Who could have predicted that 2020, the International Year of the Nurse, would coincide emergence of the global COVID-19 pandemic? In the face of uncertainty and assuming risk of personal danger, nurses have stepped up to serve on the front lines. The American people consistently identify nursing as the most trusted profession and are honoring nurses with cheers, sidewalk chalk messages, free coffee and sign displays amid adulation and cries of “Healthcare Heroes!” Invariably, these public tributes clash with the servant posture of our profession as nurses are motivated to promote health and not ourselves.
While the care provided by nurses is widely and loudly celebrated, the voice of nursing lacks equal attention. As a scientific profession, nurses are not only caregivers but scholarly practitioners of care with a distinct culture of evidence-inquiry and implementation. Nurses conduct research, advocate for effective health policy, implement evidence-based practice, provide rigorous education and lead interprofessional teams to make a difference in health systems. Although nursing as a profession safeguards the majority of public trust, nursing voices are underrepresented at decision-making tables, in leadership positions, in government-appointed task forces and in the media.
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A recent survey by the Commonwealth Fund, the New York Times and Harvard School of Public Health found the average American trusts nurses more than any other group to improve the current healthcare system, nearly doubling support expressed for physicians, who came in second. To gain more influence, nursing needs a seat at the table and equity in representation in healthcare leadership. As the United States continues a trend away from thousands of individual hospitals and care facilities to now approximately 450 systems-based networks, opportunity for leadership and voice diminishes in the executive suite. Boards of governance and other leadership bodies benefit from the unique perspective of the largest and most trusted healthcare force of nurses, nearly four million strong. Nurses have expertise to help improve effective health-care systems outcomes at the local, state, and national level.
In media sources, nurses are equally underrepresented and rendered effectively invisible. In 1998, the Woodhull Study by Sigma evaluated nursing representation in health news media. Nurses were identified as sources in a paltry 4% of sources in health news stories for leading newspapers and only 1% of weekly or industry publications. Nurses were never cited in issues relating to health policy. Unlike physicians, nursing quotes were rarely accompanied by a professional photo. Twenty years later, leading national policy expert and nurse leader Diana Mason led a team at George Washington University to revisit the Woodhull Study and see if things had improved. They found nursing representation in the media decreased to 2%! When quoted, nurses usually gave commentary on the profession itself rather than substantive insight on issues of policy, leadership, health systems operations and matters of public health.
Currently, another public health crisis is emerging alongside COVID-19. As the country is torn apart with anger and grief over racial injustices and health inequity, nursing voice is again absent from the narrative. With a holistic practice framework, direct patient care experience, leadership in directing complex care systems, and the trust of the public, nurses are integral to the nation’s health. Nursing is an adaptive, resilient, innovative and honorable profession filled with highly educated scholars, experts, and care practitioners. What nurses want resulting from this pandemic is not free coffee, parades, or even regulated distributions of adequate personal protective equipment, we want our voice to be recognized and respected as much as our care.