Not just “eating our young”: Workplace bullying strikes experienced nurses, too

Even though nursing is a profession of caring and compassion, bullying exists in many forms in it. Bullying threatens teamwork, morale, communication, and, most important, patient safety. The playground bully from our childhood has grown up to become our nursing colleague who is now bullying in the workplace (See Workplace bullying). It’s easy to understand when the phrase “eating our young” is used in relation to bullying aimed at nursing students or novice nurses; however, it is important to acknowledge that bullying also targets older, experienced nurses.

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Workplace bullying

Workplace bullying is “repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct that is threatening, humiliating, or intimidating, work interference … or verbal abuse,” according to social psychologist and anti-workplace bullying activist Gary Namie, PhD. Bullying is also referred to as horizontal hostility, incivility, and lateral violence. Although the definitions for these terms differ, all describe bullying behavior. According to the Dr. Namie’s Workplace Bullying Institute, 65 million American workers are affected by bullying. Bullying affects nurses of all ages and all levels of experience.

Bullying behaviors fall on a continuum ranging from eye-rolling and exclusion to humiliation, withholding information, scapegoating, intimidation, and backstabbing. These behaviors are deliberate. The bully sets out to destroy the victim’s confidence and credibility as a way to gain power and control. Bullying can last for months or even years. In a study of Australian nurses and bullying behaviors by Hutchinson and colleagues, the respondents reported three forms of bullying: personal attack (isolation, intimidation, and humiliation), erosion of professional competence and reputation (damaging professional identity and limiting career opportunities), and attack through work roles and tasks (obstructing work or economic sanctions). One-third of the study participants eventually left their positions because of bullying.

According to the 2010 Health Resources and Services Administration (HRSA) Registered Nurse Study, the median age of a registered nurse (RN) is 46. Forty-five percent of practicing RNs are age 50 and older, and 15.5% are age 60 and older. Even though the nursing workforce is growing and expected to increase by 500,000 in the next 10 years, there is a projected shortage of RNs in the United States that will top 260,000 by 2025. The HRSA projects that more than 1 million RNs will reach retirement age within the next 10 to 15 years. With a serious nursing shortage expected only to worsen, nursing as a profession can ill afford to lose any more nurses to bullying.

Seasoned nurses possess a great deal of knowledge that is gained only from experience. Although much has been done to recruit recently graduated nurses, current research is shifting to examine what can be done to keep valuable seasoned nurses in the workforce. Aside from modifying the physical environment by using safe patient-handling equipment and providing a more ergonomic workplace, an important factor influencing the continued tenure of experienced nurses is the organizational culture, or healthiness of the work environment. Older nurses who are the victims of a bully are more likely to experience burnout and lack of support, which contributes to their likeliness to leave an employer.

Why bully the older nurse?

Of course, bullying crosses all generational lines. Baby Boomers can engage in behaviors toward younger nurses in an effort to make them “pay their dues,” or see if a new nurse will fit in. The same traits that older, experienced nurses tend to possess—a sense of personal strength, a degree of competence, and an air of success with a “been there-done that” attitude—can also make them a target for bullying. Bullies lack self-confidence, have low self-esteem, and may even lack competence in their role. The experienced, competent nurse is seen as a threat in the bully’s eyes, and thus becomes their target. In addition, the bully may have been a target at one time, and became a bully in response.

Generational differences may influence relationships between nursing colleagues. Currently, nurses in the workplace are from three different generational groups: Baby Boomers (born 1943 to 1960), Generation Xers (born 1961 to 1981), and Millennials (born 1982 and later). Although the following characteristics of these groups are general in nature, understanding them is an important aspect to establishing healthy work environments and improving nurse retention. Of course, it’s important to consider each person as an individual. For example, a Baby Boomer may be expert with technology, while a Millennial may shun it.

  • Baby Boomers are thought of as workaholics who derive part of their identity from their occupations. They illustrate professionalism and value autonomy in their work, yet they desire loyalty and recognition from their employers. They are generally slow to adjust to technology, but they appreciate creativity and new ideas.
  • Generation Xers grew up in homes with working parents and have a strong sense of independence; they do not tend to require external support or approval. Generation Xers became familiar with computers at an early age, and know how to integrate information from a variety of sources. They do not necessarily value traditional educational tracts. They strongly value the work-life balance, and are creative and confident.
  • Millennials have just started entering the workforce in the last decade. They are the first generation to have spent their entire lives around computers. They obtain much of their information via technological devices. Millennials respond well to positive feedback, and tend to leave if they perceive the work environment is unhealthy.

Younger nurses can bully older nurses by treating them as if their knowledge is antiquated, “washed up,” or out of step with the times. Older nurses can be excluded from social activities in the unit, made fun of for physician limitations, and ignored by the younger nurses. Ellie, a nurse for over 30 years, relates, “Last week, I came out of my patient’s room. Several of the younger nurses were talking about a new product trial that was going to start the next day. I asked one of them about it, and she said, ‘You should have paid attention during the morning huddle. You might need to turn up your hearing aid battery.’ She walked away, laughing with one of the other nurses. I felt humiliated and embarrassed.”

In her book, Toxic Nursing, Cheryl Dellasega describes the “Super Nurse.” This nurse feels the need to call attention to her own abilities and alienate all others on the team as a way to demonstrate she is knowledgeable and in control of the situation, at the expense of collaboration and teamwork. Dellasega describes the Super Nurse’s behavior as a symptom of fear and insecurity rather than superiority, and when directed at an older nurse reflecting fear and insecurity about having less experience than a more seasoned colleague. Liz, a staff educator for critical care units, describes such a situation with one of her orientees:

“I was teaching a group of new graduates in the ICU about intracranial pressure monitoring. My primary background of expertise is in cardiology, but I had developed a neurological class that included hands-on practice. I consulted with the equipment company, which had excellent teaching materials for me to use. After the class was over, one of the new graduates sent an e-mail to her manager about how I should not teach this class because I was not an ICU staff member, and could not possibly know anything. She further stated that she could have figured out how to set up the equipment without the class, and it was a waste of time. I thought that was a passive-aggressive way to discredit my experience and expertise. She never said anything in class and gave me no indication she felt she was wasting her time.

When the bully is the boss

The Workplace Bullying Institute’s 2014 Workplace Bullying Survey reports that 56% of respondents who had been bullied stated that the perpetrator was a manager or supervisor. A recent study of 6,500 RNs by Estes indicated nearly 47% were victims of abusive supervision. Factors that contribute to managerial bullying include organizational instability due to downsizing, restructuring, or frequent changes in managers; autocratic or laissez faire leadership styles; oppressed-group behaviors; or a well-entrenched bullying culture. Organizations that focus on productivity and financial outcomes alone can reward nurse managers for bullying their way to meeting goals, consequently instilling the perception that bullying behaviors are necessary for career progression.

When it comes to managing by bullying, the ends do not justify the means. Managers who bully often learn by example, and may themselves have been victims of a bully in the past. Over time, they rise through the ranks, using bullying behaviors as a means to acquire perceived power. Managers who bully tend to have low self-esteem or low clinical competence and target staff members who are competent, well-liked, or receive special recognition. “Our new manager decided that I was getting too old to take care of most of the cardiac surgery patients,” said Debbie, an experienced nurse. “He announced in a staff meeting that he was going to have several new nurses trained to take care of the open heart patients. He said I needed to ‘pick up the pace’ and turn over the reins to the younger nurses. I felt like he had no respect for my experience and knowledge.”

Nurses with many years of experience are experts in their areas of nursing, able to analyze and quickly act on complex patient situations. Their life experiences also enhance their empathy for patients and families, which can increase patient satisfaction with the hospital experience. In uncertain economic times, some managers may see only the financial aspect of their human resources. The older nurse may find himself or herself to be a target of a bullying boss because he or she commands a much higher salary than a new graduate. Julie relates:

“Our new unit director began bullying staff almost from the moment she started here. Her favorite tactic was to label nurses as toxic, then make up stories about them to get them in trouble. She went after everyone who had an opinion, and when pressed, she said things changed at our hospital because of the merger with the new health system. In the first 18 months of her regime, our 18-bed unit lost 14 nurses, all with more than 5 years of experience. It added up to over 180 years of nursing knowledge. Now, there are so many ‘newbies’ that it scares me to come to work. They are smart, and will be good some day, but they lack that intuitive skill that is gained only from experience.”

The effects of bullying

Nurses who are bullied suffer myriad consequences including psychological effects such as depression, inability to focus on tasks, anxiety, sleep disturbances, burnout, and post-traumatic stress disorder. According to a 2013 study by Longo, older nurses suffer greater physical effects of bullying, including headaches, cardiovascular disorders, gastrointestinal disorders, and musculoskeletal problems. In addition, older nurses experience shame and humiliation when they witness episodes of bullying of other staff members. In a recent survey by Dumont of 955 RNs, 82% reported experiencing at least one bullying behavior either weekly or daily. Nurses ages 41 to 50 experienced bullying most often and also suffered the highest rate of adverse effects. Victims of bullying at all ages have higher absenteeism and may exhibit decreased productivity due to stress and the distraction of trying to stay out of the bully’s way.

Patients

Patients aren’t immune to bullying’s consequences. When the work environment is toxic, there is a breakdown in communication, teamwork, collaboration, and leadership. When nurses aren’t comfortable asking for help, they are more likely to make errors. Adverse patient outcomes, and even patient mortality, increase in settings where workplace bullying occurs. According to the American Association of Critical-Care Nurses, unhealthy work environments contribute to increases in hospital-acquired conditions and patient readmissions. These adverse patient outcomes, along with poor patient satisfaction scores, also result in decreased financial reimbursement. Increased nurse turnover decreases continuity of care and communication.

Organizations

Incivility and bullying have adverse outcomes for organizations as well. Incivility-associated losses in productivity (due to absenteeism, impaired time management, diminished physical ability, and decreased quality of work) were measured in a 2008 study by Hutton and Gates of 145 RNs with a mean of 9 years of experience. The results indicated a mean annual financial cost of productivity loss totaling more than $1,400 per person. In addition, nurse turnover adds to the financial burden of an organization. The average cost of replacing one seasoned nurse can be as high as $64,000, according to Walrafen et al. It is also difficult to recruit nurses to work at an organization with a bullying culture.

To sum up, bullying has adverse effects on the victim, the patients, and the organization. Older nurses may be experiencing some age-related physical limitations, which are compounded by the effects of bullying. Hospitals experience higher-than-normal nursing turnover and its many associated expenses. Poor patient quality and dissatisfaction lead to decreased financial reimbursements, which also adversely affects an organization’s bottom line. Failure to meet patient safety benchmarks can also affect accreditation as well as financial status.

Breaking the bullying cycle

Many national organizations have taken a stand against bullying. The Joint Commission issued a Sentinel Event Alert in 2008 requiring hospitals to create a code of conduct and a process for managing inappropriate behaviors. All team members must be held accountable for modeling professional behaviors, and managers must be provided with skills-based training on communication, relationship building, and collaboration.

In 2015, the American Nurses Association released the position statement “Incivility, Bullying, and Workplace Violence,” which states, “All registered nurses and employers in all settings, including practice, academia, and research must collaborate to create a culture of respect, free of incivility, bullying, and workplace violence.” The statement calls for evidence-based practices to address this type of negative behavior.

Training in effective communication and conflict resolution skills is key to starting to break the workplace bullying cycle. (See Ten steps to breaking the bullying cycle.) The first step in eliminating bullying is to admit the problem exists. Some bullying behaviors are subtle and less likely to be noticed (eye-rolling, silence). Older nurses may be entrenched in a work culture where bullying is accepted and therefore may believe it is futile to try to report it. Education of all staff on bullying behaviors helps develop an awareness of the problem and the implications of unchecked bullying. Any educational program must address both appropriate and inappropriate behaviors and any policies that exist to address them.

Ten Steps to Breaking the Bullying Cycle

  • First, admit that a problem exists.
  • Educate all staff on bullying behaviors to help develop an awareness of the problem and the implications of unchecked bullying. Address appropriate and inappropriate behaviors and policies.
  • All team members must be held accountable for modeling professional behaviors; managers must be provided with skills-based training on communication, relationship building, and collaboration.
  • Administrators must create an environment in which employees can safely report bullying and know that these issues will be addressed.
  • Training in effective communication and conflict resolution skills are key.
  • Clearly communicate what the behavioral expectations are; support bullies in efforts to change their toxic behaviors.
  • Stop gossip in its tracks and address bullying behaviors directly without being accusatory or aggressive.
  • Staff members must commit to creating a positive workplace culture, and vow to stop participating in negative and destructive behaviors.
  • Foster a culture of respect.
  • Support a zero-tolerance policy with respect to bullying; act on all instances of bullying.

Note: Educational resources, including infographics that can be downloaded, are available from the American Nurses Association at http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence

Communication with the bully also includes the manager, who can respond appropriately to reported bullying behaviors. Clearly communicating what the behavioral expectations are, and supporting bullies in efforts to change their toxic behaviors can go a long way toward changing the culture of the unit. Statements such as “I do not feel right talking about that person if she is not here” can stop gossiping in its tracks. Using strategies such as “I feel __ when you ___” are good ways to address bullying behaviors directly without being accusatory or aggressive. In some work environments, bullying behaviors are so entrenched that they have become the norm, so the bully may not even realize he or she is behaving inappropriately.

Bystanders often outnumber the bully, so there is power in numbers to prevent a minor problem from escalating into a bullying episode. Staff members must commit to creating a positive workplace culture, and vow to stop participating in negative and destructive behaviors. Remember, we encourage what we condone, and can deprive the bully of an audience if we do not buy into what the bully is saying or doing. Fostering a culture of respect can improve collaboration, teamwork, and communication, which will, in turn, promote an environment of patient safety.

Managers and nursing leaders are crucial in setting the overall tone for a nursing unit. Supporting a zero-tolerance policy with respect to bullying and acting on all instances of bullying will go a long way in demonstrating that victims are supported and the manager’s credibility is strong. If staff members see a lack of action on the part of a manager, they will grow to believe that the bully is really in charge and the behaviors will continue. By modeling professional behavior and skilled communication, managers can identify and manage bullies to ensure that the healthy work environment is maintained. Administrators must also ensure that the managers are not engaging in bullying behaviors by observation and creating an environment in which employees can safely report bullying and know that these issues will be addressed.

Getting rid of bullying

As the title of this article suggests, workplace bullying knows no age or experience level for its victims, targeting young and old nurses alike with repeated behaviors aimed at derailing a self-confidence, reputation, and career.

Bullying has adverse effects on the victim, the patients, and the organization. Older nurses may be experiencing some age-related physical limitations, which are compounded by the effects of bullying. Patients in a nursing unit with a bullying culture are deprived of teamwork and communication, and may suffer errors, healthcare-acquired conditions, and poor satisfaction. Hospitals experience higher-than-normal nursing turnover and its many associated expenses. Poor patient quality and dissatisfaction lead to decreased financial reimbursements, which also adversely affects an organization’s bottom line. Failure to meet patient safety benchmarks can also affect accreditation as well as financial status.

Education to identify bullying and how to manage it is vital to creating a healthy workplace, as well as establishing and enforcing zero-tolerance policies. By fostering a work environment that is built on trust, respect, teamwork, collaboration, and effective communication, bullying behaviors will no longer have a place in nursing.

Selected references

American Association of Critical Care Nurses (AACCN) Position Statement. Zero Tolerance for Abuse. Aliso Viego, CA: AACCN;2004. www.aacn.org/WD/Practice/Docs/Zero_Tolerance_for_Abuse.pdf

American Nurses Association. Position Statement. Incivility, Bullying, and Workplace Violence. July 22, 2015. www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/bullyingworkplaceviolence/Incivility-Bullying-and-Workplace-Violence.html

Center for American Nurses Position Statement. Lateral Violence and Bullying in the Workplace. February 2008. www.mc.vanderbilt.edu/root/pdfs/nursing/center_lateral_violence_and_bullying_position_statement_from_center_for_american_nurses.pdf.

Chipps E, McRury M. The development of an educational intervention to address workplace bullying. J Nurs Staff Dev. 2012;28(3):94-98.

Cleary M, Hunt G, Jorsfall J. (2010). Identifying and addressing bullying in nursing. Issues Ment Health Nurs. 2010;31:331-335.

Dellasega C, Volpe R. Toxic Nursing. Indianapolis, IN: Sigma Theta Tau International; 2013.

Dumont C, Meisinger S, Whitacre MJ, Corbin G. Horizontal violence survey report. Nursing. 2012;42(1):44–49.

Egues A, Leinung E. The bully within and without: Strategies to address horizontal violence in nursing. Nurs Forum. 2013;48(3):185-190.

Embree JL, White AH. Concept analysis: Nurse‐to‐nurse lateral violence. Nurs Forum. 2010;45(3):166-173.

Estes B. Abusive supervision and nursing performance. Nurs Forum. 2013;48(1):3-16.

Friedrich L, Prasun M, Henderson L, Taft L. Being a seasoned nurse in active practice. J Nurs Manag. 2011;19:897-905.

Hutchinson M, Vickers M, Wilkes L, Jackson D. A typology of bullying behaviours: The experiences of Australian nurses. J Clin Nurs. 2010;19:2319-2328.

The Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. July 9, 2008. Issue 40. www.jointcommission.org/assets/1/18/SEA_40.PDF.

Khadjehturian R. Stopping the culture of workplace incivility in nursing. Clin J Oncol Nurs. 2012;16(6):638-639.

Laschinger H. Impact of workplace mistreatment on patient safety risk and nurse-assessed patient outcomes. J Nurs Admin. 2014;44(5):284-290.

Leiter M, Price S, Laschinger H. Generational differences in distress, attitudes, and incivility among nurses. J Nurs Manag. 2010;18:970-980.

Lewis P, Malecha A. The impact of workplace incivility on the work environment, manager skill, and productivity. J Nurs Admin. 2011;41(1):41-47.

Longo J. Bullying and the older nurse. J Nurs Manag. 2013;21:950-955.

Longo J. Bullying in the workplace: reversing a culture. Silver Spring, MD: American Nurses Association; 2012.

Namie G, Christensen D, Phillips D. 2014 WBI U.S. workplace bullying survey. February 2014. www.workplacebullying.org/wbiresearch/wbi-2014-us-survey.

Townsend T. Break the bullying cycle. Am Nurs Today. 2012;7(1):12-15.

US Department of Health and Human Services. The Registered Nurse Population. Initial Findings from the 2008 National Sample Survey of Registered Nurses. March 2010. http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyinitial2008.pdf.

Walrafen N, Brewer M, Mulvenon C. Sadly caught up in the moment: An exploration of horizontal violence. Nurs Econ. 2012;30(1):6-12;49.

Terri Townsend is a staff educator for cardiovascular services at Community Hospital Anderson in Anderson, Indiana.

 

11 COMMENTS

  1. I had more open heart experience- then the director- l reported to her that the night supervisor refused to help me – she looked straight at me and said “ no one has to help me. My report of my abuse by staff members at Midland Memorial – was 55 pages — My advice is to document- everyday and be sure you have time/ date/what was saided- and who was around you at the time

  2. The unions do not protect nurses only the managers who the organisers are playing up to. Don’t be fooled and ask the union in writing what do they provide, if they come and give you a talk. Usually they are full of incompetent nurses desperate to hold onto a role in nursing, which means that they won’t necessary have to lose their relatively good salaries.

  3. The author is Terri Townsend is a staff educator for cardiovascular services at Community Hospital Anderson in Anderson, Indiana.

  4. Addendum-I am slightly freaked out concerning my comments-I actually fear repercussions if anyone were to link this to me.

  5. I have been an RN for 25 years, 24 in the same organization although in different units. As a young nurse I felt the sting from the older nurses who called me ‘kid’ and ‘child’ but eventually carved out respect within the ranks. Fast forward 20+years and numerous managers and I have recently found myself being mocked by a supervisor with the comment “if the older nurses wanted to make more money they should’ve went into management “, and “it’s nice to have the experience but the young nurses have all the new ideas and information “. I am a voracious reader and researcher and I continue to educate myself on new information and advances. I am proud to be a bedside nurse; it’s what gives my life meaning-having the knowledge and ability to help heal folks is everything. I am struggling with the eye rolling and snarky comments. I am also someone that is protective of my fellow nurses-if I see a new nurse struggling with their assignment I will jump in and help. I was chastised for this recently by my manager due to the fact that she was “in hot water” because I stayed late to assist with an admission and the manger left on time. She has now decided I am the reason she is being harassed by her manager. It’s all become a bit much. Most recently she hissed at me that if I don’t stop “yelling” (I was firm in my comments-no yelling involved) concerning an admit being assigned to an already overwhelmed co-worker that she would just make me stay and do it. ( my shift was ending in an hour). The next day she confronted me concerning a resident with a high blood pressure. This was not my resident but I had overheard the previous day the number then told my coworker twice she needed to call the physician immediately. I was consumed by my own assignment that day and quite honestly did not have the time to harass the RN if she had notified the physician. So the manager curtly informed me I was responsible for that and has now gone to every other nurse on the unit and has used that as an example that I was at fault for not reporting the BP to the physician even though I had urged the other nurse to call it in. I don’t quite know how to handle this. I think my direct manager is insecure and paranoid that she is going to be fired -she confronted three of us nurses demanding to know if we thought she was a good manager and “who is complaining about me?” . This was super uncomfortable for all of us but I have never reported any of this. I’m torn because all I want to do is my job. I don’t want anyone fired. I also don’t want to feel this anger and anxiety concerning this manger. I never considered myself to be someone that could be bullied until now.

  6. I left Nursing after almost 20 years because of bullying from managers & co-workers. Some advice I would give is: do not be easy-going. Call these people out as soon as they verbally attack you or intimidate you. If your immediate boss does nothing –some of them love the drama — then go over that head to higher heads. Keep a log of what was said & done, and what you did about it. My mistake was not being my own strong advocate. Now that I am older & have been out of Nursing for more than ten years, I would never put up with the things I did because I was nice & thought ignoring it would make it go away. It won’t; they live for this stuff. Learn about Narcissists & the subtle ways they play games & how they win people over. Nice people are targets; be your own advocate & document < you know how to do that. Nip it all in the bud.

  7. nearly 30 years in health care–I have witnessed many good things–I have also witnessed many health harming things–like the targeting of co workers–my son an RN experienced firsthand the awful affects of bullying–despite it happening in the past–that experience followed him like a thief in the night throughout his “LIFE AS A NURSE” It left him scared-it left emotional scars that ultimately left him dead-he lost a career he was good at–as a direct result, and assault he suffered sever anxiety-and fear of it happening again–I know–for I fell victim as a well–He was a young nurse–eager to put into practice what he learned–eager to make a difference–eager to have a career he worked hard at, and for–Instead–he met challenges he was unaware of–challenges that made his life a living hell–In health care its necessary for survival–( imagine that) to maintain a level of thick skin combined with compassion–NOT all nurses” eat their young” I believe its NOT only nurses–But nurses make up the majority of the health care team–But several other team players bully too–I spoke up and out–my son suffered at the hands of who I spoke up and out against–This bully was always a bully–she was my sons direct manager–who he answered to–I, a respiratory therapist–different unions–different boss–didn’t prevent me from becoming the next target after they set him up for complete failure–as others knew -watched–even participated-until they broke him–I on the other hand–had years to develop that protective coating of thick skin–I knew who was coming at me–and why–I was always a protector–advocate–There is no peace when someone has declared war on you–For a young nurse–clinician–unaware of how the system works–the food chain–the manager who has the EGO–the POWER–to incorporate, and ultimately win the war–they are devoured–and left affected by such a powerful unimaginable force–Who failed at being the reason we enter the field–TO DO NO HARM—I lost my son–his journey which started off as an eager new RN turned into his worst nightmare lasting up until he just slipped into deep deep depression—He was always kind–compassionate–looked for a peaceful solution–he was bullied in school–then the work place—He was an easy target—I’m not–but it has taken a huge toll on my life as well–physically, and emotionally–Bullying has a starting point–a reason–a plan–its a well thought out process–at times the bully was also a victim who became so jaded–unable to make peace, — Ultimately they become the bigger more powerful bully—This was the case with my son’s manager–She was allegedly abused by an ex lover–husband–who fathered a child with their son’s girlfriend–My son felt sorry for her–She told me it wasn’t my son–it was actually me she wanted to hurt–but because she couldn’t she hurt the thing closest to me–My child–my son–Things have changed–she retired–my son no longer here–

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