Professionalism in nursing 5: social media and e-professionalism

Introduction

This article – the fifth in a series on professionalism in nursing – discusses social media use and e-professionalism in nursing. The definition of social media is broad and constantly evolving. The term refers to internet-based tools that, in real time, allow individuals and communities to:

• Gather;
• Communicate;
• Share ideas, personal messages, information, images and other content (Carr and Hayes, 2015).

A range of social media platforms exist, including WhatsApp, Facebook, Twitter, Instagram, Snapchat, TikTok, LinkedIn, Google+, YouTube and other platforms that are country-specific. The term e-professionalism refers to digital professionalism and comprises the competencies and values expected of professionals when engaged in online communication (McGrath et al, 2019).

Available guidance

Registered nurses and student nurses need to understand the importance of demonstrating e-professionalism and abiding by the Nursing and Midwifery Council (NMC)’s (2018) Code, which extends to the use of social media. It is important to note that the NMC embraces the positive benefits of social media and its role in supporting registered and student nurses to connect and share knowledge with others, although it also highlights the risks.

As student nurses are not part of the live register, they are not held accountable to NMC standards; however, if a student nurse demonstrates unprofessional practice through social media, it will be investigated by the higher education institute (HEI) at which they are enrolled (NMC, 2018). HEIs, thereby, hold student nurses accountable and ensure suitable investigations take place when a lack of digital professionalism is evident.

Unprofessional digital practice examples include posting:

• Photos or comments that indicate drug use;
• Negative comments about colleagues, employers or patients;
• Other derogatory comments or content;
• Sexually explicit content;
• Content that jeopardises patient confidentiality (McGrath et al, 2019).

In 2019, the NMC produced a document called Guidance on Using Social Media Responsibly; the organisation’s code of conduct reinforces this professional guidance because, as nurses, we must use all forms of spoken, written and digital communication – including social media and networking sites – to promote professional practice and ensure confidentiality. The Code stipulates that nurses must treat their patients with kindness, respect and compassion (NMC, 2018), so it is important that social media posts made by nurses are not viewed as discriminatory towards patients; Box 1 lists examples of potentially discriminatory social media activity.

Despite the NMC’s clear guidance, there have been several investigations into the social media use of registered nurses and other health professionals. Rimmer (2017) reported that approximately 1,200 NHS staff – including doctors and nurses – had been disciplined for misuse of social media or messaging applications.

Professional boundaries

Professional boundaries are essential for nurses to build and maintain therapeutic relationships. The NMC (2018) highlights that objectivity depends on boundaries between nurses and the people in their care, including current and previous patients, families, carers and partners. However, as personal information about health professionals and clients can be accessed easily, the risk of blurred boundaries is high (Westrick, 2016). Research has shown that patients often extend online friend requests to their doctors, nurses or other health professionals on social networking sites such as Facebook (Farnan et al, 2013).

Many NHS healthcare trusts have issued organisational policy statements strongly discouraging personal online communication between health professionals and patients; professional bodies such as the NMC and the General Medical Council (GMC) have done the same (NMC, 2019; GMC, 2013). In addition, nurses who post a significant amount of highly personal information on social media should carefully consider what impact this might have on their professional relationships (British Medical Association, 2020).

Confidentiality

Confidentiality is a key area of discussion when considering social media. The need to maintain confidentiality for patients and colleagues is also an important aspect of professionalism for nurses; as stipulated by the NMC (2018): “as a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care”. It is not acceptable to discuss clinical matters outside of the clinical setting. If a social media post makes reference to work, this is likely to represent a breach of professional conduct because there is a need to demonstrate and respect the right to privacy and confidentiality.

In summer 2021, Kelly Morris, a registered nurse practising at The Citadel, a nursing facility in Winston-Salem, North Carolina, was suspended after posting multiple videos on her TikTok account about supposedly mistreating patients. The videos were shared with her 38,000+ followers and included jokes about unplugging a patient’s ventilator to charge her mobile phone and giving patients extra sleeping pills to avoid caring for them (Kilander, 2021). This activity was deemed unprofessional, because it negatively represented the nursing profession and breached the confidentiality of the facility where she practised.

Misinformation

As discussed above, there are many dangers from social media. When considering evidence-based practice, a major limitation of social media is the danger of reading or sharing sources of poor quality or reliability. ‘Fake news’ is a term that has grown in popularity over recent years and refers to false or misleading information presented as news. Fake news often has the aim of damaging a person or entity’s reputation or making money through advertising revenue (Ford, 2020).

At the beginning of the pandemic, Donald Trump made erroneous claims that injecting disinfectant and being exposed to ultraviolet light could help treat Covid-19. Due to this misinformation, many disinfectant manufacturers had to officially announce that their products were not for human consumption, but Trump’s comments were widely shared on social media (Frenkel and Alba, 2020).

In the spring of 2021, the NMC removed nurse Kay Shemirani (also known as Kate) from its register for spreading misinformation about Covid-19. Communicating with her 50,000+ Facebook followers, she referred to the pandemic as a ‘scamdemic’ and claimed the Covid-19 vaccination was a way for governments to invade people’s private thoughts. She also said the use of face coverings was not evidence-based, was more likely to make people unwell, and that compared NHS staff adminstering the vaccine to the actions of the Nazis. The NMC interpreted Shemirani’s active dissemination of these conspiracy theories to be misconduct due to the dangerous nature of the messages (Baines, 2021).

Educational purposes

Although using social media poses risks for registered and student nurses, it must be stressed that it also has several advantages. Social media has the potential to connect nurses and nursing students to their immediate colleagues, interdisciplinary colleagues and the public. The use of social media is also an emerging and popular way to increase public understanding about nursing and the complex roles nurses can occupy (ten Hoeve et al, 2014).

Social media can also be a low-cost way to share best nursing practice; for example, it has become much easier to remain up to date with changes to guidelines, as these are often released via social media. Engagement with reputable online publications can also contribute to continuing professional development and, if reflected on and documented, can be used in the NMC revalidation process. The Resuscitation Council UK recently published a video explaining how to perform cardiopulmonary resuscitation during the Covid-19 pandemic and disseminated it via Facebook, Twitter and YouTube.

Social media also gives registered and student nurses a chance to self-publish and share information via blogs. Although blogs are often not considered to be a robust source of evidence, they can play an important role in sharing information and give users a platform to convey their message (Moorley and Chinn, 2019). As an example, in the year after the emergence of Covid-19, nurse lecturers Alison Smart and Deirdre O’Neill wrote a blog to inform registered nurses, student nurses and nurse educationalists about the importance of self-care; this is available on Queen’s University Belfast’s website.

Recommendations for practice

Maintaining e-professionalism when using social media is an important area of education for student nurses, registered nurses and other health professionals. As discussed in this article, there are several threats to maintaining professionalism while engaging with social media; however, there are also important benefits and, when social media is used professionally, these benefits far outweigh the risks. Box 2 lists tips for developing and maintaining a high-quality, professional social media profile; Box 3 suggests some ways of reviewing and assessing social media activity.

Conclusion

The professional use of social media is recommended for all nurses, student nurses and health professionals. Using social media can help them develop knowledge and skills that could enhance patient care. However, when nurses use social media, it is vital they maintain e-professionalism and follow the NMC’s Code and other applicable guidance.