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

netglow, ASN, RN · Nov 28, 2009

Facebook is public. Don't trick yourself to believing that people are entering some "private space" of yours. I have assisted in hiring decisions in which a Facebook search has been a weighted aspect.

You can always do as you wish in life. I'd take heed of the great ethics and general employment advice given. If you just cannot wrap your brain around it, go back to the first legal focus in your nursing text if you have to. There are boundaries that cannot be crossed, it's simple as that.

For your own protection, do not dismiss this because it's an electronic boundary you are crossing. Some older text might not list "Facebook" but you should be able to make those connections that it's personal not professional contact when you do this. After all some posters are upset actually stating that they feel facebook is a private thing... my point would be your intent in that patient contact then?!?!...

K.P.A. · Nov 28, 2009

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

.

Not my states nurse practice act.

Just because some people are unable to maintain socially acceptable behavior outside of zero tolerance environments, doesn't mean we should all be forced to lead scripted lives.

RNperdiem, RN · Nov 28, 2009

Real friends, old schoolmates, family, friends that moved far away, and some interesting acquaintances, are people I can understand be-friending on facebook.

Why a former patient?

I am trying to come up with motivations. Attention? Curiosity about their lives? Loneliness? Like to have a high number of contacts? Some other ulterior motive?

SilentMind · Nov 28, 2009

Real friends, old schoolmates, family, friends that moved far away, and some interesting acquaintances, are people I can understand be-friending on facebook.
Why a former patient?
I am trying to come up with motivations. Attention? Curiosity about their lives? Loneliness? Like to have a high number of contacts? Some other ulterior motive?

You don't think very highly of humans, do you?

leslie :-D · Nov 28, 2009

.
Not my states nurse practice act.
Just because some people are unable to maintain socially acceptable behavior outside of zero tolerance environments, doesn't mean we should all be forced to lead scripted lives.

i seriously doubt your npa allows such relationships.

seriously.

care to tell us what state you're in?

leslie

RNperdiem, RN · Nov 28, 2009

SilentMind, I am simply asking: Why?

SunnyAndrsn · Nov 28, 2009

We have a similar situation at our LTC. A long term resident who is fairly A & O (although his disease is starting to affect his decision making abilities) had several CNAs as FB friends. We asked them to stop, as this is a difficult position for a caregiver to be in. Many of these CNA's share a great deal of their personal lives on facebook--right or wrong--and have just invited someone they care for into that.

To me it seems to be an issue of professional boundries. When we are at work, our work should be about the individuals we are caring for, and when we invite them into outside areas of our life, we begin to blur those boundries. The line gets pushed further and further back. Haven't we all heard these stories on shows like Dateline? It starts out innocently enough, but then the relationships change, and someone gets hurt. The vast majority of people in an LTC are classified as "vulnerable adults". Our relationships should stay professional at all times to protect the resident. Does it seem harmless to add them on facebook? Probably...but once you do, now you have to be careful about what you are saying...what if you just wanted to vent about your crappy day? Even if done "discretely", now a resident you care for sees it...

In the case at my workplace, we asked the CNAs to block this resident. When you block someone they can't find you through a search, nor can they 'see' you if you are on a mutual friend list. The nurses who care for him agreed to block him, none of us had considered adding him as a friend in the first place.

Sounds like health care facilities are going to have to make policies about this.

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?

SilentMind · Nov 28, 2009

SilentMind, I am simply asking: Why?

You're honestly going to have to be a little more specific in order for me to provide you with an awnser.

SunnyAndrsn · Nov 28, 2009

Not sure what is unclear about the boundry issues/ethical issues here. When someone is in need of medical care, there is implicit trust that is placed in the hands of the medical personal. The nurse-pt relationship is unique to providing (at times) incredibly personal care. There is a power differential in place, with the nurse in the more powerful "position". We've talked here before about the stress of illness, as nurses we should know this. Patients and their families do not behave the same way when in need of medical care as they might normally. Being suddenly sick or facing a long illness, or the unknown can be extremely frightening and lonely. Part of the job of a caregiver is to help the pt. through these times--and adding them as a friend on facebook is not part of a therapeutic relationship.

I've gotten to know my residents and their families fairly well. However, when the resident dies, the staff at our facility usually sees them one more time, when they drop off funeral flowers and usually a thank you basket of goodies to the staff. Then they leave and go about the next phase of their lives. We only see of our residents' families what they want us to see when they enter the building.

Unless you were friends with the pt. prior to them becoming the patient then I'm not sure why a nurse would be adding anyone they've known for such a short time as a friend on FB.

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.

morte, LPN, LVN · Nov 28, 2009

since the OP hasnt bothered to come back, i am left wondering, have we been conned into doing homework again?

txpt06 · Nov 28, 2009

SilentMind, I am simply asking: Why?

Hi, I am a patient, not a nurse. I hope I'm not violating any rules here. I have lurked for quite a while, but found this thread to be interesting. There's no patient view being expressed, I'd like to add mine.

Full disclosure: I am a post transplant patient. When I was pre-transplant, I became friends with one of the fellows. That fellow has stayed my friend and also became my doctor. Being friends with my doctor has given me some insight into professional/personal relationships.

I became friends with the doctor because we had some common interests and discussion points. The same way that other people become friends. Common interests, common philosophies, and a genuine interest in the other person is what makes the friendship start and continue.

I find this discussion interesting because it hinges on whether being firends with someone on Facebook is a violation of ethics. My question would start here: How much information is restricted between patients and nurses in a face to face situation? Do you restrict nurses from showing personal photos (of children, vacations) to patients?

hallcrest · Nov 28, 2009

I think the best answer to this issue has been given, and shouldn't be especially bothersome to anyone involved in this conversation.

Is it acceptable for a nurse-patient relationship to transition into a peer-to-peer relationship? YES. Once the patient is not a patient anymore, this is fine.

So Silentmind, nobody is a de-humanizing jerk. I'm a student like you, just a tad further along. One thing I have learned quickly is that this is a place to learn and a place to listen. Why would we argue with someone about a subject with which we have no actual experience? The thought is embarrasing.

These are nurses who understand that what patients need most during their treatment is not a peer-to-peer relationship. They need a healthcare professional who acts like a professional.