OPINION

Patient confidentiality matters in cyberspace too

12 July, 2011 | By Jenni Middleton

Ever taken a picture of a really interesting leg wound and shown it to a friend at a party?

Ever uploaded a picture of yourself and a patient on Facebook? Ever tracked a service user down using social media? All of that may leave you spiralling into orbit at the suggestion that you’d behave with such disregard for patient confidentiality, dignity and your own professional status. But there are nurses who have done all of those things. The NMC is investigating an increasing number of referrals about nurses’ fitness to practise in relation to their social media usage. So much so that last week it issued guidance about how nurses and student nurses should behave on Facebook, Twitter and LinkedIn .

According to the NMC’s Andy Jaeger, assistant director, professional and public relations, who wrote the guidance, the rise in inappropriate usage is down to a lack of understanding about just how public the information you share in cyberspace really is and how to manipulate your privacy settings. He confirms the NMC is investigating “several” cases around social media usage.

Despite policies about mobile phone usage, often nurses have their mobiles on them at all times, giving them the ability to photograph, share information and relay opinions without taking a moment to stop and think whether they really should. In the US, nurse Doyle Byrnes posed with a patient’s placenta and posted it on Facebook, while in the UK, nurse Timothy Hyde was struck off the register last year as a result of misconduct involving Facebook.

The NMC suggests that with around 78,000 UK Facebook users listing their profession as nurse, midwife or health visitor (and it believes 355,000 Facebook users are from the professions), such cases are only likely to increase. So think carefully about what you upload. Sounding off about a bad day may be tempting, but it could be construed as breaching patient confidentiality and land you in hot water. You may be a model nurse in the workplace, but make sure you are in cyberspace too.

Readers' comments (26)

mike | 12-Jul-2011 11:33 am
No, no, no!!!! I understand that there are a few, well lets just say idiots, out there who HAVE gone to the extreme of posting pictures of patients, conducting relationships etc, and yes these should be dealt with when reported but these are in the minority. The vast majority of us would not dream of doing that, nor would we be so stupid.

We understand what social media like facebook is, and we know how dangerous it can be, that is why personally I am not on it. But the vast majority of Nurses (and other professionals) who are on it use it sensibly, and there is a vast, vast difference Jenni between uploading pics of a patients placenta, and sounding off about a bad, stressful day. In what way is ranting that you are stressed and have had a bad day breaching confidentiality if no names, patient details or specifics about conditions are used? Why is it construed as 'bringing the profession into disrepute' if a Nurse decides to post a few pictures of a night out? (it has happened)! Who is to say that many of our posts on here, mine included, sounding off about poor staffing levels, lack of decent pay, etc etc, will not be taken exception to by trusts who do not want their reputations sullied (despite them being legitimate points in an argument) and the NMC won't come after us on here next?

You see, this is the danger, isn't it. As I said, there are a few extreme cases, yes, but you cannot apply that rule to everyone!!! It is then that monitoring these sites becomes a very sinister thing indeed. Outside of work, we have a right to a private life and free speech, and as long as that does not breach specific confidentiality or the other examples we have mentioned, then no professional body should have the right to judge on that.

It is just becoming very, very sinister when we have to watch what we say and do outside of work too, and it is not just about being 'professionals' at all times, (we are only human, remember), because there are no goalposts here that the NMC cannot and will not change to suit their purposes. That sentence you wrote 'it may be construed as' is a very very dangerous one.
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desertdeserter | 12-Jul-2011 12:42 pm
There are no problems with people saying they have had a bad day, or stressed with work, it is the breach of confidentiality and data protection that we are being reminded to adhere to. There should be no problem with that as most companies and workplaces are subject to some sort of clause regarding this.

It is the stupid people that this is aimed at when they use names and situations which leave no doubt as to where they work and who was involved. The NMC are providing guidelines and we will probably see the RCN doing the same thing soon, if they haven't already.

This is not a subject aimed at removing free speech, it is aimed at protection of vunerable adults which we have to respect when we are in this profession.
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Anonymous | 12-Jul-2011 12:51 pm
It is also for our own protection as those who do not respect the rules will be investigated with the risk being struck off the register.

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Anonymous | 12-Jul-2011 3:14 pm
Hey mike, didn't you get all hot under the collar about this stream back in April?
I seem to have read all this before....
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Anonymous | 12-Jul-2011 3:49 pm
Big Brother is watching you ......
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Jenni Middleton | 12-Jul-2011 5:24 pm
Mike - I wasn't suggesting that you shouldn't be able to sound off about a bad day. I should have been clearer. I meant that nurses should not sound off about a bad day if what they say breaches a patient's confidentiality. I wouldn't suggest you can't use social media to share, inform and engage with other nurses. I think it's important to make the most of new technology - socially and professionally.
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Anonymous | 13-Jul-2011 12:57 pm
It's alright Jenni, Mike is on one of his 'You are all against the nurses' rants and actually forgets that we need guidelines and that the public need protecting. In Mike's world there are only defamations against nurses and everyone is allowed to do whatever they want.

I think Mike should be allowed to have freedom of speech and discuss patients on the web. So long as all his personal and medical issues, private finances and personal life details are discussed daily on the web too. Then let us see him start whinging about that too.
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mike | 13-Jul-2011 8:51 pm
desertdeserter and Jenni, I agree with the basic tenets of the code when it relates to confidentiality etc, that is not my point, my problem with this is that there are no rules, there are no set goalposts that our regulators have to adhere to, there is absolutely NO difference between explicitly breaching patient confidentiality etc or 'simply sounding off about a bad day' online, when the regulators interpret any post/misdemeanour/whatever in any way THEY choose, and there is no comeback or redress to that.

Anonymous | 13-Jul-2011 12:57 pm, would it be 'bringing the profession into disrepute' if I replied to your 'post' the way I wanted to?
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Mags | 13-Jul-2011 10:48 pm
It goes without saying that Nurses shouldn't breach confidentiality. There can be no argument about that.

However, I have a very big problem with those in the NMC who interpret this guidance. And, more to the point, HOW they interpret it. I really want us to have a transparent and efficient regulator. That would be better for our patients. There is a perception here, and elsewhere, that anybody who expresses an objection to these NMC guidelines, thinks that we should be allowed to breach confidentiality online!! Utter nonsense. I simply don't trust the NMC to effectively manage these 'guidelines'. And I shouldn't be made to feel threatened, because I express this view.

I have posted elsewhere about the RCN Campaign on Facebook to have Margaret Haywood reinstated after being struck off by the NMC. The campaign was successful. This goes against these NMC guidelines about raising concerns online. Are the NMC going to go after the RCN? Of course not. They only go after individuals.

Anonymous | 13-Jul-2011 12:57 pm

Childish, vacuous and offensive comments. Might be an idea to actually read and attempt to understand the content of someone's post, before turning on the bile. By all means disagree with someone. It's a shame that you couldn't discuss the issues in an appropriate manner.

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Anonymous | 14-Jul-2011 12:46 pm
Going on FB and saying that you had a bad day at work is fine but once you go into any detail at all about what caused your bad day is likely to be a breach of confidentiality. You are not anonymous on FB and that is the difference about saying what you think on this site, you can remain anonymous if you want to. And signing in with you first name, Mike, Mags is still being anonymous.
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desertdeserter | 14-Jul-2011 12:53 pm
Hi Mike, I think the problems seem to stem from the fact that you are worried about who actually makes these judgements? I can only tell you from my own personal experiences that the NMC (was the UKCC at the time) do actually listen to the full arguement and then propose their actions. They can only do what they think is best and some people tend to push it to the limits.

I notice that people also seem to be objecting to the fact that it is only guidelines and not hard rules that are published. Because we are working with the public who are in a vunerable position there needs to be some flexibility in every individual case. The NMC are just - to a point, and have to base their decisions on the cases in hand. You have every right to challenge their decision and to take it to the courts. I know that when my mother was admitted and died in hospital the care she received in the A&E was appalling and I discussed it with the NMC then. They were helpful, got some things changed in the A&E from their findings and no one was held to account. They did get patient's dignity addressed which was my main concern.

I think that although we may dislike our bosses who we never see, and only hear or read about in the press, we need to respect their decisions as they have a difficult job to do and not one I would want.

Please also remember the cases we hear about are usually the extreme ones and most day to day hearings are found to have no basis against the health care professional.
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Mags | 14-Jul-2011 1:40 pm
Anonymous | 14-Jul-2011 12:46 pm

"...once you go into any detail at all about what caused your bad day is likely to be a breach of confidentiality..."

That depends what caused your bad day. If a wasp flew into the ward and stung you, causing you to have a bad day,(and you wrote about it that night on Facebook) is that a breach of confidentiality? Or merely an unfortunate event? If you mentioned where you worked, but said nothing about anything or anyone else, is that a breach of confidentiality deserving of a reprimand? The obvious examples of breaches are very easy to agree upon. But it's not always so straightforward, and that's when it gets tricky. Then people start suggesting that, if in doubt, we just stop using FB.....and then we're getting into freedom of speech issues. So the people who interpret these guidelines have to be better than this lot. That has always been my point.

"And signing in with you first name, Mike, Mags is still being anonymous."

What's your point? I don't see any problem with people posting anonymously and have never expressed anything to that effect. I am also happy to have my name disclosed if it were required, because I stand by everything I write here. And, FYI, you are not anonymous here either. Your information can be accessed if required.

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John Higgon | 14-Jul-2011 2:40 pm
Breaching patient confidentiality is a clear no-no, but there will also be a clause in your contract about limits to what you can say about your employer (e.g. business confidentiality) and your professional body will take a dim view of you having a rant about an identifiable colleague. 'Free speech', like freedom to wear what you want, is upheld by the government: but when you sign that contract with your employer....
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Anonymous | 14-Jul-2011 2:47 pm
and how many are aware of the unwritten psychological contract between them and their employer?
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mike | 14-Jul-2011 4:14 pm
Desertdeserter, to a very small extent yes, it is about who interprets these rules. I agree that we need a ruling body with guidelines, but I think that the NMC are not fit for this purpose at all. However, it is much more about the sheer fact that there are no boundaries here at all, the NMC have free reign to interpret anything they wish to investigate, ANY way they like; and I am sorry, but I do not share your trust in them acting fairly. I have seen far too many cases of the exact opposite being true. Furthermore, my main concern is what right does ANY ruling body have to intrude into our private lives? What right do they have to determine what we can or cannot do and say OUTSIDE of work? There are professional guidelines that we must and do stick by when in work, that goes without saying, but when we leave work, provided no laws or confidentiality codes, etc are broken, are we not accorded the same rights to freedom as everyone else? These warnings about patient confidentiality are the mere beginnings of a very slippery slope I think.
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desertdeserter | 15-Jul-2011 12:07 pm
Mike, I do not know any of the people personally who work for the NMC so I do not feel able to comment. All I can say is sometimes we have to trust people in a position of responsibility and trust that they know what they are doing.

Look at the govenment...
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Anonymous | 16-Jul-2011 0:39 am
desertdeserter | 14-Jul-2011 12:53 pm

'I think that although we may dislike our bosses who we never see, and only hear or read about in the press, we need to respect their decisions as they have a difficult job to do and not one I would want.'

and

desertdeserter | 15-Jul-2011 12:07 pm

'All I can say is sometimes we have to trust people in a position of responsibility and trust that they know what they are doing.'

The Council for Healthcare Regulatory Excellence (CHRE) report on the NMC in 2008.....

"The report identifies ‘serious weaknesses in the NMC’s governance and culture, in the conduct of its council, its ability to protect the interest of the public through the operation of fitness to practise processes and its ability to retain the confidence of key stakeholders’."

"We have seen and heard evidence of inappropriate and aggressive language by and between council members and between council members and the executive,’ the report says."

"We have also heard accounts of emotional and aggressive behaviour in meetings. This behaviour is undoubtedly experienced as threatening and bullying by many council members and staff involved,"

By all means, let's have this lot passing judgement on what we do in our own time!
I would suggest that anyone who accepts the status quo, isn't doing their patients or the profession much of a favour.
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Anonymous | 16-Jul-2011 8:57 pm
I am not convinced that there can be business confidentiality between an NHS trust and their employees as all details of the running of an NHS trust, including board meetings, are open to the public unlike plcs.

I cannot see that there are any commercial in confidence issues in the same way there is for manufacturing industries for example where companies have thei secrets.
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desertdeserter | 20-Jul-2011 10:39 am
Anonymous | 16-Jul-2011 0:39 am

The Council for Healthcare Regulatory Excellence (CHRE) report on the NMC in 2008.....

I would hope that improvements have been made within those three years and now provides a better service. Every person should strive to improve and I would hope the same applies to our governing body.

Let's face it, we need to have a governing body regulating our actions and if you feel you could do a better job, then you will have my vote.

Incidently, my wife's hairdresser appears eminently qualified to run the country with all the ideas and complaints she has. Prehaps she could help with the NMC issues first? I suggest she goes into partnership with the taxi driver who picked me up the other night and was explaining what the government were doing wrong.
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Anonymous | 20-Jul-2011 11:14 pm
desertdeserter | 20-Jul-2011 10:39 am

From the latest CHRE report last year,

"....we remain concerned about the customer service provided
by the fitness to practise department and the quality and consistency of decisions made and recorded by fitness to practise panels...."

"...We have concerns about the quality of the NMC’s decision making and recorded decisions."

"...the NMC believes that it is not appropriate for observers to raise matters at Council meetings, we consider that this could lead to a perception that it is not a transparent organisation and not willing to be held to account in a minuted meeting."

With regard to the receipt of complaints:
"From feedback we received from complainants about difficulties in accessing a formal complaints process and delays in receiving responses, particularly
in relation to complaints raised within the fitness to practise department,we consider that these arrangements should be put in place as a matter of urgency to ensure that public confidence in the NMC is maintained."

And in regard to security:
"...the NMC has begun work on the revision of its information governance and security arrangements. We would support the need for the prompt undertaking of
this work as we have received feedback about confidential papers being mislaid or sent to the wrong parties."

Could do better.......!!
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