Social media: blurred lines between personal and professional behaviour
The transition from engaging with social media for personal to professional use can cause pitfalls for the unwary, and while there is formal guidance, there may be times when what you consider appropriate could be unacceptable to members of the public
It is now more than 20 years since the birth of social media and, according to Statista, the number of people engaged in these types of online networking platforms has reached over 39 million in the UK alone.1
These users include a generation who have grown up with such fast social interactions in a virtual world of posts for ‘likes’, ‘friends’ and ‘followers’. These young adults’ desire to engage in social media is often intertwined with their everyday lives.
There is an increasing expectation that when a young person leaves education and enters the employment world, they make the transition from engaging in social media on a personal level to engaging with it as a professional. Young people entering the healthcare professions may struggle with their online identities,2 so there is a need to include guidance within the medical and healthcare curriculum about how individuals should engage with social media as professionals.3
WHAT IS e-PROFESSIONALISM FOR NURSES?
The transition from engaging with social media for personal to professional use has led to the rise of the term ‘e-professionalism’ or ‘e-accountability’, which has been defined as ‘the attitudes and behaviours reflecting traditional professional paradigms that are manifested through digital media’.4
For nurses, accountability is determined in accordance with the Nursing and Midwifery (NMC) professional standards of practice and behaviour.5 The NMC has additionally published guidance for nurses, midwives and nursing associates on using social media responsibly, which highlights how these professional standards can be applied to social use.6
The guidance highlights the importance for nurses of upholding the reputation of the profession and maintaining confidentiality. It is therefore crucial that nurses, and indeed all healthcare practitioners, are clear about their responsibility with regards to e-professionalism.
Guidelines and tools are available for NHS employees7 but, despite this, there may be times when public perception differs as to what might be deemed an acceptable way of presenting themselves on social media, and what might not.
In their personal life, a nurse may enjoy socialising in bars and going to nightclubs with friends while maintaining full professionalism at work. Does this mean that if they post selfies drinking alcohol with their friends, they should keep these private? Does the perceived ‘acceptability’ of this change at an intergenerational level? Additionally, if their personal profile picture is slightly revealing, could this be viewed as ‘unprofessional’ by the wider general public? Would it bring the whole of the nursing profession into disrepute?
More importantly, if a healthcare professional had a full understanding of e-professionalism, and kept their personal profiles private while choosing to network publically as a professional, can they be sure they are fully adhering to their professional code of conduct?
What is clear is that the more you explore these issues, the more it becomes apparent that the interpretation of the guidance could potentially lead to ambiguity.
In recent years, nurses have been increasingly encouraged to engage in social media. The Royal College of Nursing now highlights that engaging with social media can even count towards your continuing professional development and revalidation.8 This sends a clear message to the profession about recognising the benefits of social media.
Additionally, social media has been recognised as a tool that can assist in health policy development and even for engaging with service users in terms of health promotion.9,10 This highlights how these platforms are being recognised in health as tools to reach a multitude of communities for a collective purpose.
LEARNING FROM BEST PRACTICE
There is emerging evidence that nurses and other healthcare professionals are using social media to develop virtual communities, such as closed groups on Facebook, to share knowledge.11
This type of technology-enhanced learning for nurses is becoming increasingly popular to develop clinical skills and networking.12,13 Joining a closed group on Facebook such as ‘East Midlands Practice Nurses’ can be a great way to potentially share and learn about best practice across a locality but, according to a recent study, there are generational differences in nurse’s preferences for these types of digital approaches to learning.14
In a study using an instructor-led Facebook group, engaging in social media, such as Facebook ‘closed’ and ‘public’ groups, was found to enhance students’ perception of their course content.15 However, how these groups improve the continuation of professional development for registered nurses, and understanding how many nurses engage with colleagues this way, is unknown.
Engaging in these types of online groups or forums therefore raises a number of ethical dilemmas, which are important for any healthcare professional to consider.
ENGAGING IN ONLINE PROFESSIONAL COMMUNITY ‘GROUPS’
1. Understand the purpose of the group: Ensure you understand why the group has been set up. For example, is the group for practice discussions, sharing information on specific clinical areas or subjects, or general support for nursing practice?
2. Get to know the administrators and moderators: As much as you possibly can, contact the administrators and find out their professions, where they work and why they initially set up the group. It is important to also remember that Facebook groups can be created and moderated by anybody with an interest in the field, and are unregulated.
3. Post with caution: Remember, there is no way of truly knowing the identity of the health professional you are networking with. Despite the fact that moderators can request members declare their purpose for joining groups when approving their request, there is still a chance they could have an ulterior motive to sabotage discussions (troll). If conversations become antagonistic, do not get involved.
4. Do not assume everybody is a professional: Although a ‘closed’ group might explicitly say members are professionals, there is still a risk that they can attract service users with an interest in that topic. You may well be acting within the confines of maintaining confidentiality, but you should still consider how a member of the public might feel reading your posts. For example, to a member of the public, reading about the variations of practice and services across a locality could seem alarming without an understanding of the wider context. Additionally, if you were discussing case studies, ethical dilemmas or even poor examples of practice in general, consider how a person from the wider general public might respond and what support would they would need to receive if they had any concerns about the practice in their area.
5. Do not clinically assess online: Avoid responding to professionals asking for a clinical diagnosis or assessment of any practice-based scenario. It may be useful to share the latest research studies or talk about how a diagnosis or assessment is done in your area, but you cannot make a holistic assessment of a patient when you only have the segment of information the post offers. If anything, respond by asking more questions for the health professional to consider when they are making their own assessments.
6. Look after your mental health: We know social media has many positive and negative aspects. Remember to look after your own mental health and consider the time you spend engaged in these platforms. And although sharing and learning is important for continuing professional development, what is more important is looking after yourself after a demanding shift in clinical practice. Maintain a balance between your social media footprint and relaxation time.
In conclusion, it is clear that engaging in social media is not as clear-cut regarding what behaviour is acceptable for a private profile and what level of engagement is expected as a professional. There are multiple complex issues here, as well as many positive and negative considerations.
Remember that, despite the recent push for professionals to embrace the positive aspects of the online community, if you choose not to, that is okay too. Social media is not for everybody, and there are more and more people choosing to turn their backs on it for a number of reasons.
PUBLIC PERCEPTION
The A2A (Awareness to Action) decision-making tool has been developed as part of a 42-month ethnographic study that conducted semi-structured interviews, focus groups with nurses and nursing students, and online observations of publically accessible professional groups.16 The tool will help governing bodies and NHS groups to determine the actions needed if concerns have been raised in regards to a health professional’s e-professionalism.
- Dr Gemma Ryan from the Open University is collaborating with the author to validate this tool by exploring the public’s perception of healthcare professional behaviour online. If you know a member of the public who would like to participate in this study, you can find out more by visiting https://openuniversity.onlinesurveys.ac.uk/prism-extension. Everyone who takes part will be entered into a prize draw, with the chance to win a £20 Amazon voucher.
REFERENCES
1. Statista. Social media usage in the United Kingdom (UK) – Statistic and Facts. https://www.statista.com/topics/3236/social-media-usage-in-the-uk/
2. DeCamp M, Koenig TW, Chisolm MS. Social media and physicians' online identity crisis. Journal of the American Medical Association 2013;310:581–2.
3. Wendy Baer, Ann C. Schwartz. Teaching professionalism in the digital age on the psychiatric consultation-liaison service. Psychosomatics. 2011 Jul-Aug; 52(4): 303–309. doi: 10.1016/j.psym.2011.02.002
4. Kaczmarczyk JM, Chuang A, Dugoff L, Abbott JF, Cullimore AJ, Dalrymple J, Davis KR, Hueppchen NA, Katz NT, Nuthalapaty FS, Pradhan A, Wolf A, Casey PM. E-Professionalism: A New Frontier in Medical Education. Teach Learn Med. 2013;25(2):165-70. doi: 10.1080/10401334.2013.770741.
5. Nursing and Midwifery Council. The code. Available at: https://www.nmc.org.uk/standards/code/
6. Nursing and Midwifery Council. Guidance on Using Social media responsibly. Available at: https://www.nmc.org.uk/standards/guidance/social-media-guidance/
7. NHS Employers. Social media guidelines and tools. Available at: https://www.nhsemployers.org/your-workforce/need-to-know/social-media-and-the-nhs/social-media-guidelines
8. Royal College of Nursing https://www.rcn.org.uk/professional-development/revalidation/how-social-media-can-help-you-revalidate
9. Rolls K, Hansen M, Jackson D, Elliott D How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review J Med Internet Res 2016;18(6):e166 DOI: 10.2196/jmir.5312
10. Betton V, Tomlinson V Benefits of social media for nurses and service users. 2013 Nursing Times;109:24,20-21.
11. O'Connor S. Using social media to engage nurses in health policy development. J Nurs Manag. 2017;25:632–639. https://doi.org/10.1111/jonm.12501
12. McCutcheon K., Lohan M., Traynor M. & Martin D. A systematic review evaluating the impact of online or blended learning vs. face?to?face learning of clinical skills in undergraduate nurse education. 2015 Journal of Advanced Nursing 71(2), 255–270. doi: 10.1111/jan.12509
13. Evridiki Papastavrou, Lotta Hamari, Pilar Fuster, Natalja Istomina, Leena Salminen, Using blogs for facilitating and connecting nurse educator candidates, Nurse Education Today,Volume 45,2016, Pages 35-41, ISSN 0260 6917, doi.org/10.1016/j.nedt.2016.06.004
14. Debra Hampton, Patricia F. Pearce, Debra K. Moser, Preferred Methods of Learning for Nursing Students in an On-Line Degree Program, Journal of Professional Nursing, Volume 33, Issue 1, 2017, Pages 27-37, ISSN 8755-7223, doi.org/10.1016/j.profnurs.2016.08.004
15. Mete Akcaoglu, Nicholas David Bowman, Using instructor-led Facebook groups to enhance students’ perceptions of course content, Computers in Human Behavior, Volume 65, 2016, Pages 582-590, ISSN 0747-5632, doi.org/10.1016/j.chb.2016.05.029
16. Ryan, G and Cornock, M Awareness into Action (A2A): a tool for making decisions about professionalism on social media. In: 2nd Digital Health and Wellbeing Conference, 2018. 1-3 May 2018, Open University, Milton Keynes. http://oro.open.ac.uk/54248/
