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Picture this: It’s your very first day at your new job and you’re nervous. You walk into your new office and are suddenly relieved when you find out there is a fun onboarding process in store. The onboarding process confirms that you made a good decision by accepting this job and you look forward to your future with this company.

The importance of an enjoyable and effective onboarding process should not be overlooked. It can help new employees feel welcome and make it easier for them to adjust to their new position and your company culture. Here are some tips that can help you ensure a positive onboarding experience for your new employees. Writer, Christopher Connolly, shares a few ideas.

Play Icebreakers

If you have multiple new employees, consider playing icebreaker games so they can all get to know one another. Two Truths and a Lie, Five Favorites, and Would You Rather are all examples of some great icebreaker games. They can truly “break the ice” and help your new employees feel more comfortable at their new company.

Arrange a Special Lunch

Treating new employees to a special lunch is a nice gesture that they’re sure to appreciate. Consider taking them out to a local restaurant near your office or hiring a catering company to prepare a tasty meal. If the weather is nice, you can host an outdoor BBQ, complete with activities such as cornhole or sack races.

Create a Company Trivia Game

One of the main goals of onboarding is to educate new employees on your company history, products and services, and management team. A fun way to do this is to create a trivia game that revolves around your company and can help new employees learn everything there is to know about your mission, culture, and more.

Time Sessions Appropriately

New employees don’t want to sit through three straight days or weeks of onboarding. Rather than doing all your onboarding at once, mix things up and host multiple onboarding sessions throughout their first week or month. This way, they’ll be more likely to be engaged and you’ll receive their full attention.

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Many nursing students are graduating and looking for employment. While some may know exactly where they want to work, others might just be ready for a change and want to move across the country.

As a result, it’s good to have information about what states are the best and worst for nurses.

In a recent analysis, WalletHub, a personal finance website, compared all 50 states as well as the District of Columbia “across 21 key metrics that collectively speak to the nursing-job opportunities in each market” and determined that the top ten best states for nurses are:

  1. Oregon
  2. Minnesota
  3. Washington
  4. New Mexico
  5. Maine
  6. Montana
  7. Arizona
  8. Nevada
  9. New Hampshire
  10. Iowa

The states expected to have the lowest competition in the field by 2026 are: Nevada, Alaska, Arizona, California, and Washington. Those expected to have the most competition by 2026 are: West Virginia, Nebraska, South Dakota, North Dakota, and the District of Columbia.

This story was originally published by Michele Wojciechowski from Minority Nurse, a trusted source for nursing news and information and a portal for the latest jobs, scholarships, and books from Springer Publishing Company.

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The fourth of July is a celebration of America’s freedom and is celebrated as a Federal holiday. To help Americans everywhere make the most of the holiday, Newsweek has compiled a guide to deals available to help with family BBQs and the summer heat.

July 4 Deals

Old Navy: The store’s annual 4th of July sale started on June 26 and will last through July 7, according to Coupon Follow. Deals will be up to 60 percent off everything.

Off Broadway Shoes: Make the most of the clearance event with up to 70 percent off, plus buy one, get one for 50 percent off now through July

Safeway: According to Coupon Follow, the supermarket is offering up to $80 off four purchases

AJ Madison: Get up to 50 percent off home appliances through July 10, according to Coupon Follow.

HobbyLobby: Get 40 percent off any regular priced item.

Lowe’s: Now through July 10, shoppers can find major savings online and in-store on all the items they need to get their home ready to host the hottest family barbecue (while keeping cool inside) or complete those summer projects, the company told Newsweek.

Discounts include up to 30 percent off select grills, up to $600 Lowe’s gift card when buying two or more select major appliances, and $60 off Nest Learning third generation thermostats.

Serta: The mattress company is celebrating the red, white and blue by helping customers save some green. Purchase a Serta iComfort or iComfort Hybrid mattress between June 19 and July 8 and receive up to $200 in savings, the company told Newsweek. Plus, save up to $400 on a qualified Serta adjustable foundation.

Sonny’s BBQ: Guests can enjoy a meal deal for four with a whole chicken, pound of pulled or sliced pork, three pint-sized sidekicks and choice of bread for just $29.99, the company told Newsweek. Add a rack of ribs for $12. Take out only. Offer valid on July 4-7 at 70 participating locations.

Awara: The eco-friendly and non-toxic mattress brand is offering $200 off all mattresses through July 8, the company told Newsweek.

Cumberland Farms: From now until Labor Day, customers can stop by any of the brand’s retail locations across the northeast of the U.S. and Florida to purchase any small or large Chill Zone beverage for 79c, the company told Newsweek. The deal includes your typical fountain drink sodas as well as a wide variety of Chill Zone beverage options, including frozen HYPERFREEZE with flavors like the signature Cotton Candy Commander and Berry Backlash.

Home Depot: The company told Newsweek that there are discounts across the store, from furniture to tableware to small kitchen appliances. These deals are available until July 7, including up to 40 percent off select furniture, 30 percent off select small kitchen appliances and 30 percent off select bedding & bath.

Miguel’s Jr: For the first time in 46 years, the restaurant will be open on the Fourth of July and will celebrate the holiday by offering fans Original (Since 1975) Burritos for just $4, the company told Newsweek.

Bones Coffee: In a newsletter sent to customers, the online brand is offering up to 20 percent off for July 4. Play the Spin and Save game to get the discounts.

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Update to the Enhanced Nursing Licensure Compact (eNLC)

On January 19, 2018 the enhanced Nurse Licensure Compact (eNLC) was implemented.  The enhanced Nurse Licensure Compact increases access to care while maintaining public protection at the state level.  Under the eNLC, nurses are able to provide care to patients in other eNLC states without having to obtain additional licenses. 

Two additional states have been added to the list of Nursing Licensure Compact (NLC) member states:  Louisiana (RN and PN) and Kansas.  These states will officially become members of the compact on July 1, 2019.

The original compact dissolved July 18, 2018.  Rhode Island is no longer a compact state as of 7/18/2018.

For nurses currently holding LA or KS state licenses, they will need to apply to their state Board of Nursing for a compact license.  This may take some time due to finger printing and other requirements.  Nurses currently holding compact licenses from other compact states will be eligible to work in LA and KS after July 1, 2019.

Nursing Licensure Compact Member States:  Alabama (1/1/2020), Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana (TBD), Iowa, Kansas, Kentucky, Louisiana RN, Louisiana PN, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia RN, West Virginia PN, Wisconsin, Wyoming.

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Travel nursing can be an awesome career opportunity, but many nurses who are married and/or have kids hesitate to try it out or discount it all together. Leigh Ann from thewhatnextmom.com tells us that there’s a good reason for this: it’s not easy. At all. Travel nursing can be a great way to get more experience, earn more money, and see new places. It’s not always as amazing as it sounds, but it can be a once-in-a-lifetime opportunity for many. Can you make it as a travel nurse family? Read more from Leigh Ann to decide for yourself!

Our travel nurse family.

Last year, we decided to uproot our family of three and embark on a travel nursing adventure. There were a lot of factors that went into our decision. We were burnt out on jobs and home ownership. We were craving new scenery and opportunity. Maybe the two of us were having a bit of an early midlife crisis together? Either way, we decided to leave all known stability and support systems and move far, far away for a really unstable career. Crazy, right? Yeah, pretty much.

Not impossible, though! For the determined and extremely flexible souls out there, it’s entirely possible. Here are some major factors to consider when deciding if the travel nurse life is right for your family.

Childcare and household management.

This may seem like an obvious one, but who is going to take care of the kid(s)? Ideally, the non-nurse spouse or partner would stay home with the kids while on assignment. Perhaps one spouse works from home. Perhaps he or she becomes the stay-at-home parent, as I did. For the first time since age 16, I have the opportunity to be “unemployed,” and it’s working out well for us. I took a leave of absence from teaching to become our household’s manager on the road. I care for our toddler while my husband works. Our housing and moving logistics fall to me, as well as our finances and a lot of the paperwork for each agency job. I’m the resident adventure planner and travel agent. I find time to cook and clean some things every once in awhile too.

Childcare woes.

As a couple, we are fiercely protective of our time together. One might say we are a little selfish about it, and that’s probably fair. Maybe it’s because we had our child nine years into our marriage, so she’s definitely a newcomer to this relationship. Maybe it’s because it’s been “Ethan and Leigh Ann” for more than half our lives, so we don’t know any better. Yeah, our first date was the sophomore homecoming dance… Maybe we just really like each other and our kid is kind of stressful. Whatever it is, we get really, really grumpy when we don’t get to have date nights. Moving away from family and friends who were willing and eager to babysit? Not cool. Totally our choice, and a price we accepted, but it’s been a struggle.

If you are going to leave a support system to begin travel nursing with kids, be sure to consider this aspect.

Childcare resources:

Drop-in daycares. Do a quick Google search for drop-in daycares in your destination city. Some have them, some don’t. We have enjoyed using KidsPark, which has several locations in the U.S. I find that these are a little few and far between, though, especially if you travel to a smaller city.

Urban Sitter. This is an app and website that offers babysitters and nannies based on personal recommendations from parents in your city. Kind of like Yelp for childcare? The site/app allows you to browse profiles of sitters and read reviews from real parents. You can view their experience, background check status, pay rates and response times. It’s a very user-friendly option if available in your city. Care.com is another well known service for connecting with sitters and nannies.

On the bright side…

This is pretty much the only way I could leave my job to stay home with our child. Short of moving to a tiny apartment in a bad part of town, we could not have afforded a single income. As the stay-at-home spouse, I can honestly say that all this madness has been worth it. I get frustrated and exhausted and burnt out, like any other stay-at-home parent, but I have been gifted a year to focus on my daughter, my marriage, and my own wellness. The days still feel too short and the to-do list still feels miles too long, but I also feel more balanced than I have ever before. Going home means I have to return to the workforce, so while I crave the support of willing family and friends, I will also miss the freedom of being able to stay home.

Housing.

You can almost certainly expect to have a harder time finding housing, and it won’t be cheap. We have to find places that are at least two bedrooms, which is not super common for short-term housing. There seem to be a lot of studios, rooms for rent, and one bedroom units available on various travel nurse housing sites. Two+ bedrooms? Not so much. We have managed to find housing each time, but we have paid more than we wanted on a few occasions.

Some families choose to live the RV life. We considered it, but we couldn’t justify the expense of purchasing one when we only intended to travel for about a year. It can be a good option for some, though. It’s especially worth considering if you already have a vehicle capable of towing an RV, which we did not.

Another option is to take the housing provided by your travel nurse agency. Your mileage may vary on this: some companies offer better housing than others. A lot of the time, you end up with less take-home pay with company housing because you lose the tax-free benefits of the housing stipend. The math has never worked out for us in favor of company housing.

My top resources for finding housing:

  • Airbnb. This has been my number one choice for housing. There are a lot of housing scams out there, so going through a reputable company like Airbnb keeps me feeling secure. We have never had a bad experience in over five years of using the service.
  • FurnishedFinder.com
  • Facebook groups for travel nurse housing. Most of these are closed groups, which means you have to request to join. Search for Travel Nurse Housing or Gypsy Nurse Housing.

Transportation and Moving Logistics.

Traveling with a family means you have to consider the quantity of stuff you’ll be bringing. Does everyone get a tote of clothes and personal items? Will those totes fit in your vehicle? Do you want/need to take larger items with you? Do you need space for toys? A crib? Our little Ford Escape was definitely not big enough to haul everything we wanted to bring with, so we’ve had to get creative. Here are the different ways we’ve tackled the moving process:

U-Haul was our first choice. We had a trailer hitch installed and then rented a 4×8 trailer for the initial move.

We purchased a cargo trailer but then sold it after one move because it was a bit too big for our vehicle. The good news is that cargo trailers tend to hold their resale value extremely well, so our purchase ended up being a wash.

Lastly, we went on a major minimizing spree and outfitted our car with a rooftop cargo box and a rear cargo basket. It was a super tight fit, but we made it work. The rooftop box is definitely my favorite solution because we can use it for shorter trips, like our camping excursion to Joshua Tree.

Travel nurse agencies will reimburse you for some travel expenses, but typically it’s not enough to cover the full cost of the move. Be sure to factor that in when you are deciding if this is the life for you.

Is it worth it?

Our goal for this year was to embark on an adventure together, and we have certainly accomplished that. My husband and I have always said that our relationship works best when we have a project to work on together, and this has certainly fit the bill. It has not been easy, but let’s be honest. Life back at home wasn’t easy either. The challenges were different, maybe a bit less extreme and more mundane, but they were still plentiful.

So yes, for us it has been worth it. Will it be worth it for you? That’s a question you’ll have to tackle together with your family.

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There are vaccinations available to protect healthcare workers from contracting Hepatitis B and it is recommended that all employees take advantage of that protection. However, there aren’t vaccinations to protect against Hepatitis C or HIV, which are incurable diseases. The best way to avoid contracting these deadly diseases is to avoid needlestick injuries. Anyone coming into contact with needles is at serious risk of getting Hepatitis or HIV. This includes nursing staff, doctors, laboratory workers, housekeeping staff and sanitation workers.

Needlestick injuries most commonly occur when:

  • Needles are recapped
  • Needles are not disposed of properly in a puncture-proof container, or safety box
  • Body fluids are transferred after collection

To reduce your chances of contracting serious diseases:

  1. Avoid administering an injection when there is an equivalent oral medication, which can be even more effective.
  2. Avoid recapping needles and place them in a puncture-proof safety box immediately after usage.
  3. Plan ahead how you are going to safely handle and dispose of needles.
  4. Get a Hepatitis B vaccination.
  5. Remind colleagues about the dangers of not safely handling needles.
  6. Don’t overfill safety boxes where used needles are stored. They shouldn’t be more than ¾ full.
  7. Don’t open or empty the safety box and store it in a safe, dry place until it can be disposed of properly.
  8. Report a needle-stick injury for testing and to be treated.

Safeneedle.org

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Human trafficking is a major public health problem, both domestically and internationally. Health care providers are often the only professionals to interact with trafficking victims who are still in captivity. The expert assessment and interview skills of providers contribute to their readiness to identify victims of trafficking. The purpose of this article, written by Tiffany Dovydaitis, RN, WHCNP RN, WHCNP, is to provide clinicians with knowledge on trafficking and give specific tools that they may use to assist victims in the clinical setting. Definitions, statistics, and common health care problems of trafficking victims are reviewed. The role of the health care provider is outlined through a case study and clinical practice tools are provided.

Human trafficking is a global public health problem. Although difficult to quantify because of its underground nature, there are approximately 800,000 people trafficked across international borders annually. Of those, 80% are women or girls; 50% of these females are minors. In the United States alone, 50,000 persons are trafficked into the country every year, and there are approximately 400,000 domestic minors involved in trafficking. These statistics easily debunk the common myths that human trafficking only happens in other countries and that those who are trafficked in the United States are always of international origin. In fact, the United States is one of the largest market/destinations for trafficking in the world, second only to Germany.

Health care providers are one of the few professionals likely to interact with trafficked women and girls while they are still in captivity. One study found that 28% of trafficked women saw a health care professional while still in captivity. This represents a serious missed opportunity for intervention. Health care providers are in a unique position to identify victims of trafficking and provide important physical and psychological care for victims while in captivity and after. This article provides clinicians with knowledge on trafficking and offers specific tools that they can use to assist victims in the clinical setting.

According to the US Department of State, human trafficking is “The recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.” Sex trafficking is “when a commercial sex act is induced by force, fraud, or coercion, or when the person induced to perform such an act has not attained 18 years of age.” A victim need not be physically transported from one location to another in order for the crime to fall within these definitions.

Sex trafficking and prostitution are not the same, but the distinction between the two is subtle and difficult to define. The literature on the conceptual differences is conflicting and largely dependent on the author’s beliefs about legalized prostitution. The main distinctions made in the literature between trafficking and prostitution are consent and coercion. Sex trafficking and prostitution are similar in that both are exploitive; women may suffer sexual assault by clients and/or pimps; and women may suffer extreme stress reactions, trauma, depression, and multiple medical problems

Differences Between Prostitution and Sex Trafficking

Prostitution Sex Trafficking
Woman is generally aware of the type of work in which she will participate (voluntary involvement) Woman is generally unaware of the type of work she will be doing (involuntary involvement)
Women work independently or with a pimp Women always have a pimp or trafficker
Commonly work in the same geographic location Commonly are moved by the trafficker to different locations
Women are paid Women are generally not paid
May be legal or illegal Always illegal
Does not always involve force, fraud, or coercion Always involves force, fraud, or coercion

The International Labor Organization estimates human trafficking to be a $32 billion per year industry. Human trafficking is the third largest source of income for organized crime, and there are twice as many people enslaved today as during the African slave trade. Human trafficking involves forced labor, bonded labor, debt bondage among migrant laborers, involuntary domestic servitude, forced child labor, child soldiers, and sex trafficking. Individual victims suffer from numerous physical and psychological problems, but trafficking undermines the health, safety, and security of all nations it touches. With the onset of a global financial crisis, there has been a shrinking global demand for labor and a growing supply of workers willing to take additional risks for employment. These trends will likely increase the numbers of persons trafficked in the coming year. The two largest source countries for trafficked persons in the United States are Mexico and East Asia, but victims also come from South Asia, Central America, Africa, and Europe.

COMMON WAYS GIRLS AND WOMEN BECOME VICTIMS OF TRAFFICKING
  • Abduction
  • Meet traffickers advertising modeling jobs
  • Promises of marriage, education, employment, or a better life
  • Respond to ads to work or study abroad
  • Seek the help of smugglers to get into the United States—and then debt bondage ensues
  • Sold to traffickers by parents or intimate partner

One of the most common questions that are asked about trafficking victims is, “Why do they stay?” Although there are certainly instances when traffickers forcibly hold victims captive, more commonly victims appear able to walk away at any time. Debt bondage, control of the victim’s money, and confiscation of passports, visas, and identifying documents are common ways that traffickers maintain control. For example, a woman might promise to pay a coyote to smuggle her across the border to the United States from Mexico. When she arrives in the country, she will be thousands of dollars in debt and must “work off” her debt in agricultural, hospitality, housekeeping, or other types of work. It is likely that a large portion of her wages will go to the trafficker during her first year in the United States or longer. Until she is able to pay, she may face physical threats against herself and her family, sexual harassment and assault, housing in squalid conditions, restriction of movement, and threats of deportation if she tries to escape. Traffickers may charge exorbitant interest and fees, making it difficult for her to ever pay her debt. Because she is in the United States illegally, it is unlikely that she will report any exploitation by her employer and/or trafficker, for fear of deportation.

Traffickers also use isolation from family, friends, and the public to keep their victims in captivity. Limiting contact with outsiders and ensuring that any contact is superficial in nature will ensure that the victim does not begin to build any social support networks in the community. Also, moving victims from place to place decreases the likelihood that the victim will form relationships and/or be recognized. Perhaps most insidious, the victims are almost always subjected to harsh psychological and physical abuse, including repeated rape, in order to keep the victim submissive. According to one study, trafficking victims generally only see three ways of escape from their situation: 1) to become unprofitable because of trauma, emotional breakdown, or advanced pregnancy; 2) to be helped by a client; or 3) death.

HEALTH PROBLEMS ASSOCIATED WITH TRAFFICKING

The health problems seen in victims of trafficking are largely a result of several factors: deprivation of food and sleep, extreme stress, hazards of travel, violence (physical and sexual), and hazardous work. Because most victims do not have timely access to health care, by the time they reach a clinician it is likely that health problems are well advanced. These women are at high risk for acquiring multiple sexually transmitted infections and the sequelae of multiple forced and unsafe abortions. Physical abuse and torture often occur, which can result in broken bones, contusions, dental problems (e.g., loss of teeth), and/or cigarette burns.

Psychological violence results in high rates of posttraumatic stress disorder, depression, suicidal ideation, drug addiction, and a multitude of somatic symptoms. When providers were asked in one study about their experiences working with victims of trafficking, they reported that these victims are less stable, more isolated, have higher levels of fear, more severe trauma, and greater mental health needs than other victims of crime. One trafficking victim can take the same amount of the provider’s time as 20 domestic violence victims.

COMMON HEALTH PROBLEMS AMONG TRAFFICKING VICTIMS
  • Anxiety
  • Chronic pain
  • Cigarette burns
  • Complications from unsafe abortion
  • Contusions
  • Depression
  • Fractures
  • Gastrointestinal problems
  • Headaches
  • Oral health problems
  • Pelvic pain
  • Posttraumatic stress disorder
  • Sexually transmitted infections
  • Suicidal ideation
  • Unhealthy weight loss
  • Unwanted pregnancy
  • Vaginal pain

CLINICAL IMPLICATIONS: CARING FOR A VICTIM OF HUMAN TRACKING

The Campaign to Rescue and Restore Victims of Human Trafficking provides a list of possible clues that someone may be a victim of trafficking: 1) evidence of being controlled; 2) evidence of an inability to move or leave a job; 3) bruises or other signs of battering; 4) fear of deportation; 5) non–English speaking; 6) recently brought to this country; and 7) lack of passport, immigration, or identification documents. Although this list of clues could be used for multiple other problems (e.g., domestic violence), they indicate the need for further investigation by the provider.

Victims will likely fear authority figures and be reluctant to give out personal information, so interviewing the client can be difficult. The first steps to a successful encounter are getting the client alone (victims are often accompanied by another person), finding an interpreter if necessary, and building a trusting rapport with the client. Because the client is unlikely to identify herself as a trafficking victim, the provider needs to pay attention to subtle and nonverbal cues.

Treatment

Responding to all of the victim’s physical and emotional needs is outside of the scope of the individual provider’s practice, because the client will need long-term treatment with an interdisciplinary team of health care professionals. The provider should care for any immediate needs, including treatment of physical trauma, sexually transmitted infections, diagnosis of pregnancy, and assessing for suicidal ideation.

Making a Plan

Once a victim of trafficking is identified, the clinician and client will need to put together a plan of care. The health care provider should be aware of the following: 1) the provider cannot force the victim to report the crime, and 2) the victim and/or victim’s family may be at risk for immense harm if she reports the crime. If the victim is a minor, the provider is under legal obligation to phone child protective services.

The plan of care will be client-specific, but the provider should consider phoning the National Human Trafficking Resource Center (1-888-373-7888). This national referral line can assist in finding local resources for the victim and developing a safety plan that is acceptable to the client. Because victims of human trafficking have already experienced significant powerlessness, this is an opportunity for the provider to purposively give the client some decision-making ability. For example, the provider and client can anonymously call the referral line together and ask pertinent questions about the client’s situation. Or the provider can give the client a phone, the phone number, and a safe space in which to make the call herself. The clinician is not mandated by law to call anyone (either the referral line or law enforcement) unless the client is under 18 years of age. While the clinician may call the referral line anonymously without the client’s permission, it is not advisable to make an official report without the client’s consent. Please note that this is a gray area and that each clinician will have to make his/her own moral decision regarding the reporting of suspected trafficking.

If the client does contact the National Human Trafficking Resource Center, the staff member on the line can help the victim get to a safe place. Once in a safe location, the victim can choose to pursue the certification process, which is part of the Victims of Trafficking and Violence Protection Act. Certification provides the victim with the documentation required to remain in the United States legally and receive benefits and services under federal/state programs. If the victim is already a US citizen or a minor, she does not need to apply for certification, because she is already eligible. Examples of federally funded services and benefits are health care, translation, witness protection, legal representation, job training, transportation, and access to housing. In order to be certified, the victim must meet the following criteria: 1) be a victim of trafficking; 2) be willing to assist with the investigation and prosecution of trafficking cases (or be unable to cooperate because of physical or psychological trauma); and 3) have completed an application for a T visa.

When a victim is undocumented, deportation will likely be of great concern and a possible barrier to reporting a crime. In response to this reality, the US Department of Justice created the trafficking visa (T visa), which allows the victim (and certain family members) to remain in the United States legally if the victim complies with “reasonable requests for assistance in the investigation or prosecution of acts of trafficking.” Recipients of the T visa are eligible for legal employment and can become lawful permanent residents after 3 years. Even with the availability of the T visa, the undocumented immigrant cannot be completely assured that she will not be deported if denied the visa, and it is important for the provider to not make any promises about immigration status.

As the omniscient reader of the case study presented, how might you advise the clinician to proceed? There are multiple possible outcomes to this scenario. Two possible outcomes are:

The clinician conducts a medical history and physical examination with the help of the unknown male as interpreter. After taking cervical cultures for gonorrhea and chlamydia, the clinician makes a presumptive diagnosis of pelvic inflammatory disease (PID) and gives S.M. a prescription for antibiotics. She explains the serious nature of PID to S.M. and the importance of having her sexual partner tested. She makes a follow-up appointment, the clinician thanks the male for interpreting, and S.M. leaves the clinic with him. S.M. does not return for her next appointment.

The clinician begins obtaining S.M.’s history with the help of the unknown male as interpreter. She also asks the office secretary to try and find a language line interpreter who speaks Mixteco. She conducts her physical examination and collects cervical cultures for gonorrhea and chlamydia. She makes a presumptive diagnosis of PID and gives S.M. a prescription for antibiotics. The office secretary informs the clinician that she’s found an interpreter on the language line, who speaks Mixteco. The clinician asks the male to leave the room, explaining that she would like to talk to S.M. alone about her medications. The male argues with the clinician, but leaves the room when she insists. Using the language line, the clinician is able to talk with S.M. freely. After some time has passed, S.M. begins to cry and tells her about the multiple sexual partners and the threats of the smuggler. The clinician talks with S.M. about trafficking and validates her fears. Together they make the decision to call the National Human Trafficking Resource Center and ask for advice on how to proceed. Through this phone call, the clinician and S.M. are connected with a local crisis center that assists S.M. with an escape from her smuggler and trafficker. S.M. and her child are safely sheltered and the process of applying for a T visa and certification begins. The clinician learns later that through the certification process, S.M. was able to stay in the US legally and bring her mother and other children over safely as well. A police investigation is ongoing.

CASE STUDY

S.M. is a 26-year-old female who came to the United States from Mexico 2 years ago. She is from a small Mixtec farming community in Oaxaca and speaks Mixteco fluently. She speaks some Spanish and no English. S.M. left two young children behind in Mexico with her mother and came to the United States with her boyfriend and the help of a smuggler. She was told that when she arrived in the United States, she would be able to find work and pay the smuggler back the nearly $8,000 she owed for safe passage across the border. After paying her debt, she had plans to remit money to her mother in Mexico for the care of her children, hoping that they might eventually join her in the United States.

During the border crossing, S.M. walked for days in the Arizona desert with little food or water. Her boyfriend was not able to protect her during the crossing, and she was robbed and gang raped by a group of bandits. Upon arrival to the United States, she was transported to New Jersey, where she was placed with a family as their nanny. Shortly afterward, she discovered that she was pregnant with her third child. Her boyfriend found seasonal work nearby picking tomatoes, but when the season ended he disappeared, leaving her behind.

The New Jersey family treats her well and she enjoys caring for their two young children in addition to her own one and a half–year-old. They pay her $6 an hour and give her a room. Recently, the smuggler has been making harassing phone calls to the house about the money he is still owed, and S.M. is worried she will lose her job if he does not stop calling. She has been unable to pay him back because he continues to charge her high interest on her debt. He has threatened to harm her mother and children in Mexico if she does not pay him back soon. Fearing for her job and the lives of her family in Mexico, S.M. agreed to pay back some of her debt by having sex with the smuggler and his friends. She does not see any end in sight.

S.M. is being seen at the clinic today for abdominal pain, unusual vaginal discharge with a foul odor, painful intercourse, painful urination, and irregular menstrual bleeding. A male (the smuggler), who is interpreting for her, accompanies her into the examination room. He states that he is her boyfriend and is holding their child. There is no one at the clinic that speaks Mixteco.

DISCUSSION

The above case study serves as one example of how a trafficking victim might be completely missed or identified and assisted. The story of S.M. is not uncommon, and clinicians must consider the varied ways in which a trafficking victim might present in the clinic, at the office, in the hospital, or in the community. There are no easy answers, and the process is more likely to be frustratingly long and complicated than straightforward and simple.

The same complexities that exist in the clinical setting also make research in this area difficult. The population is hard to find because of its underground nature, and most studies have very small sample sizes. The involvement of organized crime can also make it a dangerous research topic. Because trafficking happens among men, women, and children in just about every country in the world, generalizability is problematic. Even the definition of trafficking is sometimes contentious among researchers. The exact numbers of trafficked persons are only estimates, and in many cases the statistics are provided without explanation as to methods used to obtain them. Both methodologic and ethical issues are complex, whether researching the trafficking victim or the trafficker.

If research in this area is to progress, the multiple disciplines that study trafficking issues will need to work together and develop a consistent theoretical framework with which to address the problem. Governments and law enforcement agencies should share trafficking data with researchers so that larger studies can be conducted. Research on traffickers themselves should be developed. Agencies that work with trafficking victims should work with researchers to develop best practices for the treatment of these individuals.

CONCLUSION

Human trafficking is a major global health problem, one that all health care providers cannot ignore. Although trafficking victims are unlikely to have adequate and timely access to health care, some victims will be seen in women’s health care practices for STIs, pregnancy, and/or abortion services. Health care providers should be prepared to identify, treat, and assist victims of trafficking as part of their regular clinical practice.

Acknowledgments


Tiffany Dovydaitis, RN, WHCNP would like to acknowledge the New Jersey Chapter of The American College of Nurse-Midwives for their interest in this topic and commitment to the women of New Jersey. Specifically, she would like to thank Grace Fimbel, CNM, of Princeton Midwifery Care for her encouragement and support.

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This husband and wife team currently work in the Critical Care unit in the state of Georgia. Both Starla and David received a number of nominations for the Daisy Award due to their compassion, knowledge and caring for both the patients and the family members. In addition, going above and beyond by even helping one patient find lower cost medication and healthcare benefits. They both were surprised and thrilled to win this prestigious award.

Accountable Healthcare Staffing has partnered with the DAISY Foundation to recognize clinicians for the extraordinary skillful, compassionate care they provide patients and families. The DAISY Award is an international recognition program that honors and celebrates the skillful, compassionate care nurses provide every day.

The DAISY Foundation was established by the family of J. Patrick Barnes after he died from complications of the auto-immune disease ITP in 1999. During his hospitalization, Patrick’s family deeply appreciated the care and compassion shown not only to Patrick, but to all of them as well. When he passed, they felt compelled to say “thank you” to nurses in a very public way.

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When you take a trip to the nation’s capital, you know you’re in for a lot of history, government buildings and museums. You’ll obviously spend some time on the National Mall seeing the monuments, walking through the awesome, free Smithsonian museums, maybe even going on a scheduled tour of the U.S. Capitol Building.

But what about the unconventional, non-touristy, things to do in DC — the things that might not make the list of top things to do lists (check out our 50 Things to Do in Washington DC list!), but will definitely add local flavor and a unique flare to your trip?

Savored Journeys writer, Laura Lynch, has you covered. Below you’ll find the best non-touristy things to do in Washington DC – things that locals do – that will get you off the National Mall and into the real side of DC.

Non-Touristy Things to Do in Washington DC.

These activities will get you off the beaten path and show you a side of DC most people don’t see. Most of these activities can be reached via metro, but some may be easier with a car, or a quick taxi ride.

When you’ve had your fill of monuments and history, take a break from the norm and go a brewery tour of some of the city’s best breweries. DC has enjoyed a burgeoning beer scene over the past few years and you can now find plenty of great breweries in the city, including the first brewery to brew and distribute here, DC Brau, along with Atlas Brew WorksBluejacket Brewery, and Capital City Brewing. There are tons – look them up and try a few!

If you have time, head out to Port City Brewery in Alexandria, VA, one of the best in the area and super popular with the locals. Best to visit there on the off-peak times though. I can get packed! They have great beers to sample in their tasting room every day, and a brewery tour, available on Thursday-Sunday (reservations recommended!). The tour costs around $12 and includes 6 tasters of beer. To get there by public transportation, take the metro to King Street and catch an Uber.

Explore the Local (and Ethnic) Food Scene

Washington DC is a fantastic food city. There are so many new restaurants opening every day, including hot spots like Rose’s Luxury, where you might have to wait in a really long line to get in! Not only will you find hot restaurants by Top Chef contestants like Mike Isabella’s Kapnos and Graffiato (both of which I love), you’ll also find a plethora of ethnic cuisines. Ethiopian is especially popular and you can find an enclave of great Ethiopian restaurants in the Adams Morgan neighborhood. In Washington DC, you can easily eat around the world without ever leaving the city. To decide where to go, see this list by Maria Abroad for the best ethnic restaurants in Washington DC.

I’m also a huge fan of city food tours. It’s a great way to get to know the city, its culture and its restaurants, and can also provide you with a road map for eating during the rest of your vacation. Check out this food tour in the U Street neighborhood, which blends history and food in one of the coolest areas of town. You’ll be regaled with history, info about the food culture of the area and of course you’ll eat a ton of food. And don’t forget the cocktails. Check out this really fun evening cocktail tour!

National Monuments at Night

Okay, so this is a typical tourist activity, but it’s really fun and is a unique experience that you’ll remember and cherish a lot more than the usual way of doing it. Most tourists visit the monuments during the day, when there are huge crowds, daytime heat and very little ambiance. If you wait until night to tour the monuments, you’ll find way less people, a nice cool breeze (unless it’s winter, of course) and the monuments are all lit up at night, which makes the experience so much more amazing.

One of the things I love to do is take a blanket to the Jefferson Memorial and have a picnic or just hang out on one of the pillars at the corners of the stairs. You can stare out at the gorgeous night lights across the Potomac with the towering, illuminated presence of Jefferson at your side.

Logan Circle

If there is one neighborhood that has re-gentrified itself beyond recognition in a very short time, it’s Logan Circle. A new high-end restaurant, cafe or trendy specialty shop opens there seemingly every week. Speaking of restaurants, this is where you want to make all of your dinner reservations, at top spots like Birch & BarleyMasa 14Churchkey and Le Diplomate (don’t miss weekend brunch here!).

It’s a busy area with beautiful old townhouses to gawk at, a lovely park and fountain in the center of the circle and lots of bar and restaurant hopping to do. You’ll almost feel like a local here. Just try to act like one and you’ll fit right in. There are metro stations nearby, but it’ll require a short walk, as Logan Circle doesn’t have its own metro stop.

Mitsitam Cafe at Museum of the American Indian

When you’re walking around the Smithsonian museums and hiking what seems like miles to get from one side of the National Mall to the other, you’ll work up a crazy appetite and then not find any restaurants in the vicinity for lunch. Don’t eat at a boring museum cafe, head over to the Museum of the American Indian (on the Capitol Building side of the mall).

The museum itself is worth a visit if you have the time, but it’s the Mitsitam Cafe here that will amaze you. Mitsitam features indigenous food from around the Western Hemisphere, divided into different regions. Each menu item reflects the food and cooking techniques from the region featured. You can eat entirely from one region or mix and match, plus they have a chef’s tasting experience.

Union Market

Located on 5th St NE in a busy warehouse area off New York Avenue, Union Market is a year-round local market featuring artisan products, food purveyors, and amazing food options from established and pop-up restaurants. Grab some food and relax at one of the communal indoor eating areas or cafe-style outdoor seating. It’s a fun place. to enjoy an afternoon.

Peruse the unique products and sampling food from each of the vendors, including fresh shucked oysters from Rappahannack Oyster Bar, creative sodas like the grapefruit rosemary or lemon lavender at Buffalo & Bergen, Korean kimchi tacos at TaKorean and homemade ice cream at Trickling Springs Creamery. Just make sure you go there hungry or you’ll regret it. The market is closed on Mondays, but open the rest of the week from 11am-8pm. There’s no metro in the immediate area, so you’ll need to drive or take a taxi.

Eastern Market

DC’s original food and art market, Eastern Market is now in its 31st year of service and still going strong. Located in the middle of the Capitol Hill neighborhood, the market features fresh food, community events, and on weekends, local farm-fresh produce and handmade arts and crafts that stretch into outdoor stalls and fills the neighborhood with activity. Like Union Market, it’s just a fun place to walk around and enjoy the local products and mingling with the locals.

H Street Corridor

I love the way the H Street Corridor has completely changed over the last decade. It underwent a major regentrification that turned it into a really fun place to hang out in the city.  Today it’s home to some of the best places to check out new art, with the growing number of art offerings, like City Gallery and Studio H Gallery. If you’re not into art, don’t worry, there’s lot of other things to do. The area has also become a hotspot for cafes and trendy restaurants, top music venues like The Rock and Roll Hotel, and a rowdy nightlife.

We recommend eating at Sally’s Middle Name, and there’s even a 3rd location of the iconic Ben’s Chili Bowl on H Street now. You can get there by way of the NOMA and Union Station Metro stops or by taking the DC Streetcar.

The Torpedo Factory Art Center

If you’re in to art – especially by local artists – you must make the journey to Old Town Alexandria for a look around the Torpedo Factory. The Torpedo Factory is three floors packed with over 80 local artists’ studios, many of whom will be hard at work on their latest creation while you’re visiting. It’s a rare opportunity to see the work in progress, talk to the artists themselves and peruse the art they have on display and for sale. They are open to the public most days from 10am-6pm.

The Torpedy Factory is located on the banks of the Potomac River in Old Town Alexandria (105 N Union St, Alexandria, VA). While you’re there, make sure you wander around Old Town Alexandria for a while (see below). There are tons of cool things to do there.

Old Town Alexandria

There is so much to see and do in Old Town Alexandria. While a bit removed from the downtown core, it’s definitely worth the trip. You can get to the beginning to the Old Town area by taking the metro to King Street (don’t expect to find parking) and beginning your walk south from there, or take the free trolley if you’d rather not walk. You’ll find dozens of shops to browse albeit expensive ones, plenty of sidewalk cafes and some great restaurants. I love Sonoma Cellar, especially for Taco Tuesday and Wine Down Wednesday.

At the end of the street is the Potomac River Harbor that’s packed full of boats and has amazing views and even a few restaurants where you can dine and enjoy the sunset. Chart House is an absolutely must!

Gravelly Point Park

There is a small grassy park less than half a mile from Reagan National Airport, along the George Washington Memorial Parkway, where you can hang out and watch the planes take off and land. It’s actually one of the best parks I’ve been to for this type of activity because it’s a nice park where you can spread out a blanket, have a picnic, hang out with friends, etc. It can get super noisy when the planes are overhead, and the ground shakes a little, but it’s definitely a one-of-a-kind experience worth having.

Kayaking on the Potomac River

If you’re hanging out in Georgetown, you may catch a glimpse of people kayaking on the Potomac River. You can rent a kayak from the Key Bridge Boathouse and take it along the waterway to get a unique glimpse at the Georgetown waterfront, Roosevelt Island (where many locals have never even been), and the underbelly of the Key Bridge itself.

Why not take advantage of working in the DC area with one of the many great nursing opportunities through Accountable Healthcare Staffing? To search our jobs, visit our website at: WashingtonDCJobs@ahcstaff.com or send an email to: DCMetro@ahcstaff.com

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I am an accidental correctional nurse. 

I never imagined I would ever spend my days behind bars in jails and prisons. After working in critical care and orthopedic specialties as a front-line staff nurse and then as an educator, I was looking for a change.

I happened upon a posting for the New Jersey prison system a dozen years ago. My first thought was, “There are nurses in prison?” Thus began my unexpected adventure into this hidden specialty. 

It turns out that my experience wasn’t all that unique. In fact, I’ve found that most correctional nurses find the specialty by accident while looking for work in more traditional settings.

If you are thinking about a career behind bars, you may find some surprises. Here are five things I wish I knew before becoming a correctional nurse.

1. It is safer than you think

I am frequently asked if it is safe to work in a jail or prison. After all, the patients are criminals, right?  While this is true, the security processes in correctional facilities provide added protection for healthcare staff. There are officers assigned to protect staff in the medical unit and patients are classified as to violence potential. 

Many correctional nurses feel safer in this environment than working in traditional settings where security may be less vigilant. Still, correctional nurses need to be ever alert to guard their personal safety.

2. Most patients are so appreciative

Many prisoners have had poor or no health care prior to being incarcerated and appreciate the attention given while “inside.” In addition, incarceration is a dehumanizing and demoralizing experience.

Nurses, by profession, are patient-focused. There is an unmistakable difference in this type of interaction. Inmates feel this difference and appreciate nursing staff.

3. I see some unusual conditions

No doubt about it, you see some interesting cases in corrections.

Many patients have been living on the streets with untreated conditions. Infections like leprosy and tuberculosis have been noted, as has botulism from drinking tainted prison hooch.

Dental conditions are common. I definitely wish there had been more about dental diseases in my nursing training!

4. I need to collaborate and negotiate like never before

Most nurses work in settings where the goals of top management are healthcare-focused. Not so in correctional facilities.

The medical unit is a support service and top management has a goal of public and personal safety. Therefore, correctional nurses sometimes need to negotiate with administration and officer peers in order to advance patient therapy.

5. Self-care is all important

All nursing can be stressful, but I didn’t realize just how stressful it can be to care for prisoners. These patients are often traumatized, with histories of abuse and neglect. It is easy to absorb this stress vicariously.

Compassion fatigue and general correctional stress can easily build to crippling levels if unattended. Self-care is more important than ever as a correctional nurse.

Explore Correctional Nursing

Correctional nursing is not for everyone, but many nurses find it a fulfilling and rewarding career. I hope you consider entering the specialty.

Incarcerated patients are marginalized and vulnerable. They also can be ornery and impulsive. They rarely have a history of quality health care, which gives nurses an opportunity to truly make a difference in their health and well-being.

If you are interested in exploring Correction Nursing opportunities, visit our website to see the opportunities at Accountable Healthcare Staffing at: CorrectionsJobs or email our Recruiting Team at: Corrections@ahcstaff.com

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