From Silence to Voice: What Nurses Know and Must Communicate to the Public

From Silence to Voice: What Nurses Know and Must Communicate to the Public Bernice, Buresh and Suzanne, Gordon , 2nd Edition , 2006 ; ILR Press, an imprint of Cornell University Press , Ithaca, New York and London : 296 pages. ISBN: 13: 978-0-8014-7258-9 . From Silence to Voice is a second edition of a book in the series on The Culture and Politics of Health Care Work (editors Suzanne Gordon and Sioban Nelson). In 2005, I reviewed Nursing against the Odds, an earlier book in the series which provided a detailed analysis of the many ways in which cost cutting, media stereotypes, and medical hubris undermine nurses and patient care. From Silence to Voice takes matters a further, crucial step forward by addressing not only what nurses must communicate to the public, but also by providing detailed strategies on how this may be achieved. From Silence to Voice gives nurses a series of tools to help them explain their work to the public. Buresh and Gordon believe that silence is a condition from which nurses suffer, and they set out to provide the remedies in a robust and easily accessible manner. The revised and redesigned edition has been updated to address urgent issues and controversies in nursing. It includes a new chapter that tells nurses which pitfalls to avoid, and which themes, issues and evidence to include, when they construct their stories. Throughout the book information for nurse managers is included to help them to encourage and educate nurses to end their silence. It is not all bad news. The International Council of Nurses provides striking leadership in terms of influence at the top echelons of global health policy and also through its Leadership for Change Programme around the world. Yet, I had not the slightest doubt that this book is needed when a mature student nurse of my acquaintance recently related an incident where her mentor cautioned her against speaking out on the subject of poor clinical practice observed in a fellow medic. That silence is still taught in schools of nursing is beyond belief, but Buresh and Gordon are in no doubt that ‘(b)eing seen and unknown has been a perpetual problem for nursing . . . nursing is simply overlooked, even in its most obvious and familiar form – hospital nursing’ (p. 14). They argue that every profession must speak for itself and justify its existence, and that the public needs to know that nursing care is consequential – as much so as medical treatment (p. 21). In support of their argument they quote nursing historian Joan Lynaugh, ‘Most people know they can’t get into hospital without a doctor: What they don’t know is that they won’t get out of one – at least not alive – without a nurse.’ (Gordon 2000) Buresh and Gordon emphasise that for far too long nurses have been judged and valued by their image, not by their knowledge, and that this situation must change. Their advice in Part I on strategies to end the silence is written in straightforward, easy to follow step-by-step guidelines. For example, nurses can begin to tell the world what they do, and inform the public about the nature of nursing and the role of the nurses, through anecdotes. They then illustrate how an anecdote can be constructed, and provide the steps to take when addressing administrators or policy makers. Part II on communication with the media and the public comprises six chapters: informing nurses on How the News Media Work, Reaching out to the Media, Working with Public Relations Professionals, Constructing Campaigns that Work, Letters to the Editor, and Appearing on Television and Radio. The book’s final chapter is on Promoting Nursing Research, which Buresh and Gordon emphasise requires skilful media reports on study findings that in the past have been invisible. Although written by American authors, From Silence to Voice is a text with international relevance and many of the examples given come from within the global nursing community. In her Foreword to From Silence to Voice, Patricia Benner commends it to every nurse, saying ‘It is a must-read for nurse educators, nurse executives, and all practicing nurses. It should be a required text for all levels of nursing students’ (p. xi). After such a prestigious recommendation there seems little more for me to say except that I wish that this book had been around years ago when I started in nursing. With such impressive guidance, nurses today have many strategies for leadership, communication and influence at their very fingertips.