INTRODUCTION:

As per Daniel J. Boorstin, “An image is not simply a trademark, a design, a slogan or an easily remembered picture. It is a studiously crafted personality profile of an individual, institution, corporation, product or service.” Image is part of a profession. It is the way a person appears to others, or in the case of a profession, the way that profession appears to other disciplines and to the general public who are the consumers of health care services. The image of nursing is determined by how nurses and public perceive nursing.

Image and the perception of the profession impact recruitment of students, the view of the public, funding for nursing education and research, relationships with healthcare administrators and other healthcare professionals, government agencies and legislators at all levels of government, and ultimately, the profession’s self-identity. Just like individuals may feel depressed or less effective if others view them negatively, professionals can experience similar reactions if their image is not positive. It impacts everything the profession does or wishes to do.¹

Image is a part of any profession. How nurses view themselves—their professional self-image—has an impact on professional self-esteem. How one is viewed has an impact on whether others seek that person out and how they view the effectiveness of what that person might do.¹

Meaning of Nursing Image:

Webster's dictionary defines "image" as "character projected by someone or something to the public. This definition implies that one image is formed by the public given certain inputs. On one hand, the public has fun with the stereotypical image of the nurse as the ministering angel, the battleaxe, the naughty nurse, or the doctor's handmaiden.²

The image of nursing is related to the women’s movement, labor relations competition in the health field, recruitment, scope of practice, research and educational preparation for professional nursing.

Sr. Rosemary Donley

Image of nursing is related to the nursing public (patient’s opinion-makers, hospital administrator, military, the Governments, and opinion molders).

ANA

Every time a nurse says to family, friends, or in public that he or she is a nurse, the nurse is representing the profession. This has an impact on the image of nursing. We nurses cannot expect outsiders to be the guardians of our visibility and access to public media and health policy arenas. We must develop the skills of presenting ourselves in the media and to the media- We have to take the responsibility for moving from silence to voice as stated by Buresh and Gordon, 2000.¹

Past and Current image of nursing:

The role of nursing has experienced many changes, and many more will occur. Nurses have made a tremendous endeavor to establish a strong educational base by preparing academic courses at a university level in order to guide their professional practice and research. Despite these changes, the public still holds traditional views of nurses associated with deep-rooted stereotypes and expects them to remain dependent on physicians.

Nurses have not taken the lead in standing up and discussing their own image of nursing—what it is and what it is not. Gordon and Nelson commented that nursing needs to move “away from the ‘virtue script’ toward a knowledge-based identity” (2005, p. 62). The “virtue script” continues to be present in current media campaigns that are supported by the profession.³

There needs to be a more contemporary image of nursing to attract the next generation of nurses. People have many career options today, and most want careers that are intellectually stimulating. When nurses describe what they do, they frequently tell stories of hand-holding and emotional experiences with patients, leaving out the knowledge-based care that requires high levels of competency. At the same time, nurses are confronting heavy pressure to demonstrate how nursing care impacts patient outcomes.

This does not mean that the public does not value nurses—quite the contrary. When a person tells another that he or she is a nurse, the typical response is positive. Consumers generally view nurses as good people who care for others. What is not mentioned is that knowledge and competency are required to do the job.

Each year there is a designated International Nurses Day, May 12, just as there is an annual recognition day or week for many other workers and professionals. This period was chosen because it coincides with Modern nursing Pioneer Florence Nightingale’s birthday, May 12, which is International Nurses Day. Nursing, primarily through the International Council for Nurses (ICN), identifies an annual theme and issues that are emphasized during the week. Nurses Week is also used as an opportunity to recognize nurses in practice and to advertise the profession of nursing, increasing its visibility and portraying a positive image.

During Nurses’ Week, healthcare organizations typically hold special celebrations to honor nurses, give out awards for leadership and other accomplishments, and announce via the media (such as local newspapers, radio, and TV) how proud they are of their nurses. Stories and photos that are provided to the media tend to focus on caring—a nurse holding a patient’s hand or talking to a patient. This is not to say that this type of image is not important in nursing, because it is; however, it portrays a limited image of nursing. There is less recognition of the other complex professional aspects of nursing.¹

Factors influencing the image of nursing:

Nurses have been silent about what they do and how they do it, but this has been a choice that nurses have made—to be silent or to be more visible. External and internal factors have impacted the nurse’s voice and this silence. The external factors are (Pike, 2001):

· The historical role of the nurse as a handmaiden (not an independent role)

· The hierarchical structure of healthcare organizations (has often limited the of nursing in decision making)

· Perceived authority and directives of physicians (has a limited independent role of nurses)

· Hospital policy (has often limited nursing actions)

· to nurse of disciplinary or legal action or loss of job (might limit a nurse when he or she needs to speak out—advocate)

Nurses who can deal with the internal factors can be more visible and less silent about nursing. The internal factors to consider are:

· Role confusion

· Lack of professional confidence

· Timidity

· Fear

· Insecurity

· Sense of inferiority

This loss of professional pride and self-esteem can also lead to a more serious professional problem: Nurses feel like victims and then act like victims. Victims do not take control, but rather see others in control; they abdicate responsibility. They play passive-aggressive games to exert power. This can be seen in the image of nurses, which is predominantly driven by forces outside the profession. This also has an impact on the nurse’s ability to collaborate with others—other nurses and other healthcare professionals.⁴

Importance of visibility for nurses and the nursing profession:

The public image of nursing is, to a large extent, affected by the invisibility of nurses and the way they present themselves. The public views of nursing and nurses are typically based on personal experiences with nurses, which can lead to a narrow view of a nurse often based only on a brief personal experience. This experience may not provide an accurate picture of all that nurses can and do provide in the healthcare delivery process. In addition, this view is influenced by the emotional response of a person to the situation and the encounter with a nurse. But the truth is that most often, the nurse is invisible.⁵

Consumers may not recognize that they are interacting with a nurse, or they may think someone is a nurse who is not. When patients go to their doctor’s office, they interact with staff, and often these patients think that they are interacting with a registered nurse (RN). Most likely, they are not, and the staff person is a medical assistant of some type or maybe a licensed practical/vocational nurse. When in the hospital, patients interact with many staff members, and there is little to distinguish one from another, so patients may refer to most staff like nurses.¹

Nursing has strived to achieve professional status by increasing the body of nursing knowledge and by enhancing nursing practice. The establishment of academic programs at the university level has enabled nurses to conduct nursing research as well as to establish an emerging theoretical base.⁶

Although nurses see themselves as well‐trained professionals, the public still sees nursing as a low‐status profession that is subordinate to the work of physicians, does not require any academic qualifications and lacks professional autonomy. The public is oblivious to the different levels of education and professionalism involved in nursing.⁶

Ineffective communication skills influence the public perception of nurses. Nurses should work harder to communicate their professionalism to the public and they need to make clear what they really do.

Need for adverting for the nursing profession:

Schools of nursing and employers use advertising to recruit students and staff, and professional organizations advertise to make nursing more visible. The profession needs to understand why it is necessary to advertise nursing. Goals for any initiative need to come from understanding the need, and goals for advertising nursing are no different.⁷ There are a number of reasons for advertising nursing. First, of course, is the need to attract more qualified people to nursing and to attract minorities and men to the profession. Second, advertising has an impact on other groups that need to know about nursing—what nurses do and the impact that nurses have on health care and outcomes. These groups include policymakers, healthcare organizations, insurers, educators, school counselors who may direct students into nursing, and the consumer. The more positive image of nursing, the higher the chances that students would opt for a career in nursing.

Role of Media in changing the nursing image:

Today, the media is a powerful force. Through a great variety of media methods, people can find information quickly; it is accessible anywhere, even on a cell phone. The media focuses not only on news but also on related information in broad areas, including health care. Healthcare issues can be found in all types of news and entertainment media (film and television), and in other forms of media, including publications such as magazines and books. How much is focused on nursing, and how is nursing portrayed?⁷

Nursing has many problems today, including short-staffing, poor working conditions, and in many places, inadequate pay relative to the skills and responsibility of the work. All of these should be addressed. But improving how people see the profession is one of the most critical. Despite being part of the largest segment within the healthcare workforce, nurses aren’t in the media as much as you might expect. Why is it always a physician discussing important health issues, emerging research, and health education? The roots of this persistent media failure stretch back to the start of the modern profession. Traditionally, the media has presented nurses as angelic, relatively low-skilled, and highly deferential to physicians.⁸

The Center for Nursing Advocacy, founded in 2001, was initially created to consider the nursing shortage. This organization approached the nursing shortage problem from the perspective of the impact of nursing’s image on the ability to attract qualified students to the profession and retain them long term. The center was active in identifying media examples in which nursing is portrayed positively and negatively and to mobilize nurses to respond. The Center was eliminated in 2009 and replaced with another similar organization, The Truth About Nursing (http://www. Truth about nursing.org/). This center also develops campaigns to push for changes in media (Television, Radio, Advertising, Film, Magazines, and so forth).

Role of Nurses in improving the image of the nursing and nursing profession:

Nurses could be achieved by pursuing higher education and by working in a challenging work environment that offers nurses the opportunity to break away from the daily routine and that challenges them to deepen and broaden their knowledge and skills. Job rotation, gaining professional autonomy, opportunities for inter-professional learning and peer consultation could help nurses to become more visible within their organization and on a macro level, within society.

As educators and role models, they can establish a professional nurse identity. Professional development of nurses could also be realized by sharing their work experiences with other nurses. In addition, nurses should make better use of strategic positions, such as case manager, nurse educator or clinical nurse specialist to show what their work as healthcare professionals entails. The public should be able to identify with nurses and the work they do. In the media, nurses are hardly seen as professional advisors or experts.⁶

Steps to be taken in improving nursing image:

· Cultivating a professional image by the way they represent the profession

· Defining unacceptable workplace behaviors and holding the staff accountable

· Teaching nurses the benefits of scripting such as, “My name is Shelley, and I am your registered nurse today.”

· Defining the appearance of the nursing staff in written guidelines and following through with consequences for those who don’t comply

· Involving the staff in developing the list of unacceptable behaviors and the specifics of a new dress code

· Posting, circulating, and advertising nursing’s accomplishments

· Using the local community newspapers for ongoing announcements

· Having staff contribute to the community by writing health-related articles in the newspaper

· Speaking to civic and community groups about what nursing is and does

· Listening to patients’ and caregivers’ perceptions of nursing

· Surveying staff, patients, and caregivers about these perceptions

· Teaching and mentoring staff on how to validate all they do with appropriate documentation and active committee involvement

· Teaching communication skills, so staff nurses feel empowered to respond to negative colleagues in a manner that confronts and stops behaviors that affect our image.⁸

· Use evidence-based research to support funding requests. Now more than the outcomes can be tied to resources and support for nursing staff. Advocate for work schedules that minimizes fatigue and allow veteran nurses to transition to retirement, sharing their experience and wisdom.

· When you observe the inaccurate representation of nurse in media, write or email the source to present a more accurate view of the professional nurse. Make your voice heard.

· When hiring, encourage diversity in gender, age, previous profession, etc. develop a workforce that mirrors the population from which it is taken. Create a work environment committed to formal orientation, preceptor, and mentorship programs.

· The “continuum of care” places real responsibility on nurses and all involved professionals to understand the accountability of each role, to communicate clearly, to document accurately, and to delegate carefully. Provide your staff with training in each of these critical areas.

· A professional presence, in appearance and behavior, is the key to engendering trust. Respect and trust must be earned. Always wear your name tag, always introduce yourself by your full name and identify your professional role. Require the same as your staff.⁹

REFERENCES:

1. Buresh, B., and Gordon, S. (2006). From silence to voice: What nurses know and must communicate to the public (2nd Ed.). Toronto, Ontario, Canada: Canadian Nurses Association.

2. Beauregard, Mary A. Deck, Dinah S. Kay, Kathleen Coughlin, et. Al, JONA: Journal of Nursing Administration October 2003, Volume: 33 Number 10, page 510 - 511

3. Gordon, S., and Nelson, S. (2005). An end to angels. American Journal of Nursing, 105(5), 62–69.

4. Pike, A. (2001). Entering collegial relationships. In J. Dochterman and H. Grace (Eds.), Current issues in nursing (6th ed., pp. 448–452). St. Louis, MO: Mosby.

5. Yvonne ten Hoeve, Gerard Jansen, Petrie Roodbol, The nursing profession: public image, self‐concept and professional identity. A discussion paper, Journal of Advanced Nursing, Volume70, Issue2, February 2014 Pages 295-309.

6. Takase, M. (2000). Influence of public image of nurses on nursing practice. Retrieved from https://ro.ecu.edu.au/theses/1346

7. Anita Finekelman, Professional Nursing concepts: Competencies for Quality Leadership, Jones and Bartlett Learning LLC, 4^th Edition

8. Sieber, J. R., Powers, C. A., Baggs, J. R., Knapp, J. M., and Sileo, C. M. (1998). Missing in action: Nurses in the media. American Journal of Nursing, 98(12), 55–56.

9. Karen Tomajan, contributing author of The Image of Nursing: Perspectives on Shaping, Empowering and Elevating the Nursing Profession.

Received on 12.07.2019 Modified on 18.08.2019

Int. J. Nur. Edu. and Research. 2019; 7(4):625-628.

DOI: 10.5958/2454-2660.2019.00141.8