The Placenta, The Nursing Student and the Teachable Moment

Johnson County Community College has fired back at the harsh criticism it has received  — including from this blog — for its expulsion of four nursing students, including Doyle Byrnes, the student who initiated the lawsuit against the school:

Johnson County Community College plans to vigorously defend the lawsuit brought by a student against the college. The lawsuit also asserts individual claims against the members of the college’s distinguished faculty and administrators.

“The entire college community is disappointed that the students have decided to abandon the academic appeals process and take their grievances to the court for resolution,” said Terry Calaway, JCCC president. “We regret that the students used such poor judgment to take such a unique educational opportunity that was presented in a private clinical setting and broadcast it on the Web. We teach our students to respect the confidentiality of patient care, which extends beyond the hospital room and includes situations when the nurse is not in the presence of the patient. The actions of the students showed not only poor judgment, but also lack of respect and a complete disregard for the ethical standards of the nursing profession.

[snip]

“We will not tolerate such insensitivity on the part of our nursing students. We also must protect the reputations of our business partners in health care. We provide students with real-life patient care opportunities, and we take our responsibilities very seriously. Please know their actions do not reflect the standards of our nursing program, which is renowned for the quality of its instruction and its graduates. Thankfully, the situation was brought to our attention by other students in the nursing program. We are grateful they recognized the inappropriateness of the other students’ actions and sought advice from their faculty, who took immediate action to ensure the posting was removed.

“We will do whatever we need to do to reassure the community that this behavior is not what we teach at JCCC. Because we cannot tolerate such unprofessional behavior in our students, we took what we believed to be appropriate action. The behaviors of the students were insensitive and disrespectful toward the mother and the human tissue involved. The fact that this story has so quickly gone viral is evidence itself of how damaging social media can be if not used appropriately.*

“The students who took the photos were not expelled from the college, as has been reported, but were temporarily dismissed from the nursing program. They are permitted to re-apply to continue their nursing studies in August 2011 and to graduate from the program in May 2012. In the meantime, they have been asked to participate in a project on medical ethics, which could turn this unfortunate incident into a teaching moment for the students. However, the student who filed the lawsuit is getting married out-of-state in August and therefore wants to complete her studies this spring. She is suing the college for immediate reinstatement so she can graduate in May 2011 according to her own schedule.” **

Yes, there are certainly teachable moments, but the college and the nursing program seem to have studiously avoided them:

1. We often talk about the need to acknowledge errors made and an ethical approach would demand acknowledgement of error, reflection and restoration. For example, if I commit an error adversely affecting a patient, best practice is not only to admit the mistake, and learn how to avoid it in the future,  but go to the patient to accept accountability and responsibility. I wonder if the director of nursing had any second thoughts about the punishment she doled out, and if she did, whether she considered ameliorating it. She might have avoided a lawsuit, and her nursing program going viral on the Net in the worst possible way.

Interestingly, from the published accounts, the students seem to have understood this before the school escalated the conflict out of control. Not so their instructors.

A corollary to this is the old maxim from public relations (which for this school have been disastrous): acknowledge mistakes, fix them and move on.

2. The College is now telling us after being expelled, the students would be permitted to “reapply” to the program in August 2011, and if accepted, would graduate a year late. Meanwhile, the school is requiring the students to attend some sort of “project on medical ethics.” Despite the clarification, the punishment is still high-handed and disproportionate. However, clearly the director of nursing felt there was some gross violation of ethics (even if the rest of us didn’t perceive it); Doyle Byrnes, for her part, was contrite and apologetic, and she pulled the photo off Facebook as soon as it became an issue.

Given these circumstances, measured consideration and a pragmatic, reflective approach might have suggested first meeting with the students to informally discuss the concerns about the photo, perhaps with an impartial facilitator, then working with them closely to develop a learning plan to meet the nursing school’s concerns, while keeping them in the program. That, I think, would have been true leadership. Instead, there is virtually no hope any of the students will ever complete the required ethics course, and it’s probably doubtful they would even want to return in any case. I wouldn’t blame them. So if the director’s original purpose was remediation of the situation, and rehabilitation of the students, it was a complete failure. It accomplished nothing, except some highly negative publicity. An alternative disputes resolutions process may have worked better.

Put another way, what’s the procedure at this school when a student makes a med error, when the harm is actual, not virtual, theoretical or imaginary?

3. Nerdy Nurse: “Opportunities like this should be used as ways to write policies and develop protocols to follow regarding healthcare and the growing involvement we are all having with social media, from nurses to doctors, to grandmas, and great aunts. Everyone is connected.”

Again, mission not accomplished. In the end, I’m curious what precisely the nursing school did accomplish in victimizing it students, besides trashing its own reputation and a lawsuit?

__________

*I guess that means we should all just shut up, like good nurses.

** A few random thoughts about this train wreck of a press release:

  • it still isn’t evident to me precisely which ethical principles of the nursing profession were violated. To say there was a breach of a patient’s confidentiality or privacy is frankly a stretch.
  • a placenta, post-partum, is a discarded by the body because it is no longer needed, having fulfilled its function. To fetishize it by assigning it great intrinsic value in of itself  — how can you diss a placenta? — strikes me as bizarre (to say the least).
  • calling the expulsion a “temporary dismissal” is pure spin. When you must reapply to be re-admitted to a program, you’re expelled.
  • I have seen photos in nursing textbooks which were clearly more exploitative.
  • the school’s real difficulty, it seems, was that the student posted the photo on Facebook, and Facebook, as we all know, ipso facto, is evil.
  • related to the above is that it seems there was no clear policy on the use of social media by students.
  • related to the above it’s pretty evident the school’s administration has no accurate knowledge of the nature of social media.
  • and again, the school and its nursing program are behaving like the nurses we all hope we aren’t: vindictive, arbitrary, authoritarian, backbiting  and petty, i.e. the college’s lawyers now claim, for example, the reason for lawsuit is related to Byrnes’ desire for a May wedding! Excellent role modelling, that. And great messaging the nursing program is sending out too: that any nurse who advocates for herself (and by extension her profession) and challenges a perceived wrong deserves to be slapped down, hard. The point being, if the nursing school demands exceptional ethics and professionalism from its students (as they should), it should at least demonstrate how exceptional nurses behave: with compassion, insight, and clarity of thought.
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  1. #1 by Not Nurse Ratched on Wednesday 05 January 2011 - 1059

    Sigh. But what else can they do, really, except point fingers? The fact that it’s gone viral is evidence that nurses occasionally DON’T eat their young and stand up for our newest inductees—not that social media is damaging. I’m bleakly amused at JCCC’s sadness that the students failed to avail themselves of academic due process whereas they themselves did no such thing and, moreso, of their bizarre manipulation of “explusion” and “suspension.” I live an hour from this program, and it HAS been highly regarded. I bet it will no longer be. They had a chance to backpedal and say, “Gee whiz, looks like we could have handled that better. Let’s all start over and this time, pretend we’re grown-ups.” Instead they’re engaging in prestidigitation and, not to put to fine a point on it, acting like toddlers stomping their feet.

    • #2 by torontoemerg on Wednesday 05 January 2011 - 2121

      Astonishing, isn’t it? But stupidity often is. Just shaking my head. . .

  2. #3 by onlinenursing on Wednesday 05 January 2011 - 1137

    Good for the students getting legal council. That is what I would have advised them to do in this obvious – lateral violence culture of nursing (and sometimes also academia) that was exposed throughout this entire PR nightmare that JCCC is now not handling appropriately.

    I would like to say a lot more unprofessional things here… but as I told another fellow nurse… this anger’s me beyond words. Give me a camera because I want to take 100000000000000000000000000000000 placental pictures. Placentas are fascinating there is no doubt, as is lab time and learning. I would be honored if some nursing student
    wanted to see a placenta that came out of my body and look at it extensively and even have a picture with it.

    There are pictures of students in lab on the wall in our commons area for goodness sake? The fact that they aren’t on facebook makes them not evil? Yet we have shining examples of schools like the one in Mesa County Arizona that even have a facebook account for their lab mannequin.

    The research supports that nursing education is not meeting the demands of health care and that nursing education is falling behind in technology, humanities, etc. Perhaps it is because we have this intense fear of litigation that our students education is being hampered? Just a thought.

    I am sure we have not seen the end of this yet and perhaps this will be a lesson for all nursing educational units and nurse educators on how not to behave and to have clear policies (albeit restrictive due to the lack of understanding about social media) in place and faculty education in such communication medium and policies.

  3. #4 by Barry on Wednesday 05 January 2011 - 1731

    Why do I suspect that “We also must protect the reputations of our business partners in health care” is at the root of this heavy-handed approach?

    (I assuming that patients don’t count as “business partners.”)

  4. #5 by sarahbethcorrigan on Wednesday 05 January 2011 - 2211

    Can I just say thank you for calling their press release a train wreck. So true.

    I wrote about a possible root cause of the problem if you are interested.

    http://sarahbethrn.com/post/2570306000/nursing-student-expelled-for-facebook-photo-the

  5. #7 by Sean on Wednesday 05 January 2011 - 2312

    I wonder how great our profession woulda/ coulda / shoulda have been/ could be if the all-mighty’s in power and influence would step back and ….. oh I don’t know.. remember what it is like to be a nurse, or a nursing student.

    Yes, eating our young is such a kind colloquialism isn’t it?

    *sigh*

  6. #8 by The Nerdy Nurse on Thursday 06 January 2011 - 2335

    seeing that the students were readmitted is a step in the right direction, but can you imagine what hell this semester is going to be like for them?
    Talk about bein uncomfortable, I cannot imagine what scrutiny any of their work will face.
    And the care plans, my God at what care plans they will likely have to write!

    • #9 by torontoemerg on Thursday 06 January 2011 - 2341

      Yeah, I was kinda thinking that too — I would’ve gone for the compensation possible: cold hard cash.

  7. #10 by Aero Bigboots on Tuesday 18 January 2011 - 0455

    If patient confidentiality HAD been involved, that could have been a very different story.

    It seems here that it’s mostly an august institution that hasn’t taken the time to understand the modern world. When you allow people: your employees, your patients, your community, your fans, the general public, to use social media, be it outlets like Facebook, or comments on your own website or blog, you make a tremendous amount of praise and criticism, of support and critique, possible.

    A lot of managers feel an instinctive impulse to micro-manage this media. To find ways to filter it, control it, prevent criticism, etc. I believe that increasingly, confident, forward-looking organizations are choosing to let the river run. Choosing to believe that in balance, if they’re doing good work, the discourse from all parties will reflect that. That a few negative or weird comments will be seen as such, that real problems revealed through social media should be addressed, and that in total, the organization will be stronger, better serve its community, and be perceived as more open, caring, and fair.

    To the extent that “having a social media policy in place” is code for who is allowed to speak when, I believe the public is very skilled at detecting organizational publicity and that they are deeply contemptuous of it. The small hits an honest, hard-working organization will take from a fairly open media policy are well worth the credibility and faith it will be rewarded with.

    • #11 by torontoemerg on Tuesday 18 January 2011 - 1413

      “To the extent that “having a social media policy in place” is code for who is allowed to speak when, I believe the public is very skilled at detecting organizational publicity and that they are deeply contemptuous of it.”

      Interesting point. Part of the legal case was there was no policy at the school — but maybe we don’t want policy if it’s another form of censorship.

  8. #12 by Vicki on Wednesday 09 February 2011 - 1621

    Sorry, but the students were wrong. With HIPAA and confidentiality being such a huge issue in todays health care arena, everyone must be extra cautious. The issue is not that more graphic photos are in the text, but that patient confidentiality is compromised. What would the student think if the patient decided to press charges, especially if she did not sign a waiver allowing photographs. The issue is more than social media, it is about ethical responsibility. And yes, I have been a nurse since 1974, worked in many different aspects of health care including OB and nursing education.

    • #13 by Jill on Saturday 12 February 2011 - 1028

      I totally agree. Where was common sense when the students decided to do this? Would you want this student nurse , who sees nothing wrong with what she did, to be your nurse in L&D? As a woman who has given birth, I would have been humiliated to have a picture of my placenta on facebook for everyone to make jokes about.

    • #14 by Student Nurse 2011 on Monday 14 February 2011 - 0041

      I absolutely agree that these students should have been dismissed from their program. I would NEVER in a million years dream about taking a picture of anything dealing with a patient in clincals, let alone post it on Facebook. That was plain stupid. It reminds me of the new grad that took pictures of a newborn on her unit and posted them to her FB and was fired and lost her license. If these students thought this was ok, what was going to be next? They deserved everything they got and I give kuddos to their classmates that turned them in.

      Nurses have to be ethical and be accountable for their actions. I wouldn’t want any of those people to be my nurse if they can not uphold HIPPA without a babysitter.

  9. #15 by click the up coming webpage on Saturday 26 July 2014 - 0038

    I know this if off topic but I’m looking into starting my own blog and was
    wondering what all is needed to get set up? I’m assuming having a blog like yours would cost a pretty penny?
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