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The Neolithic Media Club

May 27, 2014

The NMC. Remind me again what those letters stand for? No More Computers, is it? National Manuscript Campaign? Or why not go the whole nine yards while you’re at it and Negate Modernity Completely? Sorry? It’s the Nursing and Midwifery Council? Blimey. You could have fooled me. After reading their new Draft Standards of Conduct, Performance and Ethics for Nurses and Midwives, I thought I’d gatecrashed the Annual General Meeting of the Neolithic Media Club.

Point 114 of the Draft Standards is the one that has attracted the most comment on Twitter. That’s the one that says (and I quote) ‘You must ensure that you use social networking sites and other forms of electronic communication responsibly and in line with our guidance, in particular by not referring to employers, colleagues or past or current people you have cared for’. So let’s just see if I’ve got this right, shall we? The NMC is proposing a blanket ban on all references to employers or colleagues on social media (I have no problem with not referring to patients/service users)? Er…hello! it’s the twenty-first century!

So many questions are raised by Point 114 that it’s difficult to know where go first. So how’s this for starters: you’re a nurse who works for a medical supplies company. Your employers are going to want you to big them up any way you can aren’t they? Isn’t that what they’re employing you for, in part? And what if you’re one of those rare entrepreneurial nurses who has started their own business – will you be banned from engaging with potential customers through a Facebook page? A Twitter account? Nonsensical.

But compared to what comes next, this is just a sideshow. By far the biggest problem with Point 114 is the internal contradiction created by comparisons between it and Point 5 of the same draft document. You simply cannot comply with both – and here’s why. Point 5 states that: ‘You must provide leadership through driving quality improvement and service development to ensure people’s wellbeing and to improve their experiences of the health care system’. OK, OK. It is still possible – just about – to ‘drive improvement and service development’ in a service industry without reference to social media. But it’s bloody difficult – and in future, it’ll only be more so. NMC – you need to wake up and smell the coffee.

Point 114 also puts the NMC at odds with other branches of the service – NHS Employers for instance. Late last year NHS Employers produced a document called Increasing Staff Engagement with Social Media. That’s right – INCREASING Staff Engagement with Social Media. Everyone should read it – it’s refreshing and positive and in striking contrast to the NMC, it starts from a position of trusting staff to behave like responsible, grown-up human beings. It gives numerous examples of how social media is being used right now to improve engagement and ‘give individuals the space in which to show their professional personality and celebrate the successes of those around them’ and concludes with this challenge: ‘Read your organisation’s internet usage and social media policies. Do they allow and promote the use of social media by staff? If not, why not?’

Of course, simply unblocking certain social media portals on workplace computers and dashing off an email to make sure everyone knows how liberal-minded you are is not sufficient on its own. It’s a beginning rather than an end, as a report published last week by the Kings Fund made clear. The big message of Developing Collective Leadership for Health Care was that high quality care is most likely to be achieved where there is a culture of ‘collective leadership’ – in other words ‘everyone taking responsibility for the success of the organisation as a whole…[through] high levels of dialogue, debate and discussion to achieve shared understanding about quality problems and solutions’. It’s difficult to see how this vision can be fully realised without allowing social media to be part of the picture.

In my own professional life, I have found social media enormously motivating. When I started this blog, I knew no one. I didn’t even have anyone I could run it past to ask them what they thought about it. Alone with a computer in a spare bedroom in the West Midlands, all I could do as I launched my writing into the crowded traffic lanes of the worldwide web was pat its little head and hope that somehow, it would weave its way to the front. Social media has enabled me to find an audience, link up with like-minded others and (I hope) encourage people to think about nursing in new ways. That enthusiasm and positivity has in turn affected for the better my performance at work.

Point 114 is a curious little sentence – both too much and too little at the same time. Too much because the proposed clampdown on referencing employers and colleagues is draconian, counterproductive and probably unworkable; and too little because social media is evolving so fast, and with such sophistication, that you cannot possibly hope to encompass everything that it is in thirty-nine short words. The draft already covers confidentiality, respecting professional boundaries, raising concerns and acting with integrity. Makes you wonder why the NMC included 114 at all.

One possibility is the need to cover ‘grey areas’ ironically created in part by the pressure for greater transparency within the NHS as a whole. Combine this with the blurring of boundaries between public and private, and you’ve got a veritable minefield. How, for example should an employer react to a tweet along the lines of ‘Alone all night with12 patients #sickofthis’ from someone whose place of work could be deduced from elsewhere on the timeline? If the Trust this person works for had complied with posting its staffing figures for the night outside the ward, the information is already in the public domain, so arguably not subject to rules governing confidentiality. But they’d still be less than thrilled to see their staffing shame splashed all over Twitter. Point 114 gives grounds to act.

Trouble is, the week before, that same person might have tweeted something much more enthusiastic: ‘thanks to fabulous #teamdiabetes 4 best study day EVER!!!’  So do you also include this in the case against? Especially as, on further investigation, the Trust in question finds it was so delighted with this particular bit of positive PR that it retweeted on its own timeline. Ooops. The reality is that Point 114 as it stands does not provide a basis for clear and fair decisions; instead, it is nothing more than an open invitation to discretion and fudge.

You can picture the scene, can’t you, at the NMC: late at night, caretaker wanting to lock up, code-drafters exhausted after a long day of wrestling with difficult questions, and fast running out of time. Finally someone cracks: “Sod it. Let’s just hit ’em with a blanket ban and then go home”. It certainly reads like an idea flung together in desperation – and for that reason, it simply won’t do. This is far too complex and subtle a matter to be reduced to a mere thirty-nine words. We need more to go on, much more. Without it, we’re in danger of ending up with a Code of Conduct that has…Not Much Credibility.

For the NMC Draft Code see: http://www.nmc-uk.org/Documents/Consultations/2014/Draft-revised-code.pdf

For other NMC guidance on responsible use of social media, see: http://www.nmc-uk.org/nurses-and-midwives/advice-by-topic/a/advice/social-networking-sites/

For the NHS Employers document Increasing Staff Engagement with Social Media, see: http://www.nhsemployers.org/~/media/Employers/Publications/staff-engagement-social-media.pdf

For the Kings Fund paper Developing Collective Leadership for Health Care, see: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/developing-collective-leadership-kingsfund-may14.pdf

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