This page is reposted here with permission of Mark Gaines M.S. B.S.N. RN RRT EMT-B and is posted at Mark's own website at: www.geocities.com/dansegypsy/defense.htm

HOW TO FIGHT BACK AGAINST A BULLY BOSS!

Mark Gaines M.S. B.S.N. RN RRT EMT-B

28 January 2002 REVISION

WHY THIS WAS WRITTEN!

This article was inspired after reading still yet another thread on sci.med.nursing about the adverse effect Bully Bosses are having on Nurses in health care facilities. Everyone I have ever worked with has a few stories to tell about Bully Bosses! As I wrote this article, the fact struck me that the problem goes far beyond health care.

Almost every business in the USA is trying run “mean & lean.” But this makes the facility very vulnerable to staff who stand up as there are no reserves built into the current “just in time” method of conducting business. Staff can easily remove a bad manager and take down a facility. Companies are over automated and understaffed; try calling a company and dealing with their voice mail and call switching systems from hell, that force you to wait for long periods of time. Companies are operating on the ragged edge in the drive to maximize profits while cutting labor costs. This stresses out both staff and customers! Business today operates on the philosophy of mastery and control to ruthlessly exploit everyone they deal with.

You might be tempted to confront the Bully Boss directly in a calm and factual fashion. Be prepared by bringing a witness and selecting a private time and place. A real Bully Boss will most likely go off on you, blaming you for the problem, as blaming the victim is a common response. The Bully Boss might also promise to look into the matter or other nonsense type of responses. Don’t turn your back on the Bully Boss! That is why I always suggest a friendly witness or union representative.

Don’t expect any help from Human Relations or the Ethics Officer either. I learned the hard way when a large health care company’s ethics counselor sold me out! They used the confidential information to feed my managers and set me up. The company will always back up a Bully Boss and any management mistakes until it costs them lots of money! These strategies and tactics will hit the bottom line and gain the attention of upper management, as some of the fines, legal fees and costs to clean up are high enough to put the facility out of business! In general, higher management and ethics officers will not help you; you are far better off without them! If you decide to communicate with them, start your complaints with government agencies at the same time! I never give them the time of day, as this would spoil the element of surprise. Why give management time to try to cover their tracks with the help of highly paid corporate attorneys!

But the boss really doesn’t hold all the power. Bosses today are fearful, using intimidation techniques to hold employees in check. Managers are paid to get work done through other people; employees and staff. It costs the company money when that work doesn’t get done! Managers are afraid of employees waking up to the fact that the working man and woman really can stop a lot of abusive practices by using intelligence, assertiveness and sticking together. Knowledge is power, and business managers fear this kind of power.

I am going to draw on my experiences as a Staff Nurse, Respiratory Care Practitioner and Manager to give you some inside tips. I have had to fight for my very survival on several occasions, and will include some of the stories from my personal experiences. Several health care administrators have tried without success to take me out, black balling me in parts of Connecticut for standing up against patient abuse. Since I have nothing to lose, it’s my turn to fight back!

This is a work in progress, so feel free to send me EMAIL to suggest topics or other ideas. You can reach me at dansegypsy@earthlink.net

THE HOSPITALITY MODEL

In the days of re-engineering, downsizing and corporate crime such as the ENRON scandal, it’s obvious that business today has no interest in social justice or human needs. Corporate executives take six figure bonuses while people lose their jobs and customers are cheated with poor quality health care. My other site at http://home.earthlink.net/~dansegypsy/health.htm goes into detail on this subject.

It used to be that businesses put their employees first, with fair compensation and benefits. The expectation is these employees would then treat the customer with respect and fairness. The idea was to win the goodwill of customers who would return over the long term to buy again. A few businesses still operate on this principle. Most operate on the advice by Michael Milken, former Junk Bond King; “Greed is Good!!”

Many companies today have even set up their employee contracts with mandatory Binding Arbitration Clauses. Under these clauses, the employee gets to pay 50% of the arbitrators fee to appeal an unfavorable decision by management. This effectively creates private courts that tend to favor the business in many cases. If you are dealing with this kind of situation you must get your own attorney to attempt to level the playing field. Do this early at the first sign of trouble with your boss.

DON”T BATTER A GOOD BOSS!

These techniques are intended for the really nasty boss who would step over anyone and do anything to get what they want. These bosses are known for being over controlling, liars and having the morals of a medieval warlord. Simple jerks and the like might not be suited for this treatment. Be above the kind of boss who lacks any scruples and save the best ammunition for the biggest jerk. Don’t stoop to their level by blowing a field mouse away with a B-52 bomber!

A FRIENDLY MEETING WITH THE BOSS

Often times the first sign of trouble is a request to have a meeting with the boss over some issue. You have to know the reputation of your managers to make a decision on if you need to bring a witness in with you to protect your interests. If you have seen more than one or two people fired in the past year, or the boss is well known as being a butcher, delay the meeting until you can get a friendly witness to sit with you. I had a Nursing Home Administrator attempt to tell me I had no right to have a witness present, according to the company rules. The National Labor Relations Board later threw that one out along with deciding in my favor. Hide a tape recorder or camcorder on your person. I once hid a tape recorder in my lab coat; the administrator was not happy to hear the tape when my boss tried to claim she never made a particular statement. The National Labor Relations Board will use tapes as evidence in some cases as well.

If you think the charges are serious, get an attorney! Many Bully Bosses are very insecure and really lack knowledge of the labor laws. These bosses do what they please to suit their own particular ends.. I once had a pompous jackass boss in Chicago who was fried alive in front of his administrators after lying to his managers, for a number of serious legal violations. These Bully Bosses will turn into water once you call their game. Consider it one of the joys and rewards for your hard work!

Say as little as possible while getting the boss to talk. Get a copy of any action they take in writing, for your attorney. State your facts calmly and never let the boss get you angry. If you need a little space, excuse yourself to go to the bathroom! Stay cool, calm and factual. Take notes of everything they say, and let them see you writing the notes. Mirror back what you are writing down stating, “Is this what you meant?” You will put the boss on edge to say the least.

You don’t have to sign anything you don’t agree with. You can write a statement to the effect a rebuttal will be submitted in the near future as well.

By all means follow this up and get an attorney or legal aid friendly to employees. If you are a union member, involve the union immediately. You may well need an attorney as well as some unions work better than others. Know your union well to make this decision. If you don’t see the union standing up decisively and openly for it’s members, get your own help!

THE NEED FOR SECRECY!

Don’t tell anyone what you are up to. If you work with other staff, select only co-workers having as much to lose as you do! The company snitch might sell you out so be careful. Your attack must be secret, sudden and overwhelming as to cripple management once things kick off! If you must tell someone, talk off the job with someone you can trust, in another line of work. Once you say anything you have lost control of the situation and might gain nothing from your efforts.

KEEP A SECRET JOURNAL WELL IN ADVANCE!

I learned by experience when dealing with a Chicago area boss the great benefits of keeping a secret journal on a daily basis. Four over two years I faithfully wrote down a detailed summary of events on every shift including staffing levels, treatment and ventilator counts, incidents and more. This journal was labeled with the following header; CONFIDENTIAL COMMUNICATION TO LEGAL COUNSEL IN EXPECTATION OF LITIGATION. By the time my boss found out about it, it was too late as the header put the log beyond legal subpoena by the facility! I had a treasure chest of information to hang him out to dry! I was careful never to reference the log in any of the communications to my boss as that would make my log subject to a subpoena. I used a lap top PC for timely recording of pertinent data, along with scrap paper in my pocket. To this day my former Chicago boss hates lap top computers!

Don’t ever tell another soul on the job what you are doing either. You never know who the company snitch is! Any Bully Boss will fire you on some pre-text to stop you. Bully Bosses fear the light of day revealing their dishonest deeds; a cockroach will do their best work in the dark.

DOCUMENT & COVER YOUR ANATOMY!

In health care we utilize “Incident Reports” in response to some untoward event outcome involving a patient. Always keep a copy for yourself and don’t tell the boss you have one! I had a situation at a Hartford area nursing home where the paperwork from a patient assault was “lost” by the Director of Nursing Services [DNS]. She directed me to write another report, attempting to blame me for the failure to document. I wrote another report noting on the top, DUPLICATE REPORT: ORIGINAL LOST IN OFFICE. This DNS threw a temper fit and ordered me to remove the notation. I didn’t remove the notation and informed her this order was illegal as if the original report were to surface later, questions of false documentation would arise. She accused me of gross insubordination, to which I reminded her of my status as a Notary Public. Later the state received copies of my duplicate report along with a full account of what happened. She was fired as DNS and no longer practices nursing.

You can use a digital camera to record large numbers of photographs as evidence for future use. Use a standardized logging system to give a unique file name to each picture that includes the date.

I also use a typed formal report for other issues not suited to an incident report, including any formal complaint to any regulatory agency. I start with a chronological point in time describing what activity was going on when the issue arose. I then document factually in terms of who did or said what, how, when, why, and where in exhaustive detail. I include exact quotes with the name of the person speaking, as well as action taken, outcomes and who was notified when. I also include police case report numbers too. As always keep a copy or more for yourself. Since the Bully Boss will try to state they never received the report, I always send it by U S Mail, Certified Receipt. My ex-boss in Chicago tried to tell me he never received a report until a week later, claiming it had been delayed in the mailroom. The signed date on the return receipt is the date of receipt by federal law! The Certified mail hung him out to dry!

Any time you write anything for the boss, other than a patient chart, keep a copy for yourself. Store it in a safe place! I even use a back up storage site outside the USA as the contents are beyond the legal power of all U.S. and state courts.

If you send it by FAX, keep a copy of your phone bill and send it by toll call. This serves as proof of receipt as well. Keep the printed receipt the FAX machine provides with the RECEIVED OK printed on it.

Make sure you always have witnesses when going up against the boss. If you don’t have proof, they will attempt to eat you alive. Patients and family members can be good witnesses but do this in secret! Never tell another coworker what you are doing unless that coworker is involved with you and has as much to lose as you do.

The pen is mightier than the sword, and documentation works both ways! Take a good course in Technical Report Writing such as the one given me in North Carolina. It works!

SAFE HARBOR/WHISTLE BLOWER PROTECTION

Massachusetts has enacted a Whistle Blower Protection Law, protecting any health care professional against any form of retaliation for speaking up on any patient care or safety issue. Due to previous corruption within the Massachusetts Board of Nursing, enforcement is provided by the Massachusetts Attorney General. Violators face two years in prison and a fine. This law was enacted after the wrongful firing of a nurse by The Youvillwe Health Care Center in Cambridge, which resulted in hearings at The Statehouse in Boston. You can read another Webmasters account of this scandal which resulted in a patient death, at http://www.geocities.com/nurserebel/boston.htm

Protection against changes of job assignments, unfair discipline and more are included. It is a shame such a law should need to exist but that is the state of affairs as healthcare has become wealthcare. The Massachusetts Attorney General can be contacted at 413-784-1240 or 617-727-2200.

Other states such as Texas and California have various laws like ours in Massachusetts. Contact your state officials or local activists for more information.

COMPLAINTS TO GOVERNMENT AGENCIES

Often your complaints about patient care issues will fall upon deaf ears when you are dealing with a health care facility such as a nursing home or hospital. You will have no choice but to involve outside resources as you can count on health care administrators to defend their profit margins any way they can. Often labor costs are frozen at 40% of reimbursement by administrators to insure profits. This often translates into long waits for call bells and non-existent bedside care as staffing and supplies are cut. You can read my other Web Site at:

http://home.earthlink.net/~dansegypsy/health.htm

You will usually need to use multiple government agencies at the same time to bring pressure on the facility administrators to clean things up! This is similar to the strategy of carpet bombing used by the Allies against Hitler at the close of World War 2. Keep on them and never let them have a break!

Individual sections follow with agencies that can assist you.

COMPLAINTS TO PROFESSIONAL BOARDS AND DEPARTMENT OF PUBLIC HEALTH

One of the most feared weapons used by health care administrators is the threat to report an individual nurse to “The Board” for alleged misconduct. This concept works both ways as health care administrators are responsible for the condition of their facilities and the provision of safe and adequate care in a timely fashion. The bottom line is that states are starting to hold managers responsible for the lack of care instead of allowing managers to scapegoat staff! Remember that log? Use it to fill in specific details about patients not being fed or medicated. Document missed or late treatments. Document specific individuals spoken too about specific issues such as short staffing, etc. File a complaint for patient neglect against the nursing managers; all of them. Send it Certified U S Mail with return receipt! Keep copies and send them to your state and federal representatives as well as your local media. Watch the fur fly!

The defendant must also hire an attorney at their own expense to defend the charges against the professional board. This is pure hell in itself when they must appear before the board and risk the loss of their livelihood. Friends have told me of their experiences before the board.

Some nursing administrators will attempt to allege “Patient Abandonment” if you refuse an assignment. Until you accept an assignment by such acts as receiving report or counting the controlled substances, you are not responsible for the assignment. If the assignment is unsafe due your lack of experience, lack of orientation or short staffing, you just say no! The nursing administrator can’t report you for this and in fact can be reported by the staff nurse as managers are responsible for allowing these conditions to exist. Report management and watch the fur fly! Go home if it’s not safe. I have refused unsafe assignments a few times and it never came back on me!

If your boss attempts to impose Mandatory Overtime on you, you should assess if you are able to continue the shift safely. If you are not able to continue on duty due to feeling ill or too tired, the boss must make other arrangements while you stay a reasonable time. You should be relieved within the hour. Some states are now enacting laws to protect nurses in this way. Management is legally obligated to back you up so demand they do their part! If they refuse, report them to the Board of Nursing for patient neglect. Do this without delay!

Is the facility kitchen a mess? Are cockroaches and rats counted as part of your census? Call your local and state board of health for a food inspection. Many kitchens fail inspections!

State Departments of Public Health are often poorly staffed and able to responds only to the very worst cases of neglect, so don’t forget to send a copy of your complaints about a facility to The Health Care Finance Administration [HCFA]. HFCA pays the bills for Medicare patients and is always interested in weeding out fraud. HCFA considers poor patient care in hospitals and nursing homes to be fraud. HCFA just loves to collect money back in these cases so you can count on a response! So draft a detailed report about the lack of care in a nursing home with attention to such issues as getting residents out of bed on time, bed sores, adequate staff, getting medications and food on time, staffing available to help feed and times required to answer call bells. Send a copy of the state complaint to HCFA and watch the fur fly! You can contact HCFA for New England facilities at 617-565-1188/617-565-1083 FAX. The federal authorities will insure that the state inspectors do their job, getting a complaint inspection! I have seen this done to several facilities and they paid dearly for their Bully Bosses as this cuts off their federal funding!

If you report fraud to Medicare, get a case number and ask for a form to secure your rights as a whistle blower as up to 10% of what HCFA recovers is yours!

CALL THE POLICE!

If you experience chronic poor patient care such as neglect in a nursing home or hospital, call the police to document abuse and/or neglect of the elderly. The police must respond and write a report if you demand it. Get the officers name and report case number. Then go to the police agency and get a copy of the report. This report helps document dirty environments and poor hygienic care of a nursing home resident for HCFA and state health boards. It will wake up the facility management too!

In Connecticut any abuse or assault involving a nursing home resident must be reported to the local or state police immediately. This helped me deal with the DNS I mentioned earlier that tried to cover up an incident. If you are a nurse, document any serious incident in the patients chart and don’t let the nursing administration tell you otherwise. You could be charged in the cover up! In Massachusetts elder abuse must be reported to the Massachusetts Attorney General by the staff nurse, by calling 617-753-8165. In Connecticut call 800-842-2288. Don’t assume the DNS has done it; they often don’t in an effort to protect the rating of the facility.

I was wrongfully disciplined by two employers for properly reporting patient assaults. They both paid the price, but they have helped black ball me for obeying the law. Be aware this does happen so get another job fast if you must make a report!

CALL THE FIRE DEPARTMENT AND FIRE MARSHAL

Many store rooms and patient care areas have violations of the local Fire Safety Code. Do you have boxes piled high to the ceiling? Are boxes blocking sprinkler heads? Are there any fire extinguishers missing inspection tags or pins? Are any exits or fire extinguishers blocked? Any fire extinguishers missing? Any resident’s smoking in areas not designated for smoking? Are there any hazardous chemicals stored in unlabeled containers? Are all your hazardous substances properly labeled? Is the MSDS readily available? The Fire Department is often an overlooked but effective way to get needed action; remember your friends in the fire department.

OSHA

The Occupational Safety and Health Administration has regulations that are often ignored by healthcare facilities for financial reasons. For example, one Western Massachusetts facility was cited after several CNA’s were injured by resident assaults. Due to short staffing and known assaults by residents, as well as unsafe conditions for lifting, a number of CNA’s called in OSHA. Failure to adhere to the fire safety plan will bring in OSHA too. Do you have enough gloves of all sizes in all areas and patient rooms? Are the sharps containers more than 2/3 full or overflowing? Are sharps disposed of in regular trash? Are there any recapped needles in the sharps container as the fines start at $10K! Once OSHA comes in, they will look at the entire workplace and for other violations as well. No one wants a visit from OSHA so why not give management one? You can find OSHA under your U S Government listings in many telephone directories.

Have evidence ready for them including pictures. Make sure the daily banner of that days newspaper is in each picture. I did this to my ex-boss in Chicago when he allowed ABG needles to overflow from a sharps container in the Blood Gas Laboratory. Photograph things like broken Hoyer lifts. Do you have any staff that never received a physical examination upon hire? Were all staff offered Hepatitis B and checked for Tuberculosis upon hire? If not they are in deep trouble; many facility staff health files are illegal! They will have to sign a consent agreement on the spot.

You are protected against employer retaliation as well. Penalties are serious.

U S DEPARTMENT OF LABOR

Many health care facilities routinely violate federal labor laws every day and don’t know it. The state labor boards do not have jurisdiction in health care facilities as federal money is paid to every health care facility in the country. Each staff member must be given a thirty minute, uninterrupted lunch break that must begin within four hours of starting the shift. Sitting at the desk charting while one eats violates this standard. The staff member must not be subject to call back by pager or other means for any reason! If your lunch is interrupted for any reason, this violates the standard!

If you are required to work during your lunch or stay to chart, you must be paid for the extra time. You are entitled to eat in a separate lunch area away from the floor without being disturbed! Management can’t impose a requirement the time be approved to be paid; failure to pay violates this standard. There are no exceptions for non-management staff! Higher state standards are enforced by federal law as well. In some states overtime pay is mandatory for over eight hours. Also, you can’t pay one standard for full time and another for per diem. The facility must pay for all labor time! Of course you never want to agree to work on salary either to give up these rights.

Some facilities have elected to cheat staff by paying by salary on weeks where staff work over forty hours, and by the hour on weeks where they work less than forty hours. This is illegal as well.

You should keep an exact log of hours worked for several months, and then write your nearest office of The U S Department of Labor, listed in most telephone directories under U S Government. Keep copies of everything and allow a some time as they are not fast to respond. But once The U S Department of Labor comes in to inspect, they will examine the past two years of payroll records as well as speaking to staff away from management. I received a nice Christmas check from a former Philadelphia employer who stood against me in this way. She is no longer working in her profession either.

I once read a report stating that the fair application of labor laws in health care facilities would bankrupt many of these facilities. Stop the theft of your time and labor by corporate health care thieves! Send copies of your complaint to your federal representatives requesting assistance! The fur will fly! You are protected by federal law against employer retaliation.

OTHER STATE BOARDS

Many states have mandatory reporting statues for elder abuse and child abuse. You can call in your own reports for abuse in nursing homes if the DNS doesn’t do their job. In Connecticut you can even call in The Connecticut State Labor Board for any reprisals for reporting elder abuse! Check your state laws and state agencies for ideas.

BUILDING INSPECTORS

Do you have electrical outlets without covers or having frayed wires? Is the place in a state of general disrepair? Call the town, city or county building inspectors. Send them pictures and have witnesses. Is the elevator a bit shaky? Call the inspectors and force them to fix up the place.

EQUAL EMPLOYMENT OPPORTUNITY COMMISSION

Many health care managers fail to abide by EEOC laws by singling out a whistle blower for discipline or firing. Many times that individual is a male, over age 40, a racial minority or religious minority. The law doesn’t care about the employer’s intent. The effect of discrimination is enough! Getting sued by this agency will in many cases end the management career of an individual as the stigma is serious. The cost of defending even a frivolous EEOC complaint averages a minimum of $30K and can top $100K! This is the ultimate hell for any employer or manager!

Make sure you get your own attorney before you contact the EEOC, and have witnesses! Contact The Officer of The Day when you call, and get their name. Make sure you can prove discrimination based on age, race, sex, religion and even disability. While these are hard cases to win, you don’t really need to win to succeed! You are protected by federal law from employer retaliation for filing a complaint! Penalties are very serious!

NATIONAL LABOR RELATIONS BOARD

This government agency protects any employees banding together to improve the welfare of employees in general. The NLRB was created to protect union organizing, so if you can lay claim to taking part in any kind of union activity, you can cause your bass some serious grief! Even a probationary employee can claim protection under this law if they are organizing to improve working conditions, etc. Have proof such as witnesses and written documents! The NLRB is listed under U S Government in many telephone directories. This will really scare an employer! The NLRB can order back wages, interest, back benefits and public notices placed on corporate bulletin boards. No one likes to see the NLRB show up!

THE COMPANY PENSION PLAN AND EMBEZELEMENT

There has been a serious problem with nursing home and other health care administrators using federally protected pension monies to finance budget short falls and their own lifestyle. The problem is these monies belong to the employees! Have you noticed any serious delays in crediting deposits deducted from paychecks? Do pension plan contributions just seem to disappear? We had one nursing home administrator in Connecticut appoint himself as the Trustee, after which money never seemed to get to the pension plan books. There is a federal agency that is charged with protecting pension money, known as ERISA. Their Boston office can be reached at 617-565-9352. They will follow up this kind of federal crime without mercy!

DEALING WITH BEING BLACK BALLED

The fact is the good ole boy network doesn’t obey the law or play by the rules. There are things you can do to deal with being black balled. The “word” is spread by secret phone calls and conversations.

If you can get someone to infiltrate management and win the trust of the Bully Bosses, good for you. That will take down a bad manager. A more practical approach is to go have a talk directly with the Bully Boss, having a compact hidden camcorder. Get the Bully Boss to incriminate herself! Follow this up by applying for jobs with a hidden camcorder. If you have a good job history and are qualified, an attorney can the take it from there!

Some managers are stupid enough to make negative remarks in front of other staff. Get written accounts from these witnesses to support your claim. One DNS in Hartford bragged in front of staff about how sure she was a certain nurse had diverted drugs. Further investigation revealed the duplicate keys had been used by the supervisor to steal the stash. This former DNS is now being sued for slander and defamation of character; she will most likely lose her home.

You can use the phony reference call, using a friend who calls pretending to be a potential employer. You can even provide a “signed release” by FAX to get the person to talk. The blank forms are easily available at Staples and other discount office supply stores with generic employment applications. Call the specific Bully Boss if you can. The trick is to have someone on the line with your friend to witness what is said, having the microphone unscrewed if possible. Tape record the conversation without a beep tone if you can. Radio Shack provides some nice accessories for this kind of application. Then you can type up an exact record of who said what. Dial long distance to keep a record of the time, date and length of the call. You can even conference call with three way features to achieve the effect.

You can hire a private investigator to do the same thing. Contact Truth Inc, 1045 S Yates Rd, Memphis, TN 38119, telephone 901-763-3200 or a similar service that checks references.

GET AN ATTORNEY AND SUE THE BASTARDS!

Private lawsuits against individuals are very effective for wrongful discharge, defamation of character, slander and libel, just to name a few possible charges. Once the facility fires a bad manager, that individual is on their own for legal expenses. A good lawyer will cost about $200/hour. The grief of being sued is beyond words to describe. The stigma will remove the bad manager from the industry as no one wants them. Such an individual, once sued, will serve as a lightening rod to attract future legal action against a facility. No facility will allow the liability of this exposure! This will cause the individual to be both unemployed, and unemployable! So sue the bastards! The court just might take away their pension, house and other assets to pay you off!

CREATE A MEDIA CIRCUS!

When you have taken the steps listed above, call in your friendly local media. Identify in advance who does pro-consumer stories and call them. Have copies of pictures and relevant documents ready to give them. Have people ready to interview! Stage a demonstration to get the media there if you need to. Get nursing home residents to march with you, in wheel chairs if you can. Wear your nursing uniforms as the public loves nurses and it will look great on the six o’clock news!

YOU CAN FIGHT THE BULLY BOSS!

OTHER SITES OF INTEREST

www.geocities.com/dansegypsy/thesis.htm

http://home.earthlink.net/~dansegypsy/health.htm

http://www.geocities.com/nurserebel/protest.htm

http://www.geocities.com/nurserebel/boston.htm

This article is protected under the Copyright Laws of The United States of America and is reposted here with permission of Mark Gaines M.S. B.S.N. RN RRT EMT-B It is also posted at Mark's own website at: www.geocities.com/dansegypsy/defense.htm