Running head: NURSING IMAGE 1

Image Impact on Nursing Leadership and Influence

Elaine Dean

Jacksonville University

NUR

514

July 14, 2016

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Image Impact on Nursing Leadership and Influence

The influence of the public should not define the image of nursing. Nursing leadership

should inspire influence through self-advancement, professional and personal development,

education and mentorship. Silent indignation and choosing to ignore the stereotypical images of

nursing is not a strategy for change, a nurse leader should be deliberate in creating ways to

improve the image and practice of nursing.

The image of Nursing Overview

What is image? The Cambridge dictionary defines the term as a representation of the

external form of a thing or person. For many decades the image of nursing has been distorted and

tarnished by several outlets including advertisement, newspaper, television, and magazines.

Nurses have been fitted in negative stereotypes such as been unhealthy, sexy and subservient to

physicians. The technological age brought a media frenzy for television dramatic series,

television stations began competing for ratings and the inaccuracies became more pronounced

than ever. In the 1070’s television show MASH, Loretta Swift played a United States Army

nurse affectionately called “hot lips”. She was always unflattering clad in hot pants and tight tee

shirts. The term “nurse ratched” also became synonymous with the professional nurse, this

embodies a cold, heartless, tyrant. These exaggeration of nursing have left behind some myths

that will not go away because the negative imagery has gone unchallenged and unquestioned for

such a long time. As the profession tries to evolve from the negative historical and present public

images the basic problem remained, nursing is still poorly understood.

The nursing professional is not respected because of public perception, it is seen as

second rated, it’s a job for girls and not worthy of attracting the brightest and the best. This has

had some significant repercussion such as the severe nursing shortage currently being
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experienced. The image is important as it provides the influence to attract qualified applicants of

all gender and race. In 2011 the North Dakota Center for Nursing in collaboration with the

University of North Dakota School of Medicine and Health Services conducted a research on

students in North Dakotas High School career pathway programs. The areas of studies included

in this research were nursing, medicine, physical therapy and social work. Six hundred and two

students participated in the study, of this amount only one hundred and sixty nine would choose

medicine and health services. Of the one hundred and sixty nine, fifty-seven would enter nursing

and only twenty-three would be a registered nurse and practice in a hospital (Moulton et al.,

2011) Nursing image is surrounded by a lot of myths and myths are very powerful. Two such

myths that influence the image of nursing are that nurses are simple-minded individuals with

strong backs, and only need personality. The innuendo that nice girls do not become nurses is a

very strong deterred. According to Hein (2001) the contradicting images of nursing is so far

reaching it has affected “health care labor market, enrollment in nursing programs, the quality

and stability of health care, and the morale of nurses who provide care”(Hein, 2001, p. 54).

Literature Review

The professional of nursing have undergo some innovative changes over the last few

decades but the public still sees the physician as the prominent person in health care. This has

cause failure in the utilization of the services that nurses’ offer. The lingering negative image

may account for some of these issues. An extensive literature review was conducted to determine

the image impact as it relates to the history of nursing, the evolutionary concepts, gender role,

diversity and how these can be influenced by nursing leadership.

Remnants of the historical image of nursing remain prevalent in the society today and it

continues to influence the profession in recruitment and retention. The roots of nursing are
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deeply embedded in Victorian influences where women were aware of their “womanly” place in

society. Research done by Price and McGillis Hall (2013) determine that the initial concept of

virtue formed the fundamental image, but this only conveyed one aspect of nursing, in the mean

time all the other attributes were unnoticed. However, nursing is coming out of some of those

strict confines and utilizes their full potential assuming a more contemporary and realistic image

(Price & McGillis Hall, 2013). The advance practice nurse need to make this issue a relevant one

to make sure that our professional capacity is utilized efficiently and effectively. The public and

other health care providers need to be cognizant of the actual and potential role of the nurse.

A fundamental understanding of the evolution of image is needed to inspire influence. A

concept analysis study done to scrutinize and clarify the image of nursing. In this study the

Rodgers evolutionary concept analysis approach was utilized, a systemic model showed data

representing its attributes, antecedents, and consequences. The attributes are “multi-dimensional,

all inclusive, paradoxical, dynamic and complex”(Rezaei-Adaryani, Salsali, & Mohammadi,

2012, p. 83), several factors work on and against these attributes creating consequences such as

“resources allocation, staff recruitment and nursing shortage, nurses job performance,

interdisciplinary relationships, violence against nurses, public trust, low pay, workload, burnout

and job dissatisfaction” (Rezaei-Adaryani et al., 2012, p. 83). These are significant to the

progress of the profession and require strategic intervention. The advance practice nurse can

mitigate the effects of the antecedents such as poor communication, appearance of the

professional nurse, gender related issues and nurses behavior, this will maximize the attributes

and reduces the consequential effects.

Historical perception ties the identity of nursing to women who are “widows, unmarried

and from the lowest class of society” (Lesolang, 2011, p. 40). In a descriptive study set out to
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identify the image of nursing perceived by nurses, physician and other health care workers. What

emerged from the study was that there exist tension and conflict in what is considered “specific

nursing function” (Samaniego, 2013, p. 61). There were discrepancies in what the doctors

prescribe the nursing role to be and what is actually define by nursing (Samaniego, 2013)

profession. Professional identity and image is intimately tied together. Nursing leadership can

influence and change professional identity so that they become clearly constructed and well

defined. Influential leadership can demonstrate and create a change in what is perceived as

fiction and fantasy versus reality.

The combination of conflicting images of nursing reflecting the best and the worst has

now infiltrated the social media. With the 21st century facilitating technological advancement,

social media has increased in popularity within pop culture. YouTube videos depicting nursing

was analyzed in a descriptive study, it revealed that the image of nursing was constructed in

three distinct categories namely “a skilled knower and doer, a sexual plaything and a witless

incompetent individual”(Kelly, Fealy, & Watson, 2011, p. 1). To eliminate this derogatory

imagery the nursing profession and its governing bodies need to step boldly into the

technological era and highlight the elite status of nursing, creating influential images that will

impact a large cross-section of the mainstream population represented by teens and young adults.

For a long time, the public has assigned itself the watchdog over the profession of

nursing. It is no longer propaganda that the pendulum of nursing imagery has swung back and

forth. Such images have ranges from militant to heroine, uncaring to been angelic and behaving

badly to been noble (Lesolang, 2011, p. 1). To counter some of these disturbing images two

branches of the National Health Services in the United Kingdom formed a “coalition board”.
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Using evidence-based process as a tool in the research study to find answers, it was determined

that the reality and image of nursing were misperceived in the eye of the public (Morris, 2010).

Unfortunately, nurses themselves create a part of the public image of nursing. Nurses

tend to derive their self-worth and identity from the public instead of defining their own image

and then present it to the public. Improvement in public image can be attained through education,

becoming more visible to the public and display assertiveness in the health care delivery role

(Hoeve, Jansen, & Roodbol, 2013). A core role of nursing leadership is to influence advanced

education. When armed with knowledge, it facilitates boldness and mental changes necessary to

make physical and professional changes.

The image of female dominance has always been a hallmark of the profession and over

time each generation continued to be socialized that way. Factors affecting male inclusion such

as the “concrete ceiling and the “glass elevator” continues to be reinforced this perception.

According to McMurry (2011), the American Nurses Association perpetuated this female only

image when it “lobbied to change the military policies to permit men into the Cadet and Navy

Nurse Corp and to train in the Cadet Nurse Corp” (McMurry, 2011, p. 24). Gender stereotyping

will not influence the image of nursing. An image boost would mean diversifying the face,

population and culture of nursing.

In a qualitative survey the diversity, fulfillment and privilege felt by some nurses were

misconstrued by the general public, the distortion was based on misconception, myths and

stereotypes (Morris-Thompson, Shepherd, Plata, & Marks-Maran, 2011). There is still a lot of

pride surrounding being a nurse. An influential nurse leader who can tap into the emotional

reserves of individual nurses to recapture that essence will be rewarded with a change in attitude
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towards the profession, a change in how that person carries themselves, delivery of quality

patient care and ultimately a change in personal image.

Influencing Health Care and Advocating for Patients

In light of the present health care situation and the increasing dissatisfaction nursing now

has an opportunity to change its public image by assuming a more beneficial role in health care

delivery. The advance practice nurse has a specific body of knowledge and skills that can be

used to define and enhance the image of nursing. This positive image of nursing will create

improved health care delivery and advocate for patients trying to navigate an increasingly

complicated health system using deliberate nursing actions. The components of image are

“appearance, behavior and surroundings” (Sullivan, 2013, p. 45). The clinician is aware that

these components help to create a conscientious leader. The new millennium has seen a shift in

health care delivery. Health care consumers are more empowered and tech-savvy, with health

care information at the click of a button. The advance practice nurse cannot be tunneled vision

but need to encompass all tiers of the new evolving health care delivery system. Whether the

care is delivered through telehealth, in the outpatient setting or inpatient hospitalization, evidence

–based elements should be used to implement model of care for safe high-quality patient care.

The well-rounded leader will lead the way with the knowledge and skills of advanced clinical

system management, utilizing data and technology for the purpose of “ financial management,

process improvement, human resources, human resources management, quality improvement,

benchmarking and business intelligence” (Sewell, 2013, p. 359).

Future Goals in Advanced Nursing Practice

My immediate goal upon completion of my Masters of Science in Nursing Leadership is

to participate aggressively in my organizations nursing professional development team to

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educate our veteran population on what nurses do. Nurses have too long being equated with

performing menial tasks and being the physician helpmate. Educate this target group that nursing

is a esteemed profession, the educational standards are high, nurses have decision-making skills

and possess a specific set of skills that cannot be duplicated by any other profession or entity.

Influence our nurses to assert themselves professionally, that clothing and other attire should be

professional at all times. Help to establish an environment that promotes quality-nursing

practices, learning and positive image reflection in both professional and personal setting. I

would like to develop a strategic plan to show appreciation for the practicing nurse, boost morale

and attract application from nurses of all genders. Hopefully, some of this will filter out into the

community and create a ripple effect. My future plan beyond that is to be a Nurse Manager and

ultimately a Nurse Executive. I would like to do this in stages to get a firm foundation of solid

leadership so I can affect changes upwards and downwards the management chain. But most

importantly I want to be the model of the best professional nurse.

Conclusion

In this modern and industrialized society, the image of nursing will probably never be

static; it will be affected by changes in our environment such as political changes, socio-

economical changes, technological changes, tradition, culture and the media. However, the core

values of nursing never change, commitment, responsibility. professionalism, respect, caring and

empathy. As a profession we need to define who we are, reshape our position in the global

community, establish what we do with our specific body of knowledge, then, present ourselves

to the public as a united front, until we are able to effectively influence our own image

positively, we have given that power to others by default.

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References

Hein, E. (2001). Nursing issues in the 21st century: Perspectives from the Literature.

Philadelphia,PA: Lippincott.

Hoeve, Y., Jansen, G., & Roodbol, P. (2013). The nursing profession: Public image, self-concept

and professional identity. A discussion paper. Journal of Advanced Nursing, 70(2), 295-

309. http://dx.doi.org/10.1111/jan.12177

Kelly, J., Fealy, G. M., & Watson, R. (2011). The image of you: Constructing nursing identities

in YouTube. Journal of Advanced Nursing, 68(8), 1804-1813.

http://dx.doi.org/10.111/j.1365-2648-2011.05872.x

Lesolang, E. M. (2011). Help clean up the image of nursing. Nursing update, 40-41.

McMurry, T. B. (2011). The image of male nurses and nursing leadership mobility. Nursing

Forum, 46(1).

Morris, V. (2010). Nursing and nurses: The image and the reality. Nursing Management, 17(1),

16-19.

Morris-Thompson, T., Shepherd, J., Plata, R., & Marks-Maran, D. (2011). Diversity,

fulfilmentand privilege: The image of nursing. Journal of Nursing Management, 19, 683-

692.

Moulton, P., Johnson, L., & Amundon, M. (2011). North Dakota high school results. Retrieved

July 7,2016, from www.med.und.edu/.../finalhi

Price, S. L., & McGillis Hall, L. (2013). The history of nursing imagery and the implication for

recruitment: A discussion paper. Journal of Advanced Nursing, 70(7), 1502-1509.

http://dx.doi.org/10.1111/jan.12289
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Rezaei-Adaryani, M., Salsali, M., & Mohammadi, E. (2012). Nursing image: An evolutionary

concept analysis. Contemporary Nurse, 43(1), 81-89.

Samaniego, V. C. (2013, ). The nursing image and professional identity: The future of a

construction. Invest Educ Enferm, 31(1), 54-62.

Sewell, J. (2013). Informatics and nursing: Opportunities and challenges (5th ed.). Philadelphia,

PA: Lippincott Williams & Wilkins.

Sullivan, E. J. (2013). Becoming influential: A guide for nurses (2nd ed.). Upper Saddle River,

NJ: Pearson Education.