The Nursing Image: A Position Paper
Submitted by Melinda Kaszuk MSN, RN
The Nursing Image: A Position Paper
Currently, there are 14 million nurses globally who are the core of health-care systems (World Health Organization, 2014). One of the many challenges that nursing has had to surmount is that of stereotypical roles. Studies indicate that the nursing image is a substantial model to the discipline, because it is linked with the decision to enter nursing, remain in it and/or recommending to others as a career choice (Cabaniss, 2011; Zarea, Negarandeh, Dehghan-Nayeri, & Rezaei-Adaryani, 2009).
Furthermore, distribution social resources, funding for nursing education, research and practice, and nurses’ quality of working life are linked to the image that is perceived by the public (Kazis & Schwendimann, 2009). In spite of the importance of the nursing image, there is a scarcity of data on (Dent & Bradshaw, 2012) ethical factors shaping it (Donelan, Buerhaus, DesRoches, Dittus, & Duttwin, 2008; Kingma, 2007). The majority of studies which have investigated the boundaries of the nursing image have emphasized the need to develop interventions for image improvement based on nurse-driven input (Razaei-Adaryani, Salsali, & Mohammedi, 2012). However, the virtuous considerations of the nursing image must be examined as nurses directly impact the public health needs of diverse populations as the major health advocates (De Araujo Sartorio & Campos Pavone Zoboli, 2010).
According to Beal, et al. (2012) societal interpretation of the nursing role and profession is based directly on media representation, accepted professional behavioral standards, related personal experiences and what is instilled during nursing education. To influence professional nursing behaviors that positively support the image of nursing in both classroom and clinical environments, nursing educators must accurately understand existing student perceptions of this phenomenon to gain insight into preconceived notions which must be clarified or altered (Cabaniss, 2011). With a gap in experienced nurses leaving the profession and new multigenerational, non-traditional nursing students entering an opportunity exists within nursing education to explore and influence nursing students’ attitudes and perceptions of the nursing identity and ethical codes of conduct in promoting and protecting public safety needs (Keeling & Templeman, 2013).
With the demand for nursing services predicted to increase dramatically over the next twenty to thirty years, it is important for the nursing profession to undertake continued strategies to educate burgeoning nurses, as well as entry-level licensed individuals seeking and advanced degree, to impart a professional identity concept (Tomans, 2012) and influence media in the future. This will assist in delineating nursing to continue creating and adapting a unique body of knowledge and self-regulation (Andrew, 2012). Historically the argument for academic achievement and integration of ethical theory into nursing curricula has been discounted to the pursuit of technical proficiency. The key challenge to the advancement of nursing identity remains the need to find the ideal balance between research/scholarly activity and practice, commitment, and development with skill set attainment (Andrew & Robb, 2011) while actively influencing public health policy.
The code of ethics for nurses that drives practice delineates the nursing profession’s role and substantiates its place in the healthcare arena. The ANA Code of Ethics for Nurses with Interpretive Statements is a succinct statement of ethical obligations and duties of each individual who enters the nursing profession. This document is the guide of nursing’s own understanding of its commitment and responsibilities to society for continued promotion of health, well-being and public health safety. The true principles of the nursing profession are (1) autonomy-ability to think and work independently, (2) nonmaleficence-do no harm, (3) beneficence-acting in the benefit of others, (4) justice-ensuring equal and fair treatment, (5) fidelity-loyalty and advocacy, (6) confidentiality-respecting the privacy of others, (7) veracity-accuracy, (8) accountability (ANA, 2001). These principles are based on moral theories of deontology, utilitarianism, and relativism for proper conduct of a nursing professional as well as a virtuous aspect reflecting the character to be represented as a nurse (ANA, 2001). Nursing desires to maintain standards that are congruent with those accepted by the profession which emulates a moral sensitivity, commitment, moral perseverance and judging response to moral action in a varied response to sensitive topics that nurses often face in practice situations. Unfortunately, this is not the image depicted by the media or advertisers. In fact, media often portray nurses as ditzy, young, sex objects with little skill, often adorned in the uniform with nursing caps and lingerie-style uniforms.
It has been well established that nurses are key participants in health care reform and in the safety of patients in health care settings. A 2009 study published in Health Affairs forecasts an alarming crisis by 2025, when the shortage of nurses will grow to almost 300,000 registered nurses. This insufficiency will be double any nursing shortage in the U.S. since the 1960s, arising as 7,000 U.S. citizens will be turning 65 every day. This demographical shift is a contributing factor to the imminent nursing shortage (Howett & Evans, 2011). Conversely, however, it generates new opportunities for persons seeking an active career that enhances healthcare access, quality, and safety. As aging nurses find their offspring not following the career trajectory into nursing, it can only be surmised that the image portrayed is one of altruism toward others without consideration for the effects on individuals and families’ lifestyles. Another possibility, especially in the case of male nurses, is that they are not particularly attentive in entering a profession that is “dominated by white (79 percent), middle-aged (average age is 44) women (91 percent)” (Howett & Evans, 2011, para. 6).
Media has a strong impact on the nursing image (Donelan et al., 2008; Kazis & Schwendimann, 2009). Various scholars suppose that media present nursing in a negative fashion (Cabaniss, 2011; Kazis & Schwendimann, 2009; Howett & Evans, 2011; Kingma, 2007; Summers, 2010). The signiﬁcant role of the media in the development of the negative nursing stereotypes cannot be discounted (Jackson, 2009). Nurses are publicized in political and commercials, because ‘they are nice and smiling and cuddly and everybody likes them’ (Doonlan, 2000, p. 474). The TV series, Nurse Jackie, has been a topic of controversy as the main character performs unethical behaviors as drug uses, unprofessional behavior toward peers and other disciplines, medical fraud and forgery (Howett & Evans, 2011; Sorrell, 2009). However, Stanley (2008) recounted that, more recently, films and television are shifting from traditional stereotypical images of nursing toward epitomizing nurses as professional, skilled, autonomous, scholarly, and dedicated.
Some scholars propose nursing is an invisible profession and this is a major threat to the nursing’s social status and perceived value (Andrew & Robb, 2011; Chaperon, 2010; Kazis & Schwendimann, 2009). Chaperon (2010) posited that many correspondents report disdain as a large proportion of nurses do not communicate with the media and reporters efficiently. Hence, the nurses’ perspective is not usually understood by the public. Unfortunately, individual nurses, unlike other professionals, are inherently reserved and reluctant to share knowledge, expertise, competence and scholarship, and are unwilling to advocate for changing the portrayal of nurses in the media (Beal, 2012; Buresh & Gordon, 2006; Canam, 2008). Gordon (2004) asserted that nurses may not have enough conﬁdence, means, and skills to effectively communicate with media. After careful consideration, Gordon (2004) resolved that ‘public communication is key to resolving the shortage of respect, recognition and rewards’ for nursing (p. 278). It is suggested that detrimental consequence of poor communication and being invisible is that healthcare system will change without considering nurses’ needs, wisdom and expertise which will directly affect the delivery of healthcare and place the public at risk (Baldwin, 2011; Meier, 1999).
In contrast, the study by Stanley (2008) of 280 feature films made from 1900-2007 indicated nurses in the movies are breaking free from the unflattering portrayals. Stanley’s study found that in the early days of cinema, nurse characters were often the heroines of war-time tribulations but in recent times more diversity in age, gender and socioeconomic backgrounds has been more realistically presented. Another study of the public found that 60% of the surveyed TV viewing audience watched several healthcare-setting shows in the year prior to the study, with less than 5% reporting a loss of respect for the nursing profession or having a diminished attitude or approval toward the nursing image, while 28% said they actually have more respect, and 66% said it made no difference at all (Donelan, et al., 2008).
Other nursing advocates surmise that all professions may be represented in character and ethics in a negative manner or stereotyped, but the public is not felt to necessarily generalize an unconstructive connotation of the nursing image to the public. Registered nurses are reported to increasingly being recognized as leaders in transforming the health care system to meet the burgeoning demand for prevention, wellness, and primary care services with a focus on cost-effective, quality improvement (Hassmiller, 2011; Stanley, 2008). In addition to their clinical proficiency, nurses are being pursued to serve in leadership positions for developing public policy recommendations related to a plethora of health care policy issues (Sachs & Jones, 2012).
Social media outlets such a Twitter, YouTube and Facebook have received support from nursing organizations as a means to positively reflect the nursing image and educate the public as to the role identity of the nurse. Post-modern philosophers and ethicists surmise that a constructivist model of thought must be used as virtues and morals adapt to the changes in social reform of societies (Kurtz & Burr, 2011). The Robert Woods Johnson Foundation has funded an outreach project, The Future of Nursing, to support the nursing image as ethical and just in being instrumental in healthcare decisions while highlighting the nurse’s understanding of the complex interplay of environment and health and recognizing the unique perspectives on health from a variety of settings: the hospital, the clinic, the community and the home (Hassmiller, 2011).
Most research studies regarding the nursing image demonstrate how that the actual public image of nursing is varied and incongruous. This image is partly self-created by nurses due to their invisibility and their lack of public discourse. Nurses derive their self-concept and professional identity from their public image, work environment, work values, education and traditional social and cultural values. View as caregiver versus decision-maker in the hierarchy of healthcare has stunted professional growth for nurses as is deontological aspect of altruism as to this day the nursing profession remains concerned with public health and safety matters rather than positioning in philosophical thoughts regarding their ethical duty (Hoeve & Jansen, 2014).
Implications for Nursing
Nurses should work harder to communicate their professional, ethical and moral standards to the public. Social media like the Internet and YouTube can be utilized to show the public an improvement in their public image and to obtain a stronger position in healthcare organizations. Nurses need to increase their visibility and must take steps to reach out to media outlets. This could be achieved by ongoing education and a changing work environment that encourages nurses to stand up for a positive image of themselves. Furthermore, nurses should make better use of strategic positions, such as policy makers, case managers, nurse educators or clinical nurse specialist and use their professionalism to show the public what the nursing image really entails (Gordon, 2004).
With changes in health policy and demand for nurses to fill emergent roles and continue professional care of patients, families and communities, both local and global, the nursing image adds to its influences within the cultural norms of the American society as well as in a global arena. Nursing education has been indicated as a major influence into the comprehension of the magnitude of the nursing role and image needed to maintain professional status among other healthcare professions and influence health policy as advocates and caregivers (Keeling & Templeman, 2013).
Nursing programs are the foundation for development of the nursing image that impresses what is designated as ethical nursing behaviors and influencing future nurses in a political voice (Cabaniss, 2011). In an effort to assist educators in designing classroom learning strategies, research focused on existing judgments among nursing students, nurses, other healthcare providers and the public is needed to further ascertain the awareness of the public and policy makers that affect nursing practice (Hoeve & Jansen, 2014). Conflicting views and concepts exist within the nursing profession and public sector and recognition early during nursing academic endeavors will assist in a future where nurses can project a clear understanding of the nursing image reflects in a global society. What nursing wants to be viewed as remains unaligned with the public perception; however, changes in societal awareness and social media have decreased the chasm of the ethical image of a nurse. Continued research and advocacy on the matter is necessary on an ongoing basis to keep the public aware of the true nature of nursing.
Nurses are notorious for not ‘tooting their own horns.’ All nurses have a duty to conduct themselves in a manner to empower and enhance the image and reputation of the nursing profession, to challenge and dispute misconceptions of media portrayal, which will raise the voice of the public and health policymakers in the true profile of what is truly means to be a nurse. Respect is earned by recognizing difficult situations and at the same time suggesting solutions and leading the way to improved communication in the media. The true depiction of nurses, of both sexes and all ages, ethnic groups and body-types, must remain in the forefront of literature, television and internet, campaigns and advertising adventures. All nurses must take a stand and have a part in a collective voice to advocate for the future of the nursing image.
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