NEW YORK NURSE: September 2010

You’re up in “MySpace”

by Kathleen Morris, MSA, RN, Director of Nursing Practice, Ohio Nurses Association

Some of us will remember a time when communication was limited to ringing the dinner bell, using the telephone, or writing a letter. Distinctions between personal and professional contact become more difficult when social networking sites, blogs, and online dating services come into the mix. Is a patient a “friend” for the purpose of your social networking site? Are your comments about your professional life sufficiently obscured to avoid recognition by a patient? Are the terms you use to describe or identify yourself via email or on your social networking site giving the right impression? What about the image you are projecting on your profession? Does the fact that you are a student mean that you have less responsibility for following the tenets of professional behavior?

Medical and nursing schools have begun to recognize that policies concerning internet use need to be developed and used as a teaching tool when discussing professional behavior. A study of the online behaviors of medical students published in the September 2009 issue of the Journal of the American Medical Association (JAMA) provides some initial research on web behaviors. Over 60 percent of the respondents to this survey reported incidents of unprofessional conduct related to internet posting by medical students—a few of the incidents even leading to dismissal from medical school. The incidents included posts depicting sexually explicit content, negative comments regarding the educational institution or specific faculty members, alcohol or substance abuse, discriminatory language, profanity, and breaches of patient privacy. Hence, the need for schools and workplaces to promulgate policies concerning what constitutes appropriate, professional use of the Internet.

Here are some directions for maintaining professional boundaries in the age of information technology obtained from (where else?) the Internet:

Avoid using suggestive terms in your email address or other online communications. If needed, use separate email addresses for professional and personal communications.
Use security controls to limit the information available to the public on your social networking site.
Do not become a “friend” on a patient’s page and do not allow a patient to become a “friend” on yours. The same goes for tweets.
If you blog or otherwise discuss your profession on the Internet, make sure that you alter or camouflage any information that might be recognized by a patient or family member. Consider the possibility of a HIPAA violation before you post.
Acknowledge any conflicts of interest you have before endorsing or criticizing a product, therapeutic modality, or treatment protocol.
Help develop a policy for your facility. Explain the policy to your patients and staff during their first visit or orientation. Review the policy frequently.
Before you post, ask yourself if this is something that you would send in a letter or include in an article or educational assignment. Posting is really just another form of the written word and the same rules apply.

Professional boundaries exist in order to maintain a therapeutic or “curing” relationship between patient and caregiver. Because patients are seeking treatment or cure, the caregivers that provide that treatment hold the power in the relationship.

Social networking technology can obscure that patient/caregiver relationship, making it difficult to distinguish between the “professional with a friendly manner” and the “friend,” especially if too much personal contact and information are revealed. Patients, perhaps especially those with mental illness or addiction disorders, may see themselves as needing a friend, yet become disgruntled when the relationship does not produce what they had hoped for in terms of a cure or a relationship outside the therapeutic.

Maintaining personal and professional boundaries can be more difficult with the myriad communication systems available today; nevertheless, it is in the best interests of patients and professionals to set clear boundaries to their relationships, both inside and outside the care setting.

References

Berkman, E T. Social Networking 101 for Physicians. Massachusetts Medical Law Report, 2009. Retrieved on 3/15/2010 from http://mamedicallaw.com/blog/2009/10/19/social-networking-101-for-physicians/.

Chretien K C, Greysen S R, Chretien, J, and Kind T. Online Posting of Unprofessional Content by Medical Students. Journal of the American Medical Association, 302 (12).

Nicholson, P. MySpace is your space: Internet blurs professional boundaries. CrossCurrents, The Journal of Addiction and Mental Health, 13 (2), 14-15. Retrieved on 3/10/2010 from http://socialtechnologiesresearch.com/2010/01/06/myspace-is-your-space-internet-blurs-professional-boundaries-by-patricia-nicholson/.

Park, A. Are Med-Student Tweets Breaching Patient Privacy? Time.com 2009. Retrieved on 3/15/2010 from http://www.time.com/time/printout/0,8816,1925430,00.html. Excerpted and reprinted with permission from Ohio Nurses Review, 85 (3).