Tag Archives: ACMHN

Nurses with Cred

Last week, after a fair bit of a nudge, Australia’s federal government made the National Review of Mental Health Programs and Services available. This infographic from the report caught my eye:

That nursing is the largest single component of Australia’s mental health workforce isn’t a surprise. What is a bit unsettling is that the big bubble with 19,048 in it is mislabeled as “Total mental health nurses”.

That’s not true.

Working in mental health does not make you a mental health nurse, in the same way as driving through Bathurst does not make you a racing car driver. Just because you have a basic licence and you are in the right setting, it doesn’t mean you have the skills to perform safely at a high standard. It doesn’t mean you have cred.

As per AHPRA’s Nursing and Midwifery Board there is no registration category for a specialist mental health nurse, there are only these types of registration:

  1. Registered nurse
  2. Enrolled nurse
  3. Midwife

Compare this with types of registration listed by AHPRA’s Medical Board (sub-speciality fields and full range of speciality titles not included):

  1. Addiction medicine
  2. Anaesthesia
  3. Dermatology
  4. Emergency medicine
  5. General practice
  6. Intensive care medicine
  7. Medical administration
  8. Obstetrics and gynaecology
  9. Occupational and environmental medicine
  10. Ophthalmology
  11. Paediatrics and child health
  12. Pain medicine
  13. Palliative medicine
  14. Pathology
  15. Physician
  16. Psychiatry
  17. Public health medicine
  18. Radiation oncology
  19. Radiology
  20. Rehabilitation medicine
  21. Sexual health medicine
  22. Sport and exercise medicine
  23. Surgery

Medicine and nursing do not correlate on every detail of specialisation, but still… why such a big disparity between the two in terms of registration? Australians have rated Nurses as the most ethical and honest profession each year for 21 years in a row (1994-2015) [source], but I wonder if the public is aware of a problem with nursing specialities not being given the similar recognition as medical specialities.

Midwives have made their speciality distinctly different in the eyes of the public and other health professionals. I am sure it is a comfort for many expectant parents to know that the person guiding you through pregnancy, labour, childbirth and early parenthood is a qualified specialist and is acknowledged and registered as such.

However, people receiving support/treatment for a mental health condition will not necessarily have a specialist mental health nurse providing that service. It’s quite the opposite of midwifery – the nurse providing care may have no specialised qualifications in mental health. I wonder how service users and the people who love them feel about that.

I’ve been a medical, surgical and high-dependency/ICU nurse, and have worked closely with Midwives. I can tell you with confidence that mental health nursing is as different from general nursing as midwifery is. There are some transferable skills, of course, but midwifery, general nursing and mental health nursing each have a completely different model of care, and a very different way of working with people.

It’s not all doom and gloom though: the Australian College of Mental Health Nurses (ACMHN) have a process to credential suitably qualified and experienced mental health nurses.  In the absence of AHPRA being able to discriminate the difference between a general nurse and a mental health nurse, ACMHN are essentially saying, “Leave it to us. We will tell you who is a mental health nurse and who is not.” To be credentialed by the ACMHN, applicants must demonstrate that they:

  1. Hold a current licence to practice as a registered nurse within Australia
  2. Hold a recognised specialist / post-graduate mental health nursing qualification
  3. Have had at least 12 months experience since completing specialist / postgraduate qualification OR have three years experience as a registered nurse working in mental health
  4. Have been practicing within the last three years
  5. Have acquired minimum continuing professional development points for education and practice
  6. Are supported by two professional referees
  7. Have completed a professional declaration agreeing to uphold the standards of the profession. [source]

QHcredential_Page_27There’s more good news: Queensland Health has set targets to work towards a fully qualified, fully credentialed mental health nursing workforce. I wonder if other state health departments are thinking about implementing a similar strategy. It might be important: a program staffed entirely by Credentialed Mental Health Nurses was described as “one of the most innovative services ever funded” [source].

Credentialing + Ability = Credibility.

Credentialed Mental Health Nurses have Cred.

One last thing. It is encouraging that mental health is not the only nursing speciality in Australia that is setting the standard, for saying, “We the specialist nurses will tell you who is a specialist nurse and who is not”.  Under the Credentialing for Nurses initiative, currently there are six specialty nursing organisations working collaboratively to develop consistent, evidence based, recognition for specialist nurses:

  1. Australian College of Operating Room Nurses
  2. Australian College of Children and Young People’s Nurses
  3. Australian College of Mental Health Nurses
  4. College of Emergency Nursing Australasia
  5. Gastroenterological Nurses College of Australia
  6. Palliative Care Nurses Australia

Every speciality area of nursing,  every healthcare organisation, and every patient needs the same thing: Nurses with Cred.


That’s it, as always your comments are welcome.

Paul McNamara, 28th April 2015

Short URL: http://meta4RN.com/cred


Australian College of Mental Health Nurses, 2015: Credentialing for Practice Program

Corderoy, Amy. (2015, 25th April). Innovative mental health program falling victim to funding freeze. Sydney Morning Herald

Credentialing for Nurses

National Mental Health Commission, 2014: The National Review of Mental Health Programmes and Services. Sydney: NMHC

Roy Morgan Research. (2015, 28th April). Roy Morgan Image of Professions Survey 2015: Nurses still easily most highly regarded. Finding No. 6188



A Mental Health Nurse in the General Hospital

MHCBelow is a copy of the blog post I was invited to submit at My Health Career. The website is targeted at high school and university students considering or pursuing a career in health, guidance officers, career development professionals, and others working in or with the health care sector.

To see the post where it was first published online, and/or to have a look around at the My Health Career website, please visit www.myhealthcareer.com.au/nursing/mental-health-nurse-paul-mcnamara


A Mental Health Nurse in the General Hospital

Paul trying not to look too much like a goob.

Paul trying not to look too much like a goob.

Paul McNamara has extensive experience providing clinical and educative mental health support in general hospital and community clinical settings. He holds hospital-based, undergraduate and post-graduate qualifications, is Credentialed by the Australian College of Mental Health Nurses (ACMHN), and has been a Fellow of the ACMHN since 2007. Paul is a very active participant in health care social media, and is enthusiastic about nurses embracing “digital citizenship”. More info via his website meta4RN.com

There is an odd little sub-speciality of mental health services called “consultation liaison psychiatry”. This waffly, jargon-ridden mouthful of syllables is usually abbreviated to “CL”. What is CL? Easy – just think of it as “general hospital mental health”.

I’m a mental health nurse on a CL team. The only ward in the hospital I don’t visit is the mental health unit (the mental health unit already has heaps of mental health nurses – they don’t need me there). It’s the rest of the hospital I serve: the surgical wards, the medical wards and the maternity unit.

General hospital patients are more at risk of experiencing mental health problems than the general public – being sick is stressful. It works the other way around too: people who experience long-term mental health difficulties are more at risk of becoming physically unwell – being under lasting emotional stress can take a toll on the body.

Nurses, doctors, social workers and other allied health practitioners will phone CL when they have concerns about the mental health of a patient. Sometimes all that is required is a bit of information and clarification about medication or follow-up services available in the community – we do that over the phone. More often, we are asked to meet with the patient and determine what, if any, mental health matters can be sorted-out while they are in hospital.

The most common mental health problems experienced in the community are anxiety and depression – it’s the same in the general hospital – a lot of the people I meet with are experiencing either or both of these conditions. There are other mental health problems like eating disorders and deliberate self harm that sometimes require input from both the medical/surgical team and the mental health team concurrently. Helping-out with planning and providing support and care of these patients is a pretty big part of my job.

Sometimes it’s not the person in the pyjamas (the patient) who needs our support – sometimes it’s the communication, the systems and the clinical staff who benefit most from CL input. This can be in the form of structured education sessions or, more typically, in the form of supporting discussion, reflection and problem-solving on how best to meet the needs of the patient within the limited resources available in the hospital. In this aspect of the job, a CL nurse will try to help the clinicians involved step-back from the busyness and pressures of the hospital ward and take “a balcony view” of what is happening. By taking ourselves out of the chaos of a busy shift and calmly looking back at things with a bit of distance, sometimes we can see how we can “do business” in hospitals a little more constructively.

We also spend a lot of time “undiagnosing” (this is a “neologism” – a made-up word – I heard recently via Sydney psychiatrist Dr Anne Wand). The people we “undiagnose” the most are those who are experiencing grief. There can be a lot of grief in general hospitals, but we try to be careful not to confuse the emotions of grief (sadness, anger, temporary despair etc) with a psychiatric disorder. Grief emotions are often really uncomfortable but they are part of what makes us who we are. We don’t want to “psychiatricise” or “psychologise” the human condition. Grief is not something to be simply fixed; grief is a part of life – a difficult part of life – that is usually successfully navigated without psychiatric input. Support from loved ones and/or social workers and/or specific counselling services can help.

So, that’s an overview of what it is to be a mental health nurse in a general hospital. It’s a varied role where we spend nearly as much time with the general hospital nurses, midwives, allied health staff and doctors as we do with the hospital patients. The role involves direct clinical care, collaborating with colleagues and providing education. For more information on the speciality please visit my website or the consultation liaison nurses special interest group section of the Australian College of Mental Health Nurses website.


Print Version (PDF): CLnurse

Thanks to Amanda Griffiths of My Health Career for inviting me to submit this overview of consultation liaison nursing.

As always, your comments are welcome.

Paul McNamara, 2nd May 2014


A Twitter Workshop in Tweets

Monday at the Australian College of Mental Health Nurses (ACMHN) 39th International Mental Health Nursing Conference, we conducted a workshop on Engaging with Social Media. There were three workshop facilitators: Clare Butterfield from Canberra, Communications & Publications Officer (see @ACMHN on Twitter), Paul McNamara (me), Clinical Nurse Consultant from Cairns (see @meta4RN on Twitter) and, our special guest co-facilitator Emily Mignacca (see @emilymignacca on Twitter) graduating student nurse who commences as a RN specialising in mental health early in 2014.

Rather than use a PowerPoint or other traditional presentation method, I wrote the core content of the workshop as a series of Tweets. In real time as the hands-on part of the workshop was in action, we sent the Tweets out from the @ACMHN Twitter account. The Twitter feed on this page twubs.com/ACMHN2013 was projected onto a screen so workshop participants could see the @ACMHN tweets, their own tweets using the conference hashtag and, perhaps most importantly, the comments and interaction from other Twitter users who used #ACMHN2013. It was a successful strategy – I’ll certainly use it again for future workshops on using Twitter.

You are welcome to use all or part of A Twitter Workshop in Tweets below provided you abide by the Creative Commons Licence below. This licence lets others distribute, remix and build upon the work, but only if it is for non-commercial purposes, they credit the original creator and source – Paul McNamara (2013) A Twitter Workshop in Tweets http://meta4RN/tweets – and they license their derivative works under the same terms. You are also welcome to contact me to facilitate/co-facilitate your health care social media workshop.  My email is meta4RN [at symbol] gmail.com

1. Pre-workshop info/publicity

Engaging with Social Media – Clare Butterfield and Paul McNamara Monday 21st October 2013 12:30-2:30pm

Social media allows Collaboration and Partnerships in Mental Health Nursing to transcend time and place: time through collaborative, asynchronous communication; place by being connected to the world’s online clinical communities. This hands-on workshop aims to act as a launching-pad for those who want to turbo-charge the conference theme.

The workshop will be in two parts: The first, briefest part, will introduce four examples of professional use of social media, using Twitter as the primary example. This part of the workshop intends to show participants the value of engaging with social media.

The emphasis will be the second part of the workshop. This will be a hands-on session that will assist participants gain confidence in using Twitter. This part of the workshop intends to equip participants with skills in engaging with social media in a professional capacity. Wifi will be available. Participants are asked to bring:

  • a mobile internet device (eg: smartphone, tablet or laptop computer);
  • knowledge (ie: the relevant passwords) on how to download apps onto your mobile device;
  • for those who already have an established Twitter account, the knowledge (ie: the relevant passwords) on how to access it;
  • a spirit of curiosity and fun!

To reinforce the learning acquired in the workshop, follow-up “skill checks” will be scheduled during conference breaks on Tuesday and Wednesday. Please come along – the workshop facilitators expect it to be a dynamic, fun, enlightening masterclass in engaging with social media.

Emily Mignacca was invited to join in co-facilitating the workshop just a couple of weeks before the workshop. Although Emily missed-out on being named in the pre-conference publicity, her participation on the day was vital. Emily worked hard and did a good job supporting people who were more than twice her age pick-up some of the skills and enthusiasm she has in using social media professionally. You could do worse than follow @emilymignacca on Twitter.


Below is a list of my pre-composed, pre-ordered tweets for the workshop. There were minor adjustments, inclusions and exclusion made as we went along, but mostly we just sent them out verbatim.

2. #ACMHN2013 Twitter Workshop in Tweets

Creative Commons License
A Twitter Workshop in Tweets by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Based on a work at http://meta4RN/tweets.


Please RT to show Twitter’s potential/reach to participants in today’s #ACMHN2013 Engaging with Social Media Workshop

Starting soon: #ACMHN2013 Engaging with Social Media Workshop. Info: http://acmhnconferences.acmhn.org/speakers/ (near bottom: scroll down) #HCSMANZ

No PowerPoint slides at the Engaging with Social Media Workshop. We’re Tweeting the content using this hashtag #ACMHN2013

Warning: HEAPS of #ACMHN2013 Social Media Workshop tweets next 2 hours
To join: http://twubs.com/ACMHN2013
To mute: http://roniweiss.com/2011/05/03/muting-hashtags/


#ACMHN2013 Facilitator 1 of 3: Clare Butterfield @ACMHN Communications and Publications Officer with – Face of ACMHN’s Twitter

#ACMHN2013 Facilitator 2 of 3: Emily Mignacca @emilymignacca GenY/Millennial, Almost-Mental Health Nurse – Future of @ACMHN

#ACMHN2013 Facilitator 3 of 3: Paul McNamara @meta4RN clinical nurse consultant + educator – Fellow of @ACMHN

First-up, a hard-sell on some professional uses of Twitter. For those playing-along at home see http://meta4RN.com/poster #ACMHN2013

What is Twitter’s potential/reach? Here’s a demonstration we prepared earlier https://twitter.com/meta4rn/status/392021423943716866 #ACMHN2013

Here are the results: http://www.symplur.com/healthcare-hashtags/acmhn2013/analytics/?hashtag=acmhn2013&fdate=10%2F17%2F2013&shour=9&smin=0&tdate=10%2F21%2F2013&thour=9&tmin=0&ssec=00&tsec=00&img=1 #ACMHN2013

Enough chin-wagging. Let’s start doing! Go to https://twitter.com/signup to start an account #ACMHN2013

Make a choice now: is this an official, personal or professional twitter account? Mental health nurses know about boundaries, right? #ACMHN2013

Need clarification on official, personal + professional? This Qld Gov site is clear + succinct: http://www.qld.gov.au/web/social-media/policy-guidelines/guidelines/official-use.html#ACMHN2013

On your professional twitter account you’re not representing an organisation, but are primarily talking about work-related stuff #ACMHN2013

Choose a short name (aka “handle”) eg: instead of @BartholomewBonython maybe @BartB #ACMHN2013

Bad news for people without exotic names: @JohnSmith @JSmith + @SmithJ are all taken ;-/ #ACMHN2013

Short names and concise tweets are good. Twitter = Brevity Central #ACMHN2013

Struggling deciding on a name? Get creative! Example: a nerdy mental health nurse might be @MHnerse #ACMHN2013

Or… a graduating student nurse might be @SN2RN #ACMHN2013

Don’t use your workplace name/initials unless you’re 100% sure you’re representing your employer rather than your professional self #ACMHN2013

That’s why I’m @meta4RN rather than @QueenslandHealthRN – there’s a BIG difference in implications/expectations #ACMHN2013

Think about how you’ll describe yourself in your Twitter bio. Do you need to name your employer? It might be easier if you don’t. #ACMHN2013

Twitter bios accommodate a bit of personality along with a description of you/your interests #ACMHN2013

Re bio: maybe better not to say “lost virginity to a rockstar”, but “enthusiastically supporting musicians” would be OK🙂 #ACMHN2013

Professional doesn’t have to be boring #ACMHN2013

Still nervous re the name/bio thing? You’ll get away with being anonymous, but why? On the run? Witness protection program? #ACMHN2013

And a pic. You’ll need a pic. Eggs repel followers. #truefact #ACMHN2013

Your pic doesn’t have to be a photo. There are avatars available online PRN. eg: http://www.twittergallery.com/?p=1985 #ACMHN2013


Right. When you’re ready, announce your arrival to the Twitterverse. No pressure: channel Neil Armstrong. #ACMHN2013

Oh, and use the conference hashtag so we can see your tweet on the #ACMHN2013 screen

Next up you’ll want to start following some people, otherwise your Twitter feed will be bare, and you will get sad, lonely and bored😦 #ACMHN2013

Who to follow? We can start with each other – a learn as we go thing #ACMHN2013

Twitter is not like Facebook. It is perfectly acceptable, not at all stalker-ish, to follow a complete stranger. #ACMHN2013

#ACMHN2013 Also, if you want to see who else is active in health care social media in Aus/NZ sus-out this hashtag: #HCSMANZ

#ACMHN2013 @nurse_w_glasses is a rockstar amongst social-media-mental-health-nurses: well worth following.

While we’re looking at who to follow, sus out the #WeNurses + #OzNurses hashtags – anyone/anything of interest? #ACMHN2013

If so, you may want to follow that person and/or retweet (ie: share) their tweet. #ACMHN2013

RT = ReTweet
MT = Modified Tweet
HT = HatTip/HeardThrough
More about Twitterisms here http://meta4RN.com/FF #ACMHN2013

Now, about hashtags… don’t be intimidated. You can use Twitter happily with never using one in your whole life #ACMHN2013 BUT…

Hashtags pull disparate conversations and people together. Like at this mental health nursing conference, for instance #ACMHN2013

Eg: even if you had the most incisive political tweet ever created, QandA viewers wouldn’t know about it without the #QandA hashtag #ACMHN2013

The hashtag thing can be fiddly at first. For the #ACMHN2013 conference this site makes it REALLY easy: http://twubs.com/ACMHN2013

Create your own hashtags, BUT learn from the Susan Boyle album launch hashtag: #susanalbumparty can be read 2 ways🙂 #ACMHN2013

So, what to Tweet about? Anything that you think is relevant to people who may share all or some of your interests #ACMHN2013

Remember: the conventions of professional communication are long-established: letters, email etc. Why change it on Twitter? #ACMHN2013

Now, let’s pause and have a look at the @acn_tweet / RCNA (2011) Social Media Guidelines for Nurses http://www.rcna.org.au/WCM/Images/RCNA_website/Files%20for%20upload%20and%20link/rcna_social_media_guidelines_for_nurses.pdf #ACMHN2013

While we’re at it, let’s have a look at the @NurMidBoardAust guidelines too http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F3224&dbid=AP&chksum=qhog9%2FUCgKdssFmA0XnBlA%3D%3D #ACMHN2013

Any surprises or comments about the social media guidelines? #ACMHN2013

#ACMHN2013 The guidelines are pretty common-sense stuff. Maybe this flowchart is all we need


On a mobile device? Install an app, eg: Twitter https://about.twitter.com/download #ACMHN2013

On a mobile device? Install an app, eg: HootSuite https://hootsuite.com/features/mobile-apps #ACMHN2013

On a mobile device? Install an app, eg: Tapbot http://tapbots.com/software/tweetbot/ #ACMHN2013

Probably the easiest way to learn Twitter is to follow people who have already learned Twitter. Stick with it – it’ll click in. #ACMHN2013

Do unto others. #TwitterTips #ACMHN2013

#TwitterTips #ACMHN2013 Be careful mixing personal and professional. Boundaries are important.

#TwitterTips #ACMHN2013 You already know about confidentiality; if you’re doing confidentiality wrong online it will definitely get spotted.

#TwitterTips #ACMHN2013 Naturally, you would NEVER give individual or detailed clinical advice on Twitter.

#TwitterTips #ACMHN2013 Generalised info is fine, eg: Getting great feedback from consumers about the @mindhealthc site http://www.mindhealthconnect.org.au

#TwitterTips #ACMHN2013 Try not to act like a dickhead. Also, don’t use words like “dickhead” – it’s unprofessional. #TwitterTips #ACMHN2013

#TwitterTips #ACMHN2013 Apologise if you do/say something stupid. BTW sorry for saying “dickhead” before.

#TwitterTips #ACMHN2013 Twitter spam is especially good at playing on the insecurities of newbies, so be vigilant + don’t click dodgy links.

#TwitterTips #ACMHN2013 Spam example 1:
This person is saying horrible things about you www.dodgylink.com DON’T CLICK!

#TwitterTips #ACMHN2013 Spam example 2:
This photo of you! LOL www.dodgylink.com DON’T CLICK!

#TwitterTips #ACMHN2013 Mostly you won’t Tweet from/about your workplace… you’ll have your work to do.

#TwitterTips #ACMHN2013 There may be an occasional exception to the workplace rule, eg: Gammin Hospital Christmas decorations are fabulous!

#TwitterTips #ACMHN2013 Would your patients or boss be offended by that photo? Yes = Delete. No = Tweet.


#TwitterTips #ACMHN2013 RT @charleneli: Twitter is not a technology. It’s a conversation. And it’s happening with or without you.

#TwitterTips #ACMHN2013 No need to worry about forgetting today’s workshop, it’s all here: http://meta4RN/tweets

#TwitterTips #ACMHN2013 Connect. Be generous. Have fun.

Creative Commons License
A Twitter Workshop in Tweets by Paul McNamara is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
Based on a work at http://meta4RN/tweets.

As always, your comments and feedback is welcome. Please use the comment facility below.

Paul McNamara, 23rd October 2013

#ACMHN Looking back at the 2013 Consultation Liaison / Perinatal Infant Conference through a Social Media Lens


The 2013 ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference was held on June 6th and 7th, in Noosa – on Queensland’s Sunshine Coast. It is a boutique conference: these two subspecialties account for a tiny fraction of the total mental health nursing workforce. Given the size of these subspecialties, the conference organisers were pleased with the attendance of about 70 nurses, who gathered together from New Zealand and most states/territories in Australia. 70 is probably about par for the course.

IMG_1850The theme of the conference was “Present and Available” – an exploration of the process of presence, being with and affecting change in the variety of settings that we work. This post explores whether social media can also help mental health nurses and their conference content be present and available to others via social media, specifically: via twitter.

Quantitative Data

There were 26 twitter participants using the #ACMHN hashtag over four days (the two conference days being in the middle of this period). Interestingly, only 3 of the 26 #ACMHN participants were delegates (ie: only 12% of those tweeting about the conference were actually at the conference). Let’s look at the make-up of all #ACMHN participants:

  • 3 conference delegates (each of them Australian mental health nurses)
  • 4 Australian mental health nurses, across three states (Victoria, South Australia & Queensland)
  • 2 European mental health nurses (Germany & Netherlands)
  • 2 Australian general nurses (New South Wales & Australian Capital Territory)
  • 2 Australian nurse/midwife academics (both in Queensland)
  • 1 UK nurse academic
  • 1 Australian psychologist
  • 6 Australian health-related agencies
  • 1 Australian health service manager
  • 1 USA physician
  • 2 non-clinicians from the USA
  • 1 mental health clinician?/consumer advocate? from Scotland

It’s surprising and enthusing (to me, anyway), that a boutique conference being held in a small regional Australian city attracted such an eclectic, geographically widespread group of social media participants. The 26 #ACMHN hashtag participants sent 141 Tweets in the timeframe being examined. The three delegates generated 90 #ACMHN tweets, being 64% of the total during the examined period.

Use of the #ACMHN by those away from the conference was almost entirely in the form of retweets – a simple process where one twitter user shares the content of another twitter user, thereby spreading information quickly and widely. Through this compounding, amplifying effect that social media activity has, during the 96 hours being examined the #ACMHN hashtag had a potential reach of over 94,000 (source). Two specific examples of this will be examined below under Twitter is an Amplifier.

Qualitative Data

The qualitative data is the content of the tweets.

I recommend that you scan through the curated (ordered, edited and quite readable) version of the transcript here: http://storify.com/meta4RN/noosa

Also available is the un-curated (asynchronous and jumbled to read, but complete) transcript here: http://qld.so/tweets 

Twitter is an Amplifier

IMG_1841IMG_1840Assuming that a key purpose of a health care conference is to share information, it would be foolish to overlook the amplifying effect of social media. This first example of a simple statement in a presentation on anorexia nervosa, shows how a message reached beyond the 70 people at the conference to a potential audience of over 20,000.

Let me show the maths on that:

579 = the number of people following the @meta4RN Twitter account. So that one Tweet could have been seen by up to 579 people/organisations. I doubt very much that it was seen by that many. Believe it or not, people have better things to do with their time than read every single one of my tweets. Nevertheless there is a very good chance that many dozens, maybe as high as a couple of hundred or so, people see any single tweet sent. That single Tweet was retweeted (ie: shared/passed-on) by five other Twitter accounts, each with their own group of followers, thus:

Let’s add those numbers up: 579 + 9712 + 8433 + 1969 + 178 + 1403 = 22,274. (source)

So, the potential (not actual) audience for that one message delivered to 70 conference delegates suddenly becomes a message that would have been seen by thousands of people. How many exactly? No idea. As long as you pick a number less than 22,274 your guess will be as good as mine.

IMG_1848IMG_1849Another example of Twitter being used as an amplifier is with this Tweet regarding the publications of one of the conference presenters. The bit at the end that reads “Ping #nswiopCS13” can be interpreted as “You people following the Advances in Clinical Supervision conference may also be interested in this”.

One of those in attendance at the Clinical Supervision conference retweeted, as did two Professors of Nursing: one with James Cook University in Cairns, the other with City University in London. So, while the numbers of people exposed to the presenter’s publications via a tweeted internet link is more limited than the previous example, they were also more targeted… nobody values peer-reviewed journal publications more than an academic. It’s good for Chris Dawber’s professional profile to have nursing academics on either side of the world to be aware of his papers and sharing them with their Twitter followers. It is also useful that Chris had his papers bought to the attention of those at/following a Clinical Supervision conference that was being held in Sydney at the same time as our conference. The link to Chris’s papers is here.

Danger Will Robinson!

This amplifying effect of Twitter comes with a cautionary note… what if I misquoted or inadvertently misrepresented what Catherine Roberts said?

Easily could have.

I don’t doubt that I’ve captured the essence of what Catherine said as I heard/understood it. However, by using quotation marks I have attributed it as a direct quote from Catherine. Now, a few days after the conference, I’m not 100% confident that I have used Catherine’s exact words.

Naturally, I’ll pass-on a genuine and contrite apology to Catherine if I have got it wrong and caused any offence or embarrassment. However, in practical terms, it’s too late – the horse has bolted. For better or worse, there are probably thousands of people who now think that’s what Catherine said.

Another point of risk: all the way through the conference I tweeted out the take-home message from sessions as I understood it (as seen by scrolling through here). What if I’ve missed the point that speaker wanted emphasised? What if I got it wrong?

Does that make social media too scary and dangerous to use professionally? Of course not.

For me, there’s three strategies that these reflections suggest:

  1. Be careful with what you Tweet if you’re attributing it to others. For example, only use quotation marks when you’re sure you have the presenter’s exact phrasing correct. Also, try to make it clear whether the take home message is the presenter’s words, or your own understanding/interpretation.
  2. Encourage more social media conference participation. As with this example from a keynote presentation at the International Council of Nurses 25th Quadrennial Congress, it’s more interesting to have multiple people using social media rather than just one. Multiple participants also makes it less likely that a single participant’s misunderstanding will be read in isolation… a safety in numbers thing.
  3. For presenters: take control of your social media presence – don’t leave it to chance. That’s what I did with my presentation at the conference (see example below).


2As you can see above,  rather than take the risk of being misunderstood and/or misquoted by a conference delegate tweeting, I did the tweeting myself via scheduled tweets in the lead-up and during my presentation. As I did, you can include links to websites that are relevant to your presentation. This is a good way to keep control over your message. (BTW: a summary of my presentation is online: meta4RN.com/twit)

For presenters, the alternative way to take control of your social media impact from a conference is to announce, “No Live Tweeting Please”. That’s fine – it should be the presenter’s prerogative. However, what you’re actually saying is either, “What I Have To Say Is Too Precious For People Like You To Share” (in which case, should you be talking about it at a conference?), or “I Do Not Understand or Trust Social Media” (which sounds a bit like, “I do not understand or trust traffic lights” – charmingly quaint, but oddly old-fashioned).


For those familiar with my web site, you’ll notice that this post is an obvious companion piece to three previous posts:

Looking Back at a Nursing Conference through a Social Media Lens

Looking Back at Postnatal Depression Awareness Week through a Social Media Lens

Looking Back at a Mental Health Nursing Conference through a Social Media Lens

Through examining and reflecting on this collection of data, I am gathering confidence and understanding of professional use of social media. By sharing it online, hopefully other health professionals will do likewise: more the merrier.


That’s it. As always, your comments/feedback are welcome.

Paul McNamara, 12th June 2013

Omnipresent and always available: a mental health nurse on Twitter

or “Four Examples of Twitter being useful for Health Professionals”


The original (embarrassingly self-agrandiasing) title of this post matches the title of a presentation at the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses 2013 Annual Conference – the theme of which is “Present and Available”. As stated in the conference publicity, this theme offers an opportunity for these sub-specialities of the mental health nursing community to create conversations and explore the process of presence, of being with.  At the conference we hope to improve our understanding what constitutes being present and available in the variety of settings and ways that we work.

The presentation is a blatant hard-sell to mental health nurses regarding professional use of social media. Examples of Twitter being used to augment education, conferences, health promotion, and the profile of mental health nursing are cited. Turbo-charging the conference theme, the argument will be made that mental health nurses can go beyond being “present and available”. Through professional use of social media mental health nurses can create the impression of being “omnipresent and always available”.

It wasn’t really until I started putting the presentation together that I realised what I had in mind was mostly a summary of stuff I have already presented online. So, for those interested in the content of the presentation, here are four examples of Twitter being useful for health professionals (click the links for more info):

View from the podium at the opening session of the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference 2012

View from the podium at the opening session of the ACMHN Consultation Liaison / Perinatal & Infant Mental Health Nurses Annual Conference 2012 – I will update with a picture from the podium of the closing session for the 2013 conference ASAP

That’s it for this post. Thanks for dropping-by – please feel free to comment below.

Paul McNamara, 7th June 2013*

* Actually written on June 1st. The presentation is scheduled for 3:30pm on the last day of the conference: Friday 7th June. I’ve scheduled this blog post to be published and publicised via Twitter, Facebook & LinkedIn at 3:50pm – about the time my presentation should be winding-up (tip for conference presenters: the best way to ingratiate yourself to an audience at the end of a conference is to be quicker than expected).

Perinatal and Infant Mental Health Nurse eNetwork

At the 2nd Annual General Meeting (AGM) of the Perinatal Infant Special Interest Group (PI SIG) of the Australian College of Mental Health Nurses (ACMHN), a report will be given on the Perinatal and Infant Mental Health Nurse eNetwork.

There’s over 200 more people on the eNetwork than who will be at the AGM, so this very brief post and 5 minute-long video are for those who are interested in the eNetwork but won’t have a chance to be in Noosa when the report is given.

In short, the eNetwork is growing, thus:


Activity on the eNetwork is humming-along, like this:


And the place to subscribe/unsubscribe is here:

If you want more info please visit this page and/or have a look at the video.

Two last things.

[1] I’m not representing the Australian College of Mental Health Nurses, or anyone else for that matter (see Q13 here). This video/blog post have come about because I had a bit to do with getting the eNetwork up and running, so am interested in looking-at and reporting-on its development. That’s it.

[2] This is a scheduled blog post. So, although written on 03/06/13, it’s scheduled to go public at about the same time the ACMHN PI SIG AGM ends.

Paul McNamara, 6th June 2013

#acmhn2012: Looking Back at a Mental Health Nursing Conference through a Social Media Lens

The Australian College of Mental Health Nurses (ACMHN) held the 38th International Mental Health Nursing Conference earlier this month. The theme of the conference was “The Fabric of Life”, it was held in Darwin from the 3rd to 5th of October. The ACMHN has a very good wrap-up of the conference here. Other than add my thanks to the conference organisers and add my congratulations to the award winners, I don’t want to replicate the ACMHN conference summary. Instead, I want to look back on the conference using a social media lens.


Now that you have read to this point, non-Twitter aficionados may not leave or fall asleep.

There were those from a previous generation who may have been scared of the telephone and never had one installed in their home. They survived, but everyday social and professional communication was trickier than it had to be. More recently, there are those who have been reluctant to have a computer in their home or to use the computers at work. Again, these people have survived, but probably at the expense of feeling/being left behind. Now sometimes there are people who similarilly scared of social media, especially Twitter.

You’re too young to be left behind; please keep reading.

Twitter is Not a Toy

twitter.com/meta4RNTwitter is not just a toy – it has some real usefulness in healthcare communication.

However, despite the warning above, if you do click away at least click to something interesting – this site www.symplur.com has the transcript and analytics of the conference hashtag: #acmhn2012. It’s pretty cool, in a geeky kind of way..

Most of what follows is just a commentary, my commentary, on their content, plus a call-to-arms at the end.

Hashtag Power

You have almost certainly heard of or seen a Twitter hashtag. My first real understanding of their usefulness was watching the ABC’s political panel TV program Q&A. Since April 2010 Q&A has included viewer participation via a moderated Twitter stream which is organised/collated by using the #qanda hashtag; it’s a powerful mix.

I and a handful of other Australian Mental Health Nurses had dabbled in using Twitter hashtags at conferences on the Gold Coast and in Melbourne, but it was definately a trickle not a flood. It wasn’t until the 27th-30th June this year that I saw for the first time how that powerful Q&A hashtag idea could be replicated in a health care context.

www.icem2012.orgMike Cadogan is, like most people I follow on Twitter, someone I’ve never met or spoken to. At the risk of sounding like a stalker, I’m pleased that I’ve been following Mike: I’ve seen what he gets up to, and have been inspired. In June Mike was in Dublin attending the International Conference on Emergency Medicine. While there he was Tweeting like a demon: pumping out quips, quotes, occasional photos, thoughts, reflections and questions that were arising during conference presentations and inbetween sessions. Mike used the hashtag #ICEM2012; when you clicked on the hashtag you could see that Mike was not alone – dozens of people were adding their two-bobs worth. Intriguingly, not all of the people joining in the conversation were in Dublin – there were people commenting, asking questions, and making suggestions from all over the world.

It was pretty cool to see that the International Conference on Emergency Medicine was being truely international. People in (that’s in, not from) many countries were participating in the conversation the conference in Ireland was generating. Often the Tweets were instant – the conversation happening in real time across thousands of kilometres. Sometimes the conversation was asynchronous: threads happening hours, even days, apart. How was this happening? Simple: interested people were all using the same #ICEM2012 hashtag on Twitter. This provided a level of organisation to the conversation that allowed participation and collaboration within and beyond the conference walls; something that simply would not have been possible a few years ago.

Then came the clincher that really demonstrated the power of the hashtag. Mike had set-up #ICEM2012 as a healthcare conference hashtag on symplur – we all got to see data of how many Tweets were being sent, who was sending them, and a collation of the content. If you’re into either qualitative or quantitative data, or you’re just plain nosey, have a look at the #ICEM2012 summary here.

lifeinthefastlane.com/2012/09/why-the-hashtagIt’s a powerful demonstration of hashtag power. In fact, the strong use of social media at the conference has generated a more lasting idea and a more sustained Twitter hashtag #FOAMed – this is an abbreviation of “Free Open Access Meducation”.

To find out more about that go to Mike’s blog: lifeinthefastlane.com.

#acmhn2012 = Our First Red-Hot Go

The ACMHN’s 38th International Mental Health Nursing Conference in Darwin provided an opportunity for Mental Health Nurses to have our first red-hot go at using social media in a collaborative, planned way. A month or so before the conference, Clare Butterfield, the ACMHN Communications & Publications Officer, started releasing announcements via email updates and on social media that the conference would have a Twitter hashtag: #acmhn2012. Also around that time, Clare registered the hashtag with “The Healthcare Hashtag Project”, a free service offered by Symplur. That decision, and the good people/bots at Symplur, has given us access to the data that follows.

The Numbers

Twitter activity during the conference using the hashtag #acmhn2012:

  • Wednesday 3rd October: 16 Tweeting, 166 Tweets
  • Thursday 4th October: 16 Tweeting, 126 Tweets
  • Friday 5th October: 16 Tweeting, 167 Tweets

Total Twitter activity using the hashtag #acmhn2012:

  • 3rd October to 5th October (during the conference): 28 Tweeting, 459 Tweets
  • 11th September 2012 to 11th October 2012: 38 Tweeting, 586 Tweets

The pre-conference build-up, intra-conference crescendo, and post-conference fade-out of Tweet activity are all beautifully graphed by Symplur:

Graph courtesy of “The Healthcare Hashtag Project”, copyright of http://www.symplur.com Click on image to see original source.

What do the numbers tell us?

78% of the #acmhn2012 Tweets occurred on the three days of the conference (defined as midnight beginning Wednesday 03/10/12 to midnight ending Friday 05/10/12, Darwin time^). Two Twitter accounts (aka handles) accounted for over half of the #acmhn2012 Tweets during the conference. The most prolific account using #acmhn2012 during that period was @nursewhitebeard with 163 Tweets, closely followed by @meta4RN (my account) with 160 Tweets. Together these two accounts provided 55% of the intra-conference Tweets. The next three most prolific accounts were @ACMHN (88 Tweets, 15% of the intra-conference activity), @cityalan (44, 7.5%) and @AnabeldelaRiva (28, 5%). Those five Twitter accounts provided over 82% of the #acmhn2012 Tweets during the conference.

Image courtesy of “The Healthcare Hashtag Project” http://www.symplur.com

It is interesting to note that of the top ten most prolific users of the #acmhn2012 hashtag, two of the account holders did not attend the conference in Darwin. The account @eGPSolutions joined the Twitter conversation from Sydney, and @SkellernLecture participated from London.

In the lead-up to the conference (Tuesday 11/09/12 to Tuesday 02/10/12) ninety-eight (98) #acmhn2012 Tweets were sent; this represents 17% of the total #acmhn2012 Tweets. Nineteen Twitter accounts used #acmhn2012 prior to the conference commencing. The most prolific account Tweeting in the lead-up to the conference was the official Twitter account of the Australian College of Mental Health Nurses @ACMHN with 29 Tweets, representing 30% of pre-conference #acmhn2012 Tweet traffic.

In the days after the conference seven accounts used the hashtag in their thank-you messages, farewells and wrap-up statements. Twenty-nine (29) #acmhn2012 Tweets were sent from Saturday 06/10/12 to Thursday 11/10/12. The post-conference Tweets accounted for 5% of the total.


There are two ways to examine the content of the Tweets that used the #acmhn2012 hashtag in the month from 11/09/12 to 11/10/12.

First is the full transcript of all 586 tweets with the hashtag #acmhn2012 (time period = from 11th September 2012 to 11th October 2012) which is available here. For purists/purveyors of raw data, that’s the one for you.

Second is the curated, shortened version on Storify which is available here. In this version I have grouped tweets addressing the same topic/theme together, and left-out most of the retweets in an attempt to make a more coherent narrative than the chronological, but asynchronous, full transcript*.

Please scan through the Tweets to get an idea of what was happening at the conference. I think the #acmhn2012 Tweets capture many of the presentations and the general tone of the conference very well.

I do want to highlight just a few of the many conversations that happened via Twitter; as with using Storify, I am inadvertently more self-referential than intended (sorry about that).

Instant Reference

In this example, one of the conference speakers suggested further reading, but did not have the full reference on hand during her presentation about mindfulness. One Twitter user made note of the speaker’s suggestion of how to find the reference via a popular search engine, and within minutes another Twitter user had found the reference and shared it with everyone following the #acmhn2012 hashtag.


Topic of Interest

In this example, information about the launch of the ACMHN Clinical Supervision Special Interest Group was being followed with interest by two Twitter users who were not attending the conference. Nevertheless, they had an opportunity to interact with the official Twitter account of the College, and also one of the delegates who shared information about a presentation on clinical supervision.

It is very positive that the delegate sharing this information was one of the international Keynote Speakers; he was active and interactive on Twitter throughout the conference. It was very interesting to see his Tweets take content from the Australia-based conference, and be shared amongst UK-based Twitter users.


Conference Participation by Non-Attenders

A Sydney-based Twitter user expressed an interest in gathering the conference abstracts. S/he was not attending the conference and, let’s face it, there’s only limited detail about a presentation that can be conveyed with 140-character Tweets. Nobody responded to the initial request, so nearly 24 hours later a London-based Twitter user bought the topic up again. A few hours later a conference delegate noted the Tweet and responded with a link to the conference abstracts.


Critiquing The Data

In this last example, after the conference ended, there was still an opportunity for the #acmhn2012 hashtag to be used constructively. One Twitter user shared a link to the Symplur data that has been examined in this blog. Another Twitter user questioned the validity of a metric for how many impressions a healthcare hashtag has made in users’ tweet streams. Symplur computes total impressions by taking the number of tweets per participant and multiplying it with the number of followers that participant currently has. The brief exchange served as a timely reminder to be cautious about reading too much into some aspects of the data.

So What?

Is Twitter twaddle? Does any of this matter? Any lessons learned?

I think that both the quantitative data and the qualitative data yielded by the #acmhn2012 hashtag create a very strong argument in favour of using Twitter in a professional sense. Tweets from the 38th International Mental Health Nursing Conference show a lively exchange of information between conference delegates and amongst interested parties who were unable to attend the conference. These exchanges of information took information beyond the conference walls and beyond the three days allocated to the conference.

On whether it matters probably depends on whether you think the conference content matters. I think it does; it inspires and energises my work.

As for lessons learned, I can’t claim guru status, but here’s some reflections that I want to share with Mental Health Nurses in particular, and other health professionals more generally. Please feel free to add to the list in the comments section below.

Twitter Tips

  • Does your employer ask for a conference report when they’ve contributed to expenses? Mine does. My Tweets = my conference report.
  • My Tweets = my notes. They don’t get lost like paper notes do. They’re arranged chronologically so I can find them, and many of them have hyperlinks or photos to help me remember specifics.
  • Other people’s Tweets also = my conference notes. Other people have different perceptions and attend different sessions to me; I really like being able to use their notes to augment my notes.
  • Hashtags good. Harshtags bad. The #acmhn2012 hashtag was used in a warm, generous, occasionally collegially playful manner as is befitting of a professional conference. If you have nasty thoughts at a conference there is no need to Tweet them: write them on a dunny wall or whisper them to a trusted friend instead.
  • It only takes a spark to light a fire. As noted above, five Twitter users pumped-out over 80% of the Tweets at #acmhn2012. However, the more the merrier: more people Tweeting = more perspectives = more data = more interesting. Let’s encourage each other to get Tweeting.

Organising a conference?

  • Did you pay attention to the numbers above? It would be reasonable to suggest that the College’s official @ACMHN Twitter account played a significant part in setting the expectation that Twitter would be welcomed and encouraged at the conference.
  • Announce your conference hashtag well ahead of time, in conjunction with other forms of promotion.
  • Naturally, use Twitter to announce the hashtag too.
  • What if a conference speaker does not want their presentation Tweeted beyond the conference walls (eg: contentious results in an incomplete research project)? They will have the prerogative to make this known at the beginning of their session; it would be unusual and antisocial for delegates not to comply.
  • Definitely use tools such as Symplur’s Health Hashtag Project. All the cool kids are doing it; see this list. Register your hashtag with Symplur before you start publicising it, as soon as possible.
  • Similar deal with Storify and whatever other Twitter aggregate tools you come across. These things don’t work as retrospective ideas, get in early.

Never Tweeted before?

  1. Go to Twitter and start an account.
  2. Make a decision: is this for personal use or professional use? Don’t mix the two: I think it’s too confusing and treacherous with the boundaries thing for mental health clinicians.
  3. If it is a professional account, go here, then scroll down to the bottom where it says “All #acmhn Participants”  – they’re the people you might want to start following first. Click on the thumbnails to find out more about each of them.
  4. Think about how you’ll describe yourself; do you need to name your employer? It might be better if you don’t. Still nervous? Hide behind a nickname until you feel more confident (make that a temporary, just-getting-started-and-feeling-uncomfortable strategy only please).
  5. Announce yourself to the Twitterverse.
  6. Lurk and see how others are using Twitter. Watch, then do. That’s how you’ll learn and become confident.
  7. Get a Twitter app on your mobile phone/tablet device.
  8. Share. Enjoy. Be generous.


They’re overstated. Do unto others. Don’t be a dickhead. Watch that professional boundary thing. Apologise if you do/say something stupid. Don’t respond to spam or trolls. You’ll be fine.

participem aut mori

The last two Tweets sent in the period examined included the call to arms: participem aut mori, which, when translated from Latin, means share or die**.

That is the message I would most like to convey to my healthcare professional colleagues, especially Nurses. The Nursing workforce in Australia is a rapidly ageing: using 2011 data our average age is 44.5 years, 38.5% of us are aged 50 or older. We, as a profession, need to pull our finger out and get on with succession planning. Twitter alone isn’t going to do it for us, of course. However, if you’re a Nurse who thinks that your experience, knowledge, professionalism, communication skills, ethics or enthusiasm are worth sharing in the workplace, then they’re worth sharing online too. Nursing and health will be commented on in social media anyway, isn’t it sensible that Nurses and other health professionals participate in and shape that discussion?

Let’s get more of us using Twitter in a professional capacity (use a Guide Book to get started if you’re baffled by it). Then we can open all our conferences with the announcement, “Ladies and gentlemen please turn your mobile phone or tablet on, switch to silent, and Tweet using this hashtag…         “.

participem aut mori

*Author’s note re Storify: I found curating this list a frustrating, tedious affair, and the end product is neither as complete or as coherent as I had hoped. It still has interest, I think, but amongst other problems I had using Storify was that through my inexperience with it, the most prolific user of the #acmhn2012 hashtag is inadvertently significantly under-represented and my Tweets are over-represented; sincere apologies to @nursewhitebeard

**Author’s note re participem aut mori:. I took the book title Share or Die and translated it in lower case using Google Translate. I have no idea how accurate the translation is, but am aware that a different result is yielded if Title Case is used.

^Note for nerds: Symplur is based in California, so the dates/times are all in their time zone (amusingly called “Pacific Time”, despite the fact that nearly half of the world’s time zones occur across the Pacific Ocean). The time/date ranges used above have been adjusted to Darwin time (being the city that hosted the conference). The tool used for that calculation is www.timeanddate.com

Paul McNamara, 28th October 2012