Changing how the world thinks about nursing
Members of the media, please help increase understanding of the value of nursing
As the global population ages, it becomes even more interested in health. If you create media about health care, we urge you to learn all you can about what nurses really do. Whether you write or edit for a newspaper, a magazine or book publisher, a website, an ad agency, or Hollywood, please listen to nurses when they point out inaccuracies, distortions, and other damaging messages about their profession. The input will improve your work. No media creator is immune from sending unhelpful messages about nursing, because our social assumptions are so deeply embedded and awareness of nursing's media issues remains so limited. Consider the Wolters Klower company Lippincott Williams & Wilkins (LWW), which publishes many excellent materials in nursing and other health fields. But LWW also has a publication and series of texts it markets under the name Nursing made Incredibly Easy. We understand the appeal to overwhelmed nursing students, but would a major company publish Medicine made Incredibly Easy? Brain Surgery made Incredibly Easy? And because of the media's influence on how people think, media creators should pay special attention to the language issues discussed above. For example, it remains common for the entertainment media to refer to minimally-trained nurse's aides as "nurses," which is a problem even when the characters are positive, because such references still undervalue nursing knowledge and skill. One example is "Nurse John," a character in the 2009 film Precious. An unusual twist on this problem appeared in the recent HBO series Getting On, which follows the staff at an extended care facility. One major character is Didi, who is sometimes called a "nurse" and who appears to be a licensed vocational nurse (with about one year of nursing education). But in the November 2013 series premiere, Didi seemed to refer to herself as an "orderly," which is a term sometimes used to describe nursing assistants with perhaps 6-8 weeks of training. The show went to the trouble of having the character wear an "L.V.N." I.D. badge why would it also suggest that the term "nurse" could be applied to someone with 6-8 weeks of training?
Report on the Nurse at the Bedside
The bedside nurse saves lives and sees it all, and some reports have given readers a sense of that. But the news media has barely skimmed the surface. Nurses save lives in countless ways, managing high-tech interventions, catching subtle but deadly errors, and spearheading
public health programs. And don't forget nursing errors: the media generally assumes that only physician errors matter, but in fact nurses affect patient outcomes just as much, and so their care deserves the same scrutiny. Nurses spend far more time with patients than anyone
else, and they see people at their best and their worst. Nursing is vital and exciting. News consumers would be interested in what nurses do and what they know, if only the consumers heard more about it. Be receptive to what nurses tell you, and ask them questions. Too many
reporters and editors rely on inaccurate assumptions about nursing, or on physicians, who, sadly, often don't know much about nursing either. Physicians dominate media like the New
York Times and CNN, creating many stories themselves. But when nurses get the chance--as the Times has given oncology nurse Theresa Brown, who began contributing in 2008 to Tara Parker-Pope's "Well" blog and later to Brown's Opinionator series "Bedside"--they
too can create compelling and informative pieces.
Discover 2.5 Million Women in Science
There are scientific breakthroughs all the time and they're published in peer-reviewed nursing journals like LWW's American Journal of Nursing. The news media's audience would be interested in many of these, such as the studies about how hospital conditions affect patients, the latest advances in pain control, and innovative health initiatives addressing problems like HIV and diabetes. Nursing should be presented as the cutting-edge health science it is, and the profession's leaders, like those discussed in chapter 1 of our book Saving Lives, should be considered among the world's health leaders. The media sometimes runs stories about women in science, but these reports typically overlook the 2.5 million female RNs in the United States, including the 340,000 with master's or doctoral degrees. In fact, nurses have long done fascinating, groundbreaking work. The work of nursing pioneers like nurse midwife Mary Breckinridge and public health nurse Lillian Wald remains influential even today. Informing your audience about these nursing pioneers may pique interest in the profession's current leaders.
Consider Nurses as Expert Sources in All Health Stories
Nurses make great media health experts. They combine advanced health knowledge with the ability to communicate important health ideas to lay people, as part of their focus on patient education.
Unfortunately, nurse experts often struggle to be heard. Some news outlets consult nurses when the topic is some aspect of nursing, such as the nursing shortage. But nurses rarely appear as experts when the topic is health in general. The website Help A Reporter Out (www.helpareporter.com)
posts queries from reporters looking for sources, and those seeking health expertise often seem to assume that only a physician can help them. Nurse Wendie Howland has long monitored the site and recommended nurses when the topic is one in which nurses are at least as expert
as physicians. Virtually no hospitals have public relations officials devoted to promoting their nurses in the media, as almost all do for physicians. But Georgia Peirce of Massachusetts General Hospital is one such publicist. When reporters call Peirce looking for an expert,
she often suggests a stellar nurse who has expertise in the area of interest. Nevertheless, the reporters usually insist on a physician despite her recommendation. Similarly, physicians remain the overwhelming favorite choice for health care speaking engagements even when
the audience is a large group of nurses. In 2013, one nursing school representative in Texas told us that she had repeatedly asked a speaker's bureau for a nursing leader to speak at a conference, only to be repeatedly offered physician speakers. Indeed, many nurses themselves
plan nursing conferences featuring physicians as the most prominent speakers. It is as if the nurse planners do not know that engaging nurse experts could fill their speaking slots, or they do know but believe physicians have the real health expertise or would be more appealing
even to an audience of nurses. When the media doesn't see nurses as experts, and so does not present them that way, the public shares that view. The public does not understand why nursing requires many resources, and it takes nurses' health advice less seriously, in clinical
settings and otherwise. The public also comes to see health through a physician-centered lens, as something that involves the diagnosis and treatment of illness. If the media used more nurses as expert sources, the public might develop a stronger sense of health as attaining
and maintaining wellness. Consulting nurse experts would create richer media, help reshape debates on health, and offer new ideas to repair the broken health care system. The few media programs that do routinely use nurse experts show how effective the practice can be. One
that may use nurse experts more than any other is HealthStyles, the weekly radio show on New York's WBAI, hosted since 1986 by nurses Diana Mason, former editor-in-chief of the American Journal of Nursing, and Barbara Glickstein.
On that show, nurse experts discuss health topics we don't often hear elsewhere, such as the movement in care of the dying from a "do not resuscitate" focus toward plans to "allow a natural death." Vancouver nurse Maureen McGrath hosts the Sunday
Night Sex Talk Show on local station CKNW, relying on nurses and other experts to address a range of topics related to sexual health. In 2008 nurses Casey Hobbs and Shayne Mason started Nurse
Talk, a radio show sponsored by the union National Nurses United that is irreverent but also addresses health policy and issues direct care nurses face. Nurse Donna Cardillo has appeared on television to explain health issues to the public; Cardillo
has also served
as an expert blogger at DrOz.com. And nurses Barbara Dehn and Nancy Reame have appeared on iVillage to discuss maternal-child issues.
Make Clear That Nurse Experts Are Nurses
When nurse experts do appear in media items, their status as nurses is often hidden. When the media identifies an expert only as "Dr. Pugh" most people assume the expert is a physician. This actually works against nursing by reinforcing the sense of physicians as the only health experts and suggesting that yet another health expert is not a nurse. And even when a nurse expert's PhD is noted, few will realize he or she is a nurse unless the piece says so. The media should identify experts as nurses so that the profession receives credit for the knowledge they provide. When one nurse expert we know appeared on a major national talk show, producers told her she had to choose only one identifier. We understand that anyone who has earned a PhD would want to be identified with it. But we believe it is more important for the nursing profession that the RN to appear than the "Dr." or the PhD. People will know the nurse is expert and articulate by the way s/he speaks. But they won't know s/he is a nurse unless that is specified.
Create TV Shows about Nurses
Though real nursing is dramatic and exciting, relatively few television shows have featured nurses as main characters. Instead, they have presented nurses as peripheral to serious care and have focused almost solely on physician characters who are shown spending much of their time doing what nurses do in real life. Grey's Anatomy is the most obvious recent example, but there have been dozens of such shows, from short-lived flops to long-running hits like House, ER, St.
Elsewhere, and M*A*S*H.
There have been a few recent exceptions. As we have explained, in 2009 three new nurse shows appeared on U.S. television, and Nurse Jackie has survived at least six seasons. But Mercy was canceled after one season, and HawthoRNe survived only three seasons as a summer cable show with a limited audience. Call
the Midwife has aired at least three seasons, although each has had fewer than 10 episodes. And MTV's recent Scrubbing In has given nursing the kind of attention it doesn't need. In any case, the rarity, limited reach, and inconsistent value of these exceptions proves the rule.
But Aren't Hollywood's Current Nurse Advisers Enough?
Nurses have served as advisors to many popular Hollywood shows, like Grey's Anatomy and House, but their main role seems to have been teaching the actors playing physicians how
to behave credibly on set. Obviously, "nursing advice" that has no evident impact on how the show actually depicts nursing does not help the profession. As with the news media, physicians dominate in providing the advice that drives the story lines. And even the recent nurse-focused
shows, apart from Call
the Midwife, have at times reinforced the handmaiden and other stereotypes. Only meaningful advice on scripts by nurses who understand nursing's media issues can help, and producers must be more open to it.
In chapter 2 of our book Saving Lives, we described how a nurse who is an international expert in her specialty got a phone call from producers of a popular TV hospital show. After she gave the producers the information they
wanted, she tried to educate them about why they should include more nursing in their show. That was a great effort, but not surprisingly that one interaction wasn't enough to change the show. In fact, although the producers were stunned to learn that our friend was a nurse--an
expert and a nurse--they still told her
that they and their audience were interested only in physicians.
But How Can I Sell Things Without Using Nursing Stereotypes?
With imagination, you can advertise your product without resorting to tired and demeaning stereotypes. It's true that the naughty nurse has been an advertising mainstay, and other ads have presented nurses as handmaidens or relatively unskilled. But that need not be so.
If advertisers wonder if they are using nursing imagery in a responsible way, they should consult with those familiar with nursing's image issues. One recent example of an advertisement that conveyed respect for nursing was a full-page magazine ad the University of Phoenix
ran in The New Yorker in April 2011. The ad featured a woman in a business suit looking upward and the headline: "Offering a faculty of industry professionals
to inspire tomorrow's health care leaders." The woman was identified as "Diane Wilson, MSN/MHA, College of Nursing, Chief Operating Officer, Community Tissue Services." The ad explained the University's "cutting-edge" health care management curriculum, noting that because
many of our students are experts in their fields, they can share industry insights gained through years of experience. It's an approach to education where accomplished students like Diane Wilson, already a CEO before enrolling, can debate new ideas on how to build a more
reliable, efficient and sustainable health care system for all of us.
"Community Tissue Services" is a major Ohio-based non-profit tissue bank. Ironically, the tissue bank--Wilson's own employer--apparently failed to identify her as a nurse in its online leadership profiles until early 2014, when it did finally include a helpful biographical
sketch of her. And some advertisers have been commendably flexible when nurses bring issues to their attention. Advertisers do not wish to alienate consumers, and some, like Skechers, have curtailed ads that relied so heavily on nursing stereotypes that they could not be
salvaged. Others, including Walmart and CVS, have modified ads to eliminate nursing stereotypes, with no apparent loss of effectiveness. For example, in 2007 Heineken brand Dos
Equis launched an amusing set of beer ads in a mock-serious tribute to a character presented as "the
most interesting man in the world." The ads showed him bench-pressing two chairs in which sat attractive, giggly women in short white dresses with nurses' caps. In response to our concerns, Heineken digitally altered the women's clothing to eliminate the nursing identifiers.
We encourage other advertisers to show similar flexibility and imagination.
"I Wouldn't Stereotype Nurses — My Mom's a Nurse!"
Please don't be one of those media creators who claim that they could not possibly create media that harms nursing because they're related to nurses or just really love nurses. Just as it makes no difference that a nurse was involved in creating a television show if that show harms nursing, it makes no difference that a media creator is close to nurses if his show, ad, or other product stereotypes them. For instance, even though House regularly degraded nursing, a show representative once suggested to us that the show couldn't harm nursing, in part, because the mother of show creator David Shore was a nurse, and she just loved the show! And we have heard from other media creators that their shows couldn't harm nursing because close relatives of the show creators are nurses (as with Dr. Phil and Sean Hannity, both of whom have sisters who are nurses) or the creators previously expressed appreciation for nurses (as with David Letterman). But there's no reason to think the effects of these shows change because of the relatives or intentions of the creators. We urge media creators to consider whether the images they actually present to the public conform to their positive sentiments about nursing.
Thank you for considering creating media about nursing. If you would like our feedback on what you create, we will happily provide it at no charge. Please email us at firstname.lastname@example.org or call us at 410-323-1100. Thank you!