Thanks to a technologically advanced society and easy access to digital sources of communication, social media is becoming an increasingly effective, wide-ranging tool for nurses. However, with this resource comes great responsibility. As nurses navigate social networking sites, chat rooms, blogs and public forums, there is a dangerously thin line between professional and personal online etiquette. Health care employees must maintain patient confidentiality and privacy at all times, as well as serve as a positive representation of their place of employment. Inappropriate use of social media often leads to disciplinary action; and in the most serious cases, can negatively affect a nurse’s career and license.
Privacy Issues Regarding Nurses Using Social Media
“Nursing is a profession that is laden with risks related to disclosure of protected information,” says Jonathan Greene, social media expert and author of Facebook is a Pub Crawl: 15 Simple Strategies for Social Media Excellence. “For that reason, nurses have to be careful about anything that would violate HIPPA standards.”
According to the National Council of State Boards of Nursing (NCSBN), confidential information should be shared only with the patient’s informed consent, when legally required, or where failure to disclose the information could result in significant harm. Any breach of trust associated with a nurse-patient relationship has damaging repercussions, and often winds up hurting the overall trustworthiness of the nursing profession as a whole.
Breaches of patient confidentiality or privacy on social media platforms (whether intentional or inadvertent) can occur in many different ways, such as:
- posting videos or photos of patients – even if they can’t be identified
- posting photos or videos that reveal room numbers or patient records
- descriptions of patients, their medical conditions, and/or treatments
- referring to patients in a degrading or demeaning manner
A violation of patient confidentiality takes place as soon as a nurse shares information (or even the slightest bit of details – no matter how insignificant they may seem) over the Internet with someone who is not authorized to receive such information. Examples include reflecting on the severity of a car accident victim’s injuries, or even commenting on the number of medications that a patient has to take.
Beneficial Ways that a Nurse Can Use Social Media
With the ability to establish positive interaction and communication with patients (and their family), Debi Deerwester, DNP, FNP-BC, Chief Clinical Officer/Chief Nurse Practitioner Officer/Vice President of Clinical Operations at WhiteGlove Health, says there are many ways a nurse can utilize social media to a healthcare advantage, such as promoting the profession through educating the public.
Social media outlets and actions beneficial to nurses include the following:
- Blogging: “Blogging on the industry they love in a positive and thoughtful way, [nurses] can become subject matter experts,” says John Lincoln, of Internet marketing company Ignite Visibility. “Having an individual blog and social media presence shows their dedication to the field, helps them stay on top of trends in the industry and looks great to employers.”
He also suggests that increasing visibility through an online presence can help nurses get ahead in their career, which in some cases, could lead to a higher position and/or a raise.
In addition to promoting their value within the workplace, nurses can also use social media to promote their outside, health-related endeavors and interests. “Usually I reserve public posts about health care to try convincing colleagues to buy my books,” says Nick Angelis, author of How to Succeed in Anesthesia School (And RN, PA, or Med School).
- Twitter: Offering a popular real-time form of communication, Twitter is often seen as one of the easiest ways to maintain contact with people, especially in times of crises. From posting health safety notices to explaining drug recall information to answering emergency questions, nurses can provide quick responses and critical assistance to the public.
Twitter is also an effective way to create a health-related conversation with the public, or get a healthcare-related topic trending. “…nurses can probably capitalize on social media as an excellent tool for creating awareness about preventative health campaigns, general flu/pandemic information, educational tidbits…,” says Greene.
- Facebook:With the ability to leave messages (both public and private), upload videos, and post photos, nurses are able to connect with others on many different levels when using Facebook, and can also help bridge the information gap between health care providers and patients.
“There is an inherent need within healthcare to pass information on to a particular patient and to connect with a patient on a level that promotes not only biological health, but also psychological health and community health,” says Ben Miller, a student at Vanderbilt Law. “In this sense, a nurse Facebook messaging a teenage patient about medicine changes is easy and builds trust within the system.”
- YouTube: The visual and audio aspect of YouTube has a profound effect on a viewer’s understanding of health care, medical concerns, surgical procedures, and other treatments.
“I use YouTube to broadcast educational videos about anesthesia school…,” says Angelis. “In general, social media can be a positive force to enhance the role of nursing in the community and the perception of nursing among our friends and the public at large.”
- Discussion Groups & RSS Feeds:Social media also provides nurses with an outlet to connect with other healthcare professionals for personal, emotional, and educational reasons. From getting tips on how to cope with workplace stress to answering questions about advanced nursing degree programs, there are many nurse-specific online groups to join or participate in.
“Social media groups can provide support and help nurses stay positive even in hard times,” says Lincoln. “By following the right social media feeds on sites like Twitter, Facebook, Google + and LinkedIn, nurses can get the latest medical news.”
According to Greene, nurses who interact with others across social media channels also have an opportunity to “humanize the nursing profession.” Examples include spotlighting employer achievements, sharing nurse profiles, and providing one-on-one communication.
How Nurses Should NOT Use Social Media
“From a legal perspective, nurses using social media to reach out to patients pose a few major privacy issues,” says Miller. “Since most social media systems present security problems (in how they’re “built”, infrastructure, and/or how the user interacts with the specific social media system), open sharing of sensitive and confidential information leads to conflict with HIPAA.”
“Most of these social media systems (such as Facebook) are not as privacy forward as we believe,” Miller says. “Even something as simple as texting among nurses about a specific patient raises huge privacy issues.”
Also, social media platforms tend to create a false sense of security for nurses who often believe they are voicing their opinions, engaging in discussions, and posting images under the protection of privacy settings. Anything sent privately to an individual or posted on a closed forum has the potential to become public knowledge. Additionally, deleting statements and images from a social media account does not mean they have been completely removed from the Internet.
As a rule of thumb, nurses should not use social media to:
- Complain About or Comment on the Health of Patients: The American Nursing Association warns against making disparaging remarks about patients (even if they’re not identified) in order to avoid problems with social media. “Do not talk about how rude a patient is, how bad they look or unhealthy they are…it will find a way to leak out, and even if it doesn’t, it causes others to view you in less professional nature, as well as the institution you are associated with,” says Lincoln. “It can also damage others perception of your character.”
- Post Photographs of Patients: After posting a picture of a young cancer patient on Facebook, a nursing student was expelled from school, and the nursing program barred from using the pediatric unit for teaching after the administration was alerted. The hospital and patient were easily identified through the picture, which is a violation of HIPAA.
Even if a nurse gains permission from a patient to take pictures, employers can still take action. Despite getting the consent of a patient to photograph an injury, an emergency room nurse who shared the images on a nursing forum for learning purposes was disciplined even though the patient’s face was not visible; the type of injury made it easy to identify the patient.
- Rant About Place of Employment: Because of the nature of work that a nurse does, speaking negatively on social media about co-workers, administrators, job duties, their place of employment, and/or workplace policies can lead to disciplinary actions. These types of negative online comments also place a hospital or doctor’s office in a bad light, as well as jeopardize a nurse’s job security. Even when opinions are voiced under the strictest privacy settings, there is always the possibility that online commentary can reach unintended readers.
To minimize the chances of violating workplace policies, using a personal email address as a primary means of identification on social media accounts instead of an email address associated with a hospital or place of employment is highly recommended.
Additionally, when writing a blog or participating in online activities that have the potential to negatively impact the reputation (or go against the policies of a healthcare employer), avoid establishing a direct connection to the place of employment. For this reason, many nurses comment anonymously or write blogs using a pseudonym.
- Blow Off Work-Related Steam: Because of the visibility that social media platforms provide, Lincoln says it is critical for nurses to maintain composure and professionalism at all times.
“One of the most important things for a nurse to avoid is speaking negatively about a patient on social media,” he says. “This might seem like a no-brainer, but everyone gets frustrated at times and in many cases in medical situations, a nurse may feel overwhelmed.” Lincoln stresses to refrain from saying anything negative about “patient interaction, the prospect of patient recovery, or even just a general bad day on the job.”
- Use Offensive Language and/or Voice Offensive Comments: Since nurses work with a diverse flow of patients that come from a wide range of economic-, racial-, ethnic- and religious backgrounds, making social media comments that are threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic, or deemed controversial are often grounds for discipline at the workplace.
Social Media Policies
An increasing number of hospitals, medical facilities, and healthcare employers are developing and implementing social media policies, including the likes of the American Medical Association, the Cleveland Clinic, the Mayo Clinic, Vanderbilt University Medical Center, M.D. Anderson Cancer Center, Children’s Hospital Los Angeles, and Kaiser Permanente. The National Council of State Boards of Nursing (NCSBN) also offers a white paper titled “A Nurse’s Guide to the Use of Social Media.”
Lincoln feels that Massachusetts General Hospital’s social media policies are an example of having “really done it right.” Not only does Mass General have social media guidelines in place for employees, but also a policy established for those who interact with the hospital on social media.
|“Please understand that we cannot respond to every comment, and that we cannot offer medical advice, diagnosis or treatment via the Internet. If you have a question about your specific medical condition, you should contact your doctor or other qualified healthcare professional.”“For your privacy, you should consider carefully before posting personal medical information to the Internet. Please remember that your posts and comments are available for all to see.”“Users are responsible for content submitted to social media sites.”-from Guidelines for Participation in Mass General Social Media|
“I am a strong believer that every company should have a social media policy in place,” says Lincoln. “This can help avoid legal issues, and give employees and clients a clear perspective on what the company is comfortable with being shared online.”
Consequences of Social Media Abuse
The consequences regarding a nurse’s improper or inappropriate use of social media platforms come with varying levels of discipline – all of which are dependent upon the action in question, workplace regulations, and any social media policies already in effect.
For example, not only can a medical facility take action against a nurse who has violated a patient’s privacy, but also the state board of nursing. State laws can additionally come into play, and it is not uncommon for legal and criminal investigations to take place when a nurse crosses the line.
Disciplinary actions that individuals can face include:
- required sensitivity training
- expulsion from nursing school
- being fired from a job
- loss of licensure
- criminal charges
- jail time
The most serious offenses often involve law enforcement, with some cases being referred to the FBI for investigation of HIPAA violations, as seen in the firing of two nurses who photographed and posted the pictures on the Internet of a patient that underwent an X-ray procedure for rather sensitive, easily identifiable circumstances. Incidents of a sexual nature, such as exposing the image of a patient’s buttocks online, can also involve the Sex Crimes unit of the local police department.
Nurses who abuse social media (as well as digital and electronic media while on the job, such as taking cell phone pictures of patients) also cause their employer to come under scrutiny and suffer consequences, such as the admissions ban imposed on nursing home Kitsap Health & Rehabilitation Center for employing workers that took nude photographs on their cell phones of dementia patients. The incident led to an investigation of the facility, and the threat of being cut from the Medicare/Medicaid program, which provides vital reimbursements of funds for the services they offer.
In conclusion, social media policies for nurses will continue to evolve in order to keep in line with advancements in technology and the Internet. The key to successfully navigating the ups and downs that come with having an online presence and identity is to find a happy, safe, and responsible middle between enjoying the personal and professional benefits of social media without breaking the rules of patient privacy and confidentiality.
In addition to being mindful of the importance regarding the disclosure of patient- and workplace-related information via social media…keeping up with workplace policies, relevant state and federal laws, and professional standards as they apply to the nursing profession are just as significant.
Healthcare is one of the most promising and fastest growing industries today. Every day, we witness new drugs and medical technologies coming into the market. We can see different advancements in technology sprouting out in every nook and corner of our cities. Hospitals are exploring new technologies and avenues to reach out to the masses in an efficient way to win over the competition.
A significant portion of a hospital’s budget goes into educating its staff that includes doctors and nurses. This helps them reach their patients in an efficient and cost effective manner. Nurses who form an integral part of the healthcare system are gradually adopting social media to reach out to their patients. However, it has been seen that, though social media is turning out to be one of the most cost efficient way of reaching out to the masses, improper or insincere usage of the same can create unavoidable incidents which can lead to problem for employers, regulators and educators (1).
2. Advantages of social media
Nurses can use social media to increase awareness among people, to educate people about various infectious diseases,precautionary or preemptive measures to be taken to safeguard one from such diseases and the various treatments available to cure the same. They can also use social media for communicating with healthcare professionals and also with the family and friends of the patient.
2.1 Education and communication
Public awareness can be attained through conducting various educational programmes on mass scale. Such programmes require continuous education and communication. Hence, it is important that the various stake holders involved in such events communicate effectively (2).
Social media serves the purpose very well as it integrates the various stakeholders in one platform and streamlines the flow of information. It also helps them garner mass attention and serves as a tool for mass dissemination of information (3).
For example, if we want to create mass awareness regarding the onset of an infectious disease or about the ill effects or smoking or excessive consumption of alcohol, we can start by creating dedicated forums which would contain all useful information and would allow people including experts or victims to express their experience and views on the issue. The various connections across the social media would lead to quick dissemination of information. Similarly, if we want to conduct a mass campaign comprising hundreds of volunteers spread across wide geographies, social media would facilitate parallel flow of information and help us co-ordinate the event on a mass scale in a cost effective manner (4).
2.2 Healthcare access across vast distances
Social media can be used to communicate with patients/people, inform them about various wellness schemes, market healthcare products and provide basic healthcare advice and get instant public feedback. It also serves as a strong platform for monitoring the conditions of ex-patients or patients suffering from chronic diseases on a regular basis. Apart from these, it also serves as an effective platform for intimating critical information pertaining to a patient to their relatives/friends (5).
2.3 Professional development using social media
Social media is an important platform to develop nurses professionally. Social media helps one to connect with people of the same profession. Apart from serving one’s networking requirements, it acts as an important tool for knowledge sharing, helping one to connect with experts in different fields. It provides a platform for exchange of views on various classified works, or various developments taking place in the industry (5).
3. Disadvantages of social media
It is advisable for a nurse to use the social media in a careful and responsible manner. Irresponsible usage of social media can lead to following circumstances:
3.1 Disrespecting privacy and confidentiality of patient
It is obvious for a nurse to know about the information of the patient which is meant to be protected. Hence, it is their duty to maintain the confidentiality of the information. A nurse should not share such protected information of their patients through blogs or photos on social networking sites. Such incidents can led to violation of state laws and can put the nurse in trouble (5).
3.2 Effect of ‘’defamation” on patient’s safety and care
“Defamation” is commenting about someone which can have negative effects on the image of the person (6). If a nurse comments about his/her colleague in social media during non-working hours, it can lead to ‘’lateral violence’’ (5) which in turn affects the bonding among team mates. As a group, nurses are responsible for taking care of the patients. However, if two nurses who are responsible for one patient are not communicating to each other properly it may lead to confusion endangering the safety of the patient.
3.3 Limitations pertaining to holistic information
Monitoring a patient’s condition or providing health advice online, has its own challenges as the available information may not be a holistic representation of the patient’s condition which may lead to a misdiagnosis. Hence, it is advisable to limit such online monitoring or health advice to less critical cases only.
3.4 Social and therapeutic relationship
A nurse should be able to differentiate between social and therapeutic relationship. Therapeutic relationship deals with treating the patient with care whereas social relationship is building a relationship which gives the patient information about the personal life of the nurse that can in turn affect latter’s professional life. It is highly advisable that a nurse engages with a patient in a therapeutically relationship only (6).
4. Impact on student nurse when out of practicum
4.1 Path of Communication for recruiters
Social media forms a path of communication for many recruiters. So it is advisable to maintain a professional image in social networking platform.
4.2 Accessibility of the profile information
As many people including the recruiters are checking the profile of the candidate through social networking sites, one should be very selective about the information one chooses to share on a public platform. If someone does not want to let people know about something it is advisable not to put such information online (7).
4.3 Recruiter’s view of profile
Recruiter’s often screen suitable candidate online. Therefore sharing professional information can have good effects on the recruiter. For example, if a candidate discusses his/her professional life like information about a company’s policy or sensitive issues like his/her bad relationship with a boss in a social networking site, it can create a bad impression on the recruiters and they may turn down the candidate’s application (7).
Technological advances have their own pros and cons. However, effective integration of technological advances and professional discipline can help us reap the benefits of the same. It is advisable that the nurses use social media for effective communication and networking purposes. However, they should exercise caution in adopting social media. Improper use of social media can be a problem for both patient and nurses.
Organizations and institutes should lay out strict regulations and restrictions pertaining to the contents that are permissible to be put up on social media. Nursing institutes should shape up their students with basic ethics, skills and knowledge so that they equip themselves in a proper way for the betterment of society.
1. Rene Cronquist JRaNSPR. Nurses and Social Media: Regulatory Concerns and Guidelines. Journal of Nursing Regulation. October 2011 p. 37.
2. Communication. A framework for community health nursing education p. 32.
3. Importance of Social Media in CommunityHealth.
4. The role and scope of practice of Community Health Nurses in Victoria. May 2008.
5. A Nurse’s Guide to the Use of Social Media.
6. RCNA Social Media Guidelines for Nurses. ; October 2011.
7. Social media and the nursing profession: a guide to online professionalism for nurses and nursing students.
About the Author: Reema Deb, has done her Masters in Microbiology and is currently pursuing a course in clinical research in Mumbai, India. She can be reached at [email protected]
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