By Debra Wood, RN, contributor
August 16, 2012 - With smartphones, tablets and other devices at the ready, one’s thoughts and photos can travel around the globe in a flash. That immediacy has created scores of opportunities for people, but it also holds the potential to damage careers and reputations when nurses are not careful and post before they think.
Jordan Battani encouraged nurses to set a strict social media policy for themselves.
“When you put something on a social media outlet, it’s like putting it on the front page of the paper, and once it’s on the Internet, it’s there forever,” said Jordan Battani, managing director of CSC’s Global Institute for Emerging Healthcare Practices, headquartered in Falls Church, Va. “There’s an added nuance for people in the patient care profession in that they could violate someone’s privacy.”
Keeping patient information confidential is not new. Nurses have long known not to discuss patients with anyone outside of the care team.
Karon Gibson, RN, CCM, author of the book Nurses On Our Own, said that nurses were always told never to discuss patients in restaurants or restrooms where someone might overhear.
“Social media hasn’t really changed the rules or the concerns related to sharing sensitive, proprietary or patient-protected information inappropriately,” agreed Linda Pophal, CEO of Strategic Communications in Chippewa Falls, Wis., author of The Essentials of Corporate Communications and Public Relations, and former director of corporate communications for a large health care system.
“What social media has done, though, is significantly increase the impact that those breaches can have, which obviously heightens all of our sensitivities to these issues,” Pophal said.
A slippery slope
Some people treat social media as a friend and will write things as if they were swapping funny stories or griping about a hard day at work with a trusted buddy.
Michael Sacopulos said social media is woven into the fabric of daily life.
Michael Sacopulos, an attorney and CEO of Medical Risk Institute in Terre Haute, Ind., said the use of social media has become woven into the fabric of daily life, and it’s a trend that is not going away.
However, inappropriate posts or tweets can come back to haunt. Pophal offers as an example, a nurse might post something like: “Wow! Saw a guy today in the ER who shot himself in the eye with a nail gun! Ugh!” which could prove problematic if that person, or someone he knows, saw the post.
A nurse in Detroit lost her job for making negative comments about a patient who murdered a police officer, even though she did not give out his name or condition. In fact, nurses across the country have sometimes learned the hard way that they should never discuss patients or cases on social media networks.
In addition to concerns about HIPAA, Pophal pointed out that maintaining privacy is critical because of the trust that patients bestow upon their health care providers and the very personal and sensitive nature of the things that these providers know about their patients.
“People get into trouble when the line between what’s personal and business, public and private, is fuzzy when you add the technology innovations that create Internet-enabled social media interaction,” Battani said.
Some online actions seem foolish, and easy access to a camera phone may lead to poor decisions. Battani doubts some of the regretted posts would have occurred in the 35-mm camera world when one had to take the time to adjust the flash and lens position.
Two nurses in California were disciplined for posting photos of a dying man on their Facebook pages. And two nurses in Wisconsin lost their jobs after taking photos of patient X-rays, showing a sexual device lodged in a man’s rectum; one nurse allegedly posted it on Facebook but later took it down.
“People are not less kind, but they are not mindful of how slippery the divide has become between the personal and the public,” Battani said.
Linda Pophal said it has always been important for nurses to be cautious about the type of information they share or things they say to those outside the organization.
In addition to privacy concerns, Pophal said, “nurses must also be cautious about sharing proprietary information about their organization--the introduction of new programs, marketing plans, etc. Saying negative information about the organization or bashing supervisors or hospital leaders can be protected under National Labor Relations Board standards, however, it’s best to not go there; that kind of bashing really reflects more on the individual doing the bashing than the organization--and, remember, what you say in cyberspace stays in cyberspace.”
A 2010 Proofpoint study reports 24 percent of employers had disciplined an employee for violating a privacy procedure and 11 percent had terminated the person for the violation.
What to do
“The smartest thing anyone can do is to set personal limits and never violate them,” Battani said. For instance, avoid becoming Facebook friends with patients, and never speak poorly about a boss. “Health care providers have to have a higher standard.”
Gibson added, nurses need to be vigilant on social media and in social situations never to be overheard saying or writing anything that can be connected to an individual person or illness or even a relative. Diagnosis, prognosis and any intimate details of a patient should never be revealed.
Sacopulos recommended following applicable practice guidelines, write in the first person and identify oneself, use a personal email address, be respectful and ensure online activity does not interfere with work commitment.
A group of students in an accelerated leadership course at the University of Medicine and Dentistry of New Jersey School of Nursing (UMSNJ) in Newark recently completed a project about the repercussions of nurses using social media.
Mallory Longfield, one of the students, said “nurses should be cautious about using social media, because of the lack of clear company policies, many nurses believe that their posts are private and that deleted content is no longer available, software coding can be complex, many nurses do not fully understand what exactly is considered ‘private,’ and there is a lack of training on HIPAA policies on a regular, ongoing basis.”
LaTangie Lane, another UMDNJ student, said nurses can accidentally put patient information out for public consumption, and nurses must be involved to accept the policy change, such as not bringing cell phones into patient care areas.
“We suggested: have meetings, set policies to not take pictures in the workplace,” Lane said. “You don’t want to even say things casually on Facebook.”
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