Media representations of nurses in the pandemic: Just doing our job?

This Editorial began with conversations among co-authors regarding media representations of nurses during the COVID-19 pandemic. Annamaria Bagnasco and Gianluca Catania are working with other colleagues (see acknowledgements) to lead an international research project on the theme of media representations and experiences of nurses during the pandemic. For now, we agreed to conduct a cursory overview of media representations in Italy, the United Kingdom and the United States.

So how is the media representing the contributions and costs to nurses, and for nursing, in other countries? What message should the media be prioritising at this time? And why? Is it helpful for nurses to be represented as heroes? As victims? As valuable members of multi-professional teams? As people just doing their job?

In Italy, many nurses are being interviewed by the media and often portrayed as heroes fighting against the COVID-19 pandemic. Italian nurses keep reminding everyone that this is what they have always done: caring for patients and their families, day and night, in hospitals and at home, both in good and poor health conditions. One nurse said, ‘when my friends thank me for what I am doing and they tell me that I am a hero I always answer that it is only my job’. ¹ It seems that the Italian public is gaining a new awareness of the role played by nurses, for example, there appears to be surprise and appreciation regarding the range of activities nurses perform. One Facebook post read, ‘Having a nurse in your family is a gift’. ²

The Italian media are reporting the new daily challenges nurses are facing, for example, the stress and fear experienced from caring for patients due to the high risk of infection. Daily, the media report the number of newly infected patients. ³ Every day, the Italian Civil Protection Department receives data from the Italian Ministry of Health, analyses data and updates the database. ⁴ This includes data about nurses who have lost their lives. At the time of writing, the media reported that 28 nurses had died in Italy from COVID-19. There has also been a media focus on nurses’ need for protection to respond to patients’ needs and on the shortage of nurses with critical care competencies assigned to these intensive care units. ⁵

Generally, nurses in Italy are positively represented in the media and this may result, in the longer term, in the awakening of a widespread consciousness on behalf of the public, institutions and media. Nurses play as important a role in the healthcare system as physicians. The public’s gratitude is reported in examples such as the provision of food and sometimes even free accommodation for those nurses who choose not to return home to avoid the risk of contaminating their families. One media report stated,

So, the shifts become longer every hour, obviously without paid overtime. Some nurses sleep in care homes to reduce the possibility of infection and protect the elderly, others spend some of their salary on buying better masks. This is happening on a daily basis. ⁶

Nurses interviewed remind everyone not to forget the many episodes of violence of which nurses were victims only a few days before the beginning of this pandemic and restate the need to give the right value to the nursing profession and better social recognition. One nurse was reported as saying, ‘it is gratifying to read that people recognize our role’. ⁷ The Italian Prime Minister, Giuseppe Conte, promised, during an official speech to the Parliament, that he will not forget these difficult times and that it will be important for Italian nurses to be properly recognised in the future, and not only now during this pandemic: ‘I say this on behalf of the government, but I am sure that all Members of Parliament will agree on this commitment, we will not forget you and these days so risky and stressful’. ⁸

As we were working on this Editorial, the UK British Prime Minister (PM) Boris Johnson, was discharged from hospital. His admission to a National Health Service hospital with COVID-19 attracted much media attention. Following his discharge, a headline read ‘NHS staff saved my life’ ⁹ and there was recognition and naming of nurses who had been involved in the Prime Minister’s intensive care. Among those nurses named by the Prime Minister were ward sister, Jenny McGee from New Zealand, and Luis Pitarma from Portugal. The UK media contacted the nurses’ families, including Jenny McGee’s brother who was quoted as saying: ‘She is just doing her job and that is how she sees it. This is what she was trained for, helping people who need care’. ¹⁰ A British Broadcasting Corporation (BBC) report detailed the contribution of intensive care nurse, Juanita Nittla to patients' end of life experience. She shared how she talked on the phone with the daughter of a nurse who was dying. Nurse Nittla said, ‘I reassured her that her mum was not in pain and looked very comfortable […] I also asked about her mother’s wishes and religious needs’. She went on the describe how she placed a phone to the patient’s ear so her daughter could speak to her, she played the music the family had requested and held the patient’s hand as the ventilator was withdrawn and the patient died. Nurse Nittla was reported as saying that the ability to provide care for the dying ‘has helped her to cope with the crisis’. She went on to talk of the challenges arising from COVID-19 – ‘normally in critical care we maintain a one-to-one ratio […] now it is one nurse for every three [patients]’. In response to the need for more staff, Ms Nittla reported that her hospital is retraining nurses to work in ICU. She also highlighted the importance of teamwork at this challenging time: ‘Before the start of the shift we hold our hands together and say “stay safe!.” We make sure everyone is wearing the gloves, masks and protective gear properly’. The BBC report goes on to describe Ms Nittla’s history of tuberculosis and her employer’s decision that she now ‘remain at home, due to her underlying health condition. She plans to continue to offer support by doing administrative tasks, working from home’. ¹¹ As in Italy, there is daily reporting of deaths from COVID-19 and details of nurses who have died with ‘Calls for better protection for health care workers’. ^12,13

Giving the name ‘Nightingale’ to the 4000 bedded hospital in London, which was transformed from a conference centre in 2 weeks also, arguably. Draws attention to the history and contribution of nursing. ¹⁴ The weekly ‘clapping for carers’ is also raising the profile of nurses and other care-givers at this most challenging time. ¹⁵ This weekly expression of gratitude signals the solidarity and support of the British public for nurses and other care-givers at this most challenging time. The representation of nursing in the United Kingdom suggests public trust and confidence. There are also media reports of care-givers and managers, although it is unclear if they are registered nurses, advocating for vulnerable people in their care. For example, care home managers refusing to admit those who have COVID-19 to protect older adults in their care. ¹⁶ Other UK media reports, relating to nurses and other care-givers have focused on the tragic loss of life. The UK Health Secretary ‘was moved to comment’: ‘Many of those who have died who are from the NHS were people who came to this country to make a difference and they did, and they’ve given their lives in sacrifice, and we salute them’. ¹⁷

In the United States, similarly there has been an outpouring of appreciation for the healthcare workers who continue to work tirelessly to care for patients with and without COVID-19. As in the United Kingdom, the public have been applauding healthcare workers across the country during shift change to express their thanks. However, the UK outpouring does feel bittersweet. Politics and justice considerations regarding public and private healthcare systems aside, nurses appear to be valued differently in the United States than was Morley’s experience in the United Kingdom. One expression of value is through adequate remuneration, ¹⁸ and UK nurses have systematically seen resources (such as undergraduate and postgraduate bursaries) being taken away from them over the past 5 years. Even in the lowest paying US states, a nurse’s average salary can be almost double the salary of nurses in the United Kingdom. ¹⁹ In addition, the American Nurses Association sent a letter to President Trump with the intent of negotiating ‘hazard pay’ ²⁰ and some nursing unions have even already successfully negotiated this, stating recognition of the extra burden and risk. ²¹ Whereas in the United Kingdom, the Health Secretary Matt Hancock dismisses calls for additional nursing pay with the response that ‘now is not’ the time for negotiations. ²² Two tragically common global themes seem to have been concerns about adequate PPE and tributes to nurses who have died of COVID-19.

American nurses seem to be regarded as well-educated professionals and this has been reflected in much of the reporting during the COVID-19 pandemic. Most of the early media headlines and academic essays were focused upon the difficult decisions that physicians would face with little to no mention of the nursing role. ^{23 –25} As time has progressed, media coverage has expanded in both the United Kingdom and the United States to cover news stories focused on nurses’ experiences. ^26,27 In the field of nursing ethics, it is this focus on the nursing experience and ethical issues through a nursing lens that are of central importance. Nurses globally have a responsibility to advocate for the needs of patients and nurses during this pandemic. Nurse ethicists can play an important role in providing ethics support at this most challenging time to assist with ethical decision-making and with experiences of moral distress. It is well-reported that globally nurses struggle to navigate their position within hierarchical healthcare structures and experience moral-constraint distress. ²⁸ Now with a global pandemic in which the ethical issues are more acute, not only should we be concerned about moral distress but also psychological distress and post-traumatic stress disorder. ²⁹ The NHS may have launched a new mental health hotline, but it is questionable if it is nearly enough.

Overall, this rather cursory consideration of media reports in Italy, the United Kingdom and the United States suggest that media representations of the role of nurses are generally appreciative, illuminating and supportive. To return to our initial questions: How is the media representing the contributions and costs to nurses, and for nursing, in other countries? What message should the media be prioritising at this time? And why? Is it helpful for nurses to be represented as heroes? As victims? As valuable members of multi-professional teams? As people just doing their job?

Media reports are highlighting the exceptional contributions and sacrifices being made by nurses and other professionals and suggest these are being recognised by the public and by politicians. However, the fact that the media continues to highlight shortages of equipment (and testing) to protect nurses and other staff suggests that there is some way to go for politicians to enact the appreciative sentiments they express in the media. We hope that politicians will keep promises such as that made by the Italian Prime Minister, Giuseppe Conte, not to forget these difficult times and to recognise nurses properly in the future and not only now during this pandemic.

The media examples we’ve shared in this Editorial are a tiny proportion of coverage since the onset of COVID-19, however, the ethical issues arising from these representations are legion with questions arising about nurses’ duty of care with reciprocal duties of organisations’ and governments’ to care for nurses. Nurses are a precious resource and deserve to be protected due to both their inherent worth as individuals and also due to the most significant difference they make to the lives of patients, families and communities. Telling, hearing and reading the stories of phenomenal nurses such as Juanita Nittla is likely to be most impactful in terms of positive representations of nursing at this time. Representations that reassure the public that nurses are people who will advocate for patients, nurses are people who connect patients with families during the most challenging times and people who not only cope, but who excel, in the face of adversity. Nurses are the custodians of compassionate care and should be celebrated for their moral resilience and creative ways of coping so that patients, families and communities need never fear abandonment.

We hope that people everywhere will continue to lobby governments and the media not to forget the central and critical role of nurses in ordinary times as well as in extraordinary times.