by Alicia A. Gregory, RN BSN

Student, Masters Degree Program, College of Nursing, University of Saskatchewan

Dr. Mary Ellen Walker,  RN, PhD

Dr. June Anonson, RN, PhD

Citation: Gregory, A., Walker, M. & Anonson, J. (2022). Social Media and Nursing Activism: A Literature Review. Canadian Journal of Nursing Informatics, 17(2).  https://cjni.net/journal/?p=10088

Abstract

Social media increasingly plays a noteworthy part in shaping political landscapes, influencing government decisions, and giving rise to global socio-political movements. Social media activism can also positively influence activist behaviours and promote offline participation in collective action. Nurses are morally obligated and well-situated to take action to address social justice and health inequities. Yet nurses’ engagement in activism in the 21^st century leaves room for improvement. Social media may be a novel way for nurses to stay politically informed, promote social justice, and positively influence public discourse. This literature review provides a comprehensive overview of social media activism and its role in nurses’ activism. Exploring new and creative ways for nurses to engage in activism is essential to maintaining the relevancy of the nursing profession but also critical to improving the health and wellbeing of the individuals and communities for whom nurses care.

Introduction

Nurses’ moral and ethical obligation to take action beyond the bedside to address social and environmental justice is well established in the nursing literature (Cohen et al., 1996; Falk-Rafael, 2005; Florell, 2020; Hosseinzadegan et al., 2020; Kagan et al., 2010; Martin & Vold, 2019; McGibbon & Lukeman, 2019). Not only do nurses have a moral imperative to address these issues, but achieving social justice relies on the participation of nurses (Hosseinzadegan et al., 2020). In practice and research, nurses witness the effects of inequities, which provides them with a unique understanding of how unjust sociopolitical structures impact health (Boswell et al., 2005; Ennen, 2001; Falk-Rafael, 2005; Florell, 2020). Yet, the nursing scholarship on this subject suggests that nurses’ current level of engagement in activism leaves room for improvement (Boswell et al., 2005; Des Jardin, 2001; McGibbon & Lukeman, 2019; Santillan-Garcia et al., 2020).

Social media platforms can be a strategic means for promoting and engaging in activism  (Chon & Park, 2019; Greijdanus et al., 2020). In the 21^st century, social media increasingly shapes political landscapes and gives rise to global socio-political movements (Sandoval-Almazan & Ramon Gil-Garcia, 2014). A notable example is the Idle No More movement. Idle No More is an Indigenous grassroots movement that grew to bring awareness of Canadian environmental legislation that negatively impact Indigenous health, wellbeing and land sovereignty (Idle No More, 2020). The movement began in November 2012 as a small protest of 100 people in Saskatoon, Saskatchewan. However, the movement gained significant momentum via social media and is now an international network of Indigenous and non-Indigenous allies collaborating to protect Indigenous rights and land (Idle No More, 2020). Additionally, scholars outside of nursing have identified that social media can facilitate activism through social engagement, networking, building a sense of empowerment and creating the antecedents to offline collective action (Chon & Park, 2019; Fatkin & Lansdown, 2015; Foster et al., 2019; Kende et al., 2016; Kwak et al., 2018).

Social media’s ability to raise awareness, precipitate collective action and impact the discourse surrounding social justice issues is evident in social movements and non-nursing literature. Considering nurses’ obligation toward activism and social media’s rise in popularity and socio-political influence, one could ask the following question: Can social media meaningfully contribute to nursing activism? This literature review aims to address this question and explore social media activism and its role in the activism of nurses in the 21^st century.

Methods

Current peer-reviewed literature was searched via CINAHL Plus, Ovid Medline, and Elsevier Engineering Village databases to explore this research question. Articles were limited to those published from 2000 to the present and written in the English language. The following search terms were used: social media, social media activism, digital activism, social justice activism, political activism, social change, nursing advocacy and nursing activism. The search terms were also applied to Google Scholar to locate additional peer-reviewed studies and grey literature. References used in relevant articles were searched to identify additional articles. The first search was intended to identify peer-reviewed research articles and grey literature that directly addressed nurses’ social media activism. Articles were included if they focused on nursing or nursing activism via social media. A second search was conducted to locate literature relating specifically to nursing activism. Articles were included if they focused on nurses’ political or social justice activism. A third and final search was conducted to overview the current research regarding social media’s impact on activism. Peer-reviewed studies focused on social media activism and its effect on society, political movements, and offline activism were included.

The Impact of Social Media on Activism

Activism is a practice where “direct vigorous action” supports or opposes one side of a contentious issue (Merriam-Webster, n.d.). Social media activism is a process wherein social media users communicate and share information to solve problems collectively (Chon & Park, 2019). Social media consists of web-based platforms, such as Twitter, Facebook, YouTube, LinkedIn and Instagram. These platforms allow users to create content, share information and connect in a user-friendly and accessible manner and have been identified as a means to stimulate activism via interaction and mobilization (Bogen et al., 2019; Boulianne, 2015; Greijdanus et al., 2020; Harlow & Guo, 2014; Velasquez & Larose, 2015). However, there is a debate regarding whether social media activism detracts or contributes to meaningful offline action or social change (Christensen, 2011). A common critique of social media activism is that it gives way to ineffectual acts that do little to affect real change offline, commonly referred to as “slacktivism” or “clicktivism” (Gladwell, 2010; Morozov, 2011). Slacktivism refers to online political activity that has no impact on political outcomes in reality but only serve to “increase the participants’ feel-good factor” such as liking or sharing content related to a cause, therein inhibiting more meaningful action (Christensen, 2011, p. 1; Harlow & Guo, 2014). Overall, the concern is that social media can inhibit meaningful activism behaviours, like participating in grassroots initiatives such as protests. 

Despite the belief that social media may inhibit meaningful activism, recent research indicates that social media activism may promote offline participation rather than inhibit it. For example, social media users who engage in low-effort political expressions on social media are more likely to partake in higher-threshold political action offline (Chon & Park, 2019; Fatkin & Lansdown, 2015; Foster et al., 2019; Kende et al., 2016; Kwak et al., 2018). Additionally, Chan (2017) concluded that social media establishes the psychological antecedents of participation. Social engagement, network building, and a sense of empowerment are related to social media activism and proposed as ways that online activism can lead to offline involvement (Kende et al., 2016; Smith et al., 2019). In particular, recent research indicates that social media is an effective tool in increasing online and offline civic engagement and political activism in younger generations (Ida et al., 2020; Seelig, 2018).

  Social media is not only a means of connecting and organizing for a cause but can be a powerful tool for promoting individual and collective action for social change. While further studies will delineate social media activism’s psychological and sociological complexities, there is evidence that social media activism can promote participation and collective action. To understand the role social media activism may play in nursing activism, it is helpful to first examine the body of scholarship on nursing activism.

Nursing Activism

Nursing activism is defined as “the expenditure of personal energy and social or political capital to address upstream and downstream determinants of health” (Florell, 2020, p. 5). Nursing activism refers to action nurses take that aim to solve social and political issues (Florell, 2020). Nurses’ moral and ethical obligation to promote social justice and address inequities are well established in the literature (Cohen et al., 1996; Falk-Rafael, 2005; Kagan, 2011; Kagan et al., 2010; McGibbon & Lukeman, 2019). Nursing activism also aligns with the nursing profession’s core values and social mandate to “uphold principles of justice safeguarding human rights, equity and fairness and by promoting the public good” (Canadian Nurses Association, 2017, p. 15). While nurses have a moral and ethical responsibility to take action to promote the public good, they often face many challenges in doing so.

Barriers to Nursing Activism

Nurses must overcome both intrapersonal and external challenges when engaging in activism. Intrapersonal challenges nurses face in activism includes a lack of confidence in their public speaking skills and their political and policy knowledge, often believing they do not possess the ability to effectively address leaders and policy-makers (Jurns, 2019; Rasheed et al., 2020). Perceived lack of political efficacy, or powerlessness to impact political and policy outcomes, negatively affects nurses’ motivation to take on an activist role (Ahoya, 2016; Rasheed et al., 2020). Inadequate educational preparation regarding policy and politics contributes to low political efficacy and is identified as a barrier by 52% of the 201 registered nurses surveyed in Ontario, Canada (Avolio, 2014). Evidently, providing ample opportunity for nurses to accumulate the skills, knowledge and confidence to partake in activism is critical in empowering nurses to take action.

Interprofessional and gender power dynamics are additional barriers to nursing activism. In health care institutions, policy circles, boardrooms and political arenas, male physician voices are traditionally more prevalent than female nursing voices (Ahoya, 2016; Asuquo, 2019; Rasheed et al., 2020). The climate within health care systems and institutions present additional barriers to nurses’ activism. The rise of neoliberalism, a philosophy “centred on the principles of individualism, efficiency, and a free-market economy,” is identified as a significant barrier to nurse activism (Buck-McFadyen & MacDonnell, 2017, p. 4; Falk-Rafael, 2005). Neoliberal principles in health care and education create environments that inhibit nurse activist development by prioritizing a post-positivist, biomedical approach to nursing (Buck-McFadyen & MacDonnell, 2017). This approach to nursing results in a narrowing of focus on evidence-based practice and budgetary efficiencies that do not allow for adequate space for activism within nursing practice and education (Buck-McFadyen & MacDonnell, 2017; Falk-Rafael, 2005). Additionally, neoliberal ideology could influence the nursing profession to abandon the “legacy of sociopolitical action,” believing that such matters are outside nursing’s mandate (Falk-Rafael, 2005). Falk-Rafael (2005) warned that sociopolitical inaction on behalf of the nursing profession will negatively impact the profession’s relevancy and have a detrimental effect on public health. Nurses certainly face external systemic barriers to activism, but they may also encounter these barriers within the nursing profession.

Despite the many barriers nurses face, it is evident that factors that can mitigate these challenges exist. These factors are discussed in the following section.

Facilitators to Nurse Activism

Since a lack of education is deemed a barrier to activism, it is not surprising that educational preparation is a facilitator. Education at all nursing academia levels can provide nurses with the skills and knowledge needed to engage in activism (Avolio, 2014; Buck-McFadyen & MacDonnell, 2017; Morris et al., 2019). Educators can positively impact political efficacy and engagement through mentorship, role modelling, and participatory learning in political and social justice activism and policy-making (Anders, 2020; MacDonnell & Buck-McFadyen, 2016; Morris et al., 2019). Educators should consistently incorporate these components in all levels of nursing education to equip nurses with the knowledge and skills needed to engage in activism confidently.

Professional nursing organizations are also vital when engaging students and practicing nurses in activism. Nursing organizations and nurse leaders can regularly reach out to members to communicate about policy advocacy, provide opportunities to partake in activism initiatives, and offer mentorship (Avolio, 2014; Jurns, 2019; Kung & Rudner Lugo, 2015; Modene, 2018). For example, MacDonnell and Buck-McFadyen (2016) found that Canadian nurses and nursing students value the Registered Nurses Association of Ontario’s (RNAO) activism leadership. Nurses and nursing students appreciated the RNAO for highlighting policy and structural issues relating to the provision of equitable care, disseminating this knowledge to members, providing opportunities to participate in activist activities, and opportunities to speak out collectively without putting their careers at risk (MacDonnell & Buck-McFadyen, 2016). These perspectives highlight the numerous ways nursing organizations may facilitate nursing activism.

Undoubtedly, nurse educators, leaders, and professional nursing organizations have a crucial responsibility to facilitate and encourage nursing activism through education, mentorship, and activism opportunities. But are nurses successfully implementing facilitators and surmounting the challenges they face in their activism? The upcoming section discusses evidence from the literature describing nurses’ current activism involvement.

Nursing Participation in Activism

Nurse scholars have voiced concerns that nurses in the 21st century are not sufficiently engaged in activism (Boswell et al., 2005; Des Jardin, 2001; Falk-Rafael, 2005). Many scholars posit that the nursing profession has not optimized its influence over political and social health determinants, particularly in policy and political spheres (Avolio, 2014; McGibbon & Lukeman, 2019; Santillan-Garcia et al., 2020). Nurses’ contributions to political activities and engagement in policymaking are deemed moderate to low, and there is “little overall evidence identified that reveals a clear or sustained interest and commitment among nurses to act politically in government spheres for the public good” (Wilson et al., 2020, p. 7; Rasheed et al., 2020). In contrast, some scholars argued that nurses are involved in activism, but their activism and policy influence is highly contextualized, resulting in their impact being overlooked (Falk-Rafael & Bradley, 2014; Giddings, 2005; MacDonnell, 2010). For example, nurses engage in policy influence through their individual actions and professional involvement within committees, social spaces and organizations. MacDonnell (2010, p. 229) posits that due to “prevailing discourses that validate linear top-town models of policymaking,” nurses’ political activism and policy influence is often invisible, even to nurses themselves. MacDonnell’s (2010) perspective presented an interesting dilemma as nurses’ policy influence may be more significant than the literature indicates due to challenges in empirically measuring their heavily contextualized activism.

Nevertheless, it is evident that nurses’ current engagement in activism, particularly within health policy and political leadership, indicates room for improvement. Further research is needed to determine how the nursing profession can actively overcome the present challenges to engage in activism at all levels of society. The following section discusses what is known regarding how social media may support nurses’ activism.

Social Media and Nursing Activism

Nurses are avid social media users, making up the largest number of health care workers who use social media (Creation Healthcare, 2014, as cited in Shattell & Darmoc, 2017). Nurses also express their views more often than other health care professionals (Creation Healthcare, 2014, as cited in Shattell & Darmoc, 2017). Some nurses are experts in wielding social media, as exemplified by nurses who have obtained micro-celebrity status via social media (Kerr et al., 2020). Despite individual nurses’ expertise in social media, the nursing profession has been cautious in its approach, likely due to the potential pitfalls related to the ethical responsibilities of maintaining privacy, confidentiality and professionalism (Anderson, 2012; Ferguson, 2013; Risling, 2016; Wylie, 2014). The concerns surrounding online professionalism make it essential to acknowledge the limitations of social media platforms, including the potential for the rampant spread of misinformation, the absence of rigour and peer review in online material, unidentified methods of data storage, confidentiality, and the obscuring of professional and personal boundaries (Cleary et al., 2013; Ross & Cross, 2019). These concerns are not to be taken lightly. The consequences for nurses who misuse social media can be life-altering and severe, resulting in loss of licensure, monetary fines and termination (Brous & Olsen, 2017; Kerr et al., 2020; Milton, 2016). Accordingly, nurses are often strongly cautioned to use social media with the utmost care (Miller, 2018; Reinbeck & Antonacci, 2019).

Regardless of the apprehension regarding nurses’ social media use, a recent shift in perspective is evident in the literature. Nurse leaders and scholars are beginning to recognize social media’s immense potential for connecting nurses’ voices nationally and globally, enabling knowledge and information sharing, and providing a platform for activism (Jackson & Kennedy, 2015; Reinbeck & Antonacci, 2019; Shattell & Darmoc, 2017). The Canadian Nurses Association acknowledged the potential for social media to enhance nurses’ ability to advocate for social justice and universal, comprehensive and accessible health care services (Canadian Nurses Association, 2012). Nurse leadership presence on social media is necessary for contemporary nurse leadership (Beard, 2013; Moorley & Chinn, 2016; Risling, 2016). Social media provides nurse leaders with an accessible and visible platform to model leadership qualities and improve leadership by connecting with members on various issues (Moorley & Chinn, 2016). Social media also provides an opportunity for informal nurse leadership skills to develop, wherein nurses not in formal leadership positions combine their interpersonal and social media skills to become social media nurse leaders (Moorley & Chinn, 2016). It stands to reason that formal and informal nurse leaders can be social media thought leaders and effectively engage in nursing activism online.

Although the body of nursing scholarship relating to social media and nursing activism is small, two specific themes emerged and are outlined in the following sections. These themes highlight ways nurses can leverage social media to enhance nurse activism through nursing organizations and nursing education.

Nursing Organizations and Social Media Activism

As discussed previously, nursing organizations play a crucial role in engaging nurses in activism, and social media may be a way to augment this role. Waddell (2019) posited that social media is an effective means of communicating health policy information to many nurses, particularly in times of political upheaval where policy outcomes could negatively impact the health of the population. Professional nursing organizations can deliver social media content that consistently communicates relevant health policy information to nurses at crucial turning points in the landscape of policy and politics.

Additionally, nurses tend to have higher engagement with advocacy content posted via nursing organizations. Peixin et al. (2020) examined North Carolina’s Association of Nurse Anesthetists’ social media content to determine how the organization could increase member engagement. Through content analysis of the association’s Facebook page, Peixin et al. (2020) concluded that posts related to advocacy and public relations generated the highest activity level from members. These findings implied that nurses are ready and willing to interact and connect for advocacy and activism initiatives. By prioritizing social media content that addresses social justice advocacy, nursing organizations could increase member involvement while concurrently informing nurses of political and policy issues that require collective action.

Social Media in Policy Activism and Education

Health policy formation often occurs with little input from front-line nurses, and nurse representation at the boardroom and governmental levels is scarce (Anders, 2020; O’ Connor, 2017). Social media and information technology are accessible ways for nurses to connect and engage directly in activism by engaging in health policy discussions with nurse leaders, policy-makers and legislators without navigating the traditional bureaucratic hierarchy (Anders, 2020; O’ Connor, 2017; Taylor, 2016). Accordingly, the ability to circumnavigate hierarchical structures in health policy circles provides an opportunity for nurse voices to enter the discussion with relative ease.

Social media is an innovative method for engaging and educating nursing students about health policy. Recent studies show incorporating social media into health policy nursing education allows nursing students to stay informed, actively engage, and promotes in-depth analyses of current health policy discourse (Gazza, 2019; Mercadante & Rambur, 2020). Gazza’s (2019) study incorporated an exercise where 49 nursing students used Twitter to follow a variety of individuals and groups involved in health policy. Students not only identified social media as an easily accessible and timely method for keeping current with health policy issues but also noted that following political and policy-related content revealed “a whole new world of nursing” (Gazza, 2019, p. 109). Students’ comments indicated that the Twitter exercise invoked a newfound interest in policy and politics while providing a concrete understanding of complex political issues affecting nursing practice. The outcome of Gazza’s (2019) study revealed how social media use in health policy education can strongly impact student nurses’ level of awareness and grasp of health policy.

Discussion

The broader literature regarding social media activism indicates that social media can be a powerful facilitator for activism, potentially promoting online and offline collective action for social change. Within a nursing context, the scholarship regarding social media activism denotes an increasing consensus that social media can play a positive role in nursing activism. As nurses begin to embrace social media, there is a need to further explore social media activism in nursing education, leadership and research.

Implications for Nursing Education

Social media in health policy education increases understanding and engagement in complex and relevant health policy issues (Gazza, 2019; Mercadante & Rambur, 2020). By incorporating social media into health policy and social justice pedagogy, educators can actively mitigate concerns surrounding unprofessional conduct on social media while simultaneously providing an avenue for nursing students to grasp the complexities of the real-world application of health politics. Educating nursing students to use social media in this way is a tool that students can continue to utilize to support their policy knowledge and nurse activism throughout their careers. Additionally, nurse educators must highly prioritize engaging upcoming generations of nurses in activism. Since research indicates that social media may increase activism engagement in younger generations (Ida et al., 2020; Seelig, 2018), nurse educators should consider integrating social media in course work relating to politics, policy and activism. 

Implications for Nursing Leadership

Social media can counteract barriers to nursing activism through nurse leadership and role modelling via social media content. Nurses highly value mentorship and describe mentorship as a desirable quality for nurse leaders to possess (Anonson et al., 2014). This desirable mentorship quality undoubtedly applies to nurse leaders and social media activism. The active presence of nurse leaders on social media could provide activism mentorship as nurse leaders exemplify how to engage in discussions regarding policy failures, health care concerns and social justice matters with online professionalism. With access to mentorship that may otherwise be inaccessible without social media, nurses could develop the confidence, efficacy and leadership skills needed to make their voice heard on critical issues of concern. 

The opportunity to mentor and connect with members via social media should signal nursing organizations and nurses in formal leadership positions to embrace social media while carefully curating content to inform nurses of political initiatives and opportunities for action. Beard (2013) strongly posited that contemporary nurse leaders are responsible for becoming literate in social media to guide the profession toward developing effective social media strategies and presence. Failure to do so equates to a failure in leadership, ultimately to the detriment of the nursing profession’s relevance within society (Beard, 2013). Nurse leaders should assess their own ability to use social media and incorporate social media strategies that inform and encourage nurses to engage in activism.

Implications for Research

The potential for social media to support nurses’ activism justifies further research. Social media could support nurses’ activism by amplifying facilitators and reducing barriers. For example, social media may reduce barriers to nurses participating in policy formation. As Anders (2020) suggested, social media provides a means of traversing bureaucratic hierarchies in health policy. There is an emancipatory aspect to social media activism, as marginalized and silenced groups can use social media to amplify their voices on a public platform (Greijdanus et al., 2020). Future research could explore if and how social media provides nurses with the means to rise above the patriarchal hierarchy and whether policy influence is achievable.

Another notable knowledge gap is a lack of research examining social media activism within a nursing context. As mentioned earlier, nurses are avid users of social media. A quick search on commonly used social media sites, such as Twitter, reveals that nurses engage in social media activism to bring awareness to nursing and social justice issues. The nursing profession has focused considerably on mitigating the risks involved with nurses’ social media use; this is understandable as the outcomes of misuse are potentially life-altering for nurses both professionally and personally. This cautious approach is warranted but may also represent a missed opportunity. Considering the potential for social media to enhance activism, there is justification for research that explores how nurses can safely and effectively use social media to support and bolster their activism.

Conclusion

Nurses’ moral and social obligation to advocate and take action to promote just and healthy societies should compel the nursing profession to take a second look at social media’s potential. Social media can offer more than a minefield of potential breaches in confidentiality and professionalism; it may be a tool toward knowledge, empowerment and emancipatory nursing action. Nurses are entrusted with caring for society’s most vulnerable; thus, it stands to reason that when adequately prepared, nurses can effectively and professionally wield the power of social media to promote health and well-being. Future research should examine how front-line nurses, nurse educators, leaders, scholars, and professional organizations can professionally leverage social media’s power toward nursing activism. This research would build on the current state of nursing knowledge regarding nurse activism and continue the nursing profession’s trajectory toward fulfilling the obligation to fight for health, equality and justice for all.

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Author Bio

Alicia Gregory, RN BSN MN St.

Alicia Gregory is a practicing registered nurse in Saskatoon, Saskatchewan. Over the past 12 years, she has worked in various areas, including palliative care, ICU, and currently works as a clinical nurse educator with the provincial tuberculosis program. Alicia is currently enrolled in a masters nursing degree program at the University of Saskatchewan and preparing to complete her thesis in early 2023. Nursing activism is a passion of Alicia’s, and she hopes that through her research, she can help identify ways that nurses’ can amplify their voices on matters of social justice, health policy and politics.

Dr. Mary Ellen Walker,  RN, PhD

Mary Ellen Walker is a registered nurse. She earned her Nursing PhD in 2020. She currently works as a diabetes nurse clinician and a statistician. 

Dr. June Anonson, RN, PhD

June Anonson is a Professor at the College of Nursing, University of Saskatchewan. Her career spans many different areas; Acute Care, Medi-Vacs, Consultant for Quality Control, Community Health, Research, Education, Health Care and Post Secondary leadership. June is dedicating the remainder of her career to the support and empowerment of the next generation of nurse leaders.