Archive for August, 2014

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- and S 2134 – 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 –

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 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.