So, Your Nurse Declined Your Friend Request...

Well, guys, it happened.

I got my first Facebook friend request from a patient.

I've been sitting on it for weeks, unsure how I wanted to handle this. I mean, this decision carries some weight since it's setting a precedent for the rest of my career. It's opening a potential floodgate.  I know I have a pamphlet in my locker warning nurses to use social media carefully since these online relationships can have some serious repercussions. I've been thinking about this a lot and I've been asking my peers how they handle the patient-friend boundary lines, too. I wanted to spend some time here talking this out - as I'm still exploring my feelings on this -  though I think my decision is made.

...anticlimactic drum-roll please....

I will not be accepting any social media connection from anyone that has been under my care or could potentially be under my care in the future. I've got some reasons, I think.

1. Slippery Slope. It's the elementary school birthday party guest list nightmare all over again. Mom said "If you invite some kids, you gotta invite them all. Otherwise, you're gonna hurt feelings." That's why, that one year for my birthday party, fellow kid N.M. popped all my balloons and C.J. just sat in the corner and softly cried to go home. It just wasn't meant to be an all-inclusive environment.

If I accept one, I gotta accept 'em all. And I don't really like 'em all. Is that mean to say? No. It's reality. I take great care of each one. I just don't necessarily want them to see all my vacation photos. ;)

2. Don't Clutter the Relationship. I am a very opinionated woman on political and social issues, generally in the direction of helping those who get screwed by the world at large. The current political climate has divided our nation and it's also soured me towards some people whom I had no idea held opinions I find horrifically wrong and unkind. At times, I'd rather not know so I'm not subconsciously swayed.

I provide the best care I can for every patient I see - whether they be jerks, sweethearts, prisoners, executives, homeless folks, or whatever. Their care should not vary based on how I perceive them.

This is easy in theory and tough in practice. So I'd rather not clutter up this critical relationship with my patient with info about their views on politics, social issues, or personal beliefs unrelated to their care. More importantly, I don't want them to question whether they can trust me because I posted a meme that opposes a meme they posted. I don't want them to think I won't help them because we voted for different people last year. I like keeping work, work and personal, personal. I'll still get to know my patient in ways that benefit our therapeutic relationship, but I pray they don't small talk about immigration as I give them their insulin.

3. HIPAA (and liability) HOLLA! Uh, yeah, I'm not an expert on privacy laws, but I really don't want to lose my job, my license, my money and go to jail over an accidental slip-up online..............sooooooo I just don't wanna touch patient communication on social media with a ten-foot pole. I don't want someone who doesn't have my obsession for boundaries to be instant messaging me asking me if I can give them advice about their meds or poop or something.

4. I've worked with some difficult patients, and a few are quite manipulative. I worry that having access to information I or my family/friends post could be used negatively, even if it's not information that I consider highly private. I'm not actively worried about myself or family being stalked, but I just like to play a zero-risk game when I can.

OK, so those are the big reasons. As far as some of the opinions expressed by co-workers and friends, the answers have been varied but lean towards the general opinion of "don't do it".  A few said they regret accepting patients and now they feel obligated to accept them all. Some didn't care, citing they're not very active on Facebook. Others said they felt they reserved the right to pick and choose and didn't see any problems when they cared for those patients again (I work with a population we get to see often and know fairly well).

My verdict and advice to you, if you haven't already, don't go down this road.

If you have accepted patients as friends on social media and have had positive experiences, I'd love to hear from you.

If you're one of my patients and you've stumbled upon my blog, understand that regardless of my personal feelings for you, I will be your advocate, protector, educator and TLC-giver when I see you in that hospital room next. I hope to not see you soon. <3



Update: Many months later, I saw the patient who started this whole thing by sending me a friend request. I explained again, it wasn't personal. She laughed and said it was no big deal and that she hadn't remembered sending the request. My list remains patient-free.


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