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.






Nurse Entrepreneurship & Nightingale’s Innovative Nurses

I knew very little about entrepreneurship when I started down this path several years ago. I had the idea and vision for Know My Patient®. I knew that every bedside nurse deserves an opportunity to have accurate, up to date information needed for patient care at their fingertips. I knew chasing after information was a waste of their time and energy when it could be sent to them electronically and available in a mobile device from the comfort of their pocket. I knew nurses wanted to feel like nurses and not data entry specialists. Thus, I decided with these knowns, the best way to bring Know My Patient® to life would be to start a company, Nightingale Apps.

Know My Patient


However, unlike the rest of my career to date at that time, I did not have a nursing mentor to help guide me through the general process of taking an idea, bringing it to life, and then turning it into a company. At that time, I did not know of any other Nurse Entrepreneurs. While I didn’t see that as a barrier to my desired pathway, many others would often try to deter me from the chosen path. I reached a point where I could see in someone’s eyes that he or she was thinking. “You are going to do what?”. Instead of letting the reactions deter me, I decided to begin to learn what it meant to be an entrepreneur and learn from others.


The word entrepreneur is defined as “one who organizes, manages, and assumes the risks of a business or enterprise”. Applying that definition, the Nurse Entrepreneur is one who has identified an opportunity to solve a problem in health care that can be executed through a business entity. We all know there are many opportunities to improve health care. However, we, as nurses, don’t all realize that deciding to take on that opportunity can be a viable, profitable option that drives an impact on those whom you are providing your product, service or solution.


I remember hearing from someone several months ago, “You’re a nurse and an entrepreneur? I didn’t know you could do that.” That statement gives me a chuckle because there really are no barriers to entrepreneurship. There are no degree requirements or certifications required to start down this path. What you do need is an entrepreneurial way of thinking, an idea, and a plan to execute that you are willing to adjust as you begin to pave your own path.


You might be thinking, “Well, is it (e.g., entrepreneurship) hard?” Yes, it is hard. Nursing school is hard. The NCLEX is hard. Caring for sick and dying patients is hard. Entrepreneurship is a different kind of ‘hard’ work. However, I always come back to what it felt like to care for patients and their families. Nurses save lives every day. If you can do that, you are well equipped for a path toward entrepreneurship. However, you have to want to do it and it will not be a path for everyone. That is ok too.


Over the last several months I’ve been introduced to several Nurse Entrepreneurs and Innovators. With each new week, I learn of other nurses that have decided to create their own path and are thriving in their niche. I have also learned of nurses who have created solutions in health care that I never knew started from a nurse. For example, the crash cart and the Wong-Baker Faces Scale both started from a nurse who identified a problem with the current method of managing code situations or childhood pain.


I often talk to groups about how we as a profession need to be our best advocates. We need to demonstrate the power of our profession by modeling the way to others. Instead of complaining about some of our professional challenges (my personal pet peeve is how nurses are portrayed in television), we need to turn that around and be more on the offense in a positive constructive way. We must show others what we do and how we do it. Perhaps we will inspire others to become nurses. Perhaps we will reduce stereotypes of what we do at the bedside or what our capabilities are as professional nurses. With so many available outlets at our fingertips today, we have the ability to make an impact for others with minimal barriers.


To take a first step toward this, I decided that we, Nightingale Apps LLC, would form an initiative to showcase other entrepreneurial (and intrapreneurial) nurses who are identifying opportunities where they are making a strong, positive impact on health care through their unique skill sets and perspective on what is currently missing. This initiative is called, Nightingale’s Innovative Nurses and we will be showcasing these nurses through our Nightingale Apps newsletter and social media outlets.


Our first Innovative Nurse, Andrew Craig, RN, is a Travel Nurse that has started his own Travel Nurse business, HubbleSweet PLLC and has a YouTube channel with videos to help educate nurses on the Travel Nurse industry. You can learn more about him and his entrepreneurial mindset here:




I’d like to invite any of you reading this who are interested in learning more or being featured to either reach out to me directly or to our team at We’d love to learn about what you are doing and/or someone else that you might know who fits this description. The Nightingale Apps team and I are excited about this effort. As much as we need nurses to care for patients, we also need nurses to pave new paths for those to come and give a view into what else is possible within the nursing profession.




Dr. Tiffany Kelley




‘Do I nurse the computer or nurse the patient?’

Have you ever found yourself thinking ‘do I nurse the computer or nurse the patient?’ during your nursing shift? If the answer is yes, you are not alone. This phenomenon of ‘nursing the patient versus nursing the computer’ did not exist when I was a new nurse in 2000. This phenomenon emerged over the last decade as the nation has moved from a paper-based medical record system to the use of electronic health records (EHRs). However, unless you are a nurse (or health care professional) actively involved in providing direct patient care, this phenomenon may not be well known to you.  


The phenomenon of nursing the patient versus nursing the computer is an internal struggle. The internal struggle is visible in the nurse’s behavior but not often verbalized by the nurse. As nurses, we are there to care for our patients. I have yet to meet a nurse who entered the profession because of their joy for charting. Instead, entering the profession often comes from the joy of caring for other people, our patients, during our shifts.  


We, as nurses, know charting is part of our role and responsibilities. We learn this through nursing school courses, practicums and our preceptorship when first starting as a nurse in the health care organization. We respect the practice of charting, or documenting, on our patient. Yet, in many cases, the patient should be the priority over that of the chart. Thus, our instinct is often to care for the patient before caring for the patient’s record of information. However, there are times when this decision becomes a struggle for the nurse.  

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Transitioning from the Bedside: One Skill for Success

I often receive questions from other nurses, informaticists, entrepreneurs and students about things on their mind and what they should do or how should they do something. If one person is having the question, there are likely others as well. So last month I decided to use Facebook live as a method of addressing these questions on a weekly basis on my page: Tiffany Kelley PhD RN

In many of my videos I  mention that there were some core business skills that I had to learn when I left bedside nursing and transitioned into a more business oriented nursing role (e.g., specifically informatics and IT).These business skills included appropriate use of email, excel, powerpoint, and many others to start.

Another skill is how to have an effective phone meeting with someone.

I wanted to offer some tips on how to structure a phone call so that you can effectively utilize the time you have with that person. This can be applied to any situation!


Many people will offer you 15 or 30 minutes to start which is NOT a lot of time so you want to make sure you can use the time effectively and also make sure that person felt his/her time was well spent too!

So…if you are going to reach out and request to speak with someone, the best way to get the conversation going once on the call is to:

1. Set the stage for the call by telling the person why you are calling.

2. Briefly introduce yourself and/or company.

3. Ask the person to tell you a little about themselves to fill in any gaps that you might have from your prep research before the call (ps…you should be prepared for the call) .

4. After this, you can move on to the true purpose of the call – why you wanted to have the phone meeting.

5. It is also best to end the call with what to expect next and who is responsible for those next steps.

PS…If you need to for the first few calls, put this outline together and fill in the blanks to keep track of where you are so that time does not run out on you.

💫It is a simple outline to follow that really does work well! 💫

I hope this helps some of you who might be starting to get going with a new venture, adventure, etc. – whatever it might be!

Have a great day and let me know what you think!



PhD versus DNP: Which one should you choose?

Are you deciding upon a doctoral degree in nursing? There are two primary choices: a Doctor of Philosophy (PhD) and a Doctor of Nursing Practice (DNP). Both degrees are supported by the American Association of Colleges of Nursing (AACN) and represent terminal degrees in the field of Nursing. However, there are differences between the two degree programs that prospective students should be aware of before selecting one or the other.

In this linked video, I compare the PhD and DNP in the field of Nursing. I look forward to hearing your thoughts.

DNP versus PhD: Which one should you choose?



‘If it wasn’t documented, it wasn’t done.’

  • If you are a nurse or health care professional, the phrase, “if it wasn’t documented, it wasn’t done”, is something you have likely heard, said, and/or thought during one of your shifts. For those that aren’t familiar with this phrase, it means that if there isn’t a record of the care you delivered in the patient’s chart, (by way of your documentation), the activity was not done. While this makes sense at face value, when placed in the context of patient care delivery, this statement has more extensive implications on documentation since health care organizations have transitioned from paper based records to electronic health records.


When on paper based records, nurses documented on the patient’s flowsheet, progress note, and care plans. The paper based records offered more freedom to potentially ‘go outside of the lines’.  The boundaries were flexible but the paper record also left opportunities for unintended omissions. As the nation moved to electronic health records (EHRs) over the last several decades, we have fewer flexible boundaries.  Additionally, nurses have more documentation options. Often, there are too many documentation options for the newer nurse who is concerned about a complete patient record, or the nurse who is terrified to be the one who didn’t chart his or her work.  Thus, instead of unintended omissions, we now run the risk of having too many documented data elements that make it difficult to differentiate the essential from non-essential information.

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