corps recruited 124.000 women. Recognition The reason that The United States Cadet Nurse Corps has made it back into the public eye recently, is because they are asking for more “formal recognition” for the women who served in the corps, according to the article, “Recognition ‘Now or Never’ For U.S. Cadet Nurse Corps of World War II”, by Jill Kaufman (2019). Many of these nurses have now passed away, but the lobbying for the government to acknowledge the nurse corps is still going on. These nurses began working towards receiving full veteran’s benefits in the 70s, but have not been successful. More recently, Barbara Poremba, a nursing teacher has initiated a bill called “Honorary Veterans” that would offer the member of the nursing corps burial benefits (Kaufman, 2019). The U.S. Cadet Nurse Corps Service Recognition Act would recognize the women who served by giving them honorable discharges, the above-mentioned burial services, and ribbon and medal privileges (Scheible, 2019). These women went overseas, some were even captured by the Japanese, others worked in the states, and they all served our country. They worked under the conditions of war, and continued to serve after the war was over. They deserve at least the proposed privileges. A couple of those women, now in their 90s are Elizabeth “Betty” Beecher of Weymouth, who is now 95, and Emily Schacht from Waterford, Connecticut and is 92 years old. We honor them among our nurses’ community. Have you known a nurse who served in the corps, or know a story about it, please share with the allnurses community. To see a recruitment film, click on the link below: The CriticalPast: The need for cadet nurses and young girls to volunteer for military nursing service during World War II. References An Act Making Appropriations for the Department of Labor the Federal Security. (1942). Labor-Federal Security Appropriations Act, 1942. Retrieved from: Library of Congress Eberlein, L. (2019). Making a Difference: The U.S. Cadet Nurse Corps. National Women’s History Museum: Making a Difference: The U.S. Cadet Nurse Corps Kaufman, J. (2019). Recognition ‘Now or Never’ for U.S. Cadet Nurse Corps of World War II. New England Public Radio. Retrieved from: Recognition 'Now Or Never' For U.S. Cadet Nurse Corps Of World War II Scheible, S. (2019). Military.com. Retrieved from: Lawmakers Renew Bid to Honor US Cadet Nurses

I love my career in GI, and never thought I would change. Working in GI for the past 25 years has served me well. I enjoy it, and learn something on a daily basis. However, for the past 4 ½ years my immediate boss was the worst. I knew that I couldn’t take working under her until I retired. I had applied for other jobs, but that never worked out, and I didn’t want to go back to a night shift or to work on the floor. Having worked in GI for so long had type cast me into procedural nursing. I was so desperate at one point that I felt depressed and trapped, as if in a bad marriage. About a year ago, I opened an email that stated that my facility was increasing tuition reimbursement. My heart skipped a beat. I actually like school, and love learning new things. So I printed out the information and put it aside until I got home. I did a search of the colleges and degrees that my facility partnered with for decreased tuition. There was one problem, I really didn’t want to teach, and am not necessarily interested in upper management. There was a choice of study that I didn’t quite understand called “Nurse Informatics”. I read the description several times trying to comprehend what exactly what “informatics” meant. After finally wrapping my head around informatics, I grew to like the idea. Using my nursing knowledge and nursing science to manage and define communication data seems like a great option for me. It sounded like something that I would like to learn more about. Also, when I get to retirement age, it could segue into something that I could do from home. My age was the only deterrent that gave me pause. I was 53 at the time and I questioned myself whether I should go into debt and invest my time to change into a career that was totally foreign to me. It terrified me, but also excited me at the same time. Would people look at me and say “what? She’s too old”. However, since I really don’t care what people think, that didn’t worry me so much. I chose the online Masters Program of Nursing Informatics at WGU. I am almost done with my first year, and I am still saying the mantra to myself about my age. Should I be doing this at my age? How many years will I really be able to work in my new field? Even though I question myself about my age, I know I won’t quit. My family is very supportive and working online allows me to work when I have the time. My mentor through the school has been very helpful and encouraging. She helps me to navigate each class and gives me advice on how to proceed. The school offers enough resources that a student can complete their work without leaving their house. I’m sure most online programs are similar and offer resources like that of WGU. The instructors are available for telephone conference, or email correspondence. I was also concerned about not being in a classroom. I love being in a classroom and having interaction with the teachers and fellow students. However, I have enjoyed working in the evening on my couch doing my schoolwork. At this point in my life, the online program fits my life and I am able to learn and do the work at my own pace. Beginning anything new in life can be nerve racking. A new job, new relationship, and beginning a new degree. I was very anxious during the first two classes until I understood how they format the classes and homework. There is a lot of writing involved, but that doesn’t really bother me. Writing is one of the things I enjoy, even if it is a term paper instead of an article. As far as my job goes, the old boss is gone, and now I am the boss. Of course life gets busier as soon as you start a project. Work has calmed down and life has gone on. Class by class I get closer to the finish line. But what about the whole reason that I began this journey? It has resolved itself. Do I continue in informatics, or do I change the direction of my degree to management? So many questions, so much is unknown. I have thought long and hard about my school and career future. I have not talked about going to school with my co-workers, I have kept it on the down low. In the beginning, the reason was because I didn’t want my “at the time” boss to know. Now I don’t want them to know that I may be leaving in the next year or two. Either way, my advice to myself is to do what I need to do for myself. It doesn’t matter what anyone thinks, or expects. If you are thinking about going back to school, take a step forward and invest in yourself. Do it for yourself, and don’t let obstacles like age get in your way. We don’t know what tomorrow brings, and God leads us down the road that we need to be on. Tell us your school story!

Thank you for the kind words, you actually got what I was trying to say. I have reached out to the informatic nurse at my hospital, and she has been great. I guess it's scary stepping out into something new, especially after going through all the schooling and paying for it.

Thank you for the encouragement! So much negative comments about going back to school. I'm not bored with Informatics, just wary of options upon graduation.

You are a brave woman, and I applaud your hard work. I enjoyed reading your article, it was very well done! Keep staying strong - 24- hours at a time

The cost of nursing staff turnover is immense for hospitals according to the 2019 National Health Care Retention & RN Staffing Report (NSI, 2019). The NSI reports that on average to replace a bedside nursing job it can cost up to $52,100. Last year, it is estimated that a hospital paid out up to $5.7 million just in recruiting, educating, and training new hires (NSI, 2019). This is a huge amount of money to keep a hospital staffed. The top reasons nurses leave jobs vary - such as personal reasons, relocation, or career advancement. Other reasons that nurses leave jobs is because of salary, schedule, commute, management, retirement, and staff/patient ratios (NSI, 2019). Nurses have the luxury of being able to change jobs if they are not happy. There are so many choices for us, that if we aren’t happy, we can leave or transfer. If a facility does not value the nurses’ needs or care about retention, then they will have a large turnover rate. There is one hospital system that has created a program that is like no other. The Allegheny Health Network has developed a RetuRN to Practice program that offers nurses shorter shifts, flexible shifts, refresher courses, and a support network. This information can be found at the following link: https://www.ahn.org/education/ahn-return-to-practice-program The Allegheny Health Network purposes to lure nurses that have left nursing to raise children, or are retired, to return to the bedside. Allegheny has created a system that fits the modern nurses’ lifestyle, and as a result, decreases the workload for the current staff. According to the article, “Bring Nurses Back to the Bedside”, by Jennifer Thew, “participants must offer managers availability in a minimum of three-hour blocks at any time on a day, evening, or night shift, or on a weekend or holiday”. The agreement allows the nurse to self-schedule but requires a minimum availability. They don’t take assignments necessarily but relieve for breaks or when the nurse has to be off the unit for a period of time. They can do admissions and discharges as well, or patient teaching, the things that take a chunk of time. The hospital provides refresher courses for the RetuRN nurses to take that will help them get their license re-activated. Shadowing is also available to help the returning nurse update clinical skills. They also offer a concierge program that helps the returning nurses navigate the process of getting hired and activating their licenses. When the RetuRN nurse comes onto the unit, it is then that they get their assignment, which requires flexibility. It does create scheduling adjustments for the manager, who has to fit the RetuRN nurse with a three-hour block of time into the day’s schedule. What the program has come to find is that once these nurses are on the units, the units fight to keep them, finding them very valuable. Because this is a new program, they are constantly re-evaluating and getting feedback from all the key stakeholders. The first wave of the program hired 22 nurses, all of whom still work there. The RetuRN nurse does not have to twelve-hour shifts or work the weekends, some of the deterrents that kept them away. They can self-schedule in order to fit the job to their life schedule, creating a balanced work to life ratio. Being that the most recent percentage for staff turnover in hospitals is 19.1, this program recognizes that number and is forward thinking enough to try and decrease it. Bedside nursing turnover rate is 17.2% in 2018, compared to 16.8% turnover rate of 2017 (NSI, 2019). The numbers continue to increase each year, reflecting the satisfaction of the staff. In just five years, the average hospital has “turned over 87.8%” of their staff (NSI, 2019). This is a huge number that should get hospitals attention, not only for the money involved to recruit and train new employees but keeping staff once they hire them. The RetuRN program will be one to watch. It already has given us a lot of information. In a couple years, the program will be larger and will have even more data to backup their claims. It will be interesting to see what it becomes and how many other hospitals will begin to use the program, or create something just as effective. The nurses who take advantage of the program have a lot of experience and skills to share that will benefit their fellow nurses and the patients. In return, the nurse gets to work a schedule that they choose and keep skills current. References 2019 National Health Care Retention & Staffing Report. (2019). Nursing Solutions, Inc. Retrieved from: www.nsinnursingsolutions.com Thew, J. (2019). Bring Nurses Back to the Bedside. HealthLeaders Analysis. Retrieved from: https://www.healthleadersmedia.com/nursing/bring-nurses-back-bedside

Download allnurses Magazine The evolution of nurses day or nurses week took many years to become official. The first official attempt was in 1953 when Dorothy Sutherland of the U.S. Department of Health, Education and Welfare proposed a “Nurses Day” to President Eisenhower. She wanted it to reflect the 100th Anniversary of Florence Nightingale's mission to Crimea, but it did not get done. However, the following year in 1954, a National Nurses Week was celebrated from October 11-16 (Gillies, 2003). In 1955, a bill was introduced to declare a National Nurses Week, but it did not pass. Ten years later, the International Council of Nurses started celebrating “International Nurses Day”. President Nixon is asked in 1972 to acknowledge a “National Registered Nurse Day”, but it did not happen. However, two years later, Nixon proclaims “National Nurses Week”. The same year, the International Council of Nurses proclaims May 12 as “International Nurse Day” (Gillies, 2003). There are several milestones in the years that followed, and in 1982 the ANA recognized May 6 as “National Recognition Day for Nurses”. That same year, Congress also made a resolution for May 6 to be “National Recognition Day for Nurses”, and then President Ronald Reagan signed a proclamation on March 25 declaring the same (Gillies, 2003). The ANA made nurses week (May 6-12) official in 1990 (Gillies). May 12 is Florence Nightingale's birthday, so it is fitting that we end the week of celebration - celebrating her. After attending nursing school in Germany, Florence went back to London and became superintendent of a hospital for “gentlewomen” (The History, 2016). Her work in public health and during the Crimean War set new standards for healthcare. She decreased mortality by improving sanitary conditions. Not only that, she kept records of the people who died, and how they died. This allowed her to make the connection between sanitation and disease. Florence actually had some of the first evidence-based research in healthcare. Looking back at how many changes (or not) have taken place in nursing and the medical field, it seems overwhelming. Even so, the nurse's mission has remained steady throughout this medical metamorphosis. This is evidenced in a book published in 1930, , F.A.C.P. In the preface, he tells us what his perspective of what a nurse is. “The function of the nurse in medical diseases is to observe symptoms accurately, to recognize early signs of complications and to carry out the physician’s orders intelligently” (1930). This description applies today just as much as it did in 1930. Although we have made great strides in chemistry, biology, and electronics, our basic purpose remains as it always has been - to provide care to our patients to the best of our ability without doing any harm. I love my old medical and nursing books. I enjoy reading them and seeing the nursing students’ signatures written crookedly inside the front cover and maybe some scribbled notes of something they thought was important. These books are precious, connecting the past with the present. One of the books in my collection was written in 1917 by George M. Price, M.D. called, Hygiene and Sanitation A Text-Book for Nurses. When I flipped to the dedication page, it read, “To Lillian D. Wald - The pioneer of Public Health Nursing in the United States and the foremost advocate for the extension of the scope of the nurses’ work. This book is dedicated in appreciation and respect” (Price, 1917). Wow. Makes me wonder if he knew her or just knew of her. This is the perfect segue into talking about Lillian D. Wald and her contributions to the world of sanitation, education, and the improvement of conditions for children in that day and time. Lillian Wald is known for her work in reforming public health. Not only did she open a “settlement house” (opened in poor urban areas in an attempt to bring the rich and the poor together in proximity and socially) in 1893 called the Henry Street Settlement, she moved into the house along with her friend and fellow nurse Mary Brewster (Lillian, n.d.). There in the house, she provided nursing care for the poor. Eventually, there were many nurses who would come and volunteer their time. Soon, the settlement was able to open playgrounds, afterschool programs, kindergarten, mother’s groups and more. Lillian was able to discern what the community needed and then make sure it happened. Together, she and other well-known women’s rights activist such as Lavinia Dock and Florence Kelley helped to write textbooks, aiding to the progression of the professional nurse. New York City school children benefited from the many people living in that settlement who helped to improve conditions in the schools. Special educations classes were created, and a program for school nurses was started, along with a lunch program for the students. Lillian’s activism and hard work in her community were boundless, including her work in the political arena to end child labor. Her story is a good example of how one nurse changed a country (Lillian, n.d). Getting back to the book, I thought you would enjoy what Dr. Price had to say in his preface. “The last decade has seen a wonderful expansion of the function of the trained nurse and a great broadening of the scope of her usefulness. No longer are her duties limited to the simple care of the sick. The nurse has become a priestess of prophylaxis. Her work in preventative medicine has become invaluable. She has become an important factor in social, in municipal, and in public health work” (Lillian, n.d). **To all the wonderful male nurses out there, know that we appreciate you and you are the “princes of prophylaxis”. ** While documenting in charts has become obsolete, we now see our faces in the reflections of all of the electronic devices we use. We get lab, and other results in real time and can treat patients sooner. Communication has become easier and faster, decreasing the incidents of delay of care and improving patient outcomes. While all of this is great, let’s not forget to look up and make eye contact with our patients; they need it, and so do we. Just from looking at them we can tell so much. We can see if they are pale, in pain, or nervous, and most of all, it begins the process of building a rapport. Nurses Week is to celebrate you. All the times you ignore your back pain and keep going, or brush off the bladder that is about to burst in order to care for your patient. As you bring them their lunch while yours is getting cold, this week is for you. When a doctor yells at you for something that is no fault of yours, this week is for you. As you walk to your car on feet that are so tired they can’t take any more steps, we celebrate you. The connection we have as nurses over the past decades to now binds us in our journey of serving. The best things about the healthcare system have been created by nurses just like you. Do some creating of your own and don’t forget to get a massage to reward yourself. You never know, decades from now, nurses may be reading about you and all the wonderful things that you were able to accomplish. Tell us about some things you would like to pioneer. References Blumgarten, A. (1930). A Textbook of Medicine for Students in Schools of Nursing. New York: The MacMillan Company. Filiacia, A. Lillian Wald - Public Health Progressive. (n.d.). Wordpress. Retrieved from www.lillianwald.com Gillies, H. Florence Nightingale The History of Nurses Week. (2003). CountryJoe. Retrieved from www.countryjoe.com/nightengale/nursesweek.htm. Price, G. (1917). Hygiene and Sanitation A Textbook for Nurses. Philadelphia and New York: Lea & Febiger. The History of Nurses Week. (2016). Ashford University. Retrieved from https://www.ashford.edu/online-degrees/health-care/the-history-of-nurses-week

Praying for good results!

That is very brave!

I find that docs have different views on when to bring someone back for a follow up colonoscopy. Some of the criteria is family history, if they found any polyps, etc. If you have a screening that shows no disease at all, and no polyps, then it really can be 10 years. I hope this helps.

The hemocult card is in no way good enough. It may not detect blood in that particular sample. You need a colonoscopy, there is no substitute for a visual inspection. Once you get past the prep for the test, the rest is a piece of cake (so to speak). The standard of practice is a colonoscopy at 50, find a good Gastroenterologist and get it done.

Thank you for this article, I can relate to the information because I am in a new role of leadership after many years. The biggest change for me is the information that I learn, I also want to share, but cannot. Before, I didn't really have to have a filter, now I have to check myself before sharing certain things. Doing the little things for my unit and staff goes a long way for unity and satisfaction.