It’s widely accepted that nurses are the backbone of the healthcare delivery system. With more than four million RNs in the US¹, we are the largest profession in the industry. We occupy roles in nearly every corner of the care landscape, and we are privileged to be invited into a person’s world when most vulnerable. It is a position we should not take lightly.

Recently four Emory Nurses posted a TikTok video where they took it lightly and shared their ‘icks’². Reaction from their employer was swift. Terminated; it can be debated if the punishment fits the crime. When nurses behave negatively, while thankfully it doesn’t represent the vast majority, it tends to be more amplified than the behavior that earns us the title of the most trusted profession in the US year after year³. Let’s look beyond that for a moment and take inventory of what this behavior can have on our profession, our employers, and the people we serve. Whether in uniform, on the clock, or not, we represent our profession, our employer, and even our personal brands.

In social situations, we’ve all been asked, “What do you do?” When people find out you’re a nurse, they want to know about your job. Most are genuinely intrigued and have a real respect for your role. We should use the opportunities to tell our story. Telling our story requires knowing what we’d like to say and how to tell our story. In the early innings of nursing education, there should be a curriculum to cover professionalism both as a concept and as an action, and how to apply the concepts through the written and spoken word and video. Social media has become embedded in the professional and personal activities of daily living. In a very blended way where it’s not easily discernible where professional and personal could be separate. Nurses need to be aware of every interaction, all the time and expect that the camera is running when stepping away from home.

Our employers are constantly telling their stories and surveilling how they are perceived in the media, in the community, and even directly with the consumer. Nurses make up 30% of all employment within hospitals⁴, resulting in one of the largest operating costs. While we can be seen as a cost, nurses should also be seen as a driver of revenue. That position is destabilized when we create content like the TikTok video. Just look at the comments. Health systems, and all employers, exist because of market share. This translates into revenue. The perception in the marketplace can drive market share. As health systems and providers take on increasing amounts of risk in payer contracts (i.e., value-based contracts), market share is increasingly essential in leverage for better rates to get paid. That revenue then translates into paychecks for nurses and the chance to invest in nurses. Nurses need to help their employers gain market share and positive impressions. When we sit through the classes at work that set expectations on customer service, it’s designed to help shape those positive impressions and interactions.

In the isolation of nurses within the delivery system, when nurses are negatively reflected, it can hamper the ability to recruit into the profession or join us on a team. It would be hard to convince nurses to join us. Why would a nurse want to work at a place where we don’t treat people with respect, and the employer isn’t perceived well in the community? A potential colleague might even question if they’d be the target if they came on board. Think about recent union positions that have demanded better wages and more recruiting of nurses. In negotiations, the leverage that nurses and unions have is destabilized. We now must defend behavior and find ways to be ROI-generating rather than a cost only. It also doesn’t feel collaborative. Nurses should work towards designing an employer-of-choice for nurses and a provider-of-choice for consumers.

Lastly, all of the above is only possible with people choosing to seek our care and services. Look at the comments from the TikTok video. Individuals are saying they’d choose to go elsewhere. Word-of-mouth is the best marketing tool available. When people are asked, “Where do you go for care?” The answer needs to be your health system. That isn’t going to happen when we do not represent ourselves or the health system well. The measurement of consumer experience is becoming an embedded feature of risk contracts. The higher the consumer experience, the better health systems get paid. We may not get second chances to recover when our service falls below expectations.

This is a circle. Our behavior and brand impact ourselves and our employers. Employers are trying to attract market share and favorable payment rates to pay nurses and invest through a strong brand. Consumers choose where to seek care based on their experience and those close to them with a brand. There is no shortage of healthcare issues we need to tackle to improve it. We should do it from a position of strength as nurses with a brand that remains high. It should start with us.

‍

References:

1. AACN Fact Sheet- Nursing. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet. Accessed 12/15/22.
2. Emory Healthcare OB Nurses Fired After Mocking Patients On Viral TikTok. https://nurse.org/articles/ob-nurses-emory-fired-viral-tiktok/. Accessed 12/15/22.

3. Military Brass, Judges Among Professions at New Image Lows. https://news.gallup.com/poll/388649/military-brass-judges-among-professions-new-image-lows.aspx. Accessed 12/18/22.

4. Registered nurses made up 30 percent of hospital employment in May 2019. https://www.bls.gov/opub/ted/2020/registered-nurses-made-up-30-percent-of-hospital-employment-in-may-2019.htm. Accessed 12/18/22.