Even under the best of circumstances, social media can pose legal and ethical risks for professional nurses. Consider the three potential traps below and the guidelines listed before you put something out for others to see. (Note that the term “social media” refers not only to sites such as Facebook, Twitter, and Instagram but also to professional networking sites such as LinkedIn, blogs, podcasts, chat rooms, and messaging tools – any online or public presence or media, even if you think it is private.)
Undoubtedly, social media tools can be excellent ways to network, seek career advice, get tips about difficult situations, provide health information and public education about professional nursing and, under the right circumstances, communicate with other providers and patients. This blog site is an example of good social media use. But other situations can pose risks, and you need to know about them to protect your reputation, your patients’ privacy, and even your job or your license.
The first pitfall is also the easiest to avoid: personal contact with patients. If a patient (or family member) wants to “friend” you on social media, think hard before accepting. In rare situations, it may be all right, but in most cases it is best to decline. Keep your relationships with patients and their families on a professional level. This decreases the odds of a potential conflict of interest, inappropriate relationships, and even claims of malpractice if you give advice that turns out to be wrong. Your messages are not as private as you think and can be copied to other more visible sites. Readers may also think you are acting in an official capacity for your facility or employer when you aren’t, and your words can be edited or taken out of context.
The second problem area is the one that gets the most bad press: inadvertent or even intentional disclosures about patients. Some are obvious while some are less so.
Last month, two Navy corpsmen were removed from their patient care positions and faced disciplinary action for inappropriate use of social media. In this case, they worked in the nursery of the Navy hospital in Jacksonville, FL where they posted pictures and videos of the newborns, calling them names and making disparaging remarks. Videos and pictures of nursing home patients and patients in the OR have surfaced, causing all sorts of problems and embarrassment for everyone involved. Even seemingly innocent pictures or comments can be problematic. Student nurses have posted pictures talking about why they are proud to be in nursing, leading to dismissal from the program. Good intentions can backfire.
The third snare is one you may not think about: posts that can affect your career, working relationships, and your reputation. Negative comments about your colleagues at work are not a constructive way to address workplace problems and can be considered “lateral violence” or “cyberbullying,” leading to reprimands or disciplinary action. One Canadian nurse is appealing a $26,000 fine and reprimand by the Saskatchewan Board of Nursing after she posted comments questioning the quality of care her grandfather received in a nursing home.
Consider these points when using any form of social media in relation to your professional practice:
If you post professionally, keep it separate from your personal account. Don’t mix c
ontent from the two.
Be careful about using any social media to air grievances or expose problems. There are almost always better, more constructive ways to address situations.
HIPAA lists 18 identifying pieces of information. Even without a name, you can be cited for privacy violations if you mention any of the others or if someone can put pieces together to figure out who you are discussing. Fines range from $100 – $50,000 per violation – and there can be multiple violations in one post.
Deleted posts still exist on servers and can be discovered in legal proceedings.
Privacy settings do not stop others from reading your posts or copying them to other sites.
Do not re-post or comment in response to a patient, client, colleague or family member.
Do not post pictures or videos unless you have a signed informed consent from the person. Even then, proceed with caution.
Potential employers often search social media before offering an interview or position. Your posts may present the wrong picture of you and push you out of a position before you even know it.
Boards of nursing will investigate reports of inappropriate conduct on social media and can discipline nurses for unprofessional conduct. Boards have issued reprimands, suspensions, fines, and
Patients, family, and others harmed by your posts can file civil suit against you which will, at a minimum, lead to legal expenses and aggravation, if not problems at work, with your license, and with regulatory agencies.
There are several excellent resources available starting with your state, territorial, or provincial board of nursing. Most have a policy or position statement on the use of social media. Also look at the American Nurses’ Association site for “6 Tips for Nurses Using Social Media,” and the National Council of State Boards of Nursing for their publication, “A Nurse’s Guide to the Use of Social Media.”
When in doubt, remember the “newspaper test” – don’t post anything you wouldn’t want to see on the front page of your local paper with your name at the top. Remember that your social media presence is your public face on the internet – make sure it is a good image.