In the modern era of technology, it is inevitable that the majority of the healthcare workforce participates on Twitter, Facebook, Instagram and Snapchat, and shares their thoughts and feelings to their social media followings. There is no problem with nurses commenting on their friends’ baby pictures, or posting a picture of themselves during a night out. However, social media can blur out the black and white laws of HIPAA into a gray area, unknowingly endangering the future of nurses who inadvertently break the code.

To help nurses decide if a social media post is ethically acceptable to post, the American Nursing Association has created a list of 6 basic rules. By adhering to these 6 rules before posting on social media, nurses protect themselves from fines, suspensions, civil lawsuits, loss of nursing license, and job termination.

“Nurses must not transmit or place online individually identifiable patient information”:

This is one of the most common areas in which nurses mistakenly share too much information on their social media accounts. In past cases, seemingly innocent pictures or posts that allow viewers to make a connection as harmless as a patient with a room number have resulted in termination from nursing school or stripping of a BSN. The reason is because this breaks the anonymity that HIPAA requires health workers to take. While it is really easy to understand HIPAA laws in everyday life, this is where social media can blur the black and white boundaries.

A good general rule of thumb is not to discuss individual patients on social media. As tempting as it can be to talk about stories from work, it isn’t worth endangering your career over. As previously stated, seemingly harmless and vague social media posts have resulted in the connection of private HIPAA protected information and the termination of health care workers. If you cannot resist discussing work on social media, be sure to proofread and edit a post numerous times before posting to ensure that no HIPAA protected information could possibly be connected to a patient.

“Nurses must observe ethically prescribed professional patient – nurse boundaries”:

It is understandable that in long term patient care situations, strong relationships may form between the patient, patient’s family and friends, and yourself. This ACA rule of thumb advises that you keep your private and professional lives separate. Generally speaking, sending messages and friend requests to patients and family members of patients crosses ethical boundaries. Reaching out to patients on social media skews the nurse-patient relationship, introduces biases that may affect your care and decision-making, may make the patient uncomfortable, and definitely falls into an ethical gray area.

If a patient or family member of a patient reaches out to you on social media, it is best to avoid contact on social media until that patient is released. If you feel guilty ignoring the correspondence, it is recommended that you explain in a short message that you do not want to violate HIPAA and hospital policy, and that you do not think social media contact is a good idea until the patient is released. People are generally understanding, and this is a good method to avoid tension when you see the person again.

“Nurses should understand that patients, colleagues, institutions, and employers may view postings”:

Employers at major hospitals almost always maintain tabs on their employees social media accounts. Changing your social media account name from your first and last name to your first and middle name is not a viable solution to this problem. Many major employers will outsource this detective work to services that specialize in maintaining a watch on employee social media accounts.

This rule basically states, ‘post like your employer will see this, because they will’. That means, despite how long your day was, how short staffed your unit was, or how rude the charge nurse was to you today, do not ever utilize social media as a means of venting. You are a representation of your health care facility, and if you depict a negative representation and it is discovered, you can bet that you’ll be disciplined harshly.

“Nurses should take advantage of privacy settings and seek to separate personal and professional information online”:

Privacy settings should always be set to the strictest that the social media site allows for. By controlling your social media following, and ensuring that only they can see your postings, you are protecting yourself. With that being said, do not rely wholeheartedly on privacy settings to protect your account. If you are posting confidential things that you should not be posting, some of the private social media tracking firms previously mentioned have methods of viewing private profiles. So, the ACA recommends that you always protect yourself, but to still use wise judgment in your selection of posts.

“Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities”:

When it comes to HIPAA breaches, there is no such thing as tattling. Every nurse has taken nursing ethics classes, and repeatedly had HIPAA case studies and scenarios beaten into their brains. If you see someone posting private information about a patient, you must take that knowledge to hospital administrators or to the authorities. One of the major pillars of health care is privacy, and every patient is entitled to that as a basic right. Harboring that knowledge and failing to act on it is morally and ethically corrupt, and it could result in a punishment for you if someone realizes that you were aware.

“Nurses should participate in developing institutional policies governing online conduct”:

Essentially, this is the ACA stating that nurses should help shape the specificities of the hospital’s official stance on social media policies. In reality, any established hospital will likely already have governed these policies. It is then the responsibility of the healthcare workers to review, learn and practice these policies, raising awareness to any issues that they see with existing policies.