Japanese patient's 'tumour' turns out to be 25-year-old towel

Wed Jun 4, 3:47 AM ET

Doctors who carried out surgery on a Japanese man to remove a "tumour" had good news and bad news for him. He did not have cancer -- but the "growth" that had been causing him pain was in fact a 25-year-old surgical towel.

The patient had been carrying the cloth since 1983, when surgeons at the Asahi General Hospital in Chiba prefecture near Tokyo left it in him after an operation to treat an ulcer, a spokesman for the hospital said.

The man, now 49, went in to another hospital in late May after suffering abdominal pain.

When examinations found what was believed to be an eight-centimetre (3.2-inch) tumour, he underwent the operation to remove it. It was only then that surgeons realised it was a towel.

"The towel was greenish blue although we are not sure about its original colour," the Asahi General Hospital spokesman said, adding it had been crumpled to the size of a softball.

Asahi hospital officials visited the man and apologised, he said.

The former patient has no plans to sue the hospital, which is in talks with him over compensation or other measures, the official said.

Japanese media reports said the man, who was not identified, still had his spleen removed.

Recommendations for end-of-life care in the intensive care unit

Principal Findings:

Family-centered care, which emphasizes

the importance of the social structure within which patients are

embedded, has emerged as a comprehensive ideal for managing

end-of-life care in the ICU. ICU clinicians should be competent in

all aspects of this care, including the practical and ethical aspects

of withdrawing different modalities of life-sustaining treatment

and the use of sedatives, analgesics, and nonpharmacologic

approaches to easing the suffering of the dying process. Several

key ethical concepts play a foundational role in guiding end-of life

care, including the distinctions between withholding and

withdrawing treatments, between actions of killing and allowing
to die, and between consequences that are intended vs. those that
are merely foreseen (the doctrine of double effect). Improved
communication with the family has been shown to improve patient

care and family outcomes. Other knowledge unique to end of-

life care includes principles for notifying families of a patient’s

death and compassionate approaches to discussing options for

organ donation. End-of-life care continues even after the death of

the patient, and ICUs should consider developing comprehensive

bereavement programs to support both families and the needs of

the clinical staff. Finally, a comprehensive agenda for improving

end-of-life care in the ICU has been developed to guide research,

quality improvement efforts, and educational curricula.

End-of-life care is emerging as a comprehensive
area of expertise in the ICU and demands the same high level of
knowledge and competence as all other areas of ICU practice

Antibacterial wipes can spread superbugs: study

By Michael KahnTue Jun 3, 1:11 PM ET

Disinfectant wipes routinely used in hospitals may actually spread drug-resistant bacteria rather than kill the dangerous infections, British researchers said on Tuesday.

While the wipes killed some bacteria, a study of two hospitals showed they did not get them all and could transfer the so-called superbugs to other surfaces, Gareth Williams, a microbiologist at Cardiff University, said.

The findings presented at the American Society of Microbiology's General Meeting in Boston focused on bacteria that included methicillin-resistant Staphylococcus aureus, or MRSA.

"What we have found is there is a high risk," Williams, who led the study, said by telephone. "We need to give guidance to the staff on how to use the wipes because we found there is a possibility of cross transfer."

MRSA infections can range from boils to more severe infections of the bloodstream, lungs and surgical sites. Most cases are associated with hospitals, nursing homes or other health care facilities.

The superbug can cause life-threatening and disfiguring infections and can often only be treated with expensive, intravenous antibiotics.

Experts have been saying for years that poor hospital practices spread dangerous bacteria, and yet many studies have shown that health care workers, including doctors and nurses, often fail to even wash their hands as directed.

The findings from a study of intensive care units at two Welsh hospitals suggest that even cleaning with antimicrobial wipes may not be enough depending on how staff use them.

The researchers found that many health care workers cleaned multiple surfaces near patients, such as bed rails, monitors and tables with a single wipe and risked sweeping the infections around rather than cleaning them up.

"We found that the most effective way to prevent the risk of MRSA spread in hospital wards is to ensure the wipe is used only once on one surface," Williams said.

(Editing by Maggie Fox)

Eating Bugs

At the broad appetit food festival in downtown Richmond, Va., visitors can stuff themselves with pizza, Thai noodles, fried chicken and--this being Virginia--smoky barbecue. But some of the biggest crowds are gathered around David George Gordon, a cheerful 58-year-old writer from Seattle. Gordon isn't cooking anything that complex--just some pasta, prepared on a hot plate--but scattered among his orzo like tiny six-legged meatballs is a show-stopping ingredient: crickets. The author of The Eat-a-Bug Cookbook, Gordon considers Orthopteran Orzo his signature dish. He scoops the pasta into paper cups and begins handing out samples to the more adventuresome onlookers. That includes me--I have a deep fear of insects, but I have a deeper fear of my editors. The crickets are pretty good; they give the pasta a tangy crunch, though a few of those legs stick in my throat on the way down. Jon Fuller, 16, agrees. "It's really not that bad," he says and takes a second helping. "The goal is to get from 'Not bad' to 'Actually good,'" says Gordon. "Bug appétit!"

In the U.S., we're more accustomed to exterminating insects than to eating them, but in scores of countries around the world--including Thailand, where food markets are stocked with commercially-raised water beetles and bamboo worms--bugs have long been a part of a well-balanced meal. Insect lovers like Gordon argue that entomophagy--the scientific term for consuming insects--could also be a far greener way to get protein than eating chicken, cows or pigs. With the global livestock sector responsible for 18% of the world's greenhouse-gas emissions and grain prices reaching record highs, cheap, environmentally low-impact insects could be the food of the future--provided we can stomach them. "This is an idea that shouldn't just be ridiculed," says Paul Vantomme, an officer at the U.N.'s Food and Agriculture Organization, which recently held an entomophagy conference in Bangkok.

The very qualities that make bugs so hard to get rid of could also make them an environmentally friendly food. "Nature is very good at making insects," says David Gracer, one of the chefs at the Richmond festival and the founder of future bug purveyor Sunrise Land Shrimp. Insects require little room and few resources to grow. For instance, it takes far less water to raise a third of a pound (150 g) of grasshoppers than the staggering 869 gal. (3,290 L) needed to produce the same amount of beef. Since bugs are cold-blooded invertebrates, more of what they consume goes to building edible body parts, whereas pigs and other warm-blooded vertebrates need to consume a lot of calories just to keep their body temperature steady. There's even a formula, called the efficiency of conversion of ingested food to body substance (ECI), that can be used to compare the weight different animals gain after eating a certain quantity of feed. Beef cattle have an ECI of 10. Silkworms range from 19 to 31. German cockroaches max out at 44.

Incredibly efficient to raise, insects are also crawling packets of nutrition. A 100-gram (3.5 oz.) portion of cooked Usata terpsichore caterpillars--commonly eaten in central Africa--contains about 28 grams (1 oz.) of protein, slightly more than you'd get from the same amount of chicken. Water bugs have four times as much iron as beef.

Bugs can be tasty too--Gordon swears by his white chocolate and waxworm cookies--but Americans first need to overcome the "eww" factor. We think bugs are dirty, disease-laden or otherwise dangerous to eat--though they're not, as long as you cook them properly, are not allergic to shellfish (which, like insects, are arthropods) and aren't collecting bugs from fields that have been hit with pesticides. We're revolted by their alien appearance, but then again, lobster could hardly be described as cute and cuddly. And food taboos are not eternal; think of how unlikely it would have seemed 50 years ago that there would be more than 9,000 sushi restaurants in the U.S. There's also the possibility that someday the exploding global population and the damage of climate change could bring about the collapse of our resource-intensive food supply. "At that point," notes Gracer, "insects could become a pretty attractive option."

In Richmond, with the smell of overstuffed po'boys wafting through the air, the threat of agricultural apocalypse still seems a long way off. But if the entomophagists have yet to win many converts, they've definitely earned the curiosity of the crowd, which huddles beneath a tent to watch Gordon and Gracer in a bug cook-off. Gordon serves his crickets orzo with tarantula tempura, which he makes by frying a fist-size arachnid. (I skip the spider. I like my job, but not that much.) It's Gracer who takes first prize, however, with a series of dishes, including a tasty salad with Queen Atta ants, stinkbugs and, best of all, waxworms, whose popcorn-size larvae are meaty and flavorful. But I don't look too closely. Gordon likes to say that when you try to eat insects, there's a dialogue between your brain, which says bugs can be good for you, and your stomach, which is ready to revolt. I know my brain is right, but as Gordon says, "The stomach always votes last."

How to Survive A Disaster

By Amanda Ripley

When a plane crashes or the earth shakes, we tend to view the survivors as the lucky ones. Had they been in the next seat or the apartment across the street, they would have perished. We marvel at the whimsy of the devastation.

The recent earthquake in China and the cyclone in Burma, not to mention the battery of tornadoes and wildfires ripping through the U.S. this season, remind us that disasters are part of the human condition. We are more or less vulnerable to them, depending where we live.

But survival is not just a product of luck. We can do far more than we think to improve our odds of preventing and surviving even the most horrendous of catastrophes. It's a matter of preparation--bolting down your water heater before an earthquake or actually reading the in-flight safety card before takeoff--but also of mental conditioning. Each of us has what I call a "disaster personality," a state of being that takes over in a crisis. It is at the core of who we are. The fact is, we can refine that personality and teach our brains to work more quickly, maybe even more wisely.

Humans are programmed with basic survival skills. When frightened, we get a shot of performance-enhancing hormones, and the blood pumps to our limbs to help us outrun whatever enemy we face. But in modern times, we're hardly aware of such natural skills, and most of us do little to understand or develop them.

We could, for example, become far better at judging threats before catastrophe strikes. We have technological advantages that our ancestors lacked, and we know where disasters are likely to occur. And yet we flirt shamelessly with risk. We construct city skylines in hurricane alleys and neighborhoods on top of fault lines--as if nature will be cowed by our audacity and leave us be. And we rely on a sprawling network of faraway suppliers for necessities like warmth and food. If the power cuts off, many of us still don't know where the stairs are in our skyscrapers, and we would have trouble surviving for a week without Wal-Mart. Hurricane season starts June 1, and forecasters predict a worse-than-average summer. But for many of us, preparation means little more than crossing our fingers and hoping to live.

Yet the knowledge is out there. Risk experts understand how we could overcome our blind spots and more intelligently hedge our bets. In laboratories and on shooting ranges, there are people who study what happens to bodies and minds under extreme duress. Military researchers conduct elaborate experiments to try to predict who will melt down in a crisis and who will thrive. Police, soldiers, race-car drivers and helicopter pilots train to anticipate the strange behaviors they will encounter at the worst of times. Regular people can learn from that knowledge, since, after all, we will be the first on the scene of any disaster.

Of course, no one can promise a plan of escape. But that doesn't mean we should live in willful ignorance. As Hunter S. Thompson said, "Call on God, but row away from the rocks."

Over the years, I have interviewed survivors of unimaginable tragedies. Most say that during their ordeals, almost nothing felt, sounded or looked the way they would have expected. Reality was in some ways better, in other ways worse. They say there are things they wish they had known, things they want you to know. Here, then, are three of their stories, accompanied by some of the hard wisdom of loss and luck:

Panic Can Be Your Friend

When disaster strikes, a troubling human response can inflate the death toll: people freeze up. They shut down, becoming suddenly limp and still. That's what happened to some people on Sept. 28, 1994, when the M.V. Estonia went down in the Baltic Sea, the worst sea disaster in modern European history.

The huge automobile ferry had left its home port in Tallinn, Estonia, on a routine 15-hour trip to Stockholm. Although the weather had been stormy all night, the crew did not expect serious problems. A band was playing in the Baltic Bar, and the 10-deck vessel churned through the inky waters as it had for 14 years.

Kent Härstedt, now a member of Sweden's Parliament, was then a 29-year-old passenger. That night he was hanging out in one of the ship's bars, with about 50 other passengers. "There was karaoke music," he recalls. "Everybody was laughing and singing." But just after 1 a.m., the Estonia suddenly listed starboard 30°, hurling passengers, vending machines and flowerpots across its passageways. In the bar, almost everyone fell violently against the side of the boat. Härstedt managed to grab on to the iron bar railing and hold on, hanging above everyone else.

"In just one second, everything went from a loud, happy, wonderful moment to total silence. Every brain, I guess, was working like a computer trying to realize what had happened," he says. Then came the screaming and crying. People had been badly hurt in the fall, and the tilt of the ship made it extremely difficult to move.

Härstedt began to strategize, tapping into some of the survival skills he had learned in the military. "I started to react very differently from normal. I started to say, 'O.K., there is option one, option two. Decide. Act.' I didn't say, 'Oh, the boat is sinking.' I didn't even think about the wider perspective." Like many survivors, Härstedt experienced the illusion of centrality, a coping mechanism in which the brain fixates on the individual experience. "I just saw my very small world."

But as Härstedt made his way into the corridor, he noticed something strange about some of the other passengers. They weren't doing what he was doing. "Some people didn't seem to realize what had happened. They were just sitting there," he says. Not just one or two people, but entire groups seemed to be immobilized. They were conscious, but they were not reacting.

Contrary to popular expectations, this is what happens in many disasters. Crowds generally become quiet and docile. Panic is rare. The bigger problem is that people do too little, too slowly. They sometimes shut down completely, falling into a stupor.

On the Estonia, Härstedt climbed up the stairwell, fighting against gravity. Out on the deck, the ship's lights were on, and the moon was shining. The full range of human capacities was on display. Incredibly, one man stood to the side, smoking a cigarette, Härstedt remembers. Most people strained to hold on to the rolling ship and, at the same time, to look for life jackets and lifeboats. British passenger Paul Barney remembers groups of people standing still like statues. "I kept saying to myself, 'Why don't they try to get out of here?'" he later told the Observer.

Later, when interviewed by the police, some survivors said they understood this behavior. At some point, they too had felt an overwhelming urge to stop moving. They only snapped out of the stupor, they said, by thinking of their loved ones, especially their children--a common thread in the stories of survivors of all kinds of disasters.

At 1:50 a.m., just 30 minutes after its first Mayday call, the Estonia vanished, sinking upside down into the sea. Moments before, Härstedt had jumped off the ship. He climbed onto a life raft and held on for five hours, until finally being rescued. All told, only 137 of the 989 people on board survived the disaster. Most of the victims were entombed in the Estonia while they slept. They had no chance to save themselves. Investigators would conclude that the ship sank because the bow door to the car deck had come unlocked and the sea had come gushing into the ship.

Firefighters, police trainers--even stockbrokers--have told me similar stories of seeing people freeze under extreme stress. Animals go into the same state when they are trapped, evolutionary psychologist Gordon Gallup Jr. has found. Playing dead can discourage predators from attacking. In the case of the Estonia and other disasters, the freezing response may have been a natural and horrific mistake. Our brains search, under extreme stress, for an appropriate survival response and sometimes choose the wrong one, like deer that freeze in the headlights of a car.

But the more encouraging point is that the brain is plastic. It can be trained to respond more appropriately. Less fear makes paralysis less likely. A rat with damage to the amygdala, the primitive part of the brain that handles fear, will not freeze at all--even if it encounters a cat. If we can reduce our own fear even a little bit, we might be able to do better.

Fire drills, particularly if they are mandatory and unexpected, can dramatically reduce fear, should the worst come to pass. Just knowing where the stairs are gives your brain an advantage. Likewise, research into plane crashes has found that people who read the safety briefing cards are more likely to survive. These rituals that we consider an utter waste of time actually give our brains blueprints in the unlikely event that we need them.

We can also help each other do better. A loud sound will cause animals to snap out of their stupor. Likewise, many flight attendants are now trained to scream at passengers in burning planes, "Get out! Get out! Go!" People respond well to leadership in a disaster, and then they can do remarkable things.

We All Have Our Role to Play

Even in the most chaotic moments, our social relationships remain largely intact. That cohesion can have positive and negative consequences, but it helps to know what to expect.

On May 28, 1977, one of the deadliest fires in the U.S. broke out at a place called the Beverly Hills Supper Club, a labyrinth of dining rooms, ballrooms, fountains and gardens located on a bluff 5 miles (8 km) south of Cincinnati. Darla McCollister was there. She got married that evening at the gazebo in the garden and then, as her party began to move inside for dinner, a waitress informed her that there was a small fire in the building. It had begun as an electrical fire in the Zebra Room, adjacent to the bride's dressing room. Before the night was out, the flames would tear through the Beverly Hills, led by a roiling advance of smoke. There were nearly 3,000 people packed into the sprawling club on that Saturday night. All told, the fire would kill 167 of them.

The disaster delivered many brutal lessons. Some were obvious--and tragic: the club had no sprinkler or audible fire-alarm systems. But the fire also complicated official expectations for crowd behavior: in the middle of a crisis, the basic tenets of civilization actually hold. People move in groups whenever possible. They tend to look out for one another, and they maintain hierarchies. "People die the same way they live," says disaster sociologist Lee Clarke, "with friends, loved ones and colleagues, in communities."

At the Beverly Hills, servers warned their tables to leave. Hostesses evacuated people that they had seated but bypassed other sections (that weren't "theirs"). Cooks and busboys, perhaps accustomed to physical work, rushed to fight the fire. In general, male employees were slightly more likely to help than female employees, maybe because society expects women to be saved and men to do the saving.

And what of the guests? Most remained guests to the end. Some even continued celebrating, in defiance of the smoke seeping into the rooms. One man ordered a rum and Coke to go. When the first reporter arrived at the fire, he saw guests sipping their cocktails in the driveway, laughing about whether they would get to leave without paying their bills.

As the smoke intensified, Wayne Dammert, a banquet captain at the club, stumbled into a hallway jammed with a hundred guests. The lights flickered off and on, and the smoke started to get heavy. But what he remembers most about that crowded hallway is the silence. "Man, there wasn't a sound in there. Not a scream, nothing," he says. Standing there in the dark, the crowd was waiting to be led.

The Beverly Hills employees had received no emergency training, but they performed magnificently. The exits were few and hard to find, but Dammert directed the crowd out through a service hallway into the kitchen. "My thought was that I'm responsible for these people," he says. "I think most of the employees felt that way." McCollister, still in her wedding dress, ushered her guests outside. "I was pushing people out the door, kind of like cattle, to show them where to go," she recalls. She felt responsible: "This is my party. They were there because of me."

Norris Johnson and William Feinberg, then sociology professors at the University of Cincinnati, managed to get access to the police interviews with hundreds of survivors--a rare and valuable database. "We were just overwhelmed with what was there," says Feinberg, now retired. People were remarkably loyal to their identities. An estimated 60% of the employees tried to help in some way--either by directing guests to safety or fighting the fire. By comparison, only 17% of the guests helped. But even among the guests, identity shaped behavior. The doctors who had been dining at the club acted as doctors, administering cpr and dressing wounds like battlefield medics. Nurses did the same thing. There was even one hospital administrator there who--naturally--began to organize the doctors and nurses.

The sociologists expected to see evidence of selfish behavior. But they did not. "People kept talking about the orderliness of it all," says Feinberg. "People used what they had learned in grade-school fire drills. 'Stay in line. Don't push. We'll all get out.' People were queuing up! It was just absolutely incredible."

All of us, but especially people in charge--of a city, a theater, a business--should recognize that people can be trusted to do their best at the worst of times. They will do even better if they are encouraged to play a significant role in their own survival before anything goes wrong. In New York City, despite the pleas of safety engineers, meaningful fire drills are still not mandatory in skyscrapers. Among other concerns, the city's Real Estate Board was worried that mandatory drills could lead to injuries that could lead to lawsuits. A lawsuit, then, is more frightening than a catastrophe, which is a shame. Because if a real disaster should come to pass, people will rise to the expectations set by their CEO or headwaiter, and they will follow their leader almost anywhere.
How One Person Made a Difference
In every disaster, buried under the rubble is evidence that we can do better. Much of that work is physical--building stronger buildings in safer places, for example. But the work is also psychological. The more control people feel they have over their predicament, the better their performance. When people believe that survival is negotiable, they can be wonderfully creative. All it takes is the audacity to imagine that our behavior matters.

When the planes struck the Twin Towers on Sept. 11, 2001, Rick Rescorla embodied that spirit of survival. The head of security for Morgan Stanley Dean Witter at the World Trade Center, Rescorla believed that regular people were capable of great achievements, with a bit of leadership. He got Morgan Stanley employees to take responsibility for their survival--which happened almost nowhere else that day in the Trade Center.

Rescorla learned many of the tricks of survival in the military. He was one of those thick-necked soldier types who spend the second halves of their lives patrolling the perimeters of marble lobbies the way they once patrolled a battlefield. Born in England, he joined the U.S. military because he wanted to fight the communists in Vietnam. When he got there, he earned a Silver Star, a Bronze Star and a Purple Heart in battles memorialized in the 1992 book by Lieut. General Harold G. Moore and Joseph L. Galloway, We Were Soldiers Once ... and Young.

He eventually moved to New Jersey and settled into the life of a security executive, but Rescorla still acted, in some ways, like a man at war. His unit, Morgan Stanley, occupied 22 floors of Tower 2 and several floors in a nearby building. After the 1988 bombing of Pan Am Flight 103 over Lockerbie, Scotland, Rescorla worried about a terrorist attack on the Trade Center. In 1990, he and an old war buddy wrote a report to the Port Authority of New York and New Jersey, which owns the Trade Center site, insisting on the need for more security in the parking garage. Their recommendations, which would have been expensive, were ignored, according to James B. Stewart's biography of Rescorla, Heart of a Soldier. (The Port Authority did not respond to my requests for comment.)

Three years later, Ramzi Yousef drove a truck full of explosives into the underground parking garage of the World Trade Center, just as Rescorla had predicted. Afterward, Rescorla had the credibility he needed. Combined with his muscular personality, it was enough to change the culture of Morgan Stanley.

Rescorla implicitly understood that he could turn office workers into survivors. He respected the ability of regular people to do better. He understood the danger of lethargy, the importance of aggressively pushing through the initial stupor and getting to action. He had watched employees wind down the staircase in 1993, and he knew it took too long.

Rescorla felt it was foolish to rely on first responders to save his employees. His company was the largest tenant in the Trade Center, a village nestled in the clouds. Morgan Stanley's employees would need to take care of one another. He ordered them not to listen to any instructions from the Port Authority in a real emergency. In his eyes, it had lost all legitimacy after it failed to respond to his 1990 warnings. And so Rescorla started running the entire company through his own frequent, surprise fire drills. He trained employees to meet in the hallway between the stairwells and go down the stairs, two by two, to the 44th floor.

The radicalism of Rescorla's drills cannot be overstated. Remember, Morgan Stanley is an investment bank. Millionaire, high-performance bankers on the 73rd floor did not appreciate the interruption. Each drill, which pulled brokers off their phones and away from their computers, cost the company money. But Rescorla did it anyway. His military training had taught him a simple rule of human nature: the best way to get the brain to perform under extreme stress is to repeatedly run it through rehearsals beforehand.

After the first few drills, Rescorla chastised employees for moving too slowly in the stairwell. He started timing them with a stopwatch, and they got faster. He also lectured employees about some of the basics of fire emergencies: Because roof rescues are rare and extremely dangerous, people should always go down.

On the morning of 9/11, Rescorla heard an explosion and saw Tower 1 burning from his office window. A Port Authority official came over the P.A. system and urged people to stay at their desks. But Rescorla grabbed his bullhorn, walkie-talkie and cell phone and began systematically ordering Morgan Stanley employees to get out. They performed beautifully.

They already knew what to do, even the 250 visitors taking a stockbroker training class. They had already been shown the nearest stairway. "Knowing where to go was the most important thing. Because your brain--at least mine--just shut down. When that happens, you need to know what to do next," says Bill McMahon, a Morgan Stanley executive. "One thing you don't ever want to do is to have to think in a disaster."

On 9/11, some of the dead might well have survived if they had received Rescorla's warnings to always go down rather than up. But in the absence of other information, some people remembered that victims had been evacuated from the roof in 1993. So they used the last minutes of their lives to climb to the top of the towers--only to find the doors locked.

As Rescorla stood directing people down the stairwell on the 44th floor, the second plane hit--this time striking about 38 floors above his head. The building lunged violently, and some people were thrown to the floor. "Stop," Rescorla ordered through the bullhorn. "Be still. Be silent. Be calm." In response, "No one spoke or moved," Stewart writes. "It was as if Rescorla had cast a spell."

Rescorla had once led soldiers through the night in the Vietcong-controlled Central Highlands of Vietnam. He knew the brain responded poorly to fear--but he also knew it could be distracted. Back then, he had calmed his men by singing Cornish songs from his youth. Now, in the crowded stairwell, Rescorla sang into the bullhorn. "Men of Cornwall stand ye steady. It cannot be ever said ye for the battle were not ready. Stand and never yield!"

Between songs, Rescorla called his wife. "Stop crying," he said. "I have to get these people out safely. If something should happen to me, I want you to know I've never been happier. You made my life." Moments later, he had successfully evacuated the vast majority of Morgan Stanley employees. Then he turned around. He was last seen on the 10th floor, heading upward, shortly before the tower collapsed. His remains have never been found.

Rescorla taught Morgan Stanley employees to save themselves. It's a lesson that has become, somehow, rare and precious. When the tower collapsed, only 13 Morgan Stanley colleagues--including Rescorla and four of his security officers--were inside. The other 2,687 were safe.

To learn more about survival skills in a disaster, go to www.TheUnthinkable.com

Ripley, a senior writer at TIME, covers homeland security and risk. This article is adapted from The Unthinkable: Who Survives When Disaster Strikes--and Why. © 2008 by Amanda Ripley. To be published by Crown Publishers, a division of Random House Inc. On sale June 10, 2008.

Illnesses tied to raw tomatoes

Illnesses tied to raw tomatoes

* Story Highlights
* Same bug caused salmonella infections in Texas, New Mexico, officials say
* Investigators looking for link to illnesses in seven other states
* Raw large tomatoes are common source in New Mexico, Texas
* Illness causes fever, diarrhea, cramps; lasts 4 to 7 days

ATLANTA, Georgia (AP) -- An outbreak of salmonella food poisoning first linked to uncooked tomatoes has now been reported in nine states, U.S. health officials said Tuesday.

Lab tests have confirmed 40 illnesses in Texas and New Mexico as the same type of salmonella, right down to the genetic fingerprint.

An investigation by Texas and New Mexico health authorities and the Indian Health Service tied those cases to uncooked large tomatoes.

At least 17 people in Texas and New Mexico have been hospitalized. None have died, according to the U.S. Centers for Disease Control and Prevention.

Thirty people have become sick with the same Salmonella Saintpaul infection in Arizona, Utah, Colorado, Kansas, Idaho, Illinois and Indiana. CDC investigators are looking into whether tomatoes were culprits there, too.

In Texas and New Mexico, raw large tomatoes -- including Roma and red round tomatoes -- were found to be a common factor in the 40 illnesses. But no farm, distributor or grocery chain has been identified as the main source, said Casey Barton Behravesh, a CDC epidemiologist working on the investigation.

"The specific type and source of tomatoes is under investigation," she said.

Salmonella is a bacterial infection that lives in the intestinal tracts of humans and other animals. The bacteria are usually transmitted to humans by eating foods contaminated with animal feces.

Most infected people suffer fever, diarrhea and abdominal cramps starting 12 to 72 hours after infection. The illness tends to last four to seven days.

Many people recover without treatment. However, severe infection and even death are possible. Infants, the elderly and people with weakened immune systems are at greatest risk for severe infections.

In Texas and New Mexico, the patients ranged in age from 3 to 82. Of the 40 patients, 38 were interviewed. Most said they ate raw tomatoes from either stores or restaurants before becoming ill between April 23 and May 27.

An additional 17 cases are under investigation in New Mexico, CDC officials said.

A Genetic Clue to Quitting Smoking

By Alice Park

New genetic research helps explain why some smokers respond better to certain smoking-cessation programs than others, according to scientists at Duke University and the National Institute on Drug Abuse.

Reporting this week in the Archives of General Psychiatry, scientists describe for the first time a set of genes, about 100 in all, that seem to predict how well a smoker will respond to two different types of quitting programs — nicotine replacement or bupropion (Zyban). Nicotine-replacement methods, including the patch, pill and gum, work by weaning the smoker off nicotine gradually, usually over a period of weeks or months. Bupropion, on the other hand, is an antidepressant, which does not contain nicotine; instead, it works to curb nicotine cravings by interfering with the reward circuit in the brain, where addictions — to nicotine and other drugs, or behaviors — are reinforced. Nationally, about 70% to 80% of smokers say they want to quit, but any single attempt, regardless of the quitting method, is on average only 30% successful.

One way to boost the quitting success rate would be to match smokers with the right cessation program. A team of researchers, led by Jed Rose, director of the Duke University Center for Nicotine and Smoking Cessation Research, have begun doing just that. In their new study, the scientists screened the entire human genome and teased out a profile of genes that they think are involved in breaking nicotine addiction. Some of the genes influence basic cell communication; others code for enzymes that break down bupropion in the body. Everyone possesses all the genes in question, says Rose, but in different forms, or versions, which either amplify or dampen their effects. "We're going to see a lot more studies like this now, because the tools are there," says Dr. Normal Edelman, chief medical officer of the American Lung Association and a professor of preventive medicine at Stony Brook University. "It's a wonderful first step, because smoking cessation is a real problem — it's not easy to quit."

Rose found that people with genes that more efficiently code for bupropion breakdown respond better to the drug, while people with genetic variants that improve cell communication — also called adhesion — seem to have an easier time overall in quitting. That makes sense, since addictive behaviors such as smoking are deeply ingrained in the brain, and are strongly tied to social and environmental triggers. That network of neural connections, once cemented, is tough to break. But having certain versions of genes that facilitate neural flexibility — easing the uncoupling of certain brain connections and replacing them with new habits — could, says Rose, help people to quit smoking more quickly. "It may be that connection-forming genes are involved in the formation of addictive behaviors and in the ability to learn new behaviors that compete with and break the habit," he says. "These findings open up new, fascinating investigations into the mechanisms of addiction and how different treatments may work."
Eventually, this predictive information could come in the form of a quit-smoking "score," calculated from an individual's specific combination of different versions of the 100 or so genes that Rose's team selected. The group is also studying the genes involved in response to varenicline (Chantix), another popular smoking-cessation drug that works by blocking nicotine from binding to receptors in the brain. Even if such a test is years away, any such head start, as smokers will readily attest, would be a welcome partner in kicking the habit.

Hospice nurse resigns after alleged drug theft


A nurse employed at the Hospice of Northwest Ohio facility in South Toledo resigned last week after she was suspected of stealing liquid pain medication prescribed to patients, a spokesman confirmed yesterday.

Hospice officials and a police report filed Tuesday identified Mary E. Mitchell, 51, of Maumee as the suspect. She has not been criminally charged.

Judy Lang, hospice's director of communications, said officials became suspicious the suspect was allegedly stealing drugs so they conducted an internal investigation.

"As soon as we became aware, we reacted and did everything we were supposed to do," she said.

According to the police report, Hospice officials monitored Mitchell and the amount of drugs she administered to her patients from April 1 to May 22.

Ms. Lang said she believes none of the patients in the 24-unit facility at 800 South Detroit Ave. was harmed as a result of the nurse's actions. Relatives of patients were not made aware of the incident.

The pain medication that was stolen is an injectable liquid packaged in a premeasured vial. Patients are given their prescribed dosage and the remaining medication is to be disposed of, Ms. Lang said.

She alleged that Mitchell, who worked as a registered nurse at the hospice for about two years, administered the prescribed dosage to patients and then took the remaining medication.

When confronted, Ms. Lang said Mitchell, who otherwise had a clean disciplinary history, admitted to stealing the drugs. The suspect provided no additional details to hospice officials.

Mitchell has an unpublished phone number and could not be reached for comment last night.

Ms. Lang said criminal background checks, including fingerprinting, are conducted on all potential employees before they are hired.

But according to Lucas County Common Pleas Court records, Mitchell was convicted in 2001 of a felony charge of theft of drugs.

She was sentenced to three years of probation, ordered to submit random urine samples, and continue treatment with a state nursing program. Mitchell also was ordered to attend 12-step meetings and attend a Toledo Hospital after-care program.

Ms. Lang said last night she was unaware until recently of Mitchell's felony conviction. She said the hospice would not normally have hired an individual with a past felony conviction.

"I don't know what happened," she said.

Ms. Lang said it appears through the facilities' investigation that the suspect stole medication during each of her shifts for about a month. She declined to release the amount of medication that was taken.

Ms. Lang would not identify the specific brand name of the pain medication, citing fear that someone may break into the facility and steal it. She said it is a powerful medication given to patients with "extreme pain."

During each shift, officials conduct an inventory of drugs comparing what is prescribed to patients to what is actually used. She said there is also an inventory kept of the drugs that are disposed.

"I think she was a suspect for a while and they started monitoring more carefully," Ms. Lang said.

Ms. Lang stressed that in the organization's 27 years, this is the first incident of its kind there.

Contact Laren Weber at:
or 419-724-6050.

Liver Damage: Scarce Organs at UCLA Went to Japanese Criminals

Posted by Scott Hensley

UCLA Medical Center performed a life-saving liver transplant on one of Japan’s most powerful gang bosses a few years back, the Los Angeles Times reports.
Yakuza shrine, Sanja festival, Asakusa, Tokyo

Three other men, now prohibited from entering the U.S. due to rap sheets or suspected ties to Japanese organized crime, also got liver transplants at UCLA, the paper reports.

What’s the big deal, you ask? The transplants were done between 2000 and 2004, “a time of pronounced organ scarcity,” the LAT says. “In each of those years, more than 100 patients died awaiting liver transplants in the Greater Los Angeles region.”

Arthur Caplan, a bioethicist at the University of Pennsylvania, told the paper: “If you want to destroy public support for organ donation on the part of Americans, you’d be hard pressed to think of a practice that would be better suited.”

The paper said there’s no evidence that the hospital or the surgeon involved knew at the time of the transplants that the patients had ties to Japanese gangs, commonly called yakuza. “Both said in statements that they do not make moral judgments about patients and treat them based on their medical need,” the paper said.

Photo by apes_abroad via Flickr

Occupational Outlook Handbook, 2008-09 Edition

U.S. Department of Labor | Bureau of Labor Statistics
Source: http://www.bls.gov/oco/print/ocos083.htm

Significant Points

* Registered nurses constitute the largest health care occupation, with 2.5 million jobs.
* About 59 percent of jobs are in hospitals.
* The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program.
* Registered nurses are projected to generate about 587,000 new jobs over the 2006-16 period, one of the largest numbers among all occupations; overall job opportunities are expected to be excellent, but may vary by employment setting.

Nature of the Work
Registered nurses (RNs), regardless of specialty or work setting, treat patients, educate patients and the public about various medical conditions, and provide advice and emotional support to patients’ family members. RNs record patients’ medical histories and symptoms, help perform diagnostic tests and analyze results, operate medical machinery, administer treatment and medications, and help with patient follow-up and rehabilitation.

RNs teach patients and their families how to manage their illness or injury, explaining post-treatment home care needs; diet, nutrition, and exercise programs; and self-administration of medication and physical therapy. Some RNs work to promote general health by educating the public on warning signs and symptoms of disease. RNs also might run general health screening or immunization clinics, blood drives, and public seminars on various conditions.

When caring for patients, RNs establish a plan of care or contribute to an existing plan. Plans may include numerous activities, such as administering medication, including careful checking of dosages and avoiding interactions; starting, maintaining, and discontinuing intravenous (IV) lines for fluid, medication, blood, and blood products; administering therapies and treatments; observing the patient and recording those observations; and consulting with physicians and other health care clinicians. Some RNs provide direction to licensed practical nurses and nursing aids regarding patient care. RNs with advanced educational preparation and training may perform diagnostic and therapeutic procedures and may have prescriptive authority.

RNs can specialize in one or more areas of patient care. There generally are four ways to specialize. RNs can choose a particular work setting or type of treatment, such as perioperative nurses, who work in operating rooms and assist surgeons. RNs also may choose to specialize in specific health conditions, as do diabetes management nurses, who assist patients to manage diabetes. Other RNs specialize in working with one or more organs or body system types, such as dermatology nurses, who work with patients who have skin disorders. RNs also can choose to work with a well-defined population, such as geriatric nurses, who work with the elderly. Some RNs may combine specialties. For example, pediatric oncology nurses deal with children and adolescents who have cancer.

There are many options for RNs who specialize in a work setting or type of treatment. Ambulatory care nurses provide preventive care and treat patients with a variety of illnesses and injuries in physicians’ offices or in clinics. Some ambulatory care nurses are involved in telehealth, providing care and advice through electronic communications media such as videoconferencing, the Internet, or by telephone. Critical care nurses provide care to patients with serious, complex, and acute illnesses or injuries that require very close monitoring and extensive medication protocols and therapies. Critical care nurses often work in critical or intensive care hospital units. Emergency, or trauma, nurses work in hospital or stand-alone emergency departments, providing initial assessments and care for patients with life-threatening conditions. Some emergency nurses may become qualified to serve as transport nurses, who provide medical care to patients who are transported by helicopter or airplane to the nearest medical facility. Holistic nurses provide care such as acupuncture, massage and aroma therapy, and biofeedback, which are meant to treat patients’ mental and spiritual health in addition to their physical health. Home health care nurses provide at-home nursing care for patients, often as follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing facility. Hospice and palliative care nurses provide care, most often in home or hospice settings, focused on maintaining quality of life for terminally ill patients. Infusion nurses administer medications, fluids, and blood to patients through injections into patients’ veins. Long- term care nurses provide health care services on a recurring basis to patients with chronic physical or mental disorders, often in long-term care or skilled nursing facilities. Medical-surgical nurses provide health promotion and basic medical care to patients with various medical and surgical diagnoses. Occupational health nurses seek to prevent job-related injuries and illnesses, provide monitoring and emergency care services, and help employers implement health and safety standards. Perianesthesia nurses provide preoperative and postoperative care to patients undergoing anesthesia during surgery or other procedure. Perioperative nurses assist surgeons by selecting and handling instruments, controlling bleeding, and suturing incisions. Some of these nurses also can specialize in plastic and reconstructive surgery. Psychiatric-mental health nurses treat patients with personality and mood disorders. Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses. Rehabilitation nurses care for patients with temporary and permanent disabilities. Transplant nurses care for both transplant recipients and living donors and monitor signs of organ rejection.

RNs specializing in a particular disease, ailment, or health care condition are employed in virtually all work settings, including physicians’ offices, outpatient treatment facilities, home health care agencies, and hospitals. Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other addictions. Intellectual and developmental disabilities nurses provide care for patients with physical, mental, or behavioral disabilities; care may include help with feeding, controlling bodily functions, sitting or standing independently, and speaking or other communication. Diabetes management nurses help diabetics to manage their disease by teaching them proper nutrition and showing them how to test blood sugar levels and administer insulin injections. Genetics nurses provide early detection screenings, counseling, and treatment of patients with genetic disorders, including cystic fibrosis and Huntington’s disease. HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. Oncology nurses care for patients with various types of cancer and may assist in the administration of radiation and chemotherapies and follow-up monitoring. Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow for alternative methods of bodily waste elimination; and treat patients with urinary and fecal incontinence.

RNs specializing in treatment of a particular organ or body system usually are employed in hospital specialty or critical care units, specialty clinics, and outpatient care facilities. Cardiovascular nurses treat patients with coronary heart disease and those who have had heart surgery, providing services such as postoperative rehabilitation. Dermatology nurses treat patients with disorders of the skin, such as skin cancer and psoriasis. Gastroenterology nurses treat patients with digestive and intestinal disorders, including ulcers, acid reflux disease, and abdominal bleeding. Some nurses in this field also assist in specialized procedures such as endoscopies, which look inside the gastrointestinal tract using a tube equipped with a light and a camera that can capture images of diseased tissue. Gynecology nurses provide care to women with disorders of the reproductive system, including endometriosis, cancer, and sexually transmitted diseases. Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or substance abuse. Neuroscience nurses care for patients with dysfunctions of the nervous system, including brain and spinal cord injuries and seizures. Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness and glaucoma, and to patients undergoing eye surgery. Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis, bone fractures, and muscular dystrophy. Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as cleft palates, allergies, and sinus disorders. Respiratory nurses provide care to patients with respiratory disorders such as asthma, tuberculosis, and cystic fibrosis. Urology nurses care for patients with disorders of the kidneys, urinary tract, and male reproductive organs, including infections, kidney and bladder stones, and cancers.

RNs who specialize by population provide preventive and acute care in all health care settings to the segment of the population in which they specialize, including newborns (neonatology), children and adolescents (pediatrics), adults, and the elderly (gerontology or geriatrics). RNs also may provide basic health care to patients outside of health care settings in such venues as including correctional facilities, schools, summer camps, and the military. Some RNs travel around the United States and abroad providing care to patients in areas with shortages of health care workers.

Most RNs work as staff nurses as members of a team providing critical health care . However, some RNs choose to become advanced practice nurses, who work independently or in collaboration with physicians, and may focus on the provision of primary care services. Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties, such as psychiatric-mental health. Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. They also provide pain management and emergency services, such as airway management. Nurse-midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and health care services to patients and families. The most common specialty areas for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and geriatrics. However, there are a variety of other specialties that nurse practitioners can choose, including neonatology and mental health. Advanced practice nurses can prescribe medications in all States and in the District of Columbia.

Some nurses have jobs that require little or no direct patient care, but still require an active RN license. Case managers ensure that all of the medical needs of patients with severe injuries and severe or chronic illnesses are met. Forensics nurses participate in the scientific investigation and treatment of abuse victims, violence, criminal activity, and traumatic accident. Infection control nurses identify, track, and control infectious outbreaks in health care facilities and develop programs for outbreak prevention and response to biological terrorism. Legal nurse consultants assist lawyers in medical cases by interviewing patients and witnesses, organizing medical records, determining damages and costs, locating evidence, and educating lawyers about medical issues. Nurse administrators supervise nursing staff, establish work schedules and budgets, maintain medical supply inventories, and manage resources to ensure high-quality care. Nurse educators plan, develop, implement, and evaluate educational programs and curricula for the professional development of student nurses and RNs. Nurse informaticists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses, and other health care providers. RNs also may work as health care consultants, public policy advisors, pharmaceutical and medical supply researchers and salespersons, and medical writers and editors.

Work environment. Most RNs work in well-lighted, comfortable health care facilities. Home health and public health nurses travel to patients’ homes, schools, community centers, and other sites. RNs may spend considerable time walking, bending, stretching, and standing. Patients in hospitals and nursing care facilities require 24-hour care; consequently, nurses in these institutions may work nights, weekends, and holidays. RNs also may be on call—available to work on short notice. Nurses who work in offices, schools, and other settings that do not provide 24-hour care are more likely to work regular business hours. About 21 percent of RNs worked part time in 2006, and 7 percent held more than one job.

Nursing has its hazards, especially in hospitals, nursing care facilities, and clinics, where nurses may be in close contact with individuals who have infectious diseases and with toxic, harmful, or potentially hazardous compounds, solutions, and medications. RNs must observe rigid, standardized guidelines to guard against disease and other dangers, such as those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In addition, they are vulnerable to back injury when moving patients, shocks from electrical equipment, and hazards posed by compressed gases. RNs also may suffer emotional strain from caring for patients suffering unrelieved intense pain, close personal contact with patients’ families, the need to make critical decisions, and ethical dilemmas and concerns.

Training, Other Qualifications, and Advancement

The three major educational paths to registered nursing are a bachelor’s degree, an associate degree, and a diploma from an approved nursing program. Nurses most commonly enter the occupation by completing an associate degree or bachelor’s degree program. Individuals then must complete a national licensing examination in order to obtain a nursing license. Further training or education can qualify nurses to work in specialty areas, and may help improve advancement opportunities.

Education and training. There are three major educational paths to registered nursing—a bachelor’s of science degree in nursing (BSN), an associate degree in nursing (ADN), and a diploma. BSN programs, offered by colleges and universities, take about 4 years to complete. In 2006, 709 nursing programs offered degrees at the bachelor’s level. ADN programs, offered by community and junior colleges, take about 2 to 3 years to complete. About 850 RN programs granted associate degrees. Diploma programs, administered in hospitals, last about 3 years. Only about 70 programs offered diplomas. Generally, licensed graduates of any of the three types of educational programs qualify for entry-level positions.

Many RNs with an ADN or diploma later enter bachelor’s programs to prepare for a broader scope of nursing practice. Often, they can find an entry-level position and then take advantage of tuition reimbursement benefits to work toward a BSN by completing an RN-to-BSN program. In 2006, there were 629 RN-to-BSN programs in the United States. Accelerated master’s degree in nursing (MSN) programs also are available by combining 1 year of an accelerated BSN program with 2 years of graduate study. In 2006, there were 149 RN-to-MSN programs.

Accelerated BSN programs also are available for individuals who have a bachelor’s or higher degree in another field and who are interested in moving into nursing. In 2006, 197 of these programs were available. Accelerated BSN programs last 12 to 18 months and provide the fastest route to a BSN for individuals who already hold a degree. MSN programs also are available for individuals who hold a bachelor’s or higher degree in another field.

Individuals considering nursing should carefully weigh the advantages and disadvantages of enrolling in a BSN or MSN program because, if they do, their advancement opportunities usually are broader. In fact, some career paths are open only to nurses with a bachelor’s or master’s degree. A bachelor’s degree often is necessary for administrative positions and is a prerequisite for admission to graduate nursing programs in research, consulting, and teaching, and all four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Individuals who complete a bachelor’s receive more training in areas such as communication, leadership, and critical thinking, all of which are becoming more important as nursing care becomes more complex. Additionally, bachelor’s degree programs offer more clinical experience in nonhospital settings. Education beyond a bachelor’s degree can also help students looking to enter certain fields or increase advancement opportunities. In 2006, 448 nursing schools offered master’s degrees, 108 offered doctoral degrees, and 58 offered accelerated BSN-to-doctoral programs.

All four advanced practice nursing specialties require at least a master’s degree. Most programs include about 2 years of full-time study and require a BSN degree for entry; some programs require at least 1 to 2 years of clinical experience as an RN for admission. In 2006, there were 342 master’s and post-master’s programs offered for nurse practitioners, 230 master’s and post-master’s programs for clinical nurse specialists, 106 programs for nurse anesthetists, and 39 programs for nurse-midwives.

All nursing education programs include classroom instruction and supervised clinical experience in hospitals and other health care facilities. Students take courses in anatomy, physiology, microbiology, chemistry, nutrition, psychology and other behavioral sciences, and nursing. Coursework also includes the liberal arts for ADN and BSN students.

Supervised clinical experience is provided in hospital departments such as pediatrics, psychiatry, maternity, and surgery. A growing number of programs include clinical experience in nursing care facilities, public health departments, home health agencies, and ambulatory clinics.

Licensure and certification. In all States, the District of Columbia, and U.S. territories, students must graduate from an approved nursing program and pass a national licensing examination, known as the NCLEX-RN, in order to obtain a nursing license. Nurses may be licensed in more than one State, either by examination or by the endorsement of a license issued by another State. The Nurse Licensure Compact Agreement allows a nurse who is licensed and permanently resides in one of the member States to practice in the other member States without obtaining additional licensure. In 2006, 20 states were members of the Compact, while 2 more were pending membership. All States require periodic renewal of licenses, which may require continuing education.

Certification is common, and sometimes required, for the four advanced practice nursing specialties—clinical nurse specialists, nurse anesthetists, nurse-midwives, and nurse practitioners. Upon completion of their educational programs, most advanced practice nurses become nationally certified in their area of specialty. Certification also is available in specialty areas for all nurses. In some States, certification in a specialty is required in order to practice that specialty.

Foreign-educated and foreign-born nurses wishing to work in the United States must obtain a work visa. To obtain the visa, nurses must undergo a federal screening program to ensure that their education and licensure are comparable to that of a U.S. educated nurse, that they have proficiency in written and spoken English, and that they have passed either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Examination or the NCLEX-RN. CGFNS administers the VisaScreen Program. (The Commission is an immigration-neutral, nonprofit organization that is recognized internationally as an authority on credentials evaluation in the health care field.) Nurses educated in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom, or foreign-born nurses who were educated in the United States, are exempt from the language proficiency testing. In addition to these national requirements, foreign-born nurses must obtain state licensure in order to practice in the United States. Each State has its own requirements for licensure.

Other qualifications. Nurses should be caring, sympathetic, responsible, and detail oriented. They must be able to direct or supervise others, correctly assess patients’ conditions, and determine when consultation is required. They need emotional stability to cope with human suffering, emergencies, and other stresses.

Advancement. Some RNs start their careers as licensed practical nurses or nursing aides, and then go back to school to receive their RN degree. Most RNs begin as staff nurses in hospitals, and with experience and good performance often move to other settings or are promoted to more responsible positions. In management, nurses can advance from assistant unit manger or head nurse to more senior-level administrative roles of assistant director, director, vice president, or chief nurse. Increasingly, management-level nursing positions require a graduate or an advanced degree in nursing or health services administration. Administrative positions require leadership, communication and negotiation skills, and good judgment.

Some nurses move into the business side of health care. Their nursing expertise and experience on a health care team equip them to manage ambulatory, acute, home-based, and chronic care. Employers—including hospitals, insurance companies, pharmaceutical manufacturers, and managed care organizations, among others—need RNs for health planning and development, marketing, consulting, policy development, and quality assurance. Other nurses work as college and university faculty or conduct research.


As the largest health care occupation, registered nurses held about 2.5 million jobs in 2006. Hospitals employed the majority of RNs, with 59 percent of jobs. Other industries also employed large shares of workers. About 8 percent of jobs were in offices of physicians, 5 percent in home health care services, 5 percent in nursing care facilities, 4 percent in employment services, and 3 percent in outpatient care centers. The remainder worked mostly in government agencies, social assistance agencies, and educational services. About 21 percent of RNs worked part time.

Job Outlook
Overall job opportunities for registered nurses are expected to be excellent, but may vary by employment and geographic setting. Employment of RNs is expected to grow much faster than the average for all occupations through 2016 and, because the occupation is very large, many new jobs will result. In fact, registered nurses are projected to generate 587,000 new jobs, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation.

Employment change. Employment of registered nurses is expected to grow 23 percent from 2006 to 2016, much faster than the average for all occupations. Growth will be driven by technological advances in patient care, which permit a greater number of health problems to be treated, and by an increasing emphasis on preventive care. In addition, the number of older people, who are much more likely than younger people to need nursing care, is projected to grow rapidly.
However, employment of RNs will not grow at the same rate in every industry. The projected growth rates for RNs in the industries with the highest employment of these workers are:

Offices of physicians39%Home health care services39Outpatient care centers, except mental health and substance abuse34Employment services27General medical and surgical hospitals, public and private22Nursing care facilities20

Employment is expected to grow more slowly in hospitals—health care’s largest industry—than in most other health care industries. While the intensity of nursing care is likely to increase, requiring more nurses per patient, the number of inpatients (those who remain in the hospital for more than 24 hours) is not likely to grow by much. Patients are being discharged earlier, and more procedures are being done on an outpatient basis, both inside and outside hospitals. Rapid growth is expected in hospital outpatient facilities, such as those providing same-day surgery, rehabilitation, and chemotherapy.

More and more sophisticated procedures, once performed only in hospitals, are being performed in physicians’ offices and in outpatient care centers, such as freestanding ambulatory surgical and emergency centers. Accordingly, employment is expected to grow very fast in these places as health care in general expands.

Employment in nursing care facilities is expected to grow because of increases in the number of elderly, many of whom require long-term care. However, this growth will be relatively slower than in other health care industries because of the desire of patients to be treated at home or in residential care facilities, and the increasing availability of that type of care. The financial pressure on hospitals to discharge patients as soon as possible should produce more admissions to nursing and residential care facilities and to home health care. Job growth also is expected in units that provide specialized long-term rehabilitation for stroke and head injury patients, as well as units that treat Alzheimer’s victims.

Employment in home health care is expected to increase rapidly in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures.

Rapid employment growth in employment services industry is expected as hospitals, physician’s offices, and other health care establishments utilize temporary workers to fill short-term staffing needs. And as the demand for nurses grows, temporary nurses will be needed more often, further contributing to employment growth in this industry.

Job prospects. Overall job opportunities are expected to be excellent for registered nurses. Employers in some parts of the country and in certain employment settings report difficulty in attracting and retaining an adequate number of RNs, primarily because of an aging RN workforce and a lack of younger workers to fill positions. Enrollments in nursing programs at all levels have increased more rapidly in the past few years as students seek jobs with stable employment. However, many qualified applicants are being turned away because of a shortage of nursing faculty. The need for nursing faculty will only increase as many instructors near retirement. Many employers also are relying on foreign-educated nurses to fill vacant positions.

Even though overall employment opportunities for all nursing specialties are expected to be excellent, they can vary by employment setting. Despite the slower employment growth in hospitals, job opportunities should still be excellent because of the relatively high turnover of hospital nurses. RNs working in hospitals frequently work overtime and night and weekend shifts and also treat seriously ill and injured patients, all of which can contribute to stress and burnout. Hospital departments in which these working conditions occur most frequently—critical care units, emergency departments, and operating rooms—generally will have more job openings than other departments. To attract and retain qualified nurses, hospitals may offer signing bonuses, family-friendly work schedules, or subsidized training. A growing number of hospitals also are experimenting with online bidding to fill open shifts, in which nurses can volunteer to fill open shifts at premium wages. This can decrease the amount of mandatory overtime that nurses are required to work.

Although faster employment growth is projected in physicians’ offices and outpatient care centers, RNs may face greater competition for these positions because they generally offer regular working hours and more comfortable working environments. There also may be some competition for jobs in employment services, despite a high rate of employment growth, because a large number of workers are attracted by the industry’s relatively high wages and the flexibility of the work in this industry.

Generally, RNs with at least a bachelor’s degree will have better job prospects than those without a bachelor’s. In addition, all four advanced practice specialties—clinical nurse specialists, nurse practitioners, nurse-midwives, and nurse anesthetists—will be in high demand, particularly in medically underserved areas such as inner cities and rural areas. Relative to physicians, these RNs increasingly serve as lower-cost primary care providers.

Median annual earnings of registered nurses were $57,280 in May 2006. The middle 50 percent earned between $47,710 and $69,850. The lowest 10 percent earned less than $40,250, and the highest 10 percent earned more than $83,440. Median annual earnings in the industries employing the largest numbers of registered nurses in May 2006 were:

Employment services $64,260
General medical and surgical hospitals $58,550
Home health care services $54,190
Offices of physicians $53,800
Nursing care facilities $52,490

Many employers offer flexible work schedules, child care, educational benefits, and bonuses.

The above wage data are from the Occupational Employment Statistics (OES) survey program, unless otherwise noted. For the latest National, State, and local earnings data, visit the following pages:
Registered nurses

Job outlook for Filipino nurses no longer as bright


Days before the June 1 and 2 nursing board exams, 20-year-old Myla Bantog offered two eggs in St. Claire’s Parish in Quezon City to chalk up her chances of passing the test. She also prayed novenas in various parishes, one of which is the Lady of Manaoag Parish in Pangasinan, to seek spiritual guidance for the exams. She also sent and received good luck-text messages.

From the eggs to the prayers, these rites indicate the importance of the nursing profession to many Filipinos families. Around 65,000 nursing students are expected to take the exams on Sunday and Monday.

High costs

The stakes for taking up nursing are high. A nursing college education costs at least P300,000. But that’s not all. After finishing the four-year course, there are fees and other expenses for a series of qualifying exams.

Take the board exams today. Prior to taking these tests, nursing students spent around P10,000-P15,000 for review centers. Hundreds of pesos were shelled out for reviewer materials. They also paid a P900 exam fee.

And the expenses don’t stop after these exams.

Those who want to work in the United States, which is the dream destination for many nursing students, have to spend around P19,000-P25,000 to review for the National Council Licensure Examination (NCLEX), a standardized qualifying test.

But before they can take the NCLEX, they need to pass the Commission on Graduates of Foreign Nursing Schools (CGFNS) and English proficiency tests, such as the International English Language Testing System (IELTS), to secure a CGFNS Certification Program Certificate.

Passing the CGFNS test is one of the requirements for an occupational visa in the US. Taking it means shelling out around $450 or around P19,000. In addition, the IELTS costs around P8,000.

Of course, there’s tuition to begin with, which ranges from P50,000 to P80,000 per semester.

The financial burden of a nursing education is inarguably big, but the fruits reaped from this profession are considered commensurate with the costs.

Nurses in the US with a one-year experience have a median salary of $50,000, or around P2 million. In Saudi Arabia, compensation for staff nurses ranges from $23,000 - $33,000, or around P1 million a year.

But these financial rewards will only be enjoyed if the nursing student becomes a practicing nurse.

Going down

So for those who have difficulty passing the nursing board exams, desperation often sets in.

“Magpakamatay na lang kaya ako (Maybe I should just kill myself),” said Flor (not her real name), a nursing graduate, who asked not to be named. She spoke with abs-cbnnews.com/Newsbreak last March, after she found out that she is no longer eligible to re-take tests III and V of the board exams for a third time.

Flor was one of those who took the controversial June 2006 board exams, where a leak took place. The Court of Appeals ordered the conditional retake of tests III and V, but the CGFNS put its foot down by insisting it would not issue VisaScreen certificates, required for entry to the US, for the June 2006 exam takers.

In December 2007, Flor took the tests for the second time but failed to pass. When abs-cbnnews.com/Newsbreak interviewed her in the Professional Regulatory Commission (PRC) last March, she was waiting in front of the office of PRC chair Leonora Rosero-Tripon. She was going to appeal to the chair to let her take the tests another time, even if it may mean revocation of her license.

“I am willing to give up my license. Just let me take the board exams again,” she said.

But even if she passes the tests, the data shows that her chances of landing a job in major job destinations are slim.

POEA data shows a decline in deployment of new hires. (See page 42 of POEA table). From a high of 13,822 deployed new hires in 2001, deployment decreased to 8,528 in 2006. Significant drops in deployment of new hires happened in the following receiving countries:

· Saudi Arabia: from 5, 626 in 2004 to 2,886 in 2006;

· United Kingdom: from 800 in 2004 to 139 in 2006;

· US: from 373 in 2004 to 133 in 2006;

· Kuwait: from 408 in 2004 to 191 in 2006;

· Qatar: from 318 in 2004 to 38 in 2006;

What then lies ahead for Filipino nurses?

In her study, “Producing the ‘World-Class’ Nurse: The Philippine System of Nursing and Education Supply,” Kristel Acacio, a doctoral candidate of the Department of Sociology in the University of California, said nursing graduates who can’t find a job abroad can go into three alternative fields: teaching, medical transcription, and call centers.

Acacio warned that if deployment of nurses continues to slow down, the Philippines will face a “great surge in unemployment as well as underemployment.”

Beyond nursing

Grace Abella, vice president of the Personnel Management Association of the Philippines told abs-cbnnews.com/Newsbreak in an earlier interview that students and parents should look beyond nursing and consider alternative courses such as accountancy, engineering and information technology (IT) courses.

“Companies here and abroad are always looking for accountants, engineers, IT experts. Students should take up courses related to such professions,” she said. Deployment of IT new hires has risen since 2004. (See table 26 of POEA table)

Another alternative is to take up science courses since many doctors and scientists have also left the country.

Dr. Manuel Francisco Roxas, chief of the Colorectal Surgery Division of UP-PGH, said the country badly needs scientists, agriculturists, and other professionals who can help improve Philippine competitiveness.

However, as long as the country does not pay its scientists well, Filipinos are expected to still gamble on nursing. Data from the Commission on Higher Education (CHED) shows that nursing enrollees have gone up more than sixteen times since 1999, when only around 27,000 chose to take up nursing. In 2006, 453, 896 Filipinos enrolled in the nursing program.

Times have changed a great deal since the days of Florence Nightingale, the British nurse who committed her life to nursing because she wanted to serve the poor. For many Filipinos, nursing is now their best hope of becoming rich.