Evaluation etiquette

A topic I have wanted to address for some time is teacher and speaker evaluations. I kept toying with the idea, but never acted upon it. Now is as good a time as any. I’m sure this post will resonate with educators and conference presenters, as well as other speakers.

As a nurse leader, I have had the opportunity to review many conference evaluations, including my own. As a teaching apprentice, I have become used to receiving quarterly student evaluations. Although most are positive and some are fairly constructive, there are always several that are downright mean. I’m not sure why members of the most trusted profession in the United States feel the need to anonymously bully their peers or superiors, but I see this as a trend.

Andrey Popov/iStock/Thinkstock

Two evaluations of presentations by me stick out like sore thumbs. The first came from an attendee of a major annual nursing conference. In presenting national legislation that supports teen pregnancy prevention programs, I spoke of a new law in California that prevents insurance companies from sending explanation-of-benefits (EOB) information to anyone other than the receiver of health care services. I observed that this was a great move for reducing teen pregnancy, because minors and young adults on parental insurance who consult a health care provider no longer have to be afraid their parents will be notified. In evaluating my presentation, one person wrote that he (or she) couldn’t wait until my 16-year-old daughter came home pregnant. I was devastated when I read this! How does advocating for reproductive health autonomy lead someone to wish such an unfortunate circumstance on my future children? Why would someone write something like that?

In another instance, a student wrote that I should be kept away from students because I made him (or her) sick. Again, what would cause someone to write something like this, especially since, in this case, I didn’t interact with the class enough to make anyone dislike me that much. What could I have possibly done that this graduate student was repulsed by my very presence? Not only was this comment hurtful, it made me wonder what kind of people we are preparing to care for those who are vulnerable?

I have seen or heard other inappropriate comments, including references to the presenter’s or instructor’s hairstyle, nail polish, and accent. Yes, someone actually commented on another person’s mispronunciation of a word! I still can’t believe some people are so petty.

If you’ve read enough of my other posts, you know I like to provide lists of action items to assist readers. Well, at this point, I thought it might be nice to remind you of a few important elements of properly written evaluations. Here goes.

Be constructive, not just critical.

If your comments won’t help the speaker become a better educator or presenter, keep them to yourself. Everyone who gives a presentation wants to do a good job, and most of us are open to constructive comments. Critical comments—especially those that refer to dress, style of hair, or pronunciation—are not only unwarranted, they are just plain mean.

Say about others what you would have them say about you.

We have all heard this advice in one form or another. Before commenting, stop and think, “How would I feel if someone were saying this about me?” Apart from the truly constructive comments I advocate above, if what you are preparing to write isn’t a comment you would want to receive, don’t write it. We are always representing our family, our employers, and the nursing profession. We should never act without considering those we represent. How would your employer feel if someone wrote about you what you have written about others? Keep these thoughts in mind the next time you fill out an evaluation.

Don’t write anonymously what you wouldn’t say directly.

Some people hide behind anonymity. It happens with social media, and it happens on evaluations. Just because your identity is concealed is not a good reason to write cruel remarks about someone. Maintain integrity even when commenting anonymously. After all, almost all evaluations—especially electronic ones—can be traced back to the author. Although many companies involved in processing evaluations won’t go to the lengths necessary to identify commenters, it can be done. So, when completing an evaluation, do so as if you are signing your name at the bottom of the page.

Put yourself in his or her shoes.

When completing evaluations, we should consider what it feels like to be evaluated. Giving a presentation requires a great deal of effort. Lecturing is no easy task. In addition to the preparation and travel time involved, a certain level of vulnerability comes with speaking in front of an audience. Imagine what that feels like. Then imagine, after giving your best effort, the horror of reading a comment that is completely devastating. Think of the embarrassment of knowing that what has been written about you is available for all of the organization’s top-level administrators to read. Imagine the confidence that needs to be rebuilt before you would be able to give another presentation, one that may very well be scheduled for the next week or even the next day. If we played these images in our minds prior to completing conference or classroom evaluations, we would be more kind with our comments.

It’s not about you.

This tip is not for evaluators, but those being evaluated. Unfortunately, the powerful impact of negative evaluations may discourage educators and other presenters from reading evaluations altogether. While I encourage my students and those who attend my conference presentations to complete their evaluations, I know many nursing colleagues who refuse to read them. After reading the negative comments that come with each set of evaluations, it’s easy to become disheartened. Even if there are only one or two nasty comments in a hundred, the mean, hurtful and negative comments are the ones that tend to stick with us. They are the ones we remember, the ones we dwell on. Still, try not to internalize them. They aren’t about you. Mean and inappropriate comments say more about the person who wrote them than they ever say about the person about whom they were written.

Wrapping it up

Evaluations are a necessary component of program assessment. It’s important that those involved in program development and members of curriculum committees receive meaningful feedback. Asking workshop attendees and students to provide that feedback is necessary to refine programs for better outcomes, but negative, unconstructive, and inappropriate comments are not helpful. Rather, they reveal the immaturity of certain attendees and students and, are not useful in making accurate assessments.

I hope I never see another nasty comment about a presentation or lecture I have given, but I know this is a big wish. More than anything, I want nursing students and fellow nurses to be compassionate with each other. I want us to be kind to one another. I’m not asking that we sugarcoat bad presentation styles or ineffective teaching, but we should be considerate in what we say. This isn’t too much to ask.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Ready, set, write: 5 tips for becoming a better writer

Getting a PhD is unlike anything I’ve ever done. Once my coursework was complete, and it was up to me to continue progressing through the program, I was at a standstill. I was surprised, because writing has never been difficult for me. As a child, I loved to write. I wrote songs, short stories, and poems. I’d even doodle my name for hours on end. But it didn’t take long for me to realize that writing the chapters of my dissertation would be much different than the type of writing I was used to.

Because I had never really taken on a task that I deemed too large to complete, I was unsure of how to move forward. I tried talking to a dissertation coach. She helped me break down the overwhelmingly large chapters I had planned into more doable sections. Meeting with her was helpful, but it didn’t do the trick. I still found myself stuck. I tried writing at different times of the day, a technique that had previously been helpful. This time, it didn’t work.

"I started to think of a new, self-inflicted obstacle
I could overcome. It didn’t take long before I
decided that running would be that obstacle."

– lzf/iStock/Thinkstock

I began to feel that the only way to conquer this formidable task was to take lessons I had learned from overcoming other obstacles and apply them to my writing. The problem was, I didn’t have a plethora of previously conquered obstacles to choose from. Until then, I had led a pretty safe life, taking on only those things I knew I could achieve. So, as a way to train for writing, I started to think of a new, self-inflicted obstacle I could overcome. It didn’t take long before I decided that running would be that obstacle.

I have never enjoyed running. Never ever. I used to get in trouble during physical education class for refusing to run. I didn’t mind participating in other forms of physical activity, but running was always tough for me. Several asthma attacks had been triggered by running in cold weather, and those experiences made me hate running even more. I used to say, “If you see me running, you had better start running, too, because there’s probably something chasing me.” As I said, I hated running.

I don't remember the day I decided to run, but I remember exactly how I felt. I thought I was going to die! Upon reaching the end of that first section of bike trail, I was proud of myself. I didn’t die. I didn’t even pass out! And I had achieved a goal I once thought unattainable. As I walked the next section of the trail, my breathing slowed, my heart didn’t beat so fast, and I was ready to run again. I continued to alternate between running and walking each new section of trail, and, by the time I made it back home, I was beaming with pride. I did it! Now that I knew the truth of what could be, there was no stopping me.

Every time I went for a jog—more accurately, a jog-walk—I had to mentally prepare myself. “You can do this. You won’t die. Just keep moving. Whatever you do, don’t stop.” And every time I arrived back home, I was proud of myself. Once again, I had accomplished something I was truly scared to do.

I used the lessons I learned while jogging to help me become a better writer. There is an endless list of tips I could give to help any new jogger or writer, but I’ve chosen five to share with you:

1. Go at your own pace.

You don’t have to do what everyone else does. Quite honestly, you shouldn’t want to. This is your race. You aren’t competing with anyone but yourself. Almost every runner on the trail moves at a faster pace than I do. I don’t care. I’m not running in a competition. My only goal is to do better this week than I did last week. That’s it! When I started walking regularly, my pace was 22.5 minutes per mile. Today, I jog at a pace of 15 minutes per mile. My goal is to get below 12 minutes per mile, and it will happen. I just have to keep going. I’m committed to staying in my own lane, no matter how fast others around me are running.

The same is true with writing. Not everyone will write at the same pace. Even if we did, the dissertation chapters, journal articles, and class papers wouldn’t be the same length or word count. Some people have more references than others. Some people’s methods are more complicated than others. Nothing about a PhD program screams “competition.” I completed my dissertation proposal and advanced to candidacy a full year after some of my classmates. It doesn’t matter. In the grand scheme of things, my job was to write and defend my proposal—and I did. As hard as it is, try not to compare yourself to others. It doesn’t help you progress any faster, and, ultimately, it takes your focus away from the task at hand. In most cases, wearing blinders isn’t a good way to approach a situation. In this case, it’s OK.

2. Use the proper tools.

As I have become a more experienced runner—(I use the term “experienced” lightly—I’ve learned to use proper tools, which keep me from having sore ankles or becoming so irritated while running that I stop midstride. Not too long after beginning to run, I bought my first pair of running shoes. I thought it was the only tool I’d need. I was wrong. When I began running, my keys were in my hand, and the sun beat into my eyes. When it was cold, I wore a very thin warm-up jacket that did nothing to keep cold air from getting to my lungs. After running more than enough days feeling like my chest was on fire, I purchased a light, but very warm, running jacket, and I made sure it had zippers so I could safely secure my keys, phone, and ID.

When it rains, I put the hood on. On warmer days, when I don’t wear my jacket, I put all my belongings in my running pouch. If running after sunrise, I wear a baseball cap or sun visor. Finally, I use the Run Keeper app. It tracks the length of my runs and allows me to comment on my friends’ workouts, as well. These and other tools are staples for “real” runners.

As I’ve become somewhat of an experienced writer, I have also found several writing tools I can’t live without. One of these is EndNote, a reference manager. Once I began using EndNote, I was mad at myself for not discovering it earlier. It’s a true writing assistant! I no longer have to manually enter in-text citations or entries to my reference list, and I am able to group my 750-plus references for easy identification. I can attach article PDFs directly to the references, and EndNote saves the highlights and notes I make on the electronic copies of the articles. It’s an amazing tool, indeed! I’m not suggesting that everyone go out and buy EndNote. It’s the reference management software I like to use, but there are plenty of other software programs that can help organize your references.

Another tool I use, though not as regularly as I did when writing my proposal, is my Pomodoro app. The Pomodoro method of writing says that, for every 25 minutes of writing, you should take a five-minute break. Then, for every two hours of writing, including those brief breaks, you should take a longer break of about 15 to 30 minutes. This technique has been shown to increase productivity for many, including me. There’s an entire science behind this method, which I won’t go into now, but it’s worth checking out.

3. Find a group to encourage you.

Running was OK when I was alone, but it became really fun when I started running with a group. Earlier this year, I began to power walk and run with a local Black Girls Run (BGR) group. BGR has running groups all over the country. Members meet at various times and locations to work out together. One of the things I love about this group is their motto “No woman left behind.” Whether you are a walker, jogger, or runner, you will not have to go it alone.

I experienced this the first day my running partner couldn’t make it to our morning running group. I can’t run as fast as some of the ladies, but they promised not to leave me, and they didn’t. They’d run laps around me, run to a tree, then back to me, or just run alongside me at my pace. There’s something special about doing things with a group. Running is no different.

Just as running groups help you run, writing groups help you write and develop healthy habits. During my third year at UCLA, I joined a writing group on campus. We didn’t actually write together, but we met weekly to report our writing experiences during the previous week, give advice to each other, and thus help increase our writing efforts. We set what we thought to be attainable goals each week. Sometimes we met our goals, sometimes we didn’t, but I loved the community that was built among our group, and I remained in the group for the duration of my third year.

In addition to in-person writing groups, there are tons of group-writing websites, such as AcademicLadder.com and the Text and Academic Authors Association. Social media sites, such as Twitter, also encourage group writing through hashtags that include #AcWri (academic writing), #amwriting (early morning writing), and #shutupandwrite. Anytime you can write in the presence—or virtual presence—of another person, you will be encouraged to do your best. If you have become distracted from writing, I urge you to join a writing group. If nothing else, the group members will hold you accountable. You’ll either get with the program, or you’ll leave the group.

4. Do it even when you don’t feel like it.

If I had a dollar for every time I said, “I don’t feel like running today,” I’d be able to buy myself a nice pair of Jimmy Choo pumps. Whether or not I feel like running when I begin, I always feel great after my run is complete. And never have I regretted getting out of bed at 4:30 a.m. to go for a run. That’s right, my running group takes off at 5:15 a.m. I have plenty of excuses to stay in bed, but getting my run in early has yet to negatively affect my plans for the day. So I run, no matter how I feel.

Like running, writing is not something that comes easy for most people. Even among those for whom writing does come fairly easy, we aren’t always in the mood to write. While completing my proposal, I discovered something about writing: You don’t have to be in the mood to write to be a productive writer. The best way to become a great writer is to write as often as possible. Every day you don’t write is a 24-hour period closer to never writing again. That said, write when you want to write and especially when you don’t. I promise, once you get started, it’s not so bad. The first five or 10 minutes of writing are always the most difficult. After that, your ideas become more organized, and the words just begin to flow.

5. Quiet the mind-chatter.

Running is the most physical thing I have ever done. However, I have learned my mind will give up long before my body does. One of my friends who runs gave me the best advice ever. She told me, “Just keep moving your arms.” She was right. As long as I kept moving my arms back and forth, no matter how badly I wanted to quit, I kept running. At this point in my running journey, I don’t even listen to the negative thoughts anymore: “You’re not going to make it.” “You’re going to pass out.” “Your legs can’t take this.” My mind says these things, but my body hasn’t failed me yet.

Just like running, writing is more mental than physical. Your mind will keep you from writing long before you ever sit down to type. You can’t allow yourself to listen to those negative thoughts. You have to sit down at your desk, at the kitchen table, or wherever else you write and think like the Nike slogan: “Just do it!” While it’s important to take mental health breaks, don’t let negative mind-chatter talk you out of writing altogether. Even if it’s for only 15 minutes, write something! If you manage to write for 15 minutes, you can probably write for 15 more. Once you look up, two or three hours will have gone by, and you’ll be done with your writing for the day!

These tips are but a few that may help you become a better writer. I am no expert, by far, but each of the aforementioned tips has been of great help to me. If you are struggling to write—and even if you aren’t—I encourage you to take on a new and challenging activity, and use the lessons you learn to help you become a better writer.

For me, it was running. For you, it may be swimming, knitting, dancing, or hiking. It may also be something like jigsaw puzzles, computer games, or a musical instrument. Whatever you decide to take on, if you stick with it, you won’t be disappointed. Your writing will be much improved, and you’ll find a new hobby along the way.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Grade inflation. (I'm against it.)

I love education—always have, always will. I love being a student. Learning new information, writing papers (yes, I actually enjoy writing papers), discussing with classmates interesting topics—I love it all.

In recent years, I have discovered my love of education from the perspective of an educator. I enjoy creating exams, suggesting curricula changes, and mentoring students. (I tend to have more of a love-hate relationship with grading papers, but that is neither here nor there.)

I get it!
Working as a teaching assistant is interesting, because I am neither the student nor the faculty member of record. I get to see things from both sides. I am closer in age to most of the students than the faculty members are, and, in all of my TA experiences except one, the faculty members are further removed from nursing school than I am. That said, I understand student anxieties and frustrations. “Honestly,” I tell them, “I get it!”

koya79/iStock/Thinkstock

What I don’t “get” is the overwhelming desire to achieve perfect grades. As an MSN-prepared nurse educator, I appreciate an exam that yields beautifully shaped, bell-curve scores. I understand that not everyone can or should receive a top score. I recognize that, on the NCLEX, more than one answer may be correct but candidates are examined on their ability to choose the best answers. I realize that the drive to have a perfect GPA should never supersede one’s drive to acquire excellent nursing skills.

I will admit that, as a nursing student, I loved it when an instructor granted extra points to compensate for a poorly written exam question. I even had one professor who gave an extra point to anyone who discovered a grammatical error on exams she gave. Free points were an unexpected surprise. However, as an educator, I do not agree with this practice. I think students should receive only the grades they earn. Call me Nurse Educator Hatchet, but I am not a fan of grade inflation, and I have no plans of contributing to it.

Once, after being questioned about the legitimacy of a grade I gave, I sent the following email to a student: I understand, trust me. I once cried in a professor’s office after receiving an A- instead of an A on a paper. I get it. I have also been a nurse for nine years, so I understand the insignificance of grades in “the real world.” Your worth as a nurse will not be rooted in your GPA. To be frank, your worth as a student isn’t, either. You are so much more than the grades on your transcript. Striving for excellence is always the best way to go. As a PhD student, however, I’ve learned that the pursuit of perfection can actually cause more harm than good. You all did a wonderful job in class. You received a well-deserved grade in a fast-paced course with material that is very different from what you are used to. Please don’t be too hard on yourself.

The bigger picture
I sincerely hope this student took my words to heart. We are not the sum total of our GPAs! We cannot allow ourselves to get so caught up in getting the best grades that we miss the bigger picture of getting the best education. As students, we don’t pay tuition with the expectation of buying a stellar GPA. We pay tuition with the expectation of being well-prepared to take the NCLEX or an advanced practice licensing exam.

I have witnessed, via social media, the disrespect of students unhappy with their grades. They say things about their instructors that I’m sure they wouldn’t say to these men and women in person. It seems that they think life is over if they don’t earn an A on every assignment or exam. I remind my students that I have never been asked to show my transcripts during a job interview. No one cared whether I received an A or a C in pathophysiology or pharmacology. In the real world, nurses are judged on their ability to provide appropriate care and to do it with a smile. On the hospital unit, grades are a nonfactor.

It's not just students
Students aren’t the only ones obsessed about grades. Some educators also obsess over whether they are perceived as a friendly, likeable instructor or a hard-grading one. Obsess as we may, we are not here to be our students’ friends. It is unethical to give exams after we have already given the answers to them, or to reward students with grades that don’t match their academic or clinical performance. We need to be supportive of one another and ensure that students actually learn the material we are required to teach. We are not in a profession where we can afford to allow students to enter the workforce unprepared.

I implore educators to take a good look in the mirror. Are we helping students by giving away unearned points? Should we continue to send nursing graduates into the workforce with an unrealistic assessment of their abilities by padding their grades? Are we doing the next generation of nurses any real favors when, to quiet the voices of students disappointed with grades they have earned, we change those grades? Are we giving outstanding students in our classes an opportunity to accurately represent themselves when we inflate grades of students who should be receiving median grades? No, no, no, and no!

I believe the answer to the current obsession with grades is to move from a letter-grading system to a pass-fail system. If grades were given in the same manner as NCLEX scores, students would not have to worry about their GPAs. I honestly believe such a shift in grading would do wonders for the morale of nursing students. Until a shift to a pass-fail grading system occurs—or if it never does—nurse educators must work to ensure students are given the grades they earn, while doing their best not to break the students’ spirits in the process. We need to build up nursing students, while helping them understand that their grades do not reflect their future careers as nurses.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Making the leap from theory to practice

As a nursing student, I spent a lot of time learning what nursing practice should look like. Because I was enrolled in a bachelor’s program, I spent less time in the clinical setting than my diploma-school or associate-program counterparts. We spent a lot of time talking about theoretical patients and how they should be cared for. When it came time to take that theoretical knowledge and apply it to real-life patients, I felt slightly overwhelmed.

The same was true for my master’s program. I spent an entire year studying the ins and outs of nursing education. I wrote papers, gave presentations, and took exams. Still, moving from my theoretical understanding of the role of a nurse educator to actually functioning as a preceptor was a giant leap.

Here again

These days, I find myself at this juncture once more. I am moving from life as a PhD student who sits in classes and writes papers to that of a PhD candidate who conducts research and writes data-based manuscripts. This shift feels all too familiar and, just as before, slightly uncomfortable.

Photo credit: George Doyle/Valueline/Thinkstock

The day I passed my oral qualifying exam, I couldn’t have been happier. Once my exam paperwork was filed with UCLA’s Graduate Division, I officially became a PhD candidate, and I could move from working on my dissertation study in theory to working on my actual dissertation study.

When I submitted my application to the Institutional Review Board (IRB) to ensure adherence to research-related governmental and institutional regulations, I expected to go back and forth with them for several months before receiving final study approval. This is what everyone told me to expect, and, as someone new to research, I assumed the process would go the way everyone told me it would. Imagine my surprise when my IRB application was approved—pending revisions—just two weeks after it was submitted. I made the requested revisions during the holiday break and didn’t expect to hear back from the IRB for at least a few weeks. Again, imagine my surprise when, less than a week later, my study was approved. Exactly one month from the day I submitted my first-ever IRB application, I had permission to begin my study.

Attacked by fear

I was excited, but the excitement was soon overcome by anxiety. Were the people on the IRB really giving me full permission to conduct my own study? Had they made a mistake? Didn’t they know I had never done this before? Did I honestly have the authority to recruit participants, collect and analyze data, and write up my findings—carte blanche? I felt the same way I did when I walked into a patient’s room for the first time—scared to death!

I couldn’t believe I was so fearful of conducting a study I had been planning for more than three years. This was the moment I had been waiting for, the moment my study would move from plans in my head—and the first four chapters of my dissertation—to a real-life research study. Why was I so afraid? What, exactly, was I afraid of?

As a nursing student, I was always afraid I would hurt someone. I never wanted to do anything that could potentially harm a patient. As a nurse educator student, I was afraid my students would have a less-than-stellar educational experience. As a PhD candidate, the fear is similar, yet not quite the same. My research does not require me to use any of my bedside nursing skills, so I have no fear of physically harming someone. There isn’t even a concern about subjecting someone to mental anguish or causing a cascade of emotional unraveling. To be frank, I have no idea what caused this sudden onset of research anxiety. What I do know is that I have been at this theory-and-practice crossroad several times before, and, each time, I made it through unscathed.

Regaining perspective

Never have I been asked to move from theory to practice without having a plethora of assistance at my disposal. This time is no different. I am not being thrown to the wolves with no hope of survival. I have an amazing team cheering me on. I constructed my dissertation committee purposefully. The committee chair and each of the other members have a unique set of research skills and expertise from which I can glean. There are also tons of other resources on campus, including statistics consulting, that I can use, should I get stuck at any phase of my study.

I’ve worked on the details of this study for a long time. It may not go according to plan. I may have to change some of my recruitment methods, or I may discover findings that were not anticipated. So what? It’s actually happening! I’m on the brink of conducting my very first research study (outside of small studies conducted for class assignments). I’m the one in charge, and I have an amazing team behind me. My ideas are coming to fruition. They have moved from my mind to my dissertation proposal, and now they are taking the final leap into reality. How exciting!

As nurses, we each experience times when we are afraid to take the next step. Sometimes, those fears are caused by external factors. But, many times, we scare ourselves. When thoughts arise telling you why you can’t make progress in your nursing education or in the nursing profession, combat them with reasons why you can and will. Surround yourself with people who remind you that the leap from theory to practice isn’t as frightening as you think—and with those who won’t let you fall if the leap turns out to be larger than expected.

Above all else, remember, you were made for this! Trust the training you’ve received. Trust yourself to put into practice everything you know. Trust yourself to flourish in your new role. Maintain faith that you are headed in the right direction. And, keep walking, keep advancing, keep progressing—in spite of your fears.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

From PhD student to PhD candidate

I am excited to announce I am now a PhD candidate! I have waited for this moment for three long years. For anyone who doesn’t understand the significance of advancing to candidacy, let me explain. To move from being identified as a PhD student to being identified as a PhD candidate, I had to 1) submit a 20- to 30-page paper at the end of my first year of study, 2) complete two years of full-time coursework, 3) write the introduction, theoretical framework, literature review, and methods chapters of my dissertation, and 4) successfully defend my dissertation proposal to members of my dissertation committee. Advancing to candidacy gives me the green light to begin my dissertation study. It is the first of two important rites of passage, the second being successful defense of my dissertation.

Many in academia and research fields recognize PhD(c) as a title for those who have advanced to candidacy. This distinction is equivalent to “all but dissertation” or “ABD,” an informal title given to PhD candidates. I love the term ABD because it accurately describes the status of PhD candidates as those who have completed every requirement for the PhD, except the dissertation.

Milan Ivosevic/iStock/Thinkstock

When I began my PhD studies, I looked forward with excitement to the point in my program where I would move from student to candidate, because I knew that, once I advanced to candidacy, I could use PhD(c) as part of my credentials. Listing PhD(c) in my credentials would let the world know I had successfully completed two-thirds of my PhD program and that I was on the final leg of the PhD marathon. I knew enough not to list PhD(c) too early, lest I offend those who had already advanced to candidacy. Improper use of credentials is a major pet peeve of mine (see “The 5 no-nos of alphabet soup”), so I have been patiently waiting for the day I could update my credentials.

In the weeks leading up to my oral qualifying exam, it dawned on me I wasn’t required to use PhD(c). I also recalled that using MSN(c) in the last semester of my MSN program had felt strange, as though I was claiming the degree prematurely. I thought, therefore, long and hard about whether or not I now wanted to use PhD(c) as part of my credentials. I even looked for other authors’ opinions on the matter. In doing so, I came across an interesting Advances in Nursing Science blog post on the subject of proper credentialing, and that sealed the deal. As much as I once looked forward to writing PhD(c) behind my name, I finally decided I would not use this distinction.

First, I tend to be very traditional when it comes to special occasions and ceremonies. I don’t open Christmas gifts before Christmas morning. I don’t think brides and grooms should see each other on their wedding day prior to the ceremony. I don’t wear white skirts, white pants, or white shoes between Labor Day and Memorial Day. I’m a traditionalist at heart. For the same reason, I don’t want to use the PhD(c) designation.

I don’t want to become comfortable seeing PhD behind my name until my PhD degree is hanging on my wall, and hope that waiting to update my credentials will motivate me to continue working hard toward graduation. In addition to holding off for tradition’s sake, there are a few other reasons why using PhD(c) might not be in the best interest of a candidate.

PhD(c) isn’t recognized by some of the entities that matter most. Several professional organizations and publications, including the Honor Society of Nursing, Sigma Theta Tau International, do not permit use of degrees in progress when listing credentials. It makes sense. Why would these organizations allow us to use credentials we have not yet earned? If I chose to use PhD(c), I would constantly have to revert back to my former string of credentials, which lists MSN as my highest earned degree. I see that as extra, unnecessary work. So, instead of complicating things and taking the chance of listing unacceptable or unacknowledged credentials when submitting a journal article or conference abstract, I’m choosing to keep it simple. I’ll update my credentials when I am no longer a candidate, but a full-fledged Doctor of Philosophy.

Finally, it is widely estimated that 50 to 60 percent of PhD students never complete their PhD. While it is unclear how many PhD dropouts are ABD, what is clear is that ABD is a means to an end—an end some people never reach. PhD programs, like all other academic programs in higher education, have time limits. Most programs require completion of the terminal degree within seven to 10 years of starting the program. Even if a person has advanced to candidacy, he or she can be asked to leave the program if progression toward final defense takes an exorbitant amount of time. I’m not superstitious, scared of jinxing myself, or fearful I will be put out of my program for taking too long to graduate, because I’m only at the start of my fourth year. I just recognize PhD(c) is a status symbol, not a real credential.

I am proud of myself for reaching this milestone in my education, and I will continue to refer to myself as a PhD candidate, ABD, or, as I’ve heard a few nurses say “PhD, little c,” but I will not include PhD(c) with my credentials. There is something special about a person who has earned a PhD. It is, indeed, an honor. I don’t want to use a credential I have not yet earned. Instead, I want to save the joy of updating my credentials for the moment my PhD is actually conferred. I want to wait until my committee members refer to me as Dr. Montgomery before replacing “MSN” with “PhD” in my alphabet soup.

I feel no less accomplished or excited to advance to candidacy not using PhD(c) than I would feel if chose to update my credentials now. Nor do I fault people who choose to use PhD(c) as one of their credentials. It’s a personal choice. I choose to wait.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Maternal-child health nursing in Indonesia

During winter break of my previous academic year—for those of you in the southern hemisphere, “winter” break at UCLA is in December, not July—I had the amazing opportunity to travel to Indonesia to see, firsthand, the work of front-line maternal health workers. I wrote about my experience as a guest blogger for the Frontline Health Workers’ Coalition. The experience was so much more extensive than what I was able to capture in that blog post, so I am sharing more of my experiences here.

Two things I noticed in Bandung, West Java, Indonesia resonated with me more than anything else: use of text messaging by puskesmas (government clinic) staff and the traffic.

I am a lover of technology and an advocate for use of mobile technology in health care, so I couldn’t have been more pleased to see posters on puskesmas walls with instructions for texting patient-referral information to the local hospital. Clinic staff members said that lack of hospital staff to respond to the SMS gateway (the text messages used to refer patients to hospitals) was a large obstacle for them. Still, use of mobile technology among Indonesian nurses is an important step in health care delivery. I may be a bit biased, as my own research focuses heavily on mobile technology, but that’s OK.

Herianus/iStock/Thinkstock

The other very noticeable thing was the traffic. As a resident of Los Angeles, California, USA, I am used to traffic. My daily activities are scheduled around high traffic times. I decide what time to wake up based on anticipated traffic. I group errands so I don’t have to deal with traffic more often than necessary. I know traffic. However, I had never before experienced the type of traffic I saw in Indonesia. What should be an hour-long drive took us more than three hours. Motorcyclists bobbed in and out of lanes, all the while transporting women and children without helmets. It wasn’t just the public that had to deal with traffic. Ambulances sat in traffic with us. Sirens were on, but many of the cars on the road either wouldn’t move over or had no place to move to. It was no surprise that puskesmas staff members reported transporting patients to hospitals as one of their biggest obstacles.

Nursing practice of midwives in Bandung is very similar to practice of labor and delivery nurses in the United States. Here, we have critical events team training (CETT), where we use simulation to practice handling emergencies. In Bandung, the Expanding Maternal and Neonatal Survival (EMAS) program administers similar training.

EMAS focuses on three areas of maternal health and three areas of neonatal health: eclampsia, postpartum hemorrhage, maternal sepsis, low birth weight, neonatal sepsis, and neonatal asphyxia. Clinic and hospital participants of EMAS are selected based on the number of deliveries and maternal-fetal deaths at each facility. Staff training occurs in the home facility. Staff members are given modules and are responsible for training themselves, based on the notion that, if training occurs away from the home facility, midwives won't know what to do when they go back to their home facilities. I love this teaching philosophy!

As participants in the program, puskesmas staff members are taught what to do during maternal or neonatal emergencies. The program helps increase midwife confidence in caring for high-risk women until the patients can be safely transferred to the hospital. Checklists help in emergencies, and they understand that it is within their scope of practice to administer medications such as antibiotics and magnesium sulfate. Just like American nurses, the Indonesian nurses I met use the Neonatal Resuscitation Program (NRP) model during neonatal emergencies. They also give intramuscular Methergine and intramuscular oxytocin during postpartum hemorrhages. Puskesmas nurses said they were grateful for the increased confidence they have as a result of knowledge provided by the EMAS program.

The EMAS program, which is beginning to bridge the gap between clinics and hospitals, encourages ongoing mentoring and quarterly training. The relationship is mutually beneficial for puskesmas and hospital alike. A memorandum of understanding between clinics and hospitals allows sick patients to be referred to the closest hospital. According to puskesmas staff members, the best outcomes of the program are better clinic management and use of texting to enhance communication between clinics and hospitals. EMAS has strengthened the network among physicians and midwives. Midwives are no longer afraid to call physicians, regardless of the time of day or night, an issue some U.S. nurses continue to struggle with.

The puskesmas nurses told me that their greatest motivation was desire to save the lives of mothers. I could tell by their love for continuing education that this was, indeed, true. I had to travel all the way to the other side of the world to realize that nurses everywhere are one and the same. We may have different cultural practices and slightly different patient-care procedures, but we all cherish good outcomes. Going to Indonesia made me feel part of the global nursing profession. For the first time ever, I felt as though nursing was bigger than what I have known it to be in the United States. Nursing for me is now a global endeavor. Almost a decade after graduating from nursing school, I have a clear understanding of the importance of nursing practice, both inside and outside of my country.

I hope to continue traveling internationally to meet other nurses and gain better understanding of how they practice. There is so much we can learn from each other, so much knowledge and love to share. I am honored to be a member of the Honor Society of Nursing, Sigma Theta Tau International (STTI). When I was inducted into STTI, I had no idea I would someday travel the world meeting nurses and writing about them, an honor I do not take lightly.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Visiting the library

I recently visited a couple of my school’s libraries—UCLA’s Charles E. Young Research Library and Louise M. Darling Biomedical Library—to check out a few books. In doing so, I realized how long it had been since I last searched through library stacks for a book. Awestruck by the significance of the occasion, I took a picture of book stacks and posted it to my Instagram account.

There was a time when going to the library was normal. As an elementary-school student, I learned all about the Dewey Decimal System and how to use the card catalog to search for books. My class frequented the library to check out and return books. In high school, I studied in the library of California State University, Long Beach. I’d sit there for hours, having given my mother instructions to pick me up in the afternoon. Oddly enough, as a college student, I never studied in the library—only as a high school student. Go figure. However, during the summer months between my freshman and sophomore years in college, I went to the library almost weekly to check out books.

I took a picture of book stacks and posted it to my Instagram account.

I read a lot that summer. Reading for pleasure gave me respite from assigned readings for my summer anatomy class. During my sophomore and junior years of college, I worked in a campus satellite library—the Multicultural Resource Center. Filling my childhood and early adult years are great memories of school and public libraries. The Internet changed all that.

I can count on two hands the number of times I checked out a library book as an undergraduate or graduate student. In fact, before my PhD program, the last time I remember going to a library was during my junior year, and that was to visit friends who worked there. During my MSN program, I never once stepped foot in a library. To be honest, I couldn’t tell you where the library is at California State University, Dominguez Hills—or if one exists at all.

The few times I have visited UCLA’s Biomedical Library, I have been reminded of the joys of going to the library—the smell of books; the short-lived anxiety of searching for a single literary work among thousands of collections; the thought of who may have read this book last. What were they studying? Where did they read it? What did they think of it?

Going to the library was once a staple of the educational experience. Today, it is quite possible to earn a college degree without ever reading a book. As use of technology continues to increase, part of me is beginning to miss the good old days—the days when I either had to visit the library or have no references to cite for a paper (two or three libraries if a needed book was checked out); the days when I wrote papers by hand and went to the computer lab to type them up; the days when the Internet was but a mystery and information wasn’t handed to me on a silver spoon. Those were the days!

Today, I wonder if students are actually getting a college education or simply earning a degree. Getting an education entails so much more than simply adhering to guidelines spelled out in a syllabus and receiving a grade. For me, getting a college education meant sitting in a lecture hall full of people I didn’t know and becoming friends with some of them as a result of our shared experience. It meant engaging in meaningful discussions in a small class section, then hanging around after class to continue the discussion with the professor and a few other students. It meant searching the stacks in the library, hoping—and praying—to find the book I needed. For me, that was what getting an education was about.

Have we lost the magic of the college experience? Are technological advancements removing the very things that made us feel like students? Is technology becoming more of an educational hindrance than a help? I don’t know the answers to any of these questions but, as someone who loves everything about higher education, the thought that I am even posing these questions makes me a little sad.

I want future generations to know the joy of visiting the library—not simply downloading books and articles from Google Books and online research databases. I’m not saying we should return to the days of typewriters and Wite-Out—yes, I also remember those days—but there is a special feeling associated with frequenting a university library. I can only hope today’s educators are encouraging students to experience that feeling.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

10 tips for using Twitter in nursing

I recently attended the 2014 AWHONN Convention and was overwhelmed with joy by the conference’s use of technology. In addition to increased use of technology in the general and breakout sessions, I noticed a large increase in the use of social media—specifically, Twitter. As an avid user of Twitter, I posted more tweets, using the conference hashtag, than any other member of the Association of Women’s Health, Obstetric and Neonatal Nurses. Many of my tweets were retweeted and marked as favorites by members of AWHONN, members of other nursing and government health groups, and journals. By the end of the conference, several nursing colleagues asked me to help them set up Twitter accounts, because they wanted to tweet as well.

I am not shy about my love for Twitter. I encourage all of my students and coworkers—really any nurse I know—to utilize this social media platform for professional advancement. I first created a Twitter profile in the months preceding entrance into my PhD program, because I wanted to increase my professional presence on the Internet and social media websites. In addition to setting up a Twitter account, I became more active on LinkedIn and created a professional page on Facebook. Since then, however, I have focused my attention primarily on Twitter, because I have found it the most appropriate social media platform for professional development.

Although many use social media to stay connected with family and friends, my use of Twitter is all about connecting with other women’s-health professionals, nurses, and researchers. (I use other social media sites to connect with family and friends.) Because my research focuses on high-risk sexual behaviors, I follow many national health organizations that tweet information related to unintended pregnancy and sexually transmitted diseases. As I scroll down my Twitter timeline, I am constantly considering new information to add to the literature review and methodology chapters of my dissertation.

rvlsoft/iStock/Thinkstock

I also use Twitter for interacting socially with other PhD students and health care professionals. I have made several cyberfriends on Twitter, and I have met some of them at nursing and research conferences. Others, I may never meet in person. We encourage one another in our research efforts, celebrate accomplishments, check in with each other if long periods of time pass, and hold one another accountable for goals we want to achieve. I also check #PHinisheD and #dissertationdefense to gain inspiration and to congratulate newly minted doctors of philosophy.

Since more of you are using Twitter, I want to share a few tips to make your social media experience more beneficial to your professional growth.

Tip #1: Remember that you represent nursing. Whether or not you identify yourself as a nurse, you represent nursing and every other registered nurse. I like to remind my students that being a nurse is like being a member of a sorority. Once you are accepted into our ranks, you represent us at all times, so be careful what you post. Your pictures, statements, and interactions with others—whether or not your account is public—can shine a magnificent light on the profession or act as an unfortunate damper. I promise not to make you look bad. Please give me the same respect.

Tip #2: Interact with others using an interdisciplinary approach. While it’s nice to follow nurses on Twitter, follow other health care professionals as well. Our physician, public health, research, and health educator colleagues are gems. The information they post may not always apply directly to your role as a nurse, but it may be useful, nonetheless. Some of the most intriguing and inspiring tweets I have seen come from non-nursing colleagues.

Tip #3: Interact with health care consumers. Besides interactions that occur between health care professionals, interaction with patients or other health care consumers is also important. Just as health care providers follow the Centers for Disease Control and Prevention (@CDCgov) and researchers follow the National Institutes of Health (@NIH), consumers also follow these and other organizations. Instead of wording your tweets only for other nurses, also interact with the general public. There are hundreds—if not thousands—of support hashtags used by health care consumers. They use these hashtags to connect with one another, but they also appreciate information from health care providers. Tweeting information to consumers helps ensure that the public receives accurate information from licensed professionals and is not simply passing around old wives’ tales or anecdotal information.

Tip #4: Make use of popular hashtags. Using hashtags will not only enrich your Twitter experience, it will enrich the experience of others as well. Twitter creates a list of tweets using the same hashtags and separates tweets into two categories: popular tweets and all tweets. This allows Twitter users to see what others are saying about content at hand. Some of the hashtags I often use include #thePhDlife, #nursesrock, #nursingstudents, and #womenshealth. I encourage you to follow hashtags of importance to your practice or area of research. I also use hashtags to categorize my tweets. I am the only person on Twitter who uses #thePhDlife. Sometimes, when I need a little inspiration or want to revisit my PhD journey, I go down the list of tweets filed under #thePhDlife. You may want to create your own special hashtag so you can do the same.

Hashtags are also helpful when attending nursing conferences or other large meetings. For instance, I tweeted heavily during the AWHONN conference using #AWHONN14, and, by observing others using the same hashtag, met several people I would otherwise not have connected with. It also allowed many people to get to know me. As I walked the halls of the convention center, I often heard “Hi, Tiffany!” from nurses I had never met before or “I’m really enjoying your tweets” from others. Tweeting at conferences is easier and more meaningful than taking notes. I can always refer back to my tweets to remind myself of important information shared at the conference. Besides taking notes for my own benefit, I get the chance to share what I am learning with the world—in real time!

Tip #5: Mark favorite tweets for future reference. Marking a tweet as a favorite (by activating the little heart at the bottom of a tweet) adds it to your favorites list, a list automatically generated by Twitter. I go back to my favorites every few months and review the list. It’s always nice to be reminded of important tweets posted in prior months or years. It’s like taking a trip down memory lane.

Tip #6: Participate in Twitter chats. Twitter chats are an exceptional way to interact with others on Twitter. Some Twitter handles are dedicated specifically to weekly or other regularly scheduled chats. Others will schedule and hold chats related to specific content. These chats—heavily advertised—are well attended, even though only a few actually participate. Twitter chats allow users to participate in real-time conversations with government agencies, health care organizations, and other health care entities. If your facility or educational institution has its own Twitter handle, consider holding a Twitter chat for patients, students, or other consumers. To initiate a chat, just let people know the hashtag you will be using, set a date and time, and make sure someone is available to moderate the session and respond to tweets using your hashtag. (Consider using two people to handle these work-intensive tasks.)

Tip #7: Find opportunities to mentor novice nurses and nursing students. I have used Twitter on many occasions to communicate with nursing students. Sometimes, I tweet tips to help them navigate the troubling waters of nursing schools. Occasionally, I interact with students and new grads after they reach out to me. Less frequently, I read a tweet, using a specific hashtag, or see a tweet on my timeline that inspires me to reach out to the author of the tweet. I have yet to have a negative experience in my dealings with nursing students or novice nurses on Twitter. They are always gracious and appreciate any wisdom I have to share. I encourage other, more seasoned nurses to also reach out to newer nurses. You have a wealth of knowledge from which we can all learn. Don’t be shy about sharing your experiences and wisdom.

Tip #8: Stay up to date on current practice. By following certain government health agencies, I am alerted to the newest research, practice guidelines, and population data. Whenever a new report is published, there is a tweet about it. Usually, the authoring organization tweets, and many other organizations retweet the information, or tweet similar information of their own. Twitter was established to serve as a newsfeed, and many people still use it for this purpose. Breaking news—health-related or otherwise—hits Twitter before local news stations or public radio. Folks often wonder how I stay up to date on women’s health issues. My answer is Twitter.

Tip #9: Create lists of your favorite tweeps. In addition to the favorites list generated by Twitter, you can create your own lists. My lists include: Women’s Health, mHealth, Nursing Info, Healthcare Legislation, Nursing Publications, Schools of Nursing, Teen Pregnancy, Nursing Orgs, and Healthcare Info. As I follow various Twitter handles, I place them in the appropriate groups. If I want to know what’s going on in which nursing schools, for instance, I open my “Schools of Nursing” list. This prevents scrolling down a timeline on which I could potentially see tweets from everyone I follow (more than 850 different Twitter handles). If you are going to use Twitter for professional reasons, I strongly encourage you to create lists. It saves times and helps with organization.

Tip #10: Engage in the Twitterverse often. Every now and then, I will come across a tweep I haven’t seen on my timeline in ages. To truly get the most out of Twitter, you have to access the site often, because information is posted constantly. If you wait days or weeks between logging on to the site, you will miss important content. Don’t feel that you have to tweet constantly, however. Some people—we call them lurkers—tweet very infrequently, and there is nothing wrong with that. Just remember, when you aren’t tweeting, you’re depriving others of your knowledge. Even if you have nothing to say personally, you can retweet interesting tweets you come across. You can also tweet online articles, pictures, and websites.

I hope to continue seeing a growing presence of nurses on Twitter and other social media platforms. Engaging with nurses across the country and around the world is something we couldn’t easily do 20 years ago. Today, we can learn from nurses and other health care professionals on every continent. Social media is here to stay. It’s time to embrace it. My Twitter handle is @TMontgomeryRN. I hope to “see” you around the Twitterverse!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

For the people, not the fame

I recently read an article about a researcher in India who has made great strides for women’s hygiene in that country. “The Indian sanitary pad revolutionary,” by Vibeke Venema, writing for BBC World Service, is a long article, but one I encourage every researcher to read. After learning of the unsanitary and oftentimes embarrassing hygiene practices of many Indian menstruating women, Arunachalam Muruganantham initiated his own research about sanitary pads and how to produce them inexpensively.

Although he had no formal education, Muruganantham learned what he could about women’s sanitary habits and developed a research question. His work on this extremely taboo subject cost him his family and friends. His community also ostracized him but, after years of working toward his goal, his commitment paid off. Today, his invention, a machine that manufactures sanitary pads, has helped to improve the health of women in India and many other countries. Although he could have made a great deal of money with his machine, he decided, instead, to help more women. As a result, his creation has led to entrepreneurial jobs for women and increased health education in the communities they serve.

Intellistudies/iStock/Thinkstock

Once I started reading the article, I couldn’t stop. I was inspired by Muruganantham’s commitment to his research. Being ridiculed didn’t stop him from finding answers to his research question. Being abandoned by his wife and mother didn’t stop him, either. (They later came back.) He didn’t allow his lack of formal education to make him feel unqualified to conduct his studies. What stands out most to me is his desire, above all, to help the women of his country. Although he could have become wealthy by selling his invention, he chose, instead, to use his invention to improve the lives of those for whom it was created. This, in my opinion, is exactly how research should be.

How many researchers can honestly say they would continue to do what they do if there was no notoriety or financial gain involved? If funding dried up or if others did not understand your reason for asking an unusual research question, would you continue to investigate? How many of us truly do what we do for the love of the work and the people we help and not to secure our place in the Ivory Tower? Muruganantham’s research was not conducted for financial security and material gain, but as a way to empower and advance—economically—women in his country and around the world. If we learn one thing from this story, it should be the lesson of selflessness.

In my own research career, I never want to forget the most important aspect of any study—the people who will be helped as a result of my findings. I’ve never been one to seek knowledge simply for knowledge’s sake. Learning something I didn’t previously know is great, but applying that knowledge to improving people’s health is more important. In the grand scheme of things, changing lives through research is more important than any six-figure salary, corner office, or national award. It’s all about the people; it should never be about the researcher.

Receiving credit for hard work and adhering to intellectual property laws are important, but we must get out of the habit of keeping research tools and findings in the hands of only a few. We must stop trying to build extreme wealth by charging exorbitant amounts for use of research instruments and interventions. If we uncover a way to address a certain health issue in a specific population, we should disseminate our findings widely, not simply among colleagues who attend national or international research conferences. We could all stand to apply to our research the kind of compassion, care, and concern that Muruganantham demonstrated for the women for whom he created his machine.

As the knowledge base of nursing research continues to grow, we should always remember we are nurses first, then researchers. The Nightingale Pledge reminds us that we are to “practice [our] profession faithfully … and devote [ourselves] to the welfare of those committed to [our] care.” While I can’t speak for colleagues in other disciplines, nursing research should never be about money or fame. It should always be about the patient, or, in our case as researchers, the participants and the populations they represent. We should do our best to ensure that our findings are implemented in a way that will help those most in need. When in doubt, ask “What would Muruganantham do?” He provides a wonderful example of remaining committed to the people for whom his research was conducted. We should all be so lucky to have our research touch so many lives.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.