This Medscape article was brought to my attention by Sandy Summer's "Truth About Nursing.org. She wrote: March 12, 2010 -- Today Medscape ran a long, powerful article by Laura Stokowski headlined "A Letter to Hollywood: Nurses Are Not Handmaidens." The article features very good explanations of the common myths about nursing that Hollywood promotes, as well as information about what nurses really do to help patients.
Dear Hollywood,
We, the nurses of the world, have something to say to you. Nurses are not what you think. Nurses are independent, highly educated, and skilled healthcare experts who save lives every single day. We work hard and are dedicated to making differences in people's lives.
And we are really sick of going home after a 12-hour shift, turning on the television, and seeing ourselves depicted as brainless bimbos. This has been going on far too long, and it has to stop.
The Clown Took a Job as a Nurse
I remember a time when I was in nursing school, watching TV with my roommate, Liz. A skit came on, in which a famous comedienne of the day was dressed up like a clown. For some reason the clown had to leave the circus. "So," said the narrator, "the clown took a job as a nurse." We laughed at the absurdity of this, but I never forgot it. We were in the middle of a demanding 4-year nursing program, and the suggestion that anyone, even a clown, could be a nurse, just like that, was wounding. I think it was then that I began to take notice of how Hollywood represents nurses.
The answer is...badly. But it isn't just disrespect that comes through in Hollywood portrayals -- it's contempt, and it's not at all subtle. You scorn us in the way you pigeonhole nurses on the small screen -- it seems that we're either half-wits, nymphomaniacs, or latter-day Nurse Ratcheds. Obviously, you have no concept of nurses as autonomous, knowledgeable professionals. We work alongside physicians, but we are their colleagues, not their subordinates. Yet in every hospital drama, physician characters are ordering nurses around, treating them like uneducated servants, or performing nursing care themselves and getting the credit for it, while the nurse characters just fade from view.
I can almost hear your reaction to my complaints. There, there, dear, don't take it personally, it's harmless, it's funny. Is it, really? Will it still be harmless or funny one day in the future when you are in the hospital and you press your nurse-call button and no one responds? Or it is answered -- eventually -- by a minimally trained hospital "technician"? The nursing shortage will have reduced our ranks considerably, and driven many of us into early retirement. It doesn't help the situation when schoolchildren and teens already discount the notion of becoming nurses because of the way nurses are portrayed on Grey's Anatomy. Becoming a nurse, they believe, is a waste of their talents.[1]
Maybe You're Misinformed
I'm going to give those in Hollywood the benefit of the doubt, and assume that they just have the wrong impression of nurses, and have no idea what nurses really do. But for the non-nurse readers, we'll pretend that you are in the hospital, and you've just had emergency heart surgery.
Who do you suppose will be at your side, watching your blood pressure, making sure you don't go into shock?
Who will be alert for the slightest hint of life-threatening hemorrhage?
Who will respond in mere seconds if your heart begins to beat irregularly?
Who will make sure that your chest tube doesn't get blocked and cause you to go into cardiac arrest?
Who will keep the circulation moving in your lower legs so you a clot doesn't develop and you don't die from a pulmonary embolism?
Who will be constantly watching to make sure that you don't stop breathing, that you are getting enough oxygen, that postoperative pneumonia is not developing?
Who will relieve your pain before you even have to ask?
Who will explain everything that is happening to you and teach you how to take care of yourself after you go home?
I'll give you a hint -- it's not your physician. It is your nurses. They will see you safely through one of the most dangerous times of your life, doing all these things and more.
And just so we're clear, I'll tell you what your nurses won't be doing. They won't be clustered around the nurses' station as though at a cocktail party, flirting with physicians. They won't be in the broom closet or the stairwell or behind the patient's curtain giving sexual favors. They won't be trailing after the physician as he marches down the hall, in case he needs a cup of coffee or someone to dump on. Nor will they be in the receptionist's chair, moaning about not being able to get into medical school. If these scenes sound a little familiar -- I'm not surprised. This is how nurses are regularly portrayed on television dramas.
No Angels of Mercy, Please
Hollywood, we're not asking you to glorify nurses. Don't turn us into heroes or martyrs. We just want to be accorded the respect, the esteem that our education, status, and profession warrant. We want our dignity back. We don't want the entire world to think of us as sleazy, dim-witted underlings. We want to erase the image of the "naughty nurse" -- this is your bizarre fantasy, not ours.
We want young, impressionable children to view nursing as a viable, respected, and even admired profession, one they would be proud to call their own. But most of all, we want our patients to trust us and value our knowledge, so that when we teach them how to become healthier people and live longer, healthier lives, they will listen. This, our most treasured ability -- the core of nursing -- is what you threaten with your cheap attempts to increase ratings by ridiculing the nursing profession.
So my question to you is, is it worth it? Is the money you make from entertaining viewers with mentally unbalanced, sexually promiscuous, or idiotically subservient nurse characters worth influencing potentially hundreds of thousands of young men and women to shun a career in nursing? Will you feel content, even proud, the next time you encounter a nurse, in the thought that you regularly chip away at her self-respect and her ability to be effective in her job?
Or will you infuse some realism into your tired stereotypes? You can start by discarding the following myths -- their demise is long overdue.
Myths About Nurses Perpetuated by Hollywood and Other Uninformed Media
1. Physicians are nurses' superiors in the hospital hierarchy- nurses "work for" physicians.
Not true. Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians.
2. Nursing doesn't require much education.
Nursing education is highly specialized, intense, and rigorous, because nursing itself is a profession grounded in science. Many people, if they believe nurses go to college at all, think that most nurses attend a brief 1- or 2-year program. In fact, 58% of nurses presently have a bachelor's degree or higher, a number that is growing every year. The "2year" nursing program doesn't really exist - the associate's degree in nursing requires prerequisites even before entering the nursing program, making it essentially a 3-year program. And in many areas, new graduate nurses undergo extended fellowships in the clinical setting that greatly increase their education and skill in nursing as they enter the profession.
3. Nurses mainly "fetch things" for physicians.
Nursing is a practice that is unique and distinct from medicine. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.[2] Nursing's focus, and what sets it apart from medicine, is the whole person, not just the specific, presenting health problem, and nursing encompasses both actual and potential health problems. Nursing's scope of practice has been shown in numerous studies to save lives and improve health outcomes.
4. Nurses are those who aren't smart enough to get into medical school.
This might be the most irritating myth of all. It presupposes that nursing is just a tiny subset of medicine, a fallback for people who can't quite make it up the ladder. However, nursing is a different profession, not the same profession watered or dumbed down. Many nurses go on to earn advanced degrees at the master's or doctoral level, but they are still practicing nursing (note that nurse practitioners and other advanced practice nurses may share some of the same functions as physicians in their specialties, but they are philosophically nursing-oriented in their approach to patients). And research shows that care provided by these advanced practice nurses is equal to or better than that provided by physicians.[3-6]
Spotlight on the Best and Worst Media Portrayals of Nurses
It's award season in Hollywood, so it's timely that the Truth About Nursing organization ("the Truth") has just released both its end-of-decade (Tables 1 and 2) and annual (Table 3) awards for images of nurses in the media. From their press release:
The Truth About Nursing announces its list of the best and worst media portrayals of nurses it saw between 2000 and 2009. The Truth's Decade Awards highlight media from a decade in which the world has faced a deadly nursing shortage fueled in significant part by poor public understanding of the profession.[7]
In a promising turn of events, several nurse-focused television dramas (a rarity in Hollywood) premiered in 2009, and these shows made the "Best List." The smart and skilled nurses on Showtime's Nurse Jackie, TNT's HawthoRNe, and NBC's Mercy, rather than retreating into the background, are front and center, fighting for patients, not for attention.
The Truth gave honorable mention to newspaper columns written by Ronnie Polaneczky, reporting by Integrated Regional Information Networks, the documentary Nurses on the Discovery Health Channel, and the HBO film Wit starring Emma Thompson. "Most Improved" awards were given to the television drama ER for better depictions of nurses during the show's final 4 years, and the "Take a Loved One for a Checkup Day" campaign for changing its name from "Take a Loved One to the Doctor Day," which ignored the significant role of nurse practitioners in providing primary care to the campaign's target population.
Table 1. Ten Best Media Portrayals of Nurses of the Decade, 2000-2009
1 Nurse Jackie New York ED nurse Jackie Peyton is tough but talented, and finds creative ways to help patients lead better lives or find lasting peace
2 Mercy Veronica Callahan is an Iraq war veteran with PTSD who leads a crew of smart and committed nurses.
3 Critical Care: The Making of an ICU Nurse Boston Globe article chronicled the 8-month training of a new ICU nurse showing the high level of skill required to care for these complex patients
4 The Rookies Episode 1 of Lifeline: the Nursing Diaries shows nurses engaged in routine nursing functions, such as life-saving interventions and patient education
5 Angels in America Nurses at the center of AIDS care, balancing skill, determination, humor, and caring
6 Media by Diana Mason Weekly radio show Healthstyles with nurse experts; garnered mainstream press for nursing research
7 HawthoRNe Chief nursing officer Christina Hawthorne is a strong and skilled expert nurse in Richmond, Virginia.
8 Media by Theresa Brown Blog for New York Times about nurses, giving nursing perspective on key policy issues
9 Media by Suzanne Gordon Wrote the book Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care (2005)
10 California and Massachusetts Nursing Associations. Advocated for nursing through mass media campaigns explaining the value of nursing and presenting nurses as articulate, holistic advocates of public health
Adapted from The Truth About Nursing Decade Awards[7]
Table 2. Ten Worst Media Portrayals of Nurses of the Decade 2000-2009
1 Grey's Anatomy Nurses are insignificant, as physicians perform real-life nursing work. Nurses are portrayed as bitter or fawning losers.
2 House Ignores nurses completely or treats them as annoying fools who are there to clean up the mess.
3 Private Practice Mocks clueless nurse character who works as a receptionist.
4 The Naughty Nurse Many appearances throughout the decade, including ads by Virgin Mobile, Gzhelka Vodka, the Lung Cancer Alliance, the Heart Attack Grill; and in degrading comments made by Kelly Ripa and "Dr. Phil" McGraw on TV.
5 The Today Show For attacks on advanced practice nurses, including nurse midwives and nurse practitioners.
6 ER (2000-2005) Portrayed nurses as physician handmaidens whose highest aspirations are to go to medical school.
7 Passions An orangutan named Precious serves as a private-duty nurse, suggesting that apes can do nurses' jobs.
8 Hopkins 24/7 & Hopkins Repeatedly suggested that physicians perform all important care; virtually ignored the thousands of highly skilled nurses who work there.
9 Media by the American Medical Association Comments in major news media questioning the competence and qualifications of nurse practitioners, in spite of evidence of their effectiveness.
10 The robot nurse Doesn't exist, but makes appearances in the media as "robo-nurse," "virtual nurse," "nurse robot," electronic nurse," etc., reinforcing the view that a "nurse" is anyone or anything that acts as an assistive caregiver.
Adapted from The Truth About Nursing Decade Awards
Annual awards for the year 2009 are found in Table 3.
Table 3. Best and Worst Portrayals of Nurses in the Media, 2009
Best Worst
1 Nurse Jackie 1 Grey's Anatomy
2 Mercy 2 House
3 HawthoRNe 3 Private Practice
4 Theresa Brown 4 The Today Show
5 Pauline Chen, New York Times 5 Minette Marrin, Sunday Times (UK)
6 Nurses advocating in the media 6 New York Times damaging portrayals
7 Reports on nurse innovators 7 "Naughty nurse" advertisements
8 Zara Nicholson, Cape Argus (S. Africa) 8 Three Rivers
9 Erin Thompson, USA Today 9 Mental
10 Reports on school nurses 10 The robot nurse
Adapted from The Truth About Nursing Annual Awards, 2009.
Available at: http://truthaboutnursing.org/press/awards/2009/awd.html.
Used with permission
For some perspective on this, I contacted Truth About Nursing's Executive Director, Sandy Summers. The Truth is an organization that seeks to increase public understanding of the central, front-line role that nurses play in modern healthcare. I asked Ms. Summers how the Truth comes up with the "best" and "worst" awards.
"We analyze depictions of nurses in the news, the lay media, television, radio, music, films, billboards, plays, magazine articles - all sorts of media - and tell readers how good a job they are doing in portraying nurses," responded Summers. "Sometimes, it's good; sometimes it's bad. When a show is doing something right, we ask our readers to send letters to thank the media for doing a good job. When we find a negative or stereotypical depiction of nursing, we encourage our readers to send letters asking the media to improve its product. We set up form letters to help facilitate this and clearly, the more letters the media receives, the more likely they are to respond favorably (though the AMA appears to be an exception.)"
And the Truth has made some headway. When the Lung Cancer Alliance (LCA) used a rap-style video called "Waitin' Room Service" that included nurses dancing suggestively and making sexual overtures to "Dr. Lunglove," the Truth started a letter writing campaign to ask the LCA to remove the video from its Website. "They were admirably trying to educate people about lung cancer," explained Summers, "but they didn't need to use a naughty nurse to do that. The LCA did finally listen to all our letters and phone calls, and took the offensive video off its Website -- but with much resistance."
I asked Summers if stereotypical depiction of nurses was a global problem, to which she gave an unqualified "yes," and continued, "The whole world has this problem, not just the United States. It's even worse in some areas where nurses are viewed as the equivalent of prostitutes, and have trouble finding husbands because their jobs bring them such disrepute. But the media stereotypes are the same, largely propagated by Hollywood shows which are spread throughout the world. The US is the world's biggest purveyor of negative images of nursing.
"Trying to get messages about the value of nursing across to the media is a monumental task," explained Summers. "The media don't actually speak to nurses -- they don't think they need to. They 'learn' about nursing by watching other media depictions so they think they know what nurses do without asking about it themselves. They think, 'nurses just get stuff for physicians.' That's what goes on inside their heads, so we have to change that, shake them up with the truth about what nurses really do. It's very difficult when nurses themselves are reluctant to speak with the media -- these are 2 groups of people who need to communicate, but neither one wants to talk to the other."
Nurses will have to be stronger, louder, and more direct in their messages to all media -- not just Hollywood dramas but television and radio news programs, newspapers, and others who degrade the image of nursing -- but how? The Truth has answers. On their "Take Action" Web page, they describe "what you can do to shape a better image of nursing." You will find hundreds of ideas, such as writing letters to television programs such as Grey's Anatomy, House, or Private Practice (addresses provided), submitting your own nurse story ideas, using nurse-friendly language, or learning how to interact more effectively with the media. If you are interested in finding out more about how media portrayals of nursing affect the nursing profession, read Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk, by Sandy Summers and Harry Jacobs Summers (2009).
What Is at Stake
For a long time I just turned off the television when anything offensive came on. I avoided hospital or medical shows entirely, knowing that I would be disgusted by them. Lately I've realized that not much has changed since I was in nursing school, and there is much more at stake here than hurt feelings. As Summers said, "We cannot solve the global nursing shortage without resources for nursing clinical practice, education, research and residencies. And we cannot get this needed funding if decision-makers think we are unskilled losers. If you were in charge of a billion dollars and had to decide how to divide it, would you give it to the lifesavers or their flunkies? This is why nurses get half of 1% of the National Institute of Health budget and nursing residencies get $1 for every $375 that physician residencies receive. If nurses are not valued by the public, we will not be funded, and the global nursing shortage will continue to further spiral out of control."
The fact that nurses are often excluded from healthcare policy decisions reflects the general belief that nurses' opinions don't matter, a belief that is reinforced by media depictions of nurses. This is what we must change. The image of nursing would benefit from having a visible, highly respected nurse leader, such as the proposed Office of the National Nurse.[8]
If all 3 million of us (15 million worldwide) were to join forces and attack this issue head-on by speaking back to the media, and advocating for the nursing profession, I am convinced we could fix the image of nursing and nurses, and the snowball effect could change the direction of the nursing shortage and the future of healthcare
http://www.medscape.com/viewarticle/718032 (free registration is required. But this is the entire article).
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