One of the most challenging issues nurses striving for since 20 years ago is nursing image in nursing profession. We define ourselves and are defined by others through images and similarly in any other profession like nursing. The way nurses how nurses perceive themselves as professional will affect the way others include family, friends, associate and public to look you. In the Concise Oxford English Dictionary image is defined as ‘the general impression that a person, organization or product presents to the public’ (Soames & Stevenson, 2004) or as ‘a mental picture representing a real object or a more or less accurate likeness of a thing or person’ (Thomas, 1993, p. 965) in Tabor’s Encyclopedic Medical Dictionary. Nurses have to try to get out from the stereotype of nursing image from the past like ministering angel, battle-axe/sex symbol, handmaiden of doctors, subordinate professional and finally autonomous professional that need critical thinking to make decision to ensure the to render the most effective and efficient care for patient.
The image of a nurse portrayed in the media will very much influence the public the way they view at nurses either positively or negatively. Nurses are invisible as mentioned by public as they are used to be silent and accept what others think about them until recently some coalition announced In this write up I am interested to explore nursing image and nursing profession in past year that impact current positive image of nursing in the country with strategies that promoting and sustaining nursing image.
2 Critical Discussion on the Current Image of Nursing in the country
In order to upgrade the nursing status in Malaysia to become more profession which account to better image of nursing, nurses are encouraged to pursue higher education to admit to degree program, Master’s and PhD courses either in full time or distance-learning program. This uptake brought Malaysian nurses to become more professionalization. Besides, Malaysia Nursing Board had endorsed a mandatory CPE program in 2008 with feedbacks from nurses to update knowledge, better patient outcome, improve communication skills, increase sense of self-esteem and competency to practice autonomously and improve decision making skills (Chong, 2011).
In the study of Natan, 2009 stated 68.5% (245 out of 358) of nursing students of Israel believed they must have undergo change with these Five characteristics of the present profession of nursing, that is, Angel of Mercy, Romantic, Careerist, Obedient and Bureaucratic. Same as other studies that student nurses expect the aspect of Careerist (Mackay & Elliott, 2002; Spouse, 2000) as the major characteristic of nursing profession which represent an intelligent, logical, progressive nurse committed to achieve increasingly higher standard of patient care (Kalisch and Kalish, 1987; Natan, 2009).
Due to the strong patriarchal society, nurses in Iran have a poor image of nursing that bring to low self-esteem, sense of frustration, hopelessness and confusion about self-image and social identity of nursing. So, male nursing student strived to get a university degree to work in hospital as supervisor, internal managers, in the office of nursing, or even on business side of medicine or medical equipment but not in patient care provision. And, there is always a need for male and female nurses vacancy as female nurses have their limitation to meet all the male patients’ needs and male nurses always occupy the senior position (Nasrabadi, Emami, & Yekta, 2003; Adib Hajbaghery, & Salsali, 2005; Zamanzadeh, Azadi, Keogh, Monadi, & Negarandeh, 2013).
After the Iran-Iraq War there is an increasing demanding in male nurses to provide emergency care in affected area and also in compliance with the laws of the Islamic Republic Iranian male patients’ preference to be cared by male nurses (Fooladi, 2003). Therefore, about 50% of the baccalaureate students admitted into the nursing program in the final years of war (1985-1988) but it dropped to 20% again after the war (Zarea, Negarandeh, Dehghan-Nayeri, & Rezaei-Adaryani, 2009; Nikbakht, & Emami, 2006).
Factors that associate with nursing image
If a nurse wears a fit uniform which public perceive as sexy, which may suggested more sexualized work attire actually lessens respect for female workers in responsible jobs like management, causing others to see them as less competent and intelligent.
In general the public reflected nursing as a female profession where they are subordinate, nurturing, domestic, humble, caring and self sacrificing as stereotyped since nightingale’s work and European religious sisterhood model of nursing education (Anthony, 2004). In United State, 6.2% of RNs were men before year 2000 and then increased to 9.6% (Department of Health and Human Service, 2010).
This is the most salient factor that affect nursing image. Due to the media perception about nursing is ‘caring’ but not knowledgeable, competent in patient care, therefore, public will see nurses in the same way as they get known to nursing through what media portrayed. Nurses nowadays are aware of the poor image of nursing as perceived by public had greatly devaluing the nursing profession. Inspiringly, The Center for Nursing Advocacy who helps to guard the influence of nursing image from media by announcing the best and worst portrayal of nurses in the media annually.
d) Poor communication
According to Gordon 2004, nurses who do have enough confidence, tools and skills to communicate with media will gain respect, public recognition and rewards for being considered as a profession.
3 Critical Discussions on the Significance of Portraying Positive Image in Nursing Profession
It is important to have portraying positive image in nursing profession as it reflect nurses’ high quality of patient care, recognition from nurses and others by making a difference in patient wellbeing and hence gain empowerment in decision making in better patient outcome (Ulmer, 2000). By improving and maintaining both public perception of nursing image and nurses self-image, it help to increase nurses’ recruitment and retention, better working environment to improve nurses’ morale and motivation to work, and enhance better job performance, job satisfaction, patients’ satisfaction and empower nurses to affect policy making (Fletcher, 2007; National Students’ Nurses Association 2009-2010).
Nurses must grab every single opportunity to positively reflect share your own experiences contributed to patient care in workplace as a role model and mentor to junior nurses formally via organization authority or informally as through your own awareness, mission and enthusiasm in bringing nursing profession to perfection. In 1989, Zukav stressed the way we see and picture ourselves will affect us subconsciously to seek and make the image either positively or negatively and hence gravitate towards others to reinforce it as your image.
Nursing had been regarded as a vocation where a nurse provides service to patient and as a divine calling which linked to early roots of nursing within religious order. But in professional field today, nursing is a profession that renders patient care to a complex healthcare system by using our critical thinking skills to make clinical decision together with patients through the specialty knowledge acquired. If only we strike to portray our profession and specialty in positive manner then we must be able to attract and recruit people to join nursing career and to retain in these nursing profession.
In addition, the positive nursing image we portraying will correct the devastating image shown in media to public, friends, family members and relatives by telling them what is actually nursing profession means and its contribution to patient care, what are nurses doing in their day to day practice in clinical or non-clinical area, what types of critical or technology skills we need in order to keep abreast of medical and technology innovation. To genuinely lobbying all these messages through media and discourses with high school students we will be able to recruit more intellectual people not only thinking but also inspired to count on nursing profession as their career.
Conversely, the negative nursing image like work incompetently, not interested to work extra effort, not valuing what nurses contributed to patients, gossiping and criticize about colleagues, will make others, public and media to devalue nursing image in nursing profession. As a leader in nursing, nurses should wrote to media to correct whatever the misconception of public regarding nursing image which may devaluing nursing qualities of patient care.
4 Suggestions on Strategies in Promoting and Sustaining Nursing Image
Nurses must always identify themselves as a nurse and talking about their nursing profession to public, friends, family and relatives to promote positive image of nursing. Media always interested in human-interest stories rather than nurses professional abilities. Nurses must explicitly explain to media our aspects of work in order to make the nurses profession be visible and to advance.
Nurses take themselves seriously and dress the part. With the uniform they wear to keep reminding them to act professionally and collaborate with other healthcare profession to enhance quality of care render to patients through team work among staff and shared clinical decision making with patients and family member.
Nurses must join at least one or more professional association. It can be Malaysia Nursing Association (MNA), National Kidney Foundation (NKF) and others. These association helped to organize seminar annually on continuing nursing education in different diversities among different facilities either locally or internationally to update our knowledge to keep abreast with other healthcare professional group to enhance the image of nursing in the media to make us visible and to represent our practice area to affect the policy maker on Evidenced-Based Practice (EBP) issues by sharing nursing experiences through networking with other nurses. For example, nurses from different facilities meet together to share successful experiences of reducing the rate of Catheter Related Blood Stream infection (CRBSI) among Haemodialysis patient by instilling Gentamicin block into Intrajugular catheter (IJC) and hence to reduce the rate of mortality due to septicemia while awaiting for the Arterio-venous fistula to be mature and ready for use.
In Nurses Week, nurses write to editor of health-related magazine to announce Nurses Day to make public aware of nurses’ contribution to public through clinical experiences to improve and enhance public perception of nursing image to regards nursing as profession. Dispense nurse-related book as free gift to non-nurses to inspire and inform public of nurses’ contribution in healthcare system. Therefore, we can promote our nursing image to them by making it visible and known to public in order to breakdown the stereotype negative images of public.
Get involved in a health campaign to give talk regarding contemporary healthcare issue, for example, educate about ‘dengue fever’ by using our professional knowledge regarding disease to educate the public ways of prevention and instruct them to seek treatment in clinic if needed to early detect and improve community health problem.
Promoting and sustaining positive nursing image is very crucial in nursing profession to keep nurses to be motivated to work and retain in the profession to be more professional and be a role model and mentor nurses everywhere you go to promote nursing image either in personal life or professional workplace. It is also very inspiring to correct public media’s misconception of nursing image by writing to them to keep inform and upgrade them regarding positive image in nursing to recruit more staff to join nursing and retain in nursing and to enhance job satisfaction, job performance. By actively involved in professional organization to talk to policy maker, write to media or newspaper to keep them well-informed of nurses’ achievement and to get recognition from public.
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