Health concerns stemming from bioterrorism, mass casualties in the wake of terrorism and air disasters and war have had enormous and potential impact on the nation's health care system, images of which have flooded the media for the past three months. Professionals in firefighting, rescue, law enforcement and medicine regularly appear in the mass media.

So where has the nursing profession shown up in this national crisis?

"Nurses certainly are often invisible when there are stories like these," said Mary Katherine Wakefield, Ph.D., RN, FAAN, director of the Center for Health Policy, Research and Ethics at George Mason University in Fairfax, Va.

"I tell [nursing] students, 'If you're not mentioned in the story, basically you don't exist in the framing of the news in the public's mind,' " Wakefield said.

Nurses have not received much media coverage since Sept. 11. Even though nurses in New York and in many other states collected supplies and volunteered at hospitals and emergency care sites hours and days after the terrorist attacks, their contributions generally went unnoticed in the media.

Since early September, biological agents such as anthrax and smallpox have become part of the daily news diet, yet nurses have not been recognized for their role in safeguarding the public's health, caring for those affected and preparing for future contingencies.

Linda Strong, Ed.D., RN, assistant professor of nursing at Sacred Heart University in Fairfield, Conn., a community health specialist, has observed the lack of coverage of nurses.

"I don't think the media know enough of what to ask [about how nurses are involved]. The events have centered on terrorism, but the new emerging issues are about community health.

"Community diseases haven't been a major issue for the United States for the past 30 to 40 years. The public doesn't consider nursing when it thinks of these current concerns."

Strong believes that the public and the media still consider public health nursing to consist of home care or of visiting a public health center for treatment of STDs and HIV.

"It's not one of the glamorous occupations in nursing, not like responding to a code in the ER," she said. "Changing this image has to start with the nurses themselves. Nurses need to explain to the media that public health is about understanding the trends and issues confronting people."

Although Strong says nurses have let the media and public continue to hold these faulty images of nurses, particularly those in public health, there is no reason to let those perceptions live on.

"The holidays are coming," she said. "We can take advantage of opportunities to show nursing care and nursing knowledge, to show the media how nurses are involved in the community. Loads of people are hungry and have no clothing. These are two things that precipitate violence, both domestic and even international violence."

Strong recommended that nurses be forthright in contacting newspaper, radio and television reporters to document how nurses are involved in preventing violence, illness and other health issues that grow out of public health problems such as poor nutrition, lack of essentials for survival and mental illness, among many others. Nurses in community health or epidemiology can volunteer as spokespeople to address public health concerns, such as bioterrorism.

"We can effectively portray to the public via the media that nurses are working with people along the life span in the community," Strong said.

Wakefield, who soon will become director of the Center for Rural Health in Grand Forks, N.D., said she wasn't surprised that nurses received so little attention during the national traumatic events this fall.

"Public perception did certainly center around firefighters and police, but nurses weren't featured in that group. I don't see that as a problem, since nurses weren't on the frontline, not with the same intensity as the police and firefighters.

"In this instance, I wouldn't have expected much of a change [in how the media depict nurses]. But in general there's not enough attention paid to nurses and nursing by the media; it's pretty spotty," she said.

Notes on nursing's past
Times of war have given nursing a boost in the eyes of the public through the media.

Nurse historian Beatrice Kalisch, Ph.D., RN, FAAN, professor of nursing and director of the Nursing Business and Health Systems division at the University of Michigan at Ann Arbor, said the image of nursing may yet improve during this crisis, as it has in previous war eras.

"Nursing's image has gone through several different phases," Kalisch said. "It was really positive before and during World War I, when nurses were seen as angels of mercy. The images in the media played off the values we felt were really important then. Maybe those values will become important again."

World War II also strengthened the way the public perceived nurses. "There was a flow of wartime films showing heroic nurses; there were autobiographical films and books about nurses," Kalisch said.

"Nurses were considered essential to the wartime effort," said Elizabeth Norman, Ph.D., RN, FAAN, professor in the doctoral program of nursing at New York University in New York City. Norman is also a historian and author of We Band of Angels, the biographical account of World War II nurses who became prisoners of war of the Japanese.

The media's portrayal of nurses in the decade following World War II didn't uphold the idea that nurses are powerful, Norman said.

Times of crisis
Like Kalisch, Norman thinks that the crisis now enveloping the United States has the potential to bring about a change in the way the media perceive nurses. "During times of crisis, all of a sudden this profession that many people may not consider a primary career choice becomes vital," she said.

Norman expected more mention of nurses in the wake of Sept. 11.

"I find it shocking that there has been an utter lack of mention of nursing. Nurses have been grouped with other health care professionals who worked with victims of the attacks. It's pretty interesting that nurses haven't been singled out, since nurses were all over Manhattan, at the site, ready at hospitals," Norman said.

Nurses as a professional group, Norman said, tend to not publicize what they do or how important their roles are.

"They simply look at what they do as their jobs, not as something special. They're too humble about themselves," she said.

May Wykle, dean of the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, agreed with this assessment.

"Nurses have always been reluctant to come out and talk about what nursing really is," she said. "It's the best-kept secret as a career choice for young people. Why it's a secret is really a puzzle," Wykle said.

Educating the media
Focusing the media lens to bring nursing into sharper clarity is one of the endeavors upon which Sigma Theta Tau International Honor Society of Nursing is concentrating.

In 1997, the organization commissioned the Woodhull Study on Nursing and the Media. In surveying newspapers and magazines, the study concluded that nurses were mentioned only 3 percent of the time in hundreds of health-related articles among 16 major news publications.

The few references to nurses or nursing that did occur were brief, and even when a nurse would have been the prime source for the story, other references were chosen.

Aggressive approach
Margaret Pike, Ed.D., RN, director of strategic development for Sigma Theta Tau, said the situation hasn't changed much since the study was done.

Sigma Theta Tau is addressing this by encouraging and training nurses to be much more proactive in the media.

"The media need to be educated," she said. "It's our responsibility to take the offensive. If the media [do not] ask the provider to speak up, nurses need to say it themselves."

Sigma Theta Tau is the force behind Nurses for a Healthier Tomorrow, a coalition of 32 nursing organizations united toward the goal of improving the media image of nursing. Its print and broadcast campaign, launched in September, seeks to educate the public about the profession and encourage more young people to make nursing a career choice.

That nurses must take the initiative is the attitude of Rick Rodriguez, executive editor of the Sacramento Bee. "Nurses haven't done a good job of selling themselves as a profession," he said. "In individual cases, the media [are] portraying the work of nurses, but there's not a great understanding of the extent of the work and the services that nurses provide."

Rodriguez said one of the few times nurses are in the news is when there's a labor strike.

Nurses in Colorado Springs, Colo., received a fair portrayal in a Nov. 11 article in the Colorado Springs Gazette describing the local effects of the nursing shortage.

Reporter Bill Radford, who wrote the story with Ed Sealover, said he initiated the idea.

Radford said a few nurses had contacted him with favorable feedback about the article. He said he occasionally receives story ideas from nurses and is always open to such input.

---

Building blocks

Conclusions from the Sigma Theta Tau Woodhull study offer concrete ideas on how nurses can begin to think and plan for attracting better, more accurate and in-depth media coverage.

"Nurses cannot expect the media to cover nursing simply as a public service," according to the study. "Nurses must recognize the news value of what they do. The media and the nursing profession must educate each other. Important practice innovations and laboratory discoveries in nursing must be shared with the public.

"Thus, communicating the important contributions of nursing for building healthier communities is an essential component in all communication strategies. All nurses, whether in clinical practice, research, education or administration, must learn the skills of public communication in order to inform the public.

"By telling their 'stories' in terms that are understandable to the general public, nurses can dispel commonly held stereotypes that have inhibited the leadership potential of nursing."

~Karen Schmidt, RN

---

Take the initiative

"The media do not realize that the largest group of health care providers is nurses," said Mary Katherine Wakefield, Ph.D., RN, FAAN, director of the Center for Health Policy, Research and Ethics at George Mason University in Fairfax, Va. "We have to do a better job of reaching out to the media."

• Classes on public speaking are not a prerequisite for being a change agent in the way the media and the public view the nursing profession. Wakefield suggests that one easy way to reach out is to participate in the news. "When you hear a radio talk show about a health issue, call in, identify yourself as a nurse and contribute your expertise and insights to the discussion. There's not much heavy lifting involved in that."
• "Write letters to the editor, both to comment on current issues and to introduce new ideas to the media." Wakefield said that while it's more difficult, nurses also can contact the local health reporter and explain what health care issues the nurse sees in his or her area and ask the reporter to cover it. "Don't wait to be called, but do the calling and identify yourself as a resource on a particular topic. Build a relationship with a reporter or newspaper. Positive reinforcement of what the media is doing to enhance nursing's image is essential also, said Beatrice Kalisch, Ph.D., RN, professor of nursing at the University of Michigan at Ann Arbor.
• Local television stations, especially outside the major cities, generally are looking for stories. Wakefield advises nurses to call and suggest a story, on a particular situation in the community, issues on access to care or a breakthrough in the local health care delivery system.
• In larger cities, nurses can offer themselves as spokespeople or resources to the public relations staff of their health care facility and take part in the news process. Wakefield added that the nursing shortage is a pertinent story for every part of the country. Nurses can arm themselves with facts published by the American Nurses Association and other credible sources, then tell news gatherers how the shortage is affecting their local health care systems.
• Face-to-face contact with the media is necessary for both the news gatherers and the public to begin to understand what nursing is about, said Elizabeth Norman, Ph.D., RN, FAAN, professor in the doctoral program of nursing at New York University. Even though nurses tend not to want to talk about themselves and their work, doing just that is the only way to promote change.

Sigma Theta Tau's initiative to improve the profession's image is based on nurses being educated in media relations. Among the suggestions in the organization's package for nurses seeking to prepare for media interviews:

• Know why you are being interviewed and what message you want to deliver.
• Anticipate difficult questions and practice how you will respond. If you don't know how to answer, don't speculate; offer to get accurate information for the reporter.
• Use easy-to-understand examples and avoid jargon.
• Avoid sarcasm.
• Bring energy into the interview by thinking in the active voice.
• Repeat the key message often.

~Karen Schmidt, RN