Текст книги "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital"

Автор книги: Alexandra Robbins

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Текущая страница: 29 (всего у книги 33 страниц)

Notes

Chapter 1

“Emergency nurses practice . . . ” Emergency Nurses Association, Award Recognition Program. www.ena.org/about/annualawards/Pages/ENAAward.aspx.

“ER nurses have the raunchiest jokes . . .” Interview with author (henceforth designated as “Interview”).

“It’s like high school, except for the dying people.” Interview.

Dilaudid, a narcotic five to ten times See, for example, L. Felden et al., “Comparative Clinical Effects of Hydromorphone and Morphine,” British Journal of Anaesthesia 107, no. 3 (2011).

injecting up to 8 milligrams of Dilaudid at a time, an enormous dose, but, for Lara, just enough to keep her alert. Lara’s recollection, interview.

Medical Drug Intervention program MDI is a pseudonym. To find a rehabilitation program in your state, visit http://webapps.aana.com/Peer/directory.asp. While Peer Advisors are for CRNAs and student nurse anesthetists only, many of the programs are for all nurses.

At 3.5 million strong in the United States See U.S. Census Bureau, “Men in Nursing Occupations,” February 2013.

and more than 20 million worldwide Correspondence from World Health Organization spokesperson to author.

nurses comprise the largest group of healthcare providers See, for example, “Nursing Fact Sheet,” American Association of Colleges of Nursing, http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-fact-sheet.

women who comprise 90 percent of the workforce Interview, Office of Occupational Statistics and Employment Projections, U.S. Census Bureau. See also “Men in Nursing Occupations.”

“like a secret club . . . ” Interview.

“We are not just the bed-making . . . ” Interview.

They are, for example, frontline reporters. Thank you to nurse Meghan Yowell for inspiring the structure and content of this paragraph.

“Nursing is not a job.” Interview.

“Doctors breeze in and out . . .” Email from this nurse to author.

an “I’m-going-to-eat-my-hair-in-a-corner person.” Sam’s words, interview.

Chapter 2

“I will not be ashamed to say ‘I know not’ . . .” From the Modern Version of the Hippocratic Oath. See Peter Tyson, “The Hippocratic Oath Today.” NOVA. March 27, 2001. Accessed at pbs.org.

“The intimate nature of nursing care . . .” The American Nurses Association’s Code of Ethics For Nurses page at http://nursingworld.org.

“Lots of hot residents . . .” Interview.

I-STAT A portable device that can perform diagnostic tests at a patient’s bedside.

“ . . . shadowy, dark corners of our profession.” Barry Silbaugh, “ACPE Foreword.” In Owen MacDonald, “Disruptive Physician Behavior,” American College of Physician Executives, May 15, 2011.

bloody handprint on her scrubs. Abigail Zuger, “Nurses Speak Out, About Doctors,” The New York Times, October 28, 2008.

shoving matches in the operating room Interviews. Also see, for example, Richard Knox, “Doctors Behaving Badly? They Say It Happens All the Time,” NPR, May 25, 2011.

physicians throwing stethoscopes, pens, or surgical instruments Interviews. See also, for example, Harold Levy, “Heal Behaviour, MDs Urged,” Toronto Star, September 15, 2004.

scissors See, for example, Liz Kowalczyk, “Hospitals Try to Calm Doctors’ Outbursts; Medical Road Rage Affecting Patient Safety, Group Says,” The Boston Globe, August 10, 2008.

Physical abuse by physicians is on the rise. “Unresolved Disrespectful Behavior in Healthcare,” ISMP Medication Safety Alert, October 3, 2013.

“Are you stupid or something?” Interview.

A Texas doctor threw a metal clipboard . . . Interview.

A surgeon threw a scalpel at a Virginia nurse . . . Interview.

“. . . He-Who-Must-Not-Be-Named” Interview.

The Institute for Safe Medication Practices (ISMP) . . . has reported rampant bullying in healthcare ISMP’s Survey on Workplace Intimidation, 2013; ISMP’s Survey on Workplace Intimidation, 2003.

87 percent of nurses encountered Ibid.

“Every single nurse I know . . .” Interview.

in countries such as Australia . . . “Workplace bullying is a serious health and safety hazard affecting nurses and midwives.” See “Bullying in the Workplace,” policy paper, The Australian Nursing Federation. Reviewed and re-endorsed November 2011. See also Amanda Place, “Dealing with the Bullies in our Midst,” The Age, Melbourne, Australia, June 22, 2002.

prevalent in South Africa Simone Honikman and Ingrid Meintjes, “Nurses are Stressed, Ill-Treated, Burdened,” Cape Times, September 9, 2011.

Hong Kong R.P.W. Kwok, “Prevalence of Workplace Violence Against Nurses in Hong Kong,” Hong Kong Medical Journal, February 2006.

Canada Lucie Lemelin, Jean-Pierre Bonin and Andre Duquette, “Workplace Violence Reported by Canadian Nurses,” Canadian Journal of Nursing Research, September 2009.

In 2010, a nurse in India committed suicide “Mamata Suicide Case: Nurses Set Deadline to Nab Doc,” The Times of India, February 16, 2010.

In Korea, a 2013 survey . . . “Half the Nurses Suffer from Sexual Harassment.” Korea Times, February 26, 2013.

the more abuse that nurses experience . . . Laurie Scudder, “Physician Abuse as Reported by Early Career Nurses,” Viewpoints, Medscape Nurses, September 20, 2013.

a link between doctors’ intimidation and poor nurse satisfaction See The Joint Commission. “Behaviors that Undermine a Culture of Safety,” Sentinel Event Alert 40, July 9, 2008.

most nurses don’t speak out See, for example, David Maxfield et al. “The Silent Treatment: Why Safety Tools and Checklist Aren’t Enough to Save Lives.” VitalSmarts, AORN, and AACN.

Nurses are afraid to report doctors . . . “Workplace Violence: Assessing Occupational Hazards and Identifying Strategies for Prevention, Part 1,” a CE Home Study Course by National Nurse, January-February 2012.

a male travel nurse . . . saw cardiologist Abdul Shadani . . . Reed Abelson and Julie Creswell, “Hospital Chain Inquiry Cited Unnecessary Cardiac Work,” The New York Times, August 6, 2012.

“Sir, what are we going to fix?” . . . inserted the stent. Ibid.

Soon after Tomlinson reported . . . including several other unnecessary procedures. Ibid.

Shadani still works at Lawnwood. Author’s 2014 phone call to Lawnwood Regional Medical Center and Heart Institute.

In 2009, two Texas nurses filed . . . that risked patient health See, for example, “New State Law Bans Anonymous Complaints Against Physicians,” FierceHealthcare, September 20, 2011.

taking hospital supplies to perform at-home procedures See, for example, Betsy Blaney, “APNewsBreak: Ex-County Lawyer’s License Suspended,” February 2, 2012.

pushing patients to purchase herbal supplements that he conveniently sold on the side. See, for example, “Editorial,” The New York Times, February 10, 2010.

sewing a rubber scissor tip to a patient’s thumb See “Justice Doesn’t Always Have Happy Ending,” Austin American-Statesman, October 7, 2011.

using an unapproved olive oil solution on a patient . . . failing to diagnose a case of appendicitis See, for example, Kevin Sack, “Doctor Arrested in Whistle-Blowing Case,” The New York Times, December 23, 2010.

performing a skin graft without surgical privileges Ibid.

When the board informed Arafiles . . . his supplement business. “Medical Justice, West Texas–Style,” The New York Times, February 10, 2010.

Arafiles tracked down contact information for the patients listed in the complaint See, for example, “Former Winkler County Memorial Hospital Physician Sentenced for Scheme to Fire Nurses in 2009.” States News Service, November 7, 2011.

and gave it to the sheriff, who got hold of them Kevin Sack, “Sheriff Charged in Texas Whistle-Blowing Case,” The New York Times, January 15, 2011.

to determine the nurses’ identities . . . found the letter. Ibid.

A hospital administrator fired both nurses Ibid.

who had not signed their letter because they feared . . . retaliation. Rick Casey, “Justice, Injustice are Served,” Houston Chronicle, August 13, 2010.

after months of unsuccessful attempts . . . Betsy Blaney, “Nurse Testifies Talks on Doc’s Cases Delayed Often,” the Associated Press State and Local Wire, June 8, 2011.

charging them with “misuse of official information” . . . Editorial, The New York Times, February 10, 2010.

Charges against one of the nurses See, for example, Betsy Blaney, “Ex-County Lawyer’s License Suspended,” APNewsBreak, February 2, 2012.

filed a federal lawsuit . . . won a $750,000 settlement Ibid.

the sheriff, who lost his license . . . one-hundred days in jail Ibid.

county attorney, who was sentenced to ten years’ probation “Retaliation case merits stiff sanction,” San Antonio Express-News, February 10, 2012.

Arafiles pleaded guilty . . . five years’ probation See, for example, Betsy Blaney, “Texas Doctor Pleads Guilty in Retaliation Case,” The Associated Press, November 7, 2011.

As part of his plea agreement, he surrendered his medical license Texas Medical Board. Public Verification/Physician Profile; Ibid.

charging him with several additional violations of improperly treating patients and intimidating the nurses . . . monitored by another doctor Mary Ann Roser, “New Texas Law Bans Anonymous Complaints about Docs.” The Associated Press State and Local Wire, September 20, 2011.

Texas Legislature passed a bill . . . “Justice Doesn’t Always Have Happy Ending.”

and protecting those nurses from criminal liability. Betsy Blaney, February 2, 2012.

In 2011, another Texas law . . . “New State Law Bans Anonymous Complaints Against Physicians,” FierceHealthcare, September 20, 2011.

An examination of policies and calls Calls to every state nursing board. Arizona would be a forty-second state, but its policy is hazy. A spokesperson said, “The Arizona Board of Nursing does accept anonymous complaints, but the contact info of the complainant needs to be given to the assigned investigator. The complaint remains anonymous to the nurse.”

a nonpartisan Texas citizen advocacy organization http://www.texaswatch.org/about.

“It is shameful that nurses . . .” Interview with Alex Winslow by Eaves.

“intimidating and disruptive behaviors” The Joint Commission, “Behaviors That Undermine a Culture of Safety.”

afraid the doctor will yell at them See, for example, Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact of Disruptive Behaviors and Communication Defects on Patient Safety,” The Joint Commission Journal on Quality and Patient Safety 34, no. 8, August 2008; Interviews.

Nurses have reported . . . confrontation with a physician Alan Rosenstein and Michelle O’Daniel, “Impact and Implications of Disruptive Behavior in the Perioperative Arena.”

Approximately half of surveyed respondents . . .“intimidation clearly played a role.” “Unresolved disrespectful behavior in healthcare.” ISMP Medication Safety Alert. October 3, 2013; ISMP Medication Safety Alert: Intimidation: Practitioners Speak Up About this Unresolved Problem (Part I).” March 11, 2004.

many OR nurses are too intimidated See David Maxfield et al.

Despite mandatory safety protocols like checklists . . . See, for example, Julia Edwards, “Nurses Afraid to Speak Up When Doctors Slip Up,” The National Journal, March 23, 2011.

more than 80 percent of nurses . . . “and disrespect” at their hospitals. “New research shows communication breakdowns in hospitals undercut the effectiveness of safety tools and negatively impact patient outcomes,” AORN/Vital Smarts press release, March 22, 2011.

Of the nurses who admitted . . . 83 percent did not report the violation See David Maxfield et al.

Rhode Island Hospital in 2007. . . which side was correct Michelle R. Smith, “Brain Surgery Errors Rack Up at Prestigious R.I. Hospital.” The Virginian-Pilot, December 15, 2007.

most likely to jeopardize patient safety Carla Johnson, “Group Calls for Zero Tolerance of Doctor Bullies.” Associated Press Online, July 9, 2008. For more information on these issues, see Shellie Simons, Roland B. Stark, and Rosanna F. DeMarco, “A New, Four-Item Instrument to Measure Workplace Bullying.” Research in Nursing and Health 34 (2011). See also Arminee Kazanjian, Carolyn Green, Jennifer Wong, and Robert Reid, “Effect of the Hospital Nursing Environment on Patient Mortality: A Systematic Review,” Journal of Health Services Research and Policy 10, no. 2 (April 2005).

Botched communications See, for example, Alan H. Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

More than two-thirds . . . or patient deaths See, for example, Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact . . .”

63 percent of cases . . . communications failure The Joint Commission, “Sentinel Event Data Root Causes by Event Type 2004–2013,” April 15, 2014.

“the most significant factor . . . communication” Arminee Kazanjian et al.

patients die unnecessarily Ibid.

the mother of a toddler . . . to follow up with him. Lisa Rosetta, “Abuse Protection Sought for Healthcare Workers,” Salt Lake Tribune, October 21, 2009.

“We tried to stop the doctor . . . an advocate for the patient.” David Maxfield et al.

“Failure of MD to listen . . . outcome in newborn.” Alan Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

“When a nurse reported . . . safety and well-being.” L. L. Veltman, “Disruptive Behavior in Obstetrics: A Hidden Threat to Patient Safety,” American Journal of Obstetrics and Gynecology 196 (2007).

attending surgeons are . . . disruptive behavior. Alan Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

Doctors and nurses . . . neurologists. Ibid.

The hospital departments most likely Ibid.

three-quarters of doctors . . . affects patient care. Owen MacDonald, “Disruptive Physician Behavior,” American College of Physician Executives.

“despite the best efforts of many . . .” Barry Silbaugh.

“I could teach a monkey . . .” Interview.

Up until the mid-twentieth century . . . wait on him.” Leonard Stein, “The Doctor-Nurse Game,” Archives of General Psychiatry 16 (June 1967).

In 1967 . . . penis envy. Ibid.

“Nurses have spent . . . hate each other?” Rahul Parikh, “Do Doctors and Nurses Hate Each Other?” Salon, May 30, 2011.

“A couple of the nurses . . . got the point.” Interview.

“Female doctors” Interview.

Nurses have continued to battle . . . instructors are nurses. See, for example, Rahul Parikh, Salon.

“Nursing school . . . to be a physician.” Ibid.

Kevin Pho . . . carry that attitude into the workplace.” Kevin Pho, “Theresa Brown Unfairly Blames Doctors for Hospital Bullying,” KevinMD.com (blog), May 7, 2011.

doctor bullies blamed a heavy workload . . .” ACPE survey; see also “Reader Consult: Does the Culture of Medicine Enable Bad Behavior?” WSJ Health (blog), May 25, 2011.

“Surgeons have learned . . . behavior by observation.” Alan H. Rosenstein and Michelle O’Daniel, “Impact and Implications . . .”

“culture of disrespect among healthcare providers” “Intimidation: Practitioners Speak up About this Unresolved Problem (Part I),” ISMP Medication Safety Alert, March 11, 2004.

In October 2014 . . . Ebola from a patient See, for example, Alice Par, “Nurses ‘Infuriated’ by Suggestion of Dallas Ebola Protocol Breach,” Time.com, October 14, 2014.

“Dr. Thomas Frieden . . . breach in protocol.” Rebecca Kaplan, “CDC Chief on Second Ebola Case: There Was a Breach in Protocol,” Face the Nation, cbsnews.com, October 12, 2014.

National Nurses United . . . to an isolation unit See, for example, “Dallas Nurses Accuse Hospital of Sloppy Ebola Protocols,” abcnews.com, October 15, 2014.

protective gear left their necks exposed See, for example, Saeed Ahmed, “Ebola Outbreak: Get Up to Speed with the Latest Developments,” CNN Breaking News, October 14, 2014.

Frieden later said . . . misconstrued. See, for example, “CDC: Nurse not to blame for breach of protocols in Ebola infection.” Nurse.com, Oct. 16, 2014.

“There’s a lot of outrage . . . blame the nurse again.” Nancy Shute, “Nurses Want to Know How Safe Is Safe Enough with Ebola,” npr.org, October 14, 2014.

At Vanderbilt Medical Center in 2013 Kimberly Curth, “Vanderbilt Medical Center to Have Nurses Cleaning Up.” WSMV TV, Nashville, Tennessee, September 6, 2013.

half-and-half “Will Work for Half-and-Half,” Emergiblog (blog), July 14, 2012.

Nearly 40 percent of doctors ACPE study. The Joint Commission’s Sentinel Event Alert, July 9, 2008.

As of 2015 . . . to earn a doctorate. See, for example, Gardiner Harris, “Calling More Nurses ‘Doctor,’ A Title Physicians Begrudge,” The New York Times, October 2, 2011.

Nurse leaders say . . . respect in the medical field. Ibid.

physicians have turned the debate . . . endangers patients. See, for example, Cindy Borgmeyer, “AMA Delegates Oppose DNPs as Medical Team Leaders,” AAFP News Now, June 25, 2008; Amy Lynn Sorrel, “AMA Meeting: Physician Supervision of Nurses Sought in all Practice Agreements,” June 29, 2009.

They argue that . . . confuse patients See, for example, “American College of Physicians Response to the Institute of Medicine’s Report,” Journal of the American College of Physicians, November 1, 2010; Jeremy Olson, “U Program Turns out ‘Doctor Nurses’ but the Name Ruffles Some Doctors,” St. Paul Pioneer Press, June 21, 2008.

an attempt to equate . . . medical training. See, for example, Cindy Borgmeyer, “AMA Delegates Oppose DNPs as Medical Team Leaders,” AAFP News Now, June 25, 2008.

loudly protested the DNP . . . dentists, and podiatrists. “ANA Letter to AMA on HOD Resolution 303 (A-08) Protection of Titles ‘Doctor,’ ‘Resident,’ and ‘Residency.’” Targeted News Service, June 11, 2008. Interview with AMA spokesperson. See also Resolution 232, AMA Resolutions, June 2008.

Eventually . . . physician Interview with AMA spokesperson. See also Resolution 232, AMA Resolutions, June 2008.

Nurse practitioners say . . . the field. See, for example, Mary Anne Dumas, president, National Organization of Nurse Practitioner Faculties, “Letter to the Editor,” American Medical News, August 18, 2008.

more time to spend with patients and charge less for their services. “28 States Consider Expanding Nurse Practitioners’ Duties,” American Health Line, April 14, 2010.

“essentially the same” health See, for example, Carla K. Johnson, The Virginian-Pilot (Norfolk, VA), April 18, 2010. See also “Research from Drs. Linda Aiken, Carole Estabrooks, and Others Have Established a Clear Link Between Higher Levels of Nursing Education and Better Patient Outcomes.” Doctor of Nursing Practice (DNP) Talking Points. American Association of Colleges of Nursing, October 2009.

nineteen states and the District of Columbia Interview with AANP spokesperson. In these areas, NPs can “evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing,” according to the American Association of Nurse Practitioners. Other states require oversight of NPs.

Nurse-owned practices . . . expected to grow. Peter McMenamin, “In 2011 in Every State Thousands of Medicare F-F-S Beneficiaries Were Treated by an APRN,” ANA NurseSpace, January 2, 2013.

looming physician shortage in the United States by 2020 See, for example, Chen May Yee, “A Doctor and a Nurse, All in One Package,” Star Tribune (Minneapolis), April 27, 2008. See also Samuel Weigley et al. “Doctor shortage could take turn for the worse.” 24/7 Wall St. usatoday.com, October 20, 2012.

“The medical profession . . . in the United States.” Interview.

“code of conduct” . . . managing those behaviors. The Joint Commission Sentinel Event Alert 40.

“moderate improvement” Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact . . .” See also Julia Edwards.

In 2005 . . . quarter of these nurses. David Maxfield et al. “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough to Save Lives.” VitalSmarts, AORN Journal, and AACN.

only 41 percent . . . “greatest negative impact.” Ibid.

TJC continues to receive “Workplace Bullies Can Undermine Safety,” Occupational Health Management, March 1, 2010.

“there are still large, disconcerting” Alan H. Rosenstein and Michelle O’Daniel, “A Survey of the Impact . . .”

“Tempo!” “Workplace bullies can undermine safety.”

red phones at each nurses station Interview.

Nurses in a New Brunswick, Canada, hospital . . . in support. “Needed: Happy Endings in Workplace Bullying Cases,” The Times & Transcript (New Brunswick), May 13, 2010. Code Pink in many hospitals refers to infant or pediatric abduction.

“Code White” to the same effect. “Workplace Bullies Can Undermine Safety.”

“nurse-friendly” hospitals See, for example, Terry Simpson, “Transplant or Hospice,” Yourdoctorsorders.com, January 29, 2012. Emphasis in “doctor-unfriendly” is mine.

“it affects my entire day.” Interview.

“We train, hire. . . . They are pit crews.” Atul Gawande, “Commencement Address at Harvard Medical School,” May 26, 2011. Accessed at newyorker.com.

“the issue boils down to . . . excellent patient care?” Guest blog by the anonymous nurse of Those Emergency Blues (blog), on KevinMD, February 25, 2012. This post was in reference to a specific case against a nurse who was allegedly fired after a confrontation with a doctor; however, the quote applies to the larger issue of disrespect between the professions. I did not discuss that specific case because there were some questions as to the credibility of the sources.

of the top-ten media-generated See Jacinta Kelly, Gerard M. Fealy, and Roger Watson, “The Image of You: Constructing Nursing Identities in YouTube.” Journal of Advanced Nursing 68, no. 8 (August 2012). Also see, for example, “Study: YouTube Gives Mixed Messages About Nursing.” Nurse.com, July 17, 2012. Similarly, a “study of 280 films, produced between 1900 and 2007 from across the world, showed that 26 percent depicted nurses as sex objects,” in Nursing Times, October 2008.

2010 Dr. Oz show See, for example, Staff and Wire Reports, “Dr. Oz’s Dancing ‘Nurses’ Draw Nurse Group’s Ire.” The Oklahoman (Oklahoma City), December 10, 2010.

nurses protested Dr. Phil See, for example, Bob Groves, “An Image Problem, from TV to Silver Screen; Nurses Want Respect from Pop Culture,” The Record (Bergen County, NJ), May 6, 2007. See also, “Dr. Oz’s sexy ‘nurse’ backup dancers,” The Truth About Nursing, December 6, 2010. See also Susan Campbell, “Does Your Nurse Dance/Dress Provocatively?” Courant.com. December 8, 2010.

waitresses dressed as sexy nurses See, for example, Larissa Liepins, “World’s Weirdest Restaurant Premieres Tonight on Food Network,” The Daily Gleaner, (New Brunswick) April 4, 2012.

a sexy nurse costume with white fishnets See, for example, Sonya Padgett, “Hangover Heaven Doctor Treats the Buzz Kill on Strip,” Las Vegas Review-Journal, April 14, 2012.

In England, a bus company advertised See, for example, Flora Drury, “Sexy Nurse Sparks Fury on the Wards,” Worcester News, March 16, 2010; “Sexy Nurse Ad On Bus Causes Uproar,” NSW Nurses’ Association, May 3, 2010; “British Nurses: We’re Not Sex Objects, Either,” Adweek, March 18, 2010.

“You will be motivated . . . emergency department.” See, for example, “Hospital Advertises for ‘TV Series-Hot’ Nurses.” Asian News International, February 22, 2012. The Internet ad used the term “TV-series snygga” after a satisfied patient had praised the hospital with those words. Translated to English, “snygg” or “snygga” is the equivalent of “hot” or “good-looking.” See also “Swedish Hospital Seeks ‘Hot’ Nurses for Summer Employment,” The Digital Journal, February 22, 2012.

largest Emergency Care Unit in the Nordic region Ibid.

scrubs that might be stained with blood, urine Interviews.

“We’re sweaty and smelly” Interviews.

Certified nursing assistant Author correspondence with Erin Gloria Ryan.

“Nothing sexier . . . bowel movements on a chart.” Comment following Margaret Hartmann, “BADVERTISING: Hospitals Are Obviously Full of Sexy Nurses!“ Jezebel.com, March 18, 2010.

“Some nurses do fit . . .” Interview.

“lecherous old perverts” Interview.

“People are happy to sexualize . . . ” Claire Lomas, “Sexualising Nurses Could Lead to Attacks on Staff, Warns Unison,” Nursing Times, March 23, 2010.

In 2010, a Dutch nurse union . . . sexually gratifying him. Ben Berkowitz, “Nurses’ Union: Care Does Not Include Sex.” Reuters, March 11, 2010.

The man . . . nurses had done the same. News Staff. “Sex Is Not Healthcare, Union Says,” November, 3, 2010.

When the student refused . . . unfit for the job. Ben Berkowitz, Reuters.

“I’ve got to get myself a nurse in Holland.” Ronan McGreevy, “Nurse Stereotypes as Sex Objects Persist on Internet, Study Finds,” The Irish Times, July 24, 2012.

union launched a campaign . . . front of her face Victoria Thompson, “Sexy Nurses: Tongue in Cheek or Demeaning and Gratuitous?” Nursing Times, March 19, 2010.

patients “are free to ask. You are free to refuse.” Ibid.

87 percent of them said yes. Interviews.

“actually living Grey’s Anatomy” Interview.

“Hospital life is . . . time to eat” Interview.

“Some places . . . stressed-out people together.” Interview.

Nurses have gotten intimate in on-call rooms Interviews.

equipment lockers . . . patient rooms Interviews.

offices Interviews.

parking lots Interviews.

“heady” feeling Interview.

“Sexual exploits . . . call room at night Interview.

“It’s like any kind of trauma” Interview.

they hook up with Interviews.

“I wanted to be” Interview.

“residency was all-consuming . . .” Interview.

A camera captured a nurse giving oral sex Interview.

“She became a joke” Interview.

Louisiana oncology nurse accidentally Interview.

“Usually it only causes issues . . . ” Interview.

nurses caught having sex . . . The Herald (Glasgow), “Nurses in Sex Session Suspended,” January 30, 1997.

When a resident and a nurse were caught Interview.

“As Britons, we are obsessed . . .” Robert Gore-Langton, “Carry on Nursing our Saucy Fantasies.” The Express, March 4, 2008.

When a group of nurses posed. . . .“practice into question.” “Sexy Nurse Calendar Causes Complaints to NMC,” Nursing Times, October 28, 2008.

posed nude for a charity . . . Rob Harteveldt, “The NMC Should Focus on Things that Really Matter – Not Sexy Nurse Calendars,” Nursing Times, February 3, 2009.

knowingly rented out a ward . . . “Big Budget” Porn Film Shot in London Hospital. BBC News, July 6, 2010.

Lord Benjamin Mancroft . . . “promiscuous.” “Mancroft’s House of Lords Speech in Full.” Bath Chronicle, March 6, 2008. See also, for example, Morag Turner, “U.K. We’re No Angels,” The Express, March 8, 2008; Jenny McCartney, “Nurses: The Angels Who Fell from Grace?” Sunday Telegraph (London), March 2, 2008.

His evidence was . . . “Mancroft’s House of Lords Speech . . .”

“sexual boundaries” guidelines . . . dating patients. See, for example, “Guide to Patient Relationships,” The Times (London), January 22, 2008.

One in six U.K. nurses . . . “Nurses Risk Breaking Rules on Relationships,” Nursing Times, February 25, 2008. See also, for example, Morag Turner.

A British nurse received . . . they had sex. “Nurse Had Illicit Affair with Heart Op Patient.” Daily Mail (London), July 29, 2010.

between 1999 and 2009 . . . “constitutes sexual misconduct.” “Practical Guidelines for Boards of Nursing on Sexual Misconduct Cases.” National Council of State Boards of Nursing, 2009.

Oklahoma Nursing Board . . . broke up with him. Nolan Clay, “Nurse Loses License Over Patient Sex,” The Oklahoman, January 16, 2011.

Mayo Clinic . . . relationship was consensual. Warren Wolfe, “Male Nurse’s Sex in Psych Ward Didn’t Break Rules,” Star Tribune, August 3, 2009.

In Australia, a sixty-one-year-old . . . “ethical relationship.” Julia Medew, “Nurse Faces Disciplinary Action Over Relationship,” The Age (Melbourne), February 18, 2006.

Nurse and Midwifery Council investigated “NMC to Investigate Nurse Accused of ‘Inappropriate Relationships,’” Nursing Times, March 11, 2010.

“Cancer nurse bedded . . . ” John Kay and Alex Peake, “Cancer Nurse Bedded Three Victims’ Husbands,” The Sun, March 10, 2010.

divorced mother of two . . . his wife passed away. See, for example, Andrew Levy, “Macmillan Nurse Sacked for Having ‘Affairs’ with Patients’ Widowers Reveals Her Love for Man Whose Wife Died Last Year,” Daily Mail, March 11, 2010.

Some states, including Maine “Disciplinary Action and Violations of Law,” Department of Professional and Financial Regulation, State Board of Nursing, Chapter 4.

Arizona R4-19-403, Unprofessional Conduct, “Laws & Rules,” Arizona State Board of Nursing.

Washington State Washington Administrative Code, Title 246, Section 246-840-740.

Three weeks . . . sided with the hospital. Ed Canning, “Employee-Client Relationships are Tricky,” Hamilton Spectator (Ontario, Canada), May 6, 2006.

Lori Dupont tried to end . . . harassed her at work. See, for example, Doug Schmidt, “Daniel Turns to Blackmail,” Windsor Star (Ontario), November 9, 2006. Schmidt covered this story extensively.

When several nurses complained . . . Doug Schmidt, “Daniel’s Return Unsettling,” Windsor Star, November 10, 2006.

nurses took it upon . . . bent over to speak to him Ibid.

broke a nurse’s finger Doug Schmidt, “Daniel Turns to Blackmail.”

quiet weekend day . . . then killed himself. Doug Schmidt, “A Killing At Hôtel-Dieu: How a Workplace Romance Became a Deadly Obsession.” Windsor Star, November 4, 2006.

“an unforeseen event” Doug Schmidt, “Why?: Family, Friends Ask: Could Nurse’s Death Have Been Prevented?” Windsor Star, November 11, 2006.

Dupont’s family and coworkers . . . Colin Johnston observed. Ibid.

when Daniel was pursuing Dupont . . . “problems.” Doug Schmidt, “Dupont ‘Relentlessly’ Pursued,” Windsor Star, November 7, 2006.

Chapter 3

“The nurse takes appropriate” “The ICN Code of Ethics for Nurses.” International Council of Nurses, Geneva, Switzerland, 2006.

“Almost every single” Interview.

“If I had a dollar for every horny . . . ” Interview.

ER nurse in Sacramento . . . Interview with Dansby.

Medics brought in . . . able to revive Interview with Dansby. See also Jessica Garrison and Molly Hennessy-Fiske, “Violence Afflicts ER Workers; Incidents Often Go Unreported, but Some Evidence Points to a Growing Problem,” The Los Angeles Times, July 31, 2011.