Image of Nursing 
Elizabeth R. Bauer
Lakeview College of Nursing

	
	According to Meg Gambell (Journal of Nursing Administration), nurses are the largest healthcare providers in the United States today. This comes to no surprise to me, but it might to some others out there. With nurses being the largest healthcare providers out there, it is no wonder that the image of nursing is often skewed from time to time. One thing that can skew the image of nursing is the media as well as the diversity that is coming about because of the way the media has worked to bring in more nurses. It seems that when most people think of a nurse, they think of a caucasian woman in a white skirt and shirt with a white cap on. People even dress like this for Halloween. What is surprising though is that this particular image of nursing was over with by the 1970’s. The uniforms is just another example of how the image of nursing changes. And finally, the last major influence on the image of nursing is men in the workforce of nursing
	The media has a profound affect on most everything these days. I’m sure that  most people have heard the commercials of Johnson and Johnson commending nurses and encouraging others to join the field. Even at the Danville campus at Lakeview there is a poster from Johnson and Johnson that states, “Be someone, be a nurse.” This mantra is a very empowering way to encourage someone to grab the reins of their own life to help the lives of others. And while more and more people are turning to nursing, the field is becoming more and more diverse (Gambrell). There are nurses working in hospital settings, while others choose the home setting. Men and women are finding that there’s more places for patient care than the hospital. This includes churches, cruise ships, prisons, schools, homes, and even the courtroom (Gambrell). And while this change in nursing is great, there is a problem arising out of this diversity, and that is the image of nursing. With so many different places a nurse can work in, the image of what a nurse looks like to the public varies with each different job there is to work at. Each place has their own set of rules when it comes to what nurses wear to work.
	This leads me to my second point, the impact of uniforms on the image of nurses.
If you asked a random person to close their eyes and describe a nurse to you, they would probably say something that included a white cap, white shirt, and white skirt (Buhler, Mason). Even though this image of nurses has gone by the wayside for more than 35 years. It is an image that is brought up at Halloween parties, in newspaper cartoons, and unconsciously in the minds of a lot of the public. Why? I believe the answer lies in the nurses uniforms of today. Yes, it is reasonable to believe that nurses wear scrubs to work (at most places), but there is such a diversity in what scrubs look like nowadays that the image of nursing has been skewed yet again. Nurses are allowed to wear almost whatever they want. There is not one set color that sets nurses apart from doctors and other workers in the hospital. Simply put, the patients (and public) have a hard time recognizing who is their nurse and who is not (Buhler, Mason). Then, you add to this men in nursing uniforms and you confuse patient’s even more.
	As I mentioned before, another image of nursing is men in the workforce of nursing. While it is wonderful that more men are entering this workforce, I can’t help but feel sorry for the stigmas and the stereotypes that will follow them. Often times male nurses are confused for physicians and doctors and then almost disregarded as a competent nurse for the fact that they are a man and are not more than a nurse. According to Ann Strong Anthony, the result of gender bias are harmful to the nursing profession and because of these bias, it is a cycle that limit’s the role of men in nursing. This we cannot allow. The changing face of nurses is a wonderful thing. However, the public does not often catch up as fast as nurses in the profession. Men in nursing provide the same care, comfort, counseling, a shoulder to cry on, and support that women in nursing do. This is another face of the image of nursing.
	The image of nursing is constantly changing. From it’s meager start as caretaker and window washer in Florence Nightingale’s time to the 1950’s version with a white skirt, shirt, and white cap to the version of today’s scrubs. The image of nursing has changed with its time. Today, the image of nursing is influence by the media, such as the Johnson and Johnson commercials promoting nurses, by the uniforms the many nurses wear today, and by more men entering the nursing workforce. This is what is the image of nursing.

Reference List
Anthony, A.S. (2006). Tear down the barriers of gender bias. Men in Nursing, volume 1 	(number 4), pages 43-49.
Buhler, K., Mason, D.J. (2004). Who’s the RN?: Identifying nurses simply by the patch. 	American Journal of Nursing, volume 104 (number 4), page 11.
Gambell, M. (2004). Improving our image a nurse at a time. Journal of Nursing 	Administration, volume 34 (number 6), page 273

#

#N200 Nursing Image Paper Grading Grid 

Student Name:								

Grading for Issue/Trend Paper (50 points possible):

										Total Points

	Discussion of issue	(20 points)							

	
	Writing style, grammar, spelling (10 points)					

	References (5 points)								

	
	APA Format (15 points)								

					

					TOTAL POINTS	   =				

LETTER TO THE EDITOR: Improving Our Image a Nurse at a Time 
Meg Gambrell, BSN, RN, Doctoral student			JONA: Journal of Nursing Administration
June 2004 
Volume 34 Number 6 
Pages 273 - 273 		

The article by Beauregard et al, "Improving Our Image a Nurse at a Time," 1 is a spark that will light the fire to change the image of nursing. I, too, have often watched the Johnson & Johnson "I am a nurse" commercials and contemplated the diversity of nursing. It was nice to see Johnson & Johnson making an attempt to recognize just how diverse nursing really is-as nurses, we are men and women, old and young, majorities and minorities. We are in hospitals, homes, schools, churches, courtrooms, the armed services, prison, and the Peace Corps. We fly on helicopters and ride on cruise ships. We can be just about anywhere, and we do just about anything, so no wonder the public is having such a difficult time with the image of nursing.

In the media, nurses have been portrayed in a variety of ways. In public opinion polls, nurses stand out. In a recent Harris Poll, 85% of the 1006 sampling population indicated that they would be pleased if their son or daughter wanted to pursue a nursing career. As for integrity, 95% of the polled sample stated that they trusted a nurse. 2 In 1997, Sigma Theta Tau commissioned the Woodhull study to examine references to nursing in the media. On average, nurses were cited only 3% of the time in hundreds of health-related articles. 3 In motion pictures and television, nurses are portrayed as angels of mercy, heroines, handmaidens, and sex objects. 4

Recently, the male nurse has been recognized in the media, but often not in a respected manner. In motion pictures and sitcoms, the male nurse plays a comedic role, with little respect or professionalism. These male nurses (referred to as "murses") have experiences in which their patients confuse them with physicians and then, after being corrected, order the "murse" to empty the bedpan.

Yes, the public's image of nursing may be skewed, but we face an even bigger problem. Our image of ourselves as nurses seems to be even more off center. What image of nursing do we, as nurses, embrace? Unfortunately, the trend is to focus on the negative. The hours are long; the patients and the system challenging; staffing is a problem; and the pay rate rarely meets our expectations. For these reasons, we dissuade others from nursing; we tell horror stories to nursing students on clinical rotations; we do not encourage our children to go into nursing; and we share only the negative. We do not come home from work and talk about the patient we helped ambulate for the first time, or the overwhelmed family to whom we brought peace.

Nurses teach health improvement and prevention, coping skills, and care for those who cannot care for themselves; provide psychological and spiritual counseling; and provide the courage to live. 4 Why wouldn't we want to share this information? We do not encourage our sons, or even our daughters, to enter nursing. In our profession, we collaborate with professionals, we serve as advocates, and most importantly, we empower. We spend our shifts empowering our patients, yet we cannot find the time to empower ourselves and our future.

Nurses are the largest healthcare providers in the United States, 4 yet of the 2.6 million registered nurses, fewer than 7% are members of national nursing organizations. 1 Together, we could make one very loud voice for change, but we choose to remain silent and politically ineffective. If we, as nurses, promote a positive image of nursing and become an active voice in society, the image of nursing can change.

Like Beauregard et al, I encourage the readers of this letter to take a stand: encourage children to enter nursing by providing positive and knowledgeable role modeling, become involved in public policy, submit articles to journals, join a professional organization, get certified in a skill, and attend conferences. If someone asks what you do for a living, stand up straight, smile, and say, "I am a nurse." We cannot be the backbone of the healthcare profession if we do not choose to support our own profession.

Meg Gambrell, BSN, RN, Doctoral Student
References

1. Beauregard M, Deck D, Kay K, et al. Improving our image a nurse at a time. J Nurs Adm. 2003;33(10):510-511. [Context Link]

2. Davidson S. Shaping the present/future image of nursing. OregonAQ1Nurse. 2000;65(3):3. [Context Link]

3. Sigma Theta Tau International. The Woodhull study on nursing and the media. Available at http://www.nursingsociety.org/media/woodhullextract.html . Accessed February 8, 2004. [Context Link]

4. Murray B. The image of nursing. Vermont Nurse Connection. 2000;3(3):9. 

Tear down the barriers of gender bias 
Ann Strong Anthony RN, MSN 

	Men in Nursing
August 2006 
Volume 1 Number 4 
Pages 43 - 49 	

Abstract

In nursing education, we must become sensitized to the unique experiences of men in our programs.

"I don't know. It's so frustrating. There's only a one point difference between passing or failing this course. Yet when I look at the questions I got wrong, I don't think it shows my lack of knowledge, only that I think like a man, not like my nursing instructor."

So began a recent conversation with a current nursing student, a young man who's seeking to progress in an LPN-to-RN program. This successful LPN with 5 years experience, who's active in the Army National Guard, holds a 3.49 GPA in his nonnursing courses. Yet he's struggling with the transition to professional nursing practice. Unfortunately, his experience isn't atypical. Is it that men are less prepared to succeed in our nursing programs or is it that we don't effectively accommodate their learning styles and needs? Do we inadvertently create an environment that's biased against men? Do nursing instructors actually discriminate against men in their courses?
Examining gender bias

Studies that have explored men's experiences in nursing education programs demonstrate that gender bias and discrimination do occur.1 Recent research reports that the "barriers men face in nursing school are pervasive, consistent, and have changed little over time."2 Over 89% of the respondents from that study reported hearing anti-male remarks made by faculty in the classroom.3 Other studies have found that men experience the process of nursing education differently than women, are caught by surprise as they enter the "women's domain" of maternal-child nursing, and learn to express caring in a different manner than women.4-9

If gender bias is an unrecognized, unaddressed component of nursing education programs, the outcomes are clearly detrimental to our profession and limit our ability to recruit and retain a robust workforce. In the coverage of the current nursing shortage, the media have reported that men are more likely to leave nursing than their female counterparts. The 2000 National Sample Survey of Registered Nurses demonstrated that men leave nursing at a higher rate in the first 4 years of practice.10 It begs the question, is this higher rate of attrition related to alienation that men experience in their nursing education programs?

Unfortunately, in contemporary nursing literature, it's easy to find examples of gender bias and its impact on men who seek to pursue a nursing career.5,6,11,12 The outcomes of gender bias are harmful to the profession and create a cycle that perpetuates bias and limits the role of men in nursing. This cycle results in different learning experiences for men and women as nursing students, limits recruitment and retention of men, and perpetuates traditional male-female stereotypes that make the profession irrelevant to the diverse population that the profession claims to represent and serve.13-18
The Nightingale factor

In the 1830s, Theodore Fliedner established the first training school for deaconesses in Germany, which is where Florence Nightingale began her training in nursing.26 In the mid-1800s, Nightingale's accomplishments in the Crimean War, combined with her social prominence and political influence, coalesced with changing perceptions of gender roles in Victorian England to establish the foundation of the myth of the feminine nurse, in which it was "natural" for women to be nurses, and conversely, "unnatural" for men.

Well-educated, articulate, and influential, Nightingale advocated for nursing as an ideal occupation for gentlewomen and opposed men's involvement in nursing, even stating that their "horney hands" were detrimental to caring. She used nursing as a platform for emancipation from the limitations she faced as a single woman in Victorian England. In doing so, she sought to align nursing with women's sphere of influence, namely, motherhood and caring. By focusing on the natural characteristics of women, in which nursing was equated with caring and caring was an inborn trait fostered by mothering, nursing and femininity seemed an ideal fit. Men were excluded, as it was perceived that they didn't have the capacity for mothering or caring.1,27,28

The pervasiveness of viewing nursing as the ultimate feminine role can be traced to and throughout the twentieth century. In the 1940s, during a debate about expanding training and licensure to men who were already providing nursing care, a South African councilor was quoted as saying, "A man is a clumsy thing who does not know how to handle a sick person[horizontal ellipsis] Nursing is the proper profession for women. They are created for that purpose."29

Men were excluded from the training programs advocated by Nightingale. The nurse's role was viewed as subservient to the physician, who directed the care and ran the hospital. The training environment mimicked the cloistered atmosphere of a religious sisterhood and was designed to preserve virtue and protect young women from contamination from the outside. By the beginning of the twentieth century, there were only two training programs for men in the United States. These programs focused on clinical areas acceptable for male participation, such as psychiatry and urology. Men were often barred from training in obstetrics.

As nurses began to organize professionally, men, even those with training as nurses, were often excluded. In 1901, the Army Nurse Corps was founded and specifically excluded men from nursing roles in the military. It wasn't until after the Korean War that men were allowed to hold commissions and be nurses in the U.S. Army.
The changing tide

Despite the limited recognition given to their role and the overemphasis on women's contributions to nursing, historically men have participated in caregiving and have been described as nurses. (See "The history of men in nursing.") Since the mid-1950s, men have been commissioned as officers and nurses in all of the American military services. Although men represent less than 6% of the total nursing population, they comprise nearly 30% of military nurses. The proportion of men in first-responder roles and specialty practices such as emergency and critical care has grown at a faster rate then the total nursing population in recent years.30

The vision of the kindly, caring female evolved into the stereotype of "nurse" following the advent of organized nursing training. The image of the nurse became one of an individual who was "subordinate, nurturing, domestic, humble, and self-sacrificing."17 Consequently, men who are perceived as strong, aggressive, and dominant ceased to be seen as having a legitimate role in nursing. Research indicates that this perception has resulted in men being ostracized from nursing, and further proposes that the contributions of men to nursing have been "forgotten" as nursing evolved into a stereotyped female role.17

This collective memory loss of men's contributions to nursing has left men with little information about their historical roles as caregivers. Both men entering nursing programs and their predominately female instructors are likely to be unaware that men come to nursing with a legacy of caregiving.

This lack of knowledge may contribute to a sense that men are breaking new ground by choosing nursing as a career option in the twenty-first century. As men enter nursing programs, they may feel like pioneers starting a treacherous journey into a hostile and unwelcoming territory rather than following a well-blazed trail. Such negative perceptions limit nursing's ability to recruit from the nearly 50% of the population that isn't female.
The male experience

What happens when men enroll in a nursing education program? It's unlikely that they'll be greeted by blatant evidence of prejudice. In most instances, men are cordially and enthusiastically welcomed. However, a collision of cultures is brewing.

Men entering nursing programs tend to differ from their female counterparts. While their academic preparation is likely to be equivalent, they're typically older and have made a considered decision to enter nursing based on their knowledge of the working world and nursing acquaintances. They expect to care for others while using their knowledge and building their careers. They expect to be team players and may relate their previous life experiences to their expectations of the healthcare team. Instead, they find that not only does it take a different kind of effort to be part of a nursing team, but they've entered a female-dominated and cloistered environment.

Editorial: Who’s the RN?: Identifying nurses simply by the patch. 
Diana J. Mason PhD, RN, FAAN, AJN Editor-in-Chief 
Karen Buhler-Wilkerson PhD, RN, FAAN 

	AJN, American Journal of Nursing
April 2004 
Volume 104 Number 4 
Pages 11 - 11 	

The woman in white, that 1950s stereotype in white cap, dress, and shoes, has prevailed as the media icon of American nursing, although she has long since left contemporary practice. Nurses in this country began shedding their white uniforms in the 1960s as part of the anticonformist movement, and the clear identity of the RN was blurred. Ever since, patients have complained that nurses are unrecognizable to them. And even nurses debate what nurses ought to wear. For example, tunics festooned with flowers and cartoon Teddy bears, worn by nurses and nonnurses, seem "unprofessional" to some nurses when worn outside of pediatrics. Those critics may be right; journalist Suzanne Gordon has noted that the ways nurses present themselves to patients shape public views of the profession.

Artists Mark Dion and J. Morgan Puett extended the debate over nurses' uniforms and identity through their exhibition RN: The Past, Present, and Future of the Nurses' Uniform, on view in Philadelphia at the Fabric Workshop and Museum from October 2003 until February 2004. In collaboration with the University of Pennsylvania's Center for the Study of the History of Nursing (of which Karen Buhler-Wilkerson is director), Dion and Puett documented the societal trends that have shaped what nurses wear while at work. The single most dramatic response, from nurses and others, was that nurses are no longer distinguishable from many health care workers. This month, AJN has adapted part of the exhibition's catalog and published it with photographs of uniforms both historic and futuristic (see page 40). Read the article, and let us know what you think about nursing's uniform dilemma.

Prior to the exhibit, the artists surveyed nurses: what elements would the "ideal" nursing uniform contain? They incorporated those elements into their own design of the ideal uniform, which they displayed. In addition, the artists designed an "RN" logo for the exhibition as well as an embroidered "RN" patch distributed at the museum (and which we display this month on our cover). One nurse who attended recognized an opportunity to assert her identity and sewed the red-and-white patches on her lab coats.

We are asking uniform manufacturers to make these patches available on uniforms they sell to nurses-whether scrubs, whites, or lab coats. AJN will publish the names of uniform manufacturers that do so. Hospitals, long-term care facilities, and home care and other organizations can purchase patches in bulk for their employees. Quantities of 5,000 or more can be ordered from Valley Products Company: (800) 451-8874 or valpro@clothlabels.com. What a great gift for Nurse's Week celebrations.

We believe this could be a simple yet elegant solution to nursing's identity crisis. (Perhaps a similar patch for LPNs could be useful as well.) Help us take it from the grassroots to a national platform: apply the "RN" patch to your scrubs or lab coats, and urge your colleagues to do the same.