Law, Ethics, and Professional Guidelines for Nursing Practice

The onset of social media and its impact on medical professionalism cannot be ignored. While it is true that social media usage has created opportunities for nurses and practitioners in the healthcare sector, this platform has also created adverse impact on issues of privacy and security. The Australian Health Practitioner Regulation Agency (AHPRA) has set regulatory measures for nurses and medical practitioners with the goal of safeguarding professionalism and maintaining safety of data and privacy of patients. In spite of these measures being in place, there are cases where nurses fail to meet the standards and regulatory measures set by the regulatory agencies. This paper discusses the case study of Dan, a registered nursing student in the fifth day of his first-year placement at a local hospital. The paper discusses ethical considerations, legal, and professional issues related to the case and concludes by offering a recommendation on what Dan could have done.

Running head: LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING
PRACTICE
Law, Ethics, and Professional Guidelines for Nursing Practice
Student’s Name
Institutional Affiliation

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 1
Law, Ethics, and Professional Guidelines for Nursing Practice
The onset of social media and its impact on medical professionalism cannot be ignored.
While it is true that social media usage has created opportunities for nurses and practitioners in
the healthcare sector, this platform has also created adverse impact on issues of privacy and
security. The Australian Health Practitioner Regulation Agency (AHPRA) has set regulatory
measures for nurses and medical practitioners with the goal of safeguarding professionalism and
maintaining safety of data and privacy of patients. In spite of these measures being in place, there
are cases where nurses fail to meet the standards and regulatory measures set by the regulatory
agencies. This paper discusses the case study of Dan, a registered nursing student in the fifth day
of his first-year placement at a local hospital. The paper discusses ethical considerations, legal,
and professional issues related to the case and concludes by offering a recommendation on what
Dan could have done.
Dan committed several transgressions which are against the nursing profession as
regulated by the Nursing and Midwifery Board of Australia (NMBA). The first transgression is
the taking of the patient’s pictures of the wound. This is a transgression against the AHPRA and
attracts legal penalties. It is also unethical for the registered nurse to have taken the photos of the
patient, even when he was excited about his job. According to Bode (2015), Dan breached the
privacy and trust of the patient. The patient in this case was blind. According to the case study,
Dan chatted with the patient and took the photos of the wound. This is disrespectful and breach
of trust and confidence in the medical profession.
The second transgression is the decision to post the photos of the wound of the patient on
social media. AHPRA (2019) has set regulatory standards that prohibit taking or sharing photos
of patients on social networking sites. The responsibility of the healthcare provider is to

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 2
safeguard the welfare of the patient both physically and emotionally. Nurses are prohibited from
distributing or sharing private information with their friends or relatives. In this case, the
registered nurse shared the photos with his friends who are also nursing students. This is a breach
of trust and confidence in the profession, in addition to a breach of fiduciary duty. The nurse has
a duty of holding his patients with dignity and respect they deserve. The Australian Medical
Association (AMA) (2019) explains that photos of patients have the same protection like the
personal and private information of patients. As a result, Dan did not have to share the photos
with his friends. Additionally, even if he wanted to take the photos, he did not have a moral right
to share them on social media or with his friends because the information belonged to the client
and had to be treated with utmost privacy it deserved.
The third transgression is the embarrassing of the patient by disclosing his name on the
social media. According to the case study, Dan posted that “…Poor blind Freddie…” It is easy
for anyone that knows about Fredie to access the information from social media and use it
against the patient. Additionally, the Australian Government Department of Health (2019)
prohibits healthcare professionals from misusing or distributing private information about their
patients. In this case, the registered nurse, although still new in the profession, did not have to
disclose the private information about the patient or the name of the patient to the third party.
Once the name of the patient has reached third party sites like the social media platform, it
becomes impossible to control the flow of the information. This is especially because the social
media platforms do not have laws that regulate sharing of information. Anyone with access to
this information can misappropriate it and this can easily lead to disrespect and demeaning of the
hospital.

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 3
Dan’s transgression of taking the photo of the patient’s wound and posting it on
Facebook violates the Australian Registered Nurse Standards for Practice, the Code of Ethics for
Nurses and Code of Conduct. From the ethical point of view, The Australian Registered Nurse
Standards for Practice requires that the registered nurse respects the fiduciary duty he has
towards the patient and the dignity of the student. The message attached to Dan’s post is
demeaning and does not show respect to the patient. Additionally, the code of conduct for nurses
in Australia requires that nurses take responsibility for their actions because they are representing
the entire profession (Beltran et al., 2016). According to NAMB (2019), a similar case was
handled by the Administrative Tribunal of Western Australia where a nurse shared the private
information of the patient that was receiving care in the hospital to her sister. The tribunal
charged the registered nurse for professional misconduct and failure to promote the trust and
privilege that govern the relationship between nurses and patients receiving care in hospital
setting.
Westrick (2017) discusses some of the restrictions set forth by the code of conduct for
nurses in Australia. Some of the areas that the professional and ethical code of conduct prohibits
include description of the patient on social media, sharing the room numbers of patients,
uploading photos or videos of patients receiving care, and disclosing the names of patient on
social media. Cashin et al. (2017) explains that these transgressions are pronounced among
young nurses who spend a lot of time exposed to social media. The primary concern is that
nurses fail to strike a balance between social life and e-professionalism. E-professionalism
requires that the registered nurse treats the patient with high regard and dignity just like one
could do when dealing with the patient (Donna & Sharlene, 2017). Cashin et al. (2017) also

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 4
explains that nurses do not have a moral responsibility to disrespect the patient or demean the
status of the patient, even if the patient is vulnerable and cannot defend himself.
The transgression by the registered student nurse attracts both legal and ethical
consequences for him and the hospital where he worked. The patient may sue the hospital for
breach of confidentiality and privacy as well as the registered student nurse for defamation.
According to Zahedi et al. (2013), the employer can still take action against the registered
student nurse even when he obtained the permission from the patient to take the photo. For this
case, the nurse risks cancellation or deregistration of his certificate for his misconduct. In 2015, a
nurse was suspended for six months for failing to promote the professional conduct for nurses
and posting the photos of one of his patients on social media (NMBA, 2019). It is also evident
that the registered student nurse ranted about the hospital he was working. His comment that
accompanied the photo he posted portrayed the hospital in a negative manner and could attract
adverse consequences from the hospital management. Delaney (2017) explain that nurses are
supposed to deliver patient-centered care to patients. Patient-centered care implies that the
welfare of the patient takes precedence over
The ethical implication of the student’s decision affects the hospital where he was
working as well as his career in future. His fellow students already know him and anyone that
comes across him in future will know that the student is disrespectful to his profession and the
career at large. According to Nelsey (2014), nurses have to strive to maintain composure and
professionalism all time. It is evident that the registered student nurse was overexcited with what
he was doing and wanted to show his friends his achievement. The negative online posts can
reach some future employees of the student who will avoid employing him due to his
professional misconduct. The current institution will suspend him and dismiss him. The

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 5
Australian Administrative Tribunal will impose training measures on him to study again under
supervision with the goal of equipping him with ethical and professional codes of conduct
(Nursing and Midwifery Board of Australia 2016). During the time of study, the nurse will not
be allowed to practice, which may adversely affect his career goals. Additionally, sharing of the
private information about the patient on social media is likely to interfere with the job security of
the student nurse. When the comments reach unintended audience, there are high chances that
the audience may take note and use the information against the nurse in future.
Other ethical implications of the student’s transgressions include the response from
public outcry. The hospital will be forced to come out and explain what led to the transgression
and necessary measures that have been taken or will be taken to prevent such actions in future.
The current patients in the hospital and those that will visit the hospital later will feel insecure
when they realize that the hospital cannot protect their privacy. Similarly, there are high chances
that the nurse in charge of the ward, Mrs. Jane, will face disciplinary committee for allowing the
student nurse to take care of the patient that was under her charge. The public will not understand
that the nurse was overwhelmed or that the nurse was exhausted to the extent that he had to seek
the service of a student nurse. What everyone will need in this is accountability and
responsibility for what had happened.
In addition to the above consequences, the registered student nurse risks loss of licensure,
expulsion from the nurse school and the hospital he is working, criminal charges, fines for the
offense committed, and forceful sensitivity training in the profession (Nursing and Midwifery
Board of Australia 2015). These consequences could have been avoided if the nurses had taken
reasonable measures and used the social networking sites in a positive manner. Denecke et al.
(2015) recommends that social media policies do not seek to restrict the freedom of nurses. The

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 6
policies are passed so that nurses can act responsibly when handling information and private
information from patients.
There are several options that the registered student nurse could have done to avoid the
transgression. Social media usage should be a positive experience for nurses who understand
their rights, responsibilities, and duties they have towards their clients and patients. Social media
is a wide platform that the nurse could have used to promote positive experience and promote the
welfare of the community (Nursing and Midwifery Board of Australia 2019). He could have
posted positive message about the book he was reading to promote his career or shared a tag
promoting an upcoming social health event. He could have also used the platform to inform the
public about healthy living and what they can do to lead positive lives. These are avenues for
interaction and the registered student nurse can exploit them for positive experience in the
community.
It is evident that the registered nurse created an event that started trending after he
uploaded the photo of the patient. However, there are options for engaging the public in a
positive manner and increasing interaction by setting a topic to trend. In this case, the registered
student nurse could have used Facebook to broadcast positive messages about the healthcare and
what the healthcare sector was doing to promote the welfare of the public. All these options seek
to promote the welfare of the community and individual at large. Social media provides a
platform where nurses can motivate one another and share positive messages that uplift them in
the challenges they face. The nursing profession is facing significant challenges and it is the role
of the student nurse to intervene and have positive impact on others. The case of Dan has helped
understand how social media policies in the medical field affect professionalism in nursing
practice. Professionalism requires that the registered student nurse upholds the profession with

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 7
the dignity it deserves while at the same time maximizing the welfare and interests of patients
they serve. Social media use poses a significant challenge to nursing students. They have to stay
ahead in knowledge by understanding what is regulated and how they can use these platforms to
have positive impact in their careers.

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References
Australian Medical Association (AMA) (2019). Privacy and confidentiality. Retrieved from
https://ama.com.au/privacy-and-confidentiality
Australian Government Department of Health (2019). Confidentiality and the law. Retrieved
from http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-
pubs-front11-fa-toc~drugtreat-pubs-front11-fa-secb~drugtreat-pubs-front11-fa-secb-
6~drugtreat-pubs-front11-fa-secb-6-3
Australian Health Practitioner Regulation Agency (2019). Social media policy. Retrieved from
http://www.med.monash.edu.au/assets/docs/scs/psychiatry/ahpra-social-media-policy-
2014.pdf
Beltran-Aroca, C. M., Girela-Lopez, E., Collazo-Chao, E., Montero-Pérez-Barquero, M., &
Muñoz-Villanueva, M. C. (2016). Confidentiality breaches in clinical practice: what
happens in hospitals?. BMC medical ethics, 17(1), 52. doi:10.1186/s12910-016-0136-y.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009672/
Bode, R., L. (2015). Social media in nursing: Friend or foe? Nursing and Midwifery Board of
Australia. Retrieved from https://digitalcommons.cedarville.edu/cgi/viewcontent.cgi?
article=1036&context=student_publications
Cashin, A., Heartfield, M., Devey, L., Buckly, M.,Cox, D., Kerdo, E.,… Fisher, M. (2017).
Standards for practice for registered nurses in Australia. Collegian, 24(3). Retrieved from
https://www.collegianjournal.com/article/S1322-7696(16)30003-8/fulltext
Denecke, K., Bamidis, P., Bond, C., Gabarron, E., Househ, M., Lau, A. Y., … Hansen, M.
(2015). Ethical Issues of Social Media Usage in Healthcare. Yearbook of medical

LAW, ETHICS, AND PROFESSIONAL GUIDELINES FOR NURSING PRACTICE 9
informatics, 10(1), 137–147. doi:10.15265/IY-2015-001. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587037/
Delaney, J., L. (2017). Patient-centred care as an approach to improving health care in Australia.
Collegian. Retrieved from https://www.collegianjournal.com/article/S1322-
7696(17)30042-2/fulltext
Donna, M., & Sharlene, N. (2017). E-Professionalism and the ethical use of technology in social
work, Australian Social Work, 70(2), 131-134, DOI: 10.1080/0312407X.2016.1221790.
Retrieved from https://tandfonline.com/doi/full/10.1080/0312407X.2016.1221790
NSW Government (2019). Patient privacy. Retrieved from
https://www.health.nsw.gov.au/patients/privacy/Pages/default.aspx
Nursing and Midwifery Board of Australia (2015). Tribunal finds nurse guilty of professional
misconduct. Retrieved from https://www.nursingmidwiferyboard.gov.au/news/2015-04-
29-media-release-misconduct.aspx
Nursing and Midwifery Board of Australia (2019). Social media policy. Retrieved from
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/policies/social-
media-policy.aspx
Nursing and Midwifery Board of Australia (NAMB) (2016). Code of conduct for nurses.
Retrieved from http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?
record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D

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Nelsey, K. (2014). Australian Health Practitioner Regulation Agency (AHPRA). Retrieved from
https://www.ahpra.gov.au/documents/default.aspx?
record=WD10%2F3430&dbid=AP&chksum=d4FE%2F3gzLYdHK9LJKDKkJA%3D
%3D
Westrik, S., J. (2017). Nursing students' use of electronic and social media: law, ethics, and e-
professionalism. BMC Ethics. Retrieved from
https://www.unboundmedicine.com/medline/citation/27164772/Nursing_Students
%27_Use_of_Electronic_and_Social_Media:_Law_Ethics_and_E_Professionalism_
Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., … Dastgerdi, M. V.
(2013). The code of ethics for nurses. BMC, 42 (1), 1–8. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712593/