A Nurse’s Guide To The Use Of Social Media - NCSBN

A Nurse’s Guide to theUse ofSocial Media

A nurse mustunderstand and applythese guidelines for theuse of social media.

The use of social media and otherelectronic communication is expandingexponentially as the number of social mediaoutlets, platforms and applications availablecontinue to increase. Individuals use blogs,social networking sites, video sites, onlinechat rooms and forums to communicate bothpersonally and professionally with others.Social media is an exciting and valuable toolwhen used wisely. The very nature of thismedium, however, can pose a risk as it offersinstantaneous posting opportunities that allowlittle time for reflective thought and carriesthe added burden that what is posted on theInternet is discoverable by a court of law evenwhen it is long deleted.Nurses are welcome to use social media intheir personal lives. This may include havinga Facebook page, a Twitter feed or bloggingon various websites. Nurses can positivelyuse electronic media to share workplaceexperiences, particularly those events thatare challenging or emotionally charged, butit is imperative not to mention patients byname or provide any information or details thatcould possibly identify them in order to protectpatients’ right to privacy.

SOCIAL MEDIA IN THE WORKPLACESocial media can benefit health care in a variety of ways,including fostering professional connections, promotingtimely communication with patients and family members,and educating and informing consumers and health careprofessionals. Social media provides nurses with a way toexpress their feelings, and reflect or seek support fromfriends, colleagues, peers or virtually anyone on the Internet.Journaling and reflective practice are recognized as effectivetools in nursing practice, and the Internet provides analternative media for nurses to engage in these helpfulactivities. Without a sense of caution, however, theseunderstandable needs and potential benefits may result inthe nurse disclosing too much information, and violatingpatient privacy and confidentiality.Health care organizations that utilize electronic and socialmedia typically have policies governing employee use ofsuch media in the workplace. Components of these policiesoften address personal use of employer computers andequipment, personal computing during work hours, andthe types of websites that can be accessed from employercomputers. Health care organizations also maintain careful4

control of websites maintained by or associated with theorganization, limiting what may be posted to the site andby whom.The employer’s policies, however, typically do not addressthe nurse’s use of social media to discuss workplace issuesoutside of work on home computers, personally ownedphones and other handheld electronic devices. It is inthis context that the nurse may face potentially seriousconsequences for the inappropriate use of social media.Jamie has been working in hospice care for thelast six years and one of her patients, Maria,maintained a hospital-sponsored communicationpage to keep friends and family updated on herbattle with cancer. One day, Maria posted about herdepression. As her nurse, Jamie wanted to providesupport, so she posted, “I know the last week hasbeen difficult. Hopefully the new happy pill will help,along with the increased dose of morphine.I will see you on Wednesday.” The site automaticallylisted the user’s name with each comment. The nextday, Jamie was shopping at the local grocery storewhen a friend stopped her to ask about Maria’s condition. “I saw your post yesterday. I didn’t know youwere taking care of Maria,” the friend said. “I hopethat new medication helps with her pain.”This is an example of a violation of confidentiality throughsocial media. While Jamie had Maria’s best intentionsat heart by trying to offer her words of support, sheinadvertently disclosed information about a patient ona social media site. Everyone who read that post now knowsabout Maria’s medication and increase in morphine,violating her right to privacy and confidentiality. Instances ofinappropriate use of electronic media by nurses such as thishave been reported to boards of nursing (BONs) and, insome cases, to the media.5

CONFIDENTIALITY AND PRIVACYTo understand the limits of appropriate use of social media,it is important to have an understanding of confidentialityand privacy in the health care context.Confidentiality and privacy are related, but distinct concepts:Any patient information learned by the nurse during thecourse of treatment must be safeguarded by that nurse.Such information may only be disclosed to other membersof the health care team for the purpose of providing carefor the patient.Confidential information should be shared only with thepatient’s informed consent, when legally required or wherefailure to disclose the information could result in significantharm. Beyond these very limited exceptions, a nurse isobligated to safeguard confidential information.As a licensed practical nurse for more than 20 years,Bob knew the importance of safeguarding a patient’sprivacy and confidentiality. One day, he used hispersonal cell phone to take photos of Claire, aresident in the group home where he worked. Bobreceived permission from Claire’s brother to take thephoto since she was unable to give consent due toher mental and physical condition. That evening,Bob ran into William, a former employee of the grouphome. While catching up, he showed William thephoto of Claire and discussed her condition with him.The administrator of the group home later learned ofBob’s actions and terminated his employment forbreach of confidentiality.Bob thought it was okay for him to take Claire’s photobecause he had the consent of a family member. He alsothought it was acceptable for him to discuss Claire’s condition because William previously worked with Claire. So whywas this behavior wrong? Because, first, merely askingClaire’s brother for permission is not obtaining a validconsent. Second, confidential information should not be6

disclosed to persons nolonger involved in the care ofa patient. Even though Bobmade an honest mistake,confidentiality rules must bestrictly enforced to protect apatient’s right to privacy.Privacy relates to thepatient’s expectation andright to be treated withdignity and respect. Effectivenurse/patient relationshipsPrivacy is the patient’sare built on trust. Patientsneed to be confident thatexpectation to be treatedtheir most personal informa- with dignity and respect.tion and their basic dignityConfidentiality iswill be protected by thesafeguarding patientnurse. Patients will behesitant to disclose personal information.information if they fear it willbe disseminated beyond those who have a legitimate“need to know.” Any breach of this trust, even inadvertent,damages the nurse/patient relationship and the generaltrustworthiness of the profession of nursing.Federal law reinforces and further defines privacy throughthe Health Insurance Portability and Accountability Act(HIPAA). HIPAA regulations are intended to protect patientprivacy and confidentiality by defining individually identifiableinformation and establishing how this information may beused, by whom and under what circumstances. Thedefinition of individually identifiable information includesany information that relates to the past, present or futurephysical or mental health of an individual, or providesenough information that leads someone to believe theinformation could be used to identify an individual.Breaches of patient confidentiality or privacy can beintentional or inadvertent and can occur in a variety ofways. Nurses may breach confidentiality or privacy withinformation they post via social media sites. Examples mayinclude comments in which patients are described withenough sufficient detail to be identified, referring to patientsin a degrading or demeaning manner, or posting videos orphotos of patients.7

Emily, a 20-year-old nursing student, wasn’t awareof the potential repercussions that could occurwhen she took a photo of Tommy, a 3-year-oldleukemia patient in a pediatric unit, on her personalcell phone. When Tommy’s mom went to the cafe teria, Emily asked him if she could take his picture,and Tommy immediately said yes. Emily took hispicture as she wheeled him into his room. Sheposted Tommy’s photo on her Facebook page withthis caption: “This is my 3-year-old leukemiapatient who is bravely receiving chemotherapy!He is the reason I am so proud to be a nurse!”In the photo, Room 324 of the pediatric unit wasvisible. Days later, the dean of the nursing programcalled Emily into her office. A nurse from thehospital found the photo Emily posted of Tommyon Facebook and reported it to hospital officialswho also contacted Emily’s nursing program.While Emily never intended to breach the patient’s confidentiality, the hospital faced a HIPAA violation. From Emily’spost, people were able to identify Tommy as a cancer patientand the hospital where he was receiving treatment. Schoolofficials expelled Emily from the nursing program forbreaching patient confidentiality and HIPAA violations.The nursing program was also barred from using the pediatric unit for their students. Emily’s innocent, yetinappropriate, action of posting a patient’s photo hadrepercussions for her, the nursing program and the hospital.But what if Emily removed the photo hours later? If it’s takendown, no harm, no foul, right? No. Anything that exists on aserver is there forever and could be retrieved later, even afterdeletion; therefore, it would still be discoverable in a courtof law. Further, someone could have taken a screenshotof her Facebook page and posted it on a public website.Patient information and photos should never be posted onsocial media websites. Even after being deleted, the photois still on a server and possibly posted somewhere else onthe Internet.8

POTENTIAL CONSEQUENCESAs we’ve seen with Jamie, Bob and Emily, potential consequences for inappropriate use of social and electronic mediaby nurses vary. Consequences depend, in part, on theparticular nature of the nurse’s conduct.Instances of inappropriate use of social and electronicmedia may be reported to the BON. Laws outlining thebasis for disciplinary action by a BON vary betweenjurisdictions. Depending on the laws of a jurisdiction, aBON may investigate reports of inappropriate disclosureson social media sites by a nurse on the grounds of:Unprofessional conduct;Unethical conduct;Moral turpitude (defined as conduct that is consideredcontrary to community standards of justice, honesty orgood morals);Mismanagement of patient records;Revealing a privileged communication; andBreach of confidentiality.If the allegations are found to be true, the nurse may facedisciplinary action by the BON, including a reprimand orsanction, assessment of a monetary fine, or temporary orpermanent loss of licensure.Improper use of social media by nurses may violate stateand federal laws established to protect patient privacy andconfidentiality. Such violations may result in both civil andcriminal penalties, including fines and possible jail time. Anurse may face personal liability and be individually sued fordefamation, invasion of privacy or harassment. Particularlyflagrant misconduct on social media websites may alsoraise liability under state or federal regulations focused onpreventing patient abuse or exploitation.If the nurse’s conduct violates the policies of the employer,the nurse may face employment consequences, includingtermination. Additionally, the actions of the nurse maydamage the reputation of the health care organization,or subject the organization to a lawsuit or regulatoryconsequences.9