Wednesday, February 14, 2007

Image of Nursing in Popular Culture

The image of nursing has changed and developed throughout history. One of the main causes of this change is the media’s portrayal of the profession. American culture and major historical events have also played a factor in shaping the public’s perception of professional nursing. Views of nurses also vary globally, as seen in the comparison between the popular image of Japanese and American nurses. Despite the challenging negative impressions established by the media and pop culture, nurses must adhere to a moral and ethical code, in providing the highest quality of care.

The Historical Progression of the Image of Nursing

Historically, there have been five main stereotypes into which nurses have been categorized: angels of mercy, heroines of war, handmaiden to the physician, battleaxe/torturer, and sex symbol/bimbo (Darbyshire and Gordon, 2005). Angels of mercy, an image created with the help of Florence Nightingale, contains somewhat of a hidden negative connotation. Although angels are thought of as pure, Godly beings, that is also how they were created and did not have to work to become so caring and compassionate. The image of nurses as angels takes away from the fact that being a nurse requires a lot of hard work, sacrifice, and an immense amount of knowledge, instead of simply being born that way. The “Girl Friday” of the 1920s was probably nurses’ best image, being heroines in the ‘30s and ‘40s and noble in war (Sigma Theta Tau International, 2000). The stereotype of nurses being handmaidens to the physician is grounded in the idea that a nurse is a doctor’s right-hand woman, or a kind of lady-in-waiting, whose only purpose is to serve the doctor and not the patient (Darbyshire and Gordon, 2005). Television shows such as Chicago Hope and movies such as Nurse Betty illustrate nurses as being the doctor’s “eyes and ears,” but never the doctor’s brain. Whereas the angel is often portrayed as pretty, caring, slim, and adored by patients, the battleaxe or torturer image is the exact opposite; fearsome, cruel, monstrously large, and set on causing pain. These “bad” nurses appear in several forms of media, including Sairey Gamp from Charles Dickens' books, Anne Wilkes from Stephen King’s Misery, Nurse Ratched from One Flew Over the Cuckoo’s Nest, and the more comic figures of Hattie Jacques from the Carry On film series (Darbyshire and Gordon, 2005). According to the Center for Nursing Advocacy, the most prevalent images in today’s society are of nurses being objects of sexual desire. This has the negative effect of discouraging both practicing and potential nurses and contributing to a general atmosphere of disrespect (Nursing Advocacy).


"Angel of Mercy" This nurse is portrayed as an angel as she helps a wounded soldier. (Vermont Quarterly)


"Heroine of War" A poster advertising the desperate need for more nurses to save lives during the war. (Nurses of World War II)


"Physician's Handmaiden" This picture shows a doctor doing all the work and interacting with the patient as the nurse just stands by waiting to help him. (Research Trials)


"Battleaxe/Torturer" Nurse Ratched from the movie One Flew Over the Cuckoo's Nest. (GoneMovies.com)


"Sex Object" A women dressed in a provocative nurse outfit. (Nursing Advocacy)

The Image of Nurses in the Present Day

Presently, nurses are still typically thought of as being, primarily Caucasian women who are pretty. However, male nurses are becoming more common, breaking down the previous gender stereotype. Although the public still has a narrow view about what the profession actually does, nurses predominately are loved by their community. Most Americans have little or no idea that starting salaries in nursing compete with those of other professions. Staff RNs working in the United States average a median base salary of $41,642, while nurse practitioners start at an average of $57,000 a year (Nurse Salaries). Nurses are also perceived to not have as much authority, prestige, or knowledge as other professions. While physicians are routinely #1 in public ratings of prestige, nurses rank #91; elementary teachers are higher at #61 (Sigma Theta Tau International, 2000). Nurses are generally seen as trustworthy, capable and conscientious caregivers, who are critical to the health care system. When asked how they would rate the honesty and ethical standards of people in certain fields, 84% of Americans reported nurses have "very high" or "high" standards, second only to firefighters (Nurse Week).


These women are how most people perceive nurses in the U.S. (Traveling Nurses)

Pop Culture and its Effect on the Image of Nursing

Pop culture is the contemporary lifestyle, defined by the cultural patterns that are widespread within a population, well known, and generally accepted. (www.dictionary.com)As it is described in an American Pop Culture website, it results from the daily interactions of people and culture that create the mainstream. It includes a large variety of practices, including the many facets of entertainment such as sports and literature, and those pertaining to fashion, music, film, and mass media in general. The expression of pop culture comes through the mass circulation of items from these areas. Historically, popular culture was defined negatively as the expression of cultural facets not accepted by the social elite. In modern society, several factors have influenced the shaping of pop culture, including the development of industrial mass production, the introduction of new technology, and the growth of the mass media. (www.wsu.edu)Thus, pop culture has the tendency to change constantly and the popular view on any subject, including nursing, varies indefinitely.

Football player being aided by a nurse on the sidelines. Sports Medicine

Pop culture has affected the perception of nursing in both positive and negative ways. Positively, pop culture has portrayed nurses as primary care givers. Nurses assume the role, in many forms of media, of the helpful healthcare professionals. For example, in contact sports, such as football, nurses are respected and required beside the field in the case of emergency injuries. In film, television, and literature, nurses are depicted similarly. Although, as stated above, pop culture is defined by its constant alterations, nurses have been shown in a positive light throughout the years. Beginning as early as 1929, for example, several book series about the trials and healthcare dilemmas of nurses were released, including "The Penny Marsh Series" and "Cherry Ames". (MedHunters)Several facets of pop culture, especially the media, also demonstrate the ethical principles involved in nursing, as a healthcare profession. As far back as 1962, the show "The Nurses" defined the life of two nurses and the ethical and moral dilemmas that defined their everyday job description. (TV Review)

Movie Poster for Candy Stripe Nurses, a film which shows nurses in a derogatory light.(Movie Review)

Pop culture has also played a major role in demeaning the profession of nursing. Many of its facets have objectified nurses as sex objects. For example, "Candy Stripe Nurses" is a film that essentially depicts nurses in this harmful way. The story line follows three “Florence Nightingale trainees” as they heal the emotional and physical ailments of handsome, young basketball players and gardeners, while healing sexual tensions as well. (Movie Review)In "Grey’s Anatomy" and "House", two popular medical television shows, nurses are either invisible or shown as the hot, young females who are under the submission of the smart, genius male doctors. Besides this wrong portrayal, pop culture undermines the skill that is required to be a nurse. It is common knowledge that nurses undergo less school than doctors do, but in no way is the number of years of schooling indicative of the amount and type of skill needed for a degree in nursing. As MedHunters describes, mainstream culture has also provided sexist labels for the profession of a nurse. Nursing has been stereotyped as a mainly female profession, although more in the present than ever before, the ratio of male to female nurses is increasing.(MedHunters)


The Influence of Different Forms of Media on the Image of Nursing

Media has influenced and shaped the common image of nursing today—an image which is not always accurate. Nurses are sometimes seen as young, inexperienced, and even sometimes as risqué women. An audience can make such judgments from movies, sitcoms, commercials, and paintings viewed. Misinterpretations rise in the nursing profession through what is read in novels, newspapers, and magazines. Some forms of media have done well to show what nurses really do, but it still doesn’t always correctly portray the nursing profession.

You may know not to fall for Hollywood magic and not to trust everything you see on TV, but you can’t always believe everything you read either. According to The Center for Nursing Advocacy sometimes the artistic value of books can be much higher than the realistic view of the nursing profession. For example, the non-fiction novel "Open Heart" by Jay Neugeboren (2003) was rated three and a half out of four for artistic value and only given a half a star for nursing accuracy by The Center for Nursing Advocacy. Although the accuracy of nursing is low in some books, sometimes nurses are not given any recognition when they play a large role in a novel.



The Center for Nursing Advocacy suggests that "Open Heart" by Jay Neugeboren (2003) has a higher artistic value than in the accuracy of the nursing profession.

According to the magazine, NurseWeek, the organization, Woodhull Study on Nursing and the Media surveyed newspapers and magazines in 1997. They found that nurses were only mentioned in 3% of hundreds of major health articles. Novels, newspapers, and magazines are not always the best source of information about the nursing profession, but there are still many good sources for nursing in those media forms. Books and articles written specifically for nursing are usually reliable. Nursing journals are also good references.



NurseWeek magazine can often serve as a good source.

Television has shaped society’s view of realism on many different levels. From reality TV shows to soap operas, the varieties of schemas being portrayed are shown to be at times faulty. The nursing profession on such shows like ER , House , Scrubs , and Grey’s Anatomy is misrepresented and unacknowledged for its true aspects. Television hides the importance and demanding work a nurse does compared to a doctor and unfortunately shows nurses as insignificant parts of a health care team (Center for Nursing Advocacy, 2003). However, television has the power to change the way people view the nursing profession by a click of a button. By showing the significance of the nursing shortage to our country and the reality of how nurses affect society in such a positive way, the nursing career can be uplifted and seen as a respectful and challenging job compared to any other health care career out there.

As much of a nuisance as commercials seem to be, they are actually quite effective in sparking ideas into our heads. The mere couple of seconds you see intriguing pictures and catchy phrases, it sticks with you and you remember it. Commercials have both positively and negatively affected the nursing profession. While some advertisements promote the nursing career and helping to keep the public aware of the nursing shortage, other commercials represent nurses as demeaning individuals or sexy and scandalous employees (Center for Nursing Advocacy, 2003). Commercials, for the better, have helped promote and expand the world of nursing as a whole. By continuing to reach out to the public and show the importance of the nursing field as well as the significance of resolving the nursing shortage, people can see the true reality of what it’s like to be a nurse in today’s society.

CVS Pharmacy Commercial
Criticism of nurses failing to teach a patient how to administer twenty different medications.

Gillete TAG Body Spray
Portrays a nurse who develops a “highly contagious lusty-nurse fever” and climbs into bed with a male patient wearing Gillete TAG Body Spray (Center for Nursing Advocacy, 2003).

Nursing at John Hopkins
Recruitment

Paintings and photographs have positively affected the image of nursing in the past and today. Instead of representing nursing as an insignificant career or the stereotypical “sexy” nurse today, paintings and photographs instead show the care and nurture in helping others (Center for Nursing Advocacy, 2003). Through the years, nursing schools have been created all around the country. Photographs of nursing schools have become a significant part of showing the growing and changing aspects of the career. Nursing continues to evolve each day; with photographs and paintings being made, realistic and honest pictures are being portrayed to positively promote the image of nursing.

Nursing Class of 1900 (Saint Barnabas Medical Center)




Jean Siméon Chardin
The Attentive Nurse, 1738
(Humanities Resource)





Richard Prince
Nurse Barclay's Dilemma, 2002
(Richard Prince)



Richard Prince
A Nurse Involved, 2002
(Richard Prince)



The Power of the Media in the United States

The media has an immense impact on the perceptions of the viewers. Actions are a result of perceptions and, therefore, any false advertising of the nursing profession may negatively affect a future career desire. For example, if a viewer does not know a lot about nursing as a professional career and they are watching a television show, such as Grey’s Anatomy, in which most nurses are portrayed as being in the way, they may lose respect for nurses. This lack of respect may lead them to overlook nursing as a future profession. Although most advertisers do not aim to portraying nurses in a negative light, viewers will not consider the intentions of the creators and they will still be influenced subconsciously (Nursing Advocacy). According to the Nursing Advocacy, the media is the cause of the misunderstanding of nursing. The public does not understand the importance of nursing unless they have seen a nurse at work in a real work environment. In the majority of media doctors are portrayed as the one and only care giver, instead of giving the reality of a team. Various television programs, including ER, Grey's Anatomy, and House show doctors doing work that nurses are responsible for and, therefore, makes the nurses look useless (Nursing Advocacy). It is vital that viewers use media literacy to analyze and depict the purpose of the media. Media literacy is aimed at the younger generation so that when they become adults they will be able to interpret the media and to make independent judgments that are not based on what the media feeds them (Nursing Advocacy). Media advocacy groups along with The American Medical Association, try to correct the mass media’s perceptions and show nursing as a professional career. Media literacy and media advocacy are methods used to change the misguided image of nursing today.

The Image of Nursing in Japan

According to Promimo, Florence Nightingale influenced a Konichiwa doctor who first established nursing in Japan in 1885. The popular image of nursing in Japan was not one of an independent caregiver, but as an educated and loving assistant to the physician (Promimo,2002). This disrespect is due in large part to the negative image of the daily work of Japanese nurses. In the past, nursing in Japan has been described as “…hard, dirty, dangerous, low salary, few holidays, minimal chance for a family and children, and a poor image” (Promimo,2002). Japan is trying to improve the image of nursing by setting higher standards of education for nurses. The education program in Japan is said to be “…even more complex then that of the United States system” (Primomo,2002). Nursing programs are moving to many universities in Japan and they are focusing on perfecting the organization of the nursing programs in Japan. Gender is another issue that adds to the subordinate image of nurses in Japan. The majority of nurses in Japan are female and historically females have not been as respected in daily life or in the professional world. Traditionally, the women have been subordinate to men in society. This is reflected on to the subordinate image of nursing as a predominately female profession, where men are in control. The major role of nurses in Japan is to serve the physician as women were suppose to serve men in society. By spending time serving the doctors, nurses had less time to tend to their individual patients and caused the nurses to lose their autonomy. Hopefully, with the higher education that is being offered to Japanese nurses, the nursing career will gain more respect and produce a more professional image for nurses globally.

Japanese Nurses in the 1920s

A current picture of a Japanese Nurse

Ethics Pertaining to the Image of Nursing

Two main professional values are involved in the evaluation of public image and the effect it has on nurses: integrity and altruism. When a nurse is stereotyped and exposed to negative images, it is easy for him/her to feel undervalued and unappreciated. S/he may feel that no matter how caring and hardworking s/he is, s/he will not gain the deserved respect and credit. This may in turn affect the nurse’s work morale. In this situation, integrity tells him/her to continue to provide the best quality of care s/he can despite what patients and other professional colleagues may think of him/her. The nurse must make sure that possible negative images of nursing around him/her have not altered his/her method of patient care nor devalued the patient’s importance.
The Essentials of Baccalaureate Education for Professional Nursing Practice defines altruism as “[taking] risks on behalf of patients and colleagues.” In order to be consistent with this definition, a nurse must not let inaccurate images of nursing which undermine his/her significance stop him/her from voicing moral uncertainty or moral outrage. For example, if the nurse feels that a patient is being treated unethically, or that something is amiss with the patient’s care, s/he must not be afraid to report his/her feelings simply because common belief dictates that a nurse is less knowledgeable and less important than a physician. In some cases, altruism, “[demonstrating] understanding of cultures, beliefs, and perspectives of others” can help us to recognize when an individual sees a nurse a certain way because of cultural background rather than media influence. This recognition can prevent feelings of discomfort or anger and improve the relationship between the nurse and individual.
If a nurse can develop a strong, defined set of ethics, it is less likely s/he will be discouraged and affected by the images of nursing around him/her. Instead of feeling pressured to act according to others’ expectations, s/he will act in a way that s/he believes is ethically correct and benefits the patient the most. Instead of being unconsciously influenced by stereotypes and false beliefs, the nurse will easily discern areas where popular culture has created misleading ideas of the nursing profession.

Remedies for Improving the Image of Nursing

Over the past couple of decades, several remedies for the tainted image of nursing have been targeted. Social organizations like "'Nurses for a Healthier Tomorrow' and the 'Coalition for Nursing Careers in California' are launching image campaigns to update the public's perception of the profession." (Featured Reports) Some recommendations include making nursing attire more professional and using professional titles to refer to nurses, rather than first names. These groups hope that this new image will ensure that new RNs will enter the workforce, as the Baby Boomer nurses retire. Also, the profession is slowly seeing increasing flexibility and opportunity for advancement. As Katie Bray, a nursing workforce consultant with Kaiser Permanente California says, "The flexibility in terms of where to go in the profession is so wide. You can advance clinically or administratively, or you can do research. You have a wonderful range of opportunities”. (Featured Reports) Today, nurses work in various settings besides the hospital. In the last decade, nursing has also seen an improving job market. As stated by Featured Reports on www.monster.com, by 2020, the US Bureau of Labor Statistics predicts that our country will be facing dangerous nursing shortages, so the job market is expected to be strong for the next 20 to 30 years.(Featured Reports) Lastly, the profession is becoming more and more diverse as more men and minority groups are entering nursing schools.

The image of nursing is slowly, but surely, improving. Today, nurses are seen as one of the most trustworthy assets of the healthcare team, but unfortunately, they are not necessarily given the respect and value that they deserve, both by patients and colleagues. By recognizing the effects of media, pop culture, and global differences, nurses and the general public can advocate for a more accurate image of professional nurses.

Sources

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