Once again, and for the fifth year in a row, the Gallup poll has reported that nursing is the most trusted profession in the United States. As nurses with more than twenty-five years of experience—and hence, a deep collective memory—our conversations about the problems the profession faces circle around a persistent theme: how do people perceive us, and how can that perception be translated into better working conditions, respect on the job, and improved patient care?
Despite some improvements, most bedside nurses still have working conditions that include physically demanding and long hours, mandatory holiday and weekend work, understaffing, disrespectful treatment by other members of the healthcare team without consequence or administrative support, and such blue collar conditions as the inability to control breaks and mealtimes, make a phone call, or sit down to eat a meal without the pressure to return to work as fast as possible. Nursing schools struggle to stay open with tuition pressures, lack of faculty, and diminutive endowments compared to medical schools. But the public loves us.
In 2009 the journal Nursing Economics published a survey examining public perceptions of nursing compared to other occupations and factors (including media) influencing these attitudes. The single biggest influence on public perceptions about nursing was “personal experiences with nurses as a patient or family member.” The study found that nurses were highly valued professionals. Indeed, the public describes nurses as “caring” but also as “overworked,” yet the vast majority of respondents reported that they would recommend nursing to young people thinking about a career. Interestingly, 66 percent reported that negative media images of nurses on television did not influence their opinion of the value of nursing but that news programs showing nurses helping in disasters increased their respect.
The same study found that healthcare professionals (the doctors and nurses who know the work nurses do and the conditions in which they do it) were significantly less likely than the general public to recommend careers in nursing, citing work environment and lack of respect as key reasons.
We have put in years at the bedside. Bedside nursing typically involves a twelve-hour shift caring for five to seven critically ill patients who rely on their nurse to be well educated, calm, caring, and able to discern and respond to changes in their condition. When you are a novice, it is easy to overlook working conditions because nursing is rewarding; it is nice to feel needed. As one matures and shakes off codependent habits, nurses look around and notice that they need more help. It’s a great career with potential for advancement and diverse role opportunities (including advanced practice, bedside nursing, community health, teaching, and research), but it isn’t for the faint of heart.
It has been well established that nurses are key players in health care reform and in the safety of patients in health care settings. A 2009 study published in Health Affairs projects an alarming crisis by 2025, when the shortage of nurses will grow to 260,000 registered nurses. This deficit will be twice as large as any nursing shortage in the U.S. since the 1960s, occurring just as 7,000 U.S. citizens will be turning 65 every day. This dynamic shift in demographics is a major factor contributing to the impending nursing shortage. At the same time, however, it creates new opportunities for individuals seeking a dynamic career that improves healthcare access, quality, and safety. As mothers whose children have not followed us into nursing, we can only speculate that maybe we were too tired, worked too many hours, missed too many soccer games, or complained too much to inspire them to join us. Another possibility, at least for our sons, is that they are not particularly interested in entering a profession that is dominated by white (79 percent), middle-aged (average age is 44) women (91 percent).
Lack of respect on the job may be a problem that exists for other white, middle-aged women in the workforce, but nursing seems to have unique image problems. Media portrayals of nursing have typically been within four major archetypes: the virtuous and selfless ministering angel exemplified by the Johnson & Johnson television campaign “We Dare to Care”; the doctor’s handmaiden, dutifully taking orders and enjoying the Cherry Ames sidekick role; the dangerous and unfeeling nurse made famous by Nurse Ratched in One Flew Over the Cuckoo’s Nest; and finally the naughty, sexy nurse, exemplified by “Hotlips” Houlihan and conspicuous at Halloween if you peruse the Party City costume aisle.
Linda McCauley, dean of the nursing school at Emory University, sees the image problem as “not directed solely to our profession, but directed towards women. Unfortunately our society still has a long way to go in respecting women.” And the chief nursing officer at Emory Healthcare, Susan Grant, concurs. She points out that there is an image problem for male nurses as well. She explains, “When it comes to the individual considering nursing as an occupation, the media has subtle and not-so-subtle effects. The media portrays most nurses as women (generally white), which indicates that most nurses are not men. . . . People are influenced by what they see and also by what they don’t see. What people don’t see in the media causes them to come to their own conclusions.” The few contemporary images of male nurses are cartoonish. Consider Ben Stiller as Greg Focker, the bumbling and emasculated nurse in Meet the Parents, or the sexy, gay nurse Mo-Mo on Showtime’s Nurse Jackie.
Missing from media portrayals are images of nurses influencing critical patient care decisions as members of collaborative healthcare teams. Does Dr. House practice in a hospital that even employs nurses? Does Nurse Jackie, with her questionable code of ethics, trust that she can involve her physician colleagues collaboratively in her “heroic” attempts to save lives and render justice in the ER?
Nursing is now challenged to respond quickly to address the social changes shaping health care delivery. The 2010 Institute of Medicine report on the future of nursing concludes that nurses will play a key role in transforming health care delivery. To attract the type of individual who will contribute to such a transformation, the profession needs improved images of nurses. The right images could go a long way toward educating the public about the rigorous preparation nurses undertake to understand and work within complex systems. Real contemporary nurses have leadership, scholarship, and management skills that enable them to contribute innovative solutions that improve the care of patients within the community and hospital setting.
The university, as the setting for public scholarship, has a responsibility to insist that nurses are included in conversations about health care and reform. Nurses are the largest group of workers in health care, and as business and medicine are called on to heal our failing system, it behooves us as scientists and intellectuals to resist the notion that a fix can be achieved without including nurses in the conversation. Policy wonks can scratch their heads, but if nurses tire of being overlooked, underpaid, and ignored, no one is going to show up to do the work.
The future of nursing demands that we attract intelligent, compassionate individuals who perceive nursing as a satisfying, lifelong career. Outdated images need to change to ensure the health and safety of the public in the twenty-first century. We speculate that this will not only improve working conditions for all healthcare workers, but will attract men, minorities and those contemplating nursing as a second career to join us in improving health care within and beyond our nation.