The concept of e-professionalism or e-accountability can be defined as, ‘the attitudes and behaviours reflecting traditional professional paradigms that are manifested through digital media’ (Cain & Romanelli, 2009:1). Despite professional guidance and organisational policy being in place for several years, literature outlines issues associated with e-professionalism. For the public, this sends an inconsistent message and can lead to loss of confidence in nurses/the profession. For nursing students, evidence suggests the need for further guidance and input from educators, though the nursing profession has not reached explicit consensus about what ‘unprofessional’ behaviour is (e.g. why are pictures of drinking alcohol deemed as unprofessional when it is legal and acceptable to be doing this in the physical world?) While one nurse will assess a particular behaviour to be unprofessional, another will see it as simply unacceptable; hence, the outcome and consequences of reported and observed ‘incidents’ on social media vary significantly.
The A2A (Awareness to Action) decision making tool has been developed as part of a 42-month ethnographic study that conducted semi-structured interviews, focus groups [with nurses and nursing students] and online observations of publicly accessible professional groups. The study found that:
- There is an awareness of e-professionalism and accountability on social media but social, political and personal events impact on the perception and subsequent actions of nurses. For example, swearing and bullying is deemed as unprofessional, but when responding to posts about NHS reforms this was ‘accepted’ by the wider nursing community.
- Nurse perceptions and understanding of behaviours that require ‘action’ to be taken is inconsistent (e.g. what one nurse would discipline, another might just view as unacceptable, not unprofessional and thus, take no action).
- Nurses perceived self-efficacy (awareness) is inconsistent with ‘actual’ observed behaviours (i.e. what individuals think they do and share is not what they actually do).
- The above findings result in confusion, inconsistency and reluctance to report incidents:
– that are actually unprofessional and require further investigation
– professional penalties against acceptable or unacceptable [rather than unprofessional] behaviours (e.g. photos of drinking alcohol being shared with friends)
– the removal of online posts, investigations and/or disciplinary action for behaviours that are actually professional; serving a genuine purpose within the parameters of the NMC code (2015; 2016).
When discussing what actions would be challenged in physical practice, and why such actions would not be challenged in Facebook there were three main reasons identified: a lack of clarity, context and confirmability.