Concerned about social media use by nurses, non-hospital staff

[guest17]

I recently made the dramatic shift from acute geri & LTC to a pediatric long term, short stay medicine unit. One high turnover area to another.

I am concerned about the actions of some of the nurses, doctors, and even non-hospital staff in how much they're sharing patient information. Some staff are talking over facebook messenger about the status of patients. Staff on shift will report to nurses, doctors, volunteers when they're not on the floor, on vacation, etc.

I discovered this when a heard a co-worker thank others for keeping her updated about her patients after a week vacation. I asked how, and she said "facebook". She also mentioned how the parents were also keeping her aware of their child's state.

When I asked if they should be doing that, it was essentially shrugged off, as if to say "everyone is doing it". Looking in our protocols, it says not to share patient info for the public eyes to see. So it seems they found a loophole by using messenger amongst themselves.

I find this not only to be a mistake waiting to happen concerning HIPAA, but it's probably causing the high turnover rate. When nurses, heck, even doctors are wanting to know about their patients 24/7, it'll wear them out. They are friends on facebook with the parents of children who are admitted and volunteers who visit the unit. This is outrageous to me.

Should their actions be addressed? I don't have any proof as I don't have a facebook account. So no "patient reports" are ever discussed with me outside the hospital. This seems to be a part of the work culture on the floor, and have never seen the nurse manager address it. I'm still new to the floor and I know that co-workers will likely suspect I talked if there are sudden dramatic changes about social media usage, but the actions of the staff just seem wrong to me.

Any advice?

[nurse2033, MSN, RN]

You have described some probable HIPAA violations. Technically, once you are no longer in direct patient care, you have no "need to know" about ongoing patient information. This would include followup. Staying in touch with parents may not be a HIPAA violation but probably a professional one. It crosses the boundary between professional and personal. You could report this to your corporate compliance line, which should be confidential for you, and let them investigate. Unless you are a manager or supervisor there isn't much you can do about unit culture. Good luck.

[guest17]

There's an ethics and compliance group here, so hopefully they can step in. I don't know if anyone will admit to what's going on, but I'll have to wait and see.

Thanks very much for your input.

[KelRN215, BSN, RN]

There was some of this in the hospital I worked at. It was not uncommon, for example, to call to check on a patient you cared for if he or she was starting to go bad at change of shift or if something crazy happened on your shift or if it was a long term patient who was dying. When kids died on our unit, it was common to call the nurses on their primary team to let them know.

Examples I can think of:

*I took over a patient s/p VP shunt revision for the night shift. The nurse before me took her back from the PACU and her parents were immediately concerned that she was too drowsy. Then she started vomiting. We went down for a head CT and back to the OR she went because the shunt catheter was in her temporal lobe, not her ventricle. I did let the nurse who had her before me know what ended up happening

*I once took a patient on the day shift whose night shift nurse didn't draw her scheduled vanco trough. I drew it before the next dose, it came back critically elevated (like 60 something) along with an elevated BUN. Renal hadn't come by before I left so I asked the nurse who I passed her off to later that night what they ended up saying.

*One of my primary patients was a baby with hydrocephalus whose case was egregiously mismanaged by our Neurosurgery team (I'm still convinced the case would have gone to court had her parents not been teenagers who didn't know anything). I rushed that baby emergently to the OR more than once. One time, it was at 6am at the end of the night shift. I didn't leave work that morning until 9:30am. I did call to check on her later in the day because I wanted to know she was ok before I went away for the weekend.

If I were you, I'd leave it alone and just not partake in any of it. One new person cannot change the (probably long standing) culture of an entire unit and you could find yourself ostracized. Talking by facebook messenger is private, it's not sharing information publicly. You could conceivably ask the nurse you handed a patient off to, for example, "how's my baby?" and she'd know who you were talking about but no one else would.

[MilliePieRN]

If you're not participating and no one is messaging you, I believe it's really no concern of yours. Parents/patients can't violate their own hipaa rights. You don't really know what was shared. It's even possible to keep someone somewhat updated and it not even be a hipaa violation. "hey, that pt is doing well" or "they man you were concerned about came through his sx ok." I just don't believe in someone looking for and causing trouble for no reason. If someone asks you to share pt information, just say no. Easy peasy.

[ruby_jane, BSN, RN]

Tread carefully in your new environment. You don't have to do as they do!

[psu_213, BSN, RN]

At this point, all you have is hearsay that this is going on. Sounds like a HIPAA violation, but if you report it, really nothing substantive can happen because it is, well, hearsay. All that you will accomplish is getting yourself labeled as the unit tattle tale. My advice, until you have concrete proof of this taking place, stay out of it.

[Persephone Paige, ADN]

That sounds insane. I wouldn't even be friends on FB with people from work, let alone patients. When they ask me I say I don't have an account. This will eventually bite them in the bum, just be glad you have better sense.

[LovingLife123]

I can imagine in Peds, this would be common as the nurses become quite close with these family members.

In the adult world, I have checked on a patient before. If I had a crazy day and things were falling apart, but was off the next day, I have asked coworkers about the outcome. I think that is human nature. I never post publicly or even on our private Facebook group but I have used Facebook messenger.

It may be as simple as how is room number doing? Yesterday was crazy and I need to know if they are alive.

I've never friended a family but I would think it Peds it happens.

[nurse2033, MSN, RN]

The best way to follow up on a patient is to go see them in their room. "How are you doing?". They are free to share information if they wish, or not. They will certainly appreciate that you care enough to check on them not on the clock.

[guest17]

Thanks for all the comments. I will take the advice from psu_213 since it really is heresay at this point. Put up with it and learn from their mistakes. When it hits the fan, I know I wont be bit in the butt.

I find it so odd how this kind of stuff would never fly with the geri/adult population, yet it seems acceptable with peds.