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Can social media misuse put your nursing license at risk?

The answer is clear: Yes. Posting unprofessional or illegal pictures or writings could harm a nurse’s job, professional reputation or even their license to practice nursing.

How might nurses’ posts on Facebook, Instagram and elsewhere harm them?

The biggest issue with the use of social media by nurses, especially on their private electronic devices like tablets, phones and laptops, is the release of private and confidential health care information of patients. This is almost always inadvertent and not deliberately done, but even without directly identifying a patient by name, many aspects of a post might reveal information about their medical condition or treatment.

For example, an unidentified picture of a nurse’s favorite patient would be identifiable to someone who knows that person. Or a description of a unique medical situation could reach someone who knows enough to put the story together.

Federal and state laws and regulations as well as employer policies, ethical rules and professional standards fiercely protect patient privacy and confidentiality (most notably the federal Health Insurance Portability and Accountability Act (HIPAA)). State nursing boards (BONs) that regulate nursing and administer licensing within respective states have taken disciplinary action against nurses reported to have used social media at the expense of patients, even innocently. Discipline might include fines, license restrictions or even loss of license.

In addition to patient privacy problems, nurses may post things critical of or embarrassing about coworkers or employers, impacting professional comradery, causing reputational damage or even creating liability for cyberbullying.

There are narrow exceptions in some cases for posting such as when patient care or well-being is at stake or when legally obligated, but prior consultation with the health care employer and legal counsel is advisable.

Social media guidelines

Each state’s BON likely has its own approach to regulating social media by nurses. For example, Kentucky’s Board of Nursing issued an Advisory Opinion Statement that it classifies as a guideline for nurses’ online behavior. In the opinion, the Kentucky BON endorses national standards as outlined in an NCSBN (National Council of State Boards of Nursing) White Paper: A Nurse’s Guide to the Use of Social Media.

The Kentucky BON opinion also cites the American Nurses Association’s (ANA’s) Code of Ethics for nurses that spells out a nurse’s duty to preserve patient confidentiality, but especially concerning online postings. It says, “[b]ecause of rapidly evolving communication technology and the porous nature of social media nurses must maintain vigilance regarding postings, images, recordings, or commentary …”

Examples of nurse postings that could be ethically or legally problematic

  • Anything that identifies a patient or their medical information
  • Anything that blurs the lines between a personal and professional relationship with a patient or their family members
  • Posts that disparage, disrespect or ridicule patients, colleagues or employers, even without identifying them
  • Online communication outside of the medical setting with patients or their family members (for e-communication with them, nurses should follow employer policies and practices)
  • Comments on patient or family posts that reveal patient confidentialities

The national guidelines recommend that any nurse who sees disturbing content online posted by other nurses that could harm a patient’s privacy rights or their welfare should report it to their BON or other appropriate authorities. It is wise never to take pictures or videos with personal devices not owned by the employer or without appropriate clearance.

Seek legal counsel

A Kentucky or South Carolina nurse with concerns about social media postings, who faces an investigation or disciplinary action at work or from the state BON, or who fears a lawsuit such as for defamation or breach of privacy, or employment repercussions stemming from social media use should speak with an attorney with professional licensure experience. A lawyer can provide advice and counsel, represent a nurse in negotiations, in court or before a BON, or otherwise fight to protect the nurse’s license and reputation. Do not face this alone.