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The image of nursing: A culture of respect

In the first of our series of blogs on the image of nursing, Sandy and Harry Summers look at the portrayal of nurses in the media and the effects of these negative stereotypes.

About the author

This article was written by Sandy and Harry Summers Authors of Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk.

In recent months, nurses from Paris to Philadelphia have protested strongly about poor working conditions and insufficient respect. But there have also been troubling reports of nursing errors and patient neglect, including in the UK.

In response to these problems, some have pointed to the culture of nursing. These critics claim that nurses today have become “too posh to wash”, that they have forgotten their proper roles as devoted angels, physicians* helpers, and bedpan engineers. Instead, these brazen nurses seek more university degrees, respect for their technical skills, and an expanded scope of practice.

‘The care of graduate-prepared advanced practice nurses is at least as effective as the care of physicians’

Compassion and diligence are essential in nursing. But nurses also save lives by monitoring patient conditions, intervening with cutting-edge technology, advocating for patients and teaching them to manage their health. With more training, nurses can do even more. Research shows that the care of graduate-prepared advanced practice nurses is at least as effective as the care of physicians.

In many places under-staffing, resource shortages and abuse undermine nursing practice. The global nursing shortage is a public health crisis. Burned-out nurses have fled the bedside and many wealthy nations have rushed to recruit foreign nurses, crippling already weakened health systems overseas.

Too many nurses today are asked to do a harder job with fewer resources. And research shows that poor nurse staffing is taking lives. A study published earlier this year by nursing scholar Linda Aiken and her colleagues showed that the lives of hundreds of surgical patients might have been saved if hospitals in the US states of Pennsylvania and New Jersey had the minimum nurse-to-patient staffing ratios that have been required in California since 2004.

Many of the immediate causes of the nursing crisis have their roots in undervaluation of the profession, which is driven by stereotypes. As the reactions to recent problems show, many people still have no idea that nurses are autonomous professionals with advanced skills. Instead, much of the public continues to believe that the profession is defined by one-dimensional feminine extremes, from the handmaiden to the angel to the harlot.

Some of these images have been present in one way or another since Florence Nightingale and other reformers founded the modern nursing profession in the 19th Century. But today, the mass media plays a key role in forming and reinforcing these popular attitudes. Indeed, research confirms that even television dramas affect the public’s views and decisions about healthcare.

In a 2008 study, nursing scholars at Dundee University found that television images of nurses as “brainless, sex mad bimbos” were discouraging academically advanced primary school students from pursuing the profession. Similarly, a 2000 study of US school children by JWT Communications found that students got their main impression of nursing from the television drama ER. Those survey respondents considered nursing a technical job for girls, rather than a profession worthy of private school students.

Sometimes the public gets a good look at what nurses really do. For example, a BBC report earlier this year described a “composer in residence” programme at the Florence Nightingale School of Nursing and Midwifery at King’s College that aimed to use music to improve patient outcomes. The Royal College of Nursing engages in spirited public health advocacy. And the new television show Nurse Jackie features a nurse who, despite some ethical issues, is an authoritative clinical virtuoso.

But far more often, what the public sees in the media confirms harmful stereotypes about nursing. The television dramas House and Grey’s Anatomy will soon begin airing their seventh seasons in the US. Together, these globally popular shows have about 20 major physician characters, but not a single nurse.

The physician characters on such shows do many exciting things that nurses do in real life, from defibrillation to patient teaching to psychosocial care. The few nurses who appear are meek subordinates who rarely speak. Sometimes the smart, attractive physicians mock nurses. Doctor Greg House, the godlike diagnostician, once joked that he had “invented” nurses to clean up the mess. And Meredith Grey reacted this way to an insult by a male colleague: “Did you just call me a nurse?!”

The news media often ignores nurses’ real contributions to modern healthcare. Usually, elite press entities consult only physicians as health experts, even about topics that nurses know at least as well, such as preventative health, end of life care and hospital errors.

And modern advertising still relies heavily on regressive imagery, presenting nurses as deferential helpers or sex objects. Earlier this year, a West Midlands bus company used a large naughty nurse ad, with the tag line “Ooooh matron!”, to promote its route to the hospital.

In this series of articles, we will explore some of the most important issues related to the media image of nursing. First, we’ll examine some of the evidence showing that media portrayals of nursing - even fictional or “joking” ones -really do affect what decision-makers and the public think of the profession, and therefore affect the respect and resources the profession receives.

Then we’ll discuss the major stereotypes that continue to plague the profession in the global media: the unskilled nurse; the physician’s handmaiden; the naughty nurse; the nurse as a female trapped in a job that modern women have left behind; the angel; the battle-axe; and the advanced practice nurse as an inferior physician substitute.

Finally, we’ll discuss how everyone, from government and private sector leaders to those who create influential media, can improve the public image of nursing. As we will see, nurses themselves must take the lead in raising awareness of what they do for patients. We’ll explore ideas for nurses that include reconsidering how they interact with those around them, working with media creators to improve portrayals and encouraging nurses to create their own media.

Of course, specific instances of poor care should be addressed promptly. But in the long term, only an understanding of the true value of nursing will ensure that qualified, caring nurses are there to save us when we need them.

*Authors’ Note

We use the term “physician” because using the more common “doctor” to refer only to those who practice medicine wrongly implies that they deserve more respect than others.

Nurses and others earn doctoral degrees and make contributions to health and society that are just as valuable as contributions made by physicians. So the honorific should be available to everyone with that degree or to no one.

We also note that “physician” has been used in this way in texts ranging from Shakespeare to recent issues of the British Medical Journal.

Readers' comments (21)

  • rovergirl6@hotmail.com

    hello
    Nursing has lost respect because nurses are no longer proud of who they are and what they stand for, And it is not all their own fault. Society has changed beyond belief and behaviour of same has changed. we used to be proud to say we are nurses. We used to have the support of the management,in as much as we were taught how to behave as nurses. I have seen nurses walking in the street in uniform smoking ,not a beautiful site. We need to get back to the idea that nurses and Doctors are processionals,at present we have lost the plot.

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  • excellent article and sadly a true reflection of the public image of the profession. there are very many people, including other healthcare workers and the medical profession who have really no idea of the enormously diverse roles, skills, competencies and bodies of professional knowledge of nurses. unless they have recently been on the receiving end of nursing care, nor are they at all interested. other individuals are more able to talk about their jobs and fascinate people at social gatherings and doctors are also held in awe and high esteem but not nurses. usually admitting you a a nurse is a guaranteed conversation stopper. it is also true that as a profession we do not contribute much to presenting a public image which impresses like individuals in other high profile and often perceived as glamerous professions such as those in the commercial world.

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  • Just before I qualified I remember vividly a lecture we had which pointed out what was expected of us as nurses, this lecture, which was delivered by a male, never was talked about the importance of empathy, good communication skills, compassion, the desire to care but was all about the technical side of nursing, virtually making us believe we were now mini doctors, a colleague of mine, when the lecture finished, said to him all I want to do is nurse and care for people, he looked at her with disgust and told her that nursing was no longer about that and that she had better accept that fact. I wonder how many students start their nursing course and then drop out because the reality is so far from what they had expected, we do far more than our job description states, are paid a pittance, work in horrendous conditions and all we ask is for same amount of respect that every other healthcare professional seems to enjoy.

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  • I'm totally in agreement with Anonymous | 29-Aug-2010 2:43pm, finally an excellent article which indeed reflects the true reflection of the public image of the profession. It was a pleasure to read and encouraged me in my professional life, where I daily face these kinds of attitude. The more articles like this the better and why has this thought provoking article not been published in the popular press!

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  • Looking forward to reading the rest in the series.

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  • Nursing has changed over the last 20 years or so.Registered nurses have to be all things to all men in that we have not only have to take on some of the jobs that junior doctors used to do we are also swamped by paperwork.A registered nurse has to deal with all aspects of patient care whereas other healthcare professionals only deal with one aspect i.e physio,ot,dietician ect.Trusts are trying to do nursing on the cheap by employing so many agency staff and no new permanent staff to replace staff who have left or retired.We are expected to work with such low numbers of staff it's no wonder patients complain and despite our protests to management which fall on deaf ears.

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  • Grays Anatomy does have one nurse character. She gives one of the doctors syphillis.

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  • Sam, there's also the token black male nurse, let's not forget him!

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  • True. Thought the redhead did appear more often. And I think Doctor Webbers assistant used to be a nurse before she became his secretary...that transition has always kinda puzzled me.

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  • And yet there are still so many people on here who argue that these so called 'role models' on TV do no harm to the Nursing profession? (look at the other forums on this topic). Hmmmm!!!! The blindness of some people really does surprise me sometimes.

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  • 'Burnt out nursing fleeing the bedside' I think is just a tad rude. The problem is that it actually means a stress related illness often becomining PTSD. A clinical illness. Affecting not just retirees but younger nursing personnel too.
    My problem is with the endemic bullying and harrassment in nursing and the NHS generally, the above symptoms are related to that in many cases.
    While I think nursing has become technically more responsible the central message surely remains the same.
    We provide a massive service to the public and I think on the whole that is acknowledged by a sensible public if not always by the media.
    Other professionals don't seen to worry about there status all the time and seem
    comfortable in their skin. May be we should be using our therapeutic skills to educate the media, the public and ourselves on how we go about our work.

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  • Don't think Nurse Jackie is good role model either. Couldn't get passed the first F...
    word to watch it.

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  • To be fair Susan, a lot of othe professions - the rest of the public services for example - are on the whole respected not only by their peers but by the public, they are paid comparatively well compared to Nursing (although not well enough), and they do not have the problems with image that Nursing does. Everyone knows what a Firefighter does; they know what a Policeman or a Soldier does. Many people don't have a damn clue what Nurses do.

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  • As a student nurse I have to disagree with Sandra. Me and my friend are so proud to say we are student nurses and take every opportunity (asked or not) to tell people what we are training to do.
    The media dont give nurses the best image but us being known as 'sexy naughty nurses' well I say, so what!The uniform is less than flattering, I think people thinking the job is sexy is rather amusing!

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  • Anonymous | 5-Sep-2010 3:34 pm, I do disagree with Sandra but I see her point, and I think you are missing the point slightly yourself.

    Yes we have all had that proud feeling of doing the job, we were all students once. Can I ask you though when you tell all and sundry that you are being a Nurse do you get any of these responses:

    Why are you JUST a nurse? Did you not want to be a doctor?

    So you just want to wipe arses for a living, why?

    Oh that's not a job I'd do!

    You have a degree/A levels (insert any previous quals here), why are you going for Nursing, you don't need any qualifications for that?

    Ooh a Nurse, do you have a uniform? (usually women)

    Oh a Nurse, are you a bit 'you know'? (for the men).


    Etc etc etc etc.

    I agree that the image of the 'sexy Nurse' doesn't bother me much, (even though it doesn't directly apply to me as a guy, I do kind of resent the gay assumption though). But when the ONLY image of Nursing comes from this stereotype or one or two other equally negative stereotypes, then that causes a huge problem for our profession. I'll use Firemen as an example, they too have the 'sexy fireman' stereotype, but they also have a very strong, positive public image that overides that and ensures society do not judge them on that alone. Nurses do not have that.

    And that is the problem. We do not have a strong, positive image. We cannot be taken seriously as professionals, we are not paid the salary we are worth, etc etc etc, and part of that is due to our public image. More importantly however, patients do not know exactly what we can do for them they do not know the level of education that informs our practice or what services are available for them. They assume that we are still simple Doctors handmaidens so do not come to us for help or dismiss our advice. It is all part of the same problem.

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  • Mike, while I can see your point of view that the public as a whole may not understand the role of nurses and the fact that we are professionals in our own right, if you asked the majority of patients who we look after on a daily basis, many of them will tell you that they fully understand the professionalism of nurses and given a choice would far rather speak to/be cared for by a nurse than a doctor (no offence meant to any doctors as I feel that the majority of doctors, junior at least, have equal amount of pressure and poor working environments).

    Many of my patients have upmost respect for nurses as they see the daily pressures put on nursing staff and the amount of work that we have to do and despite the fact that their care is suffering due to the lack of nursing staff available to assist them, they do not complain or undervalue the attempts made by the nursing staff who are available, to provide the best possible care that we can! This is the only reason I have stayed in Nursing as long as I have as the value and appreciation given to me by my patients goes some way to making up for the undervalue and lack of appreciation from management and our own government!

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  • NURSING IS SUCKS - ITS ALSO A RACIST PROFESSION

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  • Flora Trigg, I see what you are saying and I agree to a small extent, but I don't think it is wholly true.

    If anyone is still reading these threads, just look at the current vitriole aimed against Nurses in the pages of the popular press and by patients rights groups, (there are echoes of this debate in the threads about the comments made about tabard wearing) there is extremely little or zero understanding of our roles, and certainly zero respect by the majority it would seem.

    No, public perception of our role is vital to our profession, and for too long we have allowed it to disintegrate to the point where now the powers that be (the government and the trusts) as well as the general public, have very little respect, understanding or gratitude for the job we do and it is about time that we stood up as a profession and argued our case. We should strike for the many reasons outlined in other threads, and at the same time make it clear to all and sundry that we are highly educated and qualified, highly skilled professionals, and our absence in striking might just instil some respect and gratitude for what we do when the general public have to do without us.

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  • this excellent article or a new updated one should go to the national press for everybody to read so that the public gain a little insight and understanding of what nurses really do.

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  • I should add to my comment above, in the light of so many damning articles in the press this last week triggered by the public's reaction to the wearing of tabards to enhance drug round safety, the public may only read and interpret what they wish to and some may sadly pass over this one giving preference to those on what seems to be the current trend and pastime of nurse bashing!

    People will only see what they want to see.

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