SandySummers

Good, I'm glad that you are working on the issues that drag down your ability to provide quality patient care. More nurses need to do this. But none of us operates in a vacuum. There is no one solution to the nursing shortage and no one person who fixes it. We all must work in our own corners of the world to improve the situation. We have had success in removing many negative stereotypical depictions of nurses and convinced others to improve their portrayals. Had those in positions of power at your institution been bombarded with the negative images that we have gotten removed, perhaps they would have further undervalued your work and not given you the ability to participate in decision-making. I think it's impossible to know exactly how the Center has affected you and how it hasn't. I'm not sure why it's so important to you to dismiss the value of our work. Sandy

There is not just one way to solve the nursing shortage. Everyone needs to do his part to work on the causes. When nursing is so undervalued in the public consciousness, nurses can't get the resources they need to do their work. For instance, it sounds like you need a secretary to do a lot of your paperwork. If your work was valued in line with its worth, maybe you would be able to convince hospital executives to give you one. But instead, you mock the people who are trying to improve your status in the world. Talk about a self-loathing nurse. Nurses themselves need to work on issues they see before them. I hope you are working on the paperwork issue that plagues you. Because if nurses aren't going to try to solve the problems we face, they likely won't get solved. And our patients ultimately suffer.

The mass media is in the business of affecting how and what people think. To believe that people are able to disregard everything they perceive in the entertainment media because the scenarios presented aren't literally "true," or because they are loosely staged simulations of reality (as in "reality" shows), we would also have to believe that people disregard all messages in advertising, since ads commonly present actors and models in simulated situations. But that is simply not how the human mind works. In order for an entertainment show or commercial to be effective, the audience must identify in some way with the characters and what they are doing, even if some aspects of the situation are "unrealistic." Most people understand that what they are seeing in fictional media products is not a depiction of "real events." In a recent TV ad, when the brilliant female "brain surgeon" and mother expertly demands a certain surgical tool in the OR, then practically commands the deferential "nurse" to buy a certain brand of minivan, we know we are not seeing real health care professionals in a real OR. (see the Caravan ad in Quicktime) The scene, which also included a dopey male "patient" and a goofy male anesthesia professional, didn't show a real surgery. But that does not stop viewers from internalizing messages and signals at conscious and subconscious levels. Despite being "fiction," media products like this can still influence: our views of the vehicle in question (as the advertiser fervently hopes); the ability of women today to become authoritative, powerful professionals, yet to still have a family (presumably this ad was directed mainly at women who would identify with the surgeon); the basic set-up of OR's, the kinds of professionals who participate, how they dress, and what tools they use; and of course, the relative power, knowledge and professional roles of physicians and nurses. Some of this may be unintended, but all of it sells the minivan to the target demographic. All of the elements above contribute to the high credibility of the "surgeon," who is, after all, doing the selling. more...

The global media's relentless linking of sexual images to the profession of nursing reinforces long-standing stereotypes. Even though those images are often "jokes" or "fantasies," the stereotypes they promote discourage practicing and potential nurses, foster sexual abuse in the workplace, and contribute to a general atmosphere of disrespect. Even humor and fantasy images affect how people act. That's why advertisers spend billions on them. Desexualizing the nursing image is a key part of building the strength the profession needs to overcome the current shortage, which is taking lives worldwide, and to meet the challenges of modern health care. Most people probably don't think the average nurse goes to work in lingerie, looking for sex. But the fusing of lingerie with nurses' work uniforms in popular media images, and the exposure of sexy "nurses'" bodies in these images, still associates the profession with sex in the public mind. One recent U.K. study found nursing was the most sexually fantasized-about job. And suggesting that nurses are primarily sex objects in turn conveys the idea that nursing work consists of satisfying the sexual needs of patients and/or physicians, or at best, that nursing is so unimportant that nurses have the time and energy to focus on sex while supposedly caring for patients. Some people may just regard nurses as being more sexually available than average. We're not kidding. Other people may simply see nurses as looking to meet a physician--even an already married one--to take them away from the dead end job of nursing, a stereotype that was actually expressed in late 2004 by Dr. Phil McGraw on his popular television show. When a profession is associated with sex, there is no bright line between "sex" and "romance." This association may be subtly reinforced even in relatively sophisticated products like "ER," which would be unlikely to present a blatant "naughty nurse" image, but in which the lone major nurse character often spends most of her time managing romances with physicians. Thus, even members of the public who don't think nurses actually have sex at work may be influenced to believe that looking for romance is a big part, if not the biggest part, of why they are at work. That is not a feature that is generally associated with serious professionals. Naughty nurse and other stereotypical images add to the chronic underfunding of nursing research, education and clinical practice. This is because health care decision makers--many of whom are sadly uninformed about what nursing really is--are less likely to devote scarce resources to a profession that has become so degraded in the public consciousness. Such images discourage talented men and women from entering and remaining in the profession. When you combine this lack of respect, the intense college-level training nursing actually requires, and the difficulty and stress of nursing practice, it is no surprise that the profession remains in the midst of a global shortage driven by rampant short-staffing. Many who display stereotypical images of nurses doubt that such images can really harm the nursing profession. However, as public health professionals at the University of Southern California's Hollywood Health and Society project and elsewhere can attest, popular media items clearly do affect how people think and act with regard to health issues. For instance, a 2000 JWT Communications study found that US youngsters in primary and secondary school got their most striking impression of nursing from the fictional television show "ER," and consistent with that show's physician-centric messages, the youngsters found nursing to be a technical field "like shop," a job reserved for "girls" and one too lowly for private school students. Nursing is none of these things. In addition, a Kaiser Family Foundation study found that "ER"'s message is so influential that one-third of the show's viewers use information from the show to make health care decisions. So what's wrong with being perceived as sexy? Nothing--as long as that's not your dominant image in the workplace. Recent research suggests that 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. Of course, the naughty nurse image seems to have little to do with a belief that real nurses are sexy, and perhaps more to do with a desire to have anonymous sex with hotties dressed in lingerie-like "nurse" uniforms. It may be diverting for some to think that nursing is populated by disposable bimbos, which may also help them handle the idea that female nurses have some power over them in clinical settings. But the disposable bimbo image does not appeal to most career seekers. Nursing remains over 90% female. Of course this sexualized female image is not the only reason, but it is part of an overwhelming social understanding of nursing as "submissive" and "female." This is the difference between sexual images of female nurses and, say, female FBI agents. The FBI is not in crisis because it does intensely demanding mental and physical work that few people really respect, in large part because of the idea that its agents are brainless handmaidens and bimbos. Nursing is. Of course, it may be hard to see how one apparently minor "naughty nurse" depiction can affect the real world. But each such image is part of a wave of images from the global entertainment, advertising, hospitality, and apparel industries, from Fortune 500 companies to isolated sandwich shops, suggesting nursing is about hot females bestowing sexual favors. In the aggregate, it's just common sense that decades of this kind of broad societal disrespect will have an impact, and will be a factor in people avoiding and leaving that profession. Of course, it's not the only factor; the handmaiden stereotype is probably more damaging because it's more credible and widespread, and nursing would be a difficult, stressful job even if it was well understood. Some argue that nursing's poor public image has nothing to do with the nursing crisis, because it's really all about poor working conditions and inadequate faculty resources. But that's like arguing that cancer death has nothing to do with cigarettes, because it's really all about cancer. Many things cause cancer, but cigarettes are one of them. For nursing, the lack of resources was not handed down from some divine place. It was the result of human decisions. Those decisions were made on the basis of what the decision-makers (government, hospital executives, the public) thought about how important nursing was relative to other things they might do with the resources available. It's also common to see suggestions that objections to the constant association of nursing with sex indicate prudishness or a lack of humor. But the Center has never objected to sexual images generally--only to the use of nursing as a marker for dim, submissive, sexually available females. So this is not about whether sexual images degrade all women, but about their frequent application to a specific professional group. And the suggestion is not just that nurses are silly ***** (ha ha! just joking!), but that their job is about that. Research shows that nurses suffer an inordinate amount of sexual and other abuse at work (see AP and Monster articles). Although it's difficult to prove the extent to which that is caused by naughty nurse stereotyping, that doesn't require that we ignore what would be the obvious results--if a profession is an object of sexual mockery and contempt, it's going to encourage sexual abuse, and the profession is unlikely to receive the human or material resources it needs. If a profession is constantly associated with female sexuality, it's not going to attract and retain many men. We assume few skeptics would require extensive evidence of ill effects if the media stopped "jokingly" suggesting that nurses were giggling bimbos, and started in on the female family members of the skeptics themselves. Even if the media barrage was "silly" (ha ha! just joking!), would the women in that family be taken as seriously in doing high-stress, life-and-death jobs with extensive public contact? Would they get all the resources they needed? Wouldn't they get more than their share of sexual abuse? Wouldn't they sometimes wish they weren't part of the family? Sure, those close to them might know there was no truth to the media image. But it's not like most in society would know them to be serious professionals. Most would just know what they heard in the media--that the women in that family were kind of a bad sex joke. The Center takes no position on the prevalence of sexual imagery in modern society. But we do object to the close association of that imagery with a traditionally female profession that must now fight through a critical shortage to keep millions of patients alive and on the road to recovery. In many cases, stereotypes do not simply go away of their own accord--they must be confronted and rejected. And the "naughty nurse" has proven its staying power for decades. Of course, we realize that sexual fantasies do not go away simply because images become less prevalent, and that deep-seated sexual desires are presumably not subject to anyone's control. Some aspects of current human sexuality may be practically unchangeable, perhaps because they have a strong evolutionary basis, or for some other reason. But we doubt that something as culturally and temporally specific as the "naughty nurse" image of recent decades is biologically predetermined or immutable, at least on a society-wide basis. It seems to us that the image is largely the result of specific cultural information, though it may incorporate some broader elements, such as the eroticism of apparent innocence. What is seen as "sexy" may vary in different contemporary communities, and we're not sure all of them have a special thing for the naughty nurse. And some aspects of human attraction may evolve over time, perhaps in response to changes in the perceived needs of the species. For instance, common standards of human beauty do not appear to be the same today as in past centuries. We think it would be in humanity's long-term interest to start considering new ways to think about nurses. One could also argue that the work of nurses is so intimate that it will always be subject to some level of sexual fantasy. But the jobs of others that are now subject to this kind of stereotyping (such as flight attendants) do not involve intimate contact. Instead, the common theme seems to be that they are traditionally female jobs that are seen--we said seen--to involve simple personal service. On the other hand, traditionally male professions that may involve intimate contact and/or personal service do not seem to suffer in the same way. People may imagine physicians sexually, but they are not generally presented with revealing images of physicians as silly and available. On the contrary, physicians are often seen as perhaps the ultimate marital prize, and it is hard to imagine the profession suffering from this kind of image in terms of recruiting, retention, or resources. At ground level, the devaluation of nursing translates into an underpowered profession that may not be strong enough to save your life when you need it to do so. The "naughty nurse" isn't going to catch deadly medication errors, intervene when a patient is about to crash, or teach a patient to survive with a life-threatening condition. It's time for her to change into something a little more comfortable. best regards, Sandy

That would take some serious cash. Cash and nursing aren't exactly synonymous. We're going to float the idea to a couple foundations. But don't hold your breath.

First of all, the article wrongly quoted me as saying "Move these sexual fantasies to other professions". I did not, and would not say that and I have written to the journalist to ask her to fix it. But there's only so much I can do to make that happen. What I did say to her was: "There are an unlimited number of sexual fantasies you can have, and we urge people to fantasize about someone else."

Of course, all nurses deserve more public credit for our work than we currently get, which is why we are working to improve public understanding of nursing through improving the accuracy of nursing's media portrayals. If our leaders get credit through Nobel Prizes, then that will bring more credit to the entire profession. Sandy

Timothy, the lamp is a strong symbol of 24/7 care. I worked for 3 years in Cambodia, and the hospitals there are essentially staffed from 8am-11am and then patients are pretty much on their own during the other hours. Round the clock surveillance saves countless lives. We should be proud of the standards of care Nightingale worked to establish. There's such a thing as clinical research, which our practice should be based upon. Reading nursing journals and doing literature research is a good way to stay current and making sure you're giving your patients the best care. Timothy, do you think nursing leaders don't have clinical practices? Does leadership and clinical practice not overlap? I think that you are wrongly equating petty bureaucrat managers with serious nursing leaders. If you don't know the difference, then you're not reading enough nursing literature.

Timothy, How sad it is that you can't appreciate nursing's leaders. Our nursing researchers and innovators make it possible for bedside nurses to change and improve our care so our patients will have better outcomes. For instance, if we had no nurse leaders we would not have any sexual assault nurse forensic examiners. Don't you think that they have improved patient care? Without anyone to push the creation of these SAFE nurses, rape patients would still be getting the barbaric care they used to receive. Did you see the leaders that we chose as potential people to consider for the Nobel prize? We're not allowed to reprint the article until 30 days have passed, but please click here and read the whole thing. http://tinyurl.com/yzy4lb Remember that the ultimate example of the "Ivory Tower Hack" is Florence Nightingale.

This is hilarious. Thank you EmerNurse.

Infirmières Sans Frontières December 3, 2006 -- Recently, the Nobel Prize-winning Médecins Sans Frontières / Doctors Without Borders (MSF) launched a U.S. tour of an exhibit highlighting the global aid group's vital work in conflict zones. "A Refugee Camp in the Heart of the City" features MSF aid workers guiding visitors through a model of actual relief facilities. The exhibit explains the challenges MSF faces in providing care, nutrition, and decent living conditions. This is a perfect time to thank the group for its admirable work--and to note that its continuing use of the name "Doctors Without Borders" sends an inaccurate message about who is doing that work. We understand nurses are the most numerous health professionals among MSF workers, and they play a central role in the group's efforts. Yet when journalist Suzanne Gordon suggested to a physician MSF leader that the group consider adopting a name that did not slight its nurses, the leader said that she hoped MSF would never be so "stupid" as to do so. The Center for Nursing Advocacy has tried to discuss the matter with MSF for two months, but we have gotten no real response. The group's name seems to reflect the undervaluation of nursing that is undermining health worldwide, particularly in the developing nations MSF tries to help. We doubt that MSF would suffer by phasing in a similar name, like "Soins Sans Frontières" ("Health Care Without Borders"). We urge MSF to give its own nurses the credit they deserve--and that nurses everywhere need to help their patients. Read more http://www.nursingadvocacy.org/news/2006/dec/msf.html or go straight to our letter-writing campaign! http://www.nursingadvocacy.org/action/letters/2006/msf/m_form.html

The Nobel Prize in Nursing December 8, 2006 -- Today The Baltimore Sun published "Nurses' achievements merit international recognition," an op-ed by Columbia University nursing professor Kristine Gebbie and Center for Nursing Advocacy executive director Sandy Summers. The op-ed argues that nurses deserve a Nobel Prize or comparable annual award because their leaders have long been at the forefront of health research and clinical practice. They have changed the world by reinventing health systems, pioneering new therapies, and improving community health, from AIDS treatment to neonatal care to pain management. Establishing such a prize would shine a light on the profession's life-saving achievements. It would also help show how important it is that nursing get the clinical and educational resources it needs to overcome the global nursing shortage. The publication of this piece is the culmination of significant effort by the Center. We thank The Baltimore Sun for its openness to new ideas on nursing, and its commitment to publishing the op-ed. And we urge you to read it, think about it, and show it to others. Thank you! See the op-ed... http://tinyurl.com/yzy4lb

The reason the "most trusted" poll results don't do too much for me is that this public view often goes hand in hand with the prevailing vision of nurses as devoted, angelic handmaidens. Of course, it's possible that a particular member of the public might fully understand how highly skilled nurses are and still "trust" them greatly. But given that public understanding of the nursing profession appears to remain very poor, we fear that the poll results are essentially an expression of a vague, sentimental affection for nurses flowing from the above stereotypes. They trust us to hold their wallets while they're in surgery. But not to save their lives. I can't help noticing that some of the professions near the bottom of the "trusted" list-- such as lawyers, journalists, and ad writers--do not seem to be suffering from any crisis in terms of supply of willing workers, working conditions, job benefits or social status. I wonder how many of the people who "trust" nurses so much would react if their son, or bright, ambitious daughter, announced that he or she wanted to be a nurse. Polling can measure many things, and much depends on the wording of questions and the context in which they are asked. In this case, we believe it would be a mistake to imagine that the word '"trust" implied genuine respect for professional skill. In this sense, putting too much stock in these poll results may actually be a dangerous illusion.

That's the way to support your profession! Sure, one result of our campaign may have been that the grill owner has had an increase in business. But our intended goal of getting people to think and talk about negative nursing images has been achieved. We cannot change the way people think and behave unless we first tell them this negativity is damaging and we ask them to stop. And just because the grill owner hasn't stopped yet, that doesn't mean the campaign has had zero effect. We have managed to educate millions of people about these damaging images, and hopefully the ones in the middle will just stop a minute and think.

http://www.nursingadvocacy.org/faq/most_trusted.html Q: Why aren't you more excited that public opinion polls often put nurses at the top of the list of "most trusted" and "most ethical" professions? A: Of course, there's nothing inherently bad about being trusted! A desire to care for others (as opposed to money, power or status) has traditionally been a major factor in why people choose to become nurses. And the public has tended to recognize that such care givers generally have their patients' best interests at heart. The reason the "most trusted" poll results don't do too much for us is that this public view often goes hand in hand with the prevailing vision of nurses as devoted, angelic handmaidens. Of course, it's possible that a particular member of the public might fully understand how highly skilled nurses are and still "trust" them greatly. But given that public understanding of the nursing profession appears to remain very poor, we fear that the poll results are essentially an expression of a vague, sentimental affection for nurses flowing from the above stereotypes. As one experienced nurse lamented: "They trust us to hold their wallets while they're in surgery. But not to save their lives." We can't help noticing that some of the professions near the bottom of the "trusted" list-- such as lawyers, journalists, and ad writers--do not seem to be suffering from any crisis in terms of supply of willing workers, working conditions, job benefits or social status. We wonder how many of the people who "trust" nurses so much would react if their son, or bright, ambitious daughter, announced that he or she wanted to be a nurse. Polling can measure many things, and much depends on the wording of questions and the context in which they are asked. In this case, we believe it would be a mistake to imagine that the word '"trust" implied genuine respect for professional skill. In this sense, putting too much stock in these poll results may actually be a dangerous illusion. http://www.nursingadvocacy.org/faq/dramatic.html Q: Nurses are just wonderful, but you really can't expect Hollywood to focus on them, can you? After all, popular media products have to be dramatic and exciting. Why don't you just focus on getting a nursing documentary on PBS or basic cable? A: Because the work of nurses is at least as dramatic as that of physicians, and getting the wider public to understand that would be of great value in resolving the nursing shortage that is one of the world's most pressing public health problems. More than a few Hollywood insiders have expressed to us some version of the sentiments in the above FAQ. But contrary to the current popular and mass media image, nurses are expert professionals who save lives autonomously--that is, in pursuit of their unique nursing scope of practice, not physician commands. They confront some of the most exciting human, policy and technological challenges in modern health care. These range from the extreme high-tech of teaching hospital ICU's, to chaotic urban level one trauma centers, to major health policymaking and research centers, to small community health projects where lives are changed, to war zones and development and humanitarian relief projects around the world. Perhaps the most telling evidence of the drama of nursing is that the major hospital shows on U.S. television today--"ER," "House" and "Grey's Anatomy"--actually do spend a great deal of time showing work that in real life is done by nurses, including fighting for better care systems, catching and preventing deadly errors, educating patients and giving them skilled emotional support, monitoring patient conditions, and performing exciting procedures like defibrillation. It's just that they inaccurately show physician characters doing it. What do nurses do? Nurses, with their years of college-level training, are on the front lines of the health care delivery team. They assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals. Nurses thus coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action. Nurse are patient advocates, protecting the interests of patients when the patients themselves cannot. Nurses are educators, explaining procedures and treatments to patients, teaching them how to care for themselves and work toward full recovery. Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home. Nurses work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education--addressing some of the leading health problems of our time. Some nurses are independent scholars whose work is at the forefront of health care research. Many nurses obtain Master's and Ph.D. degrees in nursing, then work as scholars, educators, health policy makers, managers, or advanced practitioners such as Clinical Nurse Specialists or Nurse Practitioners. Yeah, yeah, but what specifically do nurses do that a mass audience would care about? (links below are to specific examples) Nurses catch and prevent the medication error that would have killed you. http://www.nursingadvocacy.org/news/2004jul/07_boston_globe.html Nurses catch and stop the infection that would have killed you. http://www.nursingadvocacy.org/news/2003oct_rd.html Nurses diagnose an ICU patient's wide complex tachycardia, call a code, and defibrillate--saving the patient's life. http://www.nursingadvocacy.org/news/2005may/24_house.html Nurses triage ED patients based on their own expert evaluation of how sick the patients are--saving patients' lives. http://www.nursingadvocacy.org/news/2003oct09_er.html Nurses give powerful medications and vaccinations--saving patients' lives. Nurses are the care givers most likely to be there when patients are screaming, crying, laughing, or dying. Nurses manage that violent, intoxicated patient alone until security gets there--if security gets there. Nurses are the hospital caregivers most likely to be assaulted. http://www.nursingadvocacy.org/news/2004nov/27_bbc.html Nurses persuade that psychiatric patient to stick with the program. Nurses persuade a poor young mother to save her baby's life through prenatal visits and breastfeeding. http://www.nursezone.com/student_nurse_center/default.asp?articleID=10234 Nurses provide adequate pain medication for terminal patients and the opportunity to die at home. http://www.nursingadvocacy.org/news/2004mar/28_press_democrat.html Nurses provide expert support in your final hour. Nurses teach you how to avoid getting AIDS, and how to live with it if you do. http://www.nursingadvocacy.org/news/2004mar/21_parade.html Nurses subtly show the sickest patients that it's worth trying, perhaps by discussing Harry Potter with the young leukemia patient, or watching a few minutes of the news with that despondent, elderly post-op patient. http://www.nursingadvocacy.org/news/2004nov/rd.html Nursing students spend years in demanding science programs that test their sanity and cause some to quit or fail. http://www.nursingadvocacy.org/news/2005jun/12_nytimes.html Nursing scholars struggle to get grants, publish groundbreaking research and get tenure. http://www.nursingadvocacy.org/press/nursing_research.html Nurses serve as the chief executive officers of large hospitals. http://www.nursingadvocacy.org/news/2004jan/25_birmingham.html Nurses spearhead efforts to help your teenage son not start smoking. Nurses deliver babies in U.S. teaching hospitals and mountain villages in Bolivia. http://www.jhu.edu/%7Ejhumag/0605web/ruminate.html Nurses provide much, if not most, of the health care given by aid groups with names like Doctors Without Borders. Nurses explain what that physician was trying to communicate--saving countless lives. Nurses, as commissioned officers, manage complex military care operations around the world. Nurses found and run new health systems for underserved urban and rural communities--saving countless lives. http://www.nursingadvocacy.org/press/breckinridge.html Nurses confront disruptive physician behavior, life-threatening nurse short-staffing, and bitter class divisions and horizontal violence within their own profession. Nurses go on strike. http://www.nursingadvocacy.org/news/2003nov17_philly_daily.html Burned-out nurses explode and quit. http://www.nursingadvocacy.org/faq/short-staffed.html Nurses train and mentor nursing students and new nurses. Nurses kick intoxicated surgeons out of the OR and fight to have surgeons who are dangerous removed permanently. http://www.nursingadvocacy.org/news/2005jan/18_nyt.html#scrub Nurses refuse to give drugs that will hurt that fetus, or any other patient. Nurses risk their careers to blow the whistle on deadly incompetence. http://www.nursingadvocacy.org/news/2005jun/22_dr_death.html Nurses make mistakes and kill people, especially when they are understaffed. http://www.nursingadvocacy.org/news/2004jun/20_nyt.html Nurses regularly have intense interactions with physicians about patient care. For instance, nurses may identify symptoms physicians have overlooked, and they may struggle to convince physicians that those symptoms exist. Is that dramatic enough? We know it is, because we've seen physician characters doing much of the above for years. And the nursing tasks that physician characters are not shown doing would often make for equally compelling drama, if media creators knew that they occurred. Unfortunately, the incorrect traditional assumptions about nursing have led to the matrix of physician-centric programming that has dominated popular media for decades, forming a persuasive but dangerous simulation of reality. Today, virtually every major character in the top three hospital shows named above is a physician--24 out of 25, to be exact, with the sole nurse being "ER"'s Sam Taggart. The combined viewership of new episodes of these three shows at the end of the 2004-2005 season was well over 50 million in the U.S. alone. Clearly, the idea that nursing is not dramatic must be overcome if we are to transcend the matrix, and help nursing gain the power it needs to meet the health challenges that lie ahead.

Hi Kriso, Thanks for your comments. Of course I would have liked to talk for hours on the issue, but getting the media to do that is the trick... And getting them to cover nursing is an even bigger trick. There is this perception that nursing doesn't matter. So if doesn't matter, it doesn't merit media coverage, and it's a vicious cycle. Sandy

Q: Come on. Even if the mass media does ignore nursing, or present it inaccurately, how can that possibly affect nursing in real life? A: It can because what people see affects what they think, and what they think affects what they do. This isn't just an observation of how humans act. It is a basic principle of education, art, advertising, or any other organized effort to influence people. Advertising, for instance, can affect behavior when people receive persuasive, one-sided flows of information on subjects where they may not have a great deal of prior experience or knowledge. Research suggests that youngsters are especially susceptible to media influence of this kind, but no one is immune. This is why major corporations spend millions on slick advertising campaigns to promote their products, and why powerful political ads can move polling numbers and affect election results. There is no reason to think this basic principle would not apply to health issues. Indeed, in recent years a consensus has emerged in the field of public health, based on considerable research, that what people see in the media has a significant effect on their health-related views and behavior. A wide range of public agencies, private groups and scholars now devote substantial resources to analyzing and managing health messages in the media. This is part of the public health field called "health communications." Health communications is a "hybrid" with roots in communications, health care and other fields. (Deborah C. Glik, ScD., 2003. "Health Communication in Popular Media Formats," American Public Health Association Annual Meeting presentation, p. 1) "Communications about health in the popular media comprise both planned and unplanned content which has the potential to communicate positive, neutral or negative health messages to the public." (Id., emphasis added) The inclusion of "unplanned" content is significant. People are influenced by media content whether or not the creators specifically intended that they take away the message received, just as a parent may influence a child to act a certain way without intending to do so. A media product need not have the intent to harm nursing to have that effect. What the media tells people about health care works much like advertising. As one public health scholar has noted, "[f]rom a social marketing perspective, messages in the media that promote specific desirable behaviors have the potential to persuade consumers to change their behavior if messages are viewed as compatible with consumers' own self-interest, competing messages are minimal, and resistance to change is low to moderate." (Id., emphasis added) And just as people influenced by commercial or political ads will also be affected by substantive health messages, people influenced by health messages will also be affected by how the media portrays the roles and conduct of health professionals. It makes little sense to think that people would learn something about cancer or AIDS from a media product, but that they would form no opinions about the health professional who is presenting the information in that product. "Researchers have long recognized that news media coverage affects what the general public believes about health care." (Turow and Gans, "As Seen on TV: Health Policy Issues in TV's Medical Dramas," Report to the Kaiser Family Foundation, 2002, p. 1 (citing five studies dating from 1997-2002, citations omitted)) Because treatment of health topics in the news media has a significant effect on public views and actions, advocates have worked hard to affect the frequency and accuracy of the media's coverage of health topics in which they have an interest. (Glik, pp. 1-2) For example, groups promoting the professional interests of physicians have worked aggressively for decades to manage the public image of physicians and the field of medicine. The American Medical Association has devoted considerable resources to promoting coverage of medical research and other physician-centered stories in the mass media. (Buresh and Gordon, From Silence to Voice, 2001; Chocano, 2002, "Same old mish-"M*A*S*H"! Stat!". Salon; Gordon and Buresh, "Doc Hollywood", The American Prospect, 2001) These efforts have been a resounding success. (Buresh and Gordon, From Silence to Voice) Physicians, indisputably a critical part of the health care team, are now portrayed and regarded by the news media as more or less the whole team: the directors and providers of all meaningful health care. (Buresh and Gordon, From Silence to Voice; "Woodhull study on nursing and the media: Health care's invisible partner," Sigma Theta Tau International, 1997; Buresh, Gordon and Bell, "Who Counts in News Coverage of Health Care?" Nursing Outlook, 1991) Physicians are consulted on issues, such as nutrition and breastfeeding, in which other professionals generally have at least as much if not greater expertise. Physicians' combination of economic and political power with social and perceived moral status is unrivalled by any other professional group. Many other professional, corporate and advocacy groups have also tried to influence media treatment of health issues relevant to their interests. One scholar has pointed to "the pervasive influence of certain organized or corporate interests who may use behind-the-scenes methods to unduly influence news reporting. An example reported is tactics used by the tobacco industry since the 1970's to minimize negative reports in the news media and maximize positive ones." (Glik p. 2) Why have groups made such efforts? Because "the power of the mass media to reach and influence large numbers of persons is indisputable." (Id.) Of course, by the same token, "news media credibility is often criticized." (Id.). Thus, it is critical that anyone interested in health care, including nursing, understand how the media influences our lives. "Given the pervasiveness and potential power of the media to shape beliefs, attitudes and behaviors, the media literacy movement has emerged." (Id., p. 3) Though "media literacy" seems to be aimed primarily at helping children and teens "better deconstruct (analyze and assess) the ubiquitous media constructions" that are a key part of modern life, developing this skill is no less important for adults, especially those whose interests may not be served by prevailing media practice. Most media content, including advertising, is directed at adults. And achieving media literacy is not something that just happens on our 18th birthdays; it is not easy or automatic. It involves a process of "learning to analyze and question what is on the screen, how it is constructed, and what may have been left out." (Glik, p. 4 quoting Thoman, "Beyond Blame: Challenging Violence in the Media," Center for Media Literacy, 1995). The bottom line is that "while there is a tremendous potential for the popular media to include positive health messages, it is a double-edge sword...From a public health perspective, one needs to view the popular media in its entirety, as both a tool for progress and a source of ill health that is a reflection of the larger culture it represents. Thus, both media advocacy and media literacy become important strategies to influence the media to improve public health and, concurrently, to mitigate its unintended effects on the most vulnerable members of society--children and teens." (Glik p. 4). If the mass media is critical to modern health strategies, then it must also be a key means of addressing one of the most important global health problems: the crisis in nursing. The same impressionable "children and teens" whose health may be directly affected by media messages receive equally powerful messages about nursing. The result? Most students do not understand or respect nursing, and do not consider it as a career. In a study of primary and secondary school students, most respondents wrongly described nursing as a girl's job, a technical job "like shop," and an inappropriate career for private school students. (JWT Communications, Memo to Nurses for a Healthier Tomorrow on focus group studies of 1,800 school children in 10 U.S. cities, 2000) Of course, the effects of the media's undervaluing of nursing do not stop there. When adults without significant understanding of nursing--that is, the vast majority of adults who are not nurses or very close to nurses--receive a lifetime of inaccurate, stereotypical messages about the profession, they too do not consider nursing as careers later in life. (And many nurses complain that it is difficult to garner respect even from their close family members.) Likewise, public officials and health care decision-makers with little understanding of nursing's real importance do not allocate sufficient funds to nurse staffing, nursing education, or nursing research. For instance, when hospital administrators undervalue the work of nurses, they understaff nurses, which increases patient mortality and worsens the nursing shortage. Likewise, when Congress and the Executive Branch fail to understand what nurses do to save and improve lives, they grossly underfund nursing education and research, as evidenced by the fact that only $1 out of every $200 in the NIH budget is allotted to nursing research. (National Institutes of Health, Summary of the FY2005 President's Budget) (pdf). You might think physicians would have a better sense of nursing, and some do. However, much physician conduct seems to reflect a hierarchical, narrow and self-absorbed subculture that equates medicine with health care and is not known for questioning society's traditional assumptions. Representatives of this subculture typically see what they expect to see in nursing: not much. (We've heard physicians telling nurses that nurses receive "too much education" and that they could "train monkeys http://www.nursingadvocacy.org/cgi-bin/yabb/YaBB.cgi?board=news;action=display;num=1063637920;start=23#23 to do their jobs.") And nurses themselves are hardly immune to the effects of the media's ill treatment, which can sap their morale and professional pride, encourage cynicism and self-loathing, and discourage them from standing up for themselves and their patients. Few today doubt that pervasive media practices affect the self-image and conduct of other groups, such as women. On the whole, the nursing crisis can be seen as the result of an entire society failing to value nursing adequately. The media is a key factor in that failure. http://www.nursingadvocacy.org/faq/media_affects_nursing.html Also see the following related FAQ's: OK, fine. I can see that some media probably affects how people think about and act toward nursing, like maybe a respected newspaper or current affairs show on TV. But how can some TV drama, sitcom or commercial affect people that way? People know enough not to take that stuff seriously! http://www.nursingadvocacy.org/faq/media_affects_thinking.html I get that the public health community and even Hollywood itself believes that the entertainment media has a big effect on real world health. But is there any actual research showing it affects what people think and do about health issues like nursing? http://www.nursingadvocacy.org/faq/hollywood_research.html Well, if all that research shows how influential Hollywood is on health care--and Hollywood itself claims credit for improving the world through "medical accuracy"--why won't it admit that its portrayal of nursing is equally influential, and take steps to fix it? Especially since the nursing shortage is now a global public health crisis. http://www.nursingadvocacy.org/faq/hollywood_behavior.html

Q: What's the big deal about "naughty nurse" images in the media? I mean, no one believes nurses really dress like that! A: The global media's relentless linking of sexual images to the profession of nursing reinforces long-standing stereotypes. Even though those images are often "jokes" or "fantasies," the stereotypes they promote discourage practicing and potential nurses, foster sexual violence in the workplace, and contribute to a general atmosphere of disrespect. Even humor and fantasy images affect how people act. That's why advertisers spend billions on them. Desexualizing the nursing image is a key part of building the strength the profession needs to overcome the current shortage, which threatens lives worldwide, and to meet the challenges of modern health care. Most people today probably don't think the average nurse goes to work in lingerie, looking for sex. But the fusing of lingerie with nurses' work uniforms in popular media images, and the exposure of sexy "nurses'" bodies in these images, still associates the profession with sex in the public mind. One recent U.K. study found nursing was the most sexually-fantasized-about job. And suggesting that nurses are primarily sex objects in turn conveys the idea that nursing work consists of satisfying the sexual needs of patients and/or physicians, or at best, that nursing is so unimportant that nurses have the time and energy to focus on sex while supposedly caring for patients. Some people may just regard nurses as being more sexually available than average. We're not kidding: Please read a first person account by a patient who discusses how he overcame some of these ideas and developed a deep appreciation for the nursing profession. http://www.nursingadvocacy.org/faq/what_does_a_nurse_do.html Other people may simply see nurses as looking to meet a physician--even an already married one--to take them away from the dead end job of nursing, a stereotype that was actually expressed http://www.nursingadvocacy.org/news/2004nov/18_dr_phil.html in late 2004 by Dr. Phil McGraw on his popular television show. When a profession is associated with sex, there is no bright line between "sex" and "romance." This association may be subtly reinforced even in relatively sophisticated products like "ER," which would be unlikely to present a blatant "naughty nurse" image, but in which the lone major nurse character often spends most of her time managing romances with physicians. Thus, even members of the public who don't think nurses actually have sex at work may be influenced to believe that looking for romance is a big part, if not the biggest part, of why they are at work. That is not a feature that is generally associated with serious professionals. Naughty nurse and other stereotypical images add to the chronic underfunding of nursing research, education and clinical practice. This is because health care decision makers--many of whom are sadly uninformed about what nursing really is--are less likely to devote scarce resources to a profession that has become so degraded in the public consciousness. Such images also discourage men and self-respecting, talented women from entering and remaining in the profession. When you combine this lack of respect, the intense college-level training nursing actually requires, and the difficulty and stress of nursing practice, it is no surprise that the profession remains in the midst of a global shortage driven by rampant short-staffing. Many who display stereotypical images of nurses doubt that such images can really harm the nursing profession. However, as public health professionals at the University of Southern California's Hollywood, Health and Society project and elsewhere can attest, popular media items clearly do affect how people think and act with regard to health issues. For instance, a 2000 JWT Communications study found that US youngsters in primary and secondary school got their most striking impression of nursing from the fictional television show "ER," and consistent with that show's physician-centric messages, the youngsters found nursing to be a technical field "like shop," a job reserved for "girls" and one too lowly for private school students. Nursing is none of these things. In addition, a Kaiser Family Foundation study found that "ER"'s message is so influential that one-third of the show's viewers use information from the show to make health care decisions. Please see the research here. http://www.nursingadvocacy.org/faq/hollywood_research.html So what's wrong with being perceived as sexy? Nothing--as long as that's not your dominant image in the workplace. Recent research http://money.cnn.com/2006/11/07/news/economy/dress.fortune/index.htm?postversion=2006110814?cnn=yes suggests that 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. Of course, the naughty nurse image seems to have little to do with a belief that real nurses are sexy, and perhaps more to do with a desire to have anonymous sex with hotties dressed in lingerie-like "nurse" uniforms. It may be diverting for some to think that nursing is populated by disposable bimbos, which may also help them handle the idea that female nurses have some power over them in clinical settings. But the disposable bimbo image does not appeal to most career seekers, particularly men, which is a key reason the profession remains over 90% female. Yes, it's not the only reason, but it is part of an overwhelming social understanding of nursing as "submissive" and "female." This is the difference between sexual images of female nurses and, say, female FBI agents. The FBI is not in crisis because it does intensely demanding mental and physical work that few people really respect, in large part because of the idea that its agents are brainless handmaidens and bimbos. Nursing is. Of course, it may be hard to see how one apparently minor "naughty nurse" depiction can affect the real world. But each such image is part of a wave of images from the global entertainment, advertising, hospitality, and apparel industries, from Fortune 500 companies to isolated sandwich shops, suggesting nursing is about hot females bestowing sexual favors. In the aggregate, it's just common sense that decades of this kind of broad societal disrespect will have an impact, and will be a factor in people avoiding and leaving that profession. Of course, it's not the only factor; the handmaiden stereotype is probably more damaging because it's more credible and widespread, and nursing would be a difficult, stressful job even if it was well understood. Some argue that nursing's poor public image has nothing to do with the nursing crisis, because it's really all about poor working conditions and inadequate faculty resources. But that's like arguing that cancer death has nothing to do with cigarettes, because it's really all about cancer. Many things cause cancer, but cigarettes are one of them. For nursing, the lack of resources was not handed down from some divine place. It was the result of human decisions. Those decisions were made on the basis of what the decision-makers (government, hospital executives, the public) thought about how important nursing was relative to other things they might do with the resources available. It's also common to see suggestions that objections to the constant association of nursing with sex indicate prudishness or a lack of humor. But the Center has never objected to sexual images generally--only to the use of nursing as a marker for dim, submissive, sexually available females. So this is not about whether sexual images degrade all women, but about their frequent application to a specific professional group. And the suggestion is not just that nurses are silly sluts (ha ha! just joking!), but that their job is about that. Research shows that nurses suffer an inordinate amount of sexual and other abuse at work (see AP and Monster articles). Although it's difficult to prove the extent to which that is caused by naughty nurse stereotyping, that doesn't require that we ignore what would be the obvious results--if a profession is an object of sexual mockery and contempt, it's going to encourage sexual abuse, and the profession is unlikely to receive the human or material resources it needs. If a profession is constantly associated with female sexuality, it's not going to attract and retain many men. We assume few skeptics would require extensive evidence of ill effects if the media stopped "jokingly" suggesting that nurses were giggling bimbos, and started in on the female family members of the skeptics themselves. Even if the media barrage was "silly" (ha ha! just joking!), would the women in that family be taken as seriously in doing high-stress, life-and-death jobs with extensive public contact? Would they get all the resources they needed? Wouldn't they get more than their share of sexual abuse? Wouldn't they sometimes wish they weren't part of the family? Sure, those close to them might know there was no truth to the media image. But it's not like most in society would know them to be serious professionals. Most would just know what they heard in the media--that the women in that family were kind of a bad sex joke. The Center takes no position on the prevalence of sexual imagery in modern society. But we do object to the close association of that imagery with a traditionally female profession that must now fight through a critical shortage to keep millions of patients alive and on the road to recovery. In many cases, stereotypes do not simply go away of their own accord--they must be confronted and rejected. And the "naughty nurse" has proven its staying power for decades. At ground level, the devaluation of nursing translates into an underpowered profession that may not be strong enough to save your life when you need it to do so. The "naughty nurse" isn't going to catch deadly medication errors, intervene when a patient is about to crash, or teach a patient to survive with a life-threatening condition. It's time for her to change into something a little more comfortable. http://www.nursingadvocacy.org/faq/naughty_nurse.html

October 2006 -- We hear that a fine new ¨establishment in Tempe, Arizona, one Heart Attack Grill, has been the subject of complaints by those battleaxes at the Arizona State Board of Nursing. And it's all because the Grill uses scantily dressed "naughty nurse" wait staff to sell burgers and beer! Last month, the real nurses (or "Terrorists & FemiNazis," as the Grill describes them) even got the Arizona attorney general's office to ask the Grill to stop suggesting that its employees are real nurses, in alleged violation of the state's protected title statute. The Center is outraged at this assault on the free speech rights of scrubs-clad Grill owner "Dr. Jon" Basso. But we will explore what those scary Arizona nurses might be getting at, when they aren't busy killing millions of Jews or crashing jets into buildings. The nurses might be upset because the Grill is exploiting nursing's long-standing position as the most sexually-fantasized-about job on the planet. "Nurses are No. 1...in male sexual fantasies" That reinforces stereotypes that discourage practicing and potential nurses (especially men), foster sexual violence in the workplace, and contribute to a general atmosphere of disrespect that weakens nurses' claims to adequate resources. Those stereotypes exacerbate the global nursing shortage, a public health crisis that is killing thousands of people. It would even be killing those whose poor diets help lead to heart attacks, if the link between food and cardiac conditions were not just another silly lie in a world in which, as the Grill says, "insane political correctness stands as a barrier between the average man and his pursuit of happiness." The Heart Attack Grill's web site explains its striking culinary vision. That vision centers on Single, Double, Triple, and Quadruple Bypass Burgers, Flatliner Fries (fried in lard), Alpha Male Mondays, and of course, the slogan "Taste...Worth Dying For." But for our purposes, let's focus on its staffing vision, which features attractive young female servers wearing very revealing "nurse" outfits. The Grill's web site is full of photos of these "nurses" (e.g. "Nurse Nicole"). There is the "Heart Attack Grill Song," whose lyrics include "You'll Be Served By Sexy Nurses And Man That's Paradise." And there is even a Heart Attack grill cartoon, in which "Dr. Jon" and "his nurses" debate their customers' needs for burgers, bypasses, and head...on their beer. Ha ha! To top it all off, the Grill is gearing up to actually sell naughty nurse lingerie in its Pro Shop ("Imagine how your special someone will look in your favorite nurse's outfit")! Party on, Garth! The lingerie, by the way, appears largely to come from our friends "3 Wishes Lingerie"--which continues to churn out myriad naughty nurse uniforms. However, in the wake of all the recent fuss, the Grill's web site seems to have changed. It now links each of its many references to "nurses" to a disclaimer at the bottom of the page stating that it's only a "parody," and that the women pictured don't really have "medical training" or provide "medical services." The news page is full of communications from Grill management and supportive customers, who call the Grill's critics on the nursing issue "idiots," "humorless," "bitter," "short," "fat," "ugly," and "politically correct nimrods." The site devotes an entire separate page to mocking the Board of Nursing and the Attorney General's office, arguing that there is little chance that anyone would think that Grill "nurses" are actually nurses. But the page doesn't stop there. It suggests that only humorless "politically correct extremist wackos" would think there was any danger of such misunderstanding. The page includes photos of an attractive woman in various other sexually provocative work outfits, including those of a firefighter, an FBI agent, and a nun, facetiously explaining that these images do not really show members of those professions either. And the page attaches a PDF file of the Attorney General's September 1, 2006 letter, which is actually very conciliatory and does not directly threaten to bring suit. The letter does note that the Assistant AG who wrote it has spoken with Basso on the phone, informed him of the Board's problem, and expressed the hope that they could "work together" to achieve the Board's goal that the Grill not use the term "nurse" to describe anyone who is not actually a nurse. The site then invites visitors to vote on the following question: Is an American company like the Heart Attack Grill protected by our First Amendment Right to Free Speech in its parody of the nursing industry? YES, they have a Right to Free Speech which includes comedic parody NO, they should be sent to a Soviet Gulag and be bullwhipped by fat ugly Feminazis The idea that the Grill's usage of the word "nurse" violates Arizona's protected title statute is certainly an interesting one. There is a real risk that some people who wrongly identify themselves as "nurses" will mislead the public, threatening public health and undermining the nursing profession, even outside of the traditional clinical settings. One distressing example is the recent growth of infant caregivers with little or no health training who market themselves as "baby nurses." That dangerous trend appears to have played a role in New York State's recent passage of a protected title statute for nurses. For us, the real problem with the Heart Attack Grill "nurses" is not so much that many people are likely to think they are really nurses. But constantly linking powerful sexual images so closely to the profession of nursing--to even the fantasy idea that working nurses are sexually available to patients--reinforces long-standing stereotypes about nursing. Those stereotypes continue to discourage practicing and potential nurses, encourage sexual violence, and lessen respect for nursing. When you combine this lack of respect, the intense college-level training nursing actually requires, and the difficulty and stress of nursing practice, it is no surprise that the profession remains in the midst of a global shortage driven by rampant short-staffing. Of course, the naughty nurse image has little to do with a belief that real nurses are sexy, and much to do with a desire to have anonymous sex with hotties dressed in lingerie-like "nurse" uniforms. It's diverting for some men to think that nursing is populated by disposable bimbos, which may also help such men handle the notion that female nurses have some power over them in clinical settings. But the disposable bimbo image does not appeal to most career seekers, particularly men, which is a key reason the profession remains over 90% female. We note that the Grill's owner is a "doctor," and not a "nurse," and none of the female wait staff are "physicians." Physicians are powerful men, nurses are subservient sexbots--duh. But the seemingly endless devaluation of nursing through this kind of imagery translates into an underpowered profession that may not be strong enough to save your life when you need it to do so. Desexualizing the nursing image is a key part of building the strength the profession needs to overcome the current crisis. And of course, Grill enthusiasts don't just see the sexually-oriented images of "nurses" that are available on the web site. They interact closely with attractive, young, half-dressed wait staff who admittedly have no health expertise, but who do use nursing imagery and equipment (including wheel chairs) as soft-core props. Yes, these guys presumably know they're not really nurses. But this kind of intense personal interaction is likely to create a strong, lasting link in their minds between jiggly sex objects and nursing. Yeah, they might say, it's all just a big goof, and really we have the utmost respect for nursing--though we see no evidence of that on the Grill's web site, which suggests that the Grill doesn't even know or care enough to pretend it thinks real nurses play an important role in health care. But all stereotypes have some effect. For example, what do you think one of the "real men" who frequent the Grill would say if one of his friends mentioned he was thinking about a nursing career? This is the difference between sexual images of female nurses and, say, female FBI agents. The FBI is not in crisis because it does intensely demanding mental and physical work that few people really respect, in large part because of the idea that its agents are brainless handmaidens and bimbos. Nursing is. We would suggest that the Heart Attack Grill could probably do just as well if it altered its naughty nurse uniforms to be just, well, naughty. But the Grill's web site suggests that its idea of dealing with nurses' concerns is to call them names. The site also suggests that Grill thinks its responsibility to a group that feels insulted is limited to the Grill's subjective view of whether the group should feel insulted--an attitude that would justify saying anything about anyone. And in fact, the Center has tried without success in two phone calls to persuade Grill owner "Dr. Jon" to stop using the naughty nurse imagery. We do know that the Grill enjoys cartoon drama. So we put together the little script below--sorry we don't have the Grill's drawing talent--to try to explain what we mean in more dramatic terms. Read our cartoon below. NAUGHTY In a HOSPITAL ROOM, we see a middle-aged male PATIENT lying in bed. In strides a fairly young, harried-looking female PHYSICIAN. PHYSICIAN: Good morning, Mr...."Dr. Bob"? Are you a physician? PATIENT: Uh...not really. I own a theme restaurant, the Fat-Clogged Artery Grill. We have naughty "nurses" sell burgers and beer to guys, sort of flirt with them and stuff. And I'm "Dr. Bob," you know, the head honcho. PHYSICIAN (her eyes glazing slightly as she starts to examine him): That sounds great, I'll be sure to check that out. In the mean time, we do need to get ready for your bypass surgery. PATIENT: Yeah, speaking of that, I did have a couple questions-- PHYSICIAN: Has someone given you all the pre-op instructions, explained your condition and the procedure in terms you can understand, run all the tests, made sure that you're ready physically, given you and your family psychosocial care, been monitoring your status with those complex machines there, administered the various potentially lethal drugs you'll need and assessed your reaction, and gotten ready to detect subtle changes and intervene if you start failing overnight and if necessary argue with me about it, monitor and keep you alive during the surgery, monitor and assess you for post-op complications, and start you thinking about all the challenges of discharge, rehab., and turning your life around with better diet and exercise? PATIENT: Huh? PHYSICIAN: Well, you have lots of family members, right? (Looking around the empty room, then, smiling, under the bed.) Somewhere? PATIENT: How could someone who isn't trained--but wait, don't doctors do all that stuff? PHYSICIAN (shaking her head): Oh, Dr. Bob, you've been watching too many old "House" episodes! Real physicians don't do much of that. That's pretty much nursing work. PATIENT: So, why can't they do it? PHYSICIAN: Do you see any nurses here? PATIENT: No, but can't you just order one up with my dinner? I like 'em hot! PHYSICIAN (sighing): Actually, only nurse managers could "order them up"--we had nothing to do with it. But the last nurse I saw was this sad woman from a few years ago, always babbling about forced overtime, short-staffing...she was a nut! They say she came in for a shift one day and just climbed into a bed herself. Didn't last long. Anyway, they're long gone. PATIENT: Really? Why? PHYSICIAN (shrugging): Well, you know, as the years went by there were fewer and fewer. And of course, the more who left, the more back-breaking work there was for the ones who were left, with them rushing around like maniacs for 12 hours, no food, no rest room breaks, angry patients, angry physicians. The last ones were pretty much out of their minds--PTSD. PATIENT: But why did it get that way? PHYSICIAN: Well, the hospital couldn't find funding for them any more. The bean counters figured they didn't make much difference, not too smart, kind of slutty, pretty much just hanging around to fluff pillows. I also recall the nurses had a big issue with abuse--they were always getting assaulted, grabbed, propositioned, called names. "Hey baby, how about a little sexual healing?" "Say, are you the head nurse? Heh heh." Not at job I would ever consider, believe me. PATIENT: Yeah, but-- PHYSICIAN: And the male nurses! Always dealing with: "Could you give me a spongebath, nursey!" "Hey--where's your little dress, baby?" Can't blame them for getting out. Anyway, you seem fine, and I've got so many other patients, I'll be going now. A tech will check on you in a couple hours, probably. Think positive thoughts! PATIENT: But... PHYSICIAN leaves. Later that night, the PATIENT is alone in his room. A young NAUGHTY NURSE enters. PATIENT: Nurse Candy! You came! NAUGHTY NURSE (giggling): Not yet, Dr. Bob! But I did bring you a Flabby Patty, and some First Amendment Freedom Fries! PATIENT: Thanks, Candy. But I don't feel so great. Could you get someone, this call button doesn't seem to-- NAUGHTY NURSE: Dr. Bob, I wanted you to be the first to know: I got that modeling job, and my agent says I might have a shot at "Idol"! PATIENT: OK, but I really feel...ah... PATIENT passes out. NAUGHTY NURSE: That's OK, Dr. Bob, you rest. NAUGHTY NURSE picks up a TV remote and turns on the set, and we see that "Grey's Anatomy" is on. On the show, in the NICU, a chief RESIDENT sternly orders five PHYSICIAN INTERNS to monitor a critically ill infant 24/7. No nurse appears. Later, we see PATIENT again in his bed. The lighting is now SOFT and DREAMY. The TV is off. PATIENT's eyes OPEN. NAUGHTY NURSE enters and approaches the bed. NAUGHTY NURSE (sitting on the bed, her hand going under the sheet): Oh, Dr. Bob, are you wearing TAG Body Spray by Gillette? I think I'm getting "lusty-nurse fever"! NAUGHTY NURSE quickly takes off her small top and bends down to kiss PATIENT. PATIENT: Oh, Candy. Oh...mmm...uh-oh... (Struggling to breathe.) Hey...uh...uh! A MONITOR nearby beeps more quickly, then in an unbroken tone. A FLATLINE appears. Later, we see the PATIENT lying motionless in the bed. The lighting is no longer soft or dreamy. The MONITOR tone remains unbroken, but now "Grey's Anatomy" also murmurs from the television. NAUGHTY NURSE emerges from the adjoining bathroom in a NEW naughty nurse outfit, as if she has just taken a shower. Ignoring the monitor, she begins to pole dance using an IV pole, waving her long hair from side to side. NAUGHTY NURSE: Oh, Dr. Bob, that Clairol Herbal Essence shampoo is enough to make my follicles moan and writhe in ecstasy! Oh! Oh! PATIENT remains motionless. NAUGHTY NURSE eventually NOTICES and stops dancing. NAUGHTY NURSE: Well, if you're just gonna lie there, you won't mind if I have your Freedom Fries, will you? NAUGHTY NURSE settles down to watch "Grey's Anatomy" with her fries. The MONITOR continues to beep in the unbroken tone. Annoyed, NAUGHTY NURSE turns up the television volume, just in time to hear a FEMALE PHYSICIAN character snap at a MALE PHYSICIAN. FEMALE PHYSICIAN: Did you just call me a nurse?! Send our instant letter to the Heart Attack Grill! It takes just one minute. Thank you. Update on the Heart Attack Grill Story Firestarter October 31, 2006 -- The Arizona media has been covering the Center's efforts to persuade Tempe's Heart Attack Grill to stop using "naughty nurse" waitresses. The Phoenix NBC television affiliate (KPNX) ran a story yesterday, and the ABC affiliate (KNXV) ran one on Oct. 27, with a similar piece appearing in that day's East Valley Tribune. (See the clips, articles and Center press release.) These stories confirm that a key part of the half-dressed female "nurses"' job at the Grill is "role playing": helping diners with "heart attacks," pushing the overfed in wheelchairs, sitting on their laps. But why stop the "fun" there? Grill owner "Dr. Jon" is fully dressed in a lab coat and tie, but why not a skimpy "physician" outfit for him? And how about hospital gowns for Grill customers? Mind the back--it gets a little chilly! Every day can be Hospital Halloween! Meanwhile, Grill supporters have directed angry name-calling and sex-related obscenities at the Center. "Dr. Jon" has threatened to turn a fire hose on any nurse distributing leaflets outside the restaurant. What would Hippocrates say about such aggression? But even if the Grill is just one restaurant having "fun," its imagery is part of a relentless stream from the advertising, entertainment, and hospitality industries that suggests nursing is about hot females bestowing sexual favors. Even humor and fantasy images affect how people act. That's why advertisers spend billions on them. Please let the Grill know that nurses need respect to get the resources it will take to resolve the nursing shortage--and save real heart attack victims. Send our instant letter now! http://www.nursingadvocacy.org/news/2006/action/letters/2006/heart_attack/h_form.html Thank you.

Sorry that I disappointed you Kriso. We taped for about 20 minutes, and I can't say that all of the quotes they used were my best. But there is little I can do to get them to choose which quotes they should use. The media is in control of their stories, not me. In the first quote however, I did get across that it's not just the heart attack grill that's the problem. It's the whole naughty nurse image and the constant sexualization of nursing. The second quote was how nurses are expected to take the naughty nurse as a "joke." But over and over again, is it really so funny? And the third quote was in response to this inane question about shouldn't physicians be upset by Dr. Pepper. He actually asked that question again later on in the interview and I gave a much fuller answer as to how their portrayal in the media is rather robust and heroic. I'm not sure why they put that kind of non-answer in there except as an opportunity to show that I could smile. Stossel did take our side. If you read the written article about the issue here: http://abcnews.go.com/2020/story?id=2661263&page=1 which is longer than the clip, it is much more apparent that Stossel came down on the side of the Center for Nursing Advocacy. John Stossel is a libertarian and does not like government interference into business, so his "Give me a Break" was not directed at us, it was directed at the Arizona Board of Nursing and the Arizona Attorney General, which he says has dropped its claim that the Grill is misrepresenting the waitresses as nurses. I have to agree that it's a really hard claim to make that people will think these waitresses are actually nurses. Our objection is to the constant association of nurses and sex. I will post our analyses on separate threads, if I am permitted, so you can see the full nature of our arguments. Please be aware, we are a small, grass-roots 501c3 organization and I am posting information here for the purpose of information. Sandy Summers Executive Director Center for Nursing Advocacy [email protected]

Good, I'm glad. Thank you Tweety. We work hard on it...

You said that nurses can't hold drugs without an MD or parameters. That is plainly wrong--as your own care plan acknowledged. We can and must withhold drugs that are dangerous for patients--whether or not we have an advanced provider agreeing with us. Of course we tell them about it, I was never suggesting we keep it a secret. Professionals working on the same patient should all know what the other is doing.

Nobody is going to go into DKA with a blood sugar of 20! Nursing is an ongoing professional service, where we monitor people over time and intervene as appropriate--hopefully not a once-per-shift service--though I know in this age of short-staffing it can often feel that way... The common sense way to proceed is to get the patient's blood sugar back up to normal before even considering administering any insulin at all. Once it's normal, then start thinking about the patient's previous day(s) and any intervening factors that might have made her blood sugar drop. This might make you rethink the patient's insulin dose over the 24 hours instead of just blindly proceeding on with physician prescriptions regardless of what the patient really needs...

I beg to differ. We are ethically and legally bound to deliver the best possible care to our patients and advocate for them as we would if we were lying in the bed ourselves. We do not give medications just because some physician prescribes them. We give them because they would benefit the patient. We do not work for physicians. We work for our patients. We are autonomous professionals, duty-bound to protect our patients over the objections of any physician or administrator, and are held to this standard in a court of law. Giving any insulin to a patient with a blood sugar of 20 is a very bad idea. If the blood sugar is 20, then I question why this nurse would be in the mode of passing medications in the first place--we should be working vigorously to correct the blood sugar to a normal level before resuming medication administration duties. Once the blood sugar is repaired, we should examine how it got that way in the first place and consider whether or not the patient needs a dosage adjustment, and if so, negotiate with the physician or nurse practitioner for a more fitting dose. Please read the code of ethics for nurses to learn more about where our duties begin and end. http://www.nursingadvocacy.org/research/codes_of_ethics.html Also consider reading our FAQ on nursing autonomy. http://www.nursingadvocacy.org/faq/autonomy.html Sandy Summers, RN, MSN, MPH Executive Director The Center for Nursing Advocacy 203 Churchwardens Rd. Baltimore, Maryland (MD) USA 21212-2937 office 1-410-323-1100 fax 1-443-705-0260 [email protected]

Hi everyone: J&J has released this statement today regarding The View: ---------------- Statement from Johnson & Johnson to nurses We are very sorry to learn that you were offended by sequences in Monday's primetime program on ABC, "The View." The depiction of a nurse in the skit was meant to be humorous, and really dealt with consumer gullibility; but it was clearly offensive to a number of people who have written to us, and we want to apologize for that. We hope you understand that as a sponsor of network television programs, such "The View," we are not given the chance to review, let alone control, program content, except to know what the general theme of the program will be. Our opportunity to have a say in this program was further limited because the show was presented "live." Despite that, we were a sponsor and we are very concerned about your reactions and have conveyed our own feelings and reactions to the producers. We hope you also know Johnson & Johnson has devoted considerable resources to a national effort we initiated last year to help address the nursing shortage. This program, called "Dare to Care," includes television messages that portray nurses as the heroes they truly are. In addition Johnson & Johnson has raised millions of dollars to fund scholarships for both nursing students and faculty and has created a special website, http://www.discovernursing.com, where schools and nurses can order promotional materials free of charge to help with their recruiting efforts. In view of this commitment, to learn that you were offended by something we sponsored is of great concern to us. We have questioned the producers of The View and believe it was not their intention to insult anyone. Again, we're sorry you were upset by the program and we appreciate your taking the time to express your views on this matter. -----------------(end of message from J&J) Everyone--please note that The View has not responded to anyone that I know of yet, nor have they said that they would make any effort to make amends to the nursing profession. I say let's keep up the pressure on them and send more letters and ask The View and ABC to do a nurse-friendly show, or better yet, help us get a TV show about nurses produced on primetime. Or they could at least donate some money to an image campaign for nurses. Please see our write-up on The View for info on where to send the letters. http://www.nursingadvocacy.org/news/2003jun16_the_view.html Even if you only have one sentence to say--please tell them. J&J, one of The View's main sponsors should also be made of aware of your ire toward The View for their anti-nurse show. J&J's comment form is http://www.jnj.com/contact_us/contact_us_form.htm?catg=General+Inquiries Thank you for advocating for the nursing profession! --------------------------------------------- Sandy Summers, MSN, MPH, RN Executive Director The Center for Nursing Advocacy