The instantaneous nature of online communication leaves no time to consider the consequences of a comment. Once posted the action is irreversible and even if deleted, permanent in one form or another. Social media sites make that disclosure but few users are aware of the extent of the waiver they accept. Posts besides being unable to be retracted, are now subject to the control of the social media site. The distribution and dissemination are given up by the poster. Yes the original comment may have only been intended for friends. But have you ever heard about the 6 degrees of separation? Your friends know other people you do not and it could be that they or their acquaintances know your boss.
So should one traverse web communication in a fun and productive manner without encountering a professional pitfall? It starts with awareness, vigilance, and knowledge.
Health care providers, including nurses are governed by the Health Insurance Portability and Accountability Act (HIPAA). Its main objective is to protect patient privacy both online and in real life. It outlines what is individually identifiable information, seeking to eliminate any possibility of patient identification.
For instance a nurse in an Eastern metro center wrote on Facebook about treating a killer of a policeman in general terms. Yet the case was high profile enough that it was still possible to know who she was discussing. She was fired.
HIPAA is governed by the Office of Civil Rights (US Dept of Health). Patients cannot sue the individual health care professional but they can take action against their employer. One exception to this rule is if the health care organization can prove that it provided education on social media use. The worker can then be disciplined under that policy.
It is very important therefore, for nurses to be aware of all aspects of their employer’s social media use policy. There are some medical centers that have gone to extreme lengths by banning employees from any use of social media at any time even off duty. Health care organizations will have restrictions on use of social media during work hours, especially on employer provided equipment such as computers and smartphones.
Nurses also need to avoid inadvertent violations of employer, HIPAA, or professional policies. This can occur if a nurse places too much trust in a site’s privacy settings. Of course in the original post the nurse may have been very careful to either not share patient information or if it was a wild off duty activity to only share with friends. But again the poster has no control over how the friends share their post. Again the 6 degrees of separation apply. Worse yet some social media sites do not inform their users of privacy setting changes and the site often defaults users’ accounts to the least secure settings, which can leave the user open to hacking and uninvited postings.
In a 2010 survey of 46 state boards of nursing 33 had dealt with complaints about nurses and social media use, and 26 of the 33 took disciplinary action.
In web communication nurses must consider 3 ramifications: The nurse patient relationship, relationships between peers and colleagues, and the reflection on the profession of nursing by individual nurse actions as perceived by the public.
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Nurses should not for example post about a celebrity patient, or make mocking or disparaging comments about a patient even if not identified. It may not be a good idea to post about patient groups, or make negative comments about workplace conditions. This may be offside even if the comments are part of a discussion on how to improve working conditions.
Online bullying, tearing down, or criticizing colleagues is also off limits and unprofessional. But it is the last ramification that has generated the most debate. No doubt employers are sensitive to any worker actions that reflect badly on the organization. But how far can they go to censor their workers? Would it make more sense for individual nurses to police their own actions than to have rules imposed on them from an employer?
Employers also research potential applicants on social media sites as well, another incentive for nurses to maintain some degree of professionalism when online.
Here are a few examples of what not to do on a social media site. Nurses can learn from these incidents and thereby have a more productive fun online presence.
A nurse at a long term care facility discovered an unsolicited email containing a photo of a resident that violated the resident’s privacy. The nurse didn’t know who sent it to her. She discussed the email with her colleagues, and in trying to ascertain its source forwarded it to other workers, who in turn posted it on the internet. Although some workers were concerned, others found the incident funny. Later that day the director found out about the email, as did the local media and police department. Although no charges were laid, the media coverage spread and the family threatened to sue the facility.
The first nurse who saw the email should have involved her supervisor from the start and had no right to violate the anonymous patient’s privacy by forwarding the email.
A nursing student in a pediatric practicum photographed one of her patients who had cancer, after asking his permission. She was proud of both his bravery and being involved in his care. In the photo which she posted on Facebook there were enough identifying factors to show the medical center where this patient was located. Another hospital nurse found the photo and reported it to the dean of the nursing school. The photo was found to be in violation of HIPAA policy and both the hospital and school were cast in a negative light. The student was expelled from the nursing program.
In another college students had set up a Facebook page where they could blog and discuss their school experiences. In one post they discussed the handling of a clinical error made by one of the students. They were unaware that others outside their group including the general public could access their postings and since the college only used 2 clinical locations the medical center was able to be identified.
To conclude on a positive note, each nurse must productively navigate the gray area between their personal and professional lives, and find the boundary between work and personal time. Nursing associations need to survey their members to gather data relevant to the profession, to thereby offer guidance on social media use, for it to realize its vast potential to serve the profession well. Nurses can make web communication more trial than error. They can create social media that allow secure interaction and discussion of content applicable to nurses.
https://www.ncsbn.org/Social_Media.pdf
Duffy, Megan. Patient Privacy and Company Policy in Online Life. American Journal of Nursing. September 2011 Vol. 111 No. 9 pp 65-69
http://philbaumann.com/2009/01/16/140-health-care-uses-for-twitter/
