New Zealand Nursing Review

September 2003, Vol. 4, Issue 5.

The Truth About Defibrillation

By Fiona Cassie

News of nursing leader Anita Bamford’s successful campaign to stop beer being served by "nurses" at rugby games went international. In fact all the way to the US-based Center for Nursing Advocacy, which was so impressed by Bamford's campaign against "bimbo-isation" of nurses that they invited her to join their board. FIONA CASSIE finds out more about the center – which lobbies everyone from producers of TV show ER to shampoo manufacturers over their portrayal of nursing – and its New Zealand advocate.

"Nurses" brandishing red crosses on their backsides while serving beer. Or "nurses" abandoning cardiac patients to shampoo their hair in ecstasy.

They are not the negative stereotypes that the 21st century profession wants to be associated with. Particularly in times of an international nursing shortage when nursing wants to attract people into the profession not repel them.

The Center for Nursing Advocacy aims to promote more accurate and balanced media images of the modern nurse.

Centre executive director, Sandy Summers, says the current portrayal of nurses in the media is abysmal.

"They are portrayed as handmaidens, sex objects, sadists or cinematic wallpaper."

So, when Sandy was doing her daily monitoring of news reports from around the world and came across news of Anita Bamford’s successful campaign to stop "nurses" serving beer at a sports match she was very excited.

So excited in fact, that she tracked Bamford down and invited her to join the board of what is still a new and growing organisation.

For Bamford, director of nursing and midwifery for Capital Coast District Health Board, it all began back in February with a photo in the Dominion Post.

She had returned to her office from a 7.30 am meeting to find her phone had already been running hot with calls from angry nurses.

She grabbed the newspaper to find the photo in question – it showed a photo of students dressed up as nurses in short dresses with the Lion Red logo plastered in the shape of a red cross on the front and buttocks of their "uniforms." These "nurses" were to serve Lion Red beer during the upcoming Rugby Sevens tournament in Wellington.

Bamford certainly saw red, but not in the way intended by the sponsoring beer company. She saw the publicity stunt as a "tired old joke" which belonged more to the days of the Benny Hill Show. Not only did the promotion "bimbo-ise" nurses, but it also linked them to beer consumption, which was particularly insulting considering that nurses regularly deal with the consequences of alcohol abuse in accident and emergency and hospital wards.

Taking up arms on behalf of her staff, Bamford had a press release out by lunchtime and – after other media took up the story and other nurses complained – the brewery’s marketing manager apologised and withdrew the promotion.

Bamford, a nurse for more than 30 years, was heartened by the response. She said it was one of her passions to ensure that nurses were recognised for their contribution to the health of the population. The Lion Red stunt had been a step backward to days she thought nurses had left behind.

So when she was approached to join the board of the Center for Nursing Advocacy, Bamford was at first amazed but then delighted to be able to contribute on a wider scale.

Other new appointees to the board included the high profile co-authors of From Silence to Voice: What Nurses Know and Must Communicate to the Public – Bernice Buresh and Suzanne Gordon.

Bamford has joined the board for her first quarterly teleconference and is in regular email contact with her Center colleagues.

Summers founded the center in 2001. The move followed her frustration and that of fellow postgraduate students at John Hopkins University School of Nursing at their profession being ignored or stereotyped by much of society. They decided to look at how they could promote a better image for nursing.

Summers, an advanced practice community health nurse holding Masters degrees in nursing and public health, has nursed for more than 20 years including working in emergency departments and intensive care units from San Francisco General Hospital to Washington Hospital Centre (D.C.)

For the former emergency department nurse and her colleagues, the single most infuriating thing in the media at the time was the portrayal of nursing in television programme ER.

After contacting nursing organisations and not finding anyone focusing on an accurate portrayal of nursing in Hollywood or other media, they decided to take action themselves and set up the Center to do just that.

One aim is to improve the on-screen depictions of nurses with the hope it will lead to the public and news media having a better grasp of what the modern nurse actually does. A further aim is see a better-informed news media seek out nurses when researching health stories.

Summers says a particular frustration with Hollywood is physician characters routinely receiving credit for the work that nurses do. For example, performing nursing tasks such as patient education, triage or defibrillation – as happens on ER.

Researchers Kalisch and Kalisch have dubbed this the "Marcus Welby syndrome" after a 1970s television show in which Marcus Welby MD played a physician who knew everything and did everything in health care.

"Physician characters steal all of the fun stuff nurses get to do," Summers says. "Defibrillation for instance. Hollywood loves to show people getting defibrillated. In the [real] ER nurses do that, not physicians. This may seem picky, but some 17-year-old macho kid might get interested in becoming a nurse if he were to know that nurses get to do cool, important things like defibrillating patients."

She is also careful to use the word physician not doctor for similar reasons. Summers says the media’s common use of the term doctor rather than physician inaccurately suggests that only physicians earn a doctoral level of education. She fears if parents and teachers do not realise that nurses can earn PhDs in nursing they will not encourage their best and brightest students to enter nursing.

Other non nurse-friendly terms are "orders" instead of "medical care plans" or "medicine" instead of "health care" and "medical centres" rather than "health care centres" or "hospitals".

The Center in 2001 chose ER as its first project because the show’s portrayal of nurses "while positive in some ways was inadequate and inaccurate in important respects".

"The show strives so mightily to portray medical diagnosis and treatment realistically that we fear its millions of viewers might think it is equally dedicated to a realistic depiction of nursing and the roles of health care professionals generally," Summers says.

So if ER shows physicians doing nurses’ work, people can "walk around for decades thinking that this must be the truth because they saw it on TV".

In November 2001, members of the Center held a one-hour conference call with an ER producer and medical advisor. Since then they have written a series of letters to urge improvement in the show’s portrayal of nurses and believe some progress has been made, though much remains to be done.

The Center was also part of a successful campaign earlier this year to stop a television commercial for Clairol herbal essences shampoo.

The ad had shown a female nurse distracted from watching her patient’s cardiac monitor by his shampoo. She abandons her patient to wash her hair in his bathroom and then returns to dance around his room waving her hair in ecstasy.

The ad got a sharp response from American nursing organisations, including the Center, but there was initially little response from the shampoo manufacturers, Procter and Gamble, which said the ad did well in focus groups.

After a persistent letter campaign (plus pressure from a nurse with connections with Procter and Gamble) the company agreed to pull the ad in June and apologised to nurses.

The Centre has thanked the company for its action but - because it believes such commercials could cause lasting damage to the nursing image - it has called for Procter and Gamble to make amends. Possible options include creating a nurse-friendly commercial, running or contributing to an image campaign like the one sponsored by Johnson and Johnson, or taking other steps to improve the nursing image.

The fictional portrayal of nurses is not the only focus for the Center, which also wants nurses to have a higher profile in the news media.

Summers says it wants nurses to be called on as health experts instead of just physicians who were, in general, "not known for their patient educational qualities" whereas that was a nursing strength.

"We want to build up a large database of nurses and their areas of expertise so we can try to get them plugged in to a spot if a journalist or television show has a need for a particular type of health expert." The Center also wants to encourage nurses to develop "nurse for a day" programmes where they ask local journalists to experience and write about what nurses do.

Meanwhile, Summers' job includes monitoring the media – "we sit through a lot of bad television shows" – reading many articles and organising responses. The dedicated volunteer says she does everything from being the public face of the organisation to "emptying the trash".

The Center is looking for more members so it will be able to hire people in the future and step up its campaign as Summers sees plenty of work to be done on improving the image of nursing.

Bamford also believes there is much to be done for the nursing image down-under.

She has seen the profession change markedly but says the image of nursing has not yet caught up with the modern profession.

Who in the public would guess, for example, that Bamford has about 85 nurses on her staff with Masters degrees and a number with doctorates.

"Nurses are making critical decisions ever day about people’s lives that impact not only the people themselves but their families also."

Capital Coast has been making its own effort to update the image of nursing by displaying photos in its main hospital corridor that capture nurse/patient interaction.

Bamford hopes that by working with the Center New Zealand can benefit from its experience and increase the profile of modern nursing.

That includes getting the nursing voice heard in the mainstream media where the medical professions have dominated. Bamford acknowledges that, in some cases, if nurses spoke to the media in the same manner that physicians did, they could end up facing disciplinary action.

"What we’re trying to do is be more pro-active in getting our work out there."

A recent example was deciding to use the office of Wellington mayor Kerry Prendergast (a midwife) to launch the annual report of a collaborative nursing and midwifery research venture between Capital Coast and Victoria University.

Bamford says Capital Coast nurses already have a heightened awareness of countering stereotypes, and the response she got to the Lion Red promotion indicated that nurses nationwide are also ready and willing to stand up and be heard.

She now hopes that New Zealand nurses will join forces with their American colleagues at the Center to help improve the image of nursing not just downunder but around the world.

So breweries and shampoo manufacturers internationally might do more than think twice before regressing decades and using "bimbo" nurses to sell their products

[SIDEBAR]

Center for Nursing Advocacy

• Founded in April 2001 by a group of postgraduate students at John Hopkins University School of Nursing

• Monitors and lobbies media with the aim of improving and increasing the media portrayal of nurses from Hollywood to the print media

• Long-term goal is to help address the growing nursing shortage through improved understanding and support for the nursing profession

• Examples of work – coordinated successful campaign to stop Clairol shampoo TV advertisement and in late 2001 center members held a conference call with a producer of television show ER and the show’s medical advisor with aim of improving accuracy of its portrayal of nurses

• the Centre is a trust run by volunteers – Sandy Summers, her husband Harry Jacobs Summers and brother Jack Summers – and is funded by member’s fees. More information available on line at www.truthaboutnursing.org

Reprinted with permission from Editor John Gerritsen from the New Zealand Nursing Review.