Wednesday, 15 February 2012

Professional standards and boundaries must be maintained when you are online, the NMC says

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Few early users of social networking sites could have predicted how the phenomenon would both grow and grow up. Their incredible success has seen Facebook move from a domain dominated by gossiping teenagers to a powerful communication tool used by millions of people of all ages. Around 355,000 nurses and midwives registered in the UK are on Facebook.

By allowing people to share information and images with a few clicks of a mouse, social media platforms – which enable users to build, integrate or facilitate community – have fundamentally shifted our relationship with the internet. As well as using the web as an extensive information source, we can now upload a huge amount of personal content. Each user of social networking sites can choose to communicate an unlimited level of personal information and opinion, and build an online persona which may be closely linked to their real identity.

As the use of sites like Facebook and Twitter has expanded, many organisations have been quick to harness their potential as powerful tools for education and communications. The NMC uses social networking sites to engage with nurses and midwives, students and the public, and is active on Facebook, Twitter and LinkedIn. Its Facebook page alone has attracted over 21,000 regular users since its launch in 2008. It is used to share tools with online communities and answer queries on regulatory issues.

Alongside the benefits of these new communications channels, there are dangers when the online activities of regulated professionals blur the boundary between their personal and professional lives. Users of social networking sites may feel they can behave in ways they would not consider acceptable in ‘real life’. The ease of posting can make it tempting to disclose information, opinions and images that might previously have been shared only with people close to us. This highlights a tension inherent in the use of social networking sites. ‘Users desire social interaction and connectivity and disclosing information plays an essential role; yet users may not wish to have their information publicly accessible to an unknown audience’ (Bateman et al 2010).

Nearly 80 percent of adults would change the information they publish about themselves online if they thought the material would later be reproduced in the mainstream media (Press Complaints Commission 2008). This reveals a fundamental lack of understanding of the nature of sites that are as openly available as mainstream media unless the strictest privacy settings are enforced. In practice, observing professional boundaries remains more vital than ever when communication is so easy and on a much larger scale.

‘Establishing strict privacy settings represents a good first step to separating personal and professional personas’

Most nurses, midwives and students successfully manage their online presence, either by limiting the content they share or by restricting access to it. The NMC, however, has seen an increasing number of fitness to practise cases involving the use of social networking sites and other online activity. Although each case is unique and is judged on its own merits, the referrals can be divided into two broad camps: those using social networking sites to share content inappropriately, and those using them to pursue unsuitable friendships or relationships.

The first type of complaint might result from something as simple as a newly qualified midwife inappropriately posting an image of a baby she has delivered, or a nurse inadvertently sharing with patients inappropriate images from her social life by failing to adjust the privacy settings on her Facebook page. The second type of complaint is exemplified in the recent case of a community psychiatric nurse, Timothy Hyde. He was struck off in September 2010 for conducting an inappropriate relationship with a former patient. He had met her when she attended a screening assessment, and offered her counselling and support. He contacted her through Facebook two weeks after she was discharged; they saw each other regularly and developed a sexual relationship.

The NMC has introduced advice on the use of social networking sites to support nurses and midwives in this new terrain. Social networking sites (NMC 2011) sets out how The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008) should be applied to social networking, and provides practical tips. The principle that conduct online and conduct in the real world should be judged in the same way, and should be of an equally high standard, is central to this advice.

The code says nurses and midwives must uphold the reputation of the professions at all times. This may mean deliberately keeping personal and professional lives as separate online as you would at work. Even those who do not identify themselves as a nurse or midwife online should remain mindful that their conduct there could jeopardise their registration as easily as their ‘real life’ actions.

Establishing strict privacy settings represents a good first step to separating personal and professional personas, but in essence everything posted online should be considered potentially public. Before posting information or images, nurses, midwives and students should always consider whether it would be appropriate to share them in real life. If they would feel concerned about posting a particular image where patients could see it, or befriending online the partner of a woman they had assisted in labour, they should be equally cautious online. Work-related conversations that would be inappropriate on a bus are just as unacceptable on a social networking site. The premise that online behaviour should be as professional and private as possible is a helpful starting point.

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Related links

See the article NHS Facebook misuse should be resolved at local level by Andy Jaeger, Assistant Director of Professional and Public Communications at the NMC, Publisher of NMC Review and author of Caught in the Web.


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