Transcript of #RNchat, a Twitter chat for registered nurses, moderated by Ellen Richter (@EllenRichter on Twitter). Topics included: T1 Every July, as new interns begin hospital rotations, patterns show a rise in patient safety events, termed the "July Effect" T1 (contd) In what ways can the nursing profession help to reduce actual patient errors related to the "July Effect"? T2 Theres growing evidence of the benefits of family being present during resuscitative efforts, especially a child. Do you agree? T2 (contd) Would U want to be sent away from a loved one's side if its the last time U may see them alive? What are the pros/cons? Follow @RNchat (http://Twitter.com/RNchat) for updates.

1. EllenRichter: Twitter RNs! Tonight at 9 PM EST #RNchat will discuss ways nurses can help make July
of each year (with new interns) safer for patient care!
6/17/2010 06:21
daily_briefing: Obama tells nurses that they're the 'beating heart' of the U.S. health care system |
http://youtu.be/M6PLY7Q-zVA #RNchat
6/17/2010 09:39
MatthewBrowning: WOW! Safe staffing LAW!! H.R.5527 -Registered Nurse Safe Staffing Act of 2010
http://bit.ly/9s4jZp #RNChat #Nurses #YNIO
6/17/2010 11:50
EllenRichter: An interesting #RNchat read! >> A July Spike in Fatal Medication Errors: A Possible Effect
of New Medical Residents http://i.cx/1rb
6/17/2010 19:04
EllenRichter: Another article for our #RNchat topic tonight >> "Medical Errors And Patient Safety:
Beware The “July Effect" http://j.mp/bNXvhu
6/17/2010 19:06
EllenRichter: Please check out this video short for #RNchat >> "Precious Last Moments: Family
Presence During Resuscitation" http://j.mp/d4pC80
6/17/2010 19:11
EllenRichter: Another great article for tonite's #RNchat topic >> "Family Presence During CPR and
Invasive Procedures" http://j.mp/aYyUFN
6/17/2010 19:13
EllenRichter: One more great read for tonite's #RNchat topic >> "Family presence during resuscitation :
Nursing2010" http://j.mp/9ocvg1
6/17/2010 19:17
rnchat: I'm signing into TweetGrid http://tweetgrid.com/ to participate in #RNchat
6/17/2010 20:45
rnchat: Well hello to all the Twitter nurses & health care professionals who arent glued to the
Lakers game! LOL ---timing is everything! #RNchat
6/17/2010 21:00
rnchat: This is @EllenRichter filling in for the awesome @PhilBaumann tonight for our weekly
nurse chat! Hope everyone is doing well! #RNchat
6/17/2010 21:01
lisagualtieri: @RNchat Do you mean the Celtics game? #RNchat
6/17/2010 21:02
rnchat: #RNchat is a way for nurses (& all others in health care!) to meet, tweet & share feelings,
thoughts, ideas~ We welcome silent lurkers!
6/17/2010 21:02
rnchat: @lisagualtieri Well I thought @AbbieCitron just tweeted Lakers! Sorry but I am not a
sports fan so I have no clue! :) #RNchat
6/17/2010 21:03
lorryschoenly: Wish I could make the #RNChat tonight but I"m still grading student papers....
6/17/2010 21:04

2. rnchat: We can start off the hour by seeing who is joining in. Introduce yourselves & tell us
something about you in 140 or less! #RNchat tonight!
6/17/2010 21:05
rnchat: @lorryschoenly You are a good professor! We wont disturb you! :) #RNchat
6/17/2010 21:07
lisagualtieri: Lisa Gualtieri, lurker after I read my daughter a bedtime story, and Bostonian #GoCelts
#RNchat
6/17/2010 21:08
rnchat: I will introduce myself. I am Ellen, a critical care nurse working in Florida & a legal nurse
consultant & I occasionally moderate #RNchat
6/17/2010 21:09
DebErupts: Hello #RNChat
6/17/2010 21:09
rnchat: The topics will be labeled T1, T2, etc. Please remember to add topic label & hashtag
#RNchat to ea tweet so we can track your responses!
6/17/2010 21:10
rnchat: Tonight I cant seem to present the topics in a single 140 character sentence!! So please
bear with me! :) #RNchat
6/17/2010 21:12
rnchat: T1 Every July, as new interns begin hospital rotations, patterns show a rise in patient
safety events, termed the "July Effect" #RNchat
6/17/2010 21:13
KPNurseRecruit: I'm tuned in and watching a HS ballgame too! Nurse Recruiter at Kaiser Permanente.
#RNchat
6/17/2010 21:13
rnchat: T1 (contd) In what ways can the nursing profession help to reduce actual patient errors
related to the "July Effect"? #RNchat
6/17/2010 21:13
rnchat: T1 (contd) Do you think the "July Effect" is a real phenomenon or is it just bad press?
#RNchat
6/17/2010 21:15
KPNurseRecruit: RT @rnchat: #RNchat is way for nurses (& others in health care!) 2 meet, tweet, share
feelings, thoughts, ideas~We welcome silent lurkers!
6/17/2010 21:15
NursePru: T1 Communicate...the new interns seem receptive to nurse's input (so far). They actually
seem to lean on us a bit. #rnchat
6/17/2010 21:16
DebErupts: #RNChat I didn't know about the "July Effect" in relation to patient errors.
6/17/2010 21:17
rnchat: @NursePru T1 I agree. And as nurses who follow doctor's orders all the time, we know
when an order might not be 100% appropriate #RNchat
6/17/2010 21:17

3. rnchat: T1 One link -- A July Spike in Fatal Medication Errors: A Possible Effect of New Medical
Residents http://i.cx/1rb #RNchat
6/17/2010 21:19
DebErupts: Nurses are the gatekeepers. Don't be afraid to question orders and go up the chain of
command if necessary #RNChat
6/17/2010 21:20
rnchat: T1 Another link "Medical Errors And Patient Safety: Beware The “July Effect"
http://j.mp/bNXvhu #RNchat
6/17/2010 21:20
DebErupts: #RNChat Thank-you for the link on the topic of med errors. http://i.cx/1rb
6/17/2010 21:21
DebErupts: RT @rnchat: T1 Another link "Medical Errors And Patient Safety: Beware The “July
Effect" http://j.mp/bNXvhu #RNchat
6/17/2010 21:22
rnchat: T1 There are instances, such as during the night shift, when neither a new nurse or new
doctor question an erroneous decision #RNchat
6/17/2010 21:22
rnchat: T1 "Preparing for the July Effect: Five Strategies for Integrating New Residents"
http://j.mp/dfp2yT #RNchat
6/17/2010 21:23
DebErupts: Teamwork, good open communication are helpful in preventing errors. #RNChat
6/17/2010 21:23
NursePru: T1 Absolutely! Especially on night shift. Seems like the night docs don't like to question
orders written during the day. #rnchat
6/17/2010 21:24
rnchat: T1 I have also seen experienced RNs make new doctors feel like 2 inches tall by berating
them in front of others. We must be kind! #RNchat
6/17/2010 21:25
NursePru: T1 So true. Everyone is a beginner at some point. #rnchat
6/17/2010 21:26
rnchat: T1 Nurses can be excellent teachers to new medical staff yet we are notorious for eating
our young....and other's young as well! #RNchat
6/17/2010 21:27
DebErupts: #RNChat Leave your ego at the door and work together for the benefit of the patient. We
all have the same goal.
6/17/2010 21:29
rnchat: T1 I cherished the years that I worked in teaching hospitals. Its nice to have medical staff
that keeps up with changing times! :) #RNchat
6/17/2010 21:31
rnchat: OK almost time for the next topic. #RNchat
6/17/2010 21:32
DebErupts: #RNChat At the same time, I think we have to be super vigilant when it comes to new

4. staff. We are patient advocates first and foremost.
6/17/2010 21:32
NursingCenter: Hi @EllenRichter and #RNchat friends! Just got the kids to bed...will catch up on the chat
now!
6/17/2010 21:32
rnchat: YES! >> RT @DebErupts I think we have to be super vigilant when it comes to new staff.
We are patient advocates first and foremost. #RNchat
6/17/2010 21:33
rnchat: @NursingCenter Welcome! #RNchat
6/17/2010 21:34
rnchat: @DebErupts LMAO!! I'm drinking iced coffee....geez....! #RNchat
6/17/2010 21:35
rnchat: T2 Theres growing evidence of the benefits of family being present during resuscitative
efforts, especially a child. Do you agree? #RNchat
6/17/2010 21:37
rnchat: T2 (contd) Would U want to be sent away from a loved one's side if its the last time U
may see them alive? What are the pros/cons? #RNchat
6/17/2010 21:37
chemosabe: t2 hey just joined, we do not routinely have family present. #rnchat
6/17/2010 21:38
chemosabe: t2 i am under impression that this is mostly due to litigation in north america. #rnchat
6/17/2010 21:39
rnchat: T2 I think that most facilities don't routinely allow family to be present during CPR, but if
you think it thru, it might help more #RNchat
6/17/2010 21:40
DebErupts: It depends. Is the family being supportive or are they freaking out and distracting to the
task at hand? #RNChat
6/17/2010 21:40
NursePru: T2 don't think I could handle seeing a code if it was my loved one. I'd rather step away
and let everyone do their jobs. #rnchat
6/17/2010 21:40
HauteSingleMama: T2: Sorry, just popping in... I think there's tremendous benefit. For the family and for the
patient. #rnchat
6/17/2010 21:40
nursekris99: T2: If a less-messy situation, yes. If it's a full-blown rib-cracking code, don't think I'd want
to see my loved one like that #RNchat
6/17/2010 21:41
rnchat: @chemosabe T2 Yes, potential litigation is probably a primary reason we make families
step away during resuscitation #RNchat
6/17/2010 21:41
DebErupts: This may be the last time they see their loved one alive and they can be beneficial if they
help keep patient calm. #RNChat
6/17/2010 21:41

5. NursingCenter: T2 Pros -- closure, see that everything possible is being done, spending last moments
with loved one #rnchat
6/17/2010 21:41
HauteSingleMama: T2: I know in neonatal cases with extremely poor prognosis, witnessing resuscitation
attempts can change the family's mind about #rnchat
6/17/2010 21:42
nursekris99: T2: Pulmonary might be OK. People can handle bags and vents. #RNchat
6/17/2010 21:42
rnchat: T2 What if it was your child? Would you want to step away? Or be there the whole time
during CPR & resuscitation? #RNchat
6/17/2010 21:42
HauteSingleMama: T2: continuing futile care. Also, for all patients, there is the factor of "will to live"-we don't
know the power of having loved #rnchat
6/17/2010 21:43
NursePru: T2 families may create a distraction when medical staff should be concentrating. #rnchat
6/17/2010 21:43
NursingCenter: T2 Cons -- can't imagine seeing loved one during code. It tears me up just to see a
family member hospitalized. #rnchat
6/17/2010 21:43
HauteSingleMama: T2: ones present. #rnchat
6/17/2010 21:43
chemosabe: @rnchat t2 actually thinking more to do with having family present so they were away of
what occured #rnchat
6/17/2010 21:43
nursekris99: T2: If it was my child I'd probably be IN there barking orders at people!! #RNchat
6/17/2010 21:43
TgeekB: #RNchat It could be a sticky situation if the family feels things didn't go the way they
"should" have.
6/17/2010 21:43
rnchat: T2 "Family presence during resuscitation : Nursing2010" http://j.mp/9ocvg1 #RNchat
6/17/2010 21:44
DebErupts: It can also be a benefit legally if they see that you did everything possible to save their
loved one. I see pros and cons. #RNchat
6/17/2010 21:44
rnchat: T2 "Family Presence During CPR and Invasive Procedures" http://j.mp/aYyUFN #RNchat
6/17/2010 21:45
DebErupts: RT @rnchat: T2 "Family Presence During CPR and Invasive Procedures"
http://j.mp/aYyUFN #RNchat
6/17/2010 21:46
rnchat: T2 Current literature shows that there is benefit, but staff must provide someone to deal
specifically with the family during CPR #RNchat

6. 6/17/2010 21:46
NursingCenter: T2 - One of my preemie twin sons became septic...needed reintubation after being stable
for weeks. I was asked to leave (cont'd) #rnchat
6/17/2010 21:47
rnchat: T2 Video short "Precious Last Moments: Family Presence During Resuscitation"
http://j.mp/d4pC80 #RNchat
6/17/2010 21:47
DebErupts: RT @rnchat: T2 Video short "Precious Last Moments: Family Presence During
Resuscitation" http://j.mp/d4pC80 #RNchat
6/17/2010 21:48
rnchat: T2 Everyone has brought up excellent points, both pro & con. I am pro-family being
present, myself (@EllenRichter speaking) #RNchat
6/17/2010 21:48
NursePru: Gotta run folks! Nice chatting for a bit! #rnchat
6/17/2010 21:49
NursingCenter: T2 -- Needs to be individualized for pt & family members. Some feel the need to be
present, others prefer to step away (& that's OK) #rnchat
6/17/2010 21:49
rnchat: @NursingCenter T2 Your situation had to be very tough. Maybe if they told you ahead of
time, you might have been prepared & stayed #RNchat
6/17/2010 21:49
rnchat: @NursePru Was a pleasure that you came! Thanks for sharing! #RNchat
6/17/2010 21:50
rnchat: T2 With a chronically ill pt who is deteriorating, good preparation for an inevitable code
can help families deal w/ closure/grief #RNchat
6/17/2010 21:53
NursingCenter: RT @rnchat: T2 With a chronically ill pt who is deteriorating, good preparation for an
inevitable code can help families deal w/ closure/grief #RNchat
6/17/2010 21:55
rnchat: @NursingCenter T2 Glad to hear that your son recovered, Lisa! Very scary situation for
sure. Especially when its a baby. :) #RNchat
6/17/2010 21:57
chemosabe: I'm searching for #rnchat live on TweetGrid Search - http://tweetgrid.com/search?
q=%23rnchat
6/17/2010 21:57
chemosabe: #rnchat
6/17/2010 21:58
rnchat: Well, its just about time to wrap up this hour. Great tweets on these 2 topics tonight!
Thanks to all who participated! You rock. #RNchat
6/17/2010 21:58
rnchat: Welcome back @chemosabe :) #RNchat
6/17/2010 21:58

7. chemosabe: thanks for making the time more friendly for the southern hemisphere #rnchat
6/17/2010 21:59
TgeekB: RT @rnchat: T2 With a chronically ill pt who is deteriorating, good preparation for an
inevitable code can help families deal w/ closure/grief #RNchat
6/17/2010 21:59
chemosabe: sorry playing from work, old IE #rnchat
6/17/2010 21:59
rnchat: As always, @PhilBaumann will post the transcript of the chat! :) #RNchat
6/17/2010 22:00
rnchat: @chemosabe Yes, I've been on old IE from work before! Its a challenge to chat! I think I
ended up using Twitterfall :) #RNchat
6/17/2010 22:01
rnchat: @chemosabe Where are you located? #RNchat
6/17/2010 22:03
NursingCenter: Thanks @RNchat and @EllenRichter! Have a good night everyone! #RNchat
6/17/2010 22:03
rnchat: Its so awesome for health care people from all over the world to meet & chat together on
Twitter. #RNchat
6/17/2010 22:05
chemosabe: sure is, love the access social media gives us #rnchat
6/17/2010 22:06
rnchat: @Lawcats T2 Yes I agree. Family cannot just stand around and gawk. They must be
guided thru the process with explanations & comfort #RNchat
6/17/2010 22:18
Trybarefoot: Sorry to have missed #RNchat tonite.....looks like it was a great conversation!
6/17/2010 22:28