Jun 04,2015
By Rosanne Beuthin, RN, PhD

Military metaphors have outlived their usefulness

Rosanne Beuthin wants the language of nursing to reflect what we believe, value and aspire to

We need to be thoughtful about the words we use in nursing to ensure they align with the profession’s vision of client-focused, caring and respectful interactions in positive workplaces. Unfortunately, so much of our language in nursing is rooted in military metaphors, which can have a negative impact on our practice, care interactions and organizational culture. The language we use in everyday interactions with people in our care may inadvertently do harm.

First, some context. A metaphor is a figure of speech linking two unrelated subjects in a new way, on some point of comparison — sometimes for a positive effect and sometimes not. While seemingly innocuous, metaphors are powerful: they influence how we think, and these thoughts are reflected in our actions and behaviours and in how we treat one another.

Military metaphors, ingrained in nursing’s history, have spilled over into general use in health-care settings. For example, we routinely hear the phrases front-line nurses and staff in the trenches. I believe these metaphors influence how staff are perceived by organizational leaders and how staff think about themselves, their work relationships and those in their care. I prefer to use and hear the terms direct care nurses, clinical staff or care staff. Front lines and trenches liken care settings to war zones and conjure images of endless conflict and battle; the leadership and relationships imagined in this mindset are surely directive, not collaborative. In terms of patient care, the metaphors do not suggest compassion, respect and person-centredness as our focus; they don’t reflect how we want those entrusted in our care to be treated or how we want their experiences to be.

The more aware we are of the impact of our language, the more thoughtfully we will choose our words. Cancer centres across North America, for one, are questioning the potential harm to patients from the pervasive use of war metaphors related to treatment. When a woman is diagnosed with breast cancer, her nurse may encourage her to fight, to be a warrior, to conquer. If the illness worsens, will the woman feel she has failed or not tried hard enough? What is the potential emotional cost to her of being at war? What if it is a very different metaphor for her illness — the start of a journey, for example — that resonates with her?

Because language shapes our conceptualizations and influences behaviour and experience, we can see that putting focus on the words we use in nursing is part of a broader vision — to create and foster positive organizational cultures associated with patient safety and high-quality care.

I call upon nurses and nurse leaders in all domains to implement simple strategies that will increase awareness of the use and impact of military metaphors, with a view to retiring them. These strategies include listening for the metaphors you use in conversation, as well as those used by colleagues and patients, and reflecting on their intent. Or initiating conversations with others to ask what certain metaphors mean to them. The effectiveness of this approach will be reflected in the responses gathered from culture surveys, patient satisfaction surveys and audits of language used in written documents. I believe that the benefits to patients, care providers and health-care organizations will be evident in the quality of care.

To continue with the status quo is of no value to us and hinders our progress in achieving the profession’s vision. I invite you to think about your words and make a commitment to finding new metaphors that promote caring and collaboration.

Rosanne Beuthin, RN, PhD, is a practice consultant, Island Health (Health Authority) and a nurse researcher with the school of nursing, University of Victoria. 

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