Using WhatsApp at work

The majority of responses to a Nursing Standard social media post revealed most view messaging apps in a positive light, describing them as easy and quick ways to communicate. One nurse on Twitter described them as a ‘great time-saver’.

When asked which services they used, a handful of nurses said they used employer-provided instant messaging services intended for clinical use, but the majority used WhatsApp.

WhatsApp use varied. Some used it for messages about overtime and rotas, others for arranging team social events. Some nurses said they used it for important work updates, while others used it for lone worker safety.

One nurse said: ‘We use it for general information, like “I’m going to be late”, and we are setting up a second one purely for lone worker messages.’

Another nurse added: ‘We also use it, as a senior nursing group, to communicate important ward information and for advice out of hours.’

One nurse manager said WhatsApp was a time saver. ‘We have an overtime group that staff can opt in to. If we need shifts covering, the senior staff get a message out. It’s fair because everyone gets the message at the same time,’ they said.

Another added they used it for ‘sharing ward updates, team meetings, learning and training opportunities, positive events and things to learn from, plus urgent messages’. ‘Useful to get quick info out to the team,’ they concluded.

A community nurse said: ‘We use it when lone working in the community to notify of whereabouts and safety. Obviously, we don’t put patient information in the messages.’

Many nurses said they had more than one work WhatsApp group, for different uses.

One nurse said she was on three: a general one, one for important information and communication, and one for band 7 nurses.

Another nurse said: ‘We have different groups and it is an efficient way to get information quickly to the relevant people. Did take some getting used to but I like it now.’

Messaging apps can be a useful safety measure for lone workers in the community

Picture credit: iStock

NHS guidance for use

Useful though they may be, what are the rules around using messaging services for work purposes?

In 2018, NHS England published guidance that said instant messaging could be used by health services.

It said messaging had proved a vital method of communication for NHS and other emergency services staff responding to major emergencies, such as the Grenfell Tower fire, and terrorist attacks in London Bridge and the Manchester Arena in 2017.

Updated guidance was issued in February this year by the NHS Transformation Directorate, which again backs the use of standard instant messaging services.

‘It is fine to use mobile messaging to communicate with colleagues and patients/service users as needed,’ the guidance states. ‘It is also fine to use commercial, off-the-shelf applications such as WhatsApp and Telegram where there is no practical alternative and the benefits outweigh the risk.’

The guidance also sets out straightforward steps so healthcare staff can use instant messaging securely (see box, page 22). Advice includes minimising the amount of personal or confidential patient information that is shared and additional security measures such as two-step verification.

Free way to keep in touch

Instant messaging is also increasingly used as a way to stay in touch with patients, with many health charities encouraging individuals and their families to contact them via WhatsApp to request information (see box, page 21).

One mental health nurse in the south of England told Nursing Standard that WhatsApp is a useful, free way for patients to stay in touch.

When communicating with patients she often finds they cannot respond because they have run out of data on their contract, or have no credit on their pay-as-you-go phone. Sending a text message or calling may cost money, but sending a WhatsApp message just requires Wi-Fi, which individuals may have at home or be able to access when visiting somewhere else.

A ‘stepping stone’ for further information

Specialist nurses working for charity Prostate Cancer UK can now be contacted through WhatsApp by people in need of support.

The organisation added the messaging service to its options for contact, which include email, a phone line and live chat, in early 2022.

This followed a pilot in 2021 that found WhatsApp was a useful way for people to get in touch who otherwise may not, says specialist nurse Sophie Smith.

‘We are not finding any downturn in people using the live chat option, so we feel this is going to be a new group of service users using WhatsApp, who are maybe a different demographic to those using the other services,’ she says.

Approaches via WhatsApp often involve queries about treatment options and messages from newly diagnosed men.

Ms Smith says often these messages can be quite brief, so nurses will then ask the person to get in touch another way so that they can give more detailed information.

‘It is a first contact for some people who are not feeling confident enough to pick up the phone and have a long conversation’

Sophie Smith, pictured right, specialist nurse at Prostate Cancer UK

‘It is not a route where we can get or give lots of information, and it requires a new set of communication skills. But it is a first contact for some people that maybe are not feeling confident enough to pick up the phone and have a long conversation,’ Ms Smith says.

‘WhatsApp can be a good stepping stone for people to get more information.’

Disrupting work-life balance

Despite their effectiveness and convenience, there are concerns about WhatsApp and similar messaging services being used in healthcare services

Responses to Nursing Standard on social media suggest that one downside is having a constant stream of messages, making it difficult to switch off from work.

‘I’ve worked in places where it’s used constantly,’ one nurse said. ‘It becomes a bother away from work too. When you end up with 20-plus participants, it gets a little noisy at times.’

Other problems raised included colleagues being bullied through WhatsApp, or being excluded from groups that could benefit them or help them do their job, for example, when acting up.

Some nurses said they muted work groups when not on shift, to avoid notifications. But, as many nurses are using the app on their personal phones, even when muted it is easy to register and be distracted by work group messages when accessing the app for personal use.

This is an aspect that concerns Oxford University Hospitals NHS Foundation Trust chief nurse informatics officer Simon Noel. It blurs the boundaries between work and private life in a manner that can compromise a healthy work-life balance, and increase the risk of potentially sensitive information being placed on the wrong group, he says.

‘Nurses are definitely using WhatsApp fairly widely for managing their teams, and there are a few drawbacks,’ he says. ‘One of them is the merging of work and non-work life.’

While services such as WhatsApp are end-to-end encrypted, which prevents third parties accessing data while it is transferred, this does not mean that data is always protected.

‘It is so easy to respond to messages on the wrong group, which could undermine the security and confidentiality of patients or staff,’ he says.

‘While instant messaging has its place, it should never be used to share any confidential data, as the chances of sending it to the wrong place are just too high. In my team we use the instant messaging option on Microsoft Teams, as we only use this for work messages, so you are less likely to mix things up. But we would never share confidential or private information.’

Sector-specific messaging apps

A number of healthcare-focused instant messaging services have been established, including Siilo, which is used by some trusts and has more than 27,000 users across the UK.

Siilo chief executive and doctor Joost Bruggeman says there is a need for messaging apps geared towards the security healthcare staff require in their work.

‘Siilo’s sole purpose is to enable the sharing of medical information about individual patients without compromising sensitive data, which remains secure in the platform,’ he says.

However, he argues that with ‘off-the-shelf’ messaging apps the potential risks are clear.

‘A mistaken message could put patient confidentiality and data protection in jeopardy, while threatening one of the most fundamental aspects of healthcare ethics,’ he says.

Competing with WhatsApp, which is run by Facebook parent company Meta, is not an easy task.

The free Hospify app, which was the first such service to be approved for the NHS Apps library in 2018, announced it was closing at the end of January this year, due to insufficient business. The company blamed declining demand on the government’s announcement during the pandemic that healthcare professionals could use mainstream services.

Some people report finding it hard to switch off at home

Picture credit: iStock

Mr Noel says these small messaging services, often set up by doctors, struggle to have the scale and capacity to go up against large-scale instant messaging providers.

Dos and don’ts of instant messaging at work

Do:

• » Minimise the amount of personal/confidential patient information you communicate via mobile messaging

• » Remember a mobile messaging conversation does not replace the formal health and care record. Keep separate health and care records, transfer any clinical decisions communicated via mobile messaging as soon as possible and delete the original messaging notes

• » Remember messaging conversations may be subject to freedom of information requests or subject access requests

• » Switch on additional security settings such as two-step verification

• » Set your device to require a passcode immediately and for it to lock out after a short period of not being used

• » Disable message notifications on your device’s lock-screen

• » Enable the remote-wipe feature in case your device is lost or stolen

• » Check you are communicating with the correct person or group, especially if you have many similar names stored in your personal device’s address book

• » If you are a mobile messaging group administrator, take care when selecting members of the group and review membership regularly

• » Follow your organisation’s policies in relation to mobile devices and mobile messaging

Don’t:

• » Allow anyone else to use your device

• » Forget to separate your social groups on mobile messaging from any groups that share clinical or operational information

• » Forget to unlink the app from your photo library

Source: NHS Transformation Directorate

Assessing risk

Despite all these concerns, instant messaging seems embedded in many nurses’ private and working lives, bringing with it a mix of benefits and drawbacks.

‘It has become an essential component of workforce and patient care management,’ Mr Noel says.

‘But the way these services are deployed and the platforms used need to be undertaken with a clear understanding of the risks so that the safety of patients and staff may be assured.’

Further information

NHS Transformation Directorate (2022) Using mobile messaging tinyurl.com/NHSTD-mobile-messaging