Bullying & the 3 P’s

I just found this nurse’s blog recently, but you can bet I will be a regular visitor to see what she posts and to read old postings.  I love that she delivers her message in a very succinct way that is direct and useful.  I think she may become my favorite nurse blogger.

I contacted her to see if I could post this here and she agreed.  I only posted a small part of the entire blog post, so please click over to read the entire thing.  It is definitely worth the effort.

As a retired nurse, I understand exactly what this post is about and I also agree that our patients are the ones who end up paying the price for such behavior.  I have been yelled at, I have had charts thrown at me, I have had a physician report me to my nurse manager because I refused to leave my patient to get him a cup of coffee.  This is not  a rare event in the working life of any nurse, this is a daily event.

There is also the problem of nursing “eating their young” which seems absurd when you hear it but believe me is a real and horrible problem on the units.  So the bullying can come from any direction–the patient, the patient’s family, the other nurses, or even the physicians.

Please read this and maybe print it out to give to your nurse manager for your next unit meeting.  You will be doing everyone you work with, including yourself, a really big favor.


Bullying & the 3 P’s

Posted by  | Aug 7, 2017 | 

Bullying & the 3 P’s

Let’s face it; bullying is awful. Nobody likes to be yelled at, made to feel incompetent, or treated with disrespect in the work place. However, the healthcare environment can be extremely stressful and unpredictable, requiring quick action, which can sometimes lead to folks coming across as either snarky or barky.  High stress can also lead to disruptive behaviors. While some might just say, “suck it up buttercup”, the effects of disruptive behaviors reach far beyond the medical staff.


read the entire post here.

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Doctor bullying–is it real?

Doctor bullying.  What exactly is that?  Here is an article, first found in Slate Magazine, but now on Business Insider, that talks about a secret problem most nurses have had to deal with on a daily basis.  Now, I have worked with many, many doctors over the years and I can say that only one physician ever bullied me.  But, there it is.  I was bullied by my doctor who was supposed to be working  with me to help my patients get better.

In my case, I decided to stand up for myself and I had a very long and frank discussion with the physician in the break room.  Did it help?  Yes it did.  Did it stop him from bullying other nurses? No it did not.  Did he ever get called on the carpet for his behavior? Not that I am aware of.

Nursing is stressful enough without adding the aspect of doctor bullying to the stew.  In this article, which promotes a book–I know, you can see some of the issues nurses have to deal with daily that have a big impact on patient care and they have absolutely no control over.

I am not promoting the book but I am advocating for nurses, so I hope you take the time to read this article to the end and see what you think about it.


An epidemic of bullying doctors is threatening both nurses and patient

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Drug diversion–what you need to know

Drug diversion.  What exactly is this and why should nurses care?  Drug diversion is the act of taking medication assigned to a patient and giving it to another, usually the nurse.  Why should nurses care?  Well let’s see–poor patient care, it’s illegal, the nursing board frowns upon it, you can lose your nursing license if you get caught diverting medicine.  Just little things.

The other side of the problem is that nurses are exposed daily to so many medications, both controlled and not, that they become indifferent to the possibility of drug diversion.  Many a nurse has forgotten to give a med on time, or has put a shot in their pocket and forgot it.  Nursing sucks that way.  Never enough time, never sure that you did everything you need to do, too many patients to care for properly.  It is easy to become indifferent if you get too overwhelmed.

Nurses who divert drugs are not good nurses, granted.  They are impaired nurses who put patients in danger from under dosing of medications ordered for treatment.  Patients who need pain relief are not getting it and their status gets worse.

This is a big problem in healthcare, but one that should be easy enough to fix if we all put our heads together.  I have never worked with a nurse who wanted to harm patients.  I do not believe that the nurse who divert want to do harm to their patients.  I think this is a system problem that can be fixed.

Please read this article and make up your own mind about this topic.


Jennifer Thew, RN, October 4, 2016

Drug diversion and addiction among nurses is not uncommon, but

it is often misunderstood. An expert shares insights to improve


Have you ever worked with a colleague who diverted drugs to feed an addiction?

Chances are you have, though you may not have known it, since drug diversion and addiction are often very secretive issues. Most estimates put nurses’ drug and alcohol misuse at around 6% to 10%, or about one in 10 nurses.

This makes it highly likely that at some point in your career you’ll encounter a colleague or staff member who is, or will, divert and misuse drugs.

Yet, diversion and addiction are still misunderstood, says Laura Wright, PhD, CRNA, associate professor in the Department of Acute, Chronic, and Continuing Care at The University of Alabama at Birmingham, School of Nursing.

10 Ways to Halt Drug Diversion by Healthcare Workers

“Addiction is a disease, it’s not a moral defect,” she says. “But, when I talk about addiction, I still get people asking me, ‘Why would they ever do that? That’s an awful thing. How could they do that to their children?'”

Here are five things Wright, who is a member of the American Association of Nurse Anesthetists Peer Assistance Advisors Committee, (AANA) wants nurses to know about drug diversion and addiction.

1. Addiction is a disease.

Wright describes addiction as a “disease of choice.” What does this mean? I shared with her that I once had a colleague who, after going to a new employer, was caught diverting drugs.

When I worked with this nurse, they had sustained injuries from a car accident and had been prescribed prescription pain medication. Eventually, the nurse started mentioning that the medication wasn’t helping with the physical pain anymore.

“Tolerance builds and they need more,” Wright explains. “The brain has been rewired so that the drug becomes necessary for survival on a very unconscious level.”

This rewiring interrupts their ability to make proper choices and, biologically, addicts become unable to “just say no.”

2. Know the signs and behaviors of impairment.

There are often red flags that there is a problem with diversion and addiction well before the narcotics counts are “off.”

HR Strategies for Dealing with Drug Diversion

A nurse may become forgetful, unpredictable, or lack concentration. He or she may have frequent illnesses, physical complaints, and elaborate excuses for things. They may pick-up extra on-call shifts, have a labile mood with unexplained anger and overreaction to criticism, or have an increase in unexplained tardiness or absenteeism.

“When it gets to the point, when nurses are diverting, where it’s noticeable on audits and in the Pyxis, it’s way out of control,” Wright says of addiction.

3. Turning a blind-eye helps no one.

Colleagues who notice signs and behaviors of drug diversion and addiction are often hesitant to raise their concerns.

“The people who love them know that they’re a great nurse, and they don’t want to get them in trouble… because they’re worried …read the rest here.

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Antibiotic resistence–a new approach

As a nurse, even a psych nurse, we all know the dangers of antibiotic resistence.  It costs so much money to get new and stronger antibiotics developed and takes quite a long time to do so; all the while the bacteria are developing ways to negate the treatments we currently have in place.  So called superbugs are killing patients globally.

It seems that in the news there is regularly an article or episode dealing with a new bug or a new antibiotic being developed.  Well and good.  Keep up the good work of keeping us informed.  However, this article below is an example of “thinking outside the box” when researching antibiotic resistence.

This seems like a viable and new avenue to pursue in our efforts to combat bacteria that cause illness.  I hope other researchers view this promising result and it prompts them to come up with other unusual ways to combat this scourge of medicine.

Please read this article and see what you think.


Why The Science World Is Freaking Out Over

This 25-Year-Old’s Answer to Antibiotic


Could this be the end of superbugs?

26 SEP 2016
 antibiotic resistenceA 25-year-old student has come up with a way to fight drug-resistant superbugs without antibiotics.

The new approach has so far only been tested in the lab and on mice, but it could offer a potential solution to antibiotic resistance, which is now getting so bad that the United Nations recently declared it a “fundamental threat” to global health.

Antibiotic-resistant bacteria already kill around 700,000 people each year, but a recent study suggests that number could rise to around 10 million by 2050.

In addition to common hospital superbug, methicillin-resistant Staphylococcus aureus (MRSA), scientists are now also concerned that gonorrhoea is about to become resistant to all remaining drugs.

But Shu Lam, a 25-year-old PhD student at the University of Melbourne in Australia, has developed a star-shaped polymer that can kill six different superbug strains without antibiotics, simply by ripping apart their cell walls.

“We’ve discovered that [the polymers] actually target the bacteria and kill it in multiple ways,” Lam told Nicola Smith from The Telegraph. “One method is by physically disrupting or breaking apart the cell wall of the bacteria. This creates a lot of stress on the bacteria and causes it to start killing itself.”

The research has been published in Nature Microbiology, and according to Smith, it’s already being hailed by scientists in the field as “a breakthrough that could change the face of modern medicine“.

Before we get too carried away, it’s still very early days. So far, Lam has only tested her star-shaped polymers on six strains of drug-resistant bacteria in the lab, and on one superbug in live mice.

But in all experiments, they’ve been able to kill their targeted bacteria – and generation after generation don’t seem to develop resistance to the polymers.

The polymers – which they call SNAPPs, or structurally nanoengineered antimicrobial peptide polymers – work by directly attacking, penetrating, and then destabilising the cell membrane of bacteria.

Unlike antibiotics, which ‘poison’ bacteria, and can also affect healthy cells in the area, the SNAPPs that Lam has designed are so large that they don’t seem to affect healthy cells at all.

“With this polymerised peptide we are talking the difference in scale between a mouse and an elephant,” Lam’s supervisor, Greg Qiao, told Marcus Strom from the Sydney Morning Herald“The large peptide molecules can’t enter the [healthy] cells.”

Read the entire article here.

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Happy Nurse’s Week!

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The Nurse Who’s There After Sexual Assault

Here is an article from the Atlantic that includes an interview with a SANE nurse.  This is the nurse who works with the police and takes care of the victim of sexual assault.  This nurse has received hours of extra education related to forensics and the damage to the body and mind of the survivor.

This nurse is usually the first contact with healthcare for the victim.  This nurse is responsible for the collection of evidence as well as caring for the body/psyche of the victim.

This nurse acts as the conduit between the victim and the justice department, at least while in the hospital.

Please be sure to read this article in its entirety.  After reading this, you will have a really good grasp on what it is like to be a sexual assault nurse examiner.

The Nurse Who’s There After Sexual Assault

Arlette Stevens Castaño talks about her experience treating survivors and working with police in Tucson, Arizona.

The public discussion over how to think about and address sexual violence has heated up in recent years, prompted by high-profile allegations like those against Nate Parker, Woody Allen, and Bill Cosby, as well as increased attention to sexual assault on college campuses. The increased coverage has also brought attention to widespread problems in how sexual assault is investigated. Across the U.S., there is a backlog of tens of thousands untested rape kits—evidence collected during examinations following sexual assaults—that are currently in police custody. In 2015, the police department in Tucson, Arizona, received a grant of more than $1 million to test its more than 1,000 backlogged kits.Arlette Stevens Castaño, a sexual-assault nurse examiner in Tucson who conducts these examinations, acknowledges the challenges that crime labs and police departments face in getting them tested promptly. I spoke with Stevens Castaño about what inspired her to work with sexual-assault survivors, a nurse’s relationship with law enforcement, and the problem of untested examination kits. This interview has been lightly edited for length and clarity.

Adrienne Green: What made you choose nursing as a career?

Arlette Stevens Castaño, a sexual-assault
nurse in Tucson, Arizona

Arlette Stevens Castaño: Even back in high school, I knew that I wanted to take care of people. I was leaning toward health care, but I wasn’t really sure if I would become a nurse or a physician. After learning more about nursing, I decided that I liked it because I wanted to spend more time educating patients. I’ve always been a person who wanted to prevent bad things from happening, and that tied into the career that I chose. I still feel that preventing infection and disease is very important, not just treating things with medication.

I am a first-generation Mexican-American and I grew up in Tucson, Arizona. I’m bilingual—Spanish is my first language, and I still use it on a daily basis—and I wanted to be out more, working in the community. I attended the University of Arizona, and I have been a registered nurse now for 16 years. Working with the sexual-assault nurse examiner team was a life-changing event…(read the rest of this interview here)

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101 Things We Should Teach Every New Nurse

Here is an article from NurseBuff.com that delineates all the important things we need to teach every new nurse who comes to your floor.

When you graduate from nursing school, you think you are ready to take on the world; the truth of the matter is that you are just getting started and have many things to learn and skills to develop.  It is a fact that many new nurses are no longer working after the first year, at least not in the same capacity.

Being a nurse is hard and it is hard work, but most nurses wouldn’t be found doing anything else.  Therein lies the enigma.

Please read all of these things and see if you agree with this author about what new nurses need to know.


101 Things We Should Teach Every New Nurse


It sucks to be a new nurse, but no one is immune to that period of adjustment. It may take a year or two before you finally get the hang of the nursing practice, but you will get there. Here are 101 essential survival tips every new nurse must know:

1. Never be afraid to ask questions. There is always something to learn in the field of nursing.

2. Learn to admit your mistake. If you plan to keep it forever, bigger problems may arise in the end. You colleagues will understand if you admit your mistake, and they will help you solve it.

3. Always clarify if you have doubts. Never hesitate to clarify a detail regarding your patient’s care if you are unsure about it.

4. Always think before you answer. Whenever the patient, the relative or the doctor is asking you some questions, think of the safest way to answer first. This is also the best thing to do if you are not sure about your response.

5. Plan for the worst and hope for the best. You cannot always predict how peaceful or how chaotic your shift will be, so always be prepared.

6. Keep up with your charts and task as they come up. If you save them for later, there might not be enough time to complete them. Remember that you cannot fully anticipate when you will be really busy.

7. Don’t be too hard on yourself. If you need to pee, don’t hold it as it will just take few minutes of your time. If you need to hydrate yourself, drink before continuing with your tasks. Most nurses delay the little things they need because they focus on finishing a task but in reality, if you are too hard on yourself the work you do will be greatly affected.

8. Stay away from negative people at your area. Being a nurse is already a tough job and it will be helpful to have a positive outlook in your work.

9. Eat between tasks. Nurses are usually deprived of precious time to eat so learn the trick of eating between tasks.

10. Before calling a doctor, always make a list of the things you need to mention. You can’t fully trust your memory when talking through a phone call especially when the doctor is always in a hurry.

11. Invest in your footwear. You will walk a lot in your entire nursing career so wear appropriate nursing shoes that are made for ultimate comfort and durability.

12. Always be on time. Being late is an addicting habit and you need to break it early. No nurse wants to get home late – keep that in mind when receiving the nurse from the previous shift.

13. Learn to be assertive. You must be always confident with what you are doing even if you have little idea about it. How can the patient trust you if you are not confident?

14. Avoid being involved in workplace gossips. It will do nothing good to your career as a nurse.

15. Get some sleep whenever possible. Inefficiency at work happens when there is lack of sleep. You are also more prone to medical errors when you don’t have enough rest.

16. Never leave a room saying that you will be back in a minute. That minute might never come as you can’t predict when you will be busy.

17. If you are unfamiliar with the drug you are about to give, always take time to look it up. The patient has the right to know about the drug he/she will receive so you should be armed with the correct information and the precautions to take.

18. Keep in mind that a good conversation is better than medicine.

19. No one has the right to make you feel incompetent unless you allow them to. Whether you are a new graduate or a veteran nurse with 20 years of experience, there is no reason for someone to make you feel incompetent.

20. Make your statement short and precise when calling a doctor in the middle of the night. These doctors are usually sleepy and you will need to relay your concern straight-to-the-point so they can quickly…(read the rest here)

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15 Reasons to Date a Nurse

Here is a cute article about why you should date a nurse from EHarmony.  I thought something light and fun was called for because we take ourselves too seriously.

So please read and enjoy!


15 Reasons to Date a Nurse

Your crush is a nurse. We say stop nursing that crush — pardon the pun — and ask him/her out!



Here are 15 reasons to date a nurse:

1. Nurses are compassionate and patient, and are often great listeners.

2. Nurses are super-smart. If you’re into both brains and beauty, your date can deliver.

3. Tired of nursing that hangover? Let an actual nurse work his/her feel-better magic.

4. Nurses have seen bodies of all shapes and sizes — and witnessed every kind of bodily function imaginable. Your insecurities and body quirks will likely leave your date unfazed.

5. No waiting in line. You’ll get a quick diagnosis every time you feel under the weather.

6. The uniform. It’s not just sexy on Halloween. (Translation: those scrubs just look so cute and comfy.)

7. Impressive nerves. Nurses remain calm and collected in pretty stressful situations. You want to be dating a nurse in times of emergency and chaos.

8. Nurses work long hours. So if you want a little alone time, a nurse’s crazy schedule might suit you just fine. (Also, with odd hours come odd date times.  Monday afternoon might become the new Friday night.)

9. Nurses make great future parents. No pressure or anything.

10. You’ll be safe. Date a nurse and you’ve got instant access to CPR, safety advice and

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Nurses Say Stress Interferes With Caring For Their Patients

Here is an article from NPR about how stress interferes with patient care.  It also addresses the nurse’s desire to provide ethical care to the patient.  This is a dilemma that all nurses face at one time or another and so far there is no solution.

As long as administrators view nurses as interchangeable and a drain on their budgets, this problem will continue.  Doctors and nurses both have little say in hospital policies in most cases.

It seems sad to me when a nurse must be trained to deal with moral distress.  Why do we have to have the distress in the first place. Please read this article and see what you think about the points brought up by this author.


Nurses Say Stress Interferes With Caring For Their Patients

April 15, 2016    5:00 AM ET


Jordin Purcell-Riess has worked as a registered nurse at the emergency department at St. Francis Hospital in Hartford, Conn., for three years. She describes her workplace as phones going off, voices everywhere, every room full. “You look around and the hallways are full of patients on stretchers; you walk out to the waiting room and you can see on our board that there’s 15 people signing in,” she says. “The second you can get your ICU patient upstairs, there’s another one waiting for you.”

She typically doesn’t get a chance to eat or drink or go to the bathroom during her 12-hour shift, Purcell-Riess says. And she’s not alone. Her nursing manager points out that a 2007 study in the American Journal of Respiratory and Critical Care Medicinefound that 24 percent of ICU nurses and 14 percent of general nurses tested positive for symptoms of post-traumatic stress disorder.

Nursing has long been considered one of the most stressful professions, according to a review of research by the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention in 2012. Nurses and researchers say it comes down to organizational problems in hospitals worldwide. That includes cuts in staffing; some California nurses struck last month for a week over low staffing and wages.

But some researchers say that just hiring more people won’t fix things. Other proposed solutions include restructuring hospitals so that administrators pay more attention to what nurses have to say about patient care and work flow, and training programs to help nurses relieve their stress and deal with ethical dilemmas.

Theresa Brown is a clinical nurse in Pittsburgh who has written two books about what it’s like to be a nurse. She says nurses are often stretched to the limit.

“A friend said when she started working as a nurse, when she would drive, she would vomit on the way in to work just because of the incredible level of stress,” Brown says.

“One of the senior nurses said there is no place we can go to just be alone and be in a quiet room for five or 10 minutes, except for the bathroom … you could have a patient get really really sick, you could have a patient die, and there’s no break,” she says.

She adds that whenever hospitals start adding new forms of documentation or electronic health records, that work is often given to the nurses so their workload just gets larger. “It shouldn’t be this way, but the patient demands are the ones that can get put off.”

It’s not just a problem in the U.S., either. A recent study in Hong Kong found nurses to be at much higher risk for stress, depression and anxiety compared to the general population. The Guardian reported last January that the number of nurses in the U.K. taking time off due to stress has soared — 1 in 29 are off because of stress. The problem is that most hospitals aren’t organized to support nurses, or even doctors, says Linda Aiken. She is a professor of nursing and sociology at the University of Pennsylvania. “They’re highly bureaucratic, they’re very top-down organizations, they don’t really seek out clinicians’ solutions for solving problems in patient care,” Aiken says. “Therefore the problems exist over decades, and they’re basically not solvable by any individual nurse.”

If the work environment at a particular hospital is bad, just adding more nurses won’t address the problem, Aiken says. As an example of what hospitals…(read more here)

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Doctoring, Without the Doctor

Here is a great article in the NY Times about the struggle Advanced Practice Nurses have waged to be allowed to go where no doctor wants to go–rural America.  These specialized nurses have gotten additional education to enable them to work independently in remote areas.

Since the very beginning of the idea of APN’s, the AMA has been up in arms about nurses who want to be doctors!  They are missing the real point.  Nurses will never aspire to become doctors, period.  They just want to take better care of those patients that need them.  They are willing to go into the rural areas to see patients that would otherwise never receive any medical care.  Doctors don’t want to do that because there isn’t enough money in it.

Whether you agree or disagree with the use of advanced practice nurses, please read this entire article so you will be better prepared the next time you are asked your opinion.

Doctoring, Without the Doctor

It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.

“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”

But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.

“I was like, ‘Oh, my gosh, this is such a wonderful victory,’” said Ms. Osburn, who was delivering a calf when she got the news in a text message…(read the rest of the article here)

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