After a nurse posted a TikTok reacting to the death of one of her patients, backlash erupted across social media, with many calling the nurse "cringe" and the video "performative."
But some within the medical community say they believe the backlash toward the nurse, who was unreachable for comment and whose account @olivia_tylerr33 appears to be set to private, went too far.
In the widely criticized video, which has since been removed from TikTok, the nurse is seen holding her hands to her forehead as Sia's "Unstoppable" plays in the background. The text says, "lost a patient today." Then, "'shake of off, you have 5 more hours.'" She leans forward and places her hands on her knees, her face bright red and seemingly slicked with tears. "It never gets easier," the caption read. The video has since been reposted on Twitter, where it has been viewed nearly 15 million times.
The TikTok - while it may be "cringe" to some - did not appear to cross any ethical lines, those NBC News interviewed said. And making the TikTok was likely the nurse's way of coping with the trauma, especially given that the platform has become a place many health care workers turn to as a way of dealing with working tirelessly during a pandemic.
Dominic Sisti, an associate professor of medical ethics and health policy at the University of Pennsylvania, said the video was "ill-advised" and does "smack of attention-seeking."
"On the other hand, it is the case that the general public really doesn't grasp the unbelievable trauma that health care workers have experienced in the last three years," Sisti added.
Research has shown that nurses experience mental health disorders like post-traumatic stress disorder, anxiety and depression at rates higher than average, a disparity only exacerbated by the pandemic. Nurses also experience high rates of secondary traumatic stress primarily due to constant exposure to death.
Nurses have long used social media platforms to connect with those within and outside of their communities. A 2019 Vox piece profiled the rise of the "nursefluencer," a portmanteau coined by the article's author. Now, nursefluencers are commonplace on TikTok. Thousands in the community use the hashtag #NurseTikTok to upload videos of their day-to-day lives in the field.
Meg Harrell, a registered nurse who runs the TikTok account @nursemegrn, said TikTok gives nurses an avenue to build community and bond over shared experiences.
"It's like our break room has expanded into the whole world. It's so fantastic," she said.
In the early days of the Covid-19 pandemic, health care workers were sometimes praised for posting videos of their experiences on TikTok.
"During the pandemic, when I started [on TikTok], those types of videos were very common. And people were called heroes in the comments," Hadley Vlahos, a hospice nurse who runs the TikTok account @nursehadley, said. "It's very interesting to see this shift, as Covid's not been the main topic anymore."
Many nurses have made similar TikToks about dealing with patient loss, often with sounds and filters like the ones used by the nurse in the video. Vlahos has made many posts about patient death. In one video, she speaks to the camera about the hardest patient death she has had to deal with.
Still, many online, even those within the medical community, have expressed fatigue over such content, calling it "grief bait" or saying it was made in poor taste.
TikTok user Nurse Nya, who did not immediately respond to an interview request, often makes videos calling out others within the space for what she sees as unprofessional behavior in their videos.
Dr. Karen A. Scott shared a series of screenshots of nurse TikToks on Twitter, noting that in some instances health care workers who post videos can be unintentionally racist in their commentary about patients.
"Unchecked behaviors that dehumanize patients, partners, parents, & family members are acts of obstetric violence & obstetric racism," she wrote in the tweet.
Though @olivia_tylerr33's post did not clearly violate the privacy of her patient and thus does not constitute a direct HIPAA violation, many hospitals have social media guidelines in place that mandate employees not film at work or in any way damage the hospital reputation.
On its website, the American Nurses Association, a professional organization founded in 1896 to represent the interests of registered nurses, also outlines social media etiquette for nurses, though it does not have guidelines specifically for TikTok.
Nurses are advised to follow six principles for social networking. That includes observing "ethically prescribed professional patient-nurse boundaries."
As far as tips go, the ANA says "most principles come down to common sense." However, the organization reminds nurses that "standards of professionalism are the same online as in any other circumstance." That means nurses are urged to "not share or post information or photos gained through the nurse-patient relationship" and "maintain professional boundaries in the use of electronic media."
Harrell, however, expressed sympathy for the nurse.
"I remember when I first came across the video," Harrell said. "My first reaction was, 'Yeah. Totally. That's exactly what it feels like. I have been there many times, and it sucks.' On the other hand, it was pretty cringe."
The majority of hate directed at the @olivia_tylerr33 video seems to have come from those outside the medical community, who may not have been the video's target audience, Harrell said.
"She really was trying to share a complicated portion of the job that not a lot of people talk about," Harrell said. "And people that were not in health care, that can't relate to those feelings, saw it. And it was done in a cringey way, and so that's what everybody responded to."
If this nurse had just spoken candidly to the camera about her grief, Harrell said, perhaps the reactions would have been more positive.