How do colleagues or prospective employers learn more about you and your history as a nurse? Chances are, they seek your presence in the virtual world by looking at your Web site or profile in the ever-growing forms of social media. Many nurses do not realize the enduring importance of online content and its power to influence decision making by potential patients, hiring agencies, and colleagues. When managed correctly, the use of virtual resources can be a valuable way to paint a picture of expertise and professionalism. However, inappropriate postings can be a source of continuing dismay for the professional nurse. Comments or photos posted impulsively may prove to be of lasting damage to a nurse's reputation. Protecting your online image and clinical reputation patients is of growing importance in the world of social media channels.

WHAT'S IN A NAME?

An initial step in using the virtual world to showcase your skills and expertise is to examine the presence you have already created with a self-assessment. One way to begin is by conducting a self-search for the presence of your name on the Internet using Google or another common search engine. Many names are not unique, and chances are that others with your name have created online profiles. If you are not a frequent user of social media, please also note that it is possible that others have posted comments about you. Several options for name searches are available, both for free and fee based. Your name, location, and even other details such as associations (spouses, workplace, children), phone numbers, and dates of birth can be easily found on the Web. Pipl Search, a commonly used search engine, conducts a deep Web search, retrieving the user's name from sources such as Amazon, government Web sites, and Flickr. PiplSearch may also information about relationships, child/spouse/parent associations, location, and social media use. Potential employers often use this search engine for background checks, available at small fee, and to maintain contact lists for their agency.

It is worth taking a moment to review how your name is being used on the Web. Enter your name in Google and evaluate the posts that are retrieved, with a critical eye toward unflattering content associated with the use of your name. Improving the use of your name on Google is not difficult. An initial step in increasing your ranking on Google, which means that your name will appear on the first or second page of results, is to expand your presence on social media platforms. Increasing the number of social profiles that you create, and increasing the amount of user-generated content that you add to the profiles, will improve your online presence. Consider professionally based channels such as Doximity or LinkedIn, along with more common apps such as Facebook, Twitter, or Instagram.

Options for monitoring use of your name on the Web are available. Google's "Me on the Web" is a service that will allow users to create alerts for any desired topic, including their names. Social Mention will conduct a real-time search to identify user-generated content from across the Internet, identifying entries in blogs, photos, and other types of posts. If your plan is to create your own brand in healthcare, then Rankur might be another option of interest. Rankur is a fee-based monitoring site that performs social and digital media monitoring and online reputation management and even offers regular analytics designed for opinion analysis and mining. BrandYourself is an online application that will allow users to create a profile and optimize the use of up to 3 social profiles, which can boost your results in Google profiles.

Although it is difficult, if not impossible to remove offensive content about you on the Web, strategies are available that can be used to improve an online reputation. These strategies are also important for new social media users who wish to showcase their clinical knowledge and expertise. Increasing the positive activity associated with your name can "push" the negative posts further down on results lists. Consider choosing a particular area of clinical interest, conduct a review of recent literature on the interest area, and begin to post content on your social media profiles about this topic. You can also easily share information related to your area of interest on platforms such as Facebook and Twitter. For example, a pediatric nurse might wish to publish information related to newborn feeding schedules, vaccinations, or other topics pertinent to this clinical area. Blogging is also a method of increasing positive content. Blogs are short articles, often written in an informal style, that are posted to the Web. Because blogs are posted in reverse chronological order (most recent appears first in the list), regular blogging is an effective way to push negative content further down the results list. Potential authors can begin their own blog, using a selected domain name and online application, or contribute content to other high-profile blogspots. Developing the habit of sharing high-quality evidence about your clinical interests will create a positive impact upon your online reputation.

ASSESS YOUR IMAGE

It is difficult, if not impossible, to step outside your identity as a nurse. It is worth the time to consider how your social media presence can be used to promote your knowledge and skills. If you have been a frequent user of social media channels, review the content that you have posted and/or promote. Does the content that you find help you to portray your reputation to the virtual world in a positive way? Are you using social media profiles effectively to enhance your skills and knowledge?

If you are creating your first profile in social media, or reviewing what you have previously created, critically consider your profile photo, as this attracts the attention of others who want to find out more about you. Do not underestimate the power of your profile photo. Chances are your profile photo will be studied by another for less than a second; this leaves the viewer with his/her own impressions about the personality traits, skills, and expertise you possess. Minor variations in features such as lighting, smile, clothing, or hairstyles can lead viewers to interpret values such as trustworthiness, extroversion, creativity, and competence.1 Research has demonstrated that perception of these elements can be influenced by the scenario in which the photo is used.1 To portray approachability and confidence in your profile photo, use a head shot, with a small smile, asymmetry, and business dress.2 First impressions are also interpreted in the context of the scenario in which the photo is viewed. If you are a frequent user of social media, consider expanding your profiles to include those that convey your professionalism and skills in healthcare, such as LinkedIn or Doximity. If you are a new social media user, these platforms are excellent mechanisms to create your online presence.

Other sites exist that are designed for professional networking. Whereas LinkedIn is well known as a networking site, others also exist. Plaxo is an online address book with many features, such as automatic updates for your contact list, when a contact changes details such as a telephone number or address. Beyond.com offers users a means of maintaining a professional portfolio online, while promoting professional connections and job searches in specialized areas of interest. Sumry is a site that assists users in building resumes and gives them an option to submit an introductory cover letter for open positions before actually applying for the position. This provides potential employers with a quick way to review potential employees before undergoing the lengthy application and interview process. Remember that reviewing the terms of service before using a social media platform is your responsibility. Violations of the terms of service can lead to removal of content or termination.

HEALTHCARE AND THE ONLINE WORLD

Social media platforms can present valuable and simple ways for nurses to connect, reflect, and network, but keep in mind that there are special considerations within the healthcare world that should be considered before posting information about patient care. It is critically important that the privacy and confidentiality of patients be protected. The Health Insurance Portability and Accountability Act of 19964 was established to protect patient privacy and confidentiality by clearly defining types of information that could be shared and the circumstances in which information could be shared. According to a ruling handed down in 2011, the Office of Civil Rights, Department of Health and Human Services, healthcare entities are considered to be "[horizontal ellipsis]responsible for the actions of their employees."3^(p42) Breaches of patient privacy and confidentiality are serious and can result in prompt termination for the employee, along with fines and jail time (for the employee). As previously stated, it is difficult, if not impossible, to step outside the role of nurse in our communities, and our actions are often held to a higher standard. Stop and critically review your post before you launch it onto the Web. Posting private health information about any patient is considered a breach and can be prosecuted. Avoiding any discussion of patient care, especially when linked to healthcare facilities, is the best practice to avoid breaches.3

If you must use social media channels for other than personal reasons, it is best to study professional guidelines about the best ways to do so. The National Council of the State Boards of Nursing has published A Nurse's Guide to the Use of Social Media, which offers specific information on how nurses can use social media in ways that will improve workplace experiences without violating privacy and confidentiality laws or state Nurse Practice Acts (2011).5 The Guide reminds readers that anything published on social media, even if deleted by the user, cannot be deleted by the user from the social media server; content can be retrieved from these servers and used in a court as evidence. Individual state Boards of Nursing may conduct investigations and file disciplinary actions again nurses who are suspected of using social media for unprofessional or unethical conduct, breaches of confidentiality, and other violations.4 Ways that nurses can avoid disclosure confidential information are discussed in the Guide. Nurses who are users of social media channels, particularly new users, would benefit from reviewing this document and implementing its suggestion.

SUMMARY

Patients, colleagues, potential employers, and many others use social media channels to obtain information about nurses and other caregivers in healthcare. When used in a positive manner, social media can be a powerful way to build and improve one's reputation. Take the time to be a smart user and to realize the potential of creating a social media profile that will enhance your professional relationships, networking skills, and career possibilities.

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