Nursing Professionalism : Impact of Social Media Use among Nursing Students

Social media usage among young adults has increasingly become a method, by which, most every aspect of personal life are publicly communicated. Observations of these communications can quickly reveal one’s political, social, and professional viewpoints. Some human resource departments screen applicant’s public social media profiles as part of the hiring process. In a Society for Human Resource Management 2013 survey, 22% of respondents indicated that they use social media websites, such as Facebook or Instagram to research job applicants. The nursing profession is not immune to these types of recruitment and hiring practices. Due to a nursing shortage, nurse recruiters within hospital human resources departments often find that filling vacancies in some nursing units can be difficult.


Introduction
According to the Bureau of Labor Statistics, there will be a projected increased change in nursing employment of 16% from 2014 to 2024.Screening nursing applicants for professional social media communication can confound an already challenging process of filling positions within healthcare facilities.Therefore, nursing educators will need to consider providing more extensive guidance to students related to creating a professional social media impression [1,2].
Most schools of nursing emphasize the avoidance of violating provisions of the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA).These laws are typically reviewed with students and written into confidentiality and social media policies within the school's student handbook.However, to a much lesser extent, nursing students are provided with detailed guidance on using social media that exhibits the professional standards that healthcare employers demand.Consequently, young adults in nursing school can, unknowingly, be vulnerable to social media mistakes and potential negative results when seeking to secure employment in the healthcare industry.
In one study, 77% of schools of nursing had encountered at least one occurrence of students posting unprofessional content on social media [3].This seemingly high rate of incidents suggests that some young adults fail to recognize the influence of social platforms in the world today and the potential consequences in their professional life.Some of these misconceptions may be the result of students being unaware of the potential viewers of their social media content [4].In the formative years of middle and high school, many students often perceive the viewers of their social media content to be friends or acquaintances within their social circle.Unfortunately, these perceptions of social media often persist into adulthood, unaware of the increasing number of people viewing their social media content as they enter into the healthcare profession [5].Additionally, these students may be oblivious of the intent of these new viewers within the profession.
Many educators often view that social media policies for students are inadequate to properly educate or address professionalism issues.Providing details and examples of every potential pitfall in social media are difficult to provide within the confines of a single student policy [6].Therefore, nursing students can remain unqualified to discern what constitutes content that may be viewed as unprofessional even after being made aware of the existing policy or recommendations.

Social Media Mistakes
As previously mentioned, confidentiality issues within the clinical forum are generally addressed in the school's student policy handbook.However, some students do not understand

ARCHIVOS DE MEDICINA ISSN 1698-9465
Journal of Healthcare Communications ISSN 2472-1654 that avoiding the use of patient names is not a guarantee of anonymity and complete compliance with confidentiality policies or HIPAA laws [7].Details of a diagnosis, procedure, or emergency medical event in the clinical setting can lead to inadvertent disclosure of the patient's identity among social media viewers familiar with the healthcare facility [8].This can be the case, in which, the student lives and has social media friends within the community where the clinical site is located.This situation can create an opportunity for social media followers to discern the identity of the patient simply by being aware of a co-worker's or associate's hospitalization in the local hospital and general health circumstances.Discussing details of such medical information as a learning opportunity should remain within the confines of the post-clinical debriefing.Among healthcare employers, these types of posts could be viewed as reckless and narrowly bordering upon a breach of confidentiality.
Argumentative behaviors within a social media post are often poorly understood among some students.Students often view these types of posts as a simply expression of their personal, political, or social viewpoints.While students have the right to express their views in the public forum of social media, some interactions can evolve into perceived personal attacks on others with opposing views.Human resource specialists reviewing social media content of potential applicants could interpret this behavior as a tendency to be difficult to work with others or possess the potential to create a hostile work environment [9].It is important to guide students in the acceptable methods of expressing views within the confines of professional, public discourse.While some users of social media hold passionate views on a variety of topics, any perception of disrespect of the views of others can be viewed negatively and as being unprofessional for those in the nursing profession [10].
References to alcohol or drug use would seem to be obvious topics to avoid in social media for students pursuing a professional nursing degree [11].However, students unfamiliar with the importance of maintaining a professional profile can struggle as they attempt to separate personal and profession boundaries.Within social media, these boundaries do not exist as each post is typically viewed on its own merit and as a reflection of the user's personal and professional traits.The formation of these perceived traits are not limited to the mention of such behavior within the text of a social media post [12].Pictures depicting these behaviors can, in many cases, be viewed as more expressive of one's tendencies than the words themselves.A photo of a student consuming an alcoholic beverage during spring break might be viewed by some as acceptable.However, this may lead potential employers to question the applicant's judgment or ability to remain unimpaired.Additionally, a patient or patient's family viewing this content may develop a view of the student that is inconsistent with typical attributes of a professional nurse.Altered levels of trust can negatively impact the nursing student's ability to participate in the care of a patient or a family's loved one.
Inappropriate humor within social media posts can be detrimental to a nursing student's professional reputation [13].
While a good sense of humor is typically seen as a positive attribute, humorous posts that involve race, religion, sexual inferences, or foul language can be seen as a professional liability in the healthcare industry.The ability to provide unbiased and non-judgmental nursing care to the community is important to healthcare employers.Hospitals and clinics do not wish to have inappropriate attributes of their associates to become a reflection of their organization.
Social media platforms are often used to express reviews or complaints about businesses or services.Healthcare facilities can also be the subject of positive or negative commentary.Like most businesses, healthcare facilities have processes for managing complaints or concerns from patients or families.However, continuous or aggressive complaints within one's social media platform can create an impression of the inability to manage anger and utilize appropriate channels to file grievances or express concerns.Nursing students or new graduate nurses seeking employment can be labeled a "trouble-maker" and can become undesirable as a potential employee.Negative posts by nursing students related to a clinical site can jeopardize partnerships with schools of nursing.This can be detrimental to nursing education as a shortage of acceptable clinical sites for nursing schools are a problem in many locations.

Conclusion
Communication in healthcare within social media platforms can have important implications to the nursing profession.Inappropriate social media communication can complicate efforts of nursing students to find employment after graduation.
To alleviate the shortage of nurses, the healthcare system needs newly graduated nurses to be employable in a variety of settings.
Maintaining the traditional view of a nurse as professional and trustworthy requires that nursing students receive detailed guidance on the nuances of social media communication.
Young adults entering nursing education programs are often unprepared to completely comprehend the impact of their social media interactions.While confidentiality and professionalism in electronic communication are addressed in most all nursing programs, there needs to be greater emphasis on social media communication and the perceptions that each post or interaction can generate within a more detailed curriculum.