NSC 502

SEMINAR IN NURSING

A PAPER PRESENTED TO THE DEPARTMENT OF

NURSING SCIENCE

COLLEGE OF MEDICINE OF THE UNIVERSITY

OF LAGOS

IN PARTIAL FULFILLMENT OF THE AWARD OF

THE B.NSC DEGREE

THE PUBLIC IMAGE OF THE NURSE

LECTURER: DR MOBOLAJI

INTRODUCTION
The public image of the nurse describes the perceptions of the image of nurses by individuals

outside the nursing sphere; the general impression presented by nurses as perceived by the

public.

“Nursing is a profession that has suffered from public stereotyping for a long time. It has

been viewed historically as a female profession, under the orders of doctors and without its

own field of competence. Major changes have occurred in the discipline over the last decade

that directly affect the profession”. (Errasti-Ibarrondo B, 2014)

THE SELF IMAGE OF THE NURSE

This describes the way in which nurses perceive themselves within their working

environment. Nurses’ self-image is derived from their self-concept, which is defined by

Takase, as information and beliefs that nurses have about their roles, values and behaviours

(Takase M., 2013).

Turner (2016) disputes however that the self‐concept of an individual or a group (e.g. nurses)

is derived from the perceived image of the group by society.

Self-image can therefore be a function of nurses’ beliefs about their roles, values and

behaviours, as well as their awareness of their image as perceived by the society. According

to Hoeve (2013),the self-image of the nurse is influenced by the following:

 Work environment and work values

Nurses learn from their work experiences and professional interaction with colleagues, in

particular, is highly valued. A study by Gregg & Magilvy in 2011 showed that through

interaction with other nurses, they learn things about nursing and about themselves and

working as a nurse may also contribute to their personal growth and self‐concept (Gregg M.,

2011). Nurses develop their self-image through the skills, knowledge and values inherent in

their profession.
  Education

Next to work environment, education and the presence of instructors also contribute to

nurses' self‐image. The nurses in the study of Gregg and Magilvy (2011) indicated that the

influence of clinical instructors during education and in the work environment was very

important. The higher the educational qualifications, the more valuable the nurse’s self-

image.

 Traditional values, culture and gender

The nursing profession continues to suffer from the influence of traditional values and

cultural and social norms with respect to gender and professional status. As a result, nurses

are struggling for power in a gender‐segregated society.

Nursing was, and sometimes still is, portrayed as a female profession, with nurses playing

supporting roles to physicians and occupying a subordinate position with regard to decision‐

making and delegating tasks.

 Caring

The nursing profession is strongly associated with caring, both by the public and by nurses

themselves. However, a discrepancy exists in the interpretation of the concept of caring. The

studies show that nurses consider caring to be part of their professional identity, whereas the

public associates caring with feminine qualities and unprofessionalism. Today's nurses try to

gain recognition for the importance of caring in a society where caring is undervalued.

 Identity and performance

Hoeve explained that the performance of nurses in the hospital is majorly affected by the

shortage of nurses, which is partly caused by nurses themselves, who do too little to

recommend their careers to others. As long as nurses do not feel responsible for the distorted
images of the roles they have performed and are still performing in health care and as long as

they do not take a stand to correct these images, the public image would continually be

distorted, ultimately affecting how the nurse feels about herself.

THE PUBLIC IMAGE OF THE NURSE

This public image is predominantly based on misconceptions and stereotypes, which find

their origins in distorted images of nurses in the media. The media plays a part in

perpetuating the stereotype of the nurse as angels of mercy, the doctor's handmaiden, battle-

axe and sexy nurse. Due to such images, the public views nurses as feminine and caring, but

not necessarily as autonomous healthcare providers (Takase, 2013).

 Six images of nurses have been identified from media representation, corresponding

to six different periods:

(1) Angel of Mercy (1854–1919);

(2) Girl Friday (1920–1929);

(3) Heroine (1930–1945);

(4) Mother (1946–1965);

(5) Sex Object (1960–1982);

(6) Careerist (1983–Present).

 With respect to male nurses, men were either portrayed as the second sex in nursing

care (Errasti-Ibarrondo B, 2014). Turner (2016) demonstrates that male nurses

experience hesitation from clients as a result of stereotyped images.

 The media's projection of images of nurses, in ways that neglect the official

requirements of the profession, also has an impact on the view of the public on

nursing (Takase, 2013). Nurses seem to be viewed as feminine and caring, not as

autonomous healthcare providers (Takase, 2013).

  It seems that the public is predominantly ignorant of the essence and focus of the

discipline, which is none other than care of the person, family or community (Hoeve,

2013).

 Also society does not fully acknowledge that nurses have their own field of

competence, autonomy and independence. There is still a tendency to consider

nursing as a profession inferior to medicine, closely related to "tasks", and there is

trust in its carrying out those activities that have been traditionally associated with it.

However, it is coming to be perceived as a profession that is less related to femininity

and that involves greater preparation than in the past. (R & E, 2015).

THE PUBLIC IMAGE OF NURSES AT LUTH

An article by Muanya, Areo and Onyenucheya (2018) in The Guardian Nigeria reported

various perspectives of patients or patient relatives regarding nursing care at LUTH. Below

are excerpts from the article.

“The poor state of public hospitals in Nigeria has been a challenge in recent years. This has

made experts and observers, even members of the Senate to suggest that the Federal

Government should declare a state of emergency in the country’s health sector. Disgruntled

patients have complained bitterly about services received at the foremost Lagos University

Teaching Hospital (LUTH) Idi-Araba. The complaints are on old infrastructure, high cost of

medical treatment, bad attitude of health workers, especially nurses, dirty environment,

toilets, and water scarcity among others.

“Before my father died on Sunday, I called the attention of the nurse when he suddenly

showed some discomfort but the nurse gave no attention till my father died, just like that,”

Titi Adebayo lamented tearfully.

Some relatives of patients are piqued that the nurses assigned to patients rarely come around
to see their patients.

“They display this ‘I don’t care’ attitude towards patients and relatives. If we pay attention to

their attitude towards us, we will make a fight but we just have to let go so that we can leave

here on time,” Mrs. Adebayo said.

The Guardian investigation revealed that most relatives of patients at LUTH groan over

nurses’ negative attitude to treatment.

“You must come with God whenever you bring a patient here”. These were the words of a

mother whose son is on admission at LUTH. The boy who has been on admission for the past

two weeks has received little attention from the nurses, according to the mother who craved

anonymity. She said, though, her son has received little attention from the nurses, their

indifferent attitude towards patients is disturbing.

This is the same issue with a soldier, whose sister has been on admission for the same period

of time. When The Guardian engaged him in a discussion, he said his sister was referred from

a private hospital to LUTH to undergo a complicated surgery. He said on entering the

hospital, the procedures were demanding, adding that the nurses showed little concern in

tending to his sister.

In summary, the public image of nurses at LUTH as drawn from the article above shows:

Nurses are unprofessional; unreliable; do not show empathy; do not prioritize their patients

needs; do not attend to patients when due; do not provide adequate information.

INFLUENCE OF THE PUBLIC IMAGE OF THE NURSE ON THE PROFESSION

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—

consumers of health care.

A poor public image of nursing may affect not only nursing recruitment, but also nurses’

attitudes towards work (Takase, 2013). The image of nursing is important. Public image

creates a frame-work by which others approach nursing as a profession, as well as each nurse

individually.

Kearns (2016) lists the impact of the public image of the profession as follows:

 Resource allocation: Funding for healthcare, whether at an organizational or

governmental level, is dependent on a common understanding of the needs of the

population and the professional group making the request. Unless the contribution of

the professional nurse is clearly articulated, funding for nursing could be jeopardized.

From the nursing unit budget for staffing, training, equipment, and supplies, to the

national budget for nursing research and scholarships, knowledge of what nurses do

and what they contribute is vitally linked to the allocation of limited resources.

 Influence on public policy: Nursing opinion is viewed by legislators as balanced and

objectives because nurses focus on the impact of potential legislation on the public,

with little opportunity for personal gain. For this reason, the opinion of the nurse is

valued by legislators seeking to understand healthcare issues. Nurses also influence

public policy through professional associations, appointments to boards,

commissions, task forces, and committees.

 Recruitment into the profession: A growing concern is the evolving nursing work-

force shortage, expected to peak in the next 10 years. In order to recruit the best and

brightest into nursing, it is essential that students, teachers, and counselors have a

more objective view of the role of a registered nurse. The traditional view, focused on
 the virtues of nurses as caring, compassionate workers, does not accurately portray the

academic rigor required to become a nurse. A stronger focus on the expertise required

to save lives through the application of hard science would go a long way to help

recruit students with the requisite cognitive and interpersonal skills necessary to

succeed in this career field.

 Interdisciplinary relationships: Although nurses’ autonomous role is incredibly

important and should not be understated, the reality is that much of the nurse’s work

is accomplished in an interdisciplinary environment. In order to fulfill the

requirements for coordination of care and advocacy for the needs of the patient,

professional respect is essential. Patient care is best served by nurses with strong,

assertive communication skills who are able to establish collegiality that is focused on

patients and patient care.

 Patient trust: The public image of nurses as trust professional provides an important

backdrop for these relationships; however, the factors at play in the moment add other

dimensions. Through consistency and skill, this relationship is crafted moment to

moment, from nurse to nurse, and remains fluid and dynamic during the entire

encounter. The patient’s previous encounters are brought to the current situation as

well, adding further complexity to the situation.

 The nurses’ self-image: 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.

RECOMMENDATIONS

We must grow as a profession if we are to change the negative image that has plagued the
profession. From student nurses down to nurse leaders, we can effect this change we want to

see by incorporating the following into our practice:

 Value nursing and project that image daily.

 Recognize the value of what we do.

 Believe in ourselves and our colleagues.

 Cultivate a professional image by the way we represent the profession wherever and

whenever.

 Define unacceptable workplace behaviours and hold the staff accountable.

 Define the appearance of the nursing staff in written guidelines and follow through

with consequences for those who don’t comply.

 Post, circulate, and advertise nursing’s accomplishments.

 Use the local community newspapers, or social media, for ongoing announcements to

increase the visibility of nurses.

 Contribute to the community by writing health-related articles in the newspaper, as

well as social media posts.

 Speak to groups in the community about what nursing is and what nurses do.

 Listen to patients’ and caregivers’ perceptions of nursing.

 Share recent findings as relates to nursing with fellow nurses and student nurses.

 Teach and mentor staff on how to validate all they do with appropriate

documentation.

 Teach, and learn, as applies, communication skills, so nurses feel empowered to

respond to negative colleagues in a manner that confronts and stops behaviours that

affect our image.

Choosing to work together, can help bring us closer to redefining our image as well as guide

the public to see the nursing profession clearly.

CONCLUSION

Nurses should work harder to communicate their professionalism to the public. Social media

can be used to show the public what we really do. Our image is evolving as nurses now take

up political roles. These opportunities allow us to represent the reality of nursing and to show

how the profession contributes to health care. Therefore nurses should make better use of

strategic positions, such as case manager, nurse educator or clinical nurse specialist and use

their professionalism to show the public what their work really entails.

Each nurse needs to explore how his or her actions or inactions affect our image. Nursing

schools need to work with the student nurse organizations to help promote the image of

nursing. Nursing leaders need to recognize the daily impact they have on the perceptions of

staff nurses, patients, and caregivers. And staff nurses must appreciate the importance of how

they are perceived by patients and caregivers.

When someone asks about your work, instead of the regular eye rolls or shoulder shrugs,

respond enthusiastically and positively. Encourage your child or children around you who are

interested in nursing. Inspire a child to consider the privilege of being with people when they

are at both their worst and best.

These little daily actions will help improve the image of nursing.
REFERENCES

A, J., & C, B. (2015). The Image of Nursing: What It Is. In J. &. Bartlett, The profession of

nursing (pp. 85-100). LLC.

Cohen, S. C. (2017). The image of Nursing. American Nurse Today, the official journal for American
Nurses Association.

Ella, R., E, S.-A. P., Mgbekem, M. A., & Edet, G. (2016). Factors Influencing Patients

Perception of Nurses . International Journal of Humanities Social Sciences and

Education (IJHSSE).

Errasti-Ibarrondo B, A.-S. M.-A. (2014, May - August). [The public image of nursing: a

profession to learn about]. Retrieved from NCBI:

https://www.ncbi.nlm.nih.gov/pubmed/22948428

Hoeve, T. Y., Jansen, G., Roodbol P. (2013). The nursing profession: public image, self‐

concept and professional identity. A discussion paper. WILEY online Library

Kearns, S. (2016, September). Why the public image of nursing is important. Retrieved from

HCPRO: http://blogs.hcpro.com/nursemanagers/2009/09/why-the-public-image-of-

nursing-is-important/

Muanya, A. a. (2018). Perspective of patients and patients relatives regarding nursing care at

LUTH. The Guardian Nigeria.

R, E. M., & E, P. M. (2015). Impact of the perceived public image of nursing on nurses’ work

behaviour. NURSING AND HEALTHCARE MANAGEMENT AND POLICY.

Takase, M. (2013). Influence of public image of nurses on nursing. Edith Cowan University.

Turner, T. (2016). The social identity theory. International Journal of Nursing.

Hoeve, T. Y., Jansen, G., Roodbol P. (2013). The nursing profession: public image, self‐

concept and professional identity. A discussion paper. WILEY online Library

Y, S. H., S, S. S., A, D. H., & W., A. L. (2013). The public's image of nursing as described to

baccalaureate prenursing students. Retrieved from Elsevier:

https://www.sciencedirect.com/science/article/pii/S8755722398800070