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Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (1/16)
PRACTICE GUIDELINE
Ethical and Responsible Use of Social Media Technologies
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (2/16)
MISSION
The Nurses Association of New Brunswick is a professional regulatory organization that exists to protect the public and to support nurses by promoting and maintaining standards for nursing education and practice, and by promoting healthy public policy.
© NURSES ASSOCIATION OF NEW BRUNSWICK 2012
All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopying, recording, or by any
information storage and retrieval system, without prior written permission from the publisher.
ISBN 1 895613‐60‐4
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (3/16)
Table of Contents
MISSION .......................................................................................................................................... 2
ACKNOWLEDGEMENT ..................................................................................................................... 3
PURPOSE ......................................................................................................................................... 4
INTRODUCTION ............................................................................................................................... 4
ETHICAL, PROFESSIONAL AND LIABILITY CONCERNS ...................................................................... 6
APPROPRIATE USE OF SOCIAL MEDIA: A SHARED RESPONSIBILITY ............................................... 9
Role of the Individual RN ............................................................................................................. 9
Role of the Employer ................................................................................................................. 10
Role of the Nurse Educator ....................................................................................................... 11
CONCLUSION ................................................................................................................................. 12
APPENDIX A: HOW TO USE SOCIAL MEDIA SITES SAFELY ............................................................. 13
REFERENCES .................................................................................................................................. 14
ACKNOWLEDGEMENT
The Nurses Association of New Brunswick gratefully acknowledges permission granted by the
Canadian Nurses Association, the College of Registered Nurses of British Columbia, the College
of Registered Nurses of Nova Scotia and the Saskatchewan Registered Nurses Association to
quote and adapt, in whole or in part, from the publications referenced.
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (4/16)
PURPOSE
Through the Nurses Act, the nursing profession is granted the authority to set standards for
education and practice of its members, with an obligation to protect the public and serve the
public interest.
Guidelines support professional judgement and promote appropriate decision‐making in
practice. The purpose of this practice guideline is to help registered nurses1 (RNs) protect the
privacy and confidentiality of personal and health information of the client and to reiterate the
importance of maintaining the boundaries established within the therapeutic nurse‐client
relationship when using social media technology in their practice. The practice guideline further
interprets NANB’s standards and the Code of Ethics (CNA) and provides recommendations to
registered nurses, employers and nursing education programs.
INTRODUCTION
Social media represents much more than a tool for communication. It changes how people work
and interact, how relationships are formed and how people complain,
celebrate, discover and create. (Scotish Government, 2012)2.
The Nurses Association of New Brunswick (NANB) does not regulate the use of
social media; it does however, regulate the practice of RNs within an
environment where social media is ever present. Communication technologies
such as Facebook, YouTube, MySpace, blogs and mobile phone cameras have
made it increasingly common for nurses to share details of their working lives
online (Livsey, 2010). In July 2012, Twitter reported passing 500 million
accounts3 with Canada in 8th place from the top 20 countries in terms of
Twitter accounts. World Stats reported 17,987,900 Facebook users in Canada4,
making it Canada’s most popular social network site.
The Canadian Nurses Association (CNA) defines the term social media as “a group of Internet‐
based applications and technologies that allow users to have the same kind of real‐time
conversation that they might have with friends or neighbours with virtual friends from around
1 For this document, the term registered nurse includes nurse practitioner. 2 http://www.scotland.gov.uk/Resource/0039/00396525.pdf 3 http://techcrunch.com/2012/07/30/analyst‐twitter‐passed‐500m‐users‐in‐june‐2012‐140m‐of‐them‐in‐us‐jakarta‐biggest‐tweeting‐city/
4 http://www.socialbakers.com/facebook‐statistics/canada
When we combine
the use of technology
with social
connections, the line
between what we
think of as “private”
and “public” is
blurred. (CNA, 2012)
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (5/16)
the globe. Social media technologies allow users to interact and collaborate with each other
online in the creation and sharing of information, ideas, and opinions” (CNA, 2012).
Social media can benefit health care in a variety of ways such as strengthening professional
relationships, providing valuable information to health care recipients, providing timely
communication with clients and family members and educating and informing health care
professionals. However, “when we combine the use of technology with social connections, the
line between what we think of as private and public is blurred” (CNA, 2012). Table 1 offers a list
of benefits and risks associated with the use of social media in the nursing profession.
Table 1: Benefits and Risks Associated with the Use of Social Media Technologies
Benefits Risks
Fosters social and professional connections5
Enhances client communications to address concerns in a timely manner6 i.e. “Crowdsourcing”
Teaching tool for nursing students and educators
Broadcasting public message e.g. hand‐washing campaign
Collaboration on projects– however, should use internal secure system for work‐related projects
Dissemination and discussion of nursing and health related education, research, best practices7
Repository of reliable references on specific health issues/conditions
Human interest stories, with expressed written consent
More effective organization as a collective political force
Advocacy & nursing interests
Breaches of patient privacy and confidentiality
Inappropriate sharing of information
Violation of professional boundaries
Public’s trust of registered nurses can be compromised
Increased connectivity allows for increased surveillance of ones activities
Employment consequences, which could lead to termination
Regulatory implications, which could lead to disciplinary action
Violation of Personal Health Information Privacy and Access Act, which could result in both civil and criminal penalties
5 Desautels, 2008; Fultz, 2008; Grimmeralmann, 2009; Klich‐Heartt & Prion, 2010 6 Tariman, 2010 7 ANA, 2011
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (6/16)
ETHICAL, PROFESSIONAL AND LIABILITY CONCERNS
Registered nurses are held to a high standard of confidentiality with respect to client
information. Ethical considerations should be always kept first and foremost in RNs’ minds in all
communication modalities. To understand the limits of appropriate use of social media
technologies or any information technology, it is important for RNs to understand the concepts
of confidentiality and privacy in the health care context and to use NANB’s standards and the
Code of Ethics as a guiding framework when making decisions about their use of social media.
ETHICAL CONCERNS: CONFIDENTIALITY AND PRIVACY
The Code of Ethics for Registered Nurses (2008) sets RNs’ ethical responsibilities regarding
maintaining privacy and confidentiality. Confidentiality and privacy are related, but distinct
concepts. The Code of Ethics defines confidentiality as “the ethical obligation to keep
someone’s personal and private information secret or private” (p.23). The RN must safeguard
information obtained during the course of treatment/care and may only be disclosed to other
members of the health care team for health care purposes. Confidential information should be
shared only with the client’s informed consent, when legally required, or where failure to
disclose the information could result in significant harm. Beyond these very limited exceptions
the RN’s obligation to safeguard such confidential information is universal. RNs must be aware
that sharing client health information that was collected through the provision of care is a
breach of confidentiality – intentional or inadvertent ‐ when posted on a public Website, as it is
outside the scope of the intended use and purposes for which the information was collected.
Privacy relates to the right of clients to keep information about them from being disclosed to
anyone.8 The Code of Ethics defines informational privacy as “the right of individuals to
determine how, when, with whom, and for what purposes any of their personal information
will be shared” (p.27).
PROFESSIONAL CONCERNS:
Inappropriate sharing of client personal health information via social media is a breach of the
Standards for the Practice of Registered Nurses9 (2012). When using social media whether for
personal or professional purposes, RNs are responsible for their actions and accountable to the
client, employer, the profession, and the public. Some standard indicators which are applicable
to the use of social media are:
8 Crawford, H., & Kelley, P. (2012). 9 Standards of Practice for Registered Nurses (2012) http://www.nanb.nb.ca/downloads/NANB%20Standards%20of%20Practice%202012_E.pdf
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (7/16)
Practises in accordance with relevant legislation and standards, Code of Ethics and employer policies (Standard 1: Responsibility and Accountability – indicator 1.2)
Answers for own nursing actions, decisions, and professional conduct (Standard 1: Responsibility and Accountability ‐ indicator 1.4)
Initiates, maintains, and concludes the therapeutic nurse‐client relationship (Standard 2: Knowledge‐Based Practice – indicator 2.5)
Communicates effectively with clients, colleagues, and others (Standard 3: Client‐Centered Practice – indicator 3.2)
Advocates for and contributes to quality professional practice environments (Standard 3: Client‐Centered Practice – indicator 3.7)
Demonstrates a professional presence and models professional behaviour (Standard 4: Public Trust – indicator 4.1)
NANB’s Practice Standards: Documentation and the Therapeutic Nurse‐Client Relationship :
documents further define the RN’s responsibility to maintaining confidentiality and privacy
within the therapeutic nurse‐client relationship and when documenting client information as
follows:
The registered nurse:
1.10 refrains from maintaining any mode of communication with clients and clients’
significant others, outside the therapeutic nurse‐client relationship unless it is required
as part of the healthcare plan. (The Therapeutic Nurse‐Client Relationship: Practice
Standard, NANB, 201110)
The registered nurse:
3.2 maintains confidentiality of client health information, including passwords or
information required to access the client’s health record;
3.3 understands and adheres to policies, standards, and legislation related to
confidentiality, privacy and security;
10 NANB (2011)The Therapeutic Nurse‐Client Relationship : Practice Standard
http://www.nanb.nb.ca/downloads/Practice%20Standard‐Nurse‐Client%20Relationship_E.pdf
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (8/16)
3.8 uses a secure method to transmit client health information (e.g., using a secure line for
fax or e‐mail) (Documentation: Practice Standard, NANB, 201011)
PERSONAL AND LIABILITY CONCERNS
Understanding the risks involved in using social media may prevent potential adverse personal
and professional consequences. According to the Canadian Nurses Protective Society (CNPS)
InfoLAW (2012), failure to abide by these (professional standards) can lead to serious legal
consequences. The CNPS cautions RNs to respect and enforce professional boundaries and not
to electronically “friend” or communicate with clients through social media sites, as it may
extend the scope of professional responsibility. The fact that information in electronic form is
easily distributed, archived, and downloaded leaves little control over who sees the information
posted on social media sites. Also, one must add the fact that postings to social media sites are
generally permanent records that cannot easily be deleted. Postings may come back to haunt
the person who posted the information on a personal or professional level (CNPS, 2012). There
exists anecdotal evidence that an increasing number of employers check social networking
profiles of current and prospective employees looking for information that could be interpreted
as reflecting negatively on the organization or as misconduct or inappropriate behaviour on the
part of employees.
Legislation is in place to safeguard the sharing of personal health information.
The NB Personal Health Information Privacy and Access Act (2009) protects
the confidentiality of personal health information and the privacy of the
person to whom it belongs by setting rules about the collection, use,
disclosure, retention and secure destruction of personal health information.
11 NANB (2010) Documentation : Practice Standard ‐ http://www.nanb.nb.ca/PDF/Practice_Standard‐
Documentation‐E.pdf
Postings may come
back to haunt you on a
personal or professional
level. (CNPS, 2012)
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (9/16)
APPROPRIATE USE OF SOCIAL MEDIA: A SHARED RESPONSIBILITY
Role of the Individual RN
Registered nurses have a professional, ethical, and legal responsibility to understand the impact of social media on health care and more specifically, on nursing practice. The registered nurse should:
Build own social media competence; know the technology; and have the skills and judgment to use it appropriately and ethically (CRNBC, 2012);
Recognize ethical and legal obligations to maintain client privacy and confidentiality at all times;
Not share or post information, including images, about a client or information gained in the nurse‐client relationship with anyone unless there is a client‐care related need to disclose the information or other legal obligation to do so;
Not identify clients by name or post or publish information that may lead to the identification of a client;
Not take photos or videos of clients on personal devices, including cell phones. The RN should follow employer policies for taking photographs or video of client for treatment or other legitimate purposes using employer‐provided devices;
Abstain from making disparaging remarks about employer or co‐workers (e.g., threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic, or other offensive comments);
Maintain professional boundaries in the use of electronic media by refraining to accept a friend request from a client on Facebook or making a comment on a client’s blog;
Be aware of and follow organizational policies concerning personal and professional social media tools when at work, including how to manage a privacy breach;
Not post content or otherwise speak on behalf of the employer unless authorized to do so, and must follow all applicable policies of the employer;
Protect and value his/her professional image.
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (10/16)
NOTE: If an RN becomes aware of a breach of privacy on a social networking site, the
Code of Ethics states, “Nurses intervene if others inappropriately access or disclose
personal or health information of persons receiving care” (CNA, 2008, p. 16). This can
involve discussing your concern with a co‐worker, manager/supervisor, Privacy Officer,
and an NANB Practice Consultant.
Appendix A offers a quick reference list of Dos and Don’ts to guide the appropriate use of social
media sites.
Role of the Employer
Each organization needs to create privacy policies and procedures that clearly outline the
expectations of employers in regard to the use of social media technologies in the work setting.
The employer should:
Ensure that electronic/social media policy is consistent with the organization’s values, in addition to being relevant to the evolving challenges and complexity of today’s global village (Harned, 2009);
Address how certain behaviours associated with the use of social media can affect the organization, employees, clients, and other stakeholders;
Define the circumstances under which the use of employer‐owned computers, cameras, other electronic devices, and personal devices in the workplace is allowed;
Ensure client personal health information sent by email is secure and encrypted to avoid interception;
Communicate expectations to employees by incorporating into orientation for new RNs;
Identify who is authorized to post information on the organization’s websites and how to obtain permission for the use of social media sites for specific projects or programs (CRNNS, 2012);
Determine who is authorized to make public statements on behalf of the employer/organization;
Communicate the steps that will be taken to monitor and enforce compliance with the policy and establish support for nurse managers having to deal with inappropriate use of social media by RN staff;
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (11/16)
Consider having every employee sign a confidentiality oath regarding the personal health information in their custody (Privacy Commissioner, 2012)
Set limitations around the use of personal cell phones and social media tools in clinical settings with emphasis on the central importance of maintaining privacy and confidentiality of client information.
Role of the Nurse Educator
Nursing programs should have social media policies and guidelines in place and should ensure that students are not only aware of them but also understand the implications, if they ignore them. The nurse educator should:
Teach students about appropriate personal and professional use of social media early in the program and should incorporate this information throughout the curriculum, especially during discussions related to professionalism, privacy, and confidentiality (CRNNS, 2012);
Engage students in ethical discussions around educational/learning use of social media tools. Students must understand that they are responsible for what they post in any social media platform;
Engage students in ethics discussions around the need to protect the trust established as part of the therapeutic nurse‐client relationship and the proper maintenance of professional boundaries;
Act as role model.
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (12/16)
CONCLUSION
Registered nurses are expected to practise and behave in a manner that protects clients by
exercising reasonable judgment when using social media technologies whether in their
personal life or in their professional life. Social media can make a person’s poor judgment
public and permanent and can raise concerns about client’s personal and health information
privacy and confidentiality, boundary crossings within the therapeutic nurse‐client relationship,
and professionalism.
For additional information please contact:
Nurses Association of New Brunswick
165 Regent Street
Fredericton NB
E3B 7B4
Tel.: (506) 458‐8731 or 1‐800‐442‐4417
Fax: (506) 459‐2838
Website: www.nanb.nb.ca
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (13/16)
APPENDIX A: HOW TO USE SOCIAL MEDIA SITES SAFELY
DO:
Know your legal and ethical responsibilities to maintain privacy and confidentiality as an RN (i.e.: provincial/federal legislation and the Code of Ethics).
Know the standards and expectations relative to competencies for privacy and confidentiality from NANB.
Remember to separate personal and professional lives when using social networking sites.
Respect and enforce professional boundaries: noting that becoming a patient’s electronic “friend” or having communication with them through social media sites may extend the scope of professional responsibility.
Know your organization’s policies and procedures on social networking, privacy, and confidentiality.
Educate yourself about the privacy setting/statements of social networking sites you are interested in joining.
Remember that words written on social networking sites have the potential to live on forever.
Respect client privacy and protect your own.
Create strong passwords and change them frequently. Do not share passwords with others.
Log off or turn off your computer or laptop when not in use.
Manage your virtual image. Present yourself in a professional manner in photos, videos and postings. Use different accounts for personal and professional activities.
Pause before you blog, post, or tweet.
DON’T:
Post/share confidential information: an unnamed patient or person may be identifiable from posted information.
Use social media to vent or discuss work‐related events or to comment on similar postings by others.
Upload pictures or video of yourself in a clinical setting.
Make disparaging or embarrassing remarks about your organization, its patients/clients/residents, or fellow employees; disclosing information obtained at work is considered unprofessional and, if erroneous, could even lead to a defamation claim.
Offer health‐related advice in response to comments or questions posted on social media sites; if relied upon, such advice could trigger professional liability (CNPS, 2010) or a complaint to NANB.
Use social networking sites when you are supposed to be working.
Breach privacy and confidentiality, legislation, or your employment contract.
Speak on behalf of a health care organization unless authorized to do so.
Allow your use of social media to interfere with your work commitments.
Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (14/16)
REFERENCES
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https://www.facebook.com/note.php?note_id=248333435208652
Anderson, J., & Puckrin, K. (2011). Social network use: A test of self‐regulation. Journal of Nursing
Regulation, 2(1), 36‐41.
Canadian Nurses Association. (2008). Code of ethics for registered nurses. Ottawa, ON: Author. Retrieved
from http://www.nanb.nb.ca/PDF/practice/CNA%20Code%20of%20Ethics.pdf
Canadian Nurses Association. (2012). When Private Becomes Public: The ethical challenges and
opportunities of social media. Ottawa, ON: Author. Retrieved from http://www2.cna‐
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Canadian Nurses Protective Society. (July 2012). Social Media. infoLAW, 19(3), 1‐2.
College of Registered Nurses of British Columbia. (2012). Social Media: Professionalism, nurses and
social media. Retrieved from
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College of Registered Nurses of Nova Scotia. (2012). Position Statement: Social Media. Halifax, NS:
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Desautels, B. (2008). Social networking: LinkedIn.com. Journal of Leadership Studies, 2(2), 103‐104.
Fultz, J. (2008). Is blocking Facebook the answer? Conference Board of Canada. InsideEdge, 12(1), 22.
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Leader, 8(2), 56‐58.
Livsey, Trish. (2010). Post‐it pitfalls: new technology makes it easy to breach patient privacy unwittingly.
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NB: Author. Retrieved from http://www.gnb.ca/0051/acts/index‐e.asp
Saskatchewan Registered Nurses Association. (2010). Ask a practice advisor: Common sense guidelines
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Practice Guideline: Ethical and Responsible Use of Social Media Technologies October 2012 (16/16)
165 Regent Street Fredericton, NB, E3B 7B4 Canada
Tel.: 506‐458‐8731 Toll‐free: 1‐800‐442‐4417 www.nanb.nb.ca