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?

[travduck, BSN, RN, CNM]

I see the "problem" from a different angle. You have already 'set the rules' for two of your nurses. Now you seem to hesitate to require that ALL persons working under you, and yourself abide by the same rules. This is favouritism and can cause far more legal tangles them the original 'no-no'. When you assume the position of leadership you cannot allow friendship or fear of ouchies to stop you from doing the professional and fair across the board action.

[paganoid]

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.

I like it this way, but I find it difficult as the minority male on the nursing floor. It is difficult to repeat over and over (ever so tactfully) that I prefer to keep my private life separate from the work sphere and no I will not be giving up details on my private life. It makes me sound like T. Bundy or something, with a dungeon in my basement and god-knows-what buried in the backyard.

I'm just not like those nurses on TV all up in each others business.

By the way: I have a "harmless" Facebook page with my real name that acts as a family-trap. (when "nice" family members friend this dummy account, I re-friend them from my regular user page.) I only friend troublesome people to this user account and I've never updated it. I don't check it more than twice a year, but it's good for keeping "problem" people at bay (like the nursing supervisor, or people I'm not out of the closet to like my mother's priest). Whoops! Hope he doesn't read allnurses.com!

Cheers!

[Aoretta]

According to the Nurse practice Act of the state of Pennsylvania:

In the acute care setting, the nurse-patient relationship ends at discharge.

In the psychiatric settting (any setting psychiatric, I imagine), the nurse-patient relationship ends 3 years following the last discharge or point of professional contact.

This is very important. I wish I knew what the long-term care view is on that. But anyway, these laws are important to note when considering this. I don't know if CNA's fall under the nurse practice act, or if they have their own, but as a rule they should probably be held in the same respect.

This problem faced me 7 years ago. I was a nursing student, and a nursing assistant at Lehigh Valley Hospital. I met a patient who gave me his email address to teach me how to make scrapple when he had fully recovered. I didn't know what to do - I figured time was the answer. I asked a supervisor what she would do and she said that if I waited a while, it wouldn't matter, it would be the same as if I met him on the street somewhere. He gave another assistant his emial address to take him fishing. I added him to AIM list and did not see him on there for 9 months. We talked here and there, and then eventually he asked me if I wanted to come to Mariners' Harbor Yacht club for the afternoon on day 3 months later. Over the course of the next 2 years he became the second mentor in my life that I ever had. He taught me a way of life that I never knew existed. He died in 2006, and to this day I wear his favorite old "Searaptor" fishing sweater to honor him.

I guess I had a unique situation. But anyway, there are limitations.

[tewdles, RN]

According to the Nurse practice Act of the state of Pennsylvania:

In the acute care setting, the nurse-patient relationship ends at discharge.

In the psychiatric settting (any setting psychiatric, I imagine), the nurse-patient relationship ends 3 years following the last discharge or point of professional contact.

This is very important. I wish I knew what the long-term care view is on that. But anyway, these laws are important to note when considering this. I don't know if CNA's fall under the nurse practice act, or if they have their own, but as a rule they should probably be held in the same respect.

This problem faced me 7 years ago. I was a nursing student, and a nursing assistant at Lehigh Valley Hospital. I met a patient who gave me his email address to teach me how to make scrapple when he had fully recovered. I didn't know what to do - I figured time was the answer. I asked a supervisor what she would do and she said that if I waited a while, it wouldn't matter, it would be the same as if I met him on the street somewhere. He gave another assistant his emial address to take him fishing. I added him to AIM list and did not see him on there for 9 months. We talked here and there, and then eventually he asked me if I wanted to come to Mariners' Harbor Yacht club for the afternoon on day 3 months later. Over the course of the next 2 years he became the second mentor in my life that I ever had. He taught me a way of life that I never knew existed. He died in 2006, and to this day I wear his favorite old "Searaptor" fishing sweater to honor him.

I guess I had a unique situation. But anyway, there are limitations.

You did have a unique situation! Many of us have encountered "unique" situations BECAUSE we are nurses and we interact with people from all stations of life every day. Wonderful relationships are possible and acceptable when people are patient, cautious, and follow the rules. When we get impatient or rebellious we are more likely to have a problem. For the most part, rules regulating our relationships with patients are there for the safety of the nurse AND the patient.

[Emergency RN]

In terms of the OP's problem I would tell all three to stop contacts with the patient, and tell the patient the truth if they need to; that the cessation of contact (electronic or otherwise) was enforced by their employer. It doesn't matter that one of them was junior management. I would also take the issue and publicly state the unit policy that you cannot fraternize or socialize with patients, real or virtual, if you're an employee of the institution. If an employee feels so strongly about their personal relationship with a patient, they're welcome to resign and continue it without any professional or ethical concerns.

Next, (if it wasn't already mentioned) I don't see the allure in posting details of my personal life on line. Just about all my friends are real (not virtual), so I don't see the need for a Facebook account at all; and I never fell for that My Space crapola either. Secondly, this obviously touches a lot of buttons, but especially the legal and what many perceive to be issues of personal choice. From where I sit, the personal must (by a variety of statute mandates and professional ethical concerns) be subordinate to the legal. I too, have seen my share of fellow employees put their stories on Facebook, some openly (and frankly quite unthinkingly) while at work. Some will talk about their day, and especially about their nursing assignments. Some of the entries I've seen as I looked over the shoulder of colleagues typing away are really explicit in their detail. Gossip seems to be an ingrained human trait, and it certainly has hit the electronic generation. But to do so on your employer's dime, along with the potential for HIPAA concerns invites trouble. I suggest that anyone here with questions review the reasons why with their risk management department and have it spelled out, if they themselves cannot yet see (or have trouble understanding) the rationale.

A patient may have been in my hospital, but I legally cannot talk about it, even if he does or chooses to. So theoretically, if a patient is online talking about his bowel surgery, I cannot acknowledge that I ever took care of him, even if he already acknowledges that I was once his nurse . For me to acknowledge his identity in any outside forum already violates HIPAA, which states:

What Information is Protected

Protected Health Information. The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)." “Individually identifiable health information” is information, including demographic data, that relates to:

• the individual’s past, present or future physical or mental health or condition,
  
• the provision of health care to the individual, or
  
• the past, present, or future payment for the provision of health care to the individual,
  

and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number). The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. 1232g.

Source:http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

Note, there is no exclusion or provision for information that has been previously publicly released or what is considered already open knowledge. Hence, the contacts and information being bandied about on the typical Facebook page is both a legal and ethical minefield that I for one, would never risk entering. Bottom line, the gossip just ain't that important.

[MedSurgeMess]

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)

sorry, when my students have tried to friend me before graduation, I decline, and let them know that this is an inappropriate relationship. In fact, this has become part of our orientation and is a reportable incidence for both student and teacher. There could be assumed issues, whether they exist or not. I choose to not let myself be in that position. And yes, myspace and other social sites are the same as facebook, considered a no-no in some contexts. The ANA and BON is who has decided what is appropriate for caregiver/patient relationships. Read your state practice guideline and the ANAs code of ethics. It may not seem fair, but it is what it is, and there are reasons for those standards to be in place. And as today's society becomes more litigious, it becomes more apparent.

[Mars]

Clearly many of the replies are from people who live in populated areas. When you live in a very small town/rural area, the patients are your friends and you can't change that. Many of the patients who seek care from our facility are my family. When I was the only RN working on the inpatient floor then of course I had to care for family even.

I think you do need to talk with her to assure it is not an inappropriate relationship in things mentioned above, sexual, currying favors in care, or that type of inapropriateness. But I think you need to be very careful about this one.

[txpt06]

Sorry it has taken so long to respond. Life got very busy.

Here are a few observations:

In a LTC facility I can fully understand restricting non-professional contact between residents and caregivers. There are many pitfalls on both sides of the fence. The chance for residents to abuse the friendship is as great as the caregiver to pick favorites.

However, as a patient, this statement bothers me:

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.

In an acute care facility the nurse patient relationship is somewhat temporal. If we happen to see each other, I would hope that at minimum you'd be cordial. I would also hope that if you saw me first (and recognized me) that you would say "Hello". I don't believe that being cordial in a public place treads on HIPPA or any nursing code of ethics.

Finally, friendships happen. Sometimes people just "click" whether it is out of common interests or views. I am very blessed that my doctor and I are friends. Not because I might get extra "on call" (which I do not abuse). But because I have found a friend in the midst of a very stressful time. I do not expect friendship from every caregiver that I encounter. I do expect common courtesy in and out of the facility.

[netglow, ASN, RN]

TXP, It wasn't meant to be so cold. As nurses it is simply your right to privacy we are bound to uphold. Silly hypothetical: say you just had another surgery in your quest to change sexes. You and I shared many laughs during your hospital stay and we bonded. I see you in Target and happily approach you and ask, how are you doing? We chat it up. You are there with a friend from work on your lunch break, who, I know because we see each other at a spin class at the club. She knows I work for a certain type of surgeon and knows you took time off for some surgery two weeks ago...even though our conversation never went there...

A very silly scenario, but actually privacy violations far simpler often cause unforseen tragic consequences, be it for the patient or for the nurse. You see, my job might be at stake.

[K.P.A.]

i seriously doubt your npa allows such relationships.

seriously.

care to tell us what state you're in?

leslie

A link to my states nurse practice act was sent to you by private message.

We were taught in school that sometimes it's beneficial to the family if we attend a patient's funeral.

IMO that's pretty damn personal and I doubt I'm going to be clocking in and out for it.

Would I do it? It depends on my relationship with the patient and their family....

[sparketteinok]

Situations like these are exactly why Facebook, myspace, and others like it are a bad idea. Period.

What ever happened to having a "friend" that you actually talked to in person, face to face or on the phone? It seems people don't value each other anymore unless they have a social page.

I think op is absolutely within managerial rights to ask her to remove resident. When a person puts themselves out there on the internet, it is just asking for trouble- of any kind, including work-related.

[tewdles, RN]

A link to my states nurse practice act was sent to you by private message.

We were taught in school that sometimes it's beneficial to the family if we attend a patient's funeral.

IMO that's pretty damn personal and I doubt I'm going to be clocking in and out for it.

Would I do it? It depends on my relationship with the patient and their family....

In hospice we regularly attend the visitation and less often the funerals of our patients. We do clock in and out for those functions. In that respect it is both personal and professional. It is because of the nature of our relationships with these people and their families that we must be diligent in maintaining excellent professional boundaries for all concerned. Perhaps the sensibility of this separation is more evident in hospice than in other areas of nursing but it is no less important.