Social Media Professionalism in Nursing Students: A Concept Analysis

ABSTRACT

The objective is to clarify the concept of social media professionalism among nursing students. Walker and Avant's concept analysis method was used. CINAHL, Scopus, PubMed, and ProQuest Dissertations & Theses Global were used to find both empirical and gray literature published between 2014 and 2024 that discussed professionalism and social media use among nursing students; 18 articles were included. Social media professionalism among nursing students encompasses five attributes: maintaining privacy and confidentiality, clear boundaries between personal and professional identities, accountability for online actions, civil and respectful digital discourse, and adherence to professional regulatory standards and institutional policies. Antecedents include access and exposure to digital platforms, role modeling, educational preparation, awareness and internalization of professional values, and personal motivation and self‐efficacy. Consequences include an impact on professional reputation, employability, and academic progress; influence on professional identity formation; legal and regulatory outcomes; and public and institutional perceptions. The operational definition of social media professionalism among nursing students aims to clarify the concept for future use and research as well as address existing gaps in the current literature, nursing education, and institutional policy.

Summary

• Social media professionalism among nursing students has five defining attributes, influenced by five antecedents and resulting in four consequences, highlighting its importance in fostering responsible digital conduct and professional growth.

• This research contributes to enhancing the understanding of social media professionalism for students, educators, and institutions.

• The concept of social media professionalism among nursing students has significant implications for the profession. The concept analysis underscores the need for clear guidelines and education to ensure all nurses and other healthcare professionals maintain professional digital conduct.

1. Introduction

The use of digital technologies and social media has become intertwined within our everyday lives, changing the landscape of professional communication and identity formation in nursing. For nursing students, being digitally present has become unavoidable in their personal, academic, and professional lives. This is supported by O'Connor et al. (2022), as approximately 44% of nursing students were classified as heavy social media users on platforms such as Facebook, Instagram, and Snapchat, primarily being used for communication and interaction. As a result, nursing students face persistent challenges in navigating the blurred lines between their personal and professional identities within digital contexts (Gum et al. 2024; O'Connor et al. 2022). Specifically, nursing students experience confusion regarding what constitutes social media professionalism and struggle to understand the full implications of their online activity (Gum et al. 2024; O'Connor et al. 2022).

Professionalism in nursing is widely recognized as a complex and multidimensional concept that encompasses professional values, behaviors, accountability, communication, and adherence to ethical standards within the profession (Eid et al. 2018). These professional expectations shape how nurses interact with patients, interprofessional team members, and the broader public, shaping a core component of identity development within nursing education (Eid et al. 2018). However, the rapid expansion of digital communication and social networking platforms has introduced new contexts in which professional conduct must be demonstrated. The widespread use of social networking sites among healthcare professionals has been accompanied by increasing reports of breaches of professional behaviors online, highlighting the need to better understand professionalism within digital environments (Guraya et al. 2024). Digital communication platforms also enable healthcare professionals to interact with the public, disseminate health information, and engage in professional networking on an unprecedented scale, which further amplifies the importance of maintaining professional standards in online spaces (Kim et al. 2024).

In addition, there has been research conducted on how healthcare professionals use social media in an unprofessional manner (Kaczmarczyk et al. 2013; Guraya et al. 2021). For example, a study by Booth (2015) examined the behavior of nursing students' digital behavior on Twitter (X). The study found vulgar and derogatory language being used targeting courses, students, faculty members, and expression of stress and frustrations about academic performance (Booth 2015). However, the consequences of such unprofessional behavior are well documented. This can include consequences such as academic dismissal for nursing students and professional sanctions for nurses for unprofessional digital conduct (O'Connor et al. 2025). These disciplinary actions not only reflect individual failures but also systemic deficiencies in nursing governance surrounding the necessary structures and supports required to develop digital professionalism within healthcare environments (Mather and Cummings 2019).

Importantly, the need to examine social media professionalism specifically within nursing student populations stems from the unique developmental and educational context in which students are situated. During nursing education, nursing students begin to form their professional identity by internalizing the values and ideas integral to nursing and developing a sense of self derived from the role they are preparing to assume within the profession (Halverson et al. 2022). Simultaneously, many nursing students belong to a generation that is highly engaged with social media, where personal and professional identities frequently intersect. This intersection creates distinct challenges for nursing students who must learn to navigate professional expectations while still forming their professional identity within both academic and digital environments. Therefore, understanding social media professionalism specifically among nursing students is essential to support the development of appropriate professional digital behaviors before nursing students enter into independent professional practice.

The purpose of this concept analysis is to define social media professionalism by identifying its attributes, antecedents, and consequences in the context of nursing students, defined as and including undergraduate, diploma, and post‐diploma nursing programs. This analysis can help students, educators, and institutions achieve a unified understanding and approach to appropriate behavior in digital environments through student assessment, curriculum development, and policy creation.

2. Materials & Methods

The Walker and Avant (2019) concept analysis method was used to explore social media professionalism among nursing students. The method includes the following eight steps: (1) select a concept, (2) determine the purpose of analysis, (3) identify all uses of the concept, (4) determine the defining attributes, (5) identify a model case, (6) identify additional cases, (7) identify antecedents and consequences, and (8) define empirical referents (Walker and Avant 2019).

2.1. Data Sources and Search Strategy

The electronic databases CINAHL, Scopus, PubMed, and ProQuest Dissertations & Theses Global were used to locate both empirical and gray literature for inclusion and analysis. The following search strategy was used: “nurs* student*” OR “student nurs*” AND “social media” OR “TikTok” OR “Facebook” OR “Twitter (X)” OR “Snapchat” OR “Instagram” OR “Youtube” OR “Threads” OR “Reddit” OR “LinkedIn.”

2.2. Inclusion & Exclusion Criteria

The search included full‐text articles in English that were published between 2014 and 2024. This time frame was selected to ensure the findings reflect the rapid growth and advancement of technology in the last decade. In addition, articles must discuss professionalism and social media use among nursing students. For this concept analysis, professionalism is defined as ethical behavior, respectful communication, confidentiality, and maintenance of public trust (College of Nurses of Ontario 2024). Social media use is defined as any instance in which a nursing student uses any social media platform for professional purposes. These include TikTok, Facebook, Twitter (X), Snapchat, Instagram, YouTube, Threads, Reddit, and LinkedIn. The articles were not included in the analysis if they studied nurses and did not discuss professionalism with social media use.

2.3. Study Selection and Data Charting Process

The initial search yielded 595 articles, with 42 articles meeting the inclusion criteria after title and abstract review. After a full text and reference list of included studies review, 18 articles were included for analysis. Two reviewers independently screened titles and abstracts, full texts, and extracted data using Covidence. The following information was extracted from the included articles: author(s), year of publication, title, country, aims/purpose, study design/methods, and findings. Please refer to Table 1 for the data extraction table of the included articles.

TABLE 1.

Data extraction of included articles.

Author(s), year of publication	Title	Country	Aims/Purpose	Study design/Methods	Key findings
Alharbi et al. (2020)	Undergraduate nursing students' adoption of the professional identity of nursing through social media use: A qualitative descriptive study.	Saudi Arabia	Explore the influence of social media usage on nursing students' development of professional identity	Descriptive qualitative study	This study explores how social media (SM) influences the professional identity (PI) development of undergraduate nursing students. The key findings reveal that students use SM to learn about the nursing profession, fostering a sense of belonging and helping them adopt the identity of nursing. Additionally, they use SM to share their experiences, enhancing society's understanding of the importance of nursing. The study suggests that SM facilitates socialization by connecting students with the nursing community, ultimately contributing to the development of well‐educated and professionally satisfied nurses. Furthermore, SM indirectly influences nursing student retention by providing a supportive platform for PI development.
Alharbi et al. (2022)	The relationship between social media usage by undergraduate nursing students and development of their professional identity: A correlational study.	Saudi Arabia	Determine relationship between social media usage of nursing students and development of professional identity	Descriptive, correlational, cross‐sectional study.	The study found a positive relationship between social media (SM) use and the development of professional identity (PI) in undergraduate nursing students. Participants who used SM for educational or professional purposes and followed nurses on social media had higher PI scores. Additionally, actively sharing nursing student experiences and educating the public about the profession on social media also correlated with a more positive PI. These findings suggest that purposeful interaction with social media can help students establish a positive professional identity as nurses.
Barnable et al. (2018)	Nursing students' perceptions of confidentiality, accountability, and e‐professionalism in relation to Facebook.	Canada	Explore nursing students' perception of confidentiality, accountability, and e‐professionalism in relation to Facebook	Descriptive study	This study investigated nursing students' perceptions and attitudes toward Facebook, focusing on confidentiality, accountability, and e‐professionalism. While most students (96.9%) use Facebook and believe they should be held accountable for unprofessional behavior on their profiles, nearly half of them held the opinion that employers should not use information from their Facebook profiles when making hiring decisions. All students were aware that posting patient names or pictures was a breach of confidentiality. A notable finding was that senior students disagreed more strongly than junior students that employers should use Facebook profiles when making hiring decisions, suggesting heightened concern about future employment as they near graduation.
Cathala et al. (2021)	Demographic profiling of Caribbean and United Kingdom student nurses' use of social media for professional development.	Jamaica, Trinidad and Tobago and the UK	Explore the professional use of social media of nursing students from Jamaica, Trinidad and Tobago and the UK, to support development and implementation of appropriate use of social media for professional development	Cross‐Sectional Survey; quantitative descriptive design	This study explored how student nurses across three countries, Jamaica, Trinidad and Tobago, and the UK, utilize social media (SoMe) for professional development. The findings revealed that social media is integral to student nurses' professional growth, although usage patterns differ by country, generation, and program year. In the Caribbean, video viewing is the primary use of SoMe, while in the UK, it's for downloading articles. Notably, most participants believed that SoMe could positively impact their careers. However, there was a higher awareness of SoMe guidance in the UK compared to Jamaica and Trinidad and Tobago. The study underscores the need for SoMe guidance in the Caribbean and emphasizes the importance of establishing an international consensus on its professional use in nursing.
Cathala et al. (2023)	An exploration of social participation in Caribbean student nurses' use of social media in their learning journey.	Jamaica and Trinidad and Tobago	Identify how social participation in social media facilitates nursing student learning and professional development	Qualitative thematic analysis	This study explored social participation among Caribbean student nurses and their use of social media (SoMe) for learning and professional development. Key findings identified three themes: SoMe and communication, SoMe and self‐care, and SoMe and learning. The study found that SoMe is deeply ingrained in students' daily lives and enhances learning by providing accessible materials tailored to different learning styles. Social participation in SoMe improves information accessibility and facilitates information sharing, acting as a catalyst for the exchange and interaction between nodes in connectivism theory. Ultimately, this leads to improved learning experiences and student outcomes. The research suggests that higher education institutions should develop guidance and support for SoMe use in learning to meet the needs of the next generation of student nurses and future professionals.
Chu (2020)	E‐professionalism in undergraduate nursing students	Canada	Explore e‐professionalism in undergraduate nursing students in a university in Southwestern Ontario	Cross‐sectional quantitative descriptive design	This study explored e‐professionalism among undergraduate nursing students at a midsize South Western Ontario university. While students could identify blatant examples of appropriate and inappropriate social media use, they struggled with less obvious violations. The research indicated that nursing students often learn about e‐professionalism outside academic settings, potentially leading to issues with adhering to professional regulations. A significant portion of students reported using social media primarily for personal and academic reasons, but many had not read the terms of service agreements on these platforms. The study also found that the majority of participants felt responsible for the information they posted on social media and were aware that they should follow the same professional standards regardless of whether they were using social media for personal or professional purposes. These findings suggest a need for enhanced e‐professionalism education and updated social media policies within nursing programs. These policies should guide students on expected online behaviors and prevent incidents of inappropriate social media use.
Duke et al. (2017)	Social media in nurse education: Utilization and e‐professionalism.	Canada	Explore student and faculty use of social media and its professional implication in nursing education	Descriptive study	The study's key findings reveal significant differences between nursing students and faculty regarding social media use and e‐professionalism. Students spend significantly more time on social media and use it more for educational purposes compared to faculty. While Facebook is a popular educational platform for students, faculty members use it less frequently. A notable gap exists in the awareness of e‐professionalism, as highlighted by the fact that a higher percentage of students have posted information they would not want employers or faculty to see, despite claiming awareness of professional behavior expectations. This suggests a disconnect between students' perceived understanding of e‐professionalism and their actual online conduct. This disconnect emphasizes the need for improved education and support in this area for both students and faculty.
Gum et al. (2024)	Digital professionalism in preregistration nursing and midwifery students: A scoping review to explore perceptions of professionalism when using social media	N/A	To examine nursing and midwifery students perception regarding professional social media use	Scoping review	This scoping review on digital professionalism among pre‐registration nursing and midwifery students identifies two major themes: Professional Boundaries and Responsibility and Accountability. The theme of Professional Boundaries highlights the difficulty students face in navigating the overlapping personal and professional online environments. Social media use influences their professional identity and aids in career progression. The second theme, Responsibility and Accountability, emphasizes the need for educational providers to emphasize personal and professional social media use. Students often lack a clear understanding of their professional requirements in this area. The findings suggest that universities play a crucial role in educating students about appropriate social media use, developing their professional online persona, and understanding the potential consequences of their digital footprint. Overall, the review emphasizes the importance of embedding social media policies and procedures within pre‐registration curricula to guide students in positive, safe, and constructive online behaviors. This ultimately promotes digital professionalism and protects their future careers.
Hoilman (2016)	Nursing students' perspectives on social media e‐professionalism in undergraduate nursing programs.	United States of America	To explore nursing student perspective of social media e‐professionalism in undergraduate nursing education	Qualitative phenomenological design	The study on nursing students' perspectives of social media e‐professionalism revealed six key themes: uses for social media, defining e‐professionalism, negative behaviors, consequences of negative behaviors, privacy, and public perceptions. Participants primarily used social media to communicate with family and friends, browse news feeds, and view others' personal details. A significant finding was that nursing students modified their behaviors after witnessing or being involved in negative behaviors, leading to either assuming or experiencing negative consequences. Participants also expressed concern about maintaining both patient privacy and their own personal privacy while using social media. These findings provide a foundation for understanding nursing students' perspectives on social media e‐professionalism, informing the analysis of current policies and the evaluation of existing educational programs.
Li et al. (2022)	Impact of the nurse‐related information through social media use on undergraduate nursing students' professional identity in nursing: A mixed‐methods study.	China	Explore the impact of nurse‐related information using social media on the professional identity of nursing students	Sequential explanatory mixed method	This study explored how nurse‐related information on social media (SM) influences undergraduate nursing students' professional identity (PI). Quantitative findings indicated that factors such as time spent on SM, whether nursing was the first choice, and having relatives as nurses impacted PI. Students who frequently read official nursing accounts on WeChat positively perceived nurse‐related information and believed that positive information strengthened their view of nursing, leading to higher PI. The qualitative study uncovered four key themes: increased concern for nurse‐related information, the perception of limited and non‐professional information, encouragement from positive information, and the limited impact of negative information. In conclusion, the study suggests that nurse‐related information on SM can influence nursing students' PI. Educators play a crucial role in guiding students in appropriate SM use and assisting them in developing their professional identity.
Mather et al. (2016)	Social media training for professional identity development in undergraduate nurses	Australia	Explore the use of social media of first and final year nursing students during their course	Cross‐sectional study	This study explored social media usage among undergraduate nursing students and its impact on their professional development. The key findings indicated no significant difference in social media use between first and final year students, suggesting a lack of understanding of appropriate and safe practices. Online media was the preferred primary source of information, particularly among female respondents, while male students favored radio and television. Notably, Facebook was widely used by 87% of nursing students, but only 11% utilized LinkedIn for professional networking. The study underscores the importance of integrating social media etiquette into nursing curricula to foster positive professional identity formation and ensure work‐readiness upon graduation.
McGrath et al. (2019)	Understanding the benefits and risks of nursing students engaging with online social media	N/A	Enhance nursing students' and nurses' understanding of e‐professionalism to use social media effectively for peer support and enhance patient care.	Narrative paper	E‐professionalism, encompassing the competence and values expected in online communication, is a rapidly growing area in nursing practice. Nursing students gain significant benefits from social media, including developing professional networks, engaging with the nursing community, accessing support, and enhancing their knowledge. However, they must understand the potential risks associated with sharing information online, as it could lead to misconduct investigations and exclusion from studies. Educators play a crucial role in supporting students to use digital technologies effectively while minimizing risks. This includes emphasizing the importance of understanding confidentiality not only for patients but also for staff and the healthcare organization. The NMC's guidelines provide examples of unprofessional online behavior, such as sharing confidential information or posting inappropriate comments, which can jeopardize a nursing student's ability to join the professional register.
O'Connor et al. (2022)	Digital professionalism on social media: The opinions of undergraduate nursing students.	United Kingdom	Examine the opinion of nursing students on digital professionalism when using social media	Descriptive, cross‐sectional study	This study explored nursing students' opinions on digital professionalism on social media platforms like Facebook, Instagram, and Snapchat. While many students understand digital professionalism and are familiar with the Nursing and Midwifery Council (NMC) guidelines, their views on specific scenarios differ. Some find it acceptable to post photos with alcohol or of colleagues or patients, highlighting the complexities of navigating personal and professional boundaries online. While most students are aware of privacy settings and limit public access to their profiles, few check their privacy settings using search engines. Overall, the study underscores the need for specialized training and clear guidelines to help nursing students use social media professionally and safely.
Oducado et al. (2019)	Perceptions and attitude on using social media responsibly: Toward social media literacy in nursing education	Philippines	Exploring nursing students' perception and attitude toward responsible social media use	Descriptive, cross‐sectional study	This study investigated nursing students' perceptions and attitudes toward responsible social media use. The findings revealed that nursing students generally have positive perceptions and attitudes. Notably, first‐year nursing students demonstrated significantly more positive attitudes compared to fourth‐year students, although both groups expressed overall positive attitudes. The study also found no significant differences in attitude based on sex or the number of hours spent daily on social media. Nursing students agreed that social media posts should be well‐considered and that sharing clinical patient information is inappropriate. However, they largely disagreed with using fake names or posting content with smoking or sexually suggestive material. The research suggests that continuous efforts to promote social media literacy are crucial to ensure responsible online behavior among nursing students. By doing so, potential ethical and legal issues can be prevented.
Sun et al. (2023)	Nursing undergraduates' media competence in the context of health communication and its relationship to professionalism	China	Investigate the association between professionalism and social media competency in Chinese nursing students	Cross‐sectional descriptive study	The study investigated the relationship between professionalism and social media competence among Chinese nursing undergraduates and found a significant correlation between the two. Nursing undergraduates' professionalism positively correlated with social media self‐efficacy, social media experience, performance expectancy, and facilitating conditions, while negatively correlated with effort expectancy. Nursing students with higher professionalism scores also demonstrated higher scores in social media self‐efficacy, social media experience, performance expectancy, and facilitating conditions compared to those with lower professionalism. These findings suggest that integrating health communication courses on social media could enhance nursing students' professionalism and their ability to effectively use social media for health education.
Tan et al. (2024)	The influence of social media on student nurses: A systematic mixed‐studies review.	N/A	Examine the influence of social media on nursing students' personal and professional values	Systematic mixed‐studies review.	This systematic review of 26 studies explores the multifaceted influence of social media on student nurses, revealing both positive and negative effects. Social media enhances professional identity and personal growth through networking and peer support, facilitating communication and knowledge acquisition. However, it can also be a distraction, leading to mental health issues, cyberloafing, and inappropriate behavior that can harm career prospects. The review emphasizes the need for educational institutions to develop curricula that promote responsible social media use and provide support tailored to the diverse needs of student nurses, including addressing technical difficulties faced by older learners and ensuring equitable access to technology. Ultimately, the study calls for a balanced approach that harnesses the benefits of social media while mitigating its risks through education, policy, and collaboration between institutions, families, and healthcare providers.
Westrick (2016)	Nursing students' use of electronic and docial media: Law, ethics, and e‐professionalism.	N/A	Promotion of digital professionalism in nursing students using electronics and social media	Narrative review and policy analysis.	This article delves into the growing concerns about the misuse of electronic communication and social media by nursing students. This misuse can lead to breaches of patient confidentiality, legal issues, and damage to professional relationships. To address these concerns, nursing programs must establish clear policies and expectations regarding social media use. The American Nurses Association Code of Ethics and National Council of State Boards of Nursing guidelines provide valuable resources for promoting e‐professionalism. Legal cases involving students dismissed for social media misuse highlight the potential for academic or disciplinary actions, including program dismissal. This underscores the importance of educating students about responsible online conduct. The study advocates for a proactive approach in policy development, encouraging schools to specify the consequences of policy violations and expose students to the realities versus the myths associated with social media. Ultimately, the article emphasizes that by adhering to professional standards and understanding the implications of their online behavior, nursing students can avoid negative repercussions and maintain e‐professionalism.
Zhu et al. (2021)	Utilization and professionalism toward social media among undergraduate nursing students.	China	Investigate nursing students professionalism, use, and attitudes toward social media	Cross‐section study; questionnaires	This study on undergraduate nursing students' social media use revealed several key findings. All participants used social media, with QQ being the most popular platform. A significant portion of students spent 2–6 h daily on social media and held positive attitudes toward it. However, a notable percentage also admitted to posting personal content without privacy settings and witnessing unprofessional posts from peers or teachers. Many students are not aware of the professional standards of online behavior for healthcare providers, and a concerning number have accepted friend requests from patients. Self‐directed learning and learning motivation were found to be predictors of attitudes toward social media, highlighting the influence of social media on learning. This underscores the need for best practices and training in nursing education.

3. Results

3.1. Step 1: Choosing a Concept

The concept of social media professionalism was selected due to its ambiguity among nursing students (Chu 2020; Gum et al. 2024; O'Connor et al. 2022). In the current literature, studies have shown that many nursing students lack a consistent understanding of appropriate online behavior, struggle to recognize professional boundaries in social media use, and remain unaware of regulatory standards surrounding digital conduct (Gum et al. 2024; O'Connor et al. 2022). Moreover, no concept analysis currently exists about social media professionalism among nursing students. This concept analysis aims to address this gap in the literature by clarifying the concept of social media professionalism and informing the development of appropriate curricula, educational strategies, and policy frameworks to guide professional conduct in digital environments.

3.2. Step 2: Determining the Purposes of Analysis

The purpose of this concept analysis is to define social media professionalism by identifying its attributes, antecedents, and consequences in the context of nursing students. The results can support students, educators, institutions, and the nursing profession at large in achieving a unified understanding and approach to appropriate behavior in digital environments through student education and assessment, curriculum development, and policy creation.

3.3. Step 3: Identifying All Uses of the Concept

Walker and Avant (2019) concept analysis method's third step is to explore all uses of the concept in dictionaries, thesauruses, and available literature.

3.3.1. General Definition of Social Media Professionalism

Online dictionaries were first reviewed, but none recognized social media professionalism as a singular entity. Merriam‐Webster (n.d.‐b) defines social media as forms of electronic communication through which users create online communities to share information, messages, and content. Professionalism is defined as the conduct and qualities that characterize a profession (Merriam‐Webster, n.d.‐a). In the literature, digital professionalism is used interchangeably with e‐professionalism. E‐professionalism refers to the attitudes and behaviors of professionalism manifested in digital media (Kaczmarczyk et al. 2013). Similarly, digital professionalism is generally defined as the expression of professional attitudes and behaviors in digital media, inclusive of public and private digital forums (Ellaway et al. 2015). Specifically, digital professionalism encompasses integrity, respect, and accountability within digital spaces such as online forums, social media, and email communication (Ellaway et al. 2015). Therefore, social media professionalism is a subset of digital professionalism that helps guide an individual's behavior to maintain appropriate personal and professional identities within digital spaces.

3.3.2. Social Media Professionalism in Nursing

In nursing, digital professionalism is rooted in ethical standards, confidentiality, privacy, and professional boundaries in all digital interactions (Gum et al. 2024; McGrath et al. 2019; O'Connor et al. 2022; Westrick 2016). This is supported by regulatory bodies such as the American Nurses Association, which has explicit guidelines that guide nurses for respectful conduct and communication on digital platforms, such as social media (American Nurses Association [ANA] 2011; Gum et al. 2024). Specifically, these policies highlight the secure use of electronic health systems, messaging apps, and recognize that personal digital activity can overlap with professional responsibilities (ANA 2011; College of Registered Nurses of Alberta [CRNA] 2021; Gum et al. 2024). Moreover, unprofessional online behavior can result in personal and professional disciplinary actions, such as licensure loss, highlighting the need for nurses to uphold the profession's trust and reputation on digital platforms (Gum et al. 2024; McGrath et al. 2019; O'Connor et al. 2022; Westrick 2016). Therefore, digital professionalism in nursing establishes safeguards for patients and professional reputation.

3.4. Step 4: Determining the Defining Attributes

Walker and Avant (2019) concept analysis method's fourth step is to create the defining attributes of a concept. These attributes differentiate a concept from other related concepts (Walker and Avant 2019). Based on the literature review, social media professionalism in nursing students has five defining attributes: (1) adherence to confidentiality and privacy; (2) establishing boundaries between personal and professional roles; (3) accountability for online behavior; (4) respectful and civil online communication; and (5) awareness and adherence to professional regulations and guidelines.

3.4.1. Adherence to Confidentiality and Privacy

The first core attribute of social media professionalism for nursing students is the ability to maintain patient (Barnable et al. 2018), staff, and institutional confidentiality and privacy on digital platforms (McGrath et al. 2019; Westrick 2016). Nursing students should be aware that sharing any direct or indirect identifiable patient information on digital platforms can result in breaches of professional and legal responsibilities (Barnable et al. 2018; McGrath et al. 2019; O'Connor et al. 2022). For example, direct sharing of information can include disclosing a patient's name or image on digital platforms, while indirect means could involve recounting clinical experiences that identify patient information through inference (Barnable et al. 2018; McGrath et al. 2019). Despite nursing students' awareness, the literature highlights persistent students' confusion regarding how sharing anonymized patient information can still constitute a breach (Barnable et al. 2018; McGrath et al. 2019; O'Connor et al. 2022). Moreover, nursing students should be aware that maintaining confidentiality and privacy extends beyond the patient to include staff and institutions (McGrath et al. 2019; Westrick 2016). Nursing students must understand that unguarded online discourse can result in disciplinary and legal consequences from tarnishing the institutional and professional reputations of colleagues (O'Connor et al. 2022; Westrick 2016).

3.4.2. Establishing Boundaries Between Personal and Professional Roles

The ability to establish personal and professional boundaries is another defining attribute of social media professionalism among nursing students. In the literature, the term “digital duality” is used to describe the blurring of personal and professional identities, a struggle many nursing students face on digital platforms (Chu 2020; Gum et al. 2024; O'Connor et al. 2022). Nursing students often have misconceptions, believing that their private social media identity is unrelated to their professional identity (Barnable et al. 2018; Zhu et al. 2021). However, in reality, nursing students' digital conduct, whether shared publicly or privately, reflects the profession and has implications for public trust (Barnable et al. 2018; Duke et al. 2017; Sun et al. 2023). Therefore, nursing students must be mindful that sharing content that is perceived as personal, such as clinical experiences, can result in a breach of professionalism and erode public trust in the profession (Barnable et al. 2018; McGrath et al. 2019).

3.4.3. Accountability for Online Behavior

The next attribute of social media professionalism among nursing students is personal accountability for online behavior. Nursing students must recognize the permanence and public endurance of their digital footprint on their professional image (Chu 2020; Gum et al. 2024; Hoilman 2016; O'Connor et al. 2022). The literature highlights instances in which nursing students have faced disciplinary actions for a lack of self‐regulation in digital conduct (Barnable et al. 2018; Tan et al. 2024; Westrick 2016). This includes academic disciplinary actions, program dismissal, and regulatory sanctions for breaches of digital professionalism (Barnable et al. 2018; Tan et al. 2024; Westrick 2016). As a result, nursing students must be mindful and actively consider the possible repercussions of all digital interactions to prevent any misinterpretation of digital conduct as harmful to the professional reputation of individuals, colleagues, and institutions (Barnable et al. 2018; McGrath et al. 2019; Westrick 2016). Therefore, nursing students must understand the risk of private content being shared beyond its initial intended audience and must be professional in their digital conduct at all times.

3.4.4. Respectful and Civil Online Communication

Social media professionalism among nursing students also entails maintaining respect and civility in all digital communications (Chu 2020; Gum et al. 2024; McGrath et al. 2019). This includes refraining from sharing discriminatory, derogatory, or negative comments directed toward patients, colleagues, employers, and the profession (McGrath et al. 2019; O'Connor et al. 2022). In the literature, online incivility, such as cyberbullying and offensive posts, has become a growing problem both among nursing students and nurses (McGrath et al. 2019; Gum et al. 2024). These behaviors can result in disciplinary consequences, undermine public trust, and erode the profession's reputation (Westrick 2016). Nursing students have the responsibility to engage in respectful digital communication, maintaining the integrity of the profession and ensuring trust in the nurse–patient relationship (Barnable et al. 2018).

3.4.5. Awareness and Adherence to Professional Regulations and Guidelines

The final attribute of social media professionalism by nursing students is the awareness and adherence to professional regulations and guidelines governing digital conduct (Gum et al. 2024; McGrath et al. 2019; O'Connor et al. 2022). For example, the ANA (2011) and the CRNA (2021) are regulatory nursing bodies that have explicit guidelines surrounding appropriate online conduct for nursing students and nurses. However, the rapid advancement of digital platforms and social media privacy guidelines outdates these guidelines, which can create a gap in nursing students' knowledge and awareness of appropriate digital conduct (O'Connor et al. 2022). This gap is further compounded as a result of nursing students using family and peers as informal primary sources to govern their digital conduct (Alharbi et al. 2022; Gum et al. 2024). Therefore, nursing students are expected to be cautious and seek clarification from their respective academic institutions, employers, and regulatory nursing bodies to maintain social media professionalism.

3.5. Step 5: Model Case of Social Media Professionalism in Nursing Students

Walker and Avant (2019) define the model case as an example of having all defining attributes of a concept. The following example scenario demonstrates a nursing student exhibiting social media professionalism.

Richard, a fourth‐year nursing student, uses a professional email for academic‐related communications and maintains a separate personal social media account with strict privacy settings. He never discloses any patient information or post‐clinical related content online. When participating in group chats, such as Facebook Messenger, he respectfully communicates with his peers, even during disagreements, and ensures the information he shares is evidence‐based. Richard lives in Ontario, Canada, and always consults the College of Nurses of Ontario guidelines for appropriate online conduct to maintain social media professionalism. Finally, Richard holds himself accountable for everything he posts, whether public or private, and encourages his peers to do the same.

This model case demonstrates all the defining attributes of social media professionalism in nursing students. First, Richard has distinct and clear professional and personal boundaries as seen by his professional email and personal social media account. He also maintains privacy and confidentiality by never posting on social media and uses respectful communication on digital platforms. Finally, Richard is aware and consults with his specific nursing regulatory body to maintain social media professionalism, while being accountable for all of his digital footprint.

3.6. Step 6: Additional Cases of Social Media Professionalism in Nursing Students

3.6.1. Borderline Case

A borderline case is an example that includes most but not all the defining attributes of a concept (Walker and Avant 2019). The following example demonstrates a borderline case of social media professionalism in a nursing student.

Emily, a second‐year nursing student, uses her personal Instagram account to occasionally post stories about her nursing student experience. She avoids sharing any identifiable information; however, she once posted a photo from the nursing lounge with other staff in the background. In that instance, she apologized and removed the post when someone pointed out it might be unprofessional. She also generally avoids posting inappropriate content and maintains her digital communication respectfully. Emily is vaguely aware of her specific academic institution's digital conduct guidelines, as she has not reviewed them in depth.

Emily's case reflects partial attributes of social media professionalism in nursing students. While she maintains privacy and respectful online communication, she lacks sufficient understanding of her academic institution's digital conduct guidelines. This results in Emily using her personal social media account to disclose her professional experience and results in an instance of potential digital unprofessionalism.

3.6.2. Contrary Case

A contrary case is an example that does not represent the concept (Walker and Avant 2019). The following example scenario demonstrates a contrary case.

Sophia, a first‐year nursing student, frequently posts photos from her clinical placement on her public TikTok account. In these images and videos, patients and staff are recognizable. She shares jokes about her clinical encounters, at times using inappropriate language, and engages in negative online discourse about nursing practice. Moreover, Sophia uses the same account to share personal rants and stories. She is unaware of her academic institution's social media conduct guidelines and does not see any problem with her online behavior.

This example lacks all the defining attributes of social media professionalism in nursing students. Sophia disregards confidentiality, maintains no personal or professional boundaries, shows no accountability, communicates disrespectfully, and is unaware of the expected standards of the nursing profession in digital forums. This demonstrates what social media unprofessionalism looks like in nursing students.

3.7. Step 7: Identifying Antecedents and Consequences

3.7.1. Antecedents

Walker and Avant (2019) define antecedents as events or conditions that must precede the occurrence of the concept. The following five antecedents that emerged from the literature include: (1) access and exposure to digital platforms; (2) peer and professional role modeling; (3) professional educational exposure; (4) awareness and internalization of professional values; and (5) personal motivation and self‐efficacy.

First, nursing students must have access and be exposed to digital platforms, such as social media, as students regularly engage with them for personal and professional purposes, making online engagement a foundational aspect of their social media professional development (Gum et al. 2024; O'Connor et al. 2022; Zhu et al. 2021). The frequency of use in students can determine the extent to which they encounter both positive and negative exemplars of social media professionalism (Zhu et al. 2021). Next, peer and professional role models play a significant role. Nursing students' perception of acceptable digital conduct is shaped by the actions of academic and clinical faculty, influential peers, and nursing leaders on social media (Alharbi et al. 2020; Li et al. 2022). For example, nursing students can model and reinforce expected social media professionalism behaviors from respected nurses and educators (Li et al. 2022). Professional education exposure is another antecedent of social media professionalism among nursing students. These include academic activities, formal digital policy instruction, and professionalism training sessions, which have been shown to enhance nursing students' competency in navigating professional conduct in digital contexts (Gum et al. 2024). Furthermore, the awareness and internalization of professional values, such as confidentiality, accountability, and respect, serve as an ethical compass that informs nursing students' social media usage and adherence to digital codes of conduct (Gum et al. 2024; McGrath et al. 2019). Finally, nursing students' motivation and self‐efficacy play a role in social media professionalism. The literature supports this as nursing students with greater motivation and self‐efficacy are more likely to have sound judgment and uphold professionalism online, even in ambiguous situations (Sun et al. 2023; Zhu et al. 2021).

3.7.2. Consequences

Walker and Avant (2019) define consequences as the outcomes or results of the concept. Based on the literature, social media professionalism among nursing students has both positive and negative consequences. Positive consequences improve the experience of the concept, while negative consequences worsen the experience of the concept (Walker and Avant 2019). The consequences identified include: (1) impact on professional reputation, employability, and academic progress; (2) influence on professional identity formation; (3) legal and regulatory outcomes; and (4) public and institutional image.

Positive social media professionalism can strengthen nursing students' professional reputation, enhance employability, and support successful academic progression (Gum et al. 2024). Conversely, negative digital conduct, such as breaches in confidentiality, can result in academic sanctions, program dismissals, and hindered employment opportunities (Westrick 2016; Zhu et al. 2021). Social media professionalism among nursing students also plays a role in professional identity formation. Specifically, positive experiences in digital spaces can foster students' sense of belonging and pride in the profession, while negative incidents result in disruptions to professional confidence development and socialization into nursing roles (Alharbi et al. 2020). Moreover, violation of professional digital codes of conduct and privacy laws can result in legal and regulatory consequences for nursing students, such as documented cases of disciplinary action taken by academic and nursing regulatory bodies (Barnable et al. 2018; Oducado et al. 2019; Westrick 2016). Finally, nursing students' collective digital conduct has an impact on the public and institutional image of nursing as a trustworthy profession. Nursing students exhibiting positive social media professionalism can foster trust, while negative actions can erode public confidence and tarnish the reputation of academic institutions and the overall profession (Gum et al. 2024; McGrath et al. 2019; Tan et al. 2024).

3.8. Step 8: Defining Empirical Referents

The final step of Walker and Avant's (2019) concept analysis method is to define empirical referents, tools, and other means that measure or substantiate the existence of a concept. Social media professionalism can be studied through quantitative, qualitative research, and mixed methods. There is currently no standardized instrument that measures social media professionalism among nursing students. However, Imran et al. (2024) have recently developed the Digital Professionalism Self‐Assessment Instrument (DP‐SAI) to measure digital professionalism among healthcare professionals. The DP‐SAI is a 28‐item instrument that measures digital professionalism across several domains, including self‐anonymity, privacy, conflict of interest, accountability, respect, ethics, boundary maintenance, and confidentiality (Imran et al. 2024). Due to the novelty of the DP‐SAI, this tool has not been used in any other studies. There are multiple examples of this concept being studied through the use of surveys (Barnable et al. 2018; Cathala et al. 2023, 2021; Chu 2020; Duke et al. 2017; Li et al. 2022; Mather et al. 2016; Oducado et al. 2019; Sun et al. 2023) and questionnaires (Alharbi et al. 2022; O'Connor et al. 2022; Zhu et al. 2021). Whereas qualitative methods of studying social media professionalism include semi‐structured interviews (Alharbi et al. 2020; Hoilman 2016; Li et al. 2022) and policy document analysis (Westrick 2016). However, the lack of specific and standardized quantitative and qualitative methods to study social media professionalism highlights a gap for future research.

4. Discussion and Implications for Clinical Practice, Education, and Policy

Walker and Avant's (2019) concept analysis method lends itself to the production of an operational definition. Thus, social media professionalism in nursing can be operationally defined as the consistent demonstration of professional behaviors, values, and competencies on digital platforms. This is demonstrated by nursing students safeguarding privacy and confidentiality, establishing clear boundaries between personal and professional identities, being accountable for their online actions, engaging in civil and respectful digital discourse, and complying with relevant professional regulatory standards and institutional policies. This definition is grounded in the expectation that nursing students are held to the same ethical and legal standards online as they are in traditional academic and clinical settings (McGrath et al. 2019; O'Connor et al. 2022).

The ambiguity nursing students experienced in defining appropriate social media professionalism due to the blurring of personal and professional online identities (Chu 2020; Gum et al. 2024; O'Connor et al. 2022) can be alleviated through the application of the operational definition of social media professionalism that incorporates five key attributes relevant to nursing practice. The concept of digital duality, which refers to the overlap between personal and professional digital identities, provides a useful lens to contextualize this ambiguity (Gum et al. 2024; O'Connor et al. 2022). By clearly outlining expected behaviors, surrounding confidentiality, boundaries, and accountability, the operational definition can help distinguish their professional role from their personal digital presence. For example, defining digital communication standards can set expectations of respect and civility that apply to all digital interactions. This can empower students to navigate online interactions with greater clarity and confidence, thereby reducing the impact of digital duality.

The operational definition can also serve as a foundation for integrating social media professionalism into nursing curricula and institutional policies. The literature reports that students have struggled with putting abstract digital conduct guidelines into action (Barnable et al. 2018; Zhu et al. 2021). Educators can use this operational definition to develop targeted learning objectives and scenario‐based activities that demonstrate the practical application of social media professionalism in real‐life contexts. This is supported by the literature as regular and structured digital conduct education can help students internalize these standards as part of their professional identity, increasing their digital competence and professionalism (Cathala et al. 2023; Chu 2020). At the policy level, a unified operational definition can help create enforceable and clear digital conduct guidelines for students and faculty. Specifically, academic and healthcare organizations can set consistent and clear expectations for online conduct, ensuring fairness in conduct assessment and enforcement.

Walker and Avant (2019) provided a structured and systematic method to create a conceptual definition of social media professionalism among nursing students based on current literature. However, there are several limitations that exist with this concept analysis. Only four databases were accessed to collect relevant literature. Despite this, the four databases used are considered to be large and thoroughly comprehensive databases for the retrieval of such literature. As well, only English articles were included. This can potentially exclude literature and ideas written in other languages and cultural contexts.

5. Conclusion

In conclusion, the Walker and Avant (2019) concept analysis method was used to define social media professionalism among nursing students. The operational definition can serve as a foundation for a unified understanding for students, educators, and institutions. Future work should focus on applying and operationalizing the concept of social media professionalism within practice, education, and policy settings, including the development of practical frameworks and assessment tools that can guide implementation. Engagement across disciplines is also needed to examine the applicability of the concept among diverse healthcare professionals and to support the development of shared standards for digital conduct across cultural and practice contexts.

Author Contributions

Tommy Lin: conceptualization, data curation, validation, writing – review and editing. Kateryna Metersky: validation, writing – review and editing.

Funding

The authors have nothing to report.

Ethics Statement

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.