How Nurses Should Be Using Social Media
October 10, 2018, by #EveryNurse
In today’s technology-based society, we enjoy easy access to myriad sources of digital communication and information. Professions such as nursing often employ social media as an increasingly effective, wide-ranging tool. However, along with this resource comes great responsibility. As nurses navigate social networking sites, chat rooms, blogs, and public forums, they – sometimes unknowingly – approach a dangerously thin line between professional and personal online etiquette and even run the risk of breaking federal and/or state laws.
Healthcare employees are tasked not only with maintaining patient confidentiality and privacy, but also serve to represent their place of employment in a positive manner. Inappropriate use of social media can lead to disciplinary action, which can, in the most serious cases, negatively affect both a nurse’s career and his/her licensure.
Privacy Issues Regarding Nurses Using Social Media
Passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) means that patients hold the rights over their own health information, and it establishes rules and limits as to who can receive it. HIPAA calls this kind of privacy information “protected health information” and defines it as anything “transmitted or maintained in electronic media or any other form of media.”
According to the National Council of State Boards of Nursing (NCSBN), confidential information can be shared only under three specific circumstances: 1) the patient has provided informed consent; 2) in situations in which it’s legally required, or 3) when failure to disclose the information could result in significant harm. Any breach of trust associated with the nurse-patient relationship can have repercussions, and it can damage the overall trustworthiness of the nurse, the organization in which the violation occurred, and 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 forms, including:
· Videos or photos of patients – even if they can’t be identified
· 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 occurs as soon as a nurse shares information (or even the slightest detail – no matter how insignificant) online with someone who is not authorized to receive such information. Examples include reflecting on the severity of a car accident victim’s injuries or commenting on the amount of medication that a patient has been prescribed.
Positive Ways a Nurse Can Use Social Media
Research evidence reported by the Institute for Healthcare Communication notes that “strong positive relationships” between nurses and other healthcare personnel help patients follow through with the recommendations by the medical team and even self-manage their health. Since positive interactions are beneficial to the patient/nurse relationship, how can you, as a nurse, take advantage of it?
According to research compiled by Duquesne University’s School of Nursing, some 90 percent of adults use mobile technology, with 71 percent utilizing video-sharing platforms. Moreover, Forbes magazine reports that 60 percent of doctors regard social media as an “avenue for delivering better healthcare to patients.” Debi Deerwester, chief clinical officer and vice president of clinical operations at WhiteGlove Health, notes that nurses can utilize social media in many ways advantageous to the healthcare field. Nurses can write and maintain blogs, post healthcare information on Twitter and Facebook, and upload to and/or view visual content on YouTube ‒ all aimed at promoting the nursing profession by educating the public. Obviously, interactive media has become a powerful form of communication in the nursing field.
John Lincoln of internet marketing company Ignite Visibility suggests that increasing their visibility through an online presence can help nurses advance in their career, leading, in some case, to a promotion and/or a raise. Additionally, Brittney Wilson, BSN, RN, says on her blog, The Nerdy Nurse, that maintaining and reading blogs gives nurses the opportunity to “teach others… inspire others… and… find support.”
In addition to promoting their value within the workplace, nurses also can use social media to promote their personal health-related endeavors and interests. Blogging, Wilson adds, can be a way to “build your personal brand online…. You can make a name for yourself and stand out in your profession.”
Not only can you build a reputable presence on your blog, but, as Wilson goes on to say, you may even be able to use it as a means of earning extra income as a wellness expert or health coach, using your professional credentials to establish your credibility.
Twitter, a popular real-time form of communication, is one of the easiest ways to maintain contact with others, especially in times of crisis. 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. The Pew Research Center (@pewresearch), reports that “social media use is ubiquitous across genders, races, and nearly every other demographic.” Via Twitter, nurses have the potential to disseminate quality healthcare information to the “313 million adults worldwide with Twitter accounts,” reports Toni Gallo for the American Academy for Medical Colleges.
Twitter also is an effective way to create a health-related conversation with the public or get a healthcare-related topic trending. In nursing schools, students learn the hashtags (#rnchat, #nurse, #hcIT, #hcmktg, among many others) most likely to lead to effective communication on Twitter, create awareness about preventative health campaigns, find employment, stay up to date on technological advancements, etc.
As of December 2018, Facebook had 2.32 billion users worldwide. On Facebook, nurses have the ability to leave messages (both public and private), upload videos, and post photos; in short, they can connect with others on many different levels. This type of immediate, personal communication gives nurses the opportunity to help bridge the information gap between healthcare 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. James Gillespie of the Center for Healthcare Innovation and Chief Executive David Ormesher reported in Clinical Leader that healthcare providers can use [Facebook] to effectively “partner with patients, families, and communities to effectively meet the needs of patients,” providing a platform that allows nursing professionals to provide the patient-centered care necessary for optimal treatment.
The visual and audio aspects of YouTube have a profound effect on a viewer’s understanding of healthcare, medical concerns, surgical procedures, and other treatments. Watching nursing vloggers on YouTube gives nurses with varying levels of experience and education the ability to stay on top of current trends and issues in nursing. Nurse vloggers work in a specific area of nursing, giving you the scoop on trending topics in nursing in a way that only someone in the trenches can.
“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.”
Since literally millions of videos go live every day with “hundreds or even thousands of nursing channels to choose from,” nurses in any area of the world can gain valuable insight and receive educational opportunities that may not be available in their area.
Social media also provides nurses with an outlet through which they can connect with other healthcare professionals for personal, emotional, and educational reasons. From receiving tips on how to cope with workplace stress to answering questions about advanced nursing degree programs, nurses can find many nurse-specific online groups to join or participate in. For instance, the American Association of Critical-Care Nurses provides links to a variety of discussion groups where nurses can find answers to questions, communicate with other nurses and share information.
“Social media groups can provide support and help nurses stay positive even in hard times,” says Lincoln. “By following the right social media feeds… nurses can get the latest medical news.” For links to some existing feeds, see the American Journal of Nursing’s list here.
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 texts among nurses about a specific patient raises huge privacy issues.”
Moreover, social media platforms often create a false sense of security for nurses who believe they are voicing their opinions, engaging in discussions, and posting images while under the protection of privacy settings. However, 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. Posts on social media have the potential to become public record that exists forever.
As a rule of thumb, nurses should not use social media to:
Complain About or Comment About Patients
The American Nursing Association warns against making disparaging remarks about patients (even if they’re not identified by name) to avoid problems with social media. “Do not talk about how rude a patient is, how bad they look, or how 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 on Social Media
When she shared a picture of a messy trauma room on Instagram after a patient was treated, an emergency room nurse at New York Presbyterian Hospital was fired from a job she had held for seven years.
Even a seemingly innocuous post on social media can result in repercussions and dismissal from your place of employment. A Missouri nurse was fired for posting a photo of herself and her husband wearing blackface while dressed as Beyoncé and Jay-Z for Halloween on her personal Facebook page. The photo, which has since been removed and the Facebook account closed, was circulated online.
Rant About Place of Employment
Because of the nature of the work, nurses who make negative posts on social media about coworkers, administrators, job duties, their place of employment, and/or workplace policies run the risk of disciplinary actions. These types of online negative comments reflect poorly on the hospital or doctor’s office in which the nurse is affiliated, as well as jeopardize her or his job security. Even when opinions are voiced under the strictest privacy settings, the possibility always exists that online commentary can reach unintended readers.
To reduce the chance of violating workplace policies – even accidentally – you are highly recommended to use your personal email address as a primary means of identification on social media accounts instead of an email address associated with a hospital or your place of employment.
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 use a pseudonym to write blog posts.
Blow Off Work-Related Steam
Because of the visibility that social media platforms provide, Lincoln says it’s 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 that you refrain from saying anything negative about “patient interaction, the prospect of patient recovery, or even just a generally bad day on the job.”
Use Offensive Language and/or Voice Offensive Comments
Nurses work with a diverse patient population from a wide range of economic, racial, ethnic, and religious backgrounds. Social media comments that are considered threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic, or controversial are often grounds for discipline at the workplace.
Social Media Policies
An increasing number of hospitals, medical facilities, and healthcare employers are in the process of developing and implementing their own social media policies, including institutions as prestigious as the American Medical Association, the Cleveland Clinic, the Mayo Clinic, Vanderbilt University Medical Center, MD Anderson Cancer Center, Children’s Hospital Los Angeles, and Kaiser Permanente. In fact, to stress the importance of the issue, the National Council of State Boards of Nursing (NCSBN) publishes a white paper, “A Nurse’s Guide to the Use of Social Media” Additionally, the HIPAA Journal provides a compliance checklist for organizations to review to ensure their continued compliance with all HIPAA regulations regarding the security and privacy of confidential patient data.
Lincoln says 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 its employees, but it also has implemented a policy for those who interact with the hospital on social media.
Lincoln restates his policy: “I am a strong believer that every company should have a social media policy in place…. 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 of posting improper or inappropriate posts on social media platforms can lead to 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 the state board of nursing can undertake measures as well. Additionally, it’s 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
· Termination of employment
· Loss of licensure
· Criminal charges
· Jail time
The most serious offenses often involve law enforcement, which, is some cases, are referred to the FBI for investigation of HIPAA violations, as evidenced in the 2018 firing of a nurse at Texas Children’s Hospital who posted a “series of comments on Facebook about a rare case of measles at the hospital.”
Nurses who abuse social media (as well as digital and electronic media while on the job, such as taking cellphone pictures of patients) can cause their employer also to come under scrutiny and suffer consequences. After numerous employees, including two doctors, at a Pennsylvania hospital took photos and videos of a patient in the emergency room suffering from a genital injury, the facility was cited by the Pennsylvania Department of Health for multiple HIPAA violations. Even if a nurse gains permission from a patient to take pictures, authorities can still take action.
According to Nursing.org, at least 50 employees, including nurses, at Northwestern Memorial Hospital in Chicago, were fired in May 2019 after they allegedly viewed actor Jessie Smollett’s medical records after he was treated at the hospital. Apparently, the employees were simply curious about the case, but improperly viewing patient medical files for any reason is considered a HIPAA violation.
In conclusion, social media policies for nurses continue to evolve to align with advancements in technology and the internet. The key to successfully navigating the ups and downs that come with having an online presence is to find a happy, safe, and responsible middle ground between the personal and professional benefits of social media without breaking the laws governing patient privacy and confidentiality. Nurses must remain vigilant to avoid inadvertently disclosing patient- and workplace-related information via social media as well as to keep up with current workplace policies and relevant state and federal laws.