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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.

Read more

Does nursing’s media image matter? 

*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 (11)

  • It seems that is the way we are often viewed, not only by the public, but also - sadly - by our managers and so called leadership. (Just look at the constant cost cutting measures with the erroneous view that they can replace qualified Staff Nurses with HCA's without the same level of education or qualification)!

    I say lets call their bluff. Let them replace every qualified Staff Nurse with untrained and uneducated 'apes', and see how soon the NHS crumbles and mortality rates sky rocket.

    Seriously though there is a huge point here. In any piece of news or story concerning the NHS or care given to anyone, the care and expertise that is often solely given by Staff Nurses is attributed to Doctors. This is wrong.

    If the public were aware of how little Doctors actually have to do with the day to day care and treatment and how much Nurses actually do, the public perception of us would be very very different.

    'Celeb' Doctors are often wheeled in as talking heads on everything from news items and topical debate programmes when Nurses are just as qualified, if not more so in some cases to offer educated opinions and facts. Simply because Doctors are seen as the sole authority on all health matters whilst Nurses are simply 'helpful carers'. This needs to change.

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  • It does feel that way, when your at work as a nurse, or when your out telling people your a nurse....there's little respect....I have said to myself it doesn't matter...as long as you respect yourself...but this didn't really work for me...
    I've been nursing 13 yrs and was even a clinical nurse specialist....you'd think i'd feel more respected or better with this 'specialist' title...and it was nice but didn't make any difference to anything...I got an extra pound an hour aswell for my promotion too. Also, nobody had a clue what I was, drs didn't really care, neither did anyone else...
    It is such a shame and something drastically needs to happen......viscious cycle...society has been conditioned to view certain jobs a certain way.......being a nurse can be easy in some respect...like you don't need many braincells to know how to wash someone & we can prob get away with knowing a certain amount of knowledge but then we have to know the other extreme of saving peoples lives etc...and need a wealth of knowledge. I remember the outreach nurses teaching the doctors and it was quite scary how little thedrs knew.....
    I have done the drastic...(and have enjoyed nursing to a point), but have now left completely and feel a huge relief...internet business now!! Bit different!!
    I think the public can never really see what we are doing or understand how we are "monitoring' the pts at all times...even if we are talikng to them.
    Some of the stuff we do is high tech and I hope one day this respect will change. Wither way a care assistant to a top qualified nurse...we should all be respected as equals.
    Sometimes it takes things to unfortunately hit rock bottom, when it will hit enough leverage to have to change. When SHOULDS will have to change to MUSTS.

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  • It is all sadly true and well observed, and we can guarantee it is a position physicians will want to keep - why wouldn't they?

    We have to remember that Greys Anatomy, ER and House are not documentaries, and frequently don't really promote physicians in the real world.

    I believe the divisions in nursing don't help in a number of ways. There should also be more research opportunities within nursing. Some of the students should be of higher calibre.... The NMC should be more vocal in promoting nursing.... Perhaps nurses need to be contacting local TV or Newspapers themselves, no one is going to do it for us.

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  • Exactly Anonymous | 26-Sep-2010 2:41 pm, the apathy and infighting within Nursing is shocking. To give you a prime example (as if you need one), there are constant debates on NT about staffing levels, about the dangers management/government are putting patients in, the stress they are putting staff under, etc. This is well known, everyone from the staff Nurse to the Prime Minister knows it is true, yet noone cares, noone does anything, and the vast majority of Nurses simply bend over and take the status quo. Yet contrast that with a piece I read in the papers today about the hallowed Doctors finding themselves short staffed because of cuts, well the GMC was up in arms, saying that they would not allow their members to work on understaffed wards in the name of patient safety, A&E units would be shut down! The paper was up in arms, saying that it was a damnable outrage! The government should sort this out now!

    The difference a strong union and a strong professional unity makes eh?

    That is one of the main differences in the publics perception of Nurses and Doctors; when a Doctor says something, the public listen and treat it seriously, when a Nurse says the same thing, noone listens.

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  • There is no doubt that when things go wrong as they did in Stafford to name but one, the doctors will change their tack and deny their involvement laying the blame squarely at the nurses, they were the ones responsible for not caring for the patients! Nurses will rarely win! Do we fight back? No!
    I am close to the winning post in respect of my degree. It has not come easy and I have had to educate myself in the large part. There are times when I feel that I am wasting my time in progressing myself but I have done it ensure the quality of care I give is the best I can offer for my patients and for ME, I am still proud to be a nurse!

    I regularly have to offer advise to local doctors, they call our service for advice, and even request that we train them!

    Then with TCS around the corner and posts being conjoined with neighbouring Trusts and when you find out that your counterpart in the Trust you are expected to amalgamate with, has nurses on band 7 working at a lower level and are a lot less productive than you are doing, working as a band 5, then you realise how undervalued you really are!

    I believe this is down to senior nurses who have moved into managerial positions (looking after themselves) who have let this happen.

    Until recently the progression to higher grading used to happen by rite and years of service rather than ability, those in charge having been regraded in the same way. It used to be a formality to be interviewed, we always knew who would be upgraded before the interviews! In these circumstances progression did not necessarily mean you had to be educated to a higher level academically or in practice.

    Now they are in charge and rarely show they are capable in the job they are expected to do, with many staff, including doctors, observing this fact and referring to band 5 nurses for help and management decisions while the managers have their coffee! Now I wonder how many of us have suggested apes could do their jobs?

    For years nurses have sold their own colleagues down the river in this way, is it any wonder we are not respected?

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  • Marjorie Lloyd

    This is so sad but I really think we are are our own worst enemy and we should stop complaining and start doing something about it.

    Instead of complaining about degree level nursing embrace it and use it

    Instead of complaining about lack of direction take control and lead

    Instead of complaining about lack of resources do the best you can with what you have got

    Instead of blaming other people improve yourself

    Instead of being the victim become the victor

    Nurses do a lot of good work out there but we never hear about it. We must make our voices heard or as a profession we will die

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  • Anonymous you come across as a bitter person who has been passed over for propmotion. I feel sad for you if you work in an environment of cronyism but it is not like that everywhere and we dont all sit about and drink coffee. You say that nurses sell their colleagues down the river and it is no wonder we do not get respect whilst insinuating that monkeys could do the work of your senior nurses. You need to look up the word "ironic" in the dictionary. It is the lack of respect that you and others show for your colleagues that make nursing a fragmented profession and therefore an easy target for cuts etc. Instead of whinging about others why not make positive comments?

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  • So the media portray nurses as being a little dumb? You call this news?! This sort of stereotyping has been around for decades, along with the sexy nurse images.

    Unless, of course you work in mental health like myself. Mental health nurses don't get a good press either. Look at the nurses in One Flew Over The Cuckoo's Nest, High Anxiety etc. Even real life mental health patients vilify staff nurses who try to help them, even preferring social workers to RMNs. In the 10yrs I've been on the wards I've been hit, punched, kicked, verbally assaulted and the like all by patients who have no respect for nurses. Do the patients treat other members of the team that way? No chance!! All pretty tame in front of the doctors, social workers, OTs, and the like, not even the cleaners get hassled, just the nursing staff. Patients tend to complain that nurses only become nurses as we're "too stupid to do anything else", never mind that nurses like me have been university educated and have more than one degree.

    Maybe the media is partly to blame. But such shows are for entertaining purposes. Are we really expected to believe that these shows reflect reality? How often do we see medical doctors so dedicated to the lives of a few patients that they never seem to leave their side until "they are over the worst"? You'd need to be very naive to fall for that!

    And to suggest that nursing and prostitution have similar traits?! Is that coming from personal experience?? Takes me back to my student days and being given the rules on uniform. We were told no jewelery was to be worn on shifts, including anklets as that could be seen as a sign of prostitution! And I thought my father had some old fashioned views!!

    Views on nursing outside the profession are largely based on ignorance. I have people scoff or give me pathetic looks when I tell them what I do, including qualified teachers. I have been looking for a new post out with nursing for some time and it's proving difficult. I suspect the "nurse" title may be partly to blame as posts in mental health tend to ask for an nvq level 3 qualification in social care. And I think replying with degree in mental health nursing and working as RMN along with job responsibilities throws people into confusion. Of course I may be wrong.

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  • Anonymous | 27-Sep-2010 4:58 pm, we know these shows are for entertainment, but television shows made for entertainment DO influence public thinking, just look at the moronic reality TV out there and the effect that has.

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  • I stopped watching this sort of nonsense after seeing the awful 'Angels'. Also cannot stand Casualty, Holby, Midwife or anything else of that ilk.

    They're just daft soap operas. It's not good for your head or your morale and it's got as much to do with nursing as D Kildare had with medicine.

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  • Isn't this image our own fault for allowing skilled nursing work and nursing jobs to be replaced by HCAs?

    No wonder people are surprised to hear we have degrees!

    Now we need to work on the sexual stereotypes..

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