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failed to convince the general public of the depth and breadth of our practice and what then mustunderpin that in the way of knowledge and skills if we are to provide safe, individualised, effectivecare? Gordon’s 15 view is that most members of the public haven’t got a clue what we do. If theyunderstood that then we wouldn’t have politicians deciding they can get votes by ‘sorting out’nursing.Granted it is difficult to get someone to appreciate the more subtle, less obvious aspects of skillednursing care in its entirety or to even realise that it has occurred. Patients who have been seriously illand their families are probably in the best position to gain this understanding, provided they haveskilled and knowledgeable nurses caring for them. But the general public’s image of us is primarilygenerated by the media. Despite some improvements in recent times, we are still seen primarilyas merely carrying out doctors’ orders with a few other plot lines thrown in to make it interesting –personal issues, sex, life threatening errors, etc.During the time I was writing this paper I watched several episodes of ABC Compass – HospitalChaplains. 16 There was one particular female chaplain serving the intensive care wards at Royal NorthShore Hospital who I thought conveyed the complexity of her role extremely well in an authentic,direct way. I sat there thinking I wish we could get something similar made to portray nursing thiswell. The series produced by SBS several years ago RAN: Remote Area Nurse 17 did a good job ofnot only portraying the professional side of their challenging role but also the personal aspect in abalanced way, avoiding stereotypical representations. Trouble is, how many of the general publicwatch the ABC or SBS – less than one in five.All this sounds ‘glass half empty’. Let’s look at the ‘glass half full’ version of nursing‘s image. There are Ibelieve some positive signs that the portrayal of nurses and nursing is becoming more professionaland reality-based. David Stanley, 18 a former colleague of mine, concluded, after conducting aqualitative analysis of 280 feature films produced between 1900 and 2007, that more recentfilms increasingly portray nurses as strong, capable, intelligent, independent and self-confidentprofessionals. This was in contrast to early films which pictured nurses as self-sacrificial heroines, sexobjects and/or romantics. However, I’m sure you all share my view that the portrayal of nurses intelevision ‘soapies’ still has some significant catching up to do.According to numerous polls, the public trust us; we’re seen as honest and ethical. In 2011 nursingagain topped the Morgan poll 19 seeking public perceptions of 28 professions – that made it 17 yearsin a row. Trust is essential to the work we do but is it sufficient? No, according to Gordon 15 – not ifthe public don’t really grasp what our practice entails. Gordon talks about the ‘trust trap’ – that it canlull us into thinking that because we are trusted then there is no need to inform people about ourwork, but trust does not equal knowledge and understanding. Her suggested corrective strategy isfor nurses “to talk, in detail, about what they do in their daily work”, 15, p.1 not just a once off but on acontinuing basis. Perhaps we all need to do that with our local parliamentarians as a starting point.8 RCNA The 46th Patricia Chomley Memorial Oration 2012
OrationRCNAHow do other health professionals perceive us? The results from a series of surveys20 the CurtinSchool of Nursing and Midwifery conducted in the last decade of graduates, one year and threeyears after commencing employment as a nurse, provide some insights in how clinical nurses mightanswer this question. Between the first and third survey – a period of seven years – the respondentswere significantly more likely to report respect and appreciation from other health professionals –an increase from 34% to 50%, and 33% to 49% respectively. But this is barely a ‘glass-half’ – full orempty. Their perceptions of whether the nurses were well regarded and respected by the public inthe three surveys ranged from 49–66% and 52–70%. However, their rating of nursing as a prestigiousprofession ranged from 12% to 28% agreement.I’m not sure whether to include, from the image perspective, the advent of nurse practitioners in this‘glass half full’ section. By all reports the public who attend accident and emergency departments inWA hospitals where they are employed have taken to them in a very positive way, even if the AMAhasn’t. A number of studies 21, 22, 23 have found that client satisfaction with nurse practitioners in anumber of different clinical settings is consistently high. But the question is: Do the public perceivethem as delivering nursing care or, despite the title, perceive them as a mini-doctor?In the academic world my personal experience has been that nursing’s image, or perhaps moreaccurately the image of nurse academics has changed quite significantly but this assessment is basedon an ‘n of 1’. It had to change – we were coming off a base of less than zero in the mid-1970s. Letme illustrate this claim. On arriving at work one day in my first week at what was then the WesternAustralian Institute of Technology, we were greeted by large sheets of brown paper plastered overthe walls of the Architecture building, in which our basement offices were located, inscribed withcomments such as: “Go back to your hospitals and bedpans”. Needless to say this had the oppositeeffect – we were staying put no matter what. I look back now from a point where we have nursesacross the nation in very senior university positions, including a Vice-Chancellor, as chief investigatorson large research grants, undertaking research assessed as world class or above, and winningnational teaching awards for innovative teaching and learning strategies, and I marvel at the changes.But that change was the result of courage, persistence, lots of hard work and learning from ourmistakes in this totally different culture.A third area I would like to touch on is the relationship between research and clinical practice.Until relatively recently the general consensus was that there was an almighty void between thetwo that appeared to many to be unbridgeable despite their efforts. My observation is that in thelast decade we have managed to bridge that gap, albeit the bridge might be lightly constructedand a bit wobbly but with more support will carry more and more two way traffic. The destinationis evidence informed nursing care. I base the claim that I’m about to make on observation but Ithink it is still a reasonable claim: the two health care professions in Australia that have adopted theconcept of evidence-based practice and then applied it most widely are nursing and midwifery. I alsoThe 46th Patricia Chomley Memorial Oration 2012RCNA9
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