June 2011 -- Recently the drug company Johnson & Johnson (J&J) released a new batch of television advertisements as part of its Campaign for Nursing's Future, which began in 2002 as an effort to address the nursing shortage. The three new 30-second ads, like those released in 2005 and 2007, highlight different aspects of nursing practice and do a good job at promoting diversity. Each of the new ads also conveys something helpful about nursing skill. Unfortunately, each ad focuses mainly on the emotional support nurses give patients, and each concludes with the vaguely uplifting message "NURSES HEAL." One ad features an authoritative ED nurse reacting quickly to a trauma case, but even that ad is dominated by the nurse's returning of a lucky charm to the patient. And the other two ads will strike viewers as being mostly about hand-holding, by a hospice nurse and a pediatric nurse. Thus, despite some positive elements, each ad subtly reinforces the enduring image of nurses as low-skilled angels. The nursing crisis did not happen because people forgot that nurses hold hands. What decision-makers need to know is that nurses are autonomous life-saving professionals who need respect and resources, and in this regard the new ads are actually a step backwards from the 2007 ones. The new ads do at least omit the baby-soft voiceover and sappy music, which undermined the prior ads' good elements with vapid lyrics about how nurses "dare to care." The new ads are also more subtle about promoting J&J itself, though that cuts both ways; it distracts viewers less from the good and bad aspects of the ads. In any case, we thank J&J for its continued efforts to promote nursing, and we urge the company to focus more closely on telling the public that nurses are health experts who save lives.
"Emergency Room Nurses": Always after me Lucky Charms!
The ED ad includes the strongest portrayal of nursing authority and comes closest to suggesting that nurses save lives. The ad shows an African-American female nurse in green scrubs meeting an ambulance. She asks a paramedic what he's got, as they take a patient out of the rig on a stretcher. The paramedic says it's a restrained driver in a motor vehicle. We see the nurse playing a leading role in settling and caring for the patient during the busy resuscitation scene. She asks a paramedic to take over bagging as she puts on her stethoscope, taps the patient's tourniqueted arm, presumably preparing to start an IV, then takes off her stethoscope (as if she plans to use the stethoscope to start the IV, which is hard to imagine). A couple of other health workers, who seem to be physicians, appear very briefly on the other side of the patient during the busy scene, but the focus is on the nurse.
Nurse: (To the patient.) Sir, can you hear me? (Then to colleagues.) Take over bagging. (Then off screen.) We need a portable X-ray, please.
As the patient's clothes are cut off, about 11 seconds into the 32-second ad, we see the contents of his pocket fall onto the stretcher. They include a large metal shamrock charm on a key ring. The pace of the ad slows down a lot, and then we see the nurse approach the unconscious, ventilated patient later, when he is apparently stabilized but still in the ED.
Nurse (Voiceover): I'm a nurse. I believe in the power of science and medicine. (She walks to the patient, seems to look briefly at the monitor, then looks down at the patient.) But I'm also human. (She places the charm in the patient's hand and presses his hand closed.)
And I believe in stacking the deck.
Meaning, she believes in science, but if the patient thinks that the charm will give him good luck, or sees it as a symbol of faith in some higher power, she is happy to oblige--anything that might help her patient. The ad may even suggest that the nurse believes in the power of the lucky charm (though given what just happened to the patient in his car, the value of the charm is open to question). The picture cuts, and we see "NURSES HEAL" on a white background. Then that is replaced by the Campaign for Nursing's Future and J&J logos, with smaller print at the bottom encouraging viewers to learn more about becoming a nurse at the Campaign's web site (which our executive director helped to build in 2002).
The first third of the ad is pretty helpful, as the nurse is shown doing things that nurses rarely if ever do in the most popular hospital shows--meeting an ambulance, talking to patients and colleagues, displaying expertise and authority in a situation where a life is at stake. In fact, asking for portable X-ray is something a physician or advanced practice nurse would be more likely to do (there is no other suggestion that this is an APRN). These interactions will register with viewers, though many viewers may not imagine they are watching a nurse, rather than a physician, until the actor says she is a nurse.
Unfortunately, the nursing actions that require expertise end at the 11-second point, and the remaining two thirds of the ad are really about the lucky charm interactions. And the action slows abruptly for those, causing us to focus on them even more. Nurses do and should focus on patients' spiritual and psychosocial needs, and it's fine as a general matter to suggest that non-physical factors play a role in health and recovery. But the public is well aware that nurses are good at providing moral and emotional support. People already trust nurses to hold their wallets and to return their lucky charms; it's nurses' technical expertise they need to learn about. It's true that the final scene includes a reference to the nurse's "belief in the power of science and medicine," but that isn't all that helpful, since she is merely talking about her belief, not the fact that she is a science professional herself, and the script calls for her to reference "medicine" but not nursing--why couldn't she have said something like, "I practice nursing science"? Maybe she just believes in the power of physicians.
The main message of the ad is that nurses are holistic health workers who never lose sight of patients' spiritual needs. But if we had 32 seconds to tell the world something about nursing, we would not have spent 21 of them on that. Of course, as with every aspect of the Campaign for Nursing Future since the beginning, it clearly serves the public relations interests of a massive pharmaceutical corporation to associate itself with the ethical and honest angel image of nursing. We do think that this ad could have been more interesting if, rather than the shamrock charm, a handful of Lucky Charms cereal had tumbled out of the patient's pocket. That might have been a real test of the nurse's psychosocial care!
See the commercial below:
"Hospice Nurses": Halt, in the name of American squeamishness!
The hospice ad is probably the weakest for nursing. In this one, we see a white female nurse holding the hand of an older female patient who lies in bed, on oxygen. An acoustic guitar plays a gentle, lyrical melody. The nurse narrates the ad in voiceover.
Nurse (voiceover): I'm a hospice nurse. Bertha Olsen is my patient. [The nurse adjusts the patient's blood pressure cuff.] I spend long hours with her, checking her heart rate, administering her medication [the nurse helps Bertha into a chair facing a window], and just making her comfortable. [Now the nurse has placed her hands on Bertha's shoulders.] One night Bertha told me about a tradition in Denmark. [The nurse adjusts Bertha's bedding, then sits beside her.] When a person dies, she said, someone must open the window so the soul can depart. [From outside the window and below we see a curtain blowing out.] I smiled and squeezed her hand. "Not tonight, Bertha. Not tonight." [We see hands close the window.]
Finally, we see the same closing titles, with "NURSES HEAL" following by the Campaign for Nursing's Future and J&J logos.
Even more than the ED ad, this one focuses primarily on the hand-holding aspects of nursing. The nurse's voiceover does refer in passing to checking the heart rate and administering the medication, but that is unlikely to make a strong impression on viewers that nurses are autonomous professionals who improve lives. The ad does not begin to convey the technical expertise of hospice nurses, who must constantly assess their dying patients, including the course of various symptoms and care measures, as well as the patients' environments, and coordinate and advocate with a range of other professionals. "Administering her medication" and "just making her comfortable" is insufficient. The public has always known that nurses touch patients and adjust the bedding; that did not prevent the nursing crisis. The ad also includes the acoustic guitar music, which is fine and appropriate to end-of-life care, but also underlines the touchy-feely overall nature of the ad.
The most striking thing in this ad is the strong "not tonight" message at the end, a bizarre and damaging inversion of what hospice nurses are really about. That element suggests that these nurses focus on keeping patients away from death as long as possible, as if every night they can remain alive is a small victory. But hospice is about making people comfortable and allowing a natural death, not fighting it tooth and nail. We suppose it's possible to see the ad as countering the idea that hospice patients die quickly, but the far more likely message--reinforced by the reassuring repetition of "not tonight"--is that the nurse is staving off death, and maybe is even a little uncomfortable talking about death, particularly since the ad does not say directly what hospice actually is. No doubt it would be tricky today to provide a candid portrayal of hospice nursing that would not be open to misinterpretation as somehow promoting euthanasia or "death panels." We can't help but think a real hospice nurse would have been less likely to respond to Bertha's comments by sticking a smiley-face on the moment than to express interest in the Danish tradition, to ask questions--and maybe even to ask which window Bertha would prefer.
See the commercial below:
"Pediatric Nurses": Emma
The pediatric ad is the most persuasive and affecting of the new batch, but like the others it conveys little of nurses' life-saving expertise. In this one, we see a friendly, burly, deep-voiced white male nurse, sitting by a young girl's hospital bed, preparing to give her an injection. The girl has a scarf on her head and seems to be a cancer patient. The nurse asks what the patient is drawing, and she shows him a round-headed figure with close-cropped hair like his and says it is him. He laughs.
Nurse: All right, Emma. I know it's not your favorite, but it's time for your medicine, OK? [He touches her back to comfort her and prepares the syringe.] You ready? One, two, three.
As the nurse gives Emma the injection, they sing a kind of poem song together.
Nurse and Emma: Emma, emma, bo-bemma, banana-fanna, fo-femma, fee-fi-fo-femma . . . Emma!
Nurse: Very good, sweetie. How do you feel?
Nurse: Yeah? You did a really good job, OK? Let's go back to drawing. . .
And as his voice fades away, the "NURSES HEAL" and final J&J images end the ad.
Obviously this ad also focuses on emotional support. The ad does convey something more for those who are paying attention. The nurse is showing real psychosocial skill in putting Emma at ease and distracting her with their song, while at the same time accomplishing an important technical task that is presumably somewhat painful. (The ad's choice of this specific situation to illustrate the nurse's skill and Emma's courage is a little odd because the nurse is giving an intravenous medication, which should not hurt unless it is being injected too quickly or has not been diluted enough; but few of those the ad is trying to reach will realize that.) The ability to do these key tasks simultaneously is very valuable in the clinical setting; most people could not do it. And injecting drugs correctly requires some technical skill. But as impressive as the scenario is, and as much as this nurse comes off as a good guy with a talent for helping kids through difficult procedures, viewers could not conclude from this ad that nurses are life-saving health experts.
Viewers may not associate this type of emotionally astute support with men, but the nurse's voice quality, manner, and appearance suggest that he is a "regular guy." Most viewers will likely assume that he is straight, and the ad was probably intended in part to counter the gay male nurse stereotype, though as usual when media products try to do that, it's difficult to avoid the implication that maybe there is something wrong with being gay. But of course, some male nurses are gay. And in countering one stereotype about nurses, it's critical not to reinforce other stereotypes about gender roles. In fact, so many products aimed at promoting men in nursing take pains to send the "not gay" message that we have come to wish that at least some of them would include men who will be seen as gay.
See the commercial below:
On the whole, the three new J&J ads have some good elements and avoid the sappiest extremes of prior ads. But the ads' focus on emotional support tells the public little of what it really needs to know about nursing: that nurses are autonomous, educated professionals who save lives.