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Risky business: Nurses must be aware of social networking pitfalls

Thursday April 10, 2014
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Nancy Spector, RN
For anyone who has ventured into the world of social media, the initial sense of thrill is hard to forget. After entering an email address and password to open a social networking account, users discover infinite possibilities for connecting and re-connecting with friends, co-workers, relatives and people across the world.

For healthcare professionals such as nurses, however, the thrill can quickly turn to panic when a post sparks a negative reaction at work. A seemingly innocent picture or sentence has the potential to put a nursing license, school graduation, job or professional reputation at risk.

Such was the case for a nursing student at Johnson County Community College in Overland Park, Kan., in 2010. According to news reports, the student and three other students were attending a lab class when they took pictures of themselves with a placenta. The students posted the pictures on a social networking site, and then the next day they were expelled for lack of professional behavior. One student filed a lawsuit and ultimately won her case against the school, but future employers who search her name will find articles and photos about the incident.

About a year before that case hit headlines, leaders at the National Council of State Boards of Nursing also started hearing about reports of social media incidents from nursing boards throughout the country. The organization decided to conduct a national board of nursing survey to determine if these incidents were isolated, or if a larger problem existed. The survey results, which were published in 2011, revealed that 33 of 46 state boards of nursing reported receiving complaints about nurses who violated patient privacy by posting photos or information on social networking sites. Twenty-six reported taking disciplinary action based on the complaints.

"This data surprised us a great deal," said Nancy Spector, RN, PhD, FAAN, director of regulatory innovations at NCSBN. "The cases are usually very subtle, unintentional situations in which nurses are not trying to violate confidentiality. In many situations nurses do not realize the potential repercussions of a post on a social networking site. In the more extreme cases they can lose their licenses and incur civil or federal penalties."


Brittney Wilson, RN
Posting too much information

One of the most common mistakes nurses can make is a violation of HIPAA regulations, said Brittney Wilson, RN, BSN, a clinical informatics nurse in Georgia and founder of The Nerdy Nurse, an online community for nurses. Nurses may think they are disguising a patient's identity by not giving a name but other clues can pinpoint a patient.

"For example, if you write on a social media post that you took care of the cutest 92-year-old patient last night, then you are giving away the person's age and the time you were caring for him or her," Wilson said. "If your page lists where you work, then people can identify who that patient was."

Even listing a patient's initials can be too much information, said Lorie Brown, RN, MN, JD, a nurse attorney and owner of Brown Law Office in Indiana. Brown remembers working on a case in which a nurse posted something on social media that listed the initials of the patient and the comments were discovered by the facility's administrators. The nurse lost her job and was reported to the licensing board, which placed her license on probation.


Lorie Brown, RN
"The thing that bothers me the most about these cases is the impact on a nurse's license," Brown said. "The social media complaint is public record, and every future employer can access the complaint and the status of the nurse's license. It will list active, probation, suspended or revoked."

Another slippery slope while using social media for nurses is posting comments or photos that may seem private, when, in fact, current or future employers can access the information.

"I see things from nurses that make me cringe every day, such as photos of student nurses holding a beer, expletives being used and sexual references," said Donna Cardillo, RN, MA, Nurse.com's career columnist and author of "The ULTIMATE Career Guide for Nurses." "When employers, recruiters and schools do an Internet search on a name, social media references can pop up. This could include disparaging comments about co-workers, an employer or supervisor - whether they mention a specific name or not."

According to a 2012 survey conducted by CareerBuilder.com, 37% of companies use social networking sites to research job candidates. When asked why the organizations used social networking sites, 65% said they use the information to determine if a candidate presents himself or herself professionally.

Though privacy settings may seem like the ideal way to protect a reputation, Brown is adamant this is no guarantee of protection. "Even if you create privacy settings, people can forward a post," Brown said. "You have no control over what your friends will do with your information. You don't own anything you post on social media, so if a court or licensing board wants to submit a subpoena for something you have posted, it can be obtained. Even if it was deleted, it can be retrieved."


Donna Cardillo, RN
Social safety strategies

Although the risks of using social media for nurses may dampen the desire to take advantage of this communication tool, Spector encourages them to enjoy using the new technology, but to be wise.

"At the NCSBN we did not want the word to be 'never use social media' because it can be very beneficial as a way to exchange information and resources, but nurses have to use it appropriately," she said. "To get the word out about the safest ways to use social media, we've sent out more than 500,000 brochures to schools of nursing, hospitals, nursing homes and boards of nursing."

If possible, the ideal form of self-protection is to think for a moment before posting. "Don't post when you are in an emotional state," Brown said. "Ask yourself: If my boss or future employer saw this, how would they feel? If you are at all concerned, don't post."

Nurses understandably have a need to express frustration, but there are ways to do this online that still can protect patient privacy. "When I go out and speak to nurses, I explain that they can be really general and still have the freedom to vent," Spector said. "You can say that you have 'experienced something frustrating in your practice,' rather than writing that you had 'a patient yesterday who was frustrating.'"

In the event that nurses post things they later regret, it may be wise to consider making reparations. "Certainly on a personal level it would be a good approach to admit you made a mistake and ask for forgiveness," said Nancy Brent, RN, MS, JD, a nurse attorney in Illinois and legal columnist for Nurse.com. "Taking responsibility for an error can be very helpful in general, and also if a posting is reported to the board of nursing for a violation of maintaining nurse-patient confidentiality. The board may take this [transparency] into account when determining any discipline."

Nurses also can protect themselves by learning the hospital's social media policy. Brent has been receiving questions from readers who are unsure how to handle situations when patients ask relatives to take a photo of the nurse with the patient.

"The family may give consent for a photo, but what if the hospital policy states that photos with staff members and patients are not to be taken or used on social media?" Brent said. "That policy would override any consent from the patient insofar as the nurse as an employee is concerned. I encourage nurses to read the hospital policy carefully and be informed about the consequences of a breach. If the hospital does not have a social media policy, then nurses can join the facility's policy and procedure committee to help develop one."


Nancy Brent, RN
Power of positivity

When nurses find unprofessional pictures or words about themselves that someone else has posted, Wilson suggests creating positive content to counterbalance the information in a Web search. Nurses can write blogs or open other social media accounts to push the undesirable posts down the page in a search.

Finally, Wilson encourages all nurses to consider doing a social media audit on their space by deleting any questionable posts and pictures and changing the tone of future posts. When she started blogging in 2009, she was prone to grumbling about how she was being treated by co-workers, but after several months she realized this was not the way she wanted to present herself online.

"One of my biggest platforms is the fact that we need to represent our profession well online," Wilson said. "I tell student nurses to clean up the things that could potentially harm them. You can still talk about yourself, your family and the things you like, but if you would not say it to your HR manager or boss, then don't put it on social media."

Tips for staying safe on social media

The two-second rule: Before posting something on social media, ask yourself "What would my employer think?" If you have any hesitation, consider not posting the content.

Turn venting into solutions: If you are frustrated with a situation, avoid specifics and ask for suggestions from others.

Social media audit: Consider reviewing the content on your social media sites and deleting photos or other content that could be considered unprofessional by current or future employers.

Pick the right place to process: Social media is not the place to share emotionally charged situations.

Don't wait until it's too late: Seek out your facility's social media policy to learn what is permitted and the consequences of a breach of the policy.


To read the NCSBN's social media guidelines, visit www.NCSBN.org/Social_media_guidelines.pdf.

To ask Donna Cardillo a career question, visit www.Nurse.com/AsktheExperts/DearDonna.

To ask Nancy Brent a legal question, visit www.Nurse.com/AsktheExperts/BrentsLaw.


Heather Stringer is a freelance writer. Send letters to editor@nurse.com or comment below.
Common social media myths

MYTH: It's safe to refer to patients as long as they are not identified by name.

REALITY: Sharing information such as a nickname, age, diagnosis or initials can be a breach of patient confidentiality.

MYTH: Privacy settings ensure that information only will be seen by intended recipients.

REALITY: Postings can be disseminated to others or used as evidence in a court of law.

MYTH: Content deleted from a site is no longer accessible.

REALITY: When something is posted online, it can be retrieved.

MYTH: Sharing information that is positive is safe.

REALITY: Pictures of patients or anything identifiable can be a breach of HIPAA regulations.