The American Nurses Association's e-publication, “ANA’s Principles for Social Networking and the Nurse,” provides guidance on protecting the privacy, confidentiality and inherent dignity of clients. As NCLEX Mastery posts, tweets, snaps and chats about controversial topics occasionally, this seems an opportune chance to discuss how the nurse and nursing student population can best use social media.
When and where to vent?
Nursing is difficult emotionally, mentally, and physically. Since the beginning of nursing, nurses have needed a place, not to gossip, but to express thoughts and feelings, to vent. Nurses give 100% of themselves into the act of providing nursing care to others. Nurses are professionals who recognize that the client in their care is going through a rough time, but nurses are also humans with thoughts and feelings.Discussion with peers is one of the things that helps health care professionals get through it. Discussion is how nurses learn from their peers ways to cope better, what to do better, how to nurse better, and how to survive without burning out. With the advent of HIPPA, nurses are more aware now than ever that client information is not discussed in the elevator or in the cafeteria. Where can nurses discuss coping with the odor of chronic gastrointestinal bleeding, the client who challenged them to a fight, the emotions of helping a child die, or the physical strain of assisting a bariatric client through episodes of diarrhea?
Nursing is a social profession, shouldn't we be able to use social media to discuss nursing?
The answer is "yes," but also, "not exactly."
Social Media
The world of nursing is ripe with "lightning rod" topics and topics that just generally cause a stir in the social media crowd. We each have an opinion and want that opinion to be known. How does the nurse offer personal, but professional perspective on headlines such as?:Young mother kept alive for 123 days so her babies could survive What the Utah Good-Nurse, Bad-Cop Video Says About Medical Privacy Why Are Nurses Across the U.S. Refusing Mandatory Flu Vaccines? Judge: Man Accused of Stabbing Nurse Not Competent for Trial "Mini Satans": Why is this "navy nurse" giving a newborn baby the middle finger?While a true lightning rod deflects the unwanted energy harmlessly into the ground, lightning rod topics have the potential to attract, engage, and ignite everyone near them. These involve instances where the outcome is not straightforward, where accurate information both for and against is easy to find, where people have hard and fast ideas of what constitutes right and wrong and apply those ideas to situations that are murky at best.
They let him go?!
Violence against nurses has become a prominent backdrop to our nursing world. What about stories like this one?: The perpetrator has been deemed incompetent to stand trial for the stabbing of a nurse due to mental abilities. There are two camps of thought on this judicial decision: (1) Nurses should have an understanding of the mentally ill. (2) This person assaulted a nurse and there should be justice! Nurses do not have to take a middle-of-the-road stance on issues — It isn't in our nature! However, is either side wrong? Not really. It is correct that the nurse needs to have an understanding of the incompetent client, rooted in the science of nursing. It is also right for the nurse to express outrage at the injustice for colleagues. The arguments stem from a deep compassion for those suffering from mental illness and a deep devotion to the nursing profession, both important characteristics of a nurse. How does the nurse respond then? One answer might be, don't. Just don't engage this post and scroll right on past it. Recognize that no one is going to "win" this argument. If the nurse feels that it is necessary to engage in these discussions, remember to "keep it above the belt" and avoid attacking others, try to look objectively at available facts and critically for information that seems to be missing. You cannot know what experience brings a person to their beliefs, and the same respect you would exhibit in person should be used while online, even if that means ignoring the post altogether. It is an important nursing skill to be respectful online; it is easy to be hostile.Hostility
One trend in social media is to tear into any person who has an opposing opinion, especially if it is a topic you personally have strong feelings about. This math problem 6/2(1+2)= floated around Facebook and Twitter for weeks, and it brought out the worst in educated people. How could anyone have a strong opinion about a math problem, you might ask? People typically came up with one of two answers: 1 or 9. Professors, accountants, math teachers, actuaries all came out to fiercely defend their answer. Their defense statements were occasionally rooted in mathematical principles they had learned and applied; however, many responses sounded like this: "You are stupid," "Anyone who got 1 should go kill yourself," "If you got anything other than 9, don't breed."Would you ever walk up to a stranger's face and tell them that what they said, wore, wrote, did was stupid?
In a different example, if a client told you they believed vaccination was wrong, and you firmly thought vaccination was essential, would you tell them they are dumb or argue with them? No, of course not. A nurse might (1) state their position, (2) the supporting facts for that position, and (3) then make a statement respecting the client's point of view.When typing a response, remember you are speaking to a person.
Distinctive odors, impressive wounds, offensive personalities, tired feet ...
In no other profession does a person use all of their intuition, intellect, and physicality, including the senses, to perform their job.
We know during our first encounter, very often, whether a client is experiencing a clostridium difficile infection, strep throat infection, diabetic ketoacidosis, or if a client has a gastrointestinal bleed. This is useful information, the nurse can use this to request an order for a stool sample, a throat culture, or a blood type and cross match, and we are only talking about SMELL. This is, by far, not the most difficult part of what we nurses do, and this is only one example of the issues that nurses manage daily that we want to talk to each other about.
Nurses need to discuss ways in which to manage their personal reactions to any of these more difficult aspects of the job. Talking with each other helps us get a better perspective, gather the strength to keep nursing, and lets us know someone hears and understands our challenges.
Nurses can discuss these issues with dignity. In this society where everything ends up in the public domain, the nurse learns to always keep a balance between raw feelings and professional discussion.
The simplest rule of thumb is to imagine that your client will read what you post or hear what you say.
How would you frame what you were about to type if you knew that the client to which you referred was going to read it? Post things within a frame that recognizes the great fortune in being the caregiver rather than the one in need of care.
The honest truth is that whether you post in a closed group, are chatting in a private booth at dinner, or are huddled in the corner of the nurses' station, there is a good chance that what you are about to say will reach the ears of someone to whom it matters very much.
Craft your words carefully and with a dose of kindness!
The ANA advises nurses to behave on social media as though everyone might see it.
Nothing can be kept completely private. Let's look at just two examples of how this might occur:
(1) The nurse has posted a video of a client's "interesting" feet on Facebook and set the privacy setting to "friends only." ⇒ One of those friends is a young adult who thinks this is cool and takes a screen shot to share to their page. Now it is public. ⇒ The young adult's uncle "likes" the photo. ⇒ The uncle is friends with a nurse on that same unit since they go to church together who sees the "like" and recognizes the feet. ⇒ That nurse shares this photo with the manager who promptly takes action against the nurse who initially posted the photo.
(2) The student nurse posts in a closed nursing group, sharing detailed information about a client's disease process (wound location, odor, culture results, and how proud they are to have hung their first IV piggyback-Vancomycin), but no "identifying information." ⇒ The student's friend from class is in the same closed group and discusses the disease information with the clinical instructor who recognizes the information from a faculty work session where they discussed the difficulty in helping the student manage the client's complex needs. ⇒ The instructor knows which student cared for that client, and the student is reprimanded for privacy violations.
