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Think before you tweet

Social media makes guarding privacy critical for patients and you. 

Patient privacy is essential in healthcare. However, we are seeing increasing breaches on social media. From status updates containing patient information to photos of patients, x-rays or wounds, private data regularly pops up on sites such as Facebook and Twitter. Yet rarely do we see anyone commenting on these posts or questioning whether the content is appropriate.

THE Social media EXPLOSION

Social media is here to stay and continues to grow rapidly. Facebook, tweeting, blogging, LinkedIn and dozens of other terms are now part of our everyday vernacular, yet most didn’t exist just five years ago.

Social media statistics are astonishing. Facebook is the second most visited website in the world, beaten only by Google. Ten per cent of the world’s population uses the site and more than 30 billion pieces of information are shared on it monthly. More than 200 million people now access the site through mobile devices.

Twitter hosts 340 million tweets every day, by more than 140 million users. Instagram is used by 100 million people every month and 30 million photos are shared there daily.

Patient privacy

The word privacy is often mistakenly substituted for confidentiality. However, confidentiality pertains specifically to patient information, whereas privacy also involves the patient’s expectation and right to be treated with dignity and respect. A breach of privacy includes not only sharing any information that could be used to identify the individual, but also derogatory or demeaning remarks, or anything the patient – not the nurse – may find embarrassing.

Nurses and social media

Nursing can be a highly stressful and emotional job. Nurses often turn to social media to seek support and advice from their colleagues. Social media can be a source of comfort after a particularly tough day. It is commonly used to vent about a difficult situation or to find out how other nurses cope with the sad events we often witness.

Many nurses also use social media to network and form professional connections, for ongoing education and to keep up to date with union campaigns. It can even be used as a way to journal or reflect.

In a 2012 survey, nearly one-third of nurses said they primarily used social media to share stories from work. More than 40 per cent said they had witnessed a colleague using social media inappropriately, and 32 per cent of those inappropriate posts contained information about patients. Furthermore, more than 10 per cent contained actual patient photographs.

Why do breaches happen?

The way we communicate has drastically changed over the past decade. Conversations once held in the tea room or around the dinner table are now held on social media. It can be accessed virtually everywhere, meaning the idle thought that once upon a time would have been soon forgotten, is now instantly posted online. Before we can contemplate whether our posts are appropriate, or evaluate their potential consequences. Our momentary lapses in judgment are laid bare for the world to see, comment on and share.

The privacy settings on sites such as Facebook also give us a false sense of security that the information we share will be seen only by a limited audience. Unfortunately, this is not true. Screenshots can be taken and posted on other sites, the posts can then be shared and quickly go viral, well beyond the control of the person who initially posted it. Regardless of whether the post is seen by one person or a thousand, it may still be considered a breach of patient privacy.

Nurses who have posted about patients often protest that they have not breached patient privacy because they have not named the patient. However, nursing registration boards from America to New Zealand have all ruled in a number of cases that simply leaving out the patient’s name is not enough to prevent a breach occurring. Someone could easily read different entries by a number of people on a number of different sites and piece together enough information to identify the person.

Consequences of A breach

Inappropriate use of social media can destroy a nurse’s career. If the posts are reported to an employer, the nurse may be suspended or fired. Future employers may choose to look up social media interactions and suddenly those comments made on other people’s pages will cost someone the job they’ve always wanted.

If the breach is reported to the Australian Health Practitioner Regulation Agency (AHPRA), consequences can range from a verbal or written warning to suspension or even disqualification of registration, leaving a nurse with no choice but to find a new career.

Breaching patient privacy on social media can also have wide-ranging legal consequences. Once something is posted, even if it’s deleted it exists on a server that can be discovered in court. The more grievous cases are now being reported to legal authorities for investigation. Criminal charges for violation of privacy and voyeurism have been laid against nurses. Additionally, online posting can constitute publication, leaving the poster open for civil charges of intentional infliction of emotional distress or even libel.

Nursing is consistently rated as one of the most trusted and ethical professions. However, any breach of patient privacy, whether intentional or inadvertent, can break down this trust. If patients fear that the information they give will be shared, or that they will be the subject of humiliating social media posts, they may leave out critical details. Moreover, the damage caused to the nurse-patient relationship can impair nurses’ ability to care for patients effectively, leading to poorer outcomes.

Anything posted on social media is a direct reflection of the professionalism of all nurses. It is not just the poster’s reputation at risk, but that of the ward, hospital or healthcare organisation as well.

Nurses have a professional responsibility to uphold the profession’s reputation. Loss of public trust can have ramifications that are wide-ranging, including loss of support for campaigns for things such as better patient-to-nurse ratios and working conditions – support that may be critical to success.

CAN breaches be stopped?

The AHPRA is writing social media guidelines that are due to be released and will apply to all allied health professionals. All organisations, including universities, should have social media policies in place.

It is not enough just to have guidelines, however, they need to be taught. They should be covered at university, during initial workplace orientation and at regular in-services to cover any issues and stress the consequences of not adhering to policy.

Everything you post online should be considered public. If you wouldn’t shout it at the local supermarket, don’t post it online. You have an ethical and legal obligation to maintain your patient’s privacy.

One way to deal with this issue is with self-regulation. Patient advocacy is a core nursing competency, and now more than ever this role has taken on new significance. Advocating for your patients no longer ends on the ward, it includes safeguarding their privacy online as well. This may mean stopping relatives from taking photos when a patient is not competent to give consent. It may mean stopping a colleague from taking a photo or asking them to delete an inappropriate post.

Self-regulation won’t be easy. It will mean having to go against the tide, to question friends, colleagues, perhaps even a superior. It is easy to see where Mark Twain was coming from with his quote, “It is curious that physical courage should be so common in the world and moral courage so rare”.

And as Harry Potter’s Dumbledore says, “It takes a great deal of bravery to stand up to your enemies, but a great deal more to stand up to your friends.” So nurses should ask themselves how they would feel if the post was about them or a family member. Only when the profession as a whole stops “liking” and giving its approval to these posts that they will stop.

Think first

Before hitting send and posting that next social media update, everyone should stop and think. How would they feel if the patient saw it? Would they be worried if it were shown to their boss? Would they be anxious if it were reported to AHPRA? Would they be concerned if it were forwarded to the police? If the answer to any of these questions is yes, chances are that post shouldn’t be on social media.

It is imperative to practise in a manner that always protects patients’ dignity and keeps away from the slippery slope of unethical and immoral behaviour. These breaches of patient privacy will cease only when they are no longer deemed socially acceptable, when nurses are willing to speak up and regulate one another.

Laurie Bickhoff is a participant in the Australian College of Nursing Emerging Nurse Leader program.

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One comment

  1. Thanks Laurie, Interesting article. Particularly given the recent press in relation to NSW Health’s response to social media usage.

    My thoughts on the issue are available in my editorial published in JAN earlier this year. http://onlinelibrary.wiley.com/doi/10.1111/jan.12036/pdf

    I’m currently co-editing a special issue of Collegian on Social Media in Nursing – The call for papers is available here, deadline for submissions December 2013. There is lots written about the ‘dangers’ of social media, but limited information on the positive uses in professional practice. I’m keen to progress in this area of nursing, be good to hear from you.

    Cheers, Caleb

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