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

[laurasc]

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]

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.

While I applaud your efforts to take this dialogue to the next level, as far as personal attacks, I've never belittled anyone in this thread. I've simply put forth my own opinion and clearly stated that as I pre-nursing student I'm aware that I may very well be both naive and idealistic. I respect the insight of the more experienced posters, even if they disagree with me, and acknowledge the fact that I have a lot to learn before I take my place at the bedside. You may choose to see it as arguing if you like, but I see it more as providing specific thought processes that I possess that those more educated have the chance to correct. And for that, I thank them.

Two days ago, I was completely against restraining patient/nurse relationships. With the insight of our AN members, I've been able to see the other side. I'm not converted by any means, but I can understand the problems that may arise from such a relationship. My apologies in advance if my learning process brings you embarassment.

[hallcrest]

haha - well, no it doesn't embarass me...we just have different learning styles i guess. anyways, great thread, and i am learning alot too. take care.

[netglow, ASN, RN]

txpt06,

Good you decided to post.

You understand that nurses do 99% of close contact, minute to minute, day to day, etc. care for patients. This is especially true in situations where a patient is referred to as a "resident" as in sub-acute, rehab, long term care "nursing home" situations. You see your surgeon once in a while, and although he did your surgery, he is not as involved with you. Nurses make most bedside ultimate decisions for you, there are orders from MDs often with latitude. The nurse makes assessments and applies these orders and if something new needs to be addressed she/he gives the MD a call and might say, "I see this, I think you should do this for txpt06". MD's rely on nursing staff because they are not at hospital, or not immediately reachable.

Client-nurse relationship building is essential for an exchange of trust to happen. This makes it easier for the nurse to treat the patient, and truely for the patient to have less anxiety which is essential for healing to take place. This is professional behavior. When I come into your room and chat with you while I am assessing you and treating you, that is OK. I will keep it professional, and confidential as long as what you tell me doesn't suggest harm to you or another person. You are welcome to share your questions, fears, happiness with me. When my shift ends and I go home, I will not attempt to contact you. You, although you might not realize it, are vulnerable emotionally as well as physically. I am in a position of power. If I were to contact you I would be acting outside of my professional boundaries as you are no longer my patient as I am not at work. (However, your physician is, if he choses to be, available to you when you are not at the hospital, as he can decide to be "on call" for you).

If you see me at Target after your discharge, and come up to me to say hi, I will either instantly remember you, you or be a bit stunned as I see a lot of patients. I have no problem chatting with you. However I won't walk up to you to say hi.

[wonderbee, BSN, RN]

You say you are head nurse at a LTC facility but you are friends on facebook with some of your co-workers. With your position of authority, do you not think it might be inappropriate that you are friends on facebook with people who work under your authority?

A nurse manager at my previous facility requested to be friends with several staff members including myself. The minute she did that, she put me (and them) in a difficult spot. We could not say no. Really there was no choice. We often blew off steam about our shifts without naming names but that all changed. Furthermore, she used the forum as another way of pressuring staff to work shifts on their days off.

Just thinking the head nurse who originally posted should give this food for thought and others who are in positions of authority. This situation should never have come to the attention of the head nurse in the first place. Now that it has, there are several ethical issues to address here.

I agree that personal relationships and professional relationships need boundaries. The Nurse Practice Act tells us so.

[SilentMind]

You say you are head nurse at a LTC facility but you are friends on facebook with some of your co-workers. With your position of authority, do you not think it might be inappropriate that you are friends on facebook with people who work under your authority?

A nurse manager at my previous facility requested to be friends with several staff members including myself. The minute she did that, she put me (and them) in a difficult spot. We could not say no. Really there was no choice. We often blew off steam about our shifts without naming names but that all changed. Furthermore, she used the forum as another way of pressuring staff to work shifts on their days off.

Just thinking the head nurse who originally posted should give this food for thought and others who are in positions of authority. This situation should never have come to the attention of the head nurse in the first place. Now that it has, there are several ethical issues to address here.

I agree that personal relationships and professional relationships need boundaries. The Nurse Practice Act tells us so.

I've had a few requests from managers in the past. I neither confirm nor deny them, and if they ever ask...I just say I rarely check it. Which is mostly true.

[CeilingCat, ASN, RN]

My problem is that this is not a case of a romantic relationship or intimate friendship. This is FACEBOOK. A "friend" on facebook only means you're giving the user permission to look at your photos & comments, as in he's not a Spammer.

Where do we draw the line? If a resident seeing pics a nurse posted online is always wrong in all situations, then forget about enjoying the internet. Because the next step is going to be saying it's wrong any nurse posts anything anywhere online, for fear of some resident coming across it. What about the nurses who had personal web pages or myspace pages? The residents can view those as well; you just don't have a list of who is viewing what. Will nurses be eventually banned from posting anything at all online in their spare time?

I facebook-friended many of my instructors at my college. Should I be worried someone might see it and file a complaint that I'm acting inappropriately by letting a professor see my profile? (which is rather boring and has photos of my dogs, some corny jokes, and other assorted harmless tidbits)

Now if you said he was stalking someone... or if one of them was using FB to seduce him publicly, posting graphic sexual comments... then yes, the discussion itself would be inappropriate and an implication something wrong was going on.

You're within your rights to file a concern with a supervisor about anything for any reason. But I don't agree with you, and if others don't understand why you're freaking out, you may be seen at work as a troublemaker. What's next... going out grocery shopping, glimpsing a coworker automatically smile in recognition of client she sees standing ahead of her in line, and then reporting her for "contacting a patient outside the facility". I feel like you're taking things a little to far.

[knitsocks77]

This may have been brought up already...I haven't read every post. What happens in small-town rural facilities where you are already friends with someone and then you end up being the one to care for them when they become a patient at your facility? Not saying that I think it is ok to become friends with someone during or after they have been your patient. But, also not saying it is ok for supervisors to be friends with those who work under them (facebook or otherwise)...in the Army we had one training session after another about why not to get stuck in a situation of fraternization. I'm just glad it's not me.

Oh, the internet...what a tangled web we weave.

[CASSYANN]

I know that in Ohio, you can lose your license for doing this. It's just plain unprofessional, but to be honest, some nurses at my work do it also.

[makingitright]

Hmmm this is a very touchy subject. In the past I have become too personally involved with patients and their families, this is a very bad idea. There is such a thing as caring too much. There must be some element of detachment, actually it is quite healthy in fact.

[ToxicShock]

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.

I think the same can be said for people who befriend their coworkers. I would say coworkers are even less trustworthy than patients because your coworkers know you a heck of a lot better - and they've got way more dirt.

Leave business life with business life, and private life with private life.

[lpnflorida]

While I do not believe patients and their caregivers should be on a friends list with Face book. Neither do I believe that a Head Nurse, Assistant Head Nurse etc. should be friends with their staff on Face Book.

Lesson is, make your face book page private to your co=workers , patients, etc.

Face book and other sites have allowed far too many people to inadvertly to give way more personal information about themselves than they should.

[kenni]

one of my co-workers has ALL of our residents as friends. I don't see the problem. FB is a 'social networking site'. nurses and residents can be 'friends' just like nurses and managers. besides, what ppl do on FB has nothing to do with their work (unless they are writing inappropriate comments about the facility or discussing pt info).

now I don't think taking pts as friends is appropriate, but again it's at that person's discression who they want to give access to their profile.