Nursing Mutual Aid 2020: A Non-Hierarchical Model for Scholarship Dissemination
Robin Cogan MEd, RN, NCSN, FAAN, Jess Dillard-Wright, Ph.D., MA, RN, CNM, Barbara Glickstein, MPH, MS, RN, Marion Leary, MSN, MPH, RN, Wanda Montalvo, Ph.D., RN, FAAN, Monica Mclemore, Ph.D., MPH, RN, FAAN, Ann Marie Moraitis, Ph.D., MS, RN, Anna Valdez, Ph.D., RN, PHN, FAEN, FAADN, Rae Walker, Ph.D., RN, FAAN
Nursing Mutual Aid (NMA, 2020) was borne of the impulse to construct a home for nurses and midwives who had their previously accepted scholarly presentations canceled due to the coronavirus (COVID-19) pandemic. The initial concern of the collective was that these academic discussions would be lost to the COVID-19 pandemic, delaying, or limiting conveyance of timely scholarship. In the lives of scholars and activists, collaborations that occur at conferences provide essential social and scholarly functions that impact academic and clinical settings alike. The disruption due to these canceled conferences was and remains considerable. In mid-March 2020, Dr. Rachel (Rae) Walker, Associate Professor of Nursing at UMASS, Amherst, posted an inquiry on the social media platform Twitter to determine who might be interested in co-creating a virtual conference on that free and public platform.
From Virtual Conference to Nursing Mutual Aid
Several nurses, midwives, and students with diverse expertise and backgrounds immediately responded to the call with interest. When the group met for the first time at the end of March, as widespread and deadly consequences of the COVID-19 pandemic were rapidly becoming more apparent, the organizers realized they were mainly academic nurses planning from various positionalities of tremendous privilege. These canceled presentations that are often centered on privileged speakers were far less critical than the urgent need to address the devastating impact of the pandemic’s domino effect on students, colleagues engaged in direct care, and diverse communities. The collective decided that rather than focus solely on canceled presentations, the conference would welcome presenters from all positionalities. Presenters and topics that are often overlooked or marginalized by forces that structure society, such as environmental and scientific racism, ageism, ableism, homophobia and gender essentialism, poverty, and classism, were of particular concern.
In response to these initial conversations, the all-volunteer organizing team shifted its focus from merely hosting a virtual conference for re-homing canceled presentations to co-creating a collective and digital mutual aid platform. The driving force for this decision was a longing to reimagine expertise in nursing and center voices that are commonly silenced by professional conferences. The platform that we envisioned could embody emancipatory nursing praxis and scholarship through radical solidarity with students, colleagues, and communities. A desire to begin the work of providing mutual aid, including the sharing of experiences and knowledge in nursing, emerged. The concept of mutual aid has longstanding origins among oppressed and marginalized communities and more recently in community organizing and participatory action, especially within transgender, Queer, disabled, and Black, Brown and Indigenous communities. It is a voluntary, reciprocal exchange of resources and services for mutual benefit. As noted by Sylvia Rivera Law Project founder Dean Spade (2020), mutual aid is not ‘charity’ but rather an act of survival that recognizes each of us have strengths and resources, as well as needs, and that collective action that reaches across traditional siloes — including siloes of institution, academic degree, and class — is the only way to meet these urgent needs. Rooted in socialist and anarchist organizing, mutual aid is designed for reciprocal, need-derived, non-governmental, and non-charity assistance for activities of daily living. While the collective acknowledges that we have a long way to go in truly building a mutual aid organization, we strive to honor the legacy of mutual aid work, which has historically been led primarily by groups seeking liberation and survival, through continued learning, support of existing mutual aid organizations, and action.
As we outline on the NMA website, “Nursing Mutual Aid was co-created by nurses & midwives to support mutual aid, to foster global connections, and to amplify new & never-before-presented knowledge necessary to nurse the community in the context of the current pandemic, AND from conferences & other events recently canceled by COVID-19.” We envisioned a chance for nurses and midwives to support one another amidst a political and pandemic environment that has failed to prioritize the health, wellbeing, and safety of nurses and the folks with whom they work, for whom they care. The goal of the NMA Twitter conference was to highlight the work of nursing scholars, clinicians, and students whose work would otherwise have not been presented, while also creating new terrains of possibility by linking students, clinicians, and scholars from all over the country — even the world — to imagine what nursing scholarship and praxis could be, unmoored from the competitive, market-driven models of knowledge production and dissemination that are all too familiar in nursing. In part, our goal was to provide mutual aid in the form of sharing diverse knowledge and experiences.
Typically, activities like conferences would not fall under the purview of mutual aid, given the capitalist and neoliberal aims model of professional nursing conferences, the funding priorities of the topics, and administrative overhead costs. As a volunteer team of nurse scholars and activists, we set out by first articulating our mission, which includes the following:
1) To create a virtual platform and community through which nurses and scholars of nursing can share opportunities to participate in mutual aid;
2) To curate a Twitter conference where nurses and scholars of nursing present and discuss new knowledge and experiences relevant to nursing the community in the context of the current pandemic, AND from previously accepted, peer-reviewed posters, presentations, and plenary talks recently canceled due to COVID-related disruptions;
3) To amplify nursing scholarship, especially the scholarship of students or recent graduates, early career, and/or occupy positionalities currently marginalized within nursing and writ large;
4) To create a sense of connection and foster solidarity, locally and globally, during a time of social distancing and uncertainty;
5) To communicate the value and impact of nursing scholarship to media, multidisciplinary partners, and the public;
6) To offer an experience & content that is: free & open-access, accessible, and inclusive.
NMA is a collective of nurse scholars and activists that formed to support mutual aid, foster global connections, and amplify new and never-before-presented knowledge necessary to nurse the community. A collective is a group of volunteers with a flat hierarchy. We have no leaders, and no one is paid for their work. One of our collective efforts in beginning the journey of providing nursing mutual aid was the development of a virtual Twitter conference. This Twitter conference created a space where nurses and midwives could present and discuss new knowledge and experiences relevant to nursing the community and public health concerns in the context of the COVID-19 pandemic. Producing this conference without any tangible costs or pay for presenters or organizers allowed it to be presented as open access with no fees for participants. Presenters and participants were able to take what they need and leave what they can, which is a small but meaningful act of mutual aid. The article that follows will summarize the methodologies used to produce the Nursing Mutual Aid 2020 Twitter conference and discuss the outcomes generated by the conference. We also provide a critical discussion of the use of “mutual aid” in our name and in how we have framed our work, and we take ownership of our decisions to use this term in our name, the conference title, and in how we have framed what we have done. We offer our own criticism and welcome the same from outside.
One of the first concepts that explored in planning this conference was how we, as individuals but also the collective “we” of nursing, define expertise. Those who organized the #NMA2020 Twitter conference brought a wide array of specialized knowledge and experience to the collective. To this end, the collective itself is a site for the manufacture of knowledge, as we learn from and with each other. Our approach is antithetical to nursing’s general understanding of knowledge production. Nurse theorist Patricia Benner (1982) advanced a theory explaining the development of nursing clinical expertise in her foundational work, “From Novice to Expert.” In this work, Benner delineated a telos of expertise, where we all start as neophytes and progress in an orderly fashion, ideally reaching expert status in clinical nursing at some point (Benner, 1984). Thus, according to Benner’s theory, students, early career nurses and investigators, patients, and communities do not have expert status nor expertise. Acceptance of this theory is endemic in nursing and thus problematic in how it positions who are the people or communities that have knowledge or expertise that is seen as valuable.
The movement for Design Justice (Costanza-Chock, 2019) similarly challenges the hegemony of the “expert” by recognizing the invaluable expertise intrinsic to lived experience and centering the leadership of persons who might otherwise be excluded from the design process. By doing so, Design Justice redistributes power from those whose opinions and ideas are usually centered (often nurses who are more senior in their careers, and white, non-disabled, cisgender, academics) to those whose views are often excluded (students, as well as BIPOC, disabled, trans and GNC, folks who do not hold an advanced degree in nursing, and/or patients and community). We built the #NMA2020 Twitter conference on the premise that there is no implicit telos, no directionality of expertise, no point on the novice to expert spectrum that mutually excludes a knower from being in two places at once, and that the conventional approach to establishing expertise harms both the learner and the teacher. We see that everyone who participated in #NMA2020 was an expert in their own right, and those considered novice through traditional methods of determining expertise had substantive expertise in the topic on which they presented.
The “breakdown” of expertise inheres in a mutual aid approach to developing and sharing knowledge. Mutual aid is a concept rooted in need for survival because an abundance of resources, including information, is not equitably shared because it is held by those in power and/or withheld from those without power. Mutual aid recognizes that a community has extensive needs and the pooling of resources could meet community needs both during and in preparation for. Considering expertise, this concept is both exciting and terrifying: if everyone is an expert in something, what, then, does it mean to be an expert? Expertise becomes something democratic in this construction, accessible and shared. This is a truth that, in hegemonic approaches to nursing theory, knowledge, and science, we choose to obscure (Perron & Rudge, 2016). Under the auspices of nursing science as presently constructed, the work we as a discipline value are those that are fundable and contain ideas that can generate revenue for large institutions. But this kind of approach to nursing science reifies what we already know, what we already value, what is already seen and understood. This kind of nursing science stabilizes and consolidates power, reinforcing an ever-more intransigent status quo. But this is not the only possibility.
A non-hierarchical approach to knowledge building in nursing challenges what has become nursing’s received wisdom, namely the idea that nursing is an empirical science that can be defined by careful attention to the construction of concepts onto which we build frameworks out of which we construct theories that we test using “scientific” methods as we seek to describe a metaparadigm (Fawcett, 1984; Risjord, 2009). The unruliness that approaches like #NMA2020 introduced into the epistemology and ontology of nursing is exciting if chaotic, echoing Paul Feyerabend’s (1993) work in Against Method, in which no singular approach robustly accounts for the ways we do science. This kind of methodological anarchism can lead us toward a different approach to nursing, nursing science, and nursing knowledge. But for this to proceed, we have to recognize first the substantive and palpable merits of those who have not previously been understood as experts; at the same time, we reckon with how nursing knowledge production silences some perspectives even as it creates new information. The model developed by #NMA2020 for knowledge sharing, which we will elaborate on below, is one possible point of entry for a more just, equitable nursing futurity.
Between March 11, 2020, and April 30, 2020, nine nurse activists from around the United States, many of whom had only met through social media, came together via video conferencing and cloud data sharing platforms to coordinate the conference. The NMA website was created (nursingmutualaid.squarespace.com), and the purpose expanded from a one-day Twitter conference to a web-based platform for sharing mutual aid resources and volunteer opportunities as a space to digitally-connect communities of nurses and midwives around the world.
The focus of the NMA Twitter conference was to share knowledge, solutions, and imagine new futurities for nursing, including a pathway for a more just, equitable, symbiotic nursing profession during the pandemic and beyond. If NMA convened with the specific intent of developing an admittedly-novel Twitter conference, the vision for our work expanded rapidly as we came to better understand the urgencies and exigencies of our present. In the spirit of design justice, the NMA Twitter conference sought to center the experiences of nurses, nursing students, midwives, early career and seasoned researchers, interprofessional allies, and communities experiencing even greater precarity in the context of COVID-19.
The first known conference to be held exclusively on Twitter, a 2018 exercise oncology Twitter conference, informed the format for the NMA Twitter conference. The hashtag for the exercise oncology conference was #ExOncTC. #ExOncTC was organized by several exercise oncology experts, including Dr. Keith Thraen-Borowski, who served as an expert consultant to the NMA2020 team. Dr. Thraen-Borowski provided recommendations regarding the format, decision-making structure, peer review process, and logistics for setting up a global Twitter conference. A peer-reviewed paper by Thraen-Borowski, Weller, and Fairman (2020) describing methods for the #ExOncTC conference was circulated to the NMA2020 organizing committee.
The NMA Twitter conference organizers posted and shared a call for abstracts between March 30, 2020, and April 20, 2020. We promoted #NMA2020 via social media channels, including a centralized Twitter handle for the syndicate (@nrsgmutualaid) as well as organizers’ personal social media handles. The NMA co-organizers approached numerous nursing organizations to help cross-promote the NMA conference, of which only a few chose to share the information with their membership.
On April 15, 2020, two NMA group members (April 1, 2020) participated in the RN-Mentor Podcast, and on April 17, 2020, two NMA group members presented on the Amplify Nursing Podcast. In addition to podcasts, the NMA group wrote blogs in the Radical Nurse on March 30 (Radical Nurses) and in the Relentless Nurse (The Relentless School Nurse) on April 17, 2020 (Figure 1).
During the abstract submission period, 65 abstracts were submitted and peer-reviewed by the NMA group. A total of 62 abstracts were accepted, along with 12 invited subject matter experts to discuss hot topics (e.g., whistleblowing, gag orders, abortion, design justice). Conference topics proposed work that centered the perspectives of the unhoused as well as the impact of carceralization, communities of color, and highlighting existing inequities while examining the duress of the pandemic on these populations. Other topics accepted for presentation focused on communities of color, such as those examining the work of Black and Indigenous nurses and midwives. Abstracts topics also included a focus on vulnerable populations like migrant and undocumented individuals, as well as street nursing, harm reduction, and school nursing. Concerns as broad as food insecurity and economic instability to a specific focus on perspectives Queer, gender nonconforming, nonbinary, and transgender nurses and clients. Nursing workforce challenges like the existential considerations of PPE, the implications of whistleblowing, and nursing student coursework in the context of COVID-19 were represented; example topics are listed below (Figure 2, below). In addition to a broad array of topical issues, several medium formats were proposed and accepted. Many presenters used a graphic narrative to communicate their ideas like a video; others used gifs, Legos, and one presenter evoked Audre Lorde’s invocation that “poetry is not a luxury,” chose to share their work.
The NMA collective used Twitter as the platform for the conference as it allowed for an open-access and linguistically-accessible conference. The fluidity of the platform and an expansive and ambitious 12 hour conference timeframe created the possibility for global participation across time zones. The NMA organizers created a video series to promote the presenter lineup as a social media engagement strategy. Presenters hailed from the United States, Canada, and Brazil. No registration was required beyond the abstract submission process for those who presented; presentations were (and remain) freely available via Twitter. The final roster of presentations can be found here. Presentations can be located using the #NMA2020 Twitter conference hashtag or by accessing the archive of presentations, including an American Academy of Nursing 2020 Poster, is housed at the Nursing Mutual Aid website.
Presentations were assigned a 10-minute time slot and limited to six tweets. Some tweets contained just text, while others included slides, images, and even videos. These presentations were shared from presenters’ personal Twitter accounts. Conference organizers assisted those presenters who were new to Twitter or felt unsure of their Twitter skills. In some instances, these presentations were tweeted directly from the @NrsgMutualAid Twitter account. Of the 62 participants, 23 were tweeted out from the @NrsgMutualAid account and moderated by NMA organizers. Timed slides were pre-loaded on TweetDeck for nurses who could not attend synchronously due to clinical duties or caregiving.
Social media engagement by NMA organizers included introductory slides for all presenters using a templated introduction slide, which included the NMA logo, the presenter’s name, the title of the presentation, their Twitter handle, associated hashtags, and any imagery the presenter wanted to include (Figure 2, above).
All images had alt-text descriptions for accessibility. Moderators assisted with fielding questions as needed from the @NrsgMutualAid Twitter handle and retweeted all the presenters’ Tweets. All presenters were asked to include #NMA2020, the conference hashtag, on all Tweets. We also asked that each Tweet be numbered as 1/6, 2/6, 3/6, 4/6, 5/6, 6/6 to aid flow and clarity. Tweet 1 was an introductory tweet that included the topic background and/or research question being presented. Tweets 2–5 were the substantive tweets, presenting the arguments, evidence, and findings relevant to the presentation. Tweet 6 served as the concluding tweet, providing a strong takeaway message for each presentation as well as contact information (Figure 3). Information in the form of an infographic was sent to participants and posted on social media (Figure 4).
Those following the conference on Twitter were encouraged to engage with comments and questions, and the presenter was able to respond past the 10-minute time slot without disrupting the flow of presentations. This format also meant that conversations could continue well beyond the confines of the conference date, inviting future collaboration, sharing of disparate ideas, and amplifying the presence of nursing on Twitter. Using Twitter’s translate function, attendees were able to follow presentations across languages. Participants could follow along or ask questions during the conference by using the #NMA2020 hashtag or through the @NrsgMutualAid Twitter page.
Over the 12-hour time period (April 30, 2020, 9 am-9 pm ET), 75 unique presentation threads were Tweeted from nurses and midwives across six time zones and three countries. Social media statistics of Impressions, Likes, Retweets, and Engagement Rate were captured; these terms are and defined here:
● Impressions denote the time a tweet is shown in a user’s timeline (i.e., person-views)
● Likes refer to the number of individuals who “liked” a tweet by clicking on the heart icon of the respective tweet
● Retweets refers to the number of users who “re-posted” a tweet by clicking the arrow button of a tweet
● Engagement rate is the number of times an individual interacted with a tweet (i.e., Liking, retweeting, etc.) divided by the number of total impressions.
Between April 30, 2020, to May 1, 2020, the conference hashtag garnered over 7 million Impressions (“person-views”) associated with 3,818 Tweets with 479 participants (Figure 5).
Between April 30, 2020, to May 1, 2020, the @NrsgMutualAid Twitter handle garnered 290,200 Impressions, 4,700 Likes, 459 Retweets, 459 Replies, 528 Link Clicks, and an Engagement Rate of 4.6%.
Website: Nursing Mutual Aid
Traffic to the NMA website on April 30, 2020, to May 1, 2020, included 975 Unique Visitors, 2,175 page views, and 919 Visits.
Website visits by geography included 809 (88%) visits from the United States, 76 (8%) Canada, 9 (1%) Saudi Arabia, 6 (1%) United Kingdom, 3 (0.4%) Brazil, 4 (0.4%) India, 2 (0.3) Spain, 2 (0.3) Ireland, 1 (0.1%) Switzerland, 1 (0.1%) Denmark, 1 (0.1%) Japan, 1 (0.1%) Nigeria, 1 (0.1%) South Africa. An archive of the Twitter conference created on Wakelet, a content curation platform, has been viewed 150 times since May, 2020 and can be viewed here.
There is no question that the format of the #NMA2020 conference was unusual, innovative in its flattening of hierarchies and independence from direct reliance on the extraction of capital. In this way, we can think of #NMA2020 as having met some primary aims of the collective: by nurses and midwives, for nurses and midwives with the explicit intent of providing mutual aid in the sharing of knowledge. The emancipatory approach to knowledge dissemination that we were able to demonstrate with #NMA2020 speaks to the liberatory possibilities in new media while highlighting the urgent issues nurses, midwives, and allied interprofessional colleagues see as imperative for our time. Critically, #NMA2020 was unencumbered by the typical enclosures of neoliberalism that so often shape what and whose knowledge is prioritized and shared, imagining new terrains of possibility for nursing that exist if we dare to build them. Nurses and their co-conspirators are hungry for alternate modalities for knowledge dissemination and topics that are far outside the typical conference fare, judging from the robust discussions that occurred during and after the conference, including reading lists that were shared broadly.
The impact of the conference, seen in just raw numbers of impressions alone from the #NMA2020 hashtag and the NMA Twitter handle (@NrsgMutualAid), opened up access to the information presented in ways a traditional in-person conference could not. Another unexpected outcome was how the conference expanded the social media network and knowledge exchange among the presenters, participants, and #NMA2020 organizers that have continued to develop since the conference.
Despite some successes, this organization, as it is currently designed, falls short of many of its original, aspirational goals to engage in meaningful mutual aid. As explained in this recent interview with mutual aid organizer Dean Spade (2020), “Mutual aid projects are a form of political participation in which people take responsibility for caring for one another and changing political conditions, not just through symbolic acts or putting pressure on their representatives and government but by actually building new social relations that are more survivable.” Spade continues, noting that the government is not functioning for the people, and that “we can’t rely [on] it, you are not alone, the system is the problem, not the person being targeted by it. And we’re going to take matters into our own hands and help each other survive right now.” The history of mutual aid is centuries long and rooted primarily in the struggle, labor, and activism of Black communities. As the founder of the radical mutual aid group UK Mutual Aid Eshe Kiama Zuri (2020) recently stated, “Black mutual aid has always existed” (para. 1). Although they did not always use the term “mutual aid,” groups such as the Black Panther Party, Race Today, and Organization for Women of African and Asian Descent (OWAAD) have manifested this activism and collective resource-exchange in the form of intergenerational support, reproductive justice, support for trans and LGBTQIA++ communities, and disability justice. And the legacy of this work continues in the form of contemporary organizations and movements like the Black Mamas Matter Alliance, the Stop LAPD Spying Coalition, and Data for Black Lives.
The COVID-19 pandemic has caused increasing degrees of disruption to almost all levels of society. White-dominated groups labeling themselves as mutual aid groups, while generally working from a charity rather than mutual aid model, have become more and more common as the concept gained popularity within communities of middle-class, anti- or a-political folks who are not so much fighting and organizing for their very survival, as adapting to a new and perhaps inconvenient normal. This white-washing of mutual aid has distorted its meaning in such circles, as leaders of the very same, mostly-white power hierarchies that have long threatened groups at the margins have embraced a particular idea of mutual aid, one that is devoid of its radically transformative and revolutionary essence. There is even further harm that the term “mutual aid” will join the ranks of “charity” and other concepts and enactments that, within geopolitical entities, will continue to place the burden of survival on marginalized groups rather than as a responsibility of that government.
In the wake of this newfound popularity for a concept long fought against by the very same white-dominated institutions now claiming it for themselves, organizers of primarily Black-led mutual aid projects which have been doing the work for generations have made this critical and valid critique: “What we are seeing is basically white people discovering ‘community’ for the first time. And in true coloniser style, it has been declared a new idea. This network of linked groups quickly racked up member counts whilst bulldozing pre-existing, local marginalised community networks — instead of choosing to uplift and work with groups offering mutual aid and support before Covid-19” (Zuri, 2020, para. 9). As a collective, we note that we have not been immune to this phenomenon of warping, commodifying, and even appropriating the concept of mutual aid, no matter how good our original intentions may have been. Many, if not most, of the organizers of the NMA2020 conference, did not, like so many Black-led mutual aid projects assume much actual risk. If anything, organizers were rewarded through recognitions such as further speaking invitations and even an unsolicited award. Although a few of our organizers are students, which is a potentially vulnerable positionality to occupy, most of us are secure in our professional roles and current employment. The work was not done in the streets, or even at the bedside — but on video conference calls and the social media platform known as Twitter. And while the Twitter conference offered opportunities to uplift the work of folks occupying and working at the margins, and a chance to build social connections that might lead to more lasting relationships, resource-sharing, and collaboration, the Twitter conference — outside of offering some links to resources and other mutual aid organizing pages — did not go so far as to redistribute capital and other vital resources for survival fundamentally.
We are left to ask: how close did this effort come to the aspirational ideal of truly radical solidarity with communities marginalized by structures such as white supremacy and especially during COVID-19? The conclusion: Not very close at all. We are therefore left deliberating, as a collective, whether ‘mutual aid’ is, in fact, a label we have any right to retain. Or rather, while intentions were good, should we not admit this divergence transparently, engage in restorative justice, and use whatever platform we have to lift up the work of organizations, such as those named above, who continue to do the work?
The #NMA2020 Twitter conference was free, accessible, and possibly more inclusive than more traditional formats. It created a network of new working relationships and collaborations. While it fell short of meeting our original goals of mutual aid, it did challenge the status quo and open the door to new possibilities for nursing praxis and knowledge sharing.
Benner, P. (1982). From novice to expert. American Journal of nursing, 82(3), 402–407.
Costanza-Chock, S. (2019). Design justice: Community-led practices to build the worlds we need. The MIT Press.
Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: the Journal of Nursing Scholarship, 16(3), 84–87.
Nursing Mutual Aid. (2020). Radical Solidarity During Covid-19-related Disruption.
https://nursingmutualaid.squarespace.com/ Accessed 24 October 2021.
Spade, D. (2020). Solidarity not charity: Mutual aid for mobilization and survival. Retrieved from http://www.deanspade.net/wp-content/uploads/2020/03/Mutual-Aid-Article-Social- Text-Final.pdf
Thraen-Borowski, K. M., Weller, S., & Fairman, C. (2020). The Exercise Oncology Twitter Conference: Disseminating research in the age of social media. Journal of Clinical Exercise Physiology, 9(1), 40–42. https://doi.org/10.31189/2165-6193-9.1.40
Zuri, E. K. (2020, June 5). First person. Retrieved from https://gal-dem.com/weve-been- organising-like-this-since-day-why-we-must-remember-the-black-roots-of-mutual-aid- groups/