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Social Media and Patient Care: Understanding the Rules

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You receive a Facebook Friend Request from a patient's wife. Should you accept it? If you've ever dealt with this or other social media situations, learn a few tips and the reasons behind them here.

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Social Media and Patient Care: Understanding the Rules

Social media can penetrate all areas of your life. As a nurse, you understand the importance of professional boundaries, but this unique medium poses a potential threat to your ability to maintain therapeutic relationships with your patients and their families.

Understanding Professional Boundaries

The National Council of State Boards of Nursing reports that professional boundaries are the spaces between the nurse's power and the patient's vulnerability. Your relationship with your patients is unequal, meaning that you know more personal information about them than they know about you. While you must respect this imbalance of power, you also need to maintain it to keep a healthy distance between you, your patients, and their family or caregivers.

Social media can quickly create imbalances in the therapeutic relationship. To better understand social media and patient care, let's explore a few scenarios.

The Friend-Request

You hop on Facebook and see you have a new potential friend waiting to hear from you. The name sounds familiar, but you can't quite place it. You click on the profile to see the picture, and it hits you - it's the wife of the patient in Room 220. You've been caring for her husband for the past week and have had some great conversations. You go to click "confirm," and a quiet voice tells you that you might need to reconsider. What should you do?

How to handle this situation

  • You shouldn't accept this friend request. Allowing the patient's wife to have access to more personal information about you can shake up the balance of the therapeutic relationship.
  • If the patient is still in the hospital, talk to her face-to-face and let her know that while you enjoy talking to her and caring for her husband, you can't accept the friend request. If the patient is no longer in the hospital, decline the friend request and send a personal direct message letting her why you can't accept the friend request.
  • Check with your hospital's social media policy to ensure that this isn't a reportable occurrence.

The Insta-Celebrity Patient

You walk into the room of Eva Lopez. She's been admitted for acute pneumonia, but rather than lying in bed resting, she's putting on her make-up and setting up a small lighting contraption on her over- bed table. When you ask her how she is doing and inquire into the reason for the light, she tells you that she has an online business and blog. She goes on to say that she has over 50K followers who want to see images of her daily and part of her gig is to be transparent with her life.

You talk briefly about your side gig - a lifestyle blog helping fellow nurses. Eva tells you that she can probably get you a few thousand followers just by letting her take a picture of you next to her in bed. She also says that you should follow her on Insta and she will follow you back, which should get you even more followers. You're interested, but not quite sure if it's a good idea.

How to handle this situation

  • Taking a quick photo with Eva might be tempting. However, you know without a doubt that she is going to post it and you will likely see some growth in your side gig because of it. Before you do anything, read the facility policy about patients taking pictures of staff.
  • If you read the policy and think that it might be okay, talk to your immediate supervisor about it before you allow Eva to snap that picture. Better safe than sorry because, as you know, once something is out on social media, the chance of getting it back is slim to none.

Showing Support to the Patient

Maria, a cancer patient you've been seeing in hospice for the last few months posts regularly to a hospital-supported social site. While looking at a recent post, you notice that she mentions how severe her pain has been lately and how she feels a bit depressed. To show your support, you remind her that the new antidepressant and pain medications should be helping soon and that you would discuss a few other things during your next visit tomorrow.

Before you go to see Marie, you stop at the grocery store. Mrs. Smith, a local school teacher who is friends with Marie, chats with you in line and asks how Marie is doing. She then inquires what medication they started Marie on because she takes Zoloft and wonders if that's what Marie needs too. At that moment, it hits you - while the people on the site have been invited by Marie, you probably shared information that you shouldn't have shared.

How to handle this situation

  • In this scenario, the information has already been released. You need to talk to Marie and let her know what you did. You also need to report this incident to your immediate supervisor as soon as possible.
  • It's important to remember that privacy breaches can still happen on sites such as this one because you've given information without Marie's permission.

What other scenarios have you encountered with social media? Or, do you have any other social media advice for nurses? Share in the comments below. Schedule

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Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. You can see more of her work at www.melissamills.net.

26 Likes, 5 Followers, 80 Articles, 18,101 Visitors, and 222 Posts.

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This is my take on social media, your mileage may vary. Social media is my personal space. While I am very careful in what I post (no drunk half naked pics, etc) some of what I post has no business in the workplace. For me this is a very definite line I am not willing to cross. Not only do I not friend patients and their family members, I do not friend coworkers. I use my middle name with a unique spelling as my last name on these account. This is to prevents anyone from searching for my account by name. I also have different email accounts for professional/business use and for my family and friends. I also turn off the features that might enable someone to search me out. If asked I politely tell coworkers, patients and families I do not friend anyone except my family members and close friends.

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This is my take on social media, your mileage may vary. Social media is my personal space. While I am very careful in what I post (no drunk half naked pics, etc) some of what I post has no business in the workplace. For me this is a very definite line I am not willing to cross. Not only do I not friend patients and their family members, I do not friend coworkers. I use my middle name with a unique spelling as my last name on these account. This is to prevents anyone from searching for my account by name. I also have different email accounts for professional/business use and for my family and friends. I also turn off the features that might enable someone to search me out. If asked I politely tell coworkers, patients and families I do not friend anyone except my family members and close friends.

JavaJunkie RN - This seems like a very good plan! ~melissa

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This is my take on social media, your mileage may vary. Social media is my personal space. While I am very careful in what I post (no drunk half naked pics, etc) some of what I post has no business in the workplace. For me this is a very definite line I am not willing to cross. Not only do I not friend patients and their family members, I do not friend coworkers. I use my middle name with a unique spelling as my last name on these account. This is to prevents anyone from searching for my account by name. I also have different email accounts for professional/business use and for my family and friends. I also turn off the features that might enable someone to search me out. If asked I politely tell coworkers, patients and families I do not friend anyone except my family members and close friends.

Gotta agree with you. I do FB but use only my first and middle name as my last name is very unusual. I don't ever ever post anything about work, good, bad, indifferent.

I did have one instance where a friend is friends with a patient - totally caught me by surprize. So, I ramped up my security a little more.

Thanks Melissa

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I accepted 3 friend requests out of about a dozen from former patients' parents over my 6 years working in the neonatal ICU. All requests were initiated by the parents and were initiated after their baby was discharged. Each time I asked myself, would I be willing to lose my job to stay in contact with this family? In those 3 instances, the answer was yes. On a more personal and less professional note, it was something I prayed about until I felt peace about my decision with each one.

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I post a different name on FB. I have one former patient from a job at which I no longer work as a friend.

My bigger problem is being a School Nurse in the HS in my town. No fireball shot pics for me! I do have parents as friends. They were my friends long before I became a school nurse. No students.

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At my last facility, I made the mistake of accepting a friend request from a few nurses on my new unit, and then I realized that I would have to accept ALL friend requests so not to give the appearance of favoritism. It got out of hand (this was around the time of the 2016 election, and if you know how opinionated I am here, my Facebook is even worse because FB doesn't $#*%^ out my curse words) and I ended up unfriending everyone I worked with because I realized I can't have an effective working relationship with people when I know their political opinions and I'm constantly thinking "Why the **** would you vote for that *******??" Now, prior to moving to the new community and facility I'm now at, I changed my FB name to my maiden name so I'm not searchable by coworkers or anyone in this new community.

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I can't see anything good happening for my career by having a "social media" presence & I can see lots of bad things are possible.

The only "safe" things to post on social media are cat pictures and recipes- you can google those pretty easily without giving all your information to the Russians.

Deleted my Facebook ~8 months ago & not feeling a sense of loss..

I'm wondering how long it'll be & how bad it'll have to get before more people drop out.

Facebook is really really creepy with how much they snoop & how unregulated that snooping is.

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I can't see anything good happening for my career by having a "social media" presence & I can see lots of bad things are possible.

The only "safe" things to post on social media are cat pictures and recipes- you can google those pretty easily without giving all your information to the Russians.

Deleted my Facebook ~8 months ago & not feeling a sense of loss..

I'm wondering how long it'll be & how bad it'll have to get before more people drop out.

Facebook is really really creepy with how much they snoop & how unregulated that snooping is.

I congratulate you. I'm not quite ready to delete my Facebook, although I'm no longer very active there.

I've seen colleagues get in trouble over Facebook activity, and some were suspended or fired. A charge nurse one time posted a picture of a permanent night shift employee dozing off at work. We've all dozed off on night shift, and this nurse was sitting at a computer, probably charting, and just drifted off. The charge nurse was suspended, but eventually got his job back. It what is probably perfect karma, someone posted a picture of HIM, shoes off, feet on the desk, pillow and blanket and sound asleep. It looked as if he had INTENDED to take a nap there. He no longer works at the institution. Other people have been terminated over racist remarks about professional sports figures and looters in the riots after the Ferguson fiasco.

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Believe it or not, I feel much more connected to friends and family since I deactivated my Facebook account two months ago. It is liberating!

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