The professionalization of nurses through education and innovation has proven to be the focus of one of the most significant and ongoing discussions in the history of nursing. Worldwide, nurses have developed themselves into professionals with a great deal of knowledge, as witnessed by the development of nursing protocols and guidelines. Despite these developments towards professionalization, previous studies on this subject have shown that nurses are not given due recognition for the skills they have by the majority of the public. The essence of nursing is not always clear, and nurses still suffer from (gender) stereotypes (Bridges 1990, Hallam 1998, Warner et al. 1998).
A stereotype can be defined as ‘a cognitive representation or impression of a social group that people form by associating particular characteristics and emotions with the group’ (Smith & Mackie 2007). Bridges (1990) identified 34 different stereotypes of nurses, most of which have negative connotations. Bridges’ study also showed that the media often depict nurses working at the patient’s bedside and performing repetitive and routine tasks, mostly as the doctor’s handmaiden (Bridges, 1990). Other studies indicate that the portrayal of nurses in the media might give a clue as to how their public image is perceived (Kalisch ; Kalisch 1983, Warner et al. 1998, Gordon 2005).
These studies show that the public image of nurses does not always match their professional image; nurses are not depicted as autonomous professionals and the public is not aware that nowadays nursing is to a great extent a theory-based and scholarly profession (Dominiak, 2004). The nursing discipline has undergone tremendous developments over the last 30 years of the 20th century and in the first decade of the 21st century, in particular, with respect to professionalization. The professionalization of nursing is closely intertwined with a focus on the development of nursing theory (Meleis, 1997) nursing research and nursing practice, which ideally are interrelated. Research can validate theory, which then may change nursing practice (Donahue1998). The media and Hollywood in particular represent one avenue in which the general public becomes familiar with the role of nurses. How do the media positively or negatively influence the public’s image of nursing? What other avenues may better educate the general public on the role and scope of nursing as well as the changing health care system?
The media is known to have immense influences on the public perception from body images to what kind of car people should buy. And the nursing image is not immune to these influences. What Hollywood transmits to the public about nurse’s works much like an advertising industry. Television has represented nurses in varying degrees and not all of them are flattering. We have been portrayed as promiscuous or ‘the doctors assistant’. According to the American Association of College of Nursing’s fact sheet, Nursing is the nation’s largest health care profession, with more than 3.1 million registered nurses nationwide. And of all licensed RNs, 2.6 million or 84.8% are employed in nursing. As a whole, we are among the highest paying large occupations . This indicated that there is a positive nursing image. According to Hoeve, Jansen, ; Roodbol (2014), to improve the nursing public image and to obtain a stronger position in healthcare organizations, nurses need to increase their visibility. But individually, nurses needs to recognize the value in what we do, believed in ourselves and our colleagues, and dress the part. Each nurse needs to explore their actions or inactions affect the nursing image. We need to recognize that the images and behaviour outside the workplace on social media such as YouTube, Facebook or Instagram can affect our workplace image. How we portray ourselves in public to our patient can dispel any misconceptions the public may have of nurses and the profession by re-educating the community, educating nursing students on how to project a positive image of nursing, and helping students to understand the meaning of professionalism. Hoeve, Jansen, ; Roodbol (2014) also suggested that nurses should work harder to communicate both their professionalism and their contribution to the healthcare system to the public.
It is critical that anyone interested in health care especially nursing understands how the media influences our lives. “Given the pervasiveness and potential power of the media to shape beliefs, attitudes and behaviours, the media literacy movement has emerged.” (Glik, 2003) Though “media literacy” seems to be aimed primarily at helping children and teens “better deconstruct (analyse and assess) the ubiquitous media constructions” that are a key part of modern life, developing this skill is no less important for adults, especially those whose interests may not be served by prevailing media practice. Most media content including advertising is directed at adults. And achieving media literacy is not something that just happens on our 18th birthdays; it is not easy or automatic. It involves a process of “learning to analyse and question what is on the screen, how it is constructed, and what may have been left out.” (Thoman, 1995). The bottom line is that “while there is a tremendous potential for the popular media to include positive health messages, it is a double-edge sword. From a public health perspective, one needs to view the popular media in its entirety, as both a tool for progress and a source of ill health that reflects the larger culture it represents. Thus, both media advocacy and media literacy become important strategies to influence the media to improve public health and, concurrently, to mitigate its unintended effects on the most vulnerable members of society which are the children and teens.” (Glik, 2003).
If the mass media is critical to modern health strategies, then it must also be a key means of addressing one of the most important global health problems: the crisis in nursing. The same impressionable children and teens whose health may be directly affected by media messages receive equally powerful messages about nursing. Most students do not understand or respect nursing and do not consider it as a career. In a study of primary and secondary school students, most respondents wrongly described nursing as a girl’s job, a technical job “like shop,” and an inappropriate career for private school students. (JWT Communications, 2000) Nurses are generally prized for their virtues and not their knowledge. In contrast, the study of Stanley (2008), who analysed the image of nurses in feature films made in the Western world, shows a more nuanced picture. Stanley (2008) examined 36,000 feature film synopses and found that while early films portrayed nurses as self-sacrificial heroines, sex objects and romantics, more recent films portray nurses as strong and self-confident professionals. A recent study of Kelly et al. (2012) discussed how nurses and nursing identities are constructed in video clips on YouTube. Three nursing identity types could be found as follows: the nurse as ‘a skilled knower and doer’, the nurse as ‘a sexual plaything’ and the nurse as ‘a witless incompetent individual’. Although the results of these studies show a rather heterogeneous picture of the image of nursing, the stereotypical images of nurses nevertheless remain persistent.
We have identified several aspects of these stereotypical images in the studies discussed in this paper and, as can be expected from the outcomes of previous studies, the results show that the actual public image of nursing is diverse and incongruous and tends to be influenced by nursing stereotypes (Ohlen & Segesten 1998, Takase et al. 2002). With respect to male nurses, men were either portrayed as the second sex in nursing care (Dahlborg-Lyckhage & Pilhammar- Anderson 2009), or as nurses with different work patterns who are not influenced by marriage (Liu 2010). Ohlen and Segesten (1998) demonstrate that male nurses experience uncertainty from other people meeting a male nurse as a result of stereotyped images. The media’s projection of images of nurses, in ways that neglect the official requirements of the profession, also has an impact on the view of the public on nursing (Takase et al. 2001, Dahlborg-Lyckhage ; Pilhammar-Anderson 2009). Nurses seem to be viewed as feminine and caring, not as autonomous healthcare providers (Takase et al. 2006, Kemmer ; Silva 2007). Moreover, nursing is seen as a profession with limited career opportunities (Huffstutler et al. 1998, Ben Natan ; Becker 2010). Donelan et al. (2008) report more positive findings. They demonstrate that the nursing profession is highly respected by the American public, but nevertheless, the authors conclude that a nursing shortage persists in the USA. The study of Kalisch et al. (2007) also shows that nurses are seen as qualified, skilled and respectable professionals. The limitation is that in their study, Professional Nursing Organizations and job sites are populating nursing on the internet. From the results of the studies, we may carefully conclude that the image of nurses in the media does not yet meet the professional image of nursing.