Social networking sites

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This information was updated July 2011. For further information, please contact advice@nmc-uk.org

Social networking sites

This advice addresses the use of social networking sites by nurses, midwives and students. It sets out how The code: standards of conduct, performance and ethics for nurses and midwives (NMC 2008) can be applied in thinking about social networking sites, and provides practical advice for using them responsibly. It also advises employers and educators on social networking policies and investigating complaints about the use of social networking sites. This advice addresses specific issues around social networking sites such as Facebook, but its principles can be applied to all kinds of online communication, including personal websites and blogs, discussion boards, email groups and instant messaging. It also covers all kinds of content shared online, including text, photographs, images, video and audio files.

The Nursing and Midwifery Council uses social networking sites to engage with nurses and midwives, students and the public, and we have been leading the UK's health and social care regulators in developing our online communications activity. We are active on Facebook, Twitter and LinkedIn, and we have thousands of subscribers to our regular email newsletters.


At the same time, we are seeing an increasing number of cases before our fitness to practise panels which involve the use of social networking sites and other online activity. Employers and educators have also expressed concerns about the use of social networking sites by nurses, midwives and students.

Applying the code to the use of social networking sites

The code sets out our expectations for the conduct of people on our register, and is a key tool used in fitness to practise proceedings to judge issues of personal and professional misconduct. Our requirements for students are set out in Guidance on professional conduct for nursing and midwifery students (NMC 2009a).

The code states that nurses and midwives must "uphold the reputation of your profession at all times" (NMC 2008), while students must "uphold the reputation of your chosen profession at all times" (NMC 2009a). This means that conduct online and conduct in the real world should be judged in the same way, and should be at a similar high standard. Nurses and midwives will put their registration at risk, and students may jeopardise their ability to join our register, if they:

  • share confidential information online
  • post inappropriate comments about colleagues or patients
  • use social networking sites to bully or intimidate colleagues
  • pursue personal relationships with patients or service users
  • distribute sexually explicit material
  • use social networking sites in any way which is unlawful.

This list is not intended to be exhaustive. If there is any doubt about whether a particular activity online is acceptable, it can be useful to think through a real-world analogy. For example, manipulated photos that are intended to mock individuals would be considered offensive if printed and pinned on workplace notice boards, and are no less offensive when shared online, even when privately shared between friends.

Social networking sites are a relatively new phenomenon, and social norms of conduct and behaviour continue to evolve. It is important to intelligently review and reapply the principles of the code as new situations emerge. In that light, we will keep this advice under regular review, and would welcome feedback on its use in practice.

Practical advice for students, nurses and midwives using social networking sites

The standard of your conduct as a student, nurse or midwife, both online and offline, is important. The way you act online can jeopardise your ability to join and stay on our register. Make sure you read and understand the code, our guidance for students, this advice on social networking sites and other information that we produce. You should think through what this information means for you in practice, and if needed, take steps to change the way you use social networking sites.

  • Keep your personal and professional life separate as far as possible. For example, you could keep Facebook just for close friends and family, use Twitter for sharing information with people you may not know, and use LinkedIn for building and maintaining professional relationships.  
  • If you identify yourself as a nurse or midwife on Facebook, you should act responsibly at all times and uphold the reputation of your profession. Even if you do not identify yourself as a nurse or midwife, be aware that your conduct online could still jeopardise your registration if it calls your fitness to practise into question.
  • Protect your own privacy. Think through what kinds of information you want share and with whom, and adjust your privacy settings. On Facebook, you can adjust your privacy settings at group level to share different levels of information with different kinds of friends. Remember that the more your personal life is exposed through social networking sites, the more likely it is that this could have a negative impact.
  • Do not use social networks to build or pursue relationships with patients and service users, even if they are no longer in your care. If you receive a friendship request from a current or former patient, Facebook allows you to ignore this request without the person being informed, avoiding the need to give unnecessary offence.
  • Do not discuss work-related issues online, including conversations about patients or complaints about colleagues. Even when anonymised, these are likely to be inappropriate.
  • Never post pictures of patients or service users, even if they ask you to do this. Our guidance on record keeping states clearly, "you should not take or keep photographs of any person, or their family, that are not clinically relevant" (NMC 2009b). If your mobile phone has a camera, you should not use it in the workplace.
  • Social networking sites should not be used for raising and escalating concerns (commonly referred to as whistleblowing). Our guidance on raising and escalating concerns (NMC 2010) sets out your professional duty to report any concerns which put the safety of people in your care or the public at risk, and the steps you should take to do this.
  • Remember that everything you post online is public, even with the strictest privacy settings. Once something is online, it can be copied and redistributed, and it is easy to lose control of it. Presume that everything you post online will be permanent and will be shared.
  • You can take action if you find yourself the target of complaints or abuse on social networking sites. You can remove someone from your friend list and block them from interacting with you, and most sites will include mechanisms to report abusive activity and provide support for users who are subject to abuse by others. If you are very concerned about someone else's behaviour online, you should take steps to raise your concern, including if necessary with their university or employer. In the most serious circumstances, for example if someone's use of a social networking site is unlawful, you should also report the incident to the police.

Additional advice for employers and educators

We do not advocate blanket bans on nurses, midwives or students joining or using social networking sites, and employers and educators should not suggest that this is our position. Even if such bans could be imposed on workplace or university computer networks, personal computers and mobile devices offer easy access. Blanket bans are likely therefore to be both unenforceable and counter-productive. We support the responsible use of social networking sites by nurses, midwives and students.

Given the large proportion of the population using social networking sites, healthcare providers and universities can derive benefits through engaging with social media, both at a corporate and individual level. Having a corporate presence on social networking sites can also lend credibility when engaging students, nurses and midwives around these issues, and can provide a platform for encouraging responsible use.

Social networking policies and investigating complaints

  • Organisations should set out clear policies for staff and students on their use of social networking sites, encouraging responsible use. Where a policy is targeted at nurses and midwives, it should remind them of their responsibilities to the NMC, and direct them to this advice and other relevant standards and guidance.
  • Organisations should also ensure that managers, and those responsible for enforcing policies on social networking sites, understand them and apply them consistently, particularly if they are handling complaints. In some cases, where an individual handling a complaint has limited or no experience of using social networking sites, it may be appropriate to encourage them to join personally, so that they can understand better the experiences of staff and students.
  • Complaints about the use of social networking sites or other online activity should be taken as seriously as real-world events. Cyber-bullying for example, can be intrusive and distressing, and sharing confidential information online can be more damaging than sharing it verbally. When considering the circumstances of a complaint involving online activity, it can be useful to make a direct comparison with a real-world activity to ensure the seriousness of the complaint is judged appropriately.

Social networking facts and statistics

In March 2011, there were 25,789,200 people aged 18 and older, living in the United Kingdom, on Facebook. 77,580 of these list their occupation as a nurse, midwife or health visitor (Facebook, 2011a). Based on UK population figures and NMC registration data, we estimate there are around 355,000 registered nurses and midwives on Facebook.

According to the Office of National Statistics, social networking was the most popular internet activity in 2010, particularly among people ages 16 to 24. Within this group, 75 percent posted messages, while 50 percent had uploaded self-created content to social networking sites. (ONS, 2010)

The average Facebook user has 130 friends, and is connected to 80 community pages, groups and events (Facebook, 2011b).

There is an interesting difference between theory and practice when it comes to handling privacy issues online. A 2007 report for the Information Commissioner's Office discovered that 46 percent of 20-21 year olds agreed with a statement that privacy controls are "very important. I layer my profile so that full access is only granted to a very close group of friends." However, 66 percent of respondents to the same survey said that they had accepted someone on a social networking site who they didn't know personally as a friend. (Davies, 2007)

References

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