The Cost of Nurse Migration

The cost of CARICOM nurse migration is the focus of this news article reporting on a recent meeting at the PAHO headquarters in Barbados.

"Emigration of nurses is costing some CARICOM countries an estimated US$16 million in losses. This cost accounts for training and retraining people to replace those nurses who leave for greener pastures."

This is indeed worisome, as is the cost to many other countries when their nurses emigrate to a CARICOM nation. However it was acknowledged at this meeting that the problem is a global one...

"In order to address this worldwide shortage of nurses, governments and professional organisations must find creative ways of making the profession more attractive.”

Click post title to read article from the Stabroek News.

Championing Global Nursing Education

ICN Nursing Education Network (ICNEN) Memership is Growing!
"With the new international realities of migration, advances in communication technology, and a worldwide nursing shortage, educating and preparing a diverse nursing workforce has become a critical priority. To address this, the International Council of Nurses has established the ICN Nursing Education Network (ICNEN) in order to provide a forum to address nursing education issues worldwide."

NDNQI for Nursing Quality Improvement

The National Database of Nursing Quality Indicators® (NDNQI®) is a proprietary repository of nursing statistics. The American Nurses Association collects and evaluates this unique, unit-specific, nurse-sensitive data from hospitals in the United States.

Participating facilities can then use this comparative data for quality improvement purposes.
Click here to read more from ANA about the database.

Interdisciplinary Teamwork Under Stress

Disruptive behavior by doctors and nurses persists according to this research news reported in American Medical News ...by Amy Lynn Sorrel.
On their worst behavior ~ A national survey of physician and nurse executives asked how many had observed or experienced these behavior problems from doctors or nurses in their organizations:

Degrading comments and insults ~ 84.5%
Yelling ~ 73.3%
Cursing ~ 49.4%
Inappropriate joking ~ 45.5%
Refusing to work with colleague ~ 38.4%
Refusing to speak to colleague ~ 34.3%
Trying to get someone unjustly disciplined ~ 32.3%
Throwing objects ~ 18.9%
Trying to get someone unjustly fired ~ 18.6%
Spreading malicious rumors ~ 17.1%
Sexual harassment ~ 13.4%
Physical assault ~ 2.8%
Other 10.0%

"Ninety-seven percent of respondents experienced unprofessional outbursts and overreactions, with most saying these happened several times a year and sometimes even weekly. Most survey respondents, 48%, said doctors and nurses were equally culpable for the conflicts, but 45% said doctors were mostly to blame."

Source: "Bad Blood: Doctor-Nurse Behavior Problems Impact Patient Care," American College of Physician Executives 2009 Doctor-Nurse Behavior Survey, Physician Executive Journal, November/December.

Nursing Degree Requirement on the Horizon for the UK?

The British government recently announced that by 2013, the minimum education for nurses will be raised from diploma to degree level, which means three or four years of post-secondary education and training.
The Royal College of Nursing is quoted as calling this "an important and historic development", while the UK Department of Health feels the additional education will better equip nurses leading to higher quality patient care. However the move is not without controversy due to the already critical shortage of nurses.

"An increasingly high percentage of nurses working in the NHS are foreign nationals, and raising the bar at entry point would have to be communicated clearly and rolled out internationally as the NHS is staffed by an international resource pool."

As reported in Nursing In Practice, Nov 17, 2009.

Searching of a Scholarship? Need Help to Repay your Loan?

Keep in mind the National Health Service Corp!
Check out the opportunities for "primary health care providers to join the National Health Service Corps, which now has thousands of openings for qualified clinicians, plus two programs that make service in the corps very attractive at this time. A scholarship program provides payment of tuition and other reasonable academic costs, plus a stipend, in return for service in a designated health care shortage area upon graduation. And a loan repayment program provides immediate academic debt relief for licensed clinicians who will work, for a salary, in these same underserved areas." [NLN]

Ninth Annual International Research Internship for Nurse Researchers

Internships Announcement: "Multiply Interventions for Community Health" The Ninth Annual International Research Internship for Nurse Researchers will be held in Jamaica ~ May & June 2010.

"A unique, intensive training opportunity for junior nurse researchers in Canada, Jamaica and the Caribbean, Kenya, Uganda, and South Africa to launch their research career and network internationally."

Application deadline: January 4, 2010
Note: Selection is competitive and limited seats are available

INTERNSHIP FOCUS:

Community health services & policy research

Global health issues

Developing research networks

Grantsmanship and publication skills

Linking with local, national, and international decision-makers

Working on interdisciplinary teams

Innovative research methods

Developing programs of research

Mentorship

Click on title for more details, eligibility, application form, etc.

The Simulation Center for Clinical Interdiscplinary Practice

Announcing the launch of Dr. Robert Ross's latest brain child!

The Simulation Center for Clinical Interdiscplinary Practice

with the base of operations in our amazing, state-of-the-art Simulation Laboratory/ Virtual Hospital right here on our UMHS/IUON campus in St. Kitts! For more information and dates for uncoming training courses view the SCCIP-SK website.

Why limit your career horizons?

Holland America nurse explains the scope of clinical practice at sea
Published on AdvanceWeb ~ International, October 29, 2009
by Valerie Newitt

"Nursing takes on new "heights" for those who choose to practice the profession at sea. Imagine climbing into a basket lowered from a helicopter hovering over a ship in mid-ocean. Up and away, and you're in the copter. The basket is lowered again, this time to retrieve a sick passenger, now your patient, in dire need of a ship-to-air evacuation. The scenario is not all that unusual, if you are a nurse at sea, said Laura Vlaadingerbroek, MSN, RN, chief medical officer aboard Holland America Line's Zaandam." Click on the title to read the full article.

Are you a 'Curious Practitioner'?

The 'curious practitioner': effective lifelong learning. Nursing in Practice Sept/Oct 2009, No.50
by Sue Spencer, Coventry University, UK

How committed are you to providing well-informed and up-to-date nursing practice? This article explores the value of being what it calls a 'curious practitioner'. It will help you to

"explore some creative ways of transferring learning in all domains of your life to your professional practice."

"If you are a curious and questioning practitioner, you cannot help but be engaged with lifelong learning, as each day generates questions that need answers. Finding the answers to those questions is the start of lifelong learning and continuing professional development."

Protection for Healthcare Workers in the Caribbean

Protection of healthcare workers in the Caribbean region is receiving some attention at last. The First Regional Meeting for Latin America and the Caribbean on Health Protection for Health-Care Workers was held September 22nd-24th, 2009 in Maracay, Venezuela.

The meeting was organized by "PAHO/WHO, in collaboration with the Ministry of Health of Venezuela, the Instituto de Altos Estudios de Salud Dr.Arnoldo Gabaldon, and the U.S. National Institute for Occupational Safety and Health (NIOSH)" and brought together "policymakers, academics, hospital managers, epidemiologists, front line workers, and civil society from across the region".

"Healthcare workers are often exposed simultaneously to a variety of work hazards from various natures, including biological, chemical, physical, and psycho-social ones."

During the meeting "participants had the opportunity to gain hands-on experience on EPINet, a surveillance system for tracking needlestick injures and blood and body fluid exposure among healthcare workers."
Click on the title to read more from the PAHO website.

Working in Health

"An estimated shortage of over 4 million doctors, nurses and other health workers in developing countries acts as a major roadblock to economic and human development. Working in Health considers the fiscal issues in expanding the health workforce and the policy options available to governments. Through case studies in Dominican Republic, Kenya, Rwanda, and Zambia, it also examines recruitment, promotion, and pay policies in the public sector and their important influence on health workforce performance."

published by The World Bank. Click on title to access ebook.

NANDA-International Congress 2010 ~ Madrid Spain

Dr. T. Heather Herdman, NANDA-I Executive Director, is sponsoring two $800 scholarships for the 2010 Madrid Congress (May 12-14).
Intended for nurses in practice within developing countries [which includes much of the Caribbean], the deadline for application submission is December 1, 2009. (Applicant must be a licensed nurse in professional practice, residing in countries listed as Class II or Class III in this linked document, as well as a first-time NANDA-I conference attendee.)

Nursing Faculty Shortage Update: AACN

"In July 2009, 803 faculty vacancies were identified at 310 nursing schools with baccalaureate and/or graduate programs across the country [US]. Besides these vacancies, 117 schools cited the need to create 279 additional faculty positions to accommodate student demand. The latest data show a national nurse faculty vacancy rate of 6.6% with most of the vacancies (90.6%) for faculty positions requiring or preferring a doctoral degree. The top reasons cited by schools having difficulty finding faculty were noncompetitive salaries compared to positions in the practice arena (32.2%) and the limited pool of doctorally-prepared faculty (30.3%)."

Reported in Medical News Today from the American Association of Colleges of Nursing (AACN) .

Job Seekers check out the 'Applicant Blog'

The Applicant Blog has gathered seven useful SlideShare presentations for job seekers, along with other great stuff.
Worth your while!

Informatics: The Future of Nursing

"Marrying the clinical with the technological creates professional opportunites for information nurse specialists."

Have you considered specializing in Informatics?

"Information Nurse Specialists combine the expertise of nursing science, computer science, and information science to manage data gathered while caring for patients, and then making sure the IT system will aid in communicating that data to the appropriate personnel and carry out specific functions.... their role involves planning, designing, implementation, evaluation, systems maintenance, and supporting the system development life cycle along side their other professional colleagues."

Did you know that the average annual salary for information nurse specialists is approaching $85,000 annually? There are currently around 8,000 nurse informaticists but the need is 10 times that number with the wireless phenomenon happening, the need to access information at point-of-care, the EHR initiatives, the push for EBN, and other informatics developments.

Brain Drain ~ A CARICOM Dilemma

Interesting article by Rickey Singh, posted Sunday, August 16, 2009 in the Jamaica Observer . The article discusses the shortage of medical professionals serving the Caribbean region.

"According to data revealed by Caricom's Assistant Secretary General, Dr Edward Greene, this region has lost some 50,000 doctors, nurses and teachers over the past 11 years who have migrated to North America, Britain and other foreign countries.

Dr Greene, who shoulders responsibility for Human and Social Development at the Caricom Secretariat, in referring to research findings of 2006, has disclosed that accompanying the severe loss of professionals was also the drain on the public purse for money invested in training nurses and teachers in particular, with migrated nurses alone accounting for approximately US$2.02 million."

Click on the title link to read the complete article.

The 17th Caribbean Regional Nursing Council Meeting in Belize

The Regional General Nursing Council meets yearly to conduct its examinations which allows for the standardization and improvement of nursing education and the free movement of nurses throughout the countries of the region.
Nurses from the Caribbean Community and Belize are present in the city for the 2 week workshop aimed at reviewing previous examinations held in October of last year and April of this year. The Regional Nursing Council is made up of representatives from thirteen Caribbean countries.

"We have a common examination, similar to the CXC that all registered nurses take on completion and this gives them license to practice. We have representatives here from ten of the thirteen countries.” said Marjorie Parks, Chief Nursing Officer for Belize. “In Belize we have about 500 nurses total but that is no way enough to meet all our health needs but nurses have to go through rigorous training. Our nurses in Belize train at a bachelor’s level at the University Level. We have several nursing programs but the program to prepare registered nurses is for four years and they come out with a degree."

New Website Launched in Effort to Further the UN's Millennium Development Goals

"Research4Life is the collective name for three public-private partnerships which seek to help achieve the UN’s Millennium Development Goals by providing the developing world with access to critical scientific research.
Since 2002, the three programmes, Health Access to Research (HINARI), Access to Global Online Research in Agriculture (AGORA) and Online Access to Research in the Environment (OARE) , have given researchers at more than 5,000 institutions in 108 developing world countries free or low cost access to over 7,000 journals provided by the world’s leading science publishers."
Note that among CARICOM nations, institutions in St. Vincent & the Grenadines as well as Jamaica are eligible to participate!

Health Information Literacy: How it Impacts Your Patients

Close to half of all American adults have trouble understanding and using basic health information [states a recent report from the Institute of Medicine]. Most consumer health information and patient education materials are written at the 10th grade level or higher, while the majority of the population read at an 8th grade level or lower, and that is without the medical jargon!

So why worry?

~ "Literacy is the strongest predictor of health status – more than age, income, employment status, race or ethnicity, and educational level!
~ Emergency room patients with inadequate literacy skills are 2X's more likely to be hospitalized.
~ Patients with poor literacy skills are 5X's more likely to misinterpret their prescriptions.
~ People with low literacy skills have 4X's greater annual health costs.
~ The FDA, JCAHO, and NCQA require health care institutions to document evidence that patients have understood the medical information provided to them."

But what can you do about it? How can you identify patients with low literacy?
How can you improve communication with your patients?
Click on the title or here for excellent resources from the Medical Library Association to help you understand and address this issue.

Patient Safety Videos from the FDA

"FDA Patient Safety News (PSN) is a monthly video news show for healthcare professionals. It covers significant safety alerts, recalls, new product approvals, and offers important tips on protecting patients. Many of these PSN stories contain video footage and demonstrations that may be especially useful to educators in healthcare facilities and academic institutions."

Trinidad is Optimistic about it's Nursing Shortage

"Nursing shortage to end in 2012." reports Trinidad & Tobago's Newsday for Monday June 22, 2009.

Jerry Narace, Trinidad and Tobago's Minister of Health, "is confident the chronic shortage of nurses in the health sector will be remedied by 2012." What's his plan? ...for one to continue actively recruiting foreign nurses!

New Workforce Planning Research Tool Projecting Nursing Shortage in Ireland

"A Quantitative Tool for Workforce Planning in Healthcare: Example Simulations Report by the Skills and Labour Market Research Unit FAS on behalf of the Expert Group on Future Skills Needs." by Jasmina Behan, Nora Condon, Ivica Milicevic, and Caroline Shally, June 2009; 136 p.

"The research, conducted by the Skills and Labour Market Research Unit at FAS, developed a quantitative tool that facilitates the assessment of how different policy scenarios and changes in the size and composition of the population, the main determinant of demand for health services, will affect the balance between the supply and demand of a range of healthcare occupations. The research has taken an economy-wide approach and also includes the private healthcare sector. It shows that there are shortfalls facing some occupations, while others are in oversupply... The research findings underscore the continuous nature of workforce planning... Only by adopting an on-going approach to workforce planning is it possible to optimally address the issues of either skill shortages or excess supply from education and training, as well as issues with an excessive attrition from potential supply and the existing workforce." Una Halligan, Skills and Labour Market Research Unit (SLMRU).

"Supply [of nurses] from abroad – Non-EU supply: non EU-trained nurses have become an important source of supply of late: in 2007 (the period February-December inclusive), 1,412 employment permits were issued to non-EU nurses. Over the period 2000-2006, 9,442 nurses were granted work authorisations/ work visas." (p.67)

Champion Nursing in America

A new website has been launched by The Center to Champion Nursing in America, with the stated purpose and goal: "To ensure every American has access to a highly-skilled nurse, when and where they need one." Another important goal for the Center is to work to "increase funding to expand nursing education" and "decrease turnover among new nursing graduates".
The Center is a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation.

The Alzheimer's Project

In case you missed this recent HBO series on Alzheimer's Disease, or you may well want to view them again, you can still access it and other excellent information from the HBO Alzheimer's Project website.
This four-part documentary series takes a "close look at groundbreaking discoveries made by the country's leading scientists, as well as the effects of this debilitating and fatal disease both on those with Alzheimer's and on their families."

Click on the title link to the excellent informational website, the streaming videos, as well as 15 short supplemental films on the topic.

Dominica to Export Nurses to Barbadoes?

Dominica News Online carried this news story by Shermain Bique on May 29, 2009, after an announcement by Prime Minister Skerrit that Dominic could be exporting nurses to Barbadoes as early as October of this year.
Click on the title link to read the article.

DynaMed provides free access to information on Swine Flu

"Due to the recent global outbreak of Swine Influenza, EBSCO Publishing and the DynaMed Editors have made DynaMed’s information about Swine Influenza free to health care providers and institutions throughout the world.

The DynaMed topic on Swine Influenza consolidates information from multiple sources for health care providers to stay current with recommendations for monitoring, diagnosing, and treating patients with flu-like illnesses during this outbreak. DynaMed Editors will continue to monitor information and update this topic as needed throughout this global crisis. Please click on the title for information regarding Swine Influenza.

Current DynaMed subscribers [includes all faculty and students at UMHS-SK and IUON] are encouraged to use their access to DynaMed through their institutional subscription to monitor the latest clinical information on Swine Flu at http://www.ebscohost.com/dynamed/logIn.php."

Kind regards,
Susan Entrican
Programs Manager
EBSCO Publishing

The ANA has also posted information & links specifically for nurses on Swine Flu.

Measuring Hand Hygiene Adherence

Free ebook being made available through Mosby's Nursing Consult addresses the seemingly ongoing problem of hand hygiene!

"Everyone at your hospital knows when and how to clean their hands, right? Not so, says the Joint Commission, the publishers of this new monograph, "Measuring Hand Hygiene Adherence: Overcoming the Challenges."
The report notes that "A quick rinse under the sink or brief rub between palms with alcohol-based hand rub may not be thorough enough to eliminate potential pathogens". Click on the title to read the whole report on .pdf.

Is 'Compassion Fatigue' a Contributing Factor in the Nursing Shortage?

FRIDAY, April 10 (HealthDay News) -- "A type of emotional burnout called "compassion fatigue" is common among doctors, nurses and other health care workers tending to people with cancer, yet experts say little research has been done on the phenomenon, which can lead to anxiety, cynicism, chronic tiredness, irritability and problem drinking.
Often these health care workers become emotionally detached to protect themselves from the feelings of loss that accompany losing a patient. Some end up leaving their jobs."
A review article has just been published in the Journal of Health Psychology which leads one to questions such as our title and highlights the need for a deeper understanding of this issue. For more on how to recognize and cope with 'compassion fatigue' I refer you a post on the RealityRN Blog.

Nursing Job Trends from Indeed.com

There will always be the need for qualified nursing staff -- see what qualifications are asked for the most.

MSN nurse, BSN nurse, ASN nurse, LPN nurse Job Trends

MSN nurse jobs - BSN nurse jobs - ASN nurse jobs - LPN nurse jobs

New Web Site Launched on US Health Reform

HHS issues special report on health reform and launches new web site ~ "Americans expressed serious concerns regarding health care in a new report released today by the Depart of Health and Human Services.

The report, Americans Speak on Health Reform: Report on Health Care Community Discussions, summarizes comments from the thousands of Americans who hosted and participated in Health Care Community Discussions across the United States."

Top Concerns of Community Discussion Participants:
Cost of health insurance ~31%
Cost of health care services ~24%
Lack of emphasis on prevention ~20%
Difficulty finding insurance due to pre-existing conditions ~13%
Quality of care ~12%

The report is available on the new US government web site dedicated to health reform ~ www.healthreform.gov .

NLN DataView

Now "you can search for and download graphs in various formats that cast a wide lens on all types of pre-licensure nursing programs, including the 1000-plus programs offering diploma and associate nursing degrees. The graphs illustrate essential data about applications, admissions, enrollment, retention, and graduation rates; and provide a comprehensive demographic profile of the current student population documenting ethnic-racial identity, gender, and age, are also available."

The Grange Facility at Ottley's, St. Kitts

Our local SKN-Vibes takes a look at the history of the Grange Facility and the work of Dr. Patricia Richards-Leader. The Grange Health Care Facility was the first of it's kind in St. Kitts to offer nursing, residential and convalescent care to the elderly.
Our IUON student body have many a fine memory of their placements at the Grange!
Click on the title to read the full article.

Nurses' Higher Education & Loan Repayment Act

Turn-Key Legislation Lauded by National Nursing Groups
"The Nurses' Higher Education and Loan Repayment Act would establish a federal student loan repayment program for nurses who agree to teach full-time at an accredited school of nursing for at least four years in a six-year period."
Reuters ~ Washington ~ March 12, 2009
Click to listen to an mp3 of Congressman Latham
answering questions about this bill.

The Nursing Education Loan Repayment Program [NELRP]

Application Deadline Extended to March 16!
"On February 17, President Obama signed into law the American Recovery and Reinvestment Act (“Recovery Act”) of 2009. The Recovery Act provides substantial additional funding for the Nursing Education Loan Repayment Program (NELRP)."

Therefore the deadline for submission of this years applications has been extended to 5:00 pm ET March 16, 2009. Supplemental forms and documentation must be received or postmarked by March 16, 2009.
Click on the title for more information and how to apply!
Read the Applicant Information Bulletin.

Inflammatory Breast Cancer (IBC)

Dear Colleagues,
I am encouraging you to open and view this video documentary today. It will only take a few minutes and will (I believe) impact your teaching—whether you are basic science or clinically oriented, it has pertinence. It involves a type of breast cancer that even the experts have been failing to notice to the extent of contributing to patient deaths. I, myself, where I teach breast self-exam for men as well as women…have always emphasized looking for LUMPS…newly inverted nipples…breast discharge ~ Inflammatory Breast Cancer however, can present looking like a localized skin infection. If it is treated as such, it can be missed and lead to death, the cancer can be that aggressive! I was impressed enough to send it along. Hope you can take the time to get informed! We teach the people who can make a difference in so many lives even now.
Thanks! Making a difference in healthcare begins with us.
Sincerely,
Dr. Mary Jo Cannon MD
Prof. of Clinical Medicine
UMHS-SK
Click on the title link to the Mayo Clinic site for more information.

Alcohol and surgery: Don't miss the risk

"..approximately one-half of all hospital beds are filled with patients with medical conditions related to alcohol or drug dependence.." Geraldine Birch Hurst
[OR Nurse 2009, July/August 2008,Vol2(7);pp.30-5.]

"Because alcohol remains the major drug of abuse in this country [United States], nurses must be able to identify withdrawal symptoms and medicate patients appropriately within the first 24 hours to prevent complications.."
"It benefits both the patient and the nursing staff to treat alcohol withdrawal early. Unanticipated alcohol withdrawal in hospitalized patients can add to the risks and costs of the hospitalization."
"The first step in treating patients who abuse alcohol is detecting the potential for withdrawal."

Hospital Pioneers Multidisciplinary Leadership Model

by Debra Wood RN
"Aiming to create a more respectful and healthy workplace, the Hospital of the University of Pennsylvania (HUP) in Philadelphia has developed a new clinical leadership model, charging teams of nurses, physicians and quality coordinators with improving outcomes...It is an egalitarian model...Units have clamored to take part.
"We are bonded at the hip," said Victoria L. Rich, chief nursing executive, "We are not going to change this model. This model is what has to happen for the furture."
Title link takes you to the article published at NurseZone.com .

Educating Patients Before They Leave the Hospital Reduces Readmissions, Emergency Department Visits and Saves Money

"Patients who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ)." Press Release Date: February 2, 2009
~ study published February 3, 2009 in the Annals of Internal Medicine.

Leading Change: Building Healthier Nations

The ICN 24th Quadrennial Congress, its first in Africa, will showcase the key role nursing plays in leading the way to healthier nations. The Congress will permit access to and dissemination of nursing knowledge and leadership across specialities, cultures and countries.
The three ICN pillars [International Council of Nurses]- Professional Practice, Regulation and Socio-economic Welfare - will frame the Congress sessions and programmes.

The main objectives of the Congress are:
1. To lead informed and sustainable improvement in policy and nursing practice
2. To demonstrate nursing's contribution to building healthier nations
3. To encourage leadership development in the health sector

27 June – 4 July 2009 Durban, South Africa

Immune Readiness CE Courses for Nurses

Need information and/or continuing nursing education re: vaccines?
The American Nurses Association's (ANA) Center for Continuing Education and Professional Development is pleased to provide the following courses available from the Vaccine Healthcare Centers Network. Access more than 30 free, annually updated Immune Readiness Courses on immunology and vaccines, including such topics as Anaphylaxis, Botulism, Tuberculosis, Human Papillomavirus Vaccine, and Rotavirus Vaccine.
Click for a complete list of available courses.

Assessments and Best Practices in Care of Older Adults

Why is assessment of older adults so important?.
Illnesses in older people often look different than in younger ones.

In an effort to provide age appropriate assessment resources that will help to fill the gap between knowledge and practice in the care of older adults, the John A. Hartford Foundation has funded the Hartford Institute for Geriatric Nursing (HIGN) at New York University's College of Nursing for a project called How to Try This.
This initiative that will provide web access to evidence-based geriatric assessment tools free of charge along with demonstration videos. A corresponding print series will be published in the AJN.

UPDATE: Check out the online access to the videos and the print articles . [Mar 18, 2010]

Day One in the Life of a Nursing Student

"Standing at the nursing station, alone, my first day at the hospital, I silently planned my escape...." Read this great post and comments on allnurses.com [Jan 5, 2009].