Nurses and the Media: The Center for Nursing Advocacy

Richard S. Ferri, PhD, ANP, ACRN, FAAN


March 16, 2006

Editor's Note:
As anyone in the nursing profession knows, the portrayal of nurses in the media is often inaccurate and sometimes downright sexist and insulting. In this eLetter, we meet a nurse who is trying to do something about changing those stereotypes. Sandy Summers, RN, MSN, MPH, returned to graduate school to learn more about public health after spending time in Cambodia providing nursing care. While at graduate school, she and other colleagues became interested in how the media portrays nursing to the public and its impact on nurses everywhere. Sandy and her colleagues decided to do something about it. Here is Sandy's story.

Question: How and when did the Center for Nursing Advocacy begin? Why do you believe it was necessary for the Center to be established?

Response: The Center for Nursing Advocacy began in 2001, when 7 of us, all graduate students at Johns Hopkins University School of Nursing, decided to form a group to address the growing nursing shortage. The group identified the poor public understanding of nursing as a contributing factor in the continual nursing shortage. With budget cuts and short staffing, it appeared to us that nurses were being cut out of the healthcare system. We turned our group into a permanent 501(c)(3) nonprofit organization in 2002.

Question: Isn't there a "disconnect" between the "most trusted professions" polls that consistently show that the general public places a lot of trust in nurses and what the Center has found?

Response: Though annual Gallup polls routinely find nurses at the top of the "trust" scale, the Center finds a disconnect between that belief and true respect for the nursing profession. The reason the "most trusted" poll results don't do much for nursing is that this public view often goes hand in hand with the prevailing vision of nurses as devoted, angelic handmaidens. We fear that the poll results are essentially an expression of a vague, sentimental affection for nurses flowing from these stereotypes. Patients might trust us to hold their wallets while they're in surgery, but not to save their lives.

Figure 1.

Sandy Summers, RN, MSN, MPH, Executive Director, The Center for Nursing Advocacy

Question: What is your role at the Center? Are there any other staff? How do you manage to keep up with all the media coverage about nursing? Do nurses and others send in information about TV programs, books, etc., that staff then follows up on?

Response: My background is in emergency department and intensive care nursing. I spent 15 years at major trauma centers across the country. After a 3-year stint in Cambodia in the mid-90s, where I saw so many health problems caused by a broken infrastructure, I decided to go back to school for public health nursing. Clinical mistakes happen even under the best of circumstances, but nurses are often placed in untenable positions where care can be compromised. Short-staffing is an obvious example. I decided to go to graduate school so I could use my education to bring about broad-based policy changes that would strengthen nursing and patient care. Patients deserve a stronger nursing profession.

I work more than full-time directing the Center. I also have a lot of help from my family. My husband, Harry Jacobs Summers, volunteers about 20-25 hours per week writing most of our material and offering policy and strategic advice. My brother, Jack Summers, volunteers about 5 hours per week as our Web site programmer. I do about everything else, and I'm the only one who gets paid any salary (for a few of my hours per week). We're encouraging our supporters to step up and fund our work by becoming members, so we can do even more to improve nursing's media image.

We keep up to date on what's going on in the media through Google searches and other alerts, and by monitoring various media ourselves. We monitor the main US healthcare television shows and certain key news media. But our supporters often notify us about as many as half of the items we analyze. We also have small teams of media monitors watching the 3 most popular hospital shows, and for episodes we can't get to, they let us know if there's anything new for us to address.

One of the most harmful media portrayals of nursing is the invisible nurse -- where important nursing work is not mentioned, or credit for it is given to physician characters. One way we can resolve this is by educating the media as to the role nurses really play. In our recent 2005 Today show campaign, more than 3500 nurses and supporters wrote to NBC to object to a piece on quick clinics that suggested nurse practitioners were subcompetent, despite all the research showing that the care provided by nurse practitioners is at least as good as that provided by physicians.

Through the campaign, we were able to convince one producer to work with us to depict nursing more accurately. Recently, the producer, who is now at CBS's Good Morning America, did a story on nursing research related to positive clinical outcomes associated with dog visits to nursing home residents. This producer suggested to me that this coverage was at least in part a result of our Today campaign. It's time for us to start telling our own stories to the media and taking ownership of them.

Figure 2.

The Golden Lamp Awards Logo, Center for Nursing Advocacy

Question: Tell us about the annual Golden Lamp Awards. What are they and who makes the final decision on who receives a "best" or "worst" award?

Response: The Golden Lamp Awards recognize good and bad media treatment of nursing that we have seen over the previous year. We honor the 10 best media portrayals of nurses and also give out many honorable mention awards, because we think it's important to encourage good media depictions so we'll get more in the future. It also helps to educate our readers as to what we think "good" is, which may not always be obvious. For example, we think angel images, which many people point to as good depictions, can actually be quite damaging. Those images may imply that nurses are noble, spiritual beings who don't need lunch or bathroom breaks; can take care of 15 or 20 patients without a hitch; and don't need decent wages or working conditions.

Figure 3.

Nursing Against the Odds, by Suzanne Gordon, the first place winner in the best portrayal of nursing category from the Center's 2005 Golden Lamp Awards.

This year, top awards went to journalist Suzanne Gordon for her book , and to reporters from the Boston Globe and National Public Radio.

We also recognize the 10 worst media depictions. This year, like most, the worst list was dominated by television shows, including ABC's Grey's Anatomy and Fox's House . We often have special awards that are a subset of our "worst" portrayal awards. Last year, we gave 2 "Tree Falls in the Forest" awards to the world's media for failing to cover 2 important publications on nursing. One was from researchers at Columbia School of Nursing, who put out an impressive plan on universal healthcare, which was published in Nursing Economics . It was all the buzz in nursing circles, but didn't get any mainstream press coverage. And the International Council of Nurses put out a vast comprehensive report on the global nursing crisis that should have been more than sufficient to pique the press' interest.

This year we gave "Just Joking" awards to those who lobbed insults at nurses, then later said they were "just joking" as a defense. This year it went to a group of medical students at the University of Alberta, for the "Nurses' Song" they wrote and sang at their irreverent May 2005 "MedShow." Lyrics called nurses "whores" and "bitches" whose "incompetence" and persistence in "telling doctors what they ought to try" threatened to "make our patients die." But at least nurses were qualified to "fill up my coffeepot." Rather than apologize, they insisted that they were "just joking," and that nurses couldn't take a joke.

We gave "Let Them Eat Cake" awards to media creators who had been especially hostile or arrogant in response to our prior concerns about their media. This year, we gave the American Medical Association one of these awards because of its failure to respond to our concerns about the group's misleading attacks on nurse practitioners, which many in the mainstream media accepted and repeated uncritically.

Question: Is there any one television show or other medium that does a really good job of presenting nurses? Conversely, is there any that does a particularly poor job of portraying nursing?

Response: The print media, including daily newspapers and books, have offered some excellent, accurate portrayals of nursing. Of course, even the print media remains largely enthralled to a physician-centric vision and tends to ignore or marginalize the nursing role, so we cannot say that their portrayals are good overall. But that is where most of the better portrayals are now.

Television has generally been horrific for nurses, with the exception of a few documentaries and news segments. Entertainment television, which is very influential, has been a disaster for nursing for over a decade. If you look at our TV reviews , no show rates higher than 1 1/2 stars (fairly poor). ER has done some relatively good plotlines since it began in 1994, and the show had a couple pretty good episodes early this season with a nasty but expert new nurse manager. But the show missed an opportunity by turning this character into a street thug and firing her after she decked Santa Claus (a difficult patient) and poured urine on his belly. Now it's back to physician characters doing most of the important care that real nurses do. Overall, the show is still fairly poor for nursing.

But it's nothing compared with Grey's Anatomy , which topped our "worst portrayals" awards. That show depicts nurses as fawning or bitter losers with no significant role in hospital care. The 10 physician characters spend half their time doing key care tasks that nurses really do. And the show seems to make a point of attacking nursing. Some of the infamous Grey's Anatomy lines are: "What did you just say? Did you just call me a nurse?" "I didn't get stuck with someone this clueless, and that was, like, a nurse." "You're the pig who called Meredith a nurse...I hate you on principle."

House , which took our second worst award this year, is really no better. The show's 6 brilliant physician characters constantly perform nursing work. The rare nurse characters tend to be silent, barely visible clerks, like wallpaper that assumes human form to move or hold objects. On one rare occasion when a nurse did appear, she was a petty bureaucrat who couldn't spot a patient's impending doom, and she obstructed life-saving interventions. Although the show has mostly pretended that nurses do not exist, recent episodes indicate that its physician heroes consider nurses to be unskilled clean-up staff, "nurse-maids" who are good for handling stool and patients who have fallen down.

We have asked all 3 shows to work with us to create more accurate depictions of nursing. So far, they have all refused, but we will continue to put pressure on them and encourage our supporters to do the same. The way these shows depict nursing is discouraging people from entering the profession and diminishing the resources that nursing needs to resolve the global nursing crisis.

Question: What has been the response to the awards from recent recipients and to the Center itself?

Response: Those who receive the positive awards are generally very pleased. Many post information about their awards on their Web sites or blogs. Those who receive the negative awards rarely respond. Many of them are already aware of our views from when we first analyzed their work earlier in the year. Hollywood has not been very responsive to critical input from nurses, no matter how well-supported.

Question: Have you seen any changes in how the media portrays nurses in recent years? Has the situation improved or gotten worse?

Response: It's hard to give an overall answer. We've only been at this since 2001, and since then there have been some great mainstream media items, including HBO's , some very good and , and a number of excellent print press articles. But most of the media has been portraying nurses poorly since at least early last century. We have a lot of negative stereotyping to overcome. We believe the nursing image is better in some ways because of our work. There's no more CVS commercial in which a pharmacist tells everyone that he can turn a layperson into a nurse in 4 hours. And the US government is no longer suggesting that only physicians can provide primary care since we persuaded them to change their "Take a Loved One to the Doctor Day" campaign to "Take a Loved One for a Checkup Day." We have had many other successes as well. Of course, the "naughty nurse" image keeps coming from the advertising industry and even recent television hits like Grey's Anatomy, which can be discouraging.

Real overall improvement may take decades. It sometimes seems that the negative images roll in faster than we can keep track of them, and that relatively few really accurate images of nurses appear -- and very few are in the influential television medium. Educating the media about what nurses really do and empowering nurses to speak to the media and the public about their work are not things that can be done in just a few years, at least not without a huge allocation of resources to the project.

Question: What else do you think readers should know about the Center for Nursing Advocacy? How can interested readers get involved?

Response: The Center for Nursing Advocacy is a grassroots organization supported by individual and organizational donors, and we are seeking sustained funding for our work. We need to increase the number of our members so that we can increase the amount of outreach we do to the media. We would also like to work more proactively to create good media, but that depends on hiring some people to work with us, which we can't do until we get more funding.

Readers can get involved by visiting the Center's Web site at and learning about media images of nurses. We want to stimulate discussion and thinking. Some of the hundreds of reports and analyses on our site may seem provocative. Our FAQ page, for instance, gives responses to common statements and questions such as "It's just a TV show -- get over it," "It's a show about physicians, not nurses," and "How can you expect Hollywood to portray nursing? It has to be dramatic." The site is a growing resource for anyone with an interest in nursing and the media, and we hope everyone will visit often.

A partial listing of the Center for Nursing Advocacy Board includes:

  • Diana J. Mason, PhD, RN, FAAN, Editor-in-Chief of the American Journal of Nursing

  • Claire Fagin, PhD, RN, FAAN, Dean Emerita, Professor Emerita, University of Pennsylvania School of Nursing

  • Journalists Bernice Buresh and Suzanne Gordon -- coauthors of From Silence to Voice: What Nurses Know and Must Communicate to the Public; Gordon is author of Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care

  • Pam Maraldo, PhD, RN, President, PJM Associates, former CEO, National League for Nursing

  • Nancy Dickenson-Hazard, MSN, RN, Chief Executive Officer, Sigma Theta Tau International Honor Society of Nursing

  • Beatrice Kalisch, PhD, RN, FAAN, Titus Distinguished Professor of Nursing, Division Director, Nursing Business and Health Systems, University of Michigan School of Nursing

  • Maryann Fralic, DrPH, RN, Professor of Nursing, Director, Corporate Relations, Johns Hopkins University School of Nursing

  • Linda C. Pugh, PhD, RNC, FAAN, Associate Professor, Director, Baccalaureate Program, Johns Hopkins University School of Nursing

  • Colonel Dena A. Norton (Ret.), MSN, RN, Administrator, Retired Colonel and Former Director of Health Care Recruiting, HQ, US Army Recruiting Command

  • I. Alan Fein, MD, MPH, Research Associate Professor, University of Florida College of Public Health and Health Professions

  • Andrea Brassard, RN, DNSc, MPH, CRNP, Project Manager, American Nurses Foundation


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