At a party where the conversation naturally turned to occupations, Kimberly Betzler, MSN, NP, RN, braced herself for The Question. "Oh, you’re a nurse?" her inquisitor said, genuinely pleased at the news.

Then with a crinkled nose, "I don’t think I could deal with all those bodily fluids—I don’t think I could be a nurse."

Most people generally are happy to learn that someone is tending to the sick and needy, but they’re equally happy it’s not them, said Betzler, a nurse practitioner at Richard L. Roudebush VA Medical Center in Indianapolis.

Recent surveys illustrate the dichotomy between the public’s perception of nursing as a noble profession, and an equally strong opinion that nursing is difficult and often unpleasant.

A Gallup Poll released in November found that, for the second year in a row, the public believes nurses have the highest standards of honesty and ethics of any profession.

But the Jobs Rated Almanac 2001, published by St. Martin’s Press, rated nursing as the 137th most desirable job out of 250 professions.

Nurses and nurse advocates say they’re not surprised by either ranking. The findings, they say, reflect the close relationship between nurses and patients as well as the stressful, physically demanding environment in which they work.

Great news
"I think that’s great," said Kathy Geudtner, RN, a medical-surgical nurse at Children’s Hospital and Health Center-San Diego, about the Gallup Poll results. "I’m glad we came out No.1 in something."

About 79 percent of Americans say nurses have high or very high ethical standards. Pharmacists, who ranked second with 67 percent, had consistently finished first until 1999, when nurses were added to the list.

"I guess that the survey proves that the compassion nurses have for their patients comes through," said Hope Hall, a spokeswoman for the American Nurses Association. "It shows that nurses are committed people who care about their patients and that they’re out there advocating for improved patient care."

The top ranking is due, in part, to the caring role nurses play in what are often life-altering times, such as the death of a loved one, onset of a life-threatening illness or childbirth, said Jean Phillips Truscott, M.Ed., RN, vice president for patient care services/chief nursing officer at Mercy Medical Center in Durango, Colo.

"They value that caring that is the essence of what we do," she said. "We are the person the patient knows is going to be there for them."

Positive reinforcement from the general public is appreciated, Betzler said, and even enhances job performance. Everyone wants to think their job is valued, she said, and feeling as though your work is important and respected can’t help but inspire you.

Nurses can use all the help they can get in keeping their spirits up in an increasingly difficult profession. The Jobs Rated Almanac ranking was based on workplace environment, income, future prospects, physical demands, job security and stress, as well as government data on wages, length of workday, hiring trends and the author’s assessment.

Shirley Adriance, MSN, RN, a nurse manager on an adult medical surgical unit at Val Verde Regional Medical Center in Del Rio, Texas, says she’s not surprised by the ranking.

The pay, long hours and heavy workloads contribute to the profession’s modest ranking, and the general public is aware of those conditions, Adriance said. School counselors advise students as early as middle school to avoid the nursing profession, she said.

"They say, ‘You don’t want to go into nursing because of the hours and pay.’ They steer them toward other careers, so there are fewer nurses to do the work," she said.

Antiquated facilities and a lack of equipment, staff and advanced practitioner support also make the job harder, Truscott said.

Mandatory overtime, 16-hour shifts and improperly staffed units were factors listed in an ANA survey that found that more than 54 percent of nurses wouldn’t recommend their profession to their children or friends, Hall said.

Nurses are frustrated by the growing influence of insurance companies that have taken many health care decisions out of the hands of practitioners and given them to bureaucrats who often base their decisions on cost, Geudtner said.

She points to a decision to use a particular blood glucose meter for diabetic children when others might be better suited for some children and families. "Unfortunately, the insurance company says you have to use this kind of meter because this is the one [they’ve] decided to pay for," she said.

Despite the problems, Truscott believes nurses will continue to do the best they can with what they have, and that dedication contributes to what might otherwise be an even lower ranking.

"That we do make an effort keeps us from being at the absolute bottom of the pile," Truscott said. "We are very skilled in doing the best we can with what we have."