By Sheila Gibbons
Wednesday, March 30, 2005
After a hospital stay deepened her appreciation of nurses, Sheila Gibbons looked into their low standing on popular TV shows and their absence as sources for news. Unless that changes, the nursing shortage, she says, will only worsen.
(WOMENSENEWS)--After a recent hospital stay--prolonged by complications--I was like so many people in my position; grateful for the excellent nursing that had brought me through an unexpected health crisis.
The experience made me wonder why, amid the clamorous current debate over U.S. health care, we hear so little from nurses and so little about their acumen and central role in the system.
To the extent nurses have been visible in the recent news, the subject has mainly been the shortage of nurses and nursing faculty.
Nursing advocates attribute the decline to a variety of factors, including long hours, pay that hasn't always remained competitive, administrative tasks required by managed-care insurers that take time away from patients and which nurses say frustrates them no end, and nurse-to-patient ratios that can compromise patient health.
These issues are finally getting attention, thanks to the efforts of nursing associations and more attention by journalists.
But according to nursing advocates, the image of nursing continues to suffer from the long-held stereotype that it's a lesser calling than becoming a physician. That in part comes from articles, news broadcasts and entertainment programs about health care that emphasize the importance of physicians in the delivery of health care while understating--and even distorting--the role of nurses in maintaining and restoring patient health.
Nursing advocates note, for instance, that many health messages, including advertisements, tell consumers to "consult your doctor." Nurses would rather hear "contact your health care provider." In the real world, they say, many patients are likely to see a nurse practitioner for a complaint before, or instead of, a physician. Recognizing this would be a three-in-one. It would elevate the status of nursing, clarify nurses' roles and reassure consumers about nurses' capabilities.
Popular TV shows, such as "ER," about the world of an emergency room, have been a particular bane for nursing, says Sandy Summers, a registered nurse who is executive director of the Center for Nursing Advocacy in Baltimore.
Summers and members of her organization have called and written to the show's producers and writers to protest scripts. They object, for instance, to a line scripted for a stroke-patient character. "She's the nurse, maybe she doesn't know," the patient says, in reference to her knowledge of his condition. In another episode, a nurse offers a suggestion to a doctor treating a patient in acute distress. He cuts her off: "I fly the plane," he says. "You serve the coffee." (This nurse character later goes to medical school.)
In an episode of "Scrubs," another popular TV drama, a surgeon character comments that "any idiot can be a nurse."
While these denigrating comments might be lauded for dramatizing the kind of chauvinism facing nurses, Summers says putdowns of nurses by TV characters are damaging because television viewers take seriously the information conveyed by these programs.
A 2000 survey by the Centers for Disease Control and Prevention found that 52 percent of viewers trusted prime-time TV shows to be accurate. More than a quarter of this survey's respondents said such programs were among their top-three sources for health information.
In March, the Center for Nursing Advocacy began contacting companies that advertise on "ER" and asked them to halt their advertising until the show "ends its damaging handmaiden portrayal of nursing." Among those contacted are Merck and Co., Inc., Novartis, Schering-Plough, Procter and Gamble, McDonald's Corporation, American Express and Sprint, Summers says.
As for news coverage, Summers praised a number of organizations for running stories about the shortage of nurses and instructors at schools of nursing. These include Linda Lamb's three-part series in The State, a newspaper of Columbia, S.C., in February 2005; and Joel Dresang's two-part article in The Milwaukee Journal Sentinel in February 2003, in preparation for which he shadowed nurses on duty for several days.
But Summers says news coverage often disappoints. "We've seen thousands of nursing-shortage articles that don't tell readers how much nurses influence patient outcomes," she says.
That's a serious omission, Summers says, noting that reducing the proportion of nurses to patients from 1:4 to 1:8 increases patient mortality 31 percent.
California Governor Arnold Schwarzenegger is currently tangling in the courts with the California Nurses Association over this very issue, having delayed implementation of an improved nurse-to-patient ratio in the state's hospitals.
Concern over the image of nurses, and their lack of inclusion in health care journalism, isn't new.
In 1997, "The Woodhull Study on Nursing and the Media" (named in honor of the late Freedom Forum and Gannett News Service executive, Nancy Woodhull), found that nurses were cited only 4 percent of the time in more than 2,000 health-related articles published by 16 major news publications (newspapers, magazines, trade publications).
The rare references to nurses or nursing were mostly just in passing. In many of the stories, the study said, nurses and nursing would have been more germane to the story subject matter than the references selected. An example was a 1997 story in the periodical Healthplan on caring for AIDS patients. While it quoted a physician, an HIV policy operations coordinator, and a pharmacy educator, there was nothing from nurses, who at the time provided the majority of HIV/AIDS patient care and education in the community.
To their credit, many news organizations are now looking more closely at the nursing profession. The results have been stories that expose the forces that have led to a shortage of skilled nurses and the persistent lack of respect for the profession, which hurts recruiting. On this score, I can recommend work by Chip Scutari in The Arizona Republic (Feb. 1), Alyssa Kneller in the Massachusetts' paper East Bay Newspapers (Feb. 5) and James Dean in the daily newspaper Florida Today (March 1).
Lots of nurses were quoted by these reporters. But these were articles about nursing, so you would expect to see nurses as sources.
Real progress would be seeing nurses--whom we value and need so much--sourced in wider-ranging articles about our fragile health care system, in which they play such an important part. Without more attention to their contributions, we health consumers soon may end up mournfully singing the lyrics of the old Joni Mitchell song: "You don't know what you've got till it's gone."
Sheila Gibbons is editor of Media Report to Women, a quarterly news journal of news, research and commentary about women and media. She is also co-author of "Taking Their Place: A Documentary History of Women and Journalism," Strata Publishing, Inc., which received the "Texty" Textbook Excellence Award from the Text and Academic Authors Association, and of "Exploring Mass Media for A Changing World," Lawrence Erlbaum Associates.
Center for Nursing Advocacy:
NurseWeek, Oct. 23, 2000--
Image overhaul: Media are still off-target portraying nurses:
Sigma Theta Tau International Honor Society of Nursing, 1997--
The Woodhull Study on Nursing and the Media: