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PurposeThis document provides information and recommendations for registered nurses (RNs), nurse practitioners (NPs), their employers, nursing students and educators on the appropriate use of social media, both in and outside the workplace. It is not intended to cover every social media situation; however, the document sets out broad guidelines to enable you to consider issues, act professionally, and keep public safety at the forefront. These guidelines should be used in conjunction with the Standards of Practice for Registered Nurses, the Nurse Practitioner Standards of Practice, the Canadian Nurses Association’s Code of Ethics and other relevant regulatory documents.

BackgroundSocial media refers to highly-interactive electronic communication channels through which individuals, communities and organizations create, share, discuss and modify information (HIROC, 2016). Social networking websites are constantly expanding and have not only changed the way people communicate but also how they engage and network with others. Individuals use computers, tablets and handheld devices to access the various forms of social media such as Facebook, Twitter, Wikis, LinkedIn, Snapchat, Instagram, email, texting, blogging and YouTube.

Research has shown that handheld devices, which are often used to access social media, can significantly improve decision making and adherence to guidelines by healthcare providers in the practice setting by providing real time access to clinical information and safer prescribing decisions (Mickan, Atherton, Wyn Roberts, Heneghan, & Tilson, 2014). For example, one controlled study demonstrated that social media enhances student engagement and learning; even improving grades (Junco, Heiberger, & Loken, 2010).

Despite numerous benefits of social media, there is the additional complexity of blurring professional and personal worlds, creating risks to privacy1, confidentiality2, reputation, intellectual property and public confidence that can have potentially serious consequences for you as a nurse.

Benefits and Risks of Social MediaBENEFITS OF SOCIAL MEDIAWhen used in health care, social media can:

• provide evidence-informed information for client teaching;• communicate health information to clients;• provide client and family support networks;• communicate information during an emergency;• develop professional connections and mentoring relationships regardless of geographic location;• act as a teaching tool for nursing students and educators in the classroom and clinical areas;• promote an organization’s strategic plan and programs;• promote and conduct research; and• help shape the reputation and credibility of RNs and health care facilities.

1 The right of an individual to determine how, when, and with whom and for what purposes any of the personal information is to be shared (CNA, 2017).2 The obligation to keep an individual’s personal information private (CNA, 2017).

Social Media Guidelines for Registered Nurses and Nurse Practitioners

© 31 October 2017 College of Registered Nurses of Nova Scotia, Halifax, Nova Scotia. All rightsreserved. This document may be downloaded from the CRNNS website. Portions of this publication may bereproduced for personal use. Reproduction of this document for other purposes, by any means, requires permission of the copyright owner.CRNNS.CA 1

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REGULATORY RISKSAs a nurse, you are accountable for your actions and decisions as well as upholding the public trust. Inappropriate use of social media could be considered a breach of your standards of nursing practice, Code of Ethics and/or the RN Act and Regulations. This could result in a complaint to an employer and/or CRNNS and may result in disciplinary action, including the revocation of your nursing license.

WORKPLACE RISKSDisclosing information on social media about your workplace, clients, colleagues or managers could lead others to question the organizations integrity and credibility, even leading to legal action. In addition, you may face disciplinary action from your employer if you breach your organization’s policies or make negative or disrespectful comments. Frequent review of an organization’s social media policies, along with orientating new employees to these policies, is an effective approach to minimizing workplace risks (Brown, 2016).

USING SOCIAL MEDIAAlthough nurses “deserve a life apart from professional duties”, any activity on social media can be viewed and judged by the world (American Nurses Association, 2011). You must be aware of organizational policies so that you do not violate these policies by sharing information about colleagues, clients or the workplace (Stokowski, 2011).

MAINTAINING PROFESSIONAL BOUNDARIESThe Canadian Nurses Protective Society (CNPS) (2012) cautions nurses to respect and enforce professional boundaries and not to electronically “friend” or communicate with clients through social media, as it may extend the scope of professional responsibility. For example, a former or existing client may invite you to join their social media profile or you may think about approaching a client to join one of your profiles. Connecting in this way could establish a relationship that extends beyond professional boundaries. If you are unsure of how to navigate such requests, you should discuss it with your manager, refer to agency policy or contact CRNNS.

MAINTAINING PRIVACY AND CONFIDENTIALITYAs a nurse, you are held to a high standard of confidentiality in managing client information (CNPS, 2012). A breach of privacy and confidentiality, even inadvertent, can damage the nurse-client relationship and impact the trustworthiness of the nursing profession (NCSBN 2011).

It is important to think about the consequence when you are considering posting client information on social media. Even if your privacy settings are set at their highest level, postings can still reach an outside audience. Posting anonymously or under a pseudonym also does not protect you against possible consequences if there is a breach of confidentiality or defamation (CNPS, 2012).

Factors that may contribute to an inadvertent violation of a client’s privacy and confidentiality include (NCSBN 2011):

• A false belief that posting is private and accessible only to the person to whom it is sent;

• A false belief that when content is deleted, it is no longer accessible;

• A false belief that it is acceptable to write about clients as long as their name, room number or diagnosis is not identified (an unnamed client may be identifiable from posted information);

• Confusion between clients’ right to disclose their personal information on the social media site and your requirement to keep the information confidential;

• A blurring of lines between the your personal and professional life.

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RECOMMENDATIONS FOR USING SOCIAL MEDIA1. As a nurse, you should:

a. review and understand your accountability to the standards, ethics, and policies related to social media

b. follow organizational policies (e.g. employer, university/educational institution, etc.) related to the use of personal and professional social media;

c. never speak on behalf of a health care organization unless authorized to do so;

d. maintain privacy and confidentiality of clients and co-workers’ information and immediately report any breach to your employer;

e. avoid posting any client information or images unless authorized to do so by your organization and only as part of the client’s plan of care;

f. maintain nurse-client professional boundaries and avoid engaging in personal social media relationships with clients;

g. never post about work-related events or make unprofessional or negative comments about clients, co-workers, or employers;

h. avoid offering general health-related advice in response to questions or comments;

i. keep work-related social media activities separate from personal social media activities;

j. maintain a professional manner in postings, photos and/or videos on your personal social media sites;

k. protect your personal identity; and

l. create strong passwords, change them frequently and do not share them.

2. Employers have a role in educating nurses about the organization’s social media policy and incorporating this education into their orientation. An employer’s social media policy can provide information about the appropriate use of social media inside and outside of the workplace which:

a. reflects the values of the organization;

b. sets out a code of conduct, the rules for appropriate use of social media and implications for violations and/or breaches;

c. identifies who is authorized to post information on organizational websites; and

d. identifies how to obtain permission for the use of social media for specific projects or programs (if applicable).

3. Nurse educators have a role in providing information to nursing students related to professionalism, privacy and confidentiality, including:

a. information about the risks associated with inappropriate social media use;

b. the students’ personal accountability for content shared on social media; and

c. relevant social media policies of the educational institution.

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CONCLUSIONSocial media has changed the way we communicate and engage with others. According to Junco (2011), “be respectful, be careful, be responsible and be accountable” (p. 61). Nurses should maintain the same level of professionalism when using social media as they would when communicating face to face. Everyone has a responsibility to be mindful of policies and the appropriate use of social media to protect clients, nurses, colleagues, health care organizations and the integrity of the nursing profession.

REFERENCESAmerican Nurses Association. (2011). Principles for Social Networking and the Nurse. Silver Spring, MD: American

Nurses Association.

Brown, D. W. (2016). Social media policies for employers and employees: Regulatory and statutory considerations. The Journal of Nursing Regulation, 6(4), 45-50.

Canadian Nurses Protective Society. (December 2012). InfoLAW: Social Media, 19 (3), 1-2. Retrieved from http://www.cnps.ca/upload-files/pdf_english/social_media.pdf

Canadian Nurses Association. (2017). Code of ethics for registered nurses. Ottawa, ON: Author.

HIROC. (2016). Risk notes: Communicating through social media. Retrieved from https://www.hiroc.com/getmedia/de8d7e9f-1b2e-4d05-b397-167ac0d653ce/Communicating-through-Social-Media.pdf.aspx?ext=.pdf

Junco, R. (2011). The need for student social media policies. Educause Review. Retrieved from https://www.researchgate.net/publication/220030182_The_Need_for_Student_Social_Media_Policies

Junco, R., Heiberger, G., &Loken, E. (2010). The effect of Twitter on college student engagement and grades. Journal of Computer Assisted Learning. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2729.2010.00387.x/full

Mickan, S., Atherton, H., Wyn Roberts, N., Heneghan, C., & Tilson, J.K. (2014). Use of handheld computers in clinical practice: A systematic review. BMC Medical Informatics and Decision Making, 414 (56). DOI: 10.1186/1472-6947-14-56. Retrieved from http://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-14-56

National Council of State Boards of Nursing. (2011). White Paper: A Nurse’s Guide to the Use of Social Media. Chicago, IL: Author

Stokowski, L.A. (2011). Social media and nurses: Promising or perilous? Medscape Nursing. Retrieved from http://www.medscape.com/viewarticle/753317_3

© 2017, College of Registered Nurses of Nova Scotia, Halifax, Nova Scotia. All rights reserved. This document may be downloaded from the CRNNS website. Portions of this publication may be reproduced for personal use. Reproduction of this document for other purposes, by any means, requires permission of the copyright owner.

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