Monday, December 5, 2011

Nursing Violations of Patient Privacy
by Doug Capra & Joel Sherman



Nursing history emerged from a tradition of nurses as angels of mercy, selflessly devoting their working hours to care of patients.  Although modern nurses don’t like to view themselves that way, there is much truth to that image, even today.  We would trust our care to the large majority of nurses we have known.  But like all stories, there is another side to it.
Physicians have been criticized for releasing too much patient information on their blogs.  Nurses do the same.  Allnurses.com claims to be the largest online nursing community with over half a million members, the vast majority of whom are undoubtedly active nurses though membership is not restricted.    A recent thread on allnurses.com  reveals many disturbing anecdotes.   The thread is called “Nine things nurses don’t want you to know.”  The first item is: “Yeah, we look......and no, we're not above whispering to our co-workers, "Psst! Did you get a peek at the guy with the foot-long whatsis in 216?"   Now the poster said after being challenged that this was a tongue in cheek comment, but other posters in this thread make it clear that similar incidents do happen.  Although a few do condemn this as being a serious infraction (probably many more than posted that point of view), still too many seem to consider this behavior just part of the culture.  
Comments include a poster who said that she might not comment upon a man’s body parts but knows nurses who do.  Another said nurses have always engaged in shop talk and always will, but added that it’s reasonable as long as it is not done in public.  After a protest, the original poster commented that it may not be nice to discuss the anatomy of a patient over coffee, such as the guy who needs an extra long Foley, but it happens and it doesn’t help to get upset over it.  Another poster recounted having a pre-op woman up in stirrups, and people coming in to view her shark tattoo between her legs.  She doesn’t say whether the patient was under anesthesia at the time though that is likely.
In this long thread there were initially no complaints registered but slowly a negative reaction occurred, mostly from posters who are probably not nurses. Two posters challenged the female nurses to consider how they would have reacted had a male nurse written a similar statement about female patient body parts. Others warned that allnurses.com is not a private blog, but goes all over the web and is read by some who look for just such evidence to condemn nurses.
To be fair, a few nurses commented that anything like the first item (the foot long whatsis) had never occurred in their career.   We believe both of them.  Incidents like this are very individual; they may occur on one floor of a hospital and never in another.   It only needs one person to offend.  We have never been made aware of an incident like this, but it’s unlikely any nurse would confide this to a physician.  What perhaps is most disturbing about this thread is that very few people would be willing to criticize their fellow nurses for actions like this, not to mention report them. This demonstrates a very unhealthy culture of silence at some hospitals where nurses and nurse assistances fear retaliation for reporting incidents like this. It is further reinforced by a recent thread on allnurses titled “And it’s all going to be your fault."  Look below this post to see how many nurses agree with this view. In some hospitals, nurses feel they are at the bottom of the pecking order and are scapegoats for whatever goes wrong. They fear any challenge to the powers above.
These gross violations of privacy described in the original post titled “Nine Things” are against the law, but they are not covered specifically by HIPAA.  We don’t think the feds have ever brought an action against providers for physical encounters or oral breaches of privacy, though oral transfers of protected health information are covered.  HIPAA is almost all centered on digital and printed information protection, not on personal encounters.  Yet likely all states have laws regarding personal privacy in healthcare that would cover it.  Certainly taking an unnecessary peek at a patient’s genitals is considered sexual misconduct which could result in the loss of license in every state. 
There is reluctance in every profession to report one’s comrades.  This happens with physicians as well as nurses.  A New Mexico otolaryngologist, Dr. Twana Sparks, was disciplined by the state board following years of operating room misconduct wherein she would fondle the genitals of male patients under anesthesia in the presence of the OR staff, making derogatory comments about the patients.  The hospital was aware of this and did nothing until one nurse filed a formal complaint.   For years the hospital laughed off the incidents.   There have of course been many incidents over the years against male physicians though there is perhaps less reluctance to lodge complaints against men for sexual misconduct.
In the initial ‘Nine things’ thread, some patients commented that they avoid medical care because they’d get demeaned because of their obesity.   It’s not uncommon on allnurses to read what are called “rants” about obese or otherwise stigmatized patients. This is not to say there are not “difficult” patients who can be rude and overbearing. But some of these rants offer no benefit to the vast majority of nurses who treat patients with respect not only in the hospital room, but also in the break room. It’s hard to reassure anyone that their fears are unwarranted, especially if they have an unusual anatomy or disability. 
It’s astounding to us that so few nurses looked upon divulging prurient tidbits about identified patients as a serious infraction.  They seem to think that as long as it stayed on the floor or in the coffee room it was business as usual.   It is widely accepted now that no information should be divulged unless there is a need to know.  Regulations mandate that all hospital staff must be instructed on patient privacy concerns.  It seems like they do a very poor job of it.  JCAHO should mandate reforms.

32 comments:

Anonymous said...

JCAHO,as you mentioned is really not in the business
of reprimanding staff. Every state nursing board has
as guidelines sexual misconduct which states that
making sexual comments about a patients genitals
is grounds for license revocation.

What I find disturbing is that most nurses are ignorant
of these guidelines. Most are even unaware that a
boundary violation is a violation of the nurse practice
act.

Most female nurses guard their modesty and privacy
yet do little in return for their male patients. You never
see male mammography techs, male nurses in labor
and delivery, nor male nurses in post-op gyn floors.

Every high profile Hipaa violation that made it to the
news was committed by a female health care worker.
Countless military male inductees had non-medical
female observers,yet female inductees had their exams
performed in a private room with no observers.

95 percent of all nurses are female,a guarantee that
men will not be treated fairly and professionally as
females.

And finally, please google Ryan job,a navy seal who
was a hero and veteran of the Iraqi war. He received
an almost fatal bullet wound to the face,resulting in
total blindness and numerous plastic surgeries.

He died needlessly from a mistake by hospital and nursing staff, a lethal dose of narcotics. The family received a
hugh settlement from the hospital. The largest settlement
in that hospitals history. Rest in peace Ryan.
There are far too many cases of our young soldiers
returning home and not receiving the care they need
or worse bad care.

PT

Anonymous said...

When I first read "9 Things" I had some difficulty wanting to put my thoughts into words, because I had the unpopular opinion of being glad this was out there for people to see. Not that I wanted so much to stir the masses, but rather allow people to see thru the illusions that the medical arena has put on female nurses (and transfused into society's mindset)so informed and honest decisions can be made about what respectful care means to each person.
I wrote an article asking that the medical arena just be honest about gendered intimate encounters. That females are not invisible, genderless, or the sexually dispassionate entity in the room. To stop portraying them as the "safe" sexual buffer to be used as genderless care for both male and female patients. When some do finally admit to the illusion of this, it is with a wink and a nod that it stay on their shores, and not sail too far into the minds of the public sea.
The real danger still lingers.....telling people that this type of exploitation is harmless fun.

Suzy

Anonymous said...

I would ask Doug and Dr. Sherman if they agree that the almost gender-less portrayal of the female healthcare worker exists to a greater degree than male healthcare workers, and if this is a major hinderance in acknowledging this disrespectful care that men may recieve?

Suzy/swf

Doug Capra said...

suzy
I wouldn't call the portrayal genderless. In fact, it's clearly female, i.e. nursing historically and traditionally as a female profession. I would say there are several forces at work:
1. The "group think" one finds in any profession dominated by one gender (or race or class, etc.). Diversity makes big difference. If you're alone, it's more difficult to challenge the group think. If there are several of, though you still may be a minority, it's the odds are you'll get some support. Recent studies on bullying show that if at least one person stands up to the bully, the action causes others to have the courage to stand up, too.
2. Historically, culturally, the naked male body has been perceived more as a threat to female modesty than to the male's modesty, i.e. -- it was more important that the female wasn't offended by the naked male than it was that the male be embarrassed or humiliated. I just read online a post by a female nurse about how her modesty was breached when she observed a family member of a patient using the bathroom (in the patient's room) with the door open. I found it interesting that the whole modesty issue was framed in terms of her modesty.
3. Sometime after WW2, the medical profession separated itself more and more from cultural mores regarding male modesty. There seems to have been more consideration given to males in the past. Of course, there were fewer female doctors, and more male orderlies available. But there was more concern about male nudity offending female caregivers; thus, even when female worked with male patients, more care was taken with draping and other measures. At some point, during the sexual cultural revolution of the 1950's and 1960's, and as more women entered medicine, and as more tech and aide positions were created and women dominated -- the medical culture changed, tried to follow a more "gender neutral" philosophy, and just expected patients to adapt to their world view.
4. There's also the sad fact that most sexual physical crimes are committed by men. Generally speaking, men's cruelty is more physical. Females can be more cruel psychologically, and passive aggressive. So it's easier to spot male offenses. My opinions here, but you'll find this a numerous psychology books.
Having said all that, I still believe it's a minority of nurses that treat men disrespectfully and know they're doing it. Most try to treat all their patients with dignity. One problem is, and we've talked about this over and over again, the "system" has often it's own definitions of "respect" and "dignity" that fit into certain forumlas of behavior that, more and more, are connected to efficiency and profit. "This" or "That" is what dignified looks, looks like, they believe. For some patients, these definitions don't match the patient's own concept of what makes them feel dignified and respected. And because caregivers typically don't ask patients how they feel about modesty, the patients get treated according to the caregiver's standards.
Dr. Sherman and I are working on another article based upon some very interesting studies that will go into this in more detail.

Joel Sherman MD said...

I agree with Doug that I wouldn't use the term genderless to describe the popular image of nurses or other female health care providers. Indeed the dedicated caring that they are perceived as supplying is usually seen as a feminine or maternal trait. The same trait in a man is viewed as suspect by some.
Why men tend to be treated with less respect when it comes to modesty issues is a more complex question with many facets. The biggest issue is perhaps that most men are reluctant to speak up about modesty concerns, and male modesty is not widely recognized officially though certainly most nurses fully well know when their patients are embarrassed.

Anonymous said...

I read 9 things and came away with the same thoughts. The group of nurses were more angry that "outsiders" were wieghing in than the fact that the nurse posted these things. It is this us and them mentality that makes it easier to ignore what they have to know is uncomfortable for patients. I also agree 100% that the nurses who defended this post ignored the fact that 1,000's of people could read that post and failed to understand, acknowledge, or mitigate the effect it might have on future patients whom might read the post. I find a real problem when nurses in paticular claim a higher level due to their professionalism but then claim we are only human when it fits their purpose or excuses their behavior....alan

Anonymous said...

What have we learned about the thread nine things
nurses. For every female physician with the behavior
of Dr twana sparks, there are 10,000 female nurses
just like her.

PT

Doug Capra said...

I don't agree with you, PT, although I do admit that there are too many nurses who express what I consider to be an unprofessional attitude on allnurses. But I do admit that, although I think your opinion is an extreme and minority opinion, I do believe a minority but significant number of men feel that way. That's what nurses need to understand. Your view of nurses is one they need to acknowledge and deal with. And your view in turn influences other patients. Correct me if I'm wrong, PT, but I gather much of your view is not just based upon what you have seen over the years working in healthcare, but also based upon your negative experience during your military induction.

Suzy Furno-Maricle said...

http://www.huffingtonpost.com/richard-c-senelick-md/health-care-privacy_b_1140930.html

Here is an interesting article from a male M.D. who didn't understand the degree of patient humiliation until his own wife had an encounter with a male nurse.
I wonder if he would be interested in a guest post here? It seems the experience was a true eye-opener for him..........

Doug Capra said...

Suzy
That is an incredible article. What's most incredible about it is the sudden enlightenment that this doctor gets. It's as if -- Wow! -- there is such a thing as patient modesty.
The article is solid evidence, I believe, that demonstrates how clueless some providers are about this issue. This doctor didn't realize the significance of preserving patient modesty until the patient was his wife. Incredible.
What's also interesting is that we see the old basic cliche's with the "rodeo" twist in this case --"I've done this a thousand times. You've got nothing I haven't seen before."
What's your take on this, Joel? Yes, we should get this doctor to write an article for us or ask for permission to reprint this article.
Incredible.

Doug Capra said...

If you read the article, I think you'll see another very important dynamic at work.
1. The doctor is outside his role of doctor. He has no real professional authority in this situation. He's "just" a spouse or family member.
2. The doctor is not even the patient. So he doesn't have the kind of authority a patient may claim over his or her body.
3. The doctor feels himself to be in a powerless position. He knows his wife finds the treatment humiliating but is reluctant to speak up. A man who usually has considerably authority, now feels he has no authority to say anything.
5. It's not clear whether the nurse knows the woman's husband is a doctor. If he does, he assumes that it makes no difference to him -- he's just going to do his job as usual. The doctor is experiencing how powerful hospital culture and policy can be. "This is just how we do things around here."
What we see here is a medical professional -- one who works everyday in this kind of medical environment as an authority figure -- finally experiencing what it's like to be "the other," an "outsider" and powerless. It's obvious he feels the guilt and anger we've heard from patients who have gone through this kind of treatment, or from family members who have observed it happening to their loved ones.
At the beginning of the article he writes in retrospect: "I should have never let it happen." At the end of the article, looking toward the future, he writes: "It will not happen again."
Sounds like many of the patients writing on this and Bernstein's blog.

Anonymous said...

Doug

My views and perceptions are a result of my
experiences as a patient and the many years I worked
in healthcare. My military induction experience falls in a category all it's own and is synonymous with an
ungrateful nation.
I've worked with many disabled vets and you
cannot appreciate what some of these people have
been through regarding their healthcare. If you think
about it prison inmates get better care and are treated
better than most vets.
Doug, if you disagree with me then why are you
such a prolific writer on these threads.


PT

Doug Capra said...

PT -- I don't disagree with what you've just said. Since this country was first created, it's Vets have always had to fight, not only for their country, but for basic benefits like health care. It's when you talk about "all" or even "most" nurses disregarding male modesty -- that's when we disagree. My experiences haven't led me to that conclusion. I write about this issue because, as I see it, it's a human rights issue, a human dignity issue. American medicine is becoming more and more a part of the corporate culture of American. It's becoming more and more about the money. Perhaps we need an Occupy Healthcare movement.
When it comes to patient dignity and how they "should" be treated -- I think we agree, PT.

Anonymous said...

Doug


Looking back and reviewing the thread on
allnurses, nine-things-nurses-don't-want-you-to-
know. The very first person who responded to the
thread with the response "spot on" happens to be
a female army nurse. As a whole, what does that
tell you.

PT

Doug Capra said...

PT -- I'm not convinced you can really conclude much for that. I don't think all the posts on allnurses necessarily represent "all nurses." You've got to be careful with blogs. Does Bernstein's blog represent "all" patients? Or all men? Or all women? I don't know. Most nurses I've talked with don't post on allnurses or even belong to it. Some have never heard of it. You can't conclude from some of those threads that "this" is how all nurses think. And even if some think that way, you can't conclude then that their behavior professionally matches what they say online. I think anonymous bloggers will often say things online that they would never dare say using their names, and express opinions suggesting behaviors that they would never really do.
I don't take allnurses too seriously as actually representing all nurses. I think some of the threads do indicate certain trends, certain beliefs, certain tendencies. But they're indications only. If there are X members of allnurses.com, I'll be only a small percentage of them post on a regular basis. I'd bet that you'd find that perhaps less than 30 percent of the total members represent over 90 percent of the posts. Does that represent all nurses?
Now, specifically, about the military nurse. I've always thought it quite odd that all military nurses are officers. Their relationship, then, with their patients who they outrank -- how can that be a powerless relationship? It's still an officer, enlisted man relationship. The nurse has rank, the patient doesn't. How can that be considered a real caregiver-patient relationship? What's your take on that, PT. How about your Joel?

Anonymous said...

Doug

About 20 percent of all nursing staff post on
allnurses. As far as what people post, if you can think it,
you'll verbalize it. There are literally hundreds of nursing
blogs with a variety of material representative of the
culture that is seen on allnurses.
Not only do I read about the culture, I've
experienced it as well. Don't you think it disturbing that
a thread such as nine-things-nurses would have been
allowed to exist as long as it did. Don't you think that it's
members would have been so ashamed that such
subject matter presented for all to see.
Even more disturbing is the number of kudos
the nurse received. Gives you a real indication of the
mindset these people have. Most of those in disagreement
were not nurse members, something nurse members find
annoying.
One significant fact regarding nursing school trends
are that nurses entering the field are becoming younger
and only concerned about salary, not a calling.
Another fact concerns the number of nurses being
reprimanded by state boards, at all time highs.


PT

Doug Capra said...

PT -- You bring up some interesting points. I don't deny there is an unhealthy social culture in parts of American health care today, including nursing. I do think, for example, that many if not most nurses are reluctant to do or say anything when they see most violations happen, esp. no life-threatening violations. This happens mostly in hospitals and units with unhealthy cultures. It's out there -- nurse bullying, etc. And, as I've said, American medicine has become more about following the money now -- and that applies to nursing also.
This still doesn't mean that most nurses treat their patients with indignity. I don't believe they do. There are givers and takers in this world, and I believe that most people who go into professions like nursing are the givers. But, I also think that too many nurses become disenchanted, jaded, indifferent, and even negative about their jobs because of how they are treated by management, and sometimes even by patients.
I'm not defending those nurses that should never have gotten into the profession and should get out. But I am defending the vast majority of nurses to are trying to do the best job they can under difficult circumstances.

Anonymous said...

Two things:
1) Since posting my comment re: “9 Things” I noticed that I can no longer access that thread. Is it the same for anyone else? Did you two hit a public nerve?

2) Perhaps “genderless” is a misnomer. Or perhaps it depends on the gender’s point of view. To be ‘used’ as a sexually dispassionate or sexually benign bystander is in essence genderless. Care giving and nurturing are not the only known feminine traits: sexuality and sensuality are feminine as well.
But predominating such knowledge does not keep 95% of nurses female. It would, instead, cause society to question caregiver’s gender in a new and widespread way. We all know that it is not prepared to handle that.

Males may be more aggressive, but males in medicine are not usually accused of attacking and raping female patients. It is usually more subtle and deceptive techniques that are used. All techniques that the passive female is capable of using as well. Perhaps we are just not looking for it, or caring if we see it.

I just want society to be honest. Using women for these things is really no different than using men.

Suzy

Joel Sherman MD said...

Thanks Suzy. Yes they did indeed delete the thread or make it inaccessible. I kind of guessed that it would happen and I copied and have the entire thread saved. For the record, here is the full provocative comment:

1) Yeah, we look......and no, we're not above whispering to our co-workers, "Psst! Did you get a peek at the guy with the foot-long whatsis in 216?" There, I said it. We DO check out patients with unusual physical characteristics, mainly because we've seen so many naked bodies that one derriere looks like every other after a while. But not to worry: HIPAA is alive and well, and the secret of your "nonconformity" is safe with us.....at least till we get to the break room.

The comment doesn't get any better after time. Once again you'll notice the motif that they believe it's quite alright to talk about patients amongst themselves, patient privacy doesn't apply to these nurses in the coffee room. Of course that's not true; gossiping about patients without a clinical need to know is a clear violation of medical ethics. Even upon rereading the comment, it's hard to believe that it was entirely tongue in cheek as the poster later claimed.

Joel Sherman MD said...

The nurse has rank, the patient doesn't. How can that be considered a real caregiver-patient relationship? What's your take on that, PT. How about your Joel?

Doug, I have no personal experience with that having never been in an army hospital. (VA hospitals are not the same thing.) I personally doubt that the rank difference makes any significant change in treatment for patients.

Doug Capra said...

Joel: I'm not saying that the rank difference necessarily does have any influence on the treatment of the patient, at least from the nurse's point of view. But, come on, a Pfc as a patient being treated by a Leut. as a nurse -- there can be a rank/power dynamic at work there, at least from the patient's point of view. Of course, it can go in the reverse, too -- a Col. outranking the nurse that's treating him/her. I'm not saying it does happen frequently -- but there certainly is a conflict of interest at work.

Anonymous said...

Suzy

The thread on allnurses,nine things nurses
don't want you to know is still there. The thread was
closed but can be accessed by doing a search.

I cannot comment on military nurses in that I
have never had to deal with them.


PT

Nekura said...

A nurse nearly killed my step dad by almost giving him morphine which he is highly allergic to. If my mom wasn't in the room watching and asking questions.. well.. yeah..


As I understand, people enter the medical field either for money or genuinely to help people. But over the useless lawsuits (my GP is afraid to give Mardi Gras beads she caught to children out of fear of being sued) doctors, and nurses, seem to.. forget that they originally started this to help people. They become jaded.. and I think that's what leads to things like this.

Anonymous said...

Nekura

Successful medical malpractice suits are extremely
small, but yes overlooking an allergic reaction with
subsequent death would certainly be.

I can say with absolute certainty that many today
are entering medicine as a well paying job, not so much
from the physicians, but rather nursing and other allied
health programs.

Would it be fair to say that people are jaded before
they enter a program.

PT

Anonymous said...

For myself and many people I know, the top reason why we ignore health problems rather than get medical attention is because of the nurses and other assistants. If we had the opportunity to just talk to and strip for the doctor only, without the worthless nurses gawking at us and asking questions that only a doctor needs to know, we would be much more active with our medical care.

Joel Sherman MD said...

As noted on Bernstein, another thread on allnurses is covering similar territory. This time it concerns gossiping in the OR about sedated patients during surgery. Only a few nurses are defending it, but some do. One commentator even talked about a non nurse who said she couldn't wait to relate to friends the tale of the small genitalia of a hefty fireman on the table.
It is undeniable that these incidents, though never formally sanctioned, do occur. There is little formal medical or nursing instruction about this. One also has to wonder if this occurs with trained and licensed nurses, how much worse it could be with nursing assistants.

Joel Sherman MD said...

As noted on Bernstein, another thread on allnurses is covering similar territory. This time it concerns gossiping in the OR about sedated patients during surgery. Only a few nurses are defending it, but some do. One commentator even talked about a non nurse who said she couldn't wait to relate to friends the tale of the small genitalia of a hefty fireman on the table.
It is undeniable that these incidents, though never formally sanctioned, do occur. There is little formal medical or nursing instruction about this. One also has to wonder if this occurs with trained and licensed nurses, how much worse it could be with nursing assistants.

Doug Capra said...

I agree, Joel. But I do have to give allnurses credit for bringing these violations out into the open for discussion. Yes, there is a tendency among some nurses to just accept this gossip, even wallow in it. But I get the impression that most are not happy with it, though it also seems that few are willing to speak up and stop or report it.

Anonymous said...

This is sickening. More people NEED to know how they're treated while they are unconscious.

Anonymous said...

As people have pointed out, this is clearly a problem chiefly with female staff: I have yet to hear of similarly numerous parallel cases wherein the gender is switched --- i.e. male nurses or doctors telling each other over coffee that it's worth checking out a particular woman's exceptionally large/small/ugly vagina, and posting on the Internet what a laugh such things are. Is there any doubt that were this put on a blog, the feminists would be marching on Washington in armies?!

And I think that it is the attitude towards sex and men promoted and fostered by contemporary feminists which is in large part to blame --- in times past, a woman would have been utterly ashamed even to hear such talk about a man's genitalia, let alone to engage in it herself. However, today we live in a post-sexual-revolution society wherein women are far, far, more promiscuous and discuss men's genitalia freely amongst themselves without shame or thought as to how this might humiliate the men of which they speak (indeed, women appear to be enjoying the power to humiliate men without censure in this way). If this is news to you, simply go and buy a sheaf of glossy women's magazines or eavesdrop on a few hen-parties and you'll get a good picture of what I'm talking about. Nurses (and women in other professions) are simply a part of this wider and increasingly acceptable misandristic culture --- if one understands the culture, it should come as no surprise to hear the stories on this site.

Seventy years or so ago, a woman behaving and speaking in the way described above would have (quite rightly) been called out as a 'slut' (or whatever the term would have been in those days) --- just as a man who said similarly dirty and disrespectful things about a woman would have been (quite rightly) called a 'creep' (or whatever the term of the day would have been). Such terms were not a comment about anything over which the woman or man had no control --- they were a description of a repellent attitude or behaviour, indulged in openly through free choice.

Today, we are horrified at the idea of using such terms, decrying them as 'stigmatising', but they nevertheless served a good purpose (of attaching severe opprobrium to severe breaches of decency and ethics) --- and they served it well. With the de-stigmatisation of bad behaviour, and what one medical writer has termed the "rush from judgement", the only remaining means of curbing this stuff is through "training" (which is so easily ignored --- or simply discarded during a busy period) or, as a desperate last resort, through the blunt instrument of the law. ...Which (as shown above) staff are reluctant to invoke, anyway.

Dirty word though it sadly now is, simple, unvarnished stigma would do the job of preserving patient modesty (and standards of decency and ethics in general) very efficiently. ...As once it did.

interested observer said...

Just to let you know, the archive of that "Nine Things..." post and comments can still be viewed via the "Wayback Machine".

Link here:

http://web.archive.org/web/20111125125403/http://allnurses.com/nursing-blogs/nine-things-nurses-618771.html

interested observer said...

P.S. here is the main age for the Wayback Machine:

http://archive.org/web/web.php

It is handy for when authors have edited/protected/deleted a post or comment after it's had attention called to it. It is a lasting record, with "snapshots" of each web page taken on varying dates.

It is very very difficult to REALLY delete anything once it's been posted on the Internet.