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Social media: New communication platform, but old rules still apply

By: Mary E. Fortier, EdD, RN, CNL

Stop and think before you post. 


· Social media is a powerful double-edged sword capable of providing access to education and also leading to negative consequences when misused.

· Old rules of communication etiquette apply to social media.

· Nurses should educate themselves about proper social media use and act responsibly.

· Mindful social media use is crucial to ensure personal and patient privacy, safety, and security.


Social media example: A nurse posts on social media about how fulfilled she feels after successfully performing cardiopulmonary resuscitation (CPR) on a person in the local grocery store.  

Potential pitfalls: The nurse left out the person’s name and the name of the grocery store, but her friends all know where she shops and one or more may know the person on whom she performed CPR. They might be able piece together the story, which will create a breach of privacy. Maybe the person didn’t want others to know about the cardiac event at the grocery store. 

 For many of us, social media, such as Twitter, Snapchat, Instagram, Pinterest, LinkedIn, and Facebook, defines how, when, and where we communicate. We share our thoughts and ideas in blogs, wikis, podcasts, and videos, and we can enter chat rooms and have heart-to-heart talks about our livespersonal and professional. These platforms are powerful and far-reaching, creating ramifications that challenge our privacy and regulatory laws and can either enhance our profession or cause harm both to the profession and to individual nurses careers. 

Privacy and HIPAA 

Social media and electronic communication have created a need to review, revisit, and rewrite guidelines to maintain and protect patient privacyand our own. Many organizations are reframing how, when, and where staff and patients can use social media platforms, with the goal of maintaining privacy and confidentiality for everyone. Security and privacy settings and data encryption are used to maintain electronic health record integrity, but our personal electronic devices may be vulnerable to security breaches. In many cases, privacy settings aren’t as private as we think.  

The Health Insurance Portability and Accountability Act (HIPAA) was enacted to protect patient and client privacy, but the ease with which we share information, even when we change a patient’s personal data, may leave enough information that a person’s identity can be uncovered. And remember, HIPAA protects the public, not the organization or the provider.  

You know the rules

Much has been written about the “do’s and don’ts” of social media communication, but communication really hasn’t changed since the inception of the spoken word. We listen and respond. The venue and speed of communication may be different, but the etiquette remains the same. The old rules still apply. (See 8 rules of communication etiquette.)

8 rules of communication etiquette

How we communicate may have changed, but the same rules apply.

  1. Don’t take pictures of any kind—still or video—at work. Snapping photos of patients or patient care areas, even if you remove patient identifiers, is never okay.
  2. Don’t speak about your patient in a public area. In the past, that included elevators, lobbies, and cafeterias, but now it includes blogs, social media platforms, and other electronic forms of communication.
  3. If you have nothing nice to say (about a patient, a family, a coworker, or an employer), don’t say it aloud—or in a social media post. This behavior can be considered cyberbullying or lateral violence. Disparaging an employer or another employee can be professional misconduct and prosecutable.
  4. Know your professional boundaries. Consult your organization’s policy, refer to your state’s nurse practice act, and review the National Council of State Boards of Nursing white paper A Nurse’s Guide to the Use of Social Media (ncsbn.org/NCSBN_SocialMedia.pdf).
  5. Don’t conduct personal business on your employer’s time clock. This includes no posting to social media sites or reading personal emails. Follow your organization’s policies about using work computers. When using an employer’s server or devices, you should have no expectation of privacy.
  6. Never speak or post if you’re angry or need to blow off steam. Only say what you’re willing to repeat. (See rule #3.)
  7. Never put in writing what you’re not willing to stand by. Hitting delete doesn’t permanently remove content; an electronic footprint remains in cyberspace. And all personal devices—smartphones, laptops, and tablets—produce metadata. The longitude, latitude, altitude, date, time, and location of your communications can be retrieved.
  8. Remember that you represent the nursing profession. Behave in a manner that reflects positively on all nurses and that is congruent with your state’s nursing practice regulations and nurse practice act.

A good rule of thumb is to stop, think, wait, and revisit what you want to say or post, and look to your board of nursing and employer for guidance when posting to a social media site about professional behavior. Think about who you want to reach, how the information will be viewed, whether the platform is appropriate, and how you’ll evaluate your post’s effectiveness. Personal posts are just as important as professional posts and should reflect behaviors that don’t embarrass the profession. You never want to be accused of breaking patient confidentiality laws or cyberbullying your peers or employer. And remember that breaking confidences and breaching patient confidentiality can lead to financial consequences, licensure discipline, and potential lawsuits and criminal prosecution.  

Set the standard 

Social media has much to offer—networking opportunities; forums to discuss current professional issues, trends, and evidence-based practices; and platforms for health promotion and patient education dissemination. Mindful social media practices create a positive nursing presence. But it’s a double-edged sword that also can destroy trust and careers if not wielded responsibly. Educate yourself and volunteer to serve on committees that write policies about nursing practice and electronic communication, patient privacy, and confidentiality. We need to set the standard for others who use these platforms and frame the guidelines. 

Mary E. Fortier is an associate professor in the department of nursing at the New Jersey City University in Jersey City. 

Selected references

Balestra ML. Social media missteps could put your nursing license at risk. Am Nurs Today. 2018;13(3):20-21,63. myamericannurse.com/social-media-nursing-license-risk/  

Brous E. How to avoid the pitfalls of social media. Am Nurs Today. 2013;8(5). myamericannurse.com/how-to-avoid-the-pitfalls-of-social-media  

The history of social media: A timeline. 2018. phrasee.co/the-history-of-social-media-a-timeline  

National Council of State Boards of Nursing. A Nurses Guide to the Use of Social Media. 2018. https://ncsbn.org/NCSBN_SocialMedia.pdf 

Roberts SJ. Lateral violence in nursing: A review of the past three decades. Nurs Sci Q. 2015;28(1):36-41.  

Spector N, Kappel DM. Guidelines for using electronic and social media: The regulatory perspective. Online J Issues Nurs. 2012;17(3):1.  

1 Comment. Leave new

  • as healthcare professionals, we have an obligation to protect patient’s health information. Not doing so are consequences. Social media is not the place to discuss any patient. At m workplace, there are signs in the elevators stated do not to discuss patient information in the elevator, cafeteria, or any public setting. Do not discuss patient information with anyone that does not have the need to know. Even at work with working with my colleagues if someone is not caring for the patient, they should not be receiving any information about the patient.


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