As students several decades ago we recall being told ‘don't talk about patients or colleagues in the hospital lift – you never know who is listening’. In many ways, at that time, that was about the only situation a practitioner could encounter a problem with inappropriate talk. However – not so now – one of the most significant changes in the way we connect and communicate with the world around us has been the phenomenal growth of social media platforms. Although this editorial does not intend to describe them all in detail – but readers will be familiar with ‘Facebook’, ‘Twitter’, My Space, Bebo and You Tube – it argues that these systems create two diametrically opposed opportunities for practitioners. The opportunity to either connect with colleagues the world over in a professional dialogue or engage in unprofessional behaviour towards patients, carers, relatives, colleagues and employers.
Social media is now so advanced it can be used as a helpful medium – clinically and professionally, but also be an unhelpful and problematic medium too. Twitter, the social networking and microblogging service, provides a continuous and endless stream of global information between people and groups. Registered users can interface, follow health conferences and stories, search for information or share web links instantly from their desks or mobile devices, and the search for any topic has the possibility to lead to new contacts and networks (McNab 2009). While social media offers several advantages to students and health professionals, they can also raise serious professional issues (Cain 2008). E-professionalism, an emerging construct accounting for attitudes and behaviours associated with the traditional professionalism paradigm but manifested through digital media (Cain et al. 2010), is now becoming a global problem within nursing and midwifery. Recent media coverage has highlighted students of nursing and midwifery in both the UK and the USA being disciplined for inappropriate behaviour on Facebook (Cooksey 2009, Campbell 2010). Breaches of confidentiality and lapses of professionalism can lead to issues with patient safety, privacy and an individuals’ professional image being compromised inadvertently. It is becoming widely recognised that social media can be a useful source of background information of job applicants for employers – an issue that creates the further necessity for practitioners to be aware of their online ‘presence, footprints or image’. Furthermore, our patients are also users of social media too – raising the additional ethical dilemma of what to do if a patient makes contact through social media. There is certainly a research agenda emerging here about how practitioners feel about and handle this emerging professional challenge.
The problems associated with e-professionalism appear to be closely related to the concept of health professionals always being ‘on duty’. By this we mean that practitioners can always be at risk of compromising patients, employers or the broader profession at any time. Social media just makes this more evident. This issue presents challenges to both experienced practitioners and newly recruited students of nursing and midwifery alike. Professional and private lives can become blurred in ways that result in individuals becoming too comfortable and relaxed in their dialogue, disclosing personal and confidential information about the daily challenges of working in clinical settings. Whilst some students and health professionals may find this resource very valuable in terms of providing a platform for expressing views on the frustrations and challenges within the workplace, the merging of private and professional lives introduces boundary issues – where individuals become at risk of losing sight of the appropriate limits to their conversations.
Despite an overabundance of guidance, commentaries, warnings and advice about the use of SNS, e-professionalism issues remain stubbornly persistent. The dos and don'ts of online behaviour are reasonably helpful; however, they do not advise us on what to do in the many difficult situations that arise within the social media context. There is little training given on the concept and patterns of information revelation, online privacy and ‘crossing the line’ within social media, placing every health professional at some degree of risk. There is a general lack of ‘boundary theory’ among many students and health professionals (Peternelj-Taylor 2002), and busy clinicians do not have the time or resources to discuss the ethical dilemmas that arise. Holder and Schenthal (2007) identify that boundary theory in general is consistently lacking across nursing and midwifery curricula. As nurses and midwives increasingly engage with technology in this context, more needs to be done to develop their understanding about the potential problems linked to social media use.
Students of nursing and midwifery are particularly at risk of e-professionalism problems. Many students only have an emerging understanding of all the aspects of professionalism, until they have been fully prepared for working within the boundaries of professional regulation. However, many will be regular users of social media – hence the need to provide early messages on its associated problems. In addition to this, research by Sandars and Schroter (2007) and Taylor et al. (2010) identifies that younger generations define appropriate social media use differently from older, and older academics and educationalists may be less confident at facilitating classroom-based learning activities supported by the use and integration of social network sites. More experienced and more cautious practitioners may be less likely to use these technologies and potentially are more likely to encourage others to avoid their use, increasing the likelihood of students failing to engage in helpful discussions about privacy and professionalism. There is a need for increased education and training for students and practitioners. Teaching should be geared towards identifying the strengths and weaknesses of social media, the correct use of privacy settings and the career implications of e-professionalism blunders. It is also important that clinicians involved in mentoring students are engaged with the issues associated with social media and can reinforce good practice from the clinical perspective.
Social media has thrust a whole new set of issues on society. A blend of clinical networking using Twitter and social networking using sites such as Facebook and My Space may facilitate practitioners and students to benefit from social media in a personal and professional context. There is potential for educationalists and clinicians to use student engagement to assist students in their understanding of appropriate behaviour both in the online and offline environment. The priority for us all is to ensure professionalism in the digital age.