The Winkler Nurses Case on #RNchat

When I started #RNchat last year (@RNchat on Twitter), my hope was to assemble a simple and supple forum for nurses and the public to discuss important issues from the perspective of a diverse group of people.

Here’s a re-post of the transcript for Friday, February 12, 2010’s RNchat, with my commentary on the Winkler County, Texas Nurses case:

Below is a SlideShare of #RNchat for Friday February 12, 2010, organized in chronological order (from beginning of chat to sometime just after). The chat was moderated by Ellen Richter (@EllenRichter on Twitter).

The #WinklerRNs case was the topic of conversation. In Winkler County, Texas, nurses who went through the torment of being charged for leaking private medical information. One of the nurses went to trial and was acquitted within one hour. Now the nurses are responding

This is an important case, one which – among many other things – highlights the need for swift and bold and sturdy nursing organizations. This case isn’t just about defending nurses: it’s ultimately about the safety of patients, the ethical fiber of nurses and doctors and administrators and government officials. Had Anne Mitchel been found guilty, the ramifications could well have been ominous for the integrity of our entire health care landscape.

Friday’s RNchat, discussed topical features of this case: the best practices for whistle-blowing and how to get more organizations behind nurses and the public. Feel free to share the presentation below.

Let’s hope that nurses don’t become scapegoated victims. Do nurses make technical mistakes? Sure they do – we all do. But it’s critical that nurses never feel afraid of expressing their sincere perceptions, their intuition nor their ethical belief system. People can die under those circumstances.

Nurses are the last Jedi Nights of our faltering Republic. A cheesy metaphor? Yes. But it’s true. Anne Mitchell and the other nurses involved in this case are Jedi Knights who fought through a derangement of how ethics and law and responsibility should work.

Anne Mitchell has gone through a Kafka-like hell. Let’s hope she receives comfort and equity and sanity.

NOTE: We also are preparing for a special even in conjunction with the Robert Wood Johnson Foundation. Details upcoming soon!

As always, thank you to those who joined today. If you’re new to #RNchat, just follow @RNchat on Twitter and we’ll provide updates and links on how to make the best use of this nursing chat. You can also send inquires to info [at] RNchat [dot] org.

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An Open Letter to (Some) Nursing Education Faculty

Dear Nursing Faculty Around The World:

First, I’d like to thank you for devoting your time to advancing the nursing profession and passing along your knowledge to the next generation of nurses. You probably don’t get much public recognition for the work you do. I wish you did. Maybe that will change (read on).

In scanning around web, I’ve noticed lately that many nursing students are frustrated, disappointed and angry with the way they are treated in nursing school. If you honestly care about the future of the nursing profession, then you aught to determine if there’s anything you need to change about your approach.

I attended an accelerated program and my peers already had bachelors degrees. I am grateful for what the teachers did for my education. I detested most of the ridiculous and outdated approaches some of the faculty embraced, but I got what I wanted out of the whole experience. I am grateful for what the faculty did for me.

But I also had the chance back then to observe some of the behaviors of the nursing instructors. Frankly, I was disappointed in what I witnessed. The way some clinical instructors behaved toward their students was inappropriate, abusive and counterproductive. Nursing schools are going to have to put an end to these behaviors.

Having spent a few years in bedside nursing, I realized that the health care profession seems to have a higher proportion of unhealthy and harmful personalities. Most of the profession is composed of remarkable people. The bad apples, though, are spoiling the entire industry.

I suspect that the intra-professional abuse that happens stems from the need to take patient care seriously. It should be serious business: life is at stake. Using that premise as a pretext for displacing anger has no place in the health care setting. It’s dangerous: life is at stake. Berating your students or peers does nothing to help patients.

So to those of you who might be abusing your students: stop it. For those of who run nursing education facilities: do your part to stop the emotional violence. We’re losing the war in nursing and physician recruitment. In an age when one person can reach millions within minutes, you no longer can turn a blind eye to the problem.

Please think about the impact your behavior has on nursing students. If you were mistreated by crotchety nurses during your education, please don’t replicate that misfortune on people who don’t deserve it. If you do that then you are ruining the most important profession in the world.

Here are some practical tips for being a better nursing instructor:

  1. Understand that making mistakes is essential in learning well
  2. Appreciate your students’ inexperience
  3. Accept the diversity of your audience
  4. Never humiliate your students
  5. Lead your students as if they were the last hope for the profession
  6. Find a good therapist
  7. Don’t take it all so seriously
  8. Know the difference between constructive feedback and destructive emotionalism
  9. Learn to turn the most difficult students into remarkable opportunities for education innovation
  10. Elicit the help of your peers and school leadership during difficult times

We don’t have much time left to rescue the health care industry from the its eventual demise. Word is now getting out about how nurses and nursing students are treated. Bad news travels so much faster than good news.

If you don’t ensure that nursing school is a safe, effective and remarkable environment to cultivate, socialize and encourage the best and brightest minds to enter the nursing profession, history will hate you.

It’s no longer the 20th Century. Mass communication is giving way to mass connection. Nurses, and nursing students, are growing networks, establishing on-line presences and constructing novel ways to distribute ideas around the world. It’s becoming harder to conceal long-silenced wrong-doing in institutions.

Think about what I’m telling you. I love our profession, but I’m disappointed in how some people in this industry can treat each other. Nursing school is a large part of the problems we now face. You are at the center of something that could be remarkable. Please don’t rip out your place in history.

It’s your choice: continue an archaic cycle of abuse or create a remarkable future for the health care of every child, woman and man on the planet.

Sincerely,

Phil Baumann, RN BSN (whatever that means)

Stumble It!

8 Ways to Become a Better Nurse

One of the benefits of being away from bedside nursing is that I’ve had time to reflect on my own performance. How could I have been better? What simple precepts would have helped? Being out of the “fog of war” has given me a clearer view of what’s right and what’s wrong in health care. Our culture doesn’t offer much positive encouragement for the nursing profession. That’s a costly shame, as many Baby Boomers soon will discover. To help out, I’ve come up with eight ways to become a better nurse.

  1. Pay attention to how you perceive your patients
  2. Intend nothing but the best for your patients
  3. Speak the truth in a way that echoes your wisdom, not your darkness
  4. Act on the facts but respect your intuition
  5. Live your life as a connection to something greater than yourself
  6. Work through your hardest times, not against them
  7. Mind your mind: its power to destroy is its power to heal
  8. Focus on the moment, not the past

Some of us are cut for bedside nursing, some of us aren’t. I think if you’re in bedside nursing and enjoy what you do then you’re a Jedi Knight who commands more respect than you probably receive.

For those of you who don’t quite enjoy what you do, think about your reasons for what you do. Consider the eight precepts (or make up your own) and see if anything changes for the better. You have more options than you realize.

Feel free to add your own suggestions for becoming a better nurse. If I get to 101, I’ll post your thoughts here and promote the living shit out of the list.

I hope the list I’m offering here helps you to become a better nurse, a better person, a better part of our quickly-changing world.

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Are You Serious?

The Thinker, Artist's rendering of the sculptu...Image via Wikipedia

The healthcare industry is full of serious people. They should be serious, shouldn’t they? After all, health care is serious business. Life is at stake and life is sacred. But if you had to choose between two different kinds of providers, which one would you prefer: the serious one or the responsible one? The two kinds aren’t necessarily the same. Being serious is an emotion. Responsibility is a state of awareness. That difference could seriously influence the quality of your treatment.

THE COST OF BEING SERIOUS

Most of the people in health care are good, competent and emotionally secure human beings. Unfortunately, there are also a lot of angry people in the same industry. I know that I don’t want an angry surgeon or ticked off nurse giving me a medication. Do you? Could anger stem from being serious? I believe that it could.

Our culture teaches us to be serious. There’s nothing wrong with being serious per se. But it’s worth a peek at what grows beneath the word. The root word of serious is seryows, which sounds a bit like sorrows. Ours is a serious world. It’s also sorrowful. Perhaps there’s a connection. If language influences our perceptions and behaviors, then we need to re-think what we teach our children. Otherwise, they will grow up to confuse seriousness with responsibility. They will be depressed. Look around you if you think I’m exaggerating.

THE BENEFITS OF BEING RESPONSIBLE

Fortunately, our culture teaches us to be responsible too. Resonsible is rooted in respuns, or response. Responsibility by definition requires action, a reply. Being responsible, however, is not the same as being serious and yet our culture often equates and confuses the two words. That’s an error that might be costing us lives.

I understand the need for bearing a sacred sense of emotion when providing care to patients. I’m not arguing against the sacred. I am arguing for stripping away the assumptions we make which prevent us from being our most responsible. Experienced professionals have smashed medical equipment against walls because they were serious about saving their patients’ lives. That’s pretty serious. It’s not responsible, especially when the equipment is life-saving.

Many health care facilities still tolerate this madness. Why? I think it’s because some of the people who run those organizations are serious about healthcare and they’re afraid that by condemning the serious behavior they are violating the sacredness of life. Health care is an ancient business. It’s an historical confluence of religion, warfare, science, art, culture and just about everything else that makes a civilization. So it’s not much of a wonder why the healthcare industry is so serious about being serious. The industry can do better. It’s your health, so it’s your responsibility too.

If you want to find out for yourself, offer to volunteer at your local hospital. See if there’s anything you can do to lighten things up.

LESS SERIOUS. MORE RESPONSIBILITY.

I think it’s time we publicly recognize the difference between being serious and being responsible. The two aren’t necessarily mutually exclusive; but the semantic relationship might just be too close for us to dismiss.

I know I want to be responsible. If that means I have to be less serious, so be it. Nursing might be a lot more fun. It should be. After all, life is a stake and life should be fun. Fun is a responsiblity of the living. Seriousness is for the dead. It’s our responsibility to save our sorrows for the dead. That’s how we rescue them.

If being serious leads to anger and anger leads to error, then we need to be less serious and more responsible. Life is at stake and life is sacred. Seriously.

If you have ideas on how to improve our health care responsibilities, please comment here. If you like what your reading, subscribe to my feed and we can continue the discussion.

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Why a Registered Nurse is Interested in Social Media

Healthcare and technology are in a rocky relationship. Technology has been prowling about town and growing exponentially while the provision of healthcare remains cooped up inside, unrequieted and left behind. Moore’s Law, which is bleeding out of microprocessors into our lives, seems to be the other lover fueling this breakdown. If this relationship completely breaks down, you and I won’t have the health needed to enjoy the fruits of the cultural upheaval that technology is stirring and which Moore’s Law is infusing. What can be done to resuscitate this relationship? An RN shares his perspective on social media.

The ultimate promise (and perhaps lie) of social media is a transformation of society from a swarm of mindless consumers into a democracy of awakened citizens.

Enter the Registered Nurse

Before I answer the question above: a little backgound about myself and why I’m interested in social media. I have no formal training in IT or social media marketing or web design or blogging. I am an ICU nurse with a background in accounting and finance. A combo like that means that when I look at things I critically assess what I see and probe beneath the surface of appearance (and I see things which you probably don’t want to read about after your breakfast). I know how skeptical questioning leads to better ways of seeing and doing things and I believe that outsiders often provide a fresh and needed insight into traditional fields because they don’t have to uncover the blindspots that often accompany the status quo.

Business, like nursing, is 20% science and 80% common sense. And that rough metaphorical proportion probably holds true in social media.  I cannot point to specific statistics or Harvard-researched studies with complex equations supported by rigorous methodologies to prove to you that social media can revolutionize healthcare. Do I wish I had evidence-based knowledge to back my claim? Of course. But I assert: if we don’t even consider bringing social media to the healthcare industry and thereby yank the industry into the 21st century then we would be incurring a potentially lethal opportunity cost.

Before I became a nurse I was a regular guy living the bubbly posh dream of upper middle class life. My knowledge of the suffering which human beings can endure was academic. But I was interested in learning a lot more; in fact, I wanted to break-out of my bubble to see what the proverbial Rabbit Hole was all about. So when I plunged into the gulf of nursing, my intimate acquaintance with the truth of our world was almost as traumatic as drowning. But I learned to swim.

Health is Social, Social is Health

If there was one common theme I found in caring for my patients I would say it was the importance of support systems. Patients with families who supported them tended to have better outcomes: either they recovered faster or, if their condition was terminal, their deaths were dignified and in the company of love.

But often patients don’t have the support systems in place that they need. And patients sometimes need more than just family support. They need more, even if it’s just a simple link to another patient with the same or similar set of problems. Healthcare facilities don’t always provide optimal support systems. There are various reasons for this–some justifiable, others unconscionable, and the other reasons somewhere in between. Whatever the reasons, we don’t necessarily have to wait for facilities to revolutionize themselves; support systems can be developed in spite of the limitations of the healthcare industry itself. This is where social media becomes interesting.

I have been lurking and commenting on blogs about social media. I have seen amazing ideas, novel approaches to solving problems, and reviews on the latest tools for improving business. But I have also seen a lot of disconnected evangalizing about social media. There seems to be two camps with respect to social media: it’s the greatest thing since sliced bread or it’s largely a total waste of time. To that dichotomy I offer an intuition pump:

A poorly made hammer is no reason to abandon hardware in favor of pounding nails into the wall with your fist.

Twitter has Risen…with Wounded Wings

Countless social media interfaces abound the internet. There are the popular interfaces such as FaceeBook and MySpace. And there are different kinds of social media tools such which you can learn about. But for the sake of this post, I’d like to single-out Twitter.

Twitter is the sound of the Long Tail wagging.

Twitter is a-glitter in the Web 2.0 memesphere. Twitter is not something you can theoretically reject or embrace. It’s an experience. Go sign up now and download Twhirl (or any other client) if you haven’t already. Twitter, pehaps more than any other current social medium, demonstrates the strange but unstoppable power of social media.

Twitter is utter nonsense if that’s how you use it. It’s brilliant if you recognize its (unintended) brilliance. Twitter is a remarkable permission-based human linking system. I have followed incredibly successful, bright and diverse groups of people. I have been gifted with haikus of pearly wisdom, hyperlinks to places I never would have found on Google alone and those links sparked my creativity, intellect and hope. And I have even enjoyed the nit-Twits from Twitterers who probably don’t yet get it; I enjoyed them because somehow it’s all so wonderful to see the voices of people I’ll never meet but who make the experience palpable, real, and more alive than the typical web interface. Even the best blogs can’t deliver that peculiar kind of gig.

Never before in the history of our species have we had a means to instantly communicate with anybody in the world in quite the way we are able to do with Twitter. Think about that. As an interface it has a long way to go. But its ability to link human beings the way that it does is worth adopting, regardless of its future. Twitter is the sound of the Long Tail wagging.

But Twitter also provides a demonstration of the kinds of places social media is heading. As a nurse I am curious to know how it can be used from a healthcare perspective. Here are some hypothetical Tweets to consider:

  • “I was told today that I have a metastasised cancer.”
  • “I’m so depressed that I want to commit suicide. Last night I bought a gun.”
  • “My daughter was killed by a drunk driver last week.”

How would the Twittershpere handle such Tweets? I’m sure that there would be plenty of caring, supporting and concerned followers. But they might not really be equipped to handle such a circumstance. What mechanism could we implant to deal with such situations? This is a real test for social media’s power. And its danger.

Twitter raises fundamental questions that extend beyond healthcare in particular, but which have implications for our general health. What obligations, if any do we have? If I choose to follow you on Twitter (or any other social medium), what kind of permission have I given you and what kind of responsibilities do I have in return? (If you follow me, maybe we can work on the problem.)

We need to discuss these things. We need to get social media right. And right from the start.

An Interactive Connection Among People

Social media has all sorts of definitions on the web. (Google “social media” and find out what I mean.) But here’s my definition:

Social media is an ever-evolving interactive connection among people.

Interactive connection among people. Isn’t that what we are about after all? Isn’t that the very thing our ancestors struggled against the brutal elements to preserve and hand down to us? Of course it is. Religion, art, primitive science, politics…all were social projects achieved through social media. And now is our chance to produce a future to be proud of or to be cursed upon. Love it or hate it, our relationship with technology is becoming increasingly lop-sided in its direction, a direction which could increasingly favor technology more than us. Infusing the technology we are evolving with our social needs is no bad idea at all. It may be what saves us from the final scene in 2001: A Space Odyssey in which the cold and calculating computer manifests human fear while the methodical human being terminates a new kind of life.

I hope by now, I’ve convinced you about the relevance of social media in your life.

A Quick Diversion Down the Social Media Market on Main

Let’s pull-back for a moment and look at the big picture of the economic implications of social media.

The healhcare industry has been slow to properly adopt capitalism successfully. Perhaps that’s because traditional doctors and nurses and administrators didn’t used to have to concern themselves with financial matters when local philanthropy was more common than today. Whatever the reasons, the economics of healthcare is central to the problem of its provision. Any tool which can help patients receive quality care aught to receive an investment of attention.

I hear a lot of talk about universal healthcare by people who have neither first-hand experience delivering healthcare nor a working understanding of macro or micoeconomics. If we are to develop intelligent healthcare strategies, we are going to need to connect the right people together. Fighting the right war with the wrong people is worse than surrender. (The last century took a backslide because so often the wrong people fought the right wars.) The right kind of social media can bring the right people together to collaborate more effectively than political hucksters who exploit every popular pretext for election into office.

If you are intending to use social media to bake your bread, you can use it to improve your market position by delivering remarkable interaction with your customers..or it can accomplish nothing but hastle. Blogging can generate a healthy ROI or waste all of your time. It’s all in your understanding of a blog’s relevance, its place, its limits, its strengths, its science, its art. It depends upon your strategy. A well-crafted up-to-date blog on a hospital’s domain could be a practical way to offer better services, listen to what the community wants and provide a network of patients and family members who otherwise might struggle through their difficulties alone.

Aagain: a poorly made hammer is no reason to abandon hardware in favor of pounding nails into the wall with your fist.

The tools of social media are cheap, ever-evolving, ever-refining, and ever-elusive. Which is to say that social media is laddled with opportunity. It forces us to keep learning, to acquire new skills which we might not ever develop without them. That’s a quality that goes far beyond monetization, consulting fees and commerce. To simply ignore them prima facie based on their misuse is to risk being washed away by the inevitable tsunamis of Moore’s merciless Law. And social media just might be a tsunami to most of Corporate America: people who don’t understand what those tiny little waves accross the ocean really mean can end up like this (link if video missing in your browser):

If the leaders of the healthcare industry can get up to speed with the opportunities provided by social media, then they have an opportunity to converge the right kind of capitalism with the most comprehensive, preventative and effective kind of healthcare system they (and we) are responsible to produce. Not all disasters are inevitable.

An Example of How to Use Social Media in Healthcare

I would like to see social media explored more in the realm of healthcare. For instance, I would like to see a Googlesque Twitter that could link the experience of millions of doctors and nurses and other healtcare providers around the world.

Imagine a doctor treating a patient with symptoms that she just can’t put together into a cohesive diagnosis. If she could Tweet her community and get instant feedback from others who encountered similar cases then she might get that one little idea that could help her more effectively diagnose or treat her stumbling case. Could that kind of use improve treatment or even save a life? Or consider this: How many residents could benefit from following the Tweets of a world-renowned specialist attending fascinating cases? This is the kind of power I’m interesting in seeing evolve intelligently. This is why a registered nurse is interested in social media.

Conclusion: We Need to Get Social Media Right

To arguments that social media is an empty meme and a big waste of time, I say: yup, you’re right…almost. What those arguments are missing is this: the ultimate promise (and perhaps lie) of social media is a transformation of society from a swarm of mindless consumers into a democracy of awakened citizens. There is a big difference between the two. Patients aren’t consumers. They are citizens. That’s a difference worth fighting to make and keep for our descendants.

If we play it right, if we intelligently follow the tenuous thread that the leaders and adopters of this movement are consciously and unconsciously weaving, then social media just might bring us back from that healing place which our modern reasoning has been tugging us away from: home.


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