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OPINION

The image of nursing: Everyone's responsibility

In the next in our series of blogs on the image of nursing, Sandy and Harry Summers explain the steps that everyone can take to change the image of nursing for the better.

In recent months, we have outlined the major stereotypes that plague the nursing image and undermine nurses’ claims to adequate respect and resources. Poor public understanding of the profession underlies many of the more immediate causes of the global nursing shortage.

Nurses themselves must play the leading role in improving their image, as we will discuss in detail in our final piece, to be published soon. Nurses must believe in themselves and project that belief to others. Nurses should persuade the media to provide a more accurate picture of the profession, and they should try to create new media themselves.

But first, we will explore what everyone - not just nurses - can do to help. Many segments of society can influence both media portrayals of nursing and people’s understanding of nursing generally. We can all listen to nurses and watch what actually happens when we interact with the healthcare system. What are the real nurses doing? Does the media we see reflect that?

Everyone should reconsider her assumptions when it comes to nursing. Do we credit physicians for things nurses really do? If a nurse does something impressive, do we say, “You could be a doctor!” - suggesting that being a nurse is inferior?

We can also consider whether our choice of language reflects the real nursing role, because language has a profound effect on how we think and act. For example, using the word “nursing” to mean breastfeeding subtly suggests that nursing is something we can do without health education, and that only women can be nurses. Likewise, might terms like “matron” and “ward sister” reinforce unhelpful gender stereotypes about nurses? And nurses don’t take “orders” from physicians. If nurses disagree with a physician’s prescription or care plan, they are ethically obligated to work for a better one - which is not something a person who just “takes orders” generally does.

Some parts of society have special influence. The news media can learn from nurses about what nurses really do. And reporters should consult nurses about all healthcare stories, not just nursing stories - though even many nursing stories include no nurse input, as we have seen. Nurses make great expert sources because they are trained to convey their knowledge to lay people.

Creators of entertainment media should include characters to reflect the nurses who actually play central roles in the compelling healthcare that such media often shows physicians providing. Television shows like Nurse Jackie are a great start. But it would take decades of popular programming to counteract the image of nurses as peripheral subordinates (“Yes, doctor! Right away, doctor!”) that shows like House and Grey’s Anatomy have spread around the world.

Advertisers should consider the effects of nursing stereotypes and try to find alternative ways to sell their products. For example, in advertising products like alcohol, naughty nurse imagery is not technically required. Some companies, from Heineken to Cadbury-Schweppes, have been flexible in reconsidering specific ad campaigns.

Healthcare providers and executives should ensure that their public speech reflects understanding of nursing. Hospital managers might promote nursing as they do medicine, and publicise their efforts to strengthen the profession. And insurers and drug companies can advertise without wrongly suggesting that healthcare revolves solely around “doctors”, particularly given the growing role of advanced practice nurses.

Consider Médecins Sans Frontières (Doctors Without Borders). More nurses than physicians work for this international aid group, and nurses have played leadership roles in the group. Yet its name sends the public the message that the physicians provide most or all of its healthcare. We have urged MSF to consider a more inclusive name, such as Soins Sans Frontières (Healthcare Without Borders).

Government leaders and other policy makers should publicise their efforts to invest in nurses’ practice, education, research, and residencies, and place qualified nurses in visible positions of authority. Earlier this month, Nursing Times started a petition to ensure that at least one nurse sits on the board of each of the consortia that shape decision-making about the NHS. Such commendable inclusion is too rare. In 2007, Google created a Health Advisory Council with 25 members, and though many were physicians, not a single member appeared to be a nurse.

Foundations should undertake projects to build public appreciation for nursing. We have urged funders to consider an International Museum of Modern Nursing - an exciting, interactive science museum that would show visitors cutting-edge nursing practice and research. And in a 2006 opinion piece in the Baltimore Sun, Sandy and nursing scholar Kristine Gebbie proposed the creation of a Nobel Prize in Nursing to recognise nurses whose work has changed the world.

Nurses’ healthcare colleagues can also play a key role. Physicians should learn what nurses really do - for instance, that nurses do more than provide basic custodial care. In some innovative programs, medical students shadow nurses to learn what they do, or medical and nursing students take some classes together. And physicians should work to stop the crediting of physicians for nurses’ work, which happens everywhere from the hospital bedside to popular television shows.

Other health workers should ensure that they are not mistaken for nurses, which undermines the public’s sense of who nurses are. We admire the recent decision of Wales to adopt national nursing uniforms to help people identify nurses with different specialties and levels of authority.

What would the future look like if the public truly valued nursing? Understanding that nurses save lives can itself save lives - by providing the resources nurses need. Adequate resources for clinical settings are only the beginning. Through their holistic, preventative focus, nurses can intervene before conditions become severe, so patients don’t end up dead or in expensive hospitals. Teams of community health nurses and advanced practice nurses can prevent or manage much of the illness the world now suffers. Malaria might kill fewer children, obesity-related problems like heart disease could be greatly reduced, and many critically ill infants might be home with their families.

It can happen - if everyone makes an effort to understand what nursing really is.

Readers' comments (3)

  • I'm afraid that nurses are their worst own enemies when it comes to projecting a positive image to the public. The main problem is that we have lost the essential need to demonstrate COMPASSION to those that we "care" for! So often nursing actions are carried out with the neccesary technical competence yet without use of communication skills that show empathy and understanding of the human situation of the patient. It is this which is remembered by patients & their families and which gives lasting impressions of the profession. PS you say that nurses do more than merely provide "basic custodial care" - you obviously have not had the misfortune to be a patient in an acute psychiatric ward recently!

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  • I can see both sides of the arguement here. Firstly though, What nursing shortage? Out of the 278 student nurses who qualified last year only 6 were offered jobs. There were none to be had. It is the same in the other three hospitals in this county, and the twelve in the county next to us. There is an abundance of nurses out there.
    In these difficult times it is difficult for nurses to want to portray any image that is good because we are being screwed over financially and physically we are attacked by patients who see as as no threat because we are nurses. I have been in the profession 20 years and I have always done my best to behave according to the NMC guidelines, whether I am at work, or outside in civvys. I do not have a degree, but I can recognize when a patient is in pain, discomfort or upset. I can also use all my skills developed over the years as a nurse to be able to comfort that patient. Now I am starting to wonder why I bother. We get no recognition still, and degree students come through saying they are far to important to change a bed. We need nurses to do basic care as part of their job, but it is people in higher authority who give them ideas that patients should care for themselves and not get their hands dirty that make it more difficult for the actual nurse who would like to care for the patients as a nurse should. And just for your information doctors have always known what the nurses role is, and they respect it. It is articles like this that bring the profession into direpute because the authors are living in a pretty bubble

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  • I agree with the essence of the article but easier to say and harder to do. Nursing/es in the UK are quite fragmented and I don't think the 'branches' system of training helps. I have often wondered whether the fragmentation is by design to prevent power.

    I don't agree with anonymous 18/1 2.37 that doctors have always known what nurses roles are - they don't, particularly when nurses move away from the ward area, but that is not to say that many medical colleagues have respect for nurses, of course, some don't.

    We all should do our bit to try to present the profession as we know it is.

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