To: Ethics Advisory Board
From: Concerned nursing professor
Subject: Patients recording nurses
What protects nursing staff and students when a patient livestreams nursing care on Facebook? Should patients ever be permitted to photograph or record nurses while they are working and post it on social media?
From: ANA Center for Ethics and Human Rights
In this age of social media, it’s common for people to want to use their smart phones to photograph themselves and others in a variety of situations, such as health care. Action can be taken to protect both patients and nurses from perils associated with social media.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) protects patient privacy and confidentiality and prevents inappropriate disclosure of patient-protected information. Healthcare providers must obtain written consent and permission from a patient to take a photograph for any purpose, such as for education, research, or public relations.
Further, nurses have a duty to maintain confidentiality of all patient information, according to Interpretive Statement 3.1 of the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements: “Confidentiality pertains to the nondisclosure of personal information that has been communicated within the nurse-patient relationship.” Nurses have faced serious consequences, including termination, for inappropriately posting patient photos on social media, such as Facebook.
Social media guidelines for nurses
ANA and the National Council of State Boards of Nursing (NCSBN) have each published guidelines for the use of social media. ANA’s publication, “ANAs principles for social networking and the nurse,” is available on the ANA website, and NCSBN’s white papers, “A nurse’s guide to the use of social media” and “A nurse’s guide to professional boundaries,” are available at ncsbn.org. Both organizations recognize the inappropriate use of social and electronic media as an ethical violation of patient privacy and confidentiality, as well as a violation of professional boundaries.
What about the situation where a patient or visitor photographs or videotapes a nurse, either along with a patient or in the process of performing a procedure?
The potential for sharing this information on social media is equally concerning. Provision 5 of the Code states the nurse owes the same duty to self as to others. Patients or visitors should not be allowed to photograph or videotape nurses without explicit permission from the nurse. They should not ever take photos or videos of nurses performing patient care, which carries the risk of misrepresentation.
Just as employers have policies to protect patient privacy and confidentiality, some also have policies related to either requiring explicit permission from a nurse or not permitting it at all. The potential for harm can extend not only to the nurses delivering patient care, but to families or visitors who may be inadvertently included.
It’s recommended that you consult your employer policy, and if there isn’t one, that it be promoted and developed as a way of advocating for the rights, health, and safety of nurses and other healthcare professionals, as well as for patients and visitors. In this current healthcare environment in which visiting hours in many hospitals are more open and relatives and visitors are allowed in areas not previously accessible, such as postanesthesia care units, it’s even more important that there are policies in place related to the use of electronic devices and social media.
Response by Linda L. Olson, PhD, RN, NEA-BC, FAAN, member of the ANA Ethics and Human Rights Advisory Board.