Guidelines for Nurses Using Social Media Nancy Spector, PhD, RN Director, Regulatory Innovations August 16, 2011 Univer

1. Guidelines for Nurses Using Social MediaNancy Spector, PhD, RNDirector, Regulatory InnovationsAugust 16, 2011University of Chicago Medical Center

3. 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.

4. Objectives • Discuss the professional, ethical, and legal implications of using social media inappropriately. • Explain common myths and misunderstandings. • Describe guidelines for the appropriate use of social media.

5. Background: Changing Times • Blogs • Twitter • Social networking • Cell phone cameras • Posts on forums • Skype • Etc!

7. 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.

8. 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!

9. Changing Times in Nursing Headlines: “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.”

10. 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.

11. 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…”

12. Changing Times in Nursing Headlines: “Nurses Snapped Photos of Dying man and Posted on Their Facebooks”

13. Changing Times in Nursing Headlines: “Nurses' jobs at risk for allegedly posting patient information on Facebook”

14. Changing Times in Nursing Headlines: “Hospital Worker Fired over Facebook Comments about Patient”: - “I hope he rots in Hell!”

15. Changing Times in Nursing Headlines: “Student Expelled for Posting Photos of Placenta on Her Facebook.” • Wall Street Journal • Subsequent court case

16. 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”

17. Examples in Health Care • As of May, 2011, 965 U.S. hospitals were using social networking. • National Association of Clinical Nurse Specialists – LinkedIn.

18. Examples in Health Care • Smart phones for downloading information, contacting nurses at work, etc. • Surgeons use of Twitter in double-hand transplant case

19. NCSBN’s White Paper on Guidelines Disciplinary Resources Committee Charge: Develop guidelines for social and electronic media to protect patient privacy.

20. Process • Reviewed the literature • Surveyed Boards • Accessed others’ guidelines • Took middle ground approach • Approved by Board of Directors in May, 2011 • To collaborate with other organizations

21. Survey Results • 33 of 46 Boards reporting had complaints • 26 took disciplinary actions • Board actions: • Letters of concern • Censuring the nurse • Conditions on the license • Suspending the license

22. Other U.S. Organizations • ANA revising their code of ethics • Sigma Theta Tau recently published a book

23. An International Experience • Report of study out of Canada (JNR, 2011) • UK: Royal College of Nursing has published legal advice

24. 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

25. Confidentiality Differs from privacy; deals with unauthorized access to data. • Patient charts • Can be shared with patient consent or by legal requirements

26. HIPAA Violations • HIPAA Standards in 1996 (federal) • Protects privacy and confidentiality • Examples posting photos on Facebook

27. Other Consequences • Civil penalties – fines • Defamation of character • Invasion of privacy • Harrassment • Criminal penalities – jail time • Employer - fired

28. Effect on Team-Based Care • Lateral violence • Cyber bullying

29. Still being determined: • Labor laws • First Amendment rights to free speech

30. Common Myths • Communication is accessible only by the intended recipients. • Content that can be deleted is no longer accessible. • Disclosing private or confidential information is harmless if only accessed by the intended recipient.

31. Common Myths • De-identifying patients is acceptable. • Confusion between patient’s right to disclose and the need for nurses to refrain from disclosing. • Blur of nurse’s personal and professional life.

32. Guidelines • Recognize obligation to maintain privacy and confidentiality. 2. Don’t disseminate information that will degrade or embarrass the patient. 3. Don’t transmit patient related information.

33. Guidelines 4. Do not post information that could reasonably identify the patient. • Do not refer to patients in a disparaging manner. 6. Do not take photos or videos of patients, unless authorized.

34. Guidelines 7. Maintain professional boundaries. 8. Consult employer policies. 9. Report breaches of confidentiality or privacy.

35. Guidelines 10. Be aware of employer policies on the use of computers, cameras, etc. 11. Do not post disparaging remarks about coworkers.

36. Case # 1 • Photo of vulnerable patient • Showed photo to former employee • Employer found out – was terminated • Board: disciplinary action requiring CE

37. Case #2 • Strange email at work – patient with exposed backside • Photo went through organization • Prosecutor, Board and national media involved!

38. 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

39. Case #4 • Blogging on local newspaper • “Little Handicapper” • Board issued a warning

40. Case #5 • Student group on Facebook • Clinical error discussed • Students faced expulsion and discipline

41. 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

42. 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

43. Guidelines in October 2011 Issue

44. Questions? nspector@ncsbn.org www.ncsbn.org Thank you!