To Tweet or not to Tweet?

Online social media as a tool for establishing professional identity and creating change

Reflections on Social Media and the Nursing Profession

Registered nurses in the province of Ontario are bound to standards of practice outlined by the College of Nurses of Ontario (College of Nurses of Ontario [CNO], 2017) and are cautioned by the College and professional associations to use social media with professionalism (CNO, 2014; ONA, 2018). This includes maintaining a professional image, respecting patient confidentiality, establishing boundaries and being accountable for what is posted online (INRC, 2016). As a registered nurse I have always approached social media with caution and have been hesitant to use social media in a professional compacity, assuming that identifying myself as a nurse online could be damaging. Exploring options for online interaction with other professionals through the use of social media applications like Twitter © and researching the value in establishing an e-portfolio has caused me to reflect on the professional identity I want to represent in the online world and how nurses can use that identity as a force for positive change within the healthcare system.

Professional Identity

In my practice as a registered nurse I have always sought to demonstrate my clinical skill, commitment to ongoing education, my leadership and desire to help others develop into expert practitioners. I value my competence as a nurse, my compassion with clients and the ability I have to demonstrate leadership in a challenging practice environment. Ohlen & Segesten (2002) described some of the values that nurses use to establish professional identity as compassion, confidence, courage, assertiveness and commitment. Developing these values is an essential tool in creating a professional identity (Ohlen & Segesten, 2002). The development of a nurse’s professional identity can lead to greater career satisfaction and commitment to intend to stay in the nursing profession (Sharbaugh, 2009). Establishing core nursing values therefore will not only aid in establishing the individual’s professional identity and happiness in the workplace but could be a cost saving measure for healthcare systems by retaining nurse staffing.

As a function of forming professional identity Jarvis-Selinger et al. (2012) describe collective identity formation as socialization into roles and involvement in the community’s work. Social media use by professionals to explore professional communities could therefore be seen as a tool for professional socialization and aide in developing a professional identity. Professional agencies such as the Canadian Nurses Association (@canadanurses) use social media platforms such as Twitter© to give voice to the nursing profession and highlight professional nursing activities. As an individual I feel I can safely use social media to explore my professional community and develop my identity as a nurse, so long as I keep my professional values in mind when posting to the world online.

Nursing Value in the Canadian Healthcare System

As the cost of healthcare continues to rise in Canada (Canadian Institute for Health Information, 2017), nurse leaders can help the public understand the value that nursing contributes to the system. Demonstrating a positive image of nurses to the public aides in developing the identity of the nursing profession and can empower nurses through a broader public understanding of the value in nursing (Ten hoeve, Jansen & Roodbol, 2013). As nurse leaders, social media can be used as a tool to help increase the publics understanding of the value of nurses (Ten hoeve, Jansen & Roodbol, 2013). E-portfolios can be an effective online method for providing evidence of skills and achievements (Green, Wyllie & Jackson, 2014) and in creating an e-portfolio I hope to develop my professional identity demonstrating in a public forum my values and competencies as a registered nurse and my contribution to nursing in the Canadian healthcare system.

As nurse leaders we must recognize the fiscal limitations and constraints of our current healthcare climate and be actively involved in the process for creating positive change. One of the greatest potentials for positive change in healthcare can be made by investing in healthcare staff (Stenberg et al., 2017).

An investment in transformation - Stenberg, K., Hanssen, O., Edejer, et al. (2017). Financing transformative health systems towards achievement of the health Sustainable Development Goals. The Lancet Global Health, (2017)

By identifying our own values, building our professional identity and using modern social media tools, such as Twitter, YouTube and personal e-portfolios to broaden public understanding of what nurses do; we can enhance the voice of nurses who seek to create positive change in our healthcare system.

References

Canadian Institute for Health Information. (2017). How much does Canada spend on health care? Retrieved from http://www.cihi.ca/en/how-much-does-canada-spend-on-

health- care-2017

College of Nurses of Ontario. (2014). New Social Media Resource. Retrieved May 4, 2018 from http://www.cno.org/en/news/2014/september-2014/new-social-media-guidelines/

College of Nurses of Ontario. (2017). Standards and Guidelines. Retrieved May 22, 2018 from http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/

Green, J., Wyllie, A., & Jackson, D. (2014). Electronic portfolios in nursing education: A review of the literature. Nurse Education in Practice, 14(1), 4-8. doi:http://0- dx.doi.org.aupac.lib.athabascau.ca/10.1016/j.nepr.2013.08.011

International Nurse Regulator Collaborative, (2016). Social Media Use: Common Expectations for Nurses. Retrieved from http://www.cno.org/globalassets/docs/prac/incr-social-media-use-common-expectations-for-nurses.pdf

Jarvis-Selinger, S., Pratt, D., Regehr, G. (2012). Competency is not enough: Integrating identity formation into the medical education discourse. Academic Medicine, 87(9) 1185–1191. doi: 10.1097/ACM.0b013e3182604968

Ohlen, J. & Segesten, K. (2002). The professional identity of the nurse: concept analysis and development. Journal of Advanced Nursing (28)4. https://doi.org/10.1046/j.1365-2648.1998.00704.x

Ontario Nurses Association. (2018). How to Navigate Social Media Effectively: A Best Practices Primer Form Your Union. Retrieved from https://www.ona.org/wp-content/uploads/ona_socialmediabestpracticesf_201711.pdf?x72008

Sharbaugh, S. M. (2009). Relationships among nurses' professional identity, career satisfaction, occupational commitment, and intent to stay (Order No. 3407361). Available from Nursing & Allied Health Database; ProQuest Dissertations & Theses Global. (305144362). Retrieved from http://0-search.proquest.com.aupac.lib.athabascau.

ca/docview/305144362?accountid=8408

Stenberg, K., Hanssen, O., Edejer, T., Bertram, M., Brindley, C., Meshreky, A. … Soucat, A., (2017). Financing transformative health systems towards achievement of the health Sustainable Development Goals: a model for projected resource needs in 67 low-income and middle-income countries. The Lancet Global Health, (5)9, 875 – 887. https://doi.org/10.1016/S2214-109X(17)30263-2

Ten Hoeve, Y., Jansen, G. & Roodbol, P. (2014) The nursing profession: public image, self- concept and professional identity. A discussion paper. Journal of Advanced Nursing (70)2. doi: 10.1111/jan.12177

Social Media and the Healthcare Professional

The last time I was in engaged in formal post secondary education was 15 years ago while completing my Bachelor of Science degree at Ryerson University. In the time since then social media has changed the way that we see the world and how as individuals and professionals we interact with the world online. The only lessons I remember learning about social media all those years ago came from a clinical adviser in one of my placements. The basics of her advice was this, be careful, don’t talk about work and don’t tell anyone you’re a nurse on the internet. As I begin my journal through post graduate studies I have come to realize how much the online presence of professionals has changed and that I have a lot to learn about how to manage my online professional presence. Being invisible is no longer sufficient in today's online, multimedia world.

In order to prepare myself I’ve begun by evaluating the expectations of my professional governing body and workplace and identifying tools that are available in managing content in the online world. Here’s a summary of what I’ve accomplished thus far and wish me luck as I go forward!

Online Professionalism

• Registered Nurses in Ontario are mandated by the CNO to practice nursing within specific standards of practice and guidelines, however there is no practice standard relating specifically to the use of social media (CNO, 2014). The CNO does offer a webinar on responsible social media use. Click here for more information

• The CNO does direct nurses concerned about appropriate media use to a published report by the International Nurse Regulator Collaborative that outlines nine clear expectations for a nurse’s behaviour when using social media (INRC, 2016). The College directs nurses when using social media to do so within established standards especially relating to Confidentiality and Privacy and Therapeutic Nurse-Client Relationships.

• Nurses outside of Ontario rely on the College’s in their home province to guide their own practice related to social media use. Here are examples from nursing professional agencies in both BC and New Brunswick . There are many similarities in the language of these resources that center around the clients right to privacy, respectful language and the integrity of using appropriate channels of authority to address concerns.

Curation of Data

Full disclosure, when I first started exploring this topic through MHST601 I was so confused. Having been in school so long ago, I was repeatedly reminded that journal articles (and maybe a government website here or there) where the only relevant sources of information. Too many “www” references on your assignments were a sure sign of a lack of credible research. After reading through classroom posts, trolling through Twitter, and exploring more programs and watching more YouTube videos than my six-year-old, I realize that relevant and valuable information is found in so many other places.

This brings me to content curation. Finding what is out there in cyber-space, keeping it organized and synthesizing into relevant information. Here are some reviews of content curation tools I have explored so far in the course and how I am making them relevant to increasing my digital literacy.

• Mendeley - Mendeley is a great online tool for storing, sorting and making notes on journal articles. I have found it easy to use and create files for organizing papers by subject. The program can be opened with group files if several authors are collaborating on one paper, but otherwise the information is stored individually and not an open source for online collaboration. RefWorks works in much the same way,but I found the software for Mendeley more user friendly.

• Pocket was identified by other students via Twitter and on our classroom posts. It allows you to save almost anything on the internet into one easy to reach “pocket”. I find it easy to use on my phone and home computer and your account can be opened on any devise. As I’ve been researching on how to write blogs and what exactly content curation means to me I have found it easy to use and organize the information (even for a beginner like me!)

• Personal Blogs – I had to do a little research here to figure out exactly how “blogging” was relevant to my search to understand content curation. One definition of what a blog is says it is “a website that consists of entries called posts that appear in reverse chronological order with the most recent entry appearing first” (Gunelius, 2018). Blogs can be a useful tool to synthesis the information found, interpret the information into what is relevant to you and then post your own thoughts. I watched a really simple YouTube video on “How to Curate Content to Improve Your Blog”. This gives the beginner like me great overview into how to take the content I’ve curated on an application like Pocket and post my own ideas.

• Personal Webpages. You’ll see here I’m using Wix. I’ve started to use the templates available online to format my own professional portfolio. Including this blog! After a little trial and error, I’ve found to templates easy to use. I like that the program is free to use and publish your site. Classmates in our online classroom have been using the same site and others such as Wordpress.

• Exploring Twitter through this course has shown me the value of professional connections on social media. I always assumed that Twitter was just used to follow celebrity tweets and American politics. Opening up my Twitter account has allowed me to follow nurses associations that I am affiliated with and I have read interesting articles and postings by classmates MHST601. I'm still learning to navigate the Twitter universe, but you can follow my account @CoraleeSonnenb1 on Twitter.

So, what have I learned?

All those years ago in nursing school the essence of what my teacher said about social media still rings true. When using social media nurses need to remember their obligation to maintain their integrity online. We have a duty to protect our clients right to privacy, confidentiality and be accountable for what we post. By creating this online portfolio, I am learning to harness content from multiple sources on the internet and use available tools to organize data for future reference. Looking forward to the journey of creating a visible professional presence in the online world!

References

College of Nurses of Ontario. (2014). New Social Media Resource. Retrieved May 4, 2018 from http://www.cno.org/en/news/2014/september-2014/new-social-media-guidelines/

Gunelius, R. (2018). The Definition, Origin, and Purpose of the Term 'Blog'. Retrieved from

https://www.lifewire.com/what-is-a-blog-3476707

International Nurse Regulator Collaborative. (2016). Social Media Use: Common Expectations for Nurses. Retrieved from http://www.cno.org/globalassets/docs/prac/incr- social-media-use-common-expectations-for-nurses.pdf

My Role in the Canadian Healthcare System

Nursing practice in Ontario is legislated under two provincial acts. The Nursing Act, 1991 and the Regulated Health Professions Act, 1991. The Regulated Health Professions Act (RHPA) serves and protects the public by providing a framework outlining what a professions scope of practice entails, defines controlled acts, regulates how a College governs its members, and provides an appeal and review board that reviews complaints and decisions made by a regulatory College (OMHLTC, 2016). The Nursing Act (1991) defines controlled acts that are delegated to nurses in the province and regulations that are specific to nurses (CNO, 2016). It also outlines the different classes of practicing nurses and defines regulations to the use of controlled acts (CNO, 2016). Together these to regulatory acts define the ways in which nurses may practice in Ontario, creates the framework for establishing a self-regulating nursing college and protects the public safety by ensuring nurses providing their health care are adequately trained and monitored.

As a registered nurse in Ontario I am governed directly by the College of Nurses of Ontario (CNO). The CNO is the governing body for RN’s, RPN’s, and NP’s in Ontario (CNO, 2017). The College is a self-regulating body that establishes and enforces practice competencies, participates in the legislative process and administers a process for quality assurance of nursing practice in the province of Ontario (CNO, 2017). The College allows nurses to be a self-regulating body that defines entry level practice skills for nursing, reviews ongoing nurse competency and protects the public through judicious review of nurses practice and client complaints.

Healthcare Funding in Ontario

Regionally healthcare in Ontario is managed by Local Health Integration Networks since enacting the Local Health System Integration Act 2006 . In my region this is the Waterloo-Wellington LHIN. The WWLHIN began managing the healthcare needs of those in our region in 2007, their responsibility is managing the integrated health system with the goal of improving the quality and availability of local healthcare (LHIN, 2014). The LHIN connect local health services including hospitals, homecare, public health and primary care for clients and hold providers accountable for providing quality and fiscal responsibility (LHIN, 2014). The LHIN also collaborates with key community stakeholders to identify how healthcare dollars are spent within the community and are then responsible for reporting spending and efficiency back to the province (LHIN, 2014).

In my current role as a Resource RN in the emergency department, I am aware everyday of our responsibility to report our efficiency to the WWLHIN. An example is in tracking the time that ambulances are delayed in our hospital while waiting to transfer patients. Standard targets are set provincially and we are required to record the time paramedics spend transferring care of patients, report that data back to the WWLHIN and a portion of our funding is determined by these results. These types of data are reviewed with us at monthly meetings so we can see where we can improve in terms of ambulance offload delay times, target times to see physicians and length of time until discharge in the emergency department.

Reference

College of Nurses of Ontario. (2017). About the College of Nurses of Ontario. Retrieved from

http://www.cno.org/en/what-is-cno/

Local Health Integration Network. (2014). Your Local Health Integration Network. Retrieved May 15, 2018 from http://www.waterloowellingtonlhin.on.ca/aboutus.aspx

Ontario Ministry of Health and Long-term Care. (2016). Health Workforce Planning and

Regulatory Affairs Division. Retrieved May 15, 2018 from

http://www.health.gov.on.ca/en/pro/programs/hhrsd/about/rhpa.aspx