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Social media consists of a variety of online tools that share the following characteristics: participation, openness, conversation, community, and connectedness.1 The 7 common types of social media are social networks (eg, Facebook, LinkedIn), blogs, wikis, podcasts, forums, content communities (eg,, and microblogging (eg, Twitter). Two recent reports have highlighted the use of social media in the context of health. The purpose of this article is to review the current use of social media within health care, provide implications for the role of the clinical nurse specialist (CNS), and highlight policy considerations for health care institutions.


The Pew Research Center released a report, "The Social Side of the Internet," which highlights the impact that technology is having on social and civic group interactions and their influence within communities. The survey, based on telephone interviews with 2303 adults across the United States, indicates that 68% of those surveyed (both Internet and non-internet users) said the Internet has had a major impact on the ability of groups to communicate with their members. Furthermore, 62% cite the effectiveness of the Internet to draw attention to an issue; 60% find a major impact with groups connecting to other groups, whereas 59% report a major impact on society at large for the ability to organize activities. For those who are active members of groups, they cited use of social media as an important tool. The types of groups where social media users are more likely to be active are consumer groups (24%), sports or recreation groups (24%), charitable or volunteer organizations (22%), professional or trade organizations (20%), community or neighborhood groups (19%), and, of interest to the health community, support groups for patients with illness (18%).2


The second report from Manhattan Research, Cybercitizen Health US,3 documents the substantial growth in the number of adults accessing social media for health purposes. In 2010, an estimated 89 million Americans accessed social media for health purposes, compared with 63 million in 2008 and 35 million in 2007. Furthermore, use of social media for health purposes is influenced more with disease type, such as cancer, than it is for age, as occurs with social media use by individuals in broader society.


Although the benefits of using social media to reach patients seem obvious, there is concern among corporate leaders that an analysis of the concurrent risks must also be considered. Russell Herder and Ethos Business Law prepared a report analyzing the advantages and liabilities associated with the use of social media as a corporate communications strategy.4 They identified that many corporations are using social media in a reactive versus proactive manner by monitoring what customers are saying and what competitors may be doing. They suggest that using social media can be a solid corporate strategy for communications, but creating appropriate policies and rules of engagement for employees is necessary.


An analysis of corporate social media policies indicated that only about one-third of organizations (37%) use a proactive strategy, whereas 48% take a neutral stance (focusing on the known), and 15% are more restrictive (focusing on averting risk).5 However, given the CNS's role in patient education and outreach as well as the number of adults using social media for health care purposes, how can the CNS be more involved with crafting an appropriate corporate strategy? Fortunately, there is a myriad of resources available to assist with development of policies and guidelines to facilitate innovative communication modalities while protecting the reputation of the institution. Social Media Governance provides an online database of close to 200 corporate social media policies,6 and Bennett7 provides links to those policies pertinent to health care organizations.


The policy links provide examples from across the spectrum of restrictive to permissive. For institutions in need of policy development in the area of social media, these resources can be considered within the context of organizational culture and adapted to align with the institution's overall philosophy. An example of a more restrictive policy is provided by Lehigh Valley Health Network.8 The policy is restrictive in the sense that any participation in social media is managed by the marketing department, and within the health network, access to use of social media tools is restricted. At the more proactive end of the spectrum is a policy as well as employee guidelines for use of social media by the chief information officer for Ministry Health Care and Affinity Health System.9 Although the policy is written in an appropriate legal format, the employee guidelines provide an engaging and useful document for members of the workforce with statements such as


* don't betray our patient's trust (and don't get arrested);


* don't get fired;


* don't cheat your employer;


* don't think your Facebook posts are private;


* don't jeopardize your reputation and/or future employment opportunities; and


* don't alienate your coworkers.



Common themes in both the restrictive and proactive approaches are protection of patient privacy, identifying personal responsibility for published content, and following all applicable organizational network policies.


The CNS has a role in using identified best practice to assist in crafting policy and guideline use within institutions. In its social media tool kit, the Vanderbilt University Medical Center identified 13 best practices10:


1. Listen first. Remember that one of the features of social media is that it is a mode of 2-way communication. It is important to first learn what patients want and need by listening first.


2. Think it through. Identify the goals of your participation, and use the media that will engage your patients.


3. Add value to the discussion. Provide value with experience in your specialty area.


4. Adhere to organizational compliance requirements concerning Health Insurance Portability and Accountability Act and disclosure of proprietary information.


5. Be respectful. Ensure that all postings are socially appropriate and not harmful to another person or entity.


6. Abide by the law. This again includes not posting protected information as well as copyrighted materials.


7. Identify and be yourself. Social media promotes transparency. Be yourself, but always present yourself in a manner suitable to your institution.


8. Use a disclaimer. If your comments are unrelated to the work of the institution, use a disclaimer indicating that remarks do not represent the views of the organization.


9. Be relevant and accurate. It is important to state the facts as they exist.


10. Do not be argumentative. Use civil discourse in supporting arguments.


11. What you say can and will be used against you. All posts should be considered permanent.


12. Not a 1-way conversation. Social media is used to engage with others in the community.


13. Use your best judgment. Consult with appropriate personnel when unsure about the appropriateness of a post.



A CNS can be involved in the corporate strategy concerning use of social media. In addition to developing policy guidance, a CNS can also be involved in engaging fellow employees and providing training on use of social media. Hospitals are beginning to hire social media managers11 to provide assistance with reaching key patient populations in a manner consistent with organizational philosophy. Determine if your institution has such a position or how use of social media is managed within your institution. Engage members of the marketing or public relations staff by sharing expertise in your specialty. Assist with developing appropriate messaging content. Use of microblogging (via Twitter) restricts the number of characters that can be used to convey content. It is important for the CNS to assist with messaging that is clear and concise. The use of social media continues to grow among adults in the United States. It is important for the CNS to be proactive in strategizing use of social media to assist in effectively achieving patients' health goals.




1. Mayfield A. What Is Social Media? iCrossing. Accessed January 30, 2011. [Context Link]


2. Rainie L, Purcell K, Smith A. The social side of the Internet. 2011. Accessed January 27, 2011. [Context Link]


3. How many adults use social media resources for health-related purposes? Accessed January 30, 2011. [Context Link]


4. Russell C, Baer D. Social media: embracing the opportunities, averting the risks. 2009. Accessed January 28, 2011. [Context Link]


5. Boudreaux C. Analysis of social media policies: lessons and best practices. 2009. Accessed January 27, 2011. [Context Link]


6. Boudreaux C. Online database of social media policies. 2010. Accessed January 28, 2011. [Context Link]


7. Bennett E. Healthcare Social Media Policies List. 2009. Accessed January 27, 2011. [Context Link]


8. Social media guidelines. Accessed January 27, 2011. [Context Link]


9. Weider W. Social media policy and employee guidance. 2009. Accessed January 27, 2011. [Context Link]


10. Vanderbilt University Medical Center. Social media toolkit: best practices. Accessed January 27, 2011. [Context Link]


11. Cook B. Hospitals' new specialist: social media manager. American Medical News. Accessed January 27, 2011. [Context Link]