Here at The Nurse Keith Show, we love listener questions, and some really good ones have been sitting in my inbox. This episode is dedicated to providing an initial response to one worthy issue that came up from a listener named Gretchen. Many thanks to her for reaching out.
I know that many of you out there have questions, and many of those questions come to me when I’m speaking on the phone with career coaching clients. In fact, many of my interactions with my clients are the spark behind various episodes of the show.
I also receive direct questions from listeners on occasion, and I welcome those wholeheartedly. My mission is to make your nursing career more successful and satisfying, so let those questions fly!
Navigating Social Media as a Nurse
The question at hand is about who to connect not connect with on social media as a nurse, and it’s a common thing to wonder about for those of us who serve the public. How do we navigate this issue professionally? Can it impact our career in both negative and positive ways? The National Council of State Boards of Nursing has a downloadable pdf featuring guidance for nurses vis-a-vis social media, but it only focuses on how to follow employer guidelines and avoid breaching patient confidentiality online; this is not the whole picture.
Social media is part and parcel of 21st-century life, and “friending” someone on Facebook doesn’t necessarily mean that you’re actually friends “in real life” (IRL). Friending colleagues and managers on social media is dizzying and confusing enough; what about patients and their families?
Colleagues and social media:
Making the decision to be connected with a work colleague on a social media platform is not as simple a decision as it may seem on the surface. When we’re friends with someone on Facebook, they are privy to the private moments we share with our community of friends and family — this may include photos of our kids and spouses, posts about our vacation, and other things that seem innocuous on the surface.
However, some of us use Facebook to vent about our political frustrations, the social causes we care about, and perhaps our religious faith or other values. And when we cross that line beyond family and vacation photos, we can sometimes run into trouble, especially in times of heated societal debate (take the 2016 election as an example).
How much do we want our colleagues to know, and what happens if a colleague disagrees with something you’ve posted? What could possibly happen? You can, of course, customize your Facebook posts and block certain people from seeing specific posts, but how hard do you want to work at that, and how risky would it be to make a mistake in this regard?
To add fuel to this fire, what if we connect with a supervisor or manager on Facebook? Will it impact what we post? Will we begin to edit ourselves out of fear of repercussions or disagreements? Do we not want our manager to know that we had tequila shots on Saturday night with a colleague after work? Do we care that our manager sees us in a bikini?
Another modern conundrum is when we receive a friend request from a colleague and we don’t want to say yes. What then? Will they be offended? Will they cross-examine us at report and confront us about how we’re ignoring their request to connect on Facebook? How do we navigate that?
Twitter, Instagram, Snapchat, and other platforms raise similar questions, and we all must make these kinds of decisions regularly. There are no easy answers, but I lean towards honesty. If you’re uncomfortable connecting with a certain colleague on Facebook and they confront you about their unanswered request, tell them you prefer not to be connected with people from work on social media. They may react in varying ways, but you have a choice to make, and it’s often not easy.
Lateral violence and bullying between nurses have also been reported on social media. This adds another complicating factor in terms of connecting with colleagues online.
And if you have a public blog or website that addresses issues related to your work, this can add even another layer to the puzzle. Do you write about patients or colleagues on your blog? Are you careful about avoiding any information that could identify a specific patient? Do your colleagues criticize or take issue with what you say on your blog?
Finally, if you have a public social media profile as a nurse entrepreneur or businessperson, that’s another kettle of fish entirely, and you may have colleagues who are critical of your posts. Then again, some of your coworkers may become your biggest fans. If you’re a public figure, you have to expect the best and the worst when it comes to your social media presence.
Patients and their families and social media
What actually sparked this podcast episode was a listener question about connecting with patients and their families on social media. Remember the notion of your manager seeing you in a bikini or drinking tequila shots? This becomes even more fraught when we consider a patient or their family member having a window into your personal life.
As nurses, our relationships with patients and their loved ones can become rather intimate. As home health or hospice nurses, we’re in their homes, and the vibe can become rather friendly and familiar. I’ve been in this predicament before, and it’s not entirely comfortable.
Let’s say you’re sitting with a patient’s adult daughter in either a home health or inpatient scenario. You and the daughter have a lot in common, and you get along like old friends. She finds you on Facebook and sends a friend request — what do you do? How do you respond? It’s a tough question, and one you need to ponder deeply. You don’t want to offend her and jeopardize your relationship, but you know she’s a staunch conservative and she’ll likely be exasperated by the left-wing progressive agenda espoused online by you and your friends. You walk a fine line with her, and you don’t want your refusal to accept her friendship request to decrease your ability to discuss her mother’s important health issues.
You may also be involved in volunteer activities along with some of your patients, and this can also muddy the waters. You may share membership in a Facebook group of a non-profit or other organization with a patient or a patient’s family members, so navigating this may be uncomfortable for you.
An interesting 2014 article posted on the website of the National Center for Biotechnology Information (part of the US National Library of Medicine of the National Institutes for Health) states that although there has historically been reluctance among physicians in terms of interacting with patients online, there is increased interest in doing so. This can lead to fascinating and potentially troubling scenarios, including where a healthcare provider uses Google or social media to assess a patient’s lifestyle and personal choices. While this information could be helpful to the clinical relationship, it could also be perceived as a form of subtle cyber-spying by the healthcare provider and the patient may feel stalked or violated.
The Annals of Internal Medicine published an article in 2013 containing various warnings for healthcare professionals involved in the use of social media for the purposes of interacting with patients:
Establishing positive patient–physician relationships and maintaining professional decorum are core elements of training that should be fostered from medical school through all stages of professional development. Online professionalism can pose challenges because of the ambiguity of written language without the context of body language or lack of awareness of the potential abuses of such media. The ease of use and immediacy of social media tools—especially if users do not engage in “pausing before posting”—can lead to unintended outcomes or messages. Many state medical boards have received reports of violations of online professionalism.
The initial decision about whether to extend the patient–physician relationship to the online setting includes the following factors: the intended purpose of the exchange and the content of conversation; the immediacy of electronic media and expectations, including response time; how communication will take place (for example, through social networking sites, microblogging, or professional e-mail on a protected server) while maintaining confidentiality; and how emergency or urgent situations will be managed.Patients will sometimes initiate online communication. One recent study suggested that many patients extend online “friend” requests to their physicians, although very few physicians reciprocate or respond. Organizational policy statements increasingly discourage personal communication between physicians and patients online. The FSMB [Federation of State Medical Boards] specifically discourages physicians from “interacting with current or past patients on personal social networking sites such as Facebook”.
A great deal of patient education and empowerment can happen online and on social media, but direct interaction between patients and healthcare providers in a public online space certainly carries some risks, as well as potential benefits.
Coming up with a solid rule may seem hard to do, but it may save you in the end. Being able to say that you don’t connect with patients or families on social media may save you some face; you can also blame it on your workplace’s rules if need be.
In the end, you need to be cautious and extremely circumspect about how you make these important choices that could, in the end, impact patient care.
Social Media Isn’t Going Away
I can safely say that social media isn’t going away any time soon. Working as a nurse in the 21st century, you’re going to encounter situations where you’ll be forced to make some potentially tough decisions. Use your due diligence, make the best choice you know to make, and always err on the side of caution when it comes to social media.
Giving patients a voyeuristic view into your life is fraught with complication, as is using social media to learn more about patients and their lifestyle choices. Connecting with other human beings in various ways is lovely, but we healthcare professionals must be circumspect and prudent when it comes to the choices we make in this regard.
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Be well, dig deep, and keep in touch!
Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known blog, Digital Doorway.
Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses. Keith was previously the resident nursing career expert at Nurse.com.
A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century.”
He has also contributed chapters to a number of books related to the nursing profession, and has written for Nurse.org, Nurse.com, MultiViews News Service, LPNtoBSNOnline, StaffGarden, Working Nurse Magazine, and other online platforms.
Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, holistic career coach, writer, and well-known successful nurse entrepreneur.