Nurses and midwives are overwhelming embracing social media to share information but when does posting and tweeting breach patient privacy? One of Australia’s emerging nurse leaders put nurses’ use of social media under the microscope – and she was alarmed at what she found, writes Karen Keast.

There’s an image of a patient’s blood splattered across a bathroom, another disturbing picture of a dead patient while yet another photo shows the gruesome aftermath of a gun shot to the face.

These images, some of them captured in Australia, have all been shared on social media.

What’s more, they all appear to have been shared by healthcare professionals including nurses.

“To be honest, I was quite shocked at how many examples I found of nurses breaching patient privacy,” Laurie Bickhoff says.

“Public Facebook pages dedicated to nursing often have some very graphic images and posts which are very demeaning or derogatory to patients.

“Twitter, and the anonymous aspect of tweeting, sees some of the worst breaches and these are easily accessible to any member of the public.”

A registered nurse at New South Wales’ John Hunter Hospital in the HNELHD New Graduate Transition to Practice program, Ms Bickhoff is completing the second year of the Australian College of Nursing’s Emerging Nurse Leader program.

When she found some inappropriate posts on Facebook and Twitter, Ms Bickhoff decided to investigate nurses’ use of social media.

Her findings, and her suggestions for how nurses can improve their social media posts in line with patient privacy, became one of the highlight presentations, titled ‘Social Media and Patient Privacy – Where’s the Line?’, at the International Council of Nurses Congress’ Student Assembly.

Ms Bickhoff, who also presented on the topic at the CranaPlus 2013 national conference, says many nurses have since told her they never realised what they were posting might be considered a breach of privacy.

“What concerned me even more than the posts was that no-one seemed to be questioning whether they were appropriate or should be removed,” she says.

“There did not seem to be any malicious intent behind the posts - people honestly did not seem to realise what they were doing might be breaching patient privacy or what harm the posts might cause.”

New figures from www.socialmedianews.com.au show social media continues to grow in Australia with 12,800,000 active Facebook users in Australia in October, 11.8 million on YouTube, 5.1 million on WordPress.com, 4.1 million on Tumblr, 3.5 million on LinkedIn, 3.1 million on Blogspot and 2.5 million on Twitter.

A survey out of the United States in 2012 shed some light on how nurses are using social media.

In the Nursing Times study, 27 per cent of nurses revealed they use social media to share stories about working life.

Forty one per cent of nurses in the survey reported their colleagues used social media inappropriately, 32 per cent of those posts contained information about patients and 12 per cent featured photos of patients.

Ms Bickhoff says one of the most common mistakes nurses make is believing their decision not to name a patient means they are not breaching patient privacy.

“The posting or misuse of any information gathered whilst caring for a patient is a breach of their privacy, regardless of whether any identifying information is used,” she says.

“We live in a world which is only getting smaller and it will surprise you how easily someone can be identified.”

Inappropriate use of social media can have long lasting implications.

It directly reflects on the entire nursing profession, long regarded as one of the most trusted and ethical professions, negatively affecting the nurse-patient relationship.

Ms Bickhoff says it can also jeopardise a nurse’s career, from legal consequences with criminal charges for grievous cases of breach of privacy, civil claims for derogatory or defaming posts, to also affecting a nurse’s current and future employment.

“Many employers now look up social media interactions as pre-employment screening,” she says.

“If reported to your current workplace, you can be suspended or fired. AHPRA can issue verbal or written warnings or even suspend or revoke your registration.”

However, Ms Bickhoff says social media – when used correctly – can also boost your career, whether it’s enabling you to connect with potential employers through sites such as LinkedIn or connecting with other healthcare professionals.

“You can use social media to highlight your achievements or promote your research,” she says.

“Social media can open the door to amazing opportunities which you may never have heard of otherwise.”

Ms Bickhoff uses both Facebook and Twitter but keeps the two social media sites very separate.

She uses Facebook as per personal page, restricting her ‘friends’ to her family and real-life friends while she uses Twitter to engage with others in the nursing profession.

“They (Twitter) contain links to interesting articles or research or some of my random observations on life as a nurse,” she says.

“I do not discuss my ward patients, work colleagues or hospital on either page.”

Ms Bickhoff says we often forget just how public social media is and she advises nurses to consider everything they post online as publicly available.

“If you would be worried if your patient, your colleagues, your boss or AHPRA saw it, then chances are it shouldn’t be on social media,” she says.

“Even with the highest privacy settings, screenshots of posts can be taken and shared on other sites, so you never really know who will see your posts.

“(On Facebook) I have the highest level privacy settings attached, which I review monthly as they can change without you realising as FB updates.”

Nurses should familiarise themselves with social media policy at a local level. Most hospitals, organisations and local health services have their own rules on social media use.

At a national level, AHPRA plans to release its social media guidelines, which will act as a generic policy spanning all 14 National Boards, in 2014.

Ms Bickhoff says education is the key to improving nurses’ social media use alongside self-regulation.

“We need to empower our colleagues so they have the courage to question friends, colleagues, perhaps even their boss if their post is inappropriate.”

Ms Bickhoff says she hopes her presentations will generate discussion and improve the content of material nurses post online.

“I have had numerous people tell me they have changed their social media habits after learning of the consequences of these posts and that inspires me,” she says.

“The most common feedback I get, however, is that this is an important issue and nurses are very keen for guidance and discussions on social media.

“Nurses are realising just what a great tool social media is and don’t want the actions of a few to cast dispersions on the many nurses who use social media correctly and the many that share wonderful and educational material online.”


Laurie’s tips for nurses using social media:
• Everything you post online should be considered public
• Try to view your posts through the public’s eyes, not those of a nurse. After all, they will be the ones judging it. While many nurses will share the same sense of humour or understand that you may just be letting off some steam, many posts can be misconstrued as uncaring or demeaning by the public
• Before you hit ‘post’, consider how you would feel if the post was about you or your loved one
• Keep work offline. Tea rooms are a great place to debrief but social media isn’t
• Know the social media policies that apply to you in your workplace. Consider what information your profile shares about you. Remember your actions reflect on all nurses.