Advancing with Integration of Digital and Social Media: Nursing Glimpses

"You’ve Come a Long Way, Baby" (Virginia Slims, 1968); Truly an applicable slogan some practitioners might use to describe how healthcare has advanced over the span of their careers.  Likely they would list developments in technology, digital media and social media as examples of how healthcare has “…Come a Long Way.”

Nurses coming down to the home stretch of their 40-45 year careers likely have numerous accounts illustrating how the practice has changed from the pre-technology era to today’s digitally enhanced times.  Take, for example, how differently taking the nurse’s state licensure examination must have been for them.  There were no “clicking” answers on computer screens as testers do today.  Instead, they were given test booklets with pencils for shading in selected answers.     

Through a reflective and comparative approach, this article imparts several anecdotes exemplifying how technology, digital media and social media have changed nursing methods from approximately forty-five years ago.  A “Then” and “Now” approach is used to illustrate how the nursing profession has evolved and embraced technologies such as social and digital media.  Lastly, a case scenario is shared, demonstrating the importance of caution when scribing to social and digital media usage.

#1 Then:

At one time, taking the RN Licensure Examination meant traveling to a centralized location on a date prescribed to you. Testing only occurred twice a year on the same days in all states.  Having only two dates meant if you did not pass on your first attempt, you would have to wait six months before retaking the examination.  When you arrived at the testing building, you most likely would be seated at a desk or long table amongst hundreds of other testers.  All that was allowed on one’s desk/area was an issued test booklet and a #2 lead pencil. Proctors walked up and down aisles from start to finish, monitoring for cheating.  Each section of the test was timed, so when the section’s time was up, a resounding command of “Pencils Down”…“Time’s Up” resonated within the room.  For many, the worse part of the whole testing process was the waiting and wondering whether or not you passed or failed.  Finally, after 6-8 weeks via snail mail, a “nay or yay” letter arrived at your residence. 

#1 Now:

Around 1994 the testing approach changed. The first computerized adaptive nationwide RN licensure examination was launched.  Some 28 years later, and with additional refinements in computer methods, we are where we are today. 

Now every graduate in all 50 states takes the same standardized, computer-based, multiple-choice test. Licensure examinations are offered at computer testing centers, and testing times are not limited to two dates per year. Today’s computerized tests are more interactive.  And, based on the tester's performance, the level of difficulty might vary.  With new computerized graphic techniques and software programs, the types of questions posed have changed.  By integrating these different programs, test designers have improved ways of evaluating the critical thinking aptitudes of testers.  Although some testers today judge whether they passed or failed by how many questions they are asked, official results are still mailed.  Though wait times seem to vary across states, a wait time of 2 to 4 weeks is typically quoted as the norm.  However, there are now some fee-based companies reporting unofficial results to individuals within 48 business hours following testing.

#2 Then:

So what would have happened if a nurse, while working in a care setting, had a question about how to do a procedure, the pharmacotherapeutics of a medication, and/or an unfamiliar diagnosis?  Most likely, he/she would have asked a friend who was working with him/her.  Or, called the nursing supervisor or someone in another department, like pharmacy, if the question is related to a medication.  A medical dictionary, Physician Desk Reference (PDR), and a Lippincott procedure manual were typical reference books kept at nursing stations.  Unfortunately, most of the copies were old editions, “grew feet”, and/or were more medically framed than nursing oriented.  Many hospitals had medical libraries, but often, these libraries were limited to physician use.  In terms of available procedure manuals, typed guidelines for all key procedures were not always available, and included materials were not always kept updated as applicable. 

#2 Now:

Currently, nurses have many resources at their fingertips for answering questions and educating themselves. For almost instant answers, nurses can use mobile phones and computer devices to consult a plethora of professional websites and healthcare-related apps.  A social media app (e.g. LinkedIn) can help to connect professionals with one another for purposes of sharing ideas, consulting with one another, and addressing issues. Now, most healthcare facilities have incorporated digital platforms in their systems for sharing educational materials.  Many have also converted brick-and-mortar medical libraries into e-libraries to which all healthcare personnel have access. Additionally, the integration of digital telehealth services now allows healthcare providers to visible consult with professional colleagues across global healthcare systems in a manner of seconds. 

#3 Then:

Classroom Education…no desktop or laptop computers gracing classrooms! Not until around 2000 did computers noticeably become part of classroom décors.  Prior to the introduction of computers, students typically sat together in brick-and-mortar classrooms listening to educators teach in lecture-style formats, diligently trying to take handwritten lecture notes. Some professors incorporated transparency “overheads” on which key points were recorded with markers.  The lecturer used a transparency projector machine to project the scribed information onto a classroom wall.  Students often complained of aching hands due to repetitive notetaking. In time, as tape recorders became popular, some educational institutions and professors allowed lectures to be recorded; but many did not.       

#3 Now:

As computer technology advanced and the world-wide-web became a household name, the way healthcare students learned and professors taught changed expediently.  Now professors use a variety of digital and social media devices to teach and keep students abreast of the latest trends and practices.  Students no longer just learn from one voice but have the opportunity to benefit from the expertise of many. Social media (e.g., YouTube) has made it possible to learn from, interact with, and consult with other professionals and other students on large computer screens in today’s classrooms.  Digital media (e.g., digital images and videos, holograms, digital databases, eBooks…) brings greater life to the content being taught, enhances learning, and improves student engagement. Online or virtual learning is now part of every healthcare provider’s education. Back when our now senior colleagues were neophyte students, web-based learning wasn’t even part of academia’s vocabulary.

#4 Then:

Communicating with non-English speaking patients was challenging.  You did have some options for obtaining assistance with translating, but options were limited and not consistently available.  Even early on, using family members to interpret was frowned upon.  Instead, other alternatives were offered.  Some healthcare facilities had available educational booklets and pamphlets written in several different languages.  Some maintained a list of in-house individuals who spoke a language other than English and volunteered to translate.  Often care providers and patients struggled through encounters because translators were not accessible.  Eventually, fee-based telephone interpreting services became available, but only two individuals could talk at a time, and there were no visual images of participants.  Translator, patient, and provider could not simultaneously speak together on one phone line.  

#4 Now:

In 2010 an additional section of the Affordable Care Act was added, which mandated organizations receiving federal funding hire qualified language translators.  Consequently, some exciting strides were made in providing quality interpreting services when healthcare providers and patients did not speak the same language.  Now thanks to digital video interpreting services, healthcare providers, patients, and interpreters can simultaneously see and speak to one another during translation sessions.  Today digital healthcare companies offering virtual care visits are collaborating with healthcare systems to bring video remote interpreting services to the patient’s bedside. This means at any time during a virtual visit, with a simple “click”  of a button, a healthcare provider can bring a visible language interpreter into patient care encounters.  

Think Before Clicking

As one can see, healthcare practices have Come a Long Way, Baby, as advances in digital and virtual technologies have developed.  However, although many positive aspects can be cited, negative outcomes do exist.  Mentioned above are the more positive aspects of using digital and social media in healthcare practices.  However, an aspect of using any type of digital or social media that should be followed is to stop and think before “clicking”.  One needs to always keep in mind what may have taken days in the past to be seen or read can virtually be viewed or read by thousands in a matter of seconds. As a result, healthcare providers can easily implicate themselves because of a lack of thought and discretion in what they post.

For Example...

Presented is a true account of how some student nurses did not stop and think before they “clicked” and posted on their favorite social media page.  As you read this, you likely will ask yourself…..How could these individuals be so foolish to do this… Let alone even think about posting this on social media.  But they did, with one “click”….a “click” that did bring them attention…but not in the way they anticipated.  Although this account relates to students, such behaviors of not weighing potential consequences, or realizing a posting may be offensive to others, is also a concern amongst seasoned providers.

The Account

Three student nurses enrolled in a basic skills lab course were in a lab room to practice an assigned skill.  A lab facilitator was in the room and had manikins set up in beds behind drawn “patient” curtains to simulate real patient-nurse care encounters.  Behind the curtain, when the facilitator wasn’t checking on their group, these student nurses decided to use their mobile phones to take pictures of themselves with their manikins.  The three took their fun a step further and decided to pose with their manikins in provocative positions.  Assuming their friends would think this was as funny as they did, they immediately posted the pictures on their favorite social media pages.  Out it went to all their friends, and who knows how far beyond, as friends shared with friends.  Additionally, in the posted pictures, the logo of the college/university where the pictures were taken was discernable.

Some of their friends did realize the poor judgement and implications of their peers.  Within a short time, the director of the nursing program was sent the postings, the three students were called in, the images were removed, and nursing faculties were called together to address the situation.  There was no policy directly related to such a social media infraction. But, there were policies related to causes for dismissal from the nursing program and/or university, as well as disciplinary action for unethical behavior.  After much debating and discussion, a vote on the suggested disciplinary action was taken, agreed on, and implemented.

What Happened to the Students??? 

More than likely, you are thinking… So, what happened to the students?????  Instead of telling you how faculties handled the actions of these three students, the author would like you to weigh in with your thoughts.  Keep in mind though this behavior might seem unlikely, there are other examples of poor social media actions initiated by healthcare providers.  So how do we best address such behaviors? 

How would you have handled these students?  Please, share your thoughts.