1. Mayhan, Jennifer MHA, MSN, RN

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Social media has created an ethical minefield for nurse managers in the healthcare workplace. Our employees' identities are online for anyone to see, including vital information about who they are, what they think, and what they're doing. The burning question for managers is what we may and may not do with this information, especially when it reveals violations of company policy or breaches in integrity.

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What are the dangers of disciplining employees based solely on information gathered from social media? Consider the following case. In 2012, an emergency medical services provider terminated an employee based on comments made about the work environment in a social media post. The employee sued for wrongful termination and won. The court cited the organization's policy on social media as nonspecific, resulting in wrongful termination.1 That's why it's imperative for us to research our policies and compare them with current laws and state nursing board expectations to protect our organizations.


This article examines three common social media issues: abuse of the Family and Medical Leave Act (FMLA), the posting of sensitive work information, and investigating a potential new hire.


FMLA leave

Data from 2015 show that 10% of the U.S. workforce is using FMLA leave at any given time; for healthcare organizations, this can be as high as 30%.2 It may be expected that there's some abuse of the FMLA occurring. Can social media be used if you suspect someone is abusing the FMLA? What should you do if an employee who's out on FMLA leave posts pictures or comments on social media that indicate the illness for which they were off wasn't real?


Don't read employees' social media pages only to find incriminating information; however, if coworkers let you know that the individual out on FMLA leave posted about an all-day hiking expedition he or she attended, you have the right to ask questions, request additional physician documentation, and move forward with your organization's documented policies, following a consistent process of investigating, validating, and clarifying information.3


The cases that have been taken to court, with a manager who validated the situation, typically favor the organization.3 Consider the case of Jaszczyszyn v. Advantage Health Physician Network. In this case, an employee who had surgery was granted intermittent leave after her 6 weeks of FMLA leave with appropriate documentation. She called her manager several times in 1 day stating that she was sick, only to post multiple pictures throughout the same day of herself at a festival. The organization terminated the employee for fraud after an appropriate investigation and the employee sued the hospital for wrongful termination. The employee lost her case because of the organization's appropriate investigation and follow-through regarding her call-ins.3


Confidential information

What should you do about employees who post potentially private information about work? Take the scenario of a nurse who loses a patient and connects with the family. This situation can be devastating, and healthcare providers need a way to work through their feelings and thoughts. Is social media, such as a blog that's open to the public, an appropriate outlet? According to many nursing boards across the country, the simple answer is a resounding "no."


Posting information, even in general, about a patient can be perceived as a breach of privacy.4 Nurses tend to believe that as long as they aren't posting a picture or the name of a patient, then no harm is done; however, small details can be just as damaging. Any information that can be connected to a specific patient can open the organization up to liability.4 Coworkers aren't safe in such a scenario either. Depending on the state in which a nurse practices, comments about staff members, physicians, students, and employers can also be grounds for dismissal.4


Keep abreast of state laws regarding social media comments and train employees to know the risks of posting personal information. Direct staff members to utilize their employee assistance benefits when they need to talk through their feelings or bring workplace concerns directly to the management team.


Interviewing tactic

Have you ever looked up a potential new hire on social media to see what his or her online presence looks like before the in-person interview? Is this helpful? Is it legal? The answer to the last question hasn't been fully decided. Most states have no laws about employers reading prospective employees' social media pages and using the information however they see fit. However, this may be changing.


A recent law passed in Illinois protects employees' privacy, making it illegal to demand access to social media for making hiring decisions.1 But the question still remains: Even if it's legal, is it helpful? Many hiring managers seem to think so. In one survey, 89% of directors admitted to utilizing social media to make hiring decisions.1 On the other side, many nursing students acknowledged that they've accepted "friend" requests from perspective employers, but blocked information that may make them look bad. Given this increasingly common situation, how safe is it to assume that a candidate is solid based on a clean social media presence?


As an alternative to social media, which makes it so easy to manipulate one's image, consider the value of peer interviews. An interviewee's peers will pick up on issues with more accuracy and far greater depth than a scroll through a social media page. Utilize your team and human resources department to create appropriate behavioral-based interviewing methods that leave social media out of your hiring decision.


Not going away

Social media is here to stay-to ignore its misuse puts our patients, employees, and organizations at risk. Develop consistent processes for social media investigations, such as abuse of FMLA leave. Create an environment of trust and honesty that allows your team members to discuss concerns or difficult situations with you. Establish interview best practices that don't rely on social media to gauge a potential employee's character. And, most important, educate staff members about their ethical and professional obligations regarding social media.




1. Spector N, Kappel D. Guidelines for using electronic and social media: the regulatory perspective. [Context Link]


2. Schappel C. Wait there are how many people on FMLA leave? [Context Link]


3. Whittaker L. How social media can expose FMLA fraud. https:// [Context Link]


4. National Council of State Boards of Nursing. A nurse's guide to professional boundaries. https:// [Context Link]