Principles for Ethical Social Networking

Although nurses have no “written-in-stone” rules for the use of the internet, the American Nursing Association (ANA) published principles for social networking in 2011:

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  • Nurses must not transmit or place online individually identifiable patient information. They should also know their legal and ethical responsibilities as well as their own organization’s policies regarding the use of social media and protection of patient information.
  • Nurses who interact with patients on social media must observe ethically-prescribed patient-nurse boundaries.
  • Nurses should evaluate all of their postings with the understanding that a patient, a colleague, an educational institution, or employers could potentially view these postings.
  • Nurses should take advantage of privacy settings available on many social networking sites in their personal online activities and seek to separate their personal and professional online sites and information.
  • As a patient advocate, nurses have an ethical obligation to take appropriate action regarding questionable healthcare delivery at an individual or system level.
  • Nurses are encouraged to participate in the development of policies and procedures in their organizations for handling reports of inappropriate online conduct.1

Other Nursing agencies and organizations have also developed guidelines for the professional use of the internet, which fall into categories similar to the ANA.  Other healthcare team members may have association-driven regulations or guidelines that dictate online behavior.

Effective January 1, 2018, 19 new standards and revisions to the National Association of Social Workers (NASW) Code of Ethics went into effect, as approved by the Delegate Assembly of the NASW in August 2017. Among these are 2 ethical standards relevant to this article:

1.03 Informed Consent

(i) Social workers should obtain client consent before conducting an electronic search on the client. Exceptions may arise when the search is for purposes of protecting the client or other people from serious, foreseeable, and imminent harm, or for other compelling professional reasons.

1.07 Privacy and Confidentiality

(p) Social workers should develop and inform clients about their policies, consistent with prevailing social work ethical standards, on the use of electronic technology, including Internet-based search engines, to gather information about clients.

(q) Social workers should avoid searching or gathering client information electronically unless there are compelling professional reasons, and when appropriate, with the client’s informed consent.2


We usually think of informed consent as something to be obtained prior to a procedure or treatment or perhaps something that is a required part of research protocols. The notion that informed consent should be considered prior to conducting electronic searches for public information may be controversial for some. It calls into question one’s right to privacy. This “right” varies depending on the industry within which the question is posed; in this case, in the healthcare industry, does the right to privacy still exist? Should it? We acknowledge that entry into the healthcare system already connotes that one will likely share very personal details about family history, genetics, health and lifestyle habits, employment, etc; however, patients still have a right to privacy about their legal, marital, or other issues, for example, especially when those situations have no influence or impact on healthcare delivery or treatment planning.

Discussions surrounding use of online search engines for purposes of uncovering information about our patients need to be an ongoing process. These issues will continue to evolve over time, perhaps reaching a point of being standardized across practices. Being mindful of patient privacy and confidentiality, as well as ethical medical behavior, is the key to maintaining professional standards. The questions of what are you looking for and why are you looking for it should remain in the forefront of what we do online at all times.

Eucharia Borden is a social worker at Lankenau Medical Center in Wynnewood, Pennsylvania. Rosemarie Tucci is the nurse coordinator of the Main Line Health System Pulmonary Nodule Program in Radnor, Pennsylvania.


1. ANA’s Principles for Social Networking and the Nurse: Guidance for Registered Nurses. Silver Spring, MD: American Nurses Association; 2011.

2. Code of Ethics. Washington, DC: National Association of Social Workers; 2017. Accessed November 2, 2018.