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The image of nursing: Battle axes and frustrated shrews


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.


Readers' comments (5)

  • I enjoyed the first or second article in this series, since them I have found them all much the same, same old comments about American TV shows, very 'america-centric', and now a bit boring and lazy.

    I don't hold US TV producers responsible for how the British Public see Nurses, let's face it, the medics in those programmes hardly resemble real life either.

    I don't recognise much in this article and totally disagree that a 'good nurse's role is submission'.

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  • I have to agree with Sara here. I have been called many things in my time, submissive has never been one of them.

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  • Dear Sara and Mike,

    Of course we, the authors, are not saying that nurses should be submissive--quite the opposite. We are saying that the media has sent this message to the public by portraying nurses as battle-axes. They think it's cool to punish nurses who exert power. We on the other hand think that the media should be able to portray women in nursing as strong professionals who can exert authority effectively and with grace and justice.

    In this series we have applied U.K. examples where we could find them, especially in the naughty nurse piece and the upcoming piece on advanced practice nurses. We are located in the U.S., but we do try to monitor all the world's media since these nursing stereotypes are global, not local to any one country.

    We are saddened that U.S. media has such a negative global influence on the understanding of nursing.

    The way these Hollywood shows depict nurses is relevant for people in the U.K. to hear about since Hollywood shows are aired in the U.K. If you agree that the nursing portrayal is damaging, you can contact the media outlets broadcasting them in the UK--no one is forcing those outlets to broadcast the shows, and Hollywood does care about what the international market thinks because it makes a lot of money from it.

    I once had an email exchange with a nursing professor from Brazil who told me how sorry she felt for U.S. nurses because she thought we were hired, fired and supervised by physicians. When I told her that that wasn't actually the case (nurses supervise nurses here like they do (and should do) in most countries), she was surprised, because that's the impression she came away with from watching Hollywood productions broadcast in Brazil. So even though the professor knew that nurses supervise nurses in Brazil, her fellow Brazilians may not have known that in part because of what Hollywood was telling them.

    So I am sorry about what Hollywood tells the world, but I think if we all stand up to protest it, we can make a change in the depictions of nursing we see and hear from the media. Please join us at Thank you.

    Sandy Summers
    Executive Director, The Truth About Nursing

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  • Sandy, the overall thoughts I have on this particular and specific stereotype are that it is not confined to Nursing. The archetypal woman in power in many scenarios in the mass media is a harridan like battleaxe; the result of a woman trying to incorporate or display masculine leadership and power tendencies rather than trying to lead based on their own natural feminine traits. Yes this stereotype is sometimes displayed in Nursing characters, but I think that has more to do with gender roles than professional ones.

    Your earlier articles were much more relevant and accurate. I too am sick and tired of being called 'just' a Nurse (despite two degrees and professional status) and of people having no clue of the level of skill, education, authority, responsibility, accountability, etc etc etc, the role demands of us. I am sick and tired of not recieving the professional status, respect and pay I know we deserve given the high levels of each example I gave above. The fact that women in power are often displayed as somehow lacking or fallen due to taking on masculine tendencies (the same way negative sterotypes are heaped on men who portray feminine traits) is more of a gender issue rather than a specific Nursing one.

    As I said, your earlier articles portrayed this much more accurately, please go back to that and continue to fight to get the message across that we are skilled, autonomous professionals in our own right.

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  • Thank you for taking the time to reply, I agree with Mike in that I think the series started well.

    It is very frustrating that the value of nursing is not recognised and people aren't aware of how well educated nurses are. We are let down by divisions within the profession and by our representatives more than we are by US drama producers - in my opinion.

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