Drawing Lines on the Digital Frontier: Professional Boundaries and Social Media NSHEN Conference October 23, 2013 Marika D. Warren, Ph.D.

Objectives Identify some of the ethical issues around professional boundaries that arise when using social media Identify some of the key values relevant to addressing professional boundaries that arise with social media Discuss and analyze some cases regarding professional boundaries

Social Media – What Difference Does it Make? Concern: Harder to maintain distinction between personal and professional identities in these spaces Difference between various sites –LinkedIn –Facebook

Case 1: Symptoms & Superstore You see your neighbour, Glenn, at Superstore. He asks you how your day was you reply, “Rough! We had a full ED all day long and one of the other nurses was sick.” He says, “That’s too bad – say, what do you think of this rash? Should I have it looked at?” You feel a bit awkward and tell him that you aren’t sure but if he’s bothered by it he should probably get it checked out. How (if at all) would this be different if it took place in the comments section of your blog?

Case 2: Blood & Blogs You write blog about health promotion strategies, a passion of yours. A commenter posts his recent blood test results and asks if there’s cause for concern, mentioning that his family physician advises taking a wait-and-see approach. The levels are at the high end of normal ranges. You think that he would be better off taking steps now to improve his overall health and so you respond, telling the poster that he should go back to his doctor and ask about diet and lifestyle modifications that might help him.

Case 3: Smoking & Social Networks You are a pediatric oncology nurse. A patient whom you treated for five years during her teens has moved away and sent a Facebook friend request to your professional account. You liked this patient and accept the request, since you’d like to know how things go for her. She posts pictures in which she’s smoking, which trouble you because her condition and treatment have left her particularly vulnerable to the harms of tobacco smoke. You leave a comment on one photo, writing “Make good choices!” In discussing this with a colleague the next day, you start to wonder if that was a professional boundary violation.

Case 4: Friends & Frustrations You are on OT on a team of healthcare providers working in the community. One of the younger members of the team has sent you a Facebook friend request to your personal account and you’ve accepted it. Your colleague frequently posts statuses that express general frustration about aspects of her job and unhappiness with policies and directions coming from management, although no patient information is shared and no colleagues are identified. You feel that this might be construed as unprofessional, and decide to talk to your colleague about her behavior. She claims that she’s just blowing off steam and that it’s no different than if the two of you went out for nachos one night and she vented about work.

Key Values Relationship Trust Avoiding harm –Patients –Profession –Colleagues –Organization Confidentiality & privacy Respect Professionalism

Consensus – Social Media and Professional Boundaries Standards from “real life” still apply Risks and benefits to using social media Individuals need to use critical thinking Flexible policies needed; blanket bans not effective Guidelines being developed Attempt to guard against blurring of personal and professional identities

Discussion What is it about social media that makes the blurring of personal and professional identities more likely?