Servanthood

Is a Baylor ad praising its nurses as "servants" a problem?

February 2014 -- The Baylor Health Care System has recently run television ads based on the idea that its employees are faithful "servants." That concept is rooted in the non-profit company's Christian heritage and, presumably, in a recent management trend toward presenting a range of private sector workers (including executives) as "servants." The one-minute ad features many apparent nurses in clinical settings, and it certainly seems to show them in a positive light. But many nurses have objected to being presented as "servants." They have a point. Nurses have long been regarded as low-skilled physician servants--indeed, they have been encouraged to embrace an ideal of selfless devotion that has hardly helped them get the respect and resources they deserve. And the nurse scenes in the ad emphasize what seem to be the most unskilled tasks with which nurses are associated, including hand-holding, mopping brows, wheeling gurneys, changing "hearts" and sheets, and picking things up off the floor. Meanwhile, apparent physicians in the ad act as servants by doing research and cutting-edge surgeries, changing "minds" and "tomorrow." The servanthood theme may hold some appeal as a matter of spirituality or marketing, but it's dangerous to apply to a traditionally female profession that has struggled to overcome the notion that it simply serves physicians and to get respect for its advanced education and skills. We urge Baylor not to associate nursing with servanthood, or at least to ensure that any such theme be expressed at least in part through nurses' life-saving expertise.

Read more below the video:

Baylor Health Care System is a large Texas non-profit health company that recently merged with Scott & White Healthcare to become Baylor Scott & White Health. The "servant" ad apparently went up not long after their merger, and it reflects one of the merged company's stated core values, namely "Servanthood:  Serving with an attitude of unselfish concern." It also seems to relate to the company's heritage of "Christian ministry," reflecting the founders' "dedication to the spirit of servanthood." Other stated values include "excellence" and "innovation"; it's not clear how heavily nurses will figure in ads featuring those.

The ad itself is a one minute piece consisting of a friendly male voice-over on top of clinical scenes, without dialogue. Here is a basic summary:

VO:  Imagine your child tells you that when they grow up, they want to be a servant. (We see a man in scrubs placing a clean sheet on a bed.) What would you think? (Someone wheels a gurney down a hospital hallway.) Maybe they have low self-esteem. (A patient on a gurney reaches up and an apparent nurse takes her hand; the camera pulls back, and two nurses are wheeling the patient somewhere.) After all, servants change sheets. (An apparent nurse mops the brow of a new mother with a crying baby.) They do work most will not. (A white-coated researcher works in a lab. Then an apparent nurse picks a greeting card up off a patient room floor and replaces it, looking at the patient.) They pick up after others. (A rooftop helipad patient arrival, with emergency personnel.) They clean up after accidents. Servants take what's worn out and make it last another 30 years. (An apparent physician in a white coat shows a patient a new artificial body part (hip), presumably to be implanted; then that patient appears with his family, and is helped to walk down a hall by apparent nurses. Images of an OR, an apparent transplant.) Servants change sheets. (Another shot of the scrubs guy from the beginning.) And hearts. (Seems like a nurse with a patient.) And minds. (Seems like the lab researcher.) And history. (Apparent helipad emergency man.) And tomorrow. (A white-coated physician.) And how many birthday parties there will be. (Kid runs to see grandpa.) Servants change everything.

Text tag line:  Changing health care. For life. Baylor Health Care System. Baylor Scott & White Health.

The ad is effective at making its main points:  dedicated health workers do "serve" patients in many ways, and there is no shame in doing tasks that may involve cleaning up after others or doing basic things for them when they are vulnerable. No one knows this better than nurses, and some of the greatest appreciation nurses get from patients can involve helping them with intimate issues in a sensitive way at their times of great need. There is nothing wrong with holding hands or cleaning up, and those tasks are vitally important for physical and emotional wellbeing.

But nursing has a particular history and current situation that make associating the profession exclusively with such tasks and the idea of "servanthood" a major problem. Many if not most people still think nurses exist to "serve" physicians, when in fact nursing is an autonomous profession with its own scope of practice, its own knowledge base, and its own leaders. Nurses do serve patients, of course, but not physicians. In addition, many still believe nurses are low-skilled, minimally educated workers whose main responsibilities are things that most people would have the skill to do but that many people might not wish to do, like cleaning up and pushing gurneys.

In fact, nurses must have years of college-level science education, and an increasing number begin practice with bachelors of science in nursing or more advanced degrees. Nurses' skills in surveillance and analysis, intervening with high-tech procedures, and advocating for patients save lives every day. Nurses perform vital research, just like that lab researcher, and they extend lives for 30 years, just like that surgeon--actually, that surgical patient's life would not have been extended without a lot of skilled OR and post-op nursing. And unfortunately, emphasizing the selfless servant vision of nursing does not simply undermine nurses' claims to respect. It can actually encourage the enduring view that nurses should not expect to be treated fairly and should not stand up for themselves, since that would seem to run counter to an ideal of selfless virtue. Many nurses still follow this approach, and they are unlikely to be dissuaded from it by those who are content with nurses' current levels of power and resources. But it does not actually "serve" the interests of nurses--or their patients, who need strong nurses to advocate for them.

We realize Baylor and its ad agency did not set out to undermine nursing. And we understand that their intention was not to use "servant" as a marker for low-skilled drudgery or for submission in the ordinary sense, but as a shorthand for contributing selflessly to the wellbeing of others, whatever that may require. But we urge Baylor not to run this ad again, and to consider more carefully before associating nursing with "servanthood" in the future.
 

Please send your comments to Nikki Mitchell, VP of media relations, Baylor, Scott and White, at nikkimit@baylorhealth.edu. Please bcc us at letters@truthaboutnursing.org so we can follow your comments. Thank you!