Every year, the Gallup Poll
asks the public to rate the honesty and ethical standards of people in different professions. The question lists 23 fields. Nurses routinely come out on top, higher than physicians, dentists and members of the clergy.1 (Level C)
Despite this favorable response, negative images of nursing still exist — on television (the demeaning way nurses are treated on “Grey’s Anatomy”), in movies (probably the most famous being the sadistic Nurse Ratched from “One Flew Over the Cuckoo’s Nest”), in books (most novels with medical characters simply ignore nurses or put them in bit roles), on greeting cards (peruse the get-well section at your local Hallmark store for a sample) and in stock photographs (do an Internet search for images of nurses; you’ll be appalled at some of them). Negative stereotypes include the nurse as “battle-ax,” handmaiden to physicians, or sex object.
We can partly explain this dichotomy of trustworthiness vs. negative stereotypes by understanding that trust is only one component of image. The public may trust nurses, but have little understanding of what they do and don’t think of them as key players in healthcare. This is particularly true when faced with negative images in the media. It’s up to us to promote ourselves as having valuable first-hand knowledge that significantly influences patient outcomes — and get the message out that the nursing profession attracts talented and bright people.
The Gallup Poll should inspire us because we already have the public’s trust, and we can use that trust to enhance the public’s knowledge of the profession. This module discusses the interplay between public and personal image and ways in which nurses can promote the image of nursing at work, at home and in the community.
Link Between Public and Personal
The public image of nursing includes how the media portray us and how the public perceives us. Public image matters because of the complex relationship between how we view ourselves as professionals
and how the public views us
. For example, public image affects how we feel about ourselves. One study found that nurses’ perceptions of how others view them affected their self-concept; if the public image of nurses is negative, nurses’ self-concept is more likely to be negative.2 (Level B)
One nurse conducted a detailed literature review on the image of nurses, exploring why image is still an issue given the long history of discussion and proposed solutions to the problem.3 (Level C)
She concluded that public and self-image are intertwined and that as a profession, nurses don’t have a very positive self-image. Because the self-image of nurses drives the social value of nurses, we need a better self-image to ensure a better public image. In essence, changing how we feel about ourselves changes how others think about us.
Author Leann Strasen, RN, provides additional insight into the complexity of self-image and public image. She developed a model based on the linkage of thoughts and beliefs to action.4 (Level C)
Thoughts and beliefs — which are shaped by socialization factors, such as experiences, heredity, environment, gender socialization and reference groups — influence self-image, action and performance. Improving how nurses view themselves is likely to influence this cycle.4
For example, nurses who see themselves as professionals will be strong advocates for their patients. Patients see this advocacy and remember it when talking with others about their hospitalization. This simple conversation contributes to the overall public image of nursing, which in turn, improves nurses’ self-image.
Clearly, we need to tackle the image conundrum from two angles: First, we need to improve our own self-image; second, we need to improve the public’s image of nurses.
It’s easy to sit back and complain. Yet each of us is responsible for nursing’s image, from how we treat patients and colleagues to what we tell relatives, friends, neighbors and community members about our profession.
We have an ethical duty to promote the image of nursing, dating back to the Nightingale Pledge, which states, “I will do all in my power to maintain and elevate the standard of my profession.” The American Nurses Association’s Code of Ethics for Nurses
makes a stronger statement: “The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.”5
One way we can articulate nursing values is to speak to the public about what we do.
- Public communication through professional self-presentation
- Public communication through anecdotal descriptions of nursing work
- Public communication through the mass media, such as television, newspapers, and radio
This model enables all nurses to participate at least through tier 1 (professional self-presentation). As you gain new skills through practice and modeling, you can move into the other two tiers.
One challenge involves the differing perceptions about what constitutes a “good” image. For example, is the image of nurses as “angels” helpful or hurtful? It may be a little of both. Angels have a positive image, but as one nurse has stated, “If virtue is its own reward, nurses cannot claim the importance and value of what it is they do.”3 Yet we certainly want to embrace the fact that people view us as caring. Perhaps we can all agree to promote nursing as a profession that uses evidence-based practice to improve the care of people who need help. Wear your brains, as well as your heart, on your sleeves.
10 Actions to Take Today
How can we take on the image of nursing, given our already busy professional and personal lives? Here are 10 actions you can start to take today.
1. Identify yourself as a nurse. Introduce yourself as a registered nurse or a licensed practical nurse, and use RN or LPN after your name on address labels and when making donations.
2. Join a professional nursing association.
It can be the American Nurses Association, your specialty association, or The Truth About Nursing
, a nonprofit association dedicated to improving the image of nursing in the media. Ideally, join more than one association.
3. Give nurse-related books as gifts to non-nurses. Choose books that will inspire and inform. Check out some of the resources in the sidebar “Resources for Talking About Nursing.”
4. Get the word out about the work nurses do and the contributions they make. Talk about what you do with friends and family. Make presentations to children and community groups. Here are some age-specific strategies:
- Younger than 9: Use coloring sheets or books, tell stories.
- Ages 9 to 11: Play interactive games.
- Ages 12 to 14: Focus on nursing as a “cool” profession.
- Ages 15 to 24: Point out the many different jobs nurses can do throughout the country, the work flexability, the good salaries, the job security, and the rewards of making a difference in people’s lives.
5. Get involved in a political campaign and legislative efforts related to healthcare.
At the very least, find out the names of your elected officials and e-mail them, being sure to identify yourself as a nurse. You can easily send an e-mail by going to http://www.usa.gov/Contact/Elected.shtml
6. Seek donations for scholarship funds. Even small donations add up and remind people about the importance of nursing.
7. Serve on community and organization boards. This gives people the opportunity to see nurses in action. One success story is the tenure of Jennie Chin Hansen, RN, as president of AARP. You don’t have to start at the top; the school board or the board of directors of a community association would do the trick.
8. Write a letter to the editor. Make the letter brief and send it promptly. Use only RN, “registered nurse”; APRN, “advanced practice registered nurse”; or LPN, “licensed practical nurse” after your name. A string of credentials may confuse the public.
9. Use your talent. Combine your nursing and writing expertise to write articles for consumer publications. If you’re a photographer or an illustrator, have a local show of works depicting nurses in action. The talents of nurses are endless; so are the possibilities.
10. Be a role model everywhere you go. If nurses want to be treated as professionals, they must act like professionals.
Resources for Talking About Nursing
The Internet and Multimedia
- discovernursing.com. This site includes free brochures and videos from the Johnson & Johnson Campaign for Nursing’s Future, profiles of nurses in different roles, descriptions of nursing roles and a free newsletter.
- 40 Best Nursing Blogs You Aren't Reading Yet | Nursing Blog
- 2011-2012 Image of Nursing Guidelines
- Videos related to nursing careers are available online. For example, Critical Care Nurse: Day in the Life gives an excellent, positive overview. It can be accessed at youtube.com/watch?v=P3x-ASSwLv0&feature=related .
For history buffs
- “American Nightingale: The Story of Frances Slanger, Forgotten Heroine of Normandy,” by Bob Welch
- “Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale,” by Gillian Gill
- “We Band of Angels: The Untold Story of American Nurses Trapped on Bataan by the Japanese,” by Elizabeth M. Norman, RN
For those interested in U.S. healthcare
- “Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital,” by Sandy Balfour
- “Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes and Medical Hubris Undermine Nurses and Patient Care,” by Suzanne Gordon
- “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” by Sandy Summers and Harry Jacobs Summers
For mystery lovers, collectors, and short story lovers
- “Twice Dead,” by Eleanor Sullivan, RN, PhD
- “Postcards of Nursing: A World Wide Tribute,” by Michael Zwerdling, RN
- “When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” by Suzanne Gordon