Social media refers to internet-based applications that facilitate communication and collaboration between individuals and communities around the globe. Social media can serve different purposes for different users; social, professional, video/content production, knowledge sharing, and entertainment (Ventola, 2014). Social media use is one of the most popular online activities in the United States and over 80% of people 12 years and older have a social networking profile (Pew Research Center, 2022).

...social media provides opportunities to debate healthcare and practice issues, promote health behaviors, engage with the public, and to educate and inform user audiences.Social media is not without controversy. Use has been associated with violence, isolation, and spread of misinformation (Bumpus, 2022; Mammoser, 2018). Conversely, social media provides opportunities to debate healthcare and practice issues, promote health behaviors, engage with the public, and to educate and inform user audiences (Ventola, 2014). Nurses have a unique opportunity to engage with the larger community on a broad array of healthcare topics.

Numbering over 4 million, nurses are the largest contingent of health care professionals in the United States (Smiley et al., 2021). Yet, less than 10% of nurses are members of professional organizations (Black, 2014). Professional organizations are the leading drivers of nursing’s legislative agenda but are informed of current issues by a small percentage of nurses (Bumpus, 2022). More recently, nurses are using social media as a platform to highlight struggles associated with the COVID-19 (Bumpus, 2022). Experts argue this use of social media, while increasing awareness of challenges faced in nursing, can also serve to divide the profession due to lack of alignment on common issues and lack of engagement in formal nursing organizations and policy matters (Bumpus, 2022).

Nurses advocate in many ways from professional leadership opportunities to grassroots efforts to impact health and health policy.However, at the intersection of social media and nursing policy development is advocacy. Nurses advocate in many ways from professional leadership opportunities to grassroots efforts to impact health and health policy. Low confidence or knowledge of the political process may inhibit engagement in the policy process, but rethinking how to advocate for change may help to increase nurses’ confidence in their abilities to promote change (Bumpus, 2022). Oftentimes, the road to advocacy can be replete with spontaneous opportunity to enact change.

Robin Cogan MEd, RN, NCSN, FAAN has spent more than two decades as a school nurse in Camden, New Jersey (NJ) and provides an exemplar of grassroots-to-national school nurse advocacy. The following is her story:

Nurses have a unique perspective, an uncanny ability to simultaneously view the world through both a magnifying glass and a wide-angle lens. This belief is what prompted me to start writing about my nursing specialty, school nursing. I felt compelled to give voice to the scope of my practice to counteract the false narrative that school nursing was a retirement job.

In July of 2017, I participated in a blogging workshop at the National Association of School Nurses (NASN) annual conference. Blogging was always on my radar, but I needed some actionable steps to move forward. The hands-on workshop was led by Margaret Cellucci, the former communications director for NASN. She asked the participants to complete a brief blog before the conclusion of the conference and she would publish it on NASN’s website. Like most nurses, when you give us an assignment, we take it to the next level, so by the end of the conference, I had five brief blog posts ready to share. I realized that I might have a new outlet for my creative energies and a way to share the impact of school nursing. I published my first post in the summer of 2017, it was entitled: The Relentless School Nurse: Will You Be One Too? (Cogan, 2017).

Social media platforms are the new street corners where news is spread in real-time and to a much wider audience. The Relentless School Nurse has grown from a blog about school nursing to a platform for social justice and nursing advocacy. Initially, I shared stories from my health office. The original mission of my blog expanded to include highlighting the work of other school nurses and providing a place for them to share their perspectives and voice. I dipped my toe into the waters of social media platforms like Twitter and Facebook and was quickly converted to a believer in the power of social media. Social media platforms are the new street corners where news is spread in real-time and to a much wider audience.

The trajectory of using social media for school nursing advocacy took an unexpected, but necessary spike upward on February 14, 2018. My family’s unfortunate encounter with two mass shootings almost 70 years apart drives my passion for treating firearm violence through a public health lens. The aftermath of gun violence sits at the intersection of my professional and personal life.

My story begins in Camden, New Jersey, the year was 1949, and my father was a 12-year-old boy, living on what he described as Sesame Street. His world was forever shattered the morning of September 6, 1949, when a deranged neighbor, with access to a weapon, went on a “Walk of Death” (Berger, 1949), murdering 13 people, including my father’s mother, father, and grandmother. My father, Charles Cohen, survived because his mother hid him in a closet.

I work within blocks of the Camden City crime scene but try not to venture down that block. When I do find myself there, I hold my breath as I pass by the entrance to my father’s home. In 1949 it was a pharmacy and my father lived above the store. Today it is a shoe store, the family entrance is no longer there, long ago walled off, but the step is still there as a chilling reminder.

Community gun violence in Camden is almost normalized as a residual effect of living in the city. I have spent twenty-one years serving the students and families of the city with the hope that my professional role as a school nurse could somehow help heal my personal family history.

Fast forward almost seventy years to the afternoon of February 14, 2018, and my niece, Carly, hid in a closet at Marjory Stoneman Douglas High School in Parkland, Florida. She quietly sent a text message to my sister telling her that there was an active shooter at school and she was hiding in a closet with her teacher and 17 classmates. Fourteen students and three teachers died that day, and another seventeen students were injured. In both instances, troubled young men with access to weapons wreaked havoc on victims, families, and communities that will reverberate for generations to come.

The decision to use my position as a school nurse to fight against gun violence came from a promise I made to my sister and niece in the aftermath of the Parkland shootings. I vowed to do everything in my power to bring attention to the ever-growing public health emergency of gun violence. Prevention of firearm violence belongs in the healthcare arena and requires funding for research as any public health issue has been afforded.

Social media, specifically Twitter, is a world where healthcare professionals across sectors, specialties, and disciplines united over this issue so emergent that barriers fell, silos ended, and meaningful conversations ensued. Nurses were also heeding the call and welcomed the opportunity to stand side by side with all our healthcare colleagues. And together, our voices were amplifying the message that gun violence is a public health emergency.

Blogging and being present on Twitter has given me an outlet that is professionally gratifying, but also opens doors outside of my nursing comfort zone. Speaking and writing about firearm violence prevention is not a topic that I would have chosen, but it seems to have chosen me. I have no choice but to use my family’s story and my nursing perspective to move this conversation forward.

The trajectory of my influence as a school nurse thought leader has been on fast forward since the Dean of Rutgers-Camden Nursing, Donna Nickitas, Ph.D., RN, FAAN, invited me to write my first guest editorial, “How I Became a School Nurse Activist” in the Spring 2018 issue of Nursing Economic$ (Cogan, 2018). Before that publication, my sphere of influence was growing within my specialty practice, but not beyond the world of school nursing.

My presence on Twitter grew exponentially after Dr. Nickitas introduced me to nurse media strategist Barbara Glickstein, another early adopter of Twitter and co-Principal Investigator of The Woodhull Study Revisited (Mason et al., 2018). I followed the release of the study with great interest and enthusiasm. I cite the Woodhull Study Revisited as transformational to my school nursing practice because it gave me the language of media competencies that I was missing. I now consider the use of social media and engaging in media as an extension of my school nursing practice.

Within months, I was collaborating with physician colleagues who believed, as I did, that gun violence prevention belonged in the public health sphere. Through the power of narrative and storytelling, I was able to transform my generational family trauma and tragedy into a compelling reason to treat gun violence as we do other public health crises. I was invited to join AFFIRM - American Foundation for Firearm Injury Reduction in Medicine as a member of their advisory board, one of only two nurses.

My two most consequential advocacy experiences were within months of each other in the summer and fall of 2019, before the world shut down from the pandemic. The first was being invited to speak at The Future of Nursing Town Hall in Philadelphia in July of 2019 (Cogan, 2020). School nurses were highlighted in the consensus study that was released in 2021 and I was tasked with presenting to the committee at the beginning of their deliberations and information gathering sessions (NASEM, 2021).

As a direct result of that one, brief, but impactful presentation, I had reached a national nursing audience that may have never considered the scope of school nursing practice. Little did I know that a few short months later, Dr. Nickitas and I would be traveling together to Washington, DC at the invitation of Representative Lauren Underwood, the Illinois Congresswoman who is a nurse and health policy expert.

Congresswoman Underwood’s Chief of Staff contacted The American Academy of Nursing in search of a school nurse who could speak to the impact of gun violence on school communities. Thankfully, Dr. Suzanne Miyamoto, CEO of The American Academy of Nursing had viewed my presentation and recommended me for a press conference that Representative Underwood hosted in September of 2019. Dr. Nicktas and I enjoyed a Hill Day that included the press conference with Representative Underwood and a private meeting with New Jersey Congressman Donald Norcross. We ended the day visiting Kris Brown, President of Brady, one of America’s oldest gun violence prevention groups.

By the winter of 2020, both my following on The Relentless School Nurse blog and my Twitter account had grown beyond my expectations. I had created cross-sector collaborative partnerships with colleagues that I had met through my social media channels. As the pandemic unfolded and the gravity of the global emergency became clear, I turned to that professional community to partner on several Op-eds and other media engagements.

One of the most consequential media interviews I did led to a cascade of follow-up interviews that all began with one notable quote. Dr. Megan Ranney, a Twitter friend, and co-founder of AFFIRM suggested my name to New York Times health reporter Apoorva Mandavalli for an article she was writing about schools reopening during the fall of 2020. Apoorva and I spoke on a recorded line for almost thirty minutes, but the one line that she printed was this: “I’m just going to say it: It feels like we’re playing Russian roulette with our kids and our staff,” said Robin Cogan, a nurse at the Yorkship School in Camden, N.J., who serves on the state’s committee on reopening schools (Belluck et al., 2020).

My quote ended up on the front page of the Sunday New York Times, above the fold. Within 24 hours, I was being interviewed on live national and local television news segments asking me to expound on why I said what I said. I took the opportunities to raise the profile of school nurses by explaining that 60% of schools in our country either have no school nurse (25%) or only a part-time nurse (35%) and that 96,000 school nurses were tasked with caring for our nation’s 56 million children (Willgerodt et al., 2018).

With each public appearance, I focused on three main messages; the need for a school health services team in every school; school nursing workload during COVID being untenable (we could not be the defacto health department and focus our school nursing responsibilities); school leadership must include school nurses as COVID liaisons (to help interpret the ever-changing guidelines and not succumb to pressure to removed protective public health mitigation strategies). I learned through a rapid succession of interviews that I did not have to answer every question posed, but rather, that I could stick to my talking points and pivot to get important messages to the public.

Nurses are no longer sitting in silence when we see what is unjust, unfair, and broken.The pandemic has ushered in a new age of advocacy & yes, I will use the word, activism. Nurses are no longer sitting in silence when we see what is unjust, unfair, and broken. Our voices are included in boardrooms, C-Suites, classrooms, and the halls of Congress. We will no longer tolerate the intolerable. When over 4 million nurses speak, the country will listen. Our unique perspective is important, our assessment skills needed and most urgently, our sheer numbers can shift policy when we unite in a shared purpose.

We can unite over big issues that impact the health and well-being of our nation. We can unite over children being separated from their parents at our borders, or the epidemic of gun violence that permeates our society. We can unite over the unmet needs of our most vulnerable populations, our children, and the elderly. We can unite over structural inequities, racism, poverty, hunger, homelessness, the opioid crisis, human trafficking, abuse, trauma, and no longer tolerate the intolerable. We can unite, we have no other choice. Our lives and the lives of those we care for and about depend on it.

Author

Robin Cogan, MEd, RN, NCSN, FAAN
Email: robin.cogan@rutgers.edu
ORCID ID: 0000-0003-3919-807x

Robin Cogan has spent more than two decades as a school nurse in Camden, New Jersey (NJ). Robin represents her professional state school nurse organization as the NJ Director of the National Association of School Nurses. She is the clinical coordinator for the Rutgers-Camden School Nurse MSN program. Robin writes a weekly blog, The Relentless School Nurse, and has a monthly nurse influencer column in My American Nurse. You can follow Robin on Twitter at @RobinCogan.