Nursing has been identified as an “emerging profession” for at least 150 years. The historical context of nursing’s image is often traced back to Florence Nightingale, the “founder of nursing.” Florence Nightingale is recognized as a nurse, statistician, and writer who became known for her groundbreaking work during the Crimean War. Nurse Nightingale was also called the “Lady with the Lamp,” as she was reported to have made rounds on her patients at night by the light of a lantern. International Nurse’s Day is celebrated each year on her birthday, May 12, and the Nightingale Pledge is still recited by new nursing graduates around the world, often with the accompaniment of flickering candles in symbolic lamps. Even though much has been written about Florence Nightingale’s many contributions, she is undeniably remembered as the pioneer of nursing education (Bostridge, 2008).

The image of professional nursing continues to evolve and is significantly affected by the media, women’s issues and roles, and an ever-evolving high-technology health care environment. How nursing views itself in the evolution of the profession and how actively nurses are involved in the definition process will continue to determine the image and role of nursing in the future.

In a 2008 study on public perceptions of nursing and factors that influence these insights, the study determined a personal experience with nurses either as a patient or with a family member was the leading influence on perceptions of nurses and the profession of nursing (Donelan et al., 2008).

There is a new, innovative approach to recruiting and retaining more men into nursing, seeking a more gender-neutral attitude. The American Assembly of Men in Nursing (AAMN) has initiated the marketing campaign “Advancing Men in Nursing” with materials highlighting the camaraderie and opportunities available to men entering the profession. The professional, skilled, compassionate male image portrayed in posters and advertising is designed to break down the stereotypes typically associated with men in nursing (Stokowski, 2012). As more men enter the profession and there is a push to increase minorities in nursing, will the image of nursing change (Critical Thinking Box 9.1)?

Nurses should be thought of as autonomous and competent decision makers within their nursing practice areas. Throughout the 1990s, a nationwide advertising campaign supported by the National Commission on Nursing Implementation Project produced radio and television ads that said, “If caring were enough, anyone could be a nurse.” Nurses of America, an advocate organization sponsored by the National League for Nursing (NLN), implemented a very successful program directed toward improving the image of nursing as depicted on television, on radio, in print, and on lecture circuits. Consultants were contracted to work with executives, politicians, and celebrities to present nursing in a positive manner. This approach reinforced the image of the modern professional nurse as having critical thinking, evidence-based decision-making, and problem-solving skills.

At a nursing symposium in May 2012, it was noted that while the depiction of nurses in the media can affect how the public views nurses, it is truly up to each individual nurse to be proactive in presenting nursing as a respected profession (Muehlbauer, 2012). The American Academy of Nursing (http://www.aannet.org/raisethevoice, 2014) through the Raise the Voice campaign has brought nursing policy innovators to the forefront of health care policy debates. A concentrated effort by individuals and organizations is raising awareness of what nurses do and heightening the image and voice of nursing as a profession. As noted by Groves (2007), accurate portrayals of nurses as professional members of the health care team are rare, but it takes time to change perceptions. The continued trend of building a positive, intelligent, competent, and professional image of nursing must continue. Nurses who are new to the profession need to be aware of the extraordinary challenges and opportunities that they will face. It is equally important for nurses to improve the self-image of the professional nurse. The behaviors and ethics displayed by nurses on a day-to-day basis can do much to elevate the present and shape the future image of nursing (Cohen & Bartholomew, 2008).

Nursing associations are working together to promote a positive image and to handle nursing shortage issues. Nurses for a Healthier Tomorrow, an alliance of 43 nursing and health care organizations, has launched a national media campaign that demonstrates, through print and broadcast media, the many opportunities for the career of nursing. One tangible example of this effort is the website www.nursesource.org. Sigma Theta Tau International, the international honor society for nursing, is the coordinator of Nurses for a Healthier Tomorrow. Review their website at www.nursingsociety.org. The American Nurses Association published a flyer titled Every Patient Deserves a Nurse, along with other promotional materials for the lay public. The promotional message of these materials reinforces the positive image of nurses as patient advocates and critical resources both to patients and families, while also emphasizing the right of people to a safe health care environment.

In 2002, the Johnson & Johnson Company developed a nationwide campaign to support the nursing profession. This program, titled “The Campaign for Nursing’s Future,” was developed along with health care leaders and nursing organizations such as the National Student Nurse’s Association (NSNA), the American Nurse’s Association (ANA), the American Organization for Nurse Executives (AONE), the National League for Nursing, and Sigma Theta Tau. The goal of this program is to increase the number of young adults entering nursing through raising the visibility of nurses of varied races, gender, and roles. The website for the campaign can be found at www.discovernursing.com.

The negative images of nursing, those of the “naughty nurse” or the “Nurse Ratchet” that are depicted in the media, are still prevalent, but these erroneous portrayals do offer professional nurses the opportunity to educate the public about what nurses truly do. Nursing is not the only profession that struggles with a skewed media image. Some of these erroneous depictions may be related to the largely female population who seeks these professions; consider the sexual media images that are often illustrated by flight attendants, massage therapists, or secretaries. Other occupations that suffer from poor media portrayals include the “mad scientist” role (chemist or researcher), construction worker (often a sexual male image), or consider the negative images that both female and male lawyers are often faced with! Devaluation of the nursing profession by demeaning or comical images only extends the nursing shortage and further discourages talented people from entering the nursing profession. It is up to each individual to continue to display professional role modeling and provide public education on what nurses really do to empower the professional image of nursing (Cohen & Bartholomew, 2008).

How can nurses change the image of nursing? How can the image of nursing become more congruent with the actual role the nurse plays in today’s rapidly evolving health care environment? Nurses outnumber all other professions in health care. Mee (2006) suggests that nurses can promote the professional image of nursing by doing the following.

In Caplow’s classic work from the early 1950s, The Sociology of Work (Caplow, 1954), several steps in the process of “becoming professional” were defined further, and the value of forming an association that defined a special membership was addressed. Caplow suggested that making a name change to clarify an area of work or practice would subsequently produce a new role. With the creation of this new role, the group would then establish a code of ethics and legal components for licensure to practice and educational control of the profession (Caplow, 1954). This process of becoming professional was taking place in nursing in 1897 with the establishment of the ANA. Other aspects of professionalization were also beginning to develop. For example, the Code for Nurses was suggested as early as 1926, although it was not written or published by the ANA until the early 1950s. Revisions were made in 1956, 1960, and 1976, with changes made in 1985 that included interpretative statements. In the summer of 2001 at the ANA convention, delegates again updated the code and changed the name to the Code of Ethics for Nurses with Interpretive Statements. The American Nurses Association deemed 2015 the Year of Ethics and issued an updated Code of Ethics with Interpretive Statements found at http://nursingworld.org/MainMenuCategories/EthicsStandards.

Almost 20 years after Caplow’s work, Pavalko (1971) described eight dimensions of a profession. Pavalko’s dimensions of a profession and their specific application to nursing are examined in more detail later in this chapter. Nursing continues to apply these dimensions to support nursing’s move away from the occupational focus to a professional focus. Is nursing a profession or semiprofession?

By responding to the questions in Critical Thinking Box 9.2 (which presents Levenstein’s model, a fourth model of professionalism), you will identify common themes in describing a profession. What are your thoughts about the nursing profession in light of these criteria?

Others have written about professions and their development, but these sociological models present some logical characteristics for you to use to examine professionalism. According to Henshaw, a noted nursing leader and researcher, a profession includes “self-regulation and autonomy with ultimate loyalty and accountability to the professional group” (cited in Talotta, 1990). Nursing is a dynamic profession and continues to strive to enhance a professional image—which leads us to the next question.

There are approximately 2.9 million registered nurses in the workforce with an average age of all licensed RNs increasing by about 2 years for RNs, and about one-third of the current nursing workforce is older than 50. The RN supply is anticipated to grow by 952,000 full-time equivalents (FTEs)—from 2,897,000 FTEs in 2012 to 3,849,000 FTEs in 2025—a 33% national increase (U.S. Department of Health and Human Services, 2014).