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What Should I Consider When Using Social Media?
Nancy Spector, PhD, RNDirector, Regulatory InnovationsApril 9, 2011
Mission of NCSBN
The National Council of State Boards of Nursing (NCSBN) provides education,
service and research through collaborative leadership to promote
evidence-based regulatory excellence for patient safety and public protection.
Changing Times
Blogs Twitter Social networking Cell phone cameras Posts on forums Skype Etc!
The Extent of Social Media
More than 110 billion minutes on social networks and blog sites per month.
More than 22 percent of all online
time. Facebook boasts more than 500
million members. 38 million business people from
more than 200 countries have joined LinkedIn.
Changing Times in Nursing
Headlines:
“Nurses Fired Over Cell Phone Photos of Patient”
ER nurses took photos of an object lodged in her patient’s rectum…
And posted it on her Facebook page!
Changing Times in NursingHeadlines:
“Disclosure: The New Closure?” (Chicago Tribune article)
“…my sister, fresh from a tenure in Australia, shared with me the distasteful behavior of her nursing colleagues who spend their breaks offering family and cyber cohorts a snapshot of a stressful shift, complete with the evening’s death tolls, diagnoses and patient demographics.”
Changing Times in Nursing
Headlines:
“State Gives Kitsap Health & Rehab a Deadline After Nude Photos Incident”
LPN and two CNAs were fired for taking nude photos of nursing home residents.
The facility could lose its Medicare/Medicaid reimbursements.
Changing Times in Nursing
Headlines:
“Tweeting – Not Just for the Birds” (Richard Hader, 2009, Nursing Management)
“I recently had a staff member bring me a copy of a social blog in which a nurse had detailed types of patients for whom she had cared during the last shift she worked…”
Changing Times in Nursing
Headlines:
“Nurses Snapped Photos of Dying man and Posted on Their Facebooks”
Changing Times in Nursing
Headlines:
“Nurses' jobs at risk for allegedly posting patient information on Facebook”
Changing Times in Nursing
Headlines:
“Hospital Worker Fired over Facebook Comments about Patient”:
- “I hope he rots in Hell!”
Changing Times in Nursing
Headlines:
“Student Expelled for Posting Photos of Placenta on Her Facebook.”
- Wall Street JournalSubsequent court case
Positive Uses of Social Networking
Smart phones for downloading information, contacting nurses at work, etc.
Surgeons use of Twitter in double-hand transplant case
Positive Uses of Social Media
Pew Report on the Future of Online Socializing (n=895 technology stakeholders and critics): 85% agreed that the Internet has been a
positive force on their social world Example comments:
“Geography no longer an issue”
“Costs less to communicate”
NCSBN’s Next Steps
Disciplinary Resources Committee Charge:
Develop guidelines for social and electronic media to protect patient privacy.
Process
Reviewed the literature Surveyed Boards Accessed others’ guidelines Took middle ground approach To Board of Directors in May To collaborate with other organizations
Survey Results
33 of 46 Boards reporting had complaints 24 took disciplinary actions Board actions:
Letters of concernCensuring Voluntary action of nurse (including
suspension)Informal discipline (e.g., education)
An International Experience
Report of study out of Canada
UK: Royal College of Nursing is looking into specific standards
Privacy Issues
Defined: Right of a person to be free from intrusion into matters of a personal nature.
• Treating patients with dignity and respect.
• Posting about patients.• Can be intentional or unintentional
Confidentiality
Differs from privacy; deals with unauthorized access to data.
• Patient charts• Can be shared with patient consent or
by legal requirements
HIPAA Violations
HIPAA Standards in 1996 (federal)
Protects privacy and confidentiality
Examples posting photos on Facebook
Other Consequences
Civil penalties – finesDefamation of characterInvasion of privacyHarrassment
Criminal penalities – jail time
Employer - fired
Effect on Team-Based Care
Lateral violence
Cyber bullying
Still being determined:
Labor laws
First Amendment rights to free speech
Common Myths
Communication is accessible only to the intended recipients
It is acceptable to de-identify information about patients
Common Myths
Confusion between patient’s right to disclose and nurse’s right
Posts can be deleted
Blur of nurse’s personal and professional life
Tips to Avoid Problems
Recognize obligation to maintain privacy and confidentiality
Don’t transmit patient related information
Don’t disseminate information that will degrade or embarrass the patient
Tips to Avoid Problems
Do not post information that could reasonably identify the patient
Do not take photos or videos of patients, unless authorized
Maintain professional boundaries
Tips to Avoid Problems
Consult employer policies
Report breaches of confidentiality or privacy
Do not post disparaging remarks about coworkers
Case # 1
Photo of vulnerable patient
Showed photo to former employee
Employer found out – was terminated
Board: disciplinary action requiring CE
Case #2
Strange email at work – patient with exposed backside
Photo went through organization
Prosecutor, Board and national media involved!
Case #3
Student took photo of pediatric patient
Posted on her Facebook
Student expelled; hospital faces HIPAA investigation; nursing program cannot use the pediatric hospital
Case #4
Blogging on local newspaper
“Little Handicapper”
Board issued a warning
Case #5
Student group on Facebook
Clinical error discussed
Students faced expulsion and discipline
Case #6
Texting orders at party
Read aloud to wife, “Get a drug screen for Edward Smith”
Board issued warning to the nurse and the system
Case #7
Hospital sponsored communication page for hospice
“Hopefully the new happy pill will help, along with the additional morphine”
Self reported to Board – case in progress
Questions?
www.ncsbn.org
Thank you!
