The saying “just because you can, doesn’t mean you should” comes to mind when discussing social media posts and comments. Having the ability to post something on social media does not mean that those comments, likes, and shares should occur. Social media impact goes beyond downloadable applications (apps), interactive websites, and how-to videos. It has become intertwined with many aspects of daily life, but limitations are needed when working with patients in any healthcare position. Because nurses are held to standards set forth by the Nurse Practice Act and Code of Ethics, limitations and boundaries have been established to remain professional and maintain integrity while providing safe patient care (Epstein & Turner, 2015). Healthcare organizations develop policies that address nursing practice, code of conduct, and electronic communication. This column serves to provide resources for nursing professional development (NPD) practitioners and educators to remain current, support newly licensed nurses (NLN), and develop residency or transition to practice curriculum around social media and electronic social messaging.
When turning on the news or receiving push notifications from news outlets on mobile devices, the headlines contain local, national, and global examples, including videos that had gone viral and shared comments. These headlines may be positive, but most likely they are of an adverse event, which may not portray the people involved in a favorable light. When these stories involve health care, nurses may find themselves answering questions about the people involved and defending the nursing profession. In turn, nurses and healthcare organizations seek guidance for appropriate responses, which presents a unique opportunity for NPD practitioners to model professional behavior for their residents when using social media and electronic forms of communication. Nurses need to be ready to meet the challenge and seize this opportunity to create positive headlines that exemplify the nursing profession, so nurses may proudly wear their stethoscopes (Chasmar, 2015).
RISKS AND BENEFITS OF SOCIAL MEDIA IN HEALTH CARE
Healthcare organizations utilize social media platforms to address consumers, display national rankings, and educate patients about various health conditions, diseases, treatments, or prevention programs. They have connected with this form of communication, which attracts users and reaches people. From 2016 to 2017, 71% of Internet users were social network users, and more than 81% of the population in the United States had a social media profile (Statista, 2017). It is estimated that, in 2018, the number of social network users will reach 2.62 billion (Statista, 2017). If these social media consumers find themselves admitted to the hospital, nurses may strike up a conversation about which social media the patient uses. As a result, nurses could identify reliable sites for the patient to visit regarding their health concerns and conditions (Nelson, 2018).
However, if a patient asks to connect with a nurse on social media, it is not recommended for it may blur or cross professional boundaries (ANA, 2011). Preparing NLNs to respond to such requests gives them the necessary tools and empowers them to offer alternative ways to connect to healthcare personnel. For example, if patients use social media platforms that have the feature to “follow” a person or organization, nurses could suggest which sites would be more appropriate to engage with based on the patient’s interests, diagnosis, or need. As NPD practitioners work with NLNs, the risks and benefits associated with social media use in health care should be examined to identify potential avenues for effectively engaging patients. In addition, NPD practitioners should incorporate social media content in their curriculum for NLNs’ orientation and onboarding activities.
Fortunately, the National Council of State Boards of Nursing (NCSBN) has published A Nurse’s Guide to the Use of Social Media to raise awareness and provide guidelines to minimize the risks of using social media (NCSBN, 2018). There are seven guidelines that emphasize what actions nurses could take to avoid inadvertently disclosing confidential or private patient-related information. In addition, positive aspects of using social media are discussed, which benefit healthcare providers and patients. Many NLNs are digital natives and are well suited to engage their patients in conversations about using social media and interactive technology to connect different generations of healthcare providers and healthcare consumers. Social media and social networking have gone beyond apps, blogs, and news feeds to include video broadcasting (chats), electronic communication (e-mail), and electronic messaging (texting) because there is an interaction among people on an electronic medium (Nelson, 2018; Ventola, 2014).
As NLNs transition beyond the first year in practice, social media provides a platform to promote a connected and supportive environment. For example, nurses may utilize messaging services, follow healthcare bloggers, and expand their professional network to advance their career (Nelson, 2018). When using social networks, nurses should be mindful that anything written on the Internet is discoverable even if deleted far in the past. To guide nurses when using social media, the American Nurses Association (ANA) has published Principles for Social Networking (ANA, 2011). These principles include two sets of guidelines, which address what nurses should and should not be doing when interacting on electronic and online platforms. As previously discussed, nurses have professional boundaries, but they are also well positioned to influence beneficial relationships with patients (NCSBN, 2018).
COLLABORATING WITH PATIENTS AND FAMILIES ON SOCIAL MEDIA
Social platforms offer an electronic environment to foster professional connections, promote communication with patients and their significant others, and inform healthcare consumers and professionals about educational sources (NCSBN, 2018). For example, nurses can join a professional networking forum through the ANA called ANANurseSpace (http://www.ananursespace.org) or follow the ANA on Twitter @ANANursingWorld (http://www.twitter.com/ANANursingWorld). When using social media to connect with other nurses or to share educational information, nurses may describe workplace events or challenging experiences. As a result, NLNs and all nurses alike need to avoid using patient names or sharing any detail, which could identify patients (NCSBN, 2018). Also, they need to be knowledgeable of healthcare organizations’ electronic communication policy and any legal implications if their posts violate a patient’s privacy or confidentiality (NCSBN, 2018). With this knowledge comes an opportunity for NPD practitioners to raise awareness that guidelines and policies exist to protect patients and nurses. In turn, they can operationalize these social media guidelines from professional organizations and healthcare organizations’ policies into practice for NLNs during professional development presentations, into curriculum, and with simulation. Giving NLNs the tools to interact with their patients via social media and to encourage patients to access reliable healthcare information and education fosters professionalism.
The following section offers several examples for how to guide NLNs to engage patients on social media, along with their family, friends, and caregivers. When sharing knowledge and raising awareness, patients can access social media platforms to learn about newly diagnosed conditions, manage chronic diseases, and adjust medication schedules. To start, patients can gain knowledge from various professional organizations’ websites, which contain health and diagnosis-specific resources, such as the American Heart Association, the American Cancer Association, the National Institutes of Health, or the Center for Disease Control and Prevention. Many healthcare organizations, such as the Mayo Clinic, have a presence on Facebook, Twitter, LinkedIn, Instagram, and YouTube, to name a few (Ventola, 2014). These electronic platforms expand healthcare resources to support patients as they navigate through various transitions of care services.
Patients can access websites and electronic apps on portable devices before, during, and after acute health events. If they become hospitalized, some nursing units have mobile electronic interactive devices, referred to as tablets, for patients to access their inpatient medical record portals, educational videos, and telehealth services to connect with their family and community. Although patients are experiencing an acute health event, helping them to identify reliable and accurate health information while connecting them to healthcare resources could be a form of collaboration without crossing professional boundaries. NLNs should maintain a professional relationship with their patients while encouraging their patients to interact on social media on various electronic devices, depending on their functional abilty level and availability of use of those devices.
Because patients have been considered consumers of health care, they may prefer using certain facilities for their healthcare services. In a report, almost 4 of 10 Internet users follow their favorite brands on social media, whereas one of four follow brands from which they are considering making a purchase (Mander & Buckle, 2018). Having this insight presents an opportunity to utilize social media to connect consumers and communities with healthcare services to meet their health needs while enhancing the healthcare organization’s visibility and image (Ventola, 2014). Also, consumers interpret healthcare organizations with a strong media presence as offering cutting-edge technologies (Ventola, 2014). Nurses represent these organizations and are expected to uphold their mission, vision, and values. With this comes the responsibility to portray nursing in a positive light to foster knowledge sharing in the ever growing world of electronic communication.
POLICIES AND LAWS: PRIVACY AND CONFIDENTIALITY WHEN USING SOCIAL MEDIA
When discussing patient privacy and confidentiality, Health Insurance Portability and Accountability Act (HIPAA) comes to mind. Usually, this law is referred to by the abbreviation HIPAA, but how often do healthcare professionals recall its entire purpose? Even the acronym has been misspelled as “HIPPA.” It is the federal law that aims to protect patients’ right to privacy and to what extent individually identifiable information is used and by whom (NCSBN, 2018). Aspects of the law are built on privacy for which there is an expectation that patients are treated with dignity and respect. Therefore, NLNs are well positioned to treat patients with both of these to ensure that their rights are not violated. They may see someone taking a photograph or video of the patient or have heard about a social media post regarding a patient incident. In both situations, nurses have a duty to protect and intervene, when possible, to alert administration and security of such privacy violations. For example, some hospitals may use video monitoring that has a direct feed to the nursing unit’s workstation, which can been seen if walking down the hallway. If these monitors do not have a blackout screen protection to filter the view, then a visitor could take an image or record the video feed and share it publicly or on social media. In addition, an incident between a patient and a visitor could become hostile, and before administration has time to respond, someone has posted the details on social media, which could then be picked up by the local news media. These situations are examples of potential areas of vulnerability where patient rights need to be considered. NPDs could present these situations as case studies to raise awareness, emphasize a professional response, and protect patient rights to privacy and confidentiality.
Also, the relationship between a nurse and a patient is built on trust, with patients having confidence that their nurse would protect their personal information and dignity. This trust can be broken, intentionally or inadvertently, which could damage the nurse/patient relationship and impact the reliability of the nursing profession (NCSBN, 2018). When posts are seen on social media, friends and family members may ask NLNs about the situation knowing that the NLN works for the organization featured in the post. To guide NLNs with their response to such inquiries, NPD practitioners and educators should review the hospital’s social media policy, prepare and share scripted responses, utilize role playing or simulation to practice their reply, and engage in open dialogue with them. Lastly, reviewing HIPAA with NLNs would reinforce the law’s purpose and highlight the need to foster a trusting relationship among nurses and their patients.
Maintaining patient privacy and confidentiality applies to posts and comments made on social media, no matter which social platform is being used. If any individually identifiable patient information is shared or disclosed via the various electronic media or digital platforms during work hours or personal nonwork time, it is a violation that may breach professional boundaries. In addition to violating HIPAA, these inappropriate disclosures, posts, and comments could violate state laws, organizational policies, and individual state boards of nursing (BON) regulations (NCSBN, 2018). Depending on the state’s jurisdiction, the BON may investigate the situation and take disciplinary action against the nurse. Also, depending on state labor laws, employees may be terminated, and employers may not be obligated to give their reason for the termination. With social media readily available on portable devices and cellular phones, posts can be easily made with little time to reflect on their content and without the ability to retract the post to avoid violating professional standards or patient privacy and confidentiality. NLNs need to be mindful of what is posted or shared and decide to conduct themselves professionally to remain on the positive side of social media use.
Discussing HIPAA, individual state laws, and BON regulations, along with specific healthcare organizations’ policies on social media use may be a starting point for NPD specialists and educators to reinforce professional boundaries and effective ways to interact on social platforms. Follow-up conversations could discuss engaging patients in meaningful and appropriate interactions using social media. In addition, NPDs could review how emotional and difficult healthcare situations are described, so coworkers are not ridiculed in any electronic posts, comments, or methods of electronic communication (NCSBN, 2018). Once posts are made, comments are shared, or messages are sent electronically, they are date/time stamped and retrievable even if deleted. Electronic communication not only includes social media, but messages sent via electronic mail (e-mail) and texting services could be inappropriate and unprofessional and could violate patient privacy and confidentiality. Because they are electronic tools used to communicate and socialize with each other, they are a medium or “media” of choice that connect people.
Making social connections with people and society is part of human nature. Examining the how, when, where, why, and who is using social media to make these connections should be a part of the conversation that NPD practitioners are having with NLNs when interacting with patients and their support system. These conversations can be formal during orientation and onboarding activities or informally during open-forum discussions when specific situations arise, which may challenge NLNs with how to respond. NLNs need education about current social media practices, guidelines, and policies to maintain professional boundaries while fostering patient engagement. NPD practitioners should provide resources with the culture of safety in mind, model professionalism when using any electronic mode of communication, and empower NLNs to use their voice to promote patient education, provide reliable healthcare resources, and positively portray the nursing profession.