Have you ever described yourself as ‘just a nurse’?

How people talk about nursing can diminish its value and deter potential recruits, the profession’s leaders warn. Here’s what you can do differently

• Not only do nurses’ words influence the public perception of the profession, but the language you use can help change the narrative
• Get across the message that nursing is a ‘safety critical’ profession to improve its value to policymakers, employers and the public, say nurse leaders
• How to change the way you represent your role and your profession's impact on patient care

How do you describe what you do? Do you present a clear image of your role, its complexity, the fact that it’s pivotal to patient care? Or do you say you are ‘just a nurse’?

Nursing leaders warn that words used about the profession have an impact on how it is perceived – by employers, policymakers and, crucially, by patients and the general public.

While they say that nurses themselves do not bear sole responsibility for this, they are calling on nursing professionals to take action to change the narrative.

What is the true impact of nursing’s image?

The evidence that image matters is mounting. In December, a report from Anglia Ruskin University showed that public perceptions about nursing were putting people off joining the profession.

A survey of 1,000 people from around the UK found that while most thought that a sense of humour (60%) and reliability (71%) were traits associated with nursing, leadership skills and innovation were linked to nursing by just 32% and 23%, respectively.

• RELATED: Promoting recruitment by rebranding the image of nursing

This followed a publication from global campaign Nursing Now last summer, which said that the status of nursing should be raised in the wider health sector by challenging the perception that it is ‘soft science’, and called on employers to give more managerial opportunities and training to women.

‘There simply aren’t enough trained nurses, and one of the reasons is that nursing has to be seen differently... it is still seen as a job that “nice women” do’

Barbara Stilwell, Nursing Now campaign executive director

According to Nursing Now global campaign executive director Barbara Stilwell, nurses do have a role in changing perceptions, and in attracting a wider range of people into the profession. ‘There simply aren’t enough trained nurses, and I think one of the reasons there aren’t enough is that it has to be seen differently. I think nursing is still seen as a job that “nice women” do.

‘My 15-year-old grandson did one of those aptitude tests at his very posh boys’ school and it came up that the most ideal career for him was nursing. His reaction was “Oh my god – I’m going to get into medical school!”.

‘I mean, his father is a doctor, but his mother’s a nurse, his grandmother is a nurse (that’s me), his sister is a nurse, but he does not see himself in that job. We’ve all teased him, but it’s a reality – that’s why there’s only 11% men in nursing, because they see it as something wishy-washy.’

• RELATED: Time’s up for the gender-based image of nursing

Perceptions of nursing stuck in the past

Having had a long and successful career in nursing herself (and coming out of retirement to take on the Nursing Now role because she felt so strongly about it), Dr Stilwell knows that while nursing has changed, people’s ideas of what nurses are and do are often stuck in the past.

‘The thing that people remember about Florence Nightingale is that she had a lamp, but actually she was a badass woman. She took the data she had to the politicians to make a case for change’

Dr Stilwell

Asked how she thinks about nursing, and its value, she is clear: ‘I think that ideally the nurses are the guide by your side, in health. Even when you’re sick, the aim of nursing is to restore you so that you can live the life you want to live, but they do that not by interventions only, but by as it were coaching you to become an independent, fully functioning person.

'To do that, the real expertise of nursing is that it has to be able to pick out what’s physical, what’s mental, problems, issues, what’s emotional, and what’s social. I believe that nurses work in all those dimensions, and in an ideal world, this is the model of nursing that I think is really critical.’

• RELATED: Barbara Stilwell: Our chance to raise the status of nurses

We need professional nurses – and an image to match our skills

Nursing student Sam Turner is optimistic that the image of nursing is changing – for the better.

He believes that younger people have a greater understanding of the value and complexity of the nursing role, and that this will continue to grow and spread.

‘How I describe what I do depends on who’s asking’

He clearly loves his course – he is in his third year of an adult nursing degree at Manchester Metropolitan University – but he admits that he adapts how he describes what he does depending on who is asking.

‘I usually say that I’m studying nursing,’ says Mr Turner, 26. ‘I tend to avoid saying I’m “training” to be a nurse unless I’m speaking to the older generation.

‘It’s a really weird dynamic because when you say you’re training to be a nurse to the older generation they understand it a bit more, because when you say you’re studying to be a nurse, they say “you can’t study care”, although we are studying the evidence behind it. But the younger generation seem to understand what studying nursing is.’

In future, patients will know that every nurse has a degree

He believes that perceptions are changing, particularly because nursing is now an all-degree profession, and that future patients and colleagues will know that everyone who is a nurse has a university degree. ‘The older generation think of nurses doing it the old-fashioned way through schools. There’s a difference in the perception of nurses who have degrees and are professionals, and those who were taught on the job. There are very different viewpoints among the different generations.’

Mr Turner, who also represents the North West of England on the RCN student committee, says he ‘fell into’ nursing after working as a shift manager at McDonalds, then with the ambulance service.

‘I was edging towards being a paramedic, but then I decided after working as a healthcare assistant in a hospital that nursing would be better for me because of the patient contact. Whereas a paramedic would stabilise that patient and get them to hospital, a nurse would see the improvement day in and day out.’

He would like the media to update its portrayal of nursing, and ditch calls for ‘old-fashioned’ training and ‘matrons’. ‘The way nursing is moving we need professional nurses; we shouldn’t be looking back at old-fashioned ways and seeing it as a golden age.’

• RELATED: Patients are confused by inconsistent nurses’ uniforms – and they’re not alone

Link nursing’s value to its safety critical role

For Alison Leary, professor of healthcare and workforce modelling at London South Bank University, it is important to get the message across that nursing is a ‘safety critical’ profession. ‘If it [nursing] isn’t there, there are serious consequences,’ she stresses. ‘That’s the thing that the profession isn’t articulating particularly well. But that’s not all the fault of the profession.

‘There are extrinsic issues at play, such as a gendered workforce – nursing is an 89% female profession, and if you look at things like reward and recognition, traditionally female work hasn’t been recognised or rewarded. Also, the 11% of men that are in the profession get paid more and get promoted faster. So there are other factors – it’s certainly not just about the ability or inability of people to speak up.’

• RELATED: ‘Nurses would be paid more if employers recognised their role as safety-critical’

There are, she says, big structural and societal issues about the value of nursing work. ‘There’s also something about social conditioning and the way the profession is sold to people as about being “nice” and “kind”. There’s a social identity that’s about not being confrontational and not questioning things – and a lot people see it as being confrontational if you ask questions in the profession, whereas in other professions, debate is accepted and welcomed.’

‘Nurses should tell their story, but it’s not something we feel comfortable doing’

Beverley Ramdeen, senior lecturer in adult nursing at the University of Hertfordshire

Professor Leary is also clinical lead with the match-day medical service at Millwall FC, and has won recognition for her work in improving stadium safety – something she contrasts with her efforts to raise concerns about, for example, nursing workforce in the health service.

‘In one sphere – football – you get an MBE and in another, the debate is completely closed down. It’s a really interesting contrast.’

Articulate what you do as a nurse and why it’s important

She would like nurses to become better at articulating what they do and its importance, and says the resources to help are out there.

• RELATED: Nurses! Don’t under-sell the complexity or importance of our work

‘I was getting lots of emails from people saying they were getting down-banded and things like that, so we set up a website, apollonursingresource.com, with some fundamental skills.

‘There’s a whole section on there about talking about work, for example, and about phrases to avoid, things like “basic care” and “nursing is just common sense”, or the word “just” in as “I just did this”.’

How to change the way you talk about nursing

Phrases/strategies to adopt:

• Remember that everything nurses do or say sends out a message about the profession
• Tell YOUR story – every nurse makes a difference, so think of the time that your work had a positive impact and don’t be afraid to talk about it
• Develop an ‘elevator pitch’ – two sentences that sum up what you do and why it’s important – to describe your work. For example: ‘We are a group of specialist stoma nurses who independently manage a caseload of people with complex bowel and bladder problems across acute and community trusts’
• Consider using technical terms to get across the complexity of your work, for example, if you are making a case for your role to continue or be banded at a particular level. You might describe yourself as applying technical expertise, taking safety critical decisions, managing patient care and promoting self-management, being crucial to admissions avoidance and/or timely discharge, or being the ‘key accessible professional’ for patients and families

Phrases to avoid:

• Using words such as ‘basic’ or sentences such as ‘I just sat and listened’ to describe the work of nurses sends a message that nursing is not a particularly skilled role
• Saying ‘nursing is just common sense’ or ‘I do the job of a junior doctor’ devalues your expertise; it is also untrue
• Saying you are ‘just a nurse’ sounds apologetic and suggests that you do not value your role – so why should anyone else?

   

Adapted from the Apollo Nursing Resource website, which has links to other valuable sources of information

Challenge the everyday misconceptions of nursing you encounter

Senior lecturer in adult nursing at the University of Hertfordshire Beverley Ramdeen says perceptions of nursing have changed for the better since she started training in 1991.

‘Today’s nurse education is allowing students not to be a handmaiden, not to think they can’t speak to doctors, allowing them to be patient advocates. When we trained, even though you were allowed to talk to doctors, I remember a consultant who didn’t talk to me until I became a ward sister.’

Although things have undoubtedly improved, there is some way to go. ‘I do think nurses should tell their story, but it’s not something we feel comfortable doing,’ she says. ‘From a cultural point of view, I always felt it’s boastful to say what you do.’

• RELATED: Banish idea of nursing as ‘women’s work’ to promote more female health leaders

She believes, however, that it’s important to counteract misconceptions of the nursing role.

She does clinical bank nursing shifts, and says that the comments she gets socially are often out of date.

‘Some people do say “are you still cleaning bums?”, which annoys me. I do say “that’s not all that I do”, but I am almost on the defensive straightaway. Some of my non-nursing friends assume that all you do is the wiping and the cleaning and mopping sweat. They don’t see the technical side.’

‘A lot of the skills that are vital to provide healthcare are no longer seen as valued... medical technical skills have been valued above the management of care’

Alison Leary, professor of healthcare and workforce modelling at London South Bank University

Professor Leary says there is work to be done to promote the value of nursing within the health sector too. ‘If you talk to policymakers about advanced practice, they see the value of advanced practice as filling medical rotas.

‘You’ve got this hierarchy of knowledge, and you’ve got technical medical skills at the top of it and then everyone else. In workforce terms, it’s led to this task-shifting approach, which is completely fallacious: the value of a group is considered on the basis of their ability to do what is considered the next step up.

• RELATED: Let’s make 2020 our chance to push for more nurse funding

‘A lot of the skills that are vital to provide healthcare are no longer seen as valued, and that’s a really big problem, because medical technical skills have been valued above the management of care, for example, or the management of risk, which was intrinsically part of the work of registered nurses.’

Employers don’t always understand what their staff do

Professor Leary believes that nursing leaders can help change the conversation about nursing, and have a responsibility to do so. ‘I think there is absolutely something that can be done in terms of helping people really understand the safety critical nature of the work, and that it’s a knowledge-intense occupation.

‘There’s a lot that can be done with employers: one of the things that concerns me greatly is the misconception of employers about the people they are employing. Some employers are good, but I meet so many who, when they describe roles, it’s clear that they do not understand the work as done. They don’t see the asset that they have – all they see is an expensive resource.’

Dr Stilwell stresses the importance of nurses being able to take command of evidence to stand up for patients and effect positive change. And she suggests they take as their inspiration the most famous nurse of all, one whose image as, essentially, a nice and caring woman, falls far short of the impressive reality.

• RELATED: Florence Nightingale: Why the founder of modern nursing is still important

‘The thing that people remember about Florence Nightingale is that she had a lamp, but actually she was a badass woman. She took all the data she had, and made it into charts, and took it to the politicians to help make a case for change. We need to be that Florence Nightingale for the next century.’

Jennifer Trueland is a health journalist