Refrain From Social Networking On The Job

Denver, CO—In using social media, healthcare professionals should exercise caution, understand privacy issues, and always err on the side of a conservative approach, said Lisa Miller, CNM, JD, an attorney and a certified midwife.

At the 2011 Association of Women’s Health, Obstetric and Neonatal Nurses annual meeting, Ms Miller entertained a packed room with stories of nurses who failed to realize the new reality that nothing is private once it has been “tweeted” on Twitter or posted on Facebook. “If you tweet it, type it, or post it, consider it public,” Ms Miller warned.

“Social media is expanding exponentially on a daily basis,” she said. Facebook claims an estimated 550 million unique visitors monthly. Twitter now has nearly 96 million unique visitors, MySpace claims 80 million, and even LinkedIn now has 50 million monthly users. The average user has 130 friends, and on a given day, 50% of active Facebook users log on to the site (www.facebook.com/ pressinfo.php?statistics).

“Sounds like fun for everyone, right? Clearly, the reach of social media is wonderful and the ability to connect with nearly anyone in the world is amazing, but like everything else, there are pros and cons,” Ms Miller said.

Examples of What to Avoid

A picture of a placenta, posted on Facebook with the permission of a nursing instructor, nearly ended the nursing career of one student who merely intended to boast about her first delivery. She was expelled from school, but sued and was reinstated.

“The judge ruled in her favor, and his opinion included some interesting comments on expectations,” Ms Miller said. She quoted him, saying, “Photos are taken to be viewed. When granted permission to take the photos, it was unreasonable to assume that they would not be viewed….By giving the student permission to take the photos, which [the nursing supervisor] admitted, it was reasonable to anticipate that the photos would be shown to others.”

“This case bordered on silly, and it is the instructor, not the nurse, who should be reprimanded,” she maintained. “But the message is that those things for which we give permission could well end up on Facebook.” Some cases are more serious. In 2009, 2 nurses in Wisconsin were fired because they took pictures of an x-ray image of a sexual device lodged in a patient’s rectum. In 2010, a California nurse and other staff took pictures of a 60-year-old stabbing victim, posted them on Facebook, and texted them to other hospital employees; 4 staff members were fired and 3 more were disciplined. Equally risky and probably a lot more common are such postings as, “I hate my job,” and, “We had a bad outcome last night.” Ms Miller described one nurse who attended a party at a neona-tologist’s home, and posted the following day, “What a great party! I’m surprised how drunk everyone got. I’m still hungover and have to go to work in 4 hours!”

“Imagine what this does to the nursing reputation, when families see this,” she said. “Don’t type it and don’t text it. It can come back to haunt you.”

Employers Use Social Media Too

Also beware that your Facebook profile may not paint a flattering picture of you, and is available for current or prospective employers to view. “When you are interviewing for a new job, do you really want an inappropriate Facebook post or tweet to make a difference in your getting it?” Ms Miller asked.

Do not think that it will not, she said. Pharmacy residency program directors were recently surveyed about their attitudes toward social media in residency recruitment and selection (Cain J, et al. Am J Health Syst Pharm. 2010;67:1635-1639). Of the 454 program directors who responded, 20% revealed that they had viewed an applicant’s social media information; >50% had encountered “e-professionalism issues,” including questionable photos and posts revealing unprofessional attitudes; and 89% agreed that information voluntarily published online was fair game for judgments on character, attitudes, and professionalism.

Social Media and Medical Malpractice

Lawyers are also obtaining information from social media sites to support their cases—specifically in medical malpractice cases. “They can easily get an idea of your personality and perhaps your work relationships,” Ms Miller said. “And in some cases, the information has been used to provide the appearance of possible collusion.”

One malpractice suit involved an emergency situation in which the timing was questionable. Contact was documented among nursing staff, some of whom had not kept in touch for years before the suit. “Call me—having my deposition—let’s talk!” read one Facebook message. “How will it look to the jury, that after 5 years of no contact, they are talking now?” Ms Miller pointed out.

“You don’t need to prove collusion, you just need to give the appearance of it, and this case was settled when this information was brought to light,” she continued. “When you choose to use social media, you are choosing to make information public.”

She urged nurses to:

• Think twice about whatever they post, especially pictures and information referring to patients
• Kindly refuse patients’ requests to take their photos • Avoid using Google to look for their patients (“don’t create a trail”)
• Decline any “friend” requests from patients. “I have become friends with many of my patients,” she said, “but once they have accessed my Facebook page, they may view me differently.”