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Nursing Management:
doi: 10.1097/01.NUMA.0000429012.15882.d9
Department: Performance Potential

To tweet or not to tweet? Nurses, social media, and patient care

Piscotty, Ronald MS, RN-BC; Voepel-Lewis, Terri MS, RN; Lee, Soo Hee MS, RN; Annis-Emeott, Ann MS, RN; Lee, Eunjoo PhD, RN; Kalisch, Beatrice PhD, RN, FAAN

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Author Information

Ronald Piscotty is a special instructor of Nursing at the Oakland University School of Nursing in Rochester, Mich. Terri Voepel-Lewis, Soo Hee Lee, and Ann Annis-Emeott are PhD in Nursing students at the University of Michigan School of Nursing in Ann Arbor, Mich. Eunjoo Lee is a professor at the College of Nursing and Research Institute of Nursing Science at Kyungpook National University in South Korea. Beatrice Kalisch is the director of Innovation and Evaluation and the Titus Professor of Nursing at the University of Michigan School of Nursing in Ann Arbor, Mich.

The authors have disclosed that they have no financial relationships related to this article.

Access to social media is almost ubiquitous in today's connected society. Very little is known about the impact of social media use on practice and patient care. Given the identified capacity of these technologies to distract the user, it's quite possible that unintended consequences are impacting healthcare quality. What are the potential positive and negative effects of social media on nursing practice, and what are the implications for nurse leaders?

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The positives

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One of the potential benefits of social media use is to improve provider-to-provider communication and coordination of patient care, facilitating the quick transfer of information. According to one author, the use of social media in practice settings for purposes of improved provider communication may be quite effective in coordinating patient care and improving outcomes.1 This author used the camera and text messaging functions on her smartphone to send photos of wounds to physician specialists in her practice, which decreased the time to treatment.1 Such communications are occurring between clinic and surgical settings and from patients at home to clinic settings; however, the frequency, benefit, and potential harm haven't been examined.

Professional networks provide forums to share and obtain information, pose questions, and connect with others who have similar interests (such as leadership and management, informatics, and education). The benefits of such networks include rapid dissemination of relevant information to those interested in a particular topic. These networks are becoming increasingly valuable because professionals now have the capability to discuss treatment options with a more diverse community. The resulting quick dissemination and acquisition of clinical knowledge has the potential for rapid translation of up-to-date information into practice.

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The negatives

A major negative effect of social media on nursing practice is the potential to cause distractions and interruptions. There have been several studies implicating technology as a contributing factor in causing distractions and interruptions among nurses.26 Adverse outcomes, including errors in medication administration, have been identified.24,6 A nurse who's distracted during the medication administration process by a social media message may inadvertently make a mistake, potentially leading to serious patient harm or even death. The distraction may occur because of the device notifying the nurse via sound or vibration that a message has been received. Additionally, there may also be a mental distraction imposed by knowledge that a message is waiting and an urge to view the message.

The possibility of social networking distractions during handoffs is also of concern. Interruptions by social media during handoffs may distract the nurse who doesn't pay attention to specific information or forgets to ask questions that are necessary for the continuity of patient care. One study noted that, before errors occurred, nurses reported missing important information due to distractions.3 Clearly, distractions threaten safety and quality when essential information isn't collected.

In addition to the potential for distraction and its consequences, social media misuse may violate patient rights and has been implicated in boundary violations of patients by nurses and nursing students.7 Several instances have been highlighted in which patient disclosure occurred using social media, including blogging about specific patients and posting actual pictures of a patient's body part on Facebook.8 These actions have led state boards of nursing, working collaboratively with the National Council of State Boards of Nursing (NCSBN), to specify boundary violations in much clearer language, with a focus on cellphone camera usage and the Internet.8,9

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Management implications

An important practice implication regarding nurses' use of social media is how access should be managed in the clinical setting. How to address this question is of utmost importance. Currently, there are no universally accepted standards for the use of social media in the clinical setting. There are obvious advantages of allowing nurses to utilize social media in this setting, such as improved communication and access to evidenced-based resources. There are also disadvantages, such as distractions and interruptions.

One solution is organizational policies limiting nurses' use of personal smartphones. However, such limitations pose different concerns because some nurses use smartphones to expediently access evidence-based practice materials that facilitate informed decision making at the point of care. Limiting nurses' use of this information where clinical decisions are made may be a disadvantage of such policies. Another option is to restrict access to social media from the hospital computer network. Although this can be accomplished, nurses may find workarounds to circumvent restrictions, such as increased use of their personal smartphones or use of Internet access designated for patients and visitors.

Instead of outright restriction of social media in the workplace, another approach is to educate staff regarding the appropriate use of social media. Because timing of use may be helpful (to determine an appropriate clinical decision) or harmful (during medication preparation), imposing restrictions either by policy or on an individual basis may be most beneficial to patient care.

The American Nurses Association and the NCSBN have developed guidelines to ensure the safe and ethical use of social media by nurses.9,10 Principles focused on caution and awareness are delineated to protect both nurses and patients from the potential harm associated with social media use.9,10 These principles aim to preserve confidentiality, maintain professional nurse-patient boundaries, and ensure an understanding that personal information is available to patients and employers.9,10 Recommendations include complying with company policies regarding work-related social media postings and maintaining respect for the patient at all times.10 These guidelines may provide a reasonable start to establishing professional use of social media in the healthcare setting, but may fall short regarding use in the clinical setting.

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Think before you post

The impact of social media on nursing practice hasn't been widely studied and isn't well understood. There are potential benefits of social media use, including expedited collegial communications and professional networking. But the possibility does exist that social media use by nurses can have unintended negative consequences on the quality and safety of patient care due primarily to distractions and interruptions. As social media becomes even more intertwined with the daily professional lives of nurses, it's imperative that the impact on nursing be studied to ensure that patient care is enhanced, not compromised.

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REFERENCES

1. Glemblocki M.Personal communication. 2011.

2. Brady AM, Malone AM, Fleming S.A literature review of the individual and systems factors that contribute to medication errors in nursing practice. J Nurs Manag. 2009;17(6):679–697.

3. Grayson D, Boxerman S, Potter P, et al.Do transient working conditions trigger medical errors? In: Henriksen K, Battles JB, Marks ES, Lewin DI, eds. Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Rockville, MD: Agency for Healthcare Resesarch and Quality; 2005.

4. Kalisch BJ, Aebersold M.Interruptions and multitasking in nursing care. Jt Comm J Qual Patient Saf. 2010;36(3):126–132.

5. Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM3rd. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2007;142(5):658–665.

6. Trbovich P, Prakash V, Stewart J, Trip K, Savage P.Interruptions during the delivery of high-risk medications. J Nurs Adm. 2010;40(5):211–218.

7. Jones JS, Fitzpatrick JJ, Drake VK.Frequency of postlicensure registered nurse boundary violations with patients in the state of Ohio: a comparison based on type of prelicensure registered nurse education. Arch Psychiatr Nurs. 2008;22(6):356–363.

8. Spector N.Boundary violations via the internet. Texas Board of Nursing Bulletin. 2010;41(3):6.


10. Cronquist R, Spector N.Nurses and social media: regulatory concerns and guidelines. J Nursing Reg. 2011;2(3):37–40.

© 2013 by Lippincott Williams & Wilkins, Inc.

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