This week’s module focuses on the topic of professionalism in nursing and how this relates to a nurses online representation.  An example of this comes from a case involving a nursing student in her final year, Doyle Byrnes, who took a photograph of a placenta during a lab at a medical centre and posted it on Facebook.  This situation involved seven other students who asked permission of a clinical instructor to take the photograph.  The clinical instructor did not instruct the nursing students not to take the photograph.  Doyle Byrnes and three other students were expelled from the program.  This case went to court and the three nursing students including Doyle Byrnes were reinstated to finish their nursing degrees.

Using the College of Nurses Practice Document on Professional Standards (2002), there are breaches of this standard that are evident in this situation.  The nursing students did initially ask their clinical instructor if taking a photograph would be allowed.  They were not told not to and therefore, used the discretion of their instructor as a means of permission to go ahead.  In an educator role, the nurse is responsible for ensuring standards of practice are maintained for students, as well as, ensures that students are given the “appropriate education, support, and supervision when acquiring new knowledge and skills” (College of Nurses of Ontario, 2002, p. 4).  The educator should have instructed the nursing students not to take the photograph.  The other issue at hand was the perceived breach of confidentiality.  According to the judge in this scenario, there was no breach of confidentiality due to the fact that there was no identifying information.  According to the Director of Nursing at the College, Jeanne Walsh, there was a breach of confidentiality.  However, the judge dismissed this claim based on the evidence available.  Using the Practice Standard on Confidentiality, personal health information (PHI) is any identifying information about clients that is in verbal, written, or electronic form (College of Nurses of Ontario, 2019).  The donation of body parts is included in this definition (College of Nurses of Ontario, 2019).  The College of Nurses of Ontario also state that PHI does not always have to be named for it to be considered a breach of confidentiality; if the information can be combined with other information to identify the person, this can be considered PHI (College of Nurses of Ontario, 2019). 

The professional code of conduct at the College should include up to date and clear expectations of the nursing students.  This could include clear expectations of social media use.  There is a position statement available from the International Nurse Regulator Collaborative on social media use and the expectations for nurses.  The 6 ‘P’s of Social Media Use include:

This scenario is a great example of the importance of using critical thinking skills and ensuring that professional standards of practice are maintained online.  It is a nurses responsibility to maintain extreme vigilance in posting images, commentary, or recordings that intentionally or unintentionally breach patient confidentiality (Westrick, 2016).  This extends to nursing students, not only practicing nurses, that are held to the same standard professionally, legally, and ethically (Westrick, 2016).

This video includes social media guidelines for nurses with case scenarios:


College of Nurses of Ontario. (2016, December). Position Statement: Social Media Use. Retrieved from College of Nurses of Ontario:

College of Nurses of Ontario. (2002). Professional Standards, Revised 2002. Retrieved from College of Nurses of Ontario:

College of Nurses of Ontario. (2019, April). Confidentiality and Privacy – Personal Health Information. Retrieved from College of Nurses of Ontario:

NCSBNInteract. (2011, Dec 9). Social media guidelines for nurses [Video file]. Retrieved from

Westrick, S. J. (2016). Nursing Students’ Use of Electronic and Social Media: Law, Ethics, and E-Professionalism. Nursing Education Perspectives (National League for Nursing), 37(1), 16–22.

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