Friday, April 27, 2012

Layton students honor their teaching ancestors

Layton students honor their teaching ancestors
Historical marker • Daughters of the Utah Pioneers dedicate new site at elementary.
The plaque installed at Layton Elementary School to honor early education in the city. Credit: Carol Lindsay/Special to The Tribune
Pioneer teachers in Layton once really brought home the bacon.
No, they didn’t get rich being teachers, but they did get paid in the form of bacon, produce and flour.
Students at Layton Elementary School learned about the lives of teachers and students in the 1850s — they had class in one-room schoolhouses or log cabins with dirt floors. Each day, they would bring in two buckets of water, one for students to drink and another with which they would wash their hands and put out any sparks from the fireplace.
Children walked to school, or rode on horses or in wagons. They brought their lunches — consisting of tomato sandwiches or jam and molasses. There was no electricity, and Internet, cellphones and computers were 100 years away.
Teachers, students and ancestors of current Layton residents were honored April 16 at an Early Education in Layton assembly at the school, which itself has been around since 1902.
At the assembly, the Daughters of the Utah Pioneers dedicated a new historical marker at the school, the fifth placed in Layton and the 564th statewide, said Kathleen R. Brimhall, corresponding secretary of the Daughters of the Utah Pioneers.
Diatra Wilko was asked by the Daughters of Utah International organization to locate a site for a new Layton marker. “We thought, let’s do a marker on the early education in Layton and have it correspond with the 100th year centennial celebration of the school district,” said Wilko.
Wilko said before conducting research for the marker, she was unaware of how many schools there were in the early years of education in Utah. History shows there were five home schools, two log schools, one framed wood school and seven brick, one-room schools built between 1850 and 1900.
The current Layton Elementary has been located at 369 W. Gentile Street since 1984. The original school was built on that site in 1902.
There was a building in 1890 where church, school and community meetings were held, but it burned down, said Mary Ann Bundy, 2nd vice captain of the Daughters of the Utah Pioneers. Davis County bought the property from the Episcopal Church for $600, and in 1902 built a school that had four classrooms.
Eventually, the school expanded to 16 classrooms, and in 1950, a cafeteria was added.
Bundy, who attended the school, recalled the cafeteria fondly. The menu consisted of soup or chili and bread and butter with lettuce.
“It was not too fancy, but to this day I love bread and lettuce,” she said.
In 1984, the original school was torn down and the current building erected.
Layton Elementary Principal Leslee Wright is proud of her school and the teachers.
“It’s amazing how far we’ve come and how dedicated our teachers have been throughout the history. The teacher’s main focus is and always has been the children first and helping them prepare for the future. There is so much history carried on through the schools,” Wright said.
Bryan Bowles, superintendent of Davis School District, emphasized the importance of people knowing their personal history to give them direction into their future. He also focused on the importance of youths in Utah.
“When Brigham Young said the desert would bloom, he didn’t just mean the flowers and crops, he meant our children,” said Bowles.
Mayor Steve Curtis of Layton reminded students that like their ancestors, they too are pioneers — of technology.
“You guys can text with two thumbs. You are pioneering a new technology, and you are making history,” he said.

© 2012 The Salt Lake Tribune

Wednesday, April 25, 2012

Clearfield mayor shares love of music with youth

Clearfield mayor shares love of music with youth
Harmony • The children’s choir that Don Wood helped form allows kids to show their talent.
Paul Fraughton | The Salt Lake Tribune. Directors of the Clearfield Children's Choir Donna Bisseger Keri Benson and Don Wood talk to choir members before their performance at the Community Choir's Spring concert at The Clearfield Community Church. Monday, April 16, 2012
Music has always been a part of Don Wood’s life.
As a child, he sang and played piano, and even learned to play pipe organ at the Tabernacle in Temple Square.
Wood kept his love of music as he became a father of seven, but while he saw plenty of opportunities for his children to play sports, he found nothing to engage children musically.
When Wood, 58, became mayor of Clearfield, he decided to change that.
“We wanted children to be able to express themselves through music, give them the opportunity to learn parts and music theory,” Wood said. “We also wanted to give them an opportunity to perform in the community and showcase their talents.”
He and other community members formed the Clearfield Children’s Choir after an adult version had succeeded in the community. The children’s choir, now in its fourth year, has 22 members from Clearfield and surrounding communities. Members rehearse on Thursday nights at the Clearfield community center, and the choir performs throughout the year.
Their biggest show was for the Davis County Council of Governments, which includes all the county’s leaders.
“That was something that was really amazing to see — these young people sing to distinguished leaders and individuals,” Wood said. “[And ] They sang at Christmas socials in front of groups of 300 people. That was exciting,”
Helping with the choir is Don Wood’s daughter, Donna Bisseger.
“My dad and I have been involved in music my whole life. I played piano since I was 4; we’ve played piano duets around the valley. Music is a huge part of our life. My dad has always been a great example, and this was just another opportunity to do something together,” Bisseger said.
Nine-year-old Jaxsen Bisseger loves being in the choir.
“I like singing, and it’s just fun to meet every Thursday with all my friends,” Jaxsen said. “I think singing in concerts is the most fun thing we’ve done.”
Keri Benson has been involved with the choir since its inception. She has four children, all of whom have been in the choir. Early on, Benson saw the need for volunteers, and she began conducting the group.
“I have kids who love to perform, so it has taught them music appreciation, and they have been able to sing songs they would not usually have access to,” Benson said.
Benson loves to help children build character and believes performing “gets them out of the box.”
“Having the community come out and be involved and see the kids perform is great. The more they perform the more kids come out and want to join the choir,” Benson said. “I’d never heard of a city choir so this has been a great opportunity.”
When Wood envisioned the children’s choir, he saw a place where children could come together and learn and grow.
“I have a great love for the young people in our community. I have a love of music, and I like to instill that in young people. It lifts and elevates them as individuals,” he said. “It builds in them a sense of self-worth, and they can practice and accomplish something and then showcase their talents.”

Monday, April 16, 2012

Utah CNA Schools A common question

I get asked all the time what I think about the for profit nursing programs that have proliferated around the valley. I really don't have an opinion about specific programs. I would however advise you to make your continuing education decisions wisely taking all aspects of your education into consideration. Please look at the pass rates for any programs you are considering. I've posted the link below.

The other aspect to consider is money. Please read the previous post on this blog. It is an article from the Salt Lake Tribune regarding the cost of education. If you take out loans for your education they don't go away. You cannot take out bankruptcy on them. If you don't finish school you will still owe the money. If you don't get a job you will still owe the money. If you don't pass your nursing boards you will still owe the money.

My advice is ask lots of questions and think long and hard about the school you choose to attend because if you borrow money it is a decision you are going to live with a long time.

I sure am glad I'm done with college and don't have to make these decisions. Good luck everyone.
For those of you looking at RN programs you might want to check out the NCLEX pass rates cause if you don't pass the NCLEX you won't be a nurse even if you graduate from school.

Utah students caught in web of college costs, few jobs

Utah students caught in web of college costs, few jobs
Debt • Bankruptcy cases involving student loans have climbed as people enrolling in for-profit schools are increasingly unable to repay the borrowed funds.
By paul beebe

The Salt Lake Tribune

Published: April 16, 2012 01:19PM

Note next to picture: The Salt Lake Tribune Bankruptcy lawyer Marji Hanson next to the files of her bankruptcy clients with student debts that they can't repay. Most of her clients file for bankruptcy so their other debts can be discharged, which makes it a little easier to repay student loans, or they file a Chapter 13 bankruptcy, which doesn't discharge their student loans, but buys them some time. Utah students who attended for-profit colleges are showing up in growing numbers at the offices of bankruptcy lawyers hoping to find a way out from under student loans that they can’t repay.Verifiable numbers are hard to come by, but a Salt Lake Tribune survey of Utah lawyers suggests that client cases involving student loans have jumped to 15 percent to 30 percent of their caseloads after the recession started four years ago — even though student debt rarely can be eliminated through bankruptcy.

“The growth is in the for-profit colleges,” said Marji Hanson, a Salt Lake City attorney. Many of her clients are nontraditional students who lost jobs during the recession and enrolled in for-profit institutions hoping to quickly launch new careers. Many either quit before completing their education or, upon graduation, found the job market remained difficult.

The schools “tailor their programs to provide career education [and] job skills. But if there are no jobs on the other end, then [the students] just have a loan that is non-dischargeable” in bankruptcy, Hanson said.

For-profit schools are the clear beneficiaries of two economic recessions during the 2000s and the current poky recovery. The number of students enrolled at for-profit colleges in the U.S. jumped to 9 percent of all college enrollments in 2009 from 3 percent in 2000, says the National Center for Education Statistics (NCES).

“Private for-profit institutions have become an increasingly visible part of the U.S. higher education sector. They are today the most diverse by program and size, have been the fastest growing, have the highest fraction of nontraditional students, and obtain the greatest proportion of their total revenue from federal ... loan and grant programs,” three Harvard professors wrote in a paper published by the National Bureau of Economic Research (NBER) last year.

Rapid growth • The growth hasn’t backed off. Nationally, from 2007 to 2008, enrollments at for-profit colleges jumped 24 percent and now stand close to 1.5 million students, according to the NCES. (A higher estimate published by the NBER put the figure at 1.85 million.)

In Utah, the increase was more modest ­— 5.6 percent, which brought the number of students enrolled at for-profits to 9,001 in 2008. Although the velocity lagged behind the U.S. rate, it was close to the 6.7 percent gain at Utah’s not-for-profit colleges and universities. Slightly more than 4 percent of Utah college students attended a for-profit in 2008, according to the federal data.

Many students who attend for-profit colleges are older. The NCES says 30 percent of full-time students were at least 35 years old in 2009. Nearly all borrowed money to finance their educations. Ninety-two percent took out loans during the 2007-08 school year, according to the Institute for College Access and Success, a nonprofit research group.

Upon leaving school, many were saddled with big debts. In 2009, tuition and fees at for-profit colleges averaged $15,300. By contrast, the average for public institutions was $6,400, according to the NCES. Within three years of leaving, the default rate on loans made to for-profit students was 25 percent, nearly double the national average of all college students.

Brian Moran, executive vice president of government relations at the Association of Private Sector Colleges and Universities, said his organization urges for-profit institutions to counsel students on borrowing and how to manage debt as soon as they are accepted into a program. The association pushes the schools to provide information about how much to borrow, payments and the reality that loans are not dischargeable in bankruptcy, he said.

Moran attributes higher default rates and higher tuitions at for-profit schools to a mix of factors. Tuitions are more expensive than public institutions because student demand is high and for-profits don’t receive tax subsidies to underwrite expenses. What’s more, students enrolled at for-profits “do not have inherited wealth or parental support. They are typically working or the first in their families to go to school. So they have a number of disadvantages that your more-traditional student who enjoys parental support possesses,” he said.

“They do incur debt and struggle as a result of that debt,” Moran said.

Priority debt • Many of David Berry’s clients are coming to his Salt Lake City law office with unmanageable debts they incurred at a for-profit college or trade school. In the past, the amounts were small and were usually a negligible element as they weighed whether to file for bankruptcy protection. That’s changed.

“The amount is going up because I’m beginning to see people that during the recession went back to school and came out either unable to find a job or they can’t find a job that pays enough to support their families and [also] pay the debt service on their student loans,” Berry said.

The law is clear. Student loans, like back taxes and child-support payments, are considered to be priority debt. They must be paid in full. Before 2005, student loans could be eliminated in bankruptcy if they were made by a private lender. But with passage that year of the Bankruptcy Abuse Prevention and Consumer Act, privately funded loans are now treated the same as loans guaranteed by the federal government. The only way to be relieved of liability is to show undue hardship, which lawyers say isn’t easy.

Otherwise, delinquent private loans are turned over to collection agencies whose “aggressive” tactics often “drive people into bankruptcy because they don’t feel like they have any other choice,” Berry said. Or if the loan is federally guaranteed, the government will garnish up to 25 percent of the debtor’s take-home pay.

“When they do that, they do it with a vengeance,” he said.

Legal options • Although student debt usually can’t be wiped out through bankruptcy, it is possible to use the court to buy more time to repay loans, said Jeff Butler, a Salt Lake City attorney. Some of his clients will seek to reorganize their debts under Chapter 13 of the U.S. Bankruptcy Code.

“In a Chapter 13, you propose a plan to repay your creditors over time. The advantage is it gives you breathing room. You aren’t required to pay as much as [creditors] are asking for,” Butler said, adding that the borrower, not the creditor, determines the amount of the student loan payment, which he notes could be zero.

Chapter 13 plans are usually in force for three to five years. During that time, the borrower is also repaying other debts whose remaining balances, unlike the student debt balance, will be discharged at the end of the plan. At that time, the borrower can add those payments to his or her student loan payments, Salt Lake City lawyer John Evans said.

“If they take the money they were paying [to other creditors], that’s usually enough to make a dent in their student loans,” Evans said.

Berry is less sanguine. He tells his clients that they may owe more on their student loans at the end of a Chapter 13 plan if they use it to pay little or nothing.

While they may get a few years of breathing room, interest on the unpaid balance continues to accumulate, he said.

“I advise them that [they] are going to owe more on the loan, maybe twice as much as when they started. The majority of Chapter 13s don’t pay anything” on their student loans during the plan, Berry said.

He said the only other bankruptcy option is a Chapter 7 petition. It will get rid of all dischargeable debts such as credit cards, ostensibly leaving the borrower enough income to pay off his student loans.

Sometimes, he added, “we don’t have solutions for them.”

pbeebe@sltrib.comTwitter: @sltribpaul

By the numbers • The cost of a degree

1.5 million

Students nationally attended for-profit colleges in 2008 —36 percent were males; 64 percent were females


Students were enrolled in for-profit colleges in Utah — 47 percent were males; 53 percent were females


Total of average fees and tuition at for-profit colleges in 2008-09 nationally. At public colleges and universities they were $6,400. At private not-for-profit institutions they were $24,900.


Students obligated to begin repaying student loans in 2007 who had defaulted by 2010. Nearly half (48 percent) attended for-profit colleges.

Sources: National Center on Education Statistics; Institute for College Access and Success

© 2012 The Salt Lake Tribune
Utah students caught in web of college costs, few jobs
By paul beebe

The Salt Lake Tribune

Friday, April 13, 2012

CNA Student Salt Lake City

One of my day class students, Sheri Gunderson's son was born without the lower half of his leg. He's had prosthetics since he was six months. I told her it would be cool to see them all lined up. She took a picture and sent it to me. It is awesome. Her son is 14 now and the last leg is his current one. It has the metal so that his foot moves easier and he can play sports. She was fortunate to have Shriner's Hospital provide the prosthetics at no charge. That's a small fortune lined up there. I love the fourth one from the left. They had a puppy and it chewed the toes off.

Thursday, April 12, 2012

Not a Midhusband

Published Nursing Spectrum Magazine 2003
By Carol Lindsay

A man named Pete is not your average midwife. In fact, male midwives make up less than 1% of The American College of Nurse-Midwives' 7,000 members.
Certified nurse-midwife Pete Barnard, RN, BSN,CNM, MS, is used to questions about his uncommon role as a male midwife. He actually spends about half his time explaining who he is, what he does, and why he shouldn't be called a midhusband.
"You have to look at the traditional meaning of the name 'midwife,' and it means 'with woman,'" Barnard says. "So, I am not a midhusband I am a midwife." Barnard also spends time clarifying misperceptions about midwives in general. "People think midwives are the neighbor next door who comes over and delivers the baby. They don't understand that we are highly trained nurses with specialty training and degrees."
Love for L&D
Barnard graduated with a BSN from Fort Hays State University in Hays, KS, in 1985. While doing a clinical rotation in nursing school, he fell in love with labor and delivery. Barnard worked in an ED after graduation, but he knew he wanted to work in labor and delivery. He soon found a job in a hospital that did 500 deliveries a month.
Barnard says the hospital had three separate areas - labor, delivery, and recovery, which he describes as "an assembly line way of doing deliveries." Later, the hospital opened up a birthing center and Barnard was able to see the other half of the way babies should be born.
"[I saw] not just high-risk deliveries and c-sections, but natural childbirth," Barnard says. "In the birthing center you were the labor, delivery, recovery, and newborn nurse. It was so much fun that I started thinking about what kind of careers I could do in that same area and have more responsibility."
Barnard looked west for the right opportunity. "The idea of nurse-midwifery came up, but in Kansas, few people knew what a midwife was," Barnard remembers. "I did some research and discovered that nurse-midwives did just about everything. I started looking into schools across the US and found one in Utah. I thought Utah would be a cool place to deliver babies because they have a high birthrate." Barnard graduated from the University of Utah in 1990 with an MS and has worked in Utah as a midwife ever since. His practice is at OB-GYN Associates in Salt Lake City, and he delivers babies at St. Mark's Hospital.
Personality, Knowledge, and Skill Guide the Way
Although some men are scared to apply for a job in labor and delivery, Barnard had no trouble finding a job and felt very well-accepted. "Nursing has always welcomed men," he says. "How you are accepted working in labor and delivery has a lot to do with personality, how you perceive things, and how you present yourself."
Barnard has solid advice for other men who are nurses: "Some men want to pursue a career in labor and delivery but are scared about liability and how women will perceive them. All nurses should follow their hearts and work where they want in the field. If someone really wants to be a delivery room nurse, [he] should not let being a man stand in [his] way. Let your love for the profession guide you."
Barnard admits there is an occasional disadvantage to not having ovaries in a female-dominated profession. But he says he compensates for being the minority gender in the field with personality, knowledge, and skill. "There is a wide variety of women and they all want different things," he explains. "Some women prefer male providers [while] others prefer women."
Barnard respects a woman's decision to not choose a male midwife because that means she is making a choice. "She is going about her healthcare the right way," he says. "There are so many women who go through healthcare saying, 'I'll take anybody, and they can do whatever they want to me.' That is not a healthy relationship. Women should have choices and do what they want to do. If someone doesn't want me because I'm male that's great, but I still hope they'll meet me first."
Patients who choose Barnard as their healthcare provider do not see his being a male midwife as an issue. "He's just great because he is lots of fun," says Nichole Parish, one of Barnard's patients. "He'll sit and talk and is always willing to answer questions. It doesn't matter how busy he is."

Virtual ICU

Published Nursing Spectrum Magazine 3/13/2003
By Carol Lindsay

By allowing intensivists and experienced critical care nurses to treat more patients, the eICU provides specialized care to patients who would not
otherwise have access.

A patient lying in a bed in an ICU reaches for his endotracheal tube and starts to pull. A voice comes out of nowhere - "Mr. Smith*, you really don't want to do that." Startled, the patient looks around the room, but there is no one there. Seconds later a nurse walks in the room. She reminds him that he has two nurses caring for him - herself and a virtual nurse located at a remote location. It was his virtual nurse who reminded him not to pull out his endotracheal tube.
The virtual ICU, also known as the eICU, is a combination of telemedicine, teleconferencing, and integrated clinical information technology. The system allows experienced RNs and hospitalists to work at remote sites as a team with the bedside staff to manage numerous ICU patients at numerous hospitals.
While the country needs 30,000 intensivists to care for critically ill patients, currently there are only 6,000 board certified intensivists practicing. There is also a shortage of critical care nurses across the country. By allowing intensivists and experienced critical care nurses to treat more patients, the eICU provides specialized care to patients who would not otherwise have access.
The eICU systems were created by two intensivist physicians at John Hopkins in Baltimore, MD. The idea behind the eICU is to add an extra layer to the ICU system. eRNs and eMDs at a remote site monitor a patient's labs, vital signs, cardiac rhythms, medications, and bedside information. They also have the ability to "look in" on the patient via camera and listen to activity in the room. A critical care eMD is available to the hospital ICU nurses immediately via a special emergency phone. This prevents common delays involved in paging a hospital physician. Because the remote sites are staffed 24-hours-a-day, the nurse is assured of speaking with an eMD who has up-to-the-minute information about the patient.
Tina Kennedy Schlegal, RN, MSN, CCRN, CNS, is the eICU director for VISICU, an eICU in Virginia. Schlegal believes there are many advantages to working in an eICU. "Working in the eICU is being able to do one of the best parts of ICU nursing - the thinking part," says Schlegal. The eRN is able to review all the patient information, such as labs, progress notes, results from CTs, MRIs, and other tests. The eRN is able to assimilate this knowledge and understand the patient's care plan and give input about different directions of patient care.
Requirements for nurses who work in eICUs include a minimum of three years of adult ICU monitoring at the bedside, plus experience with pulmonary artery catheters, monitors, pumps, and specialized equipment. These nurses must also have the technical abilities to learn to operate the eICU computer system and have the ability to manage up to 50 patients at a time. "We are no longer acting as just a critical care nurse, but more as an advanced practice nurse, reviewing charts, following vital signs, and working to prevent the urgent situations from occurring, as well as responding to urgent situations when they do occur," says Linda Rettig, RN, a clinical eICU nurse and trainer.
Patients are possibly seen by their attending physician and consulting physician only twice during the day, even though their condition changes minute by minute. Through the eICU the patient is seen 24-hours-per-day by an eMD intensivist and constantly monitored by a critical care eRN. This ensures that urgent situations are dealt with immediately, and the nonurgent issues are responded to promptly as well. "When a physician is paged, he or she must rely on his or her memory, and the nurse must answer many questions to bring him or her up to speed on the status of the patient at that time. The eICU staff has up-to-date information in front of them. This means the patient has a fully informed eMD making prompt decisions about urgent critical situations," says Rettig. The eICU does not replace the bedside nurse or the bedside physician. It is simply an adjunct to improve the outcomes of patients and decrease mortality and morbidity.
The advantages for an eRN working in an eICU include a decreased noise level, fewer interruptions, and the availability of a critical care physician the entire shift. Nurses do not have to stockpile their questions waiting for the physician to make rounds. "I have time to ask questions while I'm going through charts in the course of the day," says Rettig.
The technology is outstanding, but eRNs admit there is always a challenge when they are not the one standing at the bedside listening to the heart sounds and feeling the rigid abdomen directly. There is a definite team effort between the eICU nurse and bedside nurse.
The eICU can also be a benefit for nurses who are no longer physically able to work at the bedside but want to continue to use their critical care knowledge and skills to help patients. This allows the newer nurse at the bedside the advantage of having a seasoned eRN available for consultation. Rettig's vision for the future of eICU nurses includes a certification similar to the CCRN, which is currently available to bedside nurses, perhaps an eCCRN. She would also like to see nursing schools located near eICUs include nursing rotations and eICU critical care internship education.
So far the eICUs are reporting favorable outcomes. A 2001 Cap-Gemini, Ernst & Young study documented the following results: A 25% reduction in severity-adjusted hospital mortality at Sentara Norfolk General Hospital, a 17% reduction in ICU length of stay, and a savings in healthcare costs of $2,150 per patient or $3 million in program costs.


Unfair Fight

Spectrum Magazine
Publisehd 3/5/2001
By Carol Lindsay
I recently cared for a man who had tried to kill himself by hooking a hose to his car's exhaust pipe and feeding the carbon monoxide emissions through the window. He was in his gas chamber long enough to lose consciousness, but he didn't die. A neighbor found the man in the car, pulled him out, and called for help.
When the paramedics brought him to the ED, the suicidal man was wide awake and very unhappy to be alive. His belligerent and combative behavior got worse so we restrained him. As he struggled to free himself, he fought the restraints with so much force that the bed rocked. The man's anger continued to boil as I forced him to wear an oxygen mask, but fortunately for me, it caught all the spit he was trying to spray in my face.
He said it didn't matter how long I kept him restrained. "As soon as I get out of here, I'm going to shoot myself! I should have shot myself today!" No family or friends came to visit. I left the man under the watch of a police officer and went to care for another patient.
My new patient was 43 years old and had arrived by ambulance, as well. But unlike the man who had tried to kill himself, the new patient came into the ED quietly. One paramedic was performing chest compressions while another did respirations. The patient's distraught wife told us she had left her husband in the car while she went into the store. When she returned, she found him slumped over the steering wheel.
When I removed his jeans, a beeper fell to the floor. I handed it to his wife and listened as she explained her husband had cardiomyopathy. He was staying in our state while he waited for a heat transplant.
The beeper was to alert him when a donor heart became available. The man had tried valiantly to live; he underwent numerous surgeries and followed a strict medical regime, but all his efforts weren't enough to save his life. Nothing we could do would repair his diseased heart.
As I returned to the room of my suicidal patient, I could hear the dead man's wife crying as she spoke on the phone with their children. I had one patient who was so unhappy with life that he was under a suicide watch and tied to the bed so he didn't hurt himself. Just down the hall, I had another who tried so hard to live but lay dead.
My combative patient had become quiet. Through the widow's sobs, the suicidal man and I could hear the conversation she was having with her children in the next room. For the first time, we made eye contact. "Life is not fair," he whispered, "he could have had my heart."

Education • Young and old learn about the early days.

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Layton museum preserves Davis County history
Education • Young and old learn about the early days.
By carol lindsay

Published: April 11, 2012 10:37PM
Layton Heritage Museum curator Bill Sanders loves his job: He is a collector, a researcher, an organizer, a tour guide and a detective.

He never knows what the day will bring. In March, someone donated two trunks found in a grandfather’s basement. The old trunks contained World War I and World War II uniforms plus souvenirs and memorabilia from the wars, including an authentic Nazi swastika flag. Sanders had never seen such a flag except in books and called the family to make sure they wanted to part with something so valuable. They wanted the museum to keep it.

“I am not sure how I will ever display it, but it is a rare artifact and part of history,” Sanders said of the flag.

For 14 years — almost half of the museum’s life — Sanders has been the keeper of Layton and Kaysville history. Tucked between a city park and the Layton City police department, the museum has far too many items to display at once. Sanders is constantly changing out the exhibits, so visitors never know exactly what they will see. Currently, it features a display based on the Davis School District’s centennial celebration.

After residents submitted nominations for favorite teachers in the county before 1945, Sanders went on the hunt for pictures and information about all the nominees. He searched yearbooks and phone books and tracked down descendants of teachers and coaches who had passed on. Residents and former residents donated photos, desks, bulletin boards and clothes from the era to add to the exhibit. Someone donated a 1950s-era hand-cranked ditto machine.

Even the location of the museum is historic, on what was once Verland Park military housing. Verland Park was built as a support system for Hill Field Air Force Base during WWII.

Sanders has arranged the museum so visitors can get a feel for what it was like to live in the area 100 years ago.

“We cover the founding of Utah. … We have a section that shows the founding of the First National Bank of Layton and the sugar mill. We have a store setup. We have a 1903 automobile that has been loaned to us from the Morgan family in Layton for the last 30 years,” said Sanders. “We even have a pickled sugar beet that we store in vinegar.”

The history of health care in Davis County also gets some space in the museum. The first Davis School District physician was Sumner Gleason, who began working for the district in 1910, treating students’ medical and dental ailments. Yet Gleason is better known for his horticultural skills and became famous for his peaches. He grafted peaches in a quest to find one suited for Utah’s climate and eventually came up with the Gleason Alberta peach.

“Many of the orchards in Davis County still use his peaches,” said Sanders.

The museum has a little something for everyone. Hayden Pedersen, 9, brought his father and brother to see his favorite object.

“I came here for Scouts and I wanted my dad and brother to see it. My favorite part is a cannon ball stuck in a tree. It looks really cool,” said Hayden.

The museum also has computerized history programs for people whose ancestors were residents of Davis County.

“Files of pioneer history have been donated and we have a picture archive. We are continually making copies for families. … People doing genealogy are always looking for information, and we have it,” said Sanders.

Roselyn Slade of Kaysville, who is on the museum’s board, loves learning about the area’s history.

“We call it a regional museum because when Kaysville was first organized it was called the Kaysville Ward and it went clear to the Weber River, so all the early days are Kaysville history. People come from all over whose ancestors were early settlers and we have their history and what they’ve written and their pictures. It is just wonderful,” said Slade.

How to help

The Layton Heritage Museum is soliciting donations of items dating to the 1950s and ’60s. “Artifacts from that time frame are the ones being lost. The kids have to go in and clean out their parents’ house and they might find things from the 1950s and 1960s and their immediate reaction is ‘This is junk.’ We are trying to preserve stuff from that time period. There are a lot of treasures that should be kept,” said museum curator Bill Sanders.

© 2012 The Salt Lake Tribune
Layton museum preserves Davis County history
By carol lindsay

Monday, April 9, 2012

Note from Utah Nurse Aide Registry

Good Afternoon! Hopefully your Easter Holiday was great! We are receiving an extraordinary amount of calls from students stating that they were told that they would see their results online in 48 hours or that they would know in 2-3 days or any other amount of time.

We would like you, as testers and teachers to please just tell them that they will receive their results from the Registry in the mail. Do not tell them that they can check online, because as soon as they see they are not on there, they call us. Do not tell them 3-5 days or 5-7 or 8-10 days.

Tell them that the Registry will not take any calls regarding test results or certification. If they call us, it will slow the process down. As you know, our turnaround on everything is very quick; the candidate will be surprised…

Please tell them we will send the results out as fast as we can.

Thank you!!

Utah Nursing Assistant Registry Director

How a Young, Healthy RN Nearly Died (Three Times) and Lived To Tell Her Story

How a Young, Healthy RN Nearly Died (Three Times) and Lived To Tell Her Story
By Scott Neumyer, guest contributor

March 29, 2012 - When you’re a healthy 32-year-old registered nurse, the last thing you expect is to be on an operating table staring death in the face. This very scenario, however, is what happened last fall to Amy Lorincz--a nurse of more than 10 years who works in the neurological-stroke unit at JFK Medical Center in Edison, N.J.

While working a normal 12-hour shift on a normal Thursday afternoon in October, Lorincz began to experience severe upper back pain and tachycardia as high as 170.

“I wanted to keep working,” Lorincz said. “I just figured it would pass, but my co-workers made me go down to the ER.”

The attending emergency room physician thought she might be dehydrated, but, after receiving a liter of fluid, her heart rate did not return to normal. It was holding steady around 100 while resting. Sitting up, however, would raise her heart rate to 130, and walking would cause it to shoot up as high as 165.

Being the patient, instead of the caregiver, has given Lorincz a whole new perspective on nursing.After undergoing a series of tests, Lorincz had an echocardiogram which revealed fluid around the heart. The cardiologist called in for consult, Dr. Robert Schanzer, initially thought she was suffering from pericarditis--she had been sick three weeks prior with a virus that pushed her temperature to 104. He treated her with medication and sent her home.

A restless weekend of simply not feeling well, shortness of breath, and a heart rate that skyrocketed while doing the most menial tasks (showering, for instance) prompted Lorincz to call Dr. Schanzer the following Monday. Over the next few days, she underwent additional testing before undergoing a cardiac catheterization on October 20, 2011. It was at this point that Lorincz’s life would change forever.

The catheterization was initially performed in Lorincz’s wrist, but she immediately began to perspire and experienced a massive drop in blood pressure. The wrist catheterization was removed as her doctors opted, instead, to go in through the groin. While performing this procedure, Dr. Schanzer realized that Amy had suffered a spontaneous dissection of the LAD (left anterior descending artery)--a dissection that often results in death before it’s even discovered.

“At that point, I was barely conscious,” said Lorincz. “My husband had to sign all my consent forms. I was in a lot of pain and just… out of it.”

Dr. Schanzer tried his best to use a stent to stop the dissection, but the stent couldn’t support the blood pressure and Amy was admitted to the critical care unit (CCU) at JFK Medical Center. She was given blood pressure medications, to no avail, and doctors were forced to insert an intra-aortic balloon pump to support her blood pressure.

Later that evening, Lorincz was transferred to Robert Wood Johnson University Hospital in New Brunswick, N.J., under the care of Dr. Peter Scholz, who was tasked with saving the young RN’s life. She would have open heart surgery the next morning.

“In certain areas of the body, in certain blood vessels, these spontaneous dissections will heal up and you can often just watch them,” said Dr. Scholz. “But in the heart artery, that’s not going to be a good idea.”

When Lorincz finally awoke from her double bypass surgery, she was still intubated and had received a large amount of blood to replenish what she’d lost. She had an atrial line, a triple lumen catheter, an out-of-the-body pacemaker, three chest tubes, and the previously-mentioned balloon pump was still intact.

She was a mess of wires and tubes. She was exhausted and emotionally drained and in a lot of pain. But she was alive.

“Dr. Scholz saved my life,” said Lorincz.“Dr. Scholz saved my life,” said Lorincz. “I know that for a fact. He saved my father’s life with a double bypass surgery 26 years ago, and now he’d saved mine. If I didn’t have the surgery, I wouldn’t be here now seeing my kids grow up.”

She was finally extubated at 11:30 that evening, and, by that Sunday morning, she had all tubes out, was out of bed, and back to inpatient rehabilitation by Tuesday, October 25. And that would have been a fitting ending to a frightening tale. Only, it wasn’t the end.

Just two days later, Lorincz suffered another episode of tachycardia as her heart rate shot up to 240 and an EKG revealed a possible acute heart attack. She was transferred back to the CCU where doctors soon found blood clots in her right femoral artery, right interjugular vein, and left cephalic vein. She received more blood and was monitored for several more days. Lorincz returned to inpatient rehab on October, 31, where she remained until November 9.

After making it through the remaining 2011 holidays while resting at home, Lorincz would return to the hospital two more times in January of 2012: once with a life-threatening pulmonary embolism after suffering from shortness of breath and immense chest pain, and once with a vasospasm of the axillary artery in her left arm. She was treated for both just in time to save her life… again.

“I’ve never experienced anything like this before in my life,” said Lorincz, when asked about her string of life-threatening situations. “We have a history of heart disease in my family, but I’ve never had any issues. I’ve always been a relatively healthy person and for all these things to happen at the same time… it’s just a huge shock.”

Along with the doctors and nurses who helped save her life, Lorincz is thankful for the family and community that rallied around her when she was at her absolute worst.

"If I didn’t have the surgery," says Lorincz, "I wouldn’t be here now seeing my kids grow up.”“I have an amazing group of family, friends, and co-workers,” she said. “You don’t realize how much everyone cares about you until you’ve almost died. In my case, I had three chances to realize that. I’d say I know now.”

Family members, friends, and parents of her young daughters’ schoolmates (her daughters were six and four at the time) organized food drives, helped with childcare, and offered to lend a hand whenever and wherever it was needed. It was an outpouring of support for a young woman who was used to being the one providing help to her patients.

Still resting and gaining her strength back in preparation for the physical demands of her job, Lorincz is scheduled to make the transition from patient back to nurse next month, on April 15. This time, however, she’ll be doing it with a whole new perspective.

“Being on that side of the equation” changed everything, she explained. “Being the patient, being the person who nearly died on that table, I know what it’s like now. I know I’ll be more sympathetic. I know I’ll be more aware. I know I’ll be more understanding of everything my patients are going through. And most of all, I know I’ll be a better nurse.”


U.S. gives nod to Eli Lilly's brain plaque test

U.S. gives nod to Eli Lilly's brain plaque test
Apr. 07, 2012 1:16PM PDT Apr. 07, 2012 1:16PM PDT
Explore and compare medications WASHINGTON (Reuters) - U.S. regulators gave the nod to an imaging test from Eli Lilly and Co. that can for the first time help doctors detect brain plaque tied to Alzheimer's disease, the company said.

The U.S. Food and Drug Administration approved the radioactive dye, called Amyvid, to help doctors rule out whether patients have Alzheimer's, the most common form of dementia, Lilly announced late on Friday.

The dye binds to clumps of a toxic protein called beta amyloid that accumulates in the brains of patients with Alzheimer's. Doctors can then see the plaque light up on a positron emission tomography, or PET, scan.

Patients with Alzheimer's always have some brain plaque, so its absence in the test would tell doctors to look for other causes of mental decline, such as depression or medications, Lilly has said.

But Lilly, which plans to sell the drug through its unit Avid Radiopharmaceuticals Inc, said the test should not be used to diagnose Alzheimer's, since brain plaque can also be tied to other neurologic conditions and may occur naturally in older people with normal mental states.

An FDA advisory panel recommended against approving the dye last year, saying doctors might have trouble interpreting scans of the plaque, and the FDA rejected Amyvid last March.

Since then, Eli Lilly said it has worked to identify better ways of training doctors to use the test.

Dr. Daniel Skovronsky, CEO of Avid, said one in five patients who are diagnosed with Alzheimer's turn out not to have the disease after an autopsy.

"The approval of Amyvid offers physicians a tool that, in conjunction with other diagnostic evaluations, can provide information to help physicians evaluate their patients," he said in the company's statement from Friday.

There is currently no cure for Alzheimer's, a mind-robbing disease that affects more than 35 million people worldwide and gets worse with age.

But an early hint that something is wrong might improve the success of drugs meant to prevent or delay disease progression, researchers believe.

Avid has been in the lead in the race for imaging agents for Alzheimer's, which are estimated to have a potential global market anywhere from $1 billion to $5 billion.

General Electric Co and Bayer AG are developing rival products.

Lilly, as well as Pfizer Inc, are the farthest along in developing experimental medicines to treat Alzheimer's. Lilly expects to release final data for its contender, solanezumab, as soon as this summer.

(Reporting by Anna Yukhananov; editing by Todd Eastham

Behind autism: Genes? Pollutants? Mom’s weight?

Behind autism: Genes? Pollutants? Mom’s weight?

The Associated Press

Updated Apr 9, 2012 01:49PM

Some questions and answers about autism.

What causes autism? • That’s what researches are trying to figure out with a host of studies. The causes are believed to be complicated, and not necessarily the same for each child.

How much of autism can be linked to genetic causes? • Some experts say that in many cases autism results from both genetic flaws that load the gun and other factors that pull the trigger. So far, they have determined genetic problems account for about 20 percent of cases. That percentage could grow as they continue to find new genetic mechanisms.

What other factors could be involved? • Some studies have suggested that obesity during pregnancy raises the risk for autism. Others found a link between autism and older fathers at the time of conception. Also being studied are other factors during pregnancy, including medications, as well as environmental pollutants.

How many children have autism? • The latest government estimate is 1 in 88 U.S. children have an autism disorder. Those can range from mild cases in which some kids lose that diagnosis as they mature to severe cases in which children are uncommunicative and severely intellectually disabled.

Why are we hearing so much about autism lately? • Several research studies have been published over the past week, and April is National Autism Awareness Month. The new research findings also followed closely the Centers for Disease Control and Prevention report on new U.S. autism estimates.

Women brawl over who should date Utah jail inmate

Women brawl over who should date Utah jail inmate

By Janelle Stecklein

The Salt Lake Tribune

Updated Apr 9, 2012 11:22AM

One woman was stabbed in the neck late Sunday at a South Salt Lake apartment complex after police allege she and another woman decided to fight over which of them should date a jail inmate.

South Salt Lake police said the incident had started earlier in the day at a park when the two women, who both wanted to be in a relationship with the same inmate, decided to fight it out. The altercation started again about 11 p.m. at the Sun River Apartments, 1080 W. 3300 South.

When police arrived, officers said they found a 19-year-old woman had been stabbed in the back of her neck. She was listed in fair condition Monday, police said.

Police said they located one of the vehicles involved in the altercation in Taylorsville, and questioned and released the occupants. Police said they were still trying to locate a second vehicle Monday.

Police said the women’s "love-triangle" involved a man who is currently incarcerated.

Thursday, April 5, 2012

Strong Demand

Is healthcare recession-proof?
Technology is playing an increasing role in nursing practice and education.
By Beth Puliti

Posted on: April 2, 2012

New reports from the Bureau of Labor Statistics (BLS) certainly suggest it is.

In the first 2 months of 2012, the healthcare sector has accounted for one in five new jobs in the overall economy, which exceeds job growth throughout much of 2011.

Specifically, in February, the healthcare sector created 49,000 jobs - up from 43,300 jobs the month before, according to the BLS.

Rhonda M. Zaleski, MS, RN, CHPN, corporate director, nurse recruitment and workforce planning at University of Pennsylvania Health System, noted the market for nurses with BSNs and those advancing their education are strong.

In fact, nursing positions account for almost 50 percent of all open positions at Penn Nursing.

"As organizations face more challenges and complexity in providing healthcare, highly educated and diverse nurses with BSN, master's and doctorate nursing degrees with skill beyond traditional functional discipline prove to be in demand," she remarked.

Regional Hiring Trends

It's no secret that, over the past 2 years, the economy has impacted the ability of new nursing graduates to find a job.

However, nurses are critical to an organization, noted Zaleski.

"Evidence that educated nurses play a pivotal role in patient safety and better patient outcomes has been acknowledged by the healthcare industry both locally and nationally," she said.

The release of the Institute of Medicine's Future of Nursing report, along with data that healthcare facilities with a higher percentage of BSNs enjoy better patient outcomes and significantly lower mortality rates, has driven organizations' recruitment to prefer BSN-only hires with a plan to increase the percentage of BSNs over time.

Zaleski acknowledged new graduate employment continues to be competitive.

However, she is encouraged as more organizations start to rethink hiring new grads to grow a higher percentage of BSNs while recruiting a younger workforce to proactively plan for nurse retirements as the economy lifts.

"At Penn Medicine, our Recruitment and Workforce Plan projected increases in nursing management and advanced practice where we experienced a 32 percent increase in advanced practice hires and 2.5 percent increase in nursing management hires that continue on this upper trend," revealed Zaleski.

She stated 40 percent of all nursing hires come from the internal nursing workforce, which gives nurses the opportunity to advance within the health system.

Regional Salary Trends

In May 2010, the BLS estimated the mean annual wage of a registered nurse in the Philadelphia metropolitan area was $72,100. Also at this time, the mean hourly rate was $34.66.

Zaleski noted nurses who advance their level of education, certification and specialty create more demand for their employment and are paid more based on experience and higher education.

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Wendy Gable, director of recruitment at Temple University Health System, said salaries within Temple's health system are based on experience.

However, nurses with advanced degrees would have the ability to earn higher salaries based on the fact that these positions tend to pay in a higher range for the additional education and experience requirements.

The shifts that RNs work can also affect their pay through shift differential, added Gable. Certifications are another area, as well as further education to move into a higher role.

"Salary is a piece of a nurse's total rewards package. Pay is important, but benefits, growth and development possibilities, and work/life balance are also significant factors," said Gable.

Zaleski added nurses can expect that Magnet-designated hospitals and large academic facilities are now requiring master's-prepared nurses for nurse manager and nursing leadership positions, and a trend toward more doctorate-prepared nurses at the director and executive nurse level.

"Experienced nurses going back to school, embracing technology and seeking interest in nursing leadership in both clinical and administrative [areas] have a high potential for advancement," said Zaleski.

Driven by the Consumer

The Internet has made it easy, fast and convenient for the general public to seek out health information, noted Kellie Smith, EdD, RN, assistant professor at Thomas Jefferson University Jefferson School of Nursing.

As patients and families are routinely educating themselves in all aspects of wellness, health and disease, nursing students are taught how to evaluate healthcare information that is on the Internet to assist patients in receiving accurate and up-to-date information.

"This is crucial as often websites are not peer-reviewed and have no quality controls," remarked Smith.

"Consumer-driven health education can be used in a positive way with the nurse and patient working in partnership to affect improved health."

She also mentioned that changing demographics and increased diversity - both in the U.S. population and student demographics - have affected nursing education.

"Cultural competency is an important component within the nursing curriculum, such as learning to respect other cultures and how to incorporate cultural sensitivity into patient care," she said.

Zane Wolf, PhD, RN, FAAN, dean and professor at La Salle University School of Nursing and Health Sciences, concurred.

"I think that diverse experiences help students look more realistically at patients. They look at themselves and their own particular cultural perspectives, and begin to look at other ways of behaving, thinking and using healthcare. You learn about yourself when you see the differences among your colleagues and the way they approach things," she said.

The 21st Century Nurse

Faculty is increasingly infusing information and instructional technology into teaching/learning practices in the classroom, laboratory and clinical settings, noted Smith.

"Instructional technology has moved beyond referential support and is currently supporting low- and high-fidelity simulation scenarios, mobile tablet computing, and enhanced inter- and intra-communication platforms," she said.

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Through mobile tablet computing, such as the iPad, nursing students have uninterrupted access to vast databases of knowledge that can be accessed anytime anywhere, including nursing skills videos, patient care algorithms and care maps, e-books and clinical companion references.

"Nurses of the 21st century need to be versed in the nursing process and standard nursing competencies as outlined in the American Association of Colleges of Nursing's Essentials of Baccalaureate Education for Professional Nursing Practice," advised Smith.

She believes technology is playing an increasing role in healthcare practice and education.

"Nurses must possess the necessary skills to effectively utilize patient care technology at the bedside, communicate and participate on interprofessional teams to enhance patient care quality and outcomes, and assume a leadership role in evidence-based patient care."

Wolf said nursing students today must be aware of trends and recognize they are never going to stop learning - both direct clinical skills and the thinking abilities that are enhanced with easy access to information.

"With easy access also brings an overwhelming amount of information. Nursing students are going to have to develop more analytical reading comprehension strategies to manage it," she said.

Beth Puliti is a frequent contributor to ADVANCE.

Nurse’s aide guilty of rape

By John Futty
The Columbus Dispatch Saturday February 4, 2012 5:51 AM

A former nurse’s aide was taken to jail yesterday after Franklin County jurors convicted him of raping a woman who was recuperating from surgery in the Victorian Village rehabilitation center where he worked.

Tizazu Arega, 34, was found guilty of one count of rape and one count of sexual battery. He was acquitted of a second rape count. He could be sentenced to as many as 15 years in prison when he appears before Common Pleas Judge John P. Bessey on March 1.

The judge revoked Arega’s bond after the verdicts were announced.

The 29-year-old woman, who is legally blind, spent nearly two months at Heartland-Victorian Village on Thurber Drive W. after having surgery on a leg that was shattered when she was struck by a car.

She testified that Arega placed her wheelchair in front of the closed door to her room and raped her vaginally and anally on Sept. 1, 2010. She was not in the courtroom for the verdict.

Arega testified that the sex was consensual, that she initiated it and that he and the woman had a flirtatious relationship. But during cross-examination by Assistant County Prosecutor Megan Jewett, Arega struggled to explain his repeated denials to Heartland officials and police detectives that any sexual contact took place.

Arega’s attorney, Karen Phipps, called it a “he-said, she-said” case and questioned inconsistencies in the woman’s story.

The jury of seven men and five women deliberated for about 10 hours over parts of three days before reaching the verdicts early yesterday afternoon.

Arega, of Irongate Lane in Whitehall, was convicted of the rape count alleging vaginal sex and acquitted of a count alleging anal sex. The verdicts were consistent with testimony from a sexual-assault nurse about where semen was found during an examination of the woman in Riverside Methodist Hospital.

The evidence provided a DNA profile that matched Arega’s.

The sexual-battery conviction was based on state law that prohibits sexual conduct between “a patient in a hospital or other institution” and anyone with “supervisory or disciplinary authority” over that person.

The Dispatch does not name those who report having been sexually assaulted unless they agree to be identified.

Most violent job in Washington? Nurses aide .


by Associated Press
Posted on July 12, 2011 at 9:20 AM

SEATTLE - The most violent job in Washington state isn't being a police officer or a security guard. It's working as a nurse's aide.

Seattle public radio station KUOW-FM made that finding as part of an investigative series on workplace safety airing this week. The station found that violence strikes health care workers in Washington at six times the state average, and frontline caregivers in emergency rooms and psychiatric wards get assaulted even more than that.

The single most violent workplace in the state is at Western State Hospital, where criminal defendants are taken when they are found incompetent to stand trial. Workers at psychiatric hospitals are assaulted on the job more often than anybody else -- 60 times more than the average worker in Washington state.

KUOW also found that even though working on steel towers remains one of the nation's most dangerous jobs, right up there with commercial fishing, line workers for Seattle City Light and other northwest power companies aren't strapped in while they climb such towers. Instead, they only strap safety ropes to their harnesses once they've climbed up to where they'll be working -- around 200 feet above ground in some cases.

Though several line worker deaths from falls were reported in other states last year, none has been reported in Washington in the past decade.

James Robinson, president of the union for many workers at Western State Hospital, says there were 313 assaults there last year -- a drop of nearly 30 percent in assaults per patient-care hour, though union officials also note that many incidents go unreported because of the time required to fill out paperwork about assaults.

At some hospitals, such as Tacoma General, emergency room security is obviously a concern. Everyone must pass through a metal detector to enter the ER, no matter the time of day. It's one of many measures Pierce County's biggest hospital has taken to keep patients from attacking hospital staff.

Other anti-violence measures are more subtle. Much of the staff is trained how to pacify agitated people. Even the colors and spaces of the ER's new waiting area were designed to soothe injured, stressed out, impatient patients.

If that doesn't work, some exam rooms have additional security measures -- such as a metal gate that can come clanging down to protect medical equipment from violent patients.

Jeaux Rinehart, a Seattle nurse and president of the state's Emergency Nurses Association, says he's been clubbed in the head by a mentally ill patient seeking narcotics and, more recently, an intoxicated patient punched him in the face and threatened to kill him. That patient served three months in jail.

"A lot of hospitals don't really encourage nurses to report violent acts against them, and some facilities just feel that it's part of your job, and you should just simply tolerate it, knowing that if you work in an emergency department, violence is going to be there, so prepare for it," he said.

Nurses' unions want hospitals to do more to protect their workers, like more hands-on training on how to avoid or defuse violent situations.

Nan Yragui, a psychologist with the Department of Labor and Industries, studies workplace violence. She said budget cuts to the health-care safety net have made emergency rooms nationwide more violence-prone.

"When patients can't get services they need, they end up going to the emergency department," she said. "So more of the severely mentally ill are going to the emergency department and then that makes that group of nurses more at risk because they're getting more exposure."

Those factors helped fuel a 26 percent rise in violent incidents last year at Providence St. Peter Hospital in Olympia, said Jeff Glass, its director of facilities.

Even after a patient smuggled three guns into the St. Peter emergency room two years ago and wound up being shot to death by a police officer, the hospital hasn't installed a metal detector, for fear it could dangerously delay patient care. Instead, they wave a hand-held metal detector at patients they deem high risk.

The guards at Harborview Medical Center in Seattle run a metal detector on the overnight shift.

The Department of Labor and Industries has cited Harborview 11 times in the past three years for serious workplace safety violations. In November, the state fined Harborview $13,000 for failing to provide a safe workplace for its security guards.

Public records show someone being assaulted at Harborview about every couple days last year. On a recent Saturday night, a patient managed to walk into the emergency room with a large knife, two cans of pepper spray, a cap gun and lots of bullets in his backpack.

Harborview has appealed the fines, calling them arbitrary and capricious enforcement of the state's workplace safety rules.

Spokeswoman Susan Gregg said the hospital uses best practices from the health care industry to provide a safe environment.

Graveyard-shift guard Mike Nervik says despite the hospital's shortcomings, Harborview is a lot less violent than it was in the 1990s.

"Like 15 years ago, you'd go home just wringed out in sweat, having gotten in confrontations with several people," he said.

From furniture to orphans, Davis students know their history

Education • District history fair draws record number of participants.
By Carol Lindsay

Published: April 4, 2012 10:52PM

Leah Hogsten | The Salt Lake Tribune Adelaide Elementary fifth graders Catherine Hall (left) and Marissa Brewster burying their heads in their books in between judging of their 21st Amendment Repeal of Prohibition project. Davis County students showed their prepared history projects related to the theme Revolution, Reaction and Reform at the annual Davis School District History Fair Thursday, March 15, at the Kendell Building, Farmington. Between 1845 and 1920, thousands of street orphans traveled by train from New York City to rural areas across the country where they were placed with farm families. This causal relocation of children by the Children’s Aid Society was the beginning of what would became the foster care system in the United States.

Ashley Hubert and Elise Willmore, both 11 and fifth graders performed a two-person play depicting events during those years as part of the Davis County School District history fair.

“Yesterday’s orphan train is sort of like today’s foster care, but today we have social workers and background checks and then they didn’t do any of that,” Willmore said.

Ashley explained that the pair chose to do their project on orphans after reading a book about them and seeing pictures of the children.

“They were all huddled up in a corner, their clothes all ripped and torn. The story just grabbed us,” she said.

But that was just one of many historical stories researched and presented by Davis students.

Davis School District has been hosting a history fair for three years. This year’s fair took place in March and was the largest yet, with more than 160 students in fourth through eighth grades participating. Students who took part in the fair had already competed at their school level and received a superior ranking.

“Early in the year, students select a broad topic that interests them, and then narrow their research to a specific event or person. Then, students must identify and argue how their chosen topic relates to the annual topic,” said Jon Hyatt, director of American History for the district. This year’s theme was “Revolution, Reaction, Reform.”

“The culmination of their research is the production of a project in one of five categories. They have the choice to produce a historical paper, website, documentary, performance or an exhibit.”

The fair was a chance for students to research subjects of personal interest. Twelve-year-old Kelsey Barber, a seventh grader at Millcreek Junior High, created a PowerPoint presentation on the history of the Episcopalian church in Utah. She learned that Rowland Hall school was founded in 1888, and that the first St. Mark’s hospital was built to provide health care for miners at 500 East and 400 South in Salt Lake City.

“I am standing up for my religion and their place in Utah history,” Barber said.

Eleven-year-olds Terah Cheng and Aspen Andersen, and Keylie Criddle, 12 — sixth graders at Syracuse Elementary — researched a local icon: RC Willey.

“Syracuse is in our hometown and so is RC Willey and almost everyone in our town has been there for something even if it was just a hot dog. We thought they might want to know a little more,” Cheng said.

What Criddle found most interesting about the company’s founder is that, because he stuttered, he didn’t verbally sell his products. “He sold appliances out of the back of his red pick up truck. He would let people use them for a couple of weeks and if they liked them they could buy them,” Criddle said.

One of the fun things the group did was interview Willey’s son-in-law, Bill Childs, who took over the business. “He’s really hometown,” Andersen said.

When Kamber Hinson and Jacob Trader, fifth graders at Adelaide Elementary School, started researching the Eighth Amendment, they had no idea they would discover Hinson’s uncle was asked to be on the firing squad for a Utah execution.

“I asked him how he felt and he said he refused because he couldn’t live with not knowing if he had killed someone,” Hinson said.

Other Utah topics included Bonneville Salt Flats Racing, Hollywood in Moab, Primary Children’s Medical Center, and Topaz, a internment camp for Japanese Americans during World War II.

Utah CNA student (Thank you note)

So, I don't really know what to tell you about me but I will tell you why I wanted to go into medical field.

I didn't want to be a CNA always at first I wanted to be a Vet technician 19.00 dollars an hour, who wouldn't.
My first experience in a nursing home was beehive home in South Jordan by Bingham high school, My great grandpa Claude Bell was there.
There were about 10 residents, 2 people I wasn't sure who was the RN or CNA, if there was a RN maybe not.

Anyways, they left my grandpa alone in a dark room blinds were always shut. Never really understood.

I guess at that point not knowing what I do now, that was normal. Long story short. He died there at 92 yrs age.

I remember one thing about my grandpa " Wee Wee said the little Bumblebee."

I want to make a difference.
Everything about abuse to elderly people or even children, it hurts.
I know how it feels, and the last thing I would want to do is put someone else through that.

I have tattoos each of them ARE apart of something tremendous to something simple but yet symbolic.
Parents tattooed on the shoulders. To remind even though they are alive but I mean when they leave,

they are always with me. :) my dads is a guitar with his name really rough edge kinda thing, he is a metal head.
My mom's is in calligraphy writing to promote the graceful yet sometimes confusing person.

the roses on my wrist is a cover up of a name, the thorn of the rose where in order to get a rose you need to let it grow,
mature then you get a blossomed Rose.

the heart on the other side is pretty much the greatest day of my life it was a hemp tattoo, I got it with my mom and 2 sisters

at the women's convention in Sandy. It was a fun experience.

the stars on my leg is pretty much for myself I am a star in my eyes maybe someday to someone else Plus I have 5 people

in my family not including in laws, immediate family yes. :) there are 5 stars and that represents my family as well.

I loved doing my Clinicals @ Sandy regional and St. Joseph Villa. I meant some really amazing people. My CNA's were incredible.
A man talked about his wife whom passed 3 days before I was there, I sat at his lunch table and I sat in his room with my CNA listening.

He had no sense of life, I knew that if he had passed that moment he would be better and happier then he was, he wanted, missed his wife.

Another story a lady I watched her @ breakfast, she wasn't able to eat on her own. I didn't see her till lunch, I help her eat.

I was putting a spoon up to her mouth and she took it from me, she started eating herself. She kept telling me she wanted to just go home,
why won't them just let me go home.

First clinical was very emotional roller coaster I guess you would say, I was happy at times and others I felt as if I couldn't do anything.

Second clinical I really didn't show the sadness I went, more confident then the first clinical. I knew how to handle certain situations better this time.

I won't forget either Clinicals, cause it was a sense of accomplishment for me. Accomplishment that on the
1st clinical a lady I gave a shower to said to me, they don't listen to us.

2nd I felt home... And at that moment I realized this is what I want to do!

From my background that felt amazing. to finally know what I wanted to do and Finally go for a career that I absolutely can't see myself NOT doing.

And I thank you Carol & Claudia and Linda And all of you at CCCNA for helping me.

I'm the first one to further my education past highschool withing of getting out of highschool.

All of you have made my dream come true. :)

I WILL be a CNA that will listen, care, be there, but also take full advantage of what you all have taught me.

Wednesday, April 4, 2012

RN shortage expected to increase in next few years

Although RN shortages have been less apparent in recent years, employers and workforce policymakers should expect significant shortages to reemerge in coming years, according to an article in the New England Journal of Medicine.

The authors referred to the "countercyclical nature of the healthcare industry, in which job gains occur faster in recessionary than in non-recessionary periods." They reported data from the Current Population Survey, which found the number of full-time RNs increased by 386,000 between 2005 and 2010. Using an analytical model, they estimated that more than a third of the increase (146,000) could be attributed to the rise in the unemployment rate from 5.1% in 2005 to 9.6% in 2010.

Douglas Staiger, PhD, of Dartmouth College, David Auerbach, PhD, of the RAND Corporation and Peter Buerhaus, RN, PhD, FAAN, of Vanderbilt University Medical Center wrote that with unemployment projected to decrease to 6.1% by 2015, "the substantial expansion in the RN workforce is largely a temporary bubble that is likely to deflate during the next several years."

According to their projections, about 118,000 full-time RNs will leave the workforce by 2015. With such an exodus, the full-time RN workforce would grow by only about 109,000 during that span — a major drop-off from 2005-10 and a smaller expansion than the authors have found during any five-year period over the previous four decades.

Although the number of young people entering nursing rose over the past decade, the authors wrote, the increase is not expected to affect the RN workforce until later in the decade and, especially, after 2020. "Thus it seems likely that growth in the demand for RNs over the next few years will outstrip the projected growth in the workforce, leading to renewed shortages of RNs in the near term."

The resulting shortages "may reduce access to care and increase costs as employers raise salaries to attract nurses, potentially imperiling the success of healthcare reform," the authors concluded. "Therefore, plans to counter the reemergence of a post-recession shortage and to use existing RNs … as efficiently and effectively as possible should be a priority for policymakers."

The authors attributed the rise in RN employment during the recent recession to several factors, including individual nurses' tendencies to fill existing job vacancies because of concern about their personal financial situations and diminished opportunities elsewhere. They noted that about seven in 10 RNs are married women and may rejoin the workforce or change to full-time status to help their household's economic outlook during a downturn.

The report — "Registered Nurse Labor Supply and the Recession — Are We in a Bubble?" — appeared March 21 on

Sadly Caught Up in the Moment: An Exploration of Horizontal Violence

Nancy Walrafen, Ms, Rn, Ocn; M. Kathleen Brewer, Phd, Arnp, Bc; Carol Mulvenon, Ms, Rn-Bc, Aocn, Achpn

Posted: 03/30/2012; Nurs Econ. 2012;30(1):6-12, 49. © 2012 Jannetti Publications, Inc.

Abstract and Introduction
While researchers continue to explore horizontal violence for a more comprehensive understanding of the phenomenon and its root causes, there is currently agreement on two issues. Horizontal violence is prevalent in the nursing profession, and the experience of this behavior is psychologically distressing, threatening patient safety, nurse moral, and nurse retention (Joint Commission, 2008; McKenna, Smith, Poole, & Coverdale, 2003; Simons, 2008). While discussing this phenomenon at a nursing retention committee meeting, all but one of the 15 members present had a story to relate about a time when they experienced bullying. Strong emotions were evident in the telling of these stories; whether they occurred in the recent or far distant past. This led members of the committee to the central question of this study: Is horizontal violence occurring within our organization, and if so, how prevalent is it? Griffin (2004) defined horizontal violence as overt and covert actions by nurses toward each other and especially towards those viewed as less powerful. Based on this definition and using the most common behaviors, Griffin (2004) identified from the nursing literature, the nurses in our hospital system were surveyed to further explore this phenomenon.

Review of Literature
A review of the scientific nursing literature presented a picture of horizontal violence which can be delineated into three distinct categories: (a) prevalence and consequences, (b) root causes, and (c) how best to address the phenomenon in the workplace.

The prevalence of horizontal vio lence has been identified as ranging from 5%-38% in Scandinavian countries, the United Kingdom, and the United States (Johnson, 2009; Simons, 2008). Two Australian studies report 50% and 57% prevalence rates, and 86.5% of participants in a Turkish study reported experiencing aggressive behaviors at work (Johnson, 2009). In a study conducted by Farrell (1997), the majority of subjects described experiencing intra-staff aggression which was more troublesome and harder to deal with than aggressive behaviors from patients or their families and contributed to a work environment that was hostile. Nursing students reported being the target of verbal or emotional abuse from staff members in the clinical environment (Longo, 2007), and McKenna et al. (2003) discovered that new graduates are also likely to experience horizontal violence.

Recognizing that aggressive behavior in the workplace jeopardizes patient safety, the Joint Commission (2008) issued a sentinel event alert calling for organizations to address the behaviors that "undermine a culture of safety." In a similar vein, the Center for American Nurses (2008) published a position statement acknowledging the affects on patient safety, quality of care, and how this phenomenon directly affects the organization's and profession's ability to attract and retain nurses. Hutchinson, Jackson, Wilkes, and Vickers (2008) developed a new model of bullying in the workplace. Embedded in this model is the notion that experiencing horizontal violence has negative health effects in addition to interruptions in work settings and career goals.

Researchers' interest has been piqued about horizontal violence for the past several decades with varying viewpoints on the cause. While some researchers believe this is a direct result of oppressed group behavior (Duffy, 1995; Roberts, Demarco, & Griffin, 2009), others contend that in order to fully understand and address the behaviors and potential outcomes associated with horizontal violence it is important to look at structures and circuits of power within organizations (Hutchinson, Vickers, Jackson, & Wilkes, 2006).

Reducing Horizontal Violence
The presence of horizontal violence in the workplace makes it difficult for an organization to improve the quality of care they provide or create a satisfied work force (Woelfe & McCaffrey, 2007). It is also difficult to decrease nurse turnover and attract the most desirable employees in an organization where horizontal violence exists (Center for American Nurses, 2008). The average cost of replacing a nurse who has left to work at a competing institution ranges from $22,000 to $64,000 (Jones & Gates, 2007).

Increased awareness has been cited as a first step in formulating a plan to decrease the incidence of horizontal violence in the workplace (Johnson, 2009; Simons, 2008). Cognitive behavioral techniques have been used successfully by nurses (Griffin, 2004). Jackson, Firtko, and Edenborough (2007) described the use of individual resilience strengthening as a way to decrease susceptibility to adversity within the workplace. Farrell (2001) advocated individual nurses can and should play an important role in changing their work environments.

Theoretical Framework
Bandura (1969), the author of Social Learning Theory, emphasized the importance of observing and modeling the behaviors, attitudes, and emotional reactions of others as a way to assimilate into a particular group. Much of our learning to navigate interpersonal situations is a result of emulating the behaviors we observe in the group to which we want to be accepted as a member (Bandura, Ross, & Ross, 1961; Bandura, 1969, 1977). Also known as reciprocal determinism, the aforementioned researchers believe the world and a person's behavior cause each other. Believing this to be true as well, this framework was selected to guide our study.

The literature about horizontal violence in the workplace revealed that individuals tend to emulate the behaviors of the group members they most intimately engage with as a way to be accepted by them. Stated another way and based on Bandura's theory, the workplace (world) and the employees (individuals) on some level cause each other's behavior (reciprocal determinism). When maltreatment of an employee(s) is occurring, members of the work unit may model the behavior of the individuals participating in the negative behavior as a way to be accepted by them (see Figure 1).

Figure 1. Horizontal Violence Intervention Model

A mixed-method descrip tive design was used to fully describe the participants' experiences with horizontal violence and to achieve a more thorough and explicit understanding of the complexities surrounding this phenomenon (Connelly, Bott, Hoffart, & Taunton, 1997). Based on the seminal work of Duffy (1995) and Griffin (2004), the researchers developed a survey to answer their research question (see Table 1). The nineitem Horizontal Violence Behavior Survey was constructed from generated items carefully examining the wording and sequencing of each item put forth by Fink and Kosecoff (1988). For each of the nine negative behaviors listed, respondents were asked to choose from three responses namely, experienced, witnessed, neither experienced nor witnes sed with the potential for multiple responses in each category. In addition to completing the quantitative survey, the participants were asked to respond to three open-ended qualitative questions.

Table 1. Quantitative Results
Behaviors Response % Response Count
Nonverbal negative innuendo (i.e., raising eyebrows, face-making)
Have witnessed this being done to someone. 72.2% 148
Have personally experienced. 54.1% 111
Have neither witnessed this being done nor experienced myself. 8.3% 17
Covert or overt verbal affront (i.e., snide remarks, withholding information, abrupt responses)
Have witnessed this being done to someone. 66.7% 136
Have personally experienced. 58.3% 119
Have neither witnessed this being done nor experienced myself. 11.3% 23
Undermining clinical activities (i.e., not available to help, turning away when asked for help)
Have witnessed this being done to someone. 50.0% 102
Have personally experienced. 46.1% 94
Have neither witnessed this being done nor experienced myself. 32.4% 66
Sabotage (i.e., deliberately setting up a negative situation)
Have witnessed this being done to someone. 28.4% 57
Have personally experienced. 19.9% 40
Have neither witnessed this being done nor experienced myself. 64.2% 129
Bickering among peers
Have witnessed this being done to someone. 72.1% 147
Have personally experienced. 48.0% 98
Have neither witnessed this being done nor experienced myself. 10.8% 22
Scapegoating (i.e., always assigning blame to one person when things go wrong)
Have witnessed this being done to someone. 56.5% 113
Have personally experienced. 26.0% 52
Have neither witnessed this being done nor experienced myself. 36.5% 73
Backstabbing (i.e., complaining to others about one individual).
Have witnessed this being done to someone. 77.0% 157
Have personally experienced. 53.4% 109
Have neither witnessed this being done nor experienced myself. 8.3% 17
Failure to respect the privacy of others (i.e., gossip/talking about others without their permission)
Have witnessed this being done to someone. 76.0% 155
Have personally experienced. 46.1% 94
Have neither witnessed this being done nor experienced myself. 10.8% 22
Broken commitments and/or broken confidences (i.e., repeating something that was meant to be kept confidential)
Have witnessed this being done to someone. 52.2% 106
Have personally experienced. 28.6% 58
Have neither witnessed this being done nor experienced myself. 37.9% 77

Seven experts from various educational institutions, and qualified to judge the questions for relevancy, were asked to respond to the appropriateness of the instrument (Okoli & Pawlowski, 2004). Six experts rated each item on the instrument a 4 on a scale of 1 (low) to 4 (high) with relevance and clarity; one expert rated each item 3.5. Based on the feedback from the experts, the researchers refined the items for clarity and word choice. The verbiage was changed in two of the nine items. Regarding survey question number two, the word action was replaced with affront. In the second instance, in question number six scapegoat was changed to scapegoating. These changes were made based on the belief of one expert reviewer that affront and scapegoating would more accurately capture the essence of the experience.

Setting, Sample, and Data Analysis
With institutional review board approval, all nurses in the multi-institutional health care system were invited to participate in the study (see Table 2). An e-mail providing a link to the survey was distributed with three subsequent reminders over a 30-day time frame when data were collected. The quantitative data were analyzed using frequency and central tendency. The responses to the open-ended qualitative questions were thematically synthesized using the steps for qualitative analysis prescribed by van Manen (1991). Qualitative content analysis is a descriptive analytical technique that serves to identify the manifest and latent content of a text; in this case the answers to the open-ended questions (Brewer, 2006; Denker, 1995; Graneheim & Lundman, 2004; Reineck, Finstuen, Connelly, & Murdock, 2001).

Table 2. Demographics of Sample (N=227)
Characteristics %
Age Group (years)
Up to 25 7
26–35 17
36–45 19
46–55 39
56–65 18
>65 1
Female 93
Male 7
White 96
Black 3
Asian 1
Highest Education
Diploma 9
AD 19
BSN 63
Masters 9
Years of Experience in Nursing
0–10 years 31
11–20 years 25
21+ years 45
Years of Employment at Organization
0–10 years 61
11–20 years 23
21+ years 16

The respondents (N=227) provided data on the nine identified horizontal violence behaviors. The highest reports of affirmative responses were in the category of personally having witnessed a peer as the victim of a negative behavior (28.4%-77%). In eight of the nine categories, a majority of respondents reported having personally witnessed the horizontal violence activity with scores in excess of 70% that included backstabbing (77%), failure to respect the privacy of others (76%), nonverbal negative innuendo (72.2%), and bickering among peers (72.1). The only behavior that was not witnessed by a majority was sabotage (28.4%).

The response range for personally experienced behaviors was 19.9%-53.3%. Six of the nine categories were 46% or more, and three of the nine were 50% or greater, including covert or overt affronts (58.3%), nonverbal negative innuendos (54.1%), and backstabbing (53.4%).

The data revealed that 8.3%-64.2% of respondents had neither witnessed nor experienced horizontal violence. The only type of horizontal violence not witnessed or experienced by the majority was sabotage (64.2%) (see Table 1).

Table 1. Quantitative Results
Behaviors Response % Response Count
Nonverbal negative innuendo (i.e., raising eyebrows, face-making)
Have witnessed this being done to someone. 72.2% 148
Have personally experienced. 54.1% 111
Have neither witnessed this being done nor experienced myself. 8.3% 17
Covert or overt verbal affront (i.e., snide remarks, withholding information, abrupt responses)
Have witnessed this being done to someone. 66.7% 136
Have personally experienced. 58.3% 119
Have neither witnessed this being done nor experienced myself. 11.3% 23
Undermining clinical activities (i.e., not available to help, turning away when asked for help)
Have witnessed this being done to someone. 50.0% 102
Have personally experienced. 46.1% 94
Have neither witnessed this being done nor experienced myself. 32.4% 66
Sabotage (i.e., deliberately setting up a negative situation)
Have witnessed this being done to someone. 28.4% 57
Have personally experienced. 19.9% 40
Have neither witnessed this being done nor experienced myself. 64.2% 129
Bickering among peers
Have witnessed this being done to someone. 72.1% 147
Have personally experienced. 48.0% 98
Have neither witnessed this being done nor experienced myself. 10.8% 22
Scapegoating (i.e., always assigning blame to one person when things go wrong)
Have witnessed this being done to someone. 56.5% 113
Have personally experienced. 26.0% 52
Have neither witnessed this being done nor experienced myself. 36.5% 73
Backstabbing (i.e., complaining to others about one individual).
Have witnessed this being done to someone. 77.0% 157
Have personally experienced. 53.4% 109
Have neither witnessed this being done nor experienced myself. 8.3% 17
Failure to respect the privacy of others (i.e., gossip/talking about others without their permission)
Have witnessed this being done to someone. 76.0% 155
Have personally experienced. 46.1% 94
Have neither witnessed this being done nor experienced myself. 10.8% 22
Broken commitments and/or broken confidences (i.e., repeating something that was meant to be kept confidential)
Have witnessed this being done to someone. 52.2% 106
Have personally experienced. 28.6% 58
Have neither witnessed this being done nor experienced myself. 37.9% 77

The nurses were forthcoming in their responses to the three open-ended qualitative questions providing specific examples of behaviors they had witnessed or experienced. From the responses to these qualitative questions, the following themes were generated: (a) sadly caught up in the moment, (b) overt and covert maltreatment, and (c) commitment to positive change in their workplace.

Theme 1: Sadly Caught up in the Moment
When asked about their experiences with horizontal violence, one-third acknowledged they had indeed engaged in these negative behaviors. The nurses who responded to this question were reflective in their comments, speaking from the perspectives of both perpetrator and victim. They at times excused their personal actions by reframing the circumstances that caused them to act in such a negative manner. Nurses used phrases such as "it's the culture," or "caught up in the drama." They expressed disappointment in their inability to keep their frustrations in check which sometimes resulted in behaviors that violated their personal and professional standards.

The nurses spoke of feeling "sadly caught up in the moment" about their participation in negative behaviors they generally would not exhibit. Nurses expressed surprise and concern about some examples of behavior on the survey identified as bullying. A nurse stated she always believed her ranting and venting were justified until she saw this behavior listed as an example of horizontal violence. She stated, "I didn't know what it sounded like." Many of the nurses seemed confused that their conversations about their peers could be construed as horizontal violence when they believed they were only offering constructive criticism. A participant offered "When we talk at work about staff problems and difficulties, it's not meant to be gossip: It's meant to share, to get updated with what's happening on the unit." Another reiterated this confusion by injecting a comment about face-making "…that is done in fun." This sense of uncertainty about what was, and was not, acceptable behavior illustrated a need to clearly define horizontally violent behaviors.

Honesty and self-disclosure were conveyed in comments that began with "…unfortunately" and "…sadly." "I may know at times I am guilty of raised eyebrows and face-making, I try not to be, but it happens so fast."

Some respondents expressed awareness they had engaged in this behavior, but offered justification for their actions. Statements such as "They just weren't doing their job" and "They need to know what it felt like" were used. A nurse believed her unkind interactions with a peer were defensible. She shared, "Her performance was a hindrance to the unit." These respondents described negative behaviors as a response to what they perceived to be inadequate work performance by their peers. There was a sense they viewed their aggressive behavior as a necessary means to an end, especially if management failed to address a grievance when reported to them.

Theme 2: Overt and Covert Maltreatment
Nurses were given an opportunity to share any negative behaviors they had personally experienced or witnessed which did not fit into the category of behaviors already described in the previous questions. While no new categories of behaviors were identified, detailed descriptions were provided of negative behaviors they had observed, or been directly involved in.

The majority of overtly aggressive behaviors were verbal in nature. They ranged from "…yelling aggressively" to the use of "…verbally dismissive or demeaning remarks." Personally denigrating terms were not identified individually, but adjectives such as "slandering" and "degrading" were used to describe witnessed conversations. Some descriptions were more specific, such as the response from one nurse, "I have been on the receiving end of taunting, and been singled out and labeled." While no physically aggressive behaviors described in the survey were aimed at individuals, one respondent described "objects being thrown around the nurses' station."

Covert and passive behaviors described by participants centered on a lack of communication and included such things as "ignoring my requests for help," as well as "general inapproachability and cold demeanor." One nurse explained, "I have witnessed someone refusing to talk to a co-worker. No communication makes for a difficult day." These comments reflecting the inability to rely on team members when providing patient care created a sense of isolation for the nurse and were seen as having an impact on patient safety. One nurse described this experience, "Two nurses drew mustaches on a staff member's picture at the desk. They were confronted about their behavior and did not think they did anything wrong."

Comments related to managers and supervisors included examples of aggression being ignored as illustrated by this nurse's statement, "I reported a couple of incidents to my manager and nothing was done, the co-worker then had an even worse attitude toward me." While no nurse reported being aware of overtly aggressive behaviors aimed at her or him from a manager, many reported feeling they were recipients of negative covert behaviors. These included being ignored by a supervisor, not encouraged to apply for advancement, and not mentored professionally as were some of their peers.

Theme 3: Commitment to Positive Change in Their Workplace
When asked to share their thoughts and suggestions about ways to decrease the amount of violence in their workplace, nurses spoke of their sincere commitment to improve relationships with their colleagues. The high number of responses to this question was interpreted as a desire on the part of the nurses to be active in the solution.

The nurses believed it was important to appreciate and celebrate differences among their ranks. Some nurses suggested hospital-sponsored continuing education programs focused on cultural awareness. One nurse shared, "What about a campaign to encourage all to 'do unto others as you would have done to you.' No one likes to be treated negatively so don't treat others that way either."

Collectively the nurses who completed the survey believed that most, if not all, needed to take responsibility for their part in perpetuating negative behavior. One nurse said, "By not participating in negative behaviors or condoning them, in a non-confrontational way, let the perpetrators know to maintain professional treatment of peers." Another shared, "Nurses need to take responsibility to do the 'right thing' for fellow nurses."

Survey participants provided thoughts about how best to tackle this dilemma. Their comments reflected the strong belief that all levels of management should be in volved in solving the problem of horizontal violence in their particular workplace. One respondent shared, "Nurse managers need the tools to act on it and quickly stop horizontal violence."

Finally, a nurse focused her response on the necessity of encouraging personal responsibility stating, "Treating staff well and trying to minimize working short staffed so people do not feel burnt out and give themselves an excuse to be concerned with self over others." Another said, "I would suggest a strict 'no tolerance' policy and make sure managers, supervisors, etc. enforce it. You would not believe how much of this goes on every day…how it affects retention, and ultimately how it effects our patients."

Participants in this study reported witnessing and/or experiencing many of the negative behaviors associated with horizontal violence. The range of positive responses in this study (19.9% to 77%) corresponded with what has been reported by previous researchers exploring this phenomenon (Johnson, 2009; Simons, 2008). The results of this study validated the appropriateness of Social Learning Theory as the framework to guide this study. According to Bandura (1969), individuals will mimic or role model the behaviors exhibited by the members of a group to which they wish to belong. Clearly some of the nurses in this study were surprised they were maltreating their peers by simply "going along with the crowd." Nurses freely spoke of being "caught up in the moment" and adopting the negative behaviors of their peers who were engaged in maltreatment of others in the workplace stating, "it's the culture." Some of the participants sought reasons to justify their actions toward their peers, when they emulated these negative behaviors. Comments left by 26 of the 65 nurses who responded to the question "Have you personally engaged in any of the described behaviors?" revealed they were unaware the behaviors they were mimicking were demonstrable of the tenets of horizontal violence

Individual responses to the qualitative questions provided rich descriptions of the nurses' experiences as observers and victims of this phenomenon. Survey respondents reported that not only did the single bullying incident have an immediate impact on nurse communication and team function, but lasting consequences. Behaviors that impact patient care specifically identified by the nurses in this study included being afraid to ask for help with a patient or ask a question for fear of being ridiculed, having requests for help ignored, and general lack of teamwork and communication. These findings were congruent with consequences identified by the Joint Commission (2008) and the Center for American Nurses (2008). The reporting of predominantly non-physical acts of aggression in our study supports the evidence found by previous investigators (Farrell, 1997; Griffin, 2004).

In that personal resilience can decrease vulnerability to workplace adversity (Jackson et al., 2007), consideration must be given to the role individual resilience plays when determining whether or not a hostile event has actually occurred. A healthy, professional work culture can provide an environment where it is possible to place some negative behaviors in a non-aggressive context.

Nurses offered suggestions for improvement focused on "fixing the problem." Study participants expressed a need for clear policies and enforcement by management that addressed disruptive behaviors and the consequences thereof. Specific requests were made by nurses for "awareness and education training" while others called for accountability, more professionalism, and the need to acquire and use non-confrontational tactics.

Strengths and Limitations of the Study
A strength of the current study was the researchers' personal experiences of being members of an organization in which nurses openly acknowledged that horizontal violence existed. Using a mixed-method design to collect data, the nurses were able to share their experiences on a deeper and more vulnerable level. Another strength of the study lies in the number of the sample (N=227) as many previous studies reviewed were conducted with small, homogenous groups of individuals who were members of nursing units or nursing specialty areas. Finally, a sense of empowerment was voiced by many of the nurses who participated in the study. Several of the respondents shared statements similar to the following "…it feels good to talk about this" and "Now maybe something will be done." While content experts were used to rank and respond to the study instrument, nonetheless, a weakness of the study might be the use of the researcher-developed tool. Finally, although the population of nurses present in the study was diverse, the majority were Caucasian females. Absent from the study were representative numbers of males and participants from minority populations.

Significance to Nursing
Nurses as health care providers are in positions to identify and intervene on the part of their colleagues when they see or experience horizontal violence. With increased awareness and sensitivity, nurses may be better able to monitor themselves, as well as assist their peers to recognize when they are participating in negative behaviors that have the potential to escalate into violence towards co-workers. Identifying and understanding particular incidences when nurses are most vulnerable and apt to engage in negative behavior (heavy workload, short staffing, etc.) may have the potential to reduce the degree to which individuals get "caught up in the moment."

A work environment that allows horizontal violence to go unchecked may impact nurse retention and nurse morale (Griffin, 2004). The Joint Commission's (2008) position on disruptive behavior and patient safety provides additional credibility in recognizing horizontal violence as a legitimate workplace issue. Nurse administrators may begin to develop management strategies and approaches to aid in the development of educational programs to address this workplace phenomenon. Establishing performance expectations that include workplace civility in nursing orientation programs and modeling professional behaviors provides a foundation to promote a healthy work culture. Nurse educators have a similar responsibility to develop nursing curricula that educate and encourage dialogue about horizontal violence to increase awareness and provide nursing students the skills to defuse and depersonalize bullying events.

Guided by the study results and with full organizational support, a plan was created to inform all nurses within the hospital system about the results of this study. A 30-minute educational program entitled "Sadly Caught Up in the Moment: An Exploration of Horizontal Violence" was developed that focused on heightening awareness by providing examples of negative behaviors. The intervention was composed of a review of each of the behaviors including appropriate responses when the behaviors were encountered. Additional components of this program included a review of available resources within the organization as well as the role of resilience in helping individuals deal with adversity. Since the development and offering of the educational program, 700 nurses in the organization have attended.

The purpose of the study was to determine the prevalence of horizontal violence in a multi-institutional hospital system. The stories nurses shared about the negative behaviors they experienced or witnessed were poignant and broadened our understanding and appreciation of the impact of horizontal violence for nurses generally and our nurse colleagues specifically. In their responses it was obvious many nurses were unaware of their participation in this phenomenon until they completed the survey and carefully reviewed the individual behaviors. Many expressed regret regarding these transgressions and described how they would like to react differently under similar circumstances in the future. While the major aim of this study was to determine the prevalence of horizontal violence within the organization, the findings clearly called for the development of an intervention to address this phenomenon (see Figure 1). As a result of the aforementioned educational program, a dialogue has begun among the nurses within our organization. The aim of these conversations is focused on encouraging an increased sense of professional accountability among nurses to break the cycle of horizontal violence in their individual work environments.$

Executive Summary
•The behaviors associated with horizontal violence can have negative consequences for nurses, patients, and organizations.
•Participants in this study were sent a survey that listed nine behaviors associated with horizontal violence.
•They were asked if they had witnessed, experienced, or neither witnessed nor experienced the nine behaviors.
•Participants were also asked to respond to three open-ended questions intended to capture their uniquely personal experiences with horizontal violence.
•For all but one behavior, the majority of participants stated they had witnessed or experienced eight of the nine behaviors associated with horizontal violence in their workplace.
•In response to the findings of this study, an educational program was developed to assist nurses in recognizing and responding to horizontal violence.
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