How Negative Nursing Stereotypes Hurt Patients
Exclusive Interview: Author Sandra Jacobs Summers, RN, MSN, MPH
We recently chatted with Sandy Summers about her book, Saving Lives: Why the Media's Portrayal of Nurses Puts Us All at Risk. In the same conversation, Summers explained in detail how negative media portrayals leads to underfunding, which directly impacts the quality of health care.
Media Depict Nursing Roles as Low-Value
Television shows and films represent physicians doing work that is actually done by nurses, while the nurse's role is misrepresented as one of fetching and carrying--a "handmaiden."
For example, one Scrubs episode depicted a nurse fussing about with bedcovers and waiting for physicians to order her to fetch a crash cart. [http://www.truthaboutnursing.org/news/2009/dec/08_scrubs.html]
The "handmaiden" and other stereotypes are conveyed not just in fictional or dramatic representations, but also in articles, documentaries and press releases. A New York Times article (http://www.truthaboutnursing.org/news/2009/dec/26_nyt.html) about end-of-life care quoted 11 different physicians and only one nurse, despite the fact that nurses are responsible for the greater part of professional health care provided to dying patients. The Truth About Nursing provides hundreds of similar examples on their website.
People Believe Nursing to Be Low-Value
The media's representation of nurses' roles negatively influences viewers' beliefs about the nursing profession. "Do physicians really do all that work that the TV shows say they do?" Summers asks. "No, they don't, because real-life nurses do at least half of the work depicted." But since viewers rarely see or hear nurses doing vital nursing work, it's no surprise that they don't respect nursing.
Gallup polls consistently show that nurses score top marks in "honesty and ethics", http://www.gallup.com/poll/1654/Honesty-Ethics-Professions.aspx which is often condensed into "trust." However, trust is not the same as respect. "What do they trust us to do?" Summers asked. "Hold their wallets while they're in surgery? They don't trust us to save their lives. They trust only the physician to do that. But nurses must be trusted to save lives before they will earn the respect that they deserve."
But how do you quantify respect? Summers uses a simple litmus test: money. "Money is the prime example of how much respect people have for nurses," she said. "If they had respect for us they'd give our profession money for education, research, residencies and practice."
Nursing is Underfunded
Because of the relatively low value placed on the nursing profession, it receives woefully little funding. "The National Institute of Health in the US gives nursing research only half of one percent of the NIH budget," Summers said. "Our nursing residencies, which have been shown to be vital in keeping new nurses in the workplace, only get $1 for every $375 that physician residencies get."
Inaccurate media depictions of nurses "working for" physicians lead people to believe that as long as physicians are being funded, the money will somehow trickle down to nurses. However, this is not the case. "Nurses and physicians are governed by two separate chains of command," Summers said. "We have our own nursing schools, our own codes of ethics, our own boards of nursing, and our own nursing licensure exam." Like any other autonomous profession, nursing has to secure its own funding--and the funding just isn't there.
Patient Health Suffers
The lack of funding for the nursing profession diminishes the standard of nursing care that patients receive. "Patients aren't getting good care if nursing is undervalued in the workplace," said Summers. "This is an underlying cause of the nursing shortage. If nursing shortage were a tall building, the undervaluation of nursing would be the bedrock foundation."
For example, understaffing increases patient mortality rates. "Some nurses try to stand tall and deliver care under these difficult circumstances anyway," said Summers, "but the data shows that if you double a nurse's workload from 4 patients to 8, patient mortality increases by over 30%." A University of Pennsylvania study showed that New Jersey and Pennsylvania could reduce patient deaths by 11-14% if they adhered to California's nurse-to-patient ratios. http://tinyurl.com/2a43zrx
This is why she encourages nurses to understand that the media issue is not just about self-empowerment. "It comes down to patient health," Summers said.
What's the Solution?
Just as negative nursing stereotypes lead to negative patient outcomes, changing media portrayals to better reflect reality may positively impact patient health.
"The care we're delivering now is substandard because there hasn't been the investment in nursing," Summers says. "So we're trying to shake the foundations, and the whole building of the nursing shortage will come tumbling down."
Is there hope for the future? Absolutely, says Summers. "Once nursing is valued in line with its actual worth, I believe it'll get funded, and nursing care will improve, and patient health will improve. We can save money, save lives and decrease the huge healthcare budget disaster, if we just invest in nursing. We encourage all nurses to join us in educating the media and everyone we know about the value of nursing."