Strategy AND Policy

I have been thinking a bit lately about social media and what we need to move social media forward in nursing.  Even after 7 years of being a Tweeting and Blogging nurse I still hear stories of social media being shot down, of employers and universities emphatically urging nurses and student nurses to steer clear of any social media; I still hear people poo-hooing social media and saying “it’s a fad”; and I still get incredulous looks when I put the idea on the table that social media has a role to play in our professional lives.  So lets clear this up here and now … social media is here to stay.  Take a look at the timeline below …

social media timeline

… and just take a moment to reflect on the fact that social media has been around for quite sometime now …..

….. yep !

Social media is not going away! Isn’t it about time we realised that ? Social media is no longer new! Isn’t it about time we realised that? Social media plays a huge part in modern life and can be of huge benefit to nursing! It’s definitely time we realised that!

It’s time to think about social media and how we can use it moving forward in nursing and although many healthcare settings have a social media policy (which don’t get me wrong is a fab thing) how many healthcare settings have a social media strategy? How many of us are looking forward and strategically thinking about how we want to shape nursing and how social media can help, support and drive that ?

policy vs strategy

I think that we need not only social media policies but also social media strategies and the two, even though at first glance seen to work in opposition, will help to create a balance that can drive forward the brilliant professional tool that social media can be.

Social media is not new, it’s firmly established .. so lets start setting guidelines and setting goals … and then I believe that nursing can really start to unlock the potential that social media has to be a productive item in our professional toolkits.

Being smart not unprofessional !

Two conversations caught my eye on Twitter last night, both seemed to get a lot of air time.  The first conversation was sparked by this tweet from @DebsCooper131:

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The tweet got many responses and a good deal of interaction with lots of people tweeting about finding and loosing pens.  It was a good fun sort of thread.

The second tweet and ensuing conversation that captured my interest was sparked by this Tweet from @captaintau:

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There were lots of answers to this tweet and subsequent conversation, and I have to admit that some of the comments surprised me a little.

The two tweets got me thinking as both mention tools that we can use in nursing, the humble pen – been around for eons, everybody has one in their pocket (or even three if you are super organised) its a pretty useful communication device and no one questions its use in nursing; then we have the smartphone – its been around for a bit, it fits in your pocket, its a really useful communication device and yet we seem to question it’s use ! The two devices, pen and smartphone both seem quite useful to me however the two Twitter conversations could not have been more diverse.

The conversation around the pen was light hearted and fun but the conversation about the smartphone could not have been more intense.  I mentioned above that I was surprised by some of the tweets … and I was.  Some people were adamant that it is unprofessional to use a smartphone as a nurse, that it was too “tempting” for nurses to have smartphones in their pockets and why would they need a smartphone anyway ?!!

Can I just say this here and now …. GOOD GRIEF !!!

Firstly a device or a tool no matter how technological can never be unprofessional, ( I am currently rolling my eyes) it’s the inappropriate use of such things that is unprofessional.  A smartphone is a pocket sized communication tool that gives us a world of knowledge and expertise in the palm of our hand ….. why on earth would we not use that?  I would actually argue that not to have one is unprofessional. As for nurses being “tempted” if they have access to a smartphone whilst on duty (again I roll my eyes) I challenge any nurse to find the time to be tempted !! I know that when I do clinical work I really don’t have time to think about anything but the people I am caring for.

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What worries me more about both of these conversations is that our willingness to accept that a nurse needs a pen and that it is a valid nursing tool for 2017 (I rarely use a pen in my personal life, yet at work could not get through a second of clinical practice without one) yet our complete inability to accept that a smartphone is not a valid nursing tool (rolls eyes for third time)

There is so much that the smartphone has to offer nursing – access to information, access to expertise, bedside recording, access to records when and where we need it, access to apps, access to the internet, portable communication and all in your pocket.  The pen … well that just writes, and maybe stirs your coffee from time to time.  I was in a restaurant the other day and the waitress got out a smartphone to take my order, I didnt think it was unprofessional of her … I thought “wow, how fab is that?” Go into any Apple store and the sales assistants all use smartphones to help you make a purchase .. are they unprofessional? Does anyone question them? No ! So lets get over this …. smartphones are a smart way to work not an unprofessional way to work.

I was glad to see that Ann-Marie Riley (@AnnMarieRiley10) from Nottingham University Hospitals tweeted and shared her experience, as I know that they are really embracing the use of smartphones for nurses at Nottingham:

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I think Ann-Marie has hit the nail firmly on the head – why wouldn’t we use technology? It’s definitely the smart thing to do – we don’t need to work harder as nurses, we need to work smarter, we need to embrace the technology, we need to stop being fearful.  We are are the people who make ourselves look professional, technology is merely a tool and it cant take away our professionalism.

Finally Matt Ballantine (@ballentine70) brought my thinking full circle when he tweeted:

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It’s not the tools, it’s how we use them …… so lets get smart !

 

Stuck on CPD

I have had a few conversations lately both on and offline around continuing professional development (CPD)  in nursing, I guess its only natural as more and more of us are revalidating CPD is very much on our minds.  However with austerity still very much the order of the day it worries me that many nurses still remain very fixed in their idea of CPD. I had a conversation with a nurse a little while back who was absolutely adamant that CPD only counted if it took place in a classroom, he was utterly convinced that this was the case until I showed him what the NMC (2017) say about CPD:

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Why was he so fixed in his idea of CPD? I guess historically CPD is something that has always “happened” to us as nurses.  I recall as a newly qualified nurse we had training sessions on the ward I worked, where people came in to teach us about different areas or skills, we were also sent on training courses regularly and CPD was something that came to us from our employer.  Most of the CPD I did was passively sat in a classroom like environment, being talked at – CPD wasn’t something I had to actively do.  So perhaps this has something to do with the reason why so many of us are so fixed in our view of what counts as CPD in nursing?

I have three problems with this idea of CPD:

Firstly – I am not so sure that sitting passively and being talked at in a classroom is really the best way to learn and develop.  I know that it’s certainly not the case with me – I need to actively discuss things, have the scope to read or find out more, explore ideas, try things out and actually “do” instead of just sit and take notes.  A few years ago I came across this on Twitter:

The-Learning-Pyramid2013

(Source: http://www.une.edu/studentlife/biddeford/las-1 )

I’m not sure if it’s steeped in any good quality evidence or research but it makes sense to me. I certainly know that passive learning is not for me, conversation, discussion, doing and showing seem to work much better. 

Secondly – There is no money… austerity reigns and classroom based CPD is expensive. Theres the cost of the venue, the speaker(s), the cost of lost work hours and also the cost of travel and expenses.  There has to be a smarter way that gathering people together at a venue … in fact we know there is, we just need to start using them.

Thirdly – We should take control of what we learn.  As a practicing nurse I have interests in social media, elderly care and dementia … learning IVI’s, TPA , BAL, HFEA or some other acronym is not really where i want to take my learning.  I was my CPD to be based around my needs.  I want to dictate when i do it, how I do it and what its on … its my learning after all.

How do we move with the times? How do we change our mindset regarding CPD – perhaps the answer is in developing . social mindset.  I really like this sketchnote by @tnvora that explores social mindset, in particular the social learning element:

social mindset

Social learning is about taking our traditional idea of learning and giving it a good shake.  I love the term “working out loud” and I think that the potential to apply this is nursing is huge.  learning together, developing communities of practice and creating an ecosystem of learning when and where we want it is, in my opinion, a very attractive proposition.

Isn’t it time that we took hold of CPD and turned it on its head? Isn’t it time we took responsibility for it? Isn’t it time we took control of it?  Isn’t it time to stop being passive about our learning as nurses? I think that social learning is the way forward – it’s time to step out of the classroom and into individualised lifelong social learning.

Oxygen

I quite often listen to Radio 2 as I go about my day to day life, it’s on in the car, the kitchen and even the office, I like the mix of music and chat … this week Chris Evans was discussing some rather interesting stuff that really resonated with me.  The section was all about worry and stress and whilst I mostly don’t get too stressed I am a worrier so the conversation was one that I stopped and listened to. Chris and the person he was chatting to (apologies I didn’t catch his name) were talking about how we can cope with stress and worry and the phrase “put your own oxygen mask on before helping others” This was something that I had not heard in this context before and it certainly made me wonder … do we do this in nursing?

Entirely by coincidence last week I ran a series of Twitter Polls through WeNurses asking nurses if they had taken their break that day.  I ran it for 3 days … and here are the results:

Whilst the polls themselves reveal some concerning results the comments made in reply to the polls were perhaps the most interesting part:

 

Not taking a break means that we don’t get to rest, eat or drink.   Hydration amongst doctors and nurses on call (El-Shakawry 2016) is a study that looked at the scale and impact of dehydration on doctors and nurses.  The study found  ”Thirty-six percent of participants were dehydrated at the start of the shift and 45% were dehydrated at the end of their shift” and “Single number and five-letter Sternberg short-term memory tests were significantly impaired in dehydrated participants” This doesn’t even take into account hunger or tiredness … and what about the long term effects on mental health and wellbeing and morale? Not taking a break is a serious problem in nursing and you might argue one that affects the care we deliver, yet from the comments not having a break seems so … well … normal … and .. acceptable!

I wonder if we were to view our breaks as oxygen masks would we think differently about the importance of them? I am not being flippant here, I honestly think that we need to take this approach.  We have to take care of ourselves before we can take care of others – how can we make important care decisions if we are have not rested, eaten or drunk throughout the course of our shift?

break

At this point I feel I must confess that I have often been on a clinical shift where I have not taken a break and recently I have been reflecting of why this has happened.  Sometimes the shift has been very busy and there just doesn’t seem to have been time for me to step off the floor .. so given the now established fact that breaks are akin to oxygen masks would I do this differently? Yes I think I will – no matter how busy the shift working tired, hungry and thirsty is counter productive and we need to recognise this.  If I were on a plane and attended to someone else’s oxygen mask before my own I would soon be on the floor gasping for air and we would both be in trouble ! By taking a break this means I can return to my work refreshed and able to care more effectively.

Although taking breaks whilst on duty takes a change in individual mindset I also think that we have to support colleagues to take breaks to … ask them if they have had a break, do that urgent thing for them whilst they go off the floor, reassure them that you will care for that really unwell person and tell them that in order to care effectively they must take care of themselves.  We also need to address organisational culture – is it normal in your work environment that people take breaks? How can we make this a good thing to do? How can we check that people have had a break? How can we support people to take breaks?

The choice is simple – we can either care until we drop, leading to unwell nurses and poor care … or we can take a break and breathe in the oxygen that enables us to provide the very best of care.

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Reflecting on a discussion

It’s not long now until I have to revalidate for the first time and I am trying to be super organised.  As my revalidation date is at the start of September I thought it best to get everything sorted this side of the summer.  I have always been an overly organised person – when we go on a long dog walk I’m the person who takes bite cream and plasters just in case! My revalidation is no exception – I have lost count of the amount of times I have logged on to the NMCs revalidation website - to the extent that I apologise to the NMC as its me who is bumping up your visitor figures, which are sure to drop post September!

I now have my portfolio ready.  I opted for a paper version in the end – I can hear you all saying “what?” – however I tried digital but felt that I needed to really see, touch and visualise my portfolio.  I think that this has something to do with the way I learn, I need to use as many senses as possible and my revalidation is no exception.

IMG_2729I have divided the portfolio into colour-coded sections that correspond to each revalidation requirement. I have my feedback and have completed my reflections.  And this week I had my reflective discussion.

IMG_2730I have an unusual role being a self-employed nurse working in social media so I was a little worried about my reflective discussion.  I approached a fellow nurse, Wendy,  who tweets who I respect and who’s opinion I value and she kindly agreed to help.  We live quite far apart from each other so we decided to use Skype.  I emailed her my reflections so that she could read them before hand and we both sat down with a cup of tea and Skyped.

Having never experienced a reflective discussion before I’m not sure that I knew what to expect.  I was worried about being put “on the spot” or having to answer tricky questions but it wasn’t like that at all.  Wendy made me feel at ease, she used phrases like “I was really interested to read……” and she related my reflections to her own work and experiences.  We found that there were similarities in situations we had come across, particularly one challenging situation that I had reflected on,  but we had dealt with them differently.  We were able to look at why that was and how we would perhaps deal with similar experiences in the future.  We chatted for almost an hour – and stayed on topic ! I can’t thank Wendy enough for making the reflective discussion a positive and worthwhile experience.

The whole discussion has left me reflecting …. Did the reflective discussion help me to become a better nurse? I think perhaps it has …. It gave me time to stop, articulate thoughts, share experiences and understand the reasons for my actions.  It helped me to reason why I felt the way I did about some things and in turn I feel that this will help me in the future in applying learning and learning from experiences and feedback. I think that it has also given me a bit more confidence, people often say that a problem shared is a problem halved perhaps this is true for reflecting on challenging situations. There is a part of you, when faced with a challenging situation, that thinks “is it me?” By reflecting and discussing it can help with that feeling of being the only person to have experienced this and give confidence to act as needed in the future when faced with similar situations.

I hope that if ever I am asked to have a reflective discussion with someone I can do it to the same excellent standard as Wendy did for me, I certainly have a great role model to follow.

At the end of the discussion Wendy asked if I had someone to act as confirmer – I sheepishly said that I hoped that she would consider doing it and again she kindly agreed.  However my hefty, well organised portfolio is somewhat of a challenge in itself – so we decided this was a great excuse to meet up and catch up in person …… I will be hiring a trailer for my portfolio ;D

 

 

That will never work !!

I recently asked a question via a Twitter Poll about nurses use of social media:

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The results didn’t surprise me too much but what did surprise me was some of the tweets i received in response to this poll. What most surprised me were the comments made in relation to using social media to communicate with the people we care for, some people were quite adamant that nurses should absolutely not engage with the people we care fro within social media spaces …. I feel that I need to challenge this thinking and ask “why not?”

With more than seven in ten internet users having a social media profile and two thirds of adults, with a profile,  using a social media site more than once a day (OFCOM 2016 ) it could be argued that social media is becoming the default way to communicate.  Particularly when I think of my teenagers social media is such a normal way for them to talk and communicate with others. So why are nurses reticent about using this communication tool to communicate with the people we care for?

The NMC Social Media Guidance does not discount engaging with patients on social media it quite rightly mentions confidentiality and not using social media to build or pursue relationships with patients, which gives us some scope to embrace the power of social media to engage with the people we care for. There are obstacles to overcome – privacy ? – confidentiality ? – do the people we care for want to engage with nurses in this way ? – to name a few … but surely the possibilities are there if we dare to think a little differently? Can we really write off social media as a means of communicating with the people we care for? I’m not sure that we can.

I think that even though there are challenges with communicating in social media spaces as nurses we will overcome them, we will evolve and the technology will evolve to find a way that works… as this is how people want to communicate.

Whilst contemplating this and browsing the internet I came across this rather interesting blog “15 Worst Tech Predictions Of all Time” Documented here are the naysayers, the people who said ‘that won’t work’, and boy did they ever get it wrong … among the worst predictions are:

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1876: “This ‘telephone’ has too many shortcomings to be seriously considered as a means of communication.” – William Orton (President of Western Union) – errrrmmmm the telephone is pretty much the basis for modern communication.  If we look at healthcare alone … how many times do you use the telephone during your working day? What about NHS 111 ? Teleconferencing? Telephone consultations?

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1981: “Cellular phones will absolutely not replace local wire systems.” — Marty Cooper, inventor. - just take two seconds to appreciate the proximity of you mobile phone. I bet it’s within hands reach.  Of course without advances in mobile communication community nursing and mobile working would be so much more challenging!

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1995: “I predict the Internet will soon go spectacularly supernova and in 1996 catastrophically collapse.” — Robert Metcalfe, founder of 3Com. - yep!! someone actually said this!! If i have all the time in the world i bet i couldn’t list what the internet has done for health – online journals, NHS Choices, sharing of information, blogs, videos … ahem … SOCIAL MEDIA!!

So in 10 years time when we are tweeting our virtual GP, Facebooking our midwife or have a Instagram outpatients appointment will we look back and say how daft we were to think that we would never be able to communicate with the people we care for through social media? Well I don’t have a crystal ball so I am not entirely sure … however I do know that without exploring the possibilities we will never realise the potential.

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Has it really been a year since #WGT16 ?

As we hurtle towards the end of February I have been thinking lots about this time last year and how we were busy plotting, planning, organising and doing in preparation for February 29th and WeGetTogether or #WGT16.  And what a day it was! For me it was definitely one of the busiest days of my life …. lots to do, lots of people to connect with, lots to see. lots of cake to eat and lots and lots to talk about.

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The whole day seemed to whiz by in the blink of an eye …. however I remember halfway through the day taking time out to just sit and watch; I went upstairs to the balcony and just sat for ten minutes and observed.  What I saw was pretty overwhelming; I saw people from all different backgrounds, with very different roles and pace in healthcare doing what we do everyday via social media .. connecting and talking.  You might think “why was that overwhelming?” – well it was overwhelming because they were all under one roof …. we did it! We got together and we connected beyond our virtual spaces.  It was overwhelming because I was just one agency nurse and here I was face to face with people I had connected with.  It was overwhelming because here was the proof that we are not alone and we are all working together with a common purpose.

One of the enduring images of the day was this time lapse video that we created … we see people coming and going, hugging and laughing, connecting and celebrating …. it has to be one of my most favourite videos of all time:

There are many things about #WGT16 that I am proud of:

  • We had an amazing team that pulled #WGT16 together
  • We crowdfunded a whole conference
  • We connected the conference to social media & social media to the conference
  • We raised money for two charities
  • We showed that there is another way of doing things
  • We had a jedi, a giant blue bird and feather boas in the same room!
  • We embraced tech like QR codes, Vine, YouTube, Infographics and Blogs
  • We had some fabulous cake
  • We had the most amazing and inspiring student nurse volunteers helping all day
  • We worked together to create something amazing

What would I change about #WGT16 if I had to do it all again ….. there is loads I would change and tweak.  I would be braver in the planning and trust my instinct more, I would think more clearly about how we connect the virtual experience to the real experience and vice versa, and I would take more time to sit back and enjoy the time with the amazing people in the room.  We said we would hold a #WGT every leap year …. so perhaps, if I am fortunate enough I can take these thoughts forward for #WGT20 !

But what came out of #WGT16, what did we achieve ? NOTHING!!! However I am not sure that this is a bad thing.  Social media is living in the moment and what #WGT16 was about was living in that moment, in that space and that time TOGETHER …. and we did that!

I feel that there is a lasting legacy to #WGT16 and that is the connections that were made, the friendships that were cemented and the conversations that we had ….. I came away feeling that if we can dream it then together we CAN do it ! Anything is possible when We Get Together !

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#NonListedButHighlyRecommended NursingTwitterFollows

I like a good list …. in fact I start every day with a to do list, it’s one of the reasons why i still have a paper diary (yes i can hear you gasping!) I like to be able to see clearly what I am doing and it gives me great satisfaction to cross things off.  I am also a big fan of shopping lists … now these ones i do write on my phones notes section, a shopping list, to me, is a vital thing that prevents me from aimlessly wandering around Asda , it saves me time and it means that I always remember to buy dog food.

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I quite like Twitter lists .. they allow me to organise my Twitter follows into sub groups and bypass a lot of Twitter noise.  Twitter lists are very useful indeed. But this is about as far as my love of lists goes …. and I have to admit that I very much dislike (even hate!) those hierarchical lists that seem to periodically make the rounds on social media.  You know the ones … the top 20 nurses, the top 100 healthcare tweeters, the most powerful 100 people in healthcare (ok so perhaps these aren’t the correct titles .. but you know the ones I mean)

I’m not a big fan of them for multiple reasons:

  • Often the methodology behind them is not revealed
  • When the methodology is revealed it is often flawed
  • They place hierarchies in high esteem – when there are many of us striving for a flatter world
  • I think that these lists are not really in the spirit of social media … where any connection with any person can add value

I wholeheartedly believe that connections made through peer recommendation is infinitely more powerful that a list generated through some computer algorithm  .. so a few weeks ago I asked people for their top nursing follows on Twitter.  I am calling it The “Non Listed But Highly Recommended Nursing Twitter Follows” its a catchy title and can even be hashtagged :

#NonListedButHighlyRecommendedNursingTwitterFollows

… snappy hey :D

So here they are (in no particular order or ranking and for no other reason than others have recommended, and presented in live embedded tweets so easy to follow) …. there were a few new and great follows here for me too, so I hope you all enjoy connecting as much as I have:

Of course the great thing about great lists .. and even non-lists …is that they can always be added to …. so please feel free to add to this one in the comments box.

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New year – old thinking ?

New year is typically a time for reflection and I am afraid to say that I am very much reverting to type with the advent of 2017 …. more by luck than design I have found myself exploring some “old” thinking around social media and nursing. Over the New Year period I have re-discovered two things that have had an impact on my thinking ….

This first thing I came across was whilst attempting to put pen to paper to write a journal article; I found myself thinking of a paper by Caleb Fergusson, written way back in 2013 “It’s time for the nursing profession to leverage social media” I remember reading it at the time and thinking that it was a bit harsh … that nurses are leveraging social media … however having re-read and some 4 years on I find myself agreeing with Caleb.  Nurses are here and using social media, but it’s in fits and spurts across the profession, there is so much potential, there are pockets of brilliance … but so much more can be done.

The second thing was sent to me by my husband and is a power point presentation that I created when I first started tweeting back in 2011:

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(Click here > is-anybody-out-there to view)

The power point was the first thing i ever created, that put my thoughts down on paper, and was written pre #WeNurses. I remember being quite nervous about doing it … it’s a scary thing to share an idea with the universe! Looking back at it now has made me realise how far we have come and what we have achieved with a bit of vision and a healthy dose of courage.

The two things together seem to contradict each other … how can we on one hand be needing to get to grips with truly unlocking the potential of social media whilst on the other seeing and acknowledging how far we have come …. my thoughts are that we have to remember that this is a journey! In the words of the (maybe) awesome Take That (which happens to be playing on the radio as i write this blog):

“We’ve come so far and we’ve reached so high
And we’ve looked each day and night in the eye
And we’re still so young and we hope for more”

Social media in nursing is still a youngster, we have achieved so much … but there is still so much to do.  And in the words of my own power point “Nurses can make it happen”

Lets make social media work for us – lets use social media to inform our practice, lets use social media as part of our practice, lets use social media to share our practice and lets use social media to celebrate our practice.  We may be young …. but lets hope, and work, for more.

Some thoughts on conference Tweeting

It seems that conference season is upon us – and our Twitter stream will soon be full of weird acronym hashtags all ending in 16! It’s tricky to get the Tweeting balance right when you are at conference, you don’t want to tweet too much for fear of boring your followers but at the same time you want to share the knowledge and atmosphere of the conference.

Here is my brainstorm on conference Tweeting:

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I don’t admit to getting it right all of the time, and sometimes I definitely feel that I have tweeted too much (if you ever feel I do then please just tell me – I promise I wont take offence) However it is important to get the balance right – both for you (as concentrating on tweeting what people are saying for long periods can be exhausting!) and for the people following the conference.

I first and foremost tweet for me, I use my tweets to refer to later in my CPD reflections.  I have been known to use Storify or Steller to collate the tweets and link them together: If you search for the conference hashtag and your Twitter handle eg “#ConferenceOfTheDecade16 @AgencyNurse” you can easily find just the tweets that you have sent, even months or years after the event!

Try to keep it informative, don’t be afraid to ask questions and draw in the people who may be watching on Twitter.  It is great watching a well tweeted conference from afar you can glean so much information however it’s even better when you start to have conversations with conference goers.

AND finally and most importantly if you have run out of phone battery by the first tea break you probably need to take a break ! Remember that there are people who are actually in the room too ;D