Nurses have made vital contributions to health and health care for generations and are essential players today. Nurses outnumber doctors by almost 3 to 1. So why are nurses missing in action when it comes to health news stories?
A landmark study conducted in 1997 painted a dismal picture of nurses and nursing in the media. The title of the report, “The Woodhull Study on Nursing and the Media: Health Care’s Invisible Partner,” says it all. The study was the brainchild of Nancy Woodhull, founding editor of USA Today, who died of lung cancer before the study was completed. She was struck by the contradiction between the excellent nursing care she received and her observation of the minimal coverage of nurses and nursing in the media.
A working group of nearly 20 researchers analyzed health news articles published in the leading print newspapers, weeklies, and trade publications of the day for the month of September 1997. The results confirmed what Woodhull suspected: Nurses were largely absent in media coverage of health issues. Just 4 percent of quotes in newspapers and 1 percent in weekly and industry publications were attributed to nurses. They were almost never included in photos that accompanied the news articles. And nurses were mentioned in only 14 percent of the articles.
Fast forward 20 years. An updated Woodhull report revealed that little progress has been made. This report looked at health news stories published in September 2017 that appeared in the same sources used in the original study. Quotes were attributed to nurses just 2 percent of the time, they were identified in 4 percent of the images, and were mentioned in 13 percent of the articles. Nurses were wholly absent in many stories in the sample despite the relevance of a nursing perspective to the topic. Nurses were most invisible in stories about policy, the business of health care, and research.
The findings of the second Woodhull study showed major gender differences. Men were quoted almost twice as often in the health news stories sampled compared to women (65 percent compared to 34 percent), and images of men outnumbered those of women 72 percent to 28 percent.
These findings are consistent with the results of other studies, which together show that most conversations in the public sphere are echo chambers with the same narrow range of white male voices dominating. It is hard to ignore the relative absence of nurses and the fact that 90 percent of nurses are female.
Here’s a non-nursing example: In a recent commentary on the absence of women in media discussions about nuclear weapons policy, Alexandra Bell and Kelsey Davenport coined the term “marticle” (man article) to describe the preponderance of articles on nuclear weapons policy that feature only male sources despite the growing prominence of women negotiating nuclear agreements, running nuclear laboratories, and a woman winning a Nobel Peace Prize for her efforts to abolish nuclear weapons.
To better understand why there was essentially no change in the representation of nurses in the media between 1997 and 2017, the Woodhull 2 team interviewed 10 health journalists. They revealed that they and their newsrooms infrequently reached out to women, nurses, and people who were not in positions of authority in the health industry. Some said they had to justify to their editors using a nurse as a source. Others were confused about what nurses actually do. Several of the interviewed journalists who did use nurses for a story noted that the nurse perspective enriched the story.
The message was loud and clear: Nurses are not viewed as experts or as key leaders, and so are not good sources. The lack of nursing representation in the media is part of deep-rooted gender disparities in the media.
In the other direction, contacts at health care organizations, academic institutions, and nursing associations do not promote nurses as subjects for stories on health and health care or sources for them.
Nurses make up the largest segment of the health care workforce and have the closest and most sustained proximity to patients. In Gallup polls, they are repeatedly voted to be the most trusted profession. Over the years, nurses have helped improve access to care; blazed new paths in telehealth, informatics, technology development, and genomics; worked to reduce medical errors and improve patient safety; promoted wellness and expanded preventive care; engaged in research with practical applications and impact; and more. In short, nurses have helped transform the delivery of health care to meet the challenges of a graying and increasingly diverse population.
Yet their visibility in the media and influence in policymaking are not commensurate with their numbers, position, and expertise. Journalists owe it to their readers to pay attention to the diversity of their sources. Increasing the diversity of sources to better reflect the interests and perspectives of media consumers enhances the value of content.
There are many things that nurses, the institutions in which they work, and their professional associations can do to be strategic about engaging journalists. For starters, they need to respond more quickly to reporter’s questions, something the Woodhull 2 report showed was a problem. Reporters working on deadlines need information fast, and are quick to move on to other sources, often male non-nurses. Reporters and other people seeking information frequently overuse the most visible “experts.” Nurses and their supporters can help broaden their definition of expert and expand the pool by transcending their reticence to stand up as experts and leaders.
Nurses need to claim their professional authority, expertise, and experiences and proactively engage with the media. Standing up and standing out can make you a target. This has never deterred nurses in doing what they had to do to improve health and health care. It shouldn’t in the media, either.
Carole R. Myers, R.N., is a senior fellow with the George Washington University Center for Health Policy and Media Engagement and an associate professor at the University of Tennessee College of Nursing and Department of Public Health.