Mission of NCSBN The National Council of State Boards of Nursing (NCSBN) provides education, service and research through collaborative leadership to promote evidence-based regulatory excellence for patient safety and public protection.
Changing Times Blogs Twitter Social networking Cell phone cameras Posts on forums Skype Etc!
The Extent of Social Media More than 110 billion minutes on social networks and blog sites per month. More than 22 percent of all online time. Facebook boasts more than 500 million members. 38 million business people from more than 200 countries have joined LinkedIn.
Changing Times in Nursing Headlines: Nurses Fired Over Cell Phone Photos of Patient ER nurses took photos of an object lodged in her patients rectum… And posted it on her Facebook page!
Changing Times in Nursing Headlines: Disclosure: The New Closure? (Chicago Tribune article) …my sister, fresh from a tenure in Australia, shared with me the distasteful behavior of her nursing colleagues who spend their breaks offering family and cyber cohorts a snapshot of a stressful shift, complete with the evenings death tolls, diagnoses and patient demographics.
Changing Times in Nursing Headlines: State Gives Kitsap Health & Rehab a Deadline After Nude Photos Incident LPN and two CNAs were fired for taking nude photos of nursing home residents. The facility could lose its Medicare/Medicaid reimbursements.
Changing Times in Nursing Headlines: Tweeting – Not Just for the Birds (Richard Hader, 2009, Nursing Management) I recently had a staff member bring me a copy of a social blog in which a nurse had detailed types of patients for whom she had cared during the last shift she worked…
Changing Times in Nursing Headlines: Nurses Snapped Photos of Dying man and Posted on Their Facebooks
Changing Times in Nursing Headlines: Nurses' jobs at risk for allegedly posting patient information on Facebook
Changing Times in Nursing Headlines: Hospital Worker Fired over Facebook Comments about Patient: - I hope he rots in Hell!
Changing Times in Nursing Headlines: Student Expelled for Posting Photos of Placenta on Her Facebook. -Wall Street Journal Subsequent court case
Positive Uses of Social Networking Smart phones for downloading information, contacting nurses at work, etc. Surgeons use of Twitter in double- hand transplant case
Positive Uses of Social Media Pew Report on the Future of Online Socializing (n=895 technology stakeholders and critics): 85% agreed that the Internet has been a positive force on their social world Example comments: Geography no longer an issue Costs less to communicate
NCSBNs Next Steps Disciplinary Resources Committee Charge: Develop guidelines for social and electronic media to protect patient privacy.
Process Reviewed the literature Surveyed Boards Accessed others guidelines Took middle ground approach To Board of Directors in May To collaborate with other organizations
Survey Results 33 of 46 Boards reporting had complaints 24 took disciplinary actions Board actions: Letters of concern Censuring Voluntary action of nurse (including suspension) Informal discipline (e.g., education)
An International Experience Report of study out of Canada UK: Royal College of Nursing is looking into specific standards
Privacy Issues Defined: Right of a person to be free from intrusion into matters of a personal nature. Treating patients with dignity and respect. Posting about patients. Can be intentional or unintentional
Confidentiality Differs from privacy; deals with unauthorized access to data. Patient charts Can be shared with patient consent or by legal requirements
HIPAA Violations HIPAA Standards in 1996 (federal) Protects privacy and confidentiality Examples posting photos on Facebook
Other Consequences Civil penalties – fines Defamation of character Invasion of privacy Harrassment Criminal penalities – jail time Employer - fired
Effect on Team-Based Care Lateral violence Cyber bullying
Still being determined: Labor laws First Amendment rights to free speech
Common Myths Communication is accessible only to the intended recipients It is acceptable to de-identify information about patients
Common Myths Confusion between patients right to disclose and nurses right Posts can be deleted Blur of nurses personal and professional life
Tips to Avoid Problems Recognize obligation to maintain privacy and confidentiality Dont transmit patient related information Dont disseminate information that will degrade or embarrass the patient
Tips to Avoid Problems Do not post information that could reasonably identify the patient Do not take photos or videos of patients, unless authorized Maintain professional boundaries
Tips to Avoid Problems Consult employer policies Report breaches of confidentiality or privacy Do not post disparaging remarks about coworkers
Case # 1 Photo of vulnerable patient Showed photo to former employee Employer found out – was terminated Board: disciplinary action requiring CE
Case #2 Strange email at work – patient with exposed backside Photo went through organization Prosecutor, Board and national media involved!
Case #3 Student took photo of pediatric patient Posted on her Facebook Student expelled; hospital faces HIPAA investigation; nursing program cannot use the pediatric hospital
Case #4 Blogging on local newspaper Little Handicapper Board issued a warning
Case #5 Student group on Facebook Clinical error discussed Students faced expulsion and discipline
Case #6 Texting orders at party Read aloud to wife, Get a drug screen for Edward Smith Board issued warning to the nurse and the system
Case #7 Hospital sponsored communication page for hospice Hopefully the new happy pill will help, along with the additional morphine Self reported to Board – case in progress