Labor & Delivery Nurse

Sciences, uncategorized

Labor & Delivery Nurse

33:17

Q: Would you please state your job title, and where you currently work? And I know, you know, we talked just before starting to record, about how you just transitioned jobs, so if you could just give us the context for your old work versus your new work?

 

A: Okay. My old job title was as a registered nurse, I recently graduated from Frontier Nursing University with my masters in nurse midwifery. So my new job title is as a nurse midwife, but I’m going to be speaking I think to my last position as a registered nurse with Inova Alexandria Hospital on labor and delivery.

Q: Wonderful. And how long has it been since you graduated from undergrad?

 

A: I graduated from undergrad in 2014, May of 2014.

 

Q: Okay, okay. So about four years. And how long have you worked in nursing?

 

A: Eight and a half years. I had my associate’s before I had my bachelor’s.

 

Q: Great, okay, perfect. So could you provide sort of a brief description of your primary job functions as a floor nurse?

 

A: So as a staff nurse on labor and delivery specifically, my primary job would be to care for generally one to two patients in the labor, delivery, and recovery setting, which can be everything from giving emotional, physical support to the laboring woman, providing them with medications, whether it be for pain control or to augment labor, to stop labor. We also had a high-level NICU at our hospital, so I would care for high risk antepartum patients – so patients who are pregnant but not trying to deliver at the time – and generally your function there is to provide medication and monitoring to assess the wellbeing of mom and baby, and the safety of them, and hopefully to stall their labor if you could. And we also have three operating rooms, so we also cared for and circulated in c-section cases, and had a recovery unit for that.

 

Q: Wonderful, okay. Could you estimate, in an average week, what percentage of that job required writing?

 

A: How many words together counts as writing [laughter]?

 

Q: I’ll say two [laughter].

 

A: Two, okay [laughter]. Okay. How many hours in a week?

 

Q: What percentage of the week?

 

A: Umm, let’s say maybe 20 percent of my working time?

 

Q: Okay, and could you tell me a little bit about the forms or types of documents that you were writing?

 

A: So most of the writing that takes place as a staff nurse is on an electronic medical record, where we joke that it’s an elaborate billing system, because it is [chuckle], but they try to make it as easy for the billers to use as possible, and as easy for you to not get yourself in trouble as possible. So they do a lot of like, selecting options for charting, so it’s like a column where you select options, you can type in things like, you know, blood pressures, or temperatures, and then you can select options for pain levels, or assessment findings, like color of the skin, they’ll give you options like, “appropriate for ethnicity, warm, dry, clammy, red, hot, weeping”, like tons of different options. And then also an option to click and write a comment, so if you were writing something that was a like deviation from expected, you’d probably want to put a comment to explain why, or what you did about it. And there’s also notes you write that are more narrative. Generally you would write a minimum of one of those a shift, but depending on what you were doing that shift, especially if it was a more complicated patient, you could have like ten.

 

Q: I see, okay. And so, could you tell me a little bit more about what those narrative pieces sort of look like or sound like?

 

A: You have to be really careful when you write a narrative in the chart, because you definitely don’t want to double chart, because that’s a waste of your time, but also because you are trying to make sure that you’re staying consistent. And it’s really easy when you’re using click boxes to fill in your answers to, if you’re not being careful, just fill in like your normal answers, like the standards, and then if you write something different in a note, and it contradicts what you already charted, it makes it look like you’re not competent. So you’re trying to make sure that you’re being consistent with what you’re writing unless it’s actually discussing a change. And you have to be careful when you’re writing it to not, as a registered nurse, not make any medical diagnosis, and also not to like throw any other providers under the bus. So a lot of the notes were intentionally vague, in writing things like, if I was concerned about a patient, let’s say she had chest pain after delivery, and I was concerned, and I took some vital signs and everything was normal, and her bleeding was all normal, and everything was great. But I’m still going to definitely go the physician, and let the physician know, “Hey, she’s having chest pain. This is her blood pressure, this is her heart rate, this is her temp, this is what her bleeding is like.” And if they say like, “I’m not worried about it.” And then I’m like, “Well, don’t you want an EKG?” If the provider’s like, “No, I don’t.” Okay, so I don’t want to write a note that says that exactly, because it makes them look like they’re not doing their job, even if I feel that way. So I have to write, for example, that note would say, “Patient complained of chest pain.” I might like list the vital signs, “Provider notified, no new orders,” [laughter].

 

Q: Interesting. So this vagueness is to make it cover yourself while making sure you’re not throwing someone else under the bus?

 

A: Right. To say, “Look, I did my job. I followed through, but I can’t speak to whether this other person did.” And if it’s really a safety issue, I mean to be 100 percent honest, there’s obviously a chain of command you follow. So if I really didn’t agree with what that provider said, there’s another physician above that one that I can always go to. So I don’t want to like, speak to them [crosstalk 6:53] with that, but that’s like a really easy example of how and when you would write it.

 

Q: That makes perfect sense, yeah. And to be clear, you talked about this system being sort of like an elaborate billing system. Obviously the billing folks aren’t the only audience, who else would look at these notes? Both the narrative and the sort of standardized pieces?

 

A: I would say your most common audience for that would be your other nurses. It’s really common when you start a shift to kind of – you get a report, generally we would do bedside handoff, so you would discuss the patient’s care side to side, at the bedside, with the patient so they can speak up if they’re awake – but then it’s a really good idea to go through and take a look at the notes. And especially when you’re working with a patient who’s been there for a long time, it’s really easy for stuff to get missed. So going through and reading the narratives can say a lot more about what has and hasn’t happened, and what’s been tried and what hasn’t been tried, and how things are responding, than just looking at the – we call them flowsheets – like the excel spreadsheet that has values in it.

 

Q: I see, okay. That makes a lot of sense. And to clarify, those narrative pieces – it sounds like they’re relatively brief, even though they’re pretty important?

 

A: Generally. There are probably some nurses who write longer narratives, but most of what you should be writing should be like, especially nowadays, should be easily found in the flowsheet, and that’s the prefered way to document, because it’s an easy way for the system to keep track of what’s going on, and you can’t do metrics, for example, from notes. So if someone in the background from the education department is trying to track a new kind of epidural medication, for example, and I’m just writing notes about a pain level, you can’t just pull that up and track it. So I’m only writing notes about things that, or making comments about things that are maybe a deviation from normal, or it’s something that really needs to be explained.

 

Q: Got it, got it. And one more follow-up question. You said you also have to be careful not to make any sort of medical diagnosis. I didn’t realize that that was a position that a nurse is in. Can you talk a little bit more about that?

 

A: Yes [chuckle], so in nursing school, you learn a lot about nursing diagnosis, which just really a fancy way of describing symptoms. But making a medical diagnosis is practicing medicine, and that’s reserved for people who are licensed to practice medicine, so your nurse practitioners, midwives, physicians, etcetera. So if you are handling a patient who looks like they have the flu, and they clearly like, have the flu, as a nurse I can’t write a note that says, “Patient presents with the flu,” unless it’s been diagnosed by a provider. I can say, “Patient presents with fever, runny nose, body aches,” you know, malaise is a nursing diagnosis, which means not feeling well [laughter]. So I can describe it all, but I can’t say, unless it’s been diagnosed by somebody else, I can’t literally say that they have the flu.

 

Q: That’s fascinating. Okay, okay. I’m sure that makes writing especially tricky, because you’re sort of talking around this really obvious thing that you know, right?

 

A: Yes. Yeah, absolutely.

 

  1. That’s really interesting, okay. So, as you are writing these sort of typical documents – let’s talk about that narrative piece, because that seems like you have sort of the most leeway in those–

 

A: Yeah.

 

Q: –when you are writing those, is there any preparation or steps that you take prior to writing?

 

A: Yeah, and especially depending on what the note is talking about or how maybe sensitive the issue is, I am probably going to be looking through the previous notes to make sure that I’m not, again, contradicting something really obvious, unless I have to. So, a big example was for a while, we had some anesthesia staff who would use an incorrect method of measuring a patient’s temperature – not that it wasn’t like, it was a fine measurement for temperature, but our unit had made a policy against using this temporal scanner, because we didn’t find it to be as accurate – and we had some anesthesia staff who were still using it because they liked it, and it was faster, and it would give them slightly warmer values on a patient coming out of the operating room; and one your risks after having surgery is having a low body temperature. So having anesthesia write in their flowsheet that the temperature was 97.4, and I’m getting a temperature of 96, I need to make sure that I see what they charted, what time they charted it, and then I have to be careful with how I chart it, and I might want to explain like, in my note, you know, “rechecked temperature after anesthesia, value 96.0 orally,” and make a note explaining what I had to do thereafter, without having to say like, “they were wrong or used incorrectly equipment,” or something like that. So I have to like, review what they actually charted, when they charted it, and make sure that my note kinda goes along with it without, you know, saying anything negative. So it’s a lot of previous chart review.

 

Q: And when you’re trying to be really diplomatic in these notes, what are the repercussions if you were not diplomatic? If you did call someone out for something like that?

 

A: Probably most of the time nothing. The issue’s going to come if they’re– I mean, maybe the physician reads it, but a lot of the times their notes, like I don’t know that a lot of their– like, they have to go look for our notes because the way that their system loads, it’s not as obvious to them. And so they might go through and reread them, and get upset with me, which could damage the relationship, but the biggest risk is if this was audited for court, for example, so if there was a complication and the patient wanted to bring it to court, anyone who’s touched the chart, it keeps a log of everyone who’s logged in and clicked and opened that chart, and anyone who’s written in the chart is probably going to get subpoenaed, and possibly deposed for this court case. And so I have to, you know, show that I’ve done my job, but I also– many court issues end up getting– like if there was incorrect care or something, a lot of times in nursing you’re taught it gets pushed back down to nursing, even if it’s not really in your control, because you’re like the last line of defense, right? So you don’t want to say in your note, you have to prove that you didn’t willfully ignore something, that you gave good, fair care, but you don’t want to provide any ammunition for – this is sounding terrible [laughter] – you know, someone trying to prosecute you saying you didn’t do your job, or the physician didn’t do their job when you know you did. And most of the time, I mean most cases have great outcomes, most cases don’t go to court, but even when they do, most of the situations that are brought to court aren’t because of any negligence or you know, it’s like something crappy happened, that couldn’t be avoided, and it wasn’t in anyone’s control, but no one wants to feel that way, you know? And so you want to make sure that you’re writing these intentionally vague notes so that no one gets in trouble for doing something wrong when most of the time things aren’t being done wrong. Does that kind of make sense?

 

Q: Got it, yeah that makes a lot of sense. Yeah, that’s really clear actually. That makes a lot of sense. There’s so much nuance to this. So how did you know how to perform these types of writing?

 

A: That’s a good question [laughter], I need to think about that one. I guess we talked about it some in nursing school, but not a ton. A lot of it comes from working on the floor, and just having to practice when you’re kind of, maybe like one of the first times that you’re put into a touchy situation, where maybe there isn’t a right answer, or you don’t agree, but the person who’s giving you orders isn’t technically wrong or something, and you have to write a note about it, you probably are learning more from your more experienced coworkers. It’s like a skill that’s passed down, because your first intention is just to want to write this like, long narrative note that explains every detail and everything, and then you’re probably doing it with someone with you know, 10 or 20 years more experience looking over your shoulder saying, “Delete that, delete that, delete that, delete that! You already charted that,” [laughter]. So a lot of practice. I do remember starting as a nurse, working in like med/surg–

 

Q: What is med/surg?

 

A: Oh, it’s like a medical/surgical floor. So if you’re admitted to the hospital for something, it’s probably where you’re going to go, unless you need like a specialty floor. So if you’re having general surgery for like appendicitis, you’re going to med/surg. If you are– on our unit we did a lot more surgical than medical, but let’s say you have pneumonia and you’re really, really sick and have to go the hospital but you don’t need the ICU, you’re probably going to go to med/surg. So it’s like a general hospital floor. I feel like situations, I remember having to sit there and write notes with people, and you would always seek out like someone you felt comfortable with and saying, “Can you help me write this note? This difficult thing happened.” Like generally then, it had to do with pain management, and you couldn’t get anesthesia to get there on time, or something like that, right?. Patient’s in pain, you’re out of pain medicine, anesthesia isn’t coming, it took an hour, your patient hates you now, you know, something like that [laughter], and you have to careful not to write, “I called anesthesia a hundred million times and they didn’t want to come, because they didn’t like the page,” like, you can’t write that, right? So it’s like going back in time and someone you know, teaching you how to write, okay, write a note for the first time that you notified anesthesia. And then write another note that says, “notified anesthesia.” Write another note that says, “notified anesthesia, anesthesia now in rounds,” you know, and you write it that way. Like these little one line notes that say, “Hey, I did it. Hey, I did it. Hey, I did it.” And as someone showing you, instead of writing one long note, it shows this persistence, for example.

 

  1. I see, without having to say, “They didn’t show up, I had to follow up.” Yeah, got it.

 

A: Yeah. It’s obvious by, you don’t have to say it, because it’s obvious by how many times you had to follow up, for example. But that’s like a learned skill from your other nurses.

 

Q: Absolutely. That’s really, really interesting. Are there other things that you did besides seeking out more experienced nurses to learn how to perform these types of writing?

 

A: That like I, that I intentionally did?

 

Q: Yeah, yeah. Are there any other sort of strategies that you utilize to, you know, learn the nuances of this and improve?

 

A: I don’t know. I guess I can think of a few situations where, a lot of times the nursing managers or the units will have someone specific to call and check up on patients after they’re discharged home to see how they’re doing, and to get like a general idea of what we can do better and what we did really well, for example. And then they would, you know, give you follow up in staff meetings and stuff to talk about, “Well, this patient said that they asked for pain medicine a hundred times and were never given pain medicine,” but I can see from the charting where you called anesthesia, and gave them pain medicine, and reassessed their pain, for example. So you get feedback like that, where you learn you have to prove everything you’ve done.

 

Q: That’s really interesting, yeah.

 

A: And there’s a nursing addage of, “If it isn’t documented, it isn’t done.” So that gets beaten into your head as well [laughter].

 

Q: Got it, yeah, yeah. This is fascinating. Okay, so does anyone oversee your writing? You talked about other nurses reading these, and you talked about how you know, in a specific situation, a doctor might seek out your narrative, or your notes, but is there anyone who actually oversees your writing directly?

 

A: No.

 

  1. Okay, alright. And how long do you typically have to complete one of these narratives?

 

A: So your charting should be done– okay, so the goal is always real-time charting. So real-time charting should be done within two hours of whatever event. But real life, it doesn’t always work like that if you’re in a really, let’s say you’re in a patient’s room and something changes and you have to go have an emergency c-section, well that whole process can take four hours, between the emergency in the room, going for the c-section, recovering the patient, getting them upstairs, and sitting back down, where you haven’t stopped moving, right? So in that kind of case, it can take a little bit longer. I think most of the applications won’t let you chart things that are older than 24 hours, and if you’re writing them really delayed like that, you should start them with like a phrase that says, “late entry,” or something, to show that, you know, if you’re really writing a, like maybe you wake up at midnight, and you’re like, “Oh no! I didn’t write this note about this thing that happened!” So you show up the next morning and you go to their chart and you write, “late entry” for the time it actually happened. And then how much time you’re given to do it – I mean, I guess as long as it takes to write it, I don’t know.

 

Q: Okay. if you, let’s say, like if it is happening in real time with a typical patient, without any sort of crisis within that, how long do you usually spend you know writing your one narrative for that shift about that patient?

 

A: Oh, I don’t know, like some seconds [laughter].

 

Q: Okay, perfect. Some seconds, perfect, okay [laughter].

 

A: If it’s like a really simple day, I’m not doing anything above and beyond, everything should be captured in that flowsheet. So my note might be like, something about like, it might just be comments I’m making – like in the fields, you can right-click and make a comment about something – like for a slightly elevated temperature, “reassessed in their axillary,” or something like that, you know?. So it could be really, really simple, or you know, “Spouse to bedside”, I don’t know, like really simple stuff like that, if it’s a really simple day, yeah.

 

Q: Got it, okay. What kinds of writing do you remember being asked to create as a student?

 

A: As a student, if you go all the way back to the beginning of nursing school, a lot of your writing is in the form of care plans, which is something nursing school really focuses a lot on still, and the idea is to be able to understand and write these nursing diagnoses, which you don’t ever use in real life. But like a true nursing diagnosis goes something like, let me think, like, “malaise secondary to spoiled milk ingestion following something.” It’s like this really silly string of words and modifiers [chuckle] that you just don’t use it, it doesn’t make any sense, no one’s looking for it, but it’s one of those things that the nursing profession really wanted to have included in part of the education. And then your careplan is based on those nursing diagnoses that you’ve made in writing like what the symptoms of the malaise are in that category, and then what you’re doing for it, and what the expected outcome should be following it. And I think the idea is supposed to be like, big picture thinking, you know, like not just saying, “Oh, okay, so they have a fever, let’s just do Tylenol. The end.” You know? High level thinking, like, “Okay, so they have an elevated temperature, and an elevated heart rate, and shortness of breath. And so I’m considering that they might not be perfusing their lungs as well, and so I’m going to follow up with the MD for XYZ.” So it’s to get you thinking like big picture, what are the causes and effects of different things. That was most of nursing school, was these really crazy mind maps and venn diagrams or something, and I don’t know.

 

Q: That’s really interesting.

 

A: I don’t think very well like that.

 

Q: Yeah, so it was more to get you to a certain way of thinking, rather than to you have you practice writing the kind of document you’d be writing on the job.

 

A: Right, exactly.

 

Q: Got it, interesting. And so how do you feel like that did prepare you for the actual writing you do at work?

 

A: I don’t remember it very well, so maybe not great [laughter]. I think it did do a good job of helping you get out of the habit of looking at medical diagnoses though, as a nurse, and get really good at describing what’s going on. Like describing someone who looks like they’re having a pulmonary embolism, instead of saying, “I think they might have a pulmonary embolism,” or, you know? So it does help you with that. But besides that, I don’t know, that kind of felt like busy work.

 

Q: Got it, okay. And are there things that you wish you had learned in school that would have set you up to be a more effective writer on the job?

 

A: Let me think for a second. So I did a lot of like educating new hires for example, and training them on the units I worked on for a long time. And I know some of the focus has really changed. When I was in school, there was definitely a focus on, you know, if you didn’t document it, you didn’t do it. And you had to learn how to write in like a paper chart, so you did do a couple examples of writing little notes in paper charts and reading your notes in paper charts, but now the focus seems to be a lot more on the immediacy of charting, because the electronic medical records are everywhere in this area, at the very least. And so for myself, I don’t, I guess maybe more of an emphasis or some more education on how language can be used in like court system, or chart reviews. Or when the hospital can get reviewed by the Joint Commission to makes sure that they’re following standards of care, for example, so you kind of have like a bigger understanding of why you’re charting what you’re charting when some stuff just seems so silly, because you’re just hitting these like charting requirements for the day that don’t have any meaning or impact on what you’re actually doing for the patient, but it’s some bigger company’s proof of what you’ve been doing. So I wish I had learned about what the Joint Commission was, and what they were looking for, so that way I wouldn’t feel so bitter when I was a new nurse about spending extra time filling in these [chuckle] silly paperwork. And I wish that, well the nursing schools it seems like from the nurses who I’ve been training, they really come out wanting to chart everything the moment it’s happening, which is great, but they are so busy charting that they will forget to actually care for their patient. So I find myself saying a lot, like, “the computer’s not your patient,” because that’s what their emphasis is in nursing school, it’s just so hardwired that you have to make sure everything is documented, you know, documentation has to be perfect, etcetera. Which, a lot of what you do is already in the chart, you don’t have to like constantly be in it, you need to be focusing on your patient first. So I wish that was a change too, I wish they really pushed patient first, rather than chart first.

 

Q: That’s wonderful. Yeah, that’s really fascinating. Um, this next question is sort of a big picture question, we touched on it earlier – but what is at stake in your writing?

 

A: Oh, I mean, I guess if I am in inappropriate with the kind of notes I write, or if I don’t write something that I’ve done that’s really important, that proves I was doing my job, that proves the provider was doing their job, that we were working as a team for example, and there is a negative outcome, and we all go to court, like I could lose my license [chuckle], yeah.

 

Q: Yeah, pretty big impact, okay.

 

A: I mean charting isn’t going to save, I mean I guess in theory charting could really impact someone’s care if you don’t chart that you’ve done something, I mean that becomes bigger with proving that you’ve passed your medications and stuff like that, but as far as narrative writing, it’s mostly going to be proof that I’ve followed up on things, and acknowledged things, and noticed changes.

 

Q: That makes perfect sense, yeah. And what is the most difficult or challenging thing about writing in that particular position?

 

A: A lot of times you’re doing so many things at one time, and you’re following up on like if you notice a change in someone’s status, and you’re following up on it, and your provider’s following up on it, and they’re getting specialists involved, and you know, you’re like trying to keep track of everything that’s happening, while also making sure you’re patient’s safe, you could definitely just forget to write something, you know? And that’s your proof that it was done.

 

Q: Right, okay, okay. You talked a little bit about seeking out more experienced nurses early on in your career – is there anyone else who’s helped you with your writing, formally or informally, since you’ve been on the job?

 

A: Like in my nursing writing?

 

Q: Yeah.

 

A: No, I guess not really. Because no one really follows up on it unless you’re not charting that you did something.

 

Q: Okay, okay. And how do you believe you’ve evolved or improved as a writer over the course of your career?

 

A: I’ve gotten a lot more efficient [chuckle]. I am really good at saying as little as possible to get my point across [laughter].

 

Q: And to what extent do you think that writing is valued in that position?

 

A: I would say among other nurses, you know, you definitely have opinions about how people chart, and there’s definitely lazy charters, which isn’t so much a big deal, unless they’re not really saying things like, that they’ve called case management, or whatever, and it’s making your day extra busy because you’re doing stuff they already did, so. I think it makes a big difference between the other nurses that you’re working with, to know what’s going on.

 

Q: Got it, got it. So sort of your reputation as a nurse also has to do with it?

 

A: Yeah, your like reputation as a nurse, and also the, how– how do I say it? Like how easy it is to care for the patient can be impacted by how willing someone was to sit down and type something out.

 

Q: Got it, got it. Okay. And this is my last couple of questions here. So how would you have defined successful writing when you were a student, versus how do you define successful writing in this job that you’ve recently left?

 

A: So especially working on my bachelor’s after I had my associate’s, the focus what a lot more on paper writing, and writing, I don’t know, a bunch of, I felt like the same essay again and again. So doing well on the essay, right, was really important, and what really became hard, because I was already working as a nurse, was when you had a word count that you had to hit; you’re getting really really good at mincing your words and being really succinct, and then you’re given a word count that’s longer, like hitting a word count becomes really hard [chuckle]. So the big difference is that, is in nursing you’re– wait, is that what you asked, I’m sorry?

 

Q: It is. How did you define successful writing then versus now, yeah.

 

A: Okay, yeah. So then, it was a lot more about hitting word counts, and saying you know, what they wanted to hear, and sometimes just being more verbose. And then now it has a lot more to do with how quickly and efficiently can I say the bare minimum to show that I did my job?

 

Q: That makes perfect sense. That’s so interesting. And I’m sure that’s– I don’t know how typical that path is for other nurses, but it seems especially tricky, because I guess most nursing in doing a bachelor of nursing have not worked as a nurse in the past? Is that a fair statement, or no?

 

A: At least in this area, that’s probably true. It depends on where you are in the country. Associates-prepared nurses, I mean this area still has associates programs, and throughout the program some places really rely heavily on associates prepared nurses.

 

Q: Gotcha, okay.

 

A: Yeah.

 

Q: And my final question – would you say that you are a successful workplace writer?

 

A: Yeah, I think I’m a good note writer. People come to me for help with their notes.

 

Q: Excellent.

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Lab Manager

Sciences

Lab Manager

52:48

Q: Okay. So would you please state your job title, where you currently work, and how long it’s been since you graduated college, as well as how long you’ve actually worked in your current field, if that’s different?

 

A: Okay. I am the lab manager of a drosophila neuroscience lab at the National Institute of Health. Our institute is the National Institute of Neurological Disease and Stroke, and our unit is the Dendrite Morphology and Plasticity Unit. I’ve been out of grad school for two years, and it’s been about a year that I’ve been at this job.

Q: Okay. And how long has it been since you graduated from undergrad?

 

A: Graduated from undergrad in 2013, so, yeah.

 

Q: Perfect. Okay, great. Can you provide just a brief description of your primary job functions?

 

A: So as lab manager, I’m in charge of– well, primarily I’m in charge of ordering materials, reagents, tools, and all of that. Making sure that I keep tabs of how much of each thing we have so we don’t run out, and part of that is keeping up with all the members of the lab, and figuring out where they are in their product so I can predict what they’ll need in the future. And that kind of goes back and forth with helping them design their experiments, and making sure that they have the tools that they need and they’re using them effectively. So technically I’m number two to the PI, so I’m like her assistant and well, manager. And then because we’re a drosophila lab, a large part of my job is just keeping all of our fly stocks alive.

 

Q: All of your what alive?


A: Fly stocks.

 

Q: Oh, okay.

 

A: So we have a bunch of different, we actually have about 2200 lines of flies – these are different, transgenic flies that have different mutations, and we keep them alive at all times so that we can always draw on them if we need to.

 

Q: Can you tell me a little bit more just about the general work that happens in that lab? That’s super interesting.

 

A: Sure. So, we research plasticity. So what we do is we genetically encode green fluorescent protein, mostly, or–GFP or TD Tomato is what I’ve been using, because that’s red – Lisa loves that name [chuckle]. There’s also M Cherry, which is a lighter red than tomato, as you can probably imagine. So we encode these tags onto proteins that already exist in their neurons, so that causes either the whole neuron to light up green, or specific proteins within the neuron to light up green or red, and that way we can take images with our very high-powered microscopes. We use confocal microscopy and two photon microscopy, which are very good machines. A lot of laboratories in my institute, they all share one confocal, but we have one to ourselves, because that’s what we do every day, is imagining. We are all about imaging, all about looking at the morphological changes with the mutants compared to wild type. So we’re investigating how those proteins function and how they lead to plasticity, which is the change in morphology based on different experiences.

 

Q: Fascinating, okay great! Thank you. How frequently are you required to write? And if it’s possible, could you sort of estimate in an average week maybe what percentage of your job requires writing?

 

A: Hmm, it varies a lot. Sometimes I’m helping with writing publications, and sometimes I’m writing justifications for large purchases. The more a purchase costs, the more writing is required to get it done. So on average, I probably spend about, I’d say an hour and a half on writing justifications for things, and then on some weeks I’ll be spending twenty or so hours on, if we’re like up against the deadline, and we need to get a publication written, I’ll be helping with that.

 

Q: So those twenty hours could be up to half your week?

 

A: Yes.

 

Q: Okay, gotcha. How long do you typically have to complete a writing project? Obviously that’s going to be really different, the justification as compared to the publication. Maybe you could tell me a little bit about both?

 

A: Sure. So with purchasing, that varies but, from when we decide we want to buy something to when we get it approved by our purchasing authority, that’s about, we want to keep it to a week, but it can go as long as six months.

 

Q: Wow, okay. And for scholarly publication, could you tell me just sort of typically what that runs? Like your actual, your piece of that project?

 

A: My piece of that?

 

Q: Yeah.

 

A: Yes. So the PI will usually write the first draft and then she’ll run it by me or someone else for– the first look is – she’s not a native English speaker – so the first look is to just make sure that the English is correct, and then we move on to the actual writing. So that first process only takes a couple days. The next process is the interplay between the figures and the actual writing, that’s the big thing, because, not just because we’re a microscopy lab primarily, but figures are always the most important part of a paper. If your figures don’t reinforce what the writing says and if the writing doesn’t match up with the figures, then you’re never going to get it published. So it’s not just– so actually what becomes the most important writing is actually the captions for the pictures. The thing that actually describes what you’re looking at – that needs to be letter perfect. So that process is always the longest process, making sure that those captions are correct. The writing of the actual paper is usually pretty much done within a couple months, but the captions and making sure that the figures are correct– sometimes if you decide you want to make your point more clear, you want to change your figure, or if you’ve realized a better way to present it in the figures, you want to change the paper, so that whole process takes about six months.

 

Q: Gotcha. Can you tell me a little bit about what makes a caption successful?

 

A: A successful caption makes the figure seem as not busy as possible. The worst thing you want is a lot of pictures and a very little bit of explanation, so it just looks like a busy figure. ‘Cause the risk you run with science is people just tune out. If there’s a bunch of figures with a bunch of subfigures and the caption doesn’t thoroughly explain them, or explain them in a way that’s intuitive, then they’ll just gloss over it, and then you’ve lost most of your impact.

 

Q: Got it, alright, that makes a lot of sense. Yeah, thank you. So what forms of writing – you’ve sort of answered that – the types of documents that you most often complete. And I can sort of guess who the primary audiences and purposes of these might be, but could you really explicitly tell me? Like for the purchase justifications and for the scholarly publications, who are they for and what is the purpose of them?

 

A: Very different audiences. I’ve actually had a couple training meetings with people who work in the purchasing office. So these are people who have mostly economics or business degrees, or just regular, some people have English degrees. I like to talk to them sometimes. So they’re not scientists, they work in purchasing. They deal with the government bureaucracy, all the regulations. They’re really good at regulations, understanding those, and figuring out their responsibility. They’re not career scientists, so they’re always telling us, the lab managers who write these justifications, to try to make things as clear as possible. ‘Cause we do have to justify it and explain that this big purchase that the government’s making is worth it for our research. At the same time, we can’t go into too much detail, not just because we don’t want to bog them down with words, but also we need to protect our information, because a lot of the documents end up being public record. So what we need to do is explain why it’s important, and explain why we need it, but also protect the information that’s going to keep our lab running.

 

Q: Tell me more about that information that you wouldn’t want to be public. Why would you not want it to be public?

 

A: So ultimately, everything is going to be published, that’s the idea of academia is that everything gets out there eventually. But, of course, you know, PIs want to protect what they made; they don’t want someone else to take credit for it. So the big currency here is credit for the work you did. So if that information gets out, and you know, for every problem that you’re tackling, there’s probably 100 or so researches worldwide who are also tackling that problem, and they’d love to get a leg up.

 

Q: Got it, got it. That’s a great explanation. Okay.

 

A: And then the other thing is [chuckle] – and this is something that I probably understand less than I should – there are regulations concerning who is allowed to make purchases, who is allowed to talk to vendors. There’s a lot of regulations about the size of the vendor, and how much information you’re allowed to give them before they make a purchase. An interesting example is, since the Trump administration came in, they put out a very vague “America First” policy, where you’re supposed to favor American companies, which is kind of baffling to scientists because, for one, it’s a global community anyway. And also a lot of these very large foreign companies like Zeiss, which makes microscopes, of course, they are a German company, but a lot of the engineers, the people who install the machinery, the people who maintain the machinery or sell the machinery, they’re all Americans. And a lot of the parts are built in America. So we kind of look at that and think, “Well, that’s overly simple.” And it’s unfortunate because people in the purchasing authority, they also don’t really know what to do with that. So they’ll come to us and say, “If you could, please buy American.” And we’re like, “Well, you need to define your terms.”

 

Q: Got it, got it. Okay, yeah, that makes a lot of sense. And then in terms of the scholarly publication, for those people who might listen to this who don’t really understand how that process works – can you talk a little bit about audience and purpose of those papers that you’re writing?

 

Q: Sure. So, from our perspective, our audience is the reviewer of the publication. So, the publication will be first read by someone who works at the publication, an editor. And the editor will read it and decide, “Okay, if this is worth looking into, if this is like–” if all the minutiae are correct: grammar’s correct, there’s no ridiculous claims, then they will move it on to the next stage, which is review. They look at what the research is about, and they reach out to people who are in a similar field, although they do make sure they don’t send it to a competitor, but they send it to someone who is in a similar field who is an expert, and then they have at least three of those people read it, give their notes, ask for clarifications, and then it comes back to us. And so our first goal is to get it past the editor, our next goal is to make it palatable to the reviewers. And the reviewers will send back very specific things like, “Hey, we want you to do this specific experiment to prove that what you’re looking at isn’t this other thing you might not have considered.” And sometimes that works out great, it’s something that we actually did, we just didn’t put it in the paper because we didn’t think it was necessary. So that’s the best case scenario, we can just plug that in. The other process is if we didn’t do that experiment and we need to, then we have to spend time doing the experiment, and that’s how you had months and months on to this process, is going back and forth, making sure that everything is– all the boxes are checked, all the possible explanations for what we’re claiming are discounted so that our theory is actually arguably the best explanation.

 

Q: Great, prefect. Okay, that makes a lot of sense. How did you know how to perform these types of writing when you got into this job?

 

A: The best way is to read it. And that goes for the academia and for the purchasing. In school, we were encouraged to read as much as we could, as many scientific articles as possible. And I remember an engineering professor – we were talking about patents actually, but patents are also academic papers – and he said, you know, the first thing you do is go to the end, and read the claims, because the claims, and in an academic paper that would be the conclusions. You go to the conclusions, you see what they’re talking about, what they’re claiming, and then, if it’s applicable to what you’re looking for, you then go back and read the rest of the paper. Well, you, talking about the abstract, ‘cause that’s like what you see before the paywall, and then you look at the conclusion, and then you read the rest of the paper. So I feel pretty good about writing academic papers because I’ve read so many. And then when I got this job is when I started doing the purchasing. So what I would do is I went into my predecessors files, and I read what she had written, and I learned how to write it from her.

 

Q: Great, great. Were there specific things that you were looking for as you read your predecessor’s documents that was especially useful for you?

 

A: Um, yes. I would say that I looked most for what she didn’t do, because there’s certain things that the regulations say are required, but in practice, most people don’t do. So when I went through and I looked for what she didn’t do, not just so that I know what I can get away with, but just, in a large bureaucracy, the best thing you can do is not stick out. So if you’re doing things differently than most people do, that can be just as harmful to you as doing what you’re not supposed to do. And I have to say that my predecessor didn’t do a lot. So I actually do more than she did, and that’s a personal choice. But yeah, I tended to look mostly for the contrast between what she did and what the regulations say.

 

Q: Perfect. That’s great, okay. Has there ever been a time in your career that you felt unprepared as a writer at work?

 

A: Oh absolutely [laughter]. The first time I had a purchase over $3500, that’s a new eschalon of regulation, and I had to write– geez, for a micropurchase, which is underneath $3500, is only like about a paragraph per purchase. And then above that, it’s about 5-10 different documents. And a surprising amount of that is actually copy and pasting between documents, it’s just that, at every level of the purchasing, different people need a different type of form. Same information, different format. And that was a learning curve, because I actually had to go down and talk to the purchasing agents, and they were the ones who told me, “Just copy and paste.” And I was like [chuckle], “Okay, good, thank you!” So I felt completely unprepared for that, but I think what saved me was, instead of trying to email people and ask them, I went and talked to them face to face. ‘Cause they’ll be more honest with you face to face than they will over email [chuckle].

 

Q: Absolutely, yeah. We talk a little bit about what you did to overcome early writing challenges, but are there other things that you did when you entered into this new job at this new organization that were especially helpful for you?

 

A: Things I did?

 

Q: Yeah, things that you– anything that you did besides reading and talking to the purchase people that prepared you to successfully write in the job.

 

A: Hmm. I think, well, yeah I mentioned talking to the purchasing agents, but also just talking to other lab managers, and talking to other scientists in general. I talk to other PIs. My PI is satisfactorily paranoid about everything going right and not sticking out, but she’s also very new to this, her lab is only about five years old. So I would go to our neighbor PI and talk to him about things. He has a more established lab, he’s more comfortable. And he gave me some pointers on things, and also his lab manager.

 

Q: Oh, interesting. Okay, yeah. Who oversees your writing? Would you just say the PI and the purchasing agents?

 

A: The purchasing agent would be the direct person to look at everything I write and make sure it’s correct. Usually the PI will just glance at it. She’s very busy, so for one thing, she doesn’t want to look at every $15 purchase and see what the justification is. So yeah, I would say it’s the purchasing agent. They’re not really my superior, but they are my partner in getting things purchased.

 

Q: Perfect. And I can guess the answer to this, but how would you say they judge the success of your writing?

 

A: It checks off a couple boxes.

 

Q: Perfect, okay. Great. Could you walk us through the process for a specific, recent project or type of project, thinking about how that starts, how the assignment, so to speak, comes to you, how you start or prepare, and then the process going from there, in terms of review?

 

A: Sure, I’ll talk about the microscope purchase. It was my first non-micropurchase, and it started off with a very vague explanation from my PI, saying, “We need a microscope for this specific purpose.” And she asked me to reach out to three different vendors and set up demonstrations for their best microscope for our purposes. And the first one I contacted, he was very perplexed by how vague I was describing it, so he ended up bringing two different models to look at. And it was only when he showed up with these models that my PI took a look at them and said, “Oh, well, this one’s obviously not what I want, this one’s closer to what I want.” And that’s something that you just have to be prepared for, is that sometimes people in charge don’t give you as much information as you need, and what I learned there was to ask [chuckle]. So if your boss tells you to do something and it’s not specific enough, you need to just stop them and say, “Hey, stop what you’re doing and explain this to me in more detail.” Because I definitely wasted some time figuring it out. And so over the course of having these three different demonstrations, I learned a lot about what my PI actually wanted, and what she was willing to give or take, based on what the people in the lab wanted to do. And I also learned about her opinions of the different sales people. And then, once we had decided between myself, the other senior scientists, and the PI, which of the three we were going to go with, then a whole new process started of dealing with the actual purchasing. So this involves figuring out what route you are going to take, because of course there’s a dozen different routes you can take. There’s sole source justification, there’s market research justification, and it was interesting because my PI was under the impression that it was very easy for us to say, “We want this specific model. Get it for us.” But when I talked to the acquisition officer, she explained that that’s not even up to us. We just say what we’d like, and then the actual purchasing department will send out a call for bids. They’ll actually auction off this contract to all the vendors.

 

Q: No matter how specific you know your needs are?

 

A: No matter how specific you want, yeah.

 

Q: Okay.

 

A: So that created this strange situation where we had all this information, we knew exactly what kind of microscope we wanted, we knew exactly why it was better than the other vendors, but that’s not my job. According to the purchasing department, my job is to just say what they need, and then they’ll take care of figuring out what’s available and what we’re going to get, which is strange, but that’s just how bureaucracy works in the government setting. So I had gotten quotes for all the pieces that we had demonstrated, and those were thrown out, because we’re not supposed to get quotes. Lab managers are not supposed to get quotes from the vendors, that’s for the purchasing department to do. So [laughter], but the funny thing is that I know lab managers get quotes all the time, and also, you know, sales people love to give you quotes. Even if you just say, “Hey, does this come in blue?”, they’ll send you a quote for the whole thing. So it’s kind of unavoidable to get quotes. So this was the process where I ended up with one option that was suggested by the acquisition officer, and then the other method, which was suggested by my PI. I went down to talk to the acquisition officer, and got the details, and the limitations, and then I went back to my PI and I explained it to her, and she was frustrated because that wasn’t her impression of how it worked. And you know, that is important lesson is that, in a bureaucracy this large, everyone has a different impression of what’s possible, what’s proper. And of course, at the end of the day, we have to defer to purchasing, because they’re the ones who control the money. So I went back to the acquisition officer, and I talked to her for a long time about what we need to do, and how best to do it. And so what we ended up doing is basically making a purchase description, which is the initial document that has all the information that gets, you know, copy and pasted out to other documents like the market research, et cetera. We just made the purchase description so specific that only that model from that vendor would work [chuckle]. Yeah, it’s interesting. So actually what’s happening now is– well, that whole process took a long time. There was some back and forth from someone above our local acquisition officer, someone in the COAC, which is the purchasing department for the whole institute. So this is someone I had never met, who’s in a different building, a different campus all together. We had been going back and forth because he was the one in charge of doing the bid. He sends out requests for bids, he sent out the purchase description to a bunch of different vendors–

 

Q: Can I interrupt you for just a second?

 

A: Sure.

 

Q: Is that because it’s over $3500 that it goes to him?

 

A: Yes, COAC is only for things above $3500.

 

Q: Got it, okay.

 

A: So it has, yeah, that’s where you have the whole bidding process. Below that, the threshold you can actually say, “I want this vendor, this item,” and they’ll do it for you.

 

Q: Oh, I see. Gotcha.

 

A: Of course, they have their own system of what are called GSAs, government– [directed to person outside the interview] do you know what that is? Government service something? I forget what it is. [inaudible]

 

Q: Yeah, I used to know it.

 

A: But it’s yeah, so yeah, certain vendors have pre-arranged deals with the government, and something I learned very early was actually if I know that there’s a GSA for the item I want, it’s better for me and the better for the purchasing agent to just find the GSA version, which usually isn’t even a different vendor, it’s just a different distributor. So instead of buying it from Sigma-Aldrich, who actually makes the product, I buy it from a distributor, because they have a GSA with the government. And I understand why they do that, because most of those distributors are like, small businesses, or women-owned businesses, minority-owned businesses, veteran-owned businesses.

 

[person outside the interview]: SWAM vendors.

 

A: SWAM vendors, exactly. Small, women-owned, and minority vendors, SWAM. So there’s also complicated things with micropurchases, but it’s much more complicated above that threshold. And this is below the, I think it’s $200,000 threshold? Above that there’s even more. Which I was able to look back and see, because the microscopes we own are million dollar microscopes, and I was able to see my predecessor’s documentation on that.

 

Q: That’s interesting, yeah.

 

A: Yeah. Which was a lot. And so where was I? Yeah, so the bidding process went through, and I had to then answer questions from vendors. So these are vendors that we hadn’t looked at, but they thought that they have something that would fit, so they would ask for clarification. And you know, occasionally my PI would ask if there was any news, and I would explain to her that I’m getting questions, and I’m making notes of all the questions, so that if we ever do this again, we’ll be able to put even more detail in and avoid this. So it’s funny because there were a couple points when I was told, “Okay, it’s out of your hands. It’s now the bureaucracy taking over.” But of course, they keep coming back to me for questions and clarification, because yeah, the acquisition people are not scientists, so if they have questions from a vendor that has to do with DIC or focal length, they’re going to come back to me [chuckle]. So yeah, it’s been very interesting and very informative.

 

Q: That’s really, really interesting. So, when we think about audience for that, you’re taking a bunch of information from the scientists, from the PI, and from the people actually performing the work, and then framing that for a couple of different audiences, right? You’re framing it first for the purchasing agents within your organization, and then, one step up, at the COAC? Is that what you said?

 

A: Yep.

 

Q: Yeah, and then also for the vendors, right?

 

A: Right.

 

Q: Gotcha, okay. Alright, that’s very useful just to sort of clearly clarify that. What is at stake in your writing?

 

A: Well, at the very basic level, what’s at stake is whether or not we get the piece we need, because if I screw up the justification, then the purchase will get delayed, and then we won’t get the piece we need in time. Which, you know, that’s a big reason why science takes so long, is just getting the pieces you need, figuring– ‘cause sometimes you think you need a piece because you’re doing something no one else has done before, that’s how science works, you get the wrong piece, you don’t know it until you buy it. So keeping up with the pace of the experimentation is number one, and that’s what’s at stake. Beyond that, I’m not sure how drastic it would be with a private sector job, but with the public sector job, there are very serious problems if you do something wrong or if you appear to be acting improprietously. For instance, we had a purchase of a custom antibody – this is a very tightly controlled industry because antibodies are made from the blood of animals, and if you don’t know that, I’m sorry [laughter] – so ordering a custom antibody means that a lot of animals are going to be used and bled just to see if it will work, so there’s– and you know, PITA might say we don’t care, but we care a lot, and we put a lot of safeguards in place so that no animals are bled or killed unnecessarily. So for the custom antibody, we ordered it, and then the vendor actually emailed back and asked, “Would you like us to do a second round? Because the first round didn’t work very well.” And the email actually got sent by mistake to a postbac – so this is someone who is a scientist, a fellow, but they only have a bachelor’s degree, they’re not even a senior member of the lab – and she, not really thinking, just responded, “Yes, please.” Which was actually the right thing to do, but there were a couple of steps to do before that, like getting clarification, getting permission from the COAC, well not the COAC, but the purchasing agent, because not only was it a new round of animals, but it was also about 300 more dollars added on to the price. So that was considered a unauthorized purchase, and that led to myself and the PI being called down to the purchasing department, and they basically gave us a little refresher course, which was actually a very slap-on-the-wrist thing, but that could have been much worse. And if there’s shown to be a pattern of unauthorized purchases, then we could definitely lose our lab, and at the very worst, we could end up on the hook personally for charges that, you know, when the government purchases things, they’re very cheap, but when it falls on an individual, suddenly you see the real price, and it can go up to hundreds of thousands of dollars, which could end up, you know, not just bankrupting a person, but leading to criminal charges, and then jail time.

 

Q: Sure, sure. Great explanation. Thank you, yeah. What would you say is the most difficult thing about writing in your field, or in your specific position?

 

A: I think for purchasing, the hardest thing is the audience. Making sure that everything is clear to the people in bureaucracy, the nonscientists, and also people who will see it, the vendors, the actual scientists. So that’s tricky. I say that because, of course, the thing I worry about the most is the bureaucracy, but that’s, I don’t know, that’s like more of a mundane thing. The thing that’s more existentially important is that the audience understands what I’m saying. And then for academia, absolutely the audience, because if the editor doesn’t like it, then it won’t get to the reviewer, and if the reviewers don’t like it, it won’t get publication, and then even at publication, you want it to be readable, so that everyone around the world can read it.

 

Q: Great, uhuh, excellent. You talked about going back to documents of your predecessor and also talking to the purchasing agents, but has anyone else helped you with your writing formally or informally in this position?

 

A: Well, for purchasing, we’ve had a couple of training courses, and these are voluntary. I’ve gone to mostly just to meet the people that I’m interacting with over email face-to-face, ‘cause that is very important. But also that they give you insights, like the fact that we’re not supposed to get quotes; like no one told me that, but that’s the thing. And then as far as academia, yeah, that’s what you do from the very beginning of a science or engineering bachelor’s degree. Like I had an engineering degree, it was bioengineering so there was a lot more science involved but, with engineering, it’s all about writing reports. So they teach you from the very beginning how to write a good report. So I’ve had training in school and I’ve had voluntary training at work.

 

Q: Perfect, that’s great. And that leads really nicely into this next question – what kind of writing do you remember being asked to create as a student? You talked about these reports. More than that, what are the ways in which you think your college writing prepared you or didn’t prepare you for the writing that you do now?

 

A: Okay. So, like I said, my training in undergrad was in engineering, and engineers mostly work in the private sector, where I would say it’s a lot more salesmanship, so making not only strong claims, but also optimistic descriptions of things. Like if you’re going– so the bioengineering school that I went to was actually very new and it was built on the chemical engineering department. So chemical engineers are all about building factories, so if you’re going to ask someone to invest, you know, a couple million dollars in a factory that’s only going to turn a profit after twenty years, that’s a lot of optimistic salesmanship, and you’ve got to have your numbers exactly on. So that was really helpful because it showed me how data is important, but what’s more important is how you present it. So of course, there will be people who will look over these proposals that you’re writing who do know what you’re talking about and will be able to read the data and know if you’re skewing numbers to make things look better. But, sometimes even more importantly, the presentation can’t be too technical. It has to be talking about how much we’ll be making in the future, and how important this is for the economy or the local people.

 

Q: This is such an interesting idea, that the presentation of the data is in a sense more than the data. Can you talk a little bit more about that?

 

A: Okay, so I’ll give you an example. A friend of mine loved data, he was a statistics whiz. And he wrote this paper about– the assignment was, you’re opening–

 

Q: This is in college? In undergrad?

 

A: This is in undergrad, yeah. The assignment was, you’re going to open a factory that makes glucose testers in Malaysia, or it was some Asian country. Just pick whatever Asian country you want, do a little research the local regulations – which I thought was a great assignment. I picked Malaysia, he picked I think Vietnam, and he had a lot of interesting data. He went through a bunch of government websites, found all kinds of information, he looked at other companies that had built factories there, and it was the most boring thing you’d ever read [chuckle]. And luckily, he actually showed it to me and a couple other kids before he handed it in, and we were able to tell him that this was as interesting as a bag of bricks [chuckle]. Not that the professor wouldn’t know how much work he’d put in, and know how correct he was in his assertions, but we thought the professor might take points off for how boring it was, and also we figured he should just learn this, because if he goes out in the world and writes these kind of reports, no one’s going to listen to him.

 

Q: Right [laughter].

 

A: Yeah [chuckle]. So, yeah, it doesn’t really matter how much work you do, if you can’t present it to your audience in a favorable way, then you’re not going to be as successful as you should.

 

Q: Great, great. What would have been useful for you to learn or do as a student to even better prepare you for the kind of writing you do now, if anything?

 

A: It’s interesting because the job I do is very specific, because it’s in the government bureaucracy, so there’s a lot of things I think would be very different in a private sector job, which was what I was being prepared for in college. But I guess, looking at the other students in my classes, and what we were all kind of missing was the sense of collaboration. You know, everyone talks about group projects as always one person does all the work, one doesn’t do any work, one person is great at selling it, you know, the archetypes. And that was something they really pushed in engineering, because they said you’ll always being working in a team, you’ll always be working together, and it’s important that you learn how to do that, and that was very important. And they also tried to create situations where we were working with people in industry and communicating with them. So that was all very good. And, you know, that’s kind of what you make of it. Some people didn’t learn as much as they could from that experience, and some people did. Some people made connections and got jobs out of it, that’s up to them. Then when I got to grad school, where it was more science-based, it was still bioengineering, but the people who were in it were more academia-focused – well, it is grad school, so it’s all more academia-focused anyway – and there was no, especially among the kids who were mostly biology background, not engineering, they had no sense of collaboration at all. Because in biology classes, it’s all about memorization and working alone. So when I would approach other students about getting together and doing homework together, they were like, “Well, that’s not okay. That’s not allowed.” And I’m like, “Yeah, but this is like, really heavy math, so you want to work together about it.” I don’t know, I had a really great experience undergrad. I can’t think of any way that it could be more useful.

 

Q: That’s wonderful. How do you believe you’ve evolved or improved as a writer over your career so far?

 

A: My year and a half [laughter]?

 

Q: Yeah [laughter].

 

A: I’ve gotten a lot better– and well, this is kind of a personal thing, but I’m sure it’s applicable to a lot of people out of school– I’ve gotten a lot more confident. And you don’t realize it when you’re not confident, but when you are confident, you realize just how valuable that is. Being able to, if something goes wrong, not immediately look at – well, you should look at what you did to see what was wrong – but you shouldn’t hyperfocus on what you did, and how you screwed up, because if you made a mistake, chances are you’re not going to recognize it. So the best thing to do is reach out to someone else, and confidently say, “I made a mistake.” And confidently say, “I need your help to fix it.”

 

Q: Great, alright. To what extent would you say that writing is valued in your organization?

 

A: On the academic side, it’s highly valued. It’s essential to be a good writer to get things published, and to have a good eye for how to build those figures. On the purchasing side, I’d say it’s essential, but not highly valued, because, like I said, with the short micropurchase justifications that are about a paragraph, all the purchasing agent is looking for is, you know, “Is their ass covered? Is my ass covered? Does it check those boxes?” So really, that’s just a couple words, and if those two words are there, like “mission critical” [chuckle] – I’m using air quotes by the way – if those phrases are there then it checks the box, and that’s it. It’s a very mechanical way of writing, so I don’t know if the quality of the writing is very valuable, but the clarity is essential.

 

Q: Got it. That makes sense. So I have just one question left on my form, but before that, you just mentioned something that I wanted to ask about, to follow up on. You talked about writing those figures. So could you talk just a little bit about that process and how you go about that in these academic papers?

 

A: Sure. So in science, you start off with a question, like “Why is this this?” and then you do a bunch of experiments, and you end up with a bunch of data. So it always starts with the figures. The images and the data are what you start with. So you always, and you know, we’re microscopy so we have very beautiful pictures that we can make look extremely pretty when we try, but even if you’re a surveyor, you’re going to have plots. You’re always going to have plots and graphs, so those are your figures. So it always starts with the figures and it ends with the figures. So number one is making it look pretty. With a plot, you know, even choosing the right type of plot – bar chart versus a scatter plot – those might seem like cosmetic changes, but they’re not. They are extremely important to how the information is conveyed.

 

Q: Tell me more about that [laughter].

 

A: So, there’s bar charts that have a bar floating in the column, and then with standard error bars, they’re the little arms reaching out from the top and the bottom of the block. And those are really useful if you have a lot of different conditions you’re trying to show on plot. But if you’re only trying to compare two of them, it’s better to use a scatter, so each bullet is each case that you tried, and you can actually see where it clusters and where it doesn’t cluster. So that’s a really important choice. That will also depend on what N is, how many times you tried it. If N is 3000, you’re not going to want to make a scatter plot, it’s going to look like a mess. And depending on the software you’re using, it might put things that are in the same place next to each other, so it ends up with a really wide bar, which is just hideous to look at. So you have to have a sense of aesthetics when you’re just at the first step of just making the figures to even show your PI and say, “Hey, look at this information.” ‘Cause that’s the first test. If you have information and you want to present it to your PI and it doesn’t look pretty, she might say, “Do it again,” or just, “Don’t show this to me again, it’s hideous.” So of course, that’s where it starts. That’s where presenting science, or any research, starts is with the figures.

 

Q: Yeah, absolutely. And you really have to have a sense of aesthetics to do this. Is that something that you learned in school, that you learned on the job, or that’s sort of innate? How do you see that skill?

 

[person outside of the interview: Talk about your resume.

 

A: Oh [laughter]! I’ll get to that, that’s a really good point. I think I was very lucky for the engineering school that I went to. I went to the University of Maine Engineering School, can’t plug it enough, amazing school. The first class was about data manipulation and linear aggression, and that might sound boring, and for a lot of kids it was. It was taking a very messy equation and then figuring out a way to make it into a straight line, and I loved the puzzle of it. It’s like sudoku for me, it’s just so much fun and relaxing, because once you finally get that straight line, it feels amazing. So you have sine waves, you have logarithmic curves, you have exponential curves, and each of them can be manipulated into a straight line, you just have to change the variables around – move things from one side of the equals side to the other, et cetera. And that was a great lesson in mathematics, it was a great lesson in teamwork, because certain people will have insights on them. There’s countless ways you can manipulate an equation, you can make it even more ridiculous if you want to, just for fun, but getting it down to the most useful, straight line is incredibly important and useful. So that was a great introduction to what you’d be doing, because I do that all the time in my job, and a lot of the scientists I work with don’t have any engineering background, they’re all life sciences. So if they see a scattering of points, they might say, “Well, that’s insignificant.” But, if I take a look at it, I’ll say, “Hey, give me your data, let me play with it a little bit. Let me see if I can make a straight line out of it.” And then sometimes I do. And then they’re like, “Oh! I see it now.” And now that changes the course of their research.

 

Q: Got it, got it.

 

A: I mean, that’s one thing. That’s playing with numbers. But the other things that I’ve learned in this job are writing the captions. I’ve learned a lot about writing captions in this job, because we do have these beautiful pictures, and that’s kind of the bait. It gets people to look at the paper. And so you’ll have a beautiful picture of a neuron– our neuron is actually beautiful, it has this sinusoidal curve, like an s, so it’s very easy to find when you’re looking at a bunch of neurons in a brain, so that’s useful, but also it just makes for some great pictures. So you have that, beautiful green or red or green/red/yellow neuron against a black background – gorgeous – and then next to that, you’ll have a plot, or you’ll have some numbers. So you’ve got the bait, and the chaff (? 45:56), and it’s all about constructing that so that the reader enjoys it and doesn’t get bogged down by too much information.

 

Q: That’s great, great explanation. Thank you. And my last couple questions here, how would you define successful writing as a student versus successful writing now? And would you say you’re a successful workplace writer?

 

A: I won’t say that [chuckle], but I will say– the answer to the first question’s very simple. Writing as a student, you have an audience of one. Writing in the workplace, you have an audience of 10 to 500 [chuckle].

 

Q: And you would not say you’re a successful workplace writer? But you would say you’re confident?

 

A: I’m a competent. And I’m getting more confident. I’ve never written a research paper where I’m the primary author, so I wouldn’t say I’m accomplished in that regard. Although I have a couple papers where I am an author, which is, you know, humbling, because I feel like the new guy still, but I am doing a lot of useful stuff, so it is worth giving me that credit.

 

Q: Is there anything I didn’t ask about that you think would be useful to tell me?

 

A: I think you did a great job. Oh–

 

[person outside of the interview]: I think coding is a language too.

 

A: Oh yeah, that’s a good point, I didn’t mention that.

 

[person outside the interview]: Different codes that you’ve created to help streamline–

 

A: Yeah, my wife is mentioning coding, computer programming. And that is a form of writing, and I’ve got to say, for someone who is just approaching coding, you need to think of it like a language, ‘cause the same rules apply. ‘Cause, you want to write a research paper, you want it to be concise and simple, nothing unnecessary. And the same rule with coding. You’ve got to find the simplest solution. If you can write it in as few lines as possible is important. Also keeping notes. In coding, there’s annotations. You’ll write a symbol that mutes what you’re writing, so it’s just text, it’s just for the person reading it, the computer doesn’t even care. And that’s so important, because when I got to this job, there were a couple different tools that were being written for data manipulation that were not well annotated. So me coming in cold, the person who had written them had already left the lab, I had to go in and parse through and figure out what they were saying. They had done a little bit of annotation, but I think, honestly, I think the person was trying to hide the things that they did that they knew weren’t the best way to do it. Which is fine, you know, I’ve got to say that, if you’re doing something that’s inefficient, and you know it is, you have to own it, and that’s not a bad thing. If it works, it works, that’s fine. But if you know that there’s a better way to do it, just say so. It’ll help the next person who comes along to improve it. So keeping notes, keeping notes is so important in science. That’s something I’ve gotten a lot better at, is keeping notes of my day-to-day activities in my lab notebook, so–

 

Q: Are they for only you to reference back to, or will other people see those eventually?

 

A: Well, if I’m going to leave the lab and someone is going to take over my project, that’s their bible for that.

 

Q: Perfect, got it.

 

A: And then for coding, yeah, the tools that have been used in the lab previously were all still in script format. So just like, the code itself, you hit “start” you hit “run”. I have been trying to make it, take it a step further. So I’ve been making gooeys, which are the user interface, so making it like a program that you actually point and click, versus actually interacting with the code.

 

Q: Is that so that the person who would be running it doesn’t need to understand the code?

 

A: Exactly, yeah.

 

Q: Got it, okay.

 

A: Because, something I noticed right away was– I made a script for generating fly labels; we have like, you know, thousands of viles of flies, and most people hand write their labels. But what we’ve been trying to do is get them to keep a database of them, like an Excel sheet of all the labels. But then they don’t want to deal with copy and pasting each label onto a template, and then printing it off onto one of the sticky labels. So I wrote a script whereby you can just copy from your Excel file and it would generate the template with all the words in place, but because it was in script form, a lot of people just didn’t even look at it. But when I made a gooey for it, they love it.

 

Q: Oh that’s great. Okay, yeah, that makes a lot of sense.

 

A: And the other thing that my wife mentioned was my resume. And I’ve got to say, it’s a funny story. In my graduate school, there were two schools involved. There was electrical engineering department and the biology department – they got together to make their bioengineering program. But there was still a lot of division. And one of the things that the electrical engineers loved was this program called LaTex, which is, it’s called, well it’s known as a what you type is what you get. ‘Cause Microsoft Word is what you see is what you get. You’re actually writing it. But with LaTex, it’s more of a code. You’re coding, it’s like HTML, you put in like dashes for italics, et cetera, and then you compile it, and it spits out a beautiful PDF. The people in the biology side hated it when I wrote my reports in LaTex, but it was actually a requirement from my advisor on the engineering side. And that got me a lot of grief from people, but I learned how to use it, I used it well, and I got my job, I went to interview with the PI, and then later I got the job, well actually, very soon after I got the job, she really liked me. And when I got there and I talked to the people who I was working with, they said, “Oh yeah, you’re the one with that resume!” Because apparently the PI had come out of her office and waved it at people, saying, “Look at this, look how pretty it is!” And so I know that’s why she called me back, well I’m sure that the content was good [laughter], but also– but you know that feeds back into my original point. No matter how good your resume is, if you don’t present it well, it might not get read. And yeah, I mean, content I think was pretty good, I mean I had a really good– I ended up with a 3.9 in my grad school, I didn’t mention my GPA for undergrad because I don’t want to [laughter], but you know, if you have a better grade that’s more recent, doesn’t matter. But yeah, I know that, I don’t know how many people applied, I don’t know how many people she interviewed, but I got onto the list because of that program.

 

Q: That’s really interesting, okay. That’s great. Thank you so much!

 

A: You’re welcome!

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Cancer Nurse Navigator

Sciences

Cancer Nurse Navigator, Oncology Clinic

Date of Interview: April 4th, 2017

Transcript:

Q: So would you please state your job title, where you currently work, and how long it’s been since you graduated from college?

A: So I am a cancer nurse navigator, I work in Milwaukee, Wisconsin at a cancer care clinic, and I recently – it was May 2016 where I graduated with my bachelor’s degree.

Q: Great, and you had an associate’s some time before that?

A: Correct. May of 2006 is when I graduated with my ADN in nursing.

Q: Excellent. And how long have you been in this current job?

A: My current job I’ve been in since November of 2016. So not too long, but I’ve been an oncology nurse my entire nursing career, almost eleven years.

Q: Eleven years, great. Could you please provide a brief description of your primary job functions?

A: My primary job functions are really helping patients who are from the spectrum of newly diagnosed all the way to end of life and beyond, even in survivorship, who have peers, to help them navigate the system. Whether it’s local resources, or helping them connect with other hospital systems to make sure that they’re getting the care that they need.

Q: Great. How frequently are you required to write in your job, and if you could maybe estimate in an average week, what percentage of your job requires writing? Anything from emails or very casual writing to more formal things.

A: So daily. We’re daily writing, because I’m seeing patients every day. So even in brief interactions, I do have to document in an electronic medical record, talking about what I did, what I taught them. I would say percentage of it, I mean, it’s not a large percent, I would probably say about 20 percent of my time is in documenting.

Q: Great, okay. And–

A: Which is– oh, go ahead.

Q: Oh no, please go ahead.

A: Well I was saying, which is very different than I think a lot of nurses, especially if you’re a nurse who works in a hospital. I would say that percentage would be much higher. They spend a lot of time behind a computer documenting.

Q: Okay, that’s good to know. What forms or types of writing or what kinds of documents do you most often complete?

A: Progress notes within the electronic medical record, and then again, email – there’s still email – I don’t communicate with patients via email, but definitely with other staff members, with doctors at other clinics. We also have something, they’re called staff messages, that we can use within the software that we use, and it’s how other caregivers at other sites, and other systems even, can communicate with one another, but it doesn’t go into a patient’s medical record.

Q: Okay, great. And so the audiences, could you tell me a little bit about the varying audiences that you’re writing to?

A: Medical assistants, the doctors, other nurses, and then other clinic staff, so my boss. It could be general, just clinic staff as well – so we have lab techs, there’s pharmacists, pharmacy techs, it’s kind of a wide spectrum. I mean, even our PSRs, which is a patient service representative, which is pretty much who you see when you walk into a clinic, who checks you in. So really, I’ll communicate with all of them on different times.

Q: Okay. It sounds like from the description that most of those communications, that the purpose is informative. Are there other purposes that you’re writing– are you ever trying to sort of make an argument in some way, or is it usually pretty informative or like relaying information?

A: Very informative in this role. Prior to me being a cancer nurse navigator, I was a supervisor of two oncology clinics for four years. So in that role, there was more policies, process changes, I think bigger-picture items that I was disseminating to staff that reported to me. But in my current role, it’s more informal, if anything, just because I’m part of the clinic staff, so it could just be honestly, something as simple as a potluck, like, “What are you going to bring?” [laughter], as far as emails are concerned. Recently, however, there’s a group of nurses within our clinic, and a nurse practitioner that we started a journal club. And as far as a journal, not like a writing journal, but where you’re reading nursing journals and specific areas of interest and, so even those, everybody is designated per month to come up with what journal we want to present, and then you have to write questions for people to think about, like your peers to think about. So in that sense, it’s more informative.

Q: Oh cool, that’s really cool, okay.

A: Yeah, it’s great.

Q: That’s great, okay. Were you familiar with the types of writing that you do in your daily work when you were a student?

A: No, I think as a student, any time you’re writing papers or anything that you had to write, there was obviously, we had to follow APA style, the format for writing. So not so much in electronic medical record, because to me, I feel like what I learned in school – it’s not as strict, it’s much more casual, what you can write in electronic medical record.

Q: In your actual work, it’s much more casual?

A: Correct. And I think I should be careful on how I say that, because I think, I mean, you still want to make sure you’re, like at least when I’m writing, I want it to be concise, and not using a lot of “its”, “the”, “he”, “she”, you know? So I’m pretty concise, but I think there was a difference, there was just more of a focus on a certain style, and bibliographies, and things like that, that I had to make sure the spaces were correct and you had things in the correct order, where it’s not like that when I’m documenting in my current job.

Q: Okay, okay. Could you describe, and it might be useful in this question to think of maybe just a typical writing project, like maybe think of one, because I’m sure that they vary significantly, but in a typical writing project, could you tell me a little bit about your writing process, starting from how writing assignments or tasks come to you, if there’s any preparation, steps in writing or revising, getting feedback, like what’s that typical process look like?

A: In my current job?

Q: In your current job, yeah. And like I said, if you want to think of a particularly specific example, that’s fine.

A: I think I’m going to revert back to even when I was a supervisor, having to write a document to pretty much ask for more staff members. So in that, I think you’re having to follow a very strict guideline of again, how you document within a medical record, being very precise, using data, making sure that you have numbers that correlate your need. So I would say that would probably be my sample.

Q: Okay, great, yeah. And so when you write a draft of something, is there a feedback process – a document like that – or is it just you revising it yourself?

A: No, no, definitely feedback process. And in that process it would have been from my boss, kind of giving it to her, who would look over it and give suggestions, or say, “Yeah, this part’s great, but add this, if this is needed to emphasize whatever the need is based on.” Because basically, when you’re sending something like that, you’re sending it to higher-ups in finance, so it can’t just be like, “Give me a staff member!” You really have to– and even if you have everything laid out and the numbers make sense, and you can still see a real need, you have to realize, you have to be able to speak to that. Because as a finance person who’s looking at that, they’re looking at those numbers, but they don’t understand the clinical side of it, so the actual piece of when somebody’s working in that clinic, what does that look like. So you can’t always write that in your document, so you have to speak to what you’re writing as well.

Q: Great, okay. And when that feedback comes from your boss on a document like that for example, could you tell me a little about the comments? Meaning like, are they high-level suggestions, or are they very specific line edits?

A: Could be both. It could really be both. It could just be rewording something, but typically yes, it’s high-level and wanting to I think cut out any extraneous verbiage that might be in there or things that just don’t pretty much cut to the point of what you need. Yeah, it could be both depending on how much time I’ve worked on it.

Q: Got it, okay. How long do you typically have to complete a writing project? That one maybe even, for example?

A: Typically, with that specifically example, I think we had a couple weeks to kind of go back and forth. And even once you submit something, there’s still going to be questions back, where you have to submit additional data. So if there’s a strict deadline, you’re going to go by that. I would think there’s typically, in that role as supervisor, we weren’t ever under very, very tight timelines. So, within a week, you can usually have something done. If not, even several days. It wasn’t really complicated.

Q: Okay, okay. And you mentioned that your boss oversees the more formal writing that you have. How would you say that he or she judges the success of your writing?

A: I would say I think as long as really looking over it, if they can understand it from a high level, looking at the document and say, “I understand exactly what you need and you’re laying out bullet points of what it is that required this.” Basically, I think if they can understand it, and feel comfortable with submitting it, that’s the feedback, and we’re able to move forward.

Q: Okay. Can you tell me a bit about what is at stake in your writing?

A: What’s at stake in my writing – I think any electronic medical record, and I think you hear this in nursing school, is – it’s a true document. So I don’t want to put things in that I maybe assumed the patient felt or said. So if I’m using verbatims, I’m using quotation marks, I’m basically stating exactly what a patient may say. Because ultimately, it has to be an accurate document to reflect, I mean, worst case scenario, if there’s ever a lawsuit, that document should be true to whatever conversations or whatever had occurred at that time, because it could be looked at. And there’s a big thing in nursing where basically, and I think in general in the medical profession, that if you don’t document, it didn’t happen. So you can have all these interactions with patients, and I could talk to a patient all day and educate them on any type of treatment or side effects or whatever it may be, but if I don’t actually put that I did all those things, it didn’t occur. So I think that’s a really big piece that’s at stake.

Q: Yeah. Is that difficult to ensure that you get all of that down every time?

A: I think it can be at times, especially if you’re feeling overwhelmed and very busy, because they want you to document in real time – so you have an interaction with a patient and family member, you want to go back and it’s like anything, if you start writing about it right away, you’re going to retain more of actually what occurred, versus you know, an hour or two go by, and you’ve met several patients, and I’m like, “Well who did I tell this to and that to?” So I really attempt to make sure, and in my job can make that happen, but it can be difficult, where if you don’t have that opportunity because you’re so busy and seeing a lot of patients, I will still even revert to writing things down, patient’s names, what we talked about, just to trigger my memory of what we did.

Q: Gotcha, gotcha, okay. In what ways do you think your academic background prepared you to write in this job?

A: If I would go back to when I started school at 18 and I took an English class, I would say not at all. Because I feel like I was not engaged as a student, and I feel like, oh I didn’t like English. But as I matured age-wise and also personality-wise, which could be debateable whoever’s hearing that [laughter], I feel like even having the experiences within my job, and again going back to school as an adult who is working fulltime and has a family, I feel like when I took a writing course within the last year, it definitely meant more to me and I was able to utilize what I had learned more in my everyday job. And to me it’s important that, I don’t know, I feel like writing proper and making sure that what I have to say makes sense to whoever is reading that. I don’t know if I answered the question, I’m sorry I got a little bit off track.

Q: No, no, you did. That’s great, that’s great. So that was about the ways in which school did prepare you to write in the workplace, and I’m wondering if there are other ways that you feel school maybe left you unprepared in other ways as a writer in the workplace?

A: Unprepared?

Q: You cut out, say that again?

A: Am I on okay?

Q: Yep, you’re good now, thank you.

A: Do you hear me?

Q: I do.

A: I don’t know if I would say I was unprepared, because in school we didn’t exactly document in a medical record, but you were writing out careplans, and so pieces of what you would have to do within your daily life as a nurse, so it definitely prepared me. The unprepared part, I feel like it’s a given in any, especially as a new nurse – yes, you get a foundation in school about anatomy and physiology and maybe English and microbiology and things like that – however, I feel like you do most of your learning, and how you want to– you learn most, in my opinion, from actually starting as a new nurse. So I’m sure if I looked back to what I wrote my first year of nursing to what I am now, I’d probably be like, “Oh!”, you could see how much is probably grown as far as being concise in what I have to say. So I don’t know, I don’t feel like I was unprepared in my education, in writing in college.

Q: That’s great. So when you think back to those early challenges that I think are very universal to anybody coming out of college and going into the workplace in terms of writing, were there specific strategies that you utilized to sort of learn the things about writing that you felt you needed to learn? For instance, a strategy might be looking at the writing of coworkers, or supervisors, or seeking out training, or anything like that.

A: Yeah, definitely. And so even in my current role as a navigator, yes, definitely looking at other navigators and what they write and what they– yes, definitely utilizing them as examples of what I think is important to put into it. And then also realizing no, I’m not going to utilize what they have, and kind of go with what I feel is important to add in a medical record. So there is definitely that.

Q: Great, okay. And have you had any, I know the most recent college graduation is pretty recent, but have you had any writing training or education since then?

A: No.

Q: Alright. And two more questions. The first is, would you say that you are a successful workplace writer?

A: I would say yes. I think yes, I feel like I am deliberate and conscious of what I’m writing and again, want to make sure that what I have to say makes sense, and I use– which can sound kind of strange at times, but I feel like I want to be proper in what I’m writing, because I don’t always see that in electronic medical records. Sometimes you see things where you’re like, “Oh that doesn’t make sense in how that’s–” you know, in what people are using. So yeah.

Q: Great, great. And what skills would you say are most central to writing in your very specific role, and in your very specific organization and industry?

A: What skills in writing – I think definitely understanding medical terminology, understanding– I speak a lot to treatments, so knowing what those things are, knowing the road that people have to be on and really incorporating that into my writing. Because you can look at a doctor’s note, and it has so much information, and so what I do is I feel like I take out the important pieces, where honestly, even if a patient read it, that they would understand really what’s going on, and not so much from a higher level from like a doctor who’s speaking certain medical jargon within their documentation, I will still use certain obviously treatment names and specifics as far as surgeries, if they’ve had biopsies, but really, if a patient were to read that, they would completely understand what I had said. And that’s kind of how I feel the role of the nurse in really important, is conveying that information to the patient in a way that’s understandable.

Q: Gotcha.

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