Where Are the Nurses in Today's Health News?

Kerry Dooley Young

Disclosures

June 12, 2019

The News Needs Nurses

A journalist once told Diana Mason, RN, PhD, that he didn't seek out nurses as sources for his stories because he covers the business of healthcare, and not "nursing issues." Mason is clearly still frustrated as she repeats the story.

With this outlook, journalists are missing out on what is arguably the most critical perspective in understanding how healthcare systems actually run, continued Mason. You can't explain hospital labor costs, for example, without the input of the executives who control spending. So "who better than the chief nursing officer to be able to explain the impact of budget cuts on patient care and safety?" Mason asks.

Mason's conversation with this journalist took place in the context of an in-depth examination of how nurse representation in the media has evolved in recent decades.

Are Nurses' Views Gaining Influence?

The heart of Mason's work was a replication of the well-regarded 1997 "Woodhull Study on Nursing and the Media,"[1] which found that nurses were too often ignored by the press. (The study was named for Nancy Woodhull, a founding editor of USA Today who was noted for championing women's issues.) In that original study, looking at a snapshot of health news stories published by leading national and regional newspapers on a single day in 1997, only 4% of the quotes were from nurses.

But much has changed in healthcare since then. The advent of electronic health records and the rollout of the Affordable Care Act—major initiatives that significantly affected the practice of nursing—were endlessly reported on by the healthcare media. Mason and colleagues wondered whether the views of nurses were sought more frequently in stories about these transformative events in healthcare.

In "The Woodhull Study Revisited: Nurses' Representation in Health News Media 20 Years Later,"[2] the researchers examined many of the same media sources used in the original Woodhull study. Their final random sample consisted of 537 articles from newspapers, news magazines, and healthcare industry reports published in September 2017.

Nurses were identified as sources for only 2% of the quotes in the 2017 health news stories (not significantly different from the 4% found in the 1997 study.) Nurses' opinions on health policy were never solicited, and only 13% of the articles used the word "nurse" at all. Mason documented many instances where nurses' voices and opinions were not represented, even though the nursing perspective was highly relevant to the story's topic.

The lack of media representation persists even though nurses are the largest group of professionals in the healthcare workforce. The United States has 3.8 million registered nurses, and about 1 million active physicians.

The second phase of the Woodhull Study Revisited[3] involved interviewing health journalists about their experiences using nurses as sources for their stories. The main conclusions of this study were that journalists didn't fully understand the range of nurses' roles, work, and education, and they expressed uncertainty about how to find nurses to interview.

Tell Reporters What Nurses Do

Nurses bear some of the responsibility for their absence in the health news media, having done little over the years to promote themselves. Healthcare employers don't typically recommend nurses to members of the media as expert sources.[3] Although the press and communications staff of most healthcare organizations routinely track down physicians to speak with journalists, they rarely do so for nurses.

"Healthcare journalists are like sports reporters who only want to interview star goalies or basketball players who can sink 3-point shots," explained Patricia Davidson, PhD, MEd, RN, and dean of the Johns Hopkins School of Nursing. "Healthcare is a team sport. Getting the whole perspective gives you a much greater insight into strategy and decisions."

Journalists' biases about nursing and women can be a barrier to understanding that nurses' views can enrich a story. This prevents them from making the effort to tap into the expertise of nurses.[3] But without those diverse viewpoints, journalists won't get a complete picture of what's happening in healthcare, warned Mason. She urges her fellow nurses to make the media—and the public—more aware of their role in healthcare. "It's your job to explain what you do every day," she said. But it's not a role that nurses are comfortable with.[3]

Exposure in the health media can correct misunderstandings about the work of nurses. A recently hospitalized woman complained to Mason that the nurses were "too chatty," and she really only wanted to speak with her physician. Mason explained the critical monitoring that nurses do by saying, "The nurse whom you think is being chatty is actually observing you. Your nurse is looking at how you are breathing, your color, whether you are sweating, all cues that tell the nurse how you are doing."

Get Into the Spotlight

Nurses may be poised to gain more influence in media reports as they advance to management positions, Davidson said. The president of Johns Hopkins Health System, for example, is Kevin Sowers, MSN, RN, who began his career as a staff nurse specializing in oncology. "Nurses are increasingly seated at the decision-making table," Davidson added, "Many nurses are now the decision-makers."

But to achieve greater influence, nurses, their employers, and their professional organizations need to be strategic and proactive about engaging with healthcare journalists and reporters.[3] Susan Hassmiller, RN, PhD, senior advisor for nursing at the Robert Wood Johnson Foundation, suggests that nurses build relationships with journalists by becoming familiar with the local reporters who cover health and medicine.[4,5] They can begin by contacting these reporters to share story ideas; tell them what's going on in their communities; or give constructive feedback, especially if a journalist's story missed an important angle.[4] Nurses can subscribe to press releases to keep up to date on important healthcare issues.

The Future of Nursing: Campaign for Action creates opportunities for nurses to share their views with members of the media. Johns Hopkins has its own The New Script of Nursing/We Got This campaign, intended to make the public more aware of the work nurses do.

Nurses who work in hospitals, healthcare organizations, or academic institutions should make sure that the public affairs/public relations departments of those facilities are aware that nurses have valuable perspectives and want the chance to speak with the media.[3] And nurses shouldn't wait for media training to be offered—they should ask for it, to acquire the skills to successfully navigate an interview and answer journalists' questions. Nurses who want to work with the media need to understand deadlines and the pressures that journalists may be working under, and respond promptly to interview or quote requests.[3]

Make Better Use of Social Media

Another area ripe for exploitation by nurses is social media. In "Nurses Can Make Mainstream Media Take Notice," Hassmiller admitted that her early use of Twitter was all wrong. She was conveying important news, but mostly to other nurses. The hashtags often used by nurses (eg, #nurse or #gonursing) are unlikely to attract attention and dialogue with members of the health media.[4] Changing nurses' social media habits could open the door to sharing their knowledge, expertise, and views on a larger stage.

There are signs that this is happening. Nurses turned to Twitter in droves recently to defend themselves and express their outrage over a prominent legislator's public comments about nurses. During a debate about a health law mandating uninterrupted meal and rest breaks for nurses, Washington state Senator Maureen Walsh said that nurses didn't need breaks because they "probably play cards for a considerable amount of the day." This sparked a furor among nurses, and the backlash prompted a #nursesdontplaycards hashtag and filled the Senator's mailbox with thousands of decks of playing cards.

Walsh got the message and dismissed her earlier remark as a misstatement that wasn't intended to insult nurses. A week later, in a speech before the state Senate, Walsh said she has "respect and "admiration" for nurses, noting that her mother worked in the profession for many years. "I was in the hospital last year, and the nurses were the one element that made that hospital stay bearable, I assure you," Walsh said.

Walsh's comments illustrates a phenomenon that Davidson has observed many times before. One of the best ways to learn to appreciate the work of nurses is to spend time under their care. "I've been a nurse for 40 years. Many physician colleagues have really not understood the importance of nursing until they became a patient and were seriously ill themselves," Davidson said.

And misconceptions about nurses are widespread, as Davidson wrote in a tweet: "The media, our legislators, and even the general public are unaware of the extent to which we work, fight, study, cry, and advocate for patients, families, and communities across the world."

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