We, as nurses, are aware of the profound impact that our profession has and continues to have on the advancement of patient care, policy and business. Nurses work at the bedside, teach at universities, conduct ground-breaking research, serve as hospital Chief Nursing Officers (CNOs) and hold high level executive positions within a variety of business organizations. While that might seem like common knowledge, I was disheartened to learn that nurses are not sought out by the media for their expertise. The research brief entitled The Woodhull Study Revisited: Nurses’ Representation in Health News Media was released this month with some rather surprising results.

In 1998, the original Woodhull Study on Nursing and the Media: HealthCare’s Invisible Partner was published by Sigma Theta Tau International Nursing Honorary Society. The study, named after Nancy Woodhull, a founding editor of USA Today, aimed to determine to what extent nurses are used as sources for health-related news stories. The researchers analyzed health news stories in two leading national and five metro daily newspapers, three general interest weeklies, one business weekly and five health industry publications. They found that nurses were quoted in only 4% of newspapers and 1% in weeklies and industry publications. The study also found that nurses were never cited in health news stories on policy and were not identified in photos within the articles (Sigma Theta Tau International, 1997).

Led by Dr. Diana Mason, PhD, RN, FAAN, editor emerita of the American Journal of Nursing, the Woodhull study was replicated by a team of researchers at the George Washington University School of Nursing to assess if progress had been made over the last twenty years. The research focused on three phases (Mason, et Al., 2018):

• Phase I: Are nurses represented as sources and identified in photos in health news stories in public and trade print publications with greater frequency than in 1997?
• Phase 2: What do health journalists perceive to be the barriers and facilitators to using nurses as sources in news stories?
• Phase 3: Are schools of nursing using social media to highlight the expertise of their faculty?

Results of the study were presented by the researchers on May 8^th at the National Press Club in Washington, D.C., followed by a panel of journalists who provided a response. A summary of the results is provided below.

Phase 1.  Replication of Original Woodhull Study (Mason, et al., 2018)
Print news was analyzed in a similar fashion to the original study. A random sample of 537 articles (out of 2,234) were extracted and reviewed from seven newspapers, three weeklies, and three healthcare industry publications, excluding those that are no longer in print. The report found that nursing representation in the media had not changed over the last 20 years. Nurses were identified as sources in only 2% of quotes or other sourcing in health news stories and 1% in weeklies and industry publications. Nurses were mentioned in 13% of stories about healthcare and were more likely to be mentioned in stories about labor (57%), profession (44%), quality (32%), and education (25%). They were less likely to be mentioned in articles about research (9%), policy (4%) and business (3%). In several cases, nurses were not included even when their point of views were applicable to the topic discussed. Nurses were identified in 4% of images in the articles. Irrespective of profession, men were quoted twice as often as women and men were featured in 72% of images versus 48% for women.

Phase 2. Health Journalists’ Experiences with Using Nurses as Sources (Mason, et al., 2018)
In phase 2, the researchers interviewed ten health journalists regarding their experiences with nurses as sources in health news stories. This phase revealed a major barrier to utilizing nurses as sources in the media is bias about women, nurses, and positions of power in health care. Additional insights include:

• Although journalists believe that nurses can contribute important perspectives to health reporting, they do not fully understand nurses’ work, education and range of responsibilities.
• Journalists often don’t know how to find nurses to interview and have little time to track them down due to tight deadlines.
• Communications staff of hospitals and universities do not offer nurses as sources unless journalists request them.
• Editorial biases, policies and processes can prohibit the use of nurses as sources.
• Nurses and their colleagues lack a strategy for engaging journalists.

Phase 3. Use of Twitter by Schools of Nursing (Mason, et al., 2018)
This phase assessed how schools of nursing use Twitter to promote nursing faculty and researchers as experts. The most recent tweets from the public Twitter accounts of 47 of the top 50 nursing schools were examined. They found almost 80% of tweets were inward-facing or intended to engage nurses, members of the university/school community, or nursing conference attendees as opposed to outward-facing (intended to engage people outside the nursing and university/school community). In addition, only 1% of the 58,000 user accounts following nursing schools belonged to the media.

Mason et al. (2018) cite several factors that may contribute to the low representation of nurses within the media.

• Nursing is a female-dominated profession and women continue to be underrepresented as expert sources in the media.
• Journalists are not familiar with nursing responsibilities and how nurses might be able to contribute to stories.
• Journalists lack knowledge on how to locate nurses with expertise for a story. If they do use a nurse, they may need to justify this with their editor.
• Communications staff of universities and health care organizations may also be unfamiliar with nurses’ expertise and rarely recommend nurses as sources for journalists.

Yanic Rice Lamb, Associate Professor of Journalism at Howard University, who served on the journalist response panel stated:

"One of the things that journalists need to keep in mind is that nurses are everywhere. They are not only in the patient rooms but in the board rooms. And they can talk about policy, they can talk about management, they can talk about finances, they can talk about utilization review… they can talk about all the things we need to talk about as journalists working on our stories… In terms of being good journalists, and showing different points of view, it’s important to interview nurses…so that we are telling the complete story."

How can nurses and nursing leaders improve our profession’s representation in the media? During the study presentation, the researchers and journalists provided several recommendations.

• Nurses should be more responsive to journalists’ requests for interviews and better prepared for media opportunities.
• Nurses should develop relationships with journalists and offer unique stories ideas.
• Schools of nursing should promote their nurses’ expertise using more outward-facing social media methods, particularly on Twitter which is followed by many journalists to track issues.
• Nurses should be more proactive in recommending their expert colleagues to journalists.
• Nursing leaders, such as school of nursing deans and CNOs, should meet with their public relations staff on a regular basis and recommend their experts as sources for news stories.
• School of nursing deans and CNOs should integrate media competency training into the curriculum to improve clinical expert nurses’ comfort in communicating with the press.

Co-investigator Barbara Glickstein, MPH, MS, RN, stated “there is brilliant research being published by nurses in nursing journals.” She advised the nursing journals to work with the nurse researchers, to support them and teach them how to write press advisories and in a way that frames the research into newsworthy stories, so their research may reach the public.

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse of Health Learning, Research & Practice for Wolters Kluwer, a sponsor of the Woodhull study, stated “The research that nurses are doing in the field of nursing and healthcare is vitally important to improve practice behavior and outcomes. It is incumbent for journal editors and publishers to work directly with authors to leverage their work in the media to improve discovery and dissemination of their research in order to integrate it into practice.” Lisa Bonsall, MSN, RN, CRNP, Senior Clinical Editor for Nursingcenter.com, part of Wolters Kluwer added, “Nurses have a perspective and an expertise that is unmatched, and I am so glad this issue is being revisited, with an even bigger view. Bringing attention to the role of nurse researchers and nursing journals, as well as the role of social media, specifically Twitter, will help fuel this movement. There is a lot to be learned from this research and I look forward to what the future holds!”

Do nurses remain invisible in the media? The study did not look at media that publishes exclusively on-line today; therefore, future studies will be needed to address this issue. Until then, the answer regretfully is “yes,” nurses do remain invisible in the media. Nurses have unique perspectives and have information to share. We need to be proactive, increase dialogue with journalists, and support one another so that the impact nurses continue to make in everyday patient care receives the recognition it deserves.
 
To view the study presentation, click here: https://nursing.gwu.edu/woodhull-study-revisited

Resources:
Women’s Media Center: https://www.womensmediacenter.com/
She Source Database: http://www.womensmediacenter.com/shesource
Progressive Media Voices Media Training: http://www.womensmediacenter.com/search?q=Progressive+Media+Voices+Media+Training

References:
Mason, D.J., Glickstein, B., Nixon, L., Westphaln, K., Han, S. and Acquaviva, K. (2018). The Woodhull study revisited: Nurses’ representation in health news media. Center for Health Policy & Media Engagement, The George Washington University. Retrieved from https://nursing.gwu.edu/woodhull-study-revisited

Sigma Theta Tau International (1997). The Woodhull study on nursing and the media: Health care’s invisible partner. Indianapolis, IN: Sigma Theta Tau International, Center Nursing Press. Retrieved from: http://www.nursinglibrary.org/vhl/handle/10755/624124

More Reading & Resources
The role of nurses, APNs, and healthcare reform in a changing political climate
Nurses and the Business of Caring: An interview with John Bluford [Podcast]
Sharing Your Knowledge: Getting Your Idea Published [CE]