Confirming our professional identity in the eyes of the general public: why our language and stories are so important
Elizabeth Matters FACN
In January, a short article from the BBC passed through my newsfeed entitled Nurses: The way the profession is changing. In this article, a collaboration with the Royal College of Nursing, three nurses were showcased who were acting as largely autonomous, advanced practitioners in their clinical areas (Therrien, 2018). I admired the work that these nurses were doing but I did wonder myself if the initiatives were really so new? Or was this was one of the few times the mainstream media had picked up and promoted what advanced practice nurses really do?
As insiders, we are naturally aware of our own work and the work of many colleagues in developing nursing theories, nursing research and specialist knowledge in unique advanced practice areas. Each area demands a huge amount of nursing experience and theoretical knowledge in order to provide unique nursing based solutions. The problem is that we tend to forget to tell the general public and this lack of recognition causes problems when we have to stand our professional ground.
Just to test, non-scientifically, how the general public views the nursing profession, I conducted a very informal survey on my Facebook page where I asked my contacts if they had ever benefited from the specialist knowledge of a talented nurse. I was really hoping to hear some concrete examples where nurses had perhaps shown a person how to care for a medical device, provided ongoing counselling in a chronic disease situation or healed a wound which had been a long-term problem. Unfortunately I was largely disappointed. My respondents all enthusiastically praised nurses as lovely people, but when asked what the nurse had done the same responses came up: ‘they were nice’, ‘they were sensible”, ‘they reassured me that everything would be fine’, ‘they held my hand’, ‘they bought me a snuggly warm blanket.’ I know the significance of these things for patients and I am not disputing their importance for a minute but it saddened me that, even with prompting, no-one could pinpoint an example where they had appreciated a nurse’s expert knowledge. Eventually, it came out that the nurses had shown skill in patient education, in managing chronic disease processes holistically and in observation and identification of impending problems. Yet, without my persistent questioning, no one would have mentioned these highly important skills. The gratitude to nurses was certainly there but there was little appreciation for nursing as a professional skill.
When one examines the definition of a profession, it is clear that contemporary Australian nursing can fulfil the criteria. We are clearly differentiated in law from other professions and operate within a legal framework which allows us self-regulation. We prepare would-be nurses with an intellectual basis for their practice through higher education. We have a clearly developed code of ethics which protects the public and our patients. We generate a positive effect on our communities through altruism and worthwhile knowledge. Increasingly, we have gained more political power (another criterion for an independent profession) through ACN and ANF activities and through an increased profile in health care policy via roles such as the Chief Nursing and Midwifery Officer (Saks 2012; ten Hoeve, Jansen & Roodbol, 2014). There are many countries with health systems as sophisticated as ours where nurses find it much more difficult to establish their professional credentials, their identity and their minimum expectations for workload and remuneration. Therefore all these achievements in Australian nursing are significant and must be celebrated!
I do believe, however, that each of us can assert more ownership of our unique body of professional knowledge and expertise (Saks 2012). I believe for the future of our profession, it is essential that we do so. If we do not, the general public will continue to have a very vague idea of what we really do and we will continue to have a sense that we have to battle for professional recognition. The public is not confronted with images, stories or language often enough which clearly articulate the nursing knowledge base. We have all seen the media campaigns for nursing recruitment… nurses are depicted smiling, holding people’s hands, cuddling babies, holding clipboards, walking down corridors and perhaps passing things to surgeons. In many campaigns where nurses are asked about their job, they emphasise ‘caring’, ‘following a family tradition’, ‘making a difference’, ‘doing something good’ and ‘enjoying gratitude’. There is very rarely any discussion of their knowledge, their specialised skills and what only they can offer to the public.
But if we value caring and so do our patients, isn’t that enough for us? Well, unfortunately, it seems it is not. We want more than to be admired as nice people. We want to be respected and recompensed for our knowledge, our years of experience and training and the critical importance of our work to the health care system. That means we have to value our own expertise and not be shy about informing the general public about what that is. We need to depict the complexity of the work we do every day and not downplay it. It is our choice whether we say ‘I take people to the toilet all day’ or whether we explain our promotion of patient wellbeing through the assessment and facilitation of mobility, skin integrity, fluid balance and elimination.
This change in language may sound like mere wordplay but it is so very important. Our own language speaks volumes about the way we respect our work. If we play down what we do, why should anyone outside the profession bother to promote the great work that lies underneath our self-deprecation on our behalf? Every industry promotes its services and knowledge in a bid for respect, influence and remuneration. Why shouldn’t nursing follow suit? We need to be unembarrassed about publicising our pursuit of knowledge, and the development of our own concepts and theories. We need to stop resenting the research-practice divide within our profession and see that research informs our practice and gives us the unique professional knowledge which we need. Conversely, we need to encourage more clinical nurses not to fear research conventions and to assist them to substantiate their ‘nursing instinct’ about one thing or another with actual rigorous evidence. We need to discuss and define where our expertise lies and then tell the world, diluting the stories we share at home and with our friends about body product catastrophes, unfair workloads and frustration with our medical colleagues. Instead we need to saturate the public consciousness with positive, proud stories of our unique achievements, targets and projects.
It was heartening to see that the BBC, one of the world’s biggest news providers, was prepared to celebrate autonomous nursing practice but there is a lot more to do in our own communities. Whether it is right or not, the modern world celebrates and values ‘Winners’: people and professional groups who are skilled, fast-paced, successful and confident. If we want to feel we are truly respected and valued in society, we have to showcase our expert services as valuable, unique offers and, in so doing, demand nothing but the highest respect.
Saks, M. (2012). ‘Defining a profession: the role of knowledge and expertise.’ Professions and Professionalism, 2(1):1-10.
Ten Hoeve, Y., Jansen, G. & Roodbol, P. (2014). ‘The nursing profession: public image, self-concept and professional identity: a discussion paper’, JAN, 70(2):295-309.
Therrien, A. (2018). ‘Nursing: the way the profession is changing’, BBC News. Available at: www.bbc.com/news/health-42692508.