The Australian Health Practitioner Regulation Agency working in partnership with the Nursing and Midwifery Board of Australia has released a consultation paper on its new Social Media Policy
Frankly, it is pretty unsettling.
In fact if it is published in its present form, impactednurse.com will immediately be in breach of it (As will my Twitter feed, and my Facebook page).
The National Boards have developed the policy to clarify the National Boards’ expected standards relating to social media use. The recent advent of social media, and its expanding use from a social networking tool to a medium for commercial/business related information sharing and advertising, has prompted the need for clarity. The development of the policy has been supported by requests from health practitioners and professional associations seeking guidance from the National Boards on this issue….
…. The primary role of the National Boards is to protect the public. The Health Practitioner Regulation National Law, as in force in each state and territory (National Law), and codes and guidelines developed by National Boards are relevant when considering social media.
You can download the Consultation Paper (pdf) (Update: the policy has been removed from the previous link but you can still download it here) to read through yourself. But I will just tease out a few sections of the draft to examine (all bold print is mine to highlight areas I have some concern about):
1.1 Professional Boundaries
Registered health practitioners should be aware that online relationships or relationships through
social media are no different to more direct forms of relationships. Disclosing personal information on social media to current or former patients may breach professional boundaries.
Practitioners should avoid non-therapeutic online relationships with current or former patients. For this reason, practitioners should be wary of accepting friend requests from individuals or organisations unknown to them.
Comment: My own site is full of personal information. Information about my private life, my dog, my partner, my holidays and of my experiences during those all too brief periods that I do not have a stethoscope within arms reach.
Oh yes AHPRA there are even stories about my sex life (if you care to dig for them).
I have quite a few people following my Facebook page, I have around 1,500 subscribers that get impactednurse.com delivered via email. Are some of these people individuals or organisations unknown to me?
Absolutely.
Have I had conversations with some of them in the comments section and via emails?
Yes.
1.2 Professional behaviour
As in any other context, registered health practitioners should act in a professional manner when using social media. While respect and good communication with colleagues and other practitioners enhances good care, critiquing or comparing and contrasting other health services does not.
Comment: In the past I have critiqued, compared and contrasted other health services as well as my own. I think it is incredibly important that nurses are allowed to have a voice on social media, a voice that is free to make ethical, sensible and relevant comment in the public interest, in representation of our profession and as a patient advocate.
We must be hardcore on this. Sometimes good communication involves rubbing up against the status-quo.
2 Confidentiality and privacy.
Registered health practitioners have an ethical and legal responsibility to maintain patient privacy and confidentiality. Practitioners should not make comments about patients on social media, even in a de- identified way, as it may breach the patients’ privacy and confidentiality.
Comment: This is always a delicate matter, and I think most bloggers who have been around the block have have now developed a clear understanding about privacy and confidentiality. We still sometimes get it wrong. But honestly, I think we get it nowhere near as wrong much of the mainstream media and a few of the healthcare organisations themselves.
If we cannot discuss patient issues in a de-identified way, much of the valuable teaching using case studies, reflective practice, cautionary tales, that the best blogs and websites develop will be lost.
I feel very strongly on this point.
All, and I will put this in capitals… ALL of the most useful skills and quality knowledge I have learned, reflected on, discussed and passed on in the past 5 years or so has come from some form of social media source.
Summary.
When using social media, health practitioners should remember that the National Law, Advertising Guidelines and the code of conduct apply.
Registered health practitioners should only post information that is not in breach of these obligations by:
• not breaching professional obligations
• not breaching confidentiality and privacy obligations (such as discussing patients or posting pictures of procedures, case studies, patients or sensitive material)
• presenting information in an unbiased, evidence informed context and not making
unsubstantiated claims and
• not using testimonials or purported testimonials in any capacity on any medium.
Comment: Again, case studies are a valuable learning tool utilised by all the best medical bloggers.
Many teaching sites now use de-identified pictures and/or videos of procedures.
And as for the definition of sensitive material……well that could be open to pretty wide interpretation.
AHPRA may dropped right off the wave here. The whole guideline should be re-written from an affirming rather than a punitive point of view.
Of course there must be standards and safeguards for both public and our colleagues. But lets work towards developing and nurturing social media not desiccating it.
The positive and beneficial results that social media can bring (and has brought) to our patient care is many orders of magnitude greater than any damage it has caused to the public. The medical profession remains in a social media nascence at this time. Sites such as Life in the Fast Lane and many others are making huge advances in delivering quality evidence based education and forums for interaction and cross-fertilisation of knowledge.
Interactions I have had with nurses, doctors and healthcare consumers both on this blog and in other social media streams, have at times been, uplifting, inspirational and transformative in my own professional practice: we>me.
I would really appreciate you taking a look at the draft policy yourself and voicing your own opinions on it.
Right now I am tired, and perhaps a bit oversensitive about the whole thing. Perhaps it is after all, just another guideline we need to keep us all on track.
What say you?
AHPRA is asking for feedback by email (socialmediaconsult@ahpra.gov.au) by close of business on 14 September 2012.
I wrote a Masters thesis on the ethical issues surrounding a clinical case – I de-identified the patient so well it not only met with the approval of my supervisor (who has an Oxford PhD in ethics) but also my university ethics committee. The case appears in a text, and I’ve presented it at conferences (most recently last month). But if I blog, tweet or post on FaceBook I breach AHPRA’s guidelines? Yeah, no.
Again though governing bodies like APHRA are looking after thier own agendas. If those “nurses” cant compare thier organisations, experiences, opinions and ideas then if something is percieved by nurses to need to change then they have nowhere to gather and discuss it!! Oh and wont the government LOVE IT when it comes to EBA time. Vic nurses used facebook to unite and stick to our guns when it came to the awful conditions proposed byt he vic government and we won. Without this type of freedom to unite the culture of nurses being able to talk, identify, learn and share with another nurse having the same issue, trouble, experience will be lost..butt out APHRA!
AHPRA is run by pathetically incompetent morons, who have no knowledge or understanding of what our trainings involve. Sack the lot of them and reinstall board members who have nursing backgrounds. AHPRA is a disgrace and yet they are controlling and are responsible for our futures.
I think it is just silly. I have to start de-friending people on FB because they have become my patient… did AHPRA think about what happens if my best friend/family/partner came in as a pt, does it mean I have to start defriending and not continue my relationship because it is no longer therapeutic? And oh, is this comment going to be taken as a defamatory case because I am so openly criticising AHPRA?? Thank you for not giving people the gift of our freedom of speech. Never knew that working as a nurse means I need to keep my mouth shut like this. Utterly crazy.
I totally agree with you.. I live in a small town and work at the local hospital so where does that leave me and my colleagues ?? The chances are pretty damn high that at one point or another my self and every Nurse, Doctor, PT, OT, and any other registered professional is going to have a friend or family member under their care so what now we have to de-friend and cut contact because it breaches AHPRA guidelines?? Wake up and get your head into the real world policy makers!! Clearly you don’t work on the front lines in the clinical setting least of all in a small community do you have noooo idea what you are talking about… And again it all comes back to our constitutional right to FREEDOM OF SPEACH!
Me too! When you live in a small town, you WILL be looking after friends and family, not to mention other staff. Nothing you can do about it. I agree there does need to be some guidance about professionalism, and obviously confidentiality is hugely important, but to create a blanket ban on anything and everything is ridiculous – and I dare to suggest discriminatory!
What do they want us to do? Create a cone of silence around our houses so that when we go home from work we have no contact with the outside world? If we do that, we will never grow as individuals, and have a hard time meeting their precious CPD targets.
Yes, AHPRA are metro based and therefore don’t have an insight into smaller communities in this regard. I have had more experience maintaining my own registration after all these years than AHPRA and their 18 month existence, I suppose they are now looking for things to justify their existence. I think I know how to professionally conduct my personal affairs. AHPRA focus on keeping the registration costs fair (since this year they went up) instead of being a “don’t do this, don’t be naughty” “Big brother is speaking…” PITA
Great article. And I have to agree with Gavin, if AHPRA struggle to handle medical complaints or registration with professionalism or due course, how do we expect them to get social media policy right? My main issue is that it could stifle an exciting new frontier in 21st century medicine. For a GP registrar like myself, I’m keen to embrace new ways of connecting and educating our patients. I have written a short comment article here: http://ruralflyingdoc.wordpress.com/2012/09/08/socialmediamed/
Cheers Gerry
I am not at all surprised that AHRPA would construct a document like this. If they can’t quite organise themselves to administer the registration of health professionals in an efficient way (that is their main job, is it not?), then how can they possibly cope with something as rapidly expanding as social media? Response: Regress and dig heals in…
I have written an email to them, and I am now awaiting a much revised document encouraging the educational and critical appraisal opportunities of Web 2.0!
This puts us in a rather deified position. Are we too special to mingle with mere mortals? I don’t want that.
I agree, what happened to freedom of speech within reasonable guidelines!!! I have learnt so much from this blog. Keep up the good work !!!
You will have to get some legal advice…de-personalise your blog/website by using a nom de plume, posting headless photos and de-identifying your workplace (e.g. a big city hospital somewhere in the southern hemisphere…).
We will know it is you, and as long as your posts keep coming they won’t be able to shut you down.
Like Batman…….
Love your work!
So if you link to a journal article that’s a case study, you would be in breach of these rules, as you are effectively discussing an individual patient? Or if your FB account is private only to real world friends, but they “like” a post, and one of their FB friends is a former patient, and sees the comment, you have also broken the rules? Really?
Well, it’s book time then. Get a publisher and get it done. Then its all just a matter of a pseudonym, and you’re all set. “ImpactedNurse Underground” or some such… I’ll never tell. Too much good stuff shared here. Keep it coming. We read you here in the heartland (Indiana University School of Nursing – USA). Knowledge, expertise, mentoring…its all good.
When I am at work, I am a nurse. I don’t use my facebook at work (against hospital policy I think). When I am at home I am a private citizen. Can AHPRA really govern and police what I do in my down time (provided it isn’t breaking the law or patient confidentiality)? I am a nurse through and through, but it is a job, and if they aren’t going to pay me when I am at home, do they get a say in what I do in my off time?
hear hear. What’s happened to freedom of speech within sensible guidelines???
Well, I’m in violation.
We all are, will they strike us all from the roll?
Here’s another breach for you: maybe AHPRA could provide education to help people instead of telling us what we can get in trouble doing?
it’s so sad that policy is written for the lowest common denominator.
it assumes the worst / dumbest / most unethical behaviour and regulates to prevent it. (ie the safe work practice memos telling us not to stick body parts in toasters!)
what it doesn’t do is acknowledge that most of us already do a wonderful job of self regulation.
social media is the future, like it or lump it, AHPRA would do well to embrace it as many of the new grads coming through certainly will
So where does that leave those of us who have been patients in our own work places?? Does that mean we can’t have friend who are also colleagues as friendS on Facebook ? And I have learnt do much from your blogs!! I refer all the studs who comet way to your website! Seems to me the policy was perhaps written with no real insight or knowledge of social media!
I live in a small town, so everyone will probably be my patient at some time. Does this mean I can’t be an online friend with anyone in my town? Seems a bit crazy. We should be able to figure out our own personal boundaries so we can live with some privacy in areas with a small population.
I think that its important to protect privacy but what we as nurses put up about our own lives, eg dogs, cats, family and whatever is our choice. What we put up about our proffessional life should be regulated, you can discuss issues without breaking privacy if its not so specific that some one could work it out.
I live in a small country town, if I did not have former, current or potential patients on my facebook page, I would not have anyone.
Proffessionally we need to monitor our coments and make sure they are appropriate. Its not really that hard, but I guess some do find it hard and thats why this new change in policy is requried.
So if a patient or their family asks about my personal life, like ” how long it take you to get to work” or “you have a suntan, have you just had a holiday?” or “do you have kids” or “it’s lovely weather out did you get to enjoy it?” is answering in a pleasant, friendly manner a breach of professional boundaries? Such questions aren’t designed to dig up the dirt on you, just to be polite or break the monotony.
And if the answer is no, then how its this information, presented in a blog or tweet or status update, which then happens to be read by someone who was once a patient, co
nsidered a breach?
Those CPD points are gonna be hard to accumulate without deidentified journal articles, teaching videos and case studies!!!