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Original Research

Journalists’ Experiences with Using Nurses as Sources in Health News Stories

Mason, Diana J., PhD, RN, FAAN; Glickstein, Barbara, MS, MPH, RN; Westphaln, Kristi, PhD, RN, CPNP-PC

AJN The American Journal of Nursing: October 2018 - Volume 118 - Issue 10 - p 42–50
doi: 10.1097/01.NAJ.0000546380.66303.a2
Original Research
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Purpose: In a 2018 replication of a 1997 study, the Woodhull Study on Nursing and the Media, nurses were identified as sources in only 2% of health news stories in the same print publications investigated in the earlier study, showing no improvement in 20 years. We sought to interview health journalists across a spectrum of media to better understand their perceptions of the barriers and facilitators to using nurses as sources in news stories.

Methods: This qualitative study employed a snowball sampling technique to obtain a sample of 10 health journalists. One-to-one semistructured telephone interviews using open-ended questions were conducted and recorded, and thematic analysis was performed on the transcripts.

Results: Analysis of the transcripts revealed an overarching theme of biases about women, nurses, and positions of authority in health care among journalists, newsrooms, and public relations staff in health care organizations and universities that impeded journalists’ use of diverse sources in health reporting. Subthemes were that 1) when used as sources, nurses can enrich a story; 2) health journalists don't understand the range of nurses’ roles, work, and education; 3) health journalists don't know how to find nurses to interview for news stories and have little time to do so; 4) communications staff of health care organizations and universities aren't offering nurses as sources; 5) editorial biases, policies, and processes can get in the way of journalists using nurses as sources; and 6) nurses and the nursing profession aren't strategic about engaging journalists.

Conclusions: Because nurses as sources can enhance the quality of health news, health journalists should become more aware of their biases and strive to include more nurses, as well as more women and people of color overall, in their stories. Nurses and nursing organizations can do more to reach out to journalists and public relations staff to raise awareness of nurses’ expertise.

The authors of a 2018 replication of the 1997 Woodhull Study on Nursing and the Media interviewed health journalists to better understand their perceptions of the barriers and facilitators to using nurses as sources.

Diana J. Mason is senior policy service professor, Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC, where Barbara Glickstein was director of communications and media projects at the time this study was conducted. Kristi Westphaln is a postdoctoral research fellow, Center for Child Health and Policy, Case Western Reserve University, Cleveland, OH. Contact author, Diana J. Mason: djmasonrn@gmail.com. Funding for this study was provided by the Gordon and Betty Moore Foundation, Robert Wood Johnson Foundation, Beatrice Renfield Foundation, Sigma Theta Tau International, American Association of Critical-Care Nurses, Donald and Barbara Jonas Foundation, National League for Nursing, OnCourse Learning, American Association of Colleges of Nursing, and American Organization of Nurse Executives. Wolters Kluwer Health, publisher of AJN, also provided funding to George Washington University in support of the study. The authors have disclosed no potential conflicts of interest, financial or otherwise.

In 1997, the Woodhull Study on Nursing and the Media found that nurses were quoted as sources in health news stories 4% of the time in leading print newspapers and 1% of the time in news magazines and trade publications such as Modern Healthcare.1 At that time, those findings were consistent with women's general underrepresentation in the news media, according to the study authors. Twenty years later, a replication of the Woodhull study found no improvement in health journalists’ use of nurses as sources in their stories in the same publications, despite modest improvements in the representation of women as sources overall.2

Why does this matter? News reports shape public perceptions not only of what but also of who is important.3 Hence, nurses’ absence from health news stories means that the public may not be getting a full picture of health, illness, and care. And because a healthy democracy requires a well-informed populace with a free press, nurses’ representation in the media may be an important avenue for their greater participation in discussions on health policy. The Institute of Medicine's 2011 report The Future of Nursing: Leading Change, Advancing Health called on nurses to be leaders in transforming health care, including in hospitals and home care and public health agencies.4 An assessment of progress five years later found some improvement, though much remained to be done to ensure nurses’ appointments to leadership positions in private, public, and governmental organizations.5

If nurses are invisible in news reports, continued progress in this area will be difficult to achieve. We therefore sought to understand health journalists’ experiences with using nurses as sources in their stories, including their perceptions of the barriers and facilitators for doing so. Our findings have implications for journalists, newsrooms, and other media outlets; public relations directors and leaders of health care organizations; and nursing organizations, schools of nursing, and individual nurses.

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BACKGROUND

Just as diversity in health care is essential to health equity, diversity in the staffing of newsrooms, and in the sources journalists use and the topics they cover, is essential to excellent and influential journalism.6 In the past 20 years health journalists have raised public awareness about many serious public health concerns—for example, how drug manufacturers fueled the opioid epidemic7—and they've shone a national spotlight on nursing, as in reports investigating lax oversight of nurses with criminal backgrounds by California's and New York's boards of nursing.8, 9 Yet in the past two decades, the Internet revolution—including blogging, podcasting, social media, and a variety of other digital formats—has all but done away with the advertising model that supported journalism throughout the 20th century, affecting the newspaper industry perhaps more than any other.10 Newsroom staffs have been cut by 45% since 2004, and daily newspaper circulation declined from 56.7 million in 1997 to 31 million in 2017.11 Journalists may therefore rely on what they call “elite” sources—those whom they trust and know will be responsive quickly to requests for interviews.12

Who are these trusted sources? It's unlikely that they're women, and since nursing is still almost 90% female,13 it's unlikely they're nurses.

Since 1995 the Global Media Monitoring Project has tracked women's representation in stories in newspapers, on television and radio, and more recently in online media in scores of countries.14 In 1995 women were represented in only 17% of all stories, increasing to 24% by 2010 and 26% by 2015.

The Women's Media Center and others have been monitoring women's representation in U.S. news media over time. Women are underrepresented in newsrooms and even more so if they are women of color. Over one-third of news reporters are women, with little change from 37% in 1999 and 39.1% in 2017.15-17 Women of color account for only 8% of print newsroom staff.17, 18 This underrepresentation of women in journalism persists despite women constituting 68% of journalism graduates.19 And although underrepresented in newsrooms, female journalists are more likely than men to be assigned to cover health, producing almost half of health news stories.16

Nancy Woodhull, a founding editor of USA Today, was concerned about women's representation in news media in the 1990s. She became aware of nurses’ work after a nurse recommended a test that became crucial in diagnosing Woodhull's cancer. She suggested to her friend Louise Woerner, an honorary member of Sigma Theta Tau International (STTI), that a study of nurses’ representation in the news media was needed. With funding from Woerner, owner of a home care agency in New York State, and the Epsilon Xi Chapter of STTI, the University of Rochester School of Nursing took on the study as part of an elective undergraduate nursing course on nurses and media, which trained students in data collection and analysis.

Published in 1997, the Woodhull Study on Nursing and the Media: Health Care's Invisible Partner examined nurses’ representation in health news stories published in September 1997 in seven newspapers (including national papers such as the New York Times and regional papers such as the Democrat and Chronicle in Rochester, New York), four newsweeklies (including Newsweek and Time), and five health care industry publications (including Modern Healthcare).1 Analysis of data gleaned from roughly 20,000 health news articles found the following:

  • Nurses were referenced in only 4% of quotations in newspapers and 1% of quotations in news magazines and trade publications; Modern Healthcare referenced nurses in only 0.6% of its stories.
  • Nurses were rarely identified in photographs accompanying the stories.
  • Nurses or nursing was mentioned in only 10% of newspaper articles and in 1% and 8% of articles in news magazines and industry publications, respectively.

Twenty years later, we collaborated with the Berkeley Media Studies Group to replicate the Woodhull study and found that little had changed.2 Using a random sample of 537 health news stories published in September 2017 in the original Woodhull study print publications, we analyzed a final sample of 365 articles (152 newspaper articles, 53 magazine articles, and 160 health care industry articles; two trade publications had ceased publication). In our 2018 study, phase 1 of a three-phase analysis, we found the following:

  • Nurses were identified as sources in only 2% of quotations or articles (2% in newspapers, 2% in magazines, and 1% in industry publications); the difference between the original 4% and the current 2% was not statistically significant, suggesting no change had occurred.
  • Nurses or nursing was mentioned in only 13% of articles.
  • Nurses were mentioned most often in stories about the nursing profession or labor and were least likely to be sourced in stories on health care research, policy, or business.
  • Nurses were identified in 4% of images accompanying the stories.

Nurses remain barely visible in health news stories.

For this study, phase 2, we sought to understand why health journalists working in any medium (print, online, television, or radio) do or do not turn to nurses as sources. We decided to conduct a qualitative study to ask two primary research questions:

  • What are health journalists’ experiences of using RNs as sources in news stories?
  • What do health journalists perceive to be the barriers and facilitators to using nurses as sources in news stories?

Phase 3, not yet published, investigated the Twitter activity of 50 top schools of nursing, finding that of more than 11,000 tweets, 80% were “inward facing”—that is, interacting with nurses about nursing concerns. (For an overview of all three phases, including a video of a press conference held in May, go to https://go.gwu.edu/Woodhull.)

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METHODS

We designed a qualitative study that would perform thematic analysis of semistructured interviews with health journalists. All invited participants received a description of the study goals and methods. From those agreeing to participate we obtained verbal consent for participation, including to be recorded. The study was approved by the institutional review board at George Washington University (GWU).

Sample. We used a snowball sampling technique to obtain a sample of health journalists. Journalists serving on the national advisory council of the Center for Health Policy and Media Engagement at the GWU School of Nursing recommended health jour-nalists we could invite to participate, and we e-mailed our contacts in journalism to publicize the study.

Our sample consisted of health journalists—all reporters or editors working as freelancers for or employed by wire services, radio, or online or print news outlets—representing a broader array of venues for health reporting than our Woodhull replication study did. Their focus varied from health research and policy to workforce and labor concerns to broader health care issues. At the end of each interview, we asked participants if they knew other journalists who might be interested in participating in the study. Data saturation was achieved at the ninth interview, and our final sample consisted of 10 health journalists, two men and eight women.

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Data collection. We constructed a semistructured interview format that addressed the research questions. After two of us (DJM and BG) conducted an initial interview with each participant to ensure consistency in our interviewing approach, we conducted one-to-one telephone interviews using open-ended questions to explore participants’ perspectives on using nurses as sources, the barriers to using them, and recommendations for addressing these barriers. After asking open-ended questions, we asked questions in further detail on potential barriers and facilitators (see Interview Questions). The interviews were recorded and transcribed. The transcriptions were additionally reviewed by the third member of our research team (KW) to verify accuracy.

Data analysis. We used thematic analysis to analyze and interpret the data.20 All three of us read the transcripts separately and then both separately and together grouped statements from each transcript by interview question, extracting illustrative quotes. We categorized the data into thematic clusters by looking for commonalities across participant interviews, discussed our findings, and reached consensus on the overall themes and subthemes in an iterative process: talking through our analyses, sharing rationales and examples of quotes, and as we reached agreement reviewing and discussing and revising again.

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RESULTS

A single overarching theme emerged from the data, along with six subthemes.

Overarching theme: Biases among journalists, editors, public relations staff, and health care organizations about women, nurses, and positions of power in the health care system can obstruct journalists’ use of diverse sources in health reporting; but when used as sources, nurses can enrich a story. Participants spoke about preconceptions that persist in health news about women and nurses and who has positions of authority in a world dominated by physicians—especially “rock-star docs.” As one participant said, “There is that bias throughout society, that because most nurses are women, they just don't rank as high. It's a broader issue, and the relative lack of attention to nurses is in part a reflection of the history of men and women in Western society. That's something we're all working on.” Another said, “Nursing is caught up in the larger biases that exist and historical hangovers in society that have favored white men and have hindered and hidden women.”

Some participants appeared to become aware of their own biases about using nurses as sources but saw the failure to use nurses more often as part of a larger movement to improve health journalism: “It still takes time to change the way people do things…. In some ways, it meshes with every effort to increase diversity in reporting of all types.”

This theme is illustrated with more specificity in the following subthemes (reported in no particular order).

Subtheme: If used as sources, nurses can bring important perspectives to health reporting. The participants had varying experiences of using sources who are nurses, including RNs, nurse researchers, NPs, PhDs, midwives, public health and infection control nurses, and nurses at the Centers for Disease Control and Prevention. Journalists were most likely to use nurse sources for stories about nursing, particularly those on the scope of practice for advanced practice nurses, and in nonnursing stories on team-based care models, particularly if a physician recommended a nurse. Other topics for which they used nurses as sources included the health care workforce, diabetes, maternal and child health, the opioid crisis, infection control, and disease or symptom management.

When they used nurses as sources, participants found them to be helpful and competent, adding perspectives other sources might not have provided. Participants described nurse sources as “down-to-earth,” “human,” “colorful,” “great educators,” and “approachable.” They referred to nurses as “on the front lines” and “present at the bedside.” One participant noted that nurses “can be actually very good at speaking in a way that patients understand, so it's a good way to connect the dots for the people.” Another described nurses as having “a more human way of explaining something.” One said,

“Doctors may talk about what's being done, but they're not the ones who are actually with the patients around the clock and monitoring their signs and symptoms…. The nurses are the ones who are on the wards, who were seeing it minute by minute. So it's that first-person perspective of actually providing care that nurses have the most expertise [in] and ability to convey.”

Nurse sources were also described as having the capacity to speak the “ground truth”—to translate complex issues, understand what matters to patients, and offer holistic options. Said one participant: “The perspective that you'll get from a nurse is much more to sort of get a sense of what the patient's unique circumstances and cultural beliefs are.”

Subtheme: Health journalists don't fully understand the range of nurses’ roles, work, and education. When asked what factors obstructed their using nurses as sources, health journalists said that although they knew what physicians do, they didn't always understand nurses’ roles, scope of work, education, and credentials. One participant said, “I kind of know what a nurse practitioner is, but I'm not quite sure what the difference [is] between, say, a four-year degree in nursing and another certification or a two-year degree.” Additionally, “not being fully aware of the scope of practice and what nurses have the authority to do and what specific health conditions or specific types of treatment that they might specialize in… I probably have a big deficit there in knowing what they all would be able to talk about.”

A few participants said they avoid speaking with nurses to avoid offending them. One spoke of asking an NP what nurses do, which implied “that she was included in that. And she didn't like that. And I didn't understand why.” Another participant found that in talking with nurses, “[If] I don't understand what is the difference between their title and qualifications versus somebody else in the broader nursing field… it made me feel like the conversation just shut down a little bit.”

Subtheme: Health journalists say they value diverse sources but often don't know how to find nurses to interview if they don't already know nurses, and they have limited time to track nurses down. Participants said they usually have no difficulty finding physicians to interview; they are familiar with medical societies and journals that include contact information for lead authors of studies. But most said they were unfamiliar with nursing associations other than the American Nurses Association, which they said they wouldn't likely contact for a story requiring a specialist nurse, and they seldom accessed nursing journals. One participant was not familiar with which associations to approach to find a nurse. “So for example, if I am writing a story that would require me to speak to a neurologist, I would know to go to AAN [the American Academy of Neurology].”

What helped them to use nurses as sources was having contact information for nurses with diverse expertise, knowing nurses, and interacting with nurses. One participant said she goes to an NP gynecologist: “I prefer them because… of experiences that I've had with doctors, you know, [which] hasn't been great, and that kind of leads also into my reporting.” Participants also said they were strongly influenced to use nurses as sources by having nurse friends or family members make word-of-mouth referrals.

Most said that when on deadline they usually do not look for nurses to interview. But having the time to “pound the pavement” in search of sources, many said, often leads them to nurses they would not otherwise find: “I found that the diabetes educators were frequently nurses or pharmacists, and so I learned… that nurses were there spending more time there than doctors were.”

Almost all participants said that building better connections between journalists and nurses would forge more solid health reporting. One participant noted that “if nurses want more recognition, want to be quoted more, you kind of have to put yourself out there. And so that means reaching out to a reporter and getting lunch or a cup of coffee and, like, developing a relationship.”

Subtheme: Communications staff of health care organizations and universities aren't offering nurses as sources, unless journalists ask for them. Interviewees said that when they approach health care institutions for an expert to interview, rarely are they referred to a nurse: “I ask for nurses, they give me physicians,” one said, and another noted, “I would say almost always if dealing with an institution and they're going to provide me with a source, it's going to be an MD. If I don't specifically say, ‘Hey, I want to do something on nursing,’ it is rarely offered.” Still another said, “The institutions aren't offering, and the journalists aren't asking.”

Hospitals are biased toward featuring physicians or hospital administrators, many participants said, with “rock-star guys”—prominent physicians, mostly men—often being pitched to the media as sources: “There's all sorts of just inherent bias inside of the hospitals and inside the universities about who they want to put on the phone. They're looking at… their rock-star guys to be the guy who [is] quoted.”

Another participant pointed out, “I receive probably 50 to 100 press releases in my e-mail every single day… telling me that some physician expert is available for an interview.”

Even when a journalist specifically asks for a nurse, one may not be offered. One participant who was writing about a disabled woman said, “I wanted to talk to the nurse who was there and who we know is with the family a lot of hours in a week, and she couldn't because the agency wouldn't allow her.”

This organizational bias extends beyond public relations staff. One journalist said a nurse who works in cardiac research at a major medical center is a reliable source for the latest research in her field, but the head physician “doesn't want her to be the one who's quoted”:

“I would love to be able to quote her when I'm running stories about interventional cardiology because she's smart, she's the one who's meeting with patients to help if they're having trouble, figuring how their devices work…. It can be really stressful for patients…. She's amazing and I'd love to quote her, but she's told that she's not supposed to do media.”

Subtheme: Editorial biases, policies, and processes can get in the way of health journalists using nurses as sources. Participants said that reporting assignments reflect newsroom biases about women, nurses, and health care hierarchies. Several participants who report on research from top medical journals said they were rarely, if ever, assigned a nursing study to cover. Such reporting usually entails summarizing the study and interviewing the lead author and an expert not connected with the study for comment. As one participant reflected on the possibility of interviewing a nurse for the comment, time limits again emerged as a factor: “Some stories are about research studies or the news of the day that the federal health agency has made some kind of an announcement…. [F]or deadline-driven stories, I might be less inclined to get a nurse on the phone.”

Newsroom culture also affects the selection of sources. Many participants said they're expected to use physicians as sources and that they've had to justify to editors using a nurse. One participant used a nurse anesthetist as a source: “I had an editor who once questioned me about how it was that I could have a nurse [in that role]…. I'm, like, ‘Well, that's what they study and that's what they do.’” Editors often determine who is quoted or featured in a story; a nurse source could be replaced by a physician at the editor's discretion. One participant has worked in male-dominated newsrooms, in which “there's not a lot of understanding of what role nurses play in medicine generally.” Additionally, “I have definitely had people in that newsroom just say: What, was I unable anywhere in America to find a doctor?”

Editorial styles can pose an additional barrier. Many participants noted that most newsrooms use the Associated Press Stylebook,21 which, until recently, called for referring to physicians as “Dr.” or “MD,” but did not permit the use of “Dr.” for anyone holding PhDs or other doctorates. Nor does it support using “RN” after a nurse's name, but rather indicates spelling out “registered nurse.” Even when a nurse is used as a source, many participants noted, she or he may not be identified as such unless the job title includes the word “nurse.” One participant, who explained to a nurse an editor's refusal to allow the credential “DNP,” said,

“I do think when [a publication uses] one type of title and not another one, it just sort of sends a message to your sources and to your readers that this is the real expert and then this is the other expert, and I don't have any control over that.”

Subtheme: Nurses and the nursing profession aren't strategic about engaging journalists. Participants also spoke to factors about nurses and nursing that inhibit media engagement, including nurses’ hesitance to speak with them. One said,

“You could be a rocket scientist of a woman and be a little bit, “Well, I'm not sure I really am the best person for you to speak to about this.”… [Nurses] need to realize that they are at the center of really important health stories that would benefit the public in a broader way.”

Participants also said that nurses often voice concerns about the legal ramifications of getting involved with media, meet resistance from employers on media engagement, don't want to speak on the record, and feel “restrained” about speaking up:

“I have had personal friends who are nurses and so I do feel that many nurses would hesitate to talk to a reporter openly and honestly unless the culture where they work is explicit in saying, “We want you to talk about your work with reporters.”"

Nurses may not always understand and respect reporters’ deadlines. Our participants said deadlines are a very real pressure in journalism, but nurses often do not respond to interview requests quickly and often seem unavailable for interviews: “I can't seem to work out schedules with nurses… as opposed to public health leaders such as doctors or spokespeople.”

While most participants said that nurse sources seem unsure of themselves in media interactions or are generally not media savvy, this was not perceived as an overall negative quality. One participant challenged the notion that nurses need media training: “I really like the fact that many nurses are not polished communicators… that they're going to talk to me in their own terms.” Many said they preferred authentic rather than coached sources.

Participants noted that individual nurses aren't solely responsible for this lack of savvy. While schools of nursing, nursing associations, and nursing journals seldom connect nurse experts with journalists, medicine is more strategic. One participant noted, “I get dozens of e-mails from around the country saying, ‘I have this doctor that will talk to you about why you need a flu shot,’ but I don't think I've ever seen something generic like that come from a nursing school.” Schools of nursing, nursing journals, and nursing associations rarely pitch journalists or offer press releases on nursing research, participants said, and don't offer journalists easy ways to contact researchers or faculty members or send out other relevant information to the media.

Nursing's overall lack of media sophistication may contribute to existing biases in journalism, including those about the scientific publications that are worthwhile. Participants said they look at weekly medical journals such as the New England Journal of Medicine, JAMA, and the Lancet but rarely read or look for nursing journals and seldom get press releases from them on the latest nursing research.

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DISCUSSION

We sought to explore why journalists use or do not use nurses as sources in health news stories, and these health journalists’ reflective responses provide insight into the intersection of health reporting and nursing. Although our sample consisted of only 10 health journalists, we were hearing redundant responses by the ninth interview.

Limitations. Our small, nonrandom sample size limits the generalizability of our findings. Also, while interviewing as a research methodology can identify respondents’ thoughts and experiences, it can't be used to capture their actions, interactions, or associated behaviors.22 Additionally, our sample was overrepresented by female journalists. We surmised that women journalists would more likely consider participating in a study conducted by researchers in a predominantly female profession, particularly given recent news reports of women's inequality in the workplace, sexual harassment, and assault. We pursued more male journalists to interview but stopped after we reached data saturation with the last two participants, both men. And our sample did not necessarily represent journalists from the same news outlets examined in our 2018 replication of the Woodhull study; therefore, no correlation between the findings of these two studies can be made. Finally, two of us (DJM and BG) came to this study with biases of our own about journalists’ underutilization of nurses as sources. As members of the Association of Health Care Journalists, we participate in a member listserv and have observed that seldom are nurses recommended as sources by nonnurse members. During our interviews for this study, journalists described stories in which they were unlikely to use a nurse as a source, and we sometimes explained why a nurse may have been relevant to the story. This may have biased these respondents’ subsequent responses.

Implications. Despite these limitations, we believe our findings have important implications for various stakeholders.

First, we encourage journalists and newsrooms to recognize how their own biases may be limiting the diversity of their sources and the quality of their journalism. Also, gender-based bias was evident in our sampling, with women responding more readily to our invitations to participate in the study. Our sample was 80% women, even though women make up only 39% of newsrooms.15 Although the percentage of women in newsrooms has increased in 20 years, the use of nurses as sources has not, suggesting that certain biases may be embedded in journalism. Our findings suggest that health news journalists, even as they adapt to continual shifts in how they perform their jobs and how people consume news, must work harder to devise innovative ways of increasing the diversity of their sources to include more nurses, women, and people of color.

Several journalists responded to our request to participate in this study by saying they don't report on “nursing stories.” Most of the women participants appeared somewhat embarrassed that they do not use nurses as sources more often, some acknowledging that our interview helped them to realize the extent of their own—and journalism's—biases. Male participants acknowledged that not using nurses as sources is sexist and biased against nursing and that physicians are perceived as holding the positions of power. A chief nurse officer or other leading nurse clinician is rarely viewed as a go-to source. Furthermore, a journalist may expect physicians to be media savvy but expect nurses to speak in their “authentic voices,” further demonstrating bias about sources.

None of the participants fully understood the scope and breadth of nurses’ work and roles. Most spoke of stories they'd written that they said would not have benefited from nurses as sources. We disagreed, underscoring the extent to which journalists are not fully aware of nurses’ expertise. One journalist who opted not to participate in the study wrote in an e-mail that he covered the business of health care and so didn't interview nurses. We believe journalists should recognize that there may be no better source for a story on the impact of hospital mergers, for example, than a chief nurse officer.

Even when journalists do interview nurses, they may need to justify using them as a source to their editors. And the bias extends to editorial style, in how nurses and other doctoral-level professionals are identified. The 2018 edition of the Associated Press Stylebook now permits journalists to use “Dr.” in referring to sources with PhDs and clinical doctorates,21 although our participants were unaware of this change. Nurses with doctorates who are interviewed by journalists should request that they be referred to as a registered nurse, if “nurse” is not in their title, and “Dr.” instead of “Ms.” or “Mr.,” noting that Associated Press style, used by most news organizations, now permits this.

Second, we found bias in health care organizations and universities, as well, where public relations staff rarely offer nurses to journalists when asked for sources for health-related stories—unless a journalist asks for a nurse. Two journalists said that even when they ask for a nurse they don't always get one. But the barrier may be others in the institution, as noted by the journalist whose trusted source is a cardiac nurse whom the head physician won't allow to be an on-the-record source.

Box.

Box.

Third, nursing organizations, associations, and journals are not helping journalists to identify nurse experts. At a time when newsrooms have slashed staff, despite today's 24-hour news cycle, reporting often uses repetitive content or is done quickly with little time to explore new sources.23 Nursing associations, health care organizations, and schools of nursing can help journalists access nurse experts quickly. Nursing associations could prepare a brief document for journalists that explains the various routes of education, titles, roles, and scopes of practice, with real-life examples that illustrate what nurses do. They can also raise journalists’ awareness of their organization and the expertise of its members. Individual nurses should do more to help journalists become aware of how a nurse would add to a story and how to access the best nurse experts (see Increasing Journalists’ Use of Nurses as Sources: What Nurses Can Do).

Several participants noted that when reporting on health-related research they are likely to review studies that come to their attention through press releases from medical journals, medical schools, or academic medical centers. They said they seldom receive press releases about nursing research from nursing journals or schools of nursing and universities. The International Academy of Nursing Editors, an unincorporated organization of editors and publishers of many nursing journals, may want to develop a strategy for assisting publishers to use their public relations staff to craft press releases and other media outreach strategies for the most important articles, particularly research. Association journals should be able to partner with their sponsoring organizations on such media outreach.

Finally, too few nurses have the requisite media competency to become go-to sources for health journalists. Nurses seldom reach out to journalists, even to compliment them on good reporting or to offer expertise, including being available for commenting on a new study someone has published. This behavior may represent nurses’ own internalized sexism or bias about the value of their voices and expertise. Instead, a nurse researcher in diabetes, for example, could be proactive in contacting journalists who report on research or cover diabetes and offer to comment on a study. Nurses also often fail to respond to journalists’ requests for interviews quickly, don't realize they can talk to journalists without employer permission if they don't name the employer, and don't always ask to be identified as RNs when interviewed.

While some of our participants did not recommend that nurses get media training, we have conducted such trainings and view the core media competencies to include understanding how to access media, framing an issue, constructing a message for that frame, and using techniques to stay on message. We believe nurses should develop such skills, which can be used when being interviewed, presenting in boardrooms, or leading care teams. Schools of nursing could teach these competencies, and health care organizations and nursing associations could reinforce them.

Conclusion and recommendations. The 2018 replication of the 1997 Woodhull study demonstrated that nurses remain invisible in health news stories.2 Journalists who participated in the present study attempted to explain why no progress has been made in 20 years. As one participant noted, “In all the stories I've written in my career there are probably hundreds of missed opportunities to have interviewed a nurse on the subject.”

Nurses must not wait another 20 years for journalists to use them as sources. Sharing nursing's expertise can be viewed as fulfilling the profession's social responsibility to promote the public's health.

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REFERENCES

1. Sigma Theta Tau International. Woodhull study on nursing and the media: health care's invisible partner. Final report. Indianapolis, IN; 1997. http://www.nursinglibrary.org/vhl/handle/10755/624124.
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Keywords:

bias; diversity; health journalism; media; nursing; Woodhull study

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