Social media and me


Private_Professional_SoMeFilmStillI think I joined Facebook in 2007; not exactly an early adopter but not a late-comer either. I can remember who sent me the link and why she said I would like it. She was right I did! Before that I was a user of ‘Friends Reunited’ too – you remember that? Where you could look people up from school? I became a Facebook fan and, as smart phones came into my life and I spent increasing amounts of time travelling with my phone in my hand, social media an increasingly important part of my personal life.

A little while later, in 2009, someone at work suggested I join Twitter. I am always curious about new things so I duly logged in and created my account – @anniecoops was born.

In February 2009, when I started my Twitter journey, I took ages to warm up. Like many people who I speak to I didn’t really ‘get’ it and after around 3 months of trying I gave up. Here is my illuminating first tweet :0) first tweet 1 (2)

I can’t remember what made me go back but after those 3 months but I suspect it was a challenge from someone who probably said ‘If you don’t get it, you are probably not trying hard enough’ and I absolutely can’t resist a challenge like that! I met some important friends along the way and by April 2015 I find that I have tweeted 74K times and now have 8600 followers. With the launch of a social media film that I have worked on with @NHSIQ I thought it was time to reflect on that journey and what has happened.

Here is a link to the film

annieAnnie was never my name, I always thought it was a bit twee for me, more of a nice girl name rather than the firm, straight and solid name Anne. I always say Anne is a good name, you can’t shorten it and it’s hard to mess with but I had no idea how ‘Annie’ was going to become part of my life. I had been called ‘Coops’ at work for quite a while and my son in the Cadets was called the same. When I tried to register @annecoops it was gone as was @annecooper. The addition of the ‘i’ to my first name was simply a pragmatic thing to do. I had no idea what was going to happen and that, by 2015, more people at work would call me Annie than Anne!

Facebook_BackyardFence_SoMeFilmStillMy social media journey has been a great addition to my professional life. Later in September 2012 started my wordpress blog and I re-discovered my love of reflecting through writing. By then AnnieCoops had taken hold as my ‘brand’ and also became the name of my blog.

I completely accept that social media is not for everyone – I dislike those who behave as zealots trying to pressurise people into using social media, particularly Twitter. It’s not for everyone but quite often there will be a platform that works for most people – I know lots of people who love Pinterest for example but I personally don’t get it as I clearly prefer the words and feelings that blogs evoke for me. I love Blipfoto as well but I am too ill-disciplined to be properly focussed on trying to improve my photography skills.

Social Media has been a positive experience for me and I thought it might be helpful to say why:

  • Professional inclusion

Working in informatics is hard. It’s like the geek club and most of the time I don’t actually belong in it – I’m tolerated and valued but not quite part of it either. Additionally in nursing informatics still feels peripheral. Back in 2009 I didn’t really think I was part of nursing, I had the sense, rightly or wrongly, that people didn’t really get the digital agenda and as a result I wasn’t really part of the nursing ‘family’ – I was labelled a geek* and therefore not part of where the nursing action was. Twitter changed that for me, I started to talk to other nurses and soon established a new network where I felt like I belonged and I continue to feel part of that family. It has given me a real opportunity to feel professionally re-connected and valued and to re-profile myself as more than the perceived ‘geek’.

  • Creating bridges

BridgesSocial Media has been great for me in making connections and creating bridges to new spaces. New spaces I have been given a glimpse into include connecting with more professionals including doctors, midwives, pharmacists, medical educators, people who working in housing and local government, the voluntary sector, leadership development, organisational development, education – the list is so long I can’t list everyone and I value all those connections more than I can explain. It has given my personal and professional life a greater breadth and depth that would not have been possible without social media. I value the eclectic nature of my connections and social media friends.

  • Being a patient

Being a professional who happens to have a long term condition like T1 Diabetes can be a challenge. I think for many years most of the time I ignored it. Social Media allowed me to not only find a Diabetes family but also to try to add value to that community. I have enjoyed blogging about my condition and also sharing via Twitter some of the ups and downs. I have tried to help others too and to share my expertise as a patient. I wish I had found this opportunity earlier in my life.

  • Access to resources and expertise

One of the very best things about Twitter is the generosity of the people I connect to. I have learnt more in the last few years about so many things and I believe that this is likely to make me a better professional but also a better person. Sharing is not just the technical stuff but thoughts feelings and emotions that help me to understand in a deeper way – it’s a better learning space than any lecture I have ever had at university.

* there is nothing wrong with being a geek it’s just that I’m not one by this definition: ‘”someone who is interested in a subject (usually intellectual or complex) for its own sake”social media film

Endings and beginnings


It’s been a tough few weeks and I feel sure it’s not quite over yet but I thought it might be better to write this in the middle of it rather than after it, if you know what I mean. I’m talking about endings and beginnings – moving from one job to another.Bridges

When I was at Roffey Park on my OD practitioner programme I fell in love with the Bridges Model of change. What is it that I love? I love the humanistic approach that it takes and how it almost ignores mechanistic approaches to change, placing a greater emphasis on how people react and eventually embrace change. I have been going through a change process and I think had people focussed on Bridges it could have been a whole lot less painful!

Bridges says there are 3 phases of change:

  1. Ending, losing and letting go
  2. The neutral zone
  3. The new beginning

Firstly I think good endings are important. They represent the chance to reflect back and unpick what has happened, good and bad, but importantly to celebrate achievements, to say thanks and to celebrate the moving on. Never leave people to go without acknowledging they played a part in whatever happened and say good luck. Marking the end for me appears to be important and without that I am left with a residual unpleasant aftertaste. Did anyone know I was even there?!old job new job

The second phase, the neutral zone, can be a scary place. It’s slow, it feels almost relentless, no matter how long or short it is, too slow for those of us who like pace. It’s like a grey middle ground, I am left with feelings of being neither here, nor there, with no sense of belonging. Fortunately for me I am old enough and experienced enough to know it will pass but it doesn’t stop me getting a lump in my throat and feeling tearful – it in other words it brings out less than the best in me.

So good beginnings, how can we do this? Create positive energy and make people feel welcome. Look after them like you would want to be cared for yourself. Look after the practical things to make the transition as easy as possible, for example make sure they have somewhere to sit and can make a drink! Simple things make a difference, no detail will go unnoticed. It’s a time when simple human kindness can help someone feel at home. Other tips include clarity about what will happen next but not too much, give them time to settle and also influence how it goes – no one wants to find themselves with no room for ideas, or manoeuvrability. I think a good beginning can colour and influence what happens next, where loyalties lie and how much of the discretionary effort people might be prepared to give as time moves on.Coffee

So what have I learnt? That we should celebrate endings, that people need support in transition and that good beginnings really matter. Simple messages really – maybe that’s why we forget.

#labelsr4jamjars


DUKA few weeks ago I was very lucky to be invited to speak at the annual Diabetes UK Professional conference. I do not have any involvement in Diabetes in my professional life and as a consequence I very much felt like I was attending as a patient, who happened to be a nurse, and the conference almost felt like it had been ‘flipped’ for me; I was an outsider looking in. (Here is the link to our presentation on Social media).

I am more used to being a more integral part of a conference these days and even though on this occasion I was also a speaker it felt very different. I was there in my own time, rather than as a professional, so that was part of it, but it led me to see the conference through a new lens.

I have noticed before how people who have a long term conditions are often referred to by professionals and always had a sense of unease. For example overhearing a doctor refer to ‘the diabetics in the clinic’ makes it sound like those people are a separate species, almost a sub- species, that the professional sees them as separate and different from themselves. This has long led me to think about labelling theory and how it might apply in these contexts.

DiabetesAt the conference I yet again experienced this dissonance around the use of language. People with Diabetes referred to as ‘Diabetics’, ‘Subjects’ (of research), and cohorts. That data points were not really about people but abstract concepts that are of interest. This type of language seems to place these people outside of what everyone else ‘is’ and although labelling theories seem to have fallen out of favour, I can see how certain groups are placed out of what might be considered as ‘normal’.

I am no sociologist and I hesitate to link my observations to any theories – I know someone will pull my thinking apart – but what I do know is that there is both a good part and a negative part of being labelled in this way.

Some people wear ‘Diabetic’ as a badge of honour. I understand why this might be so. It allows people who may be similar to group positively together and own that individual and group identity. Others, like me, see Diabetes as a part of themselves, but perhaps not the most significant, and prefer to be seen as person first (who happens to have x or y condition). There are many conditions where these language labels are used: Diabetic, Epileptic, Schizophrenic, Bulimic, Anorexic…..

Those who say labels don’t matter and its just the language we use are often people who have not experienced any stigma associated with a condition. My experiences are low level but nontheless present. When I was younger I never had to explain that I have T1 Diabetes, the assumption was I was young so I would be ‘one of those diabetics who injected’. Later in my life things changed, as a rotund middle aged woman, now I have actually been told ‘You should stay thin and then you wouldn’t be a Diabetic’. Other low level stigma includes conversations like ‘You shouldn’t be eating that (cake, chocolate, etc) should you?’

I feel labels don’t help, in fact they get in the way of empathetic relationships, they create a perception of what matters to the individual based on their condition. As Brene Brown says empathy is feeling ‘with’ the person and not applying judgements. I strongly believe that empathy should be person focussed not condition focussed.  I am, however, expressing a view that may not be popular and others may challenge. In a study by Ogden and Parkes (2013) they found no difference in the beliefs of those with and without Diabetes using the word ‘Diabetic’ vs ‘Person with Diabetes’ although they do recognise that their methods may have impacted the outcome as they used a scenario based assessment to test their theory.  I could probably have told them what they would find using this method. There is more evidence in mental health that labels are perceived as unacceptable – I think there is more debate in this area and also a deeper understanding of the impact of stigma.

labelr4jamjarsI know that not everyone holds my view but I believe #labelsr4jamjars – we should always say the person first ‘Annie with Diabetes’.  A long time ago, when I was a ward sister, we had labels we applied to beds to label the person in them ‘Diabetic’ in red letters. I didn’t like it even then and I removed these from the ward and talked to staff about how I expected everyone to know who happened to have diabetes and that the labels would not be reinstated.

As an anonymous person with diabetes at the conference I did wonder how far we had moved on. Looking at it from the outside, through a new lens, it did feel like we still had a long way to go.

Thank you to Dorcas Lambert for the inspiration and courage to write this blog – its been brewing for a while – here is her blog on the same.

‘A diabetic’ versus ‘a person with diabetes’: the impact of language on beliefs about diabetes’ Ogden J, Parkes K, (2013) Eur Diabetes Nursing 2013; 10 (3): 80-85

jamjars

Nursing workforce planning: are we just playing a numbers game?


calculator graphMost people who read the news in the UK are likely to have read recent articles that point to the possibility that there is a shortage of nurses[i][ii][iii]. In a time when we are talking about reconfiguring the way care is offered and moving care into people’s homes it is also well documented that we have an aging nursing workforce with particular concerns in community nursing.  In a report by the RCN in 2012, it was identified that almost 60% of the community nursing workforce could if they chose, retire in the next decade. Of course, it’s not just about the numbers of nurses who leave – it’s also the level of expertise that the system loses when these experienced nurses, who are likely to have up to 3 decades of experience, retire.

There are steps in place to try to attract nurses who were once registered but left the profession back into practice. This work is being led by Health Education England with a concerted public campaign to attract once registered nurses to undertake a period of updating to encourage them to return. You can read more about the campaign here.

Whilst workforce planning as a numbers game is important – we need to make sure we have an adequate flow of newly qualified nurses – what could be just as important is retaining those with the long years of experience to help to pass on their tacit knowledge and skills before they leave the profession through retirement.

Bearing this in mind a paper by Liebermann et al (2015) caught my eye. They discuss that, as well as adequately addressing the recruitment of new nurses, we also need to make sure we retain new entrants and encourage older nurses to postpone their retirement.

anne 1989 on wardI am now 51 and in the last year or so I have thought about the prospect of retirement more than ever in my life. I realise this is a natural progression, that looking forward is a good thing; I also recognise that if every one of my generation does this, there could be an inevitable skill gap. There are ways less experienced nurses can be supported to offer safe care such as decision support technology but even I (as a nurse with a passion for technology) know that this can never replace decades of practice experience. So what do we know about why it is that nurses seek to leave the profession early?

Liebermann et al undertook a longitudinal study via questionnaire that sought to understand what conditions were most likely to encourage nurses to stay, with a focus on the possible differences between younger and older nurses. In other words, do we need to do different things to encourage younger nurses to stick with nursing and for older nurses to encourage them to put off an early retirement?

In some ways the conclusions are not surprising – nurses need good management support to stay and to help them to keep up to the hard demands that nursing places on us. What is perhaps more interesting is that they found differences between the younger and older nurses. The researchers concluded that ‘supervisors [managers] should foster nurses’ expectation of remaining in the same job until retirement age by providing age-specific job resources’ (Liebermann et al 2015).

By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons

By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons

We know that a multi-generational workforce may require different leadership styles, so called ‘baby boomers’ may differ from ‘generation x’ or ‘millennials’, but do we equally need to look at what conditions keep nurses satisfied with their work conditions in this generational way too?

I think this is a fascinating thought that we may need to think about. So, it’s possible that any efforts we make to encourage people to stay in nursing, if we don’t understand the needs of particular generations, may fail. My final point is are we just addressing a numbers game, when we need to start to focus in some detail on how we can retain nurses, recognising that different generations may have different needs?

Liebermann SC., Muller A., Weigal M.,Wegge J (2015) ‘Antecedents of the expectation of remaining in nursing until retirement age’ Journal of Advanced Nursing doi: 10.1111/jan12634

With thanks to Dr Susan Hamer for bringing this journal article to my attention :0)

PS thanks to Ruth Auton for pointing out this paper from HEE http://hee.nhs.uk/wp-content/uploads/sites/321/2014/05/Growing-nursing-numbers-Literature-Review-FINAL.pdf

[i] http://www.theguardian.com/society/2014/dec/17/nhs-nurse-shortage-health-service-overseas

[ii] http://www.rcn.org.uk/newsevents/news/article/london/nursing-shortage-pmqs

[iii] http://www.telegraph.co.uk/news/nhs/11349403/AandE-units-will-be-forced-to-declare-nurse-shortages.html

Golden silence


I learnt a lesson years ago about silence, you know, those empty space between words; I learnt that I didn’t need to fill them, that I could be comfortable in deep wells of silence. This week I reflected that I need to practice more.

cropped-northumberland.jpgWhen I did my leadership programme all those years ago we did a much hated exercise called ‘large group’. There was no structure, no agenda, no objective, just us and time. At first I was so uncomfortable I had to speak. I wasn’t the only one. Some of us shuffled and worried and spoke out filling the minutes and noiseless space. After the first couple of times I reflected on mine and others behaviours and decided I would experiment. I became a silent observer and spent my time listening and watching. I proved to myself that not only could I do it, it actually didn’t feel so bad. I know it improved my listening and observing too.

When I feel anxious or stressed I know I am more likely to dive in with words. I go really fast and have a reputation for being able to talk for England. This week a couple of things happened that made me think I perhaps need to practice silence more.

GoodMorningToAll_1893_songThe first was a great session by @heatherhenry. She talked about how to engage in communities and about giving people space and time, about not barging in with (probably the wrong) answers. She made me smile and gave me a tool for practice – she told us that if you want to be sure you have given someone time to answer, sing a whole chorus of Happy Birthday in your head – that’s just the right amount of time. I’m practicing and although it feels like a long time in my head it doesn’t seem to raise any eyebrows and actually people may well have told me things that they wouldn’t had I not given them time.

time to listenThe second is I spent a great day with a student nurse who is a self-confessed introvert. I reflected that I needed not to talk quite so fast, as, unlike some other colleagues, this conversation couldn’t be like a pacey game of tennis, where I serve the ball and they bounce it back. Perhaps it’s a bit more like golf with quiet walking time between hitting the ball.

Being mindful of silence has always been a positive thing for me but I do need to focus on doing it as my brain darts backwards and forwards and round about and it all tumbles out of my mouth. My son tells me all the time that I ask questions in 3s and it drives him mad – he just says – I can only answer one at a time and which one will it be? :0)

I know that for some people, like me, we are creative when we are bouncing ideas around verbally with others but I respect others right to time and silence. I promise I will continue to try as hard as I can to give people time, careful quiet listening and golden silence.

I had to post this! Silence is golden from the Tremeloes 1967

Thank goodness it was ophthalmology clinic and not sexual health.


I have lost many hours of my life talking about Information Governance (IG) and to make it worse it is not the subject that makes my heart sing.

computerI worked on the National Programme for IT and I have to say, despite what people might say, Information Governance was taken very seriously. So much so that the technical solutions that we worked on to create the best possible situations for holding and sharing the very sensitive information about people became increasingly elaborate and in many cases the solutions themselves were beyond my understanding. I think if we fell into a trap it was that one about increasing complexity making the issue worse, not better, and that we should have gone back to the citizen and kept it very simple.

We had complex use cases that tried to cover every possible sensitive scenario and tried hard to find solutions to them all.

It was hard and not very enjoyable work. But I do think we tried, we tried really hard to make sure it was the best it could be. I’m not sure we succeeded – my test for this is whether the debates have abated, they have not – but I know we put in much determined effort.  I was glad when I moved onto other more interesting and engaging work for me.

caldicottI know IG is a sensitive issue. I get it. I do my training every year and I am clear about my personal responsibilities. I have read Caldicott 2 and I understand not only my responsibility to protect information but also my duty to share when it the best for the patient.

I contrast this effort and experience with my visit to clinic on Friday which I tweeted about at the time. I arrived to the reception desk, in front of a very full, busy waiting area. The seats face the place you stand to book in and are actually quite close. The receptionist is lovely. Both this time and the last time I attended the same clinic I watched her offer very compassionate help to a number of people. But the booking in process stinks! I was asked for my name, address, date of birth and GP in front of the full waiting room; everyone must have been able to hear. I certainly heard every person who followed me recite their information.

waiting chairsI don’t think its OK to blame technology or the people who work in informatics and this feels like where the debates circle. I understand that electronic information can be accessed and shared potentially more widely than that single clinic with the 25 people who were sat observing but I have to say these are people who may well know me, my friends or my family, as they are local. Thank goodness it was ophthalmology clinic and not sexual health.

I accurately gave the feedback about my experience in the exceedingly small feedback box on the friends and family card including the feedback about the lovely receptionist.

Information governance is not just about IT!