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Allison is a registered nurse and senior health policy adviser with some 25 years experience. Prior to launching CPD Nurse Escapes, Allison worked as a private consultant for a diverse range of clients in the government and non-government, health, community and education sectors. Allison has an extensive background in regulation, governance and professional practice and applies this in education, policy development and project management. Allison was the Principal Advisor, Professional Practice at the Nursing & Midwifery Board of South Australia, for 10 years where she was responsible for developing nursing and midwifery policy and standards and advising and educating nurses and midwives on professional practice issues.

Sunday, 11 December 2011

Nursing Autonomy Part 4: Visibility, Viability and Voice

Each year the Ray Morgan Image of Professions Survey identifies the public’s level of trust in key professions.  The 2011 results found that 90% of Australians (aged 14 and over) rate nurses as the most ethical and honest profession.  This has been the same result for the 17th year in a row, since nurses were first included on the survey in 1994.

The 2011 results showed the following;
Nurses (90%)
Pharmacists (85%)
Doctors (81%)
School Teachers (78%)
Engineers (71%)
Dentists (69%)
State Supreme Court Judges (68%)
High Court Judges (67%)
University Lecturers (67%)
Police (65%)
Source:  www.roymorgan.com 2011

 The Australian results are similar to the results in the Unites States – where nurses have been found again to be the most trusted professions for the past 11 years in row (since including on survey in 1999). The one year that nurses were not surveyed as the most trustworthy in the US was in 2001 when terrorist attacks occurred (commonly referred to as 9/11).

More importantly I believe are that the results in the US found that more Americans are likely to turn to their doctors for health and medical information (and have confidence in that information) than other potential information sources.  This seems at odds with the survey results as it suggests that although nurses are more trusted and perceived as having a higher level of honesty and ethical standards, the public have more faith in the knowledge of doctors than nurses. What does this mean for nurses?  Although it is astounding that the public hold nurses in such high regard, it is concerning that they do not have equal belief in the nursing professions level of professional knowledge and expertise.

 Bernice Buresh and Suzanne Gordon, in their book From Silence to Voice: What nurses Know and Must Communicate to the Public summarise this concern.

“In spite of years of desire and demonstration to the contrary, the public's perception of nursing practice is still largely that of a handmaiden to the physician”.

“Although the public highly regards nurses, they do not highly value nurses in terms of believing that nursing care is equally as important as medical care in contributing to health.”

So why do the public trust nurses? More importantly if the public don’t know what we do, why do they trust us?

Perhaps it is because the profession is predominantly women - the perception of woman as mother, nurturer, self-sacrificing. Perhaps nurses as care providers are seen as sympathetic?  It is easy to like people who care about you - seen as a trusted friend and confidant?  Perhaps as nurses are advocates for their clients they are seen as empathetic – on their side – part of their support group or family? Perhaps because nurses have held the universal trust of the community for many years – during war times, caring for the poor and disenfranchised over centuries – nurses hold the captive faith of the people. 

The issue is however that the public trust nurses to care for them but do not trust that nurses have the necessary knowledge, to assist them to make the most appropriate decisions about their care. Not only do we want to continue to have the faith of the public behind us but we want the public to be well informed about the unique role and contribution nurses make to their health outcomes.

The only way that this is going to be achieved is if nurses are able to articulate what they do.  Over the course of my career, however I have talked to many hundreds, if not thousands of nurses who are unable to clearly define what nursing is and what it does and how it is different from other professions.  The plain truth is if nurses can’t articulate what they do, how can the public be expected to know?

When I ask any group of nurses to define nursing they frequently offer vague responses like “care”, high standards”, quality health care” and  “health outcomes”.  When I ask them to tie these into a sentence the process becomes even more arduous and we end up in small working groups trying to include ever key word….nurses provide the highest standard of nursing care to achieve quality health outcomes (and them to finish off with a flurry)…for all Australians!  I appreciate the difficulty, writing an overarching definition for something as broad and as complex as nursing practice is a difficult task, but if we don’t clarify our role and function who will? 

 The International Council of Nurses Definition of Nursing is;

“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles” (updated 2010)

The American Nursing Association Nursing's Social Policy Statement (2003) defines six essential features of professional nursing as;

·      Provision of a caring relationship that facilitates health and healing,
·      Attention to the range of human experiences and responses to health and illness within the physical and social environments,
·      Integration of objective data with knowledge gained from an appreciation of the patient or group's subjective experience,
·      Application of scientific knowledge to the processes of diagnosis and treatment through the use of judgment and critical thinking,
·      Advancement of professional nursing knowledge through scholarly inquiry, and
·      Influence on social and public policy to promote social justice.

 What do the public see?

The public perception of nurses and nursing is shaped by the images people see – as clients, their family members, the community and as consumers of media (from the press to entertainment)

The public view of nursing focuses on the art of nursing – caring and nurturing, sweet, kind, honest, ethical, attentive and willing to talk (the emotive components of nursing that have been historically the role of nurses). The public are not commonly aware of the science of nursing. They do not view nurses as critical to their health care planning, interventions, treatment and health outcomes. They are unaware that nursing is evidence-based, technologically sound and based on critical thinking and professional judgment.

I was in a cab recently on the way to the airport.  Bruce, my cab driver was espousing his philosophies on life, one of which included his view of nurses! Bruce told me how he had recently been in hospital and he was ‘disappointed with the nurses of today. Nurses today want to be doctors not nurses…they want to be noctors.” Bruce told me how the nurses who cared for him were more concerned with the ‘technical things than just plain nursing”. When I asked what they were he said “ like taking his BP and checking his drip and doing his dressing - the doctors role. But they didn’t really spend time taking care of him.”

Bruce’s comments sunk home with me. He had no understanding at all of the role the nurses played in his care. Bruce saw any clinical task that took the nurse away from caring and nurturing him as the role of the medical practitioner.  Bruce was looking for an ‘angel of mercy’ and he got a ‘noctor’!

 If nurses do not educate their clients and the public about their role and contribution to health care they continue to be at risk of being marginalised from influencing decision making in relation to;
·      organisational policy and protocols
·      government standards and legislation
·      scope of practice and emerging roles
·      resource allocation and salaries and conditions of employment;
·      expanding autonomy and control over own practice, and
·      the ability to advocate for patients and deliver high quality nursing care.

Nurses need to focus on maximising their visibility, viability and voice to ensure the public understand the role of nursing and its contribution to health care. Without this understanding the public will continue view nurses and trustworthy and caring but lacking in knowledge and expertise and needing to be guided by the medical profession.

Do nurses really want to be viewed by the public as kind but dumb?

Recommended Readings and References

From Silence to Voice: What nurses Know and Must Communicate to the Public Bernice Buresh and Suzanne Gordon 2003 updated 2006

Darbyshire, Philip and Gordon, Suzanne (2005). Exploring Popular Images and Reputations of Nurses and Nursing. In Daly, John, et al., (ed.) Professional Nursing: Concepts, Issues, and Challenges. pp. 69–92. New York: Springer Publishing Company.

International Council of Nurses (ICN)  www.icn.ch
American Nurses Association www.nursingworld.org

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