The image of nursing: The unskilled nurse
In the third of our series of blogs on the image of nursing, Sandy and Harry Summers ask whether an ape could do your job.
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
From 2003 to 2005, the role of a private duty nurse on the popular US daytime drama Passions was played by an orangutan. The character, Precious, actually wore a nursing uniform. Fortunately, her work did not prevent her from enjoying handsome Latino men, gin and tonics, and food fights.
Yes, that was a campy soap opera, but it reflects a powerful and enduring element of the modern nursing image. In the 1990s, representatives of a California hospital group told union negotiators that nursing was so simple that the union’s nurses could be replaced with monkeys. Today, this pillow-fluffing vision of the profession lives on worldwide, including in some of the recent resistance to proposals to raise the minimum educational requirement for nurses in the UK.
Sometimes the media manages to convey something useful about nursing skill. For example, in January 2008, the Manchester Evening News (UK) reported that nurses at Stepping Hill Hospital had shown that using a particular skin wash greatly reduced the risk of developing the virulent staph infection MRSA from devices like intravenous catheters. And in November 2006 the New Zealand Herald relied mainly on the expertise of nurse educator Shona Tolley in discussing efforts to address diabetes among indigenous peoples.
Occasionally, nursing skill even appears on television. The main character in Nurse Jackie, which will return for a third season in 2011, is a formidable clinical expert who advocates strongly for her patients. Even ER, the physician-centric drama that ended its long run in 2009, at times displayed skill and even life-saving by its lone major nurse character.
But most recent media portrayals fail to convey that nurses are university-educated professionals who save lives. Instead, they present physicians as the sole masters of health knowledge and the only important staff in hospitals, even though hospitals exist mainly to provide nursing care.
Contempt for nursing is common on television. In an October 2009 episode of Grey’s Anatomy, after senior surgeon Derek Shepherd asks female resident Lexie Grey to monitor his own health during a marathon surgery, a male resident mocks Lexie by urging her to “have fun playing nurse.”
In a November 2006 House episode, when a patient’s eleven-year-old sister offers to help a physician take a sample of spinal fluid, the physician agrees, noting that it’s “quicker than calling a nurse.” The physician instructs the girl to hold her brother’s legs still, and she asks, “Is this all nurses do?” The physician responds, with a wry smile, “My boss [House] doesn’t trust ‘em to do anything else.”
Yet ironically, these shows’ physician characters spend significant time providing skilled care in which nurses would take the lead in real life, like triage, medication administration, defibrillation, and psychosocial care. A November 2009 Grey’s Anatomy episode portrayed kangaroo care (the nurse-led practice of keeping the infant skin-to-skin on the parent’s chest for certain periods) but no nurses were involved. Instead, one surgeon initiated the care, and another actually did the kangaroo care himself.
In a May 2007 ER episode, a plotline about the care of a physicist with septic shock featured relentless physician nursing. Physicians provided all skilled care in the patient’s transfer from the surgical ward to the ICU and in resuscitating the patient when she crashed on arrival at the ICU.
Many news accounts ignore nursing or assign credit for nurses’ work to physicians, “hospitals”, machines or fate. This happens even when nursing actually plays a central role in the relevant topic, such as preventing hospital errors or responding to mass casualty events.
In September 2005, a widely run Associated Press report portrayed physicians as having done everything of note for patients at New Orleans hospitals after Hurricane Katrina. The Yahoo! headline was typical: “Doctors Emerging as Heroes of Katrina.”
In May 2007, a New York Times article about New Jersey Governor Jon Corzine’s recovery from a serious traffic accident suggested that physicians provided virtually all of Corzine’s bedside care. But he spent eleven days in the ICU, where nurses take the lead 24/7, monitoring patients for the slightest changes in condition and managing a complex regimen of treatments.
Later that same month, the US Department of Transportation sponsored a public service announcement (PSA) featuring Governor Corzine urging television viewers to use seat belts. Corzine credited “a remarkable team of doctors and a series of miracles” with saving his life.
Nurses are rarely recognized as health experts or important scholars. Of course, nurses may get credit for an isolated save outside their usual workplaces, such as in April 2007 pieces in the Globe and Mail and the Toronto Star reporting that a Canadian pediatric nurse had saved a heart attack victim at a hockey game. That’s news partly because it’s a shock.
Other press items suggest that any helpful person or piece of health technology is a “nurse”. In January 2007, the Scotsman ran “Robot Nurses Could Be on the Wards in Three Years, Say Scientists,” about efforts to develop machines to “perform basic tasks” like cleaning up spills. The report even offered catchy alternative names, such as “nursebots.”
In March 2006 the news magazine Der Spiegel published a piece about a new German government program to train prostitutes to become “care workers for the elderly,” including “nurses.” The article had lots of quips comparing the trainees’ old and new roles.
In fact, a number of press reports in recent years seem to suggest that solutions to the global nursing shortage lie in recruiting those with few other options, like desperate nurses from poor nations or foreign physicians who can’t pass their physician licensing exams.
Excellent nurses may come from any background (except a factory). But the sense we get from many of these media items is that these are good options because, after all, being a “nurse” requires little critical thinking, knowledge, or skill.
We’re still waiting for the reports about breakthroughs in robot journalists and robot TV producers.
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.