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Advances in Neonatal Care:
doi: 10.1097/ANC.0b013e3181c201f1
Letter From the Editor

Social Networking: Ethics and Etiquette

Witt, Catherine L.

Free Access

I recently acquired a Facebook account. It was mainly a way to keep up with my college-aged children and some long-lost relatives whom I had not talked to in awhile. According to Facebook, I am one of more than 300 million users and part of the fastest-growing demographic—those older than 35 years.1 In addition to many old friends and family members, many of my coworkers and colleagues are members as well. It is great way to catch up and exchange information. In fact, I now know when many of my friends and relatives are washing dishes, doing laundry, cooking dinner, and feeding their pets, thanks to instant status updates.

Figure. Catherine L....
Figure. Catherine L....
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The popularity of social networking sites such as Facebook, My Space, YouTube, and Twitter attests to the allure of sharing information quickly. However, it is raising questions about personal and professional privacy. How much information should you share about yourself? Should you be “friends” with patients and families? What about students and faculty? How much do you want your students, professor, employer, or patients to know about you? Do your children really want those naked baby pictures being viewed by all their friends? A feeling of being anonymous while sitting at home on the computer can lead to a blurring of boundaries.

Employers have been perusing Facebook and My Space profiles before making hiring decisions. Bosses have been known to observe photographs taken at parties or other activities after the employee depicted has called in sick.2 Employees have been videotaped or photographed with drinks in their hands while they are supposed to be on call. Universities have noted that they research potential students on social networking sites.2 Lawyers have been known to troll for incriminating information in divorce and child custody cases. It seems reasonable that one must assume that anything posted on such sites is public information and can be seen not only by one's individual friends but by all of their friends as well.

For nurses, additional ethical questions arise. Posting of patient information, even when names are not used, has landed some nurses in significant legal difficulty. Nurses have posted photographs of patients, x-rays, and other personal information, assuming that because names are not used, there is no breaking of patient confidentiality. However, it is often possible to identify patients based on descriptions of patient condition, the hospital at which they are admitted, or other information. This can constitute a violation of the Health Insurance Portability and Accountability Act, as discovered by 2 Wisconsin nurses who allegedly posted photographs of a patient's x-ray on Facebook.3 The nurses were fired, and the case was referred to the FBI for investigation.

When nurses become “friends” with patients and families, there is perhaps an assumption of consent for sharing of information. This can be fraught with difficulties however when outcomes are not as expected, or when information becomes more public than originally intended. In addition to sharing information about patients, we may inadvertently share information about ourselves that affects the trust our patients and families place in us. What might the patient's response be upon reading that his nurse was really tired and had not slept all day before going to work (a posting I have read on more than one occasion)? Imagine the delight of a plaintiff's attorney upon reading that post.

In addition to protecting our patient's privacy and our credibility, it is important to consider what information is posted about employers, hospitals, and other healthcare workers. Complaining about the hospital administration, the referring facility that did not do something right, or the coworker who is difficult can result in legal consequences. Your boss probably does not want to read that you do not like your job, and while you may get sympathy from some coworkers, others may be forwarding that information to the one person you do not want to see it.

Networking sites can be a great way to keep in touch and share information. Several nursing programs are using YouTube for education purposes.4,5 Just always remember to think before you post. Picture your boss; your mother; and your patient's family reading the information, looking at the photographs, and watching the videos. Picture your children when they see the pictures you posted of them being viewed by the entire high school. Then err on the side of caution.

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References

1. Facebook. Facebook statistics. http://www.facebook.com/press/info.php?statistics. Published 2009. Accessed September 20, 2009.

2. Greewood B. Facebook: the next great vetting tool? Inf Today. 2009;26(8):14, 17, 46. http://www.infotoday.com. Accessed September 19, 2009.

3. WISC.com. Nurses fired over cell phone photos of patient. http://www.wisn.com/news/18796315/detail.html. Published 2009. Accessed September 19, 2009.

4. Skiba DJ. Nursing education 2.0: YouTube. Nurs Educ Perspect. 2007;28:100–102.

5. Agazio J, Buckley K. An untapped resource: using YouTube in nursing education. Nurse Educ. 2009;34(1):23–28.

© 2009 National Association of Neonatal Nurses

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