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Talk to Nurses About Facebook Before They Talk About You

 |  By  
   January 11, 2011

Yesterday, my mother joined Facebook. When she told me she wanted to sign up, I was perplexed. Who would she be friends with on Facebook, other than my brother and me? Turns out, a lot of her friends are on Facebook and she wants to stay in touch. Plus she wants to stay up-to-date with this exciting development of the modern world.

So my brother helped her set up an account and now she's off and running. Last night, in her first status update, I learned she was excited to watch a new TV series premiering that night.

And with that harmless post, I realized that everyone I know is on Facebook. Short of my 92-year-old grandmother—who takes her TV remote control into a repair shop to get the batteries replaced, so I'm pretty sure Facebook isn't on her radar—I can keep up with everyone I know, to a greater or lesser extent, via this one medium.

Facebook's ubiquity makes people not think about it very much. It's just part of life. But when your profession involves interacting in other people's lives, the lines can be blurred.

Last month, four nursing students were thrown out of school after they posted photos of themselves with a placenta on Facebook. The students from Johnson County Community College, in Overland Park, KS, were taking part in a lab experience at Olathe Medical Center. After posting the photos on their Facebook accounts, the students got the boot.

One of the students, Doyle Byrnes, took the college to court to seek an injunction that would allow her to resume classes. According to the suit, the students asked their instructor whether they could take photos.

The placenta had no identification that could have linked it to a particular patient. Byrnes included a letter in the court case that she sent to the school after her dismissal. In it, she wrote:

"In my excitement to be able to share with my loved ones the phenomenal learning experience in which I had been blessed enough to take part, I did not consider that others might view this photograph as unprofessional, offensive to the school I was representing, and more importantly the sanctity of human life," Byrnes wrote. "For my actions I am truly sorry."

And herein lies the problem for employers. We are so accustomed to sharing our lives with our friends and families on Facebook, and it is so quick and easy to do so, that many of us do not take the time to think through the implications. What seemed a personal account of an interesting learning experience to Byrnes, through such a public medium became a potential patient privacy violation, with many considering it disrespectful and embarrassing.

Interestingly, the court sided with Byrnes and ordered she be reinstated. In court, all four students testified they had asked for  and received permission to take the photo. The lawyer argued that no patient privacy violation occurred because there was nothing identifiable in the photos. The judge found the school did not give Byrnes a fair hearing, and she and her Byrnes and her classmates are slated to resume their studies.

This case is simply the latest in a string of stories about nurses getting into trouble over Facebook and other social media sites. A story last week involved a nurse suing her former employer after she was fired for complaining about staff, including physicians, posting photos of sedated patients on Facebook. There is a case before the National Labor Relations Board about a nurse fired for posting that she had come "face-to-face" with a "cop killer" and what she hoped would happen to said person.

These cases illustrate that not only should organizations have policies in place regarding social media, but that organizations should engage in discussion with staff about their use. It's all very well to have a policy about not divulging patient details on staff's Facebook pages, but it's the smaller details and the grey areas that have got most people in trouble.

As part of HIPAA training, as well as general discussions about behavior, administration should encourage educators and managers to talk about these issues on a personal level. Most people understand that using patient identifiers on social media is a no-no. Talking about one's day, however, is a different matter and all too easy for employees to get themselves into hot water.

It's important to discuss not only patients but coworkers and the organization as well. Gossip and malicious talk about coworkers in a public setting can cause hostile work environments. The line between harmless teasing and damaging harassment is all too thin.

Talk about the grey areas, giving specific examples, and bring the issue down to a personal level. Only then will nurses understand the care they must take.

Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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