Social Media and Nurses: Promising or Perilous?

Laura A. Stokowski, RN, MS


November 17, 2011

In This Article

Nursing and Social Media

Social media offer far more benefits than drawbacks to nursing and healthcare. The advantages include lightening-fast dissemination of knowledge and the ability to discuss and debate issues pertinent to education, practice, and research on a worldwide stage.[2] Social media can enable professional connections and mentoring relationships, and all nurses and students can participate, regardless of geographic location or time zone. A professional online presence is an imperative for nursing, but nurses must proceed carefully, with their eyes open to the potential negative consequences of social media.

Nurses spend so much of their lives with their coworkers that it is natural for friendships to form in the work setting, and for these friendships to spread to social networks. However, the practice of combining all of one's friends, coworkers, and acquaintances into a single venue, such as Facebook, can result in a blurring of personal and professional boundaries. A nurse's personal social habits are on view to current or potential employers, patients, and professional colleagues. Professional reputations can suffer, and job opportunites lost because of what is posted on a social networking site.

What's the Harm?

Just about everyone is wising up to the potential downsides of social media. Consequently, any hospital, healthcare organization, college or university that doesn't already have a "social media policy" is in the process of developing one to protect themselves (and in the case of hospitals, their patients) from the online actions of employees or students. Nurses and students who use social media will have to be aware of these policies -- ignorance will not suffice to forgive violations. Whether intentional or unintentional, nurses and nursing students who use poor judgment on social networking sites can harm their patients, their employers, the schools they attend, and themselves.

Consequences for patients. In the past few years, numerous incidents of nurses discussing patients online, or taking and disseminating photographs of patients have been reported by news media.[3,4,5] In one reported incident, nurses in an emergency department took cell phone photos of a dying man who had been the victim of extreme trauma, and posted the photos on Facebook.[5] Nurses involved in these incidents have been disciplined and in some cases, fired.

Dr. Carole McKenzie, Professor and Chair of the Division of Nursing at Northwestern Oklahoma State University finds that nurses and nursing students who are heavy users of social media in other aspects of their lives sometimes have a hard time grasping the privacy issues. "We need to help them understand that they can't expect privacy when they put something online," explains Dr. McKenzie.

Patient privacy and confidentiaIity are protected by state and federal laws. Improper use of social media violates these laws, and can result in both civil and criminal penalties, including fines and jail time. A nurse may face personal liability in such an instance, and be individually sued for defamation, invasion of privacy, or harassment.[6]

The other side of the coin is the possibility that patients might investigate their nurses' online personas and behaviors, and form opinions about nurses' professional abilities on the basis of what they read or view online. Nurses are people, just like the other 630,000,000 worldwide users of Facebook.[7] Shouldn't nurses be able to post photographs of themselves drinking alcohol or participating in any activity of their choosing on their time off? Shouldn't they be free to express their opinions online in blogs and discussion boards, as long as they do it on their own time?

The answer is no, according to Dr. McKenzie, who explains that it is an issue of trust in the nursing profession. "We violate our patients' trust if there are pictures of us on Facebook behaving unprofessionally, making off-color remarks, or expressing certain opinions online. Patients do see these things, and some are actively looking for them. It's our professional obligation to behave in a certain manner."

Other experts agree that although nurses "deserve a life apart from their professional duties," their conduct on social networking sites is on view for the world to see, scrutinize, and judge.[2] Nurses are certainly not alone in having to be more cautious about how they are portrayed online. Other professionals -- both in and outside of healthcare -- face similar issues with respect to their professional "digital reputations" and how they might be perceived by patients and clients.

Consequences for employers. Earlier this year, a registered nurse was fired for using her cell phone to post comments to a social networking site while she was performing patient care.[8] In this particular case, the nurse was dispensing medications at the time she made the post. The hospital's view was that this was a patient safety issue, and the action violated the hospital's policy about the use of a personal cell phone while on duty. In another incident, nurses were disciplined for taking and posting photos of one nurse removing a sliver from another nurse in an empty operating room.[9] The hospital maintained that the behavior was unprofessional and reflected poorly on the institution.

Aware of these occurrences, many nurses avoid discussing work-related issues on socially-oriented sites such as Facebook, and instead, gravitate to professional discussion boards, blogs, and nursing association Web sites. However, even when participating in "members only" discussions, comments made by nurses online may contain information about the unit or hospital that could identify the nurse's employer. Many nurses use a professional "signature" on their email and discussion board communications that identifies their workplace and position. Nurses might discuss and share information on staffing, unit or hospital policies, patient scenarios, unusual incidents, or other information, unwittingly violating hospital policies.

Consequences for educational institutions. One of the most recent social media faux-pas to be sensationalized by the news media, along with a host of online bloggers, was the "Placenta incident."[10] Four students were dismissed from their nursing program after a student posted a photo on a social networking site showing her posing, smiling widely, over a placenta in a plastic tray, while holding up the umbilical cord in her gloved hand. Although nothing in the photograph identified the patient from whom the placenta was taken, the student was wearing a uniform with a visible decal, as well as a hospital badge on a lanyard that contained identifying information. Although the photo was taken down from the student's Facebook page, it is still available on the Internet.

Dr. McKenzie is aware of social networking sites where nursing students have engaged in use of vulgar language, and displayed photographs depicting intimate behavior. "These students believe that they are protected by the privacy settings on their Facebook pages, but in reality, anything they post can be shared by another person. They have no control over what happens to this content or where it ends up."

In the United States, approximately 35% of Facebook users are 18-25 years of age, the age range of most college students. [7] Social media are widely used by both teachers and students in educational institutions and can significantly enhance the learning experience. Even Dr. McKenzie acknowledges that "the most effective way to reach students is through Facebook," but she also cautions that a line must be drawn. She doesn't believe that faculty members should "friend" their students because this could lead to misunderstandings. "A boundary must be maintained," says Dr. McKenzie.

Consequences to the nurse. In each of the incidents reported in the media, nurses or students involved were disciplined, suspended, or fired from their positions. In some cases, after legal proceedings, these penalties were reversed, but the embarrassment and damage to the nurse's professional reputation are not as easily repaired.

According to the National Council on State Boards of Nursing (NCSBN), "instances of inappropriate use of social and electronic media may be reported to boards of nursing (BON)."[6] Whether disciplinary action will be taken by a BON varies depending on the laws of the particular jurisdiction, but may include investigations on the grounds of unprofessional conduct, unethical conduct, moral turpitude, mismanagement of patient records, revealing priveleged communication, and breach of confidentiality. Possible consequences include reprimands or sanctions, monetary fines, and temporary or permanent loss of licensure.[6]

These consequences are more than theoretical. The NCSBN reports that numerous BONs have already received complaints about, and taken action on, nurses who violated patient privacy by posting patient information or photographs on social networking sites. Actions taken have included censure of the nurse, issuing letters of concern, placing conditions on the nurse's license, and suspension of licensure.

Nurses who use social media should also be aware that, right or wrong, employers and educational institution admissions staff may be checking up on current or prospective employees or students on social networking sites, and making judgments about a nurse's professional suitability.[2]


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