Position Paper on the Nurse's Use of Social Media

to privacy and confidentiality” (ANA, 2015). Information is only to be shared with those directly

involved in a patient’s care who have a direct “need to know.” Likewise, HIPAA privacy rules

seek to define and limit information sharing to those who have a need to know to participate in

the care and treatment of patients (United States Department of Health & Human Services Office

of Civil Rights, 2007). This may include information sharing with family members or friends

who are involved in care or payment for care. Disclosure of information to other people or

entities is viewed as a violation of privacy. Under both codes, identifiable patient information

should be disclosed only on a need-to-know basis.

The ANA Code of Ethics describes professional therapeutic relationships and emphasizes

the importance of maintaining boundaries within the nurse-patient relationship (ANA, 2015).

Maintaining appropriate boundaries safeguards both patients/clients and nurses by controlling or

limiting this power differential. Setting boundaries allows for safe connections between nurses

and patients based solely on the needs of patients (Holder & Schenthal, 2007). Professional

boundaries help to safeguard the patient-nurse relationship and provide a framework for

interactions that benefit patients and families (Guseh et al., 2009). Nurses who care for patients

with chronic conditions are at higher risk for being overly involved and crossing professional

boundaries (Flaherty, 1998). Establishing friendships with patients and families is not a

customary aspect of therapeutic patient-nurse relationships. Internet-based friendships may open

the door to unprofessional interactions online or in person that are not in the best interest of

patients and may lead to potentially problematic self-disclosure of nurses (Guseh et al.). Due to

the length of treatment, long-term follow-up, and the potential for recurrence, there is no clear

indication of when a nurse-patient relationship is completely terminated or would transition to a

social relationship or friendship (National Council of State Boards of Nursing [NCSBN], 2014).

Modern nursing must combine clinical and technical competence with compassion,

empathy, and respect; it is interpersonal skills that allow nurses to establish therapeutic

relationships and build trust. This sensitivity to others is an integral part of the caring profession

of nursing (McHolm, 2006; Sabo, 2006). At the same time, this sensitivity makes nurses

vulnerable to the emotional toll of compassion fatigue. Nurses who have a high degree of

empathy can easily become overinvolved with patients and their families (Newsom, 2010;

Sherman, 2004). Pediatric hematology/oncology nurses are expected to be involved in caring for

patients as well as families, and this puts them at high risk for compassion fatigue. Stressors

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