Nurses and social media: Protecting your career and reputation

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Only in the US - A tired nurse earlier this year, just off duty from her shift at a flu-ridden emergency department, posted a Facebook video urging people to take precautions to avoid influenza. She told the public, in bold terms, how to protect themselves from exposure to influenza and avoid making the ED a cesspool of funky flu. “Here are some ideas how to treat the flu at home — wash your stinking hands,” she said in the video. Ironically the video went viral, and has since been viewed more than 5 million times.

She's not the only nurse around the world who is communicating with patients, and the public, through social media. Using social media in healthcare can be incredibly beneficial from an educational and peer support point of view. Being able to discuss the latest research findings and evidence based practice is an important aspect of continuing your professional development, and social media is just one of the tools available that enables you to do that. It’s also a vital tool for networking and building your professional credentials.

While you may not think your social media use could have an impact on your career as a nurse or midwife, there are a number of possible implications if you haven’t taken adequate steps to protect yourself.

Whether you have a social media site for your own personal profile, you write a health blog, or you maintain a page for a group, nurses and midwives should remember that the National Law, the NMBA’s Codes of Conduct and Social Media Policy apply. Some common sense guidelines can help in applying those standards, protecting yourself and your career.

Patient confidentiality

As a health professional you have an obligation to safeguard the confidentiality of your patients at all times. While using social media for research and support, it’s not unusual to see case studies posted and discussed, but if this is done incorrectly it could directly breach the patient’s confidentiality and enable their sensitive information to be accessible online.

Most of what is posted on social media sites ends up discoverable in a Google search, so it’s not inconceivable that if a friend or loved one of a patient was trying to find out more about their condition or treatment, they could find a photo of the patient along with their medical history. Although you might have been careful to blur the face and use a pseudonym for your patient, it’s still possible that the patient could be recognised. It’s important that the patient or situation cannot be identified using the sum of the information available online; and before putting any patient information on the internet in any context, express consent should be obtained and acknowledged in the post.

If a commenter is also your patient, don't converse through publicly visible comments. If you do, you could be divulging the patient's protected health information.

If a patient has posted a question and you want to respond, it may be wiser to call the patient and give your answer by phone. If the answer to the question is something that many people would benefit from, you can address the question and answer in a general post without referring to the person who originally posted the question. Here's an example: You are an expert on diabetes and have written a blog on nutrition. One of your readers posts, "Is watermelon OK?" Don't get into an online discussion with them. Instead, consider contacting the patient offline with your answer, or write a separate blog, in a week or so, on which fruits are best, in general, for people with diabetes.

Maintain professional boundaries

It can be difficult enough to separate work from your personal life at the best of times. Professional boundaries are important when we consider that the only relationship between a nurse and their patient should be solely therapeutic. After you have posted something on social media, it's easy to get drawn into the discussion when a viewer or reader posts a comment. Don't get drawn into arguing back and forth among commenters, patients' family members, or groups in the community. It doesn't matter that the site is your personal profile; professional nursing requires nurses to maintain professional boundaries. Unfortunately, social media makes it incredibly easy for patients to find you online, and attempt contact on a more personal level. Not only that, but they could discover some very private details about you and your family. While this might be harmless in most cases, it could lead to problems such as abuse, harassment and even stalking.

Protect your professional reputation and career prospects

Is there anything on your social media accounts that you would not want your manager or patients to see? There’s a high probability most people have an embarrassing photo or two on social media somewhere, and they might be out of your control on a friend’s account. While no one is saying that you can’t have a good time away from work, you are responsible for preventing yourself and your profession from being brought into disrepute by your behaviour. 

Consider the images you post and the language you use. It's fine to use plain language. It's certainly not illegal to use slang, and sometimes slang can be effective, but usually it's more professional not to use slang words - and avoid coarse language. It's fine to post a photo of yourself getting an award, giving a presentation, or posing with a professional idol, student, or mentor. But don't post photos of yourself holding a beer, smoking, wearing a T-shirt with a controversial slogan, or partying with your friends. Yes, nurses are allowed to do all of this in your own time, but it's best for your credibility and your career if you maintain a professional presence online. Consider what you’re posting and if it could be professionaly misconstrued before hitting submit. Just ask yourself, “would I say or do this in public wearing my uniform?”

While frowned upon and possibly even illegal, many potential employers will also look at social media accounts while screening candidates so your social media profile could be inadvertently harming your future career prospects.

Bullying and harassment

Unfortunately we all know bullying occurs in the workplace and it is a significant problem within the profession. Social media makes it all too easy for it to hit you at home too. From unwanted comments, messages and actual abuse, through to finding your colleagues discussing something personal they’ve discovered about you online – the scope for bullying is considerable.

A flip side to bullying is the risk of defamation. It can be incredibly easy to go home after a long day at work and vent about one of your colleagues on social media. Not only is this a form of bullying that can cause tense working relationships, but it can also lead to legal hot water if someone wanted to make a defamation claim against you. If you are having issues at work, it’s always best to keep it offline and discuss with your boss or a colleague for support, or call the NM Support helpline 1800 667 877 .

Don't establish a duty of care through social media

Let's say you posted an article on a health issue, such as how to deal with overwhelming fatigue. Someone posts, "I am tired all the time. What should I do?" You can advise the person to "See your healthcare provider." But if you provide additional medical or nursing advice, and if that person relies on your advice, and it turns out that the advice was wrong and the person suffered an injury, you may be liable if they take legal action against you, even though the person wasn't your patient. You automatically have a "duty of care" to patients who are admitted to your unit at the hospital. But you don't need to, nor do you want to, establish a duty of care with people who respond to your social media posts. You can advise commenters to see their own healthcare providers or contact www.healthdirect.gov.au, but don't get take their history or give advice through the comment section.

The 'wash your stinking hands' video

The American nurse who posted the flu-avoidance video fit in with the guidelines - she gave general, correct advice; her examples of patient behaviour weren't identifiable with any individual patient; and she maintained a professional presence overall, even though she used some slang in conveying her frustration with those who come to the emergency department during flu season with non-emergencies.

Nurses have much to offer. It would be a waste of talent to hold back because someone might criticise you. On the other hand, don't jeopardise your career or your professional reputation by posting without thinking it through.