Facebook, Twitter, Instagram, blogs, chat apps – social media have changed the way we interact daily with friends and coworkers as well as how we keep up to date with news and developments in nursing, health, politics and whatever else interests us. Social media has been used effectively in nursing education, the work setting, and patient care. However, as a nurse you need to present yourself as a professional and also think twice about what you share with your 500 friends on Facebook. Nurses are governed by a code of ethics as well as laws on patient confidentiality. A quick, thoughtless post can cause years of heartache if it costs you your job or even loss of licensure and career.

1. Breach of patient confidentiality and invasion of privacy

There have been numerous incidents worldwide of nurses facing disciplinary action or being dismissed for posts which violated patient confidentiality. Some posts were clearly unprofessional such as nurses sharing an image of a patient dying in ER after severe trauma. Most are however due to not considering ethical boundaries such as a nurse sharing a photo of a patient with a former coworker who had nursed the patient in the past.

Confidentiality and protection of the patient’s privacy are a core concept in all codes of ethics for nurses and also covered by laws in most countries. Social media with its instant and widespread communication has opened a new territory which must be negotiated with care. Keep in mind that there is no privacy once something is online. Even if you post on a closed forum or in a group, you have no control over what others do with the information once it is out there. Even if a post is deleted, it can be retrieved later for use in a court of law.

You must avoid posting any information or image which might identify a patient unless you have his or her express permission. As with verbal communication in the health care setting, information about the patient may be shared only with members of the team and then only if it is in the interests of patient care.

2. Tarnishing the reputation of coworkers or an institution

A Canadian nurse posted on Facebook that the some of the nurses were not “up to speed” in caring for her dying father, also naming the institution. A case of professional misconduct was opened against her by the relevant nurses’ registration authority after the nurses laid a complaint at the institution. The case was widely reported on in the media.

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While the nurse in question felt that she was commenting on an advocacy role to open discourse about professional standards, the nurses at the institution argued that their professional reputation, as well as that of the institution, had been tarnished within the community.

Avoid posting negative comments about your workplace, co-workers, or even other health care organizations and nursing professionals – even on your own page. When discussing professional issues on member’s only forums, you should also avoid disclosing the institution or unit where you work.

3. Breakdown in relationships in the health team

Negative comments about a colleague or supervisor, even on your own profile page with a privacy setting or in a private message, can lead to unforeseen consequences. While you may be communicating with only one other person, the information could accidentally be seen by or be shared with others. Such comments can affect your reputation, that of a co-worker as well as the working relationships within the team.

The best way to prevent this from happening is never immediately to post about something that has upset you. Rather talk it out with someone than create a permanent record.

4. Putting your own reputation on the line

You might feel that what you do in your own time is your business. Keep in mind, however, that to be respected as a professional you have to maintain a professional image at all times. The interests, attitudes, values, social and personal interests, habits and behaviors you display on social networking sites are there for the world to see, analyze and judge. This can create a positive professional image or have an adverse impact on your reputation and even job opportunities.

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Potential employers can and do check up on applicants on these sites and make judgments based on what they see. The same applies to co-workers and supervisors, especially those you have befriended in a new work setting.

Our patients can also search for us on social media pages. Unprofessional behavior and comments can affect the relationship of trust between the nurse and the patient.

Especially if you are a student nurse or new graduate, you should search your name on the web and make sure that what comes up displays a professional image. Also, consider cleaning up your Facebook page posts and removing the images which do not support your professional role.

5. Blurring of personal and professional life

While spending so much time together, we tend to make friends with our coworkers and then connecting with them via social networks. This practice can lead to a blurring of our personal and professional boundaries, at some point affecting either our personal life or relationships within the working environment.

It is also wise not to extend or accept friend requests from patients or former patients as this might violate the patient-nurse boundary and set back the therapeutic relationship.

6. Embrace the benefits

The nursing profession has always adapted to change, and you needn’t shy away from using social media which are likely to play a significant role in nursing education, nursing management as well as patient care in the future.

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You can avoid potential problems as long as you consider your professional image and the ethical codes of practice. Apply the principles of patient confidentiality and privacy, respect for employers and other members of the health team, as well professional-patient boundaries in the use of social media just as you would in the health care setting.

Know your employer’s policy on the use of social media or, if they do not have one yet, you can advocate towards having a policy developed.

Some nursing organizations, including the ICN and ANA, have also issued guidelines for nurses’ use of social media, and you might want to print out and share the following handy tip card published by the ANA.