Terry Tornek for Mayor — NOT!

Not that long ago the Pasadena Star News announced that it endorsed Councilman Terry Tornek for mayor. In their editorial they characterized his running as mayor, as being brave. They came to this conclusion that he was brave by throwing his hat in the ring, before Mayor Boggard (our current mayor) had announced whether or not he’d seek another term. I don’t know about you but I would hardly call what Tornek did as brave, especially since he didn’t resign his council seat – that’s right. He’s currently an elected member of our city council, so if he loses his bid for mayor he can finish out his term. In my book that’s not called being brave, it’s called hedging your bets. At least, Jacque Robinson resigned her council seat to run for mayor – not that’s definitely showing more courage that Tornek – but still not enough to earn my vote.

At first, I was supportive of Robinson in her run for mayor, but as time would reveal she, like her fellow councilmember Tornek, were way too beholding to their union cronies. I was able to come to this conclusion because these two, like Victor Gordo and Judy Chu were only open to listening to the handful of pro-California Nurses Association (CNA) nurses from Huntington Hospital and chose to ignore the requests of the we-don’t-need the CNA nurses from Huntington Hospital (they call themselves IStandWithHuntington). It took 30 or so IStandWithHuntington nurses swarming the CNA sponsored press conference before Robinson, Tornek, et al to even acknowledge that there nurses that had a differing opinion on the issue of whether or not to unionize.

So when I took in account both Tornek and Robinson’s lack of fairness to the IStandWithHuntington nurses and that these two individuals were also sitting councilmembers during at least part of the time a city employee was able to embezzle an estimated 6.4 million of Pasadena taxpayer money – I made the decision that it was time to support a different candidate. So from among the remaining four candidates, I decided that I’d support and vote for Don Morgan.

Your can read my letter here – (LTE PSN Tonrek for Mayor2a) that I sent to the Pasadena Star News, which they have failed, refused — call it what you may. I hope you’ll consider voting for Don Morgan. I think he would be a welcomed change.

So for those who may or may not have read Mr. Grula’s latest attempt to convince the Pasadena Weekly reader’s that the California Nurses’ Association (CNA) should be given free reign at Huntington Memorial Hospital (HMH), by “just let the nurses vote” – what a disingenuous piece of tripe.

He begins by heralding that the LA region of the National Labor Relations Board (NLRB) has found “probable cause to believe the HMH has engaged in unfair labor practices against the nurses wanting to form a union”. That might be the case, but let me remind my readers that this is the same regional board of the NLRB that found that the threats made from the offices of the CNA against two Cedars’s nurses that opposed the union weren’t threats at all. However the DC NLRB (and final say on the matter) decided that threats made to one nurses children and another’s nurse’s pets were indeed threats and thus were enough to invalidate the vote – and to this day Cedar nurses remain union-free. In short, just because the regional branch feels there’s probably (i.e. a reasonable belief) cause it doesn’t mean that in the end it will be substantiated.

But what really galls me is this attempt by Grula to somehow equate union representation with the recently released “Leapfrog scores” published in a recent LA Times article — http://graphics.latimes.com/california-hospital-scores/. Granted HMH gets a rank of “C”, but so did 69 other hospitals, including such venerable institutions such as UCLA Medical Center, Loma Linda (which got a D believe it or not) and Stanford Hospital. Grula goes on, in his article to make it appear as though HMH is the only LA County hospital with such a low score – not true! He also goes on to pontificate that Kaiser (a CNA-represented hospital network) has a rank of “A”, which is true, but what he fails to disclose is many other CNA-represented hospitals that scored “C”, “D” and “F” grades– yes “F”.

So, Antelope Valley Hospital is the only LA County area hospital to receive a big fat F and is a CNA-represented hospital! California Hospital Medical Center, Citrus Valley Medical Center Inter-Community, Glendale Memorial Hospital, Good Samaritan Hospital, Henry Mayo Newhall Memorial, and UCLA Medical Center all receiving a C grade are all CNA-represented hospitals. So while HMH receiving a C-grade might provide fodder for Grula and the CNA to say that hospitals with unionized hospital staff get better grades from Leapfrog is a very weak assumption to make (I think they’re kind of leapfrogging to that assumption). It would appear that Grula is following in the footsteps of the CNA in not allowing the facts to get in his way.

The problem, in my opinion, lies with the CNA-campaign to gather enough valid RN signatures to call for a vote – and it would appear that they might be falling short of this goal. So now the CNA is trying to pressure HMH management into just giving the CNA the “keys to the kingdom” and allow a vote to go forward without showing via signed cards that a majority of HMH RNs want the union. The feedback that I’ve gotten from HMH nurses on the ground is that most have been rebuffing the CNA’s advances. So this will have to make the CNA representatives work all that much harder for the votes – oh boo hoo. The CNA likes to paint nurses that are pro-union as somehow being brave and self-determined all the while painting nurses that oppose the union as somehow misguided, naïve or shills for management. They accuse yours truly of interfering because I’m giving “aid and comfort” to those RNs standing up to the CNA union machine all the while the CNA applauds local politicians, church and community leaders who support the CNA. Their message if you support the CNA you are somehow brave and community minded, and if you don’t you’re weak minded and interfering; their logic boggles the mind.

The CNA tried this same tactic many years ago when they tried to get our state legislators to pass legislation that would bypass a vote entirely and simply allowing gathering enough signed cards to install a union. They testified that nurses were really too weak to “speak up for themselves” thus they needed this card check legislation. Union representatives even went so far as to tearfully testify that if only the nurses at that “Tenet hospital in Redding” had been unionized the RNs would have felt safe to come forward to blow the whistle on all the unnecessary cardiac surgery that was being performed. There was just one problem with that scenario. It was the nurses, themselves, that blew the whistle – the very non-unionized nurses that the union deemed to weak to speak for themselves. Meanwhile they never explained why the union represented nurses at UC Irvine never blew the whistle on the problems with the IVF program.

This is one of my fundamental issues with nursing unions, which is they all too often resort to mud slinging, fact mangling and sometimes out right lies to grow their ranks. Nursing is a profession and should be treated as such. All too often unions in their mad dash to unionize the RN workforce resort to tactics that leave a mark on our time honored profession. I say if they want to convince nurses to unionize do so with the facts, with well supported arguments and leave the bullying and threats out of it. And as I always say “if nurses are too weak and incapable to advocate for themselves (as the CNA purports) how can these same nurses advocate for their patient as they are require by The California Nursing Practice Act.

But back to the “C” grade awarded to HMH and many other hospitals. It’s important to keep in mind that there several different hospital safety “report cards” available. Leapfrog – www.hospitalsafetyscore.org- is but one of many that are recognized and used. You can also see how your local hospital stacks up by using the Joint Commission Quality Check – www.qualitycheck.org; CMS Hospital Compare – www.hospitalcompare.hhs.gov; and Consumer Reports Hospital Safety Ratings – www.consumerreports.org/health/doctors-hospitals/doctors-and-hospitals.htm to name a few.

In Grula’s opinion piece “Huntington Hospital is Ill” that ran in the November 6, 2014 edition of the Pasadena Weekly, he attempted to paint Huntington Hospital as some kind of sub-par hospital and it’s administration (calling out its CEO Steve Ralphs) as somehow cruel and uncaring of their nursing staff – all this, in my opinion, at the beck and call of the California Nurses Association (CNA).

Why? You may ask, because the CNA has been trying unsuccessfully, to date, to unionize the 1,100 RN workforce that ply their craft at Huntington Hospital. As expected, the CNA was up to its usual shenanigans, they held a rally where they claimed hundreds of supporters attended lining the length of Pasadena Avenue, when in reality somewhere about 80 – 100 people showed up, of which only a handful were actual Huntington RNs. Their theme for the rally, “restore quality patient care”.  As a RN and Pasadena resident it really irked me that the pro-CNA nurses at Huntington would allow the CNA to spread such a despicable message, because to restore something implies that something, in this case quality patient care, is missing which isn’t the case with Huntington Hospital. However, the CNA isn’t one to let the facts get in their way and neither it appears is Grula or the editors at the Pasadena Weekly.

I make this bold statement, because in Grula’s piece he tries to convince his readers that somehow it makes sense to allow the Huntington nurses to unionize because 60% of California nurses already belong to unions. He bases these numbers on two statistics both provided by, you guessed it, the CNA. The first statistic he provides is that there are 200,000 RNs in California and that 120,000 are in unions. So when you use these figures its easy to see how one might conclude that about 60% of all California RNs are in unions, but there’s one small problem. What, pray tell, might that be? All it takes is a quick telephone call to the California Board of Registered Nursing (BRN) to learn that there are currently 398,134 actively licensed California RNs with another 16,025 holding an inactive license for a total of 414,159 California RNs. It’s that quick and easy. Not sure you can look it up on line at http://www.rn.ca.gov/about_us/stats.shtml or for the most up to date figures you can call the BRN at (916) 574-7699. So with more accurate figures the 60% of all nurses belonging to unions becomes more like 30% with the majority of California nurses (about 70%) choosing to remain union-free.

Gurla also tried to make a point of Huntington’s CEO Ralphs’ salary, but failed to note how much money the CNA will make yearly off the backs of the RNs in the way of dues if they are successful in unionizing the Huntington RN workforce. Think the number one followed by six zeroes and then some. His entire piece supports solely the goal of the CNA and the Huntington RNs that support the CNA, but fails to mention that the greatest opposition comes from within the very Huntington RN family – from members who don’t want the union to represent them as they feel they don’t need an additional layer between them and management. Of course, if Grula even mentioned that opposition was coming from Huntington nurses, themselves, then the CNA’s and his argument that it’s the “evil” management that’s fighting the CNA — falls to pieces and blows the “we’re poor weak nurses who can’t speak for ourselves so we need the CNA to fight our battles for us” theory out of the water.

So when Grula’s piece was published, wrong statistics and all, I submitted a letter to the editor to both correct the erroneous statistics and to provide my two cents on what’s happening at Huntington, which is that the CNA is facing resistance, not from hospital management but from the very nurses they are attempting to organize. Some of the nurses who didn’t want a union reached out to me and asked for advice and guidance, which I was happy to give them. Something the CNA hates, because they like to portray themselves as the protector of the hard working nurse who is somehow so downtrodden by management that they can’t stand on their on two feet. So when the very nurses they want to represent, fight them and spurn the CNA overtures, the leadership of the CNA becomes practically apoplectic.

After emailing my letter to the editor I followed it up with a phone call to the editor, Kevin, and had a nice chat with him and received a promise that he’d run my letter in the November 20th edition. So when November 20th rolled around I picked a copy of the Pasadena Weekly and found that my letter to the editor hadn’t been printed as promised. I called Kevin and imagine my surprise when he informed me that he gave my letter to Grula so he could “respond”. Why? Because somehow the statistics I provided from the BRN were an “opinion”, or as he so quaintly put it “my contention”. I’d say that the Pasadena Weekly editorial staff has egg on its face for failing to fact check Grula’s stats and now their trying to find a way to save face and to dig themselves out of this fiasco of Grula’s and their making.

So, I say to the Pasadena Weekly do the math, show some journalistic integrity, make the correction, print the letter, and let your readers know that it isn’t the management resisting the CNA, but many of the Huntington nurses themselves.

You can read Grula’s “hit piece” on Huntington Hospital here

Here we go again, the C.N.A. has spent their members’ hard earned money that they take in as dues to produce (CNA Flyer1) a high-gloss hit piece on yours truly. My oh my how I must frighten the C.N.A., this handicapped, little old lady from Pasadena.

So when I saw the piece that they’re passing out at Huntington Memorial Hospital I felt compelled to respond – since as so many nurses have come to learn from past experience, many members of the C.N.A. like to play fast and loose with not just the rules, but with the truth as well.

First – IStandWithHuntington (ISWH) are the Huntington Memorial Hospital nurses that feel that they don’t need the C.N.A. to represent them. The IStandWithHuntington blog is an alternative voice to the C.N.A. message/propaganda. Nurses whose opinions differ from those backed by the C.N.A. have the right to speak their mind and get their message out and they have chosen to do so – even though it means fending often scurrilous attacks from the C.N.A. “war machine”. They express their opinions, viewpoints and so forth on their blog.

Second – Did I help the ISWH nurses – darn tooting. I contributed to their cause by securing the IStandWithHuntington domain name and offered it to them for their use. They run and have full control over their blog. This isn’t illegal, the ISWH nurses have the right to freedom of speech, just as the C.N.A. members have and for the record Huntington Memorial Hospital hasn’t spent a dime in securing, purchasing or hosting this blog.

Third – The C.N.A. really does need to go back to school if they think I’m a professional union buster. Professional is defined as – a person engaged in a specified activity as one’s main paid occupation rather than as a pastime. I’m not paid to help nurses who want to get their union-free message out. Nurses call, write and email me when they want advice on how to get their message out, on how they can even the playing field and what not. I listen to them and if I think I can help I do what I can do, there’s a whole network of us who believe that nurses can effectively advocate for themselves, without union representation.

Fourth – They’re great about listing my administrative positions that I’ve held over the years, but conveniently leave out that I’m a RN and that I’ve spent more years at the beside as first a Pediatric nurse and then a PICU/NICU nurse than I have in administration. But then again if they did that they might actually provide folks with the impression that I’m a nurse and not some boogey man “union buster”, because nurse = good and union buster = evil, don’t you know.

Fifth – It’s no secret that I don’t support the RN-to-patient ratio, because I support the far superior patient acuity system. Title 22 and Joint Commission mandates an acuity-based system because nurses aren’t workers on an assembly line and patients aren’t widgets. I believe that nurses give the best care when patients are assessed based on the complexity of their illness, care needs and so forth and then matched to the nurse that has the skills, education and training to best meet those care needs – after all that’s why I became a nurse. And I think that’s why most of you became nurses, as well.

Ask yourselves this why does the C.N.A. feel the need to play so fast and loose with the truth, why do they resort to innuendoes, and cast aspersions? This is the union that says they want to represent you and yet they appear to show utter contempt of your fellow co-workers who chose to exercise their to freedom of speech and simply put their message out as well. The ISWH nurses have spent their hard earned money on their effort and whether you agree or not about joining or not joining a union the ISWH nurses are deserving of some modicum of respect. I think their blog has strived to keep their tone civil and information fact based. So just to be clear I’m not about union busting, as the C.N.A. likes to suggest, but I’m am about making sure that these nurses who want to have their message heard get the opportunity to be heard.

The C.N.A. loves the scorched earth technique in dealing with those who disagree with or oppose their viewpoint; do you? Do you want to be associated with a group that feels entitled to denigrate others in our profession because we don’t chose to follow their rhetoric? As nurses we are charged with advocating for our patients, so how can we be expected to advocate for our patients if we can’t even advocate for ourselves? I’m proud to be a RN. You’re welcome to call, write or email me.

By Genevieve M. Clavreul, RN, Ph.D.

Working Nurse Magazine

I know that for a lot of nurses, talking about politics is about as appealing as going to the dentist. However, legislation and policy decisions can shape the way we practice at every level, sometimes dramatically. That’s why it’s important for nurses to pay close attention to proposed laws or new regulations affecting our profession.

Let’s take a look at some current healthcare-related measures and what they could mean to you.

Opioid Restrictions

If you or any of your patients suffer chronic pain and have a liver condition that contraindicates acetaminophen (the active ingredient in Tylenol), you should be very alarmed by S.2134 and H.R.4241.

These bills, prompted by the recent fear-mongering about prescription opioid abuse, would ban Zohydro ER, the only FDA-approved opioid that doesn’t contain acetaminophen. The legislation would also prohibit the FDA from re-approving Zohydro “unless it is formulated to prevent abuse.”

Aside from its impact on chronic pain sufferers, this attempt by some members of Congress to usurp the function of the FDA would set a frightening precedent. If Congress can summarily ban a drug that’s already passed the FDA’s approval process, what’s to prevent legislators from banning other approved drugs, like contraceptives, in hopes of scoring political points? I shudder at the potential consequences.

Safe Staffing Ratios

There’s brighter news in the area of nurse staffing requirements. As most of us know, California has had mandatory nurse-patient staffing ratios for the past decade and Congress is now considering national requirements.

The federal Registered Nurse Safe Staffing Act (H.R.1821 and S.2353), which would apply to all Medicare-participating hospitals, is quite different from California’s rules, which mandate specific ratios for each type of unit. Instead, the proposed federal law would require each hospital to establish a committee — at least 55 percent of which must be RNs providing direct patient care — that will create staffing plans based on patient acuity, staff experience and other factors.

Longtime readers know that I’m very critical of California’s “one size fits all” approach to staffing ratios. I strongly believe that an acuity-based system makes more sense, allowing managers to match nurses to patients based on the nurse’s skills and training rather than arbitrary legislative dictates. The federal law would also give nurses a greater voice in those decisions.

Unfortunately, these bills wouldn’t change California’s current requirements. If this law passes, Medicare hospitals in our state would still need to organize the required committees and create staffing plans, but those plans would have to comply with existing state laws.

Lab Result Reporting

Till now, patients have always been told, “The doctor will call you when your test results come back.” However, in February, the Center for Medicare and Medicaid Services amended the Clinical Laboratory Improvement Amendments of 1988 (CLIA) to give patients the right to request test results directly from the laboratory. All entities subject to HIPAA must comply with the regulation by October 6.

It will be interesting to see how the new rule will affect the patient-provider relationship. Will patients be better informed or will they be panic-stricken after trying to interpret their test results based on Internet searches? Will patients even be informed of the new rule? (I know my and my daughter’s providers have yet to say anything about it.)

If your facility’s lab is subject to CLIA, have you been educated about the new regulation? How do you feel it’s working so far? Drop me a line and let me know.

MRSA and Worker’s Comp

If you’re unlucky enough to contract a methicillin-resistant Staphylococcus aureus (MRSA) skin infection while working in patient care, a proposed state law (AB 2616) would make it easier for you to file a workers’ compensation claim. The bill, which is supported by the  California Nurses Association and National Nurses United, passed both houses of the Legislature in August and now awaits the governor’s signature.

AB 2616 states that MRSA skin infections contracted while providing direct patient care will now be presumed to be work-related unless there’s specific evidence to the contrary. That means if you file an MRSA-related claim, the burden of proof will no longer be on you, which is good news.

Workplace Violence

Workplace violence is an ongoing concern for nurses and other healthcare workers. There’s been some progress since Napa State Hospital psychiatric technician Donna Gross was strangled to death by a patient in 2010, but nursing organizations and unions have been calling for more.

SB 1299, which went to the governor’s office on August 28, is intended to light a fire under the state Occupational Safety and Health Standards Board and push state hospitals to take action. The bill would require acute care and acute psychiatric hospitals to establish plans to prevent workplace violence in both inpatient and outpatient settings.

The plans must include training and education for workers, procedures for investigating incidents, and policies for documenting and reporting incidents to the Division of Occupational Safety and Health, which would be required to post anonymized reports online starting in 2017.

Quicker Licensure

Too many new RNs have passed the NCLEX, graduated from nursing school and started applying for work — only to wait and wait for the BRN to issue their licenses. A bill in the Assembly, AB 2165, seeks to address that problem by giving professional licensing boards a 45-day deadline to issue licenses to candidates who’ve completed all the requirements.

The 45-day clock wouldn’t start ticking until you have completed all the application requirements, so this law wouldn’t help if you had missing paperwork or problems with your background check. The point is to keep qualified applicants from being held up by bureaucratic backlog.

Using our Power

This list is by no means comprehensive. New measures come up all the time, including ones that aren’t specific to nursing, but may still affect our work.

The good news is that we don’t have to sit back and watch idly. With almost 400,000 active RNs in California alone, we have more political power than many of us realize. However, for us to use that power, we have to be aware of what’s going on and willing to get involved. We can’t afford to let politics be a spectator sport.


How to Stay Informed

If you want to find out more about these bills and others like them, check out the following links:

•  The Library of Congress THOMAS database allows you to look up information about federal bills.

•  GovTrack.us  is another option for keeping track of happenings in Washington. It requires registration.

•  The Official California Legislative Information webpage includes information on current state laws and proposed legislation.

•  LegTrack is another search engine for state measures. It requires registration.

•  Ballotpedia is “an interactive almanac of U.S. politics,” including neutral descriptions of federal and state measures.

•  The Board of Registered Nursing (BRN) website often provides useful information on pending legislation. The BRN’s legislative committee examines all measures and decides whether the board should support, oppose or watch each measure.

•  Professional organizations and unions such as the American Nurses Association, California and the California Nurses Association/National Nurses Organizing Committee also monitor relevant legislation, although these organizations’ information may be available only to members.

Some professional organizations also organize “lobby days,” which are a great opportunity for nurses to learn about important current issues and the political process in general.

Working Nurse Magazine – Issue

I long ago stopped using Consumer Reports as my go to source for whether a specific product was a good or bad buy, but I was astonished to read their recent article – “Special Report: The danger of painkillers” – published in their September 2014 issue. Their special report once again tried to stoke the flames of fear over opioid use and abuse. The article cites the staggering statistic of almost 17,000 people a year die from overdoses of opioids. While 17,000 people dying every year is indeed an eye-opening number that pales in comparison to the 35,000 who died in automobile accidents in 2013. Consumer reports goes even further to cite that for every death from opioid overdoses 30 people are admitted to the ER for complications of opioid abuse. So after doing the math that’s approximately 510,000 people admitted to the ER for opioid abuse while the National Safety Council “estimated that nearly 3.8 million people suffered crash injuries that required medical attention”. And if you consider that there are nearly 319 million people living in the United States, though 17,000 people dying of opioid abuse is tragic and sad these deaths represent not even 1% of the total population.

Does this mean these deaths should be ignored or minimize, by no means! However, in my opinion I feel that the folks at Consumer Reports should be ashamed of themselves for failing to put the statistics into perspective; but just like the Los Angeles Times they seem to have chosen the approach of fear mongering over ethical journalism. Consumer Reports even dragged out the Zohydro ER “controversy” demanding that the FDA withdraw their approval of Zohydro ER Consumer Reports mentions in their report that attorney generals from 28 states have written the FDA demanding that the FDA reconsider their decision and withdraw their approval of Zohydro ER, as well as the two bills (HR 4241- https://www.govtrack.us/congress/bills/113/hr4241 and S 2134 – https://www.govtrack.us/congress/bills/113/s2134) in Congress that if passed would ban the sale of Zohydro. GovTrack, a excellent source to keep track of legislation both at the federal and state level gives HR 4241 and S 2134 a 2% and 1% (respectfully) chance of being passed by Congress, but don’t you just love it when Congress decides to practice medicine! I know I do.

The Consumer Report article also fails to mention that what separates Zohydro ER from the rest of the opioid pack is that it contains no acetaminophen (aka Tylenol). Why is this important? Simply put, for people living with chronic pain and chronic liver issues, such as Hepatitis C, liver disease and so forth, opioids can prove problematic since acetaminophen is very hard on ones liver, thus any opioid that can provide relief from chronic pain without added acetaminophen is a safer option for those patients in the long run. And Consumer Reports failure to report this very important difference only convinces this person that the folks at Consumer Reports have strayed far afield from their core mission.

Meanwhile, if you’re interested in hearing the FDA’s rationale from their “own lips” then point your browser here – http://www.biocenturytv.com/player/3476140971001

Courtesy Counts in Nursing

By Genevieve M. Clavreul, RN, Ph.D.

Working Nurse Magazine

Being busy is never an excuse for being rude

Nurses are constantly reminded that we are held to higher standards than people in other professions, both at work and in our personal lives. We are judged by how our patients and coworkers perceive us as well as how they perceive our nursing skills. People expect us to be not only competent, but also compassionate and caring.

Unfortunately, nurses often overlook the role that basic courtesy plays in our profession. When stress levels rise, good manners are often the first things to go out the window. We’ve all been there at one time or another when tired or overwhelmed. The consequences of that rudeness can be much more serious than you think.


When it comes to the workplace, politeness might seem like a very trivial issue, particularly in a profession as demanding as ours. Not so, says Pier M. Forni, Ph.D., a professor at Johns Hopkins University and the author of several books on civility and ethics. “Incivility is very costly,” he told David Zax of Smithsonian.com in 2008. “Incivility is both caused by stress and causes stress, and stress is not only a producer of human misery, but is also very costly in dollars.”

Discourtesy costs businesses and organizations a lot of money in the form of reduced productivity and higher turnover rates. Rude behavior in the workplace can make workers avoid each other when they should be collaborating, “tune out” when doing important tasks or even quit. Considering how many talented nurses become burned out, the latter is no small concern.

For healthcare workers, the stress caused by incivility is also bad news for patient safety. The Joint Commission’s 2012 report “Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation” notes that workplace civility is “[c]losely associated with, and perhaps a necessary precursor to, improving safety culture.”

Then there is the problem of lateral violence. Research has repeatedly demonstrated the terrible impact workplace bullying has on nurses and such bullying is all too common. Some researchers have estimated that as many as 85 percent of nurses suffer lateral violence at one time or another and up to 93 percent of nurses have witnessed it. Discourtesy isn’t the same thing as bullying, of course, but an environment in which coworkers are frequently rude to one another and to patients is one in which lateral violence can thrive. So, civility and manners do count and the lack thereof can and does have an impact on our workplace and in turn on our patients.


Common courtesy promotes a more positive work environment and allows for better relationships with the people you know and the ones you meet on a day-to-day basis. Good manners convey respect for those with whom you interact and encourage them to respond in kind. A more congenial workplace also makes it harder for lateral violence to take root.

Negativity feeds on negativity, but it is also possible to shift the atmosphere in a more positive direction. Sometimes, all it takes is a few people making the choice to be polite and pleasant.

I often share with people my experience of changing the negative milieu at a local county hospital — not as a nursing director or a nurse, but as a patient undergoing treatment. While the physicians at this hospital had the expertise to provide the treatment I needed, the downside of going there was the very high volume of patients: almost 100 a day. During my first few visits, it was apparent that while the nurses and auxiliary staff were good at their jobs, many treated the patients more like cattle than people.


Patients were given little guidance on how to navigate the complex procedures for making appointments or about how to get labs and X-rays done prior to being seen by the doctor. Worse, the nurses seemed to be doing almost nothing to help. I realized that the reason the nursing staff wasn’t trying to making the patients’ lives easier was that no one had made any effort to make the nurses’ lives easier.

Seeing that, I decided to perform simple acts of courtesy like making eye contact, addressing nurses by name and offering a cheerful “hello” to the nurse in the intake line. When I noticed one of the nurses go out of her way to help a patient, I made a point of complimenting the nurse for her act of kindness, remarking that such acts are a fundamental part of our nursing function. I also brought in treats like homemade cookies for the nursing staff.

This reinforcement had a gradual but observable impact in how the nurses treated me. Over time, I also saw the nursing staff demonstrate a bit more kindness and consideration to other patients and even to one another. These were all small things, but they made the clinic a more pleasant place to be and in which to work.


It’s easy for nurses to blame our lack of courtesy on having one too many patients, not enough ancillary help, being short-staffed and so forth. However, good manners and civility shouldn’t suffer just because we’re too busy.

I have a friend who’s now a plastic surgeon in France. She has a very outgoing personality and greets everyone who crosses her path with a warm “hello” or “good morning” regardless of where she is. As a result, people almost always respond positively to her. Even the curmudgeonly chief of service would find himself smiling (if for only a moment) whenever she entered the room.

Being polite to others is not a one-sided affair. People have a hard time ignoring someone who offers a kind word or other simple courtesies. Taking the time to make these small gestures will go a long way towards achieving positive outcomes in most if not all of our encounters.

Nurses face many challenges in our daily work, but civility and the practice of good manners shouldn’t be given short thrift in the name of efficiency. Courtesy never goes out of style even if people sometimes forget to practice their manners. Let’s make this one of the many areas in which nurses lead the way.


10 Ways Nurses Can Be More Courteous

1. Be respectful. Respect is reciprocal. If you want respect from others, you must be prepared to show respect to them as well.

2. Appearances count. Make a point of coming to work in clean, pressed scrubs (or the uniform of the day) and make sure you wear your identification so it can be seen by coworkers and patients.

3. Politeness wins the day. Always say “please,” “thank you” and “you’re welcome” when interacting with your coworkers, patients and their families. It’s easy to forget in the hustle and bustle of the floor, but is always remembered by the people on the receiving end.

4. Voices carry. Whether interacting with coworkers, patients or patients’ families and friends, remember not to raise your voice, use foul language or slang or talk down to others.

5. Promptness is a virtue. There are times when you’ll be late due to some unforeseen circumstance beyond your control, but chronic tardiness is disrespectful and places an additional burden on your coworkers, which breeds resentment and hostility.

6. Gossip is never harmless. Talking or gossiping about a person who isn’t present is disrespectful and generally ends badly for all involved. It harms the person who’s the subject of the gossip and reflects badly on the one doing the gossiping.

7. Don’t ignore people in your presence. The clinical floor isn’t kindergarten. It’s rude to ignore or refuse to acknowledge people when they approach. A polite “hello,” a wave of the hand or a smile will go a long way.

8. Pay attention when someone else is speaking. Show interest, maintain eye contact and listen to what the other person is saying. It’s easy to get distracted when others are speaking, but making the effort to pay attention and show an interest in their thoughts and ideas helps to build a civil work environment.

9. Keep the common areas neat. When in the nurse’s lounge, staff lunch room or other common areas, be sure to clean and put away your dirty dishes. Don’t be a food thief and make sure you keep the refrigerator, microwave and other appliances neat and clean.

10. Use the correct name. Mangling someone’s name or calling someone by a unwanted nickname doesn’t engender positive feelings. If you’re not sure how someone wants to be addressed, ask them. If you’re not sure how to pronounce a name, ask the person to spell it for you (even if that means spelling it phonetically to help you remember the correct pronunciation!).

This list is by no means exhaustive, but these 10 basic tips will prove helpful in most situations.

Rule of thumb when you submit a letter to the editor you should always follow-up to ensure that your letter has been received. This policy has served me well over the years, that is until I tried to follow-up on two letters to the editor that I sent in response to two article the Boston Globe had run on the acetaminophen-free opioid, Zohydro ER .

I felt compelled to respond because I was getting tired of reading and hearing the same incorrect statements being repeated time and time again by various media outlets. Primarily the mischaracterization that Zohydro, which is a hydrocodone, was somehow 10 to 50 times more potent (take your pick) than hydrocodone, no one seemed to question this illogical statement – because how can hydrocodone be more potent than itself? Of course, the mistake so many have made was in trying to compare “regular” Vicodin (hydrocodone with acetaminophen, aka Tylenol) to Zohydro ER (a hydrocodone with no acetaminophen and in which the medication is released over a period of time). So while the maximum recommended dosage of Vicodin can range from 40mg to 60mg depending on the type of Vicodin the maximum recommended dosage of Zohydro ER cannot exceed 50mg twice in a 24-hour period. So Zohydro ER is never 5 times let alone 10 times more potent, as cited so incorrectly by our erstwhile media.

Also another common omission by so many media outlets is that Zohydro is the first and only extended-release hydrocodone that doesn’t contain acetaminophen. This is in contrast to other opioids (even immediate release varieties) that contain either acetaminophen or some other additional ingredient. Having an opioid that contains no acetaminophen is an important tool in the pain management toolkit for people living with severe chronic pain. Of course, there’s the consideration of the abuse factor, but this pales in comparison to the estimated 6 million people living with severe chronic pain, whose voice is being drowned out by the nearly rabid and hysterical outcries of those involved with addiction issues.

As both a person living with severe chronic pain and a registered nurse, I can understand the reticence of those confronted with the issues of addiction. However I also find them unwilling to consider the needs of individuals living with intractable, severe and chronic pain. Many severe, chronic pain suffers have had to depend on opioids containing acetaminophen (done solely to “curb” the potential abuse of these same opioids) that there is a real risk of liver damage, which is why access to Zohydro ER is so critical.

Meanwhile this person wonders why no one answers the phone at the Boston Globe? How can the good people of Boston expect fair and balanced reporting if the Boston Globe only chooses to report one side of the story? Then again this is one of the main reasons so many newspapers are losing readership these days, they can’t bother to pick up the phone and, they can’t bother to report fairly both sides of the story. I guess yellow journalism is alive and well.

Finally after multiple calls and messages left to numerous individuals at the Boston Globe over many, many days — miracle of miracle the writer Milton Valencia answered his phone when I called. But when I expressed my concerns about what I believed were inaccuracies in his two articles on Zohydro ER, he suddenly had to go because he was on a deadline and anyway it didn’t really matter since he spoke with the folks at Zogenix (the makers of Zohydro ER) and they had no issues with his coverage.

You can read the two Boston Globe articles BG Judge blocks Massachusetts ban on painkiller Massachusetts and Mass. sued over restrictions on painkiller Zohydro and my letters to the editor L BG Zohydro5 and L BG Zohydro 140611b.

Nurses Answering the Call

Hurricanes, floods and earthquakes are no match for heroic nurses

By Genevieve M. Clavreul, RN, Ph.D.Working Nurse Magazine

Nurses across the country have long been at the forefront of disaster response, whether the crisis is an earthquake, hurricane or tsunami, a flood or some manmade tragedy. When disaster strikes, nurses respond at the drop of a hat, often putting their own lives on hold to offer their services and compassion to those in need.

Tales of Heroism

In 2001, nurses answered the call when terrorists flew two hijacked Boeing 767s into the Twin Towers of the World Trade Center in Manhattan. Some of the first nurses on the scene were sent to the Jacob K. Javits Convention Center, which had been converted into a makeshift 40-bed emergency hospital. At first, nurses could do little more than pour bottled water over the eyes of rescue workers.

Even when more supplies did arrive courtesy of the American Red Cross, the nurses had to cope with limited resources and nurse-patient ratios of more than 5,000 to 1.

After Hurricane Katrina in 2005, volunteer nurses streamed into the Gulf Coast, many taking unpaid leave and using vacation hours to help survivors in some of the hardest-hit areas of Louisiana, Mississippi and Texas. In response to the devastation, the California Nurses Association (CNA) formed the Registered Nurse Response Network (RNRN) to serve as a “clearinghouse” for RNs responding to disasters. The RNRN reports that some 300 nurses traveled to Gulf communities to offer aid and nursing assistance after Katrina.

Even nurses who were unable to make the trip found ways to help. One nurse answered phones at her local Red Cross. After watching television coverage of the disaster, another nurse volunteered to work in the temporary pediatric clinic that had been set up at the Houston Astrodome, treating and comforting children suffering from cuts, bruises, hunger, dehydration, disorientation and exhaustion.

Local nurses, too, put their personal needs on hold to provide much-needed assistance in the wake of Katrina. At the partially flooded Memorial Medical Center in New Orleans, where as many as 2,000 people and 200 patients were trapped without power or running water in stifling heat, nurses struggled for days to provide continuity of care and then navigated darkened stairwells and manually operated Ambu bags to transport patients to the helipad for evacuation.

International Efforts

The disasters to which American nurses have responded have not been limited to the borders of our country. In 2010, U.S. civilian nurses joined their military colleagues aboard the amphibious assault ship USS Iwo Jima for Operation Continuing Promise 2010, a four-month humanitarian deployment. Nurses provided medical assistance to Haitians after Hurricane Tomas, treating a total of 4,054 patients onboard and ashore (as well as more than 1,200 veterinary patients). As part of that operation, nurses went on to participate in seven other missions in Latin America and the Caribbean.

In 2013, Typhoon Haiyan struck the Philippines, killing more than 6,000 people and leaving almost 30,000 injured. Medical and nursing teams from hospitals and nursing associations through the U.S. raised relief funds, donated food and clothing and assembled healthcare teams to aid in disaster relief.

One team saw more than 250 patients a day, many of whom had suffered injuries that became potentially life-threatening due to the harsh conditions and delays in obtaining treatment. In addition to treating physical injuries, the healthcare teams also assisted survivors with mental health issues like anxiety, insomnia and overwhelming grief in the wake of this horrific event.

An Ethical Obligation

When a crisis strikes, people look to nurses and other medically trained professionals for information and guidance as well as care, which makes it all the more important that we learn basic disaster preparedness skills.

An article in the Australian Nursing Journal estimates that each nurse who is helpless in the face of a disaster may leave 50 or more patients in the lurch. That’s why Joanne Langan, RN, Ph.D., CNE, coauthor of the 2004 book Preparing Nurses for Disaster Management, argues that every nurse has an ethical obligation to be prepared for disasters.

Responding to a disaster doesn’t have to mean jumping on a plane at a moment’s notice. Relief efforts often need volunteers to help organize and coordinate the first responders, a role in which a nurse’s training and experience can be invaluable. Of course, nurses can also get involved by donating food, clothing, medical supplies or money to aid the victims of the disaster.

Many hospitals have established on-site disaster response teams, but nurses should also consider joining an outside organization involved in relief efforts. It’s a great way to learn more about disaster response and find opportunities to help. Below are a few places to start:

I think what nurses bring to crisis response is best summed up by a remark made by Marirose Bernard, MN, APRN, CNA-BC, then a nurse supervisor at Memorial Medical Center in New Orleans. When a reporter asked why Bernard and her colleagues didn’t leave the devastated hospital, Bernard responded, “I would never have thought of that. We were there; we were there to take care of our patients. Because we’re nurses, and that’s what nurses do.”

So, to all my fellow nurses: Keep doing what you do and have a Happy Nurses Week!

Here’s my latest article in Working Nurse Magazine —

One of nurses’ most important and underappreciated duties is advocating for our patients. While much of that advocacy takes place at the bedside, we are also in a unique position to address the larger issues that affect the practice of nursing and medicine.

The latest issue that demands our attention is the controversy over prescription opioids and the efforts of the Medical Board of California to crack down on these dangerous but necessary medications.


If you listen to the fearless pundits of the Fourth Estate, deaths related to prescription drugs are a national crisis. According to the Centers for Disease Control and Prevention, 38,329 Americans died of drug overdoses in 2010 and about 60 percent of those deaths involved prescription medications, many of them opioids.

Back in 2012, the Los Angeles Times ran a four-part investigative report on the human cost of opioid abuse and the role of some physicians in overprescribing painkillers. The story reported that between 2006 and 2011, there were 3,733 deaths related to opioid use in just four Southern California counties: Los Angeles, Orange, San Diego and Ventura. That story and others like it have put pressure on the Medical Board of California to respond to the growing “epidemic.”

I put the word “epidemic” in quotes because the outcry is somewhat out of proportion to the reality. As alarming as the number of opioid-related deaths sounds in isolation, the L.A. Times report failed to contextualize that statistic in terms of the combined population of those four counties (16.9 million as of July 2011), the population of California as a whole (37.7 million) or the number of deaths due to other causes during the same period. For example, according to the California Highway Patrol, car crashes killed 18,416 Californians between 2006 and 2011: almost five times the death toll of the headline-grabbing opioid menace.


I don’t mean to diminish the significance of those deaths or suggest that there isn’t a problem, but it’s important not to let alarmism triumph over common sense. While the number of collision-related deaths may indicate a need for better traffic safety, no one is seriously suggesting closing our freeways or restricting how far commuters are allowed to drive!

Unfortunately, when it comes to drugs, such overreaction is the rule rather than the exception. For instance, many of us are familiar with the federal Combat Methamphetamine Epidemic Act of 2005 (CMEA), which sought to stem the rise of methamphetamine abuse by restricting the sale of products containing the nasal decongestant pseudoephedrine (PSE).

PSE is not a prescription drug in most states, but the CMEA limited how much PSE a customer could buy at one time, mandated behind-the-counter placement in stores, required photo identification for purchase and forced sellers to maintain logbooks of sales and customer information. Those measures have had little impact on the meth epidemic. At a conference this February, DEA Office of Diversion Control Deputy Assistant Administrator Joseph Rannazzisi admitted that “NEITHER of these systems [tracking or rescheduling PSE] will have ANY impact on methamphetamine availability in the United States.” [emphasis in the original]. In short, these restrictions  have not curbed the meth supply, but have added a considerable bookkeeping burden for retailers while inconveniencing millions of cold and allergy sufferers.

The effects of the state medical board’s response to the outrage over opioid-related deaths may be far worse. Some of the suggestions I heard at a recent meeting of the board’s Prescribing Task Force left me wanting to tear out my hair in frustration.
the role of alcohol

California’s medical community has good reason to be embarrassed by the L.A. Times expose, which linked a substantial number of overdose deaths in Southern California to a surprisingly small number of doctors.

The story also raised serious questions about the medical board’s effectiveness in responding to complaints about excessive or reckless prescriptions. The board seldom suspends a doctor’s prescribing authority even if he or she is being actively investigated or has already been disciplined for reckless prescribing.

Given all that, you might expect that the Prescribing Task Force’s focus would be on improving the medical board’s oversight of its own members. Instead, I listened to hour after hour of experts proposing new restrictions on patients. The suggestions ranged from requiring patients to sign a contract with their physician prior to receiving prescription opioids to forcing all patients to submit to pill counts and random urine tests. Such measures would be tantamount to treating patients like criminals!

There were more sensible proposals calling for greater patient education, but overall, I was dismayed by the lack of clear-headed perspective on the issues involved. For example, one expert pontificated at length about the evils of opioid abuse without once mentioning the role of alcohol in many painkiller overdose cases. When I asked him about it, he replied that he would touch on that point at the end of his presentation, suggesting that he considered alcohol a trivial footnote rather than a significant contributing factor in many overdose deaths.


As a nurse and as one of the estimated 100 million Americans living with some degree of chronic pain, I am well aware of both the power and the dangers of opioid painkillers. There’s no argument that opioids carry a high potential for abuse and can kill if misused.

However, I’ve also witnessed the consequences of overzealous protocols that prevent patients from getting needed medication. If you suffer chronic pain, draconian limits on how much painkiller you’re allowed do not protect you; they just reduce your ability to function and increase the chances that you’ll find some other way to self-medicate — possibly with lethal consequences.

Tools like pill counting or contracts may be appropriate in certain cases, but imposing such restrictions on all patients would only have a chilling effect on the provider-patient relationship. If our approach to patients defaults to suspicion and mistrust, we only discourage our patients from communicating openly with us about issues like abuse and addiction.
comprehensive approach

So, what should be done? A better solution would include all of the following:

  • Improved education for patients about the dangers and proper use of opioids, including the risk of adverse interactions with alcohol or other drugs.
  • Better educating physicians and their healthcare teams about the signs of opioid abuse, including how to recognize potential risk factors like addictive personalities.
  • Fully implementing a real-time prescription drug monitoring program that can flag suspected prescription shoppers and physicians who may be recklessly prescribing opioids or running “pill mills.” California’s CURES (Controlled Substance Utilization Review and Evaluation System) could be but currently isn’t used for that purpose due to a lack of resources and interest.
  • More effective sanctions for doctors whose prescription history suggests a pattern of reckless or inappropriate prescribing.
  • Finding and funding alternative treatments for chronic pain and conditions that cause it. If you remove the source of the pain, you also remove the need to treat it with opioids.

Obviously, many of these are long-term solutions. In the short term, it’s important that nurses get involved in the debate. The Prescribing Task Force’s next meeting is in May. (See www.mbc.ca.gov for a schedule.) The meetings are open to the public and I urge readers to attend and participate.

This is an issue that directly affects many of us, our loved ones and our patients. We should not sit idly by while the medical community devises quick-fix solutions that may ultimately do more harm than good.

Genevieve Clavreul’s earlier article on this topic, “The Great Opioid Debate of 2012,” was published in WN127, Sept. 3, 2012.


Scott Glover and Lisa Girion, “Dying for Relief: A Times Investigation,” Los Angeles Times:

Part 1 (“Legal Drugs, Deadly Outcomes,” 11 Nov. 2012)

Part 2 (“Reckless Prescribing, Lost Lives,” 9 Dec. 2012)

Part 3 (“Rogue Pharmacists Feed Addiction,” 20 Dec. 2012)

Part 4 (“Unused Tool Could Help State Flag Deadly Doctors,” 30 Dec. 2012)


CDC, “Drug Overdose in the United States: Fact Sheet,” last updated 10 February 2014. The fact sheet says 60 percent of 2010 overdose deaths were pharmaceuticals, of which 75 percent involved opioids and 30 percent involved benzodiazepines.

Physicians for Responsible Opioid Prescribing, “Cautious, Evidence-Based Opioid Prescribing.”

The American Academy of Pain Management, cites 100 million chronic pain sufferers in America, per Institute of Medicine Report, “Relieving Pain in America.”

Transforming Prevention, Care, Education and Research (Washington, D.C.: The National Academies Press, 2011.