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Overcoming the “angel” perception of nursing

Most of us have vaguely positive sentiments about nurses, but at the same time, nursing is plagued by feminine stereotypes that continue to undermine the profession. These double-edged views are never more striking than in efforts to honor nurses, which often rely on emotional “angel” images rather than recognition of nurses’ health skills or tangible contributions to patient outcomes.

Perhaps the most prominent examples appear in the celebrations of nurses that occur in May each year for International Nurses Day, which caps an entire Nurses Week in the United States. Web searches about these events performed earlier this month revealed a few images that hinted at nurses’ expertise and advocacy, like one saluting them for stopping physicians from accidentally killing patients. A few images referred to the unusual challenges of nursing, such as the odd hours and miscellaneous bodily fluids.

But most of the search results instead showed hearts, flowers, and cuddly animals, along with text about a nurse’s gentle touch, caring, dedication, and kindness—in short, the angel. That enduring image defines nurses by their moral virtue, rather than by their health knowledge, life-saving skills, or courageous advocacy. Likewise, a survey of available Nurses Day gifts revealed an emphasis on angels, teddy bears, and hearts. Indeed, one handy feature of this decade seems to be that the “0” in years like “2015” is easily converted into a heart.

Many nurses and their supporters embrace this kind of imagery. In a typical formulation, Johnson & Johnson’s Discover Nursing website urged us to salute nurses during Nurses Week for their “dedication,” “commitment,” and “compassion.” Hospitals often honor their nurses in similar ways. During Nurses Week this year, the University of Texas Medical Branch issued its “Silent Angel Awards.” And what does “angel” mean to that major academic health center?

A:  Always thinking of others
N:  Numerous acts of kindness
G:  Going above and beyond
E:  Endless devotion
L:  Loved

Meanwhile, a global nursing shortage continues to take millions of lives. Most nations don’t have enough nurses. But even in nations without a severe shortage of nurses, governments and other decision-makers are not funding enough nursing positions to protect the public. To cut costs, many nurses have been replaced by less skilled technicians or assistants. On the whole, the overwhelmingly female nursing profession remains underpowered. As a result, patients die, preventable diseases like Ebola spread, and nurses burn out—making the shortage worse. This public health crisis flows from society’s failure to understand how nurses with sufficient resources improve outcomes, in ways ranging from skilled monitoring to patient education.

Nurse and elderly man spending time together
The angel stereotype: Lifting hearts, but not saving lives. “Checking in with a Patient” by MyFuture.com. CC BY-ND 2.0 myfuturedotcom Flickr.

But you don’t need clinical and educational resources if you are a pillow-fluffing “angel” or a devoted “backbone” of health care. You certainly don’t cause trouble by questioning dangerous practices. On the contrary, you quietly embrace challenges like working intensely for 13 hours without a break for food or the restroom, earning a low salary despite needing to support your family, or taking abuse from patients, physicians, and other colleagues. It’s just what angels do!

Nursing groups sometimes do better in paying tribute to the profession. This year, the International Council of Nurses’ theme for Nurses Day focused on nurses as a cost-effective force for change in health care financing structures. But many national nursing organizations had 2015 themes that focused on “compassion,” and “dedication.” One had a website informing us that “Nursing Rocks” and that “I [heart] nursing.”

Some nurses have argued for new approaches. In 2008, the Journal of Nursing Administration published “An Evidence-Based Approach to Nurses Week Celebrations.” Researchers had surveyed University of Michigan nurses about how they wished to celebrate. Rather than “trinkets,” “beauty makeovers,” or “foodstuffs,” the respondents wanted substance, including more education of the public about the true value of nursing.

Just last month, a Nigerian nurse argued on a nursing weblog that we should not “roll out the red carpet” for Nurses Day. Instead, offering specific complaints about the state of nursing in her nation, “Nursekalu” urged Nigerian nurses to use the occasion to “demand respect, better pay and working conditions!” We fear this may have reduced her chances of getting a “silent angel” award.

But should we have any annual celebrations of nursing? Perhaps such events give dispossessed groups a pat on the head in lieu of the real respect enjoyed by others, like physicians and lawyers. In a 2011 episode of Nurse Jackie, the life-saving (and notably non-angelic) main character dismissed Nurses Week as a “patronizing” event for the “overworked and underpaid.” If we stopped telling nurses how vaguely wonderful they are once a year, we might be able to see better why they deserve to be treated like serious professionals all year.

Nurses Day is 12 May because Florence Nightingale was born on that day in 1820. Later, during the Crimean War, Nightingale raised a ruckus to save British soldiers who were dying of preventable disease because they were not given adequate resources by their own government. The fierce advocate described her work this way: “I stand at the altar of murdered men, and while I live, I shall fight their cause.” Do you think she would add, “I [heart] nursing”?

Feature image credit: An Indonesian woman comforts her daughter as Registered Nurse Renee Cloutier (center) of Project Hope disconnects an intravenous catheter from her arm aboard the hospital ship USNS Mercy (T-AH 19) on Feb. 23, 2005. Photo by Petty Officer 3rd Class Rebecca J. Moat, U.S. Navy. Defense.gov News Photo 050223-N-8629M-050 by U.S. Military. Public Domain via Wikimedia Commons

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