What Nurses Should Know About Social Media

Editors Note: We felt it was important that our readers (potential CNA’s) knew what the effects a simple status update or picture post on social media could mean for their careers. At a time when privacy means little you could get into a lot of trouble simply be posting about a patient you interacted with during work even if you don’t mention their names. As a CNA, you will always have a bigger bond with your patients because if you’re like the majority and work in a nursing home, you’ll be interacting with the same patients day in day out with little change. This makes it harder not to talk about your work and who you interact with when discussing your day on Facebook and Twitter. We commissioned someone who’s familiar with the laws to write a guidance piece on how to make sure you’re not breaching your patients confidentiality. Read on:

 The Appropriate Use of Social Media in Nursing. Social media and electronic communication is quickly becoming a common workplace tool, used professionally and personally in blogs, social networking sites, forums and chatrooms. In the health care field, social media must be used in a way that maintains patient confidentiality and privacy. Inappropriate use by nurses has led both to disciplinary action and to more serious consequences when the media becomes involved. Not only does this negatively impact the nursing profession and harm patients, it can put a nurse’s career and license at risk.

When it comes to social media, nurses must follow appropriate guidelines so that they can use it without breaching patient confidentiality. Social media holds many potential benefits for nurses. Forums, blogs, and networking sites are places where nurses can discuss difficult or emotional events with peers. They can vent and receive helpful advice and support from colleagues, friends, and others. Nurses are encouraged to use journaling and reflective practice for professional growth, and the Internet offers many opportunities for this.

Confidentiality and Privacy
When it comes to social media, it is easy to disclose too much. Not only is patient privacy violated, but the coworkers can be negatively impacted. Although nurses are expected to understand confidentiality and privacy legislation, they often do not comprehend its application, particularly regarding social media. The importance of privacy and confidentiality cannot be understated, since it impacts trust not only in the nurse-patient relationship, but that of the whole profession.

Key concepts:

  1. Any patient information gained during the course of treatment must be safeguarded by the nurse and used or shared only for health care purposes
  2. Informed consent must always be obtained
  3. Personal information is entrusted to the nurse and must be treated with dignity and respect
  4. Many nurses make the mistake of thinking they have respected privacy by removing patient name and obvious identifiers. This is not true. If information has been shared with someone who is not authorized to receive that information, it is a violation of confidentiality. It is also extremely easy to identify a patient with even the smallest and most insignificant piece of information, particularly via the Internet.

Another common mistake is to assume that when something is sent privately to an individual or posted on a closed forum, it will remain private. Remember: once something is posted it can (and will) be shared with anyone. Deleting does not mean it is removed.
Here are a few examples of how nurses can get into trouble with social media. Some cases are fairly obvious, most are not done with malicious intent, but all have serious consequences.

Sharing something about your patient could get your license pulled and worse, leave you at the mercy of a lawsuit.

*Two nurses photographed an x-ray of a patient with a object stuck inside his rectum. They independently posted the picture on Facebook. There was no patient identifying information. The media was tipped off by another employee. Although the pictures were immediately removed, both nurses were fired.

*in a small community nurses regularly spend their breaks relieving stress by sharing information with family and friends about all shift activities, including death tolls, patient demographics, and diagnoses. Although no names are used, patients can often be identified anyway. Concern was expressed in one message about a cancer patient who was on a new medication. Word got around to a relative, who subsequently made a comment to the patient about the caring nurses who were so knowledgeable about the medication. The patient was upset, but because she could not identify the source, the trusting relationship with all her nurses was tainted.

*a nursing home worker in a facility for dementia patients received an email photo of an elderly woman’s nude backside. The source could not be identified, so she forwarded it to several colleagues. Soon it became a topic of amusement, with some staff betting on the patient’s identity. Supervisors and the media became aware. The sex crimes unit was called in and the whole facility was placed under investigation. The patient was eventually identified and the family launched a lawsuit. Although the originator of the picture was never identified, all those who forwarded it were disciplined.

*a nurse in an emergency room got permission from a patient to take pictures of his injury. She shared these on a nursing forum with her nursing friends for learning purposes. Although the patient was not visible, the type of injury made it clear who he was. The nurse was disciplined.

*a student nurse working in the pediatric unit took a picture of a very cute four-year-old who was fighting cancer. She posted the picture on her Facebook page, expressing to her fellow nursing students how excited she was to be working in pediatrics with such a special patient. The photo was brought it to the attention of administration. Because the hospital and the patient were able to be identified through the picture, the student nurse was found in violation of HIPAA. She was expelled, and the nursing program was barred from using the pediatric unit for teaching.

Where did these workers go wrong? It may be easy to see how confidentiality was breached, or where conduct was unprofessional and unethical. But what about cases where employees thought they were using the information to benefit?
For nurses to use social media in a professional way without breaching patient privacy or confidentiality or violating privacy legislation a number of guidelines must be always followed when using social media and personal media devices:

  1. Nurses have an ethical and legal obligation to maintain patient confidentiality and privacy at all times.
  2.  No information or images of a patient should be posted or shared with anyone unless that individual is involved in matters relating to patient care.
  3.  No information gathered via the nurse-patient relationship should be transmitted if it might violate privacy rights or lead to embarrassment.
  4.  Never mention a patient by name or post any identifying information, no matter how insignificant it might seem.
  5.  Always think about potential risk. What could happen if the information got into the wrong hands?
  6.  Never speak disparagingly of a patient.
  7.  Do not make disparaging comments about coworkers or employers.
  8.  Never assume privacy of communication, even on a closed forum.
  9.  No patient images or pictures should ever be transmitted by electronic media.
  10.  Do not take pictures of patients on personal devices.
  11.  If pictures of patients are required for diagnostic or treatment purposes, follow employer guidelines.
  12.  Always maintain professional boundaries in any patient/nurse contact.
  13.  Report any confidentiality or privacy breaches promptly.
  14.  Understand and comply with employer policies regarding social media.

Advances in technology have transformed health care, and electronic and social media hold great potential in nursing communication. Before using these, however, nurses must be aware of potential problems that can occur if patient information is disclosed through social media. The consequences are serious for everyone involved. Nurses who use social media in a conscientious and professional way and do not violate patient confidentiality or privacy will be able to use alternative media as an effective practice tool.


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About the Author:

Debbie Jabbour is a Canadian writer with broad life experience and grandchildren who keep her forever young. After enjoying a successful career as a professional musician, she returned to university and earned a Bachelor in Psychology/Communications and a Masters in Applied Psychology. When writing, she draws on her insight into human nature, approaching topics with a sense of humor and a keen interest in history, politics, culture, and the arts. Her work has appeared in several online magazines and blogs. Debbie’s personal philosophy is rooted in the words of Nietzsche: That which does not kill me makes me stronger.

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