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Invisible Nurse Redux

leslie nicollThis post is written by Leslie H. Nicoll, PhD, MBA, RN, FAAN  a passionate nurse, wife, and mother. She lives in Portland, Maine where she owns her own business, Maine Desk LLC. She is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Editor of Nurse Author & Editor. Dr. Nicoll is an advocate for the poor and vulnerable in our society and lives this mission by working 2 1/2 days per week as the Coordinator at the Portland Community Free Clinic. Dr. Nicoll was very proud to be inducted as a Fellow in the American Academy of Nursing in October 2014. 

Kaci Hickox, the nurse who was quarantined in a tent in New Jersey for four days, has become a household name—sort of. What isn’t as well publicized are her educational credentials and expertise. Nurse Hickox is presented as “just a nurse” and if one is to believe the comments written about her in public discourse (newspapers, Facebook, Twitter) she is the worst kind of nurse: selfish, narcissistic, ambitious, egotistical, and negligent. Definitely not the sort of nurse someone would want at their bedside when they are in extremis, if you are inclined to agree with the opinions that many anonymous writers have shared.

I’ll be honest, I didn’t start paying close attention to Nurse Hickox’s story until she left New Jersey and came home to Fort Kent, Maine. But once her situation became local news (I live in Portland), I couldn’t ignore it. “QUARANTINED NURSE” was the lead headline for the past week.

One thing I noticed, right off the bat, is that all stories about her gave the bare minimum of information—her name and sometimes, her age (33). That’s it. No mention of her employer, education, expertise, or experience. Reporters did talk about her boyfriend, Ted Wilbur, 39, a nursing student at the University of Maine at Fort Kent. It was surreal to feel like I knew more about Ted than I did about Kaci, who really was the person of interest at the heart of this story.

Limited info about Nurse Hickox didn’t stop the online “pitchforks and torches” crowd from attacking her, however. Think of the nastiest thing you can say about someone and multiply it by ten—that will give you a sense of the vitriol that has been posted on the websites of the Portland Press Herald and the Bangor Daily News. I ventured to a Kaci Hickox Facebook page and read more of the same, including this comment: “Bet this fanpage isn’t working out the way you expected it would, bitch!!”

Things reached a head, at least in my head, when I read a series of posts from people claiming to have contacted the Maine Board of Nursing demanding that her license be revoked and finding out that she isn’t even licensed to practice nursing in Maine! This caused even more outrage, with comments suggesting that she is not a “real RN” and that she was “practicing medicine” [sic] in Africa illegally.

So, who is Kaci Hickox, really? It turns out she is extremely well educated and well qualified for the work she is doing: BSN from the University of Texas at Arlington (2002), MPH and MSN from Johns Hopkins University (2011), a diploma in tropical nursing from the London School of Hygiene and Tropical Health, plus a two year post-graduate fellowship in applied epidemiology with the CDC. Nurse Hickox is a paid volunteer by Doctors Without Borders (Médecins Sans Frontières, MSF) and under their auspices, has traveled to work in Myanmar, Nigeria, and most recently, Sierra Leone. She has a very definite career path to work with poor and vulnerable populations throughout the world. Interestingly, she was turned down by MSF for a job in 2004 because she didn’t have enough experience. That motivated her pursue her tropical nursing diploma and dual master’s degrees, all while gaining international experience in Indonesia and other countries.

Clearly Nurse Hickox is a smart, assertive, and intelligent woman who knows how to stand up for her rights and fight for what she believes in. But the press seems determined not to show us that side of her—instead, they keep her anonymous and vague. In headlines she is often nameless, to wit:

  • Judge in Maine Eases Restrictions on Nurse (New York Times, October 31, 2014)
  • Unapologetic, Christie Frees Nurse From Ebola Quarantine (New York Times, October 27, 2014)
  • Tested Negative for Ebola, Nurse Criticizes Her Quarantine (New York Times, October 27, 2014)

In videos that I have watched of Gov. Christie (NJ) and Gov. LePage (ME) discussing the situation—Nurse Hickox is never mentioned by name but always referred to as “her” and “she.” Gov. LePage goes on to say that “that woman” has “violated every promise” and that “we can’t trust her—I don’t trust her.”* He has also warned that she might be attacked if she leaves her home, which I heard as a veiled threat and bullying tactic.

I posted a comment in response to a New York Times article on October 31 that detailed some of her education because I was tired of the lack of information about her. So many commenters were assuming that she was undeducated and unprepared for the job and that she had gone to Africa on a lark with an urge to become famous. I wanted to do my little bit to get accurate data into the public record. 

People thanked me for  my post, saying that this information had not been shared before and was not “common knowledge.” Was I truly the first person to investigate Nurse Hickox’s background (which took about two minutes of Googling)? Turns out I wasn’t—there was an article in the New York Times on October 25 with this background, but it was buried on page A24. It was a standalone piece and none of the information contained in that article has been referenced in subsequent articles written about her. I also found alumni articles from Johns Hopkins and the University of Texas at Arlington** but has this material been shared generally? Sadly the answer is no.

So, what is my takeaway on all of this? One—the world out there: the public, reporters, governors and everyone else—see “nurses” as a commodity, one in million, who do not need to be named and identified by education and experience. Knowing this, we need to be vigilant to provide names, degrees, and credentials, for both ourselves and our colleagues. Note that in this post I have explicitly used Nurse Hickox rather than “Kaci” or “Ms. Hickox.” I believe this is a small way to be respectful and also get the fact that she is a nurse right out front.

Two: nursing education is confusing. This, unfortunately is a problem we in the profession have created but for people who aren’t pursuing a degree in nursing, it can be simplified and made clear. Most everyone knows what a bachelor’s degree is, likewise a master’s or PhD. Use those terms. “Kaci Hickox has two master’s degrees from Johns Hopkins.” People will understand that Nurse Hickox must be “wicked smart” (to use a Maine term!) to have accomplished this.

Three: career options in nursing are wide and varied (good for us who are looking to do different things) but again, the public seems to equate nursing with being at the bedside in a staff nurse role. There were many opportunities in the Nurse Hickox story where misconceptions were not corrected: she has a definite career plan, she has the education and expertise to serve in complex public health situations, and she did not go to Africa on a whim.

Fourth: strong, assertive nurses (and women) are not bad people. Nurse Hickox stood up for her rights and was publicly shamed for it. This is not acceptable and we must be vocal and support our colleagues. Interestingly, Monica Lewinsky has recently come forward with a mission to stop cyberbullying and public humiliation, based on her experiences of the past 16 years.*** Cruel, heartless online posting, from people who can hide behind a screen name are abhorrent to me and unfortunately, the incidence seems to be increasing. We must do what we can to stop this practice. Getting on the right side of the Nurse Hickox story seems like a good place to start.

Fifth: modern nursing is not the profession that many envision—docile, subservient nurses dressed in white and working in the hospital. Instead, we are creative, educated, and intelligent men and women who work in settings unimagined a generation ago. Each of us has a responsibility to correct misconceptions about our profession and career and should do this at every opportunity. When asked what I do, I always say that I am a nurse first, then add, “I own my own business,” “I am the editor of a professional journal,” or “I am the coordinator at our local free clinic.”

I was heartened this morning when the headline in the Maine Sunday Telegram did identify Nurse Hickox by name. Of course, she was called “Ebola nurse” in the same headline. Sigh…one step forward, one step back.

Written by: Leslie H. Nicoll, PhD, MBA, RN, FAAN

Sources:

*Gov. LePage: http://www.pressherald.com/2014/10/31/maine-cdc-restaurant-worker-may-have-exposed-patrons-to-hepatitis-a/video/

Gov. Christie: http://nyti.ms/1u9zFAP

**http://www.uta.edu/utamagazine/archive-issues/2010-13/2012/07/passion-practicality-drive-nursing-graduate/

http://nursing.jhu.edu/news-events/news/news/ebola-hero

***http://www.cnn.com/2014/05/06/opinion/robbins-lewinsky-strength/

Invisible Again

invisible nurse

What’s wrong with this media advisory:

______________________________________________________________________

MEDIA ADVISORY
NIH MEDIA BRIEFING ON DISCHARGE OF EBOLA PATIENT FROM ITS CLINICAL CENTER SPECIAL CLINICAL STUDIES UNIT

WHAT
NIH officials will brief reporters about the discharge of Nina Pham, the Dallas nurse who was admitted to the NIH Clinical Center on October 16 with Ebola virus disease, and is now virus free.

WHO
– Francis S. Collins, M.D., Ph.D., Director of the National Institutes of Health
– Anthony S. Fauci, M.D., Ph.D., Director of the National Institute of Allergy and Infectious Diseases
– H. Clifford (Cliff) Lane, M.D., NIAID Clinical Director
– John I. Gallin, M.D., Director, NIH Clinical Center
– Tara Palmore, M.D., Director, Hospital Epidemiologist, NIH Clinical Center and Director, Infectious Diseases Training Program, NIAID
– Rick Davey, M.D., Deputy Clinical Director, NIAID Division of Clinical Research

___________________________________________________________________________

Once again, nurses are missing from media stories on Ebola. Why would the NIH clinical center not include at least the chief nurse for the clinical center to talk about the care that Nina Pham received?

We’re back to pre-Nina Pham days.

When nurse Nina Phan was diagnosed with Ebola, journalists were on the hunt for nurses who could be interviewed. While National Nurses United was proactive with reaching out to media, other journalists turned to nurses such as Karen Cox, Secretary of the American Academy of Nursing and COO of Mercy Children’s Hospital in Kansas City; Pamela Cipriano, president of the American Nurses Association;  and Elaine Larsen, international expert in infectious disease and professor of nursing at Columbia University. As president of the American Academy of Nursing, I was fielding multiple media requests, providing commentary on the situation and referring journalists to experts such as Cox and Larsen.

It was a ‘media frenzy’, as many called it. For nurses, it was heartening to see the attention to the daily, heroic work of many nurses and to see nurses as spokespeople in the media. But once Nina Pham was declared Ebola-free, the calls stopped. Now it’s all physicians and politicians all the time.

Of course, the exception is Kaci Hickox, the nurse who is being quarantined outside of University Hospital in Newark, NJ, after returning from Liberia where she cared for patients with Ebola. She is sympom-free and, probably Ebola-free; and, thus, not able to transmit the virus. Despite this, Governors Andrew Cuomo and Chris Christie have set policies in their states that require aid workers and other travelers from West Africa who had contact with Ebola patients to be quarantined for 21 days. This is not a house-quarantine with self-monitoring.

On CNN Sunday morning in an interview with Candy Crowley, Hickox refused to agree that the policies were reasonable. Instead, she argued that the policies do not reflect the available evidence. Indeed, as another CNN reporter pointed out, the nurses and other health care workers who are taking care of patients with active Ebola in Bellevue Hospital, demonstrating how poorly thought out the policy is. Hickox was informed, smart, and fiesty. She stood her ground and clearly articulated her reasons for opposing the new quarantine policy.

Once Hickox is able to go home, will there be any nurses’ voices in the media’s discussion of the nation’s response to Ebola and other infectious diseases? Will nurses be sought routinely by journalists as experts on health and health care issues? Will their different and important perspectives on these matters be sought?

Or will we once again be invisible?

Diana J. Mason, PhD, RN, FAAN, Rubin Professor of Nursing

Digital Health Advocacy

Sarah Mendoza AoananThis guest post is written by Sarah Mendoza Aoanan a Health Advocacy Fellow at the Global Healthy Living Foundation.  She received her Masters in Health Advocacy from Sarah Lawrence College and is a Herman Biggs Health Policy Scholar.  A compassionate supporter of people living with chronic illness, Sarah is dedicated to reducing barriers to health care.

People who are diagnosed with at least one chronic medical condition are more likely to seek information online, use social media to understand peer patients’ reviews on drugs and treatments, and learn from other patients and patient-centered organizations about their personal health experiences and how to improve them.

On October 20, Global Healthy Living Foundation (GHLF) will host its third digital advocacy summit — Digital Health Advocacy in Washington, DC and online. Digital health social media experts will help advocates realize the full potential of social media in advancing their goals and strategies. Follow the proceedings on Twitter using hashtag #dhAdv

Through the power of social media, the Global Healthy Living Foundation (GHLF) has been able to achieve its mission: to improve the quality of life for people with chronic illness. It’s most popular website, Creaky Joints and it’s Facebook page is the most popular online arthritis community in the world. The value of social media lies in its ability to reach millions of people and connect diverse ethnic, socioeconomic, and geographically dispersed individuals and communities.  Social media platforms have allowed organizations like GHLF to educate and share information about public health and social welfare such as critical public safety information and offer support to its members living with disease.

There are moments, however, when social media does more harm than good.  Just this week, Facebook had to apologize to the LGBT community for its real-name policy, which deleted members such as drag queens and kings, and transgender people who could not provide their real first and last names.  By deleting accounts, Facebook took away the safe space and in some cases identities, of its members. With lots of backlash, Facebook pledged to work with community advocates to improve its policies.

Social media is an ever-evolving medium that can unite people with shared interests and passions, and mobilizes people to take action together.  Its capacity to improve peoples’ health should be far greater than its capacity to cause harm.

GHLF invites anyone who is interested to join us in person or online via the live web stream.  The summit is free and will offer best practices, examples of what not to repeat, ways to build and strengthen social networks, and avenues for finding success in online advocacy.  Please register at dhAdvocacy.org/registration.

 

Is Grandma In An RN-ing Home?

This post is by CHMP’s Amanda Anderson, RN. More frequently than not, Amanda writes toward her simple goal, “I want nurses to start talking.” Here, she reflects on a recent newspaper article calling for registered nurses in all nursing homes, all day. Find more of her thoughts on her blog, This Nurse Wonders, and tweets, as @12hourRN.

IMG_0067.PNG

Only thirteen states require registered nurses on site in nursing homes for 24 hours a day, despite direct evidence of their benefit. Photo credit @tuddysgirl.

Please imagine my surprise, when I surfed to The New York Times yesterday evening in search of updated news on the Ferguson riots, only to be drawn to a sidebar highlighting the title, “Where Are the Nurses?

Could it be?! My trusty paper, oft neglectful of my prized profession, showcasing nurses in a headline story? A mix of fear (nurses walking out on Ebola patients), and curiosity (staffing, really?) pushed me to click the hyperlink so foreign from my initial target.

The article turned out to be about staffing, more specifically, an Illinois politician’s goal of getting a registered nurse into each nursing home for each hour of the twenty four in a day. Not an LPN, or a certified nursing assistant, a Registered Nurse. Well, shucks, this was a happy distraction.

The proposed bill, “Put A Registered Nurse in The Nursing Home Act,” hit Congress July 31st, and calls attention to the mountains of evidence for our presence in inpatient care – reduced risk and bettered outcomes. The article, sharing a paragraph of links to the evidence, goes as far as saying that to have a registered nurse in-house all day long, makes “care improve, but cost less.”

Incredible. Nurses, and nurses all day long, and all night long, directly leading to safer, healthier, less-compromised patients? And for cheap?

Jan Schackowsky, the representative fighting for this requirement, called out the obvious – the suspected 11% of nursing homes that lack a 24 hour registered nurse (only 13 states in the country require one all day) shouldn’t really be titled nursing homes. She suggests the tongue-in-cheek name: “well-intended residences for the incurably underattended to;” a quick browse of the reader comments attests to the sad truth of this title.

These residences often staff with licensed practical nurses, or nurses aides, but as the article clearly outlines, “…only registered nurses are trained and licensed to evaluate a patient’s care and conduct assessments when his or her condition changes, which can happen rapidly — and at 3 a.m.” Without an ever-present, licensed practitioner on site, these residences for convalescence have no business advertising themselves with our trusted title. Why is this reality so infrequently stated? Does our acquiescence to this false representation speak to our lack of definition as a profession?

Perhaps nurses need to start recognizing how important our registered work is to the preservation of our patient’s health and safety, and to start protecting our right to a safely staffed, and properly titled workplace. If the nursing home does not provide a registered nurse, the public should know about it – and they should know why our absence matters, as much as our presence.

I hope this bill gets made into law. But I don’t just hope for that; I hope Schackowsky changes the vernacular of nursing, too. With a registered nurse required, maybe “nursing home” will be replaced with “Registered Nursing Residence,” and the public, and patients, will begin to demand nothing less.

_

Correction: “Associate nurse” was replaced with “certified nursing assistant.” Associate-degree nurses sit for the same licensing exam as Bachelor-prepared nurses, and thus, hold the title, “registered nurse.” For more information on the different types of nurses, visit allNursingSchools.com’s overview here

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