DiversityNursing Blog

From Forbes.com

You might think working well into your eighth decade is preposterous. But it is becoming relatively commonplace. The number of working people age 65 and older reached an all-time low in 2001, when just 13% held jobs. Now that rate is rebounding, and the number of workers older than 65 is 18% of the workforce.

The Future Workplace “Multiple Generations @ Work” survey asked 1,189 workers across the generations how likely they thought they were to work past age 70.

Seventy-seven percent of baby boomers (between ages of 48 and 66) said they believed they would work into their 70s. What is surprising is that 82% of Gen Xers (between ages of 36 and 47) agreed.

There are a number of reasons for employees to believe they will be working longer. First, they are already living longer. Boomers are expected to live longer than any previous generation of Americans. Of the 3.4 million born in 1946 — including Bill Clinton, George and Laura Bush, Donald Trump, Susan Sarandon, Steven Speilberg and Sylvester Stallone — 2.8 million are still alive. The men can expect to live another 22 years, the women another 25.

By 2030, when the first baby boomers reach the age of 84, the number of Americans older than 65 will have grown by 75%, to 69 million. This means more than 20% of the population will be older then 65.

And since we are living longer, we may want and need to work longer – especially to meet the financial needs caused by sagging retirement accounts, and plunging property values. As careers get longer, workplace culture will have to accommodate age diversity. Some traditionalists (those 66 and older) and baby boomers are already working further into their 70s and 80s, so as a new batch of employees from “Generation 2020″ (born after 1997) graduates from college and joins the workforce, it will become common to find five generations working side by side at the office.

A multigenerational workplace has plenty of advantages, including the potential for knowledge sharing, mentoring and coaching. But it can also create tension, the likes of which can erode office morale and sabotage productivity.

The “Generations @ Work” survey asked workers about their expectations and requirements for an employer.  The study found the struggles among the generations often eclipsed the advantages.

As originally discussed, in my book, The 2020 Workplace, each generation brings its own lens to the workplace, and individual and group talents can become obscured by assumptions, myths and real or perceived tensions and criticisms. This can lead to  havoc in the workplace.

Here are five ways to address and prevent generational tension at your company:

Teach your managers to anticipate generational differences, starting in the recruiting process.

Many young workers today approach job interviews differently than their predecessors. For our survey, we asked a sample of 150 managers to give us examples of surprising questions they’ve been asked by interviewees, most of whom were of millennial age. To the surprise of managers, millennials asked questions such as:

“Do I have to show up each day?”

“Can I use my own tablet, phone and laptop at work?

“Do I have to wear shoes to work?”

These questions can seem irreverent, but managers must understand what’s really behind them. The applicant who asks if he has to show up each day is really inquiring about the company’s telework policies and flexibility. The applicant who inquires about her ability to bring her own devices to work each day is really asking if the company has a Bring Your Own Device (BYOD) to work policy in place to allow employees to use their own devices instead of company-owned, standard devices.

And, if you are ever faced with a question about shoes, remember Steve Jobs – he frequently went barefoot to work!

Be aware of each generation’s preferred learning and communication styles.

In our survey, 35% of Generation 2020 said they consider mentoring and coaching the most valuable form of career development with only 20% preferring the classroom. This generation also prefers to use the latest tools – such as mobile devices, gaming, video sharing and social networks – for learning new skills.

A study by Deloitte Consulting and the IABC confirms this finding as it relates to communication styles. The study concluded that younger workers want information delivered immediately, and in shorter and more-frequent chunks. Speed and frequency of communication are important to them.

Google provides a good example of how to use games to boost productivity. Google‘s management realized that the company’s large spread of office space was cutting down on human interaction. To help foster connections, the company built an online, multiplayer social game called GoCrossOffice, modeled after the game Risk. Players collaborate, organize and socialize with each other, and in the process, strengthen their team-building and strategic-thinking skills. Since then, other companies have joined in this trend, too.

Enlist Millennials as subject-matter experts on what appeals to their generation.

Some companies think of millennials as a problem to be solved in the workplace. But the forward-looking ones enlist millennials when they are trying to adopt a new product or service inside the company.

Neiman Marcus Director of Learning and Development Keith Meyerson relied on millennials who work for Neiman Marcus to promote the collaboration module of the company’s learning management system (LMS). Instead of using a top-down communication program, Neiman Marcus focused on communicating from the bottom up by using millennials to drive participation and share this practice with older workers who are typically not early adopters of new tools in the workplace.

Don’t believe the myths about each generation in the workplace.

It would be easy to put each generation in a box and characterize them based on stereotypes. But there are also plenty of similarities to be found among workers of all ages.

For instance, flexibility has become an increasingly valued workplace characteristic by workers of every generation. When Future Workplace asked how important a flexible work environment was, 35% of our survey respondents, across all ages, answered either “important” or “very important.” For all generations, flexibility –flexible hours and flexibility of location (i.e., telework) – was more important than both compensation and opportunities for advancement.

As more organizations see the importance of offering flexibility in the workplace, we will see this touted in recruiting materials as a way to attract talented new hires.  Organizations will need to probe for more cross-generational priorities such as flexibility, and communicate with both current and prospective employees about how they are delivering on those demands.

Be prepared for generational tension.

Intergenerational conflict is impossible to prevent entirely, so be prepared to address it when it does arise.

In our survey, 66% of millennials agreed with the statement, “my personal drive can be intimidating to other generations in the workplace,” and the generations’ divergent views on what to expect in the workplace of the future further outlined that tension. A study by PricewaterhouseCoopers found the same.

Take a cue from Bank of America and Pratt & Whitney. Both  organizations have created Employee Resource Groups focusing on Multi Generational issues.

Why focus on the needs and expectations of a multi-generational workforce? Just think of your future employee, the one entering your workplace in 2030. According to the Office of National Statistics, one third of the babies born today in 2012 will live to see their hundredth birthday! Now consider the age of the oldest member on your team in 2030.

The employers who adapt most quickly to the realities of a multigenerational workforce will become the ones who attract and retain the highest-quality employees now and in the future.

From NurseZone.com By Christina Orlovsky

June 13, 2012 - As the population ages and the need for health care increases, access to care is often a challenge, based on location, provider availability, chronic conditions and economic factors. One potential solution to a number of these challenges is the umbrella of care called telemedicine.

According to the American Telemedicine Association (ATA), telemedicine is defined broadly as the delivery of any health care service through any telecommunications medium--for example, a patient seeing a doctor, nurse or allied health professional via a videoconference, rather than in-person, or a patient with a chronic condition utilizing an in-home device to monitor vital signs and transmit data to a nursing center for assessment and medical intervention.

“The one thing that ties all telemedicine together is that it involves a clinical health care service, it directly contributes to the health and well-being of patients, and the patient and provider are separated by some geographic distance,” said Benjamin Forstag, senior director of communications for the Washington, D.C.-based ATA.

Nurses are directly involved in the virtual delivery of health care through telehealth nursing, defined by the ATA as “the use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice.”

According to Cindy K. Leenknecht, MS, ACNS-BC, chair of the ATA Telehealth Nursing Special Interest Group (SIG), nurses hold a variety of roles in the telehealth arena, depending on their individual scope of practice. They utilize telemedicine technology in the ICU, nursing homes and home-health environments.

“They are reaching into many remote sites using telemedicine, including homes, monitoring for congestive heart failure, diabetes, COPD, hypertension, etc., where they monitor vital signs and question responses, evaluate and call patients to clarify symptoms, and advise on further actions to take, such as call a physician, take a forgotten medicine, etc.,” she explains. “They also deliver timely education and reinforce that education.”

The ATA stresses that telehealth nursing is not a specialty area within nursing. In fact, any nurse who has ever spoken to a patient over the phone has practiced some form of telehealth. As such, the same qualities that attribute to nursing success at the bedside come into play with telemedicine.

“Telehealth nurses need the same nursing skills as all nurses practicing in specialty areas, but with an ability to utilize the technology to the best of its ability to assess and communicate the patient’s physical and mental status,” Leenknecht said. “Excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations and have the intuitiveness in how to utilize it to provide the care needed at the time.”

Treating millions of veterans across the miles

One health care system that is uniquely positioned to provide telemedicine services to its patients is the Veterans Health Administration (VHA), the health care arm of the U.S. Department of Veterans Affairs. Responsible for the care of 5.6 million American veterans each year, the VHA utilizes telehealth in a number of ways to be able to meet the health care needs of its extensive patient population, spread out across the entire country.

“In total, in fiscal year 2011, VHA provided telehealth services to 380,000 veterans,” said Adam Darkins, M.D., chief consultant of care coordination services for the VHA Office of Telehealth Services. “We anticipate that number will rise this year by somewhere between 30 to 50 percent.”

The primary use of telehealth for the VHA is through home telehealth, managing chronic conditions like diabetes and depression for 74,000 veterans in their own homes, through the use of telehealth devices that monitor vital signs such as weight, pulse, blood pressure and blood glucose, and ask questions on a daily basis about symptoms and behaviors. A care coordinator--usually a nurse employed in a full-time telehealth role--manages a panel of these patients from a remote location with the goal of educating patients and their caregivers, monitoring their disease symptoms and daily behaviors, and intervening when they’re alerted to warning signs.

“These programs were built to support aging veterans who, as they get older, are living longer and staying healthier and, like all of us, would prefer to live independently,” Darkins explained. “The care coordinator works in partnership with the patient, their family caregiver and their community caregiver to help people with multiple hospitalizations transition home after a discharge, educate them about care management, and intervene early to prevent readmissions. We have seen outcomes of a 30 percent reduction in hospital admissions and bed days of care.”

The anticipated increase in need for care is accompanied by an increased need for care providers--and a need for training.

“These are new areas of care that aren’t taught in schools of nursing or medicine, so one thing the VHA has done is created a training center for each of its areas of telehealth that train to the order of 2,500 people per year, with 90 percent of the training taking place online,” Darkins said, adding that he often sees highly trained nurses turning toward telehealth.

“What we find is often very experienced nurses toward the end of their career are attracted to this and say ‘This is why I came into health care,’” he concluded. “It really gets to the heart of providing holistic care where there’s a real need.”

From WorkingNurse.com By Christine Contillo

It’s clear that we’ve not just entered the Information Age — we’ve exploded into it. Information exchange is critical to both the advancement of science and patient care, and the impact of the Internet in the medical field has been enormous. Practitioners are now able to jump the barrier of time and access research findings worldwide; and in nursing it’s caused the creation of an entire subspecialty (nursing informatics) meant to manage the amount of information available.

But nurses studying informatics aren’t he only ones finding ways to improve their skills by surfing the web. According to a survey of the American Academy of Nurse Practitioners, more than 98 percent of nurses responded that they use the Internet or email. The survey continued to ask in what way the Internet was used, and the answers may surprise you.

No More Pencils, No More Books

Beginning with nursing education, students everywhere have access to virtual classrooms and degree programs. Online education means that the limits previously imposed by location and time become less important. Busy students with a computer, or those in the workforce trying to fit school into their already packed schedule, should be able to find a few hours at home for study.

Similarly, many states now require continuing education (CE) for licensing. Nursing needing those hours can get them without leaving home, which in many cases removes important constraints such as child care. Sites such as WorldWideLearn.com allow the student 24/7 access to courses and technical support. Employers can select educational seminars and show them in real time in a conference room or select courses that have been archived for their nurses to watch later.

Nurses were instrumental in developing accredited online continuing education for Wild Iris Medical Education. The company established the site Nursing Continuing Education to help nurses (and other health professionals) across all 50 states fulfill CE requirements. Prices range from free to $65 depending on the individual requirement and number of contact hours offered. Fees can be paid with a credit card — how else? — online.

Podcasts

For those nurses who are pretty comfortable with technology, podcasts are another avenue to investigate. Similar to audio versions of magazines, they can be heard on MP3 players for up-to-date information. Check out PodFeed.net and searching “nursing” or listen to “Nursing Education on the Go” at Podcast Alley.

Streaming Radio

Somewhat similar to podcasts is streaming radio, or radio shows that are available worldwide. AM/FM radio is usually limited by geographical distance, but streaming radio listeners only need access to the web, some free software to download, and a set of speakers.

Barbara Ficarra, RN, BSN, MPA, is a nurse educator in the metro-NYC area and host of “Health in 30,” which airs live at 5:30pm on Fridays on WRCR-AM 1300. Ms. Ficarra lines up expert guests for her weekly show, announces the topic ahead of time, and fields questions as they are phoned in. Without the Internet her show could only be heard locally, but the vast audience afforded by online listeners has enabled her to win wider recognition. In fact, in 2007, she won the Excellence in Journalism award given by the American College of Emergency Physicians.

Blogs

Nursing blogs are web logs and can range from silly to academic. Just as journals are intimate thoughts, blogs can detail nursing practice issues, patient stories, fears, triumphs or even family and leisure activity. Blogs allow nurses to vent their frustrations to their peers and share valuable resources for patient care. Following a few favorites allows you to peer into the mind of the writer. The ability to comment allows you to enter into an electronic relationship that nurses in remote areas may treasure. Certainly information about individual patients must protect their identity, but sharing the means of resolving practice issues helps to improve practice standards everywhere.

Information Sites

According to Family Nurse Practitioner Roseann Neuberg, the impact brought by the Internet to her clinical nursing practice is “huge,” and she identifies it as a valuable source of patient education material. “There are just so many things I can do in terms of patient education,” she says. “I can look up issues or treatments while my patient is sitting right next to me. I can print it up, hand it out, and be sure that they understand what I’m saying before they leave. When I prescribe a medication I can check the price and look for alternatives. I can even use a program to check for drug interactions.”

Tracy Plaskett, a staff nurse at Beth Israel Hospital in New York City, says, “When I get my patient assignment, I’m able to look up any unfamiliar terms in the notes instantly. I can check spellings and make sure that medication orders are correct.”

Ms. Neuberg is quick to point out that she sticks with sites she knows are accurate and updated frequently in order to feel confident that the advice she is giving is sound. Two such sites are UpToDateOnline.com and Epocrates.com, which provide current information about clinical management and treatment of disease. Both require a subscription and password.

Mobile Medicine

Lynda O’Grady, RN, has found another important use of the Internet. Ms. O’Grady is part of a large travel medicine clinic, assessing international travelers who participate in academic programs, sometimes to remote and disease-infested areas. Using special software she’s able to assess their individual medical risks. If she has questions she can access advice from organizations like the Center for Disease Control and the World Health Organization. But what she finds most helpful is her membership in the International Society of Travel Medicine. Through a listserv available only to members she’s able to gain up-to-the-minute answers to questions posed, such as, “Where is the nearest medical clinic to Daar es Salaam?” or, “What do you recommend for altitude sickness for a patient allergic to sulfa?” Thousands of members pose and answer questions for each other, some providing clinical advice that only a person actually living in that area might be able to give.

Support Groups for Patients

Nurses may want to suggest online communities to patients experiencing chronic illness or going through debilitating treatments. Immune-compromised patients may be unable to attend in-person meetings, but staying in touch with a virtual group may allow them to feel less isolated. CancerCare is one professional association that helps organize free groups for patients as well as their caregivers. Virtual communities and forums have been vital to patients sharing treatment experience and offering support to each other.

Consults

The Internet can be used in a novel way for clinical consults. One home care nurse described how she and her colleagues became discouraged trying to evaluate decubiti. When described in the paper chart by different clinicians using different languages or terms it was often difficult to determine if progress was being made. Solution? They used a digital camera to capture an image that could be sent daily via the web to the practitioner. In this case a picture really was worth a thousand words.

Job Searches

Work-related issues can be shared via the Internet. Nurses interested in relocating can do a web search to conduct virtual tours of hospitals they might be interested in, file an application online, get driving directions, or book travel plans through a travel site such as Velocity. When looking to change jobs they can post their resume online. Even low-cost phone communication can be run through Vonage or Skype — both require an Internet connection and headset instead of a phone line or cell phone.

Creating Community

The Internet facilitates a feeling of community and can create the ability to investigate job issues easily. Union members can use online forums to discuss contract negotiation issues, salary, benefits and legal information. New healthcare legislation and practice agreements, as well as regulatory mandates, can be tracked through blog sites. There is just no excuse now for remaining uninformed.

Brian Short, RN, discovered the importance of a nursing community over a decade ago. When Mr. Short was still a nursing student, he created AllNurses.com for the purpose of online support and education. Two years ago the site claimed to cover 400 nursing topics every day and a total of 1.5 million posts. In an interview given at the time of its 10th anniversary, Teresa Burgess, RN, pointed out the importance of the online nursing community for its ability to be used for mentoring and creating a sense of shared purpose.

Let’s end with a word of warning, however, when it comes to using the Internet. While the examples given prove that use of the Internet can be beneficial to nursing practice, we must all bear in mind that much of what we find there remains anonymous and subject to scrutiny.
Our own critical thinking must be used to determine when and how best to use the available information, and to evaluate the value and truth of what we read. Certainly if what we find can nudge us toward being better health professionals, then the monthly cost of Internet service and the time spent in connection with others is well worth it.

From RNCentral.com

I love my computer. I drag it and my iPhone almost everywhere, including to the NANDA-I Conference I attended last week. I take notes while listening to speakers, I use my phone or my digital camera to record the slides the experts use in their presentations, I post conference updates on Twitter and Facebook, and I bring it all together for this blog. I live an e-life it seems.

This is important because it has a direct bearing on healthcare, nursing, and as it would seem, nursing language (what NANDA-I uses to define “the knowledge of nursing”). My vocabulary enlarged last week as I learned a new word, some new phrases, and some new perils to look out for when I am working at the hospital.

E-Iatrogenic

We should all know that “iatrogenic” means “of or relating to illness caused by medical examination or treatment.” One of the terms we see a lot these days is “HAI” or “hospital acquired infection.” This, along with other illnesses and injuries, which happen as a result of other medical care, are no longer being paid for by the Center for Medicare and Medicaid Services (CMS) or by most insurance companies. And, there is new area of concern of which we must be aware: E-iatrogenic issues.

In the simplest way I can explain it, all the computers we’ve come to rely on in healthcare have their own perils and we are really starting to see evidence of that.

Elizabeth Borycki, RN, PhD, is an assistant professor of health information science the University of Victoria, in British Columbia, Canada. While attending NANDA-I she presented a paper on identifying and reducing “technology-induced errors” (one of those new phrases) or e-iatrogenic.

Technology-induced errors are errors that arise from the design and development of technology and the implementation and customization of that technology. In 1995 the U.S. Institute of Medicine endorsed the use of electronic health records (EHRs) as an intervention that could reduce errors. Healthcare organizations around the world ran with it and some follow-up studies reported the systems could replace the number of errors happening each year.

However, 10 years later, journal articles started publishing findings that described how EHRs and component software systems could, in themselves, lead to errors. Some of the types of errors Borycki highlighted included automatic defaults, incorrect medication dosages, and incorrect patient data. She cited some of the factors involved in these technology-induced mistakes:

• Human factors including usability and workflow.
• Organizational behavior such as socio-technical issues and system/organizational fit.
• Software engineering including testing approaches.

While chatting with Borycki, after her presentation, we noted several ways these errors happen to all of us. For example, you put in some data but forget to hit return and “oops,” the patient’s last set of vital signs don’t actually get recorded. Or the drop down box you have to pick from auto-populates an answer if you don’t pick one, or something unusual happens and there is no free-text box to record the event—all of these are situations I’ve actually dealt with as hospital’s I’ve worked in become more automated. These are all potential patient safety issues.

And this brings us to why Borycki presented at NANDA-I. Borycki and her fellow researchers believe that we need to extend the NANDA-I taxonomy to include the emergence of these new patient safety issues. That is, technology-induced errors arising from the widespread implementation of health information systems. We need some new nursing diagnoses.

According to Borycki, examples of potential interventions include:

• Reporting if computer system is not working or is malfunctioning.
• Reporting if computer system causes hazards due to inefficiencies or negatively affects workflow.
• Awareness of limitations of computer systems in nursing.
• Questioning computer generated results that may not appear to match the right patient.
• Recognizing problems in dangerous “work-arounds” due to technology.
• Training on how to proceed in situations where a computer system goes down or is not available.

Nurses I have worked with come from many camps. Some like charting electronically, some miss paper charting (although there are error problems there too) and some want EMRs to work but don’t trust the systems. The reality is EMRs and electronic charting are here to stay. It is our job as nurses to get involved, to point out where entries could be more efficient or easier to use, to learn more about the systems we are given and use every day and to be proactive in finding the best possible means for using them. For that, we need a language because it all comes back to standardized communication techniques are the best ways to keep our patients safe—our primary concern as RNs. NANDA-I has a new challenge, defining the e-knowledge of nursing.

from USA Today

COCOA BEACH, Fla. -- Yvonne Yacoub has been a nurse for half a century.

In 50 years, she has seen her profession redefine itself to meet the challenges of change, yet continue to struggle with shortages of new practitioners.

Yacoub, 72, who has worked at Cape Canaveral Hospital here for 36 years, is decades older than the 46-year-old average age of employed registered nurses. Some veteran nurses continue to work, but many more have hung up the scrubs for good or are counting the days until retirement.

"In several years, we will see many nurses semi-retire or retire completely," said Bonnie Rudolph, vice president/chief nursing officer for Holmes Regional Medical Center in Melbourne, Fla., and Health First's chief nursing officer. "Nursing is a very physical job, and many nurses cannot continue to stand, lift patients and continue to work the required shifts."

As baby boomers age, the need for nurses will increase. Even though the number of licensed registered nurses in the United States has grown from 1.7 million in 1980 to 3.1 million today, the total is not enough to meet the expected demand. Registered nurses remain at the top of the list when it comes to employment growth, so hospital systems are being proactive in trying to retain older employees.

Recruiting more male nurses, now only 7 percent of the work force, could help ease the shortage.

Most male nurses, such as baby boomer Jim Carberry, a nurse supervisor in the intensive care unit at Holmes, enter the field as a second career. Carberry was a respiratory therapist for 20 years before becoming a nurse.

"I wouldn't say it's harder to be a nurse today. It's just different," Carberry said.

"With so much specialty nursing, we all have had to learn so many new ways of doing things," he said. "It's not just one nurse doing all of a patient's care in a day. It can be several with special skills."

While nursing schools are graduating highly skilled individuals, the experience of older workers is impossible to teach in a classroom.

Registered nurse Rebecca Madore, 23 on her third day on the job at Wuesthoff Medical Center -- Rockledge, Fla., acknowledges that the reality of nursing can be daunting.

"I learned a lot at school, but it's totally different when you're actually working the floor," she said.

Madore knew she wanted to be a nurse since she was a little girl, but for many of her colleagues, the profession is a career, not a calling.

"Each group's work ethic is different," said Suzanne Woods, vice president and chief nursing officer for Health First's community hospital division.

"The veterans and baby boomers feel almost total responsibility for the workplace and will come in on short notice and cover difficult shifts. This has always been their practice. The Gen X and Millenniums are more cognizant of home-and-life balance and strive to keep this in check."

Each generation also brings different skills, all needed to best serve patients.

"The younger nurses are very technologically advanced, but the older nurses are more connected with the patients," said Rosemary Walter, director of the medical/surgical unit at Wuesthoff in Rockledge.

Technological savvy, a given for new nursing grads and necessary for survival in the health care field today, can be difficult for older nurses to embrace.

"I feel we have an advantage over older generations in the new advancements of paperless systems, computer charting and the new diagnostics," said Michele McCray Miller, 26. "Throughout nursing school, we were constantly using simulated mannequins, computer programs and other electronic devices to master skills such as NG (nasogastric) tubes, catheters and IV skills. Older generations were not as lucky to have those resources in the classroom."

Allison Rogers has been a nurse for two years. Rogers' mother was a nurse. This member of Generation X had no doubts about her career choice.

"I know how important my job is, and I consider it an honor to care for patients the way I would want my family to be taken care of," Rogers said.

The news that some employers have asked for direct access to the Facebook accounts -- including user names and passwords -- of people applying for jobs at their firms has set off a firestorm of controversy.

The reports have raised questions about whether the practice is illegal and if such a policy could expose those employers to potential discrimination lawsuits. The dust-up has even triggered calls by some in Congress for a federal investigation into the practice.

But those recent events only highlight a new reality: The identity that individuals create in the world of social media is quickly becoming an important factor in hiring decisions and in people's broader professional lives.

"The questions around employer access to social network log-ins reflect a broader debate in society about a host of digital privacy issues," says Andrea Matwyshyn, a Wharton professor of legal studies and business ethics. "This is a new concern -- the degree to which employers can gain access to all role identities through one virtual space. There is no parallel to that in the real world."

While the reaction to the practice has been swift and intense, it's hard to predict if it will become a lasting trend.

But, Matwyshyn says, she began hearing about employers requesting access to the Facebook accounts of potential hires as far back as 2008. To date, however, she says, there is no good data on how widespread the practice has become.

The fact that it exists at all is not entirely unexpected: According to Matwyshyn, a number of studies show that most employers look at candidates' online profiles when making hiring decisions, noting a 2011 survey by social-media monitoring service Reppler that found that 91 percent of recruiters report using social-networking sites to evaluate job applicants.

But checking out a publicly available profile on Facebook -- or even asking a job candidate to "friend" someone in human resources at a company where they are applying for a position -- is worlds apart from gaining unfettered access to someone's account through a password.

"If you can take Facebook passwords, what about Gmail passwords?" asks Stuart Soffer, a non-residential fellow at The Center for Internet and Society at Stanford Law School and managing director of IPriori, an intellectual-property consulting firm.

If left unchecked, Soffer says, the practice could expand beyond human resource departments evaluating potential employees.

"What about allowing Facebook access to insurers so they can see what you are saying about your health?" he says. "They could use it as a basis for judging the risk of insuring you."

The request for access to log-in information also raises some serious legal questions.

Clearly concerned about the legal and business implications of privacy breaches, Facebook has come out against the practice, stating that sharing or soliciting a Facebook password is a violation of the company's statement of rights and responsibilities.

"We don't think employers should be asking prospective employees to provide their passwords because we don't think it's the right thing to do," Facebook Chief Privacy Officer Erin Egan says. "But it also may cause problems for the employers that they are not anticipating."

Matwyshyn says employers could be essentially asking job candidates to violate their contract with Facebook if they ask for passwords, creating "an untenable conflict between contract law and employers' perceptions of their own interest in vetting candidates."

In addition, if a Facebook account includes information on an applicant's race or age, for example, that could potentially expose the employer to claims of discriminatory hiring practices. According to Matwyshyn, it is legally hazy whether accessing someone's Facebook account where that information is available is akin to asking it in the interview.

"Arguments can be made that this is a back-door method to gaining information that the prospective employer wouldn't otherwise have access to," she says.

Meanwhile, the issue is getting the attention of Congress. Senate Democrats Charles Schumer and Richard Blumenthal, from New York and Connecticut respectively, have asked the Justice Department and the Equal Employment Opportunity Commission to look into the practice.

But even if it is eventually prohibited or otherwise curbed through legal or legislative channels, Wharton management professor Nancy Rothbard predicts that the use of social media in hiring decisions will continue to be a flashpoint in the years ahead.

"The core of the problem is the blending of personal and professional lives," Rothbard says. "We are still in the infancy of trying to understand how to deal with all this."

Opening the Window -- and Closing a Door?

Just how far employers can legally go to check out job candidates online may not be clear -- but why they are looking for new methods of evaluating applicants is easy to understand, says Wharton management professor Adam Grant.

Research, he says, has shown that the typical job interview is a poor tool for predicting which candidates will succeed. If that does not work, companies need to find something that does.

"Applicants are very motivated to put their best foot forward in an interview," Grant says. "It is very difficult to spot the people who will represent an organization well. But on Facebook, you can see the applicant making day-to-day decisions -- it is a window into how an individual is likely to act."

In fact, recent research has provided evidence that online profiles can be very revealing about specific personality traits.

A paper published recently in the Journal of Applied Social Psychology entitled, "Social Networking Websites, Personality Ratings, and the Organizational Context: More Than Meets the Eye," studied 518 undergraduate students and their Facebook profiles.

The researchers found that the Facebook profiles were a good predictor of the so-called "big five personality traits:" conscientiousness, agreeableness, extroversion, emotional stability and openness. And for a subset of the group where the researchers were able to contact supervisors at companies that had hired those students, there was a correlation between scores on two personality traits -- emotional stability and agreeableness -- and job performance. (SeeHREOnline^TM story here.)

"There is strong evidence that social networking is a valid way of assessing someone's personality," says Donald Kluemper, a professor of management at the Northern Illinois University College of Business and a co-author of the study.

But he says that does not mean there is evidence that an unstructured perusal of a Facebook account will result in better hiring decisions.

"Until a method is validated in a number of ways, including a study of adverse impacts and the legal issues, I wouldn't recommend companies rely on social-networking profiles," Kluemper says.

Now, the use of social-media information is far from fine-tuned, with recruiters typically checking out social media to get a general sense of the person applying for a job or to hunt for any red flags. But it is possible the use of that information could become more sophisticated.

"People are mining that data right now for other purposes, including targeting ads to the right people," says Shawndra Hill, a Wharton operations and information management professor. "It is not out of the realm of possibility to focus that on other outcomes, like how good a match someone is for a job or whether there is a high likelihood they might do something illegal."

While the value of that data may be apparent, it remains to be seen how social media should ultimately fit into some aspects of professional life.

Take the less-controversial practice of managers' friending their colleagues through Facebook. Rothbard says this practice creates numerous potential headaches. Two years ago, she and some colleagues did a series of interviews with 20 people at a variety of levels and in a number of different industries, and found that people were often unnerved friending either bosses or subordinates.

"People felt very uncomfortable with crossing the private and professional boundary when it came to the hierarchy [within an organization]," Rothbard says. "They talked about friending their bosses with similar discomfort and language as they did when they spoke about friending their moms."

Interestingly, Rothbard adds, the rules for social networking in the workplace may differ based on gender.

She led a study of 400 students in which participants were shown Facebook profiles, told that the person was either a boss, a peer or a subordinate, and then asked to rate the individuals based on how likely they were to accept that person's friend request.

The findings: Female bosses with bare-bones profiles were less likely to be accepted than those who revealed more personal information, while the opposite pattern held for male bosses.

"Women who have limited profiles are more likely to be shunned than the women who have a more active presence," Rothbard says. "People see them as cold. But male bosses who reveal less information are more likely to be accepted than those who reveal a lot of information."

The increased scrutiny of people's virtual lives may change the way individuals operate in the social-networking realm.

According to Rothbard, there are essentially four ways of dealing with privacy issues. There are those who control their list of friends carefully, rejecting friend requests from people with whom they don't want to share personal information. Then, there are those who accept virtually all requests, but are very careful about what they post, limiting that content to very safe, less revealing information.

There is also a hybrid approach in which people use privacy settings to share some information with close friends and less-sensitive material with others. And, finally, there is the "let it all hang out" crowd -- those who are comfortable sharing all their information with a large group of close (and not so close) friends.

Grant predicts more people will opt for the more-controlled, filtered approach as they realize their social-media profiles are being scrutinized by potential employers.

"As employers gain this information, so do candidates," Grant points out. "So candidates may use Facebook more carefully and remove the cues that are so valuable [to employers]."

Soffer agrees people will become much more careful about their social-media personas.

"There are ways around this," Soffer says of the unwanted exposure of social-media behavior. "One thing that could happen is people will start having two Facebook accounts." One will be for close friends; the other, a more sanitized version for employers.

But there is always the potential that something posted for viewing by a small group of close friends on Facebook could get out into larger circulation. And for that reason, some argue, the risks of being active in the social-media space outweigh the benefits.

"If you are a CEO, or aspire to be a CEO or director of a public company, I think it makes sense to refrain from social networking," says Dennis Carey, vice chairman at Korn/Ferry International. "There are other ways to communicate with employees and the outside world through properly controlled channels. Some of the messages that are conveyed can be misconstrued or taken out of context by a third party."

The fear of a photo or comment made long ago coming back to haunt you is hardly unfounded. Because sites such as Facebook have been around less than a decade, it is not certain how long someone's social-networking history will remain accessible.

"It is unclear how long the information persists," Hill says. "Firms have different privacy policies, and often privacy policies change over time. While there are policies that allow for deleting data you no longer want on the site, it is hard to guarantee that this information won't live on a database somewhere."

The controversy worries some fans of the social-media revolution.

"I worry that there is already a sense right now that our participation online may come back to haunt us," says Chris Ridder, co-founder of the law firm Ridder, Costa & Johnstone and a non-residential fellow at The Center for Internet and Society at Stanford Law School.

"It inhibits our ability to express ourselves," he says. "If we can only express public relations-like statements, it takes away a good bit of the utility of the Internet. I think it would be a shame if we were to lose the playful aspect of this new technology."

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How would you feel if someone asked for your account information to Facebook or Twitter in an interview? What if your boss did it? Do you think this is a privacy violation? Should there be legislation on this? Let us know in the comments; we want to hear from you!

 

Are you a nurse who uses an iPhone? The iPhone is especially useful for nurses who are mobile, as this tool can help you stay in touch with medical teams and patients’ needs. Additionally, many new apps have been developed for the iPhone that fit a nurse’s lifestyle and professional requirements. Why carry 15 tools around with you when one will do the work for them all? Many of the iPhone apps listed below are not open source or free. And, many require wireless networks to operate. But, when you consider the cost of the tools you might need to simulate these apps, the app may be worth the investment.

The apps below are linked either to download sites or reviews with a link to the download site. They are listed in alphabetical order, a methodology that shows we don’t favor one app over another.

1. A.D.A.M. Symptom Navigator: If patients are using this app, maybe you should, too – easily find out what to do about any symptoms. Learn self care, when to go to the doctor, and when it is an emergency.
2. Bishop’s Score Calc: This obstetric calculator is used to calculate Bishop’s Score, a score used to assess probability of impending delivery as well as expected success rate if labor is induced. Expectant parents may also find this of use in aiding their obstetrician in determining whether induction of labor is reasonable.
3. Bio Dictionary: Bio Dictionary covers most of general biological terms. Two methods are offered for searching, and terms and their explanations are audible!
4. Cockcroft: Calculate the estimated clearance of creatinine (eCcr) with the creatinine serum rate (in mg/dL or in micromol/L). Weight can be either in kilogram or in pounds.
5. Epocrates Rx: One of the few free iPhone apps, Epocrates Rx includes a drug guide, formulary information and drug interaction checker. This product also includes continual free updates and medical news. Plus, this app resides on your device so you can look for information without wireless connections.
6. Eponyms for the iPhone: Downloadable through the iTunes store and courtesy of Pascal Pfiffner, this app brings the beautiful eponym database from Andrew J. Yee to your iPhone or iPod touch.
7. Glucose Charter: Glucose-Charter is a blood glucose, insulin and medication recording app for any iPhone. Patients can self-monitor, nurses can use it to check patients.
8. iAnesthesia: Case Logs: iAnesthesia: Case Logs allows all anesthesia providers to easily create, manage and backup case logs quickly in the operating room, leaving you with more free time when not at work.
9. iChart: Keep track of patients through this personal medical assistant. It stores everything from patient data to charts and lists of medications in a streamlined, organized fashion.
10. In Case of Emergency (ICE): You may not always practice in a hospital setting. If not, this app can provide you with all the information you need to contact emergency services in your location.
11. iRx: iRx is a pharmaceutical reference tool to get FDA information on specific drugs. This application is currently in beta status, but is fully functional.
12. Lab Tests: This laboratory test database is broken up into categories including, Blood Bank, Clinical Chemistry, Coagulation, Hematology, Serology, Immunology, Tumor Markers, Urinalysis and Therapeutic Drugs. Reference ranges and notes on the clinical significance of the test are given when indicated.
13. Medical Reference: Why memorize medical terminology when you can look it up on your iPhone?
14. Mediquations: Mediquations for the iPhone and iPod Touch brings over 201 common medical calculations and scoring tools to your fingertips with the simplicity and elegance you expect out of an iPhone application.
15. MIM Radiology: The MIM iPhone Application provides multi-planar reconstruction of data sets from modalities including CT, PET, MRI and SPECT, as well as multi-modality image fusion.
16. Mosby’s iTerms Flash Cards for Medical Terminology: Mosby’s iTerms Flash Cards for Medical Terminology, the premier study guide for mastering the prefixes, suffixes, combining forms, and abbreviations used to build medical terms, is now available for the iPhone and iPod touch.
17. NCLEX-RN Medications: Nursing students can cram for their NCLEX exam with this app that will help you study medications and conditions.
18. Netter’s Anatomy Flash Cards: Using outstanding anatomical illustrations from Netter’s hugely popular Atlas of Human Anatomy (4th Edition), Netter’s Anatomy Flash Cards allows you to carry the bestselling reference for human anatomy on your iPhone or iPod touch.
19. Netter’s Musculoskeletal Flash Cards: Master the musculoskeletal anatomy and pathology you need to know with 210 flash cards.
20. Netter’s Neuroscience Flash Cards: Enhance your understanding of key neuroscience concepts with Netter’s Neuroscience Flash Cards for iPhone and iPod touch.
21. Nursing Central: Nursing Central is the complete mobile solution for nursing produced by Unbound Medicine. The app includes premier disease, drug and test information by and for nurses.
22. Pocket First Aid Guide: Do you panic when caring for several people at once? Get a grip with this iPhone app. This is a first-aid guide for your iPhone that will help you treat anything from beestings to burns to eye injuries while you are within range of the Internet.
23. ReachMD: The ReachMD CME iPhone application is an easy-to-use and fully accredited Continuing Medical Education tool that gives healthcare practitioners a convenient way to earn free CME credits through their iPhone or iTouch.
24. ScribbleDoc: If you can’t read the good doctor’s writing, perhaps this app can help. Use your iPhone to scan the problem and ScribbleDoc should convert the image to text.
25. Skyscape Medical Resources: Available from the iTunes Apps Store, this app offers Outlines in Clinical Medicine, Archimedes – Medical Calculator, RxDrugs: Drug Dosing Tool and MedAlert for free with their download.