Come One Come All: A Successful Model for Building and Sustaining Online Community Among Nurses and Nursing Students

Teresa Burgess RN, BSN, COTL

Citation:
Burgess, T. (February, 2006) Come One Come All: A Successful Model for Building and Sustaining Online Community Among Nurses and Nursing Students. Online Journal of Nursing Informatics (OJNI), 10, (1) [Online]. Available at http://ojni.org/10_1/burgess.htm

Abstract

In an effort to identify the characteristics that define successful practice in building online community, the author reviews the allnurses.com website which claims to be the largest global online community of nurses. The site was founded in 1996 and boasts thousands of members from across the world.  Eight important features; shared purpose, trust, guidelines, humor, flexibility, accessibility, expert facilitation, and storytelling, are identified as factors which contribute to the highly active and sustained community of nurses found at this web site.

 “Without a sense of caring, there can be no sense of community.”  Anthony J. D’Angelo

Introduction

With the goal of identifying key aspects which make for building and sustaining an online community, I began a search for a successful online community within my area of professional expertise. It did not take me long to land upon and become familiar with www.allnurses.com as a successful and sustained network of nurses. Started in 1996, by chief executive officer Brian Short RN, www.allnurses.com has grown into the global leader in online nursing communities. This venue for informal education currently boasts 97,199 members and 35 moderators according to its founder. 19,594 of the members are student nurses and there were 8 student nurse forums. There are approximately 7,000 nurses from foreign countries who are members of allnurses.com Visitors have the option of lurking, registering and posting for free, or paying for a premium membership at a cost of $30/yr. Premium membership affords you additional online storage and the ability to personalize your posting profile and include a photo or clipart. Premium members are indicated as such on their posts and they are given access to upload and store documents and pictures and to create or vote in polls.

While not a formal web-based educational program, valuable lessons about what it takes to grow and sustain a community of facilitator/teachers and learners can be gleaned from this thriving online society. By examining the success of allnurses.com and aligning what is known from the literature on building online community with their model, I hoped to identify factors that I could integrate into future collaborative online coursework that I design and/or facilitate. All of the identified characteristics of successful community building and sustenance are found at this site.

Shared Purpose

The web site is mostly a gathering place for nurses who are engaged in their profession and love what they do, no matter how long they have been in the profession. While I obviously couldn’t review every member profile and every discussion forum, I found very few O.R.J.’s (On-The-Job-Retiree’s) at allnurses.com. There was a forum or two on nurse “burn-out” but no nurses seemed to discourage those in the student nurse forums or those exploring the possibility of changing careers and going into a nursing. I read many examples of nursing students seeking and receiving encouragement from experienced nurses. Sweet April 04 wrote “Please, please help me I’m overwhelmed” and received encouragement and study tips from JentheRn05 who ended her post by saying “Never give up on your dream - never give up on yourself - because if you want it bad enough - you will do it.” (JentheRn, 2005)  If burned-out nurses were present, they must have been lurking and reading, but not registering. According to an article in JAMA (Aiken, 2002) in hospitals where there is a high patient-to-nurse ratio nurses are more likely to experience burnout and job dissatisfaction. Where I did find a stray nurse who was “stressed out”, others were quick to empathize and suggest alternative nursing career paths that might be a better fit. Perhaps nursing staff to patient ratios are improving because I expected to find more discussion on nurse burnout and I read few posts where nurses were complaining about their career choice. For the most part allnurses.com seems to be doing its part to keep the career pipeline primed.

Trust

According to the dictionary, trust means assured reliance on the character, ability, strength, or truth of someone, or something, or one in which confidence is placed (Merriam-Webster Online, 2005). At allnurses.com you can ask for or offer advice, teach, show support, show your passion, chat, journal (either publicly or privately), compare experiences and explore nursing related specialty options all while maintaining as much anonymity as you prefer. Expert moderators monitor discussion and offer their expertise. Trust is built when one sees a moderator’s profile and reads his or her credentials, titles and areas of expertise.

Moderators also serve as trustworthy mentors. The moderators that I met were expert clinicians, excellent communicators and ethical role models who exhibited high standards, respect of others, a commitment to shared learning, and empathy which are some of the characteristics mentioned as those of excellent online mentors (Clark & Toto, 2004).

Guidelines/Charter

Registering at this site requires one to agree to and adhere to Terms of Participation (T.O.P.’s) before being given public posting rights. Established T.O.P.’s serve as the group’s (and visitors) team charter helping govern social interactions and assuring member accountability. As nurses join the site they gain confidence to become involved by knowing that there are rules that they and others must abide by. Not only do moderators have the ability to enforce the terms of participation and suspend a member’s posting privileges, but individual participants can report another member who fails to follow the established guidelines and can block further private communications from those they feel have violated the terms. The terms are quite specific as to what is not tolerated, including flaming, profanity, business solicitation, etc.

Additional security features also help welcome new members and guide participation at the website. Registration requires establishment of a screen name and password. Certain words have been censored by the administrator. If someone's posts contain any censored words, they will be blanked-out like this: *****. The same words are censored for all users, and censoring is done by a computer simply searching and replacing words. It is in no way “intelligent”.

Humor

Nursing is stressful and at allnurses.com, a nurse can relax and let down her or his hair. One can join in or just read and chuckle at humorous posts in a variety of nursing humor forums. Forums such as these help nurses debrief from the life and death situations, the “human dramas and traumas” they deal with daily. I call it the “MASH-factor.”

Here are a few examples extracted from the nurse humor forum that struck a note with me, thanks to my days in the emergency department:

You might be a nurse if….

  1. Discussing dismemberment over a gourmet meal seems perfectly normal to you.
  2. Your idea of a good time is a full code at shift change.
  3. You believe that unspeakable evils will befall you if anyone says, "Boy, it sure is quiet around here."
  4. When you're out in public and you compliment a complete stranger on their great veins.
  5. You believe that the waiting room should be supplied with a Valium salt lick.
  6. When you mention vegetables, you're not referring to the food group.
  7. You have ever bet on someone's blood alcohol level. (Dplear, 2001)

Empathy

After a student shared that they had just learned about failing their state board exam and admitted to crying and being depressed and frustrated, moderator Suzanne4 responded, “Try to take a couple of days for yourself and then just regroup and get back on the horse and begin your studying process. You are not the first, nor will you be the last. What exactly did you do to prepare yourself, what did you use, and how did you use it? I am willing to help you…” (Suzanne4, 2005)
         
Reading about and sharing stories, struggles, moments of excellence, successes, failures and disappointments with other nurses creates a catalyst for social and emotional bonding (Denning, 2005). In general nurses are an empathetic lot and the nature of the work requires us to develop intimacy and connectedness quickly with our patients. This characteristic serves the members of allnurses.com well for it is evident that most who contribute to the posts have honed the art of empathy to an exact science. 

Flexibility

Asynchronous and synchronous discussion options are available at allnurses.com. Sharing an understanding of each others’ busy lives, members don’t seem anxious about the time it may take others to respond. The membership is large enough and diverse enough that there is always someone online willing to lend a hand if a question or need for advice or support is urgent. Interaction ranges from live chat to asynchronous threaded discussions whose responses may span a time period of hours, days, weeks or months. Popping into the chat area, where there were multiple possible chat room topic options, I found two nurses chatting gleefully about graduate school during what were the wee hours of night in my time zone.

Accessibility

A simple, easy to spell web address makes returning to the site a breeze. Allnurses.com gives you a plethora of options. You can see how many nurse members have birthdays on any given calendar date, search for schools of nursing, nursing scholarships, or boards of nursing. You can look up educational events, search for another nurse member, view or join a forum (I counted over 50 different forums to choose from) or create your own forum or chat room. You can opt in or out of e-mail lists, take a tutorial on how to use the site, read FAQ’s on things such as reading and posting messages, customizing your personal profile, signing up to receive a free electronic nursing newsletter, and reading archived newsletters.

Each registered member receives a personal control panel where he/she can keep a buddy list and an ignore list. They can design and personalize a profile and posting salutation, add emoticons and amend posting text color, font and background. Premium membership grants members additional storage space, the ability to add a photo or avatar to posts, access to online games, the ability to create or vote in polls, and the ability to upload attachments.  These options all add to a warm sense of community and social presence.

Expert Moderation/Facilitation

Moderators are chosen by the site founder or suggested by other moderators from among the membership of involved premium members with excellent netiquette. Moderators look for clinical experts who visit the site and post frequently. They also look for members who are excellent and empathetic facilitator/exhorters. Moderators oversee specific forums. They generally have the ability to edit and delete posts, move threads, and perform other manipulations. Becoming a moderator for a specific forum is usually awarded to users who are particularly helpful and knowledgeable in the subject of the forum they are moderating. The Nursing Informatics forum, for example, is moderated by a nurse who holds her bachelor’s degree in nursing and is board certified in nursing informatics. She posted information and a link to the 2005 American Medical Informatics Associations (AMIA’s) website and upcoming annual symposium in the nursing informatics forum. VickyRN (forum name) is an associate degree nursing program instructor and moderates the Nursing Educator forum. TraumaRUs is a trauma department nurse from the Midwest who did her ADN to BSN online and then BSN to MSN online - both through University of Phoenix – and came out with $42k in student loans. She is now enrolled in an online/in person clinical nurse specialist program.  Besides relating to this moderator’s career path, as a graduate student myself, I could also relate to her accrued debt.

Storytelling

Much of what makes allnurses.com successful is the camaraderie and storytelling. As Stephen Denning explains, "Storytelling builds trust, unlocks passion, and is non-hierarchical”. “Storytelling brings people together in a common perspective, and stretches everyone’s capacity to empathize with others and share experience" (Denning, 2004). Here’s an example of a story I could relate to. The initial forum post asked if other nurses speak to their brain dead patients. And member Rhoresmith responded,

…I took care of a comatose man, he was a very large man and others were commenting about his size etc. when we were caring for him. I always talked to him and usually touched his arm or stroked his forehead when I was with him. When he woke up and I mean woke up (he opened his eyes and just tried to talk he was oriented and alert but on a vent) when I came in to take him off the vent he knew me by my voice. I still to this day get Christmas cards from him and his wife, he told me that I made him feel like a person not a slab of fat (since he heard himself be called that - he weighed over 300lbs) and he would never forget me for that reason. I have let that be my reminder whenever I deal with conscious [sic] and unconscious [sic] patients. I have always been proud of myself about this because I was very young 23-24 and working with much older more experienced [sic] people who gave me a hard time about this patient and I stuck to my guns.

Conclusion

Many lessons can be harvested from the lasting success of this online support and educational forum. Shared purpose, trust, guidelines, humor, empathy, flexibility, accessibility, facilitation and storytelling create a cozy, aromatic and inviting respite for road weary nurses at allnurses.com. The site has all the ingredients of a highly functional online collaborative community of life-long learners and creates an inspiring, wisdom-filled, non-threatening environment for aspiring nurses. I am beginning to see that there are a variety of factors including shared excitement around a profession, large volumes of practical content that is regularly updated and the skill of expert nurse/moderators that draw nurses to and sustain this online community.

References

Aiken, L., Clarke, S., Sloane, D. Sochalski, J., & Silber, J. (October 23, 2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job            Dissatisfaction, JAMA, 288 (16) 1987-1993.
Clark, Y., & Toto, R. (2004). Mentoring Students Online. Pennsylvania State University: Education Technology Services. Retrieved October 28, 2005 from http://tlt.its.psu.edu/suggestions/mentor/index.html
D’Angelo, A., (2006). Anthony J. D’Angelo Quotes [Brainy Quote], Retrieved January 13, 2006 from http://www.brainyquotes.com/quotes/quotes/a/q101307.html
Denning, S. (2005). The Leaders Guide to Storytelling: Mastering the Art and Discipline of Business Narrative. John Wiley & Sons: San Francisco, California.
Denning, S. (2004). Launching and nurturing communities through storytelling, Retrieved October 28, 2005 from            http://www.stevedenning.com/storytelling_communities.html
Dpler [forum user name]. (2001) Posted September 9, 2001 under Nursing Humor forum at www.allnurses.com. Retrieved January 13, 2005 from http://allnurses.com/forums/f58/you-might-nurse-10146.html
JenTheRN05 [forum user name]. Threaded post under General Nursing Student forum at all nurses.com.  Retrieved November 2, 2005 from
http://allnurses.com/forums/f50/please-please-help-me-im-overhelmed-prerequisites-120125.html?highlight=burn-out.
Merriam-Webster Online. Retrieved November 2, 2005 from http://www.m-w.com/dictionary/trust.
Rhoresmith [forum member name]. (2004) Posted May 24, 2004 in general nursing forum at www.allnurses.com. Retrieved November 3, 2005
from http://allnurses.com/forums/f69/do-you-talk-brain-dead-patients-67338-7.html?highlight=touching+story
Siri [forum user name]. (2005). Private e-mail exchange with Moderator Siri at www.allnurses.com October 19, 2005.
Short, B. (2005). Private e-mail exchange with founder of www.allnurses.com October 27, 2005.
Suzanne4 [forum user name]. (2005). Posted August 13, 2005 under Nursing Student forum at allnurses.com. Retrieved Janaury 13, 2005  from http://allnurses.com/forums/f197/update-my-results-115955.html

Author Bio

Teresa Burgess RN, BSN, COTL

Ms. Burgess is a professional nursing education consultant with Kaiser Permanente in northern California and also is part-time nurse manager of a faith-based non-profit clinic. She has been a Registered Nurse for over 25 years and has a broad nursing background having worked in a variety of inpatient and outpatient settings including critical care, emergency, labor and delivery, podiatry, education, telephone advice and home health/ hospice. Ms. Burgess is in her final quarter of completing her Master’s Degree in Education from California State University, East Bay and has a certificate in Online Teaching & Learning.