To post or not to post? Social media and nursing

2017 march cover
First published in Kai Tiaki Nursing New Zealand, March 2017. Reposted with permission.

Using social media offers both benefits and pitfalls for nurses. Making good decisions that ensure professional requirements are met is the key.

By NZNO president Grant Brookes

My manager said I had to have a meeting with her and with HR. It was about my Facebook post.”

This was the beginning of a story an NZNO member told me last month – she has graciously agreed to share her cautionary tale for the benefit of others.

I had been trained in a new procedure at work,” she said. “I was so excited, I took a photo of the equipment I would be using and uploaded it. There was no patient in the photo and nothing to identify my workplace – or so I thought.

But my manager opened my eyes to another way of looking at it. Not many of these procedures are done in New Zealand so it wouldn’t be hard to work out where the photo was taken. What if someone due to have their procedure here, or their family, saw my post? It might affect their trust and confidence, if they saw it was going to be my first time. They might perceive their nurse was not competent.

I hadn’t thought of it this way. So with the support of my NZNO organiser, I have agreed to do a presentation at work. I’m going to base it around the NZNO and Nursing Council guidelines and my employer’s policy.

I’d never been in trouble before, in 20 years of nursing. But I felt awful, because I would never do anything that harms a patient, or my service.”

Although this nurse’s social media story is salutary, there are some more serious recent breaches of legal, regulatory or ethical obligations by health professionals we can also learn from.

In 2015, the University of Auckland introduced a new policy for students at the Faculty of Medical and Health Sciences (FHMS). As reported, “The initial impetus for this policy was anecdotal evidence of an increasing awareness among medical students of a medical image-sharing application (app), Figure 1.

Figure 1 is currently the most prominent app enabling healthcare providers to share patient images, although many other platforms exist. According to its website, Figure 1 has over one million users internationally . . . who self-identify as healthcare providers (including nursing and medical students).”

The app features software that aims to remove identifying information, such as facial features. But as the authors comment, “whether an individual can be identified from an image can depend upon who is viewing it”, not just on characteristics of the image. The new University of Auckland policy has banned the use of Figure 1.

Disciplinary cases increasing

Given that Nursing Council chief executive Carolyn Reed notes “an increasing number of disciplinary cases related to social media”, the potential for nurses to breach professional or employment obligations could incline individuals to forswear social media altogether.

Nurses are professionally accountable to their employer, to themselves and to the public. We are expected to abide by the policies of our workplaces and to uphold Nursing Council standards of conduct at all times.

The council’s Code of Conduct contains eight principles. Four of these directly intersect with social media, and concern respecting health consumers’ privacy and confidentiality, and maintaining public trust in the nursing profession. NZNO’s own social media guidelines provide additional advice and examples.

Yet despite the potential pitfalls, social media also holds great benefits for nursing.

The International Council of Nurses (ICN), which sets the theme of International Nurses Day, is this year calling for “Nurses: A Voice to Lead, Achieving the Sustainable Development Goals (SDGs)”. The 17 goals include ending poverty and hunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests.

ICN plans to mount a social media campaign of its own to raise awareness among the nursing profession and the general population and policy makers of what the SDGs are and why they matter.

Nurses can also use social media to improve health literacy for those who have access to it. In this respect, social media is a powerful health promotion tool. It can strengthen solidarity and help nurses achieve our aspirations at work.

I am an avid user of social media. Being accessible to members and making social media posts – whether through my NZNO president’s page or blog, or through LinkedIn – is part of membership engagement/whanaungatanga in my work plan.

With such great pitfalls and promise, one thing is clear. Before acting on social media, nurses must always apply a decision-making process when selecting the option – to post, or not to post? They must weigh up the relative risks and benefits of the two options.

Are both options acceptable, or does one contravene professional requirements? If doubt remains, then do not post and seek advice from NZNO. And if it’s too late, if important parts of the decision-making process have been skipped, and if your social media activity has led to disciplinary action, then pick up the phone and seek advice through the NZNO Member Support Centre (MSC) on 0800 28 38 48. •

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