See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:
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Summary: As the elderly population continues to increase, more and more families are faced with the decision to place loved ones in nursing homes. When a family member is placed in a facility, a certain standard of care is expected. In this case, a resident was injured repeatedly while under their care. When the patient died a few days after being "dropped" the family sued.
The patient was a 95 year old woman who was placed in a Missouri nursing home when the family was no longer able to care for her needs.
"Approximately 1.5 million people live in the nation's 17,000 nursing care facilities. . .The typical nursing home resident is a woman in her 80s displaying a mild form of memory loss and dementia. Although physically healthy for a woman her age, she needs help with approximately 4 of 5 activities of daily living (eating, transferring, toiletting, dressing, and bathing)."2
During her admission the patient would sustain multiple injuries over the course of her stay. In 1993, on two occasions, the patient's legs were broken with fractures diagnosed. Each time the patient was transferred to the hospital for treatment and then returned to the nursing home.
Each time the documentation would show that the family had been "made aware." This was reflected in incident reports that had been filed. The incident reports did not specify which family members had been notified.
A third injury took place in 1995 when the patient was being transferred from her bed. Documentation of the incident stated that the patient had been "dropped" during a transfer. The charted notes documented that a head injury was sustained and that family members were notified.
The patient was again transferred to the hospital and was evaluated in the Emergency Department. Interestingly, when examined by a physician, the day after the incident, the physician stated that there was no evidence of head injury. Five days following this examination, the patient died.
The family would sue the nursing home. They would allege that standards of care had not been met. They would accuse the nursing home of rendering negligent care.
It is no secret that nursing home abuse occurs. It can take many different forms and have devastating consequences on residents and their families.
"The United States Department of Health and Human Services researchers identified seven categories of abuse. Ninety-five percent of those surveyed said they felt that all seven are problems for nursing home residents:
Physical abuse --infliction of physical pain or injury.
Misuse of restraints --chemical or physical control of a resident beyond physician's order or outside accepted medical practice.
Verbal/emotional abuse --infliction of mental or emotional suffering.
Physical neglect --disregard for the necessities of daily living.
Medical neglect --lack of care for existing medical problems.
Verbal/emotional neglect --creating situations harmful to the resident's self-esteem.
Personal property abuse --illegal or improper use of a resident's property for personal gain."3
The basis of the family's lawsuit centered on the assumption that a certain standard of care, and a "duty" is owed to nursing home residents. This duty it was assumed, included safe living conditions, freedom from harm and timely medical treatment. They alleged that these standards had not been observed by the nursing home.
In the initial trial, a review of the charting and documentation showed that in each "incident," facility protocols had been followed. Upon discovery of the injuries, medical treatment and family notification had been provided.
The Defense moved to have the charges dismissed. The court agreed.
The family appealed.
Questions to be answered.
1. Was there clear evidence of either neglect or abuse on the part of the nursing home staff in either of the three documented incidents of injury?
2. Had standards of care been met in regard to treating an injured patient and providing safe and reasonable care.
Chiefly due to the timely documentation of the incidents, the records were used to demonstrate adequate care being given.
The family's lawsuit chiefly targeted the "handling" of the incidents rather than the "cause" of injury. The documented interventions and notifications on the part of the nursing staff provided sufficient proof that standards were upheld.
It is common knowledge that documented nurses' notes and the medical chart are legal records. They should be written and treated at all times as if a jury will later examine them.
Had the incident not been documented as thoroughly or had incident reports not been filled out, it might have been a different story. It was the clear and concise charting of the nursing homes staff's handling of the incidents that saved the facility from a potentially costly lawsuit and trial.
This was particularly evident when the family accused the nursing home staff of "failure to notify" the family members. As long as efforts were documented in the notes to notify the family, the facility was covered.
It is a bit strange that the specifics as to "who" was notified was not included in the chart. Under a different set of opinions, this could easily be interpreted as a "red flag." In this case it was not.
This documentation of "notification" could have been seen as the nursing home staff charting to cover themselves regardless of whether a family member had been contacted.
To minimize suspicions of impropriety it is suggested that when a family member is contacted, the name and phone number also be documented. All evidence is subject to interpretation. This can be applied to physician notification as well.
When a patient has an attending, consulting physicians and residents responsible for their care, "MD made aware" leaves much room for debate as to who was notified. If the name of the physician is noted, the guesswork is removed and accountability easier to establish.
What was not addressed in this case was the nature of the "accidental" injuries. It is not difficult to imagine a 95-year-old patient falling as she tries to get out of bed. It is common for patients to fall on their way to or from the bathroom. The pertinent question is "could the injuries have been avoided."
It is clear from published studies that indeed many can be.
""We found that neither complaint investigations nor enforcement practices are being used effectively to assure adequate care for Nursing Homes residents and the prevention of nursing home abuse and neglect. As a result, allegations or incidents of serious problems, such as inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide appropriate care, often go uninvestigated and uncorrected."4
Lawsuits against nursing homes are common and on the rise. If you are working in a nursing home, you need to be aware that you are responsible for documenting adequate care. You are equally responsible for prevention. If a dangerous condition or "accident waiting to happen" is identified, steps must be taken and documented to correct it.
If a patient is at risk for falling they may refuse to call for assistance. If they try to get out of bed anyway, it should be documented that the patient was instructed to "call for assistance," and did not.
If a patient is clearly a danger to himself or herself and others, restraints may be indicated. The family or the physician may refuse to allow or write an order for them. The nurse must document that the need for them was communicated, to whom and the response.
Even with adequate care being given accidents can happen with legal consequences. Nursing homes are currently the focus of intense governmental supervision and regulation. The effectiveness of the regulation is debatable. There are many that feel that the only "solution" to correcting problems are legal actions against nursing homes.
If this approach is to be paralleled to eliminating medical malpractice, a solution may be a long way off. What can be anticipated is increased pressure from the government, from consumers and the courts. This will result in increased litigation and increased pressure on nursing home staff and facilities. Each member of the nursing staff would be wise to document carefully daily care and especially incidents that result in injury.
Related Case Studies:
June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htmJune 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Gordon v. Lewiston Hospital, 714 A.2d 539 - PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htmMay 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)
http://www.nursefriendly.com/nursing/clinical.cases/053099.htmRelated Link Sections:
Abuse:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htmClinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htmEmergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.htmlEthics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htmHead Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htmMechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htmNursing Homes, Long Term Care Links:
http://www.nursefriendly.com/nursing/nursing.homes.long.term.care.htm
Sources:
1. 40 RRNL 1 (June 1999)
2. American Health Care Association. September 1998. Profile: Nursing Facility Resident: Retrieved June 27, 1999 from the World Wide Web: http://www.ahca.org/secure/nfres.htm
3. Seniors-Site. No date given. Nursing Home Abuses to Senior Citizens. Retrieved June 27, 1999 from the World Wide Web: http://seniors-site.com/nursing/abuses.html
4. United States Senate. March '99. Excerpts from Committee On Aging Hearings. Retrieved June 27, 1999 from the World Wide Web: http://www.jeffdanger.com/
The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursefriendly.com/nursing/clinical.cases/062799.htmSend comments and mail to Andrew Lopez, RN Created on Saturday May 23, 1999
Last updated by Andrew Lopez, RN on Saturday, September 17, 2011
Tuesday, December 6, 2011
Elderly Patient Repeatedly Injured In Nursing Home "Accidents." Negligence, Coincidence or Abuse? #nursefriendly #nursecasestudy #elderly #geriatrics
Monday, November 28, 2011
About Registered Nurses & Nursing on: The Nurse Friendly
See also: What Attracted You To The Field of Nursing (From Nurse Interviews).
New:
Top 10 Qualities of a Great Nurse, NursingLink.com:"Nurses are pretty amazing. Great nurses aren’t just compassionate and kind — they have all the medical smarts of a doctor too! Plus, a career as a nurse offers a sense of personal satisfaction that you just can’t beat."
http://nursinglink.monster.com/benefits/articles/5019-top-10-qualities-of-a-great-nurse
Categories:
Advanced Practice Nurses (APNs), http://www.4nursing.com/apn
Licensed Practical Nurses (LPNs), Licensed Vocational Nurses (LVNs),
http://www.nursefriendly.com/lpn
Male Nurses, Men In Nursing,
http://www.nursefriendly.com/male/
Nursing Profession, About The, http://www.nursefriendly.com/profession
Registered Nurses (RNs)http://www.nursefriendly.com/rn/
Traits & Qualities That Make Nurses Excellent Entrepreneurs, http://www.nursingentrepreneurs.com/qualities
Traveling Nurses, Travel Nursing Agencies,
http://www.4travelnursing.com
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Restructuring, Work Redesign, and the Job and Career Security of Registered Nurses, Position Statement, American Nurses Association (ANA):"The American Nurses Association (ANA) is committed to safeguarding the public, protecting and advancing the careers of professional nurses, supporting individual and collective efforts by registered nurses to protect their clients and enhancing the professional development and job security of registered nurses."
American Nurses Association
600 Maryland Avenue, SW
Suite 100 West
Washington, DC 20024-2571
1-800-274-4ANA, webmaster@ana.org
http://www.ncbi.nlm.nih.gov/pubmed/8716169
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The Right to Accept or Reject an Assignment, American Nurses Association:"The American Nurses Association (ANA) believes that nurses should reject any assignment that puts patients or themselves in serious, immediate jeopardy. ANA supports the nurses obligation to reject an assignment in these situations even where there is not a specific legal protection for rejecting such an assignment."
American Nurses Association
600 Maryland Avenue, SW
Suite 100 West
Washington, DC 20024-2571
1-800-274-4ANA, webmaster@ana.org
http://www.nursingworld.org/readroom/position/workplac/wkassign.htm
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More Registered Nurses Working Part-Time and in Community-Based Care, Canadian Institute for Health Information (CIHI): 1997 Figures, "(Ottawa) - The Canadian Institute for Health Information (CIHI), the Canadian Nurses Association (CNA) and Statistics Canada jointly released figures today on the supply and distribution of registered nurses for 1997."
http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/spending+and+health+workforce/workforce/nurses/cihi010673
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Nebraska Health and Human Services System:"A Consumer's Guide to Nursing. The practice of nursing is a process that occurs during interaction between the nurse and the patient. This process begins with a thorough assessment of the patient's health care needs. The nurse assesses the patient's needs by interviewing the patient and the family to determine health history and current health status, by physically examining the patient, and by reviewing the patient's record including the results of diagnostic tests."
http://www.hhs.state.ne.us/crl/NrsgBro.htm
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Nursing: A Medical Emergency, and Opportunity, hits home by Ronald A. Reis and Karen F. Reis RN:"You’re an RN, and you’ve been at it, administering to the sick and wounded, for months, years, maybe even decades. You’ve got your hands full with 12-hour shifts, high turnover, an often less than supportive work environment, and a stressed-out health care system that is, in places, itself on life-support. What to do? How to keep going? How to make this job, career, meaningful again? How to get out of nursing what you went into it for? How to avoid adding to the national nursing shortage by short-circuiting your own involvement in a noble profession?"
Working Nurse, Working World Magazine
3600 Wilshire Blvd., Suite 1526
Los Angeles, CA 90010
Tel:(213)385-4781,
Fax:(213)385-3782, WorkingNurse@WorkingWorld.com
http://www.workingworld.com/magazine/viewarticle.asp?articleno=253&w
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Registered Nurses, Occupational Outlook Handbook Home Page:"Registered nurses (R.N.'s) work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. When providing direct patient care, they observe, assess, and record symptoms, reactions, and progress; assist physicians during treatments and examinations; administer medications; and assist in convalescence and rehabilitation."
http://stats.bls.gov/oco/ocos083.htm
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Real Vermont Nurse Stories, Nursing Quiz:"Quick Quiz. Take this quick quiz to test your knowledge and see what you know about being a nurse."
Office of Nursing Workforce Research, Planning and Development
School of Nursing, University of Vermont
Burlington, VT 05405, phone 802-656-0023
http://www.choosenursingvermont.org/becoming/quiz.php
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RNstudent.com:"RN schools have one thing in common: they are difficult to complete! Imagine the amount of nursing information you must learn to earn the RN degree you desire. it will become your life. Luckily there are many online nursing resources that will help you digest and understand the information taught by those nurses turned instructors. The problem is that this information can be hard to find because of the enormous amount of nursing web sites available. That's why we make RN school easier by pulling together the best nursing student resources into a convenient location. Here you will find original content as well as excellent links to other sites that will help you on your way to becoming a registered nurse."
tthomp5@columbus.rr.com
http://www.rnstudents.com/
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Today's Registered Nurse —
Numbers and Demographics, American Nurses Association (ANA):"Registered nurses (RNs) are the largest segment of the health care work force. 2,239,816 people living in the United States are educated and licensed to practice as RNs, and 1,853,024 are employed RNs. RNs come from every socio-economic class, every state, and every neighborhood in America. This diversity grants them a special understanding of the people for whom they care. What follows is a statistical portrait of today's RN, compiled from The Registered Nurse Population, Findings from the National Sample Survey of Registered Nurses, March 1992, U.S. Department of Health & Human Services, Public Health Service, Health Resources and Services Administration."
American Nurses Association
600 Maryland Avenue, SW
Suite 100 West
Washington, DC 20024-2571
1-800-274-4ANA, webmaster@ana.org
http://www.nursingworld.org/readroom/fsdemogr.htm
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Determination of Death By Registered Nurse (Alaska), AS 08.68.395. :
http://www.touchngo.com/lglcntr/akstats/Statutes/Title08/Chapter68/Section395.htm
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RN Gifts, CafePress.com:"CafePress is for people who love sharing their passions with others. You'll find individual designers with shops of all sizes, as well as corporate stores like Snoopy, E! Online, Stand Up To Cancer and more. With no upfront costs or inventory risk (we also take care of those thorny details of doing business online, so you can concentrate on sharing what's important to you), CafePress designers use their shops to connect with a world of members and other online shoppers. All while taking advantage of the latest developments in on-demand printing."
CafePress.com
1850 Gateway Drive, Suite 300
San Mateo, California 94404
Phone: 650-655-3000
Toll Free: 877-809-1659
Fax: 650-655-3008
Email: info@cafepress.com
http://www.cafepress.com/+rn_symbol_long_sleeve_dark_tshirt,184267863
Categories: California Nurses, California Nurse Entrepreneurs, Nursing Gifts/, Nursing Scrubs, Uniforms, Registered Nurses (RNs)
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See Also:
UsJobBoard.com: UsJobBoard.com, a career industry leader in online employment tools. Everyone needs a job at some point in their life! If you're a JobSeeker looking to make a career move or just wanting to "see what's out there" we invite you: POST YOUR RESUME for FREE to our resume database. Or, PERUSE the JOB LISTINGS from some of America's Top Employers and Recruitment Firms. When you're done there, we invite you to check out some of our great Career Resources in the USJobBoard.com Resource Center.
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http://www.nursefriendly.com/rn/
Saturday, November 26, 2011
Nursing, Not For Everyone, Not For Most People, by Andrew Lopez, RN, Nurses Views of The Nursing Profession
Pros
Ultimately Fulfilling, Satisfying, Above Average Pay, Experience Opens up multiple career options (Travel Nursing, etc)
Cons
Backbreaking Work, Expect To Work Shortstaffed, Expect To Be Unappreciated By Employers
The Bottom Line
Nursing is no longer an attractive profession for young women to go into.
Updated 07/29/05:
This review has come under a lot of fire since I first published it. It's sole purpose is to shed light on the darker side of the Nursing Profession. The side and the details you won't hear about working as a nurse from Nursing Schools, Guidance Counselors or most nurses themselves (they're only too aware that a shortage of nurses makes their jobs much harder to do).
It's a difficult article to write knowing it will potentially turn people off to nursing, or persuade them to choose another career path.
For all the talk of a nursing shortage, little is said about the fact that many licensed nurses are no longer practicing. The toxic conditions on the floors have driven them out, literally. If every licensed nurse was working, we'd have plenty of nurses and there would be no shortage. Instead, more nurses are working less or quitting completely.
A common concern among nurses is "Who will take care of us, when we get sick." It's a valid one considering how many nurses are leaving the floors.
I feel it's important and necessary that all sides of the issue be explored. I've no intention of leaving the nursing profession, don't feel I'm burned out. I do intend to open your eyes so you'll know full and well what you're in for.
It's a fact that nursing students on graduation are deciding to leave the profession after only a few months on the job. The abuse they get is simply too much. Imagine after getting through nursing school, only to find it was "much harder" than you imagined to work in Nursing.
It's a fact that seasoned nurses are leaving the floors, burning out, retiring early, and still eating their young.
It's a fact that nurses are badly needed and will offer stable job opportunities for the next two to three decades if you can hack it.
Having said that, please read on:
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Nurses are Licensed Professionals who's practice is regulated by Nurse Practice Acts, and the State Board of Nursing of each State.
Nursing is a profession of caring. The actual practice of Nursing is about something entirely different.
Nursing is no longer an attractive profession for young women (historically the largest segment of the population entering Nursing) to go into. It is having difficulty competing with corporate and other service industries that offer better working conditions, higher pay, no weekends/holidays, more prestige and much less stress.
It's a given that as a nurse, you're on a daily basis exposed to hostile families and patients, deadly diseases, abuse from doctors, families and other nurses.
This is unfortunate when a simple fact is true. When Nursing Staff in hospitals and Nursing homes are not adequate, patients get sicker and your family members die needlessly. The worse our working conditions get, the less time we'll spend on the floors, the less nurses there will be to care for you and your family members.
Paying Nursing salaries makes up one of the single largest "line items" in a hospital's budget. It is an item they cannot do without. Without nurses, hospitals shut down. Period, end of story. Entire hospital units are shut down, surgeries are delayed, Emergency Departments are put on "Divert" when Nurses cannot be found to work.
Why then, are nurses clearly expendable in the eyes of those that employ them? It feels like we're resources to be used and abused till we're no longer able to work. At that point, we're simply tossed into the trash and forgotten. Once a nurse becomes disabled due to back injury (the most common injury due to lifting/moving patients (often without help)), age or illness, their bedside Nursing career is over.
A lucky few may be able to transfer their nursing skills to Case Management, Legal Nurse Consulting, Managed Care and related fields.
It's a profession that's long since been twisted and manipulated to the financial needs of insurance companies, managed care and hospital administrators looking to milk and stretch and get the maximum amount of return from nurses for the least bit of pay.
I've been a nurse for over four years and worked in a variety of settings. My initial training was on a Medical/Surgical/Telemetry floor caring for acutely ill patients with a generous dose of patients in for Cardiac concerns. Since moving on from that environment, I've done Home Health, Nursing Home and continue to do Hospital Nursing through agencies.
Regardless of the facility or type of environment, the same concerns are clearly visible.
Too many patients, too little Nursing time to give them the care they need.
Insurance companies simply don't care that a patient may be too ill to go home, they're only concerned with the cost to keep them in the hospital.
Nurses are burning out from overwork and there is no one to take their place or give them relief. Nursing is a 24 hour, round the clock obligation, someone has to be looking after the patients.
This has two effects on the two types of Nurses most likely to enter the profession.
1. Those who enter the field because they love the work and caring for people. These often are family members who have seen the care that was given to their loved ones and want to provide the same type of care to others, they inevitably burn out:
* These nurses are frustrated by their inability to give their patients the care they deserve.
* They see their sick patients going home before they are fully recovered (insurance companies will only pay for so many days). It is usually very clear to nurses which patients will be returning for exactly the same ailment due to their early release.
* They are often given more patients to care for than they can safely handle and asked to work extra shifts and overtime despite already being tired and having family obligations.
* They do not have time to "teach" the patients they are discharging (or family members) how to care for themselves at home. Many problems could be alleviated or minimized with proper patient teaching of warning signs or medication usage. However, time for teaching is not factored into our patient loads.
* Realizing the futility of their situation, these nurses may do the minimum needed to get through a shift. In the end, it's the patient that suffers.
2. Those who enter Nursing because it's lucrative and in most places high paying, they often burn out, leave or move on:
* These nurses often become overwhelmed by the amount of work that' involved in providing adequate patient care. It's a profession that requires you to "get your hands dirty." A good comparison for nursing is plumbing. It's a trade that pays well and requires hard labor and skills. It also requires you to kneel down and reach into places that the average person would balk at.
* They see Nursing as a career "stepping stone" that will open doors to bigger and better opportunities (Nursing does this quite well as you can go far with Acute Care Nursing Experience behind you). In the meantime, knowing that they'll be leaving eventually, they do not do their best or put forth 100 percent (110 percent is required these days) in caring for their patients.
* It may come as a surprise to some after graduating Nursing school that they'll "actually have to touch" patients and do direct care. This is especially true of nurses who go through BSN programs hoping to go straight to administrative positions with at best a minimum of bedside skills. These nurses may do the minimum needed to get through a shift. In the end, it's the patient that suffers.
It's frightening to think of how little time nurses have to spend with their patients assessing their illnesses and providing direct care.
A common slogan among nurses when it comes to patients is "Do you want to talk to the Doctor in charge, or the Nurse who knows what's going on?
A physician, if their lucky, might spend a max of 10 minutes per day per patient in a hospital. They are also "stretched out" by managed care companies that overload them with patients to care for.
Nurses do slightly better at 10 to 15 minutes per day, the difference is we're there on the floors with the patients, passing medications and looking in, in case anything does go wrong.
Nurses are responsible for the 24 hour/day monitoring of patients in hospitals. It's our charge to keep the doctor informed when patients are going downhill or have complications. When a patient is going bad, we are the first to know, not the physician. It is the nurse that must call the physician, inform him/her of the patient's condition and carry out any orders or treatments.
In short, a hospital cannot function without adequate Nursing staff. To do so means compromising the quality of care patients receive. Many hospitals will deny this fact and flatly refuse to consider Nursing concerns when we raise them about our inability to provide safe care with the resources a facility provides.
As a result, nurses are leaving the bedside in droves. Those that are left, must deal with staffing shortages that mean working extra hours (many hospitals have instituted Mandatory Overtime policies that required already tired Nurses to stay unexpectedly when call outs occur) when it is not safe for them to work and to ignore family, childcare and safety concerns.
Will I stay in the profession? Yes, I went into it because I enjoy giving patient care and know it means the world to the patients safety and well being.
Would I recommend it to others considering the profession? Depends on why they are going into it and how well informed they are about the work.
Typically I recommend that a student work as a Nursing Assistant in either a hospital or Nursing home before considering Nursing School.
This will give them a firsthand look at what Nursing entails and how nurses and the staff in Hospitals and Nursing Homes interact. It is often not a pretty picture.
After seeing things firsthand, many quickly change their mind about going into the profession.
Sincerely,
Andrew Lopez, RN
In this section, you can hear from Registered Nurses, Licensed Practical Nurses, etc, new and old on why they would or would not recommend going into Nursing as a career. Our articles are frank, uncensored and brutally honest. We hope they'll help you make your decision if you're unsure about nursing being for you.
It is not our intent to "scare you off" from Nursing, some of our reviews are quite positive. It is our intention to help you go into Nursing with "open eyes" and aware of what you can reasonably expect as students and entry-level nurses.
See also:
Licensed Practical Nurses,
http://www.nursefriendly.com/lpn
Registered Nurses, http://www.nursefriendly.com/rn/
To Stay In Nursing or Not:
http://www.nursingdiscussions.com/stay
Nursing, Not For Everyone, Not For Most People by Andrew Lopez, RN
Nurses are Licensed Professionals who's practice is regulated by Nurse Practice Acts, and the State Board of Nursing of each State. Nursing is a ...
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The Beauty of Nursing by Rebekah Hinton, BSN, RN, Virginia Nurses Views of The Nursing Profession:"I have been a caretaker for as long as I can remember. I am the oldest of four daughters and have always been a second Mother to my siblings. Going into nursing seemed to be a logical choice for me. As a student I was eager to learn and worked very hard to get the best education possible. I entered into a Bachelor of Science in nursing program without knowing the difference between a RN program and a BSN program."
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Nursing: How Do I Find Out If It's For Me? by Angela Eichenlaub, RN, BSN:"The face of nursing has changed" or "Nursing is not what it used to be" are phrases I often hear from seasoned staff. I wish I knew what nursing "used to be" so I could compare! My own personal advice to anyone considering a career in nursing is to take your reason for entering the profession into account. Some go into nursing for money, some because they have always wanted to and some people go into nursing because they don't know what else to do."
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To Be Or Not To Be, by Sharon Jones, RN, Ohio Nurses Views of The Nursing Profession:"To Be…Or Not To Be… was never the question for me. I had always been a caretaker of sorts even at a very young age. The decision to return to work was based more on a career that I could relate to and be employed at. To be it was… and I started school at a local college for a Registered Nurse program. Almost two years into school, all my pre- req. courses completed and a waiting list to get into the nursing classes (a very unbelievable thing looking back- too many students- many had to wait) forced me to change course of action that lead to LPN school."
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Twenty Years of Nursing by James E. Meekins, North Carolina Nursing Views:"Thirty years ago I walked into the Navy recruiters office; laid off, without a real skill and signed up to be a Navy Hospital Corpsman (medic). I learned basic patient care---and basic first aid; and learned to work under the direction of a physician or nurse. I enjoyed what I did, the pride of being part of a team; accomplishment of a common goal, first aid in the field with Marines, or care of a patient in the hospital. . . ."
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Nursing: Pros and Cons by Christy Picton, RN, BSN, Illinois Nurses' Views of The Nursing Profession:"I struggle when asked whether I would recommend the nursing profession as a career. In the end it comes to down to a weighing of the pros and cons. Let me begin by introducing you to some of my patients, my "pros" so to speak. . . . "
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"One of The Lucky Ones" by Christine Cruz, Minnesota Nurses Views of The Nursing Profession:"My name is Chris. I have been an RN for ten-years. I have worked in a wide variety of nursing settings, from home care, long-term care to telephone triage, clinics and nursing management. Upon graduation from nursing school in, May, 1993, I had eagerly anticipated a new RN position at a local hospital, in one of its med-surgical units. . . ."
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You Want to Be a Nurse? -- Better Leave Your Heart Behind by Pennye Diane Morgan Shaw R.N., Texas Nurses Views of the Nursing Profession:"So you're thinking about being a nurse? You probably are a person who wants to make a difference, to help others, to be a compassionate healer. Are these are the same reasons I entered the nursing profession about 9 years ago. I had been through the emotional experience of watching my father being diagnosed with colon cancer. I had been by his side though radiation therapy, and though surgery and recovery. I watched as he struggled to cope with the drastic changes to his body as he tried to return to a normal life. . . . "
******************************************************
My Advice for New and Potential Nurses, by Pam Lowry, Illinois Nurses Views of the Nursing Profession:"According to the American Association of Colleges of Nursing (AACN), "The United States is in the midst of a nursing shortage that is projected to intensify as baby boomers age and the need for health care grows." They also state enrollments in nursing colleges are at a six-year decline. According to JAMA there will be a shortage of 400,000 nurses in the U.S. by the year 2020. AACN goes on to state there are declines in nursing faculty leading to limitations on enrollment, the population of R.N.'s is the lowest it has been in 20 years, and vacancy rates at hospitals are high. . . "
******************************************************
An Insight Into Nursing by Leah Stockdale, R.N., B.S.N. Maryland Nurses Views of the Nursing Profession:"Although I am extremely proud of being a nurse, I will have to say that I am not sure if I would choose the profession if I could go back. At the same time, I probably would not choose any career in the health care industry. In my opinion, as far as hospital nursing is concerned, the negatives outweigh the positives. That is why I am currently in the process of applying my nursing skills and education to another field. . . "
******************************************************
A Letter To A Future Nurse by Kristina Rzanca, LPN, Michigan Nurses Views:"Being a Nurse is a career you can be spiritually, emotionally and financially satisfied with. In this day and age this is a unique opportunity, but it is not for everyone. A special person with qualities such as empathy, compassion, intelligence and above all patience should only apply. . . . "
******************************************************
To Be A Nurse Takes A Special Kind Of Person By Vicky Oliver, LPN:"As an LPN for the last ten years I believe I could give some insight on my experience as a nurse. I am the type of person who is always doing something for others instead of me. My experiences in nursing consist of Medical Surgical, Doctors' Office, Emergency Room, Surgery, GI Lab, Urology, Utilization Review, Recovery Room, and the Nursing Home. Anyone that goes into the nursing profession needs to be a very caring person, someone who wants to give to others and someone that is very dedicated. . . "
******************************************************
After Fourteen Years As An RN, I Am Not Sorry For My Choice By Lynn Kash, RN:"Would I recommend the nursing profession? That is a good question that requires a lot of thought. Nursing was not my first choice of careers. I studied accounting in college, and after working in the business world, decided it was not for me. I fell into a job as a nursing assistant and found patient care to my liking. I then started nursing school and the rest is history. . . .
******************************************************
A New York BSN's Point of View, By Melina Begun, BSN, RN, Clinical Administrative Liaison Nurse:"Nursing is suffering. Thousands of caring people enter into this profession every year only to become disillusioned by its reality. When I first started to study nursing, I immediately felt a connection with its history and our potential to be leaders in the medical community. Excited by all of the knowledge and skills I acquired in my Ivy league nursing program, I was astonished by the harsh reality of nursing in today's hospitals when I started working as a staff nurse. . .
******************************************************
Tips To A Good Start In The Nursing Profession by Diane Hartley:"My name is Diane and I have been in the nursing profession for 12 years. In those years I have seen very many changes with this profession. One of the first changes was in DRG's. This for those of you who do not know what they are is diagnosis related groups. . . "
******************************************************
See Also: Certified Nursing Assistants, CNAs, Certified Registered Nurse Anesthetists, Disabled Nurses, Male Nurses, Men In Nursing, Legal Nurse Consultants, Licensed Practical/Vocational Nurses (LPNs/LVNs), Registered Nurses
Nurses Views Recommending The Profession,
Nurses views Not Recommending The Profession.
Male Gender Bias - Entrance to No Mans Land by Nurseman
Are you a male and thinking about entering the world of nursing? Have you ever wondered why they're so few men in nursing? If you are young, single ...
-
Gender Bias Against Male Nurses:
http://www.nursingdiscussions.com/gender
******************************************************
-
Do I want My Daughter to be a Nurse by
Raye
I am not sure why I became a nurse. I enjoy the smile on the face of someone I have helped. I worked Emergency and got quick fixes and instant ...
******************************************************
Is your life worth the BIG BUCKS?
by SurgRN911
Why are patients and families feeling they are getting less attention, and sometimes less than adequate care in a hospital setting? I wrote an ...
******************************************************
It's not all bad!
by LauraRN
Wow.. a chance to give my opinion on nursing.. here goes.. :) When I was in college, I thought I wanted to be a math teacher. As I got higher in ...
******************************************************
Requirement: Have an off-beat sense of humor by clooneyfan A review by of my favorite writers (SurgRN911) about the nursing profession prompted me to write my own review. You can read her original review at ...
******************************************************
Nursing Is In My Blood!
by Dunkjam
When I was a little girl I always thought that I would be a singer and marry Paul Anka! I thought I would live a glamorous life and travel around the ...
******************************************************
Where Are Our Leaders? by Moonflowerck
I have been an R.N. for 28 years. My range of experience encompasses nearly all aspects of critical care and pediatrics. I am a bedside nurse; that is my forte. I give quality nursing care; I am a good teacher; I am empathetic and intuitive. However, I am not a leader. My experiences in various leadership roles during my career were neither fulfilling nor very productive.
******************************************************
Nursing: Is It A Career For You? by
Bobstein
When I was faced with choosing a career I wasn't clear exactly what I wanted to do with my life. I enjoyed the sciences and helping people, and with high unemployment rates in the mid-1970's I chose to enter the nursing profession.
******************************************************
10 CONCEPTS TO CONSIDER WHEN DECIDING IF THE NURSING PROFESSION IS FOR YOU
by melissasrn
Pros: The opportunity to make a difference in someone's life; decent pay; flexible schedules.
Cons: Short staffing; floating requirements; little respect; dealing with bodily functions.
******************************************************
An LPN's Story of Progress by:
NJNurse
The Decision to Become A Nurse. When I was starting to decide on a career after high school I wanted to cry.
******************************************************
The Nursing Shortage: Reasons Nurses Are Leaving The Profession by Rebel5877
All across America, There are shortages of Registered Nurses (RN's) and Licensed Practical/Vocational Nurses (LPN's/LVN's), and Nurse's Aides entering ...
******************************************************
Response to NJ's work in progress
by jt1013
There is a shortage of nurses. That is a given. I have a large amount of respect for LPN's. My sister is one in Kentucky. She has been one for 32 ...
******************************************************
My Opinion of The Nursing Profession, by emsopinion
I have been a nurse for over twenty two years. In that time I have worked in many
different fields of medicine.
******************************************************
Feast or Famine
by lovepepsi
Pros: the feeling you get when you helps someone
Cons: short staffing, not being able to save everyone
******************************************************
See also:
"Burnout in my 5th year...another nursing statistic", Aboutmyjob.com:"I always knew I would end up in a helping profession. Nursing seemed like the perfect choice. It combined my natural curiosity about health and science with the giving, hands on, human interactions of bedside care. I also knew that nursing offers a great deal of flexability within the profession. You can change specialties, change shifts, and work in a variety of settings.
Before I decided to study nursing, I considered teaching,conservation and journalism. Prior to becoming an RN, I worked in recreation/parks, the foodservice industry, and held a factory/production type job.
I graduated a few years ago with my BS in Nursing. I certainly don't regret having gone that route, but to be honest I feel disenchanted with the health care environment and nursing in general.It certainly is nothing like what I thought it would be.The hospital setting is like a pressure cooker type of environment."
http://www.aboutmyjob.com/575/burnout-in-my-5th-yearanother-nursing-statistic/
"I am getting out of nursing to become a teacher", Aboutmyjob.com:"Hi. I made the decision to get out of the nursing profession about two years ago. I have been an RN for three years. I have floated in ER, ICU, Med/Surg and Labor and Delivery. In the back of my mind I always thought, "working conditions will get better with the more experience I have". I finally have come to the conclusion that my working conditions are not changing, in fact, are getting worse.
I come home every night with knots in my shoulders from the stress that I go through. I too get physically and mentally strained from being a nurse. Families are so insultive and expect things to happen ASAP. Do they not realize that I am running around with my head cut off trying to keep up with all the requests, duties, and paper work?"
http://www.aboutmyjob.com/601/i-am-getting-out-of-nursing-to-become-a-teacher/
"Unhappy in nursing profession too....10 year RN", Aboutmyjob.com:"I have been an RN for nearly 10 years now and I must agree with many of the others who wrote their stories. I always wanted to be a nurse, because I like people and thought I would really want to work helping them. But, the reality of the job is utterly overwhelming. I've tried long-term care,home health, dialysis nursing, physician office and now in-hospital on a Rehab unit. I have yet to really find anything I loved. We are almost always short-staffed both nurses and aides. We are being pulled to other floors now due to the shortage of nurses. I was pulled to a MICU and I've never done that type of nursing ever!! I was a nervous wreck, these patients were very high aquity, on tele, multiple lines etc. I received no orientation, just here are your 8 patients...go to it. It was nerve-wracking."
http://www.aboutmyjob.com/554/unhappy-in-nursing-profession-too10-year-rn/
Sharon Jones, RN, Ohio Nurses Views of The Nursing Profession
To Be…Or Not To Be… was never the question for me. I had always been a caretaker of sorts even at a very young age. The decision to return to work was based more on a career that I could relate to and be employed at. To be it was… and I started school at a local college for a Registered Nurse program. Almost two years into school, all my pre- req. courses completed and a waiting list to get into the nursing classes (a very unbelievable thing looking back- too many students- many had to wait) forced me to change course of action that lead to LPN school. I completed, under the supervision of very dedicated instructors, extensive training. I was instructed on patient evaluation and correct charting, bedside care and procedure, patient advocacy, and physician communication skills. Course completed recorded almost 1500 clinical hours in that one year. Experiences I would come to learn where not every course criteria. To be it continued…I after one year working at an acute care geriatric unit and then starting at a hospital inpatient rehab center I returned to complete a fast track program for L.P.N. to R.N.
To be I was…. and I enjoyed nursing. I trained both as a LPN and a RN at the inpatient hospital rehab working mostly on the head injury team and spinal cord team. I again was blessed with excellent nurses to guide me in my growth as a nurse. Later, I worked part time with hospice, worked on a cardiac step-down trauma floor (otherwise known as a dump floor), agency assignments to local hospitals and hospitals that included travel. Then I return to school to begin my BSN. It quickly became apparent the pace I keep was going to have to change.
Or not… With sad heart, I had seen changes in nursing in my short career that where not the best choice for patients, then became poor choices for nurses to have to make. I know that in nursing everyday is full of change. The team nurse mode to the independent module back to team nursing without the team. The added demands for nurses and the high standard of nursing care that was instilled in me, with the strong instilled patient advocacy voice, the stress of nursing and health problems forced my early retirement.
To have been… I could not replace the experiences of exceptional trainers, friends, patients and families. There were letters or cards of thanks from patients or families that made unnoticed or forgotten efforts worth it all. For the right to share with patients and families the worse broken hearted moments sometimes mixed with joy that allowed me to grow in knowledge of the human spirit can not be learned in books or schools.
To have not been… may have been without many challenges or victories. I would have maybe not know the shallow hearted people that are cruel in nature and chose nursing for some unknown reason but I think I would of have met some on another avenue. I also, would have not known some very dynamic caring people. I could have taken many different career roads in life that offered fewer branches but for me it was TO BE!
In this section, you can hear from Registered Nurses, Licensed Practical Nurses, etc, new and old on why they would or would not recommend going into Nursing as a career. Our articles are frank, uncensored and brutally honest. We hope they'll help you make your decision if you're unsure about nursing being for you.
It is not our intent to "scare you off" from Nursing, some of our reviews are quite positive. It is our intention to help you go into Nursing with "open eyes" and aware of what you can reasonably expect as students and entry-level nurses.
See also:
Licensed Practical Nurses,
http://www.nursefriendly.com/lpn
Registered Nurses, http://www.nursefriendly.com/rn/
To Stay In Nursing or Not:
http://www.nursingdiscussions.com/stay
Nursing, Not For Everyone, Not For Most People by Andrew Lopez, RN
Nurses are Licensed Professionals who's practice is regulated by Nurse Practice Acts, and the State Board of Nursing of each State. Nursing is a ...
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The Beauty of Nursing by Rebekah Hinton, BSN, RN, Virginia Nurses Views of The Nursing Profession:"I have been a caretaker for as long as I can remember. I am the oldest of four daughters and have always been a second Mother to my siblings. Going into nursing seemed to be a logical choice for me. As a student I was eager to learn and worked very hard to get the best education possible. I entered into a Bachelor of Science in nursing program without knowing the difference between a RN program and a BSN program."
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Nursing: How Do I Find Out If It's For Me? by Angela Eichenlaub, RN, BSN:"The face of nursing has changed" or "Nursing is not what it used to be" are phrases I often hear from seasoned staff. I wish I knew what nursing "used to be" so I could compare! My own personal advice to anyone considering a career in nursing is to take your reason for entering the profession into account. Some go into nursing for money, some because they have always wanted to and some people go into nursing because they don't know what else to do."
******************************************************
To Be Or Not To Be, by Sharon Jones, RN, Ohio Nurses Views of The Nursing Profession:"To Be…Or Not To Be… was never the question for me. I had always been a caretaker of sorts even at a very young age. The decision to return to work was based more on a career that I could relate to and be employed at. To be it was… and I started school at a local college for a Registered Nurse program. Almost two years into school, all my pre- req. courses completed and a waiting list to get into the nursing classes (a very unbelievable thing looking back- too many students- many had to wait) forced me to change course of action that lead to LPN school."
******************************************************
Twenty Years of Nursing by James E. Meekins, North Carolina Nursing Views:"Thirty years ago I walked into the Navy recruiters office; laid off, without a real skill and signed up to be a Navy Hospital Corpsman (medic). I learned basic patient care---and basic first aid; and learned to work under the direction of a physician or nurse. I enjoyed what I did, the pride of being part of a team; accomplishment of a common goal, first aid in the field with Marines, or care of a patient in the hospital. . . ."
******************************************************
Nursing: Pros and Cons by Christy Picton, RN, BSN, Illinois Nurses' Views of The Nursing Profession:"I struggle when asked whether I would recommend the nursing profession as a career. In the end it comes to down to a weighing of the pros and cons. Let me begin by introducing you to some of my patients, my "pros" so to speak. . . . "
******************************************************
"One of The Lucky Ones" by Christine Cruz, Minnesota Nurses Views of The Nursing Profession:"My name is Chris. I have been an RN for ten-years. I have worked in a wide variety of nursing settings, from home care, long-term care to telephone triage, clinics and nursing management. Upon graduation from nursing school in, May, 1993, I had eagerly anticipated a new RN position at a local hospital, in one of its med-surgical units. . . ."
******************************************************
You Want to Be a Nurse? -- Better Leave Your Heart Behind by Pennye Diane Morgan Shaw R.N., Texas Nurses Views of the Nursing Profession:"So you're thinking about being a nurse? You probably are a person who wants to make a difference, to help others, to be a compassionate healer. Are these are the same reasons I entered the nursing profession about 9 years ago. I had been through the emotional experience of watching my father being diagnosed with colon cancer. I had been by his side though radiation therapy, and though surgery and recovery. I watched as he struggled to cope with the drastic changes to his body as he tried to return to a normal life. . . . "
******************************************************
My Advice for New and Potential Nurses, by Pam Lowry, Illinois Nurses Views of the Nursing Profession:"According to the American Association of Colleges of Nursing (AACN), "The United States is in the midst of a nursing shortage that is projected to intensify as baby boomers age and the need for health care grows." They also state enrollments in nursing colleges are at a six-year decline. According to JAMA there will be a shortage of 400,000 nurses in the U.S. by the year 2020. AACN goes on to state there are declines in nursing faculty leading to limitations on enrollment, the population of R.N.'s is the lowest it has been in 20 years, and vacancy rates at hospitals are high. . . "
******************************************************
An Insight Into Nursing by Leah Stockdale, R.N., B.S.N. Maryland Nurses Views of the Nursing Profession:"Although I am extremely proud of being a nurse, I will have to say that I am not sure if I would choose the profession if I could go back. At the same time, I probably would not choose any career in the health care industry. In my opinion, as far as hospital nursing is concerned, the negatives outweigh the positives. That is why I am currently in the process of applying my nursing skills and education to another field. . . "
******************************************************
A Letter To A Future Nurse by Kristina Rzanca, LPN, Michigan Nurses Views:"Being a Nurse is a career you can be spiritually, emotionally and financially satisfied with. In this day and age this is a unique opportunity, but it is not for everyone. A special person with qualities such as empathy, compassion, intelligence and above all patience should only apply. . . . "
******************************************************
To Be A Nurse Takes A Special Kind Of Person By Vicky Oliver, LPN:"As an LPN for the last ten years I believe I could give some insight on my experience as a nurse. I am the type of person who is always doing something for others instead of me. My experiences in nursing consist of Medical Surgical, Doctors' Office, Emergency Room, Surgery, GI Lab, Urology, Utilization Review, Recovery Room, and the Nursing Home. Anyone that goes into the nursing profession needs to be a very caring person, someone who wants to give to others and someone that is very dedicated. . . "
******************************************************
After Fourteen Years As An RN, I Am Not Sorry For My Choice By Lynn Kash, RN:"Would I recommend the nursing profession? That is a good question that requires a lot of thought. Nursing was not my first choice of careers. I studied accounting in college, and after working in the business world, decided it was not for me. I fell into a job as a nursing assistant and found patient care to my liking. I then started nursing school and the rest is history. . . .
******************************************************
A New York BSN's Point of View, By Melina Begun, BSN, RN, Clinical Administrative Liaison Nurse:"Nursing is suffering. Thousands of caring people enter into this profession every year only to become disillusioned by its reality. When I first started to study nursing, I immediately felt a connection with its history and our potential to be leaders in the medical community. Excited by all of the knowledge and skills I acquired in my Ivy league nursing program, I was astonished by the harsh reality of nursing in today's hospitals when I started working as a staff nurse. . .
******************************************************
Tips To A Good Start In The Nursing Profession by Diane Hartley:"My name is Diane and I have been in the nursing profession for 12 years. In those years I have seen very many changes with this profession. One of the first changes was in DRG's. This for those of you who do not know what they are is diagnosis related groups. . . "
******************************************************
See Also: Certified Nursing Assistants, CNAs, Certified Registered Nurse Anesthetists, Disabled Nurses, Male Nurses, Men In Nursing, Legal Nurse Consultants, Licensed Practical/Vocational Nurses (LPNs/LVNs), Registered Nurses
Nurses Views Recommending The Profession,
Nurses views Not Recommending The Profession.
Male Gender Bias - Entrance to No Mans Land by Nurseman
Are you a male and thinking about entering the world of nursing? Have you ever wondered why they're so few men in nursing? If you are young, single ...
-
Gender Bias Against Male Nurses:
http://www.nursingdiscussions.com/gender
******************************************************
-
Do I want My Daughter to be a Nurse by
Raye
I am not sure why I became a nurse. I enjoy the smile on the face of someone I have helped. I worked Emergency and got quick fixes and instant ...
******************************************************
Is your life worth the BIG BUCKS?
by SurgRN911
Why are patients and families feeling they are getting less attention, and sometimes less than adequate care in a hospital setting? I wrote an ...
******************************************************
It's not all bad!
by LauraRN
Wow.. a chance to give my opinion on nursing.. here goes.. :) When I was in college, I thought I wanted to be a math teacher. As I got higher in ...
******************************************************
Requirement: Have an off-beat sense of humor by clooneyfan A review by of my favorite writers (SurgRN911) about the nursing profession prompted me to write my own review. You can read her original review at ...
******************************************************
Nursing Is In My Blood!
by Dunkjam
When I was a little girl I always thought that I would be a singer and marry Paul Anka! I thought I would live a glamorous life and travel around the ...
******************************************************
Where Are Our Leaders? by Moonflowerck
I have been an R.N. for 28 years. My range of experience encompasses nearly all aspects of critical care and pediatrics. I am a bedside nurse; that is my forte. I give quality nursing care; I am a good teacher; I am empathetic and intuitive. However, I am not a leader. My experiences in various leadership roles during my career were neither fulfilling nor very productive.
******************************************************
Nursing: Is It A Career For You? by
Bobstein
When I was faced with choosing a career I wasn't clear exactly what I wanted to do with my life. I enjoyed the sciences and helping people, and with high unemployment rates in the mid-1970's I chose to enter the nursing profession.
******************************************************
10 CONCEPTS TO CONSIDER WHEN DECIDING IF THE NURSING PROFESSION IS FOR YOU
by melissasrn
Pros: The opportunity to make a difference in someone's life; decent pay; flexible schedules.
Cons: Short staffing; floating requirements; little respect; dealing with bodily functions.
******************************************************
An LPN's Story of Progress by:
NJNurse
The Decision to Become A Nurse. When I was starting to decide on a career after high school I wanted to cry.
******************************************************
The Nursing Shortage: Reasons Nurses Are Leaving The Profession by Rebel5877
All across America, There are shortages of Registered Nurses (RN's) and Licensed Practical/Vocational Nurses (LPN's/LVN's), and Nurse's Aides entering ...
******************************************************
Response to NJ's work in progress
by jt1013
There is a shortage of nurses. That is a given. I have a large amount of respect for LPN's. My sister is one in Kentucky. She has been one for 32 ...
******************************************************
My Opinion of The Nursing Profession, by emsopinion
I have been a nurse for over twenty two years. In that time I have worked in many
different fields of medicine.
******************************************************
Feast or Famine
by lovepepsi
Pros: the feeling you get when you helps someone
Cons: short staffing, not being able to save everyone
******************************************************
