Technologists’ Attitudes Regarding Social Networking and Implications for Managers By Kelli Welch Haynes, MSRS, RT(R), Courtney Cooper Richardson, MSRS, RT(R), and Laura Aaron, PhD, RT(R)(M)(QM) The credit earned from the Quick CreditTM test accompanying this article may be applied to the CRA communication & information management (CI) domain.
Executive Summary •• Social networking has both positive and negative implications and can be an excellent communication and networking tool or it can have detrimental consequences. Healthcare workers, including radiologic technologists, need to be aware of the possible implications of their online postings. •• Radiologic technologists are extensively using and accessing social media sites and should have appropriate professional boundaries. •• Radiology administrators should assure that technologists are aware of policies related to social networking. Employee education regarding negative implications may prove helpful, creating a radiology department with sound ethical standards.
Technology
is constantly evolving, and with the advent of online social networking, so has the method people utilize to communicate and interact with each other. In the United States, 73% of adults with Internet access use social media sites.1 Online social networking allows users to create a virtual self, enabling them to express their ideas, values, interests, religious and political beliefs, and professional affiliations. Some common methods of social media include: Facebook, Twitter, LinkedIn, texting, and blogging. Facebook has the highest percentage of users compared with any other social networking site, followed by LinkedIn, Pinterest, Twitter, and Instagram.1 Statistics indicate a large and growing percentage of Americans, including healthcare professionals, use social media sites on a daily basis.2 Social media has changed the way individuals interact with one another. Online social networking provides instantaneous communication, which can result in immediate feedback and possible negative outcomes.3 Social networking has potential advantages such as professional networking and sharing of clinical advice, but there are drawbacks as well. Users of these communication outlets may not recognize the ramifications radiology management
of some of the information shared and with whom it is shared. Healthcare professionals have access to sensitive patient information, which can raise ethical, privacy, and professional issues if it is shared inappropriately.2
Review of Literature The use of social media continues to increase in the workplace, which is causing a strain on employer-employee relationships.2 Conflicts between the interests of employers and the privacy rights of employees are inevitable. For instance, to what extent does an employer have a legitimate interest in controlling the potentially harmful online activities of its employees?
E-Professionalism E-professionalism is a new term which encompasses the attitudes and behaviors professionals share on the Internet.4 Gone are the days of judgment based entirely on job performance; online content is now included.5 The rapid adoption of online personas has blurred the lines of what is considered public versus private.6 With professional information displayed alongside names, the public can view people as reflections of their professions and/or organizations.
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Privacy Concerns When healthcare professionals use social networking, there are obvious concerns regarding patient privacy, but what about the workers’ privacy? For many social networking users, it is inconceivable for them to not have an “online self.” Some social network users consider it appropriate to share their personal details with other users.7 However, users may not be knowledgeable that people other than their friends can access what they make publicly available. Once comments, pictures, and other personal information are shared on the Internet, users no longer can control how that information is accessed, who views it, or how it is utilized. These online conversations can be stored forever, searched, copied, and modified without the user’s knowledge.7 A significant number of employers monitor the online activities of their employees in the workplace.3 Most large employers have electronic communication policies which alert employees that employers reserve the right to conduct such monitoring. Email activity is also widely monitored via software programs. This tracking can be used on personal email accounts that are accessed from the employer’s network. Employers may engage in monitoring to protect the employer from an assortment of legal liabilities; to determine the extent to which employees are actually doing their jobs; or to determine if a disgruntled employee is transmitting confidential files.3
Legality Email monitoring has not been found to be unlawful, even if the employee was not aware of the company policy, since the employer owns the hardware that was used.8 Employer Internet monitoring is generally protected because employees cannot expect privacy relative to websites visited while at work and being paid. Applying for a job has always involved a certain amount of self-disclosure.9 Customarily, applicants submit resumes containing education, professional experience, personal interests, and references. Nowadays, many employers are using 24
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current and future employees’ online profiles to obtain information not readily available during an interview or from a resume. Online information may include relationship status, pictures, political preference, and other material. There are some states that have laws to protect employees from “watchdog employers.”10,11 One study found that 63% of employers elected not to hire someone based on information acquired after visiting a candidate’s online social networking site.11 Managers who explore social media sites to screen potential employees, in the absence of a clearly stated institutional policy on how social media can be used in employment decisions, could be open to discrimination lawsuits.1
HIPAA The Health Insurance Portability and Accountability Act (HIPAA) legally bars healthcare entities from sharing protected patient information publicly. Sharing confidential patient information via Internet sites exposes radiologic technologists to accusations of unethical behavior.12 There are regular reminders that healthcare professionals have lapses in judgment and post patient information on the Internet. For example, in Wisconsin, two nurses were terminated for disobeying policy by posting a photograph of a patient’s x-ray on Facebook. The nurses faced sanctions from their state licensing board, and were investigated by the Federal Bureau of Investigation.12 Employers and healthcare facilities can incorporate employee training regarding Internet postings for the protection of the patients’ privacy. In addition, employers should consider modifying or adding policies regarding social networking use.
Policies Healthcare organizations are establishing guidelines regarding the posting of online content.1 For example, the American Medical Association established a policy of professionalism in social media which addresses users’ privacy settings, maintenance of professional boundaries, radiology management
patient respect, and professional demeanor.13 One researcher asserts that medical professionals, like other public sector employees, should refrain from social media entirely.14 This solution seems unrealistic, given the widespread usage of social media. However, it is a useful suggestion if only to encourage professionals to pause and consider the broader implication of personal comments on social media.1 Policies may be in place to restrict the specific behaviors and conduct of employees.8 Policies provide clarity as to what is permitted, what consequences can be expected, and what protections are in place. Much of the previous research has concentrated on creating policies that protect the employer. The purpose of this study was to determine the awareness and attitudes of radiologic technologists related to e-professionalism and sharing via social networking sites.
Methods An online survey tool was designed and piloted to assess radiologic technologists’ opinions regarding social networking. Specifically, the survey was constructed to determine what technologists thought was appropriate to share via social networking and their views regarding employers’ use or potential use of this information in employment decisions.
Sample Full time radiologic technologists, registered in radiography by the American Registry of Radiologic Technologists (ARRT) were the population for this study. Prior to conducting the study, a power analysis was conducted to determine the appropriate sample size. To obtain a + 4% confidence interval at a 95% confidence level, a sample of 1996 of the 288,000 ARRT technologists registered in radiography would be needed (assuming a 30% response rate). A random sample of 2000 ARRT technologists were chosen for this study. The ARRT provided the sample and the mailing labels for the study.
Instrument The survey used for this study was developed and piloted in the fall of 2011. There were minor modifications made to the survey following the initial pilot. The revised survey consisted of questions to assess demographics, social network usage, and attitudes regarding social networking. A Likert scale was used to measure technologists’ attitudes (strongly disagree=1, disagree=2, neutral=3, agree=4, and strongly agree=5). There was one open ended question to determine participants’ purpose for using social networking. Reliability for the instrument used for this study was determined using Cronbach’s alpha (a=0.773).
j TABLE 1. Demographics of Survey Respondents (n=154) Characteristic Gender
40 (26) 114 (74)
20–29 30–39 40–49 50–60 >60
18 (11.8) 29 (19) 34 (22.2) 60 (39.2) 12 (7.8)
Certificate Associate Baccalaureate Masters Doctorate
46 (29.9) 62 (40.3) 35 (22.7) 10 (6.5) 1 (0.6)
0–2 3–5 6–10 11–15 16–20 21–25 26–30 >30
4 (2.6) 10 (6.5) 25 (16.2) 20 (13) 21 (13.6) 12 (7.8) 16 (10.4) 46 (29.9)
Staff technologist Senior/lead technologist Supervisor/Manager Chief technologist Administrator Instructor/Faculty Program director
83 (60.1) 28 (20.3) 12 (8.7) 6 (4.3) 2 (1.4) 5 (3.6) 2 (1.4)
Level of Education
Years of Experience
Current Position
Results Of the survey requests sent to 2000 ARRT registered technologists, 16 were returned for bad addresses and 154 technologists responded to the survey for a 7.8% return rate. Table 1 shows the demographic characteristics of the respondents to the survey. Seventy-four percent of technologists who responded were female (n=114). The largest percentage of respondents were aged 50-60 (39.2%, n=60). Over 40% had completed an associate degree
Male Female Age
Data Collection and Analysis The technologists were mailed an invitation letter to complete the online survey administered via Survey Monkey. The invitation included an introduction, the web link, and password to the survey. Each technologist was assigned an identifier that was used to determine who had completed the survey. Technologists who did not complete the survey were sent reminder postcards at approximately 3 and 6 weeks after the initial invitation was sent. Data was downloaded and analyzed using IBM SPSS release 19.0.0. Descriptive statistics were used to analyze the data. Additionally, reliability for the instrument was determined. The open ended question was analyzed with qualitative methods to find common themes in the responses.
No. (%)
(n=62) and 29.9% (n=46) had over 30 years of experience. Approximately 60% of technologists identified themselves as staff technologists.
Social Networking Usage The next section of the survey addressed participants’ use of social networking. radiology management
Over 75% (n=116) of the technologists used social networking (see Figure 1). Of those who used social networking, over 65% (n=65) accessed it daily (see Figure 2). In terms of privacy settings on social network sites, 82.5% (n=94) revealed that their social media profiles were set to private. There was one open
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Technologists’ Attitudes Regarding Social Networking and Implications for Managers
70.0%
65.2%
60.0% 50.0%
No, 24.7%
40.0% 30.0%
24.3%
20.0% Yes, 75.3%
8.7%
10.0%
1.7% 0.0%
Daily
Several times a week
Several times a month
Figure 1 • Use of Social Networking
Figure 2 • Frequency of Social Network Access
ended question on the survey asking participants to state their main purpose in using online social networking. The most common response was “keeping in touch” (n=92). Additionally, participants stated that they used social networking for “following events” (n=8), “fun” (n=6), “to play games” (n=4), and to “check their children’s posts” (n=2). Participants who used social networking also claimed to carefully consider
their posts to these sites, with 89.6% (n=103) stating they were always careful. Only 10.4% (n=12) stated they were only sometimes or occasionally careful with the content of their posts. Additionally, 97.4% (n=111) indicated they never post insults or obscenities that may be considered offensive or inflammatory on social media. Participants were asked whether they would be embarrassed by incorrect information posted about them by others
Several times a year
and only 29.6% (n=34) expressed concern while 70.4% (n=81) were not concerned.
Social Networking Attitudes The next section of the survey focused on technologists’ attitudes regarding information posted on social networking sites and use of social networking. Table 2 shows participants’ attitudes regarding the posting of various types of personal information on social
j TABLE 2. Opinions regarding appropriateness of posting personal information
Mean
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Strongly Disagree No. (%)
Disagree No. (%)
Neutral No. (%)
Agree No. (%)
Strongly Agree No. (%)
Real name
3.64
5 (4.3)
8 (7)
23 (20)
66 (57.4)
13 (11.3)
Hometown
3.51
5 (4.3)
7 (6.1)
34 (29.6)
62 (53.9)
7 (6.1)
Email address
2.57
22 (19.5)
31 (27.4)
37 (32.7)
20 (17.7)
3 (2.7)
Phone numbers
1.78
57 (49.6)
37 (32.2)
12 (10.4)
7 (6.1)
2 (1.7)
Relationship status
3.25
6 (5.2)
12 (10.4)
51 (44.3)
39 (33.9)
7 (6.1)
Religious beliefs
3.01
12 (10.4)
12 (10.4)
58 (50.4)
29 (25.2)
4 (3.5)
Political views
2.88
12 (10.4)
19 (16.5)
57 (49.6)
25 (21.7)
2 (1.7)
Photographs
3.60
4 (3.6)
3 (2.7)
31 (27.7)
70 (62.5)
4 (3.6)
Information about my employer
2.07
46 (40.4)
23 (20.2)
36 (31.6)
9 (7.9)
0 (0)
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j TABLE 3. Opinions regarding uses of social networking
Mean
Strongly Disagree No. (%)
Disagree No. (%)
Neutral No. (%)
Agree No. (%)
For current or future employers to access my online status
1.82
58 (50.9)
26 (22.8)
22 (19.3)
8 (7)
0
For current or future employers to base employment decisions on information shared on online social media
1.70
64 (55.7)
30 (26.1)
12 (10.4)
9 (7.8)
0
To share information about your current or past employers on online social media
1.54
67 (58.3)
37 (32.2)
9 (7.8)
1 (0.9)
1 (0.9)
To use online social media to vent your criticisms of your employer
1.32
87 (75.7)
21 (18.3)
5 (4.3)
2 (1.7)
0
To criticize or complain about coworkers on online social media
1.33
85 (73.9)
24 (20.9)
4 (3.5)
2 (1.7)
0
To post information regarding a patient if name is not included on online social media
1.17
101 (88.6)
8 (7)
4 (3.5)
1 (0.9)
0
Opinion concerning using social networking for the following purposes
networking sites. Respondents indicated the most positive support for posting their real names (mean=3.64), photographs (mean=3.60), and hometowns (mean=3.51). The least support was for posting phone numbers (mean=1.78), information about their employers (mean=2.07), and email addresses (mean=2.57). Table 3 demonstrates participants’ opinions regarding various uses of social networking. Of the uses listed on the survey, there were none in which respondents indicated their support. The lowest levels of support were for using social media to post information regarding a patient if the name is not included (mean=1.17) and posting criticisms regarding employers (mean=1.32) or coworkers (mean=1.33). Participants were also asked whether their current employers had policies
regarding employee social networking use. Only 51.7% (n=59) said their employers had a policy regarding social networking (see Figure 3). However, 21.1% (n=24) said there was no policy at their institutions, but 27.2% (n=31) were unsure if there was a policy.
Discussion This research focused on the awareness and attitudes of radiologic technologists regarding e-professionalism and what was appropriate to share via online social networking sites. The results demonstrate that radiologic technologists are widely using and frequently accessing social media. This is not surprising since social media is used worldwide by many users.2 Technologists’ responses to the survey showed many positive areas. However,
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Strongly Agree No. (%)
there were some areas that may be of concern to employers. One positive finding from this research was that radiologic technologists agreed that social networking sites were an inappropriate venue to share information or criticism regarding employers, coworkers, and patients. It is encouraging that these healthcare providers have boundaries regarding what is appropriate to post. However, one note of concern is for the small percentage of individuals who indicate that it was okay to post negative comments regarding employers, coworkers, or patients. It only takes one individual to create a potential problem. One question that had a great deal of variation in the responses was in regard to whether or not technologists’ current employers had a policy regarding social networking. While more than
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Technologists’ Attitudes Regarding Social Networking and Implications for Managers
60.0% 51.7% 50.0% 40.0% 30.0%
27.2% 21.1%
20.0% 10.0% 0.0%
Yes
No
Unsure
Figure 3 • Does current employer have a social networking policy?
half did have a policy at their institutions, more than 48% had no policy or were unaware of a policy at their institutions. Radiology administrators should ensure that technologists are aware of any policies related to social networking and, if there is no policy, consider developing one. Another challenge that is raised by the results of the survey is the possibility of a technologist unintentionally posting something that could be harmful. Most technologists reported that they are always careful about their online posts. However, slightly more than 10% of respondents indicated that they do not always carefully consider their posts online. This could lead to a variety of accidental posts related to the institution. Helping to educate technologists on the damages that could occur may help them to be more careful before posting anything online.
Limitations The limitations to this research are the low response rate and reliance on selfreporting from the participants. The low response rate may be due to the collection of data from an online survey. Since
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respondents had to go online to access the survey, there may have been a reluctance to open an unknown website. Suggestions for future research would be to obtain email addresses for potential participants to make access to the survey easier.
Conclusion With a large and growing percentage of Americans using social media sites, employee education and training regarding appropriate use must increase as well. Users of social network sites must be mindful of who is viewing their personal information and how it is being used.11 Sound ethical standards should be expected of all personnel in healthcare facilities, and the information shared on the Internet is no exception. The opportunity and temptation for unethical behavior is intensified in a healthcare facility due to the availability of confidential patient information. Technology allows people to communicate, receive immediate responses, and obtain gratification instantly. It only takes a moment to post personal information, and millions of people, unknown to the user, may stumble upon the information. These decisions
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regarding online interactions may result in potential negative consequences. Users must be aware that others will make decisions regarding their postings. As a field that is still gaining recognition as professionals, it is imperative for all radiologic technologists to be knowledgeable regarding the appropriate usage of social networks, especially in any situation where work and private life may become intertwined. Radiologic technologists must be cognizant that employers and patients may have access to information they post. Radiology administrators and radiologic technologists need to make certain they are mindful of their institutional policies regarding appropriate social networking usage and applicable state and federal regulations. It is essential that radiology administrators enforce these policies consistently. References 1
Bagley JE, DiGiacinto DD, Hargraves K. Imaging professionals’ views of social media and its implications. Radiol Technol. 2014; 85 (4): 377–389. 2 Hunt RJ, Kessler LL. Wanna be friends? The potential impact of lifestyle discrimination statutes on employer Facebook policies. J of Leg Stud in Business. 2013; 18: 45–68. 3 Mello JA. Social media, employee privacy and concerted activity: Brave new world or big brother? Labor Law J. 2012; 63(3): 165–173. 4 Aase S. Toward e-professionalism: Thinking through the implications of navigating the digital world. J of the Am Diet Assoc. 2010; 110(10): 1442–1449. 5 Gilman I. Online lives, offline consequences: Professionalism, information ethics and professional students. J for Educ, Community, and Values. 2009; 9(1). http://bcis. pacificu.edu/journal/article.php?id=22 Accessed: May 1, 2014. 6 Cain J, Scott DR, Akers P. Pharmacy students’ Facebook activity and opinions regarding accountability and e-professionalism. Am J of Pharm Educ. 2009; 73(6): 1–6. 7 Cain J. Online social networking issues within academia and pharmacy education. Am J of Pharm Educ. 2008; 72(1): 1–7. 8 Jacobsen WS, Tufts SH. To post or not to post: Employee rights and social media. Public Personnel Adm. 2013; 33 (1): 84–107.
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Del Riego A, Abril PS, Levin, A. Your password or your paycheck?: A job applicant’s murky right to social media privacy. J of Internet Law. 2012; 16(3): 1, 18–26. 10 Davis DC. Myspace isn’t your space: Expanding the fair credit reporting act to ensure accountability and fairness in employer searches of online social networking services. Kansas J of Law & Public Policy. 2007; 16(2). 11 Russell S. The future of social networks and privacy [unpublished dissertation]. Elon University, Elon, NC: Elon University; 2009. 12 Hader A, Brown ED. Patient privacy and social media. AANA J. 2010; 78(4): 270–274. 13 American Medical Association. Opinion 9.124—Professionalism in the use of social media. http://www.ama-assn.org/ama/ pub/physician-resources/medical-ethics/ code-medical-ethics/opinion9124.page. Issued June 2011. Accessed April 30, 2014. 14 Fulmer EH. Privacy expectations and protections for teachers in the internet age. Duke Law Tech Rev. 2010; 9(1): 1-31. Kelli Welch Haynes, MSRS, RT(R) is a tenured associate professor and program director for the bachelor of science program at Northwestern State University in Shreveport, LA. Mrs. Haynes graduated from Northwestern State with her bachelor of science degree and from Midwestern State University in Wichita Falls, TX with a master’s in radiologic sciences with a concentration in administration. She is currently pursuing her doctorate of education at the University of Louisiana at Monroe. She can be contacted at
[email protected]. Courtney Cooper Richardson, MSRS, RT(R), is is an associate EHR trainer at Willis-Knighton Health System in Shreveport. Mrs. Richardson graduated from Northwestern State with a bachelor of science degree and with a master’s in radiologic sciences with a concentration in administration. Laura Aaron, PhD, RT(R)(M)(QM), FASRT, is the director of the School of Allied Health at Northwestern State University in Shreveport, LA. Dr. Aaron graduated from McNeese State University with a bachelor of science degree and from Midwestern State University in Wichita Falls, TX with a master’s in radiologic sciences with a concentration in education. She obtained her PhD in educational leadership and research at Louisiana State University.
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