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Allison is a registered nurse and senior health policy adviser with some 25 years experience. Prior to launching CPD Nurse Escapes, Allison worked as a private consultant for a diverse range of clients in the government and non-government, health, community and education sectors. Allison has an extensive background in regulation, governance and professional practice and applies this in education, policy development and project management. Allison was the Principal Advisor, Professional Practice at the Nursing & Midwifery Board of South Australia, for 10 years where she was responsible for developing nursing and midwifery policy and standards and advising and educating nurses and midwives on professional practice issues.

Sunday, 16 October 2011

What you say on Facebook can affect your Registration!

Nurses and midwives need to aware of what they say on their social media site. Many nurses and midwives do not clearly understand that certain behaviours and choices they make in their personal lives may have implications and consequences on their professional registration. Whilst we are all entitled to our private life and our privacy, the use of online networks and social media sites blur the lines between private and public and certainly challenge our understanding of privacy.  If nurses and midwives do not carefully consider these issues they may find themselves before the regulatory authority, answering for their actions!

It is naive to think that your Facebook page (or any other social media site) is private. Sure, you can set your privacy settings but think about how easy it is to read posts from people you don't know on other peoples page, or see photos of people and things they are up to, even if you are not a 'friend'. Why not try it. Go to another persons Facebook page at random and see how much information you can gain about them and their 'friends' or randomly Google a general blog name (eg nurses blog) and though this will offer you many professional sites (such as this one) you will also find a large number of individual nurses blogging about their everyday experiences, opinions and perspectives.

What is the Definition of a Friend?

The social media phenomenon challenges our definition of 'friend.'  Search a few online dictionaries and you come up with the following definitions;

Friend: noun
  • a person whom one knows, likes, and trusts
  • a person attached to another by feelings of affection or personal regard
  • a person known well to another and regarded with liking, affection, and loyalty
  • an intimate; a confidant; someone to whom private matters are confided

But we now have a definition that may not include any of the above situations, in fact many of our 'friends' may be people we have never met, never intend to meet, and arguably know very little about, and certainly do not have a close relationship of trust or regard. This definition is of friend as a verb - ie I have just 'friended' you. This definition means to add (a person) to one's list of contacts on a social-networking website.  

We need to be mindful that friends with whom we have not invested a personal relationship with, one who holds our trust and loyalty, may not always (or in fact ever) have our best interests at heart. So whatever we post on line and share with our friends, however private we believe that to be, can be circulated or disclosed to any number of other people - even to our employer! 

Information is now instantaneous. Something we post in minutes can be circulated around the world in seconds and once posted is almost impossible to remove. Think of how many youTube videos have gone 'viral'. How many of those have you seen that you would be horrified if it were you? Consider also how many times you have posted some throw away comment or consciously targeted comment in anger.  Its much easier to make negative or derogatory comments about others when you do not have to say it to their face. A moment of careless indiscretion can have irreversible consequences.

Most Trusted Profession in Australia

As nurses and midwives, we are held in the highest regard by the public.  The recent 2012 Ray Morgan, Image of Professions Survey found that 90% of Australians aged 14 and over rated nurses and the most ethical and honest profession for the 17th year in a row (since nurses were first included in the survey in 1994). Nurses are upheld as more trusted than doctors, pharmacists, dentists, teachers, judges, police and many more professions. 

This level of trust means that nurses and midwives (who are not separately identified in the survey) have the highest responsibility to maintain and uphold this trust and that our actions, whether private or public, should never do anything that places the public's trust at risk. We must be aware that our actions, behaviours and choices could be detrimental to our clients, colleagues and employer. They may also be detrimental to ourselves, to our personal and professional integrity and potentially to our current and future career opportunities and ultimately, to our registration. 

Information Sheet on Social Media (NMBA)

The Nursing and Midwifery Board of Australia's Information Sheet on Social Media  (9 Sept 2010) states the following;
Social media is an expanding area of online communication. Social networking websites are a useful way to communicate on both a professional and personal level. Some common sites include Facebook, YouTube and MySpace.
Nurses and midwives are able to use social media not only to engage with family and friends to share feelings, opinions or photos, but also to connect with colleagues and professional associations.
The use of social media has many benefits and the Nursing and Midwifery Board of Australia (NMBA) embraces this technology. However, nurses and midwives need to be aware of the potential implications of their online behaviour, and how it can affect their professional life and registration. 
When posting information on a social networking site, nurses and midwives need to consider that the comments made are in the public domain and will remain there for an extended period of time.

In summary the Board requires that we;

  • are aware and adhere to organisation's social media and online policies
  • strongly consider whether what we are about to post 
    • is information we really want in the public domain
    • is respectful and appropriate
    • could be considered offensive (to any individual group)
  • ensure we understand and have applied appropriate privacy settings to our site

Nursing and midwivery practice is also upheld by Codes of Ethics and of Professional Conduct.  These Codes outline the expected behaviour, values and beliefs of the professions.  The Code of Professional Conduct for Nurses in Australia (2008) and the Code of Professional Conduct for Midwives in Australia (2008) outline the following conduct statements. These are essential in guiding online our activities.

  • Nurses and midwives respect the dignity, culture, ethnicity, values and belief of people receiving care and treatment, and of their colleagues.
  • Nurses and midwives treat personal information obtained in a professional capacity as private and confidential.
  • Nurses and midwives maintain and build on the community’s trust and confidence in the professions at all times.

Social Media Checklist
1. Have you ever posted anything about another staff person or you boss? Have you debriefed about a bad day at work or having had to work with difficult staff or a  boss who treats you or others badly?

2. Have you ever posted anything about a patient/client on you social media site - even if you think it was non-identifiable?  Have you posted general comments about difficult difficult patients?

3.  Who are you 'friends'?  Have you 'friended' other staff from your workplace (or have they friended you)? other nurses or midwives, other health professionals, non-nursing staff? If so can they read what you say about your work? Have you ever debriefed about a bad day/bad boss/bad patient, to them?

4. Have you ever added patients/clients on your social media site? If so have you considered the Boards Guidelines on Professional Boundaries? If so can they read what you say about work/other staff/other patients?

5. Have you posted any compromising photos of yourself or colleagues on your page? Have others tagged you in such photos? Would you be comfortable for other staff or your employer to see any or all of the photos you have posted?

6. Have you made any comments on other sites that may be negative, derogatory or offensive or could reflect badly on you?

7. Have you Googled yourself! (both on a web search and on an images search) Are you comfortable with what you find? Were you aware of the things you found or where some of them surprising to you?

8. Are you a member of any site or group that could be seen to be offensive or inappropriate? Could you be linked to any such website?

9. Have you ever downloaded anything onto your home or work computer (or tagged or emailed anyone),  that could be considered offensive or inappropriate. Are you aware that anything you access/download or share on a work computer can be accessed by your employer?

10. Have you ever posted anything on your social media site (or anyone else's) whilst you were at work? Are you aware that this can be accessed by your employer?

Here are a Few Examples....

Nurse uploads photo of patient

A patient was admitted to the hospital for a day procedure. The nurse  looking after him immediately noted his height,as her was 6'7" and she was only just 5’. The nurse and the patient openly joked about their height differences and the nurse asked the patient if he didn't mind if they had a photo together. He was happy to and they stood back to back to emphasise their height difference. 

The nurse later uploaded the photo on her Facebook page. Her employer became aware of the photo as it was seen by a 'friend' who was a work colleague. The nurse was reprimanded and told to take the photo down immediately. She said that it simply did not occur to her that she had uploaded a photo of a patient. She added that if someone had asked her would she ever upload a photo of patient that she would never consider it.

Nurse Violates Patient Confidentiality on Facebook

Cheryl James enjoyed her job at Oakwood Hospital, Michigan. She never imagined posting something on Facebook from her own computer on her own time would get her fired. “He died for us, protecting us,” said James. Like so many others, James was emotional following the shooting death of Taylor Police Corporal Matthew Edwards. She worked for the hospital organisation that treated the police officer and the person suspected of shooting this officer, Tyress Mathews. One night, while at home, she posted on Facebook that "she came face-to-face with a cop killer and hoped he rotted in hell". (he also posted another remark that the reporter would not repeat in the article.)

The following day, she got a call. Her bosses wanted to talk. “They called me in, told me that they got notice and word that I had posted this specific post on Facebook, and that they had to investigate it,” James said. She says she immediately removed the posting and thought she might get written up or suspended. Instead, she got fired. Ms James who posted her remarks offered enough information that readers were able to determine who she was talking about. This violated a federal statute that protects the confidentiality of medical information.

Doctors caught revealing secret patient information in Facebook posts

This example shows two comments on a news article. One was from a member of the public, Jodie, and the other was a response from a doctor, not to the article but to Jodie, whose comments he had clearly taken exception to.
Jodie of Perth Posted at 9:47 AM September 26, 2010
Doctors and nurses use nasty abbreviations in their notes all the time so that we may be mocked behind their backs..."GLM" - Good Looking Mum, "CTD" - Circling the drain, about to die, "GPO" - Good for Parts Only. I had the misfortune of picking up a Doctor's mag in the waiting room once, GPs complaining about "Another fat woman asking for a pap smear when the waiting room is full". And the term "Worried well" - patients who have concerns for their health but who the doctors feel are hypochondriacs. My father's doctor even spends part of the consult ridiculing patients she's had through that morning. Who cares if it's on Facebook, the lack of respect and condescending judgement is already out there.
Dr Geoff of Sydney Posted at 7:54 PM September 26, 2010

Jodie of Perth. wow, I've been a doctor for 10 years and I have NEVER once seen those abbreviations in a medical chart- ("GLM" - Good Looking Mum, "CTD" - Circling the drain, about to die, "GPO" - Good for Parts Only) We do use other abbreviations quite regularly eg. FOOSH (fall on outstretched hand) or ESRD (end-stage renal disease) or TOP (termination of pregnancy). I also just asked about 5 doctors and a couple of nurses working with me here in emergency with about 100 combined years of experience and none of them have seen these abbreviations either. Hey but I'm sure you know more than us. Or maybe you have FITH disease (the ITH stands for 'in the head’)

Dr Geoff's comment's, far from reflecting positively on the professionalism of the medical professionalism. Dr Geoff was obviously endeavouring to counter the comments made in the article and by Jodie of Perth, that doctors were did not use inappropriate language or references to patients and were highly professional people. He failed to do this. 

He in fact stated that he was actually on line whist at work (in an emergency department - to which he could be identified given the time and date it was posted). His final comment demonstrated that he was fully aware of medical abbreviations that were derogatory and offensive in nature (although he argued in his response that he had 'never once seen such abbreviations......). To top it all off he actually told Jodie that she was "F*#@ in the head" for daring to made such comments about doctors.  

His comments were highly inappropriate and in my mind only acted to support the claims of the article and the comments posted by Jodie.  

My final advice ........be careful out there!

  • www.thefreedictionary.com/friend
  • dictionary.reference.com/browse/friend
  • www.roymorgan.com
  •  www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements 
  • www.medleague.com/blog/2010/08/09/nurse-violates-confidentiality-on-facebook-by-pat-iyer/ 
  • www.news.com.au/technology/doctors-caught-revealing-secret-information-on-facebook 

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