Contemporary Nurse

ISSN: 1037-6178 (Print) 1839-3535 (Online) Journal homepage: https://www.tandfonline.com/loi/rcnj20

Rise of the e-Nurse: the power of social media in

nursing

Paul Ross & Rachel Cross

To cite this article: Paul Ross & Rachel Cross (2019) Rise of the e-Nurse: the power of social
media in nursing, Contemporary Nurse, 55:2-3, 211-220, DOI: 10.1080/10376178.2019.1641419

To link to this article: https://doi.org/10.1080/10376178.2019.1641419

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Contemporary Nurse, 2019
Vol. 55, Nos. 2–3, 211–220, https://doi.org/10.1080/10376178.2019.1641419

COMMENT
Rise of the e-Nurse: the power of social media in nursing
a,b* b
Paul Ross and Rachel Cross
a
Critical Care Registered Nurse, Alfred Intensive Care Unit, 55 Commercial Road, Melbourne, VIC 3181,
Australia; bSchool of Nursing and Midwifery, La Trobe University, 99 Commercial Road, Melbourne, 3004,
VIC, Australia
(Received 31 July 2017; accepted 5 July 2019)

The internet and social media have changed the way society communicates, requiring the
nursing workforce to develop effective digital literacy skills and attain levels of e-
professionalism. The internet provides a unique environment that both connects and disrupts
with powerful and unpredictable consequences for healthcare. A networked nursing
workforce can influence and create collaborative communities of practice that will develop
and shape healthcare. Nurse education must engage with technology and social media to
provide a future-ready workforce capable of delivering future eHealth reforms.
Keywords: e-Nurse; nurses; nursing education; learning; social media

Impact statement
This discussion paper focuses on the impact of social media and the challenges that the nursing
profession will face with the disruption of technology-driven healthcare. The future of healthcare
will require a nursing workforce which is technologically trained and who possess the digital
skills to deliver personalised and evidence-based interventions. Social media is creating new com-
munities of practice across healthcare where professionals and consumers can interact. Nursing
needs to ensure they are at the forefront of this communication revolution.

Introduction
The internet and social media are an integral part of modern-day life in how we work, commu-
nicate and share information. Both the internet and social media can be viewed equally as con-
necting or disrupting with powerful and unpredictable consequences on society (Rozenblum &
Bates, 2013). The content of social media is considered brief and provides many-to-many com-
munication, with the agility to spread rapidly (DeCamp, Koenig, & Chisolm, 2013). With the
increasing use of mobile devices, there will be further changes to the way in which society com-
municates and use social media (Villanti et al., 2017).
In healthcare, the mass of communication and technology requires the nursing workforce to
have digital literacy skills and understand this new form of health information known as eHealth
(Tubaishat & Habiballah, 2016; Weekes & Wyatt, 2013). Nursing education therefore must
engage with technology and social media to understand the future trends of global work and

*Corresponding author. Email: [email protected]

© 2019 Informa UK Limited, trading as Taylor & Francis Group

212 P. Ross and R. Cross

life practices to provide a future-ready workforce (Royal College of Nursing, 2016). Social media
and nursing can work in harmony for a modern nursing leadership approach to provide the best
possible patient outcomes (Moorley & Chinn, 2016). However, to maintain e-professionalism
conduct, aspects such as the lack of research rigour and peer review in online content,
unknown data storage practices, confidentiality and the blurring of professional and personal
boundaries need to be recognised as limitations of these social media platforms (Cleary, Ferguson,
Jackson, & Watson, 2013).

Healthcare hashtags
The influence of the hashtag in social media, is exemplified by the #hellomynameis campaign
which encourages health professionals to introduce themselves before delivering care interven-
tions (Granger, 2013) and the #proudtonurse campaign, helping acknowledge the pride and
respect within the nursing profession (Calkin, 2014). The #hellomynameis campaign uses
social media to engage healthcare clinicians with a patient-focused outcome, highlighting that
technology can aid rather than impede human interaction and connections. From a global health-
care perspective, the World Health Organisation and the Clean Your Hands Hygiene Campaign
(#safeHANDS) estimated a global reach of 98 million across Twitter (Borzykowski, Tartari,
Pires, & Pittet, 2017). The ‘WeNurses’ movement, demonstrates the impact social media can
make in providing healthcare education opportunities and how communities of practice are con-
necting and sharing information across not only nursing specialities, but also general prac-
titioners, paramedics and pharmacists (Moorley & Chinn, 2014b).
The hashtags of #FOANed (free open access nursing education) and #FOAMed (free open
access medical education) across social media platforms are supplementing traditional knowledge
by asynchronously communicating and providing education for health professionals (Carroll,
Bruno, & Vontschudi, 2016). To understand the potential impact of social media, metrics to
measure the global reach of healthcare hashtags and tweets, also termed ‘altmetrics’ are a
method for hashtag indexation, comparable to impact factor and citations of academic publi-
cations (Haustein, Costas, & Larivière, 2015; Pinho-Costa et al., 2016; Thoma et al., 2015).
An example of these altmetrics and the numbers of interactions related to the #FOAMed move-
ment conducted by Roland, Spurr, and Cabrera (2017), showed development of communities
around speciality domains and practice, with impressions of tweets at over one billion.

The e-Nurse
The potential for digital environments to create virtual eHealth communities around a model of
self-care, provides an empowering opportunity from an individualistic level (Eriksson & Sal-
zmann-Erikson, 2013). The Royal College of Nursing (2016) is ensuring that the nursing work-
force of the future are trained to professionally influence a rapidly changing digital
environment, with the development of digitally literate ‘e-Nurses’. Monitoring technology,
digital security, electronic records and medication systems are all areas where e-Nurses will
be at the forefront of change and they will need training for the skills and tools to influence
the best use of technology in healthcare to improve care delivery and health outcomes (The
Royal College of Nursing, 2016).
Virtual eHealth practices, such as telehealth has the potential to become an equitable source of
healthcare provision (Fisher & Clayton, 2012). Providing access to healthcare for those often
excluded, such as in rural areas, low socioeconomic communities and enable a personalised
approach to healthcare through diagnosing, education, consultations, monitoring, improved com-
munication and reduced acute care admissions (Fisher & Clayton, 2012). However, connecting
 Contemporary Nurse 213

patients and nurses through social media for telehealth purposes has implications for professional
boundaries that will need to be addressed to ensure relationships remain therapeutic in nature
(Chinn, 2017). Technological advances will challenge the risk-averse customs within healthcare
and innovative based practice will need to be incorporated along with best practice guidelines.

The e-Consumer
Social media has also impacted on healthcare consumers, specifically through the empowerment
of sourcing evidence-based practice, treatment options and the sharing of health journeys through
informal communities of practice (Higginson, 2017). Specialist online communities discussing
personal stories and the power of these shared experiences around specific medical issues such
as cancer (Domínguez & Sapiña, 2017) or burns (Giordano, 2016) demonstrate new channels
of support for healthcare consumers. Issues such as accessibility of services, medical jargon trans-
lation, latest treatments are common themes from such networks. Domínguez and Sapiña (2017)
in a qualitative study involving 20 cancer patients found social media provided much-needed
support and help understanding medical jargon, but also highlighted the need for more pro-
fessional information to be made available online. For the nursing profession, social media can
be incorporated and used to facilitate effective communication between patients and nurses to
improve care delivery and outcomes (Casella, Mills, & Usher, 2014).
Health organisations can potentially benefit from improving service delivery by engaging
with consumers on social media for feedback on the perceived quality of care they experienced
(Hawkins et al., 2016). The importance of customer service and connecting with patients using
social media is highlighted by Greaves et al. (2014) quantitative analysis of 198,499 tweets
sent to English hospitals over a year, of which 11% of these tweets contained information
about the quality of care provided. This uptake by healthcare consumers of digital technology
is disrupting traditional avenues of healthcare, with increasing engagement of technology from
wearable devices, remote monitoring, apps to monitor the health and supporting medication com-
pliance (Ferguson, Hickman, Wright, Davidson, & Jackson, 2018). The opportunities of futuristic
biohacking technology to understand a person’s genomics to optimise health may provide the path
for a personalised approach to healthcare (Asprey, 2018). The future of health consumer as expert,
challenges the traditional top-down approach to healthcare where healthcare professionals have
held the power of knowledge and evidence-based practice.

Social media in nurse education

In healthcare education, the increasing use of social media and the internet provide additional
sources of information to the traditional higher education institutions. Student learning and
assessment within nursing and midwifery curriculum is now using social media and technol-
ogy-based platforms to engage students and align curriculum-based activities of learning
(O’Connor et al., 2017). Twitter with the short micro-messaging platform can be effectively uti-
lised as a flashcard learning approach, using social media for innovative education and engaging
millenniums (Trueman & Miles, 2011). Learning skills such as critical thinking, active engage-
ment and communication may in fact be enriched with the use of social media (Green &
Hope, 2010). A study of nursing students in Australia by Tower, Latimer, and Hewitt (2014), uti-
lised a social network pedagogy within a medication subject whereby student feedback advocated
for the use of Facebook to assist with communication and was viewed as an innovative way of
learning. More importantly, almost all students commented on the interaction and collaboration
with their peers as an effective way to learn, and with academic staff for direct feedback oppor-
tunities (Tower et al., 2014). A small study involving ten first-year nursing students by Ferguson,
214 P. Ross and R. Cross

DiGiacomo, Gholizadeh, Ferguson, and Hickman (2017), demonstrated that embedding social
media into nursing higher education content can assist in facilitating learning interactions with
peers and academics. Key identified themes from nursing students, were the enhanced ability
to connect, interact and collaborate compared to the university online platform. Adult learning
philosophies are encouraged through independent learning by utilising social media for peer to
peer engagement, reflection opportunities, sharing resources and this provides a supported plat-
form to meet expected professional and regulatory standards (Ferguson et al., 2017).
Clinical placements are identified as vital components to the experiential learning during
nurse education (Levett-Jones & Lathlean, 2008). The additional support during clinical place-
ment with the use of social media provides an online network of peers and supervisors for debrief-
ing, reflection and an environment for safe communication (Morley, 2014). Through active
encouragement of online participation, student threads suggested that the creation of a shared
community facilitated through peer support enabled a higher level of self-efficacy (Tower, Black-
lock, Watson, Heffernan, & Tronoff, 2015). It may be proposed that social networking affords a
platform for people to stay connected, and feelings of connectiveness may enhance a sense of
wellbeing for students which can be translated to the creation of conducive learning environ-
ments. This opportunity for peer to peer networking and providing a supportive environment is
paramount in the concept of belongingness, for the successful journey of student nurses
(Levett-Jones & Lathlean, 2008).
The adoption of using social media, can have its disadvantages as not all students utilise or
have access to common social media resources (Ferguson et al., 2017). Jones et al. (2016) in a
pilot case study of undergraduate nurses, focusing on the promotion of digital professionalism,
found not all students enjoy or see the relevance of social media. There may be a real risk of exclu-
sion for those not previously educated or interested in social media, especially as there are so
many social media resources available for use in nurse education (O’Connor, 2017). Research
also shows that users do not embrace a single form of social media, but instead choose a
variety of platforms (Perrin, 2015; Quan-Haase & Young, 2010). Mistry (2011) used social
media for scaffolding learning in a critical care course with the aim to encourage critical thinking
and reflection, but difficulties were identified in maintaining momentum and enthusiasm,
especially during the busy exam period. Students use social media and online resources for learn-
ing purposes, and these need to be formally incorporated and supported in educational delivery by
universities (Hay, Carr, Dawe, & Clark-Burg, 2017).

eCommunities of practice (eCOP)

Social educational theory of participatory learning from engaging in a community of practice
(Wenger, 1998) need not be discarded in a technological driven educational approach using
social media. The community of practice theory by Wenger (1998), resonates across all aspects
of social media where unstructured sharing, resource discussing, debriefing, critiquing and advis-
ing occur in a non-hierarchal manner. In social media there is active engagement, participation,
staying connected with colleagues, networking with a wider community, sharing knowledge, hier-
archal levelling, engaging in continuing professional development and this online social commu-
nity also creates a sense of social belonging (Rolls, Hansen, Jackson, & Elliott, 2015; Thoma
et al., 2018). Communities of practice around healthcare specialities such as critical care or
acute pre-hospital develop around wider healthcare domains and interactions across social
media (Roland et al., 2017). With a combination of diverse and focused healthcare specialities,
the engagement and continuing professional development for the nursing profession through
these online communities of practice, allows participants to maintain up to date practice, reflection
opportunities, critique and evaluate research (Moorley & Chinn, 2014a).
 Contemporary Nurse 215

Personal learning networks

An important learning aspect of professional social media use is becoming a networked prac-
titioner, by becoming part of a community that allows users to branch into different knowledge
specialities (Baker-Doyle, 2011; Lundin, 2008). Access to industry leaders, innovators, educators,
academics, doctors, nurses, students, IT specialists and school teachers can provide a lens into
different speciality knowledge and professional resources. This global system provides
ongoing opportunities for networked learning (Baker-Doyle, 2011; Lundin, 2008). The use of
social media within continuing education for nursing could provide a lifelong learner approach
to professional development of the nursing profession.
Encouraging nurses to use social media to become a networked learner, provides an avenue to
create a personal learning environment where meaningful learning can occur with the construc-
tion of knowledge built around experiences and social interactions (Drexler, 2010). The edu-
cational principles of networked learning are centred around connectivism, constructivism and
social learning theory. Due to the technological environment we now inhabit, the connectivity
of everyday life is embedded in our work, study and personal lives. This allows learning to be
agile and provide constant opportunities to challenge traditional learning environments. The
development of an e-professional profile during nurse education will be essential for safe
social media engagement (Cleary et al., 2013). Learners can also be creators and collaborators
of learning, not just consumers in the social media landscape. One aspect nursing education
will need to consider in a world of mobile e-learning, is the ‘learning on the go’ approach and
how to capture micro learning opportunities from social media and mobile technology.

Nurse leaders & social media

As social media continues to change the face of healthcare, in particular the flattening of health-
care hierarchies, the necessity for nurse leaders to understand and engage will become increas-
ingly important to connect with nurses, consumers and other health systems. Carroll et al.
(2016) highlight the absence of nurse leaders and question why they are not engaging in the
social media environment like the leaders in medicine. Benton and Ferguson (2014) study of
nurse leaders demonstrated they were poorly connected in social media and lacked understand-
ing of the technology. A descriptive study by Duke et al. (2017) of 337 students highlighted that
students use social media more than nurse academics. Green, Wyllie, and Jackson (2014) state
that it is imperative for nurse educators to become more technologically relevant and compe-
tent, to engage and drive social media training. Waldrop and Wink (2016) study on the use
of social media in the nurse practitioner population, found more engagement on clinical and
professional topics rather than the creation of resources. When nurse practitioners used
social media, it was not as a leader but more as a passive participant, accessing resources or
asking for advice (Betts, O’Donoghue, Aikin, Kelly, & Boudewyns, 2016). The opportunity
for nurse leaders to engage in social media may also help shape and drive the future of
nursing e-professionalism.

Social media and translational practice

The speed of information dissemination and global audience of social media allow discussion and
critique of the latest research, thus improving knowledge translation from a new type of scholarly
engagement (Chan, Trueger, Roland, & Thoma, 2017). Supplementing the impact of publications
to a wider audience using social media tools should be considered to aid the dissemination of find-
ings and research work to a range of stakeholders such as consumers, carers and healthcare
216 P. Ross and R. Cross

professionals (Eysenbach, 2011; Schnitzler, Davies, Ross, & Harris, 2016). Wilson (2014) advo-
cate the effective use of Twitter for the discussion and dissemination of research, due to the speed
and potential spread of information. With approximately 80% of research evidence never reaching
the clinicians delivering actual patient care, social media may help the translation of new research
findings into clinical practice (Maloney et al., 2015). Topolovec-Vranic and Natarajan (2016)
analysis found social media websites are a new, powerful method for recruiting participants
into studies and the best method for hard-to-reach populations and observational studies. The
potential impact of Twitter and nursing research through networking, disseminating and recruiting
should be seen by nurse researchers as a tool for the diffusion of innovation through social visi-
bility and all at zero cost (Archibald & Clark, 2014).
Many university academics use Twitter to network, share ideas and promote research on a
global scale. Peoples, Midway, Sackett, Lynch, and Cooney (2016) found a positive correlation
between the number of tweets related to an article and its citation rate. Online collaborations
between scientists and academics through resources such as ResearchGate, Mendeley and Aca-
demia.Edu are examples of social networking on a global scale all conducted through online col-
laboration (Van Noorden, 2014). Wilkinson, Basto, Perovic, Lawrentschuk, and Murphy (2015)
analysed social media metrics using Symplur metrics on hashtags from eight international urology
conferences. They found that 112,363 tweets were sent which generated over 14 million
impressions. However, Roland, May, Body, Carley, and Lyttle (2014), caution the benefits of
using social media at conferences, in that the integrity of scientific conferences can be impacted
by dissemination of inaccurate information or the sharing of images which are taken out of
context.
Translational practice for learning using an e-journal club approach provides an opportunity
for wider engagement and creation of online communities of practice with the continued aim of
delivering evidence-based healthcare (Chan et al., 2015). Traditional journal club aims of criti-
cal thinking, engagement, discussing best practice and the translational evidence need not
change in an electronic delivery format (Dovi, 2014; Ferguson et al., 2017). Asynchronous
learning and engagement may allow for more peer collaboration and discussion in the e-
journal club format.

Professional boundaries: err on the side of caution

There are some precautional aspects of social media that must be raised, especially as workplace
and professional organisations now routinely have social media guidelines on the professional
usage (Courtney, 2013). Healthcare e-professionalism highlights issues on patient confidentiality,
low-quality information, lack of evidence-based advice and blurring of personal–professional
boundaries (Green, 2017; Green et al., 2014; Levati, 2014). Grajales, Sheps, Ho, Novak-
Lauscher, and Eysenbach (2014) in a narrative review within medical and health care sectors
on the role of social media concluded that many questions remain in terms of governance,
ethics, professionalism, privacy and confidentiality. Social media conversation is often led by
novices in the field compared to more senior healthcare leaders (Carroll et al., 2016). DeCamp
et al. (2013) explain that an identity crisis may exist between the professional and the personal
identity of the healthcare professional, blurring the therapeutic relationship. Ferguson (2013)
states that engagement is key for the nursing profession to fully understand social media. Utilising
social media for continuing professional development for nurses and revalidation requirements
provide a modern approach using online environments, but now requires clear guidance from
nursing governing bodies (Moorley & Chinn, 2014a). Social media should be incorporated
into nurse education to evolve and develop the creation of professional identities matched with
professional standards (Barnable, Cunning, & Parcon, 2018; Marnocha 2015).
 Contemporary Nurse 217

Summary
In the rapidly changing healthcare environment, digital technologies will require e-Nurses to
ensure improved care delivery and health outcomes are utilised. Social media platforms have
the potential to become essential components for engaging and enhancing evidence-based prac-
tice. Online healthcare collaboration and communication with consumers, will continue to chal-
lenge confidentiality and e-professionalism. The challenge for nursing education will be how to
incorporate social media and future technology, to ensure the nurse of the future is equipped to
manage global health challenges. Despite this focus on technology, evidence-based practice
and patient centred care will need to remain at the forefront of nursing education and care delivery.

ORCID
Paul Ross http://orcid.org/0000-0002-4143-5559
Rachel Cross http://orcid.org/0000-0002-8846-5827

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