Features

Skilled professionals or NHS ‘heroes’: has public perception of nursing really changed?

An enhanced profile is one thing, but better pay and support requires a fundamental shift

An enhanced profile is one thing, but better pay and support requires a fundamental shift in how nursing is viewed

  • Almost half of respondents to a Nursing Standard survey say they think COVID-19 has changed how people regard nurses
  • Many say labels such as angels and heroes are unhelpful and impede recognition of nurses as skilled professionals
  • Professions higher public profile presents a chance to push for better pay, better support for nurses, and a better NHS for patients
The final Clap for Carers outside Southend University Hospital, Essex in July Picture: Alamy

The clapping has faded away and many of the rainbow drawings in windows have been taken down, as the UK moves beyond the peak of

An enhanced profile is one thing, but better pay and support requires a fundamental shift in how nursing is viewed

  • Almost half of respondents to a Nursing Standard survey say they think COVID-19 has changed how people regard nurses
  • Many say labels such as ‘angels’ and ‘heroes’ are unhelpful and impede recognition of nurses as skilled professionals
  • Profession’s higher public profile presents a chance to push for ‘better pay, better support for nurses, and a better NHS for patients’
The final ‘Clap for Carers’ outside Southend University Hospital, Essex in July Picture: Alamy

The clapping has faded away and many of the rainbow drawings in windows have been taken down, as the UK moves beyond the peak of the COVID-19 pandemic.

But after the unprecedented public outpouring of praise for NHS staff, has most people’s perception of nurses changed fundamentally?

Feeling of greater respect – but what about lasting change?

An exclusive Nursing Standard survey* suggests that nurses think the pandemic has had an impact, with almost half of respondents (47%), saying that people’s understanding of what nurses do has changed.

Less than a quarter (23%) of the more than 2,000 respondents think that COVID-19 has made no difference to how people regard nurses.

Many respondents report a sense of greater respect and appreciation from families of patients, as well as their own friends and families.

‘With all the publicity during COVID-19, nurses will be more valued for what they do,’ one respondent says.

But for many, the rhetoric of NHS staff as ‘heroes’ or ‘angels’ does not move the profession forward in a constructive way.

Nurses are people with lives, families and issues outside of work

Some say they feel that understanding among the public about the knowledge and skills necessary to be a nurse, and the wide variety of different nusing roles, has not improved.

47%

of nurses think understanding of what they do has changed

Source: Nursing Standard survey

Even among those who saw improvements, many were not optimistic it would last for long. ‘Initially yes, but the interest has waned now the situation is more settled,’ one respondent says, in a comment that echoes that of many others. ‘There was a more positive image of nurses but that has changed in recent weeks.’

Some nurses say they have had a positive response from many patients and families they have cared for and been in contact with during the pandemic.

With visitors banned from hospitals, some spent a lot of time on the phone updating families on patients’ health.

One says: ‘Clients especially have been asking after the welfare of nurses and seeing them as people who have lives, families and troubles too.’

A pay rise is needed urgently, rather than more applause

However, many point out that while an increased awareness of nurses’ importance is not a bad thing, it does not appear to have led to any practical or substantial change, such as a firm promise of a pay rise or concrete steps to tackle workload problems.

‘We are not angels, we are highly trained professionals who should be appropriately paid,’ one nurse says. ‘A free meal, a gift bag or clapping every Thursday does not pay my mortgage, or indeed my Nursing and Midwifery Council (NMC) registration fee.’

Another nurse says: ‘A clap or the public's better understanding doesn't fund our services or support our workload.’

In France, nurses and other healthcare staff have received significant pay increases in light of the pandemic. French prime minister Jean Castex said the average increase of €183 a month (£164.40**) for healthcare staff was ‘recognition of those who have been on the front line in the fight against this epidemic’.

In the UK, the RCN and 13 other unions sent a letter to the prime minister and the chancellor on 3 July urging them to open pay discussions early, with the aim of introducing a pay rise this year.

Health and social care secretary Matt Hancock has since failed to commit to a pay rise for nurses this year. Meanwhile, NHS staff protests organised after the announcement of a broad public sector pay rise that excludes nurses and others on Agenda for Change contracts have met with government resistance.

Old stereotype of nurses as ‘angels’ resurfaced in the pandemic

23%

of nurses think COVID-19 has not changed understanding of what they do

Source: Nursing Standard survey

Many of our survey respondents express frustration that while general appreciation for the work of nurses has grown, this has not gone hand in hand with a better understanding of the significant skills and knowledge required in the role.

Instead the old stereotype of nurses being angels has resurfaced, along with a strong emphasis on all NHS staff being heroes – a concerning message for many respondents.

‘This image of being heroes is not a positive one,’ one says. ‘Historically nurses are seen as “angels” and now “heroes”. As a result, I feel nurses have never been deemed as professionals, which is reflected in their pay.’

Another agrees: ‘“Hero” [is] unhelpful. The reality is that I trained other professionals and final-year medical students because they didn't have the necessary knowledge, training or competency to undertake some of the fundamental roles undertaken by our nursing assistants or healthcare assistants, never mind registered nurses.’

Nursing outside hospital settings: ‘I'm not sure the public see the diversity of roles’

Throughout the pandemic, images of clinical staff working in intensive care have dominated Picture: PA

Images of healthcare staff working in intensive care in full personal protective equipment (PPE) have been an enduring image of the pandemic.

Yet for many nurses who responded to the Nursing Standard survey, this has portrayed a narrow view of nursing, focused on hospitals.

Many respondents say media coverage of COVID-19 has heightened public appreciation for intensive care unit (ICU) nurses, but failed to increase understanding of the profession beyond this setting, or the acute sector.

Some working in hospitals but not in ICU feel that the risks they have faced are poorly understood. ‘I feel most of the media coverage focused on ICU staff, to the detriment of the ward-based staff nursing with poorer PPE and, in some ways, in more stressful situations,’ one says.

Those who work in community, mental health and learning disability roles also decry the lack of awareness about their work, which has continued in often difficult circumstances.

‘We are more autonomous and provide skilled care to highly complex patients, similar to what they would receive in hospital. But the public still thinks we do a few basic dressings’

Parveen Akhtar, community matron, palliative and end of life care, Guy’s and St Thomas’ NHS Foundation Trust

‘I'm not sure the public recognise the diversity of roles,’ one respondent says. ‘There has been a lot of media attention for those working “on the front line” in ICUs, but the virus has had an impact on many people. I work in a hospice and also care for people living with dementia and their families. I doubt most people consider the effect of COVID-19 on those families.’

One community nurse says their job became more difficult and busier, but this was not understood. ‘Some members of the public only see front-line nurses as being in acute [care],’ they say. ‘They do not appreciate how many specialist roles, experts in their field, there are in the community. I have picked up two new work streams to my role as a community advanced nurse practitioner since the start of the pandemic. And there are more to be added on, as we are going to be supporting more care homes.’

A perception that hospital nurses are more skilled

Parveen Akhtar, community matron, palliative and end of life care at Guy's and St Thomas' NHS Foundation Trust, feels the work of community nurses is sometimes not understood by the rest of the nursing profession, let alone the public.

She said television portrayals, such as Call the Midwife’s district nursing of the 1950s and 60s, do not reflect the complexity of care community nurses provide.

‘The role has moved on so much,’ she says. ‘We are more autonomous and provide skilled care to highly complex patients, similar to what they would receive in hospital. But the public still thinks we do a few basic dressings.’

She says that during the pandemic, community nurses had to step into the roles of professions who were not doing home visits.

‘We were doing the home visits face to face with PPE – some of the roles of carers, GPs, counsellors, occupational therapists and physios. But the public and patients still think that hospital staff are more skilled.’

Stereotypes are more than frustrating – they affect nurse pay, says RCN

Outdated and gendered notions of nurses as ‘angels’ and ‘handmaidens’ do have a role in holding back the pay and working conditions of those in the profession, an RCN report published earlier this year concluded.

It said the idea of nursing as a vocation and a feminine profession devalues the high levels of skills involved.

The lack of awareness of the nurses’ skills remains a frustration for many.

‘The majority of the public, I believe, still think we’re there to mop brows and wipe bottoms,’ one respondent says. ‘While these are indeed important tasks in our nursing role, it is so much more.’

‘Nurses have to value nursing – or no one else will’

Alison Leary: ‘People in the profession
may see themselves in a new light’

London South Bank University chair of healthcare and workforce modelling Alison Leary agrees that being labelled as heroes is unhelpful for the profession. ‘You don’t have to pay heroes,’ she says.

But Professor Leary also called on nurses to take responsibility for raising awareness of the skilled work they do.

‘One of the issues the profession has faced for a long time is undermining its own value,’ she says.

‘Nurses often devalue their own work by saying they are “just a nurse” or they give “basic care” and so on, describing their work by its virtues and personal characteristics without talking about the skill and expertise they have.

‘COVID-19 has helped people understand the safety critical nature of professional nursing care and importantly has helped a lot of people in the profession see themselves in a new light. This is important. Nurses have to value professional nursing or no one else will.’

Maintain the profile and keep nursing on the agenda

Anne Marie Rafferty
Picture: Barney Newman

RCN president Anne Marie Rafferty, professor of nursing policy at the Florence Nightingale faculty of nursing, midwifery and palliative care at King’s College London, says that the profession needs to seize and maintain positive changes regarding the value of nurses and nursing.

‘On balance the perception of nursing is more positive from the public, policy makers and the media itself,’ she says.

30%

of nurses say they do not know if understanding of what they do had changed

Source: Nursing Standard survey

‘But I also sense from my discussions that nurses are wise to the fact that memories can easily fade and politicians are prone to “amnesia” once the pressure is off and the immediate crisis is perceived to be over.

‘We must therefore maintain the initiative and keep the profile of nursing high on the policy agenda.’

She hopes this higher profile can be leveraged to establish better pay, better health and psychological support for nurses, and a better NHS for patients.

‘We need to turn the crisis and the tragedy it has wrought into an opportunity to build a better future for patients, nursing staff and the health and care system,’ she says.

Notes

*Nursing Standard conducted an online survey, open to all UK nurses, about their COVID-19 experiences. The survey was open from 8-19 June 2020 and received a total 2,338 responses.

** Equivalent in GBP correct as of 26 August 2020.

Erin Dean is a health journalist


Further information

Sign up to continue reading for FREE

OR

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursing standard.com and the Nursing Standard app
  • Monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs