Social media: a useful tool for nurses that can become a weapon against them

Nurses can be targets of online abuse – with even fellow registrants going on the attack

Nurses can be targets of online abuse – with even fellow registrants going on the attack

  • Nurses can find themselves criticised and even abused on social media because of involvement in controversial care cases
  • Editors should consider the impact of their decisions on the NHS and nurse retention levels
  • Advice on using social media will help you join discussions while maintaining high standards of professionalism

Uproar over care decisions in cases such as that of infant Charlie Gard can be fuelled
by anger vented online. Picture: PA

High-profile cases, where hospitals are involved in ethically complex decisions about a patient’s treatment, can lead to their staff being caught up in a media frenzy.

‘The press packs aren’t just there for one day,’ says Stephen McKeever, a senior lecturer in children's nursing at London Southbank University. ‘Nursing staff are often dealing with very difficult circumstances – [and then they have] a microphone shoved in their face every time they walk out the door. Even if you’re not in that team, you can still be asked repeatedly for comments. It doesn’t help the situation.’

Stephen McKeever.

When children are involved

It can be particularly challenging when the patient is a child, the relationship between healthcare professionals and the patient’s family is fracturing, and the courts become involved. ‘Of course, the family at the core are suffering and will have to live with what happens for the rest of their lives,’ says Dr McKeever.

‘But it’s also a very difficult time to be a nurse. You’re already worrying about doing the right thing – whether it’s right for the family and the child. Couple that with having to run the gauntlet of a media pack on your way to work, while your care and your organisation is attacked on social media – it can lead to degrees of distress.’

‘It’s wholly inappropriate for nurses to share petitions. We know we all practise within the Code – it’s not for an online petition to say whether our colleagues should be held to account or not’

Stephen McKeever, senior lecturer in children's nursing, London Southbank University

In May, the RCN children and young people’s acute care forum raised the issue in a matter for discussion at the college's annual congress. Dr McKeever explains: ‘There have been a couple of recent high-profile cases relevant to paediatric intensive care, which have attracted a lot of media attention, affecting people in our forum. We wanted to talk about what happens when both the mainstream and social media get hold of these cases, and the impact that can have on the nursing workforce.’

Recent high-profile cases include that of Charlie Gard, born with mitochondrial DNA depletion syndrome and cared for at Great Ormond Street Hospital in London. Staff reported receiving thousands of abusive messages, including death threats.

Police had to be called in to protect staff and the public entering and leaving Alder Hey
Children’s Hospital during a protest about the care of Alfie Evans. Picture: PA

Another case involved Alfie Evans, who had a degenerative brain condition and was cared at Alder Hey Children’s Hospital in Liverpool for more than a year before his death in April 2018. The trust complained that staff had been subjected to a barrage of abuse, in person and on social media, from protesters opposed to the withdrawal of life support from the 23-month-old. On one occasion, during a demonstration attended by 200 people, there was an attempt to storm the hospital.  

During the congress debate, nursing student Aimie Morgan, from South Staffordshire said she had seen news articles and petitions – shared by nurses – calling for nurses who worked at these hospitals to be called to account. ‘When using social media, we must remain professional and ethical and abide by the Code, but most of all we have to stick by our fellow nurses and colleagues,’ she told congress.

Dr McKeever says: ‘If nurses were sharing petitions, it’s wholly inappropriate. As nurses, we know we all practise within the Code – and it’s not for an online petition to say whether our colleagues should be held to account or not.’

The nurse’s friend – if you use it wisely

Jessica Sainsbury of the RCN student
committee and the Student Nurse
Project. Picture: John Houlihan

While social media can fuel antagonism, over-simplify debate and ensure unfair criticism reaches a wider audience, it’s important not to forget its positive side, says third-year adult and mental health nursing student, Jessica Sainsbury.

‘A lot of universities will say at your induction, stay away from social media,’ says Ms Sainsbury, vice-chair of the RCN student committee and south east region board member. ‘I’ve been trying to change that approach. Don’t be scared of it. You’ll get a lot of benefits from it, if you use it professionally.’

Social media on the curriculum

Some students fear they will get into trouble, possibly risking their registration. ‘But if you’re educated in it and know how to navigate it, you’ll be fine,’ says Ms Sainsbury, who is studying at Southampton University, where digital competency – including in social media – will form part of a new nursing curriculum.

She is part of the Student Nurse Project, which began in 2018 as an online support network for students and those who are newly qualified. ‘Being a nursing student can feel quite lonely, as you’re separated from your cohort for half your course,’ says Ms Sainsbury.

Beware the temptation to tweet on impulse, advises Jessica Sainsbury. Picture: iStock

With more than 8,500 followers, the project shares useful information, hosting regular chats on topical debates. ‘Social media flattens the hierarchy of nursing,’ she says. ‘It builds networks and relationships. For example, as a student I can speak to the chief nursing officer.’

Be careful out there

For newcomers, she cautions against impulsive posting. ‘And don’t forget that even if you delete something, once it’s out there, it’s out there. Someone could have screenshot it,’ says Ms Sainsbury.

Having complex conversations online can be fraught, she admits. ‘Short word counts mean it can be hard to convey what you mean. If the debate becomes unprofessional or personal, you don’t want to be viewed as aggressive, but equally you don’t want to be seen to always be stepping away.

‘It can’t be an echo chamber where everyone says the same things – we do need to challenge each other, respectfully. And I’ve seen people’s minds being changed by reading what others are saying.’

Further information


Helpless to respond to criticism

Among the major difficulties facing nursing staff is that when they or their organisation are publicly criticised, they cannot respond. In contrast, families and those who support them can speak relatively freely, posting regular updates on social media, if they choose. ‘They can be very vocal, saying how bad everything is,’ says Dr McKeever. ‘But there’s another side to the story that’s not being heard.’  

He would like to see the media exercising what he sees as more responsibility. ‘They need to recognise there is a silent voice in all of this and there is an impact there,’ says Dr McKeever. ‘It’s not that we don’t want to talk about it, it’s that we can’t. And if nurses are caring for patients, but can’t say anything, they have no voice. It will lead to stress. When an editor thinks this is a public interest story, they also need to bear in mind their coverage could instigate nurses leaving their profession.’ 

Environments of heightened hostility

Another significant factor is the lack of nuance in public debate, with views becoming increasingly polarised and often hostile, particularly on social media sites, such as Twitter and Facebook. ‘I have a t-shirt that says, “I think you’ll find it’s a little more complicated than that”,’ says Dr McKeever. He argues for evidence-based and properly sourced arguments, with opposing sides appropriately weighted. ‘For example, there is overwhelming evidence that vaccinations work, yet anti-vaxxers end up with an equal amount of space given to their argument,’ he says.  

He argues there is a need to open up a public debate on the larger issues raised by these cases, shifting the focus away from specific cases and the individuals affected, including their aggrieved families.

‘The public needs a better understanding about appropriateness of care and when end of life care is instigated, the importance of palliative care – which doesn’t mean its removal – stopping curative treatment, and being able to provide a good death,’ he says. ‘Such decisions are not arrived at lightly. There are second and third opinions. All manner of people become involved. There is much more to it than a black-and-white media story.’

Dr McKeever insists there should be more support for nursing staff who are facing these difficult circumstances. ‘The RCN needs to be there to help, with members feeling they have a voice and somewhere to go, early on. At the moment, I’m not sure that happens quickly enough.’

How to use social media and remain professional

The NMC’s guidance on using social media responsibly says acting in ways that are unprofessional or unlawful on social media can jeopardise your registration, or ability to register if you’re a student. Examples of this behaviour include:

Picture: iStock

  • Sharing confidential information inappropriately
  • Posting pictures of patients and people receiving care without their consent
  • Posting inappropriate comments about patients
  • Bullying, intimidating or exploiting people
  • Building or pursuing relationships with patients or service users
  • Stealing personal information or using someone else’s identity
  • Encouraging violence or self-harm
  • Inciting hatred or discrimination

You have a professional duty to report any concerns they may have about a nurse or midwife using social media in any of these ways, says the NMC.

On protecting your professionalism and reputation, the guidance advises that if you are unsure about whether to post something, you should first think about what it means for you in practice, and how it might affect your responsibility to adhere to the Code.

Consider who and what you associate with on social media, says the NMC, adding: ‘You should consider the possibility of other people mentioning you in inappropriate posts. If you have used social media for a number of years, it is important to consider, in relation to the Code, what you have posted online in the past.’

Read the NMC's guidance in full

NHS Employers guidance include tips such as:

  • Read your employer’s policy covering social media use at work
  • Check the privacy settings on your personal social media profiles
  • Look back over your updates and see if there are any that don’t match your profession’s values and standards
  • And if you wouldn’t say it out loud in the canteen, don’t post it online

A section on the media points out that sometimes stories are based on people behaving wrongly. ‘…NHS employees are expected to behave with respect, dignity, compassion, empathy and professionalism,’ the NHS Employers briefing states.

‘If you post behaviours and opinions online that don’t match those expectations, the media may write a story about you. They’ll do this to shock their readers and keep them reading their paper and/or website.’

Read the NHS Employers briefing in full

Lynne Pearce is a health journalist

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