The Imperative to Change the Perception of Nurses

Sep 26, 2011, 1:34 PM, Posted by

By Susan Hassmiller, PhD, RN, FAAN
RWJF Senior Adviser for Nursing and Director, Future of Nursing: Campaign for Action


Last summer, I took one of the most rewarding trips of my life: a European tour of key sites in the life of Florence Nightingale, the founder of modern nursing and one of the great leaders in improving health and health care worldwide.

So why is it that now, more than a century after Nightingale’s death, nurses are underrepresented in the rooms where we make decisions about how to improve the health care system? Very few of us hold executive-level positions in health care organizations, very few are voting members of health care boards of directors, and very few sit on the editorial boards of health care journals.

We can—and must—change this reality, and our nation’s opinion leaders agree. A 2009 survey conducted by Gallup on behalf of the Robert Wood Johnson Foundation (RWJF) found that an overwhelming majority of opinion leaders—including insurance, corporate, health services, government and industry thought leaders as well as university faculty—want nurses to have more influence in our health care system. The survey captured the feelings of more than 1,500 opinion leaders and was published in a recent edition of the Journal of Nursing Administration.

While opinion leaders said nurses don’t have enough influence over health reform, they did say that nurses have a great deal of influence over key elements of a quality health care system, such as reducing medical errors, improving safety, and improving the quality of patient care.

We nurses also have valuable insights to share. Nurses spend more time providing direct care to patients than other providers, work closely with caregivers and family members, and see patients in their broader social environments. As such, we have a unique understanding of the complex interplay of environment and health, and we have perspectives on health from a variety of settings: the hospital, the clinic, the community and the home.

In addition, nurses are highly valued by the public; nursing is consistently ranked among the most ethical and honest professions by the nation’s adults.

So how do we ensure that nurses’ voices are heard in the rooms where key decisions are made? One key way is to change the perception of nurses. Our Gallup survey found that nurses are not perceived as important decision-makers or revenue generators. When asked how much influence certain groups will have over health reform in the next five-to-10 years, opinion leaders ranked nurses seventh out of seven choices. Dead last.

In short, opinion leaders see us in our traditional—but limited role—as bedside clinicians, but not in more expansive and influential roles as health care leaders.

As a nurse, and a health care leader myself, I take objection to this view—and am working diligently to correct it through the RWJF-supported Future of Nursing: Campaign for Action. The Campaign is working to implement solutions to the challenges facing the nursing profession and to build upon nurse-based approaches to health care. Our work is grounded in the report released last year by the Institute of Medicine about the future of the nursing profession.

For this campaign, I am traveling around the country to meet with nurses and others who are working to redesign the health care system. The nurses I meet are doing their part to change the perception of nurses as mere low-level players in the health care system.

We should all make that our mission. If nurses are to become leaders who help shape our health care system in this time of transformation, we must speak out and set high expectations for ourselves. One of the best ways to change the perception that nurses occupy the lower rungs of the health care hierarchy is to change the unfortunate reality on which it is based. If nurses have more equal representation where decisions are made—in board rooms, in policy circles, in publishing and elsewhere—our health care system and our country will benefit.

If Florence Nightingale could break through the constraints of her restrictive culture more than a century ago to take a leading role in health care, we 21st century nurses surely can do the same today.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.