Professional Development

8 The Image of Nursing

Publication Date: May 2007 Vol. 2 Num. 5

Author: Shelly Cohen, BS, RN, CEN

A nurse cradling a child who is receiving treatment for asthma. A nurse holding the hand of a frail diabetic patient and encouraging him during the discharge process. A nurse’s empathetic expression for a frightened teenager facing emergency surgery.
Are these the images we leave with our patients? Do they reflect how we see ourselves? Is our image obvious only in what we do, or is it also about what we say, how we say it, and what we wear? Consider these questions:
• How has our image changed over the years?
• Who is defining the image of the nurse?
• What can each nurse do to affect our image?
• How do we confront and address the negative images of nursing?
Our changing image
Over time, nurses have had many images, ranging from the angel of mercy to the sexual stereotype sometimes portrayed in works of fiction. Florence Nightingale depicted the nurse as inferior to the physician. As a child, I read every book in the popular Cherry Ames series and dreamed that every day I worked as a nurse would be a Cherry Ames day. This series ran from 1943 to 1968 and, interestingly, is now back in print. Other representations and misrepresentations that have shaped our image include Hot Lips Houlihan in the television series MASH and some less-than-inspiring nurses in soap operas.
In 2001, the Center for Nursing Advocacy was founded to address the nursing shortage. After deciding to focus on improving the portrayal of nurses in the media, the Center began a series of annual Golden Lamp awards for the best and worst depictions of nurses. The Center has developed letter-writing campaigns to target producers of shows that don’t show nursing in a positive light, such as ER and House. In December 2006, after 5 months of effort, the Center persuaded Coors brewery to stop using “naughty nurse” imagery in its ads.

Most honest and ethical
For many years, a Gallup poll has identified the most honest and ethical professions in America. And for 8 years in a row, nursing has been in the top 10. For the last 5 years, nurses have been number one (see Most honest professions).
But is this ranking really relevant to the concern we have about our image? What really matters to patients and their caregivers? What do we care about and look for in our colleagues? How much impact do these perceptions have on our image? (See Nursing’s image: What do nurses think matters most?)

Dressing with Snoopy and Sponge Bob
As the image of nursing evolved with time and changes in healthcare delivery, our appearance changed, too. The catalogue scrub companies who bombard nurses with their mailings have played an important role in this appearance change. Today, many nurses think nothing of wearing clothing adorned with cartoon characters. What other professions that serve the public have cartoon characters on their uniforms? Police officers, pre-hospital staff, judges, firefighters, and others would not be seen with Snoopy, Sponge Bob, or animal characters covering their uniforms.
Why does nursing represent itself in this way? We let people outside of our profession influence how we present ourselves to the public. Sandy Dumont, an image consultant, makes this comment about the way we dress, “You’re the only thing between the patient and death, and you’re covered in cartoons. No wonder you have no authority.” Many organizations have started to address this issue by changing the dress codes for nurses. These changes also make it easier for the patient to identify who is a nurse.

The face of nursing
The face of nursing—that is, the overwhelmingly female face—also affects our image. Although the number of men in nursing is growing, we need more campaigns and targeted recruitments to draw men into the profession. The old Cherry Ames image keeps the profession primarily female. As more men enter the profession, they will become role models and mentors for others. And other men will look at nursing as they do other career options, such as being a police officer or firefighter.
Our patients may be in the best position to answer the question, Who is the nurse? A nurse diagnosed with cancer found herself on the other side of health care. Here’s what she had to say, “I must say the majority of the time I knew who the nurses were…by the way they carried themselves and their professionalism.”

Redefining our image
Professor L.D. Andrews of Rogers State University says that to create a new image for nursing, nurses must:
• value nursing and project that image daily
• take themselves seriously and dress the part
• recognize the value of what they do
• believe in themselves and their colleagues.
Our image is evolving as nurses fill seats in the House of Representatives and news stations use us as resources for their stories on healthcare issues. These opportunities allow us to represent the reality of nursing and to show how the profession contributes to health care.
These developments show promise, but our professional image needs more, and we need it now. Each nurse needs to explore how his or her actions or inactions affect our image. Nursing faculty need to work with the student nurse organizations to help promote the image of nursing. Nursing leaders need to recognize the daily impact they have on the perceptions of staff nurses, patients, and caregivers. And staff nurses must appreciate the importance of how they are perceived by patients and caregivers.

Being a professional 24/7
We also need to recognize the effect of our behavior outside of the workplace. For some nurses, nursing is just a job, and it shows in what they say and how they act at work and away from work.
I have heard nurses emphatically state that they do not want their children to go into nursing and have to work in an environment where they are not respected, are underpaid, and have to deal with people who have unrealistic expectations. Obviously, these nurses are not helping to improve our image.
When an old friend asks about your work, don’t roll your eyes or shrug your shoulders. Try responding by putting your shoulders back, looking the person right in the eye, and saying, “I am a registered nurse now, and I work at the hospital.” Encourage your child who is interested in nursing. Inspire a child to consider the privilege of being with people when they are at both their worst and best. Such everyday actions will improve the image of nursing.

What we must do
Part of changing our image is growing as a profession, and such growth requires a nurturing process. Our nurse leaders need to guide this process by doing the following:
• Cultivating a professional image by the way they represent the profession
• Defining unacceptable workplace behaviors and holding the staff accountable
• Teaching nurses the benefits of scripting such as, “My name is Shelley, and I am your registered nurse today.”
• Defining the appearance of the nurs­ing staff in written guidelines and following through with consequences for those who don’t comply
• Involving the staff in developing the list of unacceptable behaviors and the specifics of a new dress code
• Posting, circulating, and advertising nursing’s accomplishments
• Using the local community newspapers for ongoing announcements
• Having staff contribute to the com­munity by writing health-related articles in the newspaper
• Speaking to civic and community groups about what nursing is and does
• Listening to patients’ and caregivers’ perceptions of nursing
• Surveying staff, patients, and caregivers about these perceptions
• Teaching and mentoring staff on how to validate all they do with appropriate documentation and active committee involvement
• Teaching communication skills, so staff nurses feel empowered to respond to negative colleagues in a manner that confronts and stops behaviors that affect our image
The time for us to redefine our image is now. By working together, we can help ourselves and the public see the nursing profession clearly.

Selected references
Andrews LD. Current image of professional nursing. Available at: www.rsu.edu. Accessed March 30, 2007.
The Center for Nursing Advocacy. Available at: http://nursingadvocacy.org/action/action.html. Accessed March 30, 2007.
The in/visibility of nurses in cyperculture. Available at: www.nursing-informatics.com/visiblenurse7.html. Accessed March 30, 2007.
Johnson & Johnson Discover Nursing campaign. Available at: www.discovernursing.com. Accessed March 30, 2007.
National Student Nurses’ Association. Image of Nursing Guideline Booklet. Available at: www.nsna.org/activities/nursing.asp. Accessed March 30, 2007.
For a complete list of selected references, visit www.AmericanNurseToday.com.

Shelley Cohen, BS, RN, CEN, is the educator/consultant for Health Resources Unlimited in Hohenwald, Tennessee.