Social media and nursing

Social media has become a major force in global societies in the twenty-first century, permeating many aspects of the human experience every day. Nurses are a group of people with a potentially complex relationship with social media, one which may bring both significant positive and negative consequences. As members of the medical field, nurses are part of an ancient profession that has changed enormously through the centuries. Modern nurses have at their hands unprecedented powers to help and heal people, as well as great responsibility and challenges to protect themselves and others.

Overview

Social media, generally defined as digital means of helping people communicate and network online using their own content, is rooted in many generations of ever-developing communication technology. Perhaps the most direct ancestor of today’s social media was the telegraph, first successfully debuted by Samuel Morse in 1844, which allowed people to send messages over great distances. Radios, telephones, and many other communication devices followed, culminating in the creation of the internet in the later twentieth century.

Even in its earliest forms, the internet proved useful for sharing information and content among users, even those many countries apart, almost instantaneously. Governments, the military, universities, and other high-level organizations used online networking before the public began getting involved in that process as well. One of the first true social media platforms for the masses was launched in 1997. SixDegrees allowed users to create online profiles and form networks of friends and other users with shared interests.

Later sites, such as Friendster and Myspace, developed on this basic platform and added new innovations such as links to videos, blogs, games, and more. The appearance of Facebook in 2004 pushed most other platforms into relative obscurity and made social networking a household term across most of the world. Since that time, other challengers to Facebook have arisen and claimed large segments of the social media population. These include Twitter and Instagram, which allow users to share brief snippets of information (short text messages and digital photos, respectively) with friends, family, and fans across the globe.

For many people, social media offers a helpful means of staying in touch with friends and family, including those who may live far away. For others, social media provides a fun or relaxing diversion from the challenges of the day. People may use social media websites or apps (such as Facebook, Twitter, or Instagram), blogs, video-sharing sites, chat rooms, forums, and other means of sharing their ideas online.

While some platforms were mainly used for entertainment and recreation, other social media sites have focused on professional development. Likely the foremost of these was LinkedIn, launched in 2002, which offered its members occupational networking. People hoping to develop their professional standing, search for new jobs, find employees or collaborators, or build vocational networks took to LinkedIn by the millions.

Social media has become one of the most widespread and impactful forces in modern life, used daily by some 2.6 billion people as of 2019 (Medium, 2019). However, social media use carries some significant challenges and risks. Some of these potential problems relate to all social media users, while others are more specific to certain segments of the population or members of certain professions or groups. Taking precautions against these hazards can mean careful limitations to one’s social media behavior, while failing to do so could mean serious difficulties within social media as well as in one’s life and profession.

With their field rapidly changing and prone to tension, stress, and debates, nurses may turn to social media to network with other medical professionals, exchange hints and insights, seek or offer support, share joys and sorrows, or promote policies they feel will benefit nurses and their patients. Nurses may also simply use social media to connect with friends, family, or even patients with whom they have developed close bonds. These are important and potentially positive uses of social media, but all require special tact and care, especially in cases that involve patients.

Nurses are in a unique position in that they may learn, directly or indirectly, many private details of patients’ lives. They may encounter information about patients’ health situations, personal lives, private habits, bodies, behaviors, histories, and relationships. Although much of this information may be pertinent to providing the best care for the patient, it is still private, and nurses must protect this information and patient privacy at all times. Leaking such details—even seemingly minor ones, even completely by accident—through social media or other means could lead to major repercussions for the patients and serious liability for the nurse and his or her employers and organizations.

Nurses and other medical personnel have such unusually extensive access to other people’s personal information that special guidelines have been established to help determine how, when, and by whom this information may be transmitted and used. One of the most important of these guidelines in the United States is the Health Insurance Portability and Accountability Act, better known as HIPAA, which was passed by Congress in 1996. HIPAA was a response to the increasing importance and complexity of medical insurance policies, as well as a rise in fraudulent, abusive, or negligent practices pertaining to health care coverage.

HIPAA sought to make health insurance more portable, meaning that it would be easier to transfer and continue in cases where the insurance holder had a major life change, such as a lost or changed job. Easily portable health coverage was an important and beneficial goal that would allow American workers and their families the security of unbroken protection. However, it also brought a host of challenges. Health insurance includes much more than financial figures or other accounting facts; it may also encompass years or decades worth of sensitive medical information about individuals. This information may contain private details of a person’s health, behaviors, history, and much more.

Officials seeking to make this information easily transferable also had to find ways to safeguard it from falling into the wrong hands or being misused, purposely or accidentally, in ways that could harm the patient and her or his care, privacy, finances, and reputation. The passage of HIPAA was an attempt to protect against leaked information and the damages it could cause to patients, as well as to detail subsequent legal actions that could be taken against offending or negligent medical personnel or their employers.

In short, HIPAA requires that all health care groups and providers, along with their associates, follow careful procedures when handling, sharing, receiving, or transferring health information. These procedures must serve to protect security and confidentiality of all information and apply to all forms of records including spoken, written, and digital. One of the main tenets of HIPAA is that as much information as possible should be kept secure, with only the basic facts necessary for a particular legitimate function to be released to proper authorities.

Applications

Just as social media is becoming increasingly popular, and more people are using it worldwide on a daily basis, so too are many nurses and other members of the medical profession turning to social media for a variety of purposes. Nurses have contributed in many ways to social networking platforms such as Facebook and LinkedIn, video sites such as YouTube, online chat rooms and forums, and blogs. In most cases, this activity is harmless and may yield positive results.

Social media has many potentially helpful applications in the medical profession. For example, nurses may use blogs or online journaling applications to explain important experiences. Nurses may outline various situations they faced during that day or week, explain their feelings and thoughts, and discuss their ultimate actions. These online journals may help nurses reflect on their own feelings, values, and choices, which can in turn help them to improve their skills as well as grow as nurses and as people. These materials can also be of significant value to others, such as nurses who are facing similar situations and could use insights as to what choices they might make or positions to consider.

Nurses may use video websites to create all matter of content about their lives or nursing in general. Nurses may create video content about countless topics, such as their experiences in nursing school, their day-to-day lives in their profession, or important topics of discussion or debate in the medical community. Videos may also be therapeutic or humorous, seeking to share funny or uplifting anecdotes. Nursing-themed videos may provide a valuable outlet for sharing tips, lessons, and encouragement.

Nurses may also make extensive use of sites devoted to social networking. LinkedIn and similar professional networking sites could help nurses advance their career goals or learn about new positions or developments. They can also help nurses keep in touch with friends or former colleagues who have taken new positions or career paths. Through Facebook or Twitter, nurses could share their thoughts and feelings on a wide variety of topics. Some might use the platforms to express their concerns, disappointments, or anxieties on nursing-related topics. They might seek comfort or advice from others, including fellow nurses.

Other nurses might post messages that provide help or encouragement to others, such as inspirational sayings or insights into the feelings of fulfillment that come from restoring people to health. In some cases, nurses may also use social media platforms to send messages to patients and their families, which may help to establish and maintain fast, easy routes for communication. It may also help to form bonds of trust and compassion between nurses and their patients and families. For example, during the COVID-19 pandemic, many nurses and people in the medical field used social media as a way of connecting with one another over fatigue, heartbreak, and the realities they were experiencing everyday due to COVID-19. Healthcare workers throughout the world were on the front lines of fighting the virus, and social media provided platforms for them to share their stories with the world. This practice can often be cathartic. During such a time, access to social media and sharing also proved to be an important and quick way to share realtime information.

Health care organizations often operate their own social media services, which are strictly controlled and subject to policies that ensure only suitable material can be shared. Organizations also may monitor social media use, and other computer use, of nurses and other employees while they are at work. Organizations and employers have no control over how nurses may use social media in their private lives, however. At these times, nurses must rely on their own judgment to determine whether and how to express themselves on social media so as not to disclose personal information about their patients.

Concerns and Consequences

Even though nurses may use social media for a wide range of useful and beneficial purposes, so too might social media use lead to serious problems. In many instances, nurses on social media who cause problems do so unintentionally. The very nature of social media can help to increase the likelihood of such accidental harm.

In social media, people may create posts instantaneously, meaning that they do not take time to carefully plan their actions and consider possible consequences. Nurses and other users may create media posts in the heat of the moment, perhaps if excited, nervous, or angry. Emotions may cloud their judgment. Posted information becomes more-or-less public, and may be seen by more people than the poster realized, or by certain parties the poster did not intend to get the information. In addition, information posted to social media may be very hard, if not impossible, to retract or delete, meaning that even erroneously posted or harmful material cannot always be removed. In serious cases, law enforcement or court officials may be able to retrieve posted information from social media even long after the poster believed it to be erased.

A number of common misconceptions about social media also contribute to problematic behavior by nurses. Nurses may post specific anecdotes or examples about real patients, but use nicknames for these patients instead of their real names. This practice is also problematic, because it is possible for others to identify the patients based on this information, and thus to gain personal information about the patients without their consent.

In some cases, nurses believe that posting patients’ private information is acceptable if the post is intended to be private. Sometimes, a post that seems private is accessible by more people than just the intended recipient. A post may be shared, or people replying to a post may create unexpected links to the information. In general, posting any private information online without authorization, even if it does not reach anyone except the intended recipient, is likely still a breach of confidentiality. At the very least, it can be seen as a demonstration of a lack of concern or respect for private information.

Sometimes friendly interactions between nurses, patients, and patients’ families can lead to problems in social media. For example, a nurse may post a picture of a young patient who gave permission, or of an incapacitated patient whose sibling said it would be acceptable. In the first case, the nurse did not have the permission of the child’s parents or guardians; in the second case, the nurse did not have the permission of the patient.

Furthermore, taking to social media to mock or make fun of patients based on their interactions can be seen as inappropriate. For example, in 2023, two nurses at a children's hospital in Memphis, Tennessee, posted a TikTok video mocking a patient who arrived to the hospital with gunshot wounds and then cried when he had to have a needle stuck in his arm. Both nurses were terminated from their positions at that hospital due to the video.

Though the previous case was more extreme, even a seemingly innocuous comment on another person’s social media post could lead to complications. For example, a patient might post a picture of himself smiling. His nurse might reply by saying, “I’m so happy to see your smile again! It looks like your anti-depressant meds are doing their job!” Although this comment was good-natured and supportive, it still contains confidential patient information that the nurse is publicly disclosing.

During the COVID-19 pandemic, it was easy to spread information, but disinformation and misinformation were also spread, even by nurses and those in the medical field. Some nurses put their jobs in jeopardy by taking to social media and sharing negative information about their place of work, which then subjected them to backlash and consequences. For example, the effectiveness of the COVID-19 vaccines was questioned by nurses, medical workers, and patients alike. Some medical professionals who took to social media to express their concerns about the vaccines were ridiculed, and some even lost their jobs.

All of these cases are liable to bring serious scrutiny and possible disciplinary action toward the nurses involved. The consequences they may face will vary based on many factors, including the nature of their actions and their intentions. However, all cases of inappropriately disclosed patient information are considered problematic. In some cases, nurses may be charged with unprofessional or unethical conduct, moral turpitude, mismanaged patient information, or breaching confidentiality (National Council of State Boards of Nursing, Inc., 2018). Nurses may be sanctioned, reprimanded, fined, fired, or stripped temporarily or permanently of their licensing. In serious cases, nurses may also face civil and criminal charges for their actions.

About the Author

Mark Dziak earned his BA in English from King’s College in Wilkes-Barre, Pennsylvania, in 2003 and completed a secondary education program there in 2011. He has worked at Northeast Editing, Inc., since 2004. As a content developer, he has researched and written hundreds of educational articles, test items, and other resources on a wide variety of social science topics. In his spare time, Dziak has also published numerous works of nonfiction and fiction.

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