Research on the Brand Image of Nursing
Nurses make up the largest group of healthcare professionals in the nation and have earned trust and respect from the public. However, more than 20 years of literature reports that nurses have been overlooked as autonomous healthcare providers due to a persistently outdated and inaccurate image, often fed by the media, which projects nurses as caring and trusted, yet lacking in influence. When an organization or profession fails to articulate its own brand image, others outside of the profession are in a position to fill the void with other images, frequently based on their own agendas. The public, unaware of nursing’s advanced degrees and technical competencies, recognizes the contributions of nurses primarily based on attributes of caring and kindness, and as caretakers who take orders from physicians.
The image of nursing held by the public and fed by the media is often outdated and incongruous, yet nurses have failed to respond by delivering targeted messages which create and sustain a positive brand image (Hoeve, et al, 2014). The nursing profession needs to implement unified strategies that convey the brand image "All Nurses are Leaders" within and across all domains and levels of nursing and differentiate their value to themselves, and to the public, as influential decision-makers in the healthcare industry (Brewington, et al., 2020; Finkelman & Kenner, 2013; Godfrey, et al, 2020; Godsey, et al, 2020; IOM, 2011).
The strongest brand identity is communicated through consistency of message and action over time.
- Tom Hayes
What is Branding?
Branding is a marketing technique that allows organizations to create an image in the minds of consumers that conveys core values and differentiates their products and services from those of competitors (Brodie, Whittome & Brush, 2009; De Chernatony & Segal-Horn, 2003; Kapferer, 2012). In marketing terms, a brand is defined as ‘a name, term, sign, symbol, design, or a combination of them, intended to identify the goods and services of one group and to differentiate them from those of the competitor’ (Kotler & Keller, 2012, p.114).
The concept of ‘brand’ includes logos, slogans, and any trademark, which identifies a product, organization, or even a profession.
A brand can be extended to an image or identity, which comprises ‘a unique set of associations representing what the brand stands for and offers….an aspiring brand image’ (Aaker, 1996, p. 400).
Effective brand management communicates a message that is clear, relevant, and consistent, while also articulating a meaningful strategy going forward (Aaker, 2016).
The strongest brand identity is communicated through ‘consistency of message and action over time’ (Hayes, 2015, p. 113).
Nurses must understand that their leadership is as important to providing quality care as is their technical ability to deliver care at the bedside...
Our Original Research on the Brand Image of Nursing
Nurses: Do you believe there is a consistent image for the profession?
Source: Godsey, et al., 2020
Nurses in our study (2020) clearly indicated a desire to live the brand image of “Patient-Centered Caregivers”, as well as “Leaders in Practice, Education and Research. While nurses and the general public were in agreement that nursing’s current brand image is most commonly seen as “A Caring Profession”, this descriptor fell to the bottom of the list as the most desirable brand position statement among nurse participants (Godsey et al., 2018).
• It is critically important for nurses to understand the image their profession wishes to convey, how the image falls short, and what they can do to improve it.
• A common misperception among nurses is that the term “leadership” implies executive functions (not a “typical” staff nurse). To address this persistent issue, the nursing profession needs to implement unified strategies that convey the brand image “Nurses are Leaders” within and across all domains and levels of nursing (education, practice, leadership, administration) and differentiate their value to the public as influential decision-makers in the healthcare industry (Finkelman & Kenner, 2013; Godsey, et al, 2020; IOM, 2011).
• The focus on the Nurse Leader Brand Image offers an unprecedented opportunity for nursing to strategically “re-imagine” the education of the nursing workforce in a way that boldly targets the lack of autonomy, influence, and empowerment that persists for the profession’s brand image (Godsey, et al., 2020).
“Current” Versus “Desired” Brand Image of Nursing (Top 4)
Source: Godsey, et al., 2020
Our journey into the Brand Image of Nursing started in 2014 when I invited Dr. Tom Hayes, Dean of Xavier University’s Williams College of Business, and international expert on branding and marketing, to present to students enrolled in my graduate Nursing Leadership course. The lively discussion which ensued about the inconsistent brand image of nursing caused us to turn to the literature where we surprisingly found a complete lack of empirical tools to measure this important concept. So…..we decided to develop some.
After conducting multiple focus groups with nurses, we translated the resulting 42 descriptors and themes for the nursing profession into psychometrically sound survey instruments measuring the current brand image compared to the most desired brand image of nursing (Godsey, Hayes, Schertzer & Kallmeyer, 2018). Nursing's Current Brand Image Scale (NCBIS) and Nursing's Desired Brand Image Scale (NDBIS) were administered to a national convenience sample of Bachelor of Science (BS) and Master of Science (MS) nursing alumni (n = 286).
A most revealing finding was that nurses viewed their current brand as ‘advocates’, ‘caring/compassionate’, ‘critical thinkers’ and ‘essential members of a healthcare team’, but rarely selected ‘powerful/decision-makers’, ‘leaders’, advanced degrees’, ‘autonomous’, ‘interprofessional’ or ‘health experts’ as representative of their profession. The descriptors ‘researchers’ and ‘technological’ were not selected at all.
The finding that nurses did not associate their professional role as being one of autonomous decision-makers and leaders in health care reform is quite inconsistent with IOM recommendations for nurses to ‘practice to the full extent of their education and training’ and ‘…in full partnership with physicians and other healthcare professionals’ (IOM, 2010, p. 4).
When asked which nursing brand position statements were most appealing, the responses of nurses were significantly different (p = .001).
The idea of being Patient-Centered Caregivers, as well as leaders in education, research and practice, and in healthcare reform, rose sharply, while the frequently cited descriptor of nursing as a ‘caring profession’ fell to the bottom as the most appealing brand position statement.
(Godsey et al., 2018).
Our research on the Brand Image of Nursing is consistent with decades of reports in the literature that nursing lacks a consistent brand image. Not surprisingly, almost 80% of nurse participants in our “Brand Image of Nursing” research answered “no” when asked if nursing has a consistent brand image.
Responses from a combined diverse nursing sample (n=573) were compared to public perceptions of the brand image of nursing (n=743) (Godsey, Houghton, & Hayes, 2020). Findings showed a significant gap between how nurses perceive their profession currently versus how the public perceives nursing.
Nurses indicated a desire to be seen as “patient centered” and “leaders in practice, education, and research”. However, members of the general public saw nursing’s brand image much differently. The descriptor “leader” was among the least ranking descriptors selected by the public (followed by other low ranking descriptors: holistic, technological, decision makers, autonomous, and researchers. Top ranking public descriptors included nursing’s desirable brand image descriptor “patient centered” However, the public also chose empathetic, nurturing/mothering, and physician’s assistant among the top ranked descriptors for nursing.
Public respondents (n=743) ranked the following descriptors lowest for nursing
(0 - 1.2%):
Decision Makers (n=4)
Public respondents ranked the following descriptors highest for nursing (n=743):
Caring, Healthcare Providers, Essential Members of the Healthcare Team, Patient-Centered, Skilled, Professional, Empathetic, Nurturing/Mothering, and Physician’s Assistant
Publications & Presentations
Registered Nurse Perceptions of Factors Contributing to the Inconsistent
Brand Image of the Nursing Profession
Nurses have been overlooked as autonomous healthcare providers due to an inaccurate image which projects them as caring and trusted, yet lacking in influence and autonomy. It is important for nurses to understand the image their profession wishes to convey, how the image falls short, and what can be done to improve it.
To examine responses of Registered Nurses (n = 286) describing factors influencing nursing's inconsistent brand image.
Qualitative data were thematically coded, analyzed, and grouped into eight influencing factors.
Factors contributing to nursing's inconsistent image included: variety of education/credentials, image not a priority, lack of leadership development, lack of professionalism, portrayals in the media and online, patients’ personal experiences, treatment by other professional colleagues and gender role assumptions.
A strong brand image could dispel outdated and inaccurate views while communicating new visionary leadership which aligns with priorities for the nursing profession.
Godsey, J., Houghton, D., & Hayes, T. (2020). Registered Nurse perceptions of factors contributing to the inconsistent brand image of the nursing profession. Nursing Outlook, 68(6), pp. 808-821.
Can Brand Theory Help Re-Position the Brand Image of Nursing?
The current versus desired brand position of the nursing profession is examined using brand theory.
The nursing brand has a long and revered image with various stakeholder groups. However, the current image frequently represents nurses as caring advocates rather than Influential Leaders who deliver, manage and administer health care services.
Recent quantitative field research describes perceptions of nurses' current vs desired brand position. A perceptual map illustrated a gap on the axes of Patient‐Centered Caregivers and Leaders in Healthcare. Empirical literature provided the foundation for prescriptive advice, which could address potential threats and opportunities for the brand.
Brand theory is used to describe how nurses' current image seems at odds with nurses' role in contemporary society. The largest gap on the perceptual map was on the ‘Leadership Axis', suggesting more effort is needed to change perceptions of the essential leadership role of nurses in various health care systems.
Implications for Nursing Management
The nursing profession needs to implement branding strategies, which close the gap between the current and desired brand positions. The central brand position of nurses as leaders should thread throughout practice, education, research and professional associations for effective brand repositioning to occur.
Godsey, J., Perrott, B., & Hayes, T. (2020). Can brand theory help reposition the nursing brand? Journal of Nursing Management, 28(4), p. 968-975.
Development and Testing of Three Unique Scales Measuring the
Brand Image of Nursing
Nurses have been called to be leaders in the transformation of health care and to help improve health-care access for the nation’s most vulnerable populations. However, to lead health-care transformation, the profession of nurses must first see themselves as leaders. Unfortunately, nursing has been described as lacking cohesiveness and failing to communicate a consistent brand image. No empirically tested quantitative tools exist to measure the brand identity of nursing, making it difficult to assess where the profession stands in regard to the mantel of leadership. The purpose of this study was to develop empirically sound instruments which could measure nurses’ perceptions of their professional brand image. A total of three scales were developed and then tested: The Nursing Brand Image Scale, Nursing’s Current Brand Position Scale and Nursing’s Desired Brand Position Scale. Results of this study indicate the scales measuring the Brand Image of Nursing and the Brand Position of Nursing are psychometrically sound.
Godsey, J., Hayes, T., Schertzer, C., & Kallmeyer, R. (2018). Development and testing of three unique scales measuring the brand image of nursing, International Journal of Pharmaceutical and Healthcare Marketing, 12(1).
Professional Identity in Nursing: Bridging the Gap Between Nursing's Professional Identity and the Profession's Brand Image
Professional Identity in Nursing is a “sense of oneself, and in relationship with others, that is influenced by characteristics, norms, and values of the nursing discipline, resulting in an individual thinking, acting, and feeling like a nurse.” Webinar presenters will outline the persistent problems restricting nursing’s influence as expert leaders in their discipline. Research findings will be used to explain the dichotomy of nursing’s professional identity and its inconsistent brand image. Presenters will offer strategies for creating a preferred brand image for the nursing profession while cultivating a clear understanding of professional identity for nurses.
Brewington, J, Robinson, M., Godsey, J., Hayes, T. (2020). Professional Identity in Nursing: Bridging the gap between nursing's professional identity and the profession's brand image, Sigma Theta Tau International Society, (Abstract and Webinar, 12-15-2020).
Nursing: Calling for a Shared Vision
This podcast describes why professional identity and brand recognition in nursing is important when discussing the need for professional identity and brand recognition in nursing when working with the public and other health care professionals. Differences in professionalism and professional identity in nursing will be discussed. Brand theory and strategic brand management for the nursing profession will be examined.
Godfrey, N., Godsey, J., Hayes, R., & Howard, M. (2020). Nursing: Calling for a shared vision. Sigma Repository
(Abstract and SigmaCast Recording, Episode 10).
Nursing Empowered Leaders
Numerous articles have been written describing the disconnect between the perceived image of nursing and the unfavorable, inaccurate, stereotypical representations of nursing commonly fed by the media (Morris, 2007; Cabiniss, 2011; Kelly et al., 2011; Rezaaie-Adaryani et al., 2012). Media representations of nurses have typically included their role as subservient to physicians, angels of mercy, or sex objects (Cunningham, 1999; Mendez & Louis, 1991; Pierce, et al., 2002; Ward, et al., 2003). Researchers have consistently called for the profession of nursing to pursue branding strategies that take charge of the nursing image (Pinkerton, 2002; Parish, 2004; Dominiak, 2004; Baldwin et al., 2010 and Cabiniss, 2011). A common theme in the literature describes an ongoing lack of a consistent brand identity for nursing (Goodin, 2003; Zarea et al.,2009; Emeghebo, 2006; Cabiniss, 2011 and Rezaie-Adaryani et al., 2012).
No published studies could be identified prior to this research which used valid instruments to identify, measure, and describe the current and most desired brand image for the profession of nursing. Almost three-fourths of nurses responded "no" when asked if nursing has a consistent brand image. Results of this study demonstrated that significant gaps exist on two levels regarding the brand image of the profession of nursing. Incongruences were found between how nurses perceive their profession currently versus how they would like to be perceived. Interestingly, respondents reported that nurses themselves were primarily responsible for managing their own professional brand image. Numbering more than 3.3 million, Registered Nurses make up the largest group of healthcare professionals in the nation. The authors contend that the large scale, strategic management of a profession's brand identity is a primary responsibility of the major nursing professional associations at the national level, rather than reliance on individual nurses themselves. This study provides further support that the nursing profession needs to manage its brand identity in a more deliberate and consistent manner. This research could inform the design of a more accurate and distinctive set of brand positioning statements which represent nurses as leaders in education, research and practice and essential leaders during an era of healthcare transformation.
Godsey, J., Hayes, T. (2017). Nursing empowered leaders: A study describing who we are and who we want to be (Conference Proceedings [Abstract]). Sigma Theta Tau International, “Creating Healthy Work Environments”, Indianapolis, IN, 3/17-20/2019.
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