Introduction

Social media has become integral to how individuals connect and share information. For nurses, these platforms extend professional influence and advocacy beyond the bedside, promoting public health, fostering education, and engaging communities. Yet, digital engagement also presents ethical risks. Blurred boundaries between personal and professional identities can lead to breaches of confidentiality, misinformation, and erosion of public trust.

Nurses in Oklahoma, the United States, and globally are increasingly using social media to collaborate, share innovations, and build professional networks. Without ethical guidance, these activities may expose nurses and employers to legal or reputational harm. Recent disciplinary cases, such as the termination of staff employment after a viral “patient-shaming” video (Nurse.org, 2025), highlight the need for nurses to uphold professionalism online. As the nation’s most trusted profession, nurses must ensure their digital presence reflects the same integrity, accountability, and respect expected in clinical practice.

Current Evidence

Worldwide, nurses and nursing students use social media for networking, continuing education, and professional growth. Alya et al. (2023) found that nurses in Oman use social media to enhance communication and access timely information. Likewise, Kohanová et al. (2025) reported that most nursing students engage with social media daily for collaboration and professional identity formation. Social media can amplify nursing’s voice, advance health education, and support advocacy when used responsibly. Social media promotes interdisciplinary collaboration and evidence-based communication, especially during public health emergencies (Busl et al., 2021).

Despite its advantages, social media engagement can present ethical dilemmas. Rukavina et al. (2021) noted that healthcare professionals often underestimate risks such as privacy breaches and reputational harm. Nurses face complex ethical decisions when balancing personal expression and professional duty online (Lynn et al., 2024). Without institutional policies or training, even well-intentioned posts can violate patient confidentiality or undermine trust.

Ethical and Professional Standards

The American Nurses Association (ANA) provides a solid foundation for digital professionalism:

• Code of Ethics for Nurses (ANA, 2025):
  • Provision 3: Nurses advocate for and protect patient rights, health, and safety, including privacy across all communication formats.
  • Provision 5: Nurses owe the same duty to self as to others, maintaining integrity and professional identity online and offline.
  • 2025 Update: Emphasizes digital professionalism and accountability in technology use.

• Nursing: Scope and Standards of Practice (ANA, 2021):
  • Professional conduct applies in all environments, including digital spaces. Nurses remain accountable for their communications and must demonstrate respect, honesty, and compassion.

• Nursing’s Social Policy Statement (ANA, 2010):
  • Nurse’s social contract with society is grounded in trust. Online behaviors that violate privacy or misrepresent nursing values threaten that trust and public confidence.
  • Social media engagement is therefore not a private activity, but a professional responsibility guided by nursing’s ethical and legal standards.

Application to Nursing Practice: Social Media and Vulnerable Populations

Ethical vigilance is especially critical when social media intersects with care for vulnerable populations such as children and pregnant individuals. These groups may rely on online communities for information and support but face heightened risks of misinformation, privacy loss, and inequitable access. Nurses have a moral obligation to promote accurate, evidence-based resources while protecting confidentiality. Advocacy in digital spaces, such as sharing information about immunizations, child development, or maternal health, must align with the ANA Code of Ethics (2025), which prohibits sharing identifiable patient information. Modeling discretion online upholds both privacy and the moral integrity of the profession.

Social media can also serve as a bridge for populations with limited healthcare access. Konrad’s (2025) study found that Medicaid-eligible pregnant women used Facebook groups to combat isolation, gain emotional support, and reinforce professional guidance. These online networks fostered affirmation and belonging, underscoring the need for nurses to assess patients’ digital support systems as part of holistic care. In Oklahoma, where Medicaid financed 53% of births in 2023, well above the national rate of 41% (KFF, 2025), nurses play a crucial role in guiding these online interactions ethically and safely.

By integrating such insights, nurses can recognize, validate, and direct online engagement that upholds dignity, advocacy, and equity. Merging research and practice allows nurses to bridge clinical and digital care, offering compassionate, informed support in every environment.

Gaps and Challenges

Despite clear ethical frameworks, consistent application remains limited. Many institutions lack enforceable policies, and few nursing education programs include guidance on e-professionalism. Kohanová et al. (2025) emphasized integrating digital ethics into undergraduate curricula to better prepare future nurses. Rapidly evolving technologies, including video-based and AI-driven platforms, further complicate ethical boundaries. Addressing these gaps requires intentional alignment between policy, education, and continuing professional development.

Recommendations

To strengthen digital professionalism across the workforce, nurses should cultivate a respectful online presence, apply the same standards of confidentiality and civility they uphold in person, and engage thoughtfully in discussions that affect patients and communities. Healthcare organizations and professional associations can support this by maintaining clear, evidence-based social media guidelines and providing regular updates and reminders as platforms and norms evolve. Nurse leaders, preceptors, and influencers play a pivotal role by modeling responsible engagement such as sharing accurate health information, celebrating team achievements, crediting sources, correcting misinformation without hostility, and elevating nursing’s voice in policy and advocacy. Together, these individual and organizational actions help ensure that social media strengthens, rather than undermines nursing integrity and the public’s trust.

Conclusion

The digital era brings both opportunity and ethical responsibility. Social media expands nursing’s reach but magnifies risks when professionalism lapses. Upholding the ANA Code of Ethics and core nursing values, including integrity, respect, confidentiality, and accountability, remains essential across all platforms. Every nurse’s online behavior reflects the profession’s collective reputation. Professionalism extends beyond the bedside to every post, comment, and click, reinforcing the public trust that defines nursing’s social mission.

References

Alya, A. L. R., Al-Shanfari, I., Al-Mukhaini, M., Al-Habsi, S., & Al-Shukaili, A. (2023). The use of social media by clinical nurse specialists at a tertiary hospital in Oman: Motives, barriers, and implementation. JMIR Nursing, 6(1), e45150. https://doi.org/10.2196/45150

American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession (3rd ed.). ANA.

American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). ANA.

American Nurses Association. (2025). Code of ethics for nurses with interpretive statements. https://codeofethics.ana.org/provisions

Busl, K. M., Rubin, M. A., & Patel, S. V. (2021). Use of social media in health care: Opportunities and challenges. Neurology, 97(2), 61–68. https://doi.org/10.1212/WNL.0000000000012557

Clinic staff lose jobs after cringe patient-shaming video. (2025, September). Nurse.org. https://nurse.org/news/nurse-fired-tiktok-patient-privacy/

KFF. (2025). Births financed by Medicaid by metropolitan status. Kaiser Family Foundation. https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/

Kohanová, D., Sollárová, A., Cˇakloš, M., Zrubcová, D., & Kolarczyk, E. (2025). Social media behaviour and patterns of use among nursing students: A systematized review. Nurse Education in Practice, 83, 104277. https://doi.org/10.1016/j.nepr.2025.104277

Konrad, K. M. L. (2025). Online social support for Medicaid-eligible pregnant women. MCN: The American Journal of Maternal/Child Nursing. Advance online publication. https://doi.org/10.1097/NMC.0000000000001162

Lynn, M. A., Cook, C., Neff, D. F., Kinchen, E. V., & Beever, J. (2024). Ethical decision-making among nurses participating in social media: A grounded theory study. Journal of Nursing Regulation, 15(2), 45–56. https://doi.org/10.1016/S2155-8256(24)00055-3

Rukavina, T. V., Viski´c, J., Machala Poplašen, L., Reli´c, D., Mareli´c, M., Joki´c, D., & Sedak, K. (2021). Dangers and benefits of social media on e-professionalism of health care professionals: Scoping review. Journal of Medical Internet Research, 23(11), e25770. https://doi.org/10.2196/25770