Speaking of facebook...inappropriate...but am I within my rights...?

Nurses General Nursing

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I'm head nurse at a long term care facility. I have a truly wonderful team and we have a great working relationship. Several of them are friends on facebook.

The other day I noticed one of the facility's residents leaving a message on one of my team member's page. When I checked I noticed that three of my team members were friends with this resident. Some of this resident's comments at work suddenly made sense to me....that's where it came from.

As far as I am concerned, it is most definitely not appropriate for caregivers to have an outside relationship (even on facebook) with a patient or resident under their care. I spoke with the director of the facility and she agreed with me. So I spoke with two of the three and both of them said that they agreed to take the resident as a friend and now they regret it. They don't know how to remove the resident as a friend and explain it. I told them to tell the resident that it's not appropriate and that the head nurse asked them to do so. That's the easy part.

The third team member is my assistant head nurse. She's in when I'm off. She is always chatting with the resident on-line and I seriously doubt she will want to stop.

Now the question here is this: am I within my rights as head nurse to tell her to stop and remove the resident from her list of friends?

No one has said why it's bad to do this sort of thing, just that it's unethical and crosses boundaries. Can anyone give any specific reasons why this is bad?

I still don't see how what you do outside the workplace is any of the hospital's business as long as you don't treat patients differently in the hospital and don't violate HIPAA.

for the majority, nothing 'bad' will happen.

it's those few pts, who produce the necessity of these laws.

some pts expectations can change, once a nurse becomes their 'friend'.

the couple of pts who i did befriend, started responding to me with, "if you were really my friend, you'd..."

or if i told them something they didn't necessarily want to hear, "you're not my friend" and all the interesting dynamics that go with it.

it can and does, sometimes escalate into a precarious situation, that can affect your professional duties as well as a once-cherished-relationship.

by all means, enjoy and embrace your pts...

from a distance.

leslie

for the majority, nothing 'bad' will happen.

it's those few pts, who produce the necessity of these laws.

some pts expectations can change, once a nurse becomes their 'friend'.

the couple of pts who i did befriend, started responding to me with, "if you were really my friend, you'd..."

or if i told them something they didn't necessarily want to hear, "you're not my friend" and all the interesting dynamics that go with it.

it can and does, sometimes escalate into a precarious situation, that can affect your professional duties as well as a once-cherished-relationship.

by all means, enjoy and embrace your pts...

from a distance.

leslie

Honestly, I don't think this is the least bit unique to patients. Can you really sit here and tell me you've never had a non-patient friend try to pull that trick to try to get something out of you? There are bad apples all around, patient or no. When it's a patient, you simply explain to them in a professional manner that they need to let you do what you do in order to provide them the care they need.

Specializes in LTC,Hospice/palliative care,acute care.

This is a LTC facility. These residents live here. And a lot of them don't have family around. It's only natural that they make friends with people in their environment. And that includes the staff. In an hospital ER, maybe I can understand not getting too attached to the patients. But if you're working with the same people day in and day out for extended periods of time, its inhuman not to become friends with them.

In LTC these situations can become pretty complicated.It only takes the appearancee of impropriety to bring the ombudsman or dept. of health in to investigate. It is a challenge for nuring homes to keep up with their policies and procedures regarding electronics (cell phones,computers,etc) but each facility should have clear p and p in place. That said-you can't really "make friends" with your ltc clients and remain impartial and objectively deliver the care they deserve. We can love them alot sometimes-hopefully we have a co-worker beside us to steady us when things go downhill.
In LTC these situations can become pretty complicated.It only takes the appearancee of impropriety to bring the ombudsman or dept. of health in to investigate. It is a challenge for nuring homes to keep up with their policies and procedures regarding electronics (cell phones,computers,etc) but each facility should have clear p and p in place. That said-you can't really "make friends" with your ltc clients and remain impartial and objectively deliver the care they deserve. We can love them alot sometimes-hopefully we have a co-worker beside us to steady us when things go downhill.

I don't see how being friends with them makes you less impartial then loving them.

Specializes in LTC,Hospice/palliative care,acute care.

What I meant was sometimes we DO just love them to pieces in LTC because we are with them every day-and it can be really difficult to maintain our objectivity. When you have 20 or 40 residents to care for you can be spread pretty thin-not alot of time to chit chat with a friend when the old grump across the hall needs you.

Specializes in Peds Homecare.

:redlight:I have a question? What were you doing looking so closely at your patients FB page? Seems like you were invading the patients privacy. :twocents:. I have many, many FB friends, and if you were to look at them all you would have to be signed into my account and hit the all friends list. What was your excuse to the patient while you were wading through their friends list? Were you standing behind the patient and looking over their shoulder? You seem to want to tell these nurses what to do in the cause of Nurse/Patient distance, but how did you find all this out?:typing I wonder if you explained to upper management how you came to this conclusion? And if part of the answer is that you are on their friends list, I'd defriend you quickly.

Specializes in Med/Surg, Home Health.

I work homehealth and I am here to tell you that I have a few of my long-term patients on my facebook friend list and I haved no intention of removing them. One is a quadraplegic whose only contact with the world is by internet, including facebook. I am his nurse, I am also his friend. He has NEVER said/done anything inappropriate. I also have another patient who is bedbound and her only connection to the world is by internet. She is also a friend on my facebook. We do not chat on there. But we do post on each other's walls at times.....things like "happy thanksgiving" etc. I am human and so are my patients. I am their nurse first, but I am also capable of being a friend to them. It is outside of my work and no one's business.

If a patient starts saying things like "if you were my friend, you would.." then I would have a talk with them and possibly delete them. But my goodness, being a nurse does not mean we have to be so impersonal. yes, we need to set boundaries, but that doesnt mean we have to build a cement wall between all of our patients and ourselves.

Honestly, I don't think this is the least bit unique to patients. Can you really sit here and tell me you've never had a non-patient friend try to pull that trick to try to get something out of you? There are bad apples all around, patient or no. When it's a patient, you simply explain to them in a professional manner that they need to let you do what you do in order to provide them the care they need.

nobody said it's unique to anyone.

and much of this is going to depend on exactly what kind of friend it is?

"facebook friends" can mean everything, nothing, and everything inbetween.

but if they're really, really "friends", you're crossing lines and the npa says so.

if you read about it (i believe it's under "professional conduct"), you'll gain a broader understanding of the "why nots".:)

In LTC these situations can become pretty complicated.It only takes the appearancee of impropriety to bring the ombudsman or dept. of health in to investigate. It is a challenge for nuring homes to keep up with their policies and procedures regarding electronics (cell phones,computers,etc) but each facility should have clear p and p in place. That said-you can't really "make friends" with your ltc clients and remain impartial and objectively deliver the care they deserve. We can love them alot sometimes-hopefully we have a co-worker beside us to steady us when things go downhill.

good points, ktw.

while the op sounds like a most capable, competent person, it is situations such as the ones you mentioned, that will aid him in preparing for any obstacles that may come along.

and op...

you are AWESOME!!!:balloons::balloons::balloons:

leslie

Specializes in LTAC, Onco/Hemo, ER, Clinic, Agency.
:redlight:I have a question? What were you doing looking so closely at your patients FB page? Seems like you were invading the patients privacy. :twocents:. I have many, many FB friends, and if you were to look at them all you would have to be signed into my account and hit the all friends list. What was your excuse to the patient while you were wading through their friends list? Were you standing behind the patient and looking over their shoulder? You seem to want to tell these nurses what to do in the cause of Nurse/Patient distance, but how did you find all this out?:typing I wonder if you explained to upper management how you came to this conclusion? And if part of the answer is that you are on their friends list, I'd defriend you quickly.

I came across post just browsing through the nursing news, which I enjoy reading...and am joining specifically because of this thread.

What were you doing going through everybody's personal information? Be it the staff, or resident, that to me would be a red flag to find another place of employment, specifically if my 'boss' took it upon him/herself to "check up on my facebook". Forgive me if I'm wrong, but, the way you present the situation, and the context of what you found, it seems as though your leadership style is a bit off. On line, we have no privacy, by this day in age, most of us know that (hopefully at least). Everything you say/type and do can be traced (think Big Brother). Personally, I find it rather unproffesional to befriend a patient on facebook. However, like the term 'ethics' that statement is simply based on my morals and opinions. That being said, I'm wondering who made the wrong choice in befriending who? Your asst befriending you? (Who befriends their boss on Facebook?) Or your asst befriending the patient? :eek:

That's my opinion, which like all others on this board, is a dime a dozen.

Now, what would I do, if I were you? Make management and corporate aware. Leave the reporting and legalities of the situation up to them. I do believe your heart was in the right place by just glimpsing, but, if you did violate the resident's privacy, you would and could be targeted by an Obudsman or the Resident Council. (This has recently happened in our facility with a RN supervisor).

Specializes in Med/Surg, ICU, educator.
Honestly, I don't think this is the least bit unique to patients. Can you really sit here and tell me you've never had a non-patient friend try to pull that trick to try to get something out of you? There are bad apples all around, patient or no. When it's a patient, you simply explain to them in a professional manner that they need to let you do what you do in order to provide them the care they need.

Yes, SilentMind, it can happen in any type of relationship, but within the patient/caregiver relationship, it can turn ugly, like accusations along the lines of care. To the point of someone losing a license and even lawsuit. And yes, it has happened. Now those of you who think that it's okay to have this type of relationship with a patient, go ahead and do so, I won't lose sleep over it, but if the BON in your state pursues you, remember that it is in the nursing code of ethics that the relationship is not appropriate. And claiming ignorance of this fact will not get you out of trouble. As a previous poster stated, the BON is not our friend, it is there to protect the patient.

Specializes in Post Anesthesia.

The ability of some people to get through Nursing school and still have a complete inability to think has always been a mystery to me. You are right- this contact is not appropriate. We have had this type of issue (not face book but other issues in the same line) come up on every unit I have ever worked- it still astounds me.

Specializes in Cardiac Telemetry, ED.

The third team member is my assistant head nurse. She's in when I'm off. She is always chatting with the resident on-line and I seriously doubt she will want to stop.

Now the question here is this: am I within my rights as head nurse to tell her to stop and remove the resident from her list of friends?

I would say that you're well within your rights to advise her that this violates the provision for maintaining professional boundaries as set forth in the nurse practice act.

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