Dichotomy Exists Between Nurses' Image of Trustworthiness and Negative Stereotypes
Experts say they need to work together internally and in public
By Joyce Routson
In Gallup's annual poll of most honest and ethical professions, nurses have come out on top for seven straight years. The American's public's view is very positive, but negative or sexist images of nursing still exist.
They exist in the media, where one television show had a nurse talking about her love life while administering CPR. On greeting cards, where nurses wear skimpy uniforms. And in many peoples' perceptions, where they are seen as handmaidens to physicians, rather than colleagues.
"Nurses aren't portrayed as experienced, decision-making professionals," says Eleanor Sullivan, PhD, RN, FAAN, a former nurse and author. "The public does not know what nurses do."
Nurses don't serve doctors – they serve patients. They save lives and are at the core of keeping people healthy and well. "Healthcare doesn't happen without nurses," says Mary Ann van Dam, RN, PhD, PNP, associate professor of nursing at San Francisco State University.
But often that distinction about who nurses work for and the critical role they play gets lost. They may be most trusted, but they are "most invisible" when it comes to the American healthcare system, says one.
"They have a lack of voice," says nurse author and speaker Kathleen Bartholomew, RC, RN, MN. Who surrounded President Obama when he spoke about healthcare reform recently, she asks. It was physicians, not nurses.
Experts say nurses should take that high regard the public has for them and speak out to raise their image profession-wide. It's time to "educate the public on what they do," says Bernice Buresh, co-author of "From Silence to Voice," a book about nurses and their image.
While unions have been outspoken about working conditions and pay for nurses, and many schools are now teaching student nurses about how to advocate effectively for their patients, more improvement is needed. Experts say nurses need to be outspoken on the public stage about their role in healthcare – and they need to work among themselves to improve their self-image.
It's the self-image or lack of it that bothers Bartholomew, co-author of "The Image of Nursing: Perspectives on Shaping, Empowering and Elevating the Nursing Profession."
She says nurses lack power – or perceive they do – which leads to a lack of aggressiveness, or in some cases jealousy. She points to a survey of 2,500 nurses in which they were asked about how they would go about having a conversation at work with someone on a controversial topic. The majority of nurses said they wouldn't have that conversation, for fear of upsetting his or her feelings. "They are in reactive mode, not proactive," Bartholomew says. "Until we make it safe to take on authority in the ward, we'll never be known and recognized."
She says nurses "are some of the smartest people" on earth, but many don't believe it and lack self-esteem. Instead of thinking about themselves as strong advocates and professionals, they let themselves be characterized by the old-fashioned master-servant stereotype. That leads to "acting as an oppressed group" and hostility among themselves.
As an example of how nurses can put themselves down instead of building themselves up image-wise, Bartholomew relates an experience from her time at the hospital where she works several days a month between speaking engagements. Floating to a new ward, Bartholomew was puzzled why another nurse was staring at her with a disgusting look on her face. She finally asked why and the other woman pointed to the MSN on Bartholomew's nameplate. "She said, 'Aren't we being fancy?' with this sneer in her voice," recalls Bartholomew. "She was putting me down for having a master's degree and working at the bedside."
"We have to join with each other and have our own self-esteem," she says. Adds Buresh, "You can't do this any more in nursing." There has to be a support system for success."
Van Dam says nurses need to remember, "It's not about me. A true professional says I'm here to help my patient." She adds, "They need to feel they are contributing something unique that doctors do not have."
All believe that education helps raise self-esteem and awareness. But there are disagreements about how much education – should nurses be required to have baccalaureate degrees? While she advises prospective nurses to go for a bachelor's degree if possible, van Dam says the profession should strive to establish more bridge programs for ADNs to BSNs and incentives. Right now there are no pay differentials for "diploma" nurses to seek out a four-year degree, she says.
Van Dam also stresses the importance of educating doctors about nurses' role. "We have to teach in medical schools that we are colleagues and our primary concern is the patient."
A public voice
On the public stage, nurse experts say an easy way to change the conventional wisdom that nurses are doctors' assistants is with patients. While many patients are aware of what nurses do, their families might not be, says Sullivan.
"Nurses can tell their story. They can talk to the patient's family, they can explain what they do," she says. Buresh agrees: "Instead of saying 'I'm Julie' say 'I'm Julie Smith and I'm an RN." Sullivan adds, "I've had nurses say to me that they can't do that, it's bragging. But stating the fact isn't bragging – it's benefiting the entire profession."
Sullivan, who is a former dean of the University of Kansas School of Nursing, is now working to portray nurses in a better light in her novels, which feature nurse Monika Everhardt solving mysteries. The latest is "Assumed Dead."
Buresh advises that nurses also explain what they're doing and why they're doing it to the patient's family. "It changes the whole picture. [They can see] that they're in the hands of somebody who cares."
On the public stage, Buresh and Bartholomew advocate that nurses become active in their specialty organizations but also spread the word in their communities. "I met with the mayor of my town," says Seattle-based Bartholomew. "I met with the lawyer for the Washington state hospital association."
Buresh says nurses should band together to prevent budget cuts. Unions help, but "nurses need to have a stronger political voice," she says.
Nationally, nurses need to "Deliver the message that we help people stay well," says Teri Mills, MS, CNE, RN, a member of the nursing faculty at Portland Community College. Mills is a co-founder of the National Nurse initiative, which aims to create a full-time office of National Nurse within the U.S. public health service. Currently it's a part-time position. "There needs to be a recognized nurse to the public," she says, "who understands our needs."
A national nurse could be a unifying force for all nurses and elevate the profession, Mills believes.
"This title provides the authority, the impetus, the recognition needed to capture the public's attention, encourage prevention and raise awareness of national health promotion efforts."