May you find the opportunity in every challenge.

The internet erupted on Saturday about something that Senator Walsh in Washington State said in a hearing about nurses. Her tone and underlying assumptions about our ability to play cards while at work were very disrespectful to the 4 million of us in the United States.

This is the second time in a few years where someone in the public eye made an uninformed statement about the most trusted profession in the United States for 17 years in a row.

I’ve learned over the years, through my own entrepreneurial endeavors, that assuming statements are often due to a lack of knowledge.

If we had to put a care plan together and form a nursing diagnosis for this situation, we’d likely use something similar to: “Knowledge deficit related to the reality of being a nurse.


Let me share some of my realities about being a nurse:

  • I never played cards while caring for patients. (I’ve never played cards in any of my nursing roles over the last 19 years).

Some things that I always did while caring for patients include:

  • I always felt as though despite all that I had done for my patients, there was more I could have done to care for them as I left each day over and above what was necessary. (Try carrying that around at the end of every shift and having it add up over time).
  • I always dreaded night shift because that first hour was the most anxiety provoking for me. Parents wanted to put their children to bed to get their rest (understandably so). I would be getting out of report around 7:30pm not even having prepared any of the 8 o’clock meds for my 4-5 patients all due at the same time.

 As nurses, we know we have to prioritize those patients that are in need first but try telling one parent that his or her child needs to wait while you care for another. That is REALLY hard to do. I often wouldn’t finish that first 8 o’clock med round until 11 o’clock at night.

(OF NOTE: Why do we expect nurses to deliver all of their patients’ meds in the same hour right after starting their shift and not having assessed any of them yet? Can someone find a new innovative solution to this system level problem?)

  • I always worried about whether or not one of my assigned patients would code on me during my shift. I often had palpitations before work each morning because of this concern.
  • I always wanted my patients to have a new clean bed or crib and bathed (if an infant) or have an opportunity to shower if possible. This wasn’t required but it was something I felt was important to do.
  • I always prioritized my patients and their families over my own personal needs for nourishment over 12 hours. Sometimes I wouldn’t eat anything until 8 or 9 hours into my 12-hour shift.


I say this about myself, but I know that I am not alone. Perhaps I had palpitations more than other nurses, but the other statements are likely transferable to most if not all other nurses.

Today, I spent a lot of time on my computer catching up on some things.  While working at my desk, I would occasionally open Twitter in seek of a distraction.  I could not open Twitter without a flurry of reactions to Senator Walsh’s remarks today.

Throughout the day, I continued to think of the Woodhull Report. In the most recent report, the results demonstrated that nurses are only cited in 2% of journalists’ stories.

If we are only in 2% of stories, how can we assume that the public knows the extent of our work? Well, one thing we can safely say going forward is that everyone will know we don’t play cards. :) 

Yet, this just scratches the surface. How do we use this unfortunate incident that set Twitter ablaze today as an indication that we can do more as a profession to educate others on what we do?

How do we proactively educate a nation on why we are the most trusted profession year after year at a level that abominates the possibility of such comments from happening in the future?

Honestly, it starts with us, the nursing professionals. If we each share our knowledgeable voices on a proactive and consistent basis in a consumable way, we can begin to make the positive change necessary to dispel misconceptions and assumptions.

Think about how you might be able to share something you know with others that might not know it.

We’re trained for this! We educate our patients every day about things they do not know but need to know for their own health and wellbeing.

How can you educate others through your spoken or written words in a way that can influence their perspective? How can you present the information in a way that opens the door for the reader or listener to want to know more and ask more questions?

If I can educate someone not in healthcare about the role of nurses in informatics, interoperability, and innovation, you can find your niche and do the same.






Healthcare Innovation: It takes the time that it takes.

While clinicians (e.g., nurses, doctors, CNAs, etc.). are the users of new health care technologies, they are often not the purchasers. This complicates the diffusion of innovation in healthcare. However, it doesn’t mean it can’t be done. It does mean it will likely take longer than diffusing innovation at the consumer level.

Article originally appeared on Linkedin here: Healthcare Innovation: It takes the time that it takes on October 2nd, 2017.

If we aren’t yet connected on LinkedIn, send me a connection request at: Dr. Tiffany Kelley RN

Nightingale’s Innovative Nurses Campaign

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In September, we kicked off our Nightingale’s Innovative Nurses campaign! At Nightingale Apps, we believe in innovation, compassion, and serving others. That’s why we’ve decided to highlight nurses that use ingenuity to solve problems at the bedside. If you’d like to nominate a nurse or even yourself please reach out to us at

We’ve shared their stories through our email list communications and also on social channels. To connect all of the Innovative Nurses we’ve featured, I’ll be providing those stories in a series of blog posts here on Know My Voice. I look forward to your thoughts!


Dr. Tiffany Kelley RN

I didn’t know my lab results nor that I would be asked about them.

This week I visited an acupuncturist for the first time. The acupuncturist asked me about my past medical history as well as my current health. She asked me about when I last had labs drawn and if I knew the results.

I knew I had labs drawn recently, however I had no recollection of what was drawn during my last physical nor what those lab values were as a result.

I had to tell her, ‘I don’t know.’ (I also didn’t know I would be asked about them).

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Where do I start?

Earlier this week I spent some time speaking to a group of graduate nursing students at a college in Boston Massachusetts. We talked about the foundations of nursing informatics, electronic health records (EHRs), apps, and problem solving in the field.

Each student mentioned something that could be improved with regard to their current health IT environment. I mentioned that each one of them had an opportunity to help solve those problems. The question from one student was, “where do I start? How do I help solve some of these problems?”

Her question was the BEST question of the night. Where or how do I start is usually the first barrier toward moving anything forward.

To start, KNOW that you don’t need to have a technical background to provide a suggestion for improvement. What you do need, YOU ALREADY HAVE and that is your clinical expertise and knowledge of how to care for patients.

So, if you recognize a problem that has the potential to impact care delivery in your area (e.g., inpatient, ICU, ED, PACU, Ambulatory) and is a hindrance toward the delivery of quality patient care, take a closer look.

Take a closer look beyond the technology to see why it may be a problem. What is the issue? Is it a process issue (e.g., workflow)? Is it a people issue (e.g., non-compliance)? Is it a technology issue (e.g., design/functionality)?

Then observe and ask questions. Who else is impacted? Does it bother them too? Why hasn’t anyone said anything?

Next, think about what would be the way to solve it. How could it be made better? What would be a better situation. This is where you should not focus on what you do or do not know about technology but rather how technology could support you in your delivery of care.

Finally, find someone to share your findings with and ensure that you get it to the right person.

We cannot make improvements without knowing what the issues are that are impacting care. Those in the roles of care delivery are the BEST equipped to offer suggestions to others that can evaluate and begin to implement new changes.

Joining a council, becoming a Super User or a Subject Matter Expert (SME) are three ways to get more experience and learn more about the role of technology and informatics in nursing and health care delivery.

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Healthcare Innovation: It Takes the Time that it Takes

Did you know that the first electronic health records (e.g., EHRs) were developed in the late 1960’s and early 1970’s? I did not know this when I first came to know them in the early 2000’s. I naively thought, ‘how hard can it be to take paper records and turn them into an electronic form?’.


Well, the answer to that question, it is very hard! Despite the efforts during my first few years with EHRs, I was unaware of the fascinating history that came alongside this new way of digitalizing patient information until I began writing my book on EHRs. EHRs are a case study for demonstrating that healthcare innovation is a different marketplace.  With so many influential factors, bringing innovation to healthcare environments takes the time that it takes.


Dr. Lawrence Weed conceptualized the idea for a ‘problem oriented medical record’ in 1968. His thoughts were published in the New England Journal of Medicine. He saw the opportunity to leverage technology in a way that physicians could manage patient information according to problems and understand the whole patient as a person. Dr. Weed saw the opportunity to support the clinician with information needed for decision making, and care delivery. Weed did not use the term ‘electronic health record’ or EHR, nor did any of his peers that were developing the first EHR systems. The term used at that time was ‘computerized patient record’ or CPRs.


During that time, several organizations began developing systems for use within their facilities: Duke, Massachusetts General Hospital, Beth Israel Deaconess Medical Center and the Department of Veterans Affairs are just a few of these pioneers. These efforts began nearly 50 years ago. However, fast forward 40 years and the United States had been at less than 2% adoption in 2009.


While we may not think of it now, the EHR is an innovation in healthcare. AHRQ defines healthcare innovation as, “the implementation of new or altered products, services, processes, systems, policies, organizational structures, or business models that aim to improve one or more domains of health care quality or reduce health care disparities”    ( The EHR is an example of how diffusing innovation in healthcare does not happen overnight.


I sometimes wonder where we, the United States, would be had the HITECH Act not made financial incentives available to accelerate the adoption of EHRs in health care organizations. I suspect the adoption rates would not be what they are today. As of the end of Q2 of this year, less than 2% of hospitals and outpatient practices were at a Stage 0 on the HIMSS EMRAM  (electronic medical record adoption model). In less than 10 years, the United States went from less than 2% adoption to less than 2% non-adoption!


Now, imagine you were Dr. Lawrence Weed or any of the pioneers that developed the early EHRs. Imagine the hurdles experienced to bring the idea and early concepts to life and acceptance. Imagine how many people said ‘that will never happen’ or ‘you can’t do that’ and over how long of a period of time it likely was expressed by others. Fifty years is a very long time.


EHRs faced financial, technical, organizational and legal barriers toward rapid adoption. The HITECH Act helped to breakdown some of the financial barriers. In general, healthcare innovation needs to overcome each of these barriers toward successful implementation and adoption.


In some cases, the technical environment and the organizational culture wasn’t quite ready for EHRs. Legally, the protection of electronic PHI was not defined until 2003 with the Security Rule. Thus, despite the conceptualization and recognition of the potential in the 1960’s, the healthcare innovation took the time that it needed before it could be accepted into the environment.


I believe this is a helpful perspective for those that are developing new innovations in healthcare. The general ecosystem of innovation tends to paint a picture that one can develop a solution and have it lead to rapid widespread adoption within a very short period of time. (For example, Instagram started in 2010 and was sold to Facebook in 2012 for 1B). Yet, the healthcare marketplace is not the same as the consumer marketplace. In many cases, the consumer of the innovation in healthcare is not the purchaser of the product. Additionally, the previously mentioned barriers become less conflated when managed at an individual (e.g., person/user) level rather than a system (e.g., health care organizational) level. Thus, the adoption of new innovations within healthcare organizations requires the time that it takes.


Dr. Tiffany Kelley RN


For more information about my book, Electronic Health Records for Quality Nursing and Healthcare, visit Destech Publications at: