Keeping Found Things Found . . .

About 15 to 20 years ago, in the early days of browsers and websites, colleagues from the University of Washington, led by William Jones, launched a research project called “Keeping Found Things Found.” They interviewed many people to explore what we now call personal information management. You know what this is – it’s how you keep track of your medications, your child’s vaccination record, and your family’s health history. People are amazing at devising clever ways to hold on to personally meaningful and important information – you might even have yours stored in kitchen cupboards, file cabinets, calendars, and even family bibles!

If there’s one thing that libraries do well it’s keeping found things found and making them findable to others. NLM excels at this. NLM has more than 3 million books and journals in our physical collection, millions of genomic sequences in our data banks, and we maintain electronic access to almost 13,000 journals. We’ve also been devising new ways to make our print collection accessible during the COVID-19 pandemic, when access to the NLM building is limited, and preserve the pathways to electronic journals.

One thing NLM is NOT good at is personal health information management—this just isn’t our specialty. NLM funds research to better support people’s abilities to create personal health libraries, but we don’t store personal health information. NLM’s hallmark is acquiring, preserving, and making available for public use scientific knowledge for health as represented in books, journal articles, and data banks. Under special circumstances, we will create ways to collect and archive public information that supports personal health actions that stem from events ranging from the AIDS crisis to the COVID-19 pandemic.

Sometimes libraries help create public information from personal stories. NLM is doing just that to capture the experiences of federal volunteers who have been helping support HHS’ Administration for Children and Families Office of Refugee Resettlement Unaccompanied Children Program. By partnering with the Office of NIH History & Stetten Museum, we are compiling and making available the personal stories of NIH staff who volunteered for this important initiative.

My family and I have also benefited from programs supported by federal libraries to keep the stories of individual people found. In 2005, my son and I participated in an initiative supported by a nonprofit organization to record, preserve, and share a wide variety of stories told by people just like you and me. To prepare for our interview, my then 11-year-old son, Conor, scanned the suggested questions (which he wouldn’t tell me about ahead of time) and ventured off to the mobile studio. It was an amazing experience.

Each storyteller gets about 45 minutes to speak while a sound engineer records the interview on high-quality audio, which is eventually preserved. Participants are offered the opportunity to have their story archived at the Library of Congress and have a portion of their story broadcast over NPR (National Public Radio). Conor and I agreed to both, so we became a part of the many personal stories of the United States. You can listen to the segment broadcast on NPR here.

I loved this whole experience and treasure the sound of my son’s 11-year-old voice. The variety of questions he asked me was surprising, and it gave us a new chance to document our family history. Yet, figuring out what to do with that CD recording over the ensuing decade has been a challenge to me – it’s moved with me three times and is now lodged between two cookbooks on one of my bookshelves – making me grateful that that I have a library and a URL that is helping keep this important thing found.

There are a lot of good reasons why NLM should NOT be the place where personal information is found – privacy, personal control, and the ever-growing trail of records that characterize health care across the life span. The complex mess of papers, pictures, and small books that most of us use to keep track of personal information aren’t amenable to the services of a library, whose goal is to acquire, preserve and promote access by all to a broad range of information. But there are many stories, records, and other notations about our health that individuals need to keep found across their life span. NLM needs your ideas here – should we fund the development of new apps that manage health information? Should we collaborate with electronic health records system companies to urge them to build personal health information resources for their patients? Is this a place where stimulating the business market could help?

I’m grateful that the Library of Congress committed to storing brief encounters between people telling their life stories, but in order to keep my story found, I had to share it with others.

What can we do to keep things found and accessible only to the individual?

Five Years and Counting!

On August 13, 2016, I became the first woman, nurse, and industrial engineer to serve as director of the National Library of Medicine (NLM). From its beginning in 1836 as a small collection of books in the library of the U.S. Army Surgeon General’s office, NLM has become a global force in accelerating biomedical discovery and fostering evidence-based practices. I am proud to direct this esteemed organization and delighted to guide it towards its third century beginning in 2036. 

This has been an exciting five years for NLM.

We accelerated data-driven discoveries and advanced training in analytics and data science across NIH and around the world. Our genomic resources played a crucial role in supporting NIH and the scientific community’s ability to understand a novel virus and address the COVID-19 pandemic. NLM investigators developed innovative uses of deep learning and artificial intelligence and applied them to a wide range of problems – ranging from interpretation of clinical images to improving search and retrieval of highly relevant citations from NLM’s PubMed biomedical literature database.

NLM pioneered strategies to link data sets to articles through our PubMed Central (PMC) digital archive, and doubled the size of the NLM-supported Network of the National Library of Medicine—reaching almost every congressional district in the United States with the capacity to connect NLM resources to communities in need.

We provided technical expertise to develop a secure single sign-on to a wide range of controlled data resources, and redeployed our research infrastructure to help public health authorities detect foodborne outbreaks and track the emergence of coronavirus variants. We also advanced our use of automated-first indexing to make sure that the published literature is available to our stakeholders as quickly as possible.

With the support and collaboration of other components of NIH, we are building a 21st century digital library that uses our collections to offer literature, data, analytical models, and new approaches to scientific communications that are accessible, sustainable, and available 24 hours a day and 7 days a week.

NLM’s archival collections continue to grow and evolve as the archival records of individuals, organizations, and other communities in health and medicine are increasingly created and communicated electronically or digitally. We expanded the formats and types of records we collect—and make accessible and usable— to include born-digital formats such as websites, social media, and data sets. For example, NLM deployed innovative techniques to prospectively curate and add COVID-19-related information from traditional news, social media, and other sources to our Digital Collections. These collections preserve for future research the ephemeral online record of modern health crises, documenting the work and experiences of health care providers, researchers, government agencies, news agencies, patients, and caregivers.

As a nurse and an industrial engineer specializing in health systems engineering applied to patient self-management, I bring a perspective to NLM that expands its mandate from supporting biomedical researchers and clinical practitioners to one that aggressively supports the health of the nation.

During my tenure, NLM’s footprint has expanded by:

  • Growing our research enterprise in support of data-driven discovery;
  • Supporting key priorities of the NIH in data science, access to secure data repositories, and community engagement;
  • Strengthening the integrity and efficiency of our internal resources to accelerate the acquisition, preservation, and dissemination of biomedical data; and
  • Expanding our commitment to public outreach and engagement.

Two guiding principles have shaped my work:   

One NLM

I initiated the One NLM concept as an organizing framework during my first year as director of NLM. One NLM creates a rallying point, making explicit that all our offices and divisions work in concert and in support of NLM’s mission. As described in my January 2017 blog post entitled, One NLM:


One NLM emphasizes the integration of all our valuable divisions and services under a single mantle and acknowledges the interdependency and engagement across our programs. Certainly, each of our stellar divisions . . . have important, well-refined missions that will continue to serve science and society into the future. The moniker of One NLM weaves the work of each division into a common whole. Our strategic plan will set forth the direction for all of the National Library of Medicine, building on and augmenting the particular contributions of each division.

Strengthening the NLM Senior Leadership Team

I employ a team model of leadership—engaging the deputy director, four division directors, and four office directors in biweekly meetings. With the support of external consultants, we engaged in a one-year leadership development activity focused on building capacity for joint decision making, improving risk tolerance, and creating an environment that supports trans-NLM collaborative problem solving. I found that continued engagement with individual members and the leadership team established an organizational milieu that led to improved trust in each other. And the team, which held up in good stead during a period of maximum telework in response to COVID-19, ensured the innovative mobilization of NLM resources to help NIH rapidly assume new research programs, respond to public health needs, and most importantly serve as a trusted source of information.

What I’ve Learned

While I remain true to my core values and beliefs, I’m not the same Patti Brennan as I was when I entered the ‘Mezzanine’ floor of NLM’s Building 38 nearly five years ago. I’ve learned to mobilize and reward the talents of the 1,700 people working at NLM to achieve common goals. I figured out how to work with a boss, something few academics ever actually face. I’m better at finding the niche into NIH conversations and policy-setting meetings where the talents of NLM and our deep understanding of data science accelerate NIH’s mission to turn discovery into health. I’ve created space in conversations for the voices of others, particularly the members of my leadership team with whom, I’ve learned, complement my vision and drive with their knowledge and discernment. It’s been a great ride!

How does the you of 2021 compare to the you of 2016?  

To the Nurses Today… And The Nurses Yet To Be

In early May, I had the pleasure of giving the virtual commencement speech to the graduating class of the University of Illinois College of Nursing. It was an honor to speak to the next generation of nurses as they step into a world forever changed by the COVID-19 pandemic. In a normal year, it takes hard work to complete a nursing degree; during a pandemic, it takes extra dedication to pursue your studies online.

As a nurse myself, I’m proud of the accomplishments of these 400 new nurses and look forward to providing them with resources and information as they start the next phase of their career, and for many years to come.

Please join me in wishing a warm welcome to these new graduates as they enter a world that needs and appreciates the hard work of nurses more than ever.

Video Transcript (below):

I’m Patti Brennan, Director of the National Library of Medicine. I want to add my congratulations to the choruses of friends, families, and colleagues on your accomplishments being acknowledged this day of the graduation at the University of Illinois College of Nursing.

Almost 200 of you are entering the profession for the first time, and another 200 are receiving graduate degrees in recognition of your advanced education in nursing specializations.

I want to speak today to the nurses who you are right now, the nurses who you will become, and the nurses who you will need, and finally to the nurses,  yet unborn,  who will serve society in the future.

To the nurses who you are today:  

Your nursing education experience was like no other over the past 100 years!  You’ve learned how to learn via Zoom and TikTok, transform nursing interventions into telemedicine delivery, and develop novel skills engaging patients not only as informants but as partners in care. One of the few positive outcomes of this coronavirus pandemic is the societal recognition of the essential value and contributions of nursing. So, you are entering a world that both needs you greatly and is readily accepting of the contributions you could make. 

I hope you will take with you the joy of friendships you made during your educational time here at U of I College of Nursing: the excitement of learning, the meaningful contributions of patients who accompanied you on your learning journey, and the hope that suffused your faculty members as they guided you on your journey. I trust that the foundation of your education here will give you a firm basis, grounding you in trust, supporting your explorations.

You are entering a world that needs nursing more than ever before. I urge you to use the professional education you have had to support doing the urgent tasks in front of you while remaining true to nursing’s social contract. The hallmark of a professional is doing a task that looks like something someone else could do, but is done with the sophistication of specialized knowledge and skill that grows from the deep foundation, the future vision, and the broad perspective that we draw from our profession. It’s not enough to act, we must BE nurses.

To the nurses you will be in 2031:

What do you see when you look back across the decade since graduation? Have you achieved pay equity? Did you accomplish the next level of education that you envisioned as you completed your degree today? Did you find satisfaction and depth in the area of nursing you originally selected, or did you explore several areas before finding your niche? Or maybe, did you find a way to express the values and knowledge of nursing through another profession such as law or design? Wherever you are in ten years, I hope you look back in wonder, awe, gratitude, and satisfaction.

How does the world around you look in 2031? Has our treatment of Mother Earth improved so that the UN’s 17 Goals for Sustainable Development have actually been met? Have we achieved social equity and removed health disparities engendered by structural racism? Was the coronavirus pandemic the last pandemic of the decade or was it the start of a pandemic decade? Has someone made driverless cars practical or figured out how to get rid of all of those cords on our computers?

To the nurses you will need in 2071:

Right now, I’m just about the age that you will be in 2071. I am so confident of the importance of our profession to society and of our value to it that I am sure there will be nurses out there in the future ready to serve society.

These are the nurses who will be there to care for you—I will be long gone by then. So, I’m going express my hopes for the ways nurses approach patient care and knowledge discovery with some personal reflections. 

I hope that these nurses will remember that confidence is often accompanied by uncertainty, and that nurses must consider both as they diagnose and treat the human response to living.  

I hope they will remember that many of my age want nurses to know that we feel like we did 30 years ago, think we look like they did 20 years ago, have had meaningful and interesting career and life contributions, and bring the wisdom of aging and the freedom of age. All of this makes us even more desiring of good nursing care. Nurses should let us know how to find them, how to recognize them, and how to benefit from their expertise.

I’m less afraid of dying than I was earlier in my life in part because I feel like I could live forever, or at least another 30 years, in good health with the love and support of my friends and family.

I want the nurses who care for you when you are my age to respect that goal of mine and use it to shape their practices. Like the future you, know that even now I want your guidance to help me live as fully as I can.

I don’t want nurses to be afraid to bring up hard topics—social disruption, social isolation, loss, loneliness, hopes—because all of these shape how we approach my health. We can be better partners if nurses are as brave as we need them to be.

To the nurses of 2121 yet unborn:

These are the nurses who will be there to bring nursing into the future. What legacy will you leave them? How will you help shape the future nurse? What can you do to create in them the very excitement that you feel today?

Can you share your experiences, remove barriers, open pathways of influence, give them shoulders to stand on? Can you help those nurses yet unborn know that it is better to ask a question than to answer any single question?

Can you inspire them to discover and not just remember? And more importantly, can you help them build partnerships and pathways with people who bring the best of nursing to complement and extend the best that is in that person?

What can you do to prepare the world for nursing? To make the very best practice environment for nursing? What ways can you engage with architects, home builders, city planners to make the world not only a place that nurses LIVE in, but is livable because of nursing? Over 30 years ago, a great nurse thinker identified that it is a critical function of nursing to create an environment that supports development. What will you do to build that environment so that the nurses of 2121 can live as nurses, being nurses?

Congratulations and celebrations to all of you—faculty, students, administrators, family, and friends. Another journey is complete, and another is starting.

Thank You, My Nurse Colleagues

Writing these blog posts gives me a chance to showcase some of the great work done by our team at NLM, and reflect on the roles I play as part of the NIH leadership team, Director of the National Library of Medicine, a mother-daughter-sister-aunt-friend, and an advocate for self-care management education and support for all people. Yet, nothing compares to the opportunity that this blog gives me to reflect on my chosen profession, nursing.

This year for National Nurses Day, I want to acknowledge the enormous contributions made by all health care professionals in response to the COVID-19 pandemic, particularly by the nurses and members of nursing care teams. I want to express my sorrow and deepest sympathies to the friends, families, and co-workers of nurses who faced health issues or died from work-acquired COVID-19 infections. I am grateful to front line care providers, ranging from nursing home aides to emergency department staff, particularly the nurses whose creative problem solving and attention to complex patient needs helped so many over the past year.

Nurses are well known for their ability to innovate—finding just the right way to make one patient more comfortable or address the respiratory distress of another. The perplexities brought about by the unfamiliarity of the coronavirus infection required innovation at warp speed in nursing units across the country.

I thank you, my nurse colleagues, for what you did over this past year and what you continue to do in the face of tremendous personal risk and self-sacrifice. May your accomplishments give you the strength you need to continue, and your contributions be acknowledged and treasured by those for whom you care.

For my part, I’m not on the front line physically, but the role NLM played this past year was focused on finding ways to support people who are on the front lines of this pandemic. Whether it was providing patient-specific COVID-19 information through our MedlinePlus Connect service, or expanding access to and making available coronavirus-related journal articles to support evidence based practice approaches, NLM has been here for YOU!

We collaborated with publishers to drop paywalls, so that the literature could be available to anyone who needed it. We accelerated processing of genomic sequences to speed up the process of tracking variants and identifying new drug targets. Our team at NLM helped mount the NIH’s response to the COVID pandemic with new research programs, particularly designing advanced data systems to make sure we learn as much from this experience to prepare for the next. While literature cannot provide the comfort of a hug, it can provide ideas that can aid in supporting someone through the process of grief.

My thoughts turn to my nurse colleagues who have witnessed so much death this year—among your patients, co-workers, and communities at large. I extend my wishes for resilience and comfort. I can offer little, but the acknowledgement that your experience of COVID-19 was so different from mine, and the assurance that NLM’s programs of research and offerings of significant literature resources will continue to make available the information needed for practice, and the learning that comes from practice.

In April 2020, as the pandemic was emerging, our colleagues from the United Kingdom offered some helpful hints in this Journal of Clinical Nursing article, one of the freely accessible articles made available through NLM’s Public Health Emergency COVID-19 Initiative. The authors encouraged nurses to address their own psychological and safety needs through peer and team support. This includes looking after each other’s well-being and encouraging temporary and long-standing teams to check-in on each other—particularly at the beginning of a shift, where such contact can activate a sense of social support. The authors also exhort that the stress response to staffing shortages, a sense of futility, and unrelenting grief is normal and will resolve – and yet each person responds differently, so make sure you check in with yourself!

For every one of you who greets each workday with the worry of exposing your family to COVID-19 or putting yourself in harm’s way, I thank you for persisting, and for what you are doing for patients. I trust that the next few months will be a time for resetting your practice to something that is manageable and less fraught with risks.

As we celebrate Nurses Day, we do so with sadness arising from the strains experienced by our profession over the past year, the loss from too many deaths, and the exuberance of the enduring strength of nursing! My hope for Nurses Day 2022 is that our common paths lead to a healthier, safer world. 

Please let me know how NLM can join you on this journey.

Learning from my Irish Heritage

Today is the Christian Feast of Saint Patrick, one of Ireland’s patron saints who lived during the fifth century. Celebrated today around the world as St. Patrick’s Day, this observance has evolved into a celebration of Irish culture and is a day of fun and family for those who are Irish or wish they were! As one of the 70 to 80 million people around the world who claim Irish roots, this celebration offers a chance for me to reflect on my own Irish heritage and what I have learned from it. And as those who have read this blog before know, family is of preeminent importance to me as a source of joy, strength, and comfort — all of which I have drawn on throughout my life.

Ireland is best known for its music and mythology, sports, scholars, and, most relevant to me, deep allegiance to kin groups. I can’t claim any skill on the feadan (tin whistle) or the cláirseach (the 30 string harp), although I enjoy a céilí (a celebration), and I do have some familiarity with the mythology, particularly the Morrígan, the Celtic triple war goddess of old, Queen Maeve, the strong-willed, ambitious, and fearless legend, and the warrior queens of the North. In terms of sports, I’ve learned enough to enjoy a hurling match and can follow Gaelic football. Ireland is known as ‘the land of saints and scholars,’ and my Irish heritage has provided me with a genuine and deep-seated love of learning that has been integral in my life.

Valuing my Irish heritage means also looking clearly at what makes Ireland what it is today.

The response to oppression gave rise to nationalism and a drive to be an independent sovereign state, leading to independence in 1921 (only 100 years ago!) and militance with sometimes tragic results advanced in the name of freedom. The Good Friday Agreement of 1998 brought about the end to one kind of violence. The Good Friday Agreement brought a measure of quietude to the challenges of expressing different views, yet more than twenty years later, differences still persist. And the recent investigations into mother and baby homes engendered an awareness of the need for the apologies to survivors of this awful period in Irish history.

Some believe the “Irish temperament” is a mixture of stubbornness, personal warmth, and a wit that shines through adversity. I certainly hope I have all three of these, perhaps a bit more of the latter two than the first. However, having a bit of stubbornness is important, particularly as the director of NLM, which serves as NIH’s center for biomedical informatics research and the world’s largest biomedical library. Being stubborn, coupled with warmth and wit, has helped me guide the NLM as it approaches its 3rd century in existence. It has helped me serve as an advocate for the technical infrastructure necessary to secure our resources and to make them permanently available around the world. It has provided me with the tenacity needed to hold firm to the values of what libraries mean to society – institutions rooted in collecting and disseminating the literature of the world with integrity and without censorship.

What this means to NLM is that we must continue to hold to our enabling legislation of 1956, to acquire, preserve … materials pertinent to medicine and … make available… materials in the library. As Joyce Backus, our former Associate Director of Library Operations, was fond of saying, “science is self-correcting,” meaning that we don’t need to exclude materials that are no longer aligned with our global perspectives, but we do need to continue to gather and make available the full range of information.  

So, I hope you join in the celebration of all that is Irish on this St Patrick’s Day and remember that history is complex — and the purpose of libraries, including the National Library of Medicine, is to reflect the progress and perspectives across time, rather than a snapshot of a particular point in time.

How can we help you in this celebration?