Physician Assistant, Neurosurgery

Sciences

P

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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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

[laughter]

. 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

33:17

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

 

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

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Q: I’ll say two [laughter].

 

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

 

Q: What percentage of the week?

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

A: Yes. Yeah, absolutely.

 

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

 

A: Yeah.

 

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

 

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

 

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

 

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

 

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

 

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

 

Q: What is med/surg?

 

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

 

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

 

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

 

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

 

A: That like I, that I intentionally did?

 

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

 

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

 

Q: That’s really interesting, yeah.

 

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

 

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

 

A: No.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Q: That’s really interesting.

 

A: I don’t think very well like that.

 

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

 

A: Right, exactly.

 

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

 

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

 

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

 

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

 

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

 

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

 

Q: Yeah, pretty big impact, okay.

 

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

 

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

 

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

 

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

 

A: Like in my nursing writing?

 

Q: Yeah.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Q: Gotcha, okay.

 

A: Yeah.

 

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

 

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

 

Q: Excellent.

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