In the run up to an event the NMC ran as part of Social Media Week, the Guardian Healthcare Network published an article I wrote on how healthcare professionals can engage safely with patients online. More thoughts on the event to follow, but for now, here's the article.
Talking with patients online: where are the boundaries?
Maintaining clear and appropriate boundaries in the world of social media can be a real challenge for patients and the health professionals who care for them.
Advice from the Nursing and Midwifery Council issued last year warned that nurses and midwives must not overstep those boundaries by sharing confidential information, distributing images taken in clinical environments or pursuing personal relationships with patients online.
Similar advice for doctors followed, and other regulators are taking action on a subject that concerns patients, health professionals and their employers. But while this advice has been helpful in clarifying expectations of appropriate behaviour, and allowing regulators to take action when boundaries are breached, it may have left health professionals with the impression that any online engagement with their patients is simply wrong.
An event run by the NMC as part of this year's social media week brings together bloggers, tweeters and digital enthusiasts from both sides of the patient-professional divide, to see where the boundaries should be drawn.
The simple fact is that health professionals need to understand how their patients are using the web, so they can find ways to engage with them better while still maintaining appropriate boundaries. The web presents new opportunities to empower people to improve and maintain their health, by placing the tools to discover and share information directly in their hands.
Patients are becoming more empowered as they use online tools to learn and apply expert knowledge, and play a more active role in the prevention, treatment and monitoring of their own illnesses and conditions. Empowerment is happening collectively too, as groups of patients and carers participate in solidarity networks and advocacy groups centred on specific conditions and experiences.
Ready access to health information online can give empowered patients access to a range of materials that may help them manage their own conditions. Before they go to a real-world health professional, some patients find it useful to triage their conditions online. This can speed up diagnosis, and lead to more informed discussions between patients and professionals.
But it can also lead patients to develop a firm self-diagnosis that may make it harder to explore the problem when they do eventually meet a health professional. Conversations about the credibility of online information is important, particularly with patients whose approach to searching the web can be characterised as diagnosing with Google and treating with Wikipedia.
Nurses, midwives and other health professionals, engaging with their patients online, can help correct misinformation and signpost positive, peer-reviewed websites.
The internet, as well as being a source of health-related information, also provides patients with opportunities for mutual online support. Sometimes these online communities are actively managed by organisations that provide support in more traditional ways, such as cancer charities.
Other organisations find ways to engage in online spaces that were not designed with health in mind, for example sexual health advisers reaching out with safer sex information in gay chat rooms, or midwives engaging in networks for pregnant women and new mothers.
But what about the spaces where health professionals are deliberately excluded, such as "pro-ana" websites, which have been criticised for promoting anorexia nervosa among young people? Such sites are extremely worrying to health professionals and others because vulnerable people can be damaged if they follow their advice, leading to calls to have them classified as harmful and blocked automatically by internet service providers.
Professionals need to tread carefully and understand where the boundaries of safe practice are. Sometimes, this can mean stepping back and letting patients support each other.
Working out where to draw the boundaries is not easy, and patients and professionals need to find ways to coexist safely online. In every area of social media, rules of engagement are constantly being reviewed and our expectations rapidly evolve.
But like it or not, patients are taking conversations about their health online, and professionals have to follow, rethinking boundaries and getting involved.
Back in December, I told the Guardian Health Network that we were looking at publishing information for nurses and midwives about positive uses of the internet and social media. Well, issue 4 of NMC Review is just out, with a lead article written by me (reproduced below), comment from health bloggers and lots more. And an awesome eBoy-style illustration.
Caught in the web
The internet is having a profound impact on how healthcare is delivered, managed and discussed – and there’s no turning back. We explore some implications for the public and the professions
Digital technologies have changed our lives. We feel the impact of the 'digital decade' in the way we use the media, entertain ourselves and connect with our friends and families. Being online has become an unremarkable, mainstream element of many people's daily experience. Whether you check Facebook on your smartphone as you wake up, or you are a Twitter refusenik confused by David Dimbleby mentioning hashtags during the BBC television programme Question Time, we all find ourselves caught up in the world wide web.
Being online is transforming our social lives - and changing the world. The Arab Spring of 2011 highlighted the power of blogs and social networks to mobilise real-world communities and transform societies, with digitally connected citizens playing a central role from Libya to Bahrain. Closer to home, Twitter and BlackBerry Messenger might have played some part in fanning the flames of last summer's riots in England, but the Big Society response that followed could only have been facilitated through a social network. Organising themselves around the Twitter hashtag #riotcleanup, hundreds of people armed with brooms took to the streets of London.
The online world can seem bewilderingly complex, especially for nurses, midwives and patients who are reluctant to be swept along by the digital revolution. Though websites and services may be daunting for a first-time visitor, scratch the surface and you will find the same information, news and gossip that people share with each other in everyday conversation. Beyond the jargon (see our glossary), so much is familiar.
New technology creates opportunities for patients and service users to access healthcare information online, and to connect with others with similar conditions, but this is close to the familiar world of glossy leaflets and support groups. In the arena of health promotion, social marketing and public health practitioners have harnessed online tools to help transform health outcomes, but the principles, messages and methods remain much the same. Furthermore, as we explore later, although social networking sites like Facebook present new challenges for nurses, midwives and students, as well as the institutions where they work and learn, those challenges centre on a perennial concern - appropriate professional and personal behaviour.
Empowerment and reliability
Beyond the challenges for people trying to understand and use these technologies, the world wide web also presents new opportunities to empower people to improve and maintain their health - by placing the tools to discover and share information directly in their hands. Empowerment may be a relatively straightforward idea in the context of online behaviours, but it is considerably more complex in the world of healthcare. It can underpin both the role of professionals in guiding patients' choices, and the concept of patients as consumers who make decisions independently of professional advice. It does, however, provide a useful prism through which to view the development of a wide range of technologies and their impact on patients (Lemire 2010).
Patients and service users are becoming more empowered as they use the tools of the world wide web to learn and apply expert knowledge, and play a more active role in the prevention, treatment and monitoring of their own illnesses and conditions. Empowerment has a role to play collectively too, as groups of patients and carers participate in solidarity networks and advocacy groups centred on specific conditions and experiences.
Ready access to health information online can give empowered patients access to a range of materials that may help them manage their own conditions. If access to a real-world healthcare professional is needed, patients may find it useful to 'triage their conditions with the easiest or most appropriate information source first ... the convenience of accessing online self-care information rather than visiting a health professional is oft en cited as a motivation for using the internet' (Eysenbach 2008). This can speed up diagnosis, and lead to more informed discussions between patients and professionals.
It can also lead patients to develop a firm self-diagnosis that may make it harder to explore the problem when they do eventually meet a health professional. Yet dealing with patients who are attached to inaccurate but seemingly credible information that supports their view of the world is not a new phenomenon. More positively, the world wide web opens up many possibilities for patients who want deeper knowledge of their health problems, and find information that leads to more sophisticated questions.
Credible information
Conversations about the credibility of online information are particularly important with patients whose approach to searching the web can be characterised, perhaps unfairly, as diagnosing with Google and treating with Wikipedia. Avoiding low quality and potentially harmful healthcare information online in itself represents a challenge. Initiatives like the Information Standard, designed as an accreditation scheme for online health information and supported by the Department of Health (England), may help address this but their reach will always be limited to mainstream websites willing to enter a certification process.
Information is easily distorted as it is replicated across the web, and both patients and professionals need help to find, evaluate and use high quality peer-reviewed information controlled by experts. What is most important is the credibility of the sources cited by a particular piece of health information, not how frequently it appears in online searches.
Communities and crowds
The internet, as well as being a source of health-related information, also provides mutual support opportunities for patients and service users online. Sometimes these online communities are managed by organisations that provide support in other ways, such as Breast Cancer Care's online community of 17,000 members. Others emerge spontaneously and organically in online spaces that were not designed for the purpose. There is room for healthcare professionals to engage here too. The Terrence Higgins Trust, for example, has an online outreach programme, with sexual health advisers available in chat rooms.
How can we engage with discussions about health in online spaces that deliberately exclude healthcare professionals? Take the continuing controversy around 'pro-ana' websites, which have been criticised for promoting anorexia nervosa among young people. Such sites do express a form of empowerment, but they are extremely worrying because of the potential harm to people who follow their advice. This has led to calls to have them classified as harmful (Royal College of Psychiatrists 2009), and blocked automatically by internet service providers.
Pro-ana websites are of course an extreme example. Many self-organising online communities provide valuable and health-enhancing spaces for those affected by eating disorders. Professionals need to tread carefully, to understand when to step in and when to step back while patients support each other.
Sharing experiences online
Patients and service users are not going online just for information and support. As more people use Facebook, Twitter and other social networks, more are sharing their thoughts and experiences in real time with their friends and the wider world. Talking online about experiences in healthcare environments is becoming more common, though there are competing views about whether the open, public nature of social networking sites increases or diminishes the likelihood of someone disclosing personal information (Bateman et al 2010).
This sharing can include good news, from celebrity mums using Twitter to announce their pregnancies and praise their midwives, to the hundreds of patients who shared their personal experiences of high quality NHS care in 2009, using the hashtag #welovethenhs. Patients also talk about poor experiences, like journalist Mark Sparrow. His experience of hospital food during a long in-patient stay was so poor that he photographed and blogged about every meal. This eventually led to a television documentary (Channel 4 2011).
Sharing personal information online may be a particular problem if people talk not only about their own experiences but also those of others. Just 23 breaches of patient confidentiality by NHS staff [PDF] were found on social networking sites between 2008 and 2011, (Big Brother Watch 2011), but the more widespread breaches of confidentiality by patients usually go unchallenged and unreported. While acknowledging the importance of empowering all service users, open discussions about responsibility and respect may be needed to deal with these situations.
Useful channels for those who wish to share their experiences can be provided by initiatives like Patient Opinion. This online service encourages open sharing of positive and negative stories, with opportunities for healthcare providers to respond. Such channels can be a force for good by bringing problems and solutions into the open, and providing an impetus for change.
Whether you yourself go online or not, you cannot ignore the impact of the world wide web. People in the care of nurses and midwives are increasingly going online to find healthcare information, create communities and share their experiences. It would be foolish to make predictions about the future of healthcare online, but the desire of many patients and service users to empower themselves and take control of their own health and wellbeing is not going away.
In a world transformed by digital technology, nurses and midwives can play a vital role in using the rich resources of the internet to support the health and wellbeing of people and communities, in the real world and online.
References
- Bateman, P J, Pike, J C and Butler, B S (2010). To disclose or not: publicness in social networking sites. Information Technology & People, 24(1), pp 78-100.
- Big Brother Watch (2011) NHS Breaches of Data Protection Law: How patient confidentiality was compromised five times every week. [pdf]
- The Truth about Hospital Food (2011). [Television programme] Channel 4, 21 February 2011, 20:00.
- Custers, K, and Van den Bulck, J (2009). Viewership of pro-anorexia websites in seventh, ninth and eleventh graders. European Eating Disorders Review, 17(3), pp 214-219.
- Eysenbach, G (2008). Credibility of Health Information and Digital Media: New Perspectives and Implications for Youth. In: Metzger, M J and Flanigan, A J, ed (2008), Digital Media, Youth, and Credibility. Cambridge, MA: The MIT Press, 2008. 123-154.
- Lemire, M (2010). What can be expected of information and communication technologies in terms of patient empowerment in health? Journal of Health Organization and Management, 24(2), pp 167-181.
- Nursing and Midwifery Council (2008). The code: Standards of conduct, performance and ethics for nurses and midwives.
- Nursing and Midwifery Council (2011). Social networking sites.
- Ofcom (2011). Communications Market Report: UK.
- Office for National Statistics (2011). Internet Access - Households and Individuals, 2011.
- Royal College of Psychiatrists (2009). Psychiatrists urge action to tackle 'pro-ana' websites danger.
- Wolters Kluwer Health (2011). Point-of-Care Survey.
This article, which I authored, first appeared in Autumn 2011 issue of NMC Review.
Facing the music
Healthcare regulation faces a cacophony of criticism. How should it change and what part should the public and professionals play?
‘When people’s lives and wellbeing are at stake, the public doesn’t want to hear about light touch regulation,’ according to Cynthia Bower, Chief Executive of the Care Quality Commission (CQC), the health and social care systems regulator for England (Santry 2011). She was setting out her plans in response to damning criticism, but also adding her voice to a broader debate about regulation and its purpose. Amid a crescendo of concerns about poor care, from Mid Staffordshire to the Vale of Levento Winterbourne View, healthcare regulation is in the spotlight.
There are different types of healthcare regulation and a plethora of regulators. Yet professionals have dominated regulation for much of its 500-year history. Professional self-regulation developed to recognise specialist skills and ensure that only those meeting the standards set by their peers gained professional status. As late as the 1970s the Merrison Committee, examining the role of the General Medical Council (GMC), concluded that a regulatory body must also be a professional body.
As it turned out, the 1975 Merrison report played the final chords of professional self-regulation. Its proposals represented ‘the last moment when so confident astatement of the superiority of the professions, their right to control their own affairs and their ability to act in the public interest could be made’ (Davies and Beach 2000). Significant changes began in the world of nursing and midwifery regulation. The General Nursing Council and Central Midwives Boardwere replaced by the UK Central Council for Nursing, Midwifery Council and Health Visiting (UKCC), which was in turn superseded by the Nursing and Midwifery Council (NMC).
‘Amid a crescendo of concerns about poor care, healthcare regulation is in the spotlight’
There were changing registration requirements, rising fees and growing numbers of fitness to practise cases. Amid this noise the mood music of regulation itself was changing, though almost unheard at the time. Better regulation required a balancing of the interests of the professions with those of employers, service users, educators and others, are view of the UKCC concluded (JM Consulting 1998). In tune with the emergence of patient-centred care in the 1990s, professional self-regulation gave way to a subtle but significant variation and professional regulation in the public interest came to the fore. Systems regulation also began to develop, with the Commissionfor Health Improvement founded in England in 2001.
The review that led to the establishment of the NMC chimed with a new regulatory paradigm that found its expression later in the Hampton principles (2005) and the Legislative and Regulatory Reform Act (2006). Regulators should not set aspirational standards, and should only intervene if there is a threat to public protection. Regulation should be transparent, accountable, proportionate, consistent and targeted. Above all, it should be ‘light touch’.
Politicians like cutting red tape and light touch regulation is an engaging idea, but hard to sustain when faced with care scandals. This is creating tensions in people’s expectations of regulation, as shown in the current debate on whether statutory regulation of healthcare support workers would improve care. Two recent documents highlight some of the complexities.
Enabling excellence (2011) sets out the government’s proposed direction for healthcare regulation. It adheres to the Hampton principles, and is a continuation of the regulatory paradigm of the late 1990s, being a strategy not just for reform but also for simplification. It says statutory regulation should not be extended to healthcare support workers, and instead supports a voluntary arrangement (‘Transforming regulation’, NMC Review, issue 1, p33).
Contrast this with a recent report of the House of Commons Health Committee (2011), whose chair Stephen Dorrell MP introduced it by saying, ‘At a time when there are signi?cant concerns about standards of care… it is important that the professional regulators step up to the plate.’ In a view reminiscent of Merrison, the report encouraged the NMC to ‘embrace more ambitious objectives for professional leadership’. Moreover, directly challenging government policy, it endorsed mandatory statutory regulation of healthcare support workers, as ‘the only approach which maximises public protection’.
Some opponents of extended regulation think professional regulation has failed to change the quality of everyday healthcare. Their concern that its focus on individual responsibility may lead to scapegoating has some justi?cation. And the regulatory system may in itself be inadequate to deal with increasingly complex issues, with the current separation of the potentially punitive power of a professional regulator and the enforcement regimes of a systems regulator. The regulatory paradigm that neatly separates individuals and systems is ?awed.
Take systems regulation. Despite the CQC’s recent promise that its inspections will focus more broadly on quality of care and the views of service users, systems regulation must necessarily focus on processes and policies. When failure is investigated, responsibility heads to the highest possible point in an organisation, and corporate decapitation is called for. Enforcement actions, whether closure of services or financial penalties, are not in themselves transformative. They may reduce the likelihood of terrible incidents, but they cannot alone create better outcomes.
‘We need a new language of regulation that deals with the collective and focuses on the everyday’
Professional regulation, on the other hand, focuses on individual responsibility at the expense of a corporate view. Investigated through the prism of professional misconduct, responsibility for failure tends to gravitate to the front line, and the person furthest down the chain of command is made the scapegoat. The professional regulator can remove a single dangerous person from a healthcare environment, but the removal alone does not necessarily improve the situation.
These are descriptions of extremes, and the reality is significantly more nuanced. Nevertheless, there is a gap between professional and systems regulation in dealing with the everyday reality of complex healthcare delivery. Even in the simplest of healthcare interactions, the planning, delivery and assessment of care is neither an individual act, nor the working out of a system, but a collective effort. Neither end of the regulatory spectrum adequately deals with collective action or collective responsibility.
Individual healthcare professionals create collective norms as they work together, and those norms in turn shape them. Those collective norms are codified into systems, which in turn influence collective activity. Without an acknowledgement of the power of the collective as a bridge between the individual and system, our understanding of healthcare delivery is incomplete, and our regulatory paradigm cannot be effective. In its current form, systems regulation cannot support collective responsibility, while professional regulation is too focused on punishing individuals to deal with collective failure.
Regulation is under great pressure, and perhaps even failing. We need a new language of regulation that deals with the collective: an effective regulatory regime that focuses on the everyday, not the extremes. New thinking is needed to help regulators safeguard public health and wellbeing, and drive up standards. This thinking needs to focus not just on patient safety, but also on public trust in the professions. It must avoid over-regulation, especially when it damps down positive innovation. Balancing these issues and concerns, three simple principles are central to the new regulatory paradigm: being proactive, rethinking standards and reaching out.
Being proactive
In the new paradigm, regulators have a responsibility to be proactive. For the NMC, this means responding decisively when concerns are raised. For example, the request that universities remove their nursing and midwifery students from Pilgrim Hospital in Boston, Lincolnshire, in response to serious concerns raised by the CQC, shows the power of collective action to improve healthcare education. Being proactive also means that the NMC has started initiating its own investigations, using powers under section 22(6) of the Nursing and Midwifery Order 2001. Over 200investigations have already been launched this year in response to media reports. Standing on the sidelines waiting to be invited in is no longer adequate. As Cynthia Bower says, regulators have to ‘cross the threshold’ and work collaboratively with organisations under pressure to support andenable change.
Rethinking standards
Reimagining regulation also means a fundamental rethink of the purpose and nature of standards. Standards for education and practice are NMC core business, but have too often described the bare minimum of expected quality. Used as a blunt regulatory tool, they allowed the removal from the professions of people who signi?cantly underperformed, but they have never been aspirational. Too many professionals upholding NMC standards found they simply supported existing good practice, and no more.
The NMC is now committed to setting what it describes as ‘standards with stretch’ in the current reviews of the code (NMC 2008) and record keeping guidance (NMC 2009). It recognises the need for collective effort to implement, change and improve practice at every level and in every setting. It will also set standards that focus on improving health outcomes. Looking for measurability and impact in the setting of standards is challenging, especially when the relationship between the regulator, the standards and the multifactorial delivery context is so complex. Setting standards with stretch requires regulators to become professional leaders.
Reaching out
Finally, the new regulatory paradigm requires regulators to reach out to the public by setting out clearly the standards of care they can expect, and providing an open door for expressions of concern when those standards are not met. Professional regulation, even if it is exercising professional leadership, cannot be the sole domain of professionals. Healthcare regulators are required by law to regulate in the interests of public health and wellbeing, but in reality can be far removed from the everyday concerns of patients and service users. The NMC is now listening closely to those concerns, and ensuring their voice is heard at every level of regulatory decision-making. Regulators must also reach out to each other and act collaboratively with employers for the collective good. The NMC memorandums of understanding with systems regulators across the UK help ensure information is shared, and concerns that otherwise would fall into the regulatory gap are acted on. It is also engaging more positively with employers.
Whatever happens in these uncertain times, the healthcare environment will continue to change. Can regulation also change fast enough to safeguard public health and wellbeing, and drive up professional standards? There may be trouble ahead, but it’s time for regulation to face the music.
References
- Davies, C and Beach, A (2000). Interpreting Professional Self-Regulation. London: Routledge.
- Department of Health (2011). Enabling Excellence: Autonomy and Accountability for Health and Social Care Staff. Command paper Cm 8008. London: TSOL
- Hampton, P (2005). Reducing administrative burdens: effective inspection and enforcement. London: HMSO
- House of Commons Health Committee (2011). Annual accountability hearing with the Nursing and Midwifery Council (2011). HC 1428, London: TSOL. Available at [http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhealth/1428/1428.pdf]
- JM Consulting (1998). The Regulation of Nurses, Midwives and Health Visitors: Report of a review of the Nurses, Midwives and Health Visitors Act 1997. Bristol: JM Consulting
- Nursing and Midwifery Council (2008). The code: Standards of conduct, performance and ethics for nurses and midwives.
- Nursing and Midwifery Council (2009). Record keeping: Guidance for nurses and midwives.
- Nursing and Midwifery Council (2010). Raising and escalating concerns: Guidance for nurses and midwives.
- Nursing and Midwifery Council (2011). Transforming regulation. NMC Review, issue 1, p33.
- Santry, C (2011) In charge of the not-so-light any more brigade. Health Service Journal, 28 July 2011, pp16-17.
- Legislative and Regulatory Reform Act (2006). London: HMSO
- Report of the Committee of Inquiry into the Regulation of the Medical Profession (1975). Command paper Cm 6108, London: HMSO [Merrison Committee Report]
A real surprise on the NMC's social networking story towards the end of last week, as the British Medical Association released their own advice for doctors on social networking sites. It was serendipitous really. Our story was still going strong - featuring on BBC South West's local news on Thursday morning, and I was interviewed on the BBC Radio Bristol breakfast show - but the BMA's announcement gave us an extra boost, and saw the story being picked up in more national papers, and some technology blogs.
A selection of links below. By the way, you know you've arrived in life when the Grauniad spells your name wrong. See the end of the first link.
Last week, I had a long conversation with Jenni Middleton, editor of Nursing Times, about the NMC's new social networking advice. Her editor's opinion this week is great, so I thought I'd reproduce it in full below. Obviously, it was first published on the NT website.
Patient confidentiality matters in cyberspace too
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.
Day four of press coverage for the NMC's new advice for nurses and midwives. Thanks to the work of our media team, the story's been picked up by the South Wales Evening Post, and appears on page 3 of today's Daily Telegraph. There's even talk of TV interviews tomorrow.
The story about the NMC's new social networking advice seems to be spreading more widely, now picked up by the website You at Work. By the way, I'm happy to be quoted without being interviewed, just in case Johann Hari is reading this...
Midwives and nurses given social network advice
Nurses and midwives have been given a set of guidelines to help them steer clear of misconduct cases related to the inappropriate use of social network sites.
Many firms and organisations have noticed the popularity and ease of use of the likes of Facebook and Twitter and have opted to create a professional network for the benefit of the increasing number of Gen Y staff.
However, the Nursing and Midwifery Council (NMC) has seen a notable rise in the number of people being found to be discussing privileged information over the internet - most of the time unwittingly.
Assistant director of professional and public communications at the NMC Andy Jaeger, told People Management magazine the new advice was being made available to the UK's 660,000 registered nurses and midwives to stem the flow of misconduct cases.
"This guidance is about responsible use and encouraging employers to investigate issues proportionately and seriously, rather than issue blanket bans," he told the publication.
Facebook is an increasingly powerful website, as it has more than 750 million active users.
Another interview following the publication of the NMC's new advice on social networking sites, this time in Personnel Today. This interview was an interesting departure. I'd expected to discuss the advice we've issued for nurses and midwives, but instead we spent a lot of time focusing on the role of organisations in setting proportionate policies that encourage responsible use:
Businesses warned to provide guidance on social media
Employers need to provide clear guidance for staff regarding the use of social networking sites to avoid inappropriate relationships, harassment of staff and the potential for disclosure of confidential information, the Nursing and Midwifery Council (NMC) has warned.
"Increasingly, employers are facing issues as a result of the use of social media," said Andy Jaeger, assistant director of professional and public communications at the NMC. "They need to be encouraging responsible use and when issues do arise they need to take them seriously."
The organisation suggests that companies set out clear policies for staff regarding the use of such sites, including advising employees to keep their personal and professional lives separate as far as possible, upholding the reputation of their employer and profession at all times, and ensuring that they protect their own privacy by using settings available on sites such as Facebook.
Employers should also ensure that line managers are familiar with policies and issues, and make sure they treat any complaints from online activity - such as cyber-bullying or the sharing of confidential information - in the same manner as they would in the real world.
"If someone is harassing or bullying a colleague, doing that online doesn't make it any less serious than if it was being done face-to-face," said Jaeger.
The issue was particularly important where staff were in public-facing roles such as the NHS or teaching, he added.
"We're starting to see a small number of cases coming through which directly involve the use of social networking sites and employers are increasingly raising those issues with us," he said.
One recent example involved a psychiatric nurse who was struck off the register after contacting a former patient through Facebook and developing a sexual relationship with her, resulting in the patient self-harming when it ended.
"Particularly with regard to nurses and midwives, there are issues around relationships with patients and patient confidentiality," said Jaeger.
"Informal relationships with patients online just aren't appropriate. Social networking has made all of us easier to find so sometimes it's about clearly and kindly drawing some boundaries."
A further risk was disgruntled employees posting negative comments about their employer. "Where organisations are going through significant change, the fallout can happen in all sorts of ways and some of that can be online," he said. "Again, it's about having clear policies and thinking through how you can deal with it and doing so proportionately."
But companies should not look to impose a blanket ban on the use of social media, he added.
I've been doing a lot of work recently on how social media is used by nurses and midwives. As a culmination of this, I've authored updated advice for nurses and midwives on using social networking sites responsibly, and was interviewed by People Management magazine (for the second time in as many weeks!)
Nurses warned over use of social media
Social networking guidance is being issued to nurses and midwives by their regulatory body following an increase in misconduct cases relating to online activities and ethical code breaches.
The Nursing and Midwifery Council (NMC) said it was publishing practical advice on responsible use of the internet – specifically Facebook – as there is “clearly confusion about privacy issues and the use of social networking sites.”
The guidance is also designed to give employers a steer on shaping policy related to staff internet activities inside and outside of work, and how to deal with internal disciplinary issues that arise from incidents occurring in the social media space.
The formation of advice for the UK’s 660,000 registered nurses and midwives follows an “influx of enquiries” and a series of misconduct cases centring on social networking sites, said the NMC.
Last year a male psychiatric nurse was struck off for an “inappropriate relationship with a patient”, after contacting a woman formerly in his care through Facebook.
The council also highlighted a case in the US where a student nurse became embroiled in a legal battle with her employers, after she was dismissed for posting a photograph of herself posing with a placenta to Facebook.
The regulator is warning nurses to use such networking channels responsibly and be mindful of unintentional breaches of patient confidently – as well as their own privacy. The guidelines suggest that medical staff keep their personal and private contacts, discussions and profiles separate.
“If your profession is nursing or midwifery, it is particularly inadvisable to discuss work issues online,” said Andy Jaeger, NMC’s assistant director of professional and public communications, and author of the advice. “What you regard as just an amusing story, could end up causing serious offence more easily than you think.”
He warned that personal content is often “unwittingly” shared across networks, adding: “Most people simply don’t realise how much information is shared with the world if you don’t adjust your privacy settings on Facebook – and that includes personal details and photographs.”
He also told PM that the guidance was being issued to help employers develop social networking policies, as current procedures were “inconsistent.”
“Nurses and midwives have reported that employers are not dealing with issues occurring on social networks with the same degree of seriousness – particularly around bullying, harassment and inappropriate sharing of content," he continued. “This guidance is about responsible use, and encouraging employers to investigate issues proportionately and seriously, rather than issue blanket bans."
The sense of relief and the fizzling away of tension that comes with launching a long project almost makes the whole thing worthwhile. And this web development project has been long. I got deeply involved in the project when it had been going for a year and it was stuck. Eight months later, we're live.
The website was developed for the Nursing and Midwifery Council, and I took a lead role in the information architecture, concepts and overall look and feel, as well as ensuring that my team, who will be responsible for it in the long term, took a lead role in content migration. Given the significant changes in IA, migration wasn't a straight transfer, but in many cases a total rewrite. And, now we're live, the whole thing is my baby to look after. Or beast to tame, depending on your point of view.
Just a few days since go live may be too soon to reflect properly on the project, but, based on my experience, here are my top ten tips for anyone embarking on a web development project for a large organisation:
1. Be clear about what you want to achieve
For anyone familiar with Prince2 project management, I'm not talking about having a good project charter. It's about having a coherent vision of where you're going and what it will look like when you do. There are no right or wrong answers to how you achieve that, but basically everyone involved in the project needs to be able to tell the same story. Frankly, we wasted some time at the beginning because it took a while to come to that share view of the world.
2. Get, and maintain, buy-in
In a world of stakeholders, everyone has something to say. Those opinions are fairly easy to capture at the start of the project, but if you are doing anything that's going to take any time at all, those people are going to change. For reasons that are too dull to go in to, this web development project lived through four chief executives. Maintaining buy-in was a significant challenge.
3. Put together the right team
Even a relatively simple website needs a range of specialist skills. Specialist skills come attached to people who might or might not get along, but the project won't work unless people see eye to eye. We were fortunate in having a team of people working for the project who (most of the time) got on, respected each others' opinions and worked well together.
4. Don't be a slave to project methodology
Understanding how to fill in the paperwork that goes with Prince2 doesn't make you a good project manager. It makes you good a filling in paperwork. Most importantly, you need to...
5. Get the right project manager
Ideally, this person will be obsessive in their devotion to getting the project delivered. Again, as with the project team, we were very lucky to find someone who could deliver.
6. Learn to compromise
I didn't get everything I wanted out of the website development. I still have a long list of things to do at some point. But by focusing on what we needed, rather than what I wanted, we got a new website. Compromise is a good thing.
7. Learn not to compromise
Compromise is also a bad thing. There's a fine line between having a vision and being stubborn, and I hope I stayed on the right side of that line. Most of the time.
8. Don't design by committee
In fact, don't do anything by committee. Participation is a good thing, and it has its place when you are pulling together ideas. But if at any point you think you might need to do something quickly (and you will), work out in advance who gets to decide what. It will save you from a world of endless meetings.
9. Nurture your talent
A project is a good opportunity to do things for the first time. If I have one big regret about the way the project worked out, it's that we didn't capitalise more on those opportunities, by giving key team members more of a chance to try things out.
10. Expect it to go wrong
Goes without saying really. But most of all, expect it all to go spectacularly wrong at the last minute, and make sure you have a good back out plan if it does. We didn't need ours in the end. But you never know.