Digital professionalism comprises the competencies and values expected of professionals when communicating online. This article discusses the risks and benefits of social media use for nurses. This is a Journal Club article and comes with a handout that you can download and distribute for a journal club discussion.
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There are many benefits of using social media, including for nurses and student nurses, but caution must be exerted when doing so because there are many challenges that could conflict with professional guidance. This article is the fifth part in a series on professionalism; it identifies what social media and e-professionalism are and discusses the risks and benefits for nurses of using social media.
Citation: Smart A et al (2022) Professionalism in nursing 5: social media and e-professionalism. Nursing Times [online]; 118: 8.
Authors: Alison Smart is lecturer in education; Rachel Small is teaching assistant; Gary Mitchell is senior lecturer; Johanna McMullan is senior lecturer in education; Laura Creighton is lecturer in education; all at Queen’s University Belfast.
This article – the fifth in a series on professionalism in nursing – discusses social media use and e-professionalism in nursing. The definition of social media is broad and constantly evolving. The term refers to internet-based tools that, in real time, allow individuals and communities to:
- Share ideas, personal messages, information, images and other content (Carr and Hayes, 2015).
A range of social media platforms exist, including WhatsApp, Facebook, Twitter, Instagram, Snapchat, TikTok, LinkedIn, Google+, YouTube and other platforms that are country-specific. The term e-professionalism refers to digital professionalism and comprises the competencies and values expected of professionals when engaged in online communication (McGrath et al, 2019).
Registered nurses and student nurses need to understand the importance of demonstrating e-professionalism and abiding by the Nursing and Midwifery Council (NMC)’s (2018) Code, which extends to the use of social media. It is important to note that the NMC embraces the positive benefits of social media and its role in supporting registered and student nurses to connect and share knowledge with others, although it also highlights the risks.
As student nurses are not part of the live register, they are not held accountable to NMC standards; however, if a student nurse demonstrates unprofessional practice through social media, it will be investigated by the higher education institute (HEI) at which they are enrolled (NMC, 2018). HEIs, thereby, hold student nurses accountable and ensure suitable investigations take place when a lack of digital professionalism is evident.
Unprofessional digital practice examples include posting:
- Photos or comments that indicate drug use;
- Negative comments about colleagues, employers or patients;
- Other derogatory comments or content;
- Sexually explicit content;
- Content that jeopardises patient confidentiality (McGrath et al, 2019).
In 2019, the NMC produced a document called Guidance on Using Social Media Responsibly; the organisation’s code of conduct reinforces this professional guidance because, as nurses, we must use all forms of spoken, written and digital communication – including social media and networking sites – to promote professional practice and ensure confidentiality. The Code stipulates that nurses must treat their patients with kindness, respect and compassion (NMC, 2018), so it is important that social media posts made by nurses are not viewed as discriminatory towards patients; Box 1 lists examples of potentially discriminatory social media activity.
Box 1. Social media activity that could be viewed as discriminatory towards patients
- Sharing confidential information inappropriately
- Posting pictures of patients and people receiving care without their consent
- Posting inappropriate comments about patients
- Bullying, intimidating or exploiting people
- Stealing personal information or using someone else’s identity
- Encouraging violence or self-harm
- Building or pursuing personal relationships with patients or service users
Despite the NMC’s clear guidance, there have been several investigations into the social media use of registered nurses and other health professionals. Rimmer (2017) reported that approximately 1,200 NHS staff – including doctors and nurses – had been disciplined for misuse of social media or messaging applications.
Professional boundaries are essential for nurses to build and maintain therapeutic relationships. The NMC (2018) highlights that objectivity depends on boundaries between nurses and the people in their care, including current and previous patients, families, carers and partners. However, as personal information about health professionals and clients can be accessed easily, the risk of blurred boundaries is high (Westrick, 2016). Research has shown that patients often extend online friend requests to their doctors, nurses or other health professionals on social networking sites such as Facebook (Farnan et al, 2013).
Many NHS healthcare trusts have issued organisational policy statements strongly discouraging personal online communication between health professionals and patients; professional bodies such as the NMC and the General Medical Council (GMC) have done the same (NMC, 2019; GMC, 2013). In addition, nurses who post a significant amount of highly personal information on social media should carefully consider what impact this might have on their professional relationships (British Medical Association, 2020).
Confidentiality is a key area of discussion when considering social media. The need to maintain confidentiality for patients and colleagues is also an important aspect of professionalism for nurses; as stipulated by the NMC (2018): “as a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care”. It is not acceptable to discuss clinical matters outside of the clinical setting. If a social media post makes reference to work, this is likely to represent a breach of professional conduct because there is a need to demonstrate and respect the right to privacy and confidentiality.
In summer 2021, Kelly Morris, a registered nurse practising at The Citadel, a nursing facility in Winston-Salem, North Carolina, was suspended after posting multiple videos on her TikTok account about supposedly mistreating patients. The videos were shared with her 38,000+ followers and included jokes about unplugging a patient’s ventilator to charge her mobile phone and giving patients extra sleeping pills to avoid caring for them (Kilander, 2021). This activity was deemed unprofessional, because it negatively represented the nursing profession and breached the confidentiality of the facility where she practised.
As discussed above, there are many dangers from social media. When considering evidence-based practice, a major limitation of social media is the danger of reading or sharing sources of poor quality or reliability. ‘Fake news’ is a term that has grown in popularity over recent years and refers to false or misleading information presented as news. Fake news often has the aim of damaging a person or entity’s reputation or making money through advertising revenue (Ford, 2020).
At the beginning of the pandemic, Donald Trump made erroneous claims that injecting disinfectant and being exposed to ultraviolet light could help treat Covid-19. Due to this misinformation, many disinfectant manufacturers had to officially announce that their products were not for human consumption, but Trump’s comments were widely shared on social media (Frenkel and Alba, 2020).
In the spring of 2021, the NMC removed nurse Kay Shemirani (also known as Kate) from its register for spreading misinformation about Covid-19. Communicating with her 50,000+ Facebook followers, she referred to the pandemic as a ‘scamdemic’ and claimed the Covid-19 vaccination was a way for governments to invade people’s private thoughts. She also said the use of face coverings was not evidence-based, was more likely to make people unwell, and that compared NHS staff adminstering the vaccine to the actions of the Nazis. The NMC interpreted Shemirani’s active dissemination of these conspiracy theories to be misconduct due to the dangerous nature of the messages (Baines, 2021).
Although using social media poses risks for registered and student nurses, it must be stressed that it also has several advantages. Social media has the potential to connect nurses and nursing students to their immediate colleagues, interdisciplinary colleagues and the public. The use of social media is also an emerging and popular way to increase public understanding about nursing and the complex roles nurses can occupy (ten Hoeve et al, 2014).
Social media can also be a low-cost way to share best nursing practice; for example, it has become much easier to remain up to date with changes to guidelines, as these are often released via social media. Engagement with reputable online publications can also contribute to continuing professional development and, if reflected on and documented, can be used in the NMC revalidation process. The Resuscitation Council UK recently published a video explaining how to perform cardiopulmonary resuscitation during the Covid-19 pandemic and disseminated it via Facebook, Twitter and YouTube.
Social media also gives registered and student nurses a chance to self-publish and share information via blogs. Although blogs are often not considered to be a robust source of evidence, they can play an important role in sharing information and give users a platform to convey their message (Moorley and Chinn, 2019). As an example, in the year after the emergence of Covid-19, nurse lecturers Alison Smart and Deirdre O’Neill wrote a blog to inform registered nurses, student nurses and nurse educationalists about the importance of self-care; this is available on Queen’s University Belfast’s website.
Recommendations for practice
Maintaining e-professionalism when using social media is an important area of education for student nurses, registered nurses and other health professionals. As discussed in this article, there are several threats to maintaining professionalism while engaging with social media; however, there are also important benefits and, when social media is used professionally, these benefits far outweigh the risks. Box 2 lists tips for developing and maintaining a high-quality, professional social media profile; Box 3 suggests some ways of reviewing and assessing social media activity.
Box 2. Tips on how to have a high-quality, professional social media profile
- Consider separating your personal and professional social media profiles by, for example, using Twitter as a professional channel and Facebook as a social channel. This is useful because each channel will have a different audience
- Think about your audience and who you want to engage with each social media post. As an example, when sharing a useful article about nursing, consider whether it is colleagues or friends and family who will want to read it
- Consider the language you use and be careful to avoid stereotyping and labelling; for example, using the term ‘older people’ instead of ‘elderly people’ is recommended
- Be careful about which social media posts you reshare. People often perceive this as an endorsement and if you reshare an anti-vaccination post, for example, your social media followers may interpret this as your point of view
- Profile your work on social media by, for example, posting about passing exams, sharing news of an award or highlighting quality-improvement outcomes (while protecting the confidentiality of people in your care)
- Use social media in accordance with the Nursing and Midwifery Council’s (2018) Code; as an example, maintain appropriate professional boundaries with patients
- Participate in continuing professional development activities using social media, such as by getting involved in a Twitter conversation relevant to your field of practice. This activity can be used as part of your professional revalidation
- Promote social media to your colleagues and patients by, for example, educating patients about the benefits of online patient support from a charity or special interest group
- Promote the nursing profession to your peers, colleagues and the public
- Limit screen time outside of work to two hours per day
Box 3. Reviewing social media activity and assessing boundaries
- Check the settings on all your social media accounts:
- Who can see what you post?
- Can someone tag you in a photo without your consent?
- Do you have optimum privacy on your social media accounts?
- Ask a friend to critically review one of your social media accounts and identify any posts that might be considered unprofessional
A nursing student posts a selfie on Twitter on the last day of their clinical placement.
The ward board is visible behind them and identifies patient information.
- Why is this not an acceptable post?
- What aspects of the Nursing and Midwifery Council’s (2018) Code does it compromise?
A student nurse you know recently completed a clinical placement on a neonatal unit, where a newborn they cared for died after complications. The student developed a close relationship with the baby’s parents and the mother has sent them a Facebook friend request. Consider the steps the student nurse should take to maintain professional boundaries while ensuring compassionate care for the mother
The professional use of social media is recommended for all nurses, student nurses and health professionals. Using social media can help them develop knowledge and skills that could enhance patient care. However, when nurses use social media, it is vital they maintain e-professionalism and follow the NMC’s Code and other applicable guidance.
- Professional nursing guidance extends to social media use, and higher education institutes hold student nurses accountable
- There have been several investigations into the social media use of registered nurses
- It is important to maintain professional boundaries on social media platforms
- Nurses must maintain patients’ confidentiality and avoid sharing misinformation online
- Social media can enhance nursing practice and contribute to continuing professional development
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British Medical Association (2020) Social media as a medical student. bma.org.uk, 1 May (accessed 28 June 2022).
Carr CT, Hayes RA (2015) Social media: defining, developing and divining. Atlantic Journal of Communication; 23: 1, 46-65.
Farnan JM et al (2013) Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Annals of Internal Medicine; 158: 8, 620-627.
Ford S (2020) Fake news on coronavirus could make disease outbreak worse. nursingtimes.net, 17 February (accessed 28 June 2022).
Frenkel S, Alba D (2020) Trump’s disinfectant talk trips up sites’ vows against misinformation. nytimes.com, 30 April (accessed 28 June 2022).
General Medical Council (2013) Doctors’ Use of Social Media. GMC
Kilander G (2021) Nurse suspended for TikTok videos about mistreating her patients claims they were comedy skits. independent.co.uk, 29 June (accessed 5 July 2022).
McGrath L et al (2019) Understanding the benefits and risks of nursing students engaging with online social media. Nursing Standard; 34: 10, e11362.
Moorley C, Chinn T (2019) Social media participatory CPD for nursing revalidation, professional development and beyond. British Journal of Nursing; 28: 13, 870-877.
Nursing and Midwifery Council (2019) Guidance on Using Social Media Responsibly. NMC.
Nursing and Midwifery Council (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
Rimmer A (2017) Doctors’ use of Facebook, Twitter and WhatsApp is the focus of 28 GMC investigations. BMJ; 358: j4099.
ten Hoeve Y et al (2014) The nursing profession: public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing; 70: 2, 295-309.
Westrick SJ (2016) Nursing students’ use of electronic and social media: law, ethics and e-professionalism. Nursing Education Perspectives; 37: 1, 16-22.