The image of nursing: No holier than thou
In the seventh of our series of blogs on the image of nursing, Sandy and Harry Summers ask whether being seen as an angel is more of a curse than a compliment
About the author
This article was written by Sandy and Harry Summers, authors of Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All At Risk
Are you an angel? Consider that, at least in the popular imagination, angels are spiritual beings who work miracles. They live in heaven, so they don’t need a decent check to pay the rent. They don’t need to eat or go to the toilet, so they can work 16-hour shifts without a moment’s break. And they can care for 15 to 20 patients at a time without making a single error.
Real nurses can’t do those things. But the “angel” imagery we often see in the media suggests that maybe nurses can. The imagery also reinforces the sense that nurses are all about touching and feeling rather than thinking and saving lives. The imagery deters some qualified men and women from entering the profession, and it implies that nurses should meet personal moral standards that are not a proper part of the modern workplace. And angels don’t argue, so the image even discourages nurses from advocating strongly for their patients - and themselves.
Some wonder if our concerns about angel imagery mean we’re against compassion. Far from it. Compassion is essential in nursing. And the emotional support nurses give is actually psychosocial care shaped by their healthcare training and experience.
Others point out that, among the various nursing stereotypes, the angel is the most positive. The problem is that, far from encouraging people to respect nurses and treat them better, the image works subtly but strongly to undermine the profession. Nurses deserve to be considered three-dimensional human beings, with all the skills and flaws of any other modern professional.
Of course, the angel image has deep roots. Nursing was traditionally seen as a religious vocation and the idea that the women doing the nursing were morally pure gave them social license to provide the intimate care the work requires.
Even today, many nurses and their supporters embrace the angel. Several years ago Johnson & Johnson’s Campaign for Nursing’s Future, which aims to address the nursing shortage, ran sentimental television ads about “the importance of a nurse’s touch”. Some nurses defended the ads, arguing that these softer qualities are what makes nursing special. But the nursing crisis did not happen because the public forgot that nurses had kind hearts. More recently, the campaign has run ads focusing more on nursing skill.
We think what sets nursing apart is the combination of technical prowess, psychosocial skills and mental toughness nurses use to save lives. For some in the news media, though, the word “nurse” seems to be interchangeable with “angel”. The Scotsman published and article called “Robot nurses could be on the wards in three years, say scientists” in January 2007 that reported these “mechanised ‘angels’” would “perform basic tasks such as mopping up spillages, taking messages and guiding visitors to hospital beds.” These “angels” aren’t exactly working at the core of patient care, are they?
The media often invokes angelic imagery when nurses fail to seem noble and pure, particularly when they are seen as demanding, uppity or threatening. For example, in August 2009 the UK press carried many items about a recent report detailing cruelty and neglect by some nurses. A Sunday Times column by Minette Marin argued that the problems stemmed not from a lack of resources but from a “cultural collapse” within nursing. Marin attributed that decline partly to efforts to increase nurses’ “professional status with a university degree”, which had apparently led them away from “old-fashioned bedside” care. The headline was “Fallen angels: the nightmare nurses protected by silence”.
Similarly, in the summer of 2006, anonymous UK physicians published op-eds in The Daily Mail, The Independent and The Belfast Telegraph that were designed to discourage the government from allowing nurses to move into clinical roles that have traditionally been the province of physicians. Armed with headlines asserting that today’s nurses are not angels, these paternalistic essays argued that the new nursing roles had produced nurses who were stupid, uncaring, lazy and eager to dump everything on physicians, while wrongly seeking the same high status. Instead, the pieces argued, nurses should focus on the basic caring and hygiene tasks the physicians thought defined nursing.
Nurses may also fall from grace through sex and drugs. From 2004 to 2006, Channel 4 aired the drama No Angels. According to a Times piece from February 2004, the show aimed to provide “a witty and truthful exposé of nursing” in the modern NHS. But the first episode showed the nurses “laughing over a corpse that they have warmed up in the bath to disguise the fact that the patient died, unnoticed, hours earlier”, as well as “tricking colleagues into taking drugs, showing off visible panty lines to doctors and having sex in cupboards”.
Because angel imagery is so deeply embedded in the public consciousness and nursing culture, overcoming it will be a challenge. However, we believe that nurses can have a public image that acknowledges the value of caring and compassion, but that also shows respect for nursing as a modern profession.
Any media item that portrays nurses as skilled professionals counters the angel image, even if those nurses have flaws, as all humans do. For example, the lead character in the television show Nurse Jackie is certainly no angel, but she is a clinically expert nurse who goes to great lengths to protect her patients.
Professional groups can do their part by avoiding or even subverting angel imagery. The Royal College of Nursing often advocates strongly for public health in ways that no stereotypical angel would, sometimes taking positions that may not be popular.
In 2005, the California Nurses Association (CNA) vowed to celebrate Florence Nightingale’s birthday by staging a protest at the offices of Johnson & Johnson. CNA’s press release argued the drug company had supported efforts to limit the political participation of nurses and to defeat measures to lower drug prices in California. The union said it was honouring the “legacy of the original nurse activist”.
When nurses are angels, it’s easier to keep them in a pretty box, as one might a cute figurine. But it’s pretty hard to help your patients – or yourself – from inside a box.
We use the term “physician” because using the more common “doctor” to refer only to those who practice medicine wrongly implies that they deserve more respect than others.
Nurses and others earn doctoral degrees and make contributions to health and society that are just as valuable as contributions made by physicians. So the honorific should be available to everyone with that degree or to no one.
We also note that “physician” has been used in this way in texts ranging from Shakespeare to recent issues of the British Medical Journal.