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.