What to Do When Social Media Lines Are Blurred

Social media has become a way of life. Posts, tweets, videos—these are ways in which many people now communicate with one another. I especially know how ingrained it is in our lives, as I have a teenage son who can barely live without his smartphone during mealtime.

Social media refers to any Web-based or mobile technology such as Facebook, YouTube, Instagram, Vimeo, LinkedIn, Twitter, and CaringBridge.

As we explore common boundary crossings, we delve into the blurred world of social media. In the past issue, we defined a professional boundary crossing as a “brief excursion across professional lines of behavior.” Boundary crossings can not only damage relationships but also lead to negative outcomes.

It’s only natural that patients or caregivers will reach out to their oncology nurses through social media. And this is where oncology nurses can unintentionally blur the lines between professional and personal lives.

Think about the effects of being friends with patients or their caregivers on Facebook. You have access to all personal and family information, which creates more of a personal relationship than a professional, therapeutic one. For many reasons, you would never be the nurse assigned to care for a family member. It’s too easy to lose your objectivity. When you move toward a personal relationship or friendship with your patients or their caregivers, the same issues of objectivity arise.

Use of social media can easily violate patient confidentiality. The National Council of State Boards of Nursing (NCSBN) social media guidelines state that “it is imperative not to mention patients by name or provide any information or details that could possibly identify them in order to protect patients’ right to privacy.” Nurses have a legal and ethical responsibility to maintain patient privacy and confidentiality.

Disclosure is often unintentional. Your posts are not private. Someone can simply take a screenshot of the information and send it on or upload it to the Internet. Posts never truly disappear. Even if a post is deleted, it lives somewhere on a server that can be discovered in a court of law.

To protect your nursing license, consider the downstream legal effects.

Examine how this content might be viewed by others in the following posts:

WHAT IF…a patient posts that she had a great weekend with family visiting but is now feeling really tired. Is the fatigue from overactivity or related to anemia or even a sign of recurrence? Are you legally obligated to report if you see something about her health that is concerning? What if it’s a behavior that could pose a health risk? For instance, she posts a picture of herself drinking wine when you know she is on medication that should not be taken with alcohol.

The challenge with this scenario is to know your legal and ethical responsibilities. Now that you have this piece of information, what do you do with it?

WHAT IF…your former stem cell transplant patient, who almost didn’t live, comes back to your inpatient unit to celebrate his transplant anniversary with his nurses. You take a picture of him with your colleagues and post it with the caption “This is why I became a nurse.”

This scenario could result in a HIPAA violation and disciplinary action by the Board of Nursing as well as your employer. Most organizations have guidelines about taking photos of any person who works in their facility or who received any services.

A written formal consent for photos is usually required, and it needs to be obtained from everyone in the photo. So another patient in the background of the photo or a pictured arm with a tattoo that could be even remotely linked to another patient could create a messy legal situation.

WHAT IF…you’re simply sharing about your day with a colleague. You mention in your post that you went to the coffee shop and bought coffee for two of your patients. No names mentioned, no photos, no negative comments…No violation, right? What’s the problem? Although your gesture was one of kindness for your patients, using your personal money to buy items for a patient can cause feelings of unequal care and unrealistic expectations for your colleagues.

Can you do this for all your patients? Does this post have the potential to impair your work relationships?

So how do you avoid potential boundary crossings on social media? Below are 2 action steps:

1. Politely decline friend requests. If a patient or caregiver finds you on Facebook and sends you a friend request (even if the patient has returned to the care of the referring provider), politely decline the request. Tell them that your institution has strict policies regarding social media, so you have to respectfully decline their request. Most do. If not, the NCSBN and the American Nurses Association (ANA) do.

2. Unfriend current patients/caregivers. If you are already using social media to communicate with patients and caregivers and the site is not work related, consider letting them know that you will be unfriending them. Tell them that you realize there could be a perception of a conflict or a blur between your personal and professional lives.

Importantly, find out whether there is a policy on social media where you work and then review it. If there isn’t, consider being on the team to help develop one. Read the NCSBN and ANA guides to social media and know what your particular state advises. Not only do these guidelines apply to your current role, but they can also affect your reputation for any potential future employment or educational institution admission.