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The prestige of today's nurse
AORN JOURNAL
JULY 1989, VOL. 50, NO 1
Research Reviews
PRESTIGE The prestige of today’s nurse E Martin Nursing Management Vol20 (March 1989) 8OB-8OP
As answers to the nurse shortage are sought, the causative factors already identified will continue to be researched. Status, recognition, and respect are words used to describe what nurses seek in the work environment. Prestige, as perceived by nurses, physicians, and hospital administrators,was the focus of this study. A random sample of 300 RNs, 300 physicians, and 154 hospital administrators was selected from appropriate rosters in North Carolina. Each subject was mailed a questionnaire, and approximately 41% (309) responded. Hospital administratorshad the highest rate of return (5 1%) followed by nurses (41%)and physicians (35%). The tool, which was developed by the researcher, was tested for content validity. Its intent was to measure how the respondents perceived an occupation ranked with respect to seven specific prestige-relatedjob characteristics: (1) importance of the work to society, (2) education and training necessary to practice, (3) difficulty of the job, (4) complexity of the work, (5) supply of personnel, (6) authority of the occupation over itself, and (7) income of the average worker. This was significant because measuring prestige by a subjective approach reflects an attitude that is then communicated to the members of that profession. Subjects were asked to compare the seven characteristics for nine health occupations: physical therapist, respiratory therapist, pharma-
cist, dietitian, physician’s assistant, social worker, physician, hospital administrator, and registered nurse. A seven-point scale with polar adjectives at either end was used. Nurses’ perceptions of nursing gave high rankings to importance of the work to society, difficulty, and complexity. Education and training necessary to practice was rated in the middle. Authority, income, and supply of personnel were rated low. The mean prestige score given by nurses to nursing was 3.53, a moderately low prestige score. In terms of importance to society, physicians who were sampled rated themselves, nurses, and administrators highest with the lowest rank going to physician assistants. The education and training necessary to practice was rated high for MDs and RNs. Nurses were seen as the scarcest health professionals and those receiving the lowest income. Physicians rated hospital administrators as having the highest authority followed by physicians, pharmacists, and nurses. Although physicians rated nurses second to themselves in importance and amount of education, they indicated that a nurse’s job was not as difficult or complex as that of a physician or administrator. Administrators considered their jobs to be the most difficult and complex but not as important to society as physicians and nurses. They rated nursing as not being as difficult and complex as that of either the physician or administrator. The amount of education necessary for a nurse to practice was equated with a physician assistant at the bottom of the scale. The prestige rating was fifth for nurses; physicians, administrators,and pharmacists were ranked the highest. A general analysis comparing the mean scores 165
AORN J O U R N A L
for the three groups revealed that (1) physicians rated nurses’ education significantly higher than did nurses or administrators, (2) administrators rated nurses income higher than did nurses and physicians, (3) administrators and physicians rated the nurse’s authority and prestige significantly higher than nurses did, and (4) administrators rated the nurse’s importance significantly lower than did nurses and physicians. The author stated that, in general, nurses are low in authority, receive inadequate income, and have the lowest prestige of the health professions studied. The findings indicate that perceptions among the three major health professionals differ significantly in that physicians and administrators usually were in agreement with each other but not with the nurses. Perioperative nursing implications. As perioperative nurses struggle with nursing shortage problems, it is important that physicians and hospital administrators perceive our work as we do. If there is a major difference in how nurses are perceived and valued, obtaining meaningful solutions will be impossible. The results of this study give all perioperative nurses food for thought. How we feel about ourselves influences our image and, ultimately, how others see us. Reviewing the complete results of this study should give impetus to perioperative managers, educators, and staff nurses to examine the perceptions of nurses, physicians, and hospital administrators in their respective institutions. SUZANNE F. WARD,RN, MN, CNOR NURSING RESEARCH COMMITTEE
SUBSTANCE ABUSE Nurses’ attitudes toward impaired colleagues B L Cannon, J S Brown Image: Journal of Nursing Scholarship Vol20 (Summer 1988) 96-101 Alcohol and drug abuse are crucial and prevelant problems in US society. Although most nurses are familiar with statistics related to substance abuse in patient populations, few perceive them in relation to their colleagues. 166
JULY 1989, VOL. 50. NO 1
Previous research has shown that nurses’ attitudes are influenced by societal stereotypes that typify alcholics and drug addicts as irresponsible, weak-willed, and immoral. Many nurses react negatively to substance-abusing peers. Reports from impaired nurses attest to peer rejection and lack of support. Through a literature review, the researchers found little research on nurses’ attitudes toward substance-abusing colleagues. One purpose of this study was to determine the attitudes of registered nurses toward nurse substance abusers and substance abuse, in addition to attitudes toward substance abuse in general. The study was conducted in Oregon. Likert-type questionnaires were mailed to a selected population of nurses. A systematic probability sample of 500 registered nurses was drawn from a roster at the Oregon State Board of Nursing; 396 (76.4%)were returned. Respondents were predominately women (382). Most nurses had little or no experience working with alcoholics (62.3%)or with drug abusers (74.5%), despite having been employed as nurses an average of 15.3 years. After conducting statistical analyses, the researchers concluded that nurses’ attitudes were generally supportive toward abusers in the general population. Many scores, however, fell below the neutral midpoint indicating that those nurses were negative toward substance abusers. The researchers stated that this suggests nurses view substance abuse as both a disease and a moral blemish. Researchers also found a close association between pessimistic attitudes concerning treatment and negative attitudes toward alcoholic patients. Other findings indicated that the Oregon nurses expressed generally positive attitudes toward substance-abusing colleagues. This finding was unexpected given the existing research describing impaired nurses as being isolated and stigmatized. More than 76% of the respondents said they would discuss their concerns with an alcoholic or drug-abusing colleague. Respondents expressed uncertainty regarding whether recovering nurses should return to practice; 67%favored return for the alcoholic nurse and 54% favored return for the drug-abusing nurse. Furthermore, 85%would
JULY 1989, VOL. 50, NO 1
Research Reviews
PRESTIGE The prestige of today’s nurse E Martin Nursing Management Vol20 (March 1989) 8OB-8OP
As answers to the nurse shortage are sought, the causative factors already identified will continue to be researched. Status, recognition, and respect are words used to describe what nurses seek in the work environment. Prestige, as perceived by nurses, physicians, and hospital administrators,was the focus of this study. A random sample of 300 RNs, 300 physicians, and 154 hospital administrators was selected from appropriate rosters in North Carolina. Each subject was mailed a questionnaire, and approximately 41% (309) responded. Hospital administratorshad the highest rate of return (5 1%) followed by nurses (41%)and physicians (35%). The tool, which was developed by the researcher, was tested for content validity. Its intent was to measure how the respondents perceived an occupation ranked with respect to seven specific prestige-relatedjob characteristics: (1) importance of the work to society, (2) education and training necessary to practice, (3) difficulty of the job, (4) complexity of the work, (5) supply of personnel, (6) authority of the occupation over itself, and (7) income of the average worker. This was significant because measuring prestige by a subjective approach reflects an attitude that is then communicated to the members of that profession. Subjects were asked to compare the seven characteristics for nine health occupations: physical therapist, respiratory therapist, pharma-
cist, dietitian, physician’s assistant, social worker, physician, hospital administrator, and registered nurse. A seven-point scale with polar adjectives at either end was used. Nurses’ perceptions of nursing gave high rankings to importance of the work to society, difficulty, and complexity. Education and training necessary to practice was rated in the middle. Authority, income, and supply of personnel were rated low. The mean prestige score given by nurses to nursing was 3.53, a moderately low prestige score. In terms of importance to society, physicians who were sampled rated themselves, nurses, and administrators highest with the lowest rank going to physician assistants. The education and training necessary to practice was rated high for MDs and RNs. Nurses were seen as the scarcest health professionals and those receiving the lowest income. Physicians rated hospital administrators as having the highest authority followed by physicians, pharmacists, and nurses. Although physicians rated nurses second to themselves in importance and amount of education, they indicated that a nurse’s job was not as difficult or complex as that of a physician or administrator. Administrators considered their jobs to be the most difficult and complex but not as important to society as physicians and nurses. They rated nursing as not being as difficult and complex as that of either the physician or administrator. The amount of education necessary for a nurse to practice was equated with a physician assistant at the bottom of the scale. The prestige rating was fifth for nurses; physicians, administrators,and pharmacists were ranked the highest. A general analysis comparing the mean scores 165
AORN J O U R N A L
for the three groups revealed that (1) physicians rated nurses’ education significantly higher than did nurses or administrators, (2) administrators rated nurses income higher than did nurses and physicians, (3) administrators and physicians rated the nurse’s authority and prestige significantly higher than nurses did, and (4) administrators rated the nurse’s importance significantly lower than did nurses and physicians. The author stated that, in general, nurses are low in authority, receive inadequate income, and have the lowest prestige of the health professions studied. The findings indicate that perceptions among the three major health professionals differ significantly in that physicians and administrators usually were in agreement with each other but not with the nurses. Perioperative nursing implications. As perioperative nurses struggle with nursing shortage problems, it is important that physicians and hospital administrators perceive our work as we do. If there is a major difference in how nurses are perceived and valued, obtaining meaningful solutions will be impossible. The results of this study give all perioperative nurses food for thought. How we feel about ourselves influences our image and, ultimately, how others see us. Reviewing the complete results of this study should give impetus to perioperative managers, educators, and staff nurses to examine the perceptions of nurses, physicians, and hospital administrators in their respective institutions. SUZANNE F. WARD,RN, MN, CNOR NURSING RESEARCH COMMITTEE
SUBSTANCE ABUSE Nurses’ attitudes toward impaired colleagues B L Cannon, J S Brown Image: Journal of Nursing Scholarship Vol20 (Summer 1988) 96-101 Alcohol and drug abuse are crucial and prevelant problems in US society. Although most nurses are familiar with statistics related to substance abuse in patient populations, few perceive them in relation to their colleagues. 166
JULY 1989, VOL. 50. NO 1
Previous research has shown that nurses’ attitudes are influenced by societal stereotypes that typify alcholics and drug addicts as irresponsible, weak-willed, and immoral. Many nurses react negatively to substance-abusing peers. Reports from impaired nurses attest to peer rejection and lack of support. Through a literature review, the researchers found little research on nurses’ attitudes toward substance-abusing colleagues. One purpose of this study was to determine the attitudes of registered nurses toward nurse substance abusers and substance abuse, in addition to attitudes toward substance abuse in general. The study was conducted in Oregon. Likert-type questionnaires were mailed to a selected population of nurses. A systematic probability sample of 500 registered nurses was drawn from a roster at the Oregon State Board of Nursing; 396 (76.4%)were returned. Respondents were predominately women (382). Most nurses had little or no experience working with alcoholics (62.3%)or with drug abusers (74.5%), despite having been employed as nurses an average of 15.3 years. After conducting statistical analyses, the researchers concluded that nurses’ attitudes were generally supportive toward abusers in the general population. Many scores, however, fell below the neutral midpoint indicating that those nurses were negative toward substance abusers. The researchers stated that this suggests nurses view substance abuse as both a disease and a moral blemish. Researchers also found a close association between pessimistic attitudes concerning treatment and negative attitudes toward alcoholic patients. Other findings indicated that the Oregon nurses expressed generally positive attitudes toward substance-abusing colleagues. This finding was unexpected given the existing research describing impaired nurses as being isolated and stigmatized. More than 76% of the respondents said they would discuss their concerns with an alcoholic or drug-abusing colleague. Respondents expressed uncertainty regarding whether recovering nurses should return to practice; 67%favored return for the alcoholic nurse and 54% favored return for the drug-abusing nurse. Furthermore, 85%would