Registered Nurse


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

A: I’m a registered nurse, I’m a dual position, so I work in the local hospital just as what they call a float nurse, so I’ll come in and work wherever they need me for the day, but I also work in the outpatient center that’s connected to the hospital, and there I work in their anticoagulation clinic. So I consult with patients who are primarily on a medication called warfarin, and we do education and we do blood tests, and then we give them a warfarin dose to be taking until they see us the next time. So that’s what I do. And I graduated from college ten years ago. 

Q: Ten? 

A: Yes.

Q: Great, great. And have you worked in nursing for that entire ten year period?

A: Yes.

Q: Wonderful. And can I ask just a clarifying question – what types of medical issues might someone have if they were taking that medication that you work with?

A: Um, there’s a couple, but primarily it’s people who are more likely to have blood clots or have had a blood clot, so that includes people with atrial fibrillation, which is an irregular heart rhythm, which can cause a stroke if you’re not on an anticoagulant, or people who have blood clots, it’s called a DVT, deep vein thrombosis, or PE, pulmonary embolism, who need to have anticoagulation until their body is able to break that blood clot down, or people who have genetic predisposition for blood clotting, or people who have like artificial heart valves that can more easily clot of they’re not on an anticoagulant.

Q: Gotcha, thank you. This will obviously be a little challenging because you mentioned that you’re a floater, so you’re doing different types of nursing tasks day to day when you’re in the hospital, but could you give sort of a brief overview or description of your primary job functions?

A: Sure. I’ll speak to the floating nurse part first. So when I come into that day, I am assigned between three and five, sometimes six patients for the day. I need to assess them, I need to administer medications and treatments, decipher lab values. I’m in constant communication with the other members of the care team, which are other nurses, like my supervising nurse, the physician who is of course in charge of the patient, as well as any consulting physicians, and then auxiliary healthcare team members, like physical therapy, occupational therapy, speech therapy, that sort of thing. So we all work together during the day to bring all those treatments to the patient. And then of course notifying the physician if there’s anything out of the ordinary that’s going, and then all the documentation of everything that all those people have been doing [chuckle] during the day as well. So that’s what I do when I’m floating. And then in the clinic setting, it’s really, it’s different, and it’s really, I like the dichotomy there because I kind of get to do two different things. So in the clinic I see one patient at a time, which is different in and of itself, and then I have to ask them a series of interview questions related to the medication that they’re on, warfarin. First we talk about what other medications that they’re on, then we discuss if they’ve had anything abnormal over the past few weeks since it’s been, or however long it’s been since they were last seen in our clinic, we talk about if they’ve had any issues with bleeding, because it’s an anticoagulant so it make you bleed more easily. And then of course, we talk about if they’ve had any other clotting symptoms as well, because that would mean that the blood levels aren’t correct, either – hopefully they’ve been in the emergency room in either of those scenarios, but sometimes that doesn’t happen. And then we talk about other things that affect the medication, so diet, alcohol intake, smoking, that sort of thing. And then after we go through all that, then I check their blood level, which is called the INR, and it helps us know if that medication, the warfarin medication, is therapeutic. And then if it is therapeutic, then we continue the current weekly warfarin dose that they’re on, and if it’s not, then we address if there’s a reason why it’s high or low, if it is, we correct that through counselling and then give them a new medication dose. If there is no reason, then we have to correct the medication dose anyway to try and get that level more therapeutic. And because I’m a registered nurse, I have to have it cosigned or I have to consult with my supervising nurse practitioner or pharmacist that I’m working with that day. So usually I go through all that, everything, and then I just run out to them quickly and discuss the case with them, we come up with a warfarin dose for them, and then I give that information to the patient and we send them on their way. And then if I haven’t already made the note of that visit while I’m talking to them, I finish up the note after that. And that’s it.

Q: Perfect, thank you. Either in terms of those notes or if there are additional writing tasks, could you estimate in an average week what percentage of your job requires writing?

A: Um, on the floor probably maybe like 25, 30 percent. In the clinic, I would say it’s probably higher than that, maybe 50 percent.

Q: Great, great. So could you tell me a little bit about the forms or types of writing, or the documents that you most often complete? Sort of what are they, what form do they take, but also who are the audiences and what are you trying to accomplish with them?

A: Sure. In the hospital, everything is documented on our online charting, electronic medical record. So it’s a series of, like when I’m doing an assessment, it’s a series of clicks basically. We do something that’s called charting by exception, so we can assess the patient and then just say, “This system,” for example neurological, “is within normal,” so there’s nothing unusual there. But let’s say for example the patient has a history of an old stroke, then I would not say everything’s normal, because maybe they have a residual drooping of one side of their face. So then I would check that, and then I would also want to check that this is an old thing, and it’s not something new. Because if it’s something new, then we’re going down a whole other line of assessment and notifications and checking the patient to see if the patient has had a new stroke, et cetera. So basically that documentation is click click click click click all the way through. If there’s a note that I want to add in there, like that discussion of it being an old stroke, it’s just another quick right click to add a little comment basically. So it’s clicks and comments. And then I will also write a short note usually, at least once a shift, just to talk about my care of the patient, if there’s anything abnormal, usually if it’s a pretty good healthy day for the patient, it’s a real quick note saying, “I assumed care of this patient at this time, this xyz happened,” excuse me one second, [interviewee talking to her child]. Sorry [chuckle]. Can you remind me what I was saying [chuckle]?

Q: Yes, you were talking about the click system. Oh no, you were talking about writing a note once a shift to talk about it.

A: Okay, yeah. So it might just be a little blurb about my care of the patient that day. But, if something abnormal happens, which often something abnormal’s happening because the patient’s sick and in the hospital, then I would speak to that maybe more in detail than just the standard assessment boxes that I can check about the patient’s abnormality. Like so if the patient had that facial droop, I would of course be writing a note about what time I noticed that, who I notified, and our hospital is a stroke hospital, so we would call this alert, and the patient would go off to a series of tests to see if the stroke is a true stroke and if it needs any further treatment. So it just goes down this long sort of path of all the other things I have to say about what happened. But because I just feel like it’s better to have that note in there too, just to cover everything that I have done. A lot of times it is double documenting, but I am of the thought that it’s better to say more than to not say enough about whatever has happened to the patient during the day. 

Q: Absolutely.

A: So, go ahead.

Q: Oh no, I was just going to say, yeah. So this might feel like a silly question, but because I don’t know that world very well, so why is it better to say more than less? What are you trying to accomplish with those notes?

A: Well, so you asked me who my audiences were, the people that might be reading this later, number one, would be the nurse that’s following me, so she or he’s going to want to know went on. I will of course give that to them in report, but if they want to reference that to see what has happened, a lot of times it’s easier to pull up a nurse’s note than it is to like filter through all those sections of clicking that I did before. It’s just, I can make it more succinct I guess in a note, and just kind of give the highlights of whatever the issue was that was addressed. And then the other people that might be the audience for that – physicians, I don’t really know actually how much physicians read nurses notes [chuckle] it’s just so much information and they’ve got enough going on. I know that physical therapists and social workers, everyone else on the team might reference that. And then of course, we always think in the back of our minds about the possibility that if something ever came up that went to court, we want the people that are prosecuting to know that we have done everything we can, and just to say like, “Hey, I did it. I followed all the steps and all the protocols of what needs to happen when something abnormal like this goes on in the hospital setting.” So they say, the acronym CYA, so just cover your ass when you’re in healthcare because you want everyone to be safe number one, but also to know that you’ve done everything you can and again, that saying, “if you didn’t document it, it didn’t happen.” So it has to be shown in your documentation what you did for the patient.

Q: Great, great. Thank you so much. Other than those notes and the click through system,  where you’re leaving comments, is there any other kind of writing or documents that you work on?

A: Yes, thank you for reminding me [chuckle]. In the clinic setting it’s a lot different, I really enjoy it actually, because when there’s a new patient that’s come to the clinic, you do an intake, so you have to get to know the patient and sort of what their medical history is, as well as what brought them to be on this new medication of warfarin. So that interview, it’s a longer visit because it’s the first visit with us and we do a lot of education there as well. And after I get their whole story of what brought them to me, then I have to sort of write that out as succinctly and sort of pointed toward our specific medication as possible, as that first admitting note. And then subsequent visits we sort of have a template that we use and we change it for variations from the normal. So they’re all again, in the computer, we use a specific computer program made for this type of clinic, but we do our own writing of those notes. The first note is different because it’s sort of like a narrative, versus the other notes, which I guess are also narratives but they’re a template that we just sort of fill in what we need to for the patient.

Q: Okay. Gotcha, that makes perfect sense. Could you walk me through the process for a recent project or sort of one of the typical things that you write that you mentioned? Just sort of start to finish, even if it’s something, maybe the actual click through and comments makes sense because it’s something that you do so frequently. What is the process like from start to finish, how long does it take, and sort of what steps do you take?

A: Sure. Maybe I actually will speak to that admitting note, because it’s probably the most writing. 

Q: Oh great, yeah.

A: So like I said, the patient comes in, I sort of just ask them like, “What brought you here?” And then most people really like to tell you everything that’s gone on, so you just listen, sometimes that takes a really long time [laughter], but listen to them, and then try to draw out specific pertinent medical history, because that’s what ends up going in the note. I take notes while they’re talking, and then I have a sort of a loose paper that guides my questions as well if I’m forgetting something. So after I take the notes, we do the visit, I do the education, we do the blood test, all that stuff, send them on their way, then what I often do if the patient has been in our hospital – which often they have because our hospital is the only one in the county so most of the people that are coming to the clinic have been in our hospital and were referred to use from there – I’ll actually look up their most recent hospital admissions as well, just to see if there’s anything else that was mentioned in their physician notes that maybe the patient forgot, or a lot of times patients have a really good understanding of what’s happened, but maybe they don’t have the right verbiage, so I like to go into the physicians to see what was the actual diagnosis, or what was the actual procedure that happened, because they might give me layman’s terms but I don’t want to assume that what the patient has told me went on is actually what was you know, the medical term for that. So a lot of times I’ll just like go in and double check any pertinent history in their electronic medical record, and then I sort of come up with this narrative. We use something a SOAP note, so situation, objective, assessment, and plan. So situation, “This is a 70 year old patient who comes to our clinic,” and the narrative is the same for each of these new patients but then you say, “because they had a blood clot in their lower left extremity. They came to the hospital on this day, they were started on warfarin on this day, here’s their past medical and surgical history, allergies, the medications they’re currently on,” and then we talk sort of specifically toward warfarin. So we’ll say you know, “They didn’t miss any warfarin doses since they started on the medication. This is what they’ve taken so far. They haven’t had any issues with bleeding,” or maybe they have, “they still have swelling in their lower extremity,” that would be normal. We’ll talk about other symptoms of clotting to make sure that we’ve said that they don’t have any other symptoms of clotting. We’ll talk about their diet because diet can affect the levels of warfarin in your blood, and we’ll talk about alcohol and smoking, and if they have been sick lately. So that’s all in the situation part of that note. Objective stuff, we will say they have — that usually we leave blank except sometimes we will put in weight and height and that sort of thing. Assessment we will say after we’ve done the blood test, whether it’s therapeutic, not therapeutic, and whether they have or do not have signs of bleeding and clotting. And then in the plan part of the note, we will say, “This is what we told the patient to take with their warfarin for this so many days until they return to see us.” And then in that initial note I will always also document, “We covered all this education,” and I like list all the different things I did with them, “and it took me this long to have this visit with the patient,” because that’s something the billing people have to know. And then that’s it.

Q: Okay, that’s excellent. And so is it just a sort of, you write it and it’s done? Do you ever return to those to revise them? 

A: Um, the only time I would return to revise them is if I just forgot to put something in there which happens frequently, so just add an addendum on the end of that. I do return to those notes, I wouldn’t say frequently, but sometimes if I’m looking to see maybe did they have this medical history, like let’s say it’s been a couple years since they’ve been in our clinic, and all of a sudden it pops up that they have this history of diabetes, and I never knew that before and I wanted to look back and see, did we know that when they first came to the clinic? So we I might look back and see, we have several places where we document their medical history, but sometimes if I can’t find it anywhere I’ll look back at that initial note to see, did we know it then, or is this actually a new diagnosis that they’re telling me about for years after the fact? So I do reference those occasionally, or maybe I wanted to know more of the story, like we have a chart that says why they’re on the medication, but sometimes you want to know a little bit more specifics of why they’re on, so I might look back at that note to see, what was the story? Like what actually, how did that all come down in the beginning that they started on the medication?

Q: And as you are thinking about writing those notes, like the more narrative pieces of it, is there anything that you avoid saying?

A: Well I can talk of course about being a nurse versus someone with a higher, like a prescribing power. Like I can’t say any kind of diagnosis, this goes for anywhere that I’m working, like I couldn’t say that, “I believe that they are diagnosed with atrial fibrillation,” or a blood clot or whatever. I always have to say, you know, “They were found to be in xyz diagnosis when they were admitted to the hospital,” or by their primary care, whatever. That’s never something that I say, even if I know, like that these symptoms might be present. I can’t say that they are diagnosed with, under my license. So if I’m going to say something about diagnoses, I will always tack on where they got that diagnosis from. Past medical history is a little bit less like that, but for a new diagnosis, you would definitely want to say you know where they got the diagnosis from. I’m never currently in that moment diagnosing anybody, nor would I say that in a note.

Q: Okay, I see, that’s useful, yeah.

A: I’m trying to think what else. You certainly don’t, like if the patient’s warfarin has been mismanaged by another physician, like let’s say they used to go to a different clinic and that clinic told them to do ridiculous things, and it made them issues, I’m not necessarily going to– we try to be very diplomatic. So I’m not going to say, “it’s this clinic’s fault that xyz happened,” but I would say, “the patient was told by this clinic to do this with their warfarin, and here is their INR today.” I will give the beginning and the end, but I wouldn’t say, “and it’s their fault.” Because again, we’re not going to throw other healthcare providers under the bus, but we do need to document what has happened and what the effect of that may be.

Q: That makes perfect sense. Is that more of a sort of community standard? Or is it a legal concern that you want to be cautious of?

A: I would say, I mean I was never taught about a specific legal concern that says, “don’t throw your other healthcare providers under the bus,” but I think it’s just kind of standard in medicine. Like if something really terrible happened of course there would be follow up about that, and we have certainly, if a patient comes to use in a dangerous situation, we absolutely follow up with wherever they came from, and like, “Hey, what the heck happened?” But we again, would write that in a diplomatic way. We wouldn’t necessarily write you know like,”We called this other doctor and yelled at them because they messed this patient up,” [chuckle] kind of thing. But at the same time, while you’re being diplomatic, you are highlighting and what should always highlighted in healthcare is the patient’s safety, so that is like a running theme of all documentation that we do, is showing what we did to keep the patient safe, or to get the patient safe.

Q: Excellent, excellent, thank you. So this next question feels a little bit broad, but how did you know how to perform the types of writing that you currently perform?

A: In the clinic setting, it’s certainly been a learning process. I think mostly just from reading other people’s intake notes, and when I first started there, I had to sit in with those initial visits and follow up, and my supervisor would read those notes afterward and you know, tell me if I needed to change anything. In a broader sense, we learn all of that in nursing school from very early on, I would say maybe the first or second semester of nursing school we’re learning about how to write a patient note. I learned on paper, this is before the computers were really up and running, so we would like write out our notes and sign them on a piece of lined paper, and then our instructors would check those. And I believe we had some sort of maybe a couple of days of reading examples of notes and how you might write them. I certainly remember practicing and submitting many notes throughout nursing school to be looked at by our instructors.

Q: Gotcha, okay. Has there ever been a time in your career that you felt unprepared as a writer at work?

A: Um, probably that first year of nursing, I was just, it’s just overwhelming. All the preparation does not you prepare you to just start working in the hospital. You just have to go in a start doing it. So I definately, I had some excellent preceptors when I was new to nursing, and we would stay two hours after my shift was over sometimes [chuckle], like going through all my documentation and double checking everything, I had one lady that was, she was insane, and she was always like dotting my i’s, crossing my t’s, everything. But it’s good I think to start that way, and then, you know, some of those things like dotting your i’s and crossing your t’s may not be the most important thing, but it’s good to be completely thorough I think at first just to get your grips on it. As far as now, I mean there’s certainly been some times where, I will run by a note with the nurse practitioner that I work with, if I want to make sure that I’m wording it correctly if it’s kind of a touchy situation. Like we have a lot of times in our clinic, you know, you as a patient, you’re entitled to your own decisions and opinions and it’s your body, but a lot of times we’ll recommend something, like, “You need to go to the emergency room,” and the patient outright refuses. And so in that narrative, I want to make sure that I’m saying that we educated the patient on the risks of not going to the emergency room, and that the patient refused or declined our suggestion, and I want to say that in a way that shows that we are trying to keep the patient safe, and so that if there’s ever a situation where that patient, God forbid something happened to them, and then they said, “Well, they didn’t tell me that,” then I can look back at that note and say, “Well actually I did tell you that, we told you should go to the emergency room,” kind of thing.

Q: Right, right. Gotcha, okay.

A: But that’s the kind of thing I would run by my supervisor just to make sure that I have that wording in a way that makes the most sense and speaks concisely to the issue that is at hand.

Q: Perfect, okay. Does anyone oversee your writing?

A: In the clinic, my supervisor does. She doesn’t read all my notes, she would only read it if brought something to her attention. They are signed off on either by her our medical director. And then in the hospital setting, there’s again, there’s just so much in the hospital setting, there’s so much information, that I don’t know that anyone specifically looks at my charting. I think that they do random audits, where there’s like a whole department in the hospital for auditing and looking at nursing documentation, so they will now and again audit certain parts of your charting to make sure that you are completing it as you’re supposed to. As far as, in my ten years of nursing, I have never had a note brought back to me about you know, whatever, edits or whatever like that. But there certainly have been times where an auditor will call me and say, “Hey, you forgot to chart your pain reassessment, can you please do that?” And so then I will go back in and do that for them.

Q: Great, okay, okay. How long do you typically have to complete a writing project? Like you know for the average sort of notes on a patient, for instance if you’re on the floor. 

A: On the floor, just a couple minutes probably. I don’t spend that much time unless it’s a significant issue that needs to be typed out in which case, maybe five or ten minutes. They’re not long, I mean I don’t know that I write paragraphs about any of my patients, even if it is a big issue, because again, you can accomplish a lot of the information intake by clicking through the checkmarks. But yeah, not very long.

Q: Okay. 

A: [Interviewee speaking to her child]. Alright, go ahead.

Q: Sorry. So you talked a little bit about this, but other than practicing those notes, are there any kinds of writing that you remember being asked to do as a student?

A: Hold on just a second [interviewee speaking to her child]. Go ahead [chuckle].

Q: If you need to cut this short, we understand completely. 

A: Oh it’s fine, we’re good. 

Q: Okay, so I was asking about, were there writing tasks that you completed as a student other than notes that you remember doing? Other than those practice notes that you mentioned?

A: We do, in nursing school they’re big on care plans, which involve something called a nursing diagnosis, where we would talk about the symptoms a patient has, and how we would go about managing those symptoms and then what we would look for as a favorable response to that, and sort of a goal that they would accomplish through that response. Again, it’s all very vague, not vague, but you’re skirting around the actual diagnosis because you can’t say the actual diagnosis. So we would do a lot in nursing school. You wanted just specifically nursing school or like undergrad in general?

Q: No, in general sort of your undergrad education.

A: I mean, we were all required to do a, I don’t know if it was creative writing class, or some kind of writing class, no it wasn’t creative writing, I think it was just like English 101. Just basic papers, I remember my English 101 lady was really into animals, so we did a lot of animal papers [laughter]. And you know, I was just remembering, in nursing school then we did do a research writing course, where we had to research a specific study and sort of write about that study or about several studies just to sort of gain familiarity with how to read through a clinical study. So we did do that, not very much of it, I don’t think we did – I think maybe we did one or two big papers over the course of that semester, but that was something we had to do as well.

Q: Gotcha. And in what ways do you think that the writing you did in college prepared you for the work that you do now?

A: You know, those care plans were kind of annoying, but they did help you learn that language of how nursing speaks to the condition of the patient. And sort of all the auxiliary things that happen around the what the physician might be addressing. So I think that was good in that respect, it’s definitely an approach you have to learn. The research writing was good because it, like I said, it helped me gain familiarity with how to read through a trial or something like that. I don’t think that the English 101 was particularly helpful for nursing in particular. I really enjoyed it, because I also enjoy creative writing, but I don’t think it was very helpful. It’s asking you to write a lot of things, to be as verbose as possible, and that is not how it is in medicine [chuckle].

Q: Yeah, that makes sense. So just a few more questions. Is there anything that would have been useful for you to do or learn as a student that you didn’t do?

A: I think if perhaps there were more scenarios kind of offered, like, “How would you write about this? Like you are telling the patient to go to the emergency room, and they don’t want to go.” Like having that kind of practice would be good, because I think that sort of thing happens a lot in healthcare where you have to say, “I recommended this, and the patient didn’t want to do it,” kind of thing, sort of to cover yourself. So I think that kind of practice would be good, because I think it’s sort of broad and you have to say that in multiple different scenarios. I’m trying to think if there’s anything else. Yeah, just different scenarios like that I think would be good, or just to read that sort of scenario. Maybe we did read them and I just don’t remember [chuckle]. 

Q: Could you talk a little bit about what is at stake in your writing?

A: Well ultimately, the patient’s safety, but that’s more in your practice than it is in your writing. I feel like my writing comes second to the actual care of my patient, and sometimes that makes me stay extra after my shift is over, because I want to give the care to the patient first, and then write about it later. But in an ideal world, you can do both of those things at the same time because the patient isn’t having any issues at all [chuckle]. So what is at stake? Of course, your license is at stake because if you don’t again, document something you did, that something bad happens to the patient, that will come back to you in a court scenario if you haven’t documented appropriately, even if you did do it, and you didn’t write it down, it will come back to you. So that’s probably the biggest thing that’s at stake in my writing. Also just sort of my reputation kind of in a way, because like I said, the nurse that follows me is going to want to read what I’ve been doing. So if I come in after I know what’s been a train wreck of a shift for the nurse before me, and there’s nothing written down, of course maybe they’re still working on it, sitting next to me while I’ve taken over, but I would want to know what has happened. Or like let’s say it’s been a couple days since this incident happened for the patient, like I want to be able to go back and look and see what actually happened, because nursing report is excellent I would never want to give that up, but as a story gets passed along when you’re in shift report, things might get lost or missed, and like I want to go back and look and see, okay what exactly did happen? You know, where are we at in this process of getting the patient past this event that happened?

Q: Gotcha, gotcha. What would you say is the most challenging thing about writing in your job?

A: I would say being succinct but also accurate. So I want to gather all my data and be able to present that accurately so that it is helping everyone involved in the situation.

Q: Great. How do you believe you’ve evolved or improved as a writer over the course of your career?

A: I think I’ve definitely become more succinct, I mean I enjoy writing a good story about a patient but I also have to sort of rein it in a little bit sometimes. So I think I’ve gotten a little bit better at that, and knowing what’s important to say and what’s not important to say in a note.

Q: Okay. And just two more questions – first, to what extent do you think writing is valued in your organization or in your field?

A: I think that it’s valued secondary to actually keeping the patient healthy and safe. I think it is certainly valued but I’m trying to think how to say otherwise, yeah. Yeah, I’ll just leave it at that.

Q: Yeah, that makes sense. And would you say that you’re a successful workplace writer?

A: Um, I think so. I think people read my notes and can follow what’s going on which is important. 

Q: Excellent. And is there anything else that you would want people to know about the writing that you do at work?

A: I think I’ve said what I wanted to say.

Q: Okay, thank you so much.

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Physician Assistant, Neurosurgery



SPEAKER: Would you please state your job title and the type of organization where you currently work?

SPEAKER: My job title as a physician assistant in neurosurgery and I work in a hospital.

SPEAKER: And how long has it been since you graduated from undergrad?

SPEAKER: I graduated from undergrad in 2008, so ten years, wow.

SPEAKER: Okay. And how long has it been that you’ve been working in your current field?

SPEAKER: I’ve been working in my current field since 2014, so about four four years now.

SPEAKER: Okay. And could you provide just sort of a brief description of your primary job functions?

SPEAKER: Yeah. Some of my primary job functions are to see patients when they first come into a hospital as a consult or directly. They are trauma patients so patients that have had head injuries, spine injuries, or spinal cord compression. I also take care of patients in the ICU, either before or after surgery, or to manage them medically, and also function in the operating room as a first assist to surgeons, and I help in discharging patients if they have had a complete hospital course.

SPEAKER: Okay, excellent. Could you estimate in an average week what percentage of your job requires writing of any kind?

SPEAKER: I would say that writing takes I’m going to say maybe 30 to 40 percent of my job. Documentation is pretty important in medicine.

SPEAKER: Oh great. What forms are types of writing does the documentation usually take?

SPEAKER: They are electronic, typed consultation notes or history and physicals. Also daily progress notes, so documenting events that have happened for the patient, anything pertinent, and physical exams. And for OR procedures, brief summary of the procedure itself.

SPEAKER: Okay. And who are the primary audiences for those?

SPEAKER: Primary audiences would be medical billing and coding specialists, hospital administration, other services – so for example, a medicine service – if we are seeing one of their patients, or other services and specialties, so other doctors, residents, PAs and nurse practitioners,

SPEAKER: I see. And the purposes it sounds like could range from anything from billing to just sort of like, what would other purposes be?

SPEAKER: The biggest thing is probably going to be documentation and billing for the hospital, and just as what is legally required in healthcare. But other purposes would be for helping the patient or their families themselves, so things like filling out sick leave or FMLA paperwork, disability paperwork. And then the other biggest is for social workers who are able to read our notes, so that can help them in giving patients support for services outside of the hospital for things like rehab or counseling.

SPEAKER: Okay I see. And could you just tell me a little bit about like the form that that documentation takes? How long are they typically, what are they typically include? How do you sort of approach writing them?

SPEAKER: Yeah. Most of our writing is actually in template form. So it doesn’t really take too much time, and most documentation will include a summary of the patient themselves and their background, specifically their past medical history and things that are pertinent to their hospital stay – a hospital course meaning day-to-day, if the patient has had multiple procedures or surgeries or events like low blood pressure. My writing is kind of like a concise but flow of a course of a hospital stay. They will also include a physical exam, so my exam of the patient and a plan. So plans for all of the diagnoses that the patient has, and documentation that my attendings and surgeons have agreed to plans that I’m making.

SPEAKER: I see. That’s very helpful. When it comes to writing those, is there– you know, we tend to think about writing often as having a process in terms of planning, writing, and then getting feedback or revising, but I would imagine this is sort of a one and done writing situation? You sit down to write it, you write it, and then it’s completed. Is that a fair assessment?

SPEAKER: Yeah just because we are required to document everything that we do and see. But at the same time every day we’re doing and seeing so much, so the writing for me is something that I do as quickly as I can. So it usually takes on a pretty specific flow. I always have it in my mind that I’m going to say like, for example, you know, “Patient is a such and such year old male or female, with this past medical history, who is coming to the hospital for, ” and then I’ll get into my story of the patient’s course.

SPEAKER: Gotcha,. okay So is it fair to say that you’re creating sort of – you’re writing the story, you used that actual word – even though is that a technical word, is that just a word that you use?

SPEAKER: It’s just a word I use. But what we actually call it is HPI – a history and present physical of the patient.

SPEAKER: Gotcha, okay. And how did you know how to perform these types of writing?

SPEAKER: It came when I was in grad school. So when I was training to be a physician assistant, we started to learn how to write these things, and then this is also something that if you were to read out loud, is also the way that we would talk to colleagues in presenting the patient.

SPEAKER: Oh interesting. So it really does translate exactly how you would say you would write it.

SPEAKER: Yes exactly.

SPEAKER: Gotcha, okay. Has there ever been a time in your career that you felt unprepared as a writer?

SPEAKER: Probably in the very beginning, like when I was a student and doing my rotations, and also in the first month or two of my first job. Only because, you know, it was new, and it is a pretty specific style of writing and you’re using so much medical terminology And so sometimes it’s actually a little difficult, if I was to go and talk to a patient’s family I would have to think about that note and translate that into everyday terms. But this writing, I think when you’re first learning in the medical field, you’re having to use such specific language. So that’s probably the time that it was most challenging.

SPEAKER: That’s interesting, yeah. Was there anything that you did to specifically overcome those challenges, actual strategies or steps that you took to improve?

SPEAKER: Yeah I did that when I was a student where I would practice what I was going to say to whoever was training me. And again that would translate from my notes. So I would take that time to write down what I wanted to say aloud in presenting my patient and then I would turn around and be able to write that down as my note. So practicing really helped in that.

SPEAKER: Gotcha. That makes a lot of sense. Does anybody oversee your writing?

SPEAKER: At this point no, no one oversees my writing but my surgeons do co-sign my note but they also, if they feel they need to, they will write something else in the note but never a change to what I’ve written. They would write something at the end for example to say you know, “I’ve seen and examined this patient and agree with the physician assistant’s. assessment Additionally patients said, ‘X Y and Z’ to me personally and for that reason I would also do this as a plan. ” But I think my writing was more so overseen when I was in grad school where we would have to write out example HPI and notes on patients and it would be graded.

SPEAKER: I okay se, e, okay. And was the feedback that you were getting in any way about writing style, or was it more about the content that was in there?

SPEAKER: It was I think both. It would be about content and style. So having something very long- winded is not very accepted in medicine just because again, everybody’s you know trying to also see their patients face to face, or do procedures, or be in the operating room. So sometimes it’s actually a little frustrating to have the requirement to write everything down a certain way, so I think pairing things down is the biggest thing that’s emphasized of how do you make this as brief as possible but still having as much information as possible.

SPEAKER: Got it. How do you do that? That seems extremely challenging with such technical writing.

SPEAKER: Yeah the way that we do it in medicine is for example, if you have a patient that’s there and they’re seen for a gunshot wound to the head, you would write out their past medical history so for example to say you know, “Patient is such and such year old female with a past medical history of hyperthyroidism, six weeks pregnant, diabetes, hypertension. ” And then you would get into your specific story, so how the patient was injured, how they appeared when they came in, what their blood pressure was, and then get right into a plan. But then if you were to see that patient, you know, five days later, you’d have a little bit of leeway and you can just touch very, very briefly on what brought the patient in. So at that time you wouldn’t say “Patient came in at such and such time, ” in this note you would say, “It’s been hospital day five since this happened and here’s what’s happened since. “

SPEAKER: I see, I see, okay. That’s really interesting. And I’m just thinking about like, if you’re writing these notes as someone is in there with a gunshot wound that puts a certain added pressure I would imagine!

SPEAKER: Yeah. So that goes back to, you know, we do have to see patients, you know, face to face and you’re spending time with them, sometimes every hour, to make sure that they’re doing the same things that they were doing an hour ago. Like for example, this patient was talking an hour ago and now they’re not. So what’s changed? What do I have to do? Is something happening in the brain? And then of course you do have to remember to go back and write that down, so that the hospital knows, that other people that may get involved in in the care know that these were the events that happened.

SPEAKER: I see. I see. And how long do you typically take to write up one of these notes?

SPEAKER: When I first started, that would take much longer so I would say, I would think about this for you know 15 minutes, 20 minutes, take maybe five or so to write it down. Now it sounds a little surprising, but you know you might just kind of write down little blurbs on a piece of paper for when you get to a computer. So sometimes it doesn’t take as much thought just because it’s become muscle memory and it would take maybe two minutes to write the actual note.

SPEAKER: Gotcha. Okay, okay. When you think back – this asks you to sort of look way back to undergrad – when you think back to the kinds of writing you were asked to do, what kind of writing were you asked to create as a student? And do you think that those college writing experiences prepared you at all to do the kind of work that you do now?

SPEAKER: Yeah. In college, you know, there was different kinds of notes based on what subject matter. So one of the things for me since I was a biology major was doing lab reports, and in those, the writing, you know, you have to have your grammar correct spelling etcetera, which I think is kind of lost now in medicine I think that if you see somebody misspelling something you just think, “Oh this was probably, they were just very busy had to get to another patient. ” And in the other sense, you know, you really are focusing on the grammar and you know, how your sentence flow is going more in college. And I think it was kind of taught to me after is, “No. Do the opposite. ” You know, get it as clipped and as fast as you can. So that is probably a challenge now, and I think to have been better prepared, maybe to have an assignment where you are having to be as concise as you can be with still providing as much information as possible, would have probably been helpful in undergrad.

SPEAKER: That’s really interesting. Going back to this, you mentioned – it’s super interesting to me – this idea that in a medical note now in documentation, if there’s a misspelled word or some sort of grammar issue it’s really unimportant because it’s assumed that it’s because of a time constraint. Could you talk to just a little bit more about that?

SPEAKER: Yeah I think, well not just that, but in medicine I think, you know, you’re seeing doctors or physician assistants etcetera writing notes, and I think that, at least for me, the assumption is that this person is definitely worthy of their credentials, so if they misspell something it’s not as detrimental as say, something misspelled on a resume, where, you know, you’re actually still trying to prove yourself and compete for a job or a position. And in medicine, we are all already established and we’re already doing our job, and to be honest sometimes medical terminology can, you know, the spelling and the words can be a little complicated. So I think we all give each other a little bit of leeway when it comes to spelling and grammar in those senses. I personally like to have my notes and everything spelled correctly, but I do see it in other people, and I also think it comes with just the diversity in medicine. There’s a lot of providers that have trained outside of the United States and come here to do their residencies or trainings, and then eventually establish themselves to work. So English is not always the first language for everyone in medicine. So I think that plays a little bit into it, and I think that most of us that are in the hospital setting, we know that and it’s just something that we see.

SPEAKER: That is fascinating. Yeah that’s great. Thank you for that explanation. Yeah. Could you talk a little bit about what’s at stake in your writing?

SPEAKER: Yeah. So all of us in medicine think, “Okay can our note stand up in court? ” Because if you don’t write it down, you can’t say that it happened. And you know, if you do write something down you cannot erase it, if that makes sense. So medical legal is a big thing especially in the area that I practice in this city, it’s very litigious is what, you know, kind of the common knowledge is. So again, like if you have a patient that had some kind of an event it involved an ICU and nursing there, and something that is missed, things like that, you always have to document and chronicle what happened the way that you saw it so that it’s almost as if to say, “this is my side of the story, ” for something like being in court. So that’s something that’s always kind of looming as well.

SPEAKER: Yeah, absolutely. This is my own ignorance, I should know this b ut – let’s say there is some issue and there’s a lawsuit. Do you get sued or does the hospital get sued?

SPEAKER: It depends. I think most commonly it’s the hospital or the organization that you’re with. But there are times where it would be a specific doctor that is named. Usually I have not seen anywhere where a specific nurse or a specific physician assistant etcetera is being sued, but there are times where they are named as a witness or a defendant or something.

SPEAKER: Gotcha. Okay. What would you say is the most difficult thing about writing in your specific position?

SPEAKER: That’s a good question. I think the most difficult is also the most fun part at least for me, is just being able to shape and write that story of why your patient is here or why you were called to see the patient in a concise and informative way.

SPEAKER: Yeah, how do you do that? I mean because it’s one of those things – I was really interested earlier to hear you use the word story because of course I think of medical writing as so incredibly technical – but of course after hearing you describe it, you’re telling the narrative of what happened So are there certain strategies or sort of ways of thinking that you approach writing that, and why do you think it’s fun for you?

SPEAKER: Yeah I think the way that I approach it is, how do I shape his story into something that’s going to catch someone’s attention? So most of us in medicine, like if I get a call of a consult to say, “Hey this patient has some kind of an issue and it looks like they have a fracture in a bone near the ear, ” I’m immediately checked out thinking, “Why are you calling a neurosurgeon for this? We don’t take care of this. I’m not interested. ” So same thing if I’m trying to talk to a medicine doctor. I’m trying to frame my note that would be appealing to them to say, “Hey this is exactly why we need you, and this is why we hope that you’re going to accept our patient, ” because there is still, you know, some procedure in the hospital involves once a surgical problem is managed and taken care of, you want to transfer your patient to a doctor that can better take care of their medical needs, things that I don’t really manage myself. So you want to try to kind of frame the patient of, “Oh this is a really interesting medical patient now that we’re done with the surgical part of things. ” So having to write something in a way that’s going to make it relevant to other people and catch their attention is a big challenge in writing and I think it’s a challenge that’s kind of fun to try to do.

SPEAKER: That’s fascinating. Yeah I never thought about it like that. So you’re sort of trying tell the story persuasively on behalf of your patients so that they get the best care.

SPEAKER: Yeah exactly.

SPEAKER: But you’re also sort of trying to appeal to these doctors because of course I guess what you’re saying is everybody gets bored, just like any other job at some point. Like Y you want something interesting.

SPEAKER: Like Y you want something interesting. eah I think bored too, but also protective of their workload because, you know, I’m maybe seeing 30 patients on my service and then I’m saying, “Oh my god, ” I’m having five other people try to give me other patients so I’m thinking, “Okay, do I really want this patient that’s not at all really relevant to me? Or do I want the ones that are specifically neurosurgery? Yes I can do something to help you, ” that kind of thing.

SPEAKER: That’s great. That’s really fascinating. Has anyone helped you formally or informally with your actual writing since you’ve been there?

SPEAKER: Yeah I want to say that, you know, just starting a new job at a new specialty in the beginning while I was training, I would write my notes and then of course ask people, “Hey does this look okay? ” And they would tell me things more informally of “Oh, you always want to mention this in a physical exam because in neurosurgery, this is what’s important and here’s why.

SPEAKER: Yeah that’s great. How do you believe you’ve evolved or improved as a writer if at all over the course of your career?

SPEAKER: I definitely think there has been improvement, especially from, you know, training to now, because not only can I write what I need to and have it be relevant and appropriate, but I can also then take what I’ve written and say it out loud to somebody to like collaborate and treat a patient. And I think that’s definitely improved since I started.

SPEAKER: Okay. And just a couple more questions – to what extent do you think writing is valued in this organization specifically, or in your field sort of as a whole?

SPEAKER: I think writing is valued in the sense that, you know, of course all hospitals or clinics etcetera you need to document things. But I think writing is valued in the sense that every medical provider is you know, going around seeing different patients. So when you have a note that is concise, well written, it flows properly, and it really is relevant to the patient and their illness, that’s pretty impressive in our fiel. So if I read a note that’s very relevant and you know, gives me all the information that I need, I tend to say, “Oh this is like a great note, ” versus, “Oh I’ve read this note but things don’t add up. Let me go dig through the patient’s files and charts and their note from two years ago that has something relevant in that note but wasn’t included in today’s note, ” that I think is what’s emphasized a lot in our field.

SPEAKER: Okay that makes a lot of sense. Yeah. And the last little set of questions – so first, how would you define successful writing where you are now as opposed to when you were a student?

SPEAKER: Yeah I think successful writing, it just goes back to being able to write exactly the way that you would speak it and vice versa. And I think in other fields I do acknowledge that it takes so much more thought. But in medicine a lot of it is muscle memory and flow and template, and you write things the exact same way, it just differs from patient to patient.

SPEAKER: Yeah right. And it seems like – I’m just sort of thinking out loud but – I think in a lot of different fields writing from a template, we start to think that oh the writing feels stale or it’s uninventive but here it’s like it’s necessary that you follow the same format, right?

SPEAKER: Exactly. Yeah it does really matter to have things in the same format because it’s, you know, probably at a level above my head. It’s been talked about and formulated and then dispersed out to “Hey use these kinds of templates, it gives us what we need. “

SPEAKER: Right, right. And then the last question – would you say you are a successful writer at work?

SPEAKER: Yeah I would say I’m a successful writer at work. I do think it could still get better obviously, as I become a better provider and have that experience. But I do think that I’m successful in my writing.

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Technical Delivery Manager


SPEAKER:             Could you please state your job title and where you currently work?

SPEAKER:             My job title is a technical delivery manager and I work for Microsoft.

SPEAKER:             And how long have you worked in your current field?

SPEAKER:             My current field? Six and a half years.

SPEAKER:             Okay. How long has it been since you graduated from college?

SPEAKER:             It has been, oh geez, 2008, so I guess– –from

SPEAKER:             –from undergrad.

SPEAKER:             Oh from undergrad?

SPEAKER:             Yeah.

SPEAKER:             Um 2003, so it’s been [laughter] I can’t do math–

SPEAKER:             Fifteen years [laughter].

SPEAKER:             Fifteen years, yeah, okay. 

SPEAKER:             Could you provide a brief description of your primary job functions?

SPEAKER:             Sure. So as a technical delivery manager, I have direct oversight for 30 individuals that are a blend of either a consultant or what we call a PFE. A consultant is someone that goes in to a customer, does architecture, implements new design, new software for that company. A PFE is a premier field engineer and they are someone that goes in to really do fixes, workshops, those types of things.

SPEAKER:             Does PFE stand for something?

SPEAKER:             Premier field engineer.

SPEAKER:             Oh I’m sorry. Okay, yeah, thanks, okay. Can you please estimate, in an average week, what percentage of your job requires writing?

SPEAKER:             So the unique part about this job is that I am directly managing these individuals but it is all remote. So the majority of my communications with them is through writing, either through email, or through text messaging, through Skype. We do have at least monthly phone calls, and then in the unique situation where we’re able to actually meet face to face, but we’re all located in different parts of the country so that doesn’t happen very often. So I would probably say at least 90 percent of my communication with them is through writing.

SPEAKER:             Wow, okay. That’s interesting you mentioned text messaging – so is that typical of this sort of relationship because you have to have such close contact with them and sort of rapidly, I guess?

SPEAKER:             Yeah. So we all have each other’s phone number because, like if I’m in a meeting and they know that I don’t have my computer with me, and they need an immediate answer, then they’ll have to text message me. So I’m constantly monitoring my phone when I’m in meetings too.

SPEAKER:             Interesting. Okay. You talked about how you communicate with them over email, over text, those types of modes but, are there other forms of writing or types of documents that you complete in writing?

SPEAKER:             There are. So part of my monthly one-on-one with them, we actually use OneNote, and in that OneNote it’s kind of a shared working document that we have with them. And in that OneNote, the first section is an agenda that I want to make sure that we hit on every month, because I’m not there working with them every day. Part of my job is to be able to communicate to my manager all of the amazing things that my people are doing so that I can give them the highest rewards when it comes to reward time. So part of the things that I touch on are, you know, what is the new work sold that you’re working on at your customer? So how are you increasing the revenue? How are you increasing the Cloud consumption with your customer? So if the customer is not on the Cloud yet, or how can we get them more licenses on the Cloud to get more Cloud consumption?

SPEAKER:             Can you just talk about the time, explain what that means in a little bit more detail?

SPEAKER:             Yeah, so because I work primarily with the government sector, a lot of our government customers are still on premise, meaning that they don’t host anything that’s not in the physical location at their company. But what they’re trying to move to is more Cloud based. So as you can imagine, there would be security concerns. So we have to make sure that, you know, we’re doing things in a way that has been approved by the government. And every agency is different. So it can actually take years for us to be able to write a security document that they agree to before we can even start talking about moving to the Cloud. So the first documentation that we do is the one-on-one agenda, and they’re talking about intellectual property that they’re developing. We talk about communities that they belong to, and how they’re contributing to those communities, and those are technical communities where, you know, you’re helping your fellow Microsoft employees around the world with other technical problems that they’re running into. So you’re, you know, utilizing the resources within Microsoft. The way that we judge our consultants and PFEs is we have three impact circles that we want to make sure that they’re all hitting on. And so we talk about that in the one-on-one and the three impact circles are: how are you contributing to the success of the business? How are you building off the work of others? And how are you contributing to the success of others? And so when I’m talking through these one-on-ones with my consultants and PFEs, it’s eye opening to them, too, if they don’t have anything to tell me under each of those bullets, and then they realize, “Oh those are some of the things that I can be working on, ” and I help them find ways to have more impact in those areas. And then the other thing that we talk about during those one-on-ones is their career development plan. So what’s their short term, long term, you know, do they need mentors, do they need training, things like that to help them get to the next stage in their career. So I provide them with the resources to do that, and then the other part of that is, if we are working on promoting them during the next promotion cycle, we’re working on you know, shaping that story so that when it comes time for the promotion it’s a much easier process than trying to scramble and find all the information that we’ll need to get them.

SPEAKER:             Interesting. Can we talk about that a little bit?

SPEAKER:             Yeah.

SPEAKER:             If you’re putting one of the people who work for you up for promotion, that phrase sort of “shaping a story” is really interesting. So I assume that those promotional materials happen in writing?

SPEAKER:             They do., yeah

SPEAKER:             And so can you talk a little bit about like what you mean by shaping that story, in terms of promotion materials?

SPEAKER:             Yeah, so what I want to do is if I’m promoting someone to the next level, I want to make sure that they’ll be a success in that role. So I want to make sure that they are already demonstrating some of those qualities that we would expect in that next level. And so if I’m not seeing that they’re doing these things, then I’ll give them some ideas on, you know, based on what they’re interested in. You know, “Here are some ways that you can explore your interests at Microsoft while having those impacts to be able to say that you’re ready for that next level.

SPEAKER:             Got it. Oh that’s really interesting, yeah.

SPEAKER:             And so the one-on-ones are one form of writing that we do. And then the other piece that we do in writing that’s more formal are our Connects, which are really reviews that we do twice a year, and that’s to make sure that the first Connect of the year is to make sure that they’re clear on what all of their core priorities are, and that I can make sure that they have a good plan to achieve what they need to achieve that year. And then if they don’t, then that’s, you know, a further conversation that we have so that I can help them shape that plan. And then the Connect at the end of the year is really, you know, “This is how you did   throughout the year, you know, here’s what you could have done better or here’s what you excelled at. ” [Crosstralk] a conversation.

SPEAKER:             Okay, gotcha okay. And are there other types of documents that you write frequently? Or that pretty much covers it?

SPEAKER:             That covers the documents. And then there’s the email communication that tends to happen on a daily basis.

SPEAKER:             Perfect. That makes sense. Could you walk me through the process for maybe a recent specific writing project, maybe one of the more complex writing projects that you do, sort of from start to finish, like what that process looks like for you as you’re actually preparing to draft, drafting, revising–?

SPEAKER:             Yeah so probably the most complicated writing project that I have to do is the Connects, because I have 30 individuals that I need to write all of these write ups on. Part of that also is– or a part of it that I like to get is, what we call at Microsoft, perspectives -that’s where you request feedback from people that you’ve worked with throughout the year. And that’s really helpful for me as a manager that’s not working directly with you you know, because if you have a project manager that’s there on site at the customer with you every day, it’s great to get their perspective, and understand, “Here’s what you did well, here’s what you should keep doing, here’s what you might want to rethink. ” And then it’s really interesting because, you know, every individual can see what people are writing about them, but we’ve kind of shaped the culture where we accept that none of us are perfect, and we all have things that we can work on, and so it’s really kind of interesting to read those and just how people can just take them and realize, “Oh you’re right, I can be a little bit better at that. ” Yeah. And so that’s part of the write up is getting all the perspectives from everybody that they’ve worked with. And what I have found–

SPEAKER:             Sorry to clarify, those perspectives might be coming from a Microsoft employee but maybe not? Would they ever come from a client?

SPEAKER:             They are always within Microsoft. On a rare occasion I’ll get an email from a customer to tell me about how someone is doing, but the perspective’s tool itself where we gather feedback is just Microsoft. Yeah. And then what I find helpful in the Connects, because I have so many to write, is I create a template based on what I know that I want to say to everybody, and then as I write each individual’s, I’ll customize it based on what they’ve actually accomplished, and what they actually need to work on, or what their actual next career steps are.

SPEAKER:             Okay awesome. And then as you’re actually drafting, you’re looking at the perspectives, you’re looking at other documents, sort of being retrospective about their work for the year, and then does anyone, when you’re done with it, is it final or is there someone who reviews it?

SPEAKER:             When I’m done with it is final, but it is a really good item to have, or artifact to have, if that person ends up changing managers, because then, once that person changes managers, then that manager can then go in and see all of the historical information for that individual to kind of see, you know, how are they performing before, were there any things that they needed to work on, or are there things they excelled at.

SPEAKER:             Gotcha. Oh that’s. interesting, okay This is a broad question, but how did you know how to perform these types of writing?

SPEAKER:             That’s a good question. I talked to a lot of people that had been in my particular role for longer than me to understand how they did it, and what I found really helpful was to make sure that I didn’t just talk to one person. I talked to several different people, and then what I kind of did was took everything that they all said, and the pieces that I liked and that worked for me, and then put it together into a way that worked with my style. And then that way I felt like I wasn’t missing anything. And it was really interesting how everyone really did have their own style. And so I feel like, you know, sometimes it’s better to, you know, get all of those different styles, understand what framework you have to follow, but then do what works for you, because I feel like you always have to be true to yourself and your own style, or else it really s tarts to show within your work.

SPEAKER:             Yeah, that’s really interesting. Can you describe a time in your career that you felt unprepared as a writer at work?

SPEAKER:             Yeah. So I was asked to do a presentation during an off-site without an notification at all, and it was on a topic that I wasn’t that clear on. And s o what I decided to do was to turn it into a working session, because I decided that if I wasn’t quite clear on the subject, then probably most of my peers in the room weren’t clear on it either, and so it would be a good opportunity, since it’s really rare for all of us to be in the same room together, to talk through it and, you know, kind of have it be more of a working brainstorming session than me actually presenting to them on a topic that I wasn’t quite sure of. So it ended up working out, and it and it led to an additional project that I worked on, it was helping to shape subcontractors working with our contracts. And so yeah.

SPEAKER:             Yeah that’s interesting. o in terms of like strategies to get yourself up to speed, you talked about talking to other people, asking them about their process and their style, and you talked about this presentation and sort of rethinking like, “Okay what does my audience really need? What can I offer? ” and thinking of things that way – are there other strategies or techniques that you’ve put into place about your writing to adjust or improve? Are there other things that you’ve done to improve or grow as a writer?

SPEAKER:             Yeah I think it’s really important to have other people read your work, because I think sometimes you can know a subject so well, and you think that you’re being clear because you understand that subject, but in reality, the person that could be reading it might not have that level of understanding that you do. And so I have found that when other people read my work and they ask questions, it’s really enlightening to me to realize, “Oh I think I need to take a step back sometimes and do a little bit more explaining of what the actual subject is and any definitions. ” One of my biggest pet peeves is when people use acronyms right off the bat, and you know, I think we’ve all run into cases where there can be the same acronym for multiple things. And so it can be totally misinterpreted. And so I think it’s really important to have people review your work, and also do a good job explaining in the beginning.

SPEAKER:             That’s really interesting, yeah. Is there someone, like sort of in the built in structure of your team or your hierarchy, that is sort of a natural fit for asking to look at your work, or do you have to sort of seek out those people that you would feel comfortable getting feedback from?

SPEAKER:             Yeah I have to seek out the people. So I kind of tend to know, you know, who would actually take the time to read what I’m going to send them, and then also someone that I’ve seen a good work product from. So, you know, that tends to be who I go to, but I have to seek them out.

SPEAKER:             Okay, okay. Does anyone oversee your writing?

SPEAKER:             Nobody oversees my writing.

SPEAKER:             How long, and I’m sure this varies project to project, but how long do you typically have to complete a formal writing project?

SPEAKER:             Typically the turnaround tends to be very quick at Microsoft. We usually have a very small window of time. So I would say that, like our busy times really tend to be cyclical based on, you know, what is coming up, but it’s always a quick turnaround time. So it’s always, you know, “This is our busy time all hands on deck, ” and then a kind of quiet down for a couple of months.

SPEAKER:             Okay. When you say quick are we talking like a month, weeks, days?

SPEAKER:             Probably like a week, a week turnaround time. Like the Connects I was talking about it’s usually, you know, if I know I’m going to be having those Connects with those five people, then I’ll be working on writing those the week before. But just with everything else going on during the day, it’s impossible to get them all done earlier than that.

SPEAKER:             Of course,. Right yeah. And you’re working on multiple versions at once for different people–

SPEAKER:             Yeah, exactly, yeah.

SPEAKER:             Right, okay. Sort of now looking back, what kinds of writing do you remember being asked to do as an undergraduate student?

SPEAKER:             Oh wow, that was a long time ago. As an undergraduate student, I feel like I did most of my writing, most of my actual writing in my world civ class. Yeah that seemed to be the most intense writing. And so that was, you know, reading all about, you know, different events and and really giving my opinion and take on why things happened certain ways. I did a creative writing class and that one didn’t feel as intense, I don’t think, because it felt more like open and free to write what I wanted to write. But the world civ one was very, it entailed a lot of research and a lot of reading about topics that I probably would have never read about if I hadn’t been in that class.

SPEAKER:             Yeah. Can you see any tie – let’s take that world civ class specifically – to the skills or the writing strategies that you use there, do they have any applicability to what you’re doing now?

SPEAKER:             Yeah I think that, well, I mean, not directly. The, you know, doing research and then having to write about it – that piece definitely. I mean the subject obviously doesn’t tie together, but having to do the research, and then writing, definitely does tie together. The other thing too, as being a people manager, I also find that I’m reading a lot of like leadership books and manager books and things like that, just to make sure that I’m staying in that right mindset of, you know, remembering, you know, that I’m there to really help facilitate these people to succeed. So doing a lot of that I think has been helpful to, because I think that it makes you more empathetic to the people that you’re managing. Like everyone has stuff going on in their life, they’re not just there working, they go home, they have things going on at home too, so that’s been helpful to.

SPEAKER:             That’s really interesting, yeah. W hen you think back to college and think back to the kinds of writing that you did there, are there things that would have been useful to learn or to do to have had an easier transition to writing in the workplace?

SPEAKER:             I think maybe having people that had actually been through, you know, a professional work environment would have been helpful, because I think sometimes– you can kind of tell, I think, when t he teacher is just going off of what’s in the book and they don’t have anything else to add than what is actually in the textbook, you know? ‘Cause to me I feel like I learn best when I’m hearing about people’s real life examples like, you start putting it into action versus just reading about it. So that would have been really helpful I think.

SPEAKER:             I think. What is at stake in your writing?

SPEAKER:             There’s a lot at stake in my writing. So based on what I write in someone’s Connects, in someone’s reward review at the end of the year, their whole compensation is tied to what I write. So I’m very cautious about, you know, putting anything in writing if I’m feeling emotional about what someone is doing. So I usually have to take a step back if I have someone that I’m just, you know, having a hard time with, because I know that the impacts that it could have on that person if I put that in writing. Yeah. So I like to always give people the benefit of the doubt, and I think that the majority of people have good intentions, and so I like to have those conversations with them. Instead of putting things in writing in those difficult times, I’ll usually have more conversations with that person versus writing, because I think that – I want to understand why the messages isn’t getting across.. You know, is there something else going on? Because a lot of times there it is. Like once you start digging, there’s a lot more going on beneath the surface. And then, you know, once you get that person to start opening up, then they might start trusting you a little bit more and in turn, you know, hopefully performing a little bit better So yeah, a lot can be impacted by what I put in writing. So I’m really cautious about what I put in writing, yeah.

SPEAKER:             That’s great. That makes a lot of sense. What is the most difficult thing about writing in your specific position?

SPEAKER:             The most difficult thing I would say is making sure that I am being fair, because, you know, there’s always going to be those people that, you know, you just connect with more on a personal level, even though you are their manager, that’s always going to naturally happen. So I kind of always have to take that part out of it, and really look at it from a nonbiased standpoint. Satya talks a lot about, during his company meetings, about unconscious bias. So I always try to remember that, like, why do I think this person is doing such a great job? Is it because, you know, he complements me all the time [chuckle]? Or is it because he’s really doing a great job? So I have to really take a step back sometimes and think about, you know, am I judging people on the same level? Because I think that’s really important. And also, when I took over the team from the previous manager, he had all of his perceptions of people. And so I decided I was going to just wipe all of that clean, and I was going to start from scratch. Once in a while, if I’m having like a weird moment with someone, I’ll look back at his notes and see, like, is this is just his personality or is it me? You know, and that helps, but I think just having like a clean slate sometimes and your own fresh perspective helps too.

SPEAKER:             That’s great. Has anyone helped you with your writing formally or informally?

SPEAKER:             I mean I think that probably– I can’t really think of anyone specific, but I feel like just, you know, taking feedback as I’ve gotten it throughout the years, and, you know, just being aware of that feedback. So like if sometimes things come across too harsh when I feel like I’m just trying to be direct, I’ll try to, you know, soften it a little bit. Things like that. But I can’t think of a specific person.

SPEAKER:             Okay. How would you say that you have evolved as a writer over the course of your career, or improved?

SPEAKER:             I’ve gotten a lot more confident. I think, you know, in the beginning I would reread and reread emails over and over again before hitting send and still nervous, how’s it going to be interpreted, you know? But I think also as people have gotten to know me within the company, they know who I am, so I feel a little bit more comfortable with my emails and don’t scrutinize them as much before I use them.

SPEAKER:             To what extent do you think writing is valued at Microsoft?

SPEAKER:             I think writing is– I mean we’re a worldwide company, and you’re working with people and every single time zone, and so a lot of times, you know, that might be the only way that you’ve ever communicated with someone is through writing. So I think it’s highly valued. I think what I’ve definitely learned though, is that if you have sent an email and you can already tell right away that it’s not coming across the right way, either because a person is misinterpreting what you’re saying, or because, you know, of a language barrier because they’re in a different country, and you know, English is not their first language and that’s my first language, then, you know, then I will have to find the time to do a phone call, because we think sometimes that just cuts through any of the miscommunications that are happening.

SPEAKER:             And the last set of questions – so how would you have defined successful writing as a student versus successful writing now?

SPEAKER:             Yeah, so I think that a successful writing as a student, you tend to have a lot of guidelines around formatting or writing style. You obviously have topics that you’re usually given that you have to go out there and write about, and I think now the writing is more, for me anyway, the writing is more about documenting of what has happened, what needs to happen, and then also just day-to-day communication. So it’s almost like, for me, the writing in my position has really taken the place of being face-to-face with my employees a lot.

SPEAKER:             And would you say that you’re a successful workplace writer?

SPEAKER:             I would say that I am, yeah. I very rarely have things misconstrued now. So I think I’m successful in communicating with writing.

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Marketing Manager

Business, Sciences

SPEAKER:             Could you please state your job title and the kind of organization where you work?

SPEAKER:             I am a marketing manager for a healthcare system.

SPEAKER:             Great. How long has it been since you graduated from undergrad?

SPEAKER:             Ten years.

SPEAKER:             And how long have you worked in your current field?

SPEAKER:             In my current position or in my current, just areas–

SPEAKER:             Both.

SPEAKER:             In my current position for four years, and i n healthcare marketing for eight years.

SPEAKER:             Okay, perfect, okay. Could you provide just a brief description of your primary job functions?

SPEAKER:             Sure. I manage marketing for again, a health care organization, and I manage service line marketing. So what that means is there a specific area within a healthcare organization that I’m assigned to manage all of their marketing, advertising, branding, and promotion.

SPEAKER:             Gotcha. Could you estimate, in an average week, what percentage of your job requires writing?

SPEAKER:             lot. Probably I would say maybe 60, 70 percent. A. lot. Yeah

SPEAKER:             Okay, okay. What forms or types of writing are you asked to produce?

SPEAKER:             Everything from advertising – so advertising copy – so that can be print advertising, radio, out-of-home like billboards, metro ads, things like that, to outcomes reports, which are very clinical in nature, to patient education materials, which are very black and white. So something like, “You’re coming to the hospital for X procedure. Park in this parking garage, go to this entrance, check in at this desk, bring this with you. “

SPEAKER:             Interesting. Okay.

SPEAKER:             And then e-mails of course [chuckle].

SPEAKER:             Right okay [chuckle]. Can you walk me through the process for maybe a recent project, or a type of project even, starting from sort of how that assignment or task comes to you, what do you do to prepare the writing, and any steps of like revision or editing after that?

SPEAKER:             Sure. Well every job is a little bit different. Typically what happens is my marking department typically kind of functions as kind of an in-house agency for our clients if you will. So my clients will come to me and they’ll say, “Hey we want a brochure on this new service that we’re going to launch. ” Sometimes they will have already provided that copy for me and all I do is refine it and make it a little more user friendly. Sometimes I get bullet points of what they want to highlight. Sometimes I get nothing. So it really, really just depends. A recent example we did just a quick little just trifold brochure on a new program that s launching as part of our Women’s and Children’s Services focused on breastfeeding. Didn’t have any particular copy that they wanted to cover, so I literally sat down and I Googled  facts about breastfeeding, kind of reworked those into some user friendly language, sent them off to my clients in the clinical realm, had them review, tweak as needed. Then I take their revisions back and kind of finesse them a bit for readability, and then repeat that process again  until everyone’s happy.

SPEAKER:             Gotcha. Okay. All right, that’s great. How did you know how to perform these types of writing?

SPEAKER:             I didn’t, to be quite honest with you. It was a lot of trial by fire. It was a lot of kind of learn as you go. It’s always helpful when the clients that I work with at least have some kind of idea of what they want to say, and they don’t always provide that to me in writing. Again, sometimes they will lay out all of this text for me and they want me to print that verbatim which we can’t do, or sometimes they’ll give me like three or four bullets, or sometimes they’ll just say, “I think we should talk about this. ” And whenever I get a little bit of direction that’s always more helpful, because I feel like it streamlines the process. But a lot of times I don’t, and a lot of times I’m just kind of again, I’m literally Googling medical conditions and trying to webmd my way into something that’s readable. So there was a really steep learning curve when I joined the organization of how do I write this correctly? How do I write it succinctly, and how to w rite it at a reading level that consumers who are exposed to it will understand? Because especially in healthcare it can get really, really technical and really a high level really, really fast.

SPEAKER:             Yeah, and that makes me think about this – so it seems like your audiences are pretty varied?

SPEAKER:             Absolutely.

SPEAKER:             Can you talk about maybe some different types of audiences that you’re writing to?

SPEAKER:             Sure, sure. My audiences vary from physician-facing pieces which again are very, very clinical, that have these huge like 25 cent words that I don’t know how to say or spell o r anything, all the way down to again, that straight up patient education of, “You’re going to go in for this surgery. This is where the cafeteria is located. This is the parking garage you need to park i n. This is what you need to bring with you on the day of surgery. ” So it really kind of runs the gamut and especially in an area as diverse, as this where English is not everyone’s first language, we always try as an organization to be super, super mindful to keep that reading level at a place that’s accessible for a lot of people.

SPEAKER:             That’s great. So that’s sort of a conscious, or like explicit conversation, when you’re–

SPEAKER:             Absolutely. And I talk a lot with folks in my organization, especially that are clinical, who are very, very head down into what they do and sometimes that’s a tough conversation to say, “This is all great, however we really, really need to broaden the scope because a layman isn’t going to understand these terms. “

SPEAKER:             Right.

SPEAKER:             So I always I say to them, “Dumb it down for me. Something that like a fifth grader would. understand “

SPEAKER:             Right. Gotcha. Interesting. Can you describe a time – you talked a little bit about this – but can you describe a time in your career where you felt unprepared as a writer at work?

SPEAKER:             I think it kind of goes back to that– and mine’s very specific because it’s such a specific niche, but a lot of the health care writing that we’re asked to do can get really, really technical, and I don’t have clinical background, my colleagues that I work with don’t have clinical background, we’re all  marketers. So again, it goes back to us trying to kind of decipher these huge medical terms and these huge medical words, and figuring out a) what it means, how do we make it user friendly? And that’s because I don’t think I was ever trained to do that. It was just kind of something that I had to figure out on the fly.

SPEAKER:             Okay. Were there certain strategies or things that you did to try to get up to speed in doing those?

SPEAKER:             I would typically just, I would bug people to be honest with you. I would knock on doors, I would say, “Hey I’ve got this content here, this is great. Can you explain to me what you mean by this sentence? Can you tell me this? ” And a lot of that was just I kind of absorbed it through osmosis, if you will, to kind of get up to speed really quickly on what these people were talking about. And that’s hard  because it’s really, really technical. But it was a lot of kind of in your face, “I don’t understand this. Help me understand thi s so I can write about it. “

SPEAKER:             That’s. And this is going back a few questions, but I feel like I have to ask a followup question. So let’s talk about this breastfeeding brochure.

SPEAKER:             Okay.

SPEAKER:             So when you’re tasked with this, and you’re not given any of the information, what is the client hoping to achieve if it’s– because when I hear, “Oh I was tasked with creating t his like breastfeeding pamphlet for presumably new families and others, ” I think, “Oh there is some information that specific that they want these people to have. ” But it doesn’t sound like that’s the case. So what do you think the intention was from your client?

SPEAKER:             Well, you know, and that’s really on a case by case basis. So again, some of these materials can be physician-focused, for the purpose of driving referrals, saying, “Hey I have a new physician coming in offering this service, refer her new moms to me who are having trouble breastfeeding. ” And sometimes it’s, “Oh hey, your a new mom, you just had a baby, you’re leaving the hospital, here’s a pamphlet if you ever have trouble. ” The challenge there is you don’t always know what their goal is. So I always try to make it a point to say, “Hey, do you envision this being a piece focused on physicians as your audience, or patients as your audience? ” Sometimes the answer is  both, which makes it a little more tough, because you want to try to get those high level clinical things that a physician will respond to while keeping it as accessible as you can.

SPEAKER:             Gotcha. That’s really complicated.

SPEAKER:             Yeah.

SPEAKER:             Yeah, okay. Is there anyone who specifically oversees your writing?

SPEAKER:             Not anyone in particular. There is not like a dedicated editor or a dedicated copywriter that funnels all of our work. The approval process typically goes, I will draft the content, I will send it back to the clinical person, or whoever my point of contact for this particular job is, for their review. They will typically make edits depending on the person or the job that– those can be pages and pages of edits, where they basically rewrite every hing or to, “Oh hey I think we should add this line in. ” So it just, it really kind of depends on the day and what the job is. After that’s done, I mean it’s really me. I’m proofreading my own work, I’m looking at things. We work with the graphic design department who are also in-house; those folks will proof sometimes, but again that’s not their primary role, but you know they’ll catch things, you know like, “Oh hey, you know this sentence doesn’t make sense. Can you check it out again? ” But again, there’s nobody dedicated to proofing that.

SPEAKER:             Got it. I’m sure this varies project to project, but how long do you typically have to complete a writing project?

SPEAKER:             It does depend. Typically I want to say, maybe depending on the job, like a week or two?

SPEAKER:             Okay. Thinking back to college, what kinds of writing do you remember being asked to create as a student, and in what ways do you think your college writing experience has prepared or did not prepare you for this kind of work?

SPEAKER:             Very good question. I mean did a lot of– I mean always kind of the standard like, let me write a paper on this book that I read, which is fine. And then specifically in comms class it was a lot of –

SPEAKER:             Were you a communications major? 

SPEAKER:             I was. It was a communications major. Okay. It was a

SPEAKER:             Okay.

SPEAKER:             It was a lot of papers about communication styles and different – again communication styles – ways to communicate, even like I took a PR class where we drafted press releases and those formats are always so different no matter where you go, that, I mean, it was good to kind of have like a good skeleton of what one looked like. But again, every job I’ve been in, it had a different format.

SPEAKER:             Interesting. That’s fascinating to me. Sorry I’m just going to digress for a second [laughter]. I think the thing that’s so interesting is, I think we theoretically know that, and yet I think most business writing classes, or like tangentially related to business writing classes, still teach like, “This is a form, and you’ll be asked to write this form in the workplace. ” And we know t hat some of those are outdated, like the memo. Or the memo at least looks very different than you know, most people are taught. But so even in a pretty explicit PR class, the forms that you learned didn’t match up with what you found in the workplace?

SPEAKER:             N o it didn’t match up exactly. And I think that varies from organization to organization. Everybody tries to put their own mark on a standard press release, for example, just because I can speak to that better than anything else. I mean there’s standard, you know, insignia and protocol that go on those, but even that is changing. And again, it was helpful to kind of have a little bit of background on it, like I remember my first job out of college when my boss said, “Hey, draft me a press release on this. ” Like I knew basically what I was looking at, but again, it wasn’t a carbon copy of it. I could kind of fumble my way through it, but I had to really kind of get in the groove and learn specifically from organization to organization.

SPEAKER:             Perfect. Are there things that would have been useful for you to do or learn as a student that would’ve prepared you?

SPEAKER:             I think, and I don’t know if this would have been an appropriate part of my major but I think having more discussion in school about relationship building with your clients, because I feel like, you know, in any industry you have a client of some form. And I was never really taught how to manage those people and how to kind of set expectations and goals immediately with those people who I’m have working for.

SPEAKER:             Yeah, yeah. T hat’s interesting. What is at stake in your writing?

SPEAKER:             Well depending on who you ask, I mean, well and actually no, I take that back, because depending on what we’re drafting, I mean a lot I can be at stake. I mean, you know, I even get as granular as like NPO guidelines for presurgery. And what that means is like–

SPEAKER:             What’s NPO stand for?

SPEAKER:             It’s like food and water, like nothing by mouth prior to X amount of hours before your surgery. And while t hat’s supposed to be communicated to a patient through their clinical person, whether that’s a nurse, or the physician assistant or whoever, you know, oftentimes they get a booklet, and they’re like, “I’ll look at this later, ” and then it’s the night before their procedure, and they’re like, “Oh yeah, when was I supposed to stop eating or when was I supposed to stop drinking? ” So getting those really kind of clinical things right is really, really important. And in my line of work we really rely on our clinical counterparts to provide that information accurately to us. And I mean stuff has slipped before, in you know, in my experience and you know, you just correct it as quickly as you can and move on. And then I can get it very very frivolous too. I mean it can get, you know, you put an extra letter on the back of someone’s name and you know, the world has fallen apart But I mean, and that, again that goes down to proofing

SPEAKER:             Okay. What would you say is the most difficult thing about writing in your specific position?

SPEAKER:             I think the most difficult thing is – I mean, can I say two things?

SPEAKER:             Of course. I

SPEAKER:             I think the first thing is again, kind of what we talked about of not always having a dedicated direction or not even having anything to kind of jump off from, and like I’m literally staring at a blank piece of paper again Googling breastfeeding. Like I know nothing about breastfeeding, I don’t know. And I m looking at WebMD trying to figure out how I can regurgitate this in an appropriate way. I think the other challenge is – and this is an internal thing, I don’t know if this is the same way for everybody – but we often have kind of approval by committee, if you will, in a lot of writing that we do. So if you show 15 people, you know, the same piece of collateral, they’re going to make 15 different changes. And everybody’s a writer, everybody does marketing, and that can be tough, kind of trying to juggle everyone’s expectations while still making it the way that I know as a marketer it should be.

SPEAKER:             How do you manage all that feedback?

SPEAKER:             You don’t always, to be honest with you. I try to kind of pick my battles on that. But sometimes I don’t win. I’ve had many a situation where, you know, I have said to my clients who I really feel strongly about including this or not including it, and I don’t win all the time. And you just have to let it go.

SPEAKER:             Okay. Has anyone helped you at your organization with your writing, formally or informally?

SPEAKER:             No. No one has helped me [chuckle].

SPEAKER:             Okay, very strong answer there


. How do you believe you’ve evolved or improved as a writer over the course of your career?

SPEAKER:             I think that I’ve improved greatly since I, you know, since my first job, you know, off the boat, if you will. I think that I’ve learned to do things really quickly but without sacrificing accuracy, if that make sense. Just because, we have, you know, as everybody does, we have a million things f lying at us as a department every day, so you’ve got t o get it done, and you can’t waste you know half a day working on one project. So I’ve learned to really kind of edit myself, in the sense that I don’t want t his to be too wordy, I want this to be to the point. I don’t want to use ten words when four words will do, but I have to get right. So I’ve learned, I think editing is the biggest thing that I’ve learned.

SPEAKER:             To what extent do you think writing is valued in your organization?

SPEAKER:             lot actually, a lot. A lot of what we do is writing based, whether that’s, you know, a piece of direct mail that we send out or a newsletter that we write or again, a piece of advertising that we do, a radio script. So they put a big kind of value on that from a marketing standpoint.

SPEAKER:             Great. And the last set of questions. How would you have defined successful writing as a student versus successful writing now? And would you say that you are a successful workplace writer?

SPEAKER:             How would define successful writing as a student – I would say something that would get me a good grade, and something that I feel like I didn’t have the kind of kill myself to understand, if that made sense. Like I feel like writing assignments in college, like a lot of them would come really naturally to me, like we would get a prompt and I was like, “Oh, I know I’m going to write about. I get it. I got it. Here it is. ” And I would usually do alright. And then I would get writing prompts where I’d be like, “I don’t even know where to start on this. ” And sometimes it would go really, really bad, and other times when I felt like I kind of b s ‘d my way through it I would actually do a great job. And I think successful writing now kind of looks like, again, how can I make this as accurate and as accessible as I can while still finding that balance between what I know as a quote unquote marketing professional to be the right way to do this, versus balancing kind of the powers that be politically in my organization and what they want to see. So it’s really kind of about all making sure we, you know, play nice in the sandbox together. It’s a lot of, you know, people kind of all want their own, you know, stamp on everything and want to make sure that their specialty is mentioned, they want to make sure that their name is underlined, and that’s not always the right answer. So just kind of picking my battles there. It’s a lot of like, who has a bigger slice of birthday cake, you know what I mean?

SPEAKER:             Okay, yeah, yeah

SPEAKER:             And what was your other question, sorry?

SPEAKER:             Would you say you are a successful workplace writer?

SPEAKER:             I would like to think so. I think that f rom where I started and where I am now I’ve definitely improved. I don’t think that I’m perfect by any stretch of the imagination, but I think that – I would like to think anyway – that I’ve found that fine line of not spending a ton of time on a project if it’s not warranted, but still making sure that the content that I put out is quality.

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Labor & Delivery Nurse

Sciences, uncategorized

Labor & Delivery Nurse


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


Lab Manager


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


Cancer Nurse Navigator, Oncology Clinic

Date of Interview: April 4th, 2017


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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