Posts Tagged Johnson County Community College

The Case of the Disembodied Placenta

Now, there's some cool Kelly clamp usage.

Let us bow down before the sacred placenta.

Amen.

Sorry. I don’t mean to beat the thing to death, but the media reaction to the reinstatement of Doyle Byrnes and her colleagues strikes me as, well, odd. Their consensus: the school may have been a bully, but they photographed a placenta — why, that’s a very sensitive organ! People feel very strongly about their placentas! Robyn Urback at Maclean’s, for example (for my U.S. readers, Maclean’s is a Canadian news magazine):

And they weren’t doing anything exceptionally inappropriate with the organ, just posing and snapping photos (which is curious enough, to say the least). But the situation is complicated for a number of reasons. Firstly, the placenta is an organ involved with reproduction and birth, which makes it a little more personal, sensitive, than a lung, for example. It’s the difference between posing with a heart and posing with a pair of severed testicles; one snapshot will elicit a little more reaction. Secondly, the students are studying to be nurses, a job that demands professionalism and empathy, especially when working with patients whose illnesses have robbed them of dignity. Nonchalance in the presence of blood, scars, feces, vomit, etc. (except when medically necessary) is the mark of appropriate bedside manner. Few patients would feel secure watching their nurse gawk at their oddly coloured growth.

Hmmm. Not sure exactly how photographing a placenta makes nursing students any less professional and empathetic, but let’s give that one a pass. Let’s recap for a moment, though:

The nursing student was appropriately gloved and clearly in a healthcare setting.

The placenta was not obviously attached to either mother or child, and was sitting in an examination tray (as opposed to resting next to pitcher of sangria with a little yellow umbrella poking from the cord.)

The previous user(s)/owner(s) of the placenta were in no way identified.

Anyone who has watched reality television has seen far worse and in a much more exploitative context, than say, nursing students getting excited about getting up close and personal with a placenta in the pursuit of knowledge.

In short, it’s hard to see from where I sit how the students were disrespecting the placenta, if in fact it’s possible to do such a thing. Let’s put it another way: hospitals don’t make any exceptional provision for protection of placental integrity and dignity. There are no special rules for the disposal of placentas. Evidently, the hospital which provided the placenta to the students had no concerns either. Then there’s this: when I was a nursing student there was a designated placenta freezer. The hospital sold them to cosmetic companies. (I’d be curious if that practice still goes on.) Bottom line: it’s a piece of tissue, people. 99 people out of 100 would not recognize one if they fell over it on the street. Having fulfilled its function, a placenta has no spiritual or mystical value, if it ever did so in the first place. It has no feelings to be hurt. That’s all. Or am I completely out to lunch on this?

[Update: corrected some minor spelling/grammatical issues, and changed a couple of words for clarity. Because tonight I can’t proofread worth a damn.]

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Good News from Kansas after a Spectacularly Awful Day

Your humble charge nurse had an awesomely bad day, in a week of similarly nasty days, so crappy in fact that I’m too tired and fed up even for my usual upper-management-idiocy snarkiness. The only slight consolation is that I understand nearly every hospital in the Greater Toronto region has been overwhelmed with patients. Superior Hills General, our bigger neighbour down the road, I’m told, had an 36 admitted patients boarding the ED, and an unbelievable 61 patients held for consult.

The good news is that a judge has ruled against Johnson Community College in the placenta Facebook case. To say the court spanked the College would be an understatement. Some more details on the events leading to the expulsion:

Byrnes said the picture was on her Facebook profile for about 3 hours, until Delphia [Byrnes’ lab instructor] called her and requested she remove it, which she did. Byrnes says Delphia told her she wasn’t in trouble during the conversation.

But the next day, Byrnes said, Johnson County Community College Nursing Director Jeanne Walsh blasted her and the other students by screaming and crying at them.

“During the meeting, Director Walsh’s emotional conduct precluded the students from defending themselves and adequately explaining the reasons for engaging in the conduct in question,” the complaint states.

“Director Walsh summarily dismissed Plaintiff Byrnes and three other members of the lab group from the nursing program, and exclaimed, ‘I don’t know if I would want you back.'”

Is this how we want nurse educators to act? I don’t want to flog a dead horse, but again it strikes me the true professionals were the students, not the Nursing Director. In its press release, JCCC was typically gracious towards the students in admitting defeat, as it has been in this whole process. Okay, maybe not so much.

“We are disappointed with the court’s decision today,” said Terry Calaway, JCCC president. “Of course we’ll abide by the judge’s decision and readmit the student to the nursing program.

“The JCCC nursing program is widely known and respected for the quality of its instruction and its graduates. Sensitivity to patients and confidentiality of patient care is at the heart of what we teach. We took what we believed to be appropriate action, but the court saw the situation differently, so the student will be readmitted to the program.”

The students who took the photos were never expelled from the college, as has been reported, but were temporarily dismissed from the program.

Three other students who had been dismissed from the program will also be readmitted.

Classy to the bitter end, eh? (See, I’m so tired even my sarcasm bone is exhausted.)

To Doyle Bynes and colleagues: congratulations and well done. You do us proud, and you’re a credit to our profession.

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*JCCC needs to give up on the “temporarily dismissed not expelled” spin. It’s a distinction without a difference, and it’s silly.

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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?

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*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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How To Be Arbitrarily Kicked Out of Nursing School

In some states, public display of a placenta by a nurse is punishable by death

Want to get kicked out of nursing school? Display a placenta on Facebook.

The shorter version of this story tells of a director of nursing named Jeanne Walsh arbitrarily booting a student named Doyle Byrnes (right) from the from the nursing program at Johnson County Community College in Overland Park, Kansas only a few months short of graduation. Her heinous offence? She published on Facebook (with her instructor’s permission, mind you) a photograph of herself beside an anonymous placenta. In the letter of expulsion Walsh was brutal, yet undoubtedly fair — at least in her own mind. She wrote Byrnes: “Your demeanor and lack of professional behavior surrounding this event was considered a disruption to the learning environment and did not exemplify the professional behavior that we expect in the nursing program.”

I am mystified and not only by the Walsh’s evasive, accountability-shifting use of the passive voice. All I see here is an obviously excited, eager student with the “shiny shultz” side of the placenta showing in a tray.* Bad taste? Debatable. It’s certainly no worse than reality television. It’s not as though she’s swinging the thing around by the umbilical cord. Maybe instead of the contagious grin, she should be frowning at it slightly. Is there some gross violation of nurse-placenta confidentiality I’m missing?  What, did the placenta call to complain about its treatment?

Not Nurse Ratched had the best comment:

JCCC says it’s “a lesson hard learned.” Indeed, but not the one the school probably thinks it’s sending: the lesson is that nursing is filled with inexplicable decisions and finding out after the fact you did something Bad. This student can carry that lesson with her, but is it really one our nursing schools should be teaching? Can they not teach something more like “here’s an opportunity for education regarding healthcare and social media”?

Yep, indeedy, that pretty well sums up this school’s competency. No warning letter, no chance at remediation, just straight out the door. Nothing like grabbing the figurative axe for fixing a problem —  and incidentally demonstrating the nasty underbelly of nursing. Makes you wonder how this school reacts when a student actually does something serious.

So a few conclusions: first, Johnson County Community College’s nursing program is probably — well, let’s be kind and damn with faint praise: they do their very best, despite having no sense of proportionality — or humour. Second, higher degrees in nursing are evidently not guarantees of effective skills in either nursing education and administration. Third, we often talk about nurses eating their young. After seeing this story and hearing about others like it —  and it truly pains me to say this — I’m beginning to wonder if the source lies in nursing educators inculcating those old-fashioned nursing “values.” You know, the ones that say arbitrary and unjust behaviour, back-stabbing and treating nurses as expendable are acceptable. After all, isn’t this a classic example of how colleagues and superiors knee-cap young nurses and students?

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*Note to AtYourCervix: I was not sleeping all the time during my Obs/Gyne rotation.

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