From the hot lips of Maj. Margaret Houlihan in the hit TV show M*A*S*H to the sinister demeanor of Nurse Ratched in the movie One Flew Over the Cuckoos Nest, past images of fictional nurses in film might be viewed as a public relations disaster for the profession.
But new evidence is offering a glimmer of hope for improving the often stereotypical and inaccurate images of nurses that have long been portrayed on TV and the silver screen.
Angels and Demons
Australian nurse researcher David Stanley, RN, MSc, NursD, RM, studied 280 feature films made between 1900 and 2007 and found movie nurses are breaking free from stereotypes and unflattering portrayals are becoming less common. The study, Celluloid Angels: A Research Study of Nurses in Feature Films 1900-2007, was published in the October 2008 issue of the UK-based Journal of Advanced Nursing.
Stanleys study found that in the early days of movie-making, nurse characters often were featured against the backdrop of World War I and portrayed as heroines, romantic leads, sex objects, or self-sacrificing angels of mercy.
As the nursing profession has grown, there has been a corresponding decline in the representation of the self-sacrificial nurse in feature films and a growth of dark nurses, who are able to be both powerful and evil, says Stanley, who also is a lecturer in the School of Nursing and Midwifery at Curtin University of Technology in Perth, Western Australia.
Despite often negative and inaccurate portrayals of nursing in popular TV programs, some researchers believe the public is quite capable of deciphering fact from fiction.
The study, Public Perceptions of Nursing Careers: The Influence of the Media and Nursing Shortages, found 60% of the TV viewing audience in the survey watched Scrubs, House, ER, and Greys Anatomy in the past year. Only 5% said they had less respect for RNs because of their viewing experience, while 28% said they had more respect, and 66% said it made no difference. The survey-style study included a sampling of 1,600 people and had a response rate of about 55.5% and was published in the May-June 2008 issue of Nursing Economics
That grouping of shows doesnt seem to be doing much harm to the image of nursing, says study coauthor Peter I. Buerhaus, RN, PhD, FAAN, director of the Center for Interdisciplinary Health Workforce Studies, Vanderbilt University Medical Center in Nashville, Tenn. If anything, they are adding more respect. [Study researchers] dont see the public as being as gullible in how it forms its views about the nursing profession as some might believe.
Respect for her abilities as an RN is what nurse Sam Taggart is seeking in the TV show ER, says Linda Cardellini, the actress who plays Taggart. Shes good at what she does, and I want people to respect her, Cardellini told Nursing Spectrum in a telephone interview from Warner Brothers Studio in Los Angeles. It really bothers her that she doesnt quite get the respect she deserves.
In one episode, Taggart berates boyfriend Dr. Tony Gates for belittling her in front of an intern. She was angry because she thinks of herself as an independent woman.
ER, which for 15 years has crafted the strongest nurse characters in prime time TV, including Carol Hathaway (Julianna Margulies), Abby Lockhart (Maura Tierney), and for the past six years Taggart, is in its last season. The show has always had at least one nurse in its main cast, in addition to minor nurse roles such as Chuny Marquez and Haleh Adams, who put a supercilious resident or attending physician in his or her place.
As the show winds up its last season in March, Taggart decides to go back to school to become a certified nurse anesthetist. She has this autonomy in the OR that she doesnt have in the ER, Cardellini says of Taggart. In one episode, an intern tells Sam that as a nurse anesthetist shell always have a doctor looking over her shoulder. But Taggart corrects her and says no, she wont. Shell be working autonomously, Cardellini says.
Analisa Traba, RN, a staff nurse in the ED at Cedars-Sinai Medical Center in Los Angeles, says she was a fan of ER for the first five years of the show when she was a new nurse. But then she found the show was too realistic and it was difficult for her to watch if after working in an ED every day. Hollywood, in general, could portray nurses more prominently, Traba says. We need to be acknowledged more, she says. We do a lot of hard work that nobody else wants to do or see.
Most of the newer medical TV shows, such as House, rarely show any nurses in their episodes, let alone realistically drawn nurse characters. TV is getting worse for nursing, and its weekly presence makes it far more influential and damaging than films, says Sandy Summers, RN, MSN, MPH, executive director of the Center for Nursing Advocacy in Baltimore.
In film, nurses today are represented as much more than angels and devils, doormats and divas, as writers and producers start to recognize that nursing provides fertile ground for a wide range of plot devices, says Australias Stanley.
The fact-based 2005 movie 14 hours highlights the heroism of nurses and others who saved almost 600 patients during the massive flooding that ravaged Houston as a result of Tropical Storm Allison. The 2007 movie Atonement, set in World War II, portrayed a nurse-centered view of healthcare and nurses as making a positive difference. Angels in America (2003) places nursing at the center of AIDS care in the 1980s and includes one of the best depictions of professional nursing in feature film history, according to the Center for Nursing Advocacy.
These movies show nurses as autonomous, professional, critical thinkers, says Stanley. Thats what will get people excited about becoming nurses.
Hot Lips Still a Hot Button
Can we finally kiss the image of M*A*S*H nurse Hot Lips Houlihan goodbye? Not quite yet. But the profession shouldnt give up on its efforts to improve its media image.
Jacqueline Fawcett, RN, PhD, FAAN, editor of the Journal of Advanced Nursing, still stresses its important for the media to portray nurses accurately. We need a more effective public relations machine so people understand all that nurses do, says Fawcett, who also is a professor at the College of Nursing and Health Sciences, University of Massachusetts in Boston.
To get the message out, Gorden suggests nurses hit companies that sponsor negative or unrealistic portrayals of nurses in the pocketbook. If only 10% of all nurses protested a show, thats about 760,000 consumers, she says. Perhaps the most effective public relations machine for nursing is one that promotes nursing involvement in activities such as patient safety initiatives and disaster response.
Buerhaus research found that 75% of TV viewers who saw news stories about real nurses involved in disaster relief gained more respect for nurses.
These are great media sells and what really excites the public, he says. Nurses derive a great amount of respect when they are seen in these types of situations. When you have those stories, dont be shy about getting them out.