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64 l Nursing2015 l May
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Hold the phone? Nurses, social media, and patient care By Ronald Piscotty, MS, RN-BC; Terri Voepel-Lewis, PhD, RN; Soohee Lee, MS, RN; Ann Annis, MPH, RN; Eunjoo Lee, PhD, RN; and Beatrice Kalisch, PhD, RN, FAAN
ACCESS TO SOCIAL MEDIA via computers, smartphones, and other electronic devices is almost ubiquitous in today’s connected society, yet very little is known about the impact of social media use on nursing practice and patient care. Given the identified capacity of these technologies to distract the user, it’s quite possible that unintended consequences are affecting healthcare quality. This article discusses the potential positive and negative effects of social media technology on nursing practice. Improved communication offers clear benefits One of the potential benefits of social media use is to improve provider-
to-provider communication and coordination of patient care, facilitating the quick transfer of information. According to one clinician, the use of social media in practice settings for purposes of improved provider communication may be quite effective in coordinating patient care and improving outcomes.1 This clinician used the camera and text messaging functions on her smartphone to send photos of wounds to physician specialists in her practice, which decreased the time to treatment. Professional networks provide forums to share and obtain information, pose questions, and connect with others who have similar interests. The benefits of such networks May l Nursing2015 l 65
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
include rapid dissemination of relevant information to those interested in a particular topic. These networks are becoming increasingly valuable because professionals now have the capability to discuss treatment options with a more diverse community. The resulting quick dissemination and acquisition of clinical knowledge has the potential for rapid translation of up-to-date information into practice. But beware of the pitfalls A major negative effect of social media on nursing practice is the potential to cause distractions and interruptions. Several studies have implicated technology as a contributing factor in causing distractions and interruptions among nurses.2-6 Adverse outcomes, including errors in medication administration, have been identified.2-4,6 A nurse who’s distracted by a social media message during the medication administration process may make a mistake, potentially leading to serious patient harm or even death. A sound or vibration indicating that a message has been received can be distracting even if the nurse doesn’t check the message. The mere knowledge that a message is waiting and the urge to view it can divert the nurse’s attention from the task at hand. The possibility of social networking distractions during handoffs is another concern. Interruptions by social media during handoffs may prevent the nurse from paying attention to key information or from asking questions that would ensure the continuity of patient care. One study noted that, before errors occurred, nurses reported missing important information due to distractions.3 Clearly, distractions threaten safety and quality when nurses fail to collect essential information. Besides the potential for distraction and its consequences, social media misuse may violate patient rights and has been implicated in boundary
The use of social media in practice settings to improve provider communication may be effective for coordinating patient care. violations of patients by nurses and nursing students.7 Several instances have been highlighted in which patient disclosure occurred using social media, including blogging about specific patients and posting pictures of a patient’s body part on Facebook.8 These actions have led state boards of nursing, working collaboratively with the National Council of State Boards of Nursing (NCSBN), to specify boundary violations in much clearer language, with a focus on cellphone camera usage and the Internet.8,9 Weighing the risks and benefits Currently, no universally accepted standards have been developed for the use of social media in the clinical setting. Managers and administrators must weigh the obvious advantages of allowing nurses to utilize social
media in this setting, such as improved communication and access to evidence-based resources, against the disadvantages, such as distractions and interruptions. One solution is organizational policies limiting nurses’ use of personal smartphones. However, such limitations pose different concerns because some nurses use smartphones to expediently access evidence-based practice materials that facilitate informed decision making at the point of care. Limiting nurses’ use of this information where clinical decisions are made may be a disadvantage of such policies. Another option is to restrict access to social media from the hospital computer network. Although this can be accomplished, nurses may find workarounds to circumvent restrictions, such as increased use of their personal smartphones or use of Internet access designated for patients and visitors. Instead of outright restriction of social media in the workplace, another approach is to educate staff regarding the appropriate use of social media. Because timing of use may be helpful (for example, to determine an appropriate clinical decision) or harmful (for example, interruption of medication preparation), imposing restrictions either by policy or on an individual basis may be most beneficial to patient care. The American Nurses Association and the NCSBN have developed guidelines to ensure the safe and ethical use of social media by nurses.9,10 Principles focused on caution and awareness are delineated to protect both nurses and patients from the potential harm associated with social media use.9,10 These principles aim to preserve confidentiality, maintain professional nurse-patient boundaries, and ensure an understanding that personal information is available to patients and employers.9,10 Recommendations include complying with
66 l Nursing2015 l May
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
company policies regarding workrelated social media postings and maintaining respect for the patient at all times.10 These guidelines may provide a reasonable start to establishing professional use of social media in the healthcare setting, but may fall short regarding use in the clinical setting. Think before you post The impact of social media on nursing practice hasn’t been widely studied and isn’t well understood, but nurses can mitigate the risks by using their good judgment and following professional and facility policies and standards for social media use. As social media becomes increasingly intertwined with the daily professional and personal lives of nurses, it’s imperative that the impact on nursing be studied to ensure that patient care is enhanced, not compromised. ■
REFERENCES 1. Glemblocki M. Personal communication. 2011. 2. Brady AM, Malone AM, Fleming S. A literature review of the individual and systems factors that contribute to medication errors in nursing practice. J Nurs Manag. 2009;17(6):679-697. 3. Grayson D, Boxerman S, Potter P, et al. Do transient working conditions trigger medical errors? In: Henriksen K, Battles JB, Marks ES, Lewin DI, eds. Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Rockville, MD: Agency for Healthcare Resesarch and Quality; 2005. 4. Kalisch BJ, Aebersold M. Interruptions and multitasking in nursing care. Jt Comm J Qual Patient Saf. 2010;36(3):126-132. 5. Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM 3rd. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2007;142(5):658-665. 6. Trbovich P, Prakash V, Stewart J, Trip K, Savage P. Interruptions during the delivery of high-risk medications. J Nurs Adm. 2010;40(5):211-218. 7. Jones JS, Fitzpatrick JJ, Drake VK. Frequency of postlicensure registered nurse boundary violations with patients in the state of Ohio: a comparison based on type of prelicensure registered nurse education. Arch Psychiatr Nurs. 2008;22(6):356363. 8. Spector N. Boundary violations via the internet. Texas Board of Nursing Bulletin. 2010;41(3):6.
9. American Nurses Association. Six tips for nurses using social media. http://www.nursingworld.org/ FunctionalMenuCategories/AboutANA/SocialMedia/Social-Networking-Principles-Toolkit/6-Tipsfor-Nurses-Using-Social-Media-Poster.pdf. 10. Cronquist R, Spector N. Nurses and social media: regulatory concerns and guidelines. J Nursing Reg. 2011;2(3):37-40. Ronald Piscotty is an Assistant Professor at the Wayne State University College of Nursing in Detroit, Mich. Terri Voepel-Lewis is an Associate Research Scientist at the University of Michigan Department of Anesthesiology in Ann Arbor, Mich. Soohee Lee is a PhD in Nursing student at the University of Michigan School of Nursing in Ann Arbor, Mich. Ann Annis is a PhD candidate at the University of Michigan School of Nursing and a Research Health Science Specialist at the VA Ann Arbor Healthcare System, Ann Arbor, Mich. Eunjoo Lee is a Professor at the College of Nursing and Research Institute of Nursing Science at Kyungpook National University in South Korea. Beatrice Kalisch is the Shirley Titus Distinguished Professor of Nursing at the University of Michigan School of Nursing in Ann Arbor, Mich. This article, which has been adapted and updated, first appeared in Nursing Management, 2013; 44 (5):52-53. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000459797.02711.8a
May l Nursing2015 l 67
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
64 l Nursing2015 l May
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Hold the phone? Nurses, social media, and patient care By Ronald Piscotty, MS, RN-BC; Terri Voepel-Lewis, PhD, RN; Soohee Lee, MS, RN; Ann Annis, MPH, RN; Eunjoo Lee, PhD, RN; and Beatrice Kalisch, PhD, RN, FAAN
ACCESS TO SOCIAL MEDIA via computers, smartphones, and other electronic devices is almost ubiquitous in today’s connected society, yet very little is known about the impact of social media use on nursing practice and patient care. Given the identified capacity of these technologies to distract the user, it’s quite possible that unintended consequences are affecting healthcare quality. This article discusses the potential positive and negative effects of social media technology on nursing practice. Improved communication offers clear benefits One of the potential benefits of social media use is to improve provider-
to-provider communication and coordination of patient care, facilitating the quick transfer of information. According to one clinician, the use of social media in practice settings for purposes of improved provider communication may be quite effective in coordinating patient care and improving outcomes.1 This clinician used the camera and text messaging functions on her smartphone to send photos of wounds to physician specialists in her practice, which decreased the time to treatment. Professional networks provide forums to share and obtain information, pose questions, and connect with others who have similar interests. The benefits of such networks May l Nursing2015 l 65
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
include rapid dissemination of relevant information to those interested in a particular topic. These networks are becoming increasingly valuable because professionals now have the capability to discuss treatment options with a more diverse community. The resulting quick dissemination and acquisition of clinical knowledge has the potential for rapid translation of up-to-date information into practice. But beware of the pitfalls A major negative effect of social media on nursing practice is the potential to cause distractions and interruptions. Several studies have implicated technology as a contributing factor in causing distractions and interruptions among nurses.2-6 Adverse outcomes, including errors in medication administration, have been identified.2-4,6 A nurse who’s distracted by a social media message during the medication administration process may make a mistake, potentially leading to serious patient harm or even death. A sound or vibration indicating that a message has been received can be distracting even if the nurse doesn’t check the message. The mere knowledge that a message is waiting and the urge to view it can divert the nurse’s attention from the task at hand. The possibility of social networking distractions during handoffs is another concern. Interruptions by social media during handoffs may prevent the nurse from paying attention to key information or from asking questions that would ensure the continuity of patient care. One study noted that, before errors occurred, nurses reported missing important information due to distractions.3 Clearly, distractions threaten safety and quality when nurses fail to collect essential information. Besides the potential for distraction and its consequences, social media misuse may violate patient rights and has been implicated in boundary
The use of social media in practice settings to improve provider communication may be effective for coordinating patient care. violations of patients by nurses and nursing students.7 Several instances have been highlighted in which patient disclosure occurred using social media, including blogging about specific patients and posting pictures of a patient’s body part on Facebook.8 These actions have led state boards of nursing, working collaboratively with the National Council of State Boards of Nursing (NCSBN), to specify boundary violations in much clearer language, with a focus on cellphone camera usage and the Internet.8,9 Weighing the risks and benefits Currently, no universally accepted standards have been developed for the use of social media in the clinical setting. Managers and administrators must weigh the obvious advantages of allowing nurses to utilize social
media in this setting, such as improved communication and access to evidence-based resources, against the disadvantages, such as distractions and interruptions. One solution is organizational policies limiting nurses’ use of personal smartphones. However, such limitations pose different concerns because some nurses use smartphones to expediently access evidence-based practice materials that facilitate informed decision making at the point of care. Limiting nurses’ use of this information where clinical decisions are made may be a disadvantage of such policies. Another option is to restrict access to social media from the hospital computer network. Although this can be accomplished, nurses may find workarounds to circumvent restrictions, such as increased use of their personal smartphones or use of Internet access designated for patients and visitors. Instead of outright restriction of social media in the workplace, another approach is to educate staff regarding the appropriate use of social media. Because timing of use may be helpful (for example, to determine an appropriate clinical decision) or harmful (for example, interruption of medication preparation), imposing restrictions either by policy or on an individual basis may be most beneficial to patient care. The American Nurses Association and the NCSBN have developed guidelines to ensure the safe and ethical use of social media by nurses.9,10 Principles focused on caution and awareness are delineated to protect both nurses and patients from the potential harm associated with social media use.9,10 These principles aim to preserve confidentiality, maintain professional nurse-patient boundaries, and ensure an understanding that personal information is available to patients and employers.9,10 Recommendations include complying with
66 l Nursing2015 l May
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
company policies regarding workrelated social media postings and maintaining respect for the patient at all times.10 These guidelines may provide a reasonable start to establishing professional use of social media in the healthcare setting, but may fall short regarding use in the clinical setting. Think before you post The impact of social media on nursing practice hasn’t been widely studied and isn’t well understood, but nurses can mitigate the risks by using their good judgment and following professional and facility policies and standards for social media use. As social media becomes increasingly intertwined with the daily professional and personal lives of nurses, it’s imperative that the impact on nursing be studied to ensure that patient care is enhanced, not compromised. ■
REFERENCES 1. Glemblocki M. Personal communication. 2011. 2. Brady AM, Malone AM, Fleming S. A literature review of the individual and systems factors that contribute to medication errors in nursing practice. J Nurs Manag. 2009;17(6):679-697. 3. Grayson D, Boxerman S, Potter P, et al. Do transient working conditions trigger medical errors? In: Henriksen K, Battles JB, Marks ES, Lewin DI, eds. Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Rockville, MD: Agency for Healthcare Resesarch and Quality; 2005. 4. Kalisch BJ, Aebersold M. Interruptions and multitasking in nursing care. Jt Comm J Qual Patient Saf. 2010;36(3):126-132. 5. Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM 3rd. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2007;142(5):658-665. 6. Trbovich P, Prakash V, Stewart J, Trip K, Savage P. Interruptions during the delivery of high-risk medications. J Nurs Adm. 2010;40(5):211-218. 7. Jones JS, Fitzpatrick JJ, Drake VK. Frequency of postlicensure registered nurse boundary violations with patients in the state of Ohio: a comparison based on type of prelicensure registered nurse education. Arch Psychiatr Nurs. 2008;22(6):356363. 8. Spector N. Boundary violations via the internet. Texas Board of Nursing Bulletin. 2010;41(3):6.
9. American Nurses Association. Six tips for nurses using social media. http://www.nursingworld.org/ FunctionalMenuCategories/AboutANA/SocialMedia/Social-Networking-Principles-Toolkit/6-Tipsfor-Nurses-Using-Social-Media-Poster.pdf. 10. Cronquist R, Spector N. Nurses and social media: regulatory concerns and guidelines. J Nursing Reg. 2011;2(3):37-40. Ronald Piscotty is an Assistant Professor at the Wayne State University College of Nursing in Detroit, Mich. Terri Voepel-Lewis is an Associate Research Scientist at the University of Michigan Department of Anesthesiology in Ann Arbor, Mich. Soohee Lee is a PhD in Nursing student at the University of Michigan School of Nursing in Ann Arbor, Mich. Ann Annis is a PhD candidate at the University of Michigan School of Nursing and a Research Health Science Specialist at the VA Ann Arbor Healthcare System, Ann Arbor, Mich. Eunjoo Lee is a Professor at the College of Nursing and Research Institute of Nursing Science at Kyungpook National University in South Korea. Beatrice Kalisch is the Shirley Titus Distinguished Professor of Nursing at the University of Michigan School of Nursing in Ann Arbor, Mich. This article, which has been adapted and updated, first appeared in Nursing Management, 2013; 44 (5):52-53. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000459797.02711.8a
May l Nursing2015 l 67
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
