Transcript of #RNchat Twitter chat for registered nurses on October 19, 2009. Topics discussed: Death/Dying and Public Perception of Nursing.

1. RoRod101: Hi All, My name is Rosita, ok 2 shorten 2 Ro. I am an RN, NP, Nurse Educator & DNP
student. Happy to be amongst fellow nurses. #RNchat
10/19/2009 11:30
EllenRichter: Hi friends! Gee, I'm glad I could break away for a while & come to #RNchat
10/19/2009 11:30
EllenRichter: I'm Ellen, a currently-practicing critical care nurse & behind-the-scenes consultant on
medical litigation :) #RNchat
10/19/2009 11:32
RoRod101: Hi there Ellen! #RNchat
10/19/2009 11:33
JennyBizRN: Good Morning, Jennifer RN, here telehealth and legal nurse. Twitter addict; Chicago
#RNchat
10/19/2009 11:34
rnchat: First topic coming up - it's a bit heavy for a Monday but you're all strong. #RNchat
10/19/2009 11:34
EllenRichter: Hi Ro & Phil & Jim #RNchat
10/19/2009 11:34
2healthguru: #rnchat Phil et al, have you seen this @RWJF series "#HealthCare Without Harm?"
>>http://bit.ly/23Ajs9<<
10/19/2009 11:34
lyall: G'day I'm Lyall from Perth Western Australia. I'm an agency nurse & token Gen Y RN :)
#rnchat
10/19/2009 11:35
rnchat: T1 Dying - How do help your patients (& family) with the dying process (or how in the
past if your're no longer bedside)? #RNchat
10/19/2009 11:36
JennyBizRN: hospice hospice I am all for it, having helped to many friends and relatives into and thru it
#RNchat
10/19/2009 11:37
philbaumann: @medxcentral Thank you for your passion for nursing. Why not join the #RNchat as
@jimcanto ? Jim's welcome there.
10/19/2009 11:38
EllenRichter: T1 In this day & age, people need help to make conscious decisions that support death
by dignity~nurses help provide information #RNchat
10/19/2009 11:38
JennyBizRN: Part of my ICU burnout was at a hospital where it was always "do everything", very hard
and frustrating #RNchat
10/19/2009 11:38
RoRod101: T1 I work as an NP part-time in a LTCF specializing in AIDS & unfortunately deal with
the dying process & help pts & family thru it #RNchat
10/19/2009 11:39
EllenRichter: Hi Jen & welcome @lyall & hi 2healthguru, thanks for the video link, I'm saving it for
afterwards :) #RNchat
10/19/2009 11:39

2. spf2j123va: T1-Dying RT @RNchat I'm @uvason & we are making a strong push to > compassionate
care at EOL (end of life) held an interdisc conf. #RNchat
10/19/2009 11:40
RoRod101: T1 Meant to add deal with the dying process alot #RNchat
10/19/2009 11:40
EllenRichter: T1 I help uneasy adult children realize the importance of following their parents wishes at
the time when death is imminent #RNchat
10/19/2009 11:40
JennyBizRN: RT @spf2j123va: T1-Dying RT-too long sorry, but like what u had to say #RNchat
10/19/2009 11:41
EllenRichter: @RoRod101 T1 Do you find that most of your LTCF patients have living wills & health
care surrogates? #RNchat
10/19/2009 11:42
JennyBizRN: I do my best to make sure everyone I know has a healthcare power of attorney, a MUST
#RNchat
10/19/2009 11:42
bhawkesRN: ...Beth here sneaking in for a minute or so.. #rnchat
10/19/2009 11:42
RoRod101: T1 @EllenRichter All of our residents receive counseling regarding advance directives on
admission #RNchat
10/19/2009 11:43
EllenRichter: T1 Many times its the family who uses up more health care energy when delivering
nursing care at end of life~ We have more than 1 pt #RNchat
10/19/2009 11:44
rnchat: @bhawkesRN Welcome! #RNchat
10/19/2009 11:44
bhawkesRN: @rnchat thanks! nice to be here #rnchat
10/19/2009 11:45
JennyBizRN: We know the sometimes fruitless end of life care is one of the highest expenses of
healthcare-so just have that living will/POA #RNchat
10/19/2009 11:45
rnchat: T1 Just as a follow-up: how well does our culture (or your respective country's culture)
confront dying? #RNchat
10/19/2009 11:46
EllenRichter: RT @rnchat: @bhawkesRN Welcome! Yes, & we also welcome @spf2j123va :) #RNchat
10/19/2009 11:46
bhawkesRN: RT @EllenRichter: T1 Many times its the family who uses up more health care energy
when delivering nursing care at end of life #rnchat
10/19/2009 11:46
JennyBizRN: I don't think Americans do well with preparing for /confronting dying. We can barely
handle aging LOL #RNchat
10/19/2009 11:47
TeriRN: Hi guys. Teri here. I'm a travel nurse currently traveling 2 my next assignment. Hope I

3. keep internet long enough. =) #RNChat
10/19/2009 11:47
DinahsDragonfly: Can be a discussion any time w/ pcp any office visit and hospital stay, I have discussed in
DM/CM position as routine of my own. #RNchat
10/19/2009 11:49
EllenRichter: T1 Cultural differences span the gamut of emotions when it comes to death & dying. Must
understand/support where they R coming from #RNchat
10/19/2009 11:49
TeriRN: T1 EOL care is my specialty Just being available & answering their questions is a big
help Getting docs on board is abig issue w/EOL #RNChat
10/19/2009 11:49
DinahsDragonfly: sorry this is Dinah RN CM/DM Telehealth RN #RNchat
10/19/2009 11:50
AbbieCitron: Hi fellow RNs, Abbie here reading along with you. #RNChat
10/19/2009 11:50
JennyBizRN: Hi Dinah! Hello to all of you. I know Dinah as we worked together and she is terrific and
knowledgable nurse #RNchat
10/19/2009 11:50
bhawkesRN: T1 I notice docs from different culutres have different beliefs as well re: end of life #rnchat
10/19/2009 11:50
JennyBizRN: @TeriRN yes the docs are often the hardest part #RNchat
10/19/2009 11:51
RoRod101: T1 The process of dying is very complex. It has different meanings for every culture and
each individual. #RNchat
10/19/2009 11:51
TeriRN: @EllenRichter That is so true. One reason why nurses need to be up on the cultural
differences of their patients. #RNChat
10/19/2009 11:51
EllenRichter: T1 Agree w/ @DinahsDragonfly Living will wishes & health care surrog should be
discussed all thru life, even at well-visits to pcp #RNchat
10/19/2009 11:52
AbbieCitron: TI My experiences with this topic is mainly pediatric, just wanted to add the invaluable
help of social workers during death & dying #RNChat
10/19/2009 11:52
RoRod101: RT @lyall: T1 Dont be afraid 2 give enough analgesia. Clinical judgement is based on
effective tx of sxs. Relieve pain = dignity. #RNchat
10/19/2009 11:53
bhawkesRN: Agree w @lyall I cringe when nurses withold pain med at EOL. Becuz they'll get hooked?
?! #rnchat
10/19/2009 11:53
rnchat: RT @lyall: T1 Dont b afraid 2 give enough analgesia. Clinical jdgmt based on effective Tx
of symptoms. Relieve pain = dignity. #RNchat
10/19/2009 11:53
EllenRichter: T1 Its very disheartening when health care surrogates don't follow the pts wishes at EOL~

4. Not sure how thats allowed! Educate HCSs! #RNchat
10/19/2009 11:54
TeriRN: @lyall T1 I let my pts & families know that if the pt has signs of pain their is no such thing
as too much in EOL as long as tx s/s #RNChat
10/19/2009 11:54
AbbieCitron: so true RT @RoRod101: T1 The process of dying is very complex. It has different
meanings for every culture and each individual. #RNChat
10/19/2009 11:54
JennyBizRN: RT @bhawkesRN: Agree w @lyall I cringe when nurses withold pain med at EOL. Becuz
theyll get hooked??! YES that makes me cringe so! #RNchat
10/19/2009 11:54
EllenRichter: lyall: T1 Dont be afraid to give analgesia. Clinical judgement is based on effective Rx of
symptoms Relieve pain=dignity ~How true! #RNchat
10/19/2009 11:55
JennyBizRN: @EllenRichter isn't it usually the family at that last minute? #RNchat
10/19/2009 11:55
EllenRichter: Hi @AbbieCitron & @TeriRN :) #RNchat
10/19/2009 11:55
rnchat: Wonderful discussion! Our next topic is coming up in a few minutes. #RNchat
10/19/2009 11:56
DinahsDragonfly: RT @JennyBizRN: Hi Dinah! Hello to all of you. I know Dinah as we worked together and
she is terrific and knowledgeable/ Hi&thanks #RNchat
10/19/2009 11:56
TeriRN: @bhawkesRN You hit on one of my pet peeves. If tx the s/s then there is no addiction or
getting hooked just comfort & dignity. #RNChat
10/19/2009 11:57
EllenRichter: @JennyBizRN T1 The health care surrogate is whoever the pt chose in their living will &
yes many times its family--they get scared! #RNchat
10/19/2009 11:57
rdjfraser: @EllenRichter @TerriRN I definitely agree, I spoke with Joan Lesmond who did her PhD
on the topic, really interesting #RNchat
10/19/2009 11:59
rnchat: T2 Public Perception of Nursing - What's your sense of the general public's view of
Nursing? Accurate? Misinformed? What would help? #RNchat
10/19/2009 12:00
EllenRichter: @rdjfraser Oh yes I know that death & dying is a whole science to itself, multifaceted,
complex & very interesting to participate in #RNchat
10/19/2009 12:01
TeriRN: @AbbieCitron I call in the SW & chaplain often They R a valuable part of the hospice
team. Sometimes need 2 talk not meds #RNChat
10/19/2009 12:01
JennyBizRN: As telehealth RN public LOVES us and loves to talk to us #RNchat
10/19/2009 12:01
lyall: Yay @rdjfraser Now I'm not the only Gen Y RN here :) #rnchat

5. 10/19/2009 12:02
EllenRichter: T2 ~Most of my pts in ICU say "I never KNEW a nurse did so MUCH!" People have no
idea of our scope & responsibilities #RNchat
10/19/2009 12:02
JennyBizRN: It also depends, if patient has been in hospital they see what we do. TV portrayal is way
off. #RNchat
10/19/2009 12:03
EllenRichter: @TeriRN ~Yes, I agree hospice isnt only for meds, it can be for communication &
emotional support which are important as well #RNchat
10/19/2009 12:03
AbbieCitron: RT @EllenRichter: T2 ~Most of my pts in ICU say "I never KNEW nurses did so MUCH!"
People have no idea of our scope/responsibilities #RNChat
10/19/2009 12:04
TeriRN: T2 Thanks to past & recent shows w/nurses there is a BIG misconception of what RN's
do. #RNChat
10/19/2009 12:04
bhawkesRN: T2 Instead of saying "I'll be ur nurse today" try "I'll be coordinating your care today"
#RNchat
10/19/2009 12:05
TeriRN: T1 I'm already working on my son & daughter to do LW's. I've had too many young pts
w/o one & no one willing 2 make decisions. #RNChat
10/19/2009 12:06
EllenRichter: RT @bhawkesRN T2 Instead of saying "I'll be ur nurse today" try "I'll be coordinating your
care today" ~Psych 'em out, eh :) #RNchat
10/19/2009 12:07
AbbieCitron: Like this approach! RT @bhawkesRN: T2 Instead of saying "Ill be ur nurse today" try "Ill
be coordinating your care today" #RNChat
10/19/2009 12:07
RoRod101: T2 @EllenRichter Public really does have a misconception of our scope & responsibilities
& it doesn't help da way TV portrays nurses #RNchat
10/19/2009 12:08
DinahsDragonfly: My pt's have always stated how much they rely on what I/we tell them - education,
CM/DM. learn more from us/me the nurse. They trust #RNchat
10/19/2009 12:08
TeriRN: @bhawkesRN Do U find success w/ that? It seems it still blurs what each team mem.
does. Have many tell me the CNA is their nurse =( #RNChat
10/19/2009 12:08
rnchat: @EllenRichter @bhawkesRN I like your take charge approach - rather than waiting for
something to change, be the change. Nice! #RNchat
10/19/2009 12:08
EllenRichter: @AbbieCitron LOL yes I like that too! #RNchat
10/19/2009 12:08
bhawkesRN: T2 Even pts who see what we DO may not recognize all the assessment, planning and
intervention #RNchat
10/19/2009 12:08

6. TeriRN: @EllenRichter Same here w/hospice I love talking about EOL & dispelling the myths &
misconceptions of what we do. Definitely success #RNChat
10/19/2009 12:09
rnchat: T2 Follow-up: if you had a magic wand, how would want nurses to be portrayed (given
the variety of nursing, of course). #RNchat
10/19/2009 12:10
DinahsDragonfly: Too often told that no one else told them this or that before and it made a difference in
their health outcome.= PT EDUCATION #RNchat
10/19/2009 12:10
lyall: T2 When you do stuff to pts (tasks) explain to pt what ur doing while ur doing it. It shows
we have skills & knowledge. #rnchat
10/19/2009 12:10
JennyBizRN: @DinahsDragonfly SOO TRUE, esp in telehealth we often are amazed when we tell them
things #RNchat
10/19/2009 12:11
AbbieCitron: All in all, I think most pts realize when they have a good nurse caring for them & are
appreciative. #RNChat
10/19/2009 12:12
lyall: @DinahsDragonfly hear hear. Pt education is a great opportunity to improve outcome &
demonstrate nursing skill & knowledge #rnchat
10/19/2009 12:12
TeriRN: T2 Exactly the way we do our jobs. We aren't all over the hospital on all floors, not even
the CNO. #RNChat
10/19/2009 12:13
bhawkesRN: T2 magic wand: seen as: competent, evidence based, compassionate, professional
members of the hc team #RNchat
10/19/2009 12:13
AbbieCitron: RT @lyall: @DinahsDragonfly hear hear. Pt edu. is a great opportunity to improve
outcome & demonstrate nursing skill/knowledge #RNChat
10/19/2009 12:13
EllenRichter: T2 If I had a magic wand I would wisk away doctor-nurse chain of command & raise
nursing 2 an independent yet participatory professn #RNchat
10/19/2009 12:14
lyall: @AbbieCitron I agree but I don't think they really know WHY their nurse is good #rnchat
10/19/2009 12:14
RoRod101: T2 RT @AbbieCitron: All in all, I think most pts realize when they have a good nurse
caring for them & are appreciative. #RNchat
10/19/2009 12:14
TeriRN: @DinahsDragonfly I hurt when I realize I'm the one left to tell the pt & family that they are
dying & may have 6 months left. #RNChat
10/19/2009 12:14
RoRod101: RT @bhawkesRN: T2 magic wand: seen as: competent, evidence based, compassionate,
professional members of the hc team #RNchat
10/19/2009 12:14

7. TeriRN: RT @bhawkesRN: T2 magic wand: seen as: competent, evidence based, compassionate,
professional members of the hc team //Amen #RNChat
10/19/2009 12:15
JennyBizRN: @EllenRichter great statement Ellen, what Nursing needs! #RNchat
10/19/2009 12:16
bhawkesRN: Agree! RT @lyall: @AbbieCitron I agree but I dont think they really know WHY their
nurse is good #RNchat
10/19/2009 12:16
TeriRN: RT @DinahsDragonfly hear hear. Pt edu. is a great opportunity to improve outcome &
demonstrate nursing skill/knowledge #RNChat
10/19/2009 12:16
EllenRichter: @TeriRN Actually sometimes I LIKE being the one left to tell the pt & family theyre dying
because I will B most compassionate! #RNchat
10/19/2009 12:17
mkopp1: T2b RNs r the hands on care for MDs. We need to know the details just as much as the
MD. We r the pt's care provider too #rnchat
10/19/2009 12:17
bhawkesRN: RT @EllenRichter: T2 I would wisk away doctor-nurse chain of command & raise nursing
2 an independent yet participatory professn #RNchat
10/19/2009 12:17
JennyBizRN: Still amazes me, pts leave hospital/MD offc and call us at telehealth w so many?s, but
they trust/appeciate/understand what we do #RNchat
10/19/2009 12:17
bhawkesRN: T2 isn't there a country where the RNs have to approve hospital admits? #RNchat
10/19/2009 12:18
EllenRichter: T2 @mkopp1 I agree with U. I have great relationshps w/ the MDs I work with but its
always an initial uphill battle to prove myself #RNchat
10/19/2009 12:18
JennyBizRN: This is the part I get to see, that I didn't in hospital nursing #RNchat
10/19/2009 12:19
lyall: RT @bhawkesRN: T2 magic wand: seen as: competent, evidence based, compassionate,
professional members of the hc team #rnchat
10/19/2009 12:19
EllenRichter: RT @mkopp1: T2b my magic wand: an important part of the healthcare team, caring,
knowledgable, an advocate. ~Yes you have that rite! #RNchat
10/19/2009 12:20
KPNurseRecruit: Hats off to all the nurses today improving the patient experience (and outcomes too!) with
meaningful patient education! #RNChat
10/19/2009 12:21
JennyBizRN: Next week I will miss this, my hours change....again #RNchat
10/19/2009 12:21
EllenRichter: T2 my next magic wand swing would pay nurses based on fees for services, even in a
hospital #RNchat
10/19/2009 12:22

8. JennyBizRN: RT @EllenRichter: T2 my next magic wand swing would pay nurses based on fees for
services, even in a hospital YES YES YES YES #RNchat
10/19/2009 12:23
rnchat: @JennyBizRN Next chat will be announced in a few minutes. #RNchat
10/19/2009 12:23
EllenRichter: RT @KPNurseRecruit Hats off to RNs today improving the pt experience (& outcomes
too!) with meaningful patient education! I agree!! #RNchat
10/19/2009 12:24
DinahsDragonfly: RT @EllenRichter: raise nursing 2 an independent yet participatory professn; aGREE
need more visibility as that "type" of profession.#RNchat
10/19/2009 12:24
EllenRichter: @JennyBizRN LOL glad you liked that T2 suggestion! I've been crying about that for
years! :) #RNchat
10/19/2009 12:24
EllenRichter: With our T1 & T2 a & b answers, it seems that the Twitter nurses are all on the same
page on many thoughts, ideas & subjects! :) #RNchat
10/19/2009 12:25
DinahsDragonfly: RT @lyall: I don't think they really know WHY their nurse is good/Agre but 1st they know
we come from caring/love-they tell me this #rnchat
10/19/2009 12:26
bhawkesRN: @EllenRichter As long as we are hourly employees..... we will remain hourly employees!
:) #RNchat
10/19/2009 12:26
EllenRichter: Geez, an hour has passed?? Where does it go? Great chat folks! Wow, & a nice turn-
out! TY @PhilBaumann for this #RNchat
10/19/2009 12:27
AbbieCitron: Tweeters not on chat asking me what is best way to say thank you to good nurses?
Notes to supervisors? Thoughts? #RNChat
10/19/2009 12:27
JennyBizRN: RT @EllenRichter: Geez, an hour has passed?? Where does it go? Great chat folks!
Wow, & a nice turn-out! TY @PhilBaumann for this #RNchat
10/19/2009 12:28
TeriRN: RT @EllenRichter: Geez, an hour has passed?? Where does it go? Great chat folks!
Wow, & a nice turn-out! TY @PhilBaumann for this #RNChat
10/19/2009 12:28
RoRod101: I greatly enjoyed conversing with all of you. It was also a pleasure to meet some new
tweeples. Nurses are Awesome! :) #RNchat
10/19/2009 12:28
BonnieRN: RT @EllenRichter T2 my next magic wand swing would pay nurses based on fees for
services, even in a hospital #RNchat
10/19/2009 12:28
rnchat: We're coming up on one hour. Speedy, speedy! Great discussion today & nice turnout!
Wrapping up in a few minutes. #RNchat
10/19/2009 12:28
AbbieCitron: RT @EllenRichter: Great chat folks! Wow, & a nice turn-out! TY @PhilBaumann for this

9. #RNChat
10/19/2009 12:29
DinahsDragonfly: RT @EllenRichter: because I will B most compassionate! ; agreed 100% Dr's often are at
loss- feeling of failure, poor talk #RNchat
10/19/2009 12:29
mkopp1: RT @AbbieCitron: Tweeters not on chat asking me what is best way to say thank you to
good nurses? Notes to managers & direct to RN #RNChat
10/19/2009 12:29
EllenRichter: @AbbieCitron Most hospitals (facilities) have an internal way that nurses can be praised
& rewarded by patient & family comments #rnchat
10/19/2009 12:30
TeriRN: @AbbieCitron Send goodies to the staff, notes to their supervisor. I have a file of TY
notes from patients to me. #RNChat
10/19/2009 12:30
rnchat: Thank you all: NOTE: I'm sorry if I get testy/defensive about potential spammers. I'll work
on another approach. Doing my best. #RNchat
10/19/2009 12:30
mkopp1: Sorry to pop in late. Was carried away with packing for our family trip to disney world this
Thurs. Will muss you all next week!#rnchat
10/19/2009 12:31
bhawkesRN: Thank you @RNchat for coordinating. Love chatting with you all #RNchat
10/19/2009 12:31
DinahsDragonfly: RT @JennyBizRN: Agreed Jen, they leave w/ questions & then ask the nurse for the
answers/interpretations, support, what next. #RNchat
10/19/2009 12:31
EllenRichter: Yes I see a few new "faces" here that I will be following! :) #rnchat
10/19/2009 12:32
rnchat: THANK YOU!!! All of you are creating a remarkable community here. It's clear you're all
terrific nurses. #RNchat
10/19/2009 12:32
EllenRichter: @mkopp1 Oh, have fun! & it seems like you were here for most of it & had great
comments :) #rnchat
10/19/2009 12:33
lyall: @DinahsDragonfly true however RNs often get credit for being nice whereas Drs for
knowledge/skill. We aren't good just coz we r nice #rnchat
10/19/2009 12:33
TeriRN: RT @EllenRichter: Yes I see a few new "faces" here that I will be following! :) // me too!
=D #RNChat
10/19/2009 12:33
lyall: Cheers everyone. It's half past midnight so goodnight all. #rnchat
10/19/2009 12:34
DinahsDragonfly: RT @bhawkesRN: approve hospital admits?/yes,I set up program fromour ER for Coord
to adm or send to TCU or Home Care, office visits.#RNchat
10/19/2009 12:34

10. rnchat: Our next chat is this Thursday 10/22 20:30 EDT. Transcript up in a bit on our website.
#RNchat
10/19/2009 12:34
EllenRichter: Thanks to YOU, Phil! RT @rnchat THANK YOU! All of U are creating a remarkable
community here. Its clear youre all terrific nurses #rnchat
10/19/2009 12:35
lyall: @rnchat Can you please advertise times in UTC so international nurses can calculate
time more easily? #rnchat
10/19/2009 12:35
AbbieCitron: @mkopp1 Have a great trip to Disney World! #RNChat
10/19/2009 12:36
EllenRichter: Ohh, a nite chat, my favorite ~RT @rnchat Our next chat is this Thursday 10/22 20:30
EDT. Transcript up in a bit on our website. #RNchat :)
10/19/2009 12:37
spf2j123va: RT @EllenRichter@KPNurseRecruit Hats off to RNs improving pt experience (& outcomes
too!) w/ meaningful patient education! I agree!! #RNchat
10/19/2009 12:37