Direct from the Policy & Leadership Blackboard: Social Media Ethics

From couponing and microblogs to wikis and networking, social media is all the rage. MD personalities like Oz, Mercola, and Phil, not to mention high-profile facilities like Mayo and Cleveland are all over Facebook and Twitter dispensing health and wellness advice to the masses. Yet some physicians have had some difficulty adapting to the personal privacy and boundary issues of the new medium, which is surprising for a discipline trained to put beepers and unlisted phone numbers between patient and provider. A study on Twitter use among physicians reveled violations in patient privacy, use of derogatory, profane, and sexually explicit content, unsupported medical claims, and advice in contrast to standards of care (Chretien, Azar, & Kind, 2011). The AMA (2010) has created a policy statement on professionalism in the use of social media highlighting some on the unique personal and professional considerations as well as potential benefits of social media use.

But what about the nursing organizations and the individual (and decidedly non-phenomenon) nurse practitioner?  Despite it's own engagement in multiple mediums, all the ANA has advised is a generic call to follow the code of ethics (American Nurses Association, 2010),  specifically the sections on conflict of interest, accountability for judgement and action, professional growth and maintenance of competency, and preservation of integrity and  (American Nurses Association, 2001)."  Behavior online is not necessarily analogous to behavior in person or even over the phone. Should you "friend" patients, coworkers, or students, and if you do, are you responsible for knowing and responding to their posts? Imagine one of your patients posts suicidal statements on a social media site and you see it. Students may post negative comments on your class or violate the school honor code. Coworkers who begged you to cover when their child is sick may post pictures from Fiji the same day. While some scenarios seem like cut-and-dry common sense, others require professional guidance in terms of best practice.  Moreover, no precedent has been set in regard to liability, and there are plenty of legal considerations in terms of confidentiality, nonmaleficence, veracity, solicitation, and malpractice. 

I personally use social media extensively as a way to promote my business and the profession and plan to continue to do so. Carefully. I think it is important that the ANA address this specific topic in the next edition of the code of ethics to provide a basis of guidance and support for nurses. I would much rather see our governing body set the precedent than the winning attorney of the first lawsuit.

American Medical Association. (2010). AMA Policy: Professionalism in the Use of Social Media.

American Nurses Association. (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: ANA.

American Nurses Association (2010). House of Delegates resolution: Social networking and the nurse. Kansas Nurse, 85(6), 21-21.

Chretien, K. C., Azar, J., & Kind, T. (2011). Physicians on Twitter. JAMA: Journal of the American Medical Association, 305(6), 566-568. 

Grow Up Missouri! Doctors are People with Doctorates!

This is from the Online DNP Community. While I personally do not define myself by a title and believe it is important to explain who you are and what your role is when you use one, I believe anyone who has achieved a doctorate has the right to refer to themselves as a doctor in whatever setting they choose.  Please support this action - id this passes it can be used as precedent the profession needs to avoid!

Hello everyone, 

I received a message from a colleague in Missouri, JoAnn Franklin, DNP, APRN, notifying us of some legislative plans that could transfer disciplinary authority over Nurse Practitioners, now regulated by the Board of Nursing, to the Board of Healing Arts - a physician run entity. This is her recommendation:

 334.092 needs to be completely removed because currently the judicial court system takes care of this issue and state boards should only discipline their licensees.  We do not believe the Board of Healing Arts can be the disciplinary for other professions.  Additionally the burden of proof is much less in an administrative hearing than it is in the judicial court system.

There's also a section of Senate Bill No 303 (Section 334.250 number 3) that would criminalize the use of the title Doctor. Here's the essence of that section: 

334.250 number 3.  Any person who uses the title "Doctor", "Dr.", "M.D.", or "D.O." within a hospital as defined by section 197.020, or within an ambulatory surgical center as defined by section 197.200, and is not now or has not been a registered physician within the meaning of the law or is not now or has not been licensed as a physician in another state or territory shall be guilty of a class D felony.

Here's a potential letter that we encourage you to send to the senators listed and linked below:

Senate Bill No. 303; 334.092 and 334.250 number 3

My colleagues in Missouri have notified me and other advanced practice nurses that have earned a practice doctorate degree of some of the language in the senate bill that is due to be voted out of your Financial and Governmental Organizations and Elections Committee. 

Please know that any language that criminalizes someone from using the title "doctor" is unnecessary and inflammatory. 

To make using the title a criminal offense negates the efforts and successes of an entire class of professionals. Missouri would be setting a dangerous precedent that could negatively impact the provision of health care services in the state. Health care providers that have earned a doctorate degree follow the policies of specific organizations such as hospitals to obtain privileges. The policy of the organization is more than enough to avoid any potential patient confusion due to a title. Trying to criminalize the use of a title is draconian without any evidence to show that harm has been done, or is likely to be realized on any patient or patient care organization. 

The motivation is not about safety. 

Please reconsider removing this section of the bill. Similarly, section 334.092 places disciplinary power with one profession over another. This is contrary to our tenets of democracy and definition of professionalism. 

Others outside of Missouri are watching and hoping that the citizens in your great state will not be stifled by unnecessary and ill conceived bills that have little value and a great potential to harm health care professionals and their patients. 

Thank you for reading my note and allowing me to share my concerns. 

Kindest regards, 

The following Senators are in the Financial and Governmental Organizations and Elections Committee

• Kevin Engler, 3rd, Chairman
• Jay Wasson, 20th, Vice-Chairman
• Jane Cunningham, 7th
• Will Kraus, 8th
• David Pearce, 31st
• Luann Ridgeway, 17th
• Bill Stouffer, 21st
• Jolie Justus, 10th
• Robin Wright-Jones, 5th

Thank you for your considerations and request to help our colleagues in Missouri. 

Best wishes to all,

David O'Dell

I Would Have Rather Been a Waitress

A Facebook pal and classmate posted this and I had to share. At just shy of 60 years from the writing of this passage, APRNs have almost managed to get the phrase "physician extender" out of the vocabulary, and RNs are continually ranked the highest in professionalism and respectability in the healthcare field. Enjoy how far we have come!

The Handmaiden 

Nursing is an extension or component part of medicine;

--Nurses are physical extensions of the doctors

--Nursing work is solely delegated medical work done under the close control of a doctor

--Nursing is a part of medicine’s business, and doctors can speak for nurses.

Because the nurse is no more than a participant in medical care, the nurse is expected to obey the doctor.

Nurses are not expected to challenge doctors even if they believe the doctor to be making mistakes which are endangering the patient’s life.

If the nurse carries out the orders of the doctor without question the nurse will not be at fault even if s(he) believes on reasonable grounds that the doctor’s orders are incorrect or immoral and may endanger the patient.

--Even if the nurse performs activities which s(he) knows to be morally wrong, the nurse can be exonerated if s(he) were ordered to do so by the doctor.

The nursing profession is the handmaiden of medicine and the final success of the treatment of disease is often bound up with the efficiency of both. Hon. Dr. Parr, Hansard, 9 September 1953.

ANA on Social Media and Networking

I just submitted a concept map on social networking for my concept and theory class that covered potential uses, boundary issues, and guidelines for creating an official position statement on social networking for nurses. Is a lot of it HIPPA/don't friend your patients/avoid posting naughty photos/keep the 3-day bender footage off YouTube common sense advice? Of course. But the AMA issued a policy on professionalism in the use of social media in 2010, and gee willikers, this is all the ANA had to say about it:

Social networking and the nurse. 
There is very little research regarding the new phenomena of social networking and its role in nursing practice.  The ANA HOD, in an effort to begin the dialogue, brought forth an informational resolution.  An informational resolution does not require the ANA HOD to take action, however, it does indicate action will be considered in the future as nursing research evolves and demands attention.

The nature of social networking is new to most everyone.  Nurses need to understand the potential reach of social networking sites such as Facebook®, MySpace®, and Twitter®.  Although social networking sites have positive benefits in the realm of mutual support and knowledge sharing, there are negative effects as well.  Some negative aspects include:  loss of privacy, legal liability, and loss of professionalism (Frohna, McGregor, & Spector, 2009).

The ANA Code of Ethics outlines ethical responsibilities of nurses in practice relating to social networking (ANA 2005).   Crossing over through personal and professional boundaries can represent a conflict of interest for the nurse.  Nurses have accountability for individual actions, professionally and personally.  Nurses have the responsibility to behave consistent with personal and professional values to protect the integrity of self and profession.

The HOD supported this informational resolution.  Social networking remains unfamiliar territory for the ANA.  Research is needed to guide and inform policies and practices in the utilization of social networking on the national stage as well as at the local level.



Referring to the ANA Code of Ethics is like saying "wear your cap and keep your mouth shut"- I venture to guess less than 5% of all nurses have read the thing (ohh, good idea for a survey!). I do not think we need to go through the whole finger-shaking nursing diagnosis way of creating a position on this. The time is over-ripe for the profession to play a dominant rather than handmaiden role in the healthcare marketplace and stop relying on the old "most respected profession (so why change?)" pat-on-the-head. Responsible use of social media can make that happen. Let's put it in writing!