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.
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.