Facebook--cautionary tales for nurses: nurses need to be wary about what they post on social networking sites.
Article Type: Report
Subject: Online social networks (Safety and security measures)
Online social networks (Usage)
Nurses (Ethical aspects)
Privacy (Standards)
Nursing (Standards)
Nursing (Ethical aspects)
Author: Charlotte, Thompson
Pub Date: 08/01/2010
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2010 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2010 Source Volume: 16 Source Issue: 7
Topic: Event Code: 260 General services; 290 Public affairs; 350 Product standards, safety, & recalls Advertising Code: 91 Ethics Computer Subject: Privacy issue
Product: Product Code: 8043100 Nurses; 9101216 Privacy NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners; 92219 Other Justice, Public Order, and Safety Activities
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 280005278
Full Text: By professional nursing adviser Charlotte Thompson his year Facebook announced that 500 million people were now registered on its social networking site. (1) Such sites enable health professionals and consumers to participate in interest groups, network, campaign, and share information. However, along with these benefits, there are potential risks for all users. As the Privacy Commissioner states: "Our communications have changed--but our awareness hasn't caught up yet". (2) This article aims to raise awareness among New Zealand nurses and reminds them of their responsibilities regarding personal and professional behaviour, patient confidentiality, and professional boundaries.

Personal and professional behaviour

Commentators note the initial success of social networking sites was due to their limitation to colleges or schools, enabling connection with friends. However, their growth has seen the overlapping of social groups. This poses real risks. "In the real world we can be very careful about who sees what aspect of our personality. There's our work, our friends, our family, at home, on holiday. But on Facebook, the people you work with, who are your "friends", see everything". (1)

"Seeing everything" has implications for health professionals. A North American student nurse was expelled from her academic programme following her postings on MySpace about her patients, gun rights and abortion. (3)

Photos are also an issue. A Swedish nurse was suspended after she posted an inappropriate photo on a social networking site, which showed her holding a piece of flesh during an operation. (4) The author of the article on the Swedish nurse also advised nurses to check their employer's policy on wearing their uniforms in posted photos. (4)

It is vital to avoid making disapproving comments about fellow employees, your employers or clients on your social networking site. (5) Finally, there is evidence that employers and recruiters are also using social networking sites to assess potential employees. (6)

Patient confidentiality

New Zealand nurses using social networking sites are reminded of their responsibilities regarding patient confidentiality.

* The Health & Disability Commissioner Code of Health and Disability Services Consumers' Rights 1 (section 2) states that "every consumer has the right to have his or her privacy respected". (7)

* The Health Information Privacy Code 1994 outlines the rights of health consumers regarding their health information and the responsibilities of health professionals and providers when managing this information. (8)

* The Code of Conduct for Nurses, published by the Nursing Council, provides a guide for both the public and nurses on expected standards of professional practice and includes the principle of safeguarding "confidentiality and privacy of information obtained within the professional relationship". (9)

An example of a breach of this principle is of a nurse in the United Kingdom who appeared on Facebook in a hospital, with a patient in the background. This resulted in the dismissal of the staff members involved. (4)

Professional boundaries

The Nursing Council's code of conduct also refers to the maintenance of professional boundaries, stating the nurse "respects the trust implicit in the professional nursing relationship". (9)

At times, boundary crossing may be unintentional but it can lead to unintended consequences. This is demonstrated in a Health and Disability Commissioner (HDC) report in which a health professional used "emoticons" (including happy, sad and hug) in a work communication with a client. The health professional used these as friendly gestures, whereas the client interpreted these as "romantic". (10)

One doctor reflected on his experience of a former patient who asked to join his list of Facebook friends. He asked: "Has Ms Baxter simply a grateful patient interested in sharing news about her child--as a follow up to our professional interaction--or did she have other motives that weren't apparent to me? In confirming this patient as my "friend" on Facebook, I was merging my professional and personal lives". (11)

In this instance, the patient was wanting to apply for medical school and was seeking advice. The blurring of personal and professional boundaries requires careful consideration. It is important multidisciplinary teams develop guidelines on the use of social networking sites.


In addition to knowledge of local policies, practical nursing guidelines are available to download. (4,6) These guides reinforce that a nurse is accountable for maintaining standards of professional practice both on and off duty. Social networking sites are valuable communication tools which continue to evolve, but which require wisdom to use safely.


(1) Arthur, C., & Kiss, J. (2010) Facebook reaches 500 million users. http://www.guardian.co.uk/technology/2010/jul/ 21/facebook-500million-users/print. Retrieved 21/07/10.

(2) Evans, K (2009) Twittering your rights away? http://www.privacy.org.nz/ speeches-presentations-articles/ Retrieved 12/07/10.

(3) The Chronicle of Higher Education. (2010) Nursing student sues after University of Louisville expels her for online posta about patients. www.chronicle.com/article/ Nursing-Student-Sues-After-U/4355g. Retrieved 06/07/10.

(4) Carlowe, J. (2009) How to use social networking sites safely. http://www.nursingtimes.net/nursing-times-this-weeks- issue/how-to-usesocial-networking-sites-safely/1981799.article. Retreived 06/07/2010.

(5) Royal College of Nursing. (2009) Legal advice for RCN members using the internet. www.rcn.org.uk. Retrieved 06/07/2010.

(6) New South Wales Nurses Association. (2010) Social networking: Be Careful. www.nswnurses.asn.au/ Retrieved 03/07/10.

(7) Health and Disability Commissioner. The HDC Code of Health and Disability Services Consumers' Rights Regulation 1996 from www.hdc. org.nz. Retrieved 06/07/10.

(8) Privacy Commissioner (2008) Health Information Privacy Code 1994. http://www.privacy.org.nz/assets /Files/Codes-of-Practice-materials/ HIPC-1994-2008-revised-edition.pdf. Retrieved 06/07/10.

(9) Nursing Council of New Zealand (2009) Code of Conduct for Nurses. www.nursingcouncil.org.nz. Retrieved 06/07/10.

(10) Health and Disability Commissioner (2004) Occupational Therapist, Ms B. A report by the Health and Disability Commissioner (Case 04HDC05983). http://www.hdc.org.nz/decisions--case-notes/ commissionei/s-decisions/search-results?search=04HDC05983. Retrieved 06/07/10.

(11) Jain, S.H. (2009) Practising medicine in the age of Facebook. www.nejm.org.nz. Retrieved 02/06/10.
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.