Professionalism in Social Media: The 3Cs rule

Ryan, Gemma Sinead (2018). Professionalism in Social Media: The 3Cs rule. In: RCN International Research Conference, 16-18 Apr 2018, University of Birmingham Medical School.


The concept of e-professionalism or e-accountability relates to the attitudes and behaviours the reflect professional values in the online environment. Despite professional guidance and organisational policy being in place for several years, literature outlines issues associated with e-professionalism in nursing still remain.

To explain the complex relationships that exist between professionalism, accountability and social media and, make recommendations about how this might be managed consistently.

Critical realist ethnography. Use of secondary sources of evidence: professional guidance and published research. Focus groups with registered nurses (n=8) and observation of nursing related, publicly accessible Facebook groups/pages over 3 months. A realist approach to analysis and concept mapping explained the complex interaction of components within social networks: entities, structures, tendencies, actions and events.

Issues with context, clarity and confirmability:
Actions such as. breach of confidentiality, ‘friending’ patients (breach of boundaries) were unanimously ‘unprofessional’. Other behaviours were more subjective, with no consensus about whether individuals should be held to account e.g. being obviously drunk, pole dancing. Differences of opinion were best explained by background, personal values and also the difficulties with ‘confirming context’ in social media (e.g. the currency of the post, the person who actually posted it).

Influencing factors:
External factors changed behaviours the concept of ‘acceptability’ e.g. there was initially consensus that posting pictures at work and in uniform was unprofessional. However, in response to politician comments nurses were actually doing this publicly; accepting and promoting such behaviour.

Three core considerations for online behaviours and assessing incidents in social media were ‘The 3Cs’: context, clarity and confirmability. These are presented in an ‘Awareness to Action’ (A2A) tool that facilitates 1) reflection about use of social media and, 2) decisions about whether an incident is unprofessional (warranting further action) or simply, unacceptable (warranting less severe or no action).

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