Social media has been described as a ‘revolution’ however, the professional use of social media by nurses is perhaps less revolutionary and more evolutionary. In a previous paper (Moorley and Chinn, 2014) we discussed using social media for continuous professional development (CPD) and since then the use of social media for CPD is becoming more acceptable. In 2016 the Nursing and Midwifery Council (NMC) in the UK required that all nurses enter a process of revalidation in order to remain on the NMC register to practise. This provides an opportunity for nurses to start shaping and developing social media to meet their professional needs. In this article, we discuss and provide examples of how nurses can use social media to prepare for and contribute to revalidation and professional development, and how social media and nurses' use of social media are evolving to fit their needs.
What is the potential for social media in nursing?
Some organisations responsible for health care are using social media for sharing knowledge that improves nursing practice and skills. For example, the Resuscitation Council UK has made a video on A-E assessment on sick adult patients available on YouTube (http://tinyurl.com/yxge7fw5). Technology and social media can allow learning (in this case how to assess a sick patient) to take place in the individual's own time and space.
Social media is media that allows for social interaction, for example, blogs, microblogs, picture posting and video posting sites. Figure 1 shows the potential for nurses to use social media on a professional basis.
Nursing practice
Social media as part of nursing practice is perhaps the area where there is most reticence. The concept that nurses can use social media to communicate with the people they care for is somewhat radical but needs to be explored. Social media has the potential to enable connections to be made with the people who use health and the people who provide care services and enable them to connect with each other (Krowchuk et al, 2010). There are potential collaboration and coproduction opportunities.
Celebrate nursing practice
Although celebrating nursing practice may not come naturally to nurses, it is a great way for them to use social media—celebrating what nurses do, both the small, everyday aspects and occurrences and the once-in-a-lifetime achievement or events. Hoeve et al (2014) made the point that social media has the potential to increase nursing morale and increase the public's understanding of the nursing profession, and considered some ways that nurses can use social media to achieve this.
Share nursing practice
Social media is an accessible and low-cost way of sharing nursing practice. Its ease of use has the potential to enable nurses to share best practice on a global scale. This, in turn, can raise the profile of nurses, nursing and nursing organisations.
To inform nursing practice: this is one of the possible outcomes of sharing, in that it leads to informing. The huge resource of people engaging in social media means that there is a wealth of information that has the potential to inform CPD, learning and development and reflection for revalidation.
What is revalidation?
It is important that nurses understand the difference between revalidation, renewal and retention. In the UK the register of nurses, midwives, health visitors and nursing associates is maintained by the NMC. To keep their registration nurses pay an annual fee (retention) (NMC, 2018). They must also renew their registration every 3 years—this involves demonstrating that they have maintained their practice. In 2016 the NMC introduced revalidation, which is the method nurses are now required to use to renew their registration. Revalidation is built on post-registration education and practice, known as Prep (Royal College of Nursing, 2019).
One of the aims of the NMC is to protect the public by ensuring all registrants are fit to practise (NMC, 2007). Revalidation is a way of maintaining public protection and ensuring registrants remain fit to practise. The NMC (2019) argues that revalidation is beneficial to nurses and midwives as well as the people for whom they care. It can encourage and develop a culture that allows sharing and reflection and contributes to career progression (NMC, 2019).
To revalidate nurses must:
Considering social media in the context of revalidation
Based on the requirements of revalidation and potential of social media as an educational tool, we aimed to examine how social media could be used for revalidation by analysing content on Twitter. Some within the nursing profession are starting to unlock the potential of social media; it is beneficial to nurses, nursing and the people they care for (Ventola, 2014); it can help them to connect people who traditionally may be difficult to reach. To specifically address social media in relation to revalidation and professional development in nursing we need to explore how social media informs the nursing practice element of unlocking its potential in nursing in greater depth. Based on the model we developed (Figure 2) the relationship between revalidation and social media has the potential to evolve into three areas:
When exploring the relationship between revalidation and social media the breadth of what counts as ‘social media’ is worth addressing. Figure 3 shows Cavazza's (2019) Social Media Landscape, which contains 6 distinct categories:
In each of these areas social media has the potential to aid with revalidation.
Publishing
‘Publishing’ in social media includes blogs and wikis (websites developed by a community of users, where any user can add and edit content), both of which can be read as part of CPD and reflected on for revalidation. In addition to reading, blogs can also be used for reflective accounts. Blogs have an important role to play in sharing information around revalidation. Blogging can also be enjoyable and in most respects a positive process (Clarke, 2016). However, it is important to remember that not all social media are well informed (Carroll et al, 2016).
Sharing
Sharing platforms can be used for CPD, which can be reflected on for revalidation. Examples of sharing platforms are Vimeo and YouTube. There is also a growing trend to use platforms such a Periscope to stream live events and conferences and share the knowledge beyond the conference walls (Wilkinson et al, 2015). This type of sharing provides a prime opportunity for CPD and reflection as speakers can often be experts in their field and social media can help to break through those geographical barriers. Other sharing platforms include Pinterest and Instagram. These are both great platforms for accessing infographics (an infographic is a visual representation of data or information) and blogshots (a blogshot is a very short blog post on one slide that can be shared as a picture). The UK Cochrane Centre represents a good example of the use of Instagram with its series of blogshots, ‘Evidence for Everyday …’ (http://tinyurl.com/yxv4onpe)—nursing, midwifery and allied health all have their own streams. This can be used as part of CPD and used in reflective practice. These platforms can also be used for support and information around revalidation. Some local libraries are also supporting nursing revalidation—Surrey and Sussex Library Services has a useful Pinterest page around revalidation that guides users towards information concerning revalidation and reflection.
Messaging
Messaging apps such a WhatsApp or Facebook Messenger allow for private or closed group discussions and can be useful for nurses to discuss and share views or opinion (Kamel-Boulos et al, 2016). WhatsApp offers an end-to-end encryption for security. However, it is always worth bearing in mind that while such platforms can appear private they are not appropriate places to share confidential information. It is important to note that any information posted on a closed platform has the potential to be shared beyond the platform. If used appropriately messaging apps can assist with information sharing and support around revalidation.
Discussing
Discussion platforms are perhaps one of the most exciting categories of social media in regard to revalidation. Although platforms such as Reddit have some use for nurses with regard to CPD, their scope is more news-oriented rather than research or academic. However, much discussion does take place on platforms such as Twitter and Facebook enabling nurses to share ideas, information, experiences, resources, research and evidence. Tweetchats on Twitter, such as those held weekly by the account @WeNurses using the hashtag #WeNurses, have value as they count towards participatory CPD. This was confirmed by the NMC when it tweeted ‘Yes this Twitter chat can count as participatory CPD’ (tweet from @nmcnews, 24 March 2016, https://tinyurl.com/yxsf4xfr).
In addition, platforms such as ‘WeCommunities’ and ‘MyWe’ can be used to reflect on Tweetchats. Tweetchats can take many different forms such as case studies, critical appraisal, journal clubs, discussions around videos and discussions around blog posts. Tweetchats are a part of wider online learning, the ‘School for Change Agents’ from the Horizons team at NHS England (http://horizonsnhs.com/school/) and WeLearn (a joint platform from WeCommunities and Public Health England) both fully embrace Twitter and Tweetchats as part of CPD and professional development. WeLearn was designed to help health professionals develop the skills and knowledge to promote health and wellbeing and to involve all health professional in All our Health regardless of where they work and their role.
Facebook groups are another popular discussion platform for nurses. A good example is the ‘Learning Disability Nurse.com’ Facebook group, which enables nurses to share resources, articles and discuss them. These can be used for CPD and reflection for revalidation. Both Twitter and Facebook present opportunities for nurses to obtain information and support around revalidation. The NMC has a presence on both platforms and is responsive to comments and questions, thus providing support and guidance to those needing help. The Twitter hashtag #revalidation on Twitter is full of information, ideas and support around revalidation.
Collaborating
There, are platforms and apps such as Slack and Basecamp, which are excellent collaboration tools for nurses to use as part of their work. However, their use in terms of CPD and revalidation is limited to perhaps setting up closed groups of specific interest or support and using these platforms to signpost members to relevant information.
Networking
LinkedIn is perhaps the most popular of the professional networking social media and can help nurses to create an online curriculum vitae to support their revalidation and recording of practice and CPD. LinkedIn also has a blogging function, which can be useful for reflective writing purposes, and it has a ‘learning’ function that can be used for CPD (although it is worth noting that the nursing and health learning resources are currently few and far between). LinkedIn posts can be used for CPD as they often link to other sources of information and evidence and LinkedIn can be a great place to share PowerPoint slides that may be useful for CPD purposes.
Methods
The WeNurses group known as @WeNurses (Moorley and Chinn, 2014) facilitates weekly discussions on Twitter, a micro blogging platform (Duke et al, 2017), using the hashtag #WeNurses. The Experiences of Care Week and the WeLearn Project were used as units of analysis.
An inductive thematic analysis was used following the principles of Braun and Clarke (2006). This included the six phases of thematic analysis: familiarisation, coding, searching for themes, reviewing themes, defining and naming themes and writing up. The WeNurses website and @WeNurses Twitter account were reviewed to collect relevant data. The aim was to identify the various ways that nurses were using social media for revalidation and professional development. We captured this data through tweets and WeLearn by looking at hashtags on #revalidation and #learning.
Using the revalidation relationship triangle framework, we coded data into the three spheres of the framework. This was then further conceptualised using Cavazza's social media landscape framework (Cavazza, 2019) and we reflected on how these were used by nurses.
With regard to ethical practice, social media is an open platform and all data were freely available. Guidance was sought from CM's University's ethical review committee and the study deemed not to require ethical approval. In terms of establishing good practice in social media research we only contacted the participants whose tweets were used to alert them and to ask if they were happy to have it published. No one refused the use of their tweets.
Results and discussion
Social media remains a novel area for nurse education and we present the results and discussion together to aid contextualisation of the work undertaken. Three examples are used. The first example used is before revalidation, the second and third following revalidation and demonstrate how social media learning has evolved. The three project examples fit well within Cavazza's social media landscape and embody various forms of social media. The projects post-revalidation have evolved considerably incorporating more elements of the social media landscape. This led to the development of the Social Media Relationship Triangle (Revalidation).
How the social media landscape is evolving to fit nurses' revalidation needs
Example 1: (pre-revalidation) a dementia scenario
In 2014 @WeNurses hosted a tweetchat based on a scenario of a person with dementia. The tweetchat was attended by 91 people and 789 tweets were shared over an hour. The discussion started by giving some background information on a fictional person who had dementia, then over the course 5 further developments in the person's care were tweeted and chat attendees were invited to discuss. There was much discussion demonstrating participants' engagement. There was some positive feedback tweeted following the discussion. Discussion, sharing, publishing, messaging, collaborating and networking took place via Twitter as per Cavazza's landscape. However, there was no evidence that participants used the tweetchat as part of their CPD, for participatory CPD or for reflection purposes or as information or support around CPD (we were unable to look for mentions of revalidation in this case study as it did not yet exist for nursing). Participants made no mention of how they could apply learning during the tweetchat in practice, or how they could use the tweetchat to aid reflection, or how they could log it for their CPD.
Example 2: Experiences of Care Week
WeCommunities, NHS England and NHS Improvement hosted ‘Experiences of Care Week’ in March 2017. There were 2691 contributors on Twitter for that week, with 10 266 tweets shared, potentially reaching 67 662 723 people (given the public international reach of Twitter) and there were 3035 visits to the blog pages. A range of activities took place throughout the week that embraced many areas of Cavazza's social media landscape and supported nurses with revalidation as per the social media–revalidation relationship triangle
Blogs: Several blogs were written and shared, encompassing the publishing element to Cavazza's landscape. This gave nurses the opportunity to discover new perspectives and reflect on them. There were also some reflective blogs published: ‘Why you are important to #ExpofCare’ (Kent, 2017) written by a nurse who reflected on personal and professional experiences and ‘An opportunity that was a gift’ (Tait, 2017), which shared a reflection on the week's activities. Importantly these blogs show how reflective blogging can be used for revalidation.
Twitter storm: A Twitter storm is a short burst of Twitter activity (about 30 minutes in length) where participants share evidence and research around specific subjects; this enables publishing, sharing discussing, messaging, collaborating and networking (elements of Cavazza's landscape). During this Twitter storm evidence and research were shared around experiences of care. The storm was then collated on the WeCommunities website as a resource for professional development and in turn was used for CPD. In all 135 people had ‘attended’ the Twitter storm (were active participants) and website real-time analytics showed that there were 388 visits to this particular page in the following 7 days (data from Symplur). This information shows that nurses engage with social media to meet their learning needs.
Tweetchat: The Experiences of Care Tweetchat was an hour long, where participants discussed thoughts, views and experiences. Participants ranged from student nurses to catering managers, experts in experiences of care, university lecturers and members of the public. The Tweetchat covered all of Cavazza's landscape. There were 168 participants who shared 834 tweets reaching a potential audience of 9 052 161. The discussion counted as participatory professional development as it was a professional discussion. Towards the end of the discussion participants were encouraged to reflect on what they would do as a result of the conversation. An emerging theme was how to develop patient-centred care.
‘I will keep listening and acting, but above all see the person not the patient we have to all do this.’
This view was supported by others in terms of making the patient central to the care provided. Another tweeter said:
‘Remember to ask [patients] “what matters to you” rather than “what's the matter”.’
This Twitter storm assisted nurses to think of the skills needed to provide such care:
‘So what will we do to improve #ExpofCare hope I can role model how important engagement is … Keep developing my coaching skills.’
A short burst or ‘storm’ can be beneficial. The following tweet reflects this and echoes other participants' tweets:
‘Thank you for a great hour learnt so much I can take on board for my placements and future career, thank you everyone.’
There was also mention of revalidation:
‘Can we ensure #ExpofCare is part of professional updating processes eg revalidation?’
This indicated that the tweetchat was used as participatory CPD and enabled reflection and provided support around revalidation. All three elements of the social media revalidation relationship triangle can be identified.
Participants were encouraged to use MyWe, which is a tool on the WeCommunities website. This tool collates Tweetchats in a personal space and enables nurses to create reflections on the discussions in which they have participated. These reflections can then be downloaded and added to portfolios.
Webinars: There were 12 webinars running throughout the week. These shared online presentations for people to engage, learn from and develop professionally. The webinars fitted into the sharing element of Canvazza's landscape and could be used for CPD purposes. In order to make this count as CPD participants were asked to reflect on each webinar and how it related to the code of conduct and their own practice.
Virtual book club: This involved sharing book titles around experiences of care that took place on Twitter. Participants shared their ‘most useful reads’, and this information was collated and developed into a list, which was published on a web page as a resource for learning through literature. This fitted in with the sharing aspect of the social media landscape and the books shared could potentially have been used by participants for CPD purposes.
Using Gibbs (1988) reflective cycle, and Cavazza's social media landscape we developed the social media relationship triangle model. Our data showed how nurses used social media to find information and support. It then demonstrated how through seeking out the information the nurse can get involved in social media for CPD and participatory CPD. And finally, how social media can be used for reflection and revalidation. The three elements helped us to develop the relationship triangle model. The week was an example of how online activity using social media can contribute to professional development and fulfilled all three elements of the social media relationship triangle:
The use of social media to find support and information around revalidation
Example 3: WeLearn
WeLearn was a project that ran throughout March 2017, as a collaboration between WeCommunities and Public Health England (PHE). The project aimed to situate lifelong learning into practice using social media and social media principles and applying them to learning. The project was aimed at school nurses and focused on using social media for CPD and revalidation.
We designed a bespoke e-learning platform that took participants through daily steps to gain confidence and knowledge in using social media for CPD and revalidation. The platform was fully integrated with Twitter and sent participants direct messages as reminders and encouragement. The daily tasks took 10-15 minutes to complete and there were three 1-hour Tweetchats throughout the pilot. The module content was designed to use social media and employed Powtoon videos, infographics, blogs and podcasts to bring the learning to life in a real world context. A hashtag, #WeLearnSoMe, was created to offer participants peer-to-peer support and discussion during the course. The project encompassed all of Cavazza's social media landscape bringing together a diversity of resources to the learning.
There were 62 participants on the project but 245 people used the supporting hashtag, they sent 1476 tweets in total reaching a potential 5 596 375 people.
Some of the content was PHE-based, building on key issues, campaigns and initiatives. One of the Twitter discussion that took place was on homelessness; it explored school nurses' role in preventing homelessness. Participants were asked at the end of the discussion what they would do with what they had learnt during the tweetchat. These are some of their responses:
‘I'm going to increase awareness in my areas of work, communities and commissioners as well as friends and families.’
Apart from creating awareness participants were motivated to make links with work-related areas on the topic
‘I think I will talk to the homeless team to find a way to ask young homeless people what they want from a school nurse.’
‘Going to talk to the early help team tomorrow about school nursing service. I will raise the homeless issue.’
Some were motivated to seek out networks:
‘Investigate services locally to establish the network and resources available.’
One participant tweeted to update people on how she actioned her learning into practice:
‘Update: Chat with the commissioners today about proposal. On board and supporting integration into service. Let's make this happen.’
The project encompassed all parts of the social media relationship triangle for revalidation, however, the main aim of WeLearn was to support school nurses to meet revalidation needs, equipping them with social media skills and tools for lifelong learning and CPD tailored to their needs.
Participants were also encouraged to reflect on their learning via the MyWe platform and add this to their professional portfolios for revalidation.
At the beginning and end of the WeLearn project participants were asked five questions using a Likert scale with 1 being the least attribution and 5 being the most:
Figure 4 shows the results both before (start) and after (end) the project.
All 62 participants undertook the survey. This project showed how social media is evolving and that nurses are starting to use it as an educational tool for CPD and revalidation. Particularly in questions 2, 3 and 4 there was a reported increase in knowledge of the different types of social media school nurses can use for CPD, and an increase in skills using different types of social media for revalidation. Although skills and knowledge had increased, participants' score before and after for questions 6 and 7 indicated that they did not share much of this learning, and they were not taking learning, information, ideas and resources online into practice. In our plans for future studies this will be further explored. At present reasons for this may be to do with how information is shared via social media, also nurses in the participants' network may not use social media. It may be that social learning is not seen as acceptable, or that social learning is ‘not what nurses do’. Another explanation is that although nurses read materials via social media there may be issues with identifying what is ‘fake news’ and what is reliable information.
The use of social media for CPD and participatory CPD
The WeLearn project focused on CPD, of which the tweetchats and the daily tweets and peer-to-peer support were part of participatory CPD. The PHE content provided some of the professional development and this complemented learning about the professional use of social media.
Limitations
First, we acknowledge our bias towards social media as we are pioneers in this field and we may have overlooked some nuanced areas. Social media is still in its infancy and we took a non-traditional approach to preparing and presenting this manuscript and it may not always have the expected features. The study only looked at three case studies from WeNurses and WeCommunities and this in itself can be viewed as a limitation as we did not look at other programmes from different organisations.
Conclusion
Revalidation has been a catalyst in nurses using social media for professional and educational. Before revalidation nurses were using social media but there was no evidence that they were using that learning for professional development or to improve their practice. Since revalidation has been introduced nurses have taken advantage of social media and can provide evidence of the use of what they learnt in social media spaces as part of CPD, revalidation and their ongoing development. Nurses have moved social media from the idea of a revolution to an evolution as they embrace social media applications for professional development using a participatory approach.