The Expanded Truth About Nursing Project
The Expanded Truth About Nursing Project will focus on empowering nurses to educate the public about the value of nursing.
We are seeking funding to pursue work on the following projects:
The DVD project
Nurse shadowing project
1. The 2nd Truth conference on nursing in the media
We would like to put together another conference to educate nurses about the power of the media and how they can improve nursing media's image, as we did at our 2011 conference in New Orleans. Another conference would allow us to further the achievements of our first conference in educating and empowering nurses worldwide to improve their image in a dynamic, life-changing event.
2. Media creation project
Work more closely with nurses to create a broader database of story ideas for use by the media to create movies, television shows, and other fictional works.
Create a nurse action figure and nursing board game and facilitate their placement on the shelves at major toy and department stores in the U.S. and abroad.
Facilitate the development of a wide variety of nurse-driven fictional and non-fictional media. For instance, nurses approach us fairly frequently to describe concerns about their workplaces--over the years these contacts have numbered in the hundreds. Nearly always, the nurses who contact us tell us stories of nurses being ignored, sidelined or dismissed in favor of powerful physicians or others who make decisions for patients or the health institution without nursing input. These nurses are natural leaders--they are the ones who called us or wrote to us in an effort to try to improve things at their workplaces. They are always concerned about patient care. These are perfect candidates to create op-eds for local or national newspapers. On September 5, 2013 a nurse posted such a story on our Facebook page and we spent hours working with her, encouraging her to transform her post into an op-ed, helping her edit it to send a stronger portrayal of nursing. Then we provided her with our extensive contact list of publications for possible submission. Even if her op-ed is not printed, we educated this nurse who may write something that does get published one day. And every time such an op-ed gets submitted to the media, it educates at least one editor whether it is printed or not. This may pave the way for future op-eds by nurses to be published and even affect how the news media covers nursing and health care generally. We have worked with such nurses many times over the years, helping them develop their work, but given our limited funding, there is only so much we have been able to do with any one of our contacts.
3. Disseminating information to nurses about how they can join the effort to improve nursing's media image
Disseminate information about improving public understanding of nursing by distributing brochures and bumper stickers to schools, hospitals and nursing organizations to inform them about the work of the Truth. We would invite them to join our efforts, such as by signing up for free e-news alerts, creating chapters of the Truth and distributing information, including nurse empowerment posters that educate the public about who nurses are and what they really do.
Develop a two-hour DVD presentation on nursing's media image, its effect on the global nursing shortage, and how we can improve the situation. We would widely distribute the DVD to nursing schools, organizations and hospitals to rally nurses to work to change how the world thinks about nursing.
Create and disseminate a series of DVDs of the Truth's first conference to raise awareness among nurses, their organizations, schools and workplaces.
Develop and support chapters of the Truth in major media markets around the globe to coordinate local media outreach. Chapter members will educate the media about nursing and the importance of a fair and accurate depiction of it, developing the many connections we have made. They will work to get media training, monitor local media, establish health radio shows and health minutes on television, establish relationships with media figures, and identify and promote nurses in local media markets. The Truth has more than 50 chapters in more than a dozen countries, but we do not have the personnel to keep them motivated, active, and fully effective. Our chapters need a coordinator to help train and rally them to action.
Expand and enhance the Truth's web and traditional media platforms to facilitate greater access by nurses to information on nursing in the media and to enhance grassroots action, including the creation of a library of media depictions of nursing.
Deliver presentations each year to at least 10 high-profile nursing groups, including professional organizations and university groups, to educate and mobilize support for improving the public image of nursing.
4. Outreach to school guidance counselors and potential future nurses
5. Changing the language of health care project
Language choices affect how we think. The word "orders" can make nurses, physicians and even writers for the New York Times think that nurses answer to physicians and are not autonomous. "Medical Center" can make people think that patients go to hospitals to see physicians. Of course patients go to hospitals in part to receive physician care, but the only reason patients need to stay in hospitals is that they need 24/7 nursing care. If they didn't, they would go to an outpatient center or home. Changing the language surrounding health care and nursing can empower nurses, strengthen the nursing profession, and ultimately improve patient care. We have myriad other language changes we think would help increase the power of nurses and nursing. We would like to write a book on this to educate nurses and the public about the power of language choices and how we can use language to strengthen nursing and deliver better care.
Physicians, patients, their families and the public in general often do not appear to know that nurses are college-educated science professionals. This lack of understanding of nursing education is fueled in part by clerks, nursing assistants, techs, "baby-nurses" and others who dress the same way nurses dress and do not correct people when they are wrongly called "nurse." Baby-nurses (who are often high-school graduates with a CPR certificate) appear to actively encourage this misunderstanding in order to appear to be qualified health professionals. Artists at the Fabric Workshop and Museum in Philadelphia developed the initial RN patch in 2003. With permission from the artists, we have added patches that feature educational titles so that the public is presented with information that nurses go to college. This will increase respect for the nursing profession and allow nurses to deliver better care. We would like to encourage hospitals and schools of nursing to adopt the patches.
7. Promoting individual professionalism through the nursing uniform project
When nurses wore caps, patients could identify them. But caps are annoying and transmit deadly infections, so nurses in most countries stopped wearing them in the 1970's and 80's. Now, many nursing positions are being filled by far less educated assistants and technicians, and everyone dresses the same. Patients do not know who is who, where to turn to ask their questions or why college-educated nursing professionals are dressing in pajamas covered in Hello Kitty or SpongeBob. Don't get us wrong, we love Hello Kitty and SpongeBob, but applied to adult work uniforms, they may give the impression that the wearer is a bit soft in the heart — and also soft in the head. Nurses shouldn't be sending such messages to society. In 2006, host Matt Lauer of the Today Show said that today's nurses "look like they're going on vacation" in their scrubs. Physician Patricia Raymond published a 2004 piece in the Sacramento Bee chastising nurses: "You're the only thing between [your] patients and death, and you're covered in cartoons." After Boston television reporter Sara Edwards appeared as an extra on ER in 2003 in a floral scrub top, she said, "Ugh, I look like I should be scrubbing floors in that smock." We have begun to design a new nursing uniform that projects a professional image and also protects nurses from hazards, including with an anti-microbial agent. Initial funding for the project fell through, but we are eager to move forward on it. You can see our designs and plans here.
8. The Physician Project
One key element of the project would be to educate physicians about nursing. Why educate physicians? Because they create or provide advice on much harmful media about nursing. In addition, many of the problems in today's work environment stem from the fact that physicians do not understand what nurses do or that nurses are autonomous professionals. Nurses can't practice with full autonomy until physicians understand nursing better and treat nurses as colleagues instead of underlings.
The DVD project
We would like to prepare a DVD for circulation to all medical schools to teach medical students (and their instructors) about who nurses are, what they do, and how they interact with physicians. Wide dissemination of the DVD to medical schools in the U.S. and abroad would improve relations between the professions as well as nurses' ability to practice with full autonomy. Each summer from 2003-2007 the Robert Wood Johnson Foundation distributed copies of Joseph Turow's DVD essay "Prime Time Doctors: Why Should You Care?" to about 20,000 U.S. medical students, showing that medical schools are open to such outreach.
Nurse shadowing project
We seek to promote programs in which medical students shadow nurses at medical schools in the U.S. and abroad. These programs, like the one pioneered at Dartmouth and another fashioned after it in Wisconsin, help increase understanding among those who have a great influence on public understanding of nursing and the nursing practice environment.
9. Increasing Seats at the Table Project
We would like to organize an effort to encourage greater nursing participation in hospital boards. Hospitals are nursing institutions--they exist to provide nursing care. If patients did not need 24/7 nursing care, they would seek health care at outpatient centers. Since hospitals are primarily nursing institutions, they should be run and directed by nurses. Yet we know of no instance in which nurses are a majority on a hospital board. In fact, nurses rarely sit on boards or serve as CEOs. (For example, based on our analysis of the websites of the top 17 hospitals listed in U.S. News and World Report, few nurses sit on hospital boards. Though getting an accurate count was very difficult, we found fewer than 1% of hospital directors were nurses.)
See more information on improving the number of seats at the table for nurses:
Nurses At the Table--Nurse Leadership Presentation--Missouri Action Coalition
Tamara Rose and Mary Nies: A place at the table: Positioning nurses where healthcare decisions are made, Nursing Management: January 2016 - Volume 47 - Issue 1 - p 42-46
10. Increasing the Profile of Nurses at Hospitals
We want to help hospitals tell the public about their nursing expertise and leadership by having information about how nursing is going to help patients on their websites. When nursing information does appear on hospital websites, it is almost always directed at nurses for recruiting purposes. This even includes information on the hospital's Magnet status, as if no one could care about that except for nurses. Although hospitals are mainly nursing institutions, visitors to hospitals and their websites see little or nothing about nursing. In March 2012, we examined the websites of the top 17 hospitals as listed in U.S. News and World Report to see how good of a job the sites did in giving visitors information about the hospitals' main reason to exist. We examined the main pages, "about us" pages, specialty pages, patient information pages, clinical specialty pages, and provider pages. Out of these 17 hospitals, we found a link to nursing information on only one of these webpages, Duke University's "about us" page. None of the other hospitals had links to nursing information from these pages that the public is likely to see. Apparently those building these pages do not think nursing is important to their mission as a hospital, or at least that it's not important in promoting the hospital. We must change that to help nurses improve understanding of their profession and practice to the full extent of their abilities, which is what best protects the health of patients.
11. Increasing Awareness Among Decision-Makers
We propose to take several key steps to educate influential decision-makers about the nature and value of nursing. If we are able to increase the value that decision-makers place on nursing, we think it will improve the likelihood that they will increase funding for the profession. Funding for nursing is downright abysmal. Nursing residencies get $1 for every $375 that go to physician residencies. The National Institute of Nursing Research receives only $1 out of every $200 of the budget for the National Institute of Health. Nursing education gets $1 for every $50 that goes to physician education, even though nurses outnumber physicians by about 4 to 1. If there is a way to measure just how much society and decision-makers undervalue nursing, these are those numbers. If we educate decision-makers about the disparity between the value of nursing and the funding for it, we believe that we can convince them that the world just cannot live well with an underfunded nursing profession.
Legislators control funding for nursing education, research and residencies, as well as the rules that govern nursing practice, including the regulation of staffing levels, overtime, whistleblowers, and scope of practice. We would create a DVD for legislators explaining how valuable and cost-effective nursing is and how investing in it now will save millions in the future. For example, the DVD could make clear how nurses can prevent hospitalization. The Coalition would disseminate it widely and have it for use as a tool when member organizations do in-person outreach to legislators.
Hospital executives make decisions that affect nurses and nursing care, yet so often, they appear to be ill-informed about what nursing really is. So nurses are replaced with technicians and assistants. Patients are ill-served when nursing care and nursing assessments are performed by people who have not been educated as nurses. When nurses deliver nursing care, the care is more effective and patients are less likely to return to the hospital, or get sick and die. Creating a DVD about the cost-effectiveness of nursing may help hospital executives make better decisions about nursing. This DVD would likely overlap with the DVD for legislators, but it would be aimed specifically at hospital executives.
We would like to form a task force to educate Medicare, Medicaid, and private insurers about nursing autonomy and skill to improve reimbursement for nursing. This effort would include RN care and APRN care to improve preventative care, keep patients out of hospitals, and promote effective care models, including health homes for follow-up and nurse-family partnerships.
13. Highlighting the Edge-Leaders Project
We propose to develop video programs and other materials to help nurses working on the cutting edge make their work accessible to the media, so as to convey what the profession is doing to advance global health. For example, consider this clip by former US AIDS Czar Kristine Gebbie, RN, DrPH, then-Associate Professor, Columbia School of Nursing.
14. Disseminating Best Practices
Best practices save patient lives and save money, yet to our knowledge, there is no good place to gather and disseminate this information so that all nurses and health institutions can have access to it. Coalition members could work together to submit their research, practices and data to a common database on the Coalition's website, so that all nurses could have access to practices that strengthen the profession, improve patient care, and save health care resources.
15. The Nursing Autonomy Project
We envision identifying systems within health care that undermine or encroach on nursing autonomy and working to change those systems. For instance, does new prescribing software contain a user-friendly system for the nurse to confirm either that he or she agrees that the prescription appears to be in the patient's interest or that he or she does not agree, with the ability to explain why and suggest an alternative? Each prescription should go through such a system. And can hospital billing systems be modified to extract nursing services from "room and board"? Do patient health records forms and questionnaires require patients to supply the names of physicians even in practice areas in which their provider is an APRN? There are myriad processes within the health care system that should be changed to promote full nursing autonomy.
16. Providing Health Information to the Public Project
We would like to establish a model for nurses to provide easy-to-understand health information to the public. Nurses are the health professionals who are educated specifically to teach patients about health care. Unfortunately, some health professionals fail to clarify key points and use highly technical language when imparting health information. Nurses often find themselves translating information that physicians give, including critical diagnostic and treatment data, so patients can understand it. There are sources of relatively straightforward health information, like WebMD, but as their names suggest, the information is still imparted mainly from the physician perspective.
We propose having nurse experts build a series of health education pages where patients can learn about various topics from a pragmatic, holistic nursing perspective. That will present nurses to the world as health experts.