The media is a powerful instrument that has an enormous impact on perceptions of life as portrayed on television, movies and the Internet. This phenomenon has shaped the way many people view life and gain medical information.1
A comparative analysis of nurse and physician characters in the entertainment media led Beatrice Kalisch, EdD, RN, FAAN, and Philip Kalisch, PhD, professors at the University of Michigan's Nursing School in 1986 to write that people "do not necessarily adopt the precise attitudes and opinions that may be suggested by the media, but the information provides the ingredients they use to adjust their existing attitudes and opinions to keep pace with a changing world."2 Capitalizing on this fact, nurses can positively change the image that is currently projected negatively on television, the Internet and in movies.
Historical Perspective of Nursing
During the 19th century, two opposing images of nurses were identified. Florence Nightingale represented a symbol of excellence and gave the nursing profession acceptance and public respect. But Sairy Gamp, a midwife created by Charles Dickens in "Martin Chuzzlewit," was depicted as old, fat, rough and unsightly - in Dickens' words, "unclean, uneducated, untrained and unreliable."
During the early 1890s through World War I, a tremendous growth of the nursing profession occurred. During this time, the image of nurses was identified by the "Gibson Girl," a creation of Charles D. Gibson. The physical bearing conveyed authority, power and control with "her thrown-back, upright carriage and lowered eyelids."2
The image of the good nurse ended in the 1920s, a time of national prosperity and the birth of the "Flapper" woman, with Victorian restrictions removed. Nurses were seen as subservient to physicians and the public image of nurses declined. Emphasis was placed on romantic liaisons in the work place while the negative publicity also targeted poor working conditions of nursing.
During World War II, a time of nursing shortage and economic decline because of the war effort, recruitment posters depicted nursing as a dedicated, strong profession with heroes who supported the fighting men at war. This was a time when "the media portrayed nursing as a profession that required education and skills."3
Following World War II nursing remained a profession of high status and was considered an occupation for women that was courageous, admirable and one of leadership.
From the 1960s to the present time, nurses have been portrayed as sexual, romantic, frivolous and hedonistic, and cast in demeaning roles. During this era, M*A*S*H, a novel and later a movie and TV series, developed the nurse character, Margaret "Hot Lips" Houlihan. The name alone depicts a promiscuous sex object.
In the early 1970s, according to a study by Kalisch and Kalisch, television portrayed nurses as sympathetic and dependent, having little knowledge and skill. The media image of the nurse paralleled the dominant perception of women at the time as submissive helpmates, not too bright, but inspirational - a kind of moral prop for men.2
In One Flew Over the Cuckoo's Nest, a 1970 movie, nurse Ratchet was shown to be evil by exerting power over doctors as well as her patients in the mental institution. This nurse had no redeeming qualities and was devastatingly cruel.
In another movie, Something's Gotta Give, the character played by Jack Nicholson has a heart attack and returns home to be cared for by a nurse who is middle-aged, ugly, obese and bursting out of her uniform. What is the message here? In the movies Catch-22 and The World According to Garp, nurses are portrayed as sexual beings in the profession to meet and marry a rich doctor.3
Current Trends in Nursing
In the TV shows Grey's Anatomy, Scrubs, House and ER, physicians are seen in critical scenes providing care normally provided by a nurse. Nurses are shown as handmaidens to the physician. While ER is considered one of the most popular healthcare shows ever, nurses are often shown taking vital signs, throwing IV bags around and dating doctors.
Sandy Summers, an executive for The Center for Nursing Advocacy, held a conference call with the medical directors of the show to voice concerns and to encourage a more accurate portrayal of nurses. The Center sent news releases to protest its view of nursing, which resulted in much press attention.3
Changing Media Image is Key
The mass media is in the business of attracting viewers and affecting how and what people think. To believe that people are able to disregard everything they perceive in the entertainment media because the scenarios presented are not literally "true," or because they are loosely staged simulations of reality, would have us believe that people disregard all messages in advertising. That is not how the human mind works.
For an entertainment show or commercial to be effective, the audience must identify in some way with the characters. The media affects what people see and think, and what they think affects what they do. This is not just an observation of how humans act. It is a basic principle of education, art, advertising or any other organized effort to influence people.
Advertising, for instance, can affect behavior when people receive persuasive, one-sided views of information on subjects where they may not have prior experience or knowledge. Research suggests that children are especially susceptible to media influence of this kind, but no one is immune. It is for this reason that major corporations spend millions on slick advertising campaigns to promote their products, and why powerful political ads can move polling numbers and affect election results.4
Although there are many reasons why the nursing profession is facing a crisis, one of the major reasons shortages exist in the nursing ranks is that the nurse has a poor image. In today's world of multiple media sources there are real problems affecting the nursing profession. As long as guidance personnel and teachers continue to tell students they are "too smart to be a nurse," there will continue to be a decline in the profession.
The shortage of qualified nurses has become a monumental problem and as the baby boomers retire it will become a crisis, especially for those specialty positions requiring critical care. The problems that plague the nursing profession -high stress levels and lack of respect - will continue. However, if the media began to identify nurses in a more positive image, at least one of the problems would have been negated and with a positive image, the other negatives could be addressed mor easily.
1. Turow, J., & Gans, R. (2002). As seen on TV: Health Policy Issues in TV's Medical Dramas. Menlo Park, CA: Kaiser Family Foundation.
2. Kalisch, P., Kalisch, B. (1986). A comparative analysis of nurse and physician characters in the entertainment media. Journal of Advanced Nursing, Vol. 11, 179-195.
3. Buresh, B., & Gordon, S., (2006). From Silence to Voice. Ithaca and London: Cornell University Press.
4. Fagin, C., Maraldo, P., & Mason, D. (2005). Come one. Even if the mass media does ignore nursing, or present it inaccurately, how can that possibly affect nursing in real life? The Center for Nursing Advocacy. Retrieved Aug. 9, 2007 from http://nursingadvocacy.org/research
Hereford, M., (2006). Explaining the Reel Image of Nursing: How movies, television and stereotypes portray the nursing profession. (Doctoral dissertation, University of Idaho, 2006) ProQuest Dissertation Services, AAT 3185564.
JWT Specialized Communications Healthcare Group. (2000). The Perception of Nursing as a Professional Career among Students in the United States. Nurses For A Healthier Coalition. Retrieved August 10, 2007 from http://nursingadvocacy.org/research
What Nurses Do. (2006). Topics in Advanced Practice Nursing eJournal. Medscape. 2006;6(1). Retrieved August 9, 2007 from http://www.medscape.com/viewarticle
Merriam, S.B. (1998). Qualitative Research and Case Study Applications in Education (2nd ed.). San Francisco: Jossey-Bass.
Murray, M. (2002). The nursing shortage. Past, present, and future. Nursing Adm., Feb. 32(2): 79-84. Retrieved June 15, 2007 from: http://www.ncbi.nlm.nih.gov/
National League for Nursing. (2001a). Strategies to reverse the nursing shortage. Nursing and Health Care Perspectives. 22(2), 103.
Satterly, F. (2004). Where Have All the Nurses Gone? The Impact of the nursing shortage on American healthcare. New York. Prometheus Books.
The Impact of TV's Health Content: A Case Study of ER Viewers. (2002). The Henry J. Kaiser Family Foundation. Retrieved June 15, 2007 from http://www.kaisernetwork.org
Tunstall-Pedoe, H. (1998). Did MONICA really say that? British Medical Journal. Oct. 10; 317(7164): 1023. Retrieved June 20, 2007 from http://www.pubmed
Vallano, A. (2006). Your Career in Nursing. (3rd edition). New York. Simon & Shuster.
Jana Habury is a freelance writer.