By Debra Wood, RN, contributor
With nurses ranking at the top of Gallup’s 2008 annual “Honesty and Ethics of Professions” survey for the seventh straight year, staff nurses and nursing leaders share their thoughts about how and why 84 percent of Americans rated nurses as being the most honest and having the highest ethical standards of all professionals.
“Nurses are very caring and nurturing, and they really make a connection with individuals at the most vulnerable times in their lives,” said Mary Guaracino, RN, chief nursing officer at Memorial Hospital Pembroke, in Pembroke Pines, Florida, and a nurse since 1971. “Because of that, they make a connection and that connection shines a light around nursing.”
Mary Guaracino, RN, believes nurses’ caring natures contributes to public perceptions that nurses are trustworthy.
Judy Lott, DSN, RNC, FAAN, professor and dean of Baylor University’s Louise Herrington School of Nursing in Dallas, Texas, added, “I believe the trust comes not from the extraordinary moments, such as emergencies, but from the ordinary moments when the nurse asks questions and listens to the answer, or provides support to a family member, or straightens the bed, so the patient is more comfortable.”
Building relationships with patients and their families fosters trust, added Barbara Meeks, RN, MBA, vice president of pediatric patient care services at MCGHealth Children’s Medical Center in Augusta, Georgia.
“Nurses have the patient’s best interest in mind and are sincerely empathetic and compassionate,” Meeks said.
Oftentimes, nurses are the people who help patients and families learn to live with chronic illnesses and that develops trust as well, suggested Afaf I. Meleis, Ph.D., Dr.PS(Hon), FAAN, the Margaret Bond Simon dean of nursing at the University of Pennsylvania School of Nursing in Philadelphia.
“Nurses listen and advocate for patients to make sure they get the care they need,” said Terry Park, RN, a staff nurse on the stem-cell transplant, hematology and oncology unit at Children’s Memorial Hospital in Chicago, Illinois.
Patients quickly realized that nurses look out for them and that builds bonds, said Juanita Flint, MS, RN, FNP-C, executive dean, health and human services division of Brookhaven College in Dallas, Texas.
“Nurses care about their patients—not just for them—and nurses tend to be loyal and ethical,” Flint said. “They are passionate about what they do.”
Being in a hospital disrupts patients’ routines and removes much decision making, yet nurses help restore some of that control, added Tuni Borrego, RN, MSN, director of nursing of med-surg and telemetry at Memorial Hospital West in Pembroke Pines, Florida, and Broward County chapter president and national secretary of the National Association of Hispanic Nurses.
Juanita Flint, MS, RN, FNP-C, said, “The public trusts nurses because of nurse-patient relationships. Patients quickly realize that the nurse is their advocate and that understanding contributes to the strong bond.”
“Nurses are upfront with them,” said Borrego, adding that the relationship begins with the admission assessment. “You have to create the bond and show you are worthy of the trust.”
Joan Clark, RN, MSN, NEA-BC, senior vice president and chief nurse executive for Texas Health Resources in Arlington, Texas, which includes Harris Methodist Hospitals, Arlington Memorial Hospital and the Presbyterian Healthcare System, felt the public identifies with nurses because, in most cases, their experiences with nurses have been positive.
“More often than not, a nurse’s role has either been instrumental in helping patients and families adapt to the situation, or their observations have prompted life-saving interventions,” Clark said.
Jessica Halas, RN, BSN, clinical educator for clinical care operations and student placement coordinator at Banner Estrella Medical Center in Phoenix, Arizona, added that nurses spend more time directly communicating with patients than other health care professionals. They get to know their patients.
“As humans we realize when another human cares for us, and that is what nurses do,” Halas said. “Physicians may prescribe the care but nurses figure out how it can be delivered in the best possible way so that the patient has the tools to maintain or improve his or her health.”
While first-hand experiences shape many public perceptions, Scarlett R. Conway RN, C, MSN, a nursing faculty member at the University of South Carolina Mary Black School of Nursing in Spartanburg, suggested, “one of the reasons society in general trusts nurses is because nurses have been and still are portrayed by the media as kind, caring individuals, working tirelessly with low pay.”
Maureen White, RN, MBA, CNAA, senior vice president and chief nurse executive of the 15-hospital North Shore-LIJ Health System based in Great Neck, New York, also attributed nurses’ high ratings to their association with the caring aspects of health care and patient advocacy, rather than the business side of it.
“In order for nurses to maintain this high standing they must always put the needs of the patient first, above all else,” White added. “Nurses cannot lose sight of the fine art of nursing which is caring. We must continue to build trusting relationships within the workplace where patients and families feel safe and [that] someone is looking out for their best interests when they are the most vulnerable and least able to adequately advocate for themselves.”
The USA Today/Gallup poll, conducted in November, interviewed 1,010 adults, aged 18 or older by telephone.
Nurses have topped the Gallup ethics and honest poll every year but one since the polling firm added nurses to the list in 1999. In 2001, shortly after the September 11 terrorist attacks, Gallup included firefighters on a one-time basis, and they ranked first that year.
For nurses to retain their high ratings, Clark encouraged administrators to “provide maximum support of nurses by creating desirable work environments that allow nurses to thrive and provide excellent care.” She also suggested continued screening of potential nurses to ensure high standards and a desire to enter the profession for the right reasons.
“It’s a calling,” Borrego added. “It’s a good career but if you don’t have the feeling, calling and empathy, your patients will not see you as ethical.”
Most professions retained a standing similar to a year ago, with the exception of bankers, whose standing declined 12 percent, from 35 percent in 2007 to 23 percent this year, something pollsters called “not surprising given that the banking industry is at the center of the Wall Street meltdown currently gutting many Americans’ investment accounts and destabilizing the U.S. economy.”
Pharmacists ranked second, receiving a 70 percent rating, followed by high school teachers at 65 percent, medical doctors at 64 percent, and policemen and clergy at 56 percent.
Lobbyists ranked at the bottom, with 64 percent of people polled saying they had low or very low honesty and ethics, followed by telemarketers at 60 percent, car salesmen at 54 percent and Congressmen at 46 percent. Seven percent rated car salesmen as having high standards and 12 percent felt Congressmen were honest and ethical.
Despite lawmakers’ low rating, Clark encouraged nurses to “be active with their votes in electing public officials who promote health, as well as seeking public office themselves, where they can influence health policy directly.”
Halas suggested nurses participate in their professional organizations and stay current about legislation that could affect patient care or nursing.
White cautioned nurses not to take the positive public perception lightly.
“We should look at it as high praise for the work that we do,” White said. “But we have a responsibility, if not an obligation, to raise the bar for ourselves and our profession, to continue to advocate for the best care for our patients. We must lead the charge in creating a health care delivery model that embraces best practices 100 percent of the time, that strives for zero percent adverse or avoidable events, and embraces the coordination of patient care along the continuum not just as siloed episodes of care in different care settings.”
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