Public perceptions of the brand image of nursing: Cross-cultural differences between the United States and China

Background: Measures of public opinion regarding nursing's brand image are needed to identify and correct perceptions that are incongruent with the breadth and scope of contemporary nursing practice. Misperceptions of nursing's influence may serve to minimize or disregard nursing's unique contributions to addressing the Social Determinants of Health which are foundational for improving the health of global populations. Purpose: To compare public perceptions of the brand image of nursing between China and the United States (US) and determine whether sociodemographic variables influenced factors between the two countries. Methods: A cross-sectional online survey was distributed among members of the Chinese and U.S. public. Perceptions of nursing's brand image were assessed through the original Nursing Brand Image Scale-Public Version in the US (NBIS-P) and when translated to Chinese (NBIS-P-C). Descriptive statistics and multigroup confirmatory factor analyses were used to compare perceptions of the brand image of nursing and to examine the influence of demographics. Discussion: The reliability of the Chinese version of the NBIS-P-C was confirmed by this study. Age and gender did not influence public perceptions of nursing's brand image in either China or the US. Instead, educational attainment was the significant demographic variable and positively correlated with the public's perceptions of nursing in both countries (p < .05). Public respondents with lower educational attainment scored both the traditional nursing factor "Caregiver Virtues/Attributes" (e.g., Trusted, Caring, Nurturing/ Mothering) and the factor "Lack Authority/Identity" (e.g., White Cap/Uniform, Subservient, Female) higher, while scoring the factor for "Leadership" (e.g., Decision Makers, Influential, Leaders) significantly lower than those with higher educational levels. Conclusion: A disparity exists between nursing's contemporary contributions to healthcare and the public's limited understanding of the diverse leadership roles all nurses provide, across a variety of settings, and in global public health initiatives. The 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. Enhancing the accuracy and visibility of a strong brand image could advance public perceptions of nurses as experts and leaders in nursing science, thus paving the way for nurses to more effectively direct and influence the health of the public, particularly those with lower educational attainment who represent some of the most vulnerable populations. Targeted interventions that incorporate the educational level of the public offer a foundational opportunity for the nursing profession to correct inaccurate and outdated stereotypes that prevent nurses from achieving their desired brand image as influential leaders. Such campaigns could also be used to inform policy, guide strategic planning, and transform the future direction of the nursing profession.