Running head: MEDIA INFLUENCE

Media Influence on the Image of Nursing Jessi Chipman Ferris State University

MEDIA INFLUENCE Abstract

There have been several research studies regarding the medias influence on the general publics view of nursing. Although not all that the media portrays of nursing is negative, the vast majority of it is unrealistic. The media can influence the way people think and perceive different groups of people and nurses are not immune to this. The field of nursing over time has been labeled with four different stereotypical groups; the battleaxe nurse, naughty nurse, physicians handmaiden, and ministering angel. All of these false generalizations of nurses can impact the recruitment of new nurses into the field, less funding for nurses, and lower job satisfaction for nurses. In order to change the publics beliefs about nursing, it is essential for nurses to educate themselves and others on the issue. It is important for nurses to have a voice and help provide the public with a more positive, realistic image on what nursing entails.

MEDIA INFLUENCE Media Influence on the Image of Nursing Merriam-Webster Dictionary (2014) defines stereotyping as a standardized mental picture that is held in common by members of a group and that represents an oversimplified opinion, prejudiced attitude, or uncritical judgment (Merriam-Webster 2014). Stereotypes are present in almost all groups within society and nurses are not exempt from this. The image of nursing is continuously changing through the publics perspectives and this paper will explore how the media is influencing and reinforcing nursing stereotypes. Through television, internet, radio, and literature, media aids in shaping positive and negative images within the public reflecting on attitudes and feelings toward the art of nursing. These stereotypical images can have a significant impact on treatment or care provided to individuals and in return, increase or decrease patient safety and quality care (Hoeve, Jansen, & Roodbol, 2014). According to Donelan, Buerhaus, DesRoches, Dittus, & Dutwin (2008), the publics long-standing positive esteem for registered nurses (RNs) is well documented in public opinion polls (p. 143). However, this positive outlook has not transferred into higher rates of

individuals wanting to pursue a career in nursing. On the opposing side, there are many negative ramifications for the medias negative and sometimes absent view of the field of nursing. There are many research studies and scholarly articles that suggest the medias portrayal of nurses impact the recruitment of new nurses into the field. According to Morris-Thompson, Shepherd, Plata, & Marks-Maran (2011), negative stereotypes of nursing still persist and these media perceptions of nursing are damaging to the publics image of nursing and to nurse recruitment (p. 684). This enhances the suggestion that it is important for the healthcare system, especially nurses, to get involved in providing the general public with realistic and knowledgeable images regarding the art of nursing. The Truth about Nursing is a nonprofit organization that, seeks to

MEDIA INFLUENCE increase public understanding of the central, front-line role nurses play in modern health care. (The Truth About Nursing, 2014). This organizations primary focus is to promote more

accurate, balanced and frequent media portrayals of nurses and increase the media's use of nurses as expert resources. The Truth about Nursing involves all different levels of nursing including those outside of health care system to aid in the creation of a more realistic image of nursing (The Truth About Nursing, 2014). Stereotypes Four main nursing stereotypes have developed over the past several years; the battleaxe, naughty nurse, ministering angel, and physicians handmaiden. The battleaxe nurse image emerged during the 1960s and 1970s when the feminist movement began to transmit female power and male dependence as the nurse who does not comply with the stereotype image of an ideal nurse (Cabaniss, 2011, p. 115). This image portrayed nurses as overweight, experienced, and authoritative women with an overbearing personality. This type of nurse uses intimidation to overpower peers and to increase compliance within her patients. An example would be Nurse Ratchet from the movie One Flew Over the Cuckoos Nest. Nurse Ratchet was a depicted as a battleaxe nurse that used her power to mistreat patients, doctors, and other nurses (Cabaniss, 2011). The naughty nurse was depicted in the 1960s and 1970s in movies and on television (Cabaniss, 2011, p. 114). This stereotype was also result of the feminist movement and the media began to display nurses wearing low-cut blouses, short skirts, and high heels. This image jeopardizes patient trust in nursing because nurses have access to patients intimate body parts. (Cabaniss, 2011). An example of this display involves a Sketchers print ad with a famous singer Christina Aguilera. In this ad Aguilera is dressed as a naughty nurse wearing a short dress,

MEDIA INFLUENCE push-up bra, high heels, and carrying a large syringe. Sexually exploiting nurses only reinforces to the public that this role has an erotic purpose and compromises a trusting nurse/patient relationship. The ministering angel stereotype reinforces the idea that nursing is a womans work

by taking on a motherly role and dedicating all time and self-worth to a single patients recovery (Cabaniss, 2008, p. 114). This has been a common title for nurses for many years and has several angelic characteristics to it as well. An example of this stereotype is from the movie The English Patient. The nurse in this movie dedicates her life to restoring a mans health after a near death experience in an aircraft accident. Although restoring health is a nursing obligation, the removal of self-worth and leaving ones life behind is a false portrayal (Cabaniss, 2008). The most portrayed image in media today is the physicians handmaiden (Cabaniss, 2008, p. 115). Physician handmaiden stereotype suggests that nursing is not autonomous but dictated by physicians and their interns. Cabaniss (2008) states, the depiction of nurses as a doctors woman servant who blindly follows physicians demands invalidates a nurse as a licensed professional operating within a distinct scope of practice (p. 115). This image is displayed most in medical dramas such as Greys Anatomy and House. Nursing absenteeism within medical dramas suggests to the public that the majority of a nurses work is done by doctors, which is false and unrealistic. Media Message Television and media are the main sources of entertainment for the general public. Donelan et al. (2008) suggests, It is television, more than any other medium, which provides false companionship through a form of intimacy that is illusive and pretend (p. 143). Medical drama series saturate televisions nightly lineups with popular medical dramas including; Greys

MEDIA INFLUENCE Anatomy, Nurse Jackie, House, Hawthorne, Private Practice, and Scrubbing In. The vast

majorities of these television dramas give nursing an absent role within the medical environment and depict physicians as the main, heroic characters. In the television show House, nurses are not incorporated into the medical scene at all. Viewers may see nurses dressed in scrubs holding clipboards as they walk on and off screen (Cabaniss, 2008 p. 115). Another popular television series is Greys Anatomy and the nurses on this television show are seen as glorified secretaries at the nurses station (Cabaniss, 2008, p. 116). The nurses on Greys Anatomy are seen doing more paperwork and working on computers rather than participating in patient care. Private Practice is another medical drama very similar to Greys Anatomy that focuses on the lives of seven intelligent and good-looking physician characters (Cabaniss, 2008, p. 116). The one existing nurse character that is incorporated into this particular drama is the receptionist and comes across as the least knowledgeable character. The show Nurse Jackie has stirred up a lot of controversy regarding the portrayal of nursing. The main character Jackie is addicted to prescription drugs and has extramarital sex while having assigned patients in her care. Jackies character is involved in several unethical events such as; stealing medication from the Pyxis machine and stealing patient belongings, resulting in the display of a dysfunctional nurse character (Nemeth, 2011). The American Nurses Association issued a statement of disappointment at how the show negatively portrayed nursing and nurses in such a manner that erosion of patient trust could result (Nemeth, 2011, p. 10). On the other hand there are viewers, including nurses, who see Jackie as a character as smart, caring, respected by her peers, and an advocate for her patients. The Truth About Nursing organization praised the television series Nurse Jackie saying that, Jackie remained a tough clinical virtuoso

MEDIA INFLUENCE who used creative and effective ways to help patients lead better lives or find lasting peace, despite her own ethical and personal issues (Nemeth, 2011, p. 9). Another medical drama entitled Hawthorne has a chief nursing officer, Christina Hawthorne, as the leading character. The show depicts Christina as very dedicated to her work and a strong patient advocate (Cabaniss, 2011, p. 116). Christina Hawthorne is an African American character in a leadership role which pleases many nurses. On the other hand, Hawthorne is viewed by some nurses as unrealistic because chief nursing officers are not present at the bedside performing routine patient care, and they do not come to work wearing scrubs (Cabaniss, 2011, p. 116).

Advertisements are also another large medium that provides positive and negative images of nursing. The majority of advertisements show nurses in stereotypical roles. The image of the naughty nurse is used quite often in many advertisements. For example, Dentyne Ice gum, Gillette TAG body spray, and Schick Quattro Titanium razors created advertisements that lured sexy nurses into bed with men who used their products (Cabaniss, 2011, p. 116). Another example of this was mentioned previously regarding the Sketchers shoes advertisement that portrayed singer Christina Aguilera as a naughty nurse (Cabaniss, 2011, p. 116). The drug company Johnson & Johnson released a set of commercials aimed at addressing the nursing shortage. These commercials were attempting to put a positive spin on nursing and show nurses in a better light than do most advertisements. Johnson & Johnson did a good job at promoting diversity in nursing and depicting nurses in helping situation with their focus on the emotional supportive side of nursing (American Nurses Association, 2012). Nursing Shortage

MEDIA INFLUENCE There are many factors in play that influence the necessity for more nurses. One major

contributing factor is regarding the baby boomers generation and the amount of registered nurses that will be leaving the profession into retirement. The American Nurses Association reports that the median age of nurses is 46 meaning that more than 50% of the nursing workforce is close to retirement and the American population of people who are 65 and older is vastly increasing (Weaver, Salamonson, Koch, & Johnson, 2013). This indicates that a very large portion of the population is going to be seeking medical care and another large portion will be retiring from the health care environment. Another factor contributing to the expected nursing shortage is the recent healthcare reforms that have been put into place by the president of the United States; Barack Obama. This new healthcare reform will give healthcare access to many individuals who have not had access in the past. This causes concern because a massive amount of people are estimated to seek healthcare which greatly increases the need for more nurses (American Nurses Association, 2012). Theory Base Dorothy Johnsons Behavioral System model defines nursing as, an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health, or in which illness is found (Current Nursing, 2013). Johnsons theory implies all human beings have a biological system and a behavioral system; the biological system taken care of by medicine and the behavioral system addressed by nurses. Johnsons theory suggests that the individuals environment influences their behavior therefore stereotypical images portrayed in the media would have an impact on the individuals behavior. If the public views negative or false images of nurses then public may believe nurses are not competent enough to

MEDIA INFLUENCE provide adequate care. Johnson suggests the nurses primary goal is to help the individual achieve equilibrium and has a responsibility to help change the individuals negative thoughts and images of nurses (Current Nursing, 2013). George Gerbner and Larry Grosss Cultivation theory states that television makes specific and measurable contributions to viewers conceptions of reality (Gerbner, Gross, Morgan, & Signorielli, 1980, p. 14). Gerbner and Gross suggested that the more hours of television an individual watched, the more likely that person would turn the images viewed into reality (Gerber et al., 1980). If this theorys hypothesis is true, then it could have significant implications for the image of nursing. The images portrayed through television depicting nurses

in unrealistic roles could potentially turn false images into reality for the public. This could have repercussions for the quality of care patients perceive they are getting. If the public views doctors as heroic, competent individuals who does nurses work, they may have poor opinions when a nurse performs realistic roles instead of doctors. Patients may believe they are receiving care from a less competent individual and this could negatively impact the patients perceived quality of care (Donelan et al., 2008). Implications/Consequences Research studies have highlighted several issues that can impact the field of nursing. The entertainment industry has a significant impact on nursing as well as a considerable influence on the opinions of the viewers (Morris-Thompson, Shepard, Plata, Marks-Maran, 2011). The media more often portrays nursing in a negative light rather than positive or eliminates nursing roles from the healthcare environment completely. Secondly, the perceptions of the public gained by the medias portrayals tend to harm the recruitment of new nurses (Weaver et al., 2013). The last issue discussed is nurse satisfaction. One research study found that the negative views held by

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the public about nurses had an impact on nurses satisfaction and self-image (Morris-Thompson et al., 2011) This is why it is essential that the field of nursing is educated on the harmful effects the medias portrayal of nurses can have on nursing as a whole. Recommendations for Quality and Safety Improvements All nursing graduates must take and pass a licensure examination before being allowed to practice as a registered nurse. Once a nurse has obtained a license they are expected to provide care to patients according to a set of professional standards (Cabaniss, 2011 p. 117). In order to give the general public a more positive, realistic view of the work that nurses perform, they should be openly communicating with their patients, other healthcare workers, and the general public. Communication is one of the American Nurses Associations (ANA) professional standards (American Nurses Association [ANA], 2010). According to this standard, the registered nurse communicates effectively in a variety of formats in all areas of practice (ANA, 2010, p. 54). Nurses can help change the stereotypical views of nurses by being proactive and getting involved in ongoing discussions about health care. Nurses should no longer be unseen or unheard (Cabaniss, 2011, p. 117). Leadership is another ANA professional standard that states the registered nurse must demonstrate leadership in the professional practice setting and in the profession (ANA, 2010, p. 55). Leadership in nursing could impact the image of nursing in a positive manner. Being an excellent leader means that the nurse commits to life-long learning and education of self and others (ANA, 2010 p. 55). If a nurse is educated and fully aware of how the media portrays nurses then that nurse can help to change those images. Being a strong leader also involves mentoring colleagues on the impact negative stereotypes have on the nursing profession. This creates an awareness regarding the publics views of nurses and how it is impacting the

MEDIA INFLUENCE recruitment of new nurses into the field. Only if nurses are aware of the implications the media has on the future of nursing can nurses get involved and help to make a change. ANA standard regarding collaboration states, the registered nurse collaborates with

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healthcare consumer, family, and others in the conduct of nursing practice (ANA, 2010 p. 57). Collaboration involves partnering with others to effect change and produce positive outcomes through the sharing of knowledge of the healthcare consumer and/or situation (ANA, 2010). Education is key, if nurses can inform the public and the entertainment industry on the true reality of what nurses really do then a more positive image could be brought to light. The healthcare system is always looking for ways to improve and provide the highest, safest care possible. The Quality and Safety Education for Nurses (QSEN) project provides a variety of information to help facilitate future nurses so nurses will be able to contribute positively to the healthcare system (Quality and Safety Education for Nurses [QSEN], 2014). One QSEN competency is patient-centered care; defined as, recognizing the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs (QSEN, 2014, p. 1). If the public has a more realistic image of nurses this could contribute to a stronger view of nursing. This will enhance the nurse-patient relationship creating more self-confident nurses. Having selfconfidence as a nurse creates a safer environment for the patient and other nurses as well as reduces the chances of medical errors (Rezaei-Adaryani, Salsali, & Mohammadi, 2012). Safety is another crucial QSEN competency that is directly affected by negative images within nursing. QSEN (2014) defines safety as, minimizing the risk of harm to patients and providers through both system effectiveness and individual performance (p. 1). The more confidence patients have in the care that their nurses are providing them will result in a safer

MEDIA INFLUENCE environment for the patient and the nurse. Mentioned previously is the importance of self-

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confidence within nursing, on an individual level as well as a whole. Being confident in the care provided increases the chance of safe care and lessens the chance for medical errors (RezaeiAdaryani, Salsali, & Mohammadi, 2012). Conclusion Laying blame on the media is neither the answer nor the place to start in resolving the issues within the media and field of nursing. In order to recruit more males and females into a nursing career, the field of nursing needs to take stand against these false portrayals. Nurses should be seen and heard instead of allowing the media to show them in an unrealistic and false manner. Education is the key to changing these portrayals. Educating ones self on the subject of nursing image portrayals allows nurses to educate their peers as well as the public. Having more nurses being actively involved in helping change and shape the publics view of nurses, the more influential it will be. An excellent way to accomplish this is by joining large organizations where everyone is working together. The Truth About Nursing is an excellent organization that is well informed and aware on this issue and has many reliable resources to help communicate the issue to the media and healthcare field. Research suggests that the majority of the general public does not have a realistic image of what a nurses role is. It is nursings responsibility to inform the general public that nurses are highly skilled, educated individuals that work autonomously from a specific scope of standards. Changing the publics perception of nurses will have positive results and more individuals will possibly be encouraged and interested in having a career in nursing. It could also lead to more funding possibilities for the field of nursing. If the publics view of nurses changes into a more realistic one, then they will receive better care by instilling

MEDIA INFLUENCE trust into nurses. The more confident a nurse feels the more likely he/she will provide high

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quality care. Another positive result of changing the publics views of nurses is that nurses will possibly have greater job satisfaction. If nurses feel as though their patients perceive them as highly competent and capable of taking care of them then that will increase nurses self-esteem and job satisfaction. Overall, the medias unrealistic portrayal of nurses is a topic that is overlooked but can have several negative consequences. The field of nursing needs to pay more attention to these negative consequences and what they can do to change them. Nurses should no longer be unseen and unheard, it is time for nurses to stand up and take action.

MEDIA INFLUENCE References American Nurses Association. (2012). Nursing shortage. American Nurses Association. Retrieved from

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http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/w orkforce/NursingShortage American Nurses Association. (2010). Scope and standards of practice: Nursing 2nd ed., pp. 5458). Silver Spring, MD Cabaniss, R. (2011). Educating nurses to impact change in nursing's image. Teaching & Learning in Nursing, 6(3), 112-118. doi:10.1016/j.teln.2011.01.003 Current Nursing (2013). Johnsons behavior system model. Retrieved from http://currentnursing.com/nursing_theory/behavioural_system_model.html Donelan, K., Buerhaus, P., DesRoches, C., Dittus, R., & Dutwin, D. (2008). Public perceptions of nursing careers: The influence of the media and nursing shortages. Nursing Economics, 26(3), 143. Gerbner, G., Gross, L., Morgan, M., & Signorielli, N. (1980). The "mainstreaming" of america: Violence profile no. 11. Journal of Communication, 30, 10-29. Hoeve, Y., Jansen, G., & Roodbol, P. (2014). The nursing profession: public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing, 70(2), 295309. doi:10.1111/jan.12177 Merriam-Webster (2014). Stereotype. Merriam-Webster Dictionary. Retrieved from http://www.merriam-webster.com/dictionary/stereotype.

MEDIA INFLUENCE Morris-Thompson, T., Shepard, J., Plata, R., & Marks-Maran D. (2011). Diversity, fulfilment and privilege: The image of nursing. Journal of Nursing Management, 19(5), 683-692. doi:10.1111/j.1365-2834.2011.01268.x Nemeth, L. (2011). Nurse jackie and nurse ethics: How tv and the media influence our public image. Beginnings, 31(2), 8-10.

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Quality and Safety Education for Nurses (2014). Pre-licensure ksas: Overview. QSEN Institute. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/ Rezaei-Adaryani, M., Salsali, M., & Mohammadi, E. (2012). Nursing image: An evolutionary concept analysis. Contemporary Nurse: A Journal for the Australian Nursing Profession, 43(1), 81-89. doi:10.5172/conu.2012.43.1.81 The Truth about Nursing (2014). What can you do to shape a better image of nursing?. Retrieved from http://www.truthaboutnursing.org/action/ Weaver, R., Salamonson, Y., Koch, J., & Jackson, D. (2013). Nursing on television: Student perceptions of television's role in public image, recruitment and education. Journal of Advanced Nursing, 69(12), 2635-2643. doi:10.1111/jan.12148