The social media outcry over the host of the “The View” making disparaging comments toward nurses last month was noisy. But this isn’t the first time nurses have been disparaged. In fact, it’s been a pattern for over a century. From the drunken Victorian-era nurse embodied in Charles Dickens’ Sarah Gamp, to the sadistic Nurse Ratchet of the 1970s, and drug-addicted Nurse Jackie of our day, nurses have been subject to sexist parodies and lampooned as low-class and generally incompetent subordinates.
Historically, this portrayal of the nursing profession led to an anemic talent pipeline, and the well-documented nursing shortage of the eighties and nineties. Today, nurses face a different set of challenges—and opportunities. Gallup polls tell us that nurses are among the most trusted professionals in the country. Schools of nursing can’t keep pace with demand, as highly qualified candidates compete for limited spots in nursing programs. Nevertheless, the caricature of nurses on TV and other media continues to impact our ability to respond to the patient safety and quality care imperative, drive change within rapidly changing patient care and reimbursement models, and address our looming primary care crisis.
Offering a new image of nursing that confronts stereotypes with reality is a good place to start. But we need to do more than simply redraw the perception of nurses. Here are three areas where #NursesUnite can take a stand to help shape the field, and bend the curve on healthcare outcomes.
Scope of practice
It’s hard to ignore the impact that the negative perception of nursing as a contributing factor in limitations on our scope of practice. Advanced practice nurses, in particular, hold the potential to increase access to and decrease cost of healthcare: nurse practitioners can deliver the majority of primary care in the U.S. at a lower cost with the same or higher quality than physicians. Yet, only nineteen states allow full independent practice for nurse practitioners.
Governance
Nurses should play a critical role in the governance of the institutions where they practice. The American Nurses Credentialing Center designates Magnet® status to hospitals that have engaged nurses in critical aspects of governance to dramatically improve outcomes. When nurses are involved in management decisionmaking, they are more likely to communicate about errors—and participate in error-related problem solving. By involving nurses as active partners, Magnet-designated hospitals have also been able to reduce patient fall rates and improve patient satisfaction.
Educational advancement
Despite the robust evidence that suggests patient and institutional outcomes improve with a more highly educated nursing workforce, only half of registered nurses have earned a BSN degree. Higher education’s accreditors are beginning to approve urgently needed affordable and flexible competency-based educational models that value and recognize the expertise that registered nurses bring as the foundation for their continued education.
A call to action
To realize the promise of our profession, we need systemic change. This latest controversy over “The View” presents us with an opportunity to re-examine the attitudes that shape the policies and conditions that affect nurses. Today’s nurses are highly skilled, caring professionals who are making a demonstrable impact on the health of our nation. But they are also expert knowledge workers who are driving significant progress in our fractured healthcare system. Let’s consider a new image of nurses as transformational leaders who are helping to define the future of health care – but let’s also put the structures in place for them succeed.
Patrick Robinson, PhD, RN, FAAN, is the dean of Capella University’s School of Nursing and Health Sciences, which recently announced a new Bachelor’s degree program that allows registered nurses to save time and money by leveraging their existing work experience. Dr. Robinson is a Certified Nurse Educator through the National League for Nursing, and had been awarded the Frank Lamendola Memorial Award for exemplary leadership in HIV/AIDS care and the Association of Nurses in AIDS Care Life Time Achievement Award.
