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The image of nursing: Does nursing's media image matter?


In the second of our series of blogs on the image of nursing, Sandy and Harry Summers wonder if it really matters what the media says.

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

Isn’t television just a lot of rubbish that no one takes seriously?

Most nurses would agree that the media’s treatment of nursing falls short of a fair and accurate portrayal. Of course, there are some serious news reports about the nature and challenges of the profession. And even the entertainment media has offered a few helpful depictions in recent years, showing nurses as troubled but skilled professionals with some autonomy.

But the dominant images remain the stereotypes we find in the most popular television shows and global advertising. In these ubiquitous media products, nurses tend to be no more than submissive helpers of the physicians who do everything that matters, or else vacuous sex toys who help companies sell everything from milk to chewing gum.

One nurse who is a leading expert in her specialty told us that producers of one of the most popular US hospital dramas called her in 2007 for advice on a plotline. They had heard that she was an expert in this specialty, but were shocked to discover that she was a nurse, with a PhD. They took her substantive advice on the plotline, but rejected her ideas about how they could improve their portrayal of nursing, insisting that their audience was interested only in physicians.

The roots of this persistent media failure stretch back to the start of the modern profession. Traditionally, the media has presented nurses as angelic, relatively low-skilled, and highly deferential to physicians.

But with the social changes of recent decades, nursing came to be associated with an expanded set of feminine extremes that also included the naughty nurse and the battle-axe, even in otherwise thoughtful works like M*A*S*H. As women began to pursue traditionally male professions like medicine, nursing was seen as a job for less able females that time had left behind. And that brings us to House and Grey’s Anatomy.

We are often told that none of this matters, because society forms its opinion of nurses solely based on its own careful observations and positive sentiments. According to this view, social views of nurses are untouched by the prevailing media stereotypes, and in any case, what people think of nurses has nothing to do with how nurses are actually treated. But common sense, public health research, and the conduct of Hollywood itself suggests otherwise.

What we see and hear affects what we think. And that affects what we do. This is a basic principle of education, advertising, and any other organised effort to influence people.

Public health experts have come to understand the power that the media has to affect health-related views and actions. So government agencies, universities, and private groups like the Los Angeles-based Hollywood, Health & Society now devote considerable energy to studying and managing health messages in the media. Hollywood producers embed dramatic plotlines they hope will educate and advance health, and they eagerly absorb praise for doing so.

In the last decade, reports by the Kaiser Family Foundation and others have documented how different media, including fictional television products, affect how the public sees health care issues. Research has shown that television shows can improve people’s understanding of diseases like HIV, but also discourage people from considering important measures like organ donation.

A few studies have focused on how media stereotypes undermine nursing. As we noted in our last piece, in 2008 nursing scholars at Dundee University found that television images of nurses as “brainless, sex mad bimbos” discouraged academically advanced primary school students from pursuing the profession. These high-achieving students reported that their main source of information about nursing was television shows like the long-running BBC drama Casualty.

Similarly, a 2000 focus group study of 1,800 US school children by JWT Communications found that students got their main impression of nursing from the television drama ER. Those survey respondents considered nursing a technical job for girls, rather than a profession worthy of private school students, of whom more was expected.

It’s not just impressionable youngsters who are affected by how the entertainment media presents health care. Indeed, a March 2009 University of Alberta study published in the journal Resuscitation found that many resident physicians and medical students had learned incorrect intubation techniques by watching ER and other television shows.

We think key factors in Hollywood’s nursing problem include entrenched stereotypes, insufficient support from physicians and from media “feminists” with disdain for nursing, and nursing’s own overall failure to represent itself well. No one embraces the angel stereotype more strongly than some nurses.

Nursing has many problems today, including short-staffing, poor working conditions, and in many places, inadequate pay relative to the skills and responsibility of the work. All of these should be addressed. But improving how people see the profession is one of the most critical.

Why? Because undervaluation leads to a lack of power and resources for nursing practice, education, and research. When nurses are understaffed, patients do not receive vital care. Nurses burn out and leave the bedside. Underpaid nurses look for other professions. Without sufficient funding, faculty shortages grow. And the profession’s base of clinical and theoretical knowledge erodes.

When nurses lack power, they cannot advocate for patients, and patients die from errors and incompetence. A March 2009 feature in The Sunday Times (UK) told the story of a tormented nurse in India who regularly gave injections with used needles because she could not question the revered physicians and hospital managers who insisted on the potentially deadly practice.

And when nurses lack power, they suffer abuse from colleagues and patients. According to a 2008 study by the US Joint Commission on the Accreditation of Healthcare Organizations, more than half of US nurses had been bullied on the job. Common effects included severe distress, depression, insomnia—and nurses themselves continuing the cycle of abuse.

Just a stupid television show? Maybe. But to a significant extent, the future of health care depends on it becoming a little less stupid.

*Authors’ note

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.



Readers' comments (7)

  • Excellent article!!!!

    First of all I would like to make the point that of course media image matters. Unfortunately we live in a society now where more people vote for Big Brother and X Factor than they do for government, more people are concerned with what some vaccuous bint with no discernable talent is wearing or who they're sleeping with than they are with serious issues. Unfortunately that is the society we live in. So does media image matter to these mindless sheep like zombies? Of course it does!

    Im sorry but the vast majority of the general public do not base viewpoints on own careful observations and positive sentiments, they mindlessly follow the celeb culture and rely on stereotypes.

    I absolutely agree with your evaluation that undervaluation of Nursing by the media and general publiuc leads to a lack of power in our profession, this in turn leads to the current situation the 'profession' finds itself in. And Nurses in general do not have the mindset or the backbone to deal with this, just look at all the comments on previous articles on this subject.

    Also I would like to wholeheartedly agree on your point about the honorific 'Doctor'. Many people do not realise that there is a Doctorate of Nursing, nor do they realise that the term 'Doctor' is an academic term, actually bestowed on physicians as an honorific by the academic community, where the term 'Doctor' has real meaning as the highest level of academic achievement in a particular field. A Doctor of Nursing for example would academically speaking of course, be 'superior' than a medical Doctor.

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  • I agree that the powerlessness that nurses and the profession feels leads to abuse and poor standards of care across the board.
    I'm not entirely convinced that the media projection of nursing is entirely to blame for this though.
    It implies that people are products of media generated processes, as stereotyping implies ,and therefore unable to formulate ideas in any intellectual and reflective sense, based on their own judgement, experience and personal knowledge. Unfortunately , the nature of instant news via internet,blogs and emails do deter the quality of thinking skills amongst folks somewhat ( I include myself here!) and our computer dependant communiites are but another example of poor communication caused by interfacing with a screen rather than real people. I think that is a problem faced by most professions in our communities.
    People seem less repectful or tolerant and show scant regard for authoritative figures.
    Nursing may also be partly to blame for the false projections picked up by the media and wrongly interpreted by them. So we do need to educate ourselves and others to improve on self imagery and give support for our professional integrity as a whole.
    We should by now be changing the stereotype of the 'handmaiden' and deferential public servant, (as projected in an ?old fashioned somewhat rigidly, heirarchical structure which some would say, increases the sense of oppression in the profession),to a confident and totally respected professionals in our own right.

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  • Susan I see your point but I don't think anyone is saying that media representations are ENTIRELY to blame, but I do think it is certainly a large contributing factor.

    And if you don't think a large proportion of people out there aren't mindless media sheep, just look at the recent story on NT of how the 'Jade Goody effect encouraged screening'!! That's just one example of dozens I could use. People in this pathetically celeb obsessed culture ARE heavily influenced by media portrayals.

    I do agree however that we need to change the stereotypes. We need to challenge the media portrayals. We need to let the world know what our profession is truly worth.

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  • I completely agree with the above comments. It is especially important in the present political and financial climate that the media start to understand the real role played by nurses. We are not as we are portrayed in popular television and it is time that reality came into plots. The public are obsessed by what they see on TV so lets show them what nurses really are and what they do.

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  • And we could start by standing up for our 'rights' a bit more.

    The public image is one of bottom wiping Dr's servants. And to an extent the public is correct.

    They have no perception of the training involved, the qualifications gained or the specialities of nurses roles. Couldn't the wonderful RCN put together a short TV advert showing the real world of nursing. Couldn't channel 4 do a documentary on say primary care nursing and show patients the multitude of nursing specialities that operate within that environ? And more to the point just what they'll be missing when it's all privatised!

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  • This article is very good and this subject needs alot more discussion, but I feel the public do not want to see the real face of nursing, queit often, any so called real portrayal, leaves us looking like angels or demons. Its a difficult area, when I tell friends my stories from over my many years in nursing they are either in hysterics or find it hard to believe what is expected of us on a daily bases.
    Like many things in life, the public only become interested when it affects them personally and then they make their own minds up.
    However we are portrayed it will never show the reality of nursing, only being part of our very fine profession will do this.

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  • Nursing as a profession will never get the respect it fully deserves because its too female dominated.

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