Putting the Professionalism back into the nursing profession

From the Floor

Putting the professionalism back into the nursing profession.

By

Geneviève M. Clavreul, RN, Ph.D.

Several nurses had gathered in the corridor of their unit and were carrying on a very animated discussion. What, my friend thought could have initiated such an animated discussion, could it be a patient care issues, union talk (contract negotiations were eminent)? Ever curious my friend decided to eaves drop and imagine his surprise to learn that what had the nurses so invigorated was comparing break times and length of said breaks, and when their next scheduled time off would be. They were so engrossed in discussing when their next scheduled break would be that they were unaware that their hallway discussion was being heard by everyone around them, fellow nurses, visitors and patients. Were these nurses aware that their behavior was unprofessional? Unlikely, otherwise they would have chosen to hold this type of conversation behind the closed doors of the nurse’s lounge rather then the very public hallway.
Over the years, while working as a beside nurse and even as a Director of Nursing I have seen nurse behaving in the most professional of manners under the most challenging of circumstances; and of course I have seen the contrary, nurses behaving in the most un-professional of manner disgracing themselves and our profession. Many of us so-called old-timers often bemoan what appears to be a growing lack of professionalism in nursing. Some point to the abandonment of the traditional white uniform as the start of this disintegration of professionalism, others blame the unionization of nursing as the cause, and still others blame the “me-generation” pointing out that this generation has little appreciation of societal norms and the meaning of manners, etc. So what is the state of professionalism in the nursing profession? In my opinion I believe that in many hospitals professionalism is in serious trouble and where there is a lack of professionalism you will often find nurse dissatisfaction, burnout and turnover. As with any good discussion we should always start with a “common point” and in this case it would be the “what does professionalism mean?” For the purpose of this article, I choose to rely on the dictionary. When looking up the definition of professionalism in the Merriam-Webster online dictionary, the search refers you to “professional” and its definition to further define the word and that definition is:
1 a : of, relating to, or characteristic of a profession b : engaged in one of the learned professions c (1) : characterized by or conforming to the technical or ethical standards of a profession (2) : exhibiting a courteous, conscientious, and generally businesslike manner in the workplace
There are occasions when I think good and caring nurses often feel as though professionalism is out of style in the nursing profession, and I would respond that like chivalry, professionalism is not dead – yet. All too often, for a variety of reasons nurses often fail to meet the definition of a “professional”. This lack of “professionalism” usually starts small, the occasional tardy nurse, or “have to leave early to pick up the kids”, leaving their duty station a mess because of the new admission admitted minutes before the end of shift, and so forth are common trends that if not “nipped in the bud” can quickly spread to other susceptible members of the nursing team. The leadership and other members of the nursing team often overlook this behavior when it first manifest itself, and when the nursing team is comprised of strong, motivated, and yes, professional members the behavior is an exception to the rule and does not become the new “norm” of the unit. However, where the nursing team is working under continuous stress (real or perceived), constant short staffing, lacking of strong internal (head/charge nurse) or external (Director of Nursing [DON]/Chief Nursing Officer [CNO]) leadership then unprofessional behavior can subsume what professionalism is left.
If nurses were to be honest with themselves, many would agree that nursing today in many hospitals sit at this very brink, the thin line between the professional versus the unprofessional. We saw it not that long ago when two nurses chose to take out their frustrations on the evening shift by intentionally feeding the patients under their care excessive doses of exlax. Thank goodness their plot was found out and they are now facing criminal charges. We see it with the continuous battle for supremacy, diploma/A.D.N. prepared nurse versus B.S.N. prepared nurse and the jockeying to be recognized as the only “real” nurse. We see it when strikes (rare as they are) occur and nurses feel driven to extreme behavior such as locking out relief nurses from much needed life saving equipment by altering codes, misplacing instruction books, etc. Though these examples are the “extreme” of the unprofessional meter, they can and do grow out of the lesser “offensive” unprofessional behavior. Sleeping or eating at the bedside, arriving late or leaving early from the shift, arriving unkempt to work, gossiping in public areas, carrying on a conversation in a language not understood by all present are just some examples of more common unprofessional behavior.
When we began to accept mediocre nursing behavior, care, and practices we lay the ground work for even greater acts of unprofessional behavior that is exhibited not by a few but by the many. When this occurs then nursing has become devoid of professionalism, and one can only think that Florence Nightingale must be doing “jumping jacks” in her grave (or as my children remind me “mom, that’s rolling over in her grave”). Nursing does not ask us to be perfect (except within our practice), but it does demand that we behave as role models not only to other nurses, but healthcare professionals and those that look to us. Consistent lack of professional behavior can and does drive away good nurses, leaving the “bad” and mediocre nurses behind. Most of the time it is the lack of social skills that is often the main culprit. We all know that individuals rise, or sink as the case may be, to the occasion. Where professionalism is stressed and expected nurses, even the mediocre ones strive to excel because such excellence is rewarded and recognized. On the contrary where there is little expectation of excellence then the mediocre and “I don’t give a darn” nurse will find safe haven and thrive. Like with parenting keeping expectations high takes work and effort, and as with parenting many don’t put the energy forth as it is so much easier to just shrug your shoulders and say “well what can I do” – there is a nursing shortage after all and I need the body.
I used to say that whether I was head nurse or DON I never had to fire anyone (place individuals on suspension yes, but that’s for a different article). There were two reason why I never had to fire any one, the first I kept excellent documentation (I see another article in this) and I always modeled and expected the highest. Nurses that were just in it for the paycheck, or “putting in their time” either rose to the occasion and began exhibiting the new behavior or quietly left for other pastures. This process cost in the short run a loss of some nurses, but it didn’t take long for the remaining nurses to “advertise” the new professional atmosphere at work and I often made up the loss of a few nurses, with a waiting list of nurses who wanted to join our nursing team.

March 2009

PARADIGM BYTES
Newsletter for Paradigm 97
March 8, 2009

PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.Our website...... http://paradigm97.blogspot.com/

MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to help survive them. We offer research results and other ideas to enrich the nursing experience.

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SNIPPETS

Please see Genevieve's article

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MEDICAL NEWS
(Reuters 3/5) -Scientists remove cancer genes from stem cells - Scientists have taken another important step toward using ordinary skin cells that are made to behave like embryonic stem cells to find treatments for conditions like Parkinson's disease.... http://www.reuters.com/article/healthNews/idUSTRE5247ZV20090306?feedType=nl&feedName=ushealth1100

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FROM THE MEMBERS

(Submitted by Laregis....her publication. Congratulations !)

Getting Ready for Medicare enrollment A Step-byStep Guide to Get Your Clinic Prepared

by Laura Regis, RN 02/26/2009
So you want to open a dialysis facility and have no idea where to start to apply for Medicare reimbursement of services? You are not alone. What seems like only a small portion of the planning process for opening a clinic is a most important part that requires pre-planning your business structure, and also requires accuracy of reporting the information on the correct forms. The large application form is about 50 pages long and is used for multiple purposes. There is no form solely for the first-time applicant, and attempting to decode the verbiage can be challenging at best. ...
http://www.renalbusiness.com/articles/medicare-enrollment.html
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This was sent in by Birdijo (Cary) who writes:

A friend of mine has started a new website to bring attention to the issue of domestic violence in the US, violence unsilenced. She is an awesome writer and a terrific human being. Please take a moment to check the site out and pass it on. It just went live today, but I think it is going to help an awful lot of people as time goes on http://violenceunsilenced.com



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INTERESTING READING

Please remember that the REUTERS articles are usually good for 30 days.

(Reuters 3/5) - Two studies published on Thursday provide evidence that common viruses may cause childhood diabetes, paving the way for potential vaccines against the life-threatening condition, researchers said.One team showed that enteroviruses -- which normally cause colds, vomiting or diarrhea -- were found frequently in the pancreases of young people who had recently died from type 1 diabetes, sometimes called juvenile diabetes, but not in healthy samples.... http://www.reuters.com/article/healthNews/idUSTRE5246GM20090305?feedType=nl&feedName=ushealth1100
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Here is an Excellent hint: Cut Your Electric Bill in Half Unplug items you are not using. Even if they are off they are still pulling current. This cost savings will add up to more than you think. If you don't want to continually be unplugging items, invest in a Smart Strip (different than a standard power strip). It does not allow your items to pull electric current when off. You will probably cut your electric bill in half.
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A tangy treat that's good for your bladder... Here’s a diet "do" that may help keep your bladder cancer-free. Start your day with some yogurt. Later, have some more for a snack. Compared with their peers who never ate yogurt, people in a study who ate two or more servings daily had almost a 40 percent lower risk of bladder cancer. Talk about an anti-ager! ...
http://www.realage.com/ct/eat-smart/food-and-nutrition/tip/8254
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Why Nursee Don't Get Enough Credit ...Nurses perform much of the patient care that TV shows attribute to the much more glamorous profession of doctor. It is an age-old problem, the clash of cultures and tug of war over credit between two professions working in close quarters toward an identical goal. But "Saving Lives" by Sandy Summers and Harry Jacobs Summers: has a serious point, that the devaluation of nursing—both by overlooking nurses' contributions to positive outcomes for patients, and more subtly by emphasizing their devotion, compassion and self-sacrifice over their lifesaving skills—discourages students from the field and contributes to a critical nursing shortage.... http://www.newsweek.com/id/187004
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Doing the Right Thing ... Moral Distress February 6, 2009 -- Today the New York Times ran a remarkably astute "Doctor and Patient" piece in which Pauline W. Chen, M.D., explained the problem of "moral distress," when nurses and physicians feel that they cannot do what is right for patients because of the "competing demands" of the health system that surrounds them....
http://www.truthaboutnursing.org/news/2009/feb/06_nyt.html
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RANDOM FACT The inventor of Vaseline ate a spoonful of the stuff every morning!

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Blood Thinner, Heartburn Drugs May Be Risky After Heart Attack Patients taking Plavix, PPIs have 25 percent increased chance of death, rehospitalization.
http://www.healthday.com/Article.asp?AID=624675
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(Reuters 2/18) Doctors test new way to regulate warfarin dose A new system for predicting the proper dose of the blood thinner warfarin could help doctors do a better job of preventing dangerous blood clots and serious bleeding, researchers reported on Wednesday.
Some patients needed more than twice the weekly dose than others did, the study showed, and the new test better predicted who needed more and who needed less.... http://www.reuters.com/article/healthNews/idUSTRE51H7DF20090218?feedType=nl&feedName=ushealth1100
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Aluminum, silica in water affect Alzheimer's risk NEW YORK (Reuters 3/4) - Higher levels of aluminum in drinking water appear to increase people's risk of developing Alzheimer's disease, whereas higher levels of silica appear to decrease the risk, according to French investigators.... http://www.reuters.com/article/healthNews/idUSTRE52361D20090304?feedType=nl&feedName=ushealth1100
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FDA approves Ferring Pharmaceuticals' degarelix (generic name) for treatment of advanced prostate cancer FDA's approval of injectable degarelix (trade name pending) for treatment of advanced prostate cancer, saying it's the first new drug approved for prostate cancer in several years. . By day 14, 99% of those receiving degarelix had achieved lower levels of testosterone, compared with 14% of those receiving leuprolide. http://www.medicalnewstoday.com/articles/134153.php
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RANDOM TIDBIT - The Aflac Duck: Art director Eric David was trying to come up with an idea for a campaign when he realized that the company's name sounds quite similar to a duck's quack.

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HB 219 which will require that a bitter substance be put in antifreeze, preventing accidental or purposeful death to humans, and HB 429, which will protect pets as well as the family members in domestic violence cases, both passed out of subcommittee favorably. To see the full language on these bills, you can go to www.legis.ga.gov and put in the bill numbers.
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Undermining to Underpinning... Some nurses prey upon new nurses because that is the only approach to teaching they are familiar with. Some of the rationales these experienced staff members use to justify their unsupportive behaviors include, "its survival of the fittest"; "they need tough love"; "this will make you a better nurse"; and the classic, "I went through it when I was orienting, so."
http://nursing.advanceweb.com/Editorial/Content/Editorial.aspx?CC=1949
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SYDNEY, Australia—A combination of two blood-pressure-lowering drugs reduces the risk of kidney disease by about 20 percent for type 2 diabetics, according to a study in the April 2009 issue of the Journal of the American Society of Nephrology (JASN).The analysis was based on the randomized ADVANCE study that included 11,140 patients with type 2 diabetes.... http://www.renalbusiness.com/hotnews/drug-combo-reduces-kidney-disease-risk-in-dia.html
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PHILADELPHIA—Obese people who drink fructose-sweetened beverages with meals have an increased rise of triglycerides following the meal, according to new research from the Monell Chemical Senses Center.In the study, published online by the Journal of Clinical Endocrinology and Metabolism, researchers studied 17 obese men and women; each was admitted two times to the Clinical and Translational Research Center at the ... http://www.renalbusiness.com/hotnews/fructose-sweetened-drinks-increase-non-fastin.html
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LOL Who thinks of these??? RANDOM FACT If you unfolded your brain, it would cover an ironing board.

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Second team finds a natural super flu fighter (Reuters 2/26) - An antibody being developed by a Dutch drug company chokes off both seasonal flu and the H5N1 avian flu virus and might offer a way to develop better treatments and vaccines, researchers reported on Thursday....
http://www.reuters.com/article/healthNews/idUSTRE51P6M220090226?feedType=nl&feedName=ushealth1100
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RANDOM TIDBIT

The California Raisins: Frustration led to the famous Claymation icons. In 1987,
a copywriter at Foote, Cone & Belding was working on the California Raisin Advisory Board campaign and said, "We have tried everything but dancing raisins singing 'I Heard it Through the Grapevine.'" The idea was pitched to the client, and the sale of raisins increased by 20 percent!

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Study of "spit" offers insight to human health - Bacteria found in people's spit does not vary much around the world, a surprising finding that could provide insights into how diet and cultural factors affect human health, researchers said on Thursday....
http://www.reuters.com/article/healthNews/idUSTRE51P7QC20090227?feedType=nl&feedName=ushealth1100
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Research reveals some of Alzheimer's secrets (Reuters 2/26) - Scientists are unraveling some of the mechanisms behind the plaques in the brain that are a hallmark of Alzheimer's disease, offering new leads for drugs to treat the fatal brain-wasting disease.
http://www.reuters.com/article/healthNews/idUSTRE51P6F420090226?feedType=nl&feedName=ushealth1100
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The Journal of School Nursing (JOSN) provides a forum for advancing the specialty of school nursing, contributing to knowledge development about school nursing practice, and promoting the professional growth of school nurses. Published bi-monthly, peer-reviewed and featuring original research articles, it is indexed in MEDLINE, the Cumulative Index to Nursing & Allied Health Literature, PsychINFO, and Scopus. It is the official journal of the National Association of School Nurses. (www.nasn.org)
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This was sent in by BAcello (Barbara)........ I hadn't considered this aspect !

Nursing Shortage: 1 in 5 quits within first year, study shows ... That turnover rate is a major contributor to the nation's growing shortage of nurses.... http://www.usatoday.com/news/health/2009-02-15-nursing-shortage_N.htm?csp=34
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LOS ANGELES – Low-fat, low-carb or high-protein? The kind of diet doesn't matter, scientists say. All that really counts is cutting calories and sticking with it, according to a federal study that followed people for two years. However, participants had trouble staying with a single approach that long and the weight loss was modest for most....
http://news.yahoo.com/s/ap/20090226/ap_on_he_me/med_dueling_diets;_ylt=
Apu6ZRa9EF2JPTM1A7i1w.PVJRIF
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This is just interesting stuff:

The smallest bones in the human body are the stapes, incus, and malleus bones,

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In Czechhoslovakia, there is a church that has a chandelier made of human bones.

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Humans are born with 300 bones in their body, however when a person reaches adulthood they only have 206 bones. This occurs because many of them join together to make a single bone. (as we know)

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The chances of getting a cavity is higher if candy is eaten slowly throughout the day compared to eating it all at once and then brushing your teeth.

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Adult human bones account for 14% of the body's total. **************
Ten things you can quit cleaning....Right Now !
http://home.ivillage.com/cleanandorganize/0,,bbtbbpsw,00.html?nlcid=wh02-24-2009 **************
Can you rub out blood pressure problems? Finally. An indulgence that may actually be good for you. What is it, you ask? A long, deep massage. When people with sore muscles received a deep-tissue massage, both their systolic and diastolic blood pressure (BP) numbers dropped several points. ... http://www.realage.com/ct/tips/8188
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Osteoarthritis of the Hip Osteoarthritis may affect one or both hips and can cause pain, stiffness, and severe disability. Hip pain is felt mostly when the hip has to bear weight. The pain is felt mainly in the front of the groin, but sometimes around the side and front of the thigh and the buttock. Sometimes the pain radiates down to the knee. In affected hip joints, the range of motion is reduced and painful. ... http://www.realage.com/health_guides/Osteoarthritis/topics/topicsContent.asp?topic=11
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(I have problems with the online learning...need interaction with prof and fellow students) Gerkin K et al.-- Despite the education challenges faced by healthcare institutions, the use of online technology (eLearning) to demonstate competency for practicing nurses in the acute care environment has only recently been explored. The authors discuss the implementation of an online-based nursing education competency. The results demonstrate that the use of the eLearning format provides both a satisfactory and effective learning medium. The study provides support for the use of online learning in the healthcare setting.... http://www.mdlinx.com/NurseLinx/newsl-article.cfm/2583859/ZZ5603146585149290157159/?news_id=399&subspec_id=44

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This is the section for Humor........nothing "came to mind" so, I am submitting these medical facts instead.

In 1628, William Harvey publishes An Anatomical Study of the Motion of the Heart and of the Blood in Animals, describing how blood is pumped throughout the body by the heart, and then returns to the heart and recirculates. The book is very controversial but becomes the basis for modern research on the heart and blood vessels.

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In 1747, James Lind , a Scottish naval surgeon, discovers that citrus fruits prevent scurvy. He publishes his Treatise of the Scurvy in 1754, identifying the cure for this common and dangerous disease of sailors, although it takes another 40 years before an official Admiralty order dictates the supply of lemon juice to ships.

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In 1842, American surgeon Crawford W. Long uses Ether as a general anesthetic during surgery but does not publish his results. Credit goes to dentist William Morton.

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In 1867, Joseph Lister publishes Antiseptic Principle of the Practice of Surgery, one of the most important developments in medicine. Lister was convinced of the need for cleanliness in the operating room, a revolutionary idea at the time. He develops antiseptic surgical methods, using carbolic acid to clean wounds and surgical instruments. The immediate success of his methods leads to general adoption. In one hospital that adopts his methods, deaths from infection decrease from nearly 60% to just 4%.

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In 1901, Austrian-American Karl Landsteiner describes blood compatibility and rejection developing the ABO system of blood typing. This system classifies the bloods of human beings into A, B, AB, and O groups. Landsteiner receives the 1930 Nobel Prize for Physiology or Medicine for this discovery.

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In 1953, James Watson and Francis Crick at Cambridge University describe the structure of the DNA molecule. Maurice Wilkins and Rosalind Franklin at King's College in London are also studying DNA. (Wilkins in fact shares Franklin's data with Watson and Crick without her knowledge.) Watson, Crick, and Wilkins share the Nobel Prize for Physiology or Medicine in 1962 (Franklin had died and the Nobel Prize only goes to living recipients). ~~**~~**~~**~~**~~**~~

CEU and CME SITES

Those that are-----Free and Otherwise.........IF you have a favorite CEU/CME site, please share !
Send your links to me: RNFrankie@AOL.com

Free CEs http://www.myfreece.com/welcome.asp

https://nursing.advanceweb.com/CE/TestCenter/Main.aspx

Can either pay $8 / course OR pay $26.99 for a year for all the CE courses you want to take
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www.nurse.com Pay Only $34.99 for a full year of CONTACT HOURS .
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For a Healthy Environment, Nurses and Hospi… CE489
Pulseless Electrical Activity: Where is the… CE497
Critical Blood Loss Demands Fluid Resuscita… CE490
Aspiration: Preventing a Deadly Complicatio… CE491

http://www.nurse.com
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links. Please send them to:RNFrankie@AOL.com.

School Nursing links:
The Role of the School Nurse in Providing School Health Services: Council on School Health
Ethics and the HPV Vaccine: Considerations for School Nurses
The Number of Students Sent Home by School Nurses Compared to Unlicensed Personnel
RNs launch a national safe staffing campaign http://www.1199seiu.org/media/magazine/sept_2007/safe_staffing.cfm

H.R. 2123, The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2007
http://www.washingtonwatch.com/bills/show/110_HR_2123.html

Board Supports Your Right to Refuse An Unsafe Assignment: Nurse Practice Act cites three conditions for patient abandonment http://findarticles.com/p/articles/mi_qa4102/is_200408/ai_n9450263

Click here: Dismantling the Arguments of the Hospital Industry Against a Minimum Safe Standard of Care

These were sent in by BAcello (Barbara):
QIS Surveyor Training Manual http://www.aging.state.ks.us/Manuals/QISManual.htm Resident Functional Capacity Screen Manualhttp://www.agingkansas.org/ProviderInfo/forms/RFCSManualJuly08.pdf Resident Functional Capacity Screen Formhttp://www.agingkansas.org/ProviderInfo/forms/ResidentFunctionalCapacityScreen.pdf Restorative and peer-shared tools for ADLshttp://www.kfmc.org/providers/nh/tools/adl/index.html
Click here: Internal and External Urinary Catheters: A Primer for Clinical Practice Ostomy Wound Management

http://www.thebreastcancersite.com/clickToGive/home.faces?siteId=2
http://www.snopes.com

Stimulus Watch ....this website gives a breakdown in the planned projects per state. Check your state out!
http://www.stimuluswatch.org/project/by_state
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http://www.solutionsoutsidethebox.net/

the National Nurse's new website: http://nationalnurse.org/

Any time you want to check a rumor ... this is the link:
http://www.snopes.com/


This site has passed the Snopes.com test
http://www.theanimalrescuesite.com/clickToGive/home.faces?siteId=3

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MEDICAL RECALLS

FDA notified healthcare professionals that manufacturers of metoclopramide, a drug used to treat gastrointestinal disorders, must add a boxed warning to their drug labels about the risk of its long-term or high-dose use. Chronic use of metoclopramide has been linked to tardive dyskinesia, even after the drugs are no longer taken. These symptoms are rarely reversible and there is no known treatment. Metoclopramide is available in a variety of formulations including tablets, syrups and injections. Names of metoclopramide-containing products include Reglan Tablets, Reglan Oral Disintegrating Tablets, Metoclopramide Oral Solution, and Reglan Injection. http://www.fda.gov/medwatch/safety/2009/safety09.htm#Metoclopramide
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FDA issued a Public Health Advisory to notify healthcare professionals of three confirmed, and one possible report of progressive multifocal leukoencephalopathy (PML), a rare brain infection, in patients using the psoriasis drug Raptiva.... http://www.fda.gov/medwatch/safety/2009/safety09.htm#Raptiva

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NURSING HINTS CORNER

Don't forget to document When you teach your patient about his/her medications during administration times, make sure to document this as formal patient teaching. Initially assess his/her familiarity with the medication and give him/her a basic explanation of the drug's action. During subsequent administrations, further assess and reinforce his/her understanding of the drug, remembering to document this as well. Karen Teves Frazier, RN

(this is so important...and always feels like it is consuming too much time to do--- but if you do this as you assess the patient, you have accomplished both without expending valuable time.)

Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 21, Springhouse Corporation/www.springnetcom.

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ADVERTISEMENTS
from the members

This ad is from Decubqueen (Gerry)..........Accu-RulerAccurate wound measurement designed by nurses, for nurses. Now carrying wound care and first-aid supplies at prices you can afford. By using the following code: Paradigm10 , you will get 10% off of their first order. ( I have ordered through Gerry...and it was very satisfactory. )
Visit us at http://www.accu-ruler.com/.

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NEW MEMBERS
No new members this issue
Please send the prospective members' screen names and first names to me: RNFrankie@AOL.com

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NOTICE:
I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the email address until you contact me with an updated email address; I have no way to reach you without a correct email address....You could always send me your Home number.......lol So please send me your new name/address, ok? RNFrankie@AOL.com

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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne), GALLO RN @AOL.com (Sue), HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com (Miriam), and Schulthe @AOL.com (Susan)

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PARADIGM 97 CO-FOUNDERS:
MarGerlach @AOL.com (Marlene) and RNFrankie @AOL.com (Frankie) ~~**~~**~~**~~**~~**~~
DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the hyperlinks and information provided by our members. The articles and web sites are not personally endorsed by the editors, nor do the articles necessarily reflect the staff's views.~~**~~**~~**~~**~~**~~

THOUGHT FOR THE DAY

"Medicine, the only profession that labors incessantly to destroy the reason for its own existence." James Bryce.

Eleanor Roosevelt and Helen Keller are my favorites for QADs

“You gain strength, courage and confidence by everyexperience in which you really stop to look fear in the face.
You must do the thing which you think you cannotdo.”

Eleanor Roosevelt



Hope to see you online.....

RNFrankie@AOL.com