This week in my informatics nursing class discussed the concepts of ethical practice and privacy as they relate to the use of social media. After class I was left with the following question:
1.What are the professional regulations and obligations of nurses concerning the use of social media?
In this posting I will explore the information nursing literature has gathered related to my question and attempt of develop a greater understanding about the contexts where it is appropriate for nurses to use social media with a client and the obligations I will have to uphold in my future practice.
Questions 1: What are the professional regulations for nurses concerning the use of social media?
Nurses commonly use social media in the workplace. Results from a 2011 survey determined that 88% of nurses between 18 and 24 and 67% of nurses over 55 use social media (The Standard, 2012). Furthermore, over half of nurses reported that social media is
critical or
important to their practice (The Standard, 2012). The CNO's standards of practice documents are applied in the context of social media to guide its appropriate use, including the following standards:
practice,
the therapeutic nurse-client relationship, and
ethics (CNO, 2013). Many workplaces also have polices for the use of social media (The Standard, 2012). It is important to ensure the appropriate use of social media, because of the increasing number of nurses being investigated and disciplined by their college for its misuse (ONA, 2011). Nurses need to use their clinical judgment and reflection skills before posting online.
Prior to posting online nurses should reflect on the standards of practice that apply to the situation (CNO, 2013). Nurses may need to consider the following before deciding to post on social media: who will see the post; if the post is ethical; how the post reflects on the profession or as an individual professional; if it breaches confidentiality or privacy of clients, colleagues, or the workplace; if it interferes with a therapeutic relationship with a client; and if it portrays client, colleagues or the workplace in a negative manner(CNO, 2013). Situations may arise where the nurse is in danger of damaging the public's trust for the profession of nursing, crossing boundaries with clients, breaching privacy and confidentiality or negatively impacting the therapeutic nurse-client relationship, if he or she is not well informed on the appropriate use of social media (CNO,2013).
Nurses are responsible for maintaining public interest and avoiding social media interactions that damage the public's trust and respect for the profession; therefore, posting negative or inappropriate comments about a client, colleagues, or workplace is not appropriate (The Standard, 2012). Nurses have access to sensitive private health information and an obligation to maintain privacy and confidentiality; therefore, posting information that contains clients' personal information is not appropriate (CNO, 2002). The use of social media could also lead to crossing boundaries and damaging the therapeutic nurse client relationship. For example, if a client sends you a friend request on facebook. In this situation the nurse needs to reflect on if he or she still has a therapeutic relationship with the client and consider the reasons why the client is contacting him or her (CNO, 2013). The standards of practice decision tree can also be used to determine if a post is appropriate (CNO, 2006).
In this example I will show how a nurse is not meeting the standards of practice by making inappropriate postings on social media.
Scenario: A nurse is frustrated with her colleagues and workplace. She decides to tweet about her frustrations on her break and makes negative comments about her colleagues and workplace.
Accountability
The nurse has a professional obligation to act in a way that promotes respect for the profession (CNO, 2006). By publicly portraying her colleagues and workplace in a negative way the nurse is not promoting respect for the nursing profession. The nurse is also accountable for demonstrating fidelity to her employer and by publicly criticizing her employer she is not upholding her duty (ONA, 2011).
Leadership
The nurse is not practicing the standard of leadership, because she is not taking action to resolve the conflict with her colleagues and workplace (CNO, 2002)
Relationships
The nurse is not showing effective conflict-management skills , or promoting a work environment based on trust and respect (CNO, 2002).
Ethical Dilemma Artifact:
While researching I found an interesting ethical dilemma that relates to client privacy and the use of social media. The nurse wrote to the Nursing Times magazine asking for advice on an ethical dilemma.
The dilemma:
The nurse is caring for a
client who was cognitively intact, but physically disabled
(Chinn, 2012) The client lives in a long term care facility and had no family,
but he enjoys connecting with new people on Facebook(Chinn, 2012) He asks
nurses to take photos of him and post them on the website, because he is not
physically able to do this task himself. The nurses use their personal cell
phones to take the photos, because the client does not have one. The nurse is
aware that taking photos of clients in not permitted (Chinn, 2012).
This situation is a good example of an ethical
dilemma a nurse might face due to social media. By agreeing to take the picture
of the man and posting them online the nurses are contributing to building the
therapeutic nurse-client relationship. Taking the photos are serving the needs
of the client; therefore, it is part of client centered care (CNO, 2006). However, by
taking photos of the client and posting them online the nurses are technically
using social media in an inappropriate manner. To solve this problem the nurse communicate with her manager about the concern, and work together to find a solution so that the patient can continue using Facebook without nurses having to violate confidentiality and privacy (Chinn, 2012). They could then work together and explore if the patient could get a cellphone, or if the organization could create a policy that would allow nurses to take photos of patients with the patient's consent (Chinn, 2012). This dilemma sheds light on the issue of some organizations not having appropriate policies in place to deal with social media concerns.
The CNO's Social Media: Reflect Before you Post video
Chinn, T.
(2012, June). Ethical problems. Nursing
Times, 43 (6), 12-13. doi: 10.1097/01.NURSE.0000429807.41730.65
