In Barbara Gilchrist’s 2017 thesis for her Master of Nursing, which explored the effect of the portrayal of nurses on television on the decision to become a nurse in New Zealand, she identified four stereotypes– the naughty/sexy nurse, the battle-axe, the ministering angel and the doctor’s handmaiden.
“I found that all these stereotypes are perpetuated in the media, yet the nurse as a well-trained, critical thinking professional is very, very rarely portrayed,” says Gilchrist.
She also concluded that nurses are cast as the central character in very few TV programmes. Instead, they are cast as a side character – “the handmaiden or love interest of a doctor”.
And nurses on TV are usually female, says Gilchrist. “Where male nurses are featured, there are two main stereotypes – the gay nurse or the nurse who wasn’t good enough to be a doctor.”
Gilchrist’s experience over her 30-year nursing career, is attitudes are slow to change. “There’s always the odd joke around being bathed by a nurse, for example, and the stereotype of the battle-axe – the busty matron throwing orders – there’s a bit of that.
“Pay rounds bring out some interesting views, too,” she says, “with a few voices continuing the ministering angel stereotype, that nursing is a calling, hence nurses should be happy just doing their job.”
Gilchrist says the myth of nursing as a second-choice profession also persists – that if people can’t make it to medical school, they become nurses.
“I definitely think TV producers have a role to play,” she says, “but also the profession. Every time we hear someone say something, we should challenge them and ask, ‘What do you mean by that? This is what it takes to be a nurse’.”
She believes nursing could do more advertising like the recruitment ads run by the New Zealand Police to educate the public about what it takes to be a nurse.
“I think a lot of people would be surprised at what’s involved, the standard of academic work, the time spent looking at research and so on.
“I would definitely like to see the stereotypes fade into oblivion or be replaced by a much more realistic understanding about what it takes to be a nurse. And that we’re not all the same; we join for different reasons and we leave for different reasons.”
In their book Complexities of Care: Nursing Reconsidered, Sioban Nelson and Suzanne Gordon pulled together a series of essays that looked at the challenges facing nursing and the problem the profession has created “by talking only of caring and emotional and relational work and never about the technical and scientific basis of nursing expertise”.
“We argued that even where the primary intervention is emotional support – this is not because the nurse is a good person, or a natural carer … but because she or he has understood that this is the intervention that the patient requires at this time, and because the nurse has the expertise and education to effectively provide support to the patient,” writes Nelson.
“We also argued that the image of nurses as caring and kind support workers, as opposed to being highly skilled professionals, is actually produced by nurses. In fact, we described a phenomenon we called the ‘Virtue Script’, where nurses portray themselves as angels, or as sweet kind people…”
The ‘Virtue Script’, which began in the late nineteenth and early twentieth centuries to justify upper-class women working, has changed little in the early twenty-first century, maintains Nelson.
“A sampling of campaigns – from advertisements, to videos, brochures, articles, newsletters, tee-shirts all of which not only describe but define nursing to the public – suggests that nurses are still grounding their claims for social legitimacy and respect on their virtues rather than their knowledge.”
She suggests the persistence of the ministering angel stereotype may discourage “the right kind of candidate” entering nursing – “someone interested in combining caring with intellectual and scientific challenges” – and undermines the profession’s ability to convey the importance and value of nursing to the public.
“I would urge all nurses to look for the virtue script in your organization, in your schools or associations or health care provider. We need to all be aware of the image of nursing that we all portray in our professional lives and take responsibility to communicate a professional and knowledgeable role model.
“Only in this way will be move beyond ‘say little, do much’ and become visible in the health care system.”
Associate Professor Kathy Holloway, Co-Chair College of Nurses Aotearoa, agrees stereotypical and uninformed images of the nursing profession are best challenged by supporting a better public understanding of the role of nurses in our health systems.
“Strong public messages about the pivotal role of nursing services in the delivery of universal health care and supporting functional communities exist and could be used more widely,” she says.
These include those referred to in the Triple Impact Report, a global review of nursing by the All-Party Parliamentary Group on Global Health (APPG). The report found that developing nursing services improves health, promotes gender equality and supports economic growth. “Powerful messages for nursing.”
She also points to global initiatives, such as the Nursing Now campaign run by the World Health Organisation, in partnership with the Burdett Trust for Nursing, which aim to significantly raise the profile and status of nursing globally.
“Raising the level of global awareness reflects a clear understanding that the health challenges of the 21st century cannot be addressed without strengthening the roles of nursing and midwifery,” says Holloway.
“Significantly, earlier this year the World Health Organisation Executive Board designated 2020 as the Year of Nurse and Midwife signalling further recognition of the pivotal role of nurses and midwives in health systems.”
Holloway points out that nurses remain the largest group of health professionals and are those closest to the public. “It makes good sense therefore to optimise nursing’s contribution to health through recognising the full potential of their education and training and to provide an alternative view to unhelpful stereotypes.
“The global campaign for nursing is a step in this direction and provides excellent resources to support an informed understanding of the profession.”