Essay on Professionalism in Nursing

This essay will explore how reading the article ‘Nurse’s responsibility when using social media' (Barrett, 2018) and investigating the concept of professionalism has helped me develop my understanding of nursing throughout this module. To begin, there will be an explanation of the key concepts within the article, and how researching these concepts has improved my understanding of nursing. There will then be a summary of the chosen article and the main concepts involved. Following this, the essay will explore a more detailed view of social media, including the positives and negatives that come along with it. Then I will examine the difficulty of setting boundaries and guidelines for social media. I will use references to other articles and studies to explain my points. Finally, the conclusion will explore what I have learned and how this will benefit me in placement.

One key concept of the chosen article is professionalism and accountability. The Nursing and Midwifery Council makes it clear that you are accountable for your own actions and the codes are in place to protect both you and the patients (Nursing and Midwifery Council, 2013). In 1919, the Nurse Registration Act was passed, meaning that all nurses in Britain achieved the highly regarded status of an accountable profession. This meant that registered nurses were accountable for their work and could now lose their job for ‘unprofessional behavior’ (Tilley and Watson 2004). The passing of this Act, therefore, led to the setting of the standards we have today, such as the Nursing and Midwifery Council. Researching the Nursing and Midwifery Council has significantly developed my understanding of nursing as I am more aware of the background as to how the standards we follow today were formed. Over time, more rules and regulations have been added to stay up to date with modern advances such as technology. One branch of Professionalism that I am now thoroughly aware of is e-professionalism. E-professionalism encapsulates the attitudes and behaviors that reflect traditional professionalism, but through digital media (Kaczmarczyk, 2013). This is how your actions online should be the same rules as in practice - you wouldn't share private information about a patient in person, and therefore you shouldn't share this information online either. Learning about this has enabled me to be aware of how Professionalism should be applied in person, and with my actions online. Additionally, studying e-professionalism has further developed my understanding of nursing as I am now aware of both Professionalism and Accountability in more detail and how their rules and regulations were to come about. I have always been somewhat aware of the rules and regulations that are in place concerning what can and cannot be shared on social media, such as it being unacceptable for nurses' midwives and nursing associates to discuss matters related to people in their care outside clinical settings (Nursing and Midwifery Council, 2015). However, my understanding has deepened during this module as am I now aware of how social media creates a 'context collapse' (Cooper and Inglehearn, 2015) where communication is changed based on the situation the individual is in, with social media and its influences being the main reason for this change.

The article chosen for discussion is entitled ‘Nurse’s responsibility when using social media' (Barrett, 2018) based on ‘Uncovering cyber incivility among nurses and nursing students on Twitter’ (De Gagne et al, 2019). The article begins by setting the context and explaining how social media has evolved throughout the last decade. It then explains the cross-sectional approach from registered and student nurses, before going on to dissect the study and the findings from inappropriate tweets. The article mentions how the NMC guidelines state that the mentioned tweets are inappropriate.

The main topic of this article is Professionalism. The writing includes professionalism standards and how nurses have accountability within their job role, which has therefore improved my understanding of nursing and how to behave in the role. The essence of this article is about 'uncivil' tweets from registered or student nurses. Tweets were observed for 6 weeks and almost nine thousand tweets from just 163 individual users were taken to be evaluated to establish if they were considered to be 'uncivil'. The basis for choosing these tweets was that they may have been deemed derogatory, unprofessional, disrespectful, or have contained aggressive language (Barrett, 2018). The study showed that 37% of the nurses included in the sample had posted inappropriate messages and of the 8934 tweets analyzed, 4.6% were classified as 'uncivil'. (De Gagne et al, 2019). This study reinforces the professional standards set by the Nursing and Midwifery Council - ‘Use all forms of spoken, written and digital communication (including social media and networking sites) responsibly’ (Nursing and Midwifery Council, 2013). The article shows that quite a significant proportion of nurses act unprofessionally over social media, with acts committed such as discriminatory language and breaches of patient confidentiality (Barrett, 2018). This study has shown how even with NMC guidance on e-professionalism, there is still a huge lack of understanding, or perhaps respect, for what can and cannot be posted. An example of this is that the article mentions that some tweets were classed as 'uncivil'. However, everyone's opinion of what is ‘uncivil’ will differ, and therefore what some may see as ‘uncivil’ others won't. This makes it difficult for nurses to know what exactly is classed as ‘uncivil’ therefore what is acceptable under the current guidelines. I chose this article as in today's society, social media plays a huge role in our daily lives and often our careers. Although social media offers huge opportunities to promote nursing in a variety of ways, it also comes with many risks of breaching professional behavior.

With the main concept of this article being Professionalism, I have been able to look into this concept in depth, particularly e-professionalism. The chosen article mentions how social media can be used in a positive way such as by promoting healthcare, but the main purpose of the article is to show the risks that come with it too. It addresses the boundaries nurses have and how their professional image can be put at risk by their actions on social media. The 37% of nurses in the study who had posted a tweet that was classed as inappropriate had gone against their duty of care to care for a patient and protect their privacy. 275 of the nurses admitted that they used social media to share stories about their work life, with 32% reporting that one of their colleagues posted information about patients, and 12% of those included photos of the patient (Keast, 2015). This often led to misconduct investigations and resulted in them being excluded or being unable to join the professional register. Consequently, this has helped improve my understanding of Professionalism as I am now aware of the consequences of posting on social media and how important it is to understand e-professionalism and the rules that come with it, so I can use social media effectively and improve future patient care.

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On the other hand, social media cannot be completely criticized. For example, one of the many positive aspects that have come from social media is the #hellomynameis campaign which encouraged nurses to introduce themselves before going ahead with the care of a patient (Granger, 2013). One study showed that social media within healthcare settings led to more engagement within clinical settings and it led to better care for patients (Waldrop and Wink, 2016). This links to the article I chose on 'Nurse's responsibility when using social media' (Barrett, 2018) as it enhances nurses' understanding of e-professionalism to show them how to use social media effectively. In addition, another positive aspect of social media is how easily accessible it is. One-third of adults use a form of social media to help diagnose a medical condition (Avci et al, 2015). Another positive of social media is also highlighted in a cross-sectional survey conducted by Z Wang (Wang Z et al, 2019). This survey showed that 84.5% of nurses in this particular study believed that social media had positive influences on their clinical practice. They used it for receiving messages from work and reading other nurses' experiences to show they weren't alone. However, 50.3% of the participants indicated they had witnessed inappropriate posts on social media by their colleagues. This data further highlights that social media can have both positive and negative aspects when it comes to healthcare as it is clear that a large proportion of nurses do use social media inappropriately. However, there is nothing to say that the nurses were aware that what they had posted was inappropriate. This once again shows that if there were clearer boundaries when it comes to e-professionalism, these issues may not occur or may be minimized.

Boundaries are required to achieve self-care. Having boundaries in day-to-day life helps people take care of themselves and without them, we may feel resentful (Nelson, 2016). Having boundaries set in place more often than not leads to the correct choices, and this is the same within boundaries on social media. This links to the main concept of the article - Professionalism - as having boundaries in place will offer the best protection for both healthcare professionals and patients. As mentioned previously, the article states how 37% of nurses identified were judged to have posted inappropriate messages. There does not appear to be any general understanding of what may be classed as ‘inappropriate messages’ or where the line is drawn. The way the public may view a post could be different from the way healthcare professionals do and vice-versa. An example of this is shown in the study ‘Exploring public perspective of e-professionalism in nursing' (Ryan, 2013). This study concluded that the public makes their own decisions on what’s acceptable for a nurse to post. This decision was based on their personal factors including social and individual values, attitudes, and beliefs. The best way for this to be resolved, according to the public survey respondents, would be to use a separate platform for personal and professional purposes, therefore keeping the two aspects of their lives completely separate. This again highlights how the boundaries when it comes to e-professionalism are not easily defined and make it difficult to use social media effectively. For this to be resolved, both healthcare professionals and patients need to be aware of the limitations of social media. This can be solved by creating boundaries between personal and professional use of social media - such as only professionally discussing patient information - usually in person - rather than over social media. Healthcare professionals should be aware that they have an ethical and legal obligation to maintain patient confidentiality at all times and social media is not safe for protecting any information that they share. All healthcare professionals should therefore have their privacy settings at the highest level possible. The article I chose to discuss states that some tweets were ‘demeaning towards patients’. Although the nurse may have meant no harm or offense in what they posted, the patient or the public could interpret the words in an entirely different way, again showing that the boundaries when it comes to e-professionalism aren't noticeably clear. If there were boundaries that clearly stated that you were not allowed to mention any scenario about a patient then this would be easily resolved, but there are currently no clear lines as to what can and cannot be posted. leading to uncertainty in following Professionalism Guidelines.

To maintain a high level of professionalism among new nurses, the study of social media should be incorporated into a nurse's education. (Barnable, Cunning, and Parcon, 2018). By this, E-professionalism should be maintained significantly better as they would be aware of the newest guidelines. However, encouraging students to use social media for communication but still expecting professional boundaries to be obeyed can lead to confusion about how the personal and professional uses of social media differ (Henderson and Dahnke, 2015). Nurses are often unaware of the professional responsibilities of sharing confidential information as it differs from the personal use of it (Westrick, 2016). Therefore, if Professionalism were taught among new nurses, they would be able to maintain their professionalism and they would understand the legal and ethical responsibilities that their profession requires. This links to the chosen article, which states that one of the biggest challenges for nurses is to be clear on where the line is between freedom of expression and unprofessional behavior (Barrett, 2016). It is important to consider how this may also benefit registered nurses due to the ever-changing atmosphere on any social media app. One question that the article puts forward is whether the profanity in tweets really is 'uncivil' or is it simply a manifestation of the culture and expectations of the online world. This shows how there need to be clearer boundaries for Nurses to maintain their professionality, and without this, their use of social media will not improve. Although I am now aware of e-professionalism, I still do not fully understand what truly is acceptable and what isn't for every circumstance, and therefore this shows that until clearer boundaries have been made, people's understanding of professionalism may be improved.

Overall, my understanding of nursing has significantly developed as I am deeply aware of both the advantages and disadvantages of social media. Before studying the concept of care and learning about accountability, I wasn't fully aware of how my actions on social media could affect my job. I was aware that I couldn't speak about patients' health or post photos of them online as I had previously read about similar cases in the media. However, I was less aware of how posting on my social media about work and my daily social life could have a huge impact on my position; if a patient were to see something on my social media and report me for 'not being in a fit state to work', many more allegations could appear and impact not only my career but also my own mental health. Therefore, I am aware of how to use social media in ways that will help me and others, but I am also now aware of the risks that come with it and how to minimize these. I have read - and will continue to read - the NMC guidance, and if I were to speak about a patient online, I would ensure that I have proof of the patient giving me permission. This will help me when I start to practice, as I will be aware of what I can and cannot post and will ensure my social media profiles are private.

In conclusion, my understanding of nursing has increasingly developed during this module. The key concept of Professionalism in the chosen article has made me aware of the NMC guidelines and I am aware of both the ethical and legal obligations I have as a student nurse. I am more aware of the risk of social media and now feel more prepared how to use it correctly, which will help me in my future placements. It is clear to see that the boundaries set by the NMC are not exactly defined, and it is, therefore, best to ensure you are aware that what you're posting is appropriate, and unless you feel the necessity to, I would not post at all. From exploring the theme of Professionalism, I am aware of how your care for patients and their privacy is constant, including online. I am aware of what the Nursing and Midwifery Code states regarding social media and know I can apply this to practice. I am aware of professionalism and even more so of e-professionalism. In most ways, I do now feel comfortable using social media as it can be useful for many things, such as blogs from experienced staff. I am also aware of what to do if I see uncivil things from other nurses or colleagues as I am aware it is my duty to protect patients. Overall, my understanding has significantly improved, and I am now more prepared and aware of how I can use my understanding of professionalism in practice. For more nurses to be aware of e-professionalism rules and guidance, it should be taught as part of the course. This should therefore lead to fewer inappropriate posts on social media and should improve future healthcare and protect both nurses and patients too. As social media is still growing and changing every day, there should be training for those already registered nurses to maintain consistency for all staff. In conclusion, my understanding of nursing, about professionalism has significantly improved and will benefit me in practice.