“Doc said if he ‘acts up again’ give em’ all at once!” How Far Is Too Far?

Before you get into reading this blog about Nursing, Social Media Etiquette, and representing the Nursing profession in an appropriate manner, I want to make it clear that there is a BIG DIFFERENCE in utilizing various media outlets as a means of raising a red flag when a patient has been harmed or had their rights stripped from them and taking to Twitter to spout off after having to insert an IV into “the biggest hypochondriac I’ve ever seen!”

DISCLAIMER—Yes, I know that not ALL NURSES do this.

Look, I get it. Nursing isn’t always pretty, it’s not always easy, and its certainly not always black and white…in fact I’m sure most of you remember hearing the phrase “It depends” A LOT during nursing school. Seriously– we all have our limits, our boiling points, our triggers as nurses. We like to vent, we NEED. TO. VENT… and while we’re on the job we do it in various ways. Some nurses get together and go down to the cafeteria to have a break and blow off some steam and talk about things frustrating them in the safe company of peers, others go into the break room and take a time out by themselves to deep breathe, ground themselves, rethink a situation or maybe even prepare a response.

Since the dawn of the profession nurses have found ways to share with one another in order to rally, garner much needed peer support, a sympathetic ear, and to hear those soothing, golden words of validation:  “I totally understand….that happened to me too….” There was no such thing as Social Media, and nurses weren’t being showcased as a profession everywhere via television shows, movies (both good and ‘bad’ ones), websites, blogs, and social networking sites such as Twitter, Instagram, and Facebook.

If we take a moment to revisit Maslow’s Heirarchy of Needs you’ll recall that there exists several basic human needs that we all must have in order to achieve a sense of wellness: good self esteem, a sense of safety, belonging, and acceptance. Patients aside, no truer statement could apply to our profession then that one when it comes to promoting and nurturing the mental well being of the nursing workforce. Y’all know what Im talking about too. So many of you out there strive to fit in, to be part of “that group” or the management team that calls the shots. You know it boosts your self confidence, fosters that sense of security, strokes the ego, establishes a foundation of reassurance that you are who and what everyone expects you to be. You do what everyone else does, because everyone else is “doing it” and because it “must be okay” (even though the Code of Ethics clearly states it is not). If it’s your goal and if that’s how you wish to fulfill those basic needs in your professional life, then go with it.

Inevitably, there comes a time when doing “what everyone else does” is just not okay. Not even by a mile. A moment when you have to see past what everyone else is doing and really examine the right and wrong of a situation, break away from the pack mentality, and listen to your own inner voice. When it comes to blowing off steam on the job, venting, or whatever it is you want to call it, there is no “It depends” and there is no such thing as a “Gray Area.” It is, indeed,  “black and white” and the intent shines right through what you post on sites such as Twitter, Facebook, or Instagram.

Its a simple concept, really. There is a right way and a wrong way to vent, share your experiences, ‘horror stories’ or ‘funny moments’ in a way that doesn’t misrepresent our profession and everyone who is a part of it or hurts healthcare consumers who may be reading your posts. Whether you realize it or not, when you send off jokes into the Twitterverse about the penis of a patient whom you just put a foley in bragging that you did it “extra rough to teach him a lesson for being a perv” or the “crazy guy who won’t stay off the call light” or the “needy family that wants me in the room every second because the patient is dying” you are representing ALL OF US. You are showcasing NURSING as a PROFESSION:  TO THE WORLD. You are showing PATIENTS that we cannot be trusted, that they can assume the minute we leave their rooms we’re going to go right onto our smartphones to tweet an update about the latest irritating incident with the “Fibromyalgia patient who thinks she knows more than me, the nurse.”  (By the way these were actual tweets taken off of Twitter, posted by nurses during their shifts)

Here’s a newsflash to all you geniuses out there: Our patients DO KNOW MORE THAN THE NURSE in more ways than you can even think of… and the list is longer than what would fit in one tweet, or two, or three. More than that, they are on to the whole “Social Media venting about patients” phenomenon. Yes, patients are actually pretty tech savvy, especially the Patient Safety and Medical Mal Awareness crowd. I’ll be a nice nurse and “share” the following “intel” for you to consider if you’d like to keep your license and save yourself hell on earth and a trip or two to court.

Healthcare consumers actually create fake Twitter and Facebook accounts so they ca surf different forums, reading through discussions in an effort to better arm themselves against the potential harm that exists within the healthcare system. They pose as nurses, as doctors, and they respond to the snarky posts like the “other nurses do.” Depending on how offensive the discussion is and if they get upset enough, they write down the Facebook name or Twitter handle,  copy and paste the links to your accounts,  the offensive discussion, and they report it as unprofessional conduct to the local Board of Nursing if they are able to find out where you are located. One patient told me that she reported to where the nurse(s) actually worked, complete with screenshots from a smartphone.

Yes, it’s happened. And if you think for even half a second that a Board of Nursing cannot blaze a trail right to you—you’d be devastatingly naïve. A State Board has, at its beck and call, the ability to utilize experienced IT Technicians and Private Investigators when they want to track down individuals, and it’s a lot easier than you think it is. In fact, I STILL HAVE IT TECHS monitoring all my social media accounts! (Regardless of this I don’t hide or censor anything I have to say, for those of you who don’t know that by now) The postings that these investigators compile are procured at all times of day or night …think on that for a second. If your state wants to spend the money to find you, latch itself onto your social media accounts, they will do so… and because they had to go through all the trouble of doing it—your outcome may not be so good. I will reiterate once more that my case is not applicable here, I made carefully calculated decisions upon which I felt I had to act for not just one patient, but the greater good of a community and I took the consequences.  I wasn’t making fun of patients on Social Media.

Now before you start saying to yourself that the First Amendment covers you and your Social Media activity, THIS is where “It Depends” and the “Gray Area” comes into play…

First things first. If you are making harmful, untrue, or non factual statements about a “private person” like another nurse, a nurse manager, or a patient of yours—the First Amendment does NOT apply to you. But! If you are opining about, or criticizing President Barack Obama, his policies, your Governor’s psychotic choices or the local Sheriff’s tendency to focus on all people who are brown—well, then, the First Amendment DOES APPLY. Why? Because these are public officials. People who took these positions or were elected into them knowing that their actions and the things they say or policies and regulations they set or implement are subject to criticism by their constituency. The First Amendment was set into place for that reason. To protect the very people that are subject to the rules, policies, regulations and whatever else government officials come up with that affects YOU as a PRIVATE CITIZEN. It was created to protect you from being retaliated against, harmed, or jailed for expressing your views. It was set forth to prevent government from getting too heavy with power. Think of it as a “checks and balances.” Now, is it always implemented or enforced? No. A prime example would be my situation in Arizona. The Arizona Board of Nursing doesn’t like to be criticized, their rules and policies scrutinized or discussed, so I feel like (as do so many others here) the agency retaliates to inflict fear/harm and the Arizona State Government ALLOWS IT. An example of that? The State of Arizona’s Ombudsmen’s office not completing their investigations into serious allegations I, attorneys, and other nurses filed against the AZBON.

So lets review—want to criticize your Governor, the President, or local law makers on Social Media and flex a little political muscle? Go for it. It’s your right. You can’t be dragged into your Board of Nursing for it (Arizona nurses are exempt from this, of course,  because its moment to moment here and it depends on “who you know”).

Want to whine about the “pain seeking Fibromyalgia patient you’ve had to ‘put up with’ all day,” unload about the “crazy family” you have to contend with on your shift by itemizing their crazy actions on Twitter throughout your shift, or perhaps you’d like to share a chuckle about the “unusual anatomy of the young guy you just put a foley into and can’t get over”—-You ARE NOT COVERED by the First Amendment. In fact, if your colleagues are included in on your Social Media feeds and are particularly horrified (because they KNOW WHO you are talking about) they may just report you to the hospital’s management or your state’s Board of Nursing themselves—anonymously.

There are just so many opportunities for you to fall into the quicksand on Social Media that it is not worth it to make snarky remarks about patients on Social Media.  It’s also not fair or therapeutic for patients to be frightened of healthcare providers because of discussions they see on Social Media. Healthcare consumers have the right to feel like they are in a safe environment, one  in which they can trust their providers enough to undress, or allow themselves to be examined.

A word about “Nursing jokes.” It is not even near appropriate or acceptable to post a picture of IV sedative vials lined up on a med room counter and caption it “Doc said if he ‘acts up’ again to give em’ all at once!” on Social Media—AT ALL. EVER. I mean, really? Where in nursing school did any professor say it was okay to be representing the values of the profession this way? At a time when we as a nation are losing 1,000 lives per day due to medical errors, making tasteless “innocent” jokes like this that you think are harmless actually hurt the entire profession by casting a negative light on what we do, and who and what we are about. Not to mention the fact that it could literally scare healthcare consumers to see such a thing—as well as  nurses laughing along with it—showing support of that behavior.

Once the RN is beside your name, its like a light switch you cannot turn off. What you say and do on Social Media and in real life doesn’t just affect YOU, it doesn’t just reflect on YOU, it reflects and represents the values and beliefs of the thousands of nurses all across the country. The profession of Nursing in its entirety. No single nurse in this profession has the right to undermine the trust people have in Nurses as healthcare providers. No single nurse has the “right by license” or “freedom of speech” to engage in harmful behaviors that make the rest of us look like we are uncaring, all knowing, sarcastic, short tempered, insensitive individuals. No single nurse has the right to set that example to the future of our profession.

Karma is a crazy thing….and you never know when a “nurse” in a Facebook discussion forum or a Tweet chat in which you all are sharing jokes about various patients or parts of their anatomy or their weight, or their body odor etc. might actually be a “patient” or a member of your local Board of Nursing perusing through your discussion. You never know when the “nurse” you are tweeting back and forth with and sharing “patient stories” with that are harmful, insensitive, and judgmental might be a patient just wanting to test the waters and see HOW NURSES REALLY feel about taking care of people.

The reality is, all of these scenarios are playing out every day. The patient safety movement has gotten EXPONENTIALLY larger. There are some angry, angry, permanently harmed patients out there (and I don’t blame them one bit) who have been wrongly maimed in hospitals– some of whom, are hungry for some justice regardless of where it comes from. One patient told me “as long as I can get whoever I can in trouble for harming someone else or being unprofessional I’m gonna do it, because ‘they’ hurt me.” You see, some of these patients lump all nurses together. Some of them also lump all doctors together. You may have nothing to do with what happened to a patient, but lets say they stumble on to some of your snarky Tweets about patients (regardless of the fact you didn’t share identifying information) and you happen to live in their home state? They could easily copy and paste tweet after tweet, look around a little to try and find out your “real name” and turn it all in to the State Board of Nursing—maybe even your hospital’s administrative team.

Is passing judgment on patients, making fun of them, or misrepresenting the profession on Social Media really worth the price you will pay?

You guessed it!

“That depends”….

On what? You ask.

On how “invincible and all knowing” you think you are and how big you think that bubble is that shields you from reality.