Hayley Thrumble (left) and Dr Neesha Oozageer Gunowa (right)   

Professional networking is a valuable tool to build advantageous professional support systems of people who will advise, encourage and enhance healthcare practice (Donelan, 2014). Networking benefits include increased engagement and insight into healthcare policy and subsequent changes and trends in the professions, along with better opportunities for career advancement (Meiring, 2018). As a result of developments in communication technology and influential organisations, such as the World Health Organization (WHO) and the Queen’s Nursing Institute (QNI), demonstrating a strong presence on social media, use of online social networking sites is gaining increasing momentum among healthcare professionals, including the nursing community (Barry and Hardiker, 2012). Ferguson (2013) shows that social media popularity in networking falls under four main themes: connection, confidence building, information sharing and enhancing practice. However, social networking sites such as Twitter and Facebook demonstrate minimal regulation, which has sparked debate regarding their compatibility within a profession which values privacy, confidentiality and face-to-face relationship building (Nursing and Midwifery Council [NMC], 2018).  
In contrast, Sandlin and Hinmon (2016) suggest that by using social networking sites ethically to develop professional networks, clinical practice and patient safety can be improved.  

Strong professional networks take time and effort to build and require nurses to participate in professional societies, events and meetings to make themselves visible and recognisable (Meiring, 2018). Before the availability of online connectivity and social networking, some nursing groups, such as hospital staff nurses and community nursing teams, may have become marginalised because of their roles and locations being incompatible with face-to-face networking events (Donelan, 2014). This isolation could result in service users of these groups receiving differing levels of care than those who are able to benefit from the connections and information gained from these engagement and professional networking events (Ferguson, 2013). Meiring (2018) highlights that the value of networking is not recognised or promoted enough among nurses and due to lack of confidence, nurses often find opportunities for networking particularly difficult. However, De Klerk and Verreynne (2017) suggest that increased exposure to social interactions can support development of confidence and, in turn, enhance visibility. Kahnum et al (2016) also explain that online social networking sites can reduce networking barriers by increasing access to information, creating an inclusive environment, and allowing those who may previously have been passive observers to gain confidence to actively participate in discussions and debates.  

A descriptive study by Power (2015) highlights the benefit of Twitter specifically for its role in developing professional digital networks. This is supported by a similar study conducted by Tower et al (2014), which indicates an overwhelming majority (89.8%) of nursing students included reporting professional social media participation increased their knowledge and understanding of subject content. Additionally, 92% of these nursing students felt that social networking sites demonstrated an inclusive and respectful environment, indicating that online social networking sites can provide an innovative learning platform which allows nurses to explore different opinions and enhance personal autonomy in learning (Tower et al, 2014). 
Furthermore, use of social networking sites to ask questions and voice opinions without fear of judgement can provide nurses with transferrable skills which can be used in clinical practice, such as teamwork, advanced communication and workforce development (Barry and Hardiker, 2012). However, due to minimal regulation of social networking sites, there is an increased risk of dissemination of misinformation (Donelan, 2014). Additionally, social networking sites have been criticised for their inability to support communication of complex ideas due to the lack of immediate feedback required to do this (Green et al, 2014). Lack of feedback can lead to superficial learning which lacks the in-depth analysis and critical thinking required for innovative practice (Green et al, 2014). 

To avoid dissemination of misinformation and reduce risks to patient safety, nurses must utilise critical analysis skills and examine the reliability and validity of literature prior to dissemination via social media platforms (Power, 2015). If used efficiently, social networking sites could encourage nurses and other healthcare professionals to collaborate, reflect and share knowledge, which could lead to increased self-efficacy and success (Barry and Hardiker, 2012).  

In contrast, using social media professionally can be an intimidating prospect, due to fears regarding professionalism which have been instilled from undergraduate education (NMC, 2018). Historically, healthcare professionals have been able to apply distinct personal and professional boundaries, as traditional networking events typically occur in professional capacities (Sandlin and Hinmon, 2016). However, social networking sites complicate this with non-restrictive access, meaning participation in networking events can be accessed from the comfort of an individual’s home (Tower et al, 2014). Additionally, concerns regarding security, privacy and inappropriate content have been identified, presenting potential for violation of the NMC Code of Conduct (NMC, 2018) if personal and professional social media accounts are combined (De Klerk and Verreynne, 2017). Social networking sites provide an illusion of privacy, consequently, many violations include pictures or posts which include patient information — a breach of Information Governance and patient confidentiality (Data Protection Act, 2018). As a result of this, many healthcare organisations place social networking site bans on nurses and restrict access to them on work technology (Green et al, 2014).  
However, Power (2015) states that Twitter can be used in accordance with the NMC Code of Conduct (2018) with appropriate privacy settings and the separation of personal and professional social media accounts. Additionally, in 2016, the NHS published a briefing which recognised the impracticality of social networking site bans, arguing that nurses are entrusted with patient lives and therefore should be trusted to use social media appropriately (Sandlin and Hinmon, 2016). Organisational addressment of these issues surrounding legal, ethical and regulatory risks are evident through implementation of ongoing training and organisational policies which evolve in line with technological advances (Barry and Hardiker, 2012). Through this, nurses can be empowered to share clinical experiences, information and opinions publicly, while maintaining professionalism and preventing repercussions on professional reputations (Fraser, 2011).  

In conclusion, the safe and professional use of social networking sites provides a comfortable and familiar environment to reduce the anxieties nurses often face surrounding professional networking (Cisco, 2018). Online networking can empower nurses to demonstrate a more direct approach to networking, enhancing engagement in continual professional development and improving clinical practice (Slank, 2019). This, in turn, allows effective advocation for patients and increased patient safety (Kahnum et al, 2016). However, there is still little research in the use of social media to confirm its superiority over face-to-face networking, an area that needs to be improved. 
Hayley Thrumble is district nurse, First Community Health and Care, Horley and Dr Neesha Oozageer Gunowa is senior lecturer and community pathway lead, University of Surrey. 


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This piece was first published in the Journal of General Practice Nursing. To cite this article use: Thrumble H, Gunowa NO (2022) Using social media to enhance nursing practice and patient safety. J Gen Pract Nurs 8(4): 20–21