How Much Are Nurses Worth?
This was originally published on the Oxford University Press blog
October 22, 2014 -- If you ask many people about nurses, they will tell you how caring and kind nurses are. The word “angel” might even appear. Nursing consistently tops the annual Gallup poll comparing the ethics and honesty of different professions.
But it’s worth exploring the extent to which society really values nursing. In recent decades, a global nursing shortage has often meant too few nurses to fill open positions, woefully inadequate nurse staffing levels, and not enough funds for nursing education. Many nurses have migrated across the globe, easing shortages in developed nations but exacerbating them in the developed world, where health systems are already under great stress. In a world where funds for health care are limited, nursing does not seem to be getting the love we profess to have for it.
This all starts with how decision-makers and members of the public view nursing. In reality, nurses are autonomous, college-educated science professionals who save lives and improve patient outcomes, in settings that range from war zones to high-tech ICUs. But nursing remains subject to a set of toxic gender-related stereotypes, which the mass media both reflects and reinforces, undermining the profession’s claims to scarce resources. Research in the field of health communication confirms that what the public sees on television and in films has a significant effect on health-related views and actions.
Consider some recent examples. The recent Ebola outbreak has attracted great interest from the global news media. There have been stories about the work of nurses to fight the disease, such as a strong piece in the Guardian earlier this month in which nurses described in great detail what they were doing to care for patients in West Africa. Some reports about the recent infections of the nurses in Dallas have highlighted allegations by nurses at Texas Health Presbyterian about infection control failures, and a few of the pieces have even consulted nurse experts.
But most Ebola pieces consult only physicians for expert comment, and many suggest that physicians are the only health workers who really matter, with nurses as their faithful assistants. One long article from August 2014 in the New York Times described the shortage of local and international physicians in Liberia and suggested that this shortage was the main health staffing problem. In fact, nurses provide far more hands-on care to patients suffering from debilitating infectious diseases, and so they tend to face greater associated burdens and risks, as the first infections in the U.S. have now made clear. Indeed, it’s likely that those first cases were nurses because nurses provide most skilled inpatient care, not because they are unusually poor at infection control. Yet even many reports that have mentioned nurses and other health workers have used “doctors” as shorthand for everyone, reinforcing the message that even if physicians aren’t the only ones involved, they are the only ones who count.
Much Ebola coverage has involved the prominent aid group Doctors Without Borders/Médecins Sans Frontières (MSF), whose name has long suggested that it’s an organization comprised solely of physicians. In reality, nurses outnumber physicians among MSF health professionals. But each time MSF’s name is mentioned, physicians receive all the credit for its work.
Hollywood’s vision of nursing remains largely caught in a time warp of unskilled handmaidens, pathetic losers, and prickly battleaxes, despite the gifted (if flawed) Nurse Jackie and a few other good portrayals. ABC’s Grey’s Anatomy has spent a decade telling the world that nursing consists of chirping “Right away, doctor!” and handing things to the brilliant, pretty surgeons who provide all meaningful health care. Fox’s The Mindy Project is mostly about the romantic interactions of quirky New York City OB-GYN physicians, but it also includes three stooges, uh, nurses, who make lots of ludicrous remarks yet seem to know almost nothing about health care. Fox’s new Red Band Society features a senior nurse (a.k.a. “Scary Bitch”) who is often portrayed as a battle-axe. But the nurse shows little expertise. She once asked a physician colleague about a recent operation, in which he had chosen not to amputate a cancer patient’s leg, this way: “So, getting to keep his leg was a bad thing…?”
The naughty nurse remains an advertising staple worldwide. In one current U.S. television ad, a young woman suggests that colleagues should eat food from the sandwich chain Subway so they’ll be able to fit into skimpy Halloween outfits. She proceeds to demonstrate with a very skimpy hot nurse costume, among others. Another recent ad campaign presents the new Klondike Kandy Bar as the love child of what Adweek accurately describes as “an illicit tryst between a [male] Klondike bar and a tall, striking, chocolaty [female] candy-bar nurse,” who seems to have seduced her surprised ice cream patient. Yes, those images are “just jokes.” But research shows that jokes have great influence over attitudes, and of course jokes remain a primary vehicle for delivering prejudice.
Nurses must take the lead in improving understanding of their profession, but we can all do something. We urge people to pay close attention when interacting with nurses and to ask if what they observe bears any relation to what they often see in the media. Was it just a “caring angel,” or did the nurse also save a life by educating a patient or detecting a subtle change in condition? Even the language we use matters. For instance, hospitals are not so much “medical centers” as they are “nursing centers,” since patients wouldn't stay there unless they needed 24/7 nursing care. And calling physicians “doctors” wrongly implies that they are the only health professionals who earn doctorates. Yet nurses and others get doctorates as well. We hope the public can see past traditional assumptions about nursing—because they threaten our lives.