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

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.