The Invisible Providers

We know nurses are the largest segment of the healthcare workforce. So why don’t we see them in the news?

By Jennifer Garrett

They seem to be everywhere. Schools. Clinics. Hospitals. Community organizations. As the largest segment of the healthcare workforce—the American Nurses Association estimates that there are 4 million practicing nurses in the United States—nurses have quite a presence in our lives. That is why it is particularly shocking that they have virtually no presence in the media.

In 2017, a team from George Washington University replicated a study from 1997 on nursing’s representation in mainstream health stories. Two decades ago, only four percent of those stories featured nurses as sources of healthcare information. Last year? Two percent.

Barbara Glickstein headshot
Barbara Glickstein, co-author, the Woodhull Study Revisited, courtesy of the author.

While the change is insignificant—within the margin of error, so statistically irrelevant—the number itself is striking. Some numbers have nurses comprising 80 percent of hospital provider staffs. They have the most constant and direct interaction with patients. And yet what nurses know from all this patient interaction is not informing the stories that inform the public about important health, safety, and wellness issues.

Barbara Glickstein is one of the authors of the Woodhull Study Revisited, the report that revealed that nurses are nearly invisible in mainstream media. A seasoned public health nurse and media consultant, Glickstein says the lack of nursing voice and perspective in health journalism is concerning not only for nurses but also for the public, who stand to benefit from learning what nurses know.

“There is a huge imbalance in the number of nurses’ voices in the media. Nurses have stories to share that are on the margins and often missed by health reporters,” she says.

Two Events Will Explore Nursing and Media Presence

Glickstein will headline a panel on nurses in the media at the UW–Madison School of Nursing on April 25. That panel also features local public radio journalist Shamane Mills, School of Journalism and Mass Communications Associate Professor Katy Culver, and School of Nursing Associate Dean Dan Willis. The following day Glickstein will sit on another panel about how the #MeToo movement has influenced journalists at the annual UW–Madison Center for Journalism Ethics conference.

Both events, Glickstein says, are opportunities to raise awareness about how nurses can broaden health issues beyond the individual to include social and cultural factors that influence disease, health, and wellbeing.

“Many sources in news coverage discuss solutions that focus on individual behavior change. Nurses are equipped to tie compelling stories about individuals and the need for individual interventions and treatment to broader landscape stories about policy solutions and highlight solutions that address issues including racial and health inequities,” Glickstein says. “Nurses can describe the problem and can connect the dots to bigger social issues, like housing, jobs, and violence in communities.”

Linsey Steeg
Associate Professor Linsey Steege (right) is a human factors engineer who studies nurse fatigue. She works with nurses at UW Hospital, including Christina Butzine (left), to identify ways to reduce nurse fatigue and improve the hospital work environment. Photo by Alex André.

Nurses are also strikingly absent in stories about healthcare practice and delivery. Linsey Steege is a human factors engineer and associate professor in the School of Nursing. She studies the ways health systems—particularly their workflows, staffing models, and systems—affect nurse fatigue. An avid consumer of journalism about medical technology, she is both concerned yet not surprised that nurses are missing from most of the stories she reads.

“Nurses are high users of medical technology, and yet much of the technology I have studied was not designed for the way nurses work,” Steege says.

“When their feedback on how technology interrupts their work or limits their ability to provide appropriate and necessary care because of the time it takes or the way it operates is lost, nurses suffer. They are more fatigued, which can lead to dangerous or expensive mistakes. They become burned out, which drives them from the profession at a time when we need more nurses. Ultimately this all affects the quality of patient care. Health systems, technology designers, the public—we all benefit when we hear what nurses experience and know.”

What We See Is What We Get

“Nurses need to own nursing. We are licensed, educated professionals who serve a distinct and vital role in healthcare delivery,” McGranahan says.

Pam McGranahan, DNP, RN Clinical Assistant Professor, DNP Program Director
Pam McGranahan, DNP, RN Clinical Assistant Professor, DNP Program Director. Photo by Alex André.

Another part of the problem, according to Pam McGranahan (pictured right), isn’t that the media does not ignore nurses altogether. While journalists may not speak to nurses, media outlets allow other providers and disciplines to speak for nursing and about nursing. McGranahan, a former public health nurse and director of the School of Nursing DNP program, says this is both a result and the cause of the confusion regarding what nurses do and what their role in healthcare delivery is.

“Nurses need to own nursing. We are licensed, educated professionals who serve a distinct and vital role in healthcare delivery,” McGranahan says. “We are not support staff for other disciplines. Nursing is its own profession and has its own scope of practice. ”

McGranahan’s other concern is that what is presented about nursing in the media represents only a fraction of what nurses do and leaves out the rationale behind much of the practice. For example, the tear-jerking, heart-wrenching stories about nurses reinforce the misconception that nurses primarily provide emotional support to patients.

And she is not discounting emotional support. “Patients fare better when they are comfortable, when they are not anxious. Distress exacerbates almost every condition,” McGranahan says. “Yet what is missing from the narrative is the why behind the caretaking work.”

In other words, nurses perform some of these caretaking tasks not because nurses are kind, loving people, but because they are consciously and intentionally trying to support a patient’s health, minimize suffering, and promote healing. So, yes, a nurse might hold a patient’s hand to help her feel at ease. That nurse is also checking to see if the patient’s hand has become cold or clammy, which could indicate a change in status. The nurse might adjust a pillow and help a patient sit upright to support proper lung function. Nurses ask questions about family in part to ascertain who might be able to support patients when they return home. They ask about pets not because they love cats but because a pet left home alone might cause the patient unnecessary worry and distress, which could slow recovery.

“Nursing is nuanced, sometimes subtle, but it is not arbitrary,” McGranahan says. “The stories we all consume about what nursing is leave so much out, but we all hear them. And it isn’t just the lay public that begins to adopt them. Nurses do, too. The public might never have really understood what nursing is or what nurses do, but for nurses it is almost worse. Many of us did know. But if we don’t correct the false narrative, even nurses risk forgetting who we are.”

Do You Know What Nurses Know is co-sponsored by the Center for Journalism Ethics and the UW Women at 150 campaign.

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