Selfie Time: What Could Go Wrong?

By Margaret Scavotto, JD
Director of Compliance Services
Management Performance Associates

A nurse aide, lab tech, medical assistant – or any other healthcare employee  – is new on the job. They are excited about their new position and decide to take a selfie to memorialize the occasion, then send it off to Facebook, Instagram, Twitter and Snapchat, with the click of a button, in under 20 seconds. What could go wrong?

Or maybe this employee is not new on the job. Maybe they’ve been with you quite a while, through ups and downs – lately, mostly downs – had a challenging time at home last night, and are feeling fed up. They pick up the phone, put on their best “exasperated” face, take a selfie, caption it with a summary of their frustrated state of mind, and send it off.  What could go wrong?

Next consider a great day at work. This employee had a great performance review, met a team goal or helped a patient meet a milestone – and is proud. What better way to celebrate than by capturing that smile on camera and sharing the good news with 856 social media friends? Think of all of the “likes” and “thumbs ups” they will get to see on their next break. What could go wrong?

A lot.

HIPAA Hazards

Let’s start with HIPAA.

By itself, a work selfie might only amount to bad judgment and a violation of your company’s cell phone policy.

But what if there is protected health information in the background? Maybe a patient in the hallway? A visible nurse kiosk screen? A patient’s name placard on a door? Or a rounding white board with patient status or surgery information? When employees are excited or frustrated, are they more or less likely to notice these items as HIPAA hazards?

Privacy Problems

HIPAA isn’t the only risk.  Selfies that incorporate patients can violate privacy laws. Also, in nursing facilities, CMS considers photos or videos of residents that are demeaning or humiliating to be abuse. While it is less likely and more extreme for selfies to include abusive context (which typically require intentional conduct), it happens.

For example, two paramedics were arrested and face criminal charges after they engaged in a selfie war by text. They competed to take the most shocking pictures of themselves with patients in compromising positions (I cannot bear to repeat the details).

What you can do

Taking on the force of social media can seem insurmountable, but providers have had great success with social media compliance culture campaigns.  Employees need to understand that their phone might be their personal property, but HIPAA privacy laws and abuse laws apply when they use it at work.

Train staff to be mindful of their surroundings and background if they are using their phones at work (and, of course, if this is permitted under your policies). Remind them that taking, with some very limited exceptions, a picture of a patient is never okay – even if the patient is in the background. This sounds obvious, but countless employees have made headlines by inadvertently making this mistake.

Tell employees that inappropriate photos can violate privacy laws, constitute abuse, and lead to license discipline, criminal charges and lawsuits. Make sure they understand the stakes.

Finally, make the message pervasive. Not just at hire and once a year. ProPublica has posted 65 examples of inappropriate social media posts by nursing home staff since 2017. In many of the examples, the home had a social media policy. Social media use is rampant. Your social media compliance campaign should be, too.

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  1. Good Morning Margaret – A thorough post on a timely topic, stressing mindfulness and being keenly aware of one’s surroundings.

    Nicely done.

    Very respectfully,


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