In the eighth of our series of blogs on the image of nursing, Sandy and Harry Summers ask what price female nurses pay in return for authority
Can female nurses handle seniority? Or do they become battle axes - frustrated old shrews who are bent on enforcing pointless hospital rules and making everyone miserable?
In our view, most nurses are able to exert managerial and clinical authority in a constructive way. But such nurses are not common in the popular media, which continues to present the battle axe stereotype long after it supposedly became OK for women to hold positions of power.
A 2003 study by Linda Smith at Oregon Health and Science University examined greeting card depictions of nurses. In addition to the expected naughty nurse themes, Smith found a focus on malevolence, with nurses threatening to inflict pain with everything from needles to whips.
Of course, the classic nurse battle axe is the sociopathic Nurse Ratched in One Flew Over the Cuckoo’s Nest. Milos Forman’s classic 1975 film adaptation of Ken Kesey’s novel captures the anti-authoritarian spirit of the 60s counterculture—and its underlying misogyny. Ratched effectively runs an Oregon state mental health facility unit while absentee male physicians fiddle. A sexually repressed soul killer, she psychologically tortures those she is ostensibly helping. Ratched resorts to increasingly harsh measures to maintain control when the hero, Randle McMurphy, subverts her authority by leading the all-male patients on forbidden adventures.
The other classic battle axe is the Margaret “Hot Lips” Houlihan character in M*A*S*H. Robert Altman’s 1970 film about a US Army surgical unit in the Korean War, based on the novel by Richard Hooker, is another anti-authoritarian classic with a misogynistic approach. Major Houlihan, the unit’s new chief nurse, is a martinet aghast at the unmilitary conduct she finds, and the film’s surgeon heroes must bring her down. In the popular television series that followed (1972-1983), Houlihan was more sympathetic and committed to the patients, but the character still suggested that strong nurses are control freaks driven by half-repressed romantic urges.
The battle axe has re-surfaced in more recent Hollywood shows, often as the nasty enforcer of hospital rules that are seen as oppressive or trivial. The image has even appeared on Nurse Jackie. In the first season, emergency nurse manager Gloria Akalitus was a killjoy obsessed with following rules regardless of their effect on patients. In one July 2009 episode, she prevented a responsible 10-year-old girl from sitting with her mother, who had Lupus, because of a hospital age limit. The show often punished Akalitus. In that same episode, while Akalitus was yelling about a Taser someone had left on the floor, she accidentally Tasered herself. Fortunately, Jackie herself countered the image somewhat in projecting sensitive clinical authority.
Grey’s Anatomy has also presented senior nurses as vindictive bureaucrats who are always working against the young surgical heroes. In one November 2005 episode, hotshot intern Cristina Yang steals an interesting case from the psychiatric ward. But cranky veteran nurse Debbie questions Cristina rudely about who transferred the patient and the lack of “paperwork.” Yang dismisses Debbie, telling her that the physicians will let her know if a bedpan needs changing. The nurses retaliate by paging Yang to do disgusting scut work. Recall Winston Churchill’s response to a woman who told him he was drunk, one version of which is “I may be drunk, Miss, but in the morning I will be sober, and you will still be ugly.” Cristina may have been a little drunk on ego and ambition, but in the morning of future episodes, she remains a pretty, esteemed surgeon. Debbie is still a disagreeable battle-axe who cleans up the mess.
ER also indulged in battle axe imagery. Several late 2005 episodes featured nurse manager Eve Peyton, a strong clinical expert with a doctorate who seemed to care about patients. However, she was also a strict micromanager—one staff nurse suggested that she was a “bitch”—and her departure marked a crude swerve into extreme battle axe territory. In just one episode, Peyton got dumped by her boyfriend, decked an offensive patient with no physical provocation, was fired from the hospital, and bid farewell to the ED staff with a string of profane insults.
A recent variation on the classic battle axe is the malevolent hottie, a sexually aggressive young “nurse” who poses a real or mock threat to patients or others. This fictional image, which we might call the “naughty-axe,” has appeared in horror films, ads, and video games. The naughty-axe does not seem to oppose sex, but the image does associate sexuality with danger, so it is true to the underlying spirit of the classic battle axe.
The image of a “nurse” as a sexy but sadistic shot giver wielding a large phallic syringe seems to be a cool way for pop musicians to move product. A 2004 ad campaign for Skechers shoes featured naughty nurse Christina Aguilera brandishing an enormous syringe connected to a big needle. And the pop-punk band blink-182 used a photo of a porn star as a naughty nurse flaunting another huge syringe in the artwork of a 1999 album.
Do some nurses really act like vindictive bureaucrats? Of course some do, as in any profession. But battle axe portrayals provide little balance or context to explain why some nurses might act that way.
By contrast, there are many admiring portrayals of powerful female physicians, particularly in recent television dramas. And media items that do question female physicians’ use of power often make clear how hard it still is for those women to assert authority without being labeled “bitches.”
The continuing appearance of battle axe imagery in the media suggests that, for many, nursing remains caught in an ugly cultural time warp. Today’s society may be ambivalent about punishing women generally for exercising power, but it’s still fine to punish women for trying to be powerful nurses. Apparently, modern women can be, smart, tough and independent — as long as they pursue a traditionally male career, like medicine, police work, or law.
But female nurses with any power must be threatening, frustrated, and/or disagreeable. A good nurse’s role is still submission.