Matter of Opinion: Reframing the Public Image of Nursing

Podcast Transcript

Carol Pehotsky:

When we look at media today, or even when most of us are growing up, the images of nurses range everything from completely nonexistent to the superheroes of the pandemic. But the reality, as we all know, is somewhere in between. How do we tell our story? What is our responsibility to tell our story? And how do we inspire the next generation of would-be nurses? I'm joined today by Dr. Mary Beth Modic as we discuss the image of nursing.

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing from patient care to advancing your career, to navigating tough on-the-job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

I came to the career of nursing a bit later in life than many. I was 28 when I graduated from nursing school and had previously earned two other college degrees before being open to the calling of becoming a nurse. My childhood best friend, now she's my sister-in-law, Jamie, always knew she wanted to be a pediatric nurse. So, I have known her since I was eight, and she would always talk about, I'm gonna be a pediatric nurse when I grow up. And she is! She became a school nurse.

For me growing up, there was 0 percent of me that wanted to do that. I associated nursing with an inordinate amount of blood, which is ironic now that I lead perioperative nursing. And just my gut reaction to a lot of that was, no, thank you. I didn't think I had it in me. And you add onto that some of the things I was exposed to as a child. Part of nursing for me was seeing my loved ones in a hospital, receiving care from a nurse, and seeing people who were larger than life to me as a child, suddenly very vulnerable. And instead of, because I was eight, seven at the time, I couldn't really pull out what these individuals were doing for this person I loved versus really focusing on that helplessness of my loved one.

And then you think about, I grew up in the '70s and '80s, and the images of nurses that were, and to an extent, are still out there, didn't really align in my head as something that could be autonomous, something that would be fulfilling for me because I just didn't know what I didn't know. And so on. I went onto other careers. Eventually though, I did really get to finally see nursing in one of its truest forms. I was a music therapist on a burn unit. And really being able to work alongside those amazing professionals and really see what they could do, the care they provided, the autonomy they had, finally clicked. And, finally, I was open to hearing that call.

So, the topic today is the image of nursing, and I'm so very thrilled to be joined by Mary Beth Modic. She's a clinical nurse specialist at Cleveland Clinic and has so much to offer nurses and the nursing profession. But we will specifically talk about the image of nursing today and how we can all contribute to it. Thank you so much for joining me today.

Mary Beth Modic:

I'm delighted to be here.

Carol Pehotsky:

Excellent. So, let's just kick it off with, you know, you've spoken at great lengths about this, so maybe if you can share with our listeners some of the history and the current state of the image of nursing.

Mary Beth Modic:

Well, I got into exploring the image of nursing because what I noticed was on all the dramas, and I would say that physicians and lawyers and policemen and firefighters, police officers let me correct that, don't like how they're portrayed either, but nurses are missing. So, when you look at why, I think there's such an interest in medicine because the physicians are doing medical care and they're doing nursing care and they're doing physical therapy. So, they're doing it all, and we aren't there at all, at all.

Carol Pehotsky:

Right. Yeah.

Mary Beth Modic:

So that propelled me to speak to children, just high school students. And it is fascinating because I'll say, so who out there wants to be a nurse? And like you, they talk about, well, I don't want to deal with, you know, all of the bodily fluids that we do encounter. And so, I spent a lot of time in that venue, and then I started really exploring the image of nursing and doing a lot of reading by Suzanne Gordon. And Suzanne Gordon is a journalist who started out in Boston, the daughter of a physician, but she has spent her professional life dedicated to promoting the image of nursing. And she chastises us a lot for missing opportunities when we have afforded them.

Carol Pehotsky:

Sure.

Mary Beth Modic:

So, I might get a phone call to speak, be interviewed about diabetes. And perhaps 20 years ago, I would've said, oh, well, I don't think I can do that. I don't feel I have the knowledge. Why don't you ask Dr. So-and-so and so-and-so.

Carol Pehotsky:

Sure.

Mary Beth Modic:

So I think that as we become more, and we've always been essential, but I think that the pandemic really propelled us into the eye of the society and that we were in the room, mass managing 13 IV pumps and a patient who was critically ill and offering often, uh, ushering that person into death without their family. So, I think we got society's attention, but as things go on and life moves on, I think we've, again, are back into the backstage, if you will.

Carol Pehotsky:

Yeah. It, you certainly, we saw some momentum during the pandemic of even seeing images of nursing out there in the media et cetera. But often it was also the superhero archetype, which feels good in the moment, but then it's like, well what are, what is society asking me to do in this role? Versus a, whether it's a calling or career for a nurse, it isn't necessarily putting on a cape?

Mary Beth Modic:

Correct. Correct. No, I've never really embraced that concept because heroes also have failings and I'm upset about that, I guess.

Carol Pehotsky:

So, let's linger on that a little bit more. Nurses and the nursing profession have gone through a lot in the last three years. Uh, so spending a little more time on what do you think that's done to our profession for better or for worse? And, and so trying to get away from that superhero image but really there was some momentum. How do we get that back?

Mary Beth Modic:

Well, I think we're just stalled for a moment. I don't share many people's belief that we're in dire circumstances and that our profession is in peril. And I can say that because I have the opportunity to work with just the most magnificent nurses, I think the world has ever seen. And in this experience called Magnus that I created with a colleague of mine at Francis Payne Bolton School of Nursing, Dr. Joyce Fitzpatrick, what I hear and what I witness is the absolute dedication, affection commitment to this profession. And I think we just need to spend more time. Also, there is a documentarian, her name is Carolyn Jones. And I know you know her well.

So, she again, has been dedicating this part of her, the later part of her career, to highlighting the contributions of n- nurses. And what she says is, I don't want to hear about the problems. I want to hear about the solutions. And I am showcasing those nurses who are innovators, leaders, provocateurs. And I want to tell their stories. And so, I think that we are in an unusual place, but a place there, where we can really, really make a difference and advocate for our contribution that is unique to the health and well-being of society.

Carol Pehotsky:

Absolutely. And when you think about the future of nursing, the supply-and-demand piece of it, you know, we saw there was an uptick in nursing school enrollments during the middle of the early part of the pandemic, and then it sorts of tapered off. And so, we all want to be able to hand the baton to someone else when it's our time to retire. And so, what do you think we could all be doing, whether I'm cons- curious about nursing or in nursing school or toward the end of my career, what can I be doing to really help portray that image of nursing to maybe inspire the next person to consider it as a profession?

Mary Beth Modic:

Well, I think we need to talk about what we do. Often, we talk about that we didn't have lunch and we didn't have any water. And who wants to do that? Who wants to be starving and thirsty? Um, so I think that we need to be saying that I identified this problem that was unclear to anyone else, or that I realized that this family member was struggling so much that they were acting out. And we realized that again, we are encountering patients and their families who are more aggressive than we've had in the past.

Carol Pehotsky:

Sure.

Mary Beth Modi:

And I think that's reflective of the fact that we're having sicker and sicker patients in the hospital and that families aren't nearby. And so, either they're not being able or they haven't seen their loved one in a while, and they come, and they see this catastrophic situation. And so, I think that we do remarkable things, but we just think it's not that big a deal.

And I love nursing for a number of reasons. First, I've had the most extraordinary career, and when I reflect on it, I want that for everyone because it was continually learning. And I worked with people who saw something in me that I didn't see in myself. They were also patient with me when I was very immature. And they gave me mercy. And I think that all of those things set me up to want to advocate for this. So, tell our stories, and second of all, I think that we need to be there for one another. And I think we, we have done that, but I think that the concept of belonging is, is so important now in organizations, and I don't mean it from the perspective of, um, the diversity, equity and inclusion movement, but that the belonging is that when you're not there, people do miss you.

Or they'll notice that there is a change in your behavior, you're quieter, more reflective, and you, you know, you found out they'll share with you, your colleague, that their father was just diagnosed with cancer, but they, they didn't really want to share it because they didn't want to bother anyone else. And so, I think, again, telling the public and telling our stories that are really sacred stories. Being there for one another in belonging. And then I think investing in our schools of nursing.

And so, as an alumnus, we make contributions so that we can afford scholarships or help with scholarships so that students who otherwise may not be able to go to school can do that.

Carol Pehotsky:

Yeah. Absolutely. And it's never too early to start.

Mary Beth Modic:

No.

Carol Pehotsky:

You know, you'd mentioned going to schools and somewhat, maybe it's ironic, it was career day at my daughter's school, and they were looking for parent volunteers, yes, I'll go talk about nursing. That happened in January 2020.

Mary Beth Modic:

Oh, God.

Carol Pehotsky:

And I had come planned to teach hand-washing and surgical scrubs. So, it’s interesting how things all played out. But it is incumbent upon all of us who are listening wherever we are in our nursing journey, to be able to turn to the next person and ask them, why are you excited to go into nursing school? If, if you're listening right now and you're on your, on your journey, what brought you here? And, and telling somebody about that and what, what the meaning is. And, and because if we're relying on most media images, they're not gonna get that.

Mary Beth Modic:

Absolutely.

Carol Pehotsky:

I think, think back to, you know, you, you'd mentioned TV shows like House for a great example, like maybe that's one of the more egregious examples. And, and to your point, you know, I have friends who are lawyers that hate, hate watching law shows as well, but just this idea that there is nobody else present. So, no wonder if we aren't telling our stories, then our patients, our loved ones are saying, well, why would you go into nursing? What do you do?

There's also out there the image of the sexy nurse. Everybody's favorite.

Mary Beth Modic:

Yes.

Carol Pehotsky:

I was horrified to see some pictures of a group that my daughter participates in and another group of girls who are in their, you know, hats and their short little skirts. And they're little, so it's adorable, but it's like, ugh, man, there it is. So, what do we do to combat that?

Mary Beth Modic:

So, I spend a lot of time writing about those images. And so, I think it was a printed ad of, you know, a razor blade, but there were four nurses surrounding this man in the bed and, but it was, I think the ad was pulled within two months because of the outcry of nurses. And I think that we just need to be on top of it. And to say, I think that there are other ways in which we can be represented instead of this. And I also think that we need to be not passive-aggressive. So, for example, in the Washington State Senator a couple of years ago, there was a bill pending to make sure that nurses in extended care facilities would get break time. You know, she made the statement, and I'm paraphrasing here, but you know, that, oh my gosh, they don't need a break time because they had to spend all their time playing cards.

Carol Pehotsky:

Right.

Mary Beth Modic:

So, she was inundated with thousands and thousands of decks of cards. And you know, that is certainly one way to convey your displeasure. But what if every one of those nurses had made a contribution to the American Heart Association or AARP or something and saying, this is a donation in contrast to the image that was being portrayed? So, I think there are lots of ways to do it. And my children will say, when I'm in a public place, and I, you know, at one place I, I heard a group of people really trashing nurses and they were in a position to know better. And I will say no more than that. And they looked at me and said, Mom, please let's just leave, don't cause a scene.

Carol Pehotsky:

Don't. Not today. I can’t help it.

Mary Beth Modic:

And I just felt that I am not an out of one but an ensemble of millions of nurses and I feel that I have an obligation to speak on our behalf. So, I do write letters and I also commend organizations or images when we are portrayed in a wise way. Because I think, again, appreciation is much better than constantly getting negative comments.

Carol Pehotsky:

Yes. Well, and it's like the controversy on The View, when they talked about the doctor's stethoscope.

Mary Beth Modic:

Yeah.

Carol Pehotsky:

Everybody would turn to social media, which created a moment. But what do we do beyond that moment to turn to the next person and say, here's why she was misinformed.

Mary Beth Modic:

Absolutely.

Carol Pehotsky:

How do we make a donation or make good out of it versus? So, let's go to social media for a bit of time.

Mary Beth Modic:

Okay.

Carol Pehotsky:

That could be its own episode.

Mary Beth Modic:

Oh, okay.

Carol Pehotsky:

But certainly, I feel like I've seen lately people who are dressed, at least dressed as nurses, appearing to be in hospital units filming Tik Toks. Especially those that are derogatory towards patients. So that could again be in its own episode. But your gut reaction to some of that and, and what we need to do to contrast some of those images.

Mary Beth Modic:

You know, I think part of it might be my response is really formed because of my age. I'm not one who really embraces a lot of social media, so to one extent I might be missing out on tremendous things. On the other hand, I'm happy. I do think, again, we have an obligation and there's one person in particular who comes to mind and has a huge following and has now taken his show on the road and is filling auditoriums. And, you know, I'm on the fence. I guess I say, well, it's novel and it's a way for nurses to release the angst and a lot of the worry that they carry with them. On the other hand, I just don't see pharmacists doing that, or physical therapists or social workers. And so, I guess I don't really have an answer for you. It, it disturbs me greatly, and I just wish that we would own it more and say, you know. Obviously, you are a very innovative individual.

Carol Pehotsky:

Sure.

Mary Beth Modic:

And how about making a short little video or reel about identifying heart failure or that you are noticing that a person's blood pressure is dropping and if you hadn't intervened, this person wouldn't be around, or I mean, the community health setting, what we're doing? And I think that again, in terms of nursing, I see most of its hospital-based charges and good gravy we're in schools we're in clinics, we're in, we're in vans, we're in the community and in faith-based programs.

And so, I think we need more diversity in terms of our settings. So, if, again, people are listening and they say, gosh, I'm a community health nurse and I should be or I'm a home healthcare nurse, and I can talk about what it is a privilege to go into people's home and just, they open the door and let you in and you can see, 0h my gosh, they, they have hardly any food. And you know, they, it's, they are really struggling with paying the bills. Like, and while we have those things in the chart to witness it and to see what people are living and encountering every day and trying to make great choices for themselves, I think is compelling.

Carol Pehotsky:

And social media could be that platform to instead say, how do we improve the health of our patients when they aren't in our hospitals, when they are coming to the clinic, and then they leave and say, now what do I do? It, it goes back to your point about, yeah, sometimes we need to blow off that steam and talk about the, I didn't get a break today, et cetera. But if we're using social media as that outlet, and that's the only thing we're talking about is what's wrong with nursing then, no wonder it's might be good for quick laugh, but no wonder we're fighting against ourselves versus using that opportunity to say, we have some hard days, but we have some really amazing ones too.

Mary Beth Modic:

So, my youngest daughter is a nurse, and I, her name's Claire and I always ask permission to tell stories about her but one of the things, so she's not in Ohio, but she works at a phenomenal place. They call nurses that have been practicing for a while, the Golden Ones.

Carol Pehotsky:

Oh, nice.

Mary Beth Modic:

And, as opposed to the older ones or whatever else. Oh, oh yeah. The whole, um, and she was telling this story to me, and I shared because I think that it was so profound for her, but she was caring for a young woman who was 24 and had instantaneously become blind because of some retinal artery in parts and just a whole clotting episode of which I'm don't appreciate the, the pathophysiology. She had two little children.

Carol Pehotsky:

Oh my gosh.

Mary Beth Modic:

And she was in the ICU, and she was becoming very, very anxious and having a panic attack and wrestling around in the bed and dislodging her catheters. And Claire is trying to calm her down and prevent the catheters from dislodging and pulling them out. And again, a Golden One came in and she said to Claire, may I help you? Not, do you need help, or may I help you? Yeah.

Carol Pehotsky:

Yes.

Mary Beth Modic:

And she went up to the patient and she said, hello, my name is Sarah and I'm with Claire, and is it okay if I touch your shoulder and hold your hand?

Carol Pehotsky:

Oh, gosh. Yeah.

Mary Beth Modic:

And she proceeded to say, you are surrounded by love, and I know you are afraid. And just, and Claire, who was saying, the tears are coming down my face and I thought I was in this sacred moment where I was witnessing all of the skill and expertise that can be in one person, and that lulled her into sleep without any medication.

Carol Pehotsky:

Yeah.

Mary Beth Modic:

So, I think, and we do that every day. And we don't think it's a big deal. And so, she, Claire, wrote up the story for her nurse manager, and this work was showcased. So, I think, and how we learned that. We'd learned how tone of voice, how she asked permission. And I once was caring for a patient who was blind and who had diabetes. And he said to me, I can always tell the caliber of the nurse by the way in which she enters and leaves the room. He said she, so I was using that as a pronoun.

Carol Pehotsky:

Yes.

Mary Beth Modic:

But because some come in. Or others, they don't want to know that you're there.

Carol Pehotsky:

Hmm. Right.

Mary Beth Modic:

So that I won't ask them, so I won't spend more time.

Carol Pehotsky:

Sure.

Mary Beth Modic:

And there are others that say, I'm here so-and-so, and I'm adjusting your IV, or I'm doing this, I'm doing that, and I'm about to walk out of the room. Is there something else that you need?

Carol Pehotsky:

So simple. Yeah.

Mary Beth Modic:

Simple stuff and it doesn't seem like you have to have a lot of brain power to do that. But that is taking in the whole person and offering healing in that moment.

Carol Pehotsky:

And what better description of the art of nursing than anything.

Mary Beth Modic:

Yeah.

Carol Pehotsky:

So, one of the many ways you have contributed to the image of nursing is the book you coauthored with Dr. Fitzpatrick, Luminaries of the Past, Stories of 50 Extraordinary Nurses. What inspired you to write this book?

Mary Beth Modic:

Well, again, I was worried about our invisibility. And I also thought that in middle school, kids learn about famous physicians.

Carol Pehotsky:

Yep.

Mary Beth Modic:

So, they learned about William Harvey, discovered circulation, or John Snow, who was instrumental in identifying the cholera outbreak in London. But we don't know besides Florence Nightingale, any other nurse.

Carol Pehotsky:

Yeah.

Mary Beth Modic:

And I love this saying, and I, I don't know who came up with it, but it’s, to understand the present and prepare for the future, we must appreciate the past. And there are so many men and women who forged the path and just were innovators or persistent or just saw suffering at immeasurable indices that they stepped up and they made nursing more visible. And I, I just wanted to tell their stories. And so, when you ask about so-and-so, they've not heard about that person.

And also, I was chagrined, I guess in 2020, when it was the year of the nurse. And I happened to be in, again, Dr. Joyce Fitzpatrick's office, and I was telling her I wanted to do this book. And she said, oh my gosh, yes, let's do it. And that was January 2020.

We started kind of working on it in February 2020. And you could imagine.

Carol Pehotsky:

Yes.

Mary Beth Modic:

But in August of 2020, USA Today published the 100 Greatest Women of the Century.

Carol Pehotsky:

Okay.

Mary Beth Modic:

And Lillian Wald was not even mentioned, not any nurse, but Lillian Wald, who was so integral in the healing of New York immigrants, was to me a very, very abysmal showing of their research. I think again, we can't promote the profession if we don't understand what and who led us to this point. So that was the idea. And then it was really difficult because we were thinking, well, how do we decide?

Carol Pehotsky:

Yeah.

Mary Beth Modic:

And so, we decided, well, the primary criteria are you couldn't be alive. So, we weren't going to offend anyone who is leading, and making. And, then the other criteria were we wanted it to be diverse so that when a child looked in that book, they saw someone who looked like them.

Carol Pehotsky:

Who looked like them. Yeah.

Mary Beth Modic:

And so, we have a nurse from Japan we have a nurse from Israel, we have a nurse from the Philippines. We have several nurses from Canada. And I think their stories are so gripping. And again, the tenacity and what they've done and how we just don't really know about them.

Carol Pehotsky:

Do you have a favorite one?

Mary Beth Modic:

You know, I was thinking you might ask me that, and it's probably like, you know, an author writing a fiction book and you think, what character? And you think is, each one of them has tugged at my heartstrings in a different way. And so, I probably couldn't offer you one because this day I think of this person, or this day I think of that person. And so, I just really sometimes ruminate when I'm really feeling sorry for myself or something else.

I'll read about Mod Collin, or I'll read about Edith Cavell and yeah, think, Mary Beth, you have nothing to complain about.

Carol Pehotsky:

You know, I, I've read this book with my now middle schooler who, who says, at this point in her life, she'd like to be a nurse. So, it's been very helpful having that. And one of the stories that was most impactful for my daughter and I, as we read the book together, was the story of the young man who was a nurse during the COVID pandemic.

Mary Beth Modic:

You know, it was really fascinating to me because I called his sister.

Carol Pehotsky:

Okay.

Mary Beth Modic:

I interviewed her and I just said, I just want to make sure that it's okay to tell his story. We listed him as a humanitarian.

Carol Pehotsky:

Yes.

Mary Beth Modic:

And he was an assistant nurse manager at a hospital in New York and was very, very concerned about protective equipment. And just he, you know, had a chronic condition and succumbed. His story is worth telling.

Carol Pehotsky:

Absolutely.

Mary Beth Modic:

Yeah.

Carol Pehotsky:

So, everybody go check it out. You can get it wherever books are sold. I highly recommend it, even if you don't have a middle schooler in your home. It's a fantastic read. It's beautifully illustrated. It's a wonderful book. We're running short on time, so we're gonna wrap it up a little bit here. A couple just gut-reaction questions.

Mary Beth Modic:

Okay.

Carol Pehotsky:

Who's your inspiration in nursing?

Mary Beth Modic:

I'm hesitant to say because I think that there are so many people that formed me as a nurse and that continue to form me as a nurse. So, I know it's a chicken's way out, but I couldn't pick, I couldn't pick, just pick one.

Carol Pehotsky:

All right. Okay, what brings you joy in nursing?

Mary Beth Modic:

Oh my gosh. Just the ability to be innovative. I mean, to be innovative and to come into people's lives when they're so vulnerable and they really don't really want to show the depth of perhaps their despair or their fear and be able to bridge that and attenuating their suffering is quite remarkable. And I guess the final thing that I would want to offer you is that nurses are always portrayed as very caring and empathic. And we are that but we're also very, very smart people.

And to be able to know what to say, when not to speak, when to hold someone's hand, that's predicated on lots of science and the humanities. And so, it's not, we're just because we're nice people. We're smart people.

Carol Pehotsky:

That's right. All right, listeners, well, we all have some homework. So, if you haven't yet checked out the American Nurse by Carolyn Jones, you should definitely do that. Make sure you check out Dr. Modic's and Dr. Fitzpatrick's books, Luminaries of the Past, Stories of 50 Extraordinary Nurses, available wherever books are sold, and go tell a friend how amazing it is to be a nurse. Mary Beth, thank you for joining us today.

Mary Beth Modic:

Oh, I was so delighted to be with you, Carol. Thank you.

Carol Pehotsky:

As always. Thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other. The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.