A social networking site provides an open service enabling anyone with a valid email address to register and use the website which connects people from all over the world. Users create profiles and are encouraged to share personal information about themselves including such information as where they live and where they work, as well as how they are feeling that day via updating their ‘status’.
Photographs can be uploaded where users can ‘tag’ friends so that it is clear who is who. Users can even add their current location and link this to the person they are with; this enables others to know where they are and what they are doing. Users can list family members including their children and partners, so that people on their ‘friends’ list can be directed to others' profiles also (Azizi, 2013). With the average of 130 friends accessing a single account user's ‘wall’, with many younger users having hundreds more ‘friends’, any postings have the potential to be read by a huge number of associates (Smith, 2012). However the concept of inviting a diverse collection of ‘friends’, in numbers most people would have never previously considered as such, is not without its problems (Smith, 2012).
Users need to consider who has access to them and their details? Is it just friends or friends of friends? The more people who have access to a profile, the more users open themselves up to potential problems (Ackerley, 2011). Individuals often assume a false sense of security when using social network sites as they assume that their privacy settings are such that others are unable to see certain things on their profile or ‘wall’ (Azizi, 2013). However Smith (2012) stated that even ensuring maximum protection does not eliminate the possibility of ‘friends’ feeling compelled to report incidents that they may find inappropriate or offensive.
Benefits of social networking sites
When used appropriately, social network sites do provide valuable opportunities to share information and can contain useful educational resources. Regardless of age, gender, religion or profession, a great number of individuals own a social network account with Facebook alone hitting a user base of a billion people in recent months (Zuckerberg, 2012). The ease of making these interactions, combined with the resulting interconnectedness, provides individuals with a wealth of information (Ross, 2012).
Such sites have transformed the way in which information is accessed and shared. Conversely, it also raises concerns due to the recreational element of use with these websites (Azizi, 2013). Not all users realise just how quickly information can be spread via a social network, a fact that was highlighted when an earthquake measuring 5.9 on the Richter scale hit near Virginia (USA) and New York residents read about the incident on Twitter at least 30 seconds before they actually felt the earthquake for themselves (Ford, 2011).
Professionals and social media
Many companies, organisations and charities use social network sites to generate interest, initiate contact, raise their profile and maintain a link with interested parties (Smith, 2012). Healthcare professionals including veterinary personnel are not immune to such sites, with a number of interest groups and forums using such media to disseminate research or evidence-based practice findings or communicate forthcoming meetings and events (Figure 1).
However, there are drawbacks to the use of social media for professionals, including the inappropriate sharing of personal or professional information that reflects poorly on the individual and, in turn, their profession (Odom-Forren, 2012).
All professionals, but importantly healthcare professionals, must consider whether their status, comments and photographs are in line with their duty of confidentiality and their professional code of conduct (Griffith, 2012). Such issues affect all healthcare staff and trainees, including student practitioners who are unable to rely on their student status or inexperience to excuse them from inappropriate use of social networking (Azizi, 2013), a fact highlighted by the high profile case in Kansas (USA) which resulted in four nursing students being expelled from their nursing school for ‘lack of professional behaviour’ after they posted a picture of themselves on Facebook posing with a human placenta. The students were subsequently reinstated following a lawsuit however much damage was done to the reputation of both the students and the nursing school. This was a case about social media that in turn was fuelled by the Internet to become a worldwide external debate over what professional behaviour is and what it is not (Kennedy, 2011). Similarly, two NHS nurses and a healthcare worker were fired from jobs in NHS Trust hospitals in West Yorkshire and Kent (UK) after expletiveridden rants were posted on Twitter regarding a patient's health status, appearance and even toilet habits (Davies, 2013). Further comments included being too hungover to work after drinking heavily the night before and being considered a ‘higher risk of dying’ than their patients. One of the nurses also uploaded inappropriate images of herself including one where she was wearing hospital incontinence pads over her uniform while on duty.
These are by no means isolated incidents, a number of members of the human nursing profession have been dismissed from their duty because of social media-related incidents. There are numerous articles and reports that have demonstrated that healthcare professionals are clearly not as aware as they should be regarding the risks of social networking or the risks that they carry from their interaction with such sites (BBC, 2011). Interestingly, most questionable postings and disclosures amongst nursing staff are typically done unintentionally (Ross, 2012). Even when specific names and places are not mentioned though, it may always be possible to relate the information back to a patient and/or the professional, and this is how a seemingly ‘innocent’ posting can actually violate privacy issues (Azizi, 2013). An issue that healthcare workers often overlook is the innocent provision of their place of work on their Facebook profile. As a sole factor, this is not necessarily a problem. However, along with a status or comments written regarding something in the workplace, or something they write on a colleague's profile, it can link specific cases to specific dates and times. Healthcare professionals need to be aware of these risks to avoid sensitive information being released into the public domain (Azizi, 2013).
Postings that directly violate privacy and breach confidentiality include those concerning personal data. The Department of Health (2006) define personal data as an individual's name, address, age, religion, race, gender and physical, mental or sexual health. In Nottingham (UK), eight nurses were dismissed for such breaches which included one nurse posting a picture of a patient on Facebook (BBC, 2011).
Healthcare professionals need to be aware that social network sites such as Facebook are still in the public domain, and as such there is always the risk of public awareness. For this reason nothing in relation to their work, patients or professional experiences should be shared in this way (Azizi, 2013). The implications are not just for the confidential work that they perform, but also for the patients they care for.
There are of course cases where disgruntled employees deliberately post their dislike of their employer or job, which can result in severe consequences. This is exemplified by the Essex (UK) office worker whose Facebook entry, using a works computer, lost her a job after disclosing it was ‘boring’ (BBC, 2009). The draw of social networking sites, especially after a long or emotional day, seems to tempt some professionals to disclose inappropriate information. Ackerley (2010) suggested social networking sites are not an appropriate site to air work-related grievances or to discuss them with colleagues or friends. It is essential to always use the grievance procedure and raise the issue through the correct channels at work.
Legal and regulatory implications for healthcare professionals
Human healthcare professionals have a duty of care imposed on them by law; this duty exists where patients could be or are affected by acts or omissions of the people involved in their care (Pirie, 2012). Confidentiality is protected by data protection law, which is set by common law and statutory law. Human healthcare professionals have a fiduciary duty (a legal duty to act solely in another party's interests) towards their patients, which is the highest standard of care in law (Azizi, 2013).
However all healthcare professionals, including veterinary personnel, must also consider code of conduct implications. Registered healthcare professionals have an obligation to work at a standard set by their respective regulatory body as part of their professional registration. They are professionally accountable to the regulator, which is a normal part of professional healthcare practice (Pirie, 2012). Healthcare practitioners have a professional duty of confidence not to disclose information gained in a professional capacity to a third party, and this includes via inappropriate use of social networking sites (Griffith, 2012). Azizi (2013) suggested all relevant healthcare professionals should abide by their respective code of conduct at all times in order to demonstrate compliance with their duty of care and to assume responsibility for their own actions (Figure 2).
Veterinary professionals should consider the following table of DOs and DON'Ts in order to ensure professional behaviour appropriate to their regulatory body codes of conduct (Table 1)
Table 1. The Dos and Don'ts of social networking for healthcare professionals
| DO | DON'T |
|---|---|
| Engage with social media for educational purposes | Discuss patients, clients or colleagues |
| Make a distinction between your personal life and professional life | Be lulled by a false sense of security that your comments are private |
| Set your privacy settings as high as possible and minimise friends/followers | Upload photographs of you, your colleagues or your patients at work |
| Think before you type — should you be writing what you are about to write? | Comment on anything you see colleagues writing — you may be implicated merely by commenting |
| Be truthful — deleted comments or statuses can actually be retrieved | Post information that you know would be embarrassing if seen by an employer or colleague |
| Treat everything online as public, permanent and shared | Use social network sites to raise or escalate concerns or whistle blow |
| Follow workplace policy for both staff and students | Assume there is no policy in place. If in doubt — ask |
Computer use policies
Many veterinary practices have a presence on a social networking site such as Facebook or Twitter. Strategic, well-considered posts and updates relevant to pet owners in the community enhance relationships, build trust, and create dialogue all of which will encourage new clients, strengthen an existing client base, and increase practice revenue (VetNetwork, 2013).
Where this is the case, employees would be wise to ask if there is a policy in place regarding the use of social media. Such policies would likely include when employees can access various sites, and what sites cannot be accessed while at work. Such policies may further indicate what employees can and cannot post on websites associated with the practice (Ross, 2012). It is essential that employees familiarise themselves with such policies to avoid the cancellation or removal of computer privileges, or in the case of a serious breach of policy, disciplinary action (Ackerley, 2010). When a policy is not in place, Ross (2012) suggested it would be prudent to implement one to ensure staff are unlikely to make mistakes online. In addition, Saver (2010) suggested managers would benefit by developing and presenting education on social networking issues. Odom-Forren (2012) suggested the online conversation of healthcare employers should reflect the same professionalism that is expected when encountering the public day to day.
Digital footprint
As previously discussed, student healthcare professionals are responsible for their actions online and cannot rely on their inexperience to excuse them from posting inappropriate content. Coe et al (2012) surveyed students at three veterinary schools across Canada to explore their use of and attitude towards the social networking site, Facebook. Students were invited to complete an online survey with questions relating to their knowledge of privacy in relation to using Facebook, their views on the acceptability of posting certain types of information, and their level of professional accountability online. Their findings revealed that a notable proportion of the student-posted content was deemed inappropriate, and as such, could have significant repercussions for the students, their college of study, and the veterinary profession as a whole. Barry (2012) suggested educators, employers, and regulators across the world need to communicate clearly and effectively to students, nurses, and healthcare consumers about the appropriate use of social media.
It is important to note that deleting previously posted material does not remove accountability, as deleted posts can be retrieved by website administrators. Smith (2012) reported that the digital footprint and the lingering ghost of information placed on the internet has in some instances prevented account users' admission to university and employment. This is in congruence with Ackerley (2011) who reported that many employers use social networking sites as a means of finding out more about potential employees during the recruitment process. Prinz (2011) further stated that many potential employers use social network sites to do background and character checks, scanning them for questionable posts or photographs of applicants. It is prudent therefore, to suggest that professionals and aspiring professionals review the content and style of their personal online profile and consider what message it sends to a potential employer or university (Ackerley, 2011).
Distracted health care
A discussion regarding accessing social media at work would be incomplete without discussing the phenomenon of distracted health care. Odom-Forren (2012) described distracted health care as the problems encounted with inappropriate access to social media sites at work. Smart phones and tablets have entered both the human and veterinary healthcare arena and enable easy access of vital information that can facilitate effective patient care (Figure 3). However, with that, the potential for distraction of healthcare professionals has increased, a fact highlighted by the tragic case of a New York (USA) neurosurgeon who was sued, in part, for being distracted after a patient was paralysed during surgery. The surgeon had made ten telephone calls throughout the duration of the procedure (Pho, 2011).
Conclusion
Social networking can offer a place where veterinary professionals can discuss current trends, develop innovative ways to address issues and simply talk about veterinary issues (Ross, 2012). It is imperative however that veterinary professionals, uphold trust and respect in all areas of their lives, including the use of social media. Through knowledge of employers' policy regarding the use of social media, along with careful consideration before posting, veterinary professionals can avoid potential conflicts and continue to enjoy the benefits that access to a wealth of educational resources such websites can provide.
Key Points
- Users need to consider who has access to them and their details.
- Maximum privacy settings do not eliminate the possibility of ‘friends’ reporting incidents that they find inappropriate or offensive.
- Healthcare professionals must consider whether their status, comments and photographs are in line with their professional code of conduct.
- Most questionable postings and disclosures are typically done unintentionally.
- Employees would be wise to ask if there is a policy in place regarding the use of social media.
- Social media can be used effectively to disseminate research or evidence-based practice findings.