Know Your NetiquetteJENNIFER M. BRUSCO, BS, CNA

E-mail and text messaging are popularforms of personal and professional com-munication, offering users a method of

relaying information in a quick, efficient, and in-expensive fashion. Mobile devices, such as smart-phones and tablets,1,2 optimize these forms ofcommunication by allowing users to send andreceive messages via e-mail or other mobile ap-plications from virtually anywhere. According toan Ericsson consumer insight summary,

to date in 2011, 35 percent of US Android™/iPhone™ users interact with non-voice appli-cations on their smartphones before gettingout of bed . . . 23 percent access the internetvia their browsers, and 24 percent checktheir mail.3

Before the use of smartphones became common-place,

consumers tended to use the internet in‘chunks’—they would tend to confine their in-ternet activities to when they had an opportu-nity to sit in front of a computer.3

Often, electronic communication, data transfer,and file storage occur in “the cloud,” which is

a set of services and technologies that enablethe delivery of computing services over the In-ternet in real-time, allowing end-users instantaccess to data and applications from any de-vice with Internet access.4

The cloud can be used in two ways, for cloudcomputing and cloud storage. Cloud computinginvolves using software that is not installed on

your computer or mobile device. For example,Gmail™ is a popular e-mail client that does notneed to be installed on a personal computer ormobile device for use; instead, it relies on thecloud, which allows the user to access and manip-ulate the same information from any device thathas an Internet connection. In contrast, MicrosoftOutlook®, another popular e-mail client, must beinstalled on your computer for use. Cloud storageinvolves storing files in a location that is not onyour computer or mobile device. For example,DropBox™ is a popular file sharing program thatdoes not need to be installed on a computer ormobile device and can be accessed from virtuallyany device with Internet access. Facebook™ isan example of a site that uses both cloud com-puting and cloud storage. Users update and in-teract with information on Facebook withoutever having to download a Facebook programto their computer or mobile device. It is allhandled within the cloud.

With these new technological conveniences, itis essential that users understand and practice notonly safe computing practices,5 but also properelectronic communication etiquette. We have allheard the saying “treat others as you would liketo be treated,” but how does that apply to elec-tronic communication? Etiquette is a set of rulesfor proper and polite behavior.6 Electronic eti-quette or “netiquette” refers to the rules for theproper and appropriate way to communicate usingan electronic device or activities online. This arti-cle addresses the concept of netiquette and tips

If you have an idea for a column or a technology-related question that you would like to see addressed, contact

Jennifer M. Brusco at journalcolumns@aorn.org.

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doi: 10.1016/j.aorn.2011.07.003

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for ensuring that electronic communication is han-dled in a proper and appropriate manner.

BASIC E-MAIL ETIQUETTE TIPSE-mail provides users with documentation of con-versations and a means of convenient communica-tion when a telephone call or face-to-face interac-tion is not possible or desirable. It is important toremember that, even though e-mail is convenientand quick, there are certain rules that should befollowed to ensure that your message is commu-nicated in the way you intend. E-mail messagesdo not allow for facial expressions or tone ofvoice to help communicate a message, so it isvery important to choose words wisely and formatthe text appropriately. Following are some tips forpreparing an effective e-mail message.

Use Proper Grammar, Punctuation,and SpellingAlthough it is common to use abbreviations, acro-nyms, and creative spelling while sending textmessages (ie, “texting”), these shortcuts shouldnot be taken when writing a professional e-mail.

Taking the time to ensure that you use propergrammar, punctuation, and spelling can mean thedifference between a message that is clearly un-derstood and one that is misleading or unintelligi-ble. The following examples illustrate this point:

� Poor use: we r seeing a consistant problimwith sterilized instruments coming back notcleaned right have recintly discovered threemaj abd sets 2 plastik instrument sets and 2drills cleaned b4 sterilization still contami-nated w/ tissue debris we need 2 addressASAP RU available Fri 2 figure out wherebreakdown hapning

� Recommended use: We are seeing a consistentproblem with sterilized instruments being re-turned to sterile processing that have not beenproperly cleaned. We have recently discoveredthree major abdominal sets, two plastic instru-ment sets, and two drills that were improperlycleaned before sterilization (ie, still contami-nated with tissue debris). Obviously, this issomething that we need to address as quicklyas possible. Are you available to meet with

me on Friday to go overthe instrument handlingprocess to figure outwhere the breakdown ishappening?

Avoid Overuse ofAbbreviationsand AcronymsAbbreviations and acronymsare a great way to shortenwords or phrases (eg, anorganization name, com-monly used term) in text tomake a message or docu-ment easier to read. It is im-portant to remember themessage’s audience, how-ever, because an abbrevia-tion that may be commonlyused within your organization

Glossary of Terms

Cloud: a set of services and technologies that enable the deliv-ery of computing services over the Internet in real time, allowingend-users instant access to data and applications from any devicewith Internet access.1

Emoticons: “a textual expression representing the face of awriter’s mood or facial expression. For example, :), :(, and :D.They are often used to alert a responder to the tenor or temper ofa statement and can change and improve interpretation of plaintext.”2

Netiquette: rules indicating the proper and polite way to be-have while using an electronic device or engaging in communica-tion or activities online.

1. What is the cloud? Novell. http://www.novell.com/cloud/faq.html. Accessed June 10,2011.

2. Emoticons. Computeruser.com. http://www.computeruser.com/resources/dictionary/emoticons.html. Accessed June 15, 2011.

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may not be commonly used at another facility ororganization. For example, it is common forAORN staff members to use the abbreviation “PI”when referring to our weekly newsletter PeriopInsider; however, this may not be easily under-stood by someone outside of AORN’s walls.

Limit Use of EmoticonsAlthough emoticons (eg, ) are used heavily inpersonal text messaging, they may not be appro-priate for use in a professional message and maytake away from the formality or authority of themessage you are trying to convey. Always con-sider your audience before adding an emoticon.

Do Not Overuse the High Priority OptionFlagging something as a high priority (eg, bychecking the “!” in e-mail) is an effective way tolet the recipient know that he or she should readand respond to the message as soon as possible.This option should be reserved for messages thatare, in fact, a high priority. Consider the chil-dren’s story about the boy who cried wolf. If youflag messages as high priority when they are notreally a high priority or flag messages this way ona regular basis, the impact of the selection willbecome reduced. As a result, recipients may notview your future messages as important, regard-less of the flag. So, reserve the high-importanceflag for messages that necessitate the recipient toread and act on the message as soon as possible.

Use Bullets to Break Up Long MessagesBullets allow you to call attention to several itemsor questions for discussion. As shown here, theuse of bullets will allow the recipient to

� easily distinguish individual items and� address each item or question separately.

Avoid Using All CapsIn the electronic world, using all capital letters(“all caps”) is the same as screaming. So to typean entire message in all caps is the equivalent ofyelling the entire message at the recipient.

� A MESSAGE LIKE THIS CAN BE DIFFI-CULT TO READ AND IS OFTEN PER-CEIVED AS AGGRESSIVE, AS THOUGHYOU ARE SHOUTING AT THE RECIPI-ENT. USING ALL CAPS FOR MESSAGESIS NOT RECOMMENDED.

� A message like this is much easier to read andhas a more respectful feel compared with amessage in all caps.

Capitalization CAN be used to add emphasis to aword in a section of text. This should be donesparingly and, when available, alternative format-ting options (eg, bold, underline, italics) shouldbe used to provide the emphasis instead.

Use a “Signature” With YourContact InformationAlthough e-mail is a quick and efficient mode ofcommunication, sometimes it is necessary to pickup the telephone and call the person for additionalclarification or to better understand the tone of themessage. If you are corresponding with someonewith whom you do not normally talk or who maynot have your contact information readily avail-able, then your signature line could provide himor her with the necessary information, includingan office or mobile telephone number, a fax num-ber, a business address, and a web site. To set upyour signature by using Outlook, select “Options”from the “Tools” menu on the top navigation bar.Next, select “Signatures . . .” from the “Mail for-mat” tab.

If this is the first time you are setting up a sig-nature, you will need to add a new signature inthe “Select signatures to edit” box at the top, left-hand side of the text box. To do this, select“New” and type in the name of the signature (eg,Jennifer Brusco), then “OK.” To edit the signa-ture, select it from the “Select signature to edit”box and begin typing the signature information inthe “Edit signature” field. You can customizeyour signature by adjusting the font size and typein this field as well. When complete, select “OK.”

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Your signature will now appear on all outgoinge-mails that you create.

Use Appropriate GreetingsAlways begin your e-mail with an appropriategreeting. For example, “Hello,” “Greetings,”“Good Morning,” “Good Afternoon,” or “GoodEvening” are all acceptable greetings for profes-sional communications. If you decide to personal-ize your e-mail by including the recipient’s name(eg, Dear Dr Jones), be sure that you have spelledhis or her name correctly and have included theappropriate title (eg, Dr, Mr, Mrs, Ms, Col,Professor).

Introduce Yourself and Include aMeaningful Subject LineIf you are writing an e-mail to someone for thefirst time, take a moment to introduce yourself(eg, your name, job title or function). A simpleintroduction can prevent a “who is this personand why are they contacting me” response from

your recipient. Subject lines also help the recipi-ent quickly discern what the e-mail is about andprioritize the message.

Avoid Sending SensitiveInformation via E-mailAlthough e-mails may be deleted, they can al-ways be retrieved, especially in a business situa-tion. Most organizations run backup programsthat can restore deleted information, which meansthat the message you or your intended recipientdeleted can be restored at a later date, potentiallyrevealing sensitive information (eg, username,password) to someone you may not want to haveit. Also, use caution when sending personal mes-sages via a business e-mail address (eg, an unflat-tering e-mail about a coworker) because youre-mail could be forwarded to others. It is impor-tant to craft your message carefully and rereadyour e-mail before sending it with the understand-ing that it could be viewed by multiple people.

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With this in mind, try not to forward another per-son’s e-mail without his or her permission.

Avoid Overusing the “Reply All” FeatureIf you need to have a back-and-forth conversationwith someone via e-mail about a specific subject,it is best to do so with just the one person with-out copying everyone on the original e-mail. Ifyou believe the resolution of your discussion isimportant for the group to know, then send theresolution to the group members but leave themout of the debate unless their viewpoints areessential.

Use the Out-of-Office AssistantIf you are going to be away from e-mail for morethan a day or two (eg, on vacation), you shouldset up your out-of-office assistant to let anyonetrying to contact you know that you are unavail-able and whom they should contact in your ab-sence. Following are instructions for setting up an

out-of-office message when using MicrosoftOutlook.

� Step 1: Select “Out of Office Assistant” fromthe Tools menu on the top navigation.

� Step 2: Select “Send Out of Office auto re-plies.” You can set the time frame for the re-sponses in one of two ways.� Type in a message for inside the organiza-

tion and one for outside the organization.When you select “OK,” your messages willbe sent immediately to anyone trying tocontact you. These replies will continueuntil you manually access the out of officeassistant again and switch the selection to“Do not send Out of Office auto-replies.”

� Select the box for “Only send during thistime range.” This allows you to customizethe delivery timing of the messages, auto-matically turning them on and off at prese-lected dates and times.

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� Step 3: Enter your out of office message. Youmay opt to have a different message for inter-nal versus external messages. Do not forget toinclude contact information for someonewithin your organization who could answerquestions in your absence. In some cases, youmay want to include your cell phone numberfor emergencies, but this will depend on yourpersonal preference for giving out thisinformation.

� Step 4: Select “OK” to confirm yourselections.

ELECTRONIC ETIQUETTEBEYOND E-MAILPresenting yourself professionally via e-mail is aneffective way to maintain your credibility andconvey important information to key parties.E-mail is not the only form of electronic commu-nication that should be handled with proper eti-quette, however.

Customize Your Voice Mail GreetingJust like e-mail, you will want to set up your tele-phone voice mail greeting to let callers knowwhen you will be away from the office for anextended period of time. This message shouldinclude the dates that you will be unavailable anda contact person, if possible, to address any ur-gent matters. There may be times when a profes-sional client or colleague calls your cell phone.For these situations, you will want to opt for aprofessional or, at the very least, appropriatevoice mail message.

Refrain From Having Loud ConversationsWhether you are talking on your cell phone orlandline telephone, you should always try to keepyour voice volume at a reasonable level. It is easyto forget that others can hear you when you are inthe midst of a telephone conversation; however,talking too loudly may be distracting to your co-workers and viewed as disrespectful to those

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around you. Additionally, personal conversations

may not be appropriate for all environments (eg,

the workplace). If you need to have a personal

conversation, ask the caller if you can call him or

her back at a more appropriate time or find a lo-

cation that is more private to discuss your per-

sonal information.

Avoid Texting During Other InteractionsWhen someone is talking to you, they expect to

have your full attention. By texting while the per-

son is talking—whether on the telephone or in

person—you are telling this person that what he

or she has to say is not important to you. Because

texting has become so common, people often read

and answer text messages without thinking. How-

ever, you should always do your best to show

your respect for the person you are speaking with

and refrain from texting during these interations.

Pay Attention to Signs That DiscourageCell Phone UseMany businesses have signs that indicate whereyou may or may not use your cell phone or othermobile device. These signs are intended to giveyou the autonomy to curtail your mobile deviceuse. If you ignore these requests, you are display-ing disrespect to the business owner and otherclientele.

CONCLUSIONThe advent of mobile technology has allowedusers to communicate virtually instantaneouslywith friends, colleagues, and loved ones. Keepingin mind the golden rule of treating others as youwould like to be treated can mean the differencebetween conveying a message that is understoodand meaningful or conveying a message that ismisunderstood and personally or professionallydamaging. Before you send an e-mail, answer a

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telephone call, text, or communicate via otherelectronic modes, consider how you want othersto receive your message. Following the tips sug-gested in this article could help you communicatemore effectively and avoid some commonnetiquette blunders.

Editor’s note: Android and Gmail are trademarksof Google, Inc, Mountain View, CA. iPhone is atrademark of Apple, Inc, Cuppertino, CA. Outlookis a registered trademark of Microsoft Corp, Red-mond, WA. Dropbox is a trademark of Dropbox,inc, San Francisco, CA. Facebook is a registeredtrademark of Facebook, Inc, Palo Alto, CA.Publication of this article does not imply AORNendorsement of specific products or services.

References1. Brusco JM. Using smartphone applications in periopera-

tive practice. AORN J. 2010;92(5):503-508.

2. Brusco JM. Tablet and e-reader technology in healthcare and education. AORN J. 2011;93(6):775-781.

3. From apps to everyday situations: and Ericsson con-sumer insight summary. Ericsson.com. http://www.ericsson.com/res/docs/2011/silicon_valley_brochure_letter.pdf. Accessed June 10, 2011.

4. What is the cloud? Novell. http://www.novell.com/cloud/faq.html. Accessed June 10, 2011.

5. Brusco JM. Implementing safe computer practices.AORN J. 2011;93(2):276-281.

6. Etiquette. Merriam-Webster’s Learning Dictionary.http://www.learnersdictionary.com/search/etiquette. Ac-cessed June 10, 2011.

Jennifer M. Brusco, BS, CNA, is an editor atAORN, Inc, Denver, CO. Ms Brusco has nodeclared affiliation that could be perceived asposing a potential conflict of interest in thepublication of this article.

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