Public image of nursing: an integrative review of challenges and solutions

Abstract

Introduction

The nursing profession, despite comprising the largest segment of the global healthcare workforce, faces a significant challenge: a negative public image. This unfavorable perception adversely impacts recruitment, retention, and job satisfaction. Entrenched stereotypes and cultural biases often erode the profession’s credibility and diminish its appeal. This integrative review explores the challenges contributing to this public image issue and identifies potential solutions to enhance it.

Methods

This integrative review followed the Whittemore and Knafl’s (2005) method, encompassing five stages: problem identification, literature search, data evaluation, analysis, and presentation. A comprehensive search of relevant databases, including SID, Irandoc, Magiran, Google Scholar, Web of Science, PubMed, CINAHL, and Scopus, was conducted using the keywords “image,” “public,” “nurs*,” “solutions,” and “challenges” covering the period from January 2010 to January 2025. Of the 868 articles initially retrieved, 54 met the inclusion criteria and were assessed using the Mixed Methods Appraisal Tool for inclusion in the final review.

Results

Critical appraisal and synthesis of the selected articles revealed three overarching themes related to the public image of nursing: professional enhancement, professional advancement, and systemic factors. These themes encompassed nine sub-themes.

Conclusion

This review demonstrates that the public image of nursing is influenced by both professional and systemic factors, with nurses themselves playing a critical role in shaping perceptions. Improving this image requires a collaborative effort involving nurses, healthcare organizations, and policymakers. Crucially, nurses must cultivate a confident and self-assured professional identity to ensure the public’s perception accurately reflects the vital contributions of the nursing profession.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03160-3.

Introduction

Nurses constitute the largest segment of the healthcare workforce and play a vital role in policy development, planning, implementation, and reform [1]. Globally, they deliver at least half of all healthcare services, a proportion that reaches nearly 80% in some countries [2]. Therefore, the quality of healthcare is inextricably linked to the quality of nursing care [3]. With the expanding scope of nursing roles and responsibilities, the profession is increasingly recognized as a distinct and autonomous discipline within the broader medical field. A robust and effective nursing workforce is thus essential for the success of any healthcare organization [4].

The public image of nursing is a complex and dynamic construct, presenting a significant challenge for the profession [5]. It encompasses societal opinions, beliefs, and perceptions regarding nurses and their profession. These perceptions are often shaped by observations of nurses’ appearance, attire, communication style, behavior, and attitudes [6]. This public image serves as a key indicator of the profession’s standing within society and significantly influences nurse recruitment, retention, and job satisfaction [7]. Furthermore, it is intrinsically linked to nurses’ professional identity and perceived roles, making the management of public perception a persistent challenge [8]. Historically, the image of nursing has undergone considerable evolution. From the “angels and servants” in the 1910s to the “feminine and weak” image prevalent in the 1920s, the perception has shifted over time, encompassing periods where nurses were viewed as subordinate to physicians and primarily as recipients of orders. More recently, the “carer” archetype has become dominant [9]. Despite advancements in the profession, negative stereotypes persist, particularly in developing countries, where nurses may still be perceived as less intelligent than physicians, overly dependent, powerless, and underpaid [7]. However, recent research suggests that public attitudes toward nursing may be evolving, with studies like that of Yavaş et al. indicating a significant shift in public perception, particularly during events such as the COVID-19 pandemic [10].

The public image of nursing faces a significant challenge rooted in historical perceptions of the profession as a traditionally female occupation, often associated with emotion, femininity, and a lack of autonomy [11]. This perception is reinforced by cultural connotations. For example, in Turkey, the term “Hemşire” (the Turkish word for nurse) shares semantic space with “sister,” “foster mother,” and “nanny,” effectively linking it to traditional women’s roles and expectations of inherent altruism [12]. Similarly, in Iran, the term “nurse” can carry connotations of “servant” or “maid.” Adding to this complexity in Iran is the semantic ambiguity of “Parastar,” the Persian word for “nurse,” which, due to improper and unprofessional usage, contributes to a diminished public image of the profession [13]. This challenge is not unique to these contexts. For instance, in Saudi Arabia, the profession suffers from a lack of respect [14]. Nursing also struggles with a negative image, lack of credibility, and insufficient social recognition in Europe [15].

A negative public image of nursing poses significant challenges to the profession. It can deter qualified individuals from entering the field, diminishing both the quantity and quality of the nursing workforce [16]. Furthermore, prevalent stereotypes can limit career opportunities for nurses, impacting their job retention and performance [17], and ultimately affecting community health [18]. Conversely, cultivating a positive public image is essential for the growth and success of the nursing profession [16]. A positive image contributes to the development of healthcare organizations, reflects high-quality nursing care, empowers nurses, and ultimately improves patient outcomes. Perceptions of the nursing profession significantly influence career choices and are crucial for attracting and retaining qualified staff, boosting morale, and increasing job satisfaction [19]. Recent studies have also demonstrated a positive correlation between nurses’ perceptions of their professional image and both their perceived quality of working life [20] and quality of care [21].

A comprehensive understanding of the challenges and solutions related to nursing’s public image is crucial for the profession’s advancement. While numerous studies have highlighted the importance of a positive public perception of nursing, few have synthesized the available evidence to offer practical, actionable solutions [20]. To clarify the multifaceted nature of the issue and propose evidence-based strategies to enhance public perceptions of the profession, this integrative review aimed to provide an overview of the challenges and potential solutions related to the public image of the nursing profession.

Methods

Study design

This study employed an integrative review methodology to explore the challenges and potential solutions related to the public image of nursing. Integrative reviews, known for their ability to synthesize diverse research methodologies, were deemed appropriate for this topic, allowing for a comprehensive understanding of the multifaceted nature of public perception. The five-stage process outlined by Whittemore and Knafl (2005) guided the review, encompassing problem identification, literature search, data evaluation, data analysis, and presentation. This systematic approach ensured the rigorous gathering and analysis of relevant research, ultimately contributing to a robust and evidence-based understanding of the public image of nursing [22].

Search strategy

The review sought to answer the central question: What are the challenges and potential solutions contributing to a suboptimal public image of nursing? A systematic search of relevant databases was conducted by two independent researchers covering the period from January 2010 to January 2025. The following electronic databases were searched: PubMed, CINAHL, Scopus, Web of Science, Google Scholar, and the Persian databases Magiran, SID, and Irandoc. The search strategy employed a combination of keywords, including “image”, “public”, “nurs*”, “solutions”, and “challenges” connected by Boolean operators (AND and OR). The asterisk (*) wildcard was used to capture variations in the “nurs” term (e.g., nurse, nurses, nursing). (Appendix A)

Study selection

The initial search retrieved a total of 868 articles. Study selection was performed in three steps:

1. Title and Abstract Screening: After removal of duplicates, articles were screened for relevance to the research question. The title and abstract were reviewed independently by two reviewers to determine whether they contained predefined keywords and focused on the topic of interest. Articles that failed to meet these minimum criteria were excluded.

2. Full-text review: Other articles were reviewed in their full text for inclusion in the study. The eligible studies would be the ones published either in Persian or English, accessible in full text, and published within the period from 2010 to 2025.

3. Final Selection and Consensus: After full-text screening, 54 articles met al.l the inclusion criteria and thus formed part of this review. Any discrepancies between the two reviewers were discussed, and when necessary, a third reviewer was consulted. A flow diagram illustrating the study selection process is presented in Fig. 1 [23].

Fig. 1.

PRISMA flowchart of the inclusion process

Eligibility criteria

This integrative review included studies employing a range of methodologies to explore the public image of nursing. Eligible studies included randomized controlled trials, experimental, quasi-experimental, descriptive, mixed methods, and qualitative studies. Articles published in either English or Persian from January 2010 to January 2025 and available in full text were considered for inclusion. Review articles, editorials, policy papers, and conference proceedings were excluded.

Data extraction

Data extraction was conducted systematically using a pre-defined data extraction form. Information retrieved from the 54 included articles encompassed several key elements: study title, author(s), year of publication, country of origin, study purpose, study type/design, study focus, and key findings related to the challenges and potential solutions of public image of nursing. This structured approach ensured consistency and comprehensiveness in the data abstracted for the integrative review.

Data synthesis

Data synthesis followed a rigorous, iterative process. Two researchers independently evaluated the included studies, with discrepancies resolved through discussion and consensus. This continuous process of review and refinement ensured the integrity of the synthesized findings. Thematic analysis, as described by Braun and Clarke (2006), guided the data analysis, encompassing six phases: [1] familiarization with the data; [2] generating initial codes; [3] searching for themes; [4] reviewing themes; [5] defining and naming themes; and [6] producing the report [24].

Specifically, the synthesis began with a thorough reading of each study to identify salient quotes and develop preliminary impressions. Subsequently, an initial round of open coding was conducted, assigning codes to all concepts relevant to the research question. A color-coding system facilitated the identification of patterns across the studies. This coding process was repeated for each paper to ensure comprehensive data familiarization, with recurring patterns documented for subsequent analysis. As patterns emerged, codes were iteratively grouped and linked, both within and across studies, leading to the development of broader themes. These preliminary themes were then rigorously reviewed and refined. Some themes were combined, others discarded, and challenging data points were re-examined in light of the established codes. During this stage, themes were carefully defined and named, maintaining a critical perspective and ensuring a thorough and nuanced interpretation of the coded data. Finally, the resulting themes were evaluated for coherence and relevance to the overall research question, ensuring they accurately represented the synthesized findings.

Quality appraisal

The quality appraisal process for this integrative review was conducted by two independent reviewers (GM and SG) using the Mixed Methods Appraisal Tool (MMAT) [25]. While Whittemore and Knafl (2005) suggest that formal quality appraisal may not be mandatory for supplementary reviews [22], we chose to implement this step to enhance the rigor of our review and minimize potential bias. The MMAT was selected due to its capacity to evaluate the methodological quality of diverse research designs, including qualitative, quantitative, and mixed-methods studies. Each study was assessed against the five criteria within the relevant MMAT template, providing a comprehensive evaluation of its methodological rigor. Discrepancies in scoring between the two reviewers were resolved through discussion with a third reviewer (AS), who served as the study supervisor. Although no studies were excluded based solely on methodological limitations, the quality assessment results will be considered when interpreting the findings and formulating conclusions, allowing us to weigh the strength of evidence supporting different themes and recommendations. The MMAT assessment forms are provided in Appendix B.

Results

This integrative review synthesized findings from 54 articles selected from an initial pool of 868. While the search yielded primarily English-language publications, one relevant article in Persian was also included. The final sample comprised 32 quantitative studies, 18 qualitative studies, and 4 using mixed-methods. Most of the included articles (n = 35) focused on potential solutions, while 10 specifically addressed challenges, and the remaining nine explored both challenges and solutions. A summary of the included studies is presented in Table 1.

Table 1.

Summary of studies included in the integrative review

N	Title	Author/Year/Country	Aim/Research question	Study Type/Design	Study Focus	Challenges/Solutions
1	Sociocultural and perceived public image of nurses among nursing students: the mediating role of self-concept [26]	Sacgaca L, et al. (2024) Saudi Arabia	Studying the public perception of nurses among nursing students	Correlational approach	Solutions	Solutions: • Need for programs to boost self-concept and public image that consider sociocultural influences • Strengthening public image by promoting self-confidence
2	The public image of nursing during the COVID-19 pandemic: A cross-sectional study [10]	Yavaş G, et al. (2025) Turkey	Assess the public image of the nursing profession during the COVID-19 pandemic.	Cross-sectional	Solutions	Solutions: • Use online platforms and social media to introduce the nursing profession and its roles to the public • Use print and visual media to showcase nurses’ roles and contribute to projects such as films and documentaries • Improve healthcare service organization by governments (provide safer working conditions for nurses, enhance measures to prevent violence against healthcare workers, and make plans to better prepare for future health crises)
3	Public Perceptions and Attitudes on the Image of Nursing in the Wake of COVID-19 [8]	Blau A, et al. (2023) Israel	Relationship between the public’s perceptions and attitudes to the nursing profession compared with other healthcare professions	Cross-sectional	Solutions	Solutions: • Design strategies to preserve the improved image of nursing among the public (so the more positive public opinion was, the more positive the image of nursing would be)
4	Public image of the profession is associated with the choice of nursing career among Arab high school students: A cross-sectional study [27]	Mohsen A, et al. (2022) Israel	Examine public image of nursing and the intention to choose nursing as a future career	Cross-sectional	Challenges	Challenges: • School graduates may be influenced by providing information and presenting the role of a nurse as significant, as well as by emphasizing the positive image of nursing to parents and influential people in the Arab community.
5	Iranian nurses’ perception of the public image of nursing and its association with their quality of working life [20]	Roshangar F, et al. (2021) Iran	association between the nurses’ perception of the public image of nursing and the quality of nursing work life	Descriptive correlational study	Solutions	Solutions: • Optimization of the image of the nursing profession in the public’s view along with considering other significant predictors including gender, age, position, work shifts, residency, financial status, level of family support, spouse’s education and spouse’s job by authorities • Promotion of community awareness of nurses’ real roles, responsibilities and competencies in healthcare systems • Motivate nurses to improve the public image of nursing through better performance
6	Contemporary public image of the nursing profession in Saudi Arabia [14]	Elmorshedy H, et al. (2020) Saudi Arabia	Explore the level of community awareness and public image of the nursing profession	Cross-sectional	Challenges	Challenges: • Negative public image of the nursing profession • Poor awareness about the nursing profession • Barriers to pursue a nursing career including; working in a gender-mixed environment, delayed marriage of females, and poor social life
7	Nursing’s public image in the Republic of Georgia: A qualitative, exploratory study [28]	Squires A, et al. (2019) Republic of Georgia	Gain a better understanding of nursing’s professional image	Exploratory, qualitative approach	Challenges	Challenges: • Appropriateness of the nursing profession for men versus women • Positive and negative experiences of patients from nursing care • Soviet legacy created a poor representation of nursing and educational status among Georgian citizens
8	The public’s perception of the nursing profession: Validity and reliability of the Chinese version of the nursing image scale in Taiwan [29]	Hu ST, et al. (2024) Taiwan	Compare public perceptions of the brand image of nursing between China and the United States	Cross-sectional	Challenges and Solutions	Challenges: • Virtuous traits of the nurse are perceived most directly and immediately by the public while their roles as autonomous decision-makers and leaders are less (or not at all) visible. Solutions: • Enhancing the accuracy and visibility of a strong brand image
9	Nursing on television: student perceptions of television’s role in public image, recruitment and education [30]	Weaver R, et al. (2013) Australia	Explore nursing students’ perceptions of how their profession is portrayed on medical television programs	Convergent parallel mixed methods	Challenges and Solutions	Challenges: • Television can have a negative influence on the image of nursing Solutions: • Engaging more closely with contemporary media portrayals of nursing for students and educators alike
10	The image of care delivery by public health nurses as disseminated in Revista da Semana (1929) [31]	de Matos Deslandes AK, et al. (2013) Spain	Analyze the images of Public Health Nurses in care delivery to society, disseminated by the Revista da Semana, in 1929.	Historical-semiotic study	Solutions	Solutions: • The distinctive use of uniforms for the Public Health Nurses’ activities was a non-verbal communication strategy to gain visibility and credibility
11	Greek intensive and emergency care nurses’ perception of their public image: a phenomenological approach [6]	Karanikola MN, et al. (2011) Greek	Disclose the way nurses internalize their professional public image and professional worth, as well as nurses’ feelings about that image	Qualitative study	Challenges And Solutions	Challenges: • Outdated Terminology: The use of “nosokoma,” meaning “servant” and “sister,” instead of “nurse,” undermines the profession’s standing. • Stereotypes and Misconceptions: In Greece, nursing is often portrayed as unscientific, focusing solely on bodily fluids, alongside harmful sexualized images. • Unclear professional identity: Vague duties and incorrect role perceptions undermine nurses’ professional standing. • Medical dominance: A strong focus on medicalism in Greek culture marginalizes nursing’s role. • Workplace Challenges: Low salaries and high workloads hinder effective communication between nurses and patients, impacting care quality. Solution: • Nurses have to actively participate in policy making and enhance their educational and cultural profile through the media.
12	Explain the professional identity of nursing during COVID-19 pandemic [32]	Hoseini Azizi T, et al. (2024) Iran	Explore the professional identity of nursing during the COVID-19 pandemic	Conventional content analysis approach	Challenges and Solutions	Challenges: • Nurses are concerned about the instability of improving the nursing image in society Solutions: • Utilize media platforms to portray the nursing profession in a positive light and emphasize the scientific capabilities of nurses
13	Gender Bias and Perceptions of the Nursing Profession in Croatia: A Cross-Sectional Study Comparing Patients and the General Population [33]	Neuberg M, et al. (2024) Croatia	Examined how the title “nurse” reflects the profession’s identity, perception as a female occupation	Cross-sectional	Challenges and Solutions	Challenges: • Nursing profession as being desirable for men Solutions: • Tailored education and patient communication initiatives to improve the image of nursing by nurses (ensuring patients are better informed about the competencies and responsibilities of nurses)
14	Public perceptions of the brand image of nursing: Cross-cultural differences between the United States and China [34]	Zhou L, et al. (2024) China and USA	Compare public perceptions of the brand image of nursing between China and the United States	Cross-sectional	Solutions	Solutions: • Enhancing the accuracy and visibility of a strong brand image in nursing by accurate representations of their profession and by consistently messaging their desired brand as leaders by nurses • Inform policy, guide strategic planning, and transform the future direction of the nursing profession
15	The positioning of nursing in Turkish mass media: Before and after the COVID-19 outbreak [35]	Ersan Yaman H, et al. (2023) Turkey	Power of the media can be used as a tool to introduce nursing services	Qualitative design	Solutions	Solutions: • Mass media, which are indispensable in social communication, can be used as an effective tool to improve the image of nursing in society. • All professionals must act in a planned and purposeful manner to present nursing professionals positively as leaders in public healthcare
16	Association between patient choice of provider and patient-reported experience [36]	Kim DH, et al. (2023) Korea	Association between determinants of patient choice of provider and patient-reported experience	Cross-sectional	Solutions	Solutions: • Improve patient-reported experience by increasing communication skills and proper information about the nature • Manage public image factors comprehensively and continuously by maintaining good quality of care and to brand patients
17	Perception of the professional self-image by nurses and midwives. Psychometric adaptation of the Belimage questionnaire [37]	Stadnicka SK, et al. (2023) Poland	Present the research results on the perception of the professional self-image by Polish nurses and midwives	Cross-sectional	Challenges	Challenges: • The effect of people’s negative image on nurses’ view of themselves
18	The Social and Professional Image of the Nurse: Results of an Online Snowball Sampling Survey among the General Population in the Post-Pandemic Period [38]	Rubbi I, et al. (2023) Italia	Examining public perception of nursing	Cross-sectional	Challenges	Challenges: • The profession suffers from low attractiveness due to poor pay, limited political representation, and a lack of respect
19	Nurses are background actors in medical reality television: A character network analysis and call for authentic action [39]	Hayward BA, (2023) Australia	Describe how nurses’ dialogue compares with that of doctors in the Australian reality television program Emergency	Descriptive study	Solutions	Solutions: • It is the shared responsibility of individual nurses, nursing organizations and writers and journalists to accurately portray nurses in the media
20	The Image of Nurses and Midwives in Ghana: Patient and Family Perspectives [40]	Ohene LA, et al. (2022) Ghana	Explore the perceptions of patients and family caregivers on the image of nurses and midwives	Qualitative exploratory descriptive approach	Challenges	Challenges: • Low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image
21	The image of nursing perceived by the society in the Covid-19 pandemic: A cross‐sectional study [41]	Uysal N, et al. (2022) Turkey	Determine the nursing image perceived by the society during the Covid-19 pandemic.	Cross-sectional	Solutions	Solutions: • Creating a modern image of nurses as producers of scientific knowledge and independent leaders by nurses • Written, visual, and social media must be used effectively • Nurse leaders must be more visible.
22	The influence of media representations on citizens’ perceptions towards nurses: a comparison between before and after the COVID-19 pandemic [42]	Foà C, et al. (2021) Italy	Investigate whether and how, during the pandemic, citizens’ perceptions of nurses have changed	Cross-sectional	Solutions	Solutions: • Make well-know their role, • Promoting public communication
23	Italian Nurses’ experiences during the COVID-19 pandemic: a qualitative analysis of internet posts [43]	Fontanini R, et al. (2021) Italy	Investigate the experience of Italian nurses during the first wave of the COVID-19	Qualitative descriptive study	Solutions	Solutions: • Supporting nurses’ mental health • Zero-tolerance policy towards violence and aggression towards nurses
24	Nurses’ role, importance and status in Armenia: A mixed method study [44]	Sahakyan S, et al. (2020) Armenia	Assess the perception of the nursing profession in Armenia from the perspective of multiple stakeholders, including nurses and the general public	Convergent parallel mixed-methods	Challenges and Solutions	Challenges: • Nursing profession has been influenced by medical hierarchy Solutionss: • Develop a national definition of nursing and introduce higher educational opportunities for nurses • Quality education for preparing highly competent nurse managers
25	Exploration of service recipients’ image of a perfect nurse: A qualitative descriptive study [45]	Valiee S, et al. (2020) Iran	Explore the image of the perfect nurse from service recipients’ perspective	Qualitative descriptive study	Solutions	Solutions: • Improve their skills in providing care • Focus on the communication dimension and respond to the patients. • Identifying communication barriers with the clients
26	Nursing knowledge patterns: nurses’ image and role in society perceived by students [46]	Pierrotti VW, et al. (2020) São Paulo	Understand high school students’ perception about the nurse’s image and role in society	Phenomenographic qualitative study	Challenges	Challenges: • Subordination to medical knowledge and lack of knowledge of nurses’ functions
27	Qualitative study of socio-cultural challenges in the nursing profession in Pakistan [47]	Abbas S, et al. (2020) Pakistan	Explore the social and cultural challenges faced by nurses while creating their professional image	Qualitative study	Solutions	Solutions: • Redefining gender roles and gender integration within the nursing profession • Positive portrayals in the media for the removal of public misperceptions related to nursing
28	Does student orientation improve nursing image and positively influence the enrolment of nursing students in the University? An observational study [48]	Rubbi I, et al. (2019) Italy	Investigate the image of the nurse among year 4 and 5 high school students	Cross-sectional	Solutions	Solutions: • Extend orientation and tutoring activities to junior high school students, families and teachers in the choice of their university courses by nurses • Involving junior high school students and teachers in simulation activities performed in university laboratories and in educational projects carried out by community nurses, in which students’ families can also be involved
29	Perceived images and expected roles of Indonesian nurses [49]	Sommers CL, et al. (2018) Indonesia	Explore how non-nurses and nurses differ regarding the perceived images and expected roles of Indonesian nurses	Cross-sectional	Solutions	Solutions: • Public education campaign • Monitoring nurses’ image on a regular basis by a public education campaign
30	How to Prevent Workplace Incivility?: Nurses’ Perspective [50]	Abdollahzadeh F, et al. (2017) Iran	Determine how to prevent workplace incivility from the nurses’ perspective	Qualitative study	Solutions	Solutions: • Nurses should try to improve their skills • Officials should try to show the real image and position of nurses and hospitals to the community.
31	Promotion or marketing of the nursing profession by nurses [51]	Kagan I, et al. (2015) Israel	Examine factors explaining the marketing of the nursing profession by nurses working	Cross-sectional	Solutions	Solutions: • A three-level (individual, organizational and national) nursing marketing program • At the individual level: While providing high quality nursing care nurses need to be proud of themselves and their work and not be ashamed to promote the image of their profession in the course of their daily activities. • At the organizational level: Formulate and implement policies and programs to promote the image of nursing. • Encourage and train nurses to take part in marketing activities. • At the national level: Draw up a long-term program for promoting or marketing the professional status of nursing. • formulation and implementation of policies and programs to promote the image of nursing at the organizational level
32	The image of you: constructing nursing identities in YouTube [52]	Kelly J, et al. (2012) United Kingdom	This article is a report on a descriptive study of nursing identity as constructed in the Web 2.0 site YouTube.	Descriptive study	Solutions	Solutions: • Protect the profession from unduly immoderate representations of the nurse and to support nurses in their efforts to maximize opportunities afforded by YouTube
33	The Public Nursing Image as Perceived by Nurses and Citizens: A Questionnaire Survey [53]	Ashraf A, et al. (2020) Iran	Describe and compare the perspectives of both urban citizens and nurses on the public nursing image	Cross-sectional	Solutions	Solutions: • Elevating working condition, education and number of nurses in management positions • Highlighting the role of nurses via mass media
34	Relationship among public nursing image, self-image, and self-esteem of nurses [54]	Abdelrahman S, et al. (2018) Egypt	To identify the relationship among public nursing image, self-image, and self-esteem of nurses	Cross-sectional	Challenges and Solutions	Challenge: • Effect of negative public image on nurses’ self-esteem Solution: • Providing positive nursing image by the media to enhance public nursing image.
35	Comparing shaping resources of the nursing public image and their importance from the perspective of nurses and general public [55]	Heshmati Nabavi F, et al. (2014) Iran	Compare the perspective of nurses who worked in teaching hospitals and general public	Cross-sectional	Solutions	Solutions: • Effective interaction with the media group would be prevent distorted and unreal image of nursing in video production
36	Implications Of Stereotypical Self and Public Nursing Image on Performance of Nurses and Nursing Students [56]	Mostafa GM, (2013) India	Find out implications of stereotypical self and public nursing image on performance of nurses and nursing students.	Mixed Methods	Solutions	Solutions: • Self-correction from inside the profession, which would lead to change in the public image (nurses should be have self-confidences from inside themselves to reflect it for public and patients which would lead to change in the public image, improve negative nursing images through the media and marketing for the genuine nursing roles through the public and stakeholders)
37	Perception of Junior Nurse Students and Nurse Interns Regarding Public Image of Nursing [57]	Nasser Rayan H, et al. (2018) Egypt	Relationship between perception of junior nurse students and nurse interns regarding public image of nursing	Cross-sectional	Solutions	Solutions: • Conducting conference to appropriate orientation for junior undergraduates’ nurse students& nurse interns about the nursing profession • Media portray positive image of nursing to recruit more staff to join nursing
38	The Influencing Factors of Nurse image and Ego-Resilience on Nursing Professional Values of Nursing Students [58]	Park G. (2020) Korea	Examine the factors influencing Nursing professional values of nursing students	Cross-sectional	Solutions	Solutions: • Theoretical curricula and extra-curricular programs to improve Nurse image and Ego-resilience
39	Social Image of Nurse in Medical Dramas in Pre- and Post-COVID19 Pandemic: An Observational Study [59]	Gradellini C, et al. (2022) Italy	How the nursing role is described by the media system	Cross-sectional	Solutions	Solutions: • Creating consciousness of the social image of nursing professionals to alert the media power and its related risks and, but above all, to use them as a resource of change
40	The social and professional image of the nurse: results of a survey during the Covid-19 pandemic [60]	Lauria E, et al. (2022) Italy	Investigate the perception of students at the University of Piemonte Orientale about the nursing profession	Cross-sectional	Solutions	Solutions: • TV series or news reports have positively influenced public image of nursing
41	Perception of the image of the nursing profession and its relationship with quality of care [21]	Grinberg K, et al. (2022) Israel	Examine whether there is a relationship between the self-image of nursing and the nurses’ good quality of care, and whether men and women differ in their nursing image	Cross-sectional	Solutions	Solutions: • Create an empowering and positive working environment among nursing teams • Improving the nursing profession’s prestige and social position in nursing practice • Health policy makers should build national programs that improve the image of nursing
42	The effect of gender-friendliness barriers on perceived image in nursing and caring behavior among male nursing students [61]	Hung CA, et al. (2019) Taiwan	Relationships among nursing students’ perceived nursing image, caring behaviors and gender-friendliness barriers	Cross-sectional	Challenges and Solutions	Challenges: • Male nursing students with a higher nursing image Solutions: • Improve male nursing students’ caring behaviors and professional nursing image and decrease gender-friendliness barriers
43	The new script of nursing: using social media and advances in communication – to create a contemporary image of nursing [62]	Kress D, et al. (2018) USA	Break through the stereotypical images of nursing and showcase the depth and breadth of the nursing profession	Cross-sectional	Solutions	Solutions: • Social media is an accessible, affordable and efficacious method to address misconceptions and inaccuracies of nursing as a profession. Nurses must adopt communication science and social media to profile the profession.
44	Diversity, fulfilment and privilege: the image of nursing [63]	Morris-thompson T, et al. (2011) UK	Explore the image that nurses have of nursing and the image of nursing held by the public	Qualitative study	Challenges	Challenges: • The public appear ill-informed of what nurses do, purporting to respect nursing but would not recommend nursing as a career choice for themselves, their children or their pupils.
45	Role and Image of Nursing in Children’s Literature: A Qualitative Media Analysis [64]	Carroll SM., et al. (2016) Chicago	Nurses’ role and image as portrayed in young children’s literature were described and analyzed.	Qualitative study	Solutions	Solutions: • Future children’s books authored by nurses may more closely reflect accurate contemporary nursing practice and contribute to an improved image of the nursing profession.
46	The role of high-involvement work practices and professional self-image in nursing recruits’ turnover: A three-year prospective study [65]	Chênevert D, et al. (2016) Canada	Extends previous research on nurse turnover by looking at the combined effects of nurses’ pre-entry expectations, perceived high-involvement work practices, and professional self-image	Prospective, longitudinal study	Solutions	Solutions: • Developing high-involvement work practices as these practices foster a stronger professional self-image among nurses
47	The image of nursing in the eyes of Generation Alpha and their parents in Türkiye: A multicenter cross-sectional survey [66]	Cirik VA, et al. (2024) Turkey	It investigated the image of nursing in the eyes of Generation Alpha and their parents.	Cross-sectional	Solutions	Solutions: • Nurses should be professionally autonomous, promote their professional identity through the media, and interact with their colleagues to have a professional image in the eyes of children and their parents.
48	The image of nursing among nursing and other healthcare professional university students: A mixed-method study [67]	Cirik VA, et al. (2022) Turkey	Determining the image of nursing in the eyes of undergraduate health sciences students; (2) identifying factors affecting that image; and (3) evaluating students’ views and experiences regarding that image	Explanatory sequential design	Solutions	Solutions: • Detecting nursing image early can increase professional training and improve the professional image of nursing (by account the factors that negatively affect the image of nursing).
49	The effect of creative drama on nursing image: Randomized controlled study [68]	Uzun LN, (2024) Turkey	Examine the effects of the creative drama method on first-year nursing students’ perceptions of the image of nursing	Randomized clinical-trial	Solutions	Solutions: • Creative drama can be used as an effective method to develop positive perceptions of nursing
50	Registered nurse perceptions of factors contributing to the inconsistent brand image of the nursing profession [69]	Godsey JA, et al. (2020) USA	Examine responses of Registered Nurses describing factors influencing nursing’s inconsistent brand image	Qualitative study	Challenges	Challenges: • 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 • the lack of uniforms that distinguish nurses from ancillary staff
51	Assessment of the Nurse Image in Iranian Cinema [70]	Matbouei M, et al. (2020) Iran	Explain the image of nurses in Iranian cinema in the last three decades.	Content analysis	Challenges and Solutions	Challenges: • Fewer mentions of nurses’ names in TV movies Solutions: • Improving communication with the media and professional participation of nurses in professional consultations for movie projects.
52	Possible influence of social media on shaping the image of nurses on the Internet [71]	Pawłowski P, et al. (2019) Poland	Analysis of the possibilities of using social media in shaping the image of nurses on the Internet.	Comparative study	Challenges	Challenges: • offensive language of comments of people following the website or displaying negative traits of nurses
53	The image of nursing: A glimpse of the Internet [72]	Koo M, et al. (2016) Taiwan	Explore how the nursing profession is portrayed on the Internet by using two popular sources of photographic images	Descriptive	Solutions	Solutions: • A plan needs to be developed to accurately and comprehensively represent the nursing profession on the Internet
54	Nurses’ views on the impact of mass media on the public perception of nursing and nurse–service user interactions [73]	Hoyle LP, et al. (2017) UK	Examine nurses’ views on the impact that mass media has on service users	Qualitative interpretivist study	Solutions	Solutions: • Closer engagement between health journalists and nurses through ‘journalist-in-residence’ programs

Following a review and evaluation of eligible articles, the findings classified into three overarching themes encompassing nine sub-themes (Fig. 2; Table 2): [1] Professional Enhancement [2], Professional Advancement, and [3] Systemic Factors.

Fig. 2.

Classification of Public Image of Nursing Challenges and Potential Solutions

Table 2.

Main themes and sub-themes of challenges and solutions for improving the public image of nursing

Main themes	Sub-themes	Solutions	Challenges
Professional Enhancement	Skills Development	• Introduce higher educational opportunities for nurses • Theoretical curricula and extra-curricular programs to improve Nurse image and Ego-resilience • Improve nurse’s skills in providing high quality of care	• variety of education/credentials
	Professional Identity	• Self-correction programs that enhance self-concept and account for sociocultural influences can motivate nurses to improve the public image of nursing. • Nurses should be proud of themselves and their work and not be ashamed to promote the image of their profession in the course of their daily activities	• The effect of people’s negative image on nurses’ view of themselves • Effect of negative public image on nurses’ self-esteem • Sociocultural factors (working in a gender-mixed environment, delayed marriage of females, and poor social life, Society’s unscientific view of nurses and the use of unprofessional terms instead of nurse)
Professional Advancement	Empowering Nursing Through Media	• Promoting Nursing Roles and Highlighting Contributions through Online Platforms and media power • Use Mass media to positively highlight the nursing profession and showcase nurses’ scientific skills. • Media must be used effectively to eliminate public misperceptions about nursing. • Engaging with media to prevent distorted portrayals of nursing in films and enhance nurses’ professional image in TV series. • Leveraging media to inspire more individuals to pursue a career in nursing. • Writing future children’s books by nurses to provide a more accurate representation of contemporary nursing practice. • Strengthening the relationship between nurses and the media while encouraging their professional involvement in consulting projects. • Effective interaction of managers with media groups	• Television can have a negative influence on the image of nursing • Fewer mentions of nurses’ names in TV movies • offensive language of comments of people following the website or displaying negative traits of nurse’s portrayals in the media and online • Negative nursing stereotypes in media
	Effective Communication	• Providing information and presenting the role of a nurse by emphasizing the positive image of nursing to parents • Extend nursing-led orientation and tutoring activities to junior high students, families, and teachers regarding university course choices. • Promotion of community awareness of nurses’ real roles, responsibilities and competencies in healthcare systems • Conducting conference to appropriate orientation for junior undergraduates’ nurse students& nurse interns about the nursing profession • Tailored education and patient communication initiatives to improve the image of nursing by nurses (ensuring patients are better informed about the competencies and responsibilities of nurses)	• Poor awareness about the nursing profession • Positive and negative experiences of patients from nursing care • Low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image • The public appear ill-informed of what nurses do, purporting to respect nursing but would not recommend nursing as a career choice for themselves, their children or their pupils • virtuous traits of the nurse are perceived most directly and immediately by the public while their roles as autonomous decision-makers and leaders are less (or not at all) visible
	Professional Collaboration	• Developing high-involvement work practices as these practices foster a stronger professional self-image among nurses • Interact with their colleagues	• lack of professionalism
Systemic Factors	Transformational Policies	• Inform policy, guide strategic planning, and transform the future direction of the nursing profession • Zero-tolerance policy towards violence and aggression towards nurses • Preparing highly competent nurse managers and leaders in public healthcare • Formulation and implementation of policies and programs to promote the image of nursing at the organizational level. • Elevating working condition, education and number of nurses, financial status, family support in management positions • Enhancing the accuracy and visibility of a strong brand image in nursing by accurate representations of their profession and by consistently messaging their desired brand as leaders by nurses. • Creating a modern image of nurses as producers of scientific knowledge and independent leaders by nurses. • Monitoring nurses’ image on a regular basis by a public education campaign • Encourage and train nurses to take part in marketing activities. • Measures to prevent violence against healthcare workers and foster a safe and positive working environment.	• Image not a priority • lack of leadership development • Nursing profession has been influenced by medical hierarchy • The profession suffers from low attractiveness due to poor pay, limited political representation, and a lack of respect
	Nursing Globalization	• Develop a national definition of nursing • Health policy makers should build national programs that improve the image of nursing
	Nursing Attire	• Utilizing uniforms as a distinctive non-verbal communication strategy to capture attention.	• the lack of uniforms that distinguish nurses from ancillary staff
	Redefining Gender Roles in Nursing	• Redefining gender roles and gender integration within the nursing profession • Improve male nursing students’ caring behaviors and professional nursing image and decrease gender-friendliness barriers	• Gender role stereotyping

Professional enhancement

Professional Enhancement, encompassing the personal and professional growth of nurses, is crucial for cultivating competence, confidence, and a strong sense of belonging within the healthcare community. This overarching theme is comprised of two key sub-themes: skills development and professional identity.

Skill development

Several key themes emerged regarding skill development within the nursing profession, encompassing both challenges and potential solutions. A consistent finding highlighted the importance of educational programs focused on building professional skills, as these empower nurses to deliver high-quality care, thereby increasing their perceived value within healthcare settings [36, 45, 50]. Furthermore, access to higher education opportunities enables nurses to achieve advanced competencies [44], contributing to their professional growth. Integrating theoretical curricula with extracurricular activities was also identified as vital for enhancing nurses’ professional image and fostering ego-resilience [58].

Despite these advancements, significant challenges remain concerning the diversity of qualifications within the nursing field. High entry-level requirements, coupled with unclear qualification standards and ambiguous role definitions, hinder the standardization and broader recognition of nursing professionals’ skill sets. Nurses have expressed concerns that the lack of standardized entry-level training, combined with widely varying responsibilities across different roles, undermines public understanding of their comprehensive competencies [69]. This inconsistency can contribute to a fragmented public perception of the profession and its capabilities.

Professional identity

A crucial element in shaping both professional identity and public image is the cultivation of a strong sense of self among nurses. Negative self-perception and a diminished public image can significantly impact nurses’ professional identity and self-esteem [6, 37]. When nurses experience feelings of undervaluation or insecurity regarding their professional standing, their self-confidence diminishes, hindering their capacity to advocate for the profession and effectively demonstrate their skills. This can perpetuate a cycle of misunderstanding and devaluation in the public eye [54]. Targeted self-development programs, addressing sociocultural influences on self-perception, can empower nurses to embrace their professional roles with pride and actively promote the profession. This proactive approach can counteract feelings of shame or inadequacy stemming from negative external perceptions [20, 43, 56]. Furthermore, cultivating a positive self-concept strengthens nurses’ self-confidence and resilience, equipping them to navigate professional challenges more effectively. This enhanced self-confidence not only increases job satisfaction but also contributes to a more positive public perception of nursing as a respected and valued profession [26]. Empowered and proud nurses are more likely to engage in behaviors that positively influence public perception, ultimately reinforcing their professional identity and elevating the overall image of nursing [51].

Professional advancement

Professional advancement plays a crucial role in shaping the public image of nursing. This theme encompasses strategies aimed at fostering career growth, increasing visibility, and maximizing the profession’s impact within the healthcare arena. Three interconnected sub-themes emerged that contribute to enhancing the profession’s image and effectiveness: empowering nursing through media, effective communication, and professional collaboration.

Empowering nursing through media

Negative stereotypes of nursing in media, compounded by derogatory online comments, pose a significant challenge to the profession’s public image [6, 71]. This finding underscores the powerful influence of media in shaping public perception. While acknowledging the potential for online platforms and mass media to perpetuate negative stereotypes, our results also highlight their potential to enhance the visibility of nursing roles and showcase nurses’ vital contributions to healthcare [10, 30, 52, 53, 58, 63]. Specifically, studies included in this review emphasized the importance of proactively leveraging mass media to promote a positive image of nursing and improve public perception [32, 35, 39, 54, 56, 67, 68]. This includes actively counteracting misconceptions and stereotypes that undermine nursing’s credibility [41, 47, 55, 60]. Furthermore, innovative approaches, such as nurse-authored children’s books, can inspire future generations to consider nursing as a career [57, 64]. Crucially, building stronger relationships between nurses and media professionals, including collaborative efforts with media organizations, is essential for fostering a more positive and accurate portrayal of nursing in society [55, 70, 73].

Effective communication

Effective communication plays a crucial role in shaping the public image of nursing, presenting both significant challenges and promising solutions. A key challenge identified in the literature is a general lack of public awareness regarding the breadth and depth of the nursing profession, leading to widespread misconceptions about nurses’ roles and responsibilities [14, 29, 40, 46]. While many express respect for nurses, a reluctance to recommend nursing as a career path suggests a disconnect between perceived value and a true understanding of the profession [63]. This is further exacerbated by the relative invisibility of nurses in public discourse, where their contributions as autonomous decision-makers and leaders are frequently overlooked [29]. Several promising solutions have emerged to address these communication barriers. Crucially, initiatives designed to enhance community awareness of nurses’ actual roles and competencies are essential [27]. Targeted information sessions for parents and orientation programs for junior high school students, for example, can effectively showcase the positive aspects of nursing and clarify its significance as a profession [48]. Furthermore, patient-focused educational initiatives highlighting nurses’ diverse competencies can contribute to a more accurate public perception [33, 36, 45]. By prioritizing open communication and targeted education, the nursing profession can increase its visibility, foster a deeper understanding of its essential contributions to healthcare, and ultimately improve its public image [42].

Professional collaboration

Professional collaboration is crucial for enhancing the public image of nursing by identifying effective solutions and addressing underlying challenges. High-involvement work practices offer a key strategy in this regard. These practices foster teamwork and empower nurses to actively participate in shaping their work environments. This empowerment strengthens nurses’ professional identity, enabling them to articulate their value within interdisciplinary teams and the broader healthcare system [65]. Moreover, fostering interaction among nurses, both within and across different work areas, facilitates the exchange of knowledge, skills, and experiences, contributing to a more unified and impactful nursing workforce [66].

Systemic factors

Systemic factors, encompassing policies, regulations, and organizational structures, significantly influence both the public image of nursing and the professional practices of nurses. This influence manifests across four interconnected sub-themes: transformational policies, nursing globalization, nursing attire, and redefining gender roles in nursing.

Transformational policies

Transformational policies are crucial for reshaping the public image of nursing and addressing systemic challenges. These policies should inform strategic planning and guide the future direction of the profession, ultimately elevating its status within healthcare systems [34]. A zero-tolerance policy regarding violence and aggression against nurses is essential for fostering a safe working environment, which directly impacts professional image and job satisfaction [10, 21, 43]. Developing highly competent nurse managers and leaders is also necessary for effective governance in public healthcare settings [35, 41, 44]. Addressing the profession’s low attractiveness due to inadequate pay and gender bias requires policies that improve working conditions, enhance educational opportunities, and increase nurse representation in management positions [8, 34, 38, 51]. Moreover, comprehensive strategies that consider factors such as gender, age, and socioeconomic status are needed to mitigate systemic inequalities within nursing [20, 53]. Finally, public education campaigns and marketing initiatives that highlight nursing as a scientific and leadership-driven field can significantly improve public perceptions and solidify nursing’s position as a respected profession [34, 41, 49, 51, 67].

Nursing globalization

Globalization offers significant opportunities to enhance nursing’s public image. This integrative review highlights the critical need for a nationally standardized definition of nursing that reflects contemporary practices and global values [44]. Furthermore, national health policymakers should prioritize developing programs to improve public perceptions of nursing. Such initiatives could encompass public awareness campaigns, educational programs, and collaborations with international nursing organizations [21, 51].

Nursing attire

Nursing uniforms, a potent form of nonverbal communication, significantly shape public perceptions of the nursing profession [31]. While attire influences how individuals are perceived in various settings, the healthcare environment presents a unique challenge. The widespread use of similar uniforms, particularly white attire, by diverse professionals—including nurses, nutritionists, physiotherapists, and kitchen staff—can create confusion among patients and their families. This ambiguity not only hinders immediate role clarification but also has broader implications for how nursing is currently perceived, and will be perceived in the future, as a distinct and highly valued profession [69].

Redefining gender roles in nursing

This integrative review reveals that the nursing profession continues to be perceived through a lens of historical gender stereotypes, predominantly as a female-dominated field. These entrenched stereotypes not only shape public perception but also influence internal professional dynamics [28, 33, 69]. Challenging and redefining these traditional gender roles is crucial for improving the public image of nursing and fostering greater equality within the profession. A key strategy for achieving this involves actively promoting nursing as a viable and appealing career path for both men and women [47]. This promotion should go beyond simply recruiting men into the field. It requires a concerted effort to cultivate and enhance caring behaviors in male nursing students, thereby reinforcing a professional image that transcends gender stereotypes. Furthermore, addressing and dismantling barriers related to gender-friendliness within nursing education and practice settings is essential to create a more inclusive and equitable environment [61].

Discussion

This integrative review explored the challenges and potential solutions related to the public image of nursing, identifying three overarching themes—professional enhancement, professional advancement, and systemic factors—and nine sub-themes within these. Our findings underscore the crucial role of nurses and nursing organizations, including policymakers, in actively shaping and improving the public perception of nursing. Critically, this review highlights the significant influence of nurses themselves. Their individual actions, unwavering professionalism, and dedicated service are central to how the public perceives and values the nursing profession.

Regarding professional enhancement, the findings of this integrative review suggest that enhancing nurses’ professional skills is crucial for improving the public image of nursing. Studies indicate a strong correlation between nurses’ skill development and a more positive perception of the profession [36, 45, 50]. This aligns with Foucault’s theory, which posits that power and knowledge are intertwined, with knowledge being a key component of professional influence [74]. Consistent with this, research has demonstrated a significant link between nurses’ educational levels and their competencies in areas like group power and communication. Therefore, bolstering nurses’ skills and knowledge is essential for cultivating a positive image of nursing, both within the broader community and among interprofessional colleagues [75]. This can be achieved through comprehensive needs assessments to identify knowledge gaps, followed by targeted retraining programs and robust continuing education opportunities that promote competent practice and ensure high-quality care [5, 76].

It is important to acknowledge that sociocultural factors play a significant role in shaping public perceptions of nursing [26]. For example, in the United States, nursing is a highly respected profession, and the public generally encourages nursing as a career path [77]. Conversely, in Saudi Arabia, cultural factors such as challenging work environments (e.g., poor social life, mixed-gender workplaces, and delayed marriage) contribute to a less favorable image, often discouraging potential recruits [14]. Similarly, Greek nurses have expressed concerns about the profession’s poor image in their society, citing perceptions of unprofessionalism, subordination to physicians, low pay, and even derogatory language used to describe nurses [6]. In contrast, nursing enjoys a positive public image in Israel [21]. In contrast, nursing enjoys a positive public image in Israel.

On the other hand, cultivating a strong sense of professional self among nurses is crucial, as it significantly influences both individual professional identity and the broader public image of nursing [78]. Tajfel and Turner’s Social Identity Theory (1986) posits that an individual’s self-concept, including that of a nurse, is shaped by societal perceptions of their group [79]. Positive societal perceptions enhance self-concept, while negative perceptions can diminish it. When nurses experience feelings of undervaluation or uncertainty regarding their professional image, their self-confidence can be negatively impacted, potentially hindering their ability to effectively advocate for the profession and demonstrate their competencies [78]. Research has demonstrated a strong link between professional identity and professional self-concept in nurses, with the latter often being influenced by public opinion [80]. This creates a reciprocal relationship: nurses who perceive a negative public image of their profession are more likely to develop a lower professional self-concept [81]. This creates a reciprocal relationship: nurses who perceive a negative public image of their profession are more likely to develop a lower professional self-concept [82].

Regarding professional advancement, effectively utilizing media is crucial for enhancing the public image of nursing. A key first step is identifying weaknesses and misrepresentations of the profession in media portrayals. This awareness among nursing managers, policymakers, and media representatives is essential for improving public perception [47, 55]. One promising strategy, supported by a systematic review, is the development of media projects like television series, movies, or documentaries that feature nurses and the nursing profession prominently in their titles and content. Consultation with nurses during production is vital to ensure accurate portrayals of nursing work and the scope of independent healthcare services they provide. Furthermore, casting well-known actors in nursing roles can increase audience engagement and help humanize the profession [83]. Social media also plays a vital role in shaping public understanding. A systematic study highlights its potential for directly engaging with the public, challenging stereotypes, and fostering a more nuanced understanding of nursing [84]. However, it’s important to be mindful of how nurses are portrayed, even in positive contexts. A narrative review reveals that pre-pandemic media often stereotyped nurses based on appearance and limited their roles to basic medical tasks. While the COVID-19 pandemic led to increased recognition of nurses as “heroes” or “soldiers,” this “hero” imagery, while seemingly positive, can be problematic. As the review suggests, this type of portrayal can be a political and cultural strategy that normalizes nurses’ risk exposure and reinforces existing power dynamics, potentially conditioning them to accept “necessary sacrifices” during crises. Nurses and their advocates should be aware of these potential negative consequences and work towards more balanced and realistic representations [85].

Strengthening professional behaviors is crucial for enhancing the public image of nursing. This involves cultivating strong communication skills, fostering professional collaboration, and promoting mutual respect among all healthcare providers [20, 43, 63]. Conversely, unprofessional behaviors significantly erode the perception of nursing [69]. These include, but are not limited to, inappropriate patient treatment, neglecting patient questions and requests, and exhibiting aggression towards patients and their families. Such actions not only negatively impact individual patient experiences but also contribute to a broader negative perception of the nursing profession [86]. Furthermore, ineffective inter-/intra-professional communication, characterized by poor interactions among nurses, nurse managers, and other healthcare staff, creates substantial barriers to effective teamwork [87]. A lack of cohesion within the healthcare team can lead to internal conflicts and challenges, such as disputes with supervisors, inadequate supervision of nurses, and an unprofessional work environment. These issues can manifest as negative interpersonal dynamics, the use of overly informal address among colleagues (undermining professional boundaries), and a general lack of respect for hierarchical structures (88). To mitigate these challenges and improve the public image of nursing, it is essential to reinforce the importance of professional conduct among nurses. Targeted interventions, such as monitoring professional interactions and implementing training workshops focused on enhancing communication and behavioral skills, can be effective strategies for achieving this goal [78].

Systemic factors are crucial for improving the public image of nursing. Professional organizations play a vital role in empowering nurse managers to engage effectively within political structures and resolve intra-organizational conflicts [35]. Placing qualified individuals in key leadership positions at all levels strengthens nursing’s voice in decision-making, which in turn enhances the perceived authority and standing of the profession among both healthcare professionals and the public [29]. However, the persistent disparity in compensation and benefits between nurses and physicians, often exceeding differences in educational qualifications, undermines nurses’ motivation and perpetuates societal misconceptions, contributing to job dissatisfaction. In Iran, this deeply ingrained issue requires long-term, multifaceted strategies, including sustained resource investment and infrastructure improvements [86]. Addressing nurses’ salaries is a critical component of enhancing their societal image [20, 38].

Conversely, the globalization of nursing can elevate the profession’s prestige by promoting international standards and improving nursing education [21, 51]. The World Health Organization (2019) emphasizes that global nursing frameworks enhance credibility through rigorous standards and regulations [89]. Furthermore, a global perspective facilitates the effective addressing of local health needs and reinforces the essential role of nurses within health systems worldwide [90].

Despite these positive trends, nursing continues to be perceived by some as a female-dominated profession characterized by low skills, status, salaries, academic standards, and autonomy. Male nurses, in particular, may face scrutiny regarding their qualifications, while female nurses may be unfairly perceived as unprofessional. To combat these damaging stereotypes, nursing must be actively promoted as a scientific discipline that benefits from the contributions of both genders. This can be achieved through targeted awareness campaigns conducted by universities and media outlets, coupled with increased nurse participation in health policy development. In some countries, increased male representation within the nursing workforce has positively impacted the profession’s public image by challenging traditional gender stereotypes and contributing to its evolution into a respected academic profession. In conclusion, strategically promoting nursing as a scientific and inclusive profession is essential for dismantling harmful stereotypes and ultimately enhancing its societal status [11].

Conclusion

This integrative review reveals that the public image of nursing is shaped by a complex interplay of professional and systemic factors. Nurses themselves are key agents of change, and their competence and professionalism significantly influence public perceptions. Investing in continuing education and professional development empowers nurses to enhance their skills, advocate effectively for their profession, and ultimately improve the quality of care. Strategic engagement with media outlets is crucial for showcasing the diverse and vital contributions of nurses to healthcare, challenging outdated stereotypes, and highlighting their expertise. Furthermore, addressing systemic issues such as wage disparities and promoting diversity within the nursing workforce are essential for fostering a more equitable and representative profession, thereby enhancing its reputation. A positive public image of nursing requires presenting the profession as dynamic, inclusive, and one that values the multifaceted contributions of its members. This can be achieved by showcasing the flexibility and professionalism inherent in modern nursing practice. Ultimately, cultivating a positive and accurate image of nursing necessitates a collaborative effort involving nurses, healthcare organizations, policymakers, and the public. This requires a fundamental shift in how nurses themselves perceive their profession, embracing self-confidence and a strong belief in their value to redefine and elevate the public’s understanding of nursing.

Implications

This review offers several key implications for various stakeholders. Clinically, nurses should prioritize professional behaviors to foster patient trust, strengthen therapeutic relationships, and facilitate participatory care. In terms of education, nursing curricula should integrate these findings, emphasizing professionalism and acknowledging the significant influence of faculty and the learning environment on students’ professional identity formation. Organizationally, healthcare organizations can enhance nursing’s public image by collaborating with media outlets to showcase positive stories and impactful contributions. Furthermore, organizational managers and nursing leaders should advocate for policy changes that improve professional income, working conditions, and organizational unity, recognizing the importance of engaging in political, social, and cultural arenas to achieve these goals. Finally, from a research perspective, future research should focus on rigorous evaluations of interventions designed to improve the public image of nursing, providing evidence to inform the development of supportive policies. Specifically, research should investigate and highlight the effectiveness and critical contributions of nurses across diverse healthcare settings and healthcare professionals. This collaborative approach will not only promote a unified, team-based approach to healthcare but also underscore the vital and integrated role of nursing within the broader healthcare system.

Limitations

This integrative review has limitations that should be acknowledged. First, the restriction to studies published in English and Persian introduces a potential language bias, excluding potentially relevant research published in other languages, such as Spanish and Portuguese. Future reviews could benefit from including a broader range of languages to provide a more comprehensive understanding of the public image of nursing. Second, while we employed rigorous search methods across multiple databases, the possibility of inadvertently missing relevant literature due to variations in indexing practices, search terms, or publication formats cannot be entirely excluded. Finally, the heterogeneity of the included studies, in terms of methodologies, settings, and participant characteristics, while inherent in an integrative review, may limit the generalizability of specific findings. While we synthesized the findings across studies to identify overarching themes, the diverse nature of the data should be considered when interpreting the results.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

GM: original concept, study design, data collection, analysis, and interpretation, manuscript drafting; SG: data collection and search, analysis, and interpretation; and AS: study design, review supervision, the final manuscript’s critical revision, and the corresponding author. All authors read and approved the final manuscript.

Funding

No external funding was obtained for the conduct of this study.

Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This integrative review examined published research on the public image of nursing. As this study synthesized existing, publicly available data, it did not involve direct interaction with human subjects and therefore did not require ethical approval from an institutional review board or ethics committee.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.