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An ER nurse has a rough day at work. When she gets home she vents on facebook about her exhausting shift, about the drug addict that staggered in, about the drunk that urinated on himself in the waiting area, and how irritable each of her patients were that day. Harmless, right? She didn't mention any names. Didn't post any pictures. And yet, a 'friend' of the nurse who was angry at her, decided to file a complaint with her state board of nursing alleging "unprofessional conduct." Though this is a hypothetical situation, the end result is fairly common. If the nurse does not have her own professional liability insurance, she may not be able to afford a lawyer. And though she probably does not feel she did anything wrong, she could end up plea bargaining with the board and taking a year of probation. Probation appears on your record and can have adverse effects when you apply for a job. What to Avoid When Posting Many of us use social media daily to share our lives with friends, colleagues and family. Unfortunately, there are associated risks, particularly for nurses, who are held to a high standard by their state boards. Two areas of risk include: Unprofessional behavior Examples include posting photos or comments about alcohol or drug use; profane, sexually explicit, or racially derogatory comments; negative comments about co-workers, and employers; or threatening or harassing comments. Patient privacy and/or confidentiality Breaches of patient privacy/confidentially can be intentional or inadvertent, with inappropriate postings including patient photos, negative comments about patients, or details that might identify patients. A Simple Tweet or Text can Result in a Licensing Complaint Violations of the above risks can result in a complaint being filed against your license with your state board of nursing. Complaints can be filed by virtually anyone, including friends, family, patients, patients' family members, your employer, even your own spouse. Licensing complaints are more common than you think. There are almost 30 times more licensing complaints filed against nurses than malpractice lawsuits. Between 2010 and 2014, there were 3,357 malpractice suits filed against nurses and 96,659 licensing complaints.* Disciplinary actions by your state board can involve; no action, a simple reprimand, fine, continuing education, probation, suspension or permanent loss of licensure. Simple Do's and Don'ts When Posting, Tweeting, Texting or Blogging By using caution, nurses can enjoy the benefits of social media without risking the loss of their license and their livelihood. The following tips can help keep your social media content in the clear Always maintain patient privacy and confidentiality. Do not post patient photos or videos of patients or identify patients by name. Do not refer to patients in a disparaging manner, even if patients are not identified. Use caution when connecting with patients or former patients via social media. Do not post inappropriate photos, negative comments about colleagues or employers. Never discuss drug and alcohol use. Use social media to post positive comments about your workplace and its staff. Share educational information that may benefit others, such as safety notices and medical news. It is permissible to refer doctors, specialists and healthcare practices. Use social media to enhance the role of nursing in the community, among friends and the public. Remember posting, tweeting, texting and blogging are not private communications and can be used against you in an investigation by your Board of Nursing Protect Yourself Social media is great way to connect with family and friends, but you need to be cautious. If a complaint is filed against your license for whatever reason, your state board of nursing will conduct its own investigation. That could include looking to see if you have a presence on social media. You might be investigated for one reason, and have your situation made worse by comments you made on facebook, Twitter or in text message. Nursing professionals need to be aware that online postings are permanent and can negatively affect their license and ability to practice. Think twice before you post content that could be judged as "unprofessional." About the Author Melanie Balestra, NP, Esq., owns her own law practice, the Law Offices of Melanie L. Balestra in Irvine, Calif. She also works as a pediatric nurse practitioner at the Laguna Beach Community Clinic in Laguna Beach, Calif. *National Practitioner Data Bank, Department of Health & Human Services, www.npdb.HRSA.gov, October 2016.

Though it can vary by state, typically the statute of limitations to file a medical malpractice lawsuit is two to three years. Though most claims are settled out of court, if it does go to trial, the average malpractice case takes 3-5 years to resolve.* Now, take all the patients you see in a week, a year, three years. Then imagine being called to testify in a trial involving medication you administered a patient six years ago. Without documentation, it can be difficult to remember exactly what happened four months ago, let alone six years ago. Regardless of whether you are using electronic or hand-written medical records, get into the habit of thoroughly documenting the file so any healthcare provider can clearly understand the patient's condition, treatment and all interventions you performed on their behalf. When a malpractice claim occurs, your legal team uses the patient record to build a defense. If the documentation is absent, incomplete, or sloppy, it can reflect poorly on you and make it impossible to mount a successful case. Complete, accurate documentation will help you build a strong defense. Practice These 3 Rules to Avoid Common Charting MistakesCheck that you have the correct chart before you begin writingWhile this may sound like common sense, if patients in the unit have the same name, same condition, or same doctor, it can often lead to confusion that causes charting errors. When you have two or more patients with the same name, a good tip is to make sure a different nurse is assigned to each patient. Record all pertinent health or drug informationIn a recent case, a nurse neglected to record her patient's penicillin allergy in the admission notes. An intern who wasn't aware of the allergy gave the patient a penicillin injection, causing them to go into anaphylactic shock and suffer irreversible brain damage. Forget to record a patient's food and drug allergies, diseases or chronic health conditions that caregivers need to know about, and you could end up in court. Record all nursing actionsIn another case, a day nurse observed heavy drainage from a surgical wound and changed the patient's dressing, but forgot to document it. When the evening nurse checked the notes and found no evidence the dressing was changed, she considered the amount of drainage normal for a period of several hours. What if the condition had worsened? No one knows whether to raise an alarm if each nurse's actions are not recorded. These tips may also help you improve your chartingChart promptlyAs soon as possible after you make an observation or provide care, document your action. If you wait until the end of your shift, you could forget important information. Check spelling and grammarMisspelled words and poor grammar make an unprofessional impression. Keep it neatThere is nothing worse than not being able to read your own handwriting. Illegible notes could lead to a patient injury. Be conciseAvoid vague terms such as "appears" or "apparently" when describing symptoms. They make you sound unsure of your observations. Use objective termsDocument the specific length, width, and depth of the wound or for a small wound compare it to a common object ("size of a penny"). Chart a patient's refusalIf a patient refuses to take a medication or allow treatment be sure to document it in the chart and report it to your supervisor and the patient's physician. Avoid criticismDon't criticize the patient and/or other caregivers. Most patients have the right to review their clinical records, so be professional. Correct errors properlyIf you make a mistake, draw a line through it and write "mistaken entry." Never erase an erroneous entry, which could appear like a cover-up. No matter what you did, it is easily proven if clearly documented. If you want to stay out of the courtroom, document, document and document should be the mantra around all patient care activities. *Chesanow, Neil, "Malpractice: When to Settle a Suit and When to Fight," Medscape, Sept. 25, 2013. Resources8 Common Charting Mistakes to Avoid, Marianne DeMilliano, BSN, JD, Defensive Documentation Do's and Don'ts of Documentation Documentation on Trial: 9 Ways to Protect Your Agency Documentation: Proactive Prevention of Litigation, Barbara Resnick, PhD, CRNP, University of Maryland, School of Nursing This article is provided for general informational purposes only and is not intended to provide individualized business, insurance or legal advice.