RN Jobs in Pembroke, NH

Parkland Medical Center Derry, NH

RN Intensive Care Unit ICU Registered Nurse

Description *** Up to a 12,000 Sign on Bonus*** Introduction Are you looking for a place to deliver excellent care patients deserve? At Parkland Medical Center we support our colleagues in their positions. Join our Team as a(an) RN Intensive Care Unit ICU Registered Nurse and access programs to assist with every stage of your career. Benefits Parkland Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation. Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Free counseling services and resources for emotional, physical and financial wellbeing 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) Employee Stock Purchase Plan with 10% off HCA Healthcare stock Family support through fertility and family building benefits with Progyny and adoption assistance. Referral services for child, elder and pet care, home and auto repair, event planning and more Consumer discounts through Abenity and Consumer Discounts Retirement readiness, rollover assistance services and preferred banking partnerships Education assistance (tuition, student loan, certification support, dependent scholarships) Colleague recognition program Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income. Learn more about Employee Benefits Note: Eligibility for benefits may vary by location. Are you a continuous learner? With more than 94,000 nurses throughout HCA Healthcare, we are one of the largest employers of nurses in the United States. Education is key to excellence! As a majority owner of Galen College of Nursing, which joins Research College of Nursing and Mercy School of Nursing as educational facilities within the HCA Healthcare family, we make it easier and more affordable to gain certifications and job skills. Apply today for our RN Intensive Care Unit ICU Registered Nurse opening and continue to learn! Job Summary and Qualifications The Registered Nurse coordinates and delivers high quality, patient-centered care in accordance with the nature and specific requirements of the department, and consistent with the scope and standards of practice for the relevant state and specialty. In collaboration with medical providers and other members of the care team, the RN provides individualized, comprehensive, and compassionate care using established nursing models such as “Assess, Perform, Teach, and Manage.” The RN serves as an advocate for patients/families/caregivers and models a commitment to the organization’s vision/mission/values to support an unparalleled patient experience and clinical outcomes that contribute to overall departmental performance. Performs procedures, monitoring, or other functions as ordered by the medical provider(s). Documents the administration of care in the patient medical record in a timely and thorough manner. Teaches patients/families/caregivers about patient medical condition, patient status, treatment plan, medications and possible side effects, and follow-up measures. Translates complex medical terminology to ensure complete understanding. Teaches patients/families/caregivers about any non-medicinal follow-up measures, such as healthy diet and exercise, disease prevention, and/or other lifestyle changes. Prepares patients and families/caregivers for future self-management. Manages evidence-based practices and continuous process improvement initiatives to meet and exceed quality measures and enhance the exceptional care provided to patients. Manages the quality of care by collaborating with a multidisciplinary team to coordinate, evaluate, customize, and deliver a holistic patient treatment plan that promotes and supports recovery. What qualifications you will need: Active NH Registered Nurse license or Compact State Registered Nurse License Associate Degree in Nursing 1-2 years of related experience Advanced Cardiac Life Spt must be obtained within 30 days of employment start date Basic Cardiac Life Support Grow your career where your work truly matters—at Parkland Medical Center . Located in Derry, NH, Parkland is an 86-bed regional acute-care hospital and a designated Level III Trauma Center, delivering high-quality care to the community with compassion and innovation. As part of HCA Healthcare’s trusted network, you’ll be connected to Catholic Medical Center in Manchester, Portsmouth Regional Hospital in Portsmouth, Frisbie Memorial Hospital in Rochester , three freestanding ERs, and more than 70 care sites across New Hampshire. With nearly 5,000 colleagues—including 1,500 nurses and 1,000 affiliated physicians—HCA Healthcare offers a supportive, team-oriented environment where your contributions are valued, your growth is encouraged, and your impact is felt every day. Join us and be part of something bigger. HCA Healthcare has been recognized as one of the Worlds Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses. "Good people beget good people." - Dr. Thomas Frist, Sr. HCA Healthcare Co-Founder If growth and continued learning is important to you, we encourage you to apply for our RN Intensive Care Unit ICU Registered Nurse opening. Our team will promptly review your application. Highly qualified candidates will be contacted for interviews. Unlock the possibilities apply today! We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Outpatient

Elliot Health System Bedford, NH

Registered Nurse Ambulatory - Pediatrics Bedford - Full Time

Come work at the best place to give and receive care! Job Description: About Us Elliot Pediatrics at Bedford, a department of Elliot Hospital, is committed to the healthy growth and development of our patients. All our physicians are fully trained, Board-Certified Pediatricians. Position Summary: M - F 8am-5:00pm The Registered Nurse for Elliot Pediatrics at Bedford will be primarily responsible for telephone triage. Additional duties may include nurse visits, rooming patients, vaccine and medication administration, performing point of care testing, conducting vision and hearing screening, and assisting providers with procedures. Key Responsibilities Embraces and promotes change to support optimal patient outcomes and an effective professional practice environment. Involves patient/family in goal setting and planning, and communicates that plan of care to patient and family for input; and to colleagues to ensure seamless care across shifts and settings. Utilizes current evidence and relevant national/specialty standards to guide practice and/or performance and identifies areas for improvement. Demonstrates competent clinical practice utilizing clinical decision making and critical thinking skills. Education/Experience/Licensure Education: Graduate of an accredited school of nursing. Bachelors of Science in Nursing preferred. Licensure: New Hampshire Registered Nurse or Compact State Registered Nurse License. Technical Certification: Ability to obtain BLS qualification during orientation period and maintain during employment. What Elliot Health System Has to Offer Health, dental, prescription, and vision coverage for full-time & part-time employees Short-term disability, long-term disability, and life insurance coverage Competitive pay Tuition Reimbursement 403(b) Retirement Savings Plan And more ! Work Shift: M- F 8a-5p SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

Elliot Health System Manchester, NH

Registered Nurse - Geropsyche - Full Time - Nights

Come work at the best place to give and receive care! Job Description: Registered Nurse – Geropsyche (GPU) Who We Are: GPU is our 29-bed Geropsychiatric Unit specializing in the care of patients ages 65+ with co-occurring cognitive impairment and psychiatric illness. About the Job: The GPU RN delivers care for patients with psychiatric conditions based on the physical ability, intellectual development, psychosocial, education and safety needs of the geriatric patient. This role works closely with a multidisciplinary treatment team model within a collaborative and supportive environment. What You’ll Do: Provide care to patients with complex psychiatric and medical needs Create and maintain a safe and therapeutic environment for patients and families Embraces and promotes change to support optimal patient outcomes and an effective professional practice environment Involves patient/family in goal setting and planning, and communicates that plan of care to patient and family for input; and to colleagues to ensure seamless care across shifts and settings Utilizes current evidence and relevant national/specialty standards to guide practice and/or performance and identifies areas for improvement Demonstrates competent clinical practice utilizing clinical decision making and critical thinking skills Who You Are: Graduate of an accredited school of nursing (ASN or BSN – BSN preferred) Current New Hampshire, compact, or multistate licensure as Registered Nurse required Ability to obtain BLS qualification during orientation period and maintain during employment Why You’ll Love Us: Medical, Dental, Vision Benefits starting the 1st of the month following start date Accrued Earned Time 403b with matching (fully vested) and discretionary annual core contributions Tuition Reimbursement up to $4,000/year for full time coded employees over 30 hours/week Nursing Student Loan Paydown Program up to $20,000 Sign on Bonus Eligible Miscellaneous Benefits – Pet Insurance, Legal Services, Vendor Discounts Work Shift: 7:00pm - 7:30am - Nights - Every Other Weekend SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

Benchmark Senior Living Concord, NH

RN-Registered Nurse FT Nights

$36 - $40 / hour

Join, stay, and grow with Benchmark. Connect with your calling. The Birches of Concord are l ooking for a compassionate Registered Nurse (RN) to join our team! Full Time Nights Up to $40/HR As a Registered Nurse, your main role will be to deliver nursing care to our residents within a warm, comfortable, and home-like environment. You will be part of a team of dedicated, like-minded individuals whose support and camaraderie build community, and where long-lasting relationships with both associates and residents await. Responsibilities Accurately assesses, communicates, and documents residents’ status. Observes and reports any significant changes in resident behavior and health to the Resident Care Director, physician, family, RCAs, and Executive Director per state regulations. Directs and supervises the daily work assignments of the Resident Care Assistants Closely mentors, guides, and directs the Lead Resident Care Assistants in all aspects of their job. Coordinates care needs with community providers via an effective case management process Effectively balances service demands with supporting resident independence. Recognizes and assists in the prevention of elder abuse, neglect, and exploitation (financial and other) and reports to appropriate sources per state regulations. Responds to emergencies and personal emergency response system and knows when to call for backup. Requirements Current state license as an RN and CPR certification Graduate of an approved RN program (per state requirements) Minimum of 1 to 2 years of experience working as a nurse preferred. Previous experience working with the elderly in a paid or volunteer position is highly desirable. As a community associate at Benchmark, you will have access to a variety of benefits including, but not limited to, the following: 8 holidays & 3 floating holidays Discounted Meal Program Paid Training & Company-provided Uniforms Associate Referral Bonus Program Physical & Mental Health Wellness Programs 401k Retirement Plan with Company Match* Medical, Vision & Dental Benefits* Tuition Reimbursement Program* Vacation and Health & Wellness Paid Time Off* *Eligibility may vary by employment status

Outpatient

Elliot Health System Manchester, NH

Registered Nurse- Vascular Surgery- Per Diem (Day Shift)

Come work at the best place to give and receive care! Job Description: Who We Are: At Elliot Vascular Surgery, we provide comprehensive cardiovascular care to the community. Our group of experienced and talented cardiologists has been serving your needs for decades. The comprehensive cardiovascular care we offer includes Consultative Cardiology, Invasive and Non-Invasive Cardiology, Interventional Cardiology, Peripheral Vascular Disease Testing and Treatment, Pacemaker Implantation and Follow Up, Electrophysiology Testing, Defibrillator Implantation and Follow Up, Nuclear Cardiology, and In-Office Finger Stick Coumadin Testing About the Job: Delivers care to patients and families with needs ranging from basic to complex utilizing the nursing process. Creates a therapeutic and caring environment for patient and families. Practices in a manner consistent with the Elliot Hospital Interprofessional Practice model; the ANA’s Social Policy Statement, Scope and Standards of Practice, and the Nursing Code of Ethics; and relevant specialty standards of practice. What You’ll Do: Work is required to be performed on-site. Expected to cover for absences by rotating, working extra shifts, as needed. Assigned to one area upon employment but may be required to assume assignments in other areas to meet patient needs. Embraces and promotes change to support optimal patient outcomes and an effective professional practice environment. Involves patient/family in goal setting and planning and communicates that plan of care to patient and family for input; and to colleagues to ensure seamless care across shifts and settings. Demonstrates accountability for continued professional growth and development. Demonstrates accountability for own role in smooth operations of unit. Demonstrates the ability to recognize and manage rapidly changing situations. Utilizes current evidence and relevant national/specialty standards to guide practice and/or performance and identifies areas for improvement. Demonstrates competent clinical practice utilizing clinical decision making and critical thinking skills. Who You Are: Graduate of an accredited school of nursing. Bachelor of Science in Nursing preferred. New Hampshire Registered Nurse or Compact State Registered Nurse license required. Ability to obtain BLS qualification during orientation period and maintain during employment required. ACLS preferred. Nurses are expected to pursue professional certification upon eligibility or within three (3) years of entering the specialty practice. Why You’ll Love Us: Newly enhanced Nursing Pay Grade! Miscellaneous Benefits – Pet Insurance, Legal Services, Vendor Discounts Work Shift: Per Diem, Day Shift 8-5 SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

Manager/Supervisor

Concord Hospital Laconia, NH

Nursing Supervisor | Per Diem | Rotating (Laconia/Franklin)

Summary Under the direction of the Administrative Director, the Nursing Supervisor (Registered Nurse) is responsible for daily supervision and coordination of operations for the hospital and patient care areas. He/she is responsible for responding to clinical and organizational emergency situations. The Supervisor is responsible for supporting and assisting in the delivery of quality patient care and professional nursing practice. Education Bachelors of Science in Nursing from an accredited college/university preferred or commensurate education and experience. Certification, Registration & Licensure Licensure required: Current license to practice in the state of New Hampshire. Certification required : Current American Heart Association Basic Life Support for Healthcare Providers certification, ACLS, and PALS or equivalent course credentialed by American Heart Association. MOAB is required is required within 1 year. Experience Minimum of 3 years of acute care clinical experience. Previous supervisory/ leadership experience preferred. Demonstrated ability to effectively and positively interact with a multidisciplinary staff, patients and others, as well as ability to perform as a member of a team Responsibilities Leadership & Resource Management Serves as a leader and resource for staff, patients, and families. Provides support, guidance, and feedback to staff. Coaches and directs staff in clinical decision-making. Demonstrates cost-effective staffing and resource allocation. Serves as on-site leadership during evenings, nights, and weekends, with access to an Administrator On-Call Works in a manner that role models the organization’s values and service behaviors Per Diems are required to work a minimum of 24 clinical hours every 4 weeks, which will include at least 1 weekend shift and at least 1 summer holiday and 1 winter holiday or difficult-to-fill shift around the observed summer and winter holidays. Operational & Staffing Coordination Develops and implements staffing plans based on patient needs. Coordinates bed management and patient flow to optimize hospital capacity. Works collaboratively to solve operational and administrative issues. Ensures adherence to policies, procedures, and nursing philosophy. Clinical Support & Emergency Response Responds to emergency situations (e.g., Rapid Response, Stroke Alerts, Trauma). Serves as a clinical resource, assisting with patient care as needed. Guides nursing care using critical thinking to promote quality outcomes. Acts as Incident Command in emergencies until relieved. Problem-Solving & Decision-Making Anticipates and prioritizes potential problems on shift. Acts as a resource in solving administrative and clinical challenges. Contacts appropriate departments or personnel for assistance when needed. Maintains composure while handling patient, family, and staff concerns. Communication & Service Excellence Serves as a conduit for department and organizational communication. Documents and communicates incidents to management in a timely fashion. Manages service recovery for patient and family concerns. Supports and implements organizational change initiatives. Mission & Policy Adherence Promotes the mission, vision, and values of the organization. Promotes a healthy work environment Facilitates sharing of information, especially on off-shifts, such that staff are informed of organizational communication and initiatives and management is aware of staff feedback Ensures compliance with hospital policies and nursing standards. Participates in hospital-wide initiatives to improve patient care and operations Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Know Your Rights: Workplace Discrimination is Illegal Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269. Physical and Work Requirements The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Dictionary of Occupational Titles Material Handling Classification is MEDIUM. The employee must regularly lift, carry or push/pull up to 10 pounds, frequently lift, carry or push/pull up to 10 - 25 pounds, and occasionally lift, carry or push/pull up to 20 - 50 pounds. While performing the duties of this Job, the employee is regularly required to hear and speak. The employee is frequently required to bend, do fine motor, do repetitive motion, reach, sit, and walk. The employee is occasionally required to climb, kneel, smell, squat, and stand. Specific vision abilities required by this job include color vision, depth perception, far vision, near vision and peripheral vision. The employee is frequently exposed to airborne pathogens. The employee is occasionally exposed to airborne contaminants, blood borne pathogens, bodily fluids, chemotherapeutic agents, electrical hazards - shock, moving mechanical parts, radiation, slippery surfaces, toxic or caustic chemicals. The noise level in the work environment is usually moderate.

Outpatient

Concord Hospital Concord, NH

Concord Endoscopy Center RN | Per Diem

Education Graduation from an accredited School of Nursing, BSN preferred. Certification, Registration & Licensure Certification required: Current American Heart Association Basic Life Support for Healthcare Providers certification, or equivalent course credentialed by American Heart Association. ACLS within 6 months of hire date. Licensure required: Current New Hampshire State Registered Nurse license. Experience Demonstrated proficiency in a clinical specialty such as endoscopy, ambulatory care nursing, intensive care unit or perioperative nursing with at least 2 years of experience. Registered nurses with two or more years of medical/surgical acute care experience within the last ten years will be given consideration. Demonstrated ability to effectively and positively interact with multi-disciplinary staff, patients, and others. Demonstrated ability to perform as a member of a team. Responsibilities Bases nursing actions by applying principles of purposeful, organized thinking to make clinical judgment/decisions. Performs initial assessments, and reassessments on all patients. Reports changes in the patient’s condition to the appropriate provider. Provides education in response to identified needs. Monitors and maintains infection control procedures and safety in all work environments. Administers moderate sedation and other medications to patients as ordered. Documents patient response to each phase of the patient’s procedure experience. Manages time and resources effectively. Leads the health care team. Performs other duties as assigned, with additional training as necessary. Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Know Your Rights: Workplace Discrimination is Illegal Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269. Physical and Work Requirements The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Dictionary of Occupational Titles Material Handling Classification is MEDIUM. The employee must regularly lift, carry or push/pull up to 10 pounds, frequently lift, carry or push/pull up to 10 - 25 pounds, and occasionally lift, carry or push/pull up to 20 - 50 pounds. While performing the duties of this job, the employee is regularly required to hear, speak, and walk. The employee is frequently required to do fine motor. The employee is occasionally required to bend, do repetitive motion, reach, sit, smell, squat, and stand. Specific vision abilities required by this job include color vision, depth perception, far vision, near vision, and peripheral vision. The employee is frequently exposed to airborne contaminants, airborne pathogens, bloodborne pathogens, bodily fluids, and toxic or caustic chemicals. The employee is occasionally exposed to electrical hazards - shock, moving mechanical parts, and slippery surfaces. The noise level in the work environment is usually moderate.

Manager/Supervisor

Concord Hospital Laconia, NH

Nursing Supervisor | Nights | Per Diem (Laconia/Franklin)

Summary Under the direction of the Administrative Director, the Nursing Supervisor (Registered Nurse) is responsible for daily supervision and coordination of operations for the hospital and patient care areas. He/she is responsible for responding to clinical and organizational emergency situations. The Supervisor is responsible for supporting and assisting in the delivery of quality patient care and professional nursing practice. Education Bachelors of Science in Nursing from an accredited college/university preferred or commensurate education and experience. Certification, Registration & Licensure Licensure required: Current license to practice in the state of New Hampshire. Certification required : Current American Heart Association Basic Life Support for Healthcare Providers certification, ACLS, and PALS or equivalent course credentialed by American Heart Association. MOAB is required is required within 1 year. Experience Minimum of 3 years of acute care clinical experience. Previous supervisory/ leadership experience preferred. Demonstrated ability to effectively and positively interact with a multidisciplinary staff, patients and others, as well as ability to perform as a member of a team Responsibilities Leadership & Resource Management Serves as a leader and resource for staff, patients, and families. Provides support, guidance, and feedback to staff. Coaches and directs staff in clinical decision-making. Demonstrates cost-effective staffing and resource allocation. Serves as on-site leadership during evenings, nights, and weekends, with access to an Administrator On-Call Works in a manner that role models the organization’s values and service behaviors Per Diems are required to work a minimum of 24 clinical hours every 4 weeks, which will include at least 1 weekend shift and at least 1 summer holiday and 1 winter holiday or difficult-to-fill shift around the observed summer and winter holidays." Operational & Staffing Coordination Develops and implements staffing plans based on patient needs. Coordinates bed management and patient flow to optimize hospital capacity. Works collaboratively to solve operational and administrative issues. Ensures adherence to policies, procedures, and nursing philosophy. Clinical Support & Emergency Response Responds to emergency situations (e.g., Rapid Response, Stroke Alerts, Trauma). Serves as a clinical resource, assisting with patient care as needed. Guides nursing care using critical thinking to promote quality outcomes. Acts as Incident Command in emergencies until relieved. Problem-Solving & Decision-Making Anticipates and prioritizes potential problems on shift. Acts as a resource in solving administrative and clinical challenges. Contacts appropriate departments or personnel for assistance when needed. Maintains composure while handling patient, family, and staff concerns. Communication & Service Excellence Serves as a conduit for department and organizational communication. Documents and communicates incidents to management in a timely fashion. Manages service recovery for patient and family concerns. Supports and implements organizational change initiatives. Mission & Policy Adherence Promotes the mission, vision, and values of the organization. Promotes a healthy work environment Facilitates sharing of information, especially on off-shifts, such that staff are informed of organizational communication and initiatives and management is aware of staff feedback Ensures compliance with hospital policies and nursing standards. Participates in hospital-wide initiatives to improve patient care and operations Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race, color, religion, sex, sexual orientation, gender, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. Know Your Rights: Workplace Discrimination is Illegal Applicants to and employees of this company are protected under federal law from discrimination on several bases. Follow the link above to find out more. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, you may contact Human Resources at 603-230-7269. Physical and Work Requirements The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Dictionary of Occupational Titles Material Handling Classification is MEDIUM. The employee must regularly lift, carry or push/pull up to 10 pounds, frequently lift, carry or push/pull up to 10 - 25 pounds, and occasionally lift, carry or push/pull up to 20 - 50 pounds. While performing the duties of this Job, the employee is regularly required to hear and speak. The employee is frequently required to bend, do fine motor, do repetitive motion, reach, sit, and walk. The employee is occasionally required to climb, kneel, smell, squat, and stand. Specific vision abilities required by this job include color vision, depth perception, far vision, near vision and peripheral vision. The employee is frequently exposed to airborne pathogens. The employee is occasionally exposed to airborne contaminants, blood borne pathogens, bodily fluids, chemotherapeutic agents, electrical hazards - shock, moving mechanical parts, radiation, slippery surfaces, toxic or caustic chemicals. The noise level in the work environment is usually moderate.

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