A Christmas Message for Nurses

For the Christian world its nearly Christmas. Its time to think of others. When I think of family I also think of my nursing colleagues all around the world.

Nurses truly are a global village. We come from all races, countries, religions and beliefs. We are Christians, Muslims, Jews, Hindus, Buddhists, Sikhs, Taoists, Atheists. We celebrate Christmas, Ramadan, Hanukkha, Diwali, Maghi and so many others around the world. We are women and men, young and old. We are parents, siblings, children, relatives and friends.

We wear theatre scrubs, nuns habits, the hijab and military uniform. We work in large city hospitals and small remote villages. We work in wealthy, prosperous communities and in poverty stricken refugee camps. We work in the most harsh and remote places. We practice in clinical settings, education, research, health policy, management and the law.

We practice in peace times and in war zones. We are there at birth and at death. We  relieve pain and promote healing, fight sickness and advance health. We have access to the most advanced technology in western medicine and we make do with the most basic resources in developing countries. We care for the very young and the very old, the disenfranchised and diseased. We care without imposing judgment and we advocate for those without voice.

We are teachers and philosophers, councellors and confidantes, mentors, experts and leaders. We are team players and negotiators, we are unwavering in ensuring our clients right to self-determination and choice.  We care about humanity, the environment, social justice and freedom of speech. We are lobbyists and conscientious objectors. We are often stereotyped and we are frequently objectified but respond with dignity and professionalism. We are run off our feet but will sit quietly by the bedside of someone who needs our time and our caring.

To all nurses everywhere. I wish you health and happiness. I hope you are safe.  And I hope wherever you are, you receive the respect and acknowledgement you deserve. 

With love and recognition

Allison Willis, A Nurse

www.thehealthobjective@blogspot.com

Nursing stereotypes...what do we do to change them?

All you have to do is type ‘nurse’ into Google images and you will see every stereotype of nurses from angel to devil. Are these stereotypes really ever dispersed? What do the public really think of nurses? We are no more angels of mercy than we are naughty nymphets. Nurses remain misrepresented in and the public remain ignorant of the important contribution nurses make to health care.

We have reality talk shows like Dr Oz (Nov 2011) showing a line-up of naughty nurses  dancing provocatively with him, wearing high heels, retro nurses' caps and white dresses with red lingerie showing.  We have popular TV dramas like Grey’s Anatomy representing nurses as largely absent from the provision of care (performed mainly by doctors) and portrayed as 'kind but dumb' nymphets. How can we even hope to change the perception of the public?

Nurses are as negatively stereotyped today as they ever were, even though the profession has become a highly educated and technologically expert field of health science, along side its healthcare colleagues, and there is innumerable evidence that where nurses provide care, morbidity and mortality rates decline.

I suppose we should ask ourselves, are these stereotypes deleterious to nursing? Do the public believe them or are they just a bit of fun? 

Not all stereotypes are negative in nature. The image of the Angel of Mercy is one of a self-sacrificing, morally superior, noble nurse, selfless, altruistic and a reliever of suffering - based on the origin of nursing in the religious orders. The Heroine is the depiction of a brave, tirelessly dedicated nurse with its origins of war time nurses, virtuous – the good nurse ideal.

The trouble with these stereotypes is that they are no more accurate of nursing today than the negative images. The problem for nursing is that the common stereotypes are unrelentingly negative and totally removed from the reality of nursing. 

If public does not understand the complexity of nursing practice, it can’t support nurses fight for the necessary resources and infrastructure that enable nurses to do their work.  If the role of nurses is discounted and demeaned by these images then the public will not recognise the importance nurses play in meeting their health needs nor cry out when nursing numbers decline with the ever declining health dollar.

Although the public continue to hold nurses in the highest regard in relation to qualities of honesty, kindness and caring, the public have more faith in the doctor's knowledge than the nurse's knowledge. Although the public hold nurses in such high regard, it is deeply concerning that they do not have equal belief in the nursing professions level of professional knowledge and expertise. This view appears to be supported by the Gallop Polls (refer Nursing Autonomy Part 3).

But do nurses work at changing this perception or do they passively accept the stereotypes?

Have a look at the first images below. When I show these two images to nurses I ask them to describe who they see in the pictures. In the image on the left nurses routinely describe these as - a female doctor with two males nurses behind.  Nurses routinely describe the image on the right as - three doctors. When I ask them to explain why -  they rationalise that the first image shows the women in different scrubs and standing in front of and taller than the two men, hence this position of seeming authority must mean she is a doctor! They're rationale therefore that the subordinate positions must therefore be nurses!

The second image shows the same three people but now dressed identically and at the same height. When I ask nurses who these people are the most common response is - three doctors. When I ask why they couldn’t  be three theatre nurses the usual rationale is they were three nurses, there would be no doctor present and therefore unlikely!   I am astounded that nurses identify with these images in this way and seem to accept (and foster) the subordinate stereotype of nurses. 

Have a look at the images in the next slide. These are all generic stock photographs found on the web. What do you see these images representing? Be honest with yourself. Do you automatically identify with the subordinate images? Do you see the male roles as more likely to be a doctor? Do you see the person giving information as the doctor and the person listening as the nurse (taking orders)?

The next image is a poignant example how nurses are portrayed in the media (to the public) and how detrimental this is to our profession.  

The two photographs are from the Minister for Foreign Affairs, Mr Kevin Rudd’s, official website. The caption for the first image identifies the medical officer by name and even summaries the nature of the conversation he has with the Minister “....he relays the typical medical conditions presenting at the Camp Cockatoo Health Centre."  Mr Rudd attentively listens to what the doctor has to say.

The second image is captioned “Mr Rudd meets two Australian nurses with the AusAID civilian team” and even included in brackets “(names not known)”  We see two nameless, faceless nurses, Mr Rudd shaking hands with as he walks past. Did the nurses have an audience with Mr Rudd as he did with the doctor? Did he ask or was given their names? Did they have the opportunity to discuss nursing issues in Camp Cockatoo? Did the photojournalist take the time to ask the nurses their names so he could reference this information with the photographs (as he did with the doctor)? I somehow doubt it.

So how do we want to be represented? What images do we want the public to see when they Google us? Aren't these images amazing?

Isn't this what we want the public to see..to know, about nurses?

          

 

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