Author: Anita Prinz, MSN, RN, CWOCN, CFNC, COS-C

WHEN MY GRANDPARENTS were children, they communicated in person or by letter. In my parents’ generation, the telephone became popular. Today, much of our communication takes place through social media—namely, social networking websites and services. Websites such as Facebook® and LinkedIn® and social media services such as Twitter® let us connect with a network of friends and colleagues to share ideas, updates, and events in a virtual community. Many nursing organizations are accessible on these sites. For instance, if you use the microblogging service Twitter, you can get up-to-the minute mini-messages ("tweets") on your cell phone from colleagues, or you can follow organizations such as the American Nurses Association (ANA) and Sigma Theta Tau International (STTI).

Using social media for professional networking with colleagues worldwide is proving to be an effective way to advance your career. It’s easy and free, too. Social networking helps nurses think more globally and understand nursing perspectives in other parts of the country and world. Online nursing groups give you unlimited opportunities to network with like-minded nurses in your profession or specialty.

To network with peers in your specialty, you can join a nursing group or form your own specialty nursing group. You can stay in touch with group members by registering with the social media websites they use and creating a profile. Use of these websites is fairly intuitive for the average computer user.

FaceBook, the largest social networking site, claims to have more than 500 million active users around the world connecting to an average of 80 community pages, groups, and events. Professional nursing associations such as the ANA and journals such as American Nurse Today have Facebook pages that allow users to connect with an online community of nurses.

LinkedIn claims it has 100 million members worldwide and is gaining about 1 million new members every week. It maintains it gives users the keys to controlling their online identities because its subscriber profiles rise to the top of Google and other search engine results. With its job search tools and company pages, LinkedIn is a great site if you’re looking for work or exploring career options. You can search for employers you want to research and find out which companies’ profiles are the most viewed, fastest growing, and most connected. Posting your profile (which should include a photo of yourself, your current position, where you work, past work experience, and education) helps the right people and opportunities find you.

Twitter users can send and receive tweets (up to 140 characters) via the Twitter website, compatible external applications such as smart phones, or the Short Message Service (SMS). While Twitter use is free, accessing it through SMS may incur phone-service provider fees. Tweets communicate up-to-the-moment updates of any person or organization you’re following. ANA and STTI are a few of the nursing organizations that can tell you "what’s happening" on Twitter.

Some organizations are trying out their own social networking sites, such as STTI’s The Circle (www.nursingsociety.org/Pages/TheCircle.aspx). These sites require you to be a member of the organization.

Social media and nursing education

Social media can enhance nursing education. Some nursing schools have started to use social media to enhance their classrooms. For instance, Mesa Community College in Arizona has a manikin named Stella Bellman who has her own Facebook page. Stella provides welcome messages and notices about exams; more importantly, she provides simulation scenarios for students. Harriet L. Schwartz, PhD, assistant professor of professional leadership at Carlow University in Pittsburgh, calls Facebook her "cyber hallway" where she provides relational mentoring to her students.

Hospital networking sites

Many hospitals and other healthcare organizations are creating their own social networking sites and blogs as a marketing and outreach tool. As of May 2011, 965 U.S. hospitals were using social networking. One example is the Mayo Clinic (http://sharing.mayoclinic.org), which has blogs where patients and others can share their stories of strength and hope.

Make sure to find out your employer’s policies on using social media. Many healthcare organizations prohibit employees from using social media at work or using an organizational handle on a social networking site (such as Mary.nurse@hospitalxyz.org).

Privacy concerns

Sharing information on social networking sites is easy—too easy, some might say. Health care is one of the most regulated professions in the United States, and nurses are held to the highest standard of confidentiality. When using social media, always adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations and maintain professional boundaries of the nurse-patient relationship.

Revealing private patient information is a leading type of social-networking misuse. The National Council of State Boards of Nursing (NCSBN) has published “Professional boundaries: A nurse’s guide to the importance of appropriate professional boundaries,” which addresses some of the issues involved. Currently, the ANA is revising its Code of Ethics for Nurses to include principles of social networking.

The distinction between the privacy of one’s personal life versus one’s work life is a gray area poorly defined by current laws. Consider this: Should your patient be your Facebook friend? Patricia Sullivan, APN, FNP-BC, states, "accepting a patient’s ‘friend’ request can damage the nurse-patient therapeutic relationship." When a patient becomes privy to a nurse’s personal information, erosion of trust may occur.

Control how much you share

Social networking sites offer tools that let you control how you share your information and communications; options include sharing with everyone and sharing with friends only. Sharing with friends only is recommended as the default—yet making it your default doesn’t guarantee your posts will stay between friends. For example, suppose you post something witty about a challenging patient, while withholding names and identifying remarks. Your friends find your comments amusing and repost it on their Facebook “walls,” where friends of their friends see it and repost it on their own sites. Now your friends-only message has gone viral and is circulating around the social-media universe—and potentially can get back to the patient or your supervisor.

Nurses have been terminated for posting even seemingly harmless statements, such as "My job is boring." Five California nurses lost their jobs and are facing disciplinary action for discussing a patient on Facebook even though their posts included no names, photos, or identifying information.

Tom Breslin, Associate Director of Labor Education for the Massachusetts Nurses Association, suggests following these rules when using social networking sites:

• Assume anything you post will be read by everyone, especially those you don’t want reading it.
• If there’s something you don’t want your employer to read or to know about you, don’t post it.
• Don’t post anything you wouldn’t want your spouse, child, parent, or employer to read. (See Social networking: Some do’s and don’ts by clicking the PDF icon above.)

Realize the risks

Most employers can terminate employees for making disparaging comments about their employer, coworkers, or patients. Posting defamatory remarks on the Internet can lead to civil lawsuits alleging defamation or slander. What’s more, postings to social media sites generally are considered permanent, even if you delete them. Electronic information is easily distributed, archived, and downloaded, and copies of your deleted posts may still exist on search engines or in friends’ electronic files.

You might ask, "What about my freedom of speech?" Privacy in the United States is a given natural right guaranteed by several constitutional amendments. But U.S. laws regarding digital rights vary by jurisdiction. The National Labor Relations Board (NLRB) has been working actively with employees who believe they’ve been terminated unjustly for social networking activity. A Connecticut ambulance driver was fired for posting negative comments about her supervisor on Facebook; the case was settled by the NLRB more than 6 months later, but the employee’s reputation has been damaged.

Is your boss watching?

Nursing recruiters pore over social networking sites for new nursing hires. Many nursing employers use these sites to do background and character checks, scanning them for questionable posts or photographs of employees or applicants. In multiple cases, nurses have been terminated for violating employers’ Internet communication policies, and some employers have rejected applicants based on Facebook or other postings that cast the applicants in a bad light.

Social networking is a great tool you can use to expand your professional network, connect with colleagues, and increase your nursing knowledge. But using it carelessly can imperil your job and livelihood. Let common sense and discretion guide you online. Maintain appropriate boundaries and privacy and adhere to your employer’s code of professional conduct and social networking policies. Remember—you’re a professional nurse 24/7.

Note: This article is not meant to constitute legal advice.