Saving Lives

S AV I N G L I V E S
SAVING LIVES
Why the Media’s Portrayal of Nursing
Puts Us All at Risk
Sandy Summers, RN, MSN, MPH
Harry Jacobs Summers
U P D AT E D S E C O N D E D I T I O N
1
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© Sandy Summers and Harry Jacobs Summers, 2015

Lyrics from Aimee Mann’s “Invisible Ink”
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Library of Congress Cataloging-in-Publication Data

Summers, Sandy, author.
Saving lives : why the media’s portrayal of nursing puts us all at risk/Sandy Summers, Harry Jacobs Summers.—Updated
edition.
p. ; cm.
Why the media’s portrayal of nursing puts us all at risk
Includes bibliographical references and index.
ISBN 978–0–19–933706–4 (paperback : alk. paper)
I. Summers, Harry, author. II. Title. III. Title: Why the media’s portrayal of nursing puts us all at risk.
[DNLM: 1. Nurses—standards. 2. Nursing—standards. 3. Mass Media. 4. Nurse’s Role. 5. Nurse-Patient
Relations. 6. Public Relations. WY 16.1]
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This material is not intended to be, and should not be considered, a substitute for medical or other professional
advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances.
And, while this material is designed to offer accurate information with respect to the subject matter covered and to be
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Printed in the United States of America
on acid-free paper
For our children Cole and Simone
And their future nurses
There comes a time when you swim or sink
So I jumped in the drink
Cause I couldn’t make myself clear
Maybe I wrote in invisible ink
Oh I’ve tried to think
How I could’ve made it appear.
But another illustration is wasted

‘Cause the results are the same
I feel like a ghost
Who’s trying to move your hands
Over some Ouija board
In the hopes I can spell out my name.
What some take for magic at first glance

Is just sleight of hand
Depending on what you believe
Something gets lost when you translate
It’s hard to keep straight
Perspective is everything.
Aimee Mann and Clayton Scoble

from “Invisible Ink”
Aimee Mann, Lost in Space (2002)
CONTENTS
Foreword xvii
Acknowledgments xxi
Introduction xxiii
PART ONE: Dangerous Ignorance: Why Our Understanding of

Nursing Matters
1. Who Are Nurses and Where Have They Gone? 3

A Few Notes on Nursing History 7
The Nursing Shortage 11
2. How Nursing’s Image Affects Your Health 29
Virtue and Vice: Some Roots of Nursing’s Media Stereotypes 34
Does What’s in Our Brains Matter? How the Media Influences
Nursing 37
PART T WO : The Great Divide: The Media versus Real Nursing
3. Could Monkeys Be Nurses? 65

Media Portrayals of Nurses as Serious Professionals 66
“Might Be a Genius”: Nursing Skill on Television and in Film 66
“Startling Discoveries”: Nursing Skill in the News Media 71
Experts, Life Savers, and Leaders 71
What We’re Missing: Reporting on the Shortage 73
A Nurse Did What? Public Health Nurses in the News 74
Ninety Pounds and the Truth: Nursing Research and
Innovation 75
x
• Contents
“No One Wants to Hear from a Nurse”: The Nurse as Media

Health Expert 76
“Is This All Nurses Do?” Media Contempt for Nursing Skill 77
Hollywood Tells the World Nursing Is for Losers 77
Grey’s Anatomy: “You’re the Pig Who Called Meredith a Nurse” 77
House: “Clean-Up on Aisle Three!” 79
The Mindy Project: “Just a Big Loser” 81
Other Hollywood Television Shows: “Any Idiot Can Be a Nurse” 82
“More Than a Nurse”: How the News Media Disrespects Nurses 85
“Don’t Forget to Pack a Nurse”: Even Good Intentions Can Go
Wrong 87
If It’s Important Work, Credit Anyone but a Nurse 88
Physician Nursing: Prime-Time Physicians Do Nursing Work 88
Physician Nursing: The News Media Knows Who Saves Lives 91
Physicians Get the Credit 91
Physicians Get the Blame 92
Nursing Just Happens 94
Innovation: Which Nonnurse Thought of That? 95
Ghosts in the Machine: Nurses Go Missing in the Media 96
Lost in Hollywood 96
Lost in the News 97
Nurses Evacuated from Disaster Areas 98
Can We Be “Heroes”? 99
Nurses? Health care Experts? 101
Can Any Helpful Person or Thing Be a Nurse? 101
I, Robot, Will Be Your Nurse 102
You Just Haven’t Earned It Yet, Baby Nurse 102
I Say You’re a Nurse, and the Shortage Is Over 103
4. Yes, Doctor! No, Doctor! 118
Are You Sure Nurses Are Autonomous? It Sure Looks like
Physicians Call All the Shots 120
Media Portrayals of the Nurse as an Autonomous Professional 126
Nursing Authority in Television and Film 126
Bitches and Autonomous Professionals 126
Confronting the Zombies 130
True Colors in the News Media 131
Contents •
xi
“Nurse, Hand Me My Laptop”: Media Portrayals of the Nurse as

Handmaiden 133
Grey’s Anatomy: “You’re the Man” 134
House: Help! Golems Are Loose in the Hospital! 137
ER: “I’m the Doctor. This Is My Call.” 138
Shut Up and Follow Orders: Nursing on Other Healthcare
Shows 140
“I’ll Go Get the Doctor!”: Nursing on Non-Healthcare Shows 144
News Media Helpers 145
5. The Naughtiest Nurse 154
“Penny Shots for Naughty Nurses”: Why the Naughty Nurse
Matters 158
Call Me Magdalene: Is Nursing the World’s Oldest Profession? 161
Catching “Lusty-Nurse Fever”: The Nurse in Global Advertising 162
“Ranking Nurses in Order of Do-Ability”:
Modern Hollywood’s Tribute 166
Night Shift Nurses: Nursing in Sexually-Oriented Products 170
Promiscuous Girls: The Nurse in Pop Music 172
Hot or Not? Sexy Nurses in the News Media 174
6. Who Wants Yesterday’s Girl? 186
The Work Feminism Forgot 190
Hollywood Feminism 191
Escaping the Pink Ghetto: The News Media Tells You How! 195
The Male Nurse Action Figure: The Media Confronts Men in
Nursing 197
Nurses and Murses: Men in Hollywood Nursing 199
I Want to Be a Macho Man: Male Nurses in the News 207
7. You Are My Angel 217
What’s Wrong, Angel? 218
‘Bless This Angel of Mercy’ Nurse Collectible Figurine! 222
Angels Everywhere 222
Nurse or Mom? 227
The Fallen Angels 228
The Strivers Who Have Forgotten Their Place 228
x i i
• Contents
Promiscuous Girls 230

The Angel of Death 230
The Angel Within 232
Transcending the Angel: What Can Be Done? 236
8. Winning the Battle-Axe, Losing the War 245
Tyrants, Bureaucrats, Monsters: Hollywood Celebrates
Nursing Authority 249
Hovering Like Ghouls: Battle-Axes in Other Media 256
9. Advanced Practice Nurses: Skilled Professionals or Cut-Rate
“Physician Extenders”? 261
Who Are APRNs and How Good Is Their Care? 264
“Midwifs” and Minor Ailments: APRNs in Hollywood 268
The Doctorate of Splinter Diagnosis: APRNs in the News and
Advertising Media 275
Fair Reporting on APRNs 275
The News and Advertising Media Often Ignores or
Disrespects APRNs 280
PART THREE: Seeking Better Understanding of Nursing—and Better

Health Care
10. How We Can All Improve Understanding of Nursing 297

I’m a Citizen of the World. What Can I Do? 301
“What Do You Do All Day, Anyway?” 301
“You Could Be a Doctor!” 301
Don’t Believe the Hype 302
Try to Resist That Naughty Nurse’s Charms 302
What’s My Name? 302
I’m a Member of the Media. What Can I Do? 305
Report on the Nurse at the Bedside 306
Discover 2.5 Million Women in Science 307
Consider Nurses as Expert Sources in All Health Stories 307
Make Clear That Nurse Experts Are Nurses 308
Create Television Shows about Nurses 309
Contents •
xiii
But Aren’t Hollywood’s Current Nurse Advisers Enough? 309

But How Can I Sell Things Without Using Nursing
Stereotypes? 310
“I Wouldn’t Stereotype Nurses—My Mom’s a Nurse!” 311
I’m a Private Sector Healthcare Executive. What Can I Do? 311
Hospitals and Other Health Facilities Should Promote Nursing 312
Invest in Public Relations for Nursing 314
Publicize Efforts to Improve Nurses’ Working Conditions 314
Public Health Organizations Can Help Promote Nursing 315
Healthcare Billing 316
Drug Companies Should Ask Their Nurses 316
I’m a Government or Health Policy Maker. What Can I Do? 317
Governments Should Communicate the Value of Nursing 317
Governments Should Give Nurses a Seat at the Table 318
Governments Should Publicize Efforts to Address the Shortage 318
Foundations and Other Health Policy Makers Should Honor
Nursing and Include the Profession in Policy Initiatives 319
I’m a Health Worker but Not a Nurse. What Can I Do? 321
Physicians 321
Medical Technicians and Nursing Assistants 322
Receptionists and Appointment Clerks 322
11. How Nurses Can Improve Their Own Image 327
Nurses Have the Power 328
Take Credit for Nursing’s Life-Saving Work 328
Take Responsibility 328
Take the Lead 329
Your Voice—Yes, Just Yours—Can Make a Critical Difference 329
Projecting a Professional Image Every Day 329
Accentuate the Positive: Promoting Nursing in Hard Times 329
Identify as a Nurse 330
Who Put Cartoon Characters All over My Uniform? 330
Nursing Out Loud 332
Walk the Walk 333
Act for Change 333
Educate Physicians and Medical Students 334
x i v
• Contents
Equal Rights for Equal Work 334

Explaining Nursing’s Role to Patients 334
Educating the Media about Nursing 335
Develop Media Expertise and Get Coverage for Nursing 335
Catch the Media Being Good 338
Different Ways to Persuade the Media to Reconsider Products 338
Telephone Calls 339
Letters and Emails 339
Letter-Writing Campaigns 339
Press Releases 340
Unorthodox Approaches 341
Persuading Media Decision Makers in Direct Interactions 342
Identify and Reach the Decision Maker 342
Be Persistent! 344
Study the Media Product and Anticipate Arguments 345
Play Good Cop/Bad Cop 346
Move Fast 347
Use the Media’s Own Process 347
Collaborate 348
Suggest Alternatives 348
Expect Resistance 349
Organize Chapters of the Truth About Nursing 349
Message in a Bottle: Create Your Own Media 350
Writing about Nursing 350
Letters to the Editor 350
Op-eds 351
Feature Articles 352
Advertisements 352
Nonfiction Books 352
Novels 353
Other Literature and Storytelling 354
Kids’ Literature 354
The Internet: Websites, Blogs, and Discussion Boards 355
Visual, Performance, and Tactile Media 357
Video, Broadcast, and Film 359
Video 359
Contentsâ†œâ•‡ • â•‡â†œxv
Radio 360
Television and Film 361
It’s Up to Us 362
About the Truth About Nursing 373

About the Authors 375
Index 377
FOREWORD
Some years ago, I was invited to be a guest on a national talk show to discuss
a popular television drama I’ll call Hospital. Also on the panel of guests were
the actors who played physicians on the drama, a physician who wrote for the
show, and two other physicians. The producers of the talk show suggested
that if I’d never seen the series (I had not) I should watch a couple of episodes
before coming to Los Angeles.
I complied, watched several episodes, and was disappointed not to be
surprised by the way they’d chosen to depict nursing. In the episodes, nurses
were a nebulous, silent presence in the background. They never actually did
anything other than stand around watching the doctors, who were busy
single-handedly saving lives.
These Hollywood superdocs did it all—including the nursing duties that
I, in my short twenty-year nursing career, never witnessed any physician per-
form. The only featured nurse role was the most dysfunctional character of all.
Portrayed as a brooding, damaged nurse, she was tortured not by overwhelm-
ing responsibilities to the patients or by understaffing or burnout, but rather
by having to decide which physician to sleep with next.
As with most Hollywood-generated medical shows, I found myself asking
the same question I’ve been asking since my first Dr. Kildare episode: Where
are the real nurses?
According to the Gallup polls, nurses are the most trusted professionals.
Still, that has not changed Hollywood’s hackneyed, one-dimensional portray-
als of nurses as sex objects, handmaidens, psychopaths, and worse. In fact, the
entertainment industry has done very little to present nurses in a positive light.
Consider my experience on the talk show. After arriving at the Los
Angeles studio, I was taken to a small room obviously intended for storage of
extra equipment and maintenance supplies, and I was told to wait there until
someone came to get me. Thinking I had been mistaken as an applicant for
a janitorial position, I explained that I was actually a guest on the show and
x v i i i
• Foreword
asked to be taken to the Green Room. I was told the Green Room was not
available and left to stare at the walls.
After two hours of staring at brooms and discarded stage lights, I wan-
dered to the floor below. There I found the Green Room where a party for the
show’s other guests was in full progress. When asked who I was, I replied that
I was the nurse author who had been asked to be a guest on the show.
Apparently that answer didn’t cut it because I was told that the event in
the Green Room was a private party for the show’s other guests, and I would
have to return to my special waiting area upstairs, or, as I had named it, the
“nurses only” closet.
When taping began, I was seated next to Hospital’s scriptwriting emer-
gency room (ER) physician. The show was taped in front of a live audience,
and what should have been a two-hour taping session turned into a seven-hour
fiasco. Taping was stop and go, and the retaping had tempers and egos run-
ning high.
During one of the numerous breaks, an audience member fell from the
bleachers, having a full-blown seizure. I’d unhooked my microphone and
was on my way to see what could be done when I realized the scriptwriting
ER physician had not moved. Over my shoulder I said, “Come on doc. Man
down. Let’s go.”
He looked at me as if I were insane and replied, “No way. You’re the
nurse—you take care of it.”
So, being an ER nurse, I did.
The show host, dumbstruck that none of the physicians present had
offered their assistance, asked me off-camera what the hell that was all about.
In a few words I explained that in the real world, it was the nurses who pro-
vide most of the care to the patients—a fact that was never brought up during
the taping.
After I returned to my place on the stage, I asked the writer/physician if
there were any nurses on the show’s writing staff.
He answered—and I quote here—“Why in God’s name would we ever
consider such a thing as that?”
I counted to ten and replied: “Because, as an ER physician you know full
well that it is the nurses who run the ER. The nurses triage, make the ini-
tial decisions, do most of the work, provide emotional support to both the
patient and the family, and at times save the doctor’s butt. That’s why.”
I tried to reason with him that the writers needed to make the nurses’ roles
more realistic, or the show could not be seen as an accurate portrayal of a real
hospital setting.
Foreword •
xix
Of course nothing I said made a dent (me being just a nurse and all), and
Hollywood in general is still reluctant to change its attitudes about nurses.
Recently, a producer for a popular hospital reality show asked me to write
a script for an episode. I was pretty excited about the prospect until he added
that the script had to showcase a heroic ER physician. I told him that if I did
agree to write a script, it would have to showcase a heroic ER nurse, since in
my personal experience, nurses were the heroes.
Faced with that novel idea, he assured me that viewers were only interested
in stories about doctors, not nurses. I finally directed him to the previously-
mentioned scriptwriting ER physician who I was sure could give him exactly
what he wanted.
It seems that the entertainment industry cannot, or will not, accept nurses
as the autonomous, highly-educated health professionals they are. Thus, the
subtle demeaning of the nursing profession continues. Unless they already
have learned by firsthand experience, the public needs to be shown a true por-
trayal of the nurse as a professional rich in compassion, skill, and knowledge.
This is a rare combination of traits to possess and maintain, especially when
considering that nurses work in environments that most people would liken
to war zones.
Saving Lives takes a hard look at what is wrong with the way Hollywood
and other media have gone about undermining the nursing profession. The
chapters in this book instill an awareness that will forever change the way
people view nurses in the media.
But take warning: you may be left with a strong desire to change the sys-
tem. Luckily, the authors tell you how.
Echo Heron, RN, author of Intensive Care: The Story of a Nurse, Tending
Lives: Nurses on the Medical Front, and the Adele Monsarrat medical
mystery series
ACKNOWLEDGMENTS
Many people helped us write this book. We thank those who have been with
us from the beginning, Truth About Nursing board members Gina Pistulka,
Rich Kimball, Kelly Bower-Joffe, and Christine Stainton, as well as our advi-
sor Pat Woods. We also appreciate the vital contributions of the Truth About
Nursing’s supporters and staff, especially Sandy’s mother Joan Summers and
brother Jack Summers, Havely Taylor, Saniya Tildon, Hope Keller, Barbara
Chamberlain, Carolyn Yucha, Mona Shattell, Kathleen Bartholomew, Donna
Cardillo, Ruth DiMarzo, Sara Kozup, and Rose Teskie.
We salute the nursing leaders who have inspired us and given us tireless
support over the years, especially Claire Fagin, Diana Mason, and Linda
Pugh. We also owe much to others who have explored how the media treats
nursing, particularly scholars Beatrice Kalisch and Philip Kalisch.
Our children Cole Summers and Simone Summers graciously tolerated
our absences and the stresses associated with this book. They also performed
valuable research and analysis of children’s television programming, particu-
larly Doc McStuffins.
We thank our editor Chad Zimmerman and assistant editor Meredith
Keller for their support, insights, and understanding. We are also grateful to
everyone else at Oxford University Press who helped us complete this project.
And as always we appreciate the efforts of Shannon Berning, the editor of our
first edition, who suggested we write the book.
Finally, we thank everyone who has helped us tell the public what nurses
really do.
INTRODUCTION
Nurses save lives every day. But the media usually ignores their vital role in
health care. That contributes to a lack of respect and resources for the profes-
sion, putting many lives at risk.
In 2005 US Army Sergeant Tony Wood was riding in a Humvee in Iraq.
A roadside bomb exploded. Metal tore into Wood’s internal organs. A month
later he woke up at Walter Reed Army Medical Center in Washington, DC.
Wood’s story appeared in an August 2008 New York Times article by Lizette
Alvarez about traumatic brain injuries in combat veterans.1 Once Wood
arrived at a hospital, expert nurses led the 24/7 effort that helped him sur-
vive, as they do with any patient whose injuries are so severe. But here is how
Alvarez summed up that effort: “Doctors patched up most of his physical
wounds over five months.”
In a similar incident, a roadside bomb blew up near a Humvee in which US
Army Sergeant Nick Paupore was riding in Kirkuk City. Paupore lost his leg
and an enormous amount of blood, but he too survived. In March 2008 the
CNN website posted a story by Saundra Young about a Walter Reed neurolo-
gist’s use of a promising new mirror therapy to help amputees like Paupore
cope with phantom limb pain.2 Once again, nurses no doubt provided the
great majority of the care that helped Paupore live. But in describing the care
Paupore received in Germany on his way to Walter Reed, the article reported
simply that “doctors fought to save his life.”
Of course, sometimes the media is merely repeating without question
what it hears from those with influence. In November 2013 remarks reported
around the world, French Foreign Minister Laurent Fabius called for inter-
vention in the Central African Republic because that nation was in “complete
chaos” and “on the verge of genocide.” What was most worrisome, specifically?
“You have seven surgeons for a population of five million, an infant mortality
rate of 25 percent in some areas and 1.5 million people who have nothing,
not even food, and armed gangs, bandits, etc.”3 It sure sounded like surgeons
x x i v
• Introduction
were the nation’s most pressing need. But in fact, to resolve the grave public
health problems lurking behind the Minister’s comment—poverty, malnutri-
tion, malaria, pneumonia, birth trauma, social conflict—the African nation’s
critical shortage of nurses and midwives would be far more important.
Meanwhile, over the last decade, a new wave of television hospital dra-
mas has become popular around the world. On ABC’s Grey’s Anatomy,
fifteen elite surgeon characters agonize adorably about love ‘n’ stuff and in
their spare moments handle every meaningful aspect of patient care. On
Fox’s House, a witty, misanthropic genius led a team of hospital physicians
in diagnosing mysterious diseases, work that the show seems to equate
with restoring patients to health. Once again, physician characters pro-
vide all important care. Fox’s more recent sitcom The Mindy Project focuses
mainly on the personal lives of quirky but skilled obstetrics/gynecology
physicians. It also includes three minor nurse characters that display virtu-
ally no skill and might be described charitably as kooky, less charitably as
punchlines.
When nurses appear on most hospital shows and other popular
Hollywood products, it is generally to mutely absorb physician commands, to
move things or convey messages, or to serve as disposable romantic foils. The
nurses are dramatic mirrors, reflecting light back on the beautiful physicians.
And physician characters on hospital shows have repeatedly mocked nursing,
making clear that they see it as a job for pathetic losers.
In 2009, although no nurse-focused shows had appeared in more than
15 years, three such shows premiered: Showtime’s Nurse Jackie, NBC’s Mercy,
and TNT’s HawthoRNe. At times each show wrongly suggested that phy-
sicians are really in charge of nurses, but each also featured a strong, smart
central character that fought for patients and saved lives. Jackie Peyton in par-
ticular has displayed true clinical virtuosity. But Mercy lasted only 22 episodes
and Hawthorne 30 total episodes over three seasons. The recent Channel 4/
PBS drama Call the Midwife has shown London nurses to be tough, skilled,
and autonomous—in the 1950s.
In this anxious post-9/11 world, we have found our high-tech
heroes, and for the most part they aren’t nurses. Sadly, the media often
ignores nurses’ real contributions to health. Instead, it presents nurses as
low-skilled handmaidens, sex objects, or angels. In countless media prod-
ucts, only “doctors” receive credit for care that is actually provided by a
team of nurses and other skilled health professionals. These misconcep-
tions are widespread in global society, but the media strongly reinforces
and even exacerbates them.
Introduction •
xxv
Who cares?
You should. In reality, nurses are science professionals who save lives and
improve patient outcomes every day. They monitor patients 24/7, provide
high-tech treatments, advocate for patients, and teach them how to live with
their conditions. But since the late 1990s, the world has suffered from a deadly
nursing shortage—the worst in modern history. A key element underlying
many of the immediate causes of the shortage is poor public understanding of
what nurses really do. That ignorance undermines nurses’ claims to adequate
staffing, nursing faculty, and other resources in our era of ruthless cost cut-
ting. A critical nursing role is to prevent healthcare errors, but data collected
between 2008 and 2011 showed that there were roughly 400,000 deaths per
year in the United States from healthcare errors,4 making it the third leading
cause of death.5 These deaths happen in large part because the nurses who
could prevent most of them are undervalued and underfunded. It is true that
the shortage of nurses needed to fill open nursing positions has declined in
some places as a result of the Great Recession. But the shortage of nursing care
due to an insufficient number of funded nursing positions remains rampant.
Saving Lives explores what the public is told about the nurses who are
fighting to save your life. We focus on the most universal source of informa-
tion: the media. We wrote the book to expand upon our work to improve
public understanding of nursing. In 2001, Sandy and other graduate nurs-
ing students at Johns Hopkins—Gina Pistulka, Kelly Bower-Joffe, Richard
Kimball, and Christine Stainton—started a nonprofit organization called the
Center for Nursing Advocacy to improve nursing’s image. After the Center
decided to close in 2008, we founded the Truth About Nursing (www.truth
aboutnursing.org) to continue our work, and Gina, Kelly, Rich, and Christine
stayed with us. When we first started, Sandy had practiced nursing for fif-
teen years in emergency and critical care units at leading trauma centers in
Washington, DC, San Francisco, and New Orleans. Sandy’s husband, Harry,
a lawyer and media junkie, agreed to help her stir things up. Many nurses,
nurse educators, and advocates rely on us to monitor and analyze what the
media is doing, to push for more accurate portrayals of nursing, and to be
a resource for media creators with an interest in what nurses really do. We
often use an approach we have called “entertainment advocacy,” which aims to
stimulate thinking in some of the same ways the media itself does, including
irreverent and satirical elements.
Our advocacy has had a real impact on media creators. We have per-
suaded major corporations to reconsider advertising campaigns that relied on
x x v i
• Introduction
nursing stereotypes, such as a global Skechers campaign featuring Christina

Aguilera as a “naughty nurse.” We have helped companies rework advertis-
ing campaigns to avoid nursing stereotypes. In 2005 we convinced the US
government to revise the name of an annual minority health care campaign
to one that would not exclude the nurses who actually provide much of that
care. News stories about our advocacy have appeared on major television net-
works and in print sources from the Los Angeles Times to the Times of India.
Even Hollywood has reacted, grudgingly, to our analysis of its mostly poor
portrayal of nursing. We interact with producers and executives, and some
have been receptive to our concerns. In 2013, the Truth About Nursing and
other nurses prevailed upon MTV to take several steps to lessen the dam-
age caused by the partyin’ portrayal of young nurses on the “reality” show
Scrubbing In. But far more needs to be done.
Of course, we also create controversy. Some people, including some
nurses, cannot accept criticism of their favorite media products or challenges
to the status quo generally. That criticism seems especially unwelcome when it
comes from females in a traditionally female profession. Nurses are supposed
to serve in silence! Nursing is about hearts and bedpans, not aggressive pub-
lic advocacy, so shut up! Rock star Jack White accused us of “metaphorical
ignorance” when we pointed out that one of his songs used nursing as a lazy
metaphor for unskilled romantic care. Other critics deny that the popular
media could affect the real world (“It’s just a television show. Get over it!”).
That attitude persists despite research to the contrary. It happens even though
other fields (such as education, politics, and advertising) rely on the same
basic concept: what we see affects what we think and what we do, even when
what we see is fiction. Still other critics insist that nursing can be helped only
in some particular way other than what we do. Therefore, we must stop what
we’re doing.
Because the global media has a keen interest in the many life-and-death
issues in health care, the media that relates to nursing is vast. So this book
is not comprehensive. It presents some basic ideas and notable recent exam-
ples. For in-depth treatment of the subjects discussed here, please consult the
Truth About Nursing’s website, www.truthaboutnursing.org.
Here is a short summary of what you will find in Saving Lives. As we explain
in Chapter 1, nursing is a distinct scientific field and an autonomous profes-
sion. Nurses follow a holistic practice model that emphasizes preventive care
and overall well-being. Virtually all US nurses are now educated at colleges by
nursing scholars. Nurses report to senior nurses, not physicians. Nurses prac-
tice in high-tech urban trauma centers and in vital health programs for poor
Introduction •
xxvii
mothers in bayou swamps. They work in leading research centers and in disas-
ter zones. Nurses manage patient conditions, prevent deadly errors, teach and
advocate for patients, and work for better health systems. But patients die
when nurses are understaffed or underempowered and when nursing care is
assigned to those who are not nurses in order to cut costs. The current nursing
shortage kills thousands, if not millions, of people every year.
Chapter 2 shows how the media affects nursing. Research confirms that
even entertainment television affects popular attitudes about health care gen-
erally and nursing specifically. At times, the media offers an insightful look
at what nurses really do. But usually nurses are portrayed as the peripheral
servants of heroic physicians. Despite the introduction of a few nurse-focused
television shows in recent years, physicians and physician characters have
continued to dominate most health care depictions. Hollywood has often
presented nursing as a job in a sad time warp. As Meredith Grey snapped
at a male colleague in a 2005 Grey’s Anatomy episode: “Did you just call me
a nurse?!” In a 2013 episode of The Mindy Project, the female lead character
was offended for the same reason. Key factors in Hollywood’s nursing prob-
lem include entrenched stereotypes, insufficient support from physicians,
and nursing’s own overall failure to represent itself well. Unfortunately, poor
understanding limits the resources available for nursing practice, education,
and research, which in turn leads to worse patient outcomes, including death.
The media often portrays nursing with a mix of toxic female stereotypes.
As we discuss in Chapter 3, most media portrayals fail to convey that nurses
are college-educated professionals who save lives. A few media items, particu-
larly in the print press, have conveyed something of advanced nursing skills.
Occasionally, this has even happened on television, particularly on Nurse
Jackie and the other recent nurse-focused shows. The most influential media,
however, regularly sends the message that physicians are the sole masters of
health knowledge and the only important staff in hospitals, even though hos-
pitals exist mainly to provide nursing care. Contempt for nursing remains
common. In a 2012 segment of Comedy Central’s The Daily Show with Jon
Stewart about reintegrating military veterans into the civilian workforce, the
host suggested that school nursing basically involves “kickball” and “tummy
aches.” On Hollywood shows, physician characters often do exciting things in
which nurses would actually take the lead, like defibrillation, triage, and psy-
chosocial care. Many news accounts assign credit for nurses’ work to physi-
cians, “hospitals,” or machines. Some media ignore nursing even when nurses
play a central role in the relevant topic, such as responding to mass casualty
events. Nurses are rarely recognized as health experts or important scholars.
x x v i i i
• Introduction
Of course, nurses may get credit for an isolated save outside their usual work-
places, which is news because it’s a shock (Nurse passerby saves life?! Dog
dials 9-1-1?!). Other items suggest that any helpful person or piece of health-
care technology is a “nurse.” Some call newborn nannies “baby nurses,” but
those caregivers are no more nurses than they are babies.
Chapter 4 explores the prevailing media view of nurses as the faceless crew
of a healthcare ship captained by charismatic physicians. Contrary to that
view, nursing is an autonomous profession. Nurses train and manage them-
selves. They have independent legal duties to patients and a unique scope of
practice, including special expertise in such areas as pain management and
lactation research and practice. Hundreds of thousands have at least a mas-
ter’s degree in nursing. Occasionally media products have given some sense
of nursing autonomy. These include infrequent news items about nursing
leaders or pioneering nursing research, and a few fictional portrayals, such
as Call the Midwife. But the most influential entertainment media presents
nurses as physician handmaidens. Major Hollywood hospital shows have
done so regularly, including Grey’s Anatomy, House, and The Mindy Project.
The paradigmatic nurse-physician interaction is a physician “order” followed
by a meek nurse’s “Yes, doctor!” And although all of the 2009 US nurse shows
have shown nurses pushing back against poor physician care, every one of
them—even Nurse Jackie—has at times wrongly suggested that nurses report
to physicians.
The media often presents nurses as half-dressed bimbos. In Chapter 5 we
examine the staggering global prevalence of the “naughty nurse” image. It
appears in television shows, music videos, sexually-oriented products, and even
the news media. In 2007, on LIVE with Regis and Kelly, Kelly Ripa promised
to be a “sponge bath nurse” in her “little nursey costume” for cohost Regis
Philbin, who was undergoing heart bypass surgery. At half-time during a tele-
vised 2012 basketball game, the Dallas Mavericks Dancers donned naughty
nurse outfits and did a sexually-oriented dance to the tune of Robert Palmer’s
“Bad Case of Loving You.” Major corporations have used the naughty nurse to
sell alcohol, razor blades, cosmetics, shoes, and even milk. The naughty image
encompasses more subtle messages that nurses are mainly about the roman-
tic pursuit of men, particularly physicians. Of course, the creators of naughty
nurse imagery are “just joking”! But such social contempt discourages practic-
ing and potential nurses, undermines nurses’ claims to adequate resources, and
encourages workplace sexual abuse—a major problem for real nurses.
Not surprisingly, nursing remains more than 90 percent female. Yet as we
explain in Chapter 6, a lot of media created by “feminists” has been hostile to
Introduction •
xxix
nursing. Many popular Hollywood hospital shows of recent years, particu-

larly Grey’s Anatomy, have sent the message that nursing is not good enough
for smart modern women. Films like Akeelah and the Bee (2006) and Gracie
(2007) have celebrated the idea that promising girls, unlike their bitter moth-
ers, do not have to settle for nursing. This same media can be open to the idea
of men in nursing, particularly in news stories. But the entertainment media
has mocked male nurses. TNT’s Rizzoli & Isles spent a 2010 episode jeering at
a male nurse for wanting to be a “stay-at-home-daddy” and for being an ugly
caricature of a traditional woman. On ABC’s Private Practice, nurse Dell was
a clinic receptionist. He became a midwife, then proudly announced that he
had been admitted to medical school just before the show killed him off in
2010. Too much of the media defines success solely in terms of traditionally
male jobs, such as medicine.
The media commonly presents nurses as angels of mercy or loving mothers,
as we explain in Chapter 7. Even many nurses and their supporters embrace the
angel image. Johnson & Johnson’s Campaign for Nursing’s Future, which aims
to address the nursing shortage, has aired gooey, soft-focus television advertise-
ments about “the importance of a nurse’s touch.” For Nurses Week in 2011,
Kaiser Permanente ran a radio advertisement that relentlessly portrayed nurses
as selfless angels, as exemplified by a reference to a nurse’s “gargantuan heart all
squishy with compassion thumping away.” Compassion and caring are impor-
tant parts of nursing, but the extreme emphasis on “angel” qualities reinforces
the sense that nursing is not about thinking or advanced skills. It implies that
nurses, as virtuous spiritual beings, need very little education, clinical support,
or workplace security. Nursing was traditionally seen as a religious vocation.
But today, angel imagery suggests that nursing is not a serious modern profes-
sion and deters nurses from advocating for themselves and their patients.
Chapter 8 shows that the media often views nurses who do exert authority
as battle-axes. The classic manifestation was the sociopathic Nurse Ratched
in One Flew Over the Cuckoo’s Nest, but the 2012 film Cloud Atlas included
Nurse Noakes, the oppressive, violent supervisor of a nursing home that held
older people against their will. The battle-axe has survived on prime time
television as a vindictive bureaucrat enforcing oppressive, trivial hospital
rules—even on Nurse Jackie. The battle-axe image seems to be the opposite of
both the angel and the naughty images. But it is yet another one-dimensional
female extreme. So while today’s society may be ambivalent about punishing
women generally for exercising power, it’s still cool to punish women for try-
ing to be powerful nurses. Sure, modern women are allowed to be tough and
independent—as long as they pursue a traditionally male career.
x x x
• Introduction
As we discuss in Chapter 9, advanced practice registered nurses (APRNs)

provide care that includes tasks traditionally done by physicians. APRNs
combine the holistic nursing care model with additional practitioner train-
ing, offering a hybrid approach that is changing health care. Contrary to
the claims of some physicians, research shows that APRN care is at least as
effective as that of physicians. Hollywood has offered a few well-meaning
depictions of APRNs, but these tend to wrongly suggest that APRNs are
skilled assistants to physicians. Other portrayals show disdain, as in a mocking
suggestion on Disney’s Lab Rats in 2013 that one character could be called a
nurse practitioner because he had flunked out of medical school. Some shows,
including TNT’s The Glades and even Mercy, have suggested that really ambi-
tious nurses aim for medical school. A number of news stories have given a
good sense of actual APRN practice, but APRNs are usually ignored as health
experts. Many press accounts have wrongly suggested that APRNs can treat
only minor problems. The news and advertising media constantly reinforce
the idea that practitioner care is provided only by “doctors.”
Chapter 10 explains what everyone—not just nurses—can do to improve
understanding of nursing. We can all look closely at the role nurses play in
the healthcare system and consider whether our language reflects that role; for
instance, some use the word “nurse” to refer to any untrained caregiver. The
media can convey a sense of what nursing really is. The news media should
consult nurses when they have the expertise it needs. To learn more, journal-
ists might shadow nurses. Hollywood should include characters to reflect the
nurses who actually provide the compelling health care it has shown physicians
providing. Governments and foundations must recognize the value of nursing.
Hospital managers should promote nursing as they do medicine. Hospitals and
universities should consider launching nurse shadowing programs, in which
medical students and physicians follow nurses in the clinical setting to learn
about nursing. When more physicians learn about the skill and autonomy that
nurses have, the physicians can use their social power to communicate that
reality to the public. Lack of understanding by medical professionals has led to
many workplace conflicts and serious healthcare errors.
But as we argue in Chapter 11, nurses themselves must play the leading
role in improving their image. Nurses should recognize that they have the
power—and the responsibility—to foster change in their profession. They
can start by projecting a professional image in everyday interactions, from
how they deal with patients to the way they dress (we suggest fewer cartoon
characters on scrubs). Nurses can also show that they are serious professionals
by offering health advice to others and by becoming more engaged in health
Introduction •
xxxi
policy issues. Nurses must work to help the media create more accurate
depictions and persuade the media to reconsider harmful existing portray-
als. In that respect, nurses can think globally by following the Truth About
Nursing’s media analyses and campaigns online and by signing up to receive
our free news alerts. They can act locally by starting chapters of the Truth
About Nursing to reach out to local media makers. Nurses should also con-
sider creating their own media to explain the value of nursing to the public
directly. Modern media technology offers nurses many options, including
letters to the editor, op-eds, blogs about health care issues, children’s books,
online radio shows, and even television shows and films.
Nurses are the critical front-line caregivers in modern health care. For mil-
lions of people worldwide, nurses are the difference between life and death,
self-sufficiency and dependency, hope and despair. Yet a lack of true apprecia-
tion for nursing has contributed to a shortage that is one of our most urgent
public health crises. Many nurses feel that they’ve written in invisible ink,
that their hard work is not understood, and the result is a lack of resources for
their practice, education, and research. The shortage of nurses and nursing is
overwhelming the world’s health systems. It is no exaggeration to say that our
future depends on a better understanding of nursing.
Changing the way the world thinks about nursing may require a super-
human effort. But as the philosopher Albert Camus once wrote, “tasks are
called superhuman when humans take a long time to complete them, that is
all. The first thing is not to despair.”6
We can do it—if you help.
Notes
1. Lizette Alvarez, “War Veterans’ Concussions Are Often Overlooked,” New York
Times (August 25, 2008), http://tinyurl.com/myjwg2g.
2. Saundra Young, “For Amputees, an Unlikely Painkiller: Mirrors,” CNN (March 19,
2008), http://tinyurl.com/26r9h2.
3. Reuters, “France Says Central African Republic on Verge of Genocide” (November
21, 2013), http://tinyurl.com/n5oj2nc.
4. John T. James, “A New, Evidence-based Estimate of Patient Harms Associated
with Hospital Care,” Journal of Patient Safety 9, no. 3 (September 2013): 122–128,
http://tinyurl.com/lfbmbeq.
5. Centers for Disease Control and Prevention, “Leading Causes of Death” (2011),
http://tinyurl.com/6js8e.
6. Albert Camus, “The Almond Trees” (1940), http://tinyurl.com/mg9xr2g.
I DANGEROUS IGNORANCE:
W H Y O U R U N D E R S TA N D I N G O F
N U R S I N G M AT T E R S
1
WHO ARE NURSES AND WHERE HAVE
THEY GONE?
One night our friend Dan Lynch had a patient who had just under-
gone a mechanical replacement of the aortic valve—the exit valve
of the heart. As a cardiac surgical intensive care unit (ICU) nurse at
a major hospital in Florida, Dan was monitoring the patient’s heart
that night with an arterial blood pressure line, among other ways.
The “art line,” as it’s called, is a tube that runs from an artery in the
patient’s wrist to a monitor, which displays in waveforms how well
the heart is pumping blood through the arteries. Dan noticed that
about every fifteen minutes the patient’s art line waveform became
flat. That could indicate that the patient’s heart had stopped. Or,
less dramatically, it could indicate that the art line’s interior cath-
eter had simply become kinked or stuck next to the arterial wall.
After some moments, the patient’s waveform returned to normal.
During the episodes, the heart monitor continued to indicate
that the heart was beating normally. But Dan also noted that when
the art line waveform became flat, the patient’s central venous pres-
sure monitor that measured the pressure of the blood coming into
the heart failed to fluctuate in the expected waveform. Because the
patient was still on the ventilator and heavily sedated, Dan was not
able to measure whether he got dizzy or his level of consciousness
dropped during these episodes. But Dan could not find a pulse
at these times. Dan surmised that when the waveforms went flat,
blood was not being pumped from the heart.
Dan concluded that the new aortic valve was sticking closed
during the episodes. He called the surgeon at home and woke him
up. The surgeon said that he had “never heard of such a thing” and
that the art line was probably positioned incorrectly. Dan con-
firmed that this was not the case, and noted that even if it were, it
would not explain the lack of pulse and lack of central venous pres-
sure waveform. The surgeon, unconvinced, hung up the telephone.
4
• S A V I N G L I V ES
Then the surgeon called the nursing supervisor, who was overseeing the whole
hospital’s nursing staff that night, to report Dan for bothering him at home
with unfounded telephone calls. Neither she nor the charge nurse supervising
the ICU nurses that night would back Dan up because they too had “never
heard of such a thing.”
Despite this adversity, Dan continued to call persistently, over the course
of hours, until the surgeon finally came in to prove him wrong. But Dan
wasn’t wrong. It turned out that one of the stitches holding the valve in place
was periodically obstructing its opening and closing—a problem that, left
unaddressed even for a short time, could have killed the patient. The surgeon
removed the stitch and resewed it. The patient survived.
The surgeon did not thank Dan for saving the patient, but he did allow
that it was “the craziest thing” he’d ever seen. As far as Dan knows, neither the
patient nor his family ever learned what Dan had done to save his life.
Nurses save lives every day by using advanced skills and fighting for
patients. But few people know it or even know what nursing is: a distinct sci-
entific field. Nurses promote health and prevent illness. They follow a holistic
practice model emphasizing a wide-angle view of health, with a strong focus
on preventive care.
Nurses confront some of the most exciting challenges in health care. Their
work settings range from the high-tech of teaching hospital ICUs to chaotic
urban level-one trauma centers, from major research centers to community
projects, war zones, and humanitarian relief projects around the world.
Nurses teach and advocate for patients. Nurses monitor and manage
patient conditions, prevent deadly errors, provide skilled emotional support,
perform key procedures, and work for better health systems. But if nurses are
understaffed or underempowered, or if they simply make an error under pres-
sure, patients can die.
Nursing is an autonomous profession.1 Hospital nurses collaborate with
physicians, but they are not managed by physicians. Instead, senior nurses
manage nurses. Some nurses lead hospitals. Of course, physicians receive sub-
stantial medical training, and there is certainly an overlap with what nurses
learn, as well as knowledge unique to physician training. But nursing also
encompasses a great deal of unique health expertise that physicians as a class
do not have. Therefore, contrary to popular belief, physicians as a class cannot
do or manage nursing work.
Nurses are educated at colleges by nursing scholars who conduct
cutting-edge research. Hundreds of thousands of nurses have graduate degrees
in nursing. An increasing number have doctorates in nursing science. Nurses
1 Who Are Nurses and Where Have They Gone? •
5
take rigorous examinations to secure the government licenses they need to

practice. Once licensed, nurses are bound by their own legal and ethical
practice codes.
In addition to using the physiological expertise Dan Lynch displayed,
nurses save lives in other ways. In a 2004 American Journal of Nursing arti-
cle titled “Two Cups: The Healing Power of Tea,” Hanne Dina Bernstein
described how she cared for an emaciated leukemia patient who had recently
had a bone marrow transplant.2
The patient was depressed, refusing soup, grimacing at his medication, and
turning down a newspaper. Bernstein took a pot of tea and two cups to the
patient’s room and declared, “I would like to watch the news.” The patient
was “clearly taken aback.” He closed his eyes. Bernstein turned on the news
and sat down.
Some time later Bernstein noticed that her patient was watching the tele-
vision. She told him that she had brought an extra cup of tea. The patient
said he might have half a cup. The next night the patient had two cups of tea
and a piece of toast, “his first solid food in a month.” The following night the
patient told Bernstein about his family, who lived too far away to visit. The
fourth night the patient got out of bed.
A few days later he left the hospital, able to recuperate closer to home.
Months later, while Bernstein was shopping, a “booming voice” greeted her.
It was the now vigorous patient. He gave the nurse a hug and introduced her
to his wife: “This is Hanne. She saved my life with a cup of tea.”
She did. The story may bring a tear to readers’ eyes, and at the most basic
level, this kind of intervention is something that even lay people may understand
nurses do. Consider US Vice President Joe Biden’s June 2013 half-compliment
that physicians “allow you to live” but nurses “make you want to live”—imply-
ing that nurses do not save lives with physiological skill.3 But let’s look at the
depth and importance of what Bernstein did. She quickly saw that the patient
was depressed, alone, not eating—all of which could spell decline in a frail,
critically ill patient. Although Bernstein initially felt “defeated,” she decided to
politely barge into her patient’s life. At first the patient did not seem interested,
but through her presence and the television, Bernstein reminded him of his con-
nection to other humans. At the same time, she started him on the path to physi-
cal recovery with a cup of tea. She followed up in the ensuing days. The patient
started eating and gaining strength. Of course almost anyone could physically do
these things. But what average person would insist on “watching the news” in the
room of a tired and depressed postoperative cancer patient?
6
However, when nurses make mistakes, patients can die. Nurses have so
many complex judgment calls to make—calls like Dan Lynch made with his
heart patient or Bernstein with her leukemia patient—that it is easy to miss
something, especially when a nurse is responsible for too many patients.
In 2006 veteran Wisconsin obstetrics nurse Julie Thao mistakenly gave a
pregnant patient an epidural anesthetic through her intravenous line, think-
ing the drug was penicillin prescribed for a streptococcus infection. The
anesthetic stopped the mother’s heart and she died. (Her son was delivered
alive by cesarean section.) Fatigue from excessive overtime and medication
packaging problems may have contributed to the error. The case received
national attention because Wisconsin for a time unwisely pursued a felony
neglect charge against the nurse. Julie Thao herself expressed great remorse,
started a support group for nurses involved in serious errors, and has since
devoted her time to changing hospital systems that lead to nursing errors.4
She also promotes post-error hospital policies that focus less on narrow finan-
cial concerns and more on learning from the error and allowing nurses to help
affected families heal.
Such high-profile cases are rare. In general, nurses operate under the radar,
making health care function if they can. There are an estimated 16 million
registered nurses (RNs) worldwide.5 In the United States, there were about
2.8 million RNs practicing or teaching nursing6 and another half million not
employed in nursing in 2012.7 By comparison, there are about 690,000 physi-
cians,8 a ratio of about four nurses to one physician. RNs in the United States
must have at least an associate’s degree in nursing, which can require up to
three years of rigorous college science work—one year of prerequisites plus
two years of nursing courses. About 60 percent of US RNs have at least a
bachelor of science in nursing degree.9 More than 375,000 hold at least a mas-
ter’s degree in nursing and 50,000 hold doctoral degrees.10 In 2012 there were
more than 260,000 employed advanced practice nurses and nursing educa-
tors in the United States, including 106,000 nurse practitioners, 70,000 clini-
cal nurse specialists, 34,000 nurse anesthetists, 5,700 nurse midwives, and
56,000 nursing educators.11 Advanced practice nurses play leadership roles
in clinical nursing and assume some duties traditionally performed by physi-
cians. For example, nurse anesthetists now outnumber physician anesthesi-
ologists by 53–47 percent.12 Just fewer than 10 percent of US nurses are men,
but their numbers have grown as barriers to their entry decrease.13 Nursing
schools often refused admittance to men before the US Supreme Court ruled
such practices illegal in 1981.14 The number of men is higher in some nursing
specialties; more than 40 percent of nurse anesthetists are men.15
7
What exactly do all these nurses do?
• Nurses identify and address life-threatening infections.

• Nurses coordinate the care provided by other health professionals, includ-
ing physicians, social workers, and physical therapists.
• Nurses advocate for patients and protect them from instances of inferior
care; some nurses risk their careers to blow the whistle on incompetence.16
• Nurses found and run new health systems for underserved communities,
providing care to patients confronting obesity, prenatal difficulties, vio-
lence, and substance abuse.
• ICU nurses diagnose patients’ wide-complex tachycardia, call codes, and
defibrillate—saving the patients’ lives.
• Emergency department nurses triage patients based on their own expert
evaluation of who needs care first.
• Military nurses, as commissioned officers, manage complex military care
operations around the world.
• Nurses provide most of the professional health care given by aid groups,
such as Doctors Without Borders.17
• Nurses manage violent, intoxicated patients alone until hospital security
arrives—which sometimes does not happen at all, because of resource
issues—and so nurses are most at risk for assault in a hospital setting.
• Nurses are the caregivers most likely to be present when patients are
screaming, crying, laughing, or dying.
Real nursing is exciting. That’s why major hospital shows on television,

such as Grey’s Anatomy, House, and ER, have spent so much time showing
work that real nurses do. Sadly, they have shown physician characters doing
it. But more on that later.
A Few Notes on Nursing History

The origins of nursing depend on what one thinks nursing is. Is it skilled pro-
fessional health care or just any care? Family members have always cared for
the sick. But calling that care “nursing” suggests that anyone is qualified to be
a nurse.
Even in ancient times, groups of people cared for those who could not
care for themselves. In the third century b.c.e., a school for male caregivers
was established in India.18 Its practitioners focused on moral purity and skill,
8
especially in cleaning beds. In the third century c.e., the Parabolani order in
Greece began caring for plague victims. The name Parabolani referred, aptly,
to those who took a risk.19
The roots of modern nursing are in religious and military settings. In
the Middle Ages, European religious orders began to establish groups of
trained caregivers. Saint Benedict founded such an order around 500 c.e.
Christian deacons and deaconesses cared for the sick in order to serve
God.20 In the sixteenth century the Italian priest Saint Camillus worked
to improve care in facilities for the ill and in the wider community.21 He
developed the first ambulance and invented the sign of the red cross to rep-
resent care for the sick. In the seventeenth century, Saints Vincent de Paul
and Louise de Marillac established the Sisters of Charity (though de Paul
preferred “Daughters of Charity”) in France to provide health care to the
poor. The Sisters did their nursing in patients’ homes, on battlefields, and in
their own facilities.22
But by the nineteenth century, basic care was often provided by less
religious individuals. In Europe a “nurse” was commonly thought of as
a drunken woman of uncertain morality, such as Sairey Gamp in Charles
Dickens’s satirical 1844 novel Martin Chuzzlewit. In a sense, modern nurs-
ing has been caught between the “angel” and the “naughty” images from the
beginning.
By the mid-nineteenth century, reformers in Europe and the United
States sought to improve the horrific conditions the sick endured, in part by
developing a cadre of dedicated female caregivers: nurses. In Bernice Buresh
and Suzanne Gordon’s From Silence to Voice (3rd ed. 2013) and in Gordon’s
Nursing Against the Odds (2005), the authors show that when these reform-
ers professionalized nursing, they sought to establish a respectable job for
women outside the home.23 They had to steer clear of the Gamp image, to
enable the nurses to provide intimate care to strangers. The authors, relying
in part on the work of nursing scholar Sioban Nelson, show that the reform-
ers used a moral or “virtue” script—first Christian, later civic.24 This script
strongly reinforced nursing’s “angel” image. The reformers also assured male
physicians that the female nurses would not challenge their authority over
care or their scope of practice. Those assurances are important roots of nurs-
ing’s “handmaiden” image.
The best-known of the reformers was Florence Nightingale, the fierce,
brilliant British nurse. Nightingale’s wealthy parents initially refused to let
her become a nurse. But she managed to receive some hospital training, and
in 1854, during the Crimean War, she led a group of nurses in providing
9
care to wounded British soldiers near Constantinople. She soon became

revered for her tireless efforts to improve conditions.25 Back in England,
Nightingale tried to reform hospitals, military and civil, particularly in the
area of sanitation. In 1860 she established the hospital-based Nightingale
Training School for Nurses and published Notes on Nursing, which pre-
sented nursing as a distinct scientific profession. It is arguably the most
influential book ever published about nursing. Nightingale’s Nursing Notes,
the first nursing journal, appeared in 1887. Nightingale also pioneered
reforms in care delivery structures and the use of health statistics. Her work
had a profound effect on health worldwide. Her nickname—the “Lady with
the Lamp”—does not do justice to her accomplishments. But it does at least
call attention to her use of light for close 24/7 surveillance and interven-
tion—the hallmark of nursing that may distinguish the profession most
clearly from other health care work. Figure 1.1 shows how nurses save lives
by using this continuous cycle of monitoring, decision-making, and action.
Other nineteenth century figures also played key roles in the development
of nursing, although not all had nursing training. In the middle decades of
the century, Dorothea Dix worked to reform US institutions caring for the
mentally ill. Clara Barton organized and provided care to soldiers on the
Figure 1.1 How Nurses Save Lives.

1 0
battlefields of the Civil War and later founded and led the American Red
Cross.26 She was known as the “Angel of the Battlefield” (“Visionary Disaster
Relief Leader” must not have caught on). Linda Richards was the first nurse to
graduate from a US nurse training school, at Boston’s New England Hospital
for Women and Children, in 1872. Richards later established several nurse
training schools, including the first in Japan.27 In 1893, nurse Lillian Wald
established New York’s Henry Street Settlement, the first visiting nurse insti-
tution in the United States.28 Wald effectively created public health nursing,
invented school nursing, and influenced care across the globe.
Although many very early caregivers were male, modern nursing has strug-
gled from the beginning with its gender imbalance. Some men were consid-
ered to be acting as nurses during the American Civil War—most famously
the poet Walt Whitman—but men were prevented from serving as US mili-
tary nurses or joining some nursing professional associations until well into
the twentieth century.29
In the last century, nations began to license nurses, nursing education
gradually moved from hospitals to universities, and nursing journals began
to flourish. The University of Minnesota granted the first bachelor’s degree in
nursing in 1909.30 Yale established the first autonomous school of nursing in
1923.31 Columbia University first offered a doctorate in education for nurses
in 1924, and New York University established the first doctoral program in
nursing in 1934.32
Meanwhile, nurses were improving care in ways that cut against the grain
of accepted practice. In the early part of the last century, Mary Breckinridge
established the Frontier Nursing Service in Kentucky, effectively founding
US nurse-midwifery. The Frontier Nursing Service has saved the lives of many
mothers and children, and it has served as a global model for rural health care
delivery.33
In the 1960s New York nursing leader and theorist Lydia Hall estab-
lished an influential nurse-centered rehabilitation hospital, the Loeb Center,
where RNs provided all hands-on care. Physicians and other staff played only
minor roles.34
As understanding and technology advanced, nurses managed increas-
ingly complex patient conditions and care technologies. In the 1960s nurses
began training as advanced practitioners in fields that included tasks tradition-
ally done by physicians, although the nurses used their own holistic approach.
These advanced practice nurses, most with at least master’s degrees in nursing,
now provide high-quality care in many health care specialties, but they are espe-
cially prominent in family practice, anesthesia, and midwifery. At the same time,
11
graduate-prepared clinical nurse specialists began providing clinical leadership

to bedside nurses. In 2004 Columbia established the first doctorate of nursing
practice program to award more comprehensive clinical degrees to advanced
practice nurses.35 Nurses have taken the lead in developing better end-of-life
care,36 reducing domestic violence,37 and improving pain management.38 Nurses
have pioneered cutting-edge fields, such as health informatics, which focuses
on managing the increasingly complex body of information in patient care. The
American Medical Informatics Association has video interviews of 34 nurse pio-
neers on its website.39 And sexual assault forensic nurses represent the state of the
art in caring for victims and assembling court evidence.40
In recent years nursing leaders have improved public health worldwide
through research and innovation. Korean Susie Kim has pioneered new psy-
chiatric treatments and cost-effective mental health centers for the developing
world.41 Kenyan Elizabeth Ngugi has saved countless lives by changing how
AIDS care is delivered and studied in ostracized communities.42 University
of Pennsylvania professor Loretta Sweet Jemmott, one of the world’s leading
experts in preventing HIV transmission to youth, has led efforts to improve
the health of underserved urban communities.43 Jemmott’s Penn colleague,
prominent scholar Linda Aiken, has published a series of groundbreaking
studies linking better working conditions for nurses, including higher staff-
ing levels, with better patient outcomes.44 Tennessee nurse Carol Etherington
has worked to secure the health and human rights of vulnerable populations
worldwide, creating effective programs for survivors of natural disaster, war,
and other abuses.45 Johns Hopkins nursing professor Jacquelyn Campbell is
one of the world’s leading experts in understanding and reducing domestic
violence.46 Ruth Lubic and other nurses have led the struggle to increase US
use of nurse midwife-centered childbirth care, which the rest of the devel-
oped world uses to achieve better outcomes at a lower cost.47
For nursing, the future should be wide open. Nurses have more expertise
and in some ways are more empowered than ever, and their holistic approach
to public health is sorely needed. But a perfect storm of economic and social
factors now poses a threat to nurses and their patients that may be unparal-
leled in modern times: the global nursing shortage.
The Nursing Shortage

Since the late 1990s, the world has experienced one of the longest and worst
nursing shortages in modern history. The shortage has had a devastating
1 2
effect on patient outcomes—literally killing millions of people every year.

While the number of open nursing positions has declined in some places as a
result of the Great Recession of recent years, the shortage of nursing care due
to understaffing and undervaluation remains a critical issue worldwide. At its
core, the shortage stems from a lack of understanding that nurses are needed
to do vital work that could greatly improve global health and prevent costs
from spiraling out of control.
Too few nurses are practicing today, and tomorrow may be worse. A 2010
report by the American Hospital Association estimated that US hospitals
needed about 4 percent more RNs simply to fill currently vacant positions.48
A May 2012 poll by National Public Radio, the Robert Wood Johnson
Foundation, and the Harvard School of Public Health found that about
one-third of hospitalized patients in the United States said nurses were not
available when needed or did not respond quickly to requests for help.49 In
January 2012 the US Department of Labor estimated that more than 712,000
new and replacement nurses will be needed by 2020 to create an RN work-
force of 3.5 million—a 26 percent increase.50 A June 2009 report by nurs-
ing scholars estimated that the shortage of US nurses could reach 260,000
by 2025.51 Other developed nations are experiencing similar shortfalls.52
Meanwhile, as developing nations struggle to finance their meager health care
systems, many of their best nurses are emigrating to developed nations eager
for their skills.
Immediate causes of the shortage are numerous. Many nurses leave the
bedside because of nurse short-staffing or poor working conditions.53 The
nursing workforce is rapidly aging, as too few new nurses are being educated.
Inadequate resources are devoted to nursing education, and there is a short-
age of qualified faculty. Women in many nations have come to enjoy a far
greater range of career choices than in the past. For the most part, women in
nursing have not made the gains in workplace empowerment that their coun-
terparts in many other professions have made. At the same time, men are still
not entering nursing in significant numbers.54 Many do not consider the field
because they do not know that what nurses do matters. Abusive treatment
from physicians and others creates hostile workplaces that continue to drive
nurses from the workforce,55 especially where nurses’ status is low.56 While
these problems continue, the demand for nurses has grown because of rap-
idly aging populations in developed nations and the increasing complexity of
health care and care technology.
Short-staffing, driven by the undervaluation of nursing, is central to the
crisis. Several key books have explored this, among them Safety in Numbers
13
(2008) by Suzanne Gordon, John Buchanan, and Tanya Bretherton;

Gordon’s Nursing Against the Odds (2005); and Dana Beth Weinberg’s Code
Green: Money-Driven Hospitals and the Dismantling of Nursing (2003).57
Many nursing positions were actually cut in the 1990s due to managed
care, which had curtailed insurance reimbursement, threatening many care
facilities. Many hospitals implemented restructuring plans that drastically
increased the workloads of RNs. Nurses, who remained underempowered,
lacked the resources to resist these threats to their patients and themselves.
At the same time, many care tasks formerly performed by nurses—tasks
that enabled nurses to perform critical assessments—were given to less expen-
sive, unlicensed assistive caregivers or not done at all. The job titles of these
assistive caregivers include certified nursing assistant (about 6–8 weeks of
training), patient care assistant (about 3–4 months), and patient care techni-
cian (about 5–7 months).58 It seems that hospital decision-makers concluded
that because tasks like collecting vital signs, walking and bathing patients, and
emptying bedpans did not look all that hard to them, facilities could cut costs
by having nonnurses do them (while dressed in scrubs like nurses, of course).
But patients pay the price. For example, the vital sign machines upon
which such assistive caregivers rely often cannot be trusted; most nurses can
attest to seeing these machines report good numbers on patients who were
in fact doing very poorly. One of the authors (Sandy) once observed such a
machine, still in place after an unsuccessful code, report good numbers on a
patient who had died 15 minutes earlier. Imagine if your heart rate was 220
but the machine was only picking up every other heartbeat and reporting it
at 110, leading to a lower triage ranking. The author (Sandy) has seen that
happen. Consider also that subtle symptoms, such as a tinge of blue color
around the mouth, or a little moisture on the skin, or slight retraction of the
muscles between the ribs, can signal that a patient is struggling to oxygen-
ate, a condition that could soon lead to death. Wouldn’t you want a skilled
nurse who could evaluate these tiny cues to your health to determine what
was actually going on? And can we talk about poop? Bedpans full of black
stool signal intestinal bleeding to nurses, but probably not to assistive care-
givers. To nurses, pencil-thin stool sends off warning bells of colon cancer or
bowel obstruction; white or light stool suggests possible hepatitis, cirrhosis,
or gallbladder obstruction; and mucous stools signal a possible dead bowel.
But it’s hard to imagine the same analysis from assistive caregivers.
In recent years, austerity policies undertaken in many nations in response
to the global recession have resulted in even more pressure to reduce nursing
staff. That is why even high nurse vacancy rates do not fully convey the scope
1 4
of denursification in hospitals. Most hospitals need many more nurses than

they are actually seeking.
These conditions have in turn driven away many nurses who could no lon-
ger face their growing burnout and the realization that they could not meet
their professional responsibilities to their patients.59 By 2008 roughly half a
million US RNs (about one-sixth of the national total) had chosen not to
work in nursing.60
In recent years many reports have described what short-staffing does to nurses
and patients. In February 2004 Newsweek ran Michigan emergency department
nurse Paul Duke’s powerful “If ER Nurses Crash, Will Patients Follow?” Duke’s
column told how chronic short-staffing was leading him to ask “Did I kill any-
one today?” In five years Duke’s patient loads had increased from four or five
up to ten or twelve. In that environment, he wrote, nurses are “tired and beaten
down.” Duke vowed to continue with the profession he loved despite feeling
“steamrolled,” but nurses in general cannot be expected to do so.61
In October 2003 Reader’s Digest published an anonymous ICU nurse’s
powerful account of one shift in which she was expected, apparently because
of staffing decisions made by hospital managers, to do the work of an electro-
cardiogram technician, nurses’ aides, housekeepers, secretaries, and pharmacy
delivery people. This overload kept her from giving patients critical medicines
on time. Meanwhile, she was responsible for three ICU patients, even though
more than one or two is generally regarded as unsafe.62
Her patients were an agitated man in restraints suffering alcohol with-
drawal, a 300-pound woman with a serious blood infection, and a man with
severe cerebral palsy suffering pneumonia and bedsores. The nurse con-
stantly monitored the conditions of these patients and handled their dif-
ficult minute-to-minute needs. With the help of other nurses, she adjusted
the overweight patient’s position so she could breathe. The nurse stopped a
dietary worker from giving the patient a meal that would have harmed her.
For these key interventions, the nurse received abuse from the patient.
The nurse negotiated a change in a patient’s medication to reduce his
agitation and the likelihood of complications, despite resistance from junior
physicians. The nurse coordinated relations among patients, their families,
and other health workers, suffering abuse from family members for not being
responsive enough. She also managed to provide skilled support and an
Al-Anon referral to a patient’s distraught mother. Miraculously, none of the
nurse’s patients appeared to suffer serious problems. But the nurse ended her
piece by describing the physical pain the shift had caused her, noting, “How
much longer I can work like this, I just don’t know.”
15
In May 2012, National Public Radio reported that understaffing remained

widespread in US hospitals. Many nurses were caring for patients nonstop,
without breaks, during twelve-hour shifts, while worrying that poor staffing
made it impossible to provide safe care. One nurse, declining to give her name
because she feared hospital retaliation, gave the example of being unable to
respond to one patient’s call bell when she had to stay with a different patient
while pushing a medication over an extended period, as required to avoid
harming the patient. The nurse described driving home at the end of these
shifts, her knuckles white on the steering wheel, worrying that she had missed
something and thinking that the day she makes a harmful mistake “because
the demands exceeded any reasonable capacity on the part of a nurse, that’s
the day that I never want to be a nurse again.”63
Sadly, that’s not the only thing that can happen on those drives home from
work. In November 2013, CNN reported that a man had filed suit against a
hospital after the death of his wife, a Cincinnati nurse whose car had veered
off the road and hit a tree as she drove home after a long shift. The suit alleged
that the nurse’s supervisor had expressed fear that she was being “worked to
death”; the piece quoted a representative of National Nurses United who
argued that “chronic understaffing” remained “rampant” throughout the
nation.64
A wealth of research links lower nurse staffing levels to nurse burnout and
worse patient outcomes, including medication errors, serious complications,
longer hospital stays, missed care from surveillance to feedings, and death.65
Nursing scholar Linda Aiken and colleagues published an influential 2002
study in the Journal of the American Medical Association showing that postop-
erative patients whose nurse had eight patients had a 31 percent higher chance
of dying than patients whose nurse had four patients.66 In 2006 a study in
Health Affairs showed that raising the number of RNs in hospitals would
reduce millions of hospital days and save thousands of lives each year, at a
relatively small or no cost.67 A 2012 follow-up study of hospital data by Aiken
and her colleagues found links between poor nurse staffing, nurse burnout,
and higher rates of infection, which cost lives and money.68
Missed nursing care is a revealing but subtle effect of understaffing, a
problem that is so far below the radar that nursing scholar Beatrice Kalisch
and colleagues felt the need to explain it in a 2009 concept analysis.69 In
a 2006 study, Kalisch found that the types of care most often left undone
were patient education, surveillance, discharge planning, ambulation, turn-
ing, feedings, emotional support, hygiene, and intake/output documenta-
tion. Eight of those nine critical activities are nurse-prescribed, suggesting
1 6
that understaffed nurses sacrifice those first. That may be because they view
physician-prescribed care, such as medication administration, as more impor-
tant. Or they may, understandably, want to avoid complaints from a powerful
external source.70
Globally, the nursing shortage is even more worrisome. A 2009 survey
of more than 2,000 nurses across the world by the International Council of
Nurses (ICN) and Pfizer found that time constraints prevented 92 percent
of nurses from spending the time they thought necessary with patients.71
The survey also indicated that there were almost twice as many nurses most
concerned about heavy workloads (42 percent) as there were nurses most
concerned about insufficient pay and benefits (22 percent). Even in highly
developed nations, short-staffing can be severe. A 2013 study in the journal
BMJ Quality & Safety, based on data from hundreds of hospitals in twelve
European nations, confirmed that the problem of missed nursing care had
become serious and widespread.72 A 2012 study of staffing at forty-six United
Kingdom hospitals by researchers at Kings College London found that nurses
had an average of eight patients during the day and eleven at night, in some
places fifteen patients at night, and that much nursing care was left undone
because of the stressful work environment.73 The nurse-to-population ratio
now varies greatly worldwide. The average ratio in Europe is ten times higher
than that in Africa and South East Asia. Some nations, particularly in Central
and South America, actually have more physicians than nurses. Bringing the
nurse-to-population ratio seen in the most developed nations—roughly
1:100—to the rest of the world would require about 55 million additional
nurses, for a total of more than four times the number of nurses we have now.
Many nations also have a poor distribution of nurses, with few nurses in rural
and remote areas.
In a 2006 report the ICN explained that key factors in the global short-
age include the continuing threats of HIV/AIDS, nurse migration, and
health sector reform and restructuring.74 The 2009 ICN report on nurses’
socioeconomic welfare noted that gender-based discrimination continues in
many countries and cultures, with nursing being undervalued, and that “has
resulted in inappropriately low economic and social conditions for many
nurses.”75 As the ICN observed, “current compensation structures are often
based on gender and not on the value of the job to society.”
One of the most alarming global trends is the migration of developing
world nurses (and physicians) to much better-paying positions in developed
nations with shortages. Notwithstanding the funds these workers send home,
this trend has had a devastating impact on already overburdened health
17
systems in poor nations. In a June 2007 article in Health Services Research,

nursing migration expert Mireille Kingma explained that developed-world
shortages had led to aggressive recruiting campaigns overseas. Yet Kingma
argued that nurse migration was primarily a “symptom” of larger systemic
problems that cause nurses to leave jobs, mainly poor salaries and working
conditions. She noted that “no matter how attractive the pull factors of the
destination country, little migration takes place without substantial push
factors driving people away from the source country.” Indeed, in July 2009
CNN reported that Malawi had succeeded in halting its severe nursing
“brain drain,” at least temporarily, by using international aid funds to give
nurses modest pay raises and more educational opportunities. In her 2007
report, Kingma also concluded that “injecting migrant nurses into dysfunc-
tional health systems—ones that are not capable of attracting and retaining
domestic-educated staff—is not likely to meet the growing health needs of
national populations.”76 Other research has found that foreign-trained nurses
working in developed nations tend to practice with less autonomy and to
assume less responsibility than their native-born colleagues.77 In addition,
the use of non–US-educated nurses increases patient mortality and failure
to rescue.78
Although policy makers and thinkers around the world have repeatedly
called for measures to strengthen nursing, such as in the landmark 2010
Institute of Medicine report The Future of Nursing,79 legislative efforts to
combat the nursing shortage have not yet had a broad impact. Nurse staff-
ing has been a major concern. Following the lead of the Australian state of
Victoria, California has been the first US state to impose mandatory mini-
mum nurse staffing ratios, despite fierce opposition from the hospital and
insurance industries, which argued that the ratios were impractical and
might force hospitals to close. Other jurisdictions that have considered leg-
islation mandating specific minimum ratios include Arizona, the District
of Columbia, Florida, Illinois, Iowa, Michigan, Minnesota, Nevada, New
Jersey, New York, Pennsylvania, Oregon, Texas, and West Virginia. Fifteen
states have passed some sort of staffing legislation, but most of it is weak; only
California establishes minimum ratios across all major clinical settings.80 In
June 2014, Massachusetts took a first step by passing legislation for minimum
ratios in ICUs.81 In recent years bills have also been introduced in the US
Congress to address staffing ratios, although none has passed. The National
Nursing Shortage Reform and Patient Advocacy Act bill, introduced in April
2013, would mandate minimum staffing ratios comparable to those set by
California for all hospitals that receive Medicare or Medicaid funds, as well
1 8
as provide whistleblower protections to nurses. However, passage remains

unlikely.82 The book Safety in Numbers argues strongly that mandatory mini-
mum ratios, although not perfect, have proven a cost-effective way to improve
working conditions, nurse retention, and patient outcomes in the Australian
state of Victoria and in California. The authors show that the horror scenarios
predicted by hospitals have not materialized.83 A 2010 study by Linda Aiken
and her colleagues showed that applying the California ratios in Pennsylvania
and New Jersey hospitals would save at least hundreds of lives.84
Governments have also tried to address some other factors underlying the
shortage. By 2010 fifteen US states had prohibited mandatory overtime,85 but
such legislation had yet to pass at the national level. The American Recovery
and Reinvestment Act (2009), the massive federal stimulus package passed
in response to the economic crisis, did include significant funding for nurs-
ing education and community health programs. In addition, the Patient
Protection and Affordable Care Act (2010), the major health care reform
law known as “ACA” or “Obamacare,” includes measures, particularly more
insurance coverage, that are likely to increase demand for advanced practice
nursing as well as expand federal support for nursing education and commu-
nity health nursing.86 But despite these encouraging initiatives, it is not clear
whether any current federal legislative measure will have a positive and mean-
ingful long-term impact on nursing.
Hospitals have responded to the shortage in various ways. Many have
recruited nurses from overseas87 and relied on nurse staffing agencies and
travel agencies to supplement their staff.88 Some hospitals have made efforts
to improve working conditions, including staffing levels and scheduling poli-
cies. In 2012, Philadelphia’s Hahnemann Hospital announced that it was
adopting an all-RN staffing model.89 A relatively small number of hospi-
tals, mostly in the United States, have earned Magnet status. The American
Nurses’ Credentialing Center awards Magnet status to hospitals that satisfy
criteria designed to measure the strength and quality of their nursing, includ-
ing nurses’ participation in decision making, job satisfaction, low turnover,
and appropriate grievance resolution. Some critics (including nursing unions)
have argued that the program is inadequate because it lacks minimum
nurse-to-patient ratios, that the nurse empowerment it offers is mostly illu-
sory, and that hospitals have used it mainly as a promotional tool.90 Recent
research has indicated that Magnet hospitals offer some benefits. A 2011
study found that they had “better work environments,” with better educated
nurses who were less burned out,91 and a 2013 study found that Magnet hos-
pital patients had lower mortality rates.92
19
Hospital residencies for nurses are a very promising trend. A major resi-
dency program involving twenty-eight US care facilities reported a one-year
retention rate of 94 percent of new nurses compared to the mere 66 percent
who stayed for one year in the absence of the residencies, under the traditional
“throw them in and see if they can swim” approach.93 Yet funding remains
elusive. From 2003 to 2008 nursing residencies received roughly $1 of federal
funding for every $375 that physician residencies received.94
Several media campaigns have aimed to address the nursing shortage.
Perhaps the most prominent is Johnson & Johnson’s ongoing Campaign
for Nursing’s Future, launched in 2002. Since then, the drug company has
spent tens of millions of dollars on television ads, recruiting videos, a website,
and scholarships. Some of these campaign efforts have been positive, but the
widely seen television ads have often presented nursing in the same emotional
ways in which the public already sees the profession, de-emphasizing nursing
skill, and so have done little to enhance real understanding.95 Nurses for a
Healthier Tomorrow, a coalition of health care groups, has tried to interest
secondary school students in nursing through focus groups, a website, and
other activities. Nurses for a Healthier Tomorrow has also encouraged nurses
to become nurse educators. Their media efforts have given specific examples
of the life-saving value of nursing.96
In recent years, interest in nursing careers has increased somewhat in the
United States, due at least in part to a dismal economy and a growing aware-
ness that nursing offers plentiful, diverse positions with the chance to better
lives, along with starting pay that is good relative to the amount of formal
training required. No doubt this awareness has been driven by extensive media
coverage of the shortage and by the previously mentioned media campaigns.
Unfortunately, simply training more nurses, like recruiting from other
nations or regions, will do little to address many of the key underlying causes
of the nursing shortage. Moreover, a critical shortage of nursing faculty has
hampered efforts to educate more nurses, and US nursing schools have turned
away many qualified applicants; more than 75,000 such applicants were
denied admission in 2011 alone.97 A 2007 report by the National League for
Nursing and the Carnegie Foundation found that nurse educators earn only
three-fourths of what faculty in other academic disciplines earn and signifi-
cantly less than other nurses with the same educational credentials, such as
advanced practice nurses.98 Nursing scholars get relatively little funding from
the US government. As of 2014, funding for nursing research made up less
than half of 1 percent of the budget for the National Institutes of Health.99
2 0
Recent reports show that the nursing shortage and nurse short-staffing
remain critical problems throughout the world. The long-term crisis in the
United States is ongoing, although the shortage of nurses seemed to ease
temporarily during the Great Recession, as veteran nurses who had left the
bedside were forced to return and some care facilities cut staffing even fur-
ther.100 In May 2009 the New York Times reported that clinics in Prague
were offering nurses free plastic surgery in efforts to replace the thousands
who had left the Czech Republic for higher-paying jobs in other European
nations.101 Other reports show that the shortage remains critical in nations
ranging from Israel to South Korea, where, according to a June 2010
Korea Times piece, many nurses face crushing workloads and can think
only of sleep.102
The picture in poorer nations is often worse. An August 2009 study
in Health Affairs estimated that the nations of sub-Saharan Africa would
be short 551,000 nurses and midwives by 2015.103 A July 2011 item from
the South Africa Press Association reported a “debilitating” brain drain of
Zimbabwean nurses not only to developed nations, but also to neighboring
Botswana, while nurses who remained had “been reduced to selling tomatoes
and other fruit to survive due to poor public sector salaries,” according to
the health minister.104 In March 2008 the Indian newspaper The Hindu ran
a story headlined “India Running Short of Two Million Nurses.” The piece
reported that nearly 20 percent of “experienced nurses” had left India for the
United States or Europe.105
If the shortage continues as projected, it will have catastrophic effects.
Already it severely hampers our ability to respond effectively to mass casu-
alty events, because nurses would provide the great majority of the care
those require. For example, the critical shortage of US school nursing
undermines efforts to prevent and contain the H1N1 flu, as a September
2009 Associated Press story reported.106 In some nations, the shortage
is obstructing economic, social, and political development across the
board. As the 2006 ICN report stressed, the nursing shortage is a public
health crisis.107
But as we argue in the chapters that follow, a critical factor underlying
the shortage is the huge gap between the actual nature and value of nurs-
ing, on the one hand, and what policy makers, career seekers, and the public
at large believe about nursing on the other. Nursing has not received ade-
quate resources because it continues to be seen as a peripheral, menial job
for women with few other options. Legislative reforms and better funding
will not be enough, vital as those steps are. All the numbers measuring the
21
shortage reflect what starts in our minds. The shortage cannot be resolved
until public understanding improves. We must change how the world thinks
about nursing.
Notes
In these endnotes, The Truth About Nursing is abbreviated “TAN” and the Center for
Nursing Advocacy as “CFNA.” Please see www.truthaboutnursing.org/references/ for
live hyperlinks providing easy online access to virtually all of the references cited below.
1. TAN, “Q: Are You Sure Nurses Are Autonomous? Based on What I’ve Seen, It
Sure Looks Like Physicians Are Calling the Shots,” accessed January 28, 2014,
http://tinyurl.com/7qfa8zu.
2. Hanne Dina Bernstein, “Reflections: Two Cups: The Healing Power of Tea,”
American Journal of Nursing 104, no. 4 (April 2004): 39, http://tinyurl.com/
nqjbyez.
3. Cnet.com, “Biden: ‘Doctors Allow You to Live; Nurses Make You Want to Live’ ”
( June 3, 2013), http://tinyurl.com/ks6jlgm.
4. Julie Thao, “Julie Thao’s Speech in Pasadena,” California, January 28, 2010, YouTube
video, http://tinyurl.com/obtuutb.
5. International Council of Nurses, “About ICN” ( June 14, 2013), http://tinyurl.
com/nxubwo4.
6. US Department of Labor, Bureau of Labor Statistics, “Occupational Employment
Statistics: May 2012 National Occupational Employment and Wage Estimates,”
http://tinyurl.com/q2ywzuv.
7. US Department of Health and Human Services, Health Resources and Services
Administration (HRSA), “The Registered Nurse Population: Findings from the 2008
National Sample Survey of Registered Nurses” (2010), http://tinyurl.com/7zgyet7.
8. US Department of Labor, Bureau of Labor Statistics, “Physicians and Surgeons,”
accessed January 8, 2014, http://tinyurl.com/77ghlzk.
9. David I. Auerbach, Douglas O. Staiger, Ulrike Muench, and Peter I. Buerhaus, “The
Nursing Workforce: A Comparison of Three National Surveys,” Nursing Economic$
30, no. 5 (September-October 2012), http://tinyurl.com/kd63p27.
10. HRSA, “RN Sample Survey” (2010), http://tinyurl.com/7zgyet7; Jane Kirschling,
“Designing DNP Programs to Meet Required Competencies—Context for the
Conversation” (2012), http://tinyurl.com/oajvwx8.
11. US Department of Labor, Bureau of Labor Statistics, “Query System: Occupational
Employment Statistics: Registered Nurses, Nursing Instructors and Teachers,
Postsecondary (251072); Registered Nurses (291141); Nurse Anesthetists (291151);
Nurse Midwives (291161); Nurse Practitioners (291171); Licensed Practical and
Licensed Vocational Nurses (292061)” (May 2012), http://data.bls.gov/oes/;
2 2
National Association of Clinical Nurse Specialists, “Clinical Nurse Specialist”

(2012), http://tinyurl.com/lcn9eaj.
Statistics: 29–1151 Nurse Anesthetists; 29–1061 Anesthesiologists” (May 2012),
http://tinyurl.com/k4jb5yg and http://tinyurl.com/azxds7v.
13. US Census Bureau, “Men in Nursing Occupations: American Community Survey
Highlight Report” (February 2013), http://tinyurl.com/mjxgvue.
14. Michael J. Villeneuve, “Recruiting and Retaining Men in Nursing: A Review
of the Literature,” Journal of Professional Nursing 10, no. 4 (1994): 217–228,
http://tinyurl.com/k2jdvsj.
15. US Census Bureau, “Men in Nursing Occupations: American Community
Survey Highlight Report” (February 2013), http://tinyurl.com/mjxgvue;
Michael J. Villeneuve, “Recruiting and Retaining Men in Nursing: A Review
of the Literature,” Journal of Professional Nursing 10, no. 4 (1994): 217–228,
http://tinyurl.com/k2jdvsj.
16. TAN, “Remain in Light” (February 11, 2010), http://tinyurl.com/o9khkr7; CFNA,
“Enemy of the People,” TAN ( June 22, 2005), http://tinyurl.com/o4y7bhs.
17. CFNA, “Infirmières Sans Frontières,” TAN (December 3, 2006), http://tinyurl.
com/jwa9goe.
18. Bruce Wilson, “The Story of Men in American Nursing,” American Assembly
of Men in Nursing (November 5, 1997), citing The Charaka, Vol. 1, Section xv,
http://tinyurl.com/oxrnt38.
19. Patrick Healy, “Parabolani,” The Catholic Encyclopedia, Vol. 11 (New York: Robert
Appleton Company, 1911), http://tinyurl.com/pal4o6o.
20. Christian Classics Ethereal Library, “The Holy Rule of St. Benedict” (1949),
Chapter 31, http://tinyurl.com/5w5ely; M. Patricia Donahue, Nursing, the Finest
Art: An Illustrated History, 3rd ed. (St. Louis: Mosby, 2010): 54.
21. Alban Butler, Donald Attwater, and Herbert Thurston, Lives of the Saints
(London: Burns & Oates, 1956): 135.
22. AmericanCatholic.org, “St. Louise de Marillac,” accessed March 15, 2014, http://
tinyurl.com/k2hm3hy.
23. Bernice Buresh and Suzanne Gordon, From Silence to Voice, 3rd ed. (Ithaca: Cornell
University Press, 2013); Suzanne Gordon, Nursing Against the Odds: How Health
Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and
Patient Care (Ithaca: Cornell University Press, 2005).
24. Sioban Nelson, “The Image of Nurses – The Historical Origins of Invisibility
in Nursing,” Texto & Contexto – Enfermagem 20, no. 2 (April–June 2011),
http://tinyurl.com/ngrw3hs.
25. Florence Nightingale Museum, “Florence’s Biography,” accessed June 17, 2014,
http://tinyurl.com/mppnene.
26. Cole Summers, “Clara Barton,” TAN, accessed June 19, 2014, http://tinyurl.com/
p3yrayf.
23
27. American Association for the History of Nursing, “Linda A. J. Richard,” accessed
June 17, 2104, http://tinyurl.com/2flqy7m.
28. Henry Street Settlement, “Lillian Wald,” accessed January 29, 2014, http://tinyurl.
com/lqcskyx.
29. Bruce Wilson, “The Story of Men in American Nursing,” American Assembly of
Men in Nursing (November 5, 1997), http://tinyurl.com/ylecjh4, http://tinyurl.
com/yh4mqyh.
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2 4
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25
Nurse” (August 5, 2012), http://tinyurl.com/pmfs55o; TAN, “Angels on Earth”

(October 14, 2012), http://tinyurl.com/or8qhrr.
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Silber, “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and
Job Dissatisfaction,” Journal of the American Medical Association 288, no. 16
(October 23–30, 2002): 1987–93, http://tinyurl.com/lf7qr48.
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Magic Number,” TAN ( January 21, 2006), http://tinyurl.com/qxfjgzu.
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Staffing, Burnout, and Health Care–Associated Infection,” American Journal of
Infection Control 40, no. 6 (August 2012): 486–490, http://tinyurl.com/prg2vzd;
2 6
TAN, “How to Help Nurses Practice at the Top of Their Game” (August 5, 2012),
http://tinyurl.com/qamfcof.
69. Beatrice J. Kalisch, Gay L. Landstrom, and Ada Sue Hinshaw, “Missed Nursing
Care: A Concept Analysis,” Journal of Advanced Care 65, no. 7 (2009): 1509–1517,
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Care Quality 21, no. 4 (December 2006): 306–313, http://tinyurl.com/n5vmrlb.
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and Needs” (May 2009), http://tinyurl.com/mzsyne2.
72. Dietmar Ausserhofer, Britta Zander, Reinhard Busse, Maria Schubert, Sabina De
Geest, Anne Marie Rafferty, Jane Ball, et al., “Prevalence, Patterns and Predictors of
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Cross-Sectional RN4CAST Study,” BMJ Quality & Safety (November 11, 2013),
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73. Jane E. Ball, Trevor Murrells, Anne Marie Rafferty, Elizabeth Morrow, and Peter
Griffiths, “Care Left Undone,” http://tinyurl.com/kdhq75w.
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Overview of Issues and Actions” (2006), http://tinyurl.com/k45zym6.
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Nurses” (2009), http://tinyurl.com/kvl2dkp.
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Research 42, no. 3 (March 20, 2007): 1281–1298, http://tinyurl.com/km738zu.
See also Mireille Kingma, Nurses on the Move: Migration and the Global Health
Care Economy (Ithaca: Cornell University Press, 2006); TAN, “Q: How Is Nurse
Migration Affecting Nurses and the Nursing Shortage?,” accessed January 28, 2014,
http://tinyurl.com/oe3ep66.
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Approach,” Human Resources for Health 2007, 5:15, http://tinyurl.com/ljbbelr.
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for Quality in Health Care 25, no. 4 (2013): 366–372, http://tinyurl.com/n857hxx.
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http://tinyurl.com/par65rs.
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( June 30, 2014), http://tinyurl.com/qxs3q4j.
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par65rs.
83. Gordon, Buchanan, and Bretherton, Safety (2008).
27
84. Linda H. Aiken, Douglas M. Sloane, Jeannie P. Cimiotti, Sean P. Clarke, Linda
Flynn, Jean Ann Seago, Joanne Spetz, and Herbert L. Smith, “Implications of the
California Nurse Staffing Mandate for Other States,” Health Services Research 45,
no. 4 (April 2010): 904–921, http://tinyurl.com/lkwzvlt.
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(March 17, 2006), http://tinyurl.com/nr5v4p9.
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January 29, 2014, http://tinyurl.com/paftxzb.
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Highly Educated Nurses” (March 22, 2012), http://tinyurl.com/y9dtqnv.
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Foundation: Study of Nurse Educators Released” (August 29, 2007),
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2 8
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101. Dan Bilefsky, “If Plastic Surgery Won’t Convince You, What Will?,” The New York
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2
HOW NURSING’S IMAGE AFFECTS
YO U R H E A LT H
In 2007 a friend of ours got a telephone call. Producers of a popular

US prime-time television hospital show that was seen around the
world had found her name, presumably in a database of experts.
The producers called for a script consultation because our friend is
a leading expert in a certain health field. Our friend gave the televi-
sion producers cutting-edge information to help them develop a
plotline.
Our friend said that these Hollywood producers “were super
surprised I was a nurse—and super, super surprised I had a PhD and
was one of the leading researchers in the country on this issue.” She
also “took the opportunity to say quite a bit to them about nurs-
ing—both how nurses could be used in the story line and how their
general approach to nursing could be substantively improved.”
The result? The producers said the show’s audience was “inter-
ested in doctors not nurses.” They said there were no plans to have
a nurse character with a significant role: “We have a stable cast and
the focus of the show is on physicians.” Do not attempt to adjust
your television: the stereotypes are in control.
this is a self-reinforcing loop: Hollywood tells its audi-
ence that physicians’ work is dramatic and important, and nursing
is not, because that’s what the audience expects. And the audience
expects to see the stories of physicians rather than nurses in large
part because that’s what Hollywood presents as compelling enter-
tainment. In fact, as we explained in Chapter 1, real nursing work is
highly dramatic and real nurses are much more present in the sto-
ries of hospital patients1—which is why television physicians spend
so much time doing nursing work. Even on the diagnosis-über-alles
Fox drama House, physician characters spent a good deal of time
doing what is really nursing work. However, it was presented as the
work of physicians. The real physician role alone does not seem to
be interesting enough to carry a television drama.
3 0
The media has long been fascinated with health care, especially what goes
on in hospitals. Countless health items appear daily in the various news media,
particularly in light of ongoing national debates over health care financing
and technology. Many of the most popular recent television series have been
hospital shows, which, like shows about police and lawyers, provide a poten-
tially endless array of cases and characters in conflict, often on the edge of life
and death, which tends to make for good television drama. The media’s inter-
est in health care, in which nursing plays a central role, is unlikely to wane.
Occasionally the media offers insight into what nurses really do. Examples
include an excellent 2012 New York Times “Fixes” piece by Tina Rosenberg
explaining how clinics run by nurse practitioners can address the shortage of
primary care,2 a 2007 series on the nursing shortage on WBUR (the Boston
National Public Radio [NPR] affiliate),3 and the 2003 HBO film Angels
in America.4
But most of the time nurses are presented as the peripheral and/or sexy
servants of the heroic physicians who provide all important care—the care
that saves or improves lives. The health sections of major booksellers over-
flow with titles by or about physicians. Even the elite news media, such as
the New York Times and NPR, relentlessly equate “doctors” with all of health
care. “Doctors are doing all they can,” but “doctors say the patient’s condition
is critical.” This is true even in such areas as intensive care, in which nurses
actually take the lead in keeping critical patients alive by constantly evaluating
them and managing highly complex treatments.
Research has shown that nurses appear in less than 7 percent of
health-related newspaper articles. Studies in the United States in the 1990s
found that nurses appeared in just 1–4 percent of such articles.5 More recently,
a 2011 study by Pedro Alcântara da Silva of 2,781 articles published between
1990 and 2004 in three Portuguese newspapers found that nurses were
sources of information in only 1.1 percent of the news pieces, appeared in
4.4 percent of article titles, and were mentioned in 2.6 percent of the first-page
health-related stories.6 Still, in research published in 2014, Rodrigo Cardoso
and colleagues at Coimbra Nursing School found that nurses appeared in
6.6 percent of 1,271 online Portuguese health news items from 2011.7 Maybe
we’re making progress! When nurses do appear, it’s usually in pieces specifi-
cally about nursing’s discontents—the nursing shortage, understaffing, abuse
of nurses, labor disputes, or extreme misconduct by nurses, like serial killing.
It’s relatively rare for the media to cover the life-saving work nurses do every
day at their jobs or to consult nurses as the health care experts they really are.
That contributes to nurses feeling invisible in their work.8
2 How Nursing’s Image Affects Your Health •
31
The entertainment media is even more troubling. It’s true that

J. K. Rowling’s vastly popular Harry Potter novels, published from 1997 to
2007, include the very minor character Madam Pomfrey. This wizardry school
nurse is single-handedly able to cure dragon bites, treat curses, and heal Harry
after he falls fifty feet off a flying broom.
But television remains in many ways the dominant global medium. On
health-related shows airing during the 2012–2013 prime-time US television
season, physician characters outnumbered nurse characters by roughly 47 to
2, unless you count Call the Midwife, the United Kingdom show that airs to a
limited audience on PBS in the United States. Thus, physician shows contin-
ued to dominate. Since 2005 Grey’s Anatomy has shown its smart, attractive
surgeon stars providing all significant care. Although appearances by nurse
characters are few and far between, the lives of the nurses who do appear
on the show revolve around the physician characters.9 Over the last decade
Grey’s vied with House, which ran from 2004 to 2012, to be the contempo-
rary show most damaging to nursing (the two of us debated which one was
worse). House also featured a slew of smart, pretty physicians, led by the bril-
liant, acerbic lead character, Greg House. Again, these physicians provided
all important bedside care. The show generally treated the few nurses who
appeared—to mutely absorb physician commands—with contempt.10 These
two shows regularly attracted tens of millions of US viewers, and both have
been popular around the world.
Other notable contemporary shows have not been much better. The
Grey’s spinoff Private Practice, which ran on ABC from 2007 to 2013, focused
on another group of pretty, smart physicians. One early character was clinic
receptionist Dell, a cute surfer boy—and a nurse studying midwifery, a field
the show mocked relentlessly in its first season.11 Dell appeared in a May 2008
TV Guide poll of the “sexiest secretaries” on television. Portrayals of Dell
improved somewhat over time, but he was unlikely to be mistaken for a health
care expert. And just before the show killed him off in 2010, there was a part-
ing insult to nursing: Dell proudly announced that he had been admitted to
medical school, the path Hollywood often suggests that capable nurses ulti-
mately take, even though real nurses are about one hundred times more likely
to pursue graduate education in nursing.12 Similarly, in TNT’s summer show
The Glades (2010–2013), the lead detective character’s fiancée Callie Cargill
was a nurse who occasionally displayed some skill, but she was also a medical
student, again reinforcing the wannabe physician stereotype. Still, those nurse
characters are fabulous compared to the idiotic nurses on Fox’s sitcom The
Mindy Project (2012–). That show focuses on a practice of skilled if quirky
3 2
obstetrics and gynecology physicians, but it also includes three kooky nurses:
Morgan, a cheerful but loony ex-convict; the off-kilter Tamra, who at times
functions as an office insult comic; and Dorothy, a hostile, inept burnout who
the practice fired and later rehired as an office assistant.
Shorter-lived shows have also offered a limited range of physician-centric
portrayals. CBS’s Miami Medical13 (2010) and the Canadian-based Combat
Hospital14 (Global/ABC; 2011) at least included a fairly skilled and authori-
tative male nurse manager among the trauma physician leads. But the CW’s
Emily Owens, MD (2012–2013), CBS’s A Gifted Man15 (2011–2012), and
ABC’s Off the Map16 (2011) all featured physician characters saving lives by
themselves. Producer Terence Wrong’s popular ABC documentaries about
prominent US hospitals, including Hopkins17 (2008), Boston Med18 (2010),
and NY Med (2012 and 2014), were largely exercises in physician glorifica-
tion, presenting surgeons in particular as the moral and intellectual heroes of
health care, although nurses did appear sporadically.
In late 2013, two new cable shows did nursing no favors. MTV’s “reality”
show Scrubbing In spent 10 episodes with nine young travel nurses in
California. Not surprisingly, the great majority of the show was the nurses’
personal dramas, with a focus on partying, romance, and sex. Clinical interac-
tions were very limited and generally unimpressive.19 HBO’s Getting On is a
dark sitcom adapted from a UK series about the staff at a California geriatric
care facility. Virtually every character is a pathetic loser. Nurse Dawn, proba-
bly the most prominent character, displays some health knowledge and inter-
est in the patients. But she is a meek, sad soul. Her nursing supervisor Patsy,
who uses Dawn for sex, is a weak, ineffective man who either is or pretends to
be unsure if he is gay.20
Successful health-related shows of the past decade were not much bet-
ter. NBC’s drama ER21 (1994–2009) and the NBC/ABC sitcom Scrubs22
(2001–2010) were overwhelmingly physician-centric, although each did
always at least have one major nurse character who could think and talk. But
FX’s edgy Nip/Tuck (2003–2010), which followed the exploits of two ethi-
cally challenged plastic surgeons, never had any nurses.
In 2009, an astonishing three new prime-time shows about skilled nurses
fighting for their patients appeared in the United States. The most notable was
Showtime’s compelling “dark comedy” Nurse Jackie23 (2009–), which intro-
duced a tough and expert (though deeply flawed) New York City emergency
nurse. This was the first major US prime-time show with a nurse character as
the central focus since the early 1990s. Although the portrayal of nursing is
not perfect—it has suggested that nurses report to physicians—the show has
33
included many valuable illustrations of nurses’ clinical virtuosity and patient

advocacy. Also in 2009, NBC began airing Mercy (2009–2010), which fol-
lowed the romantic and work lives of a troubled Iraq war veteran and other
New Jersey hospital nurses. Some episodes suggested that nurses report to
physicians, but Mercy also included some dramatic examples of nursing skill
and advocacy.24 TNT introduced the summer show HawthoRNe (2009–
2011), whose lead character was a tough, committed chief nursing officer at
a Richmond, Virginia hospital. Although some other nurse characters were
weak or stereotypical, this show too included strong nursing portrayals, and
simply showing the public that chief nursing officers exist has value.25
More recently, helpful shows arrived from the United Kingdom. In the
drama Call the Midwife (BBC/PBS; 2012–), tough, autonomous nurse mid-
wives provide a full range of skilled nursing care to a poor community in
London in the 1950s. The show may seem a bit remote from current practice
and some critics have found it too sentimental, but it has exposed millions
to a strong vision of nursing they would not otherwise see, especially in the
United Kingdom, where it has been very popular.26 The documentary series
24 Hours in A&E (Channel 4/BBC America; 2011–2013) has given viewers
an engaging look at skilled, articulate nurses and other staff working in a busy
emergency department at London’s King’s College Hospital. The show has
run at least five seasons in the United Kingdom, although to date only the
first season has aired in the United States, as 24 Hours in the ER.
The appearance of these shows has been encouraging. Possible explana-
tions include a new interest in underdogs and resentment of the health care
status quo in a recessionary era. Nurse Jackie has lasted at least six seasons, Call
the Midwife at least three, and HawthoRNe three. However, those three shows
had far smaller US audiences and far shorter seasons than regular season US
shows. Mercy, the only one of the new US shows to air on a broadcast net-
work, was canceled after its first season.
The fact is that many shows with accurate nursing portrayals would need
to attract large audiences for a long time to counter the huge impact of years
of misportrayals in globally successful shows, such as Grey’s Anatomy and
House, as well as many short-lived shows like Emily Owens, MD. Ironically,
the sudden appearance of the 2009 nurse shows generated a backlash from
some critics, who reacted to one common theme (skilled nurses challenging
physicians to protect patients) with boredom, skepticism, or mockery. For
now, the televised health care world remains physician-shaped.
Research confirms that the media plays a key role in forming and rein-
forcing popular attitudes about health care, including nursing. So it’s not
3 4
surprising that many people still believe nurses are low-skilled physician assis-
tants rather than college-educated professionals who save lives. A 2002 US
poll found that only half of respondents knew that RNs must have at least an
associate’s degree; less than 20 percent knew that nurses must be licensed.27
In fact, given what people see every day in the media, it would be surpris-
ing if most were not convinced that health care revolves around brilliant,
commanding physicians. This misportrayal undermines the work of all the
health professionals who make up the modern healthcare team, including
social workers, physical therapists, and respiratory therapists. In particular,
physician-centric media undermines nursing practice and education. That, in
the end, costs lives.
How did the media get so far from the reality of nursing?
Virtue and Vice: Some Roots of Nursing’s Media Stereotypes

Nursing’s popular image has long veered among one-dimensional visions of
femininity: the angel, the handmaiden, the harlot, or the battle-axe. All of
these stereotypes can be traced back to the roots of modern nursing, in which
groups of nineteenth-century females began trying to help patients with their
most intimate problems at times of great stress. But it’s worth taking a brief
look at the development of nursing image’s since then. In doing so, we rely in
part on insightful research on the history of the nursing image that scholars
Beatrice and Philip Kalisch produced in the 1980s.28
Men and women have long cared for the sick in religious and other set-
tings, as discussed in Chapter 1. But in the period just before the founding
of modern nursing, the work was regarded as unskilled drudgery unfit for
a respectable person. Nursing was consigned to the likes of the immoral,
alcohol-abusing Sairey Gamp in Dickens’s Martin Chuzzlewit.
Florence Nightingale and her fellow reformers changed that. Kalisch and
Kalisch describe the era from Nightingale’s mid–nineteenth-century work in
the Crimea until the end of World War I as one defined by a female “angel
of mercy” image. In this period, popular media tended to see nursing as a
noble calling, associated it with the military, and regarded nurses themselves
with reverence. Some World War I films featured nurses who volunteered
for war duty to be near their soldier boyfriends, then ended up nursing their
wounded sweethearts back to health. Kalisch and Kalisch observe that this
theme provided a way “to mask the novelty of female independence with tra-
ditional female values.”
35
From the 1920s until the end of World War II, nurses were generally seen
as pragmatic, even heroic, particularly in war movies. The film A Farewell to
Arms (1932) presented nurses as noble but relatively unskilled, with strict
supervisors who enforced a moral code and deference to physicians.29 The Dr.
Kildare films of the 1930s and 1940s focused on an idealized young physi-
cian. Nurse characters were either young love interests or formidable veter-
ans. Kildare also had a crusty, brilliant diagnostician mentor—a forerunner
to Greg House, perhaps. Hitchcock’s Rear Window (1954) included a late
example of what Kalisch and Kalisch describe as this era’s “private nurse as
detective” portrayals. In the film, the older “insurance company nurse” Stella
helps the lovely lead characters unravel a mystery. Stella says she is not well
educated, but she is autonomous, quick-witted, and tough.30
From the end of World War II until the 1960s, nurses tended to be por-
trayed as maternal helpers to essentially omniscient male physicians. The
television show Ben Casey (1961–1966), for instance, focused on an idealistic
young physician not unlike Kildare. The show’s nurse character Miss Wills
was motherly and relatively unskilled. Marcus Welby (1969–1976) presented
physicians as giving all meaningful care, including even the emotional “caring”
that many nurses have traditionally regarded as their area. Kalisch and
Kalisch refer to depictions of physicians doing everything as “Marcus Welby
syndrome,” a malady that remains endemic in Hollywood. According to com-
munications scholar Joseph Turow, in the 1950s and 1960s the American
Medical Association (AMA) asserted control over network television
shows, actually vetting scripts. The AMA helpfully ensured that heroic phy-
sician characters generally made no errors and lived morally. Nurses were
insignificant.
A few products of the era did focus on nurses. A series of juvenile nov-
els appearing from the 1940s to the 1960s featured Cherry Ames, a virtuous,
adventurous, and bright young nurse who moved from job to job solving mys-
teries (Cherry Ames: Army Nurse was a typical title). Cherry Ames inspired
many young women to become nurses. A television series called The Nurses
(1962–1965) actually focused on two hospital nurses, a senior mentor and an
inexperienced young nurse. The program even hired a nurse adviser to help
the producers develop the show. But already some parents were discouraging
talented, ambitious girls from entering nursing.
Then came The Sixties. Sexual liberation and expanding work opportuni-
ties for women did not enhance public regard for nursing. As many ambi-
tious women began to contemplate careers in medicine and other fields, the
nursing image fled back to the poles of extreme female stereotypes. Naughty
3 6
nurses became a staple of pornography and exploitation films by B-movie

king Roger Corman and others. At times, the free-love nurse characters were
balanced with senior battle-axes.
Of course, the most notorious example was Nurse Ratched of One Flew
Over the Cuckoo’s Nest (1975). Milos Forman’s film adaptation of Ken Kesey’s
anti-authoritarian 1963 novel featured the senior nurse as a sociopath who
abuses her professional and institutional power over her patients. The film is
deeply misogynistic—every female character is a stereotype—with Ratched
as a horrific vision of society’s repressed Mom.31
Robert Altman’s antiwar film M*A*S*H (1970), based on Richard
Hooker’s 1968 novel, was less extreme. But it still presented senior US Army
nurse “Hot Lips” Houlihan and other nurses as battle-axes, sex objects, and/or
handmaidens to cynical but gifted surgeons during the Korean War.32 The
portrayal of nurses on the influential M*A*S*H television show (1972–1983)
was somewhat more evolved. The show still focused on the male physicians,
who were nicer versions of the film characters: irreverent, gifted leaders trying
to save lives in impossible situations—a model for countless future shows.
Nurses were mostly there to hand the surgeons things or provide casual sex.
Houlihan was a repressed martinet, although she did become far more human
as the show went on, and she displayed some skill and autonomy.33
In the 1980s and 1990s, most television nurses were marginal assistants
to the dominant physicians, some of whom were now female. A few shows
managed to suggest something of what nursing really was. The influential
St. Elsewhere (1982–1988) depicted a fairly gritty Boston hospital. The show’s
physicians were flawed, but they were still the focus, with the occasional for-
midable nurse character. China Beach (1988–1991) was set on a US military
base in Vietnam during the Vietnam War. Lead character Colleen McMurphy
was a competent, fairly tough Army nurse, but she did not generally display
much skill, and the show was mainly about nonhealth subjects. The minor
sitcom Nurses (1991–1994) treated nurses with some respect. However, the
notorious Nightingales (1988–1989) featured sexy but vacuous nursing stu-
dents who spent so much time in states of partial undress that outraged nurses
actually managed to chase the show off the air—a historic anomaly.
ER (1994–2009) was one of the most influential healthcare shows in
history. It relied on intense, fairly realistic scenes from a tough Chicago
emergency department and the romantic interactions of roughly ten major
characters. ER also presented some of the best depictions of nursing ever
to appear on network television, occasionally showing serious nursing skill
and even autonomy. But on the whole it featured an evolved handmaiden
37
image: nurses were skilled physician assistants who ultimately had to defer.
The show never had more than one major nurse character at a time, and it
always relied heavily on physician nursing. Like Marcus Welby, ER physicians
saved lives using traditional medical skills and provided virtually all impor-
tant bedside care, including key psychosocial care.34
At the turn of the millennium, a few other shows had nurse characters
of some substance, although no show challenged the idea that only physi-
cians really matter. The Lifetime drama Strong Medicine (2000–2006)
included hunky, articulate nurse midwife Peter Riggs, a progressive under-
ling set against the female physician stars—probably a model for Dell from
Private Practice. But the show’s other nurses were mute handmaidens.35 The
kooky sitcom Scrubs (2001–2010) featured tough nurse Carla Espinosa, who
at times displayed real skill. But the show’s physicians provided virtually all
important care, and the nurses were generally meek assistants with no signifi-
cant clinical role.36
Despite the recent nurse shows, the standard Hollywood nursing por-
trayal remains the peripheral, low-skilled physician handmaiden with
virtually nothing to contribute. Grey’s Anatomy remains popular and its
cute-young-physicians-in-training model has inspired other shows, like Off
the Map37 and Emily Owens, MD. House continues to air in syndication.
Every major character on these shows has been a physician, and the shows’
vision of nursing is that of a job in a sad time warp. Now that female phy-
sicians are so common, there’s no need to include nurse characters at all to
have a gender mix that is good for drama. The subtext is obvious: today, no
person of substance would even think of becoming a nurse. Those who do are
pathetic losers unworthy of a second glance from television viewers. Or even
a first glance: let’s just show their forearms at the edge of the frame, holding
something for the smart, interesting physicians as they save a patient’s life.
Does What’s in Our Brains Matter? How the Media

Influences Nursing
At this point, you may be wondering how media portrayals of nurses affect the
profession. We often receive skeptical messages on this subject. Here are some
of the questions we receive about why the media matters, and our replies.
Come on. Even if the media ignores nursing or presents it inaccurately,

how can that possibly affect nursing in real life?
3 8
What people see and hear affects what they think, and what they think affects
what they do. This is a basic principle of education, religion, art, and any other
organized effort to influence people. It is why major corporations spend mil-
lions on advertising campaigns to promote their products, and why powerful
political advertisements can move polling numbers and affect election results.
In 2012, US advertisers spent $140 billion on advertising.38 Research shows
that television can affect conduct greatly. For example, a 2008 study found
that the introduction of cable television in rural India resulted in women
reporting that they had increased autonomy as well as significant decreases in
the acceptability of violence toward them—and in their own preference for
having sons.39
The same principle applies to health issues. Indeed, in recent years a con-
sensus has emerged in the field of public health that the media affects soci-
ety’s health-related views and behavior. Public agencies, private groups, and
scholars now devote substantial resources to analyzing and managing health
messages in the media.
The field of health communication addresses how this works. In recent
years, health communication has gained prominence40 and scholars have rec-
ognized the growing impact of new media on the public’s understanding of
key health issues.41 As public health scholar Deborah Glik noted in “Health
Communication in Popular Media Formats,” media products “comprise both
planned and unplanned content which has the potential to communicate
positive, neutral or negative health messages to the public.”42 The inclusion of
“unplanned” content means the media influences people whether or not the
creators intended it, just as a cigarette-smoking parent may influence a child
to smoke without intending to do so. The media need not intend to harm
nursing to have that effect.
Glik has noted that “from a social marketing perspective, messages in the
media that promote specific desirable behaviors have the potential to per-
suade consumers to change their behavior if messages are viewed as compat-
ible with consumers’ own self-interest, competing messages are minimal, and
resistance to change is low to moderate.” It makes little sense to think that
people would learn about substantive health topics like cancer or AIDS from
a media product but form no opinions about the health worker who is pre-
senting the information.
In a 2002 report for the Kaiser Family Foundation, scholars Joseph
Turow and Rachel Gans noted that “researchers have long recognized that
news media coverage affects what the public believes about health care.”43
39
Advocates have therefore worked hard to affect the media’s coverage of health
topics in which they have an interest.
For example, physicians have worked hard for decades to manage their
public image. We have noted that the AMA has historically tried to control
how physicians are depicted in the media. It has also aggressively promoted
coverage of medical research and other physician-centered stories. In general,
these efforts have been a resounding success. Today physicians, a critical part
of the healthcare team, are generally portrayed by the news media as more or
less the whole team. The media often consults physicians on issues, such as
nutrition and breastfeeding, in which others generally have as much if not
greater expertise. Physicians’ combination of economic, social, and moral sta-
tus is unrivaled by any other professional group.
Public health scholars try to increase understanding of what the media is
saying, sometimes subtly, about health issues. Glik has explained that, “given
the pervasiveness and potential power of the media to shape beliefs, attitudes
and behaviors, the media literacy movement has emerged.” This movement
aims to help children and teenagers understand what the media is really doing,
but these skills are also important for adults, especially those whose interests
are not served by current media practice. Glik describes the popular media as
a “double-edged sword” that may function “as both a tool for progress and a
source of ill health that is a reflection of the larger culture it represents.”
In particular, we must explore how the media affects one of the most
important global health problems: the crisis in nursing. When those without
much understanding of nursing get a lifetime of negative stereotypical mes-
sages about the profession, they do not consider nursing as a career. Likewise,
public officials and healthcare decision makers with little understanding of
nursing’s real importance do not allocate sufficient funds for nurse staffing,
nursing residencies, nursing education, or nursing research. Nurses themselves
are not immune. The media’s undervaluation can sap nurses’ pride, encourage
cynicism and self-loathing, and discourage nurses from standing up for them-
selves and their patients. It can even persuade nurses that physicians really are
their masters, rather than colleagues.
On the whole, the nursing crisis can be seen as the result of an entire
society’s failing to value nursing adequately. But the media is a key factor in
that failure.
OK, I can see that some media probably affect how people think about and
act toward nursing, like maybe a newspaper article. But how can some
4 0
television drama, sitcom, or commercial affect people that way? People

don’t take that stuff seriously!
The effects of fictional media are not always obvious, but they have been
felt throughout history in every culture, from Homer to Homer Simpson.
These effects have been recognized as important by the health community,
the news media, and even Hollywood. Today, more fictional media are more
available to more of the world’s people than ever before.
To believe that we can disregard everything we perceive in the entertain-
ment media because the scenarios presented aren’t literally “true,” we would
also have to believe that people disregard all messages in advertising, since
advertisements often present actors in simulated situations. But that is not
how our minds work.
In a recent television advertisement for the Dodge Caravan minivan, a
female operating room “nurse” asks a female “brain surgeon” which of two
scalpels she wants. The surgeon confidently explains which one she needs.
Then, in response to a similarly phrased question from the nurse, the surgeon
practically commands the nurse to buy a Caravan rather than a sport utility
vehicle. The advertisement also features a goofy male anesthesia professional
and a dopey male patient (who drives a sport utility vehicle). Later, the sur-
geon picks up her kids with the Caravan. The voiceover notes that it “doesn’t
take a brain surgeon” to know that there’s “no smarter choice.”44
We know we are not seeing real operating room workers. But that does
not stop us from absorbing the messages embedded in this clever advertise-
ment. Despite being fiction, the advertisement might influence our views of
the vehicle, the ability of women to become authoritative professionals, and
the knowledge and roles of physicians and nurses. Some of this result may be
“unplanned,” but all of it sells the minivan to the target demographic, which
is presumably working mothers. Most people would probably admit that this
advertisement has some positive influence on society’s overall view of women.
But that is because there is broad social understanding that women can now
become esteemed professionals. Nursing is not well understood, and society
has little basis to question the subtext that the brain surgeon is “smarter” than
the submissive nurse about health care (and everything else).
The idea that fictional media can influence public views and conduct is
not controversial in the field of public health. In their 2002 Kaiser Report,
Turow and Gans conclude that “fictional television can . . . play a significant
role in shaping public images about the state of our health care system and
policy options for improving the delivery of care.”45 Evidently recognizing
41
this, each summer from 2003 to 2007 the Robert Wood Johnson Foundation
distributed copies of Turow’s DVD essay “Prime Time Doctors: Why Should
You Care?” to about 20,000 US medical students.46
Glik notes that “an important aspect of health communication today is
working with the entertainment media to include or improve health messages
in popular programs.” A 2004 Kaiser Family Foundation Report confirmed
that “many groups have come to believe that entertainment media can play
an important positive role in educating the public about significant health
messages.”47 Conversely, Glik notes that a good deal of ongoing research has
found “unhealthy messages” in entertainment media, for instance smoking
in films, which Glik reports has been shown to influence rates of teenage
smoking. In fact, a July 2009 Dartmouth study published in the journal
Pediatrics found that any type of smoking character in movies made teenagers
more likely to try smoking, with characters perceived as “bad” actually being
most influential.48
Turow and Gans explain why entertainment television may actually
influence views of health care even more than the news media does:
Certainly TV dramas reach a much wider audience than most news

programs. Beyond the size of their audience, some media scholars
argue that entertainment TV’s impact can be even more powerful than
news in subtly shaping the public’s impressions of key societal insti-
tutions. The messages are more engaging, often playing out in com-
pelling human dramas involving characters the audience cares about.
Viewers are taken behind the scenes to see the hidden forces affecting
whether there’s a happy ending or a sad one. There are good guys and
bad guys, heroes and villains and innocent bystanders. Instead of bill
numbers and budget figures, policy issues are portrayed through the
lives of “real” human beings, often in life-and-death situations. These
health policy discussions take place not only in hospital dramas, but
also in dramatic storylines on programs like “Law and Order,” “The
Practice,” and “The West Wing.”
Hospital dramas provide an opportunity for viewers to learn spe-
cifically what goes on at the center of high-intensity medicine. The
dramas’ fictional presentations open curtains on relationships between
doctors and nurses, specialists and generalists. In ways that news
reports cannot, they play out various assumptions about how health
care ought to be delivered, about what conflicts arise that affect health
care, and about how those conflicts should be resolved and why. Doing
4 2
that, hospital dramas represent an important part of viewers’ curricu-

lum on the problems and possibilities of health care in America.
Even more to the point, Turow and Gans stress that television hospital dra-
mas’ “consistent focus on the relation of doctors and nurses with patients
who are in jeopardy make them the source of many viewers’ understandings
of how the health care system works.”49
Echoing these ideas, a 2008 report by the Kaiser Family Foundation and
the University of Southern California’s Hollywood, Health & Society proj-
ect noted that “entertainment television may be a uniquely powerful health
communication tool” because television, particularly prime time shows on
major networks, continues to have “enormous reach” and health information
“delivered through engaging storytelling—often involving characters the
viewer already ‘knows’ and cares about—is more likely to be attended to than
traditional health information sources.”50
In light of this great influence, Turow and Gans note, public health organi-
zations everywhere “are increasingly turning to entertainment media—from
soap operas to sitcoms to reality shows—as a way to reach the public with
health messages.” This growing effort is often called “entertainment educa-
tion.” Glik defines it as “a way of informing the public about a social issue or
concern” by “incorporating an educational message into popular entertain-
ment content in order to raise awareness, increase knowledge, create favorable
attitudes, and ultimately motivate people to take socially responsible action
in their own lives.” Much entertainment education results from what the
2004 Kaiser Report describes as “outreach efforts of special interest groups
or health agencies to deliver their message to audiences. These groups often
work with Hollywood-based advocacy organizations that serve as liaisons to
the entertainment community via industry forums, roundtable briefings, and
technical script consultations.”
Among the organizations devoting significant resources to entertain-
ment education in recent years are the Harvard and UCLA schools of public
health. In addition, USC’s Hollywood, Health & Society project has collabo-
rated with television producers to place messages on a wide variety of health
topics, including infectious diseases, diabetes, and health care access. That
project, part of the school’s Norman Lear Center, is a joint venture whose
sponsors include the Centers for Disease Control and Prevention (CDC).
The Kaiser Family Foundation has worked with various Hollywood shows to
place health messages and story lines on subjects including emergency con-
traception and teenage sexual activity. In an October 2009 episode of Private
43
Practice, the physicians gave free checkups at a shelter for homeless teenagers,
as part of the Entertainment Industry Foundation’s “iParticipate” project to
place storylines promoting community service.51 In a March 2013 episode of
Grey’s Anatomy, Sarah Chalke played a distraught mother whose son’s mys-
terious ailment was finally diagnosed as Kawasaki disease; the plotline was
entertainment education, the result of Chalke lobbying Grey’s producers after
her own son was belatedly diagnosed with the rare condition.52
In October 2013 American Public Media’s Marketplace radio show
reported that The California Endowment had given a substantial grant to
Hollywood, Health & Society to encourage shows to do plotlines to promote
understanding of the Affordable Care Act. The report noted that shows like
Grey’s Anatomy and Scrubs had found drama in insurance coverage issues, and
it quoted Norman Lear Center director Marty Kaplan: “People learn from
TV. Even if they know it is fiction, even if they know that writers can make
stuff up, especially in the realm of medicine and public health, if a doctor says
something to a patient, people tend to think that someone has checked that,
that it’s true.”53
The health community’s entertainment education efforts are not con-
fined to the developed world. In December 2004 press reports described
a Cambodian soap opera created by British soap guru Matthew Robinson
and funded by the BBC World Service Trust to educate Cambodians about
disease, especially HIV/AIDS. Taste of Life reportedly “follows five student
nurses and a student doctor as they move through a nursing college, the local
pub and ‘Friendship Hospital.’ ”54
On the other hand, public health scholars confirm that Hollywood shows
can also cause real harm. Purdue communications professor Susan Morgan
is the coauthor of research suggesting that negative entertainment television
portrayals of organ donation (including on Grey’s Anatomy) have contrib-
uted to negative views about the vital health practice. Morgan is quoted in
a September 2007 Forbes article: “It’s hard not to get kind of outraged when
you see what’s going on. You could start drawing this out to real human lives
being lost.”55
Hollywood itself embraces the idea that it can have a positive effect on pub-
lic health. Indeed, many industry figures seem proud to have improved health
through entertainment. In presenting former ER producer (and physician)
Neal Baer with a public service award in December 2003, the Writers Guild of
America lauded him for “creating a culture of medical accuracy and ground-
breaking realism that revolutionized the primetime landscape.”56 The Writers
Guild of America also asserted that the producer’s “passion for medical
4 4
accuracy has paid dividends to the American public, as a recent Harvard study
revealed most Americans learn more about health-related problems from
series television like Law and Order: Special Victims Unit than from their
own doctors.” In addition to running SVU for more than a decade, Baer was
responsible for A Gifted Man, and he has long cochaired the advisory board
of Hollywood, Health & Society. Likewise, in a 2004 issue of TV Guide, a
medical adviser and an executive producer from ER were eager to celebrate
the show’s apparent influence on the number of women pursuing emergency
medicine.57 In a 2005 NPR interview, Grey’s creator Shonda Rhimes stressed
that her show could help people of color, because “the way people look at
people on television is the way they perceive the world. And for me the idea
of the show, part of it, is that we can change the assumptions that people have
simply by the images they see in the background of the show.”58
But sadly, those who proclaim the positive health effects of Hollywood
shows seem unwilling to consider how the industry’s inaccurate depiction of
nurses as peripheral subordinates could have negative effects. Although there
is no dispute that the shows affect social views and knowledge of disease,
viewers must have some innate filter that blocks even the most compelling
media information about health workers’ professional roles.
In fact, as we have shown, physicians have long understood the power
of entertainment media. In her article “Doc Hollywood,” Suzanne Gordon
describes the “symbiotic relationship” physicians have with Hollywood,
which “has been an active partner in the creation of a heroic medical narrative
that has shaped Americans’ view of health care . . . and conferred status on
medical practitioners and specialists.”59 Today, physicians like Baer provide
virtually all significant expert health care advice for entertainment program-
ming other than the recent nurse shows. Nurses may be on set adjusting minor
technical details, but physicians are the ones who consult regularly on and
even write the scripts that actually drive the shows. Indeed, ER was created by
physician Michael Crichton, and a number of its key writers have been physi-
cians. At least one House writer was a physician. The creator of Scrubs based
the show on the experiences of one of his best friends, a physician who advised
the show.
In 2006–2007, there was a notable burst of US news articles addressing
how entertainment programming affects viewers’ health-related actions.
In October 2006, the Orange County Register ran Lisa Liddane’s “Paging
Dr. Nielsen: TV medical shows.” The piece examined how popular hospi-
tal dramas like Grey’s Anatomy reflect and shape real-life health matters.
Producers, physician writers, and public health experts confirmed that
45
although such shows are fiction, they affect what the public thinks about
health care. Vicky Rideout of the Kaiser Family Foundation noted that “TV
medical dramas contribute to agenda-setting—and influence how people
look at situations and professions.”60
Many similar and higher-profile articles followed, all focusing on the accu-
racy of the shows’ technical portrayal of medical conditions. A March 2007
article in Reader’s Digest, Mary A. Fischer’s “Docs in the Box,” mentioned
one nurse: Grey’s consultant Linda Klein. Star Ellen Pompeo assured readers
Klein “takes the time to show us exactly how something should be done.”61
That is, the nurse consultant shows the actors playing physicians how to do
important things nurses really do, and lends an air of realism to a show that
portrays her profession as trivial scut work.
A few of the later articles focused on the inaccurate nursing portrayals on
these shows. Carol Ann Campbell’s excellent “Nurses Urge TV Dramas: Get
Real,” in the New Jersey Star-Ledger in January 2007, had nurses explain how
television dramas regularly show physicians doing important work that nurses
really do, while showing nurses as peripheral subordinates. House creator
David Shore admitted to the Star-Ledger that his show “ignores” nurses but
said that the character Greg House treats everyone badly. In fact, the show gen-
erally treated nurses in the same contemptuous way House did and made little
effort to rebut House’s slurs. Shore even resorted to noting that his mother is
a nurse and she “loves” the show.62 In September 2007 Forbes ran Allison Van
Dusen’s “Playing Doctor: Medical TV Isn’t Always Right,” which addressed
the effects of popular health-related drama, including the concerns of nurses.
It noted that nurse characters tend to absorb abuse from physicians like House
with no response, reinforcing the image of nurses as meek servants.63
More recently, a few helpful articles have focused directly on nurses’
concerns with entertainment media. In January 2010, Baltimore Sun health
reporter Kelly Brewington posted “TV Nurses—The Good and the Bad,” a
widely reprinted look at the Truth’s 2009 awards for best and worst media
portrayals of nurses.64 In April 2010, the Voice of America ran “Nurse, I Need
a Reality Check: Hollywood shapes many perceptions of medical profes-
sionals but that’s a problem for real-life nurses,” an in-depth report by Faiza
Elmasry with quotes from Sandy Summers and Johns Hopkins nurses.65 In
April 2012, More magazine published Jessica Testa’s “A Real Nurse Rates the
TV Fakes,” with critical commentary on major hospital shows then on the air
(the “real nurse” was Sandy Summers).66
This is an era of media saturation, diverse content, and technological
development—an age of virtual reality. It is increasingly difficult to tell what
4 6
is “real.” There is little doubt that today’s “fictional” media profoundly affects
how we think and act.
Fine, I get that public health and communications scholars, physicians,

and even Hollywood believes the entertainment media affects real world
health. But does any recent research say so?
Recent research has shown that the entertainment media, especially televi-
sion, has a clear and powerful effect on viewers’ health-related thoughts—and
actions. This influence flows not only from prime-time dramas like Grey’s
Anatomy and ER but even from sitcoms and soap operas.
Research has directly addressed how the entertainment media affects
public views of health care workers, including nurses. In their 2002 Kaiser
Report, Turow and Gans noted that their research had found that physi-
cians dominated discussions of health policy issues on US hospital dramas,
whereas nurses hardly appeared.67 The 2008 Kaiser Report evaluated the top
10 scripted prime-time US shows of all types in each year during the period
2004–2006 (including Grey’s, House, and ER) and reported that “popular
prime time television conveys a substantial amount of health information.”
The study concluded that the shows mostly portrayed characters dealing with
“a wide range of health issues” and receiving “quality care from physicians
with whom they have favorable interactions”—although that conclusion was
not an effort to draw attention to the dominance of physician characters, but
instead seemed to reflect the same basic assumption seen in the shows them-
selves: health care = physician care.68 A 2009 study published in the Journal of
Broadcasting and Electronic Media by University of Illinois health communi-
cation scholar Brian Quick found that regular Grey’s viewers were more likely
to view real physicians similarly to the show’s physician characters—as smart,
pretty, capable, and interesting.69
Some studies have focused on how the popular media affects those
who might consider nursing careers. In 2000 the advertising agency JWT
Communications conducted a focus group study of 1,800 US youngsters in
grades two through ten; respondents said they received their main impression
of nursing from ER. They knew more about the nurses’ love lives than their
professional work. Consistent with the show’s physician-centric approach,
the young people wrongly said nursing was a girl’s job, that it was a techni-
cal job “like shop,” and that it was not a career for private school students, of
whom more was expected.70
47
A 2008 University of Dundee (Scotland) study found that media imagery

discouraged academically advanced primary school students from pursuing
nursing careers by presenting nurses as, in the words of one student, “brain-
less, sex-mad bimbos” looking to “romance” physicians. Consistent with the
earlier JWT research, the Dundee study found that the students’ main source
of images about nursing was television. Based on all imagery, the students
concluded that becoming a nurse would not be “using their examination
grades to maximum benefit.”71
A 2013 study by Roslyn Weaver and colleagues measured the views on
health-related television shows held by 484 Australian nursing students, for
whom the most-watched show was Grey’s Anatomy. Most of the nursing
students found that the shows presented nurses as handmaidens dither-
ing with unimportant things while physicians did the work that mattered.
Most also believed that television lacked role models to inspire the next
generation of nurses.72
In 2012 a study at University College Dublin (Ireland) found that
the most popular videos posted on the YouTube website stereotype nurses
as stupid and/or sex objects. The researchers found that, of the ten most
popular nurse-related YouTube videos, four portrayed nurses as sex objects,
two showed nurses as stupid or incompetent, and only four—all posted by
nurses themselves—showed nursing as a skilled and caring profession. All
six of the stereotypical depictions were drawn from television products or
advertisements.73
A May/June 2008 Nursing Economics study confirmed that the media
affects public understanding of nursing—although the article claimed that
nursing is “highly respected.”74 The 2007 public opinion research on which
the article relied was funded by drug company Johnson & Johnson, which
we had faulted for airing television recruiting advertisements promoting an
unskilled angel image of nursing. One survey question asked respondents
whether certain broad categories of media made them “respect” nurses more
or less. A category consisting of the television shows ER, Scrubs, House, and
Grey’s Anatomy reportedly made no difference to 66 percent of respondents
but made 28 percent respect nurses more, and only 5 percent respect nurses
less. The vague category “advertisements about nursing”—which presum-
ably included the Johnson & Johnson advertisements—had no effect on
60 percent, but supposedly created more respect in 38 percent and less in
only 1 percent. In fact, none of the media tested had a large negative effect.
Evidently, either every class of media creates positive views of nurses, or else
4 8
only the positive media affects people. The Nursing Economics survey was
too vague and subject to self-reporting bias to provide much useful data.
Respondents are unlikely to admit to a pollster that the media makes them
“respect” real nurses less. Most people know they are supposed to honor
nurses in the abstract. But this generalized affection has not translated into the
resources that would show real respect for nurses as professionals. “Respect”
can mean different things: is it respect for nurses’ life-saving skills, or for their
hearts of gold? The study failed to reconcile its shiny happy results with what
the media it tested actually said about nursing.
Entertainment television’s influence on healthcare views is broad and
strong. When the US CDC surveyed prime-time television viewers in 2000,
they found that most (52 percent) reported getting information that they
trust to be accurate from prime-time television shows.75 More than a quarter
said such shows were among their top three sources for health information.
Nine out of ten regular viewers said they learned something about diseases
from television, with almost half citing prime-time or daytime entertainment
shows. Moreover, almost half of regular viewers who heard something about a
health issue on a prime-time show said they took one or more actions, includ-
ing telling someone about the story line (42 percent), telling someone to do
something, or doing it themselves, such as using a condom or getting more
exercise (16 percent), or visiting a clinic or health provider (9 percent).76
Recent research has also shown that entertainment shows affect public
views of specific areas of health care. One 2007 study published in Health
Communication found that organ donation was presented in a negative or
inaccurate way in the great majority of plotlines in fictional prime-time and
daytime shows (including comedies and soap operas) in 2004 and 2005.77
A 2005 study published in Clinical Transplantation found that respon-
dents who had negative views of organ donation often mentioned what they
had seen on television as a basis for their opinions.78 A 2007 study by Yale
researchers published in the journal Plastic & Reconstructive Surgery found
that plastic surgery reality shows played an important role in patients’ knowl-
edge and decisions about the procedures.79
Substantial research has confirmed the influence of specific shows. One
striking January 2014 study by two economists found that the MTV real-
ity franchise 16 and Pregnant, including its Teen Mom sequels, had not only
sparked more online activity regarding birth control and abortion, but “ulti-
mately led to a 5.7 percent reduction in teen births in the 18 months follow-
ing its introduction,” accounting for “around one-third of the overall decline
in teen births in the United States during that period.”80 A 2011 study at the
49
University of Western Sydney found that about 94 percent of 386 medical

students surveyed watched popular health-related entertainment shows, such
as Grey’s Anatomy, House, and Scrubs, with 48 percent of female medical stu-
dents watching Grey’s.81 The students reported that they had discussed ethi-
cal and medical issues presented on at least one show with their friends “and
most believed that medical programs generally portrayed ideals of profes-
sionalism well.”82 In September 2008, the Kaiser Family Foundation released
a study showing that an embedded Grey’s Anatomy plotline about maternal
HIV transmission had significantly increased audience understanding of the
issue.83 The show’s “director of medical research” helped to publicize the study,
and she told TV Guide that the show took its influence “very seriously.”84
Many studies have also documented ER’s effects on views about health
care—even the views of health professionals. A 2009 University of Alberta
study published in the journal Resuscitation found that many residents and
medical students had learned incorrect intubation techniques by watching
ER and other shows.85 A 1998 article in the Journal of the American Medical
Association concluded that medical students’ reactions to shows like ER sug-
gested that the students “may incorporate the attitudes and beliefs of phy-
sicians on television in much the same way they acquire the qualities and
behaviors of physicians through their experiences in patient care.” The article
cited research showing the dramatic growth in emergency department medi-
cal residencies since ER’s premiere a few years earlier.86
A Kaiser Family Foundation survey found that more than half of those
who were regular ER viewers during the 1997–2000 seasons said they learned
about important health issues while watching the show. Almost a third said
information from the show helped them make choices about their family’s
health care. Almost a quarter had sought further information about a health
issue, and 14 percent had actually contacted a health care provider because
of something they saw in an ER episode.87 According to a 2001 Kaiser
Foundation National Survey of Physicians, “one in five doctors say they are
consulted ‘very’ or ‘somewhat’ often about specific diseases or treatments that
patients heard about on TV shows such as ER.”88
ER also affects what viewers think about specific conditions. In
September 2007, University of Southern California researchers published a
study in the Journal of Health Communication that found those who saw an
ER plotline about teenage obesity and hypertension were 65 percent more
likely to report that they had acted in a healthier way.89 A 2002 study at the
Harvard School of Public Health found that regular ER viewers were far
more aware (57 versus 39 percent) of the need to get a smallpox vaccination
5 0
right after exposure to the disease following an ER episode dealing with

the subject.90
Entertainment media does not have to be mainly about health care to
affect viewers’ understanding of health care issues, as the 2008 Kaiser Report’s
analysis of all types of scripted shows indicated. In 2002 a RAND Health sur-
vey of regular viewers of the sitcom Friends aged twelve to seventeen found
that respondents retained important information from a story line depicting
an unplanned pregnancy caused by condom failure. The report concluded
that “entertainment television can be most effective as an educator when
teens and parents view together and discuss what they watch.”91
The effects of health-related entertainment programming are also not
confined to popular prime-time shows. In 1999 a CDC survey “found that
many daytime viewers also report learning about health issues from TV.”
Almost half of regular daytime drama viewers reported learning something
about a disease from watching soap operas. Over one-third reported taking
some action after hearing about a health issue or disease on a soap opera.92
And a 2004 study published in the Journal of Communication found that
after an episode of The Bold and the Beautiful with an HIV subplot, and sub-
sequent display of the CDC’s National STD and AIDS hotline, calls to the
hotline spiked.93
This wealth of research shows that entertainment programming is easily
“realistic” enough to affect real world health care—including nursing.
Well, if all that research shows how influential Hollywood is, why won’t
the industry improve its damaging portrayal of nursing?
So far, despite the minor impact of the recent nurse-focused shows,

Hollywood’s responses to critics of its nursing portrayal have been inad-
equate. The industry argues that Hollywood shows are not documentaries
and producers must have “dramatic license”; that entertainment media has
to focus on physicians because that’s what viewers want; that it’s just a mean
central character who hates nurses, the show really loves them; that there was
a shortage of nurses before their show came on the air; that nurses do advise
the show and they work on set ensuring “medical accuracy”; that the show
creator’s mother or sister is a nurse and she just loves the show; and that the
show works super-hard, really, to present an accurate portrayal of all health
professionals. But none of that has prevented the industry from offering hun-
dreds of hours of damaging misportrayals of nursing.
51
The factors underlying Hollywood’s overall failure to portray nursing

fairly are complex and varied. In our view, they include:
• entrenched stereotypes about nursing that persist even among the edu-
cated media elite, despite the increasing scope and complexity of modern
nursing care;
• Hollywood’s reliance on conventions and its fairly light focus on the com-
plex realities of society compared to the focus of the news media, which is
trained to at least try to report what it actually sees, rather than just what
its audience expects to see;
• the fact that nursing remains overwhelmingly female, while men still con-
trol most Hollywood programming, and that nursing has not generally
enjoyed the respect or understanding of media “feminists” with the power
to effect change;
• insufficient support from physicians, who are often the beneficiaries of the
misportrayal of nursing, and who provide most meaningful health care
advice in Hollywood;
• nursing’s own overall failure to represent itself well to the media and the
public at large;
• the failure of nurses’ concerns, even when assertively presented, to be taken
as seriously as the concerns of other groups, perhaps owing to the Catch-22
of the poor image itself (why pay attention to nurses when they’re just
unskilled handmaidens?); and
• “PC fatigue” and an apparent belief among “progressive” media creators
that their work has a positive social impact (e.g., on race, gender, and sex-
ual orientation issues), immunizing them from having to consider whether
their work could also be causing harm because they don’t actually under-
stand some things as well as they imagine.
At one time, healthcare media creators might have believed they had to
include nurses to get a good gender mix and good drama. But today, with so
many female physicians, most media creators evidently feel that they need not
include any significant nurse characters at all. On serial television, once all the
main characters are physicians, the need to constantly sell those characters
means they’re going to be doing every meaningful act, regardless of what hap-
pens in real life.
You might think physicians, who wield so much power in Hollywood,
would have a better sense of nursing. Some physicians do. But much
5 2
physician conduct seems to reflect a narrow, internally focused approach that

assumes physicians provide all important health care and need not consider
unexpected information. Physicians in general know little about nursing.
Some physicians have even said that nurses get “too much education” and
that they could “train monkeys” to do nurses’ jobs.
But don’t nurses bear some responsibility for the poor understanding of
their profession?
Yes, of course. But we focus on the media’s treatment of nursing because

most of it is wildly inaccurate or distorted. Millions are given access to the
lives and work of nurses through the media, so the media plays an enormous
role in shaping and reinforcing social beliefs, as public health research shows.
The popular media also provides an excellent vehicle to engage the public’s
interest. With its focus on celebrities and compelling characters, the media
presents a set of common social reference points in which large parts of the
world public already have a deep interest.
Nursing itself has many problems. Far from trying to substitute a positive
stereotype of nurses for the negative ones, we simply want people to look at
nurses as they really are. We also recognize that nurses often do not present
themselves in an ideal way; we discuss that in Chapter 11. From major nursing
institutions that continue to embrace unskilled “angel” imagery (“Nurses have
a passion for caring!”), to nurses who welcome the idea that people will assess
them professionally by how “hot” they are, to nurses who disclaim their own
autonomy or won’t speak up in clinical or public settings about the work they
really do, to nurses who show the Hollywood actors playing physicians how
to do things nurses really do—there is plenty of responsibility to go around.
Solving nursing’s problems will require a range of strategies. Improving
public understanding is one of the most important.
But that television show just happens to be about physicians. Even if it

might help nursing to include nurse characters, how can you expect the
show to do that?
In mid-2012, as House ended its eight-year run, all twenty-seven major

characters on the top three US hospital dramas just “happened” to be phy-
sicians. In all those hospital shows, in hundreds of hours of programming
seen by many millions around the world, the physician characters just “hap-
pened” to spend half their time doing key tasks that nurses do in real life.
53
Those are not random phenomena. Despite the recent appearance of a few
nurse-focused shows with limited reach, we see no sign that things will soon
even out, that the most popular shows will spend many years with 100 per-
cent nurse characters, who will spend lots of time on tasks physicians really
do. Today’s healthcare media landscape reflects a critical lack of understand-
ing of nursing and widespread social bias.
What seems to just “happen” in Hollywood is actually driven by the
vast gulf between what media creators think and how things really are. In
Hollywood, physicians single-handedly save lives. In real life, nurses also
save countless lives. In Hollywood, physicians do virtually all critical proce-
dures, like defibrillation. In real life, nurses perform many critical procedures,
including most defibrillations. In Hollywood, physicians stay with patients
24/7, providing monitoring, emotional support, and education. In real life,
nurses do that. In Hollywood, nurses are mute, deferential physician servants.
In real life, they are autonomous professionals with years of college-level edu-
cation who play the central role in hospitals. Their work is challenging and
exciting, and they use their advanced skills to improve patient outcomes every
day, often with little or no involvement from physicians.
Sorry, but even if media stereotypes do undermine nursing, I just don’t see
why I should care. What’s in it for me?
You get to live. People sometimes ask journalist Suzanne Gordon why she,
not a nurse, has worked so hard to publicize the roots of the nursing crisis
and potential solutions. Her response is that it’s enlightened self-interest: she
wants someone to be there to care for her when she needs it. Having too few
nurses leads to worse patient outcomes, suffering, and death.
The effects of the undervaluation of nursing are everywhere. When nurses
lack resources, patients do not receive vital care. When nurses lack resources,
they burn out and leave the bedside. When nurses lack social power, they can-
not advocate for patients, and patients die needlessly from healthcare errors
and incompetence. A March 2013 story in The Washington Post about efforts
to help physicians manage their anger included reports of deaths in California
because nurses were too scared of physicians to alert them to worrisome fetal
monitor readings.94 A March 2011 New York Daily News piece reported that
a local hospital nurse had allegedly been fired for trying to expose her col-
leagues’ refusal to treat a homeless man who was later found dead outside
the hospital.95 A November 2007 Associated Press article reported that oper-
ating room nurses at a Rhode Island hospital had repeatedly failed to stop
5 4
life-threatening surgical errors—like operating on the wrong side of a patient’s

head—because they lacked the social power to do so.96 A March 2009 feature
in the Sunday Times (U.K.) 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.97
When nurses lack social power, they also suffer abuse from patients and col-
leagues. Although data about the extent of that abuse varies, Rose Chapman
and colleagues found in a 2010 study of Australian hospital nurses that more
than half had been physically assaulted at work in the past year, with an aver-
age of twenty-one incidents of assault per nurse per year!98 A 2002 study by
May and Grubbs found that 74 percent of all nurses and 82 percent of emer-
gency nurses surveyed at one Florida hospital had been physically assaulted
in the preceding year.99 The 2010 Australian study found that nurses do not
tend to report the violence unless they have been injured—96 percent of
incident reports revealed nurse injury. In fact, the nurses did not report five
of six assaults because they believed violence “was just part of the job”; per-
haps that had something to do with the fact that 50 percent of the reports to
senior managers were met with inaction.100 The research shows that triggers
for abuse generally relate to some dysfunction in the health system, including
the enforcement of hospital policies and long wait times, which, of course,
often result from understaffing.101
Abuse doesn’t come only from patients. Visitors and family members
are just as likely to be the assailant as are the patients.102 A 2009 study of
Canadian nurses in the Journal of Nursing Management found that 77 per-
cent of the nurses had been bullied by coworkers.103 A 2008 study by the Joint
Commission that accredits hospitals found that more than half of US nurses
had been bullied on the job.104 Common effects on the nurses include severe
distress, depression, insomnia—and nurses themselves continuing the cycle
of abuse.
These are the people who hold your life in their hands.
Notes
1. TAN, “Q: Nurses Are Just Wonderful, but You Really Can’t Expect Hollywood to
Focus on Them, Can You? After All, Popular Media Products Have to Be Dramatic
and Exciting. Why Don’t You Just Focus on Getting a Nursing Documentary on
PBS or Basic Cable?,” accessed January 24, 2014, http://tinyurl.com/ndvwsbz.
55
2. Tina Rosenberg, “The Family Doctor, Minus the M.D.,” New York Times (October
24, 2012), http://tinyurl.com/9cjwrvj; TAN, “Fixes” (October 24, 2012),
http://tinyurl.com/ke7dmo8.
3. WBUR, “Nursing a Shortage: Inside Out” ( January 19, 2007), http://tinyurl.
com/ljolky2; CFNA, “Our Favourite Worst Nightmare,” TAN ( January 19, 2007),
http://tinyurl.com/putwtfs.
4. Tony Kushner, writer, Mike Nichols, director, Angels in America, HBO Films
(2003); CFNA, “Angels in America,” TAN (April 4, 2004), http://tinyurl.com/
mqcbd3l.
5. The University of Rochester School of Nursing, “Woodhull Study on Nursing
and the Media: Health Care’s Invisible Partner,” Sigma Theta Tau International
(1997), http://tinyurl.com/kwgguga; Bernice Buresh, Suzanne Gordon, and Nica
Bell, “Who Counts in News Coverage of Health Care?,” Nursing Outlook 39, no. 5
(September/October 1991): 204–208.
6. Pedro Alcântara da Silva, “A Saúde nos Media. Representações do Sistema de
Saúde e das Políticas Públicas na Imprensa Escrita Portuguesa,” Mundos Sociais
(Lisboa, 2011), http://tinyurl.com/l28ltk7.
7. Rodrigo José Martins Cardoso, João Manuel Garcia de Nascimento Graveto, and
Ana Maria Correia Albuquerque Queiroz, “The Exposure of the Nursing Profession
in Online and Print Media,” Revista Latino-Americana de Enfermagem 22, no. 1
( Jan-Feb 2014): 144, doi:10.1590/0104-1169.3144.2394, http://tinyurl.com/
lr3yo88.
8. Maria Aparecida Baggio and Alacoque Lorenzini Erdmann, “The (In)visibility of
Caring and of the Profession of Nursing in the Relations Space,” Acta Paulista de
Enfermagem 23, no. 6 (2010): 745–750, http://tinyurl.com/k6wr62f.
9. TAN, “Grey’s Anatomy Analyses and Action,” accessed January 29, 2014, http://
tinyurl.com/pgayg7h.
10. TAN, “House Single Episode Reviews” (2011), http://tinyurl.com/py4b5ug.
11. TAN, “Private Practice Individual Episode Analyses” (2013), http://tinyurl.com/
lecehka.
12. CFNA, “Nurses Are about 100 Times More Likely to Attend Graduate Nursing
School than Medical School,” TAN (2002), http://tinyurl.com/p7orchc.
13. TAN, “Letting the Exiles Bleed on Main Street” (April 2010), http://tinyurl.com/
kunazup.
14. TAN, “Commander” (September 2011), http://tinyurl.com/n8z5zum.
15. TAN, “A Gifted Man: The Lionel Messi of Surgeon Glorification” (March 2, 2012),
http://tinyurl.com/kr88jes.
16. TAN, “Admiring Their Credentials” ( January 12, 2011), http://tinyurl.com/
oe9eox7.
17. CFNA, “Cinema Faux,” TAN ( June 26, 2008), http://tinyurl.com/m48c3bx.
18. TAN, “Physicians Are Awesome” ( July 22, 2010), http://tinyurl.com/o7m9olh.
5 6
19. TAN, “Scrubbing Out” (October 24, 2013), http://tinyurl.com/nwb8zn9.

20. Jo Brand, Vicki Pepperdine, Joanna Scanlan, Mark V. Olsen, and Will Scheffer,
creators, Getting On, HBO, accessed March 24, 2014, http://www.hbo.com/
getting-on.
21. TAN, “ER Episode Analyses” (2009), http://tinyurl.com/odsbmqw.
22. TAN, “Scrubs Episode Analyses” (2009), http://tinyurl.com/p9n8e58.
23. TAN, “Nurse Jackie Episode Reviews,” accessed March 24, 2014, http://tinyurl.
com/kqm3k6b.
24. TAN, “Mercy Episode Reviews” (2010), http://tinyurl.com/kj3t63s.
25. TAN, “HawthoRNe Episode Reviews” (2011), http://tinyurl.com/jwd7neg.
26. TAN, “Call the Midwife Episode Reviews,” accessed March 24, 2014, http://tinyurl.
com/m3bf4lw.
27. Cathryn Domrose, “Mending Our Image,” NurseWeek ( June 26, 2002), http://
tinyurl.com/l6j486c.
28. Beatrice J. Kalisch and Philip A. Kalisch, “Anatomy of the Image of the
Nurse: Dissonant and Ideal Models,” American Nurses Association Publications
G-161 (1983): 3–23. See generally “The Work of Beatrice Kalisch and Philip Kalisch
on Nursing’s Public Image and the Nursing Shortage,” TAN, accessed January 29,
2014, http://tinyurl.com/lq3ebxh.
29. CFNA, “A Farewell to Arms,” TAN (2003), http://tinyurl.com/mj7hyo2.
30. CFNA, “Rear Window,” TAN (2003), http://tinyurl.com/oyre8hy.
31. CFNA, “One Flew Over the Cuckoo’s Nest,” TAN (2003), http://tinyurl.com/
pvz3267.
32. CFNA, “M*A*S*H” (film review), TAN (2003), http://tinyurl.com/qc58j2k.
33. CFNA, “M*A*S*H” (television review), TAN (2003), http://tinyurl.com/
opyqegz.
35. TAN, “Strong Medicine Single Episode Analyses” (2006), http://tinyurl.com/
o5q2awp.
37. TAN, “Off the Map Single Episode Analyses” (2011), http://tinyurl.com/oc5vaqg.
38. Kantar Media, “Kantar Media Reports U.S. Advertising Expenditures Increased 3
Percent in 2012” (March 11, 2013), http://tinyurl.com/lspr69o.
39. Robert Jensen and Emily Oster, “The Power of TV: Cable Television and Women’s
Status in India” (September 23, 2008), http://tinyurl.com/q4bzpfp.
40. Rajiv N. Rimal and Maria K. Lapinski, “Why Health Communication Is Important
in Public Health,” Bulletin of the World Health Organization 87 (2009): 247,
http://tinyurl.com/da6dg3.
41. Jerry C. Parker and Esther Thorson, Health Communication in the New Media
Landscape (New York: Springer Publishing, 2009), http://tinyurl.com/l2qwnme.
57
42. Deborah Glik, “Health Communication in Popular Media Formats” (paper

presented at the 131st annual meeting of the American Public Health Association,
San Francisco, California, November 15–19, 2003), http://tinyurl.com/ohx64ds.
43. Joseph Turow and Rachel Gans, “As Seen on TV: Health Policy Issues in TV’s
Medical Dramas,” Kaiser Family Foundation (2002), http://tinyurl.com/lfpy9jz.
See generally Joseph Turow, Playing Doctor: Television, Storytelling, and Medical
Power (Ann Arbor: University of Michigan Press, 2010), http://tinyurl.com/
nmdyvjv.
44. DaimlerChrysler, “It Doesn’t Take a Brain Surgeon,” Dodge Caravan commercial
(2003), http://tinyurl.com/k3qp2n9.
45. Turow and Gans, “As Seen on TV,” http://tinyurl.com/lfpy9jz.
46. Bill D. Herman, The Fight Over Digital Rights: The Politics of Copyright and
Technology (New York: Cambridge University Press, 2013): xv, http://tinyurl.com/
mvy2vkp.
47. Kaiser Family Foundation, “Entertainment Education and Health in the United
States” (2004), http://tinyurl.com/n33q8uf.
48. Dartmouth College, “Both Good and Bad Movie Characters Who Smoke
Influence Teens to Do the Same,” Science Daily 3 ( July 2009), http://tinyurl.
com/n2vuea; Susanne E. Tanski, Mike Stoolmiller, Sonya Dal Cin, Keilah Worth,
Jennifer Gibson, and James D. Sargent, “Adolescent Smoking: Who Matters
More, Good Guys or Bad Guys?,” Pediatrics 124, no. 1 ( July 2009): 135–143,
http://tinyurl.com/kwaxbx3.
50. Kaiser Family Foundation and Norman Lear Center, “How Healthy Is Prime
Time?,” Hollywood, Health and Society (September 2008): 1, http://tinyurl.com/
ky6x4pk.
51. Matea Gold and Maria Elena Fernandez, “Community Service as a TV Theme,” Los
Angeles Times (October 19, 2009), http://tinyurl.com/pgdqdps.
52. Marc Malkin, “Sarah Chalke’s Very Personal Grey’s Anatomy,” TV Scoop (March 28,
2013), http://tinyurl.com/qf778kv.
53. Adriene Hill, “Hollywood Writes a New Storyline for Obamacare,” Marketplace
(October 20, 2013), http://tinyurl.com/lsw66fx.
54. Elena Lesley, “New Soap Helps Battle AIDS,” Phnom Penh Post (December 3,
2004), http://tinyurl.com/m27couh.
55. Allison Van Dusen, “TV’s Medical Missteps,” Forbes (September 19, 2007),
http://tinyurl.com/lg2adh3.
56. Writers Guild of America, West, “Neal Baer to Receive Valentine Davies Award
from Writers Guild of America, West,” press release (December 1, 2003),
http://tinyurl.com/kwgx3wb.
57. Mary Murphy, “The Women Who Revived ER,” TV Guide (February 14, 2014),
http://tinyurl.com/lvtmaqh.
5 8
58. Ed Gordon, “An Ethnically Diverse ‘Grey’s Anatomy,’” National Public Radio
(March 25, 2005), http://tinyurl.com/phpkpw2.
59. Suzanne Gordon, “Doc Hollywood,” The American Prospect (November 5, 2001),
http://tinyurl.com/kz58hcc.
60. Lisa Liddane, “Paging Dr. Nielsen: TV Medical Shows,” Orange County Register
(October 8, 2006), http://tinyurl.com/lyx3nsx.
61. Mary A. Fischer, “Docs in the Box,” Reader’s Digest (March 2007), reprinted
January 15, 2010, http://tinyurl.com/krp7upc.
62. Carol Ann Campbell, “Nurses Urge TV Dramas: Get Real,” The Star-Ledger
( January 28, 2007), http://tinyurl.com/k5ofcbl.
63. Allison Van Dusen, “Playing Doctor: Medical TV Isn’t Always Right,” Forbes
(September 20, 2007), http://tinyurl.com/n5jvn7x.
64. Kelly Brewington, “TV Nurses—The Good and the Bad,” Baltimore Sun ( January 7,
2010), http://tinyurl.com/pn7ncku.
65. Faiza Elmasry, “Nurse, I Need a Reality Check,” Voice of America (April 13, 2010),
http://tinyurl.com/qj6f5do.
66. Jessica Testa, “A Real Nurse Rates the TV Fakes,” More (March 26, 2012),
http://tinyurl.com/qxluqod.
68. Kaiser and Norman Lear, “How Healthy” (September 2008): 14, http://tinyurl.
com/ky6x4pk.
69. Brian L. Quick, “The Effects of Viewing Grey’s Anatomy on Perceptions of Doctors
and Patient Satisfaction,” Journal of Broadcasting and Electronic Media 53, no. 1
(March 12, 2009): 38–55, http://tinyurl.com/leogd7d.
70. JWT Communications, “Memo to Nurses for a Healthier Tomorrow Coalition
Members on a Focus Group Study of 1800 School Children in 10 US Cities,” TAN
(2000), http://tinyurl.com/l2q5mma.
71. Gavin R. Neilson and William Lauder, “What Do High Academic Achieving
School Pupils Really Think about a Career in Nursing: Analysis of the Narrative
from Paradigmatic Case Interviews,” Nurse Education Today 28 (2008): 680–690,
http://tinyurl.com/m8ewewz.
72. Roslyn Weaver, Yenna Salamonson, Jane Koch, and Debra Jackson, “Nursing on
Television: Student Perceptions of Television’s Role in Public Image, Recruitment
and Education,” Journal of Advanced Nursing 69, no. 12 (December 2013): 2635–
2643, http://tinyurl.com/oy6o2or.
73. Jacinta Kelly, Gerard M. Fealy, and Roger Watson, “The Image of You: Constructing
Nursing Identities in YouTube,” Journal of Advanced Nursing 68, no. 8 (2012):
1804–1813, http://tinyurl.com/k5carcm.
74. Karen Donelan, Peter Buerhaus, Catherine Desroches, Robert Dittus, and David
Dutwin, “Public Perceptions of Nursing Careers: The Influence of the Media and
Nursing Shortages,” Nursing Economics 26, no. 3 (2008), http://tinyurl.com/
mram6xl.
59
75. Centers for Disease Control (CDC), “Entertainment Education: 2000 Porter
Novelli Healthstyles Survey” (2000), http://tinyurl.com/k9qastz.
States” (2004), http://tinyurl.com/n33q8uf.
77. Susan E. Morgan, Tyler R. Harrison, Lisa Chewning, LaShara Davis, and Mark
DiCorcia, “Entertainment (Mis)Education: The Framing of Organ Donation
in Entertainment Television,” Health Communication 22, no. 2 (August 2007):
143–151, http://tinyurl.com/nmde27r.
78. Susan Morgan, Tyler Harrison, Shawn Long, Walid Afifi, Michael Stephenson,
and Tom Reichert, “Family Discussions about Organ Donation: How the Media
Influences Opinions about Donation Decisions,” Clinical Transplantation 19, no. 5
(2005): 674–682, http://tinyurl.com/kck563a.
79. Richard J. Crockett, Thomas Pruzinsky, and John A. Persing, “The Influence of
Plastic Surgery ‘Reality TV’ on Cosmetic Surgery Patient Expectations and
Decision Making,” Plastic & Reconstructive Surgery 120, no. 1 ( July 2007):
316–324, http://tinyurl.com/6y97d3; Kathleen Doheny, “Cosmetic Surgery TV
Shows Get Viewers Pondering,” HealthDay (August 9, 2007), http://tinyurl.com/
l8fae62.
80. Melissa S. Kearney and Phillip B. Levine, “Media Influences on Social
Outcomes: The Impact of MTV’s 16 and Pregnant on Teen Childbearing” ( January
2014), http://tinyurl.com/nnb8ufu; Nicholas Kristof, “TV Lowers Birthrate
(Seriously),” New York Times (March 19, 2014), http://tinyurl.com/nnb8ufu.
81. Roslyn Weaver and Ian Wilson, “Australian Medical Students’ Perceptions of
Professionalism and Ethics in Medical Television Programs,” BMC Medical
Education 11 (2011): 50, http://tinyurl.com/l3z8ss2.
82. Weaver and Wilson, “Australian Medical Students,” http://tinyurl.com/l3z8ss2.
83. Victoria Rideout, “Television as a Health Educator: A Case Study of Grey’s
Anatomy,” Kaiser Family Foundation (September 16, 2008), http://tinyurl.com/
ld27y4s.
84. Henry J. Kaiser Foundation, “Unique Experiment Finds Health Content Placed in
Grey’s Anatomy Episode Quadrupled Awareness Among Audience,” press release
(September 16, 2008), http://tinyurl.com/lp6krre.
85. P. G. Brindley and C. Needham, “Positioning Prior to Endotracheal Intubation
on a Television Medical Drama: Perhaps Life Mimics Art,” Resuscitation 80, no. 5
(May 2009): 604, http://tinyurl.com/kdwd2sw.
86. Michael M. O’Connor, “The Role of the Television Drama ER in Medical Student
Life: Entertainment or Socialization?,” Journal of the American Medical Association
280, no. 9 (September 2, 1998): 854–855, http://tinyurl.com/qdf8ymn.
87. Mollyann Brodie, Ursula Foehr, Vicky Rideout, Neal Baer, Carolyn Miller, Rebecca
Flournoy, and Drew Altman, “Communicating Health Information through
the Entertainment Media,” Health Affairs 20, no. 1 ( January/February 2001):
192–199, http://tinyurl.com/lutka8m.
6 0
States” (2004), http://tinyurl.com/n33q8uf; Kaiser Family Foundation,
“The Impact of TV’s Health Content: A Case Study of ER Viewers” (2002),
http://tinyurl.com/orpdwtm.
89. Thomas Valente, Sheila Murphy, Grace Huang, Jodi Gusek, Jennie Greene, and
Vicki Beck, “Evaluating a Minor Storyline on ER about Teen Obesity, Hypertension,
and 5 a Day,” Journal of Health Communication 12, no. 6 (September 2007): 551–
566, http://tinyurl.com/o3c8kzn.
90. Harvard School of Public Health, “After ‘ER’ Smallpox Episode, Fewer ‘ER’
Viewers Report They Would Go to Emergency Room if They Had Symptoms of
the Disease,” press release ( June 13, 2002), http://tinyurl.com/oapocqj.
91. RAND Health, “Entertainment TV Can Help Teach Teens Responsible Sex
Messages” (November 3, 2003), http://tinyurl.com/lln6eg7, citing Rebecca Collins,
Marc Elliott, Sandra Berry, David Kanouse, and Sarah Hunter, “Entertainment
Television as a Healthy Sex Educator: The Impact of Condom Efficacy Information
in an Episode of Friends,” Pediatrics 112, no. 5 (November 2003): 1115–1121,
http://tinyurl.com/tku8.
92. Kaiser Family Foundation, “Entertainment Education” (2004), http://tinyurl.
com/n33q8uf; CDC, “Soap Opera,” http://tinyurl.com/qa5mewv.
93. May G. Kennedy, Ann O’Leary, Vicki Beck, Katrina Pollard, and Penny Simpson,
“Increases in Calls to the CDC’s National STD and AIDS Hotline Following
AIDS-Related Episodes in a Soap Opera,” Journal of Communication 54, no. 2
( June 2004): 287–301, http://tinyurl.com/lqe3ra7.
94. Sandra G. Boodman, “Anger Management Courses Are a New Tool for Dealing
with Out-of-Control Doctors,” Washington Post (March 4, 2013), http://tinyurl.
com/bxcyt3f; TAN, “The Weather in My Head” (March 16, 2013), http://tinyurl.
com/q6h6fmx.
95. Alison Gendar, “Nurse Fired for Trying to Expose Roosevelt Hospital’s Neglect
in Death of Homeless Man: Lawsuit,” New York Daily News (March 28, 2011),
http://tinyurl.com/mwau98t; TAN, “Patients Unattended” (March 28, 2011),
http://tinyurl.com/pwyshqr.
96. Michelle Smith, “Brain Surgery Goes Awry in R.I.,” USA Today/Associated Press
(November 27, 2011), http://tinyurl.com/nxgd73e.
97. Amy Turner, “Used Needles are Causing a Health Crisis in India,” Sunday Times
(March 22, 2009), http://tinyurl.com/l7hz8mf; TAN, “Against Everything She
Has Been Taught” (March 22, 2009), http://tinyurl.com/mqcqx7v.
98. Rose Chapman, I. Styles, L. Perry, and Shane Combs, “Examining the Characteristics
of Workplace Violence in One Non-Tertiary Hospital,” Journal of Clinical Nursing
19 (2010): 479–488, press release, http://tinyurl.com/m77bhcx;Fran Lowry,
“Nurses Are Frequent Targets of Workplace Violence,” Medscape (February 4,
2010), http://tinyurl.com/ksfow8d.
61
99. Deborah D. May and Laurie M. Grubbs, “The Extent, Nature, and Precipitating
Factors of Nurse Assault among Three Groups of Registered Nurses in a
Regional Medical Center,” Journal of Emergency Nursing 28, no. 1 (2002): 11–17,
http://tinyurl.com/ks7cdj9.
100. Chapman, et al., “Examining,” http://tinyurl.com/m77bhcx; Lowry,
“Workplace,” http://tinyurl.com/ksfow8d.
101. May and Grubbs, “The Extent,” http://tinyurl.com/ks7cdj9.
102. May and Grubbs, “The Extent,” http://tinyurl.com/ks7cdj9.
103. Heather K. Spence Laschinger, Michael Leiter, Arla Day, and Debra Gilin-Oore,
“Workplace Empowerment, Incivility, and Burnout: Impact on Staff Nurse
Recruitment and Retention Outcomes,” Journal of Nursing Management 17, no. 3
(April 2009): 302–311, http://tinyurl.com/mby29r4.
104. Dianne Felblinger, “Incivility and Bullying in the Workplace and Nurses’ Shame
Responses,” Journal of Obstetric, Gynecologic, & Neonatal Nursing 37, no. 2
(March/April 2008): 234–242, http://tinyurl.com/6s28ut, summary available
at http://tinyurl.com/6kyzkq.
II T H E G R E AT D I V I D E :
THE MEDIA VERSUS REAL NURSING
3
COULD MONKEYS BE NURSES?
NBC’s campy daytime drama Passions offered a very special solu-

tion to the nursing shortage: an orangutan. From 2003 until 2005,
the monkey played the role of Precious, a private duty nurse.
Character Beth Wallace hired Precious to replace her invalid
mother’s previous nurse, who had blabbed Beth’s evil secrets.1
The NBC website told us the “dutiful caretaker” changed Mrs.
Wallace’s diapers, wore “a modern version of a nurse’s uniform,
complete with cap,” adored “handsome Latino men, bananas, fruit
smoothies, shopping, food fights, gin and tonics,” and wanted “to
do the best job possible as Mrs. Wallace’s nurse . . . and to have some
fun at the same time!”
While Passions was known for being somewhat surreal, the role
of Precious reflects public sentiment about the work of nurses. There
are those who believe nursing requires so little skill that a monkey
could do it. In fact, in the 1990s, representatives of a California
hospital group told top-level union negotiators that nursing was
so simple that the union’s nurses could be replaced with monkeys.
This chapter explores how recent media has portrayed nursing
skill. A number of media items, particularly in print news, have
communicated some sense of the advanced scientific skills that
nurses use to improve patient outcomes. Unfortunately, much of
the most influential media, particularly television, regularly sends
the message that nursing is low-skilled loser work unworthy of
serious consideration by anyone with a brain.
In addition, countless media items portray important nursing
work as being performed by others, particularly physicians, thus
robbing nurses of credit they need to save their profession. Others
ignore nursing work and expertise, even when nursing actually
plays a central role in the relevant subject, such as patient educa-
tion, managing healthcare errors, or mass casualty events. Still
other items suggest that any helpful person or machine is a “nurse,”
6 6
consistent with the broad use of the term “nursing” to include unskilled
tending.
The prevailing view of nursing as inferior grunt work undermines nurses’
claims to respect and resources. In a May 2008 Arab News article, Taqwa
Omer Yahia, a nursing dean at Saudi Arabia’s King Saud University, described
what happened when she gave a lecture at a local university. She was intro-
duced as “Dr. Yahia” and “treated with respect and admiration” until, after her
talk, a student asked “what kind of doctor” she was. Dr. Yahia said that her
PhD was in nursing. The students’ disappointment was palpable, and she felt
she had “lost all credibility as a trusted speaker.”
The stories of Dr. Yahia and Nurse Precious remind us of research on inat-
tentional blindness. In one famous Harvard study, participants watching a
small circle of people throw basketballs to each other were asked to count the
passes. As the balls went back and forth, a person dressed in a gorilla costume
walked into the middle of the circle, stopped to beat her chest, and left the cir-
cle. But most observers later reported seeing no gorilla.2 In a 2013 variation of
this experiment, when white female subjects were first told they would later
have to select a coworker or neighbor from online profiles, they were equally
likely to notice white and African-American men walk into the circle. But
when the subjects were instead told they would later be looking for a friend
or mate, goals that were “closer to self,” they were more than twice as likely
to notice the white man. Even their “unconscious screeners” were biased.3
Similarly, most of us fail to see what nurses really do because we have been
conditioned to focus—consciously or unconsciously—on what physicians do.
Media Portrayals of Nurses as Serious Professionals

Portrayals of nurses as skilled professionals do exist. They tend to appear in
the print news media, but they can be found even on entertainment tele-
vision and in feature films. Nurses have been depicted as skilled clinicians,
vital public health workers, researchers and innovators, healthcare experts
and leaders.
“Might Be a Genius”: Nursing Skill on Television and in Film

The nurse-focused television dramas that have appeared since 2009 have all
shown nurses to have healthcare skills that may surprise viewers, although
3 Could Monkeys Be Nurses? •
67
there has been a little physician nursing on the US shows. For instance, even
on those shows, physicians have often done the defibrillation.
Perhaps the strongest examples of nursing skill have appeared on Nurse
Jackie. Although Jackie Peyton is a “world class liar” who struggles with drug
addiction and occasionally disregards ethical obligations, she is also probably
the best nurse in television history, a tough clinical virtuoso who excels at
physical and psychosocial care, patient advocacy, and mentoring. She regu-
larly saves lives. In the first season, Jackie casually saved a choking restaurant
patron with the Heimlich maneuver and taught a precocious 10-year-old girl
how to manage her mother’s debilitating lupus. Jackie takes innovative, effec-
tive approaches to troublesome colleagues, violent patients, and agitated fam-
ily members. In one July 2009 episode, she used index cards to give a mute
stroke victim some pointed options to show his skeptical, obnoxious family
that he was still “in there” and in need of their support. Jackie’s style of holistic
care includes masterfully manipulating an insurance company into covering
an expensive surgery for a deaf woman who has had several fingers shot off4
and blackmailing a wealthy athlete into donating a much-needed $400,000
computed tomography [CT] scanner to the emergency department (ED) in
exchange for not revealing his drug possession.5 Like many real nurses, Jackie
has fought to give dying patients the endings they wanted, helping them avoid
being tortured with unwanted procedures.6 Jackie has trained not only her
quirky protégée Zoey Barkow, who now displays Jackie-like life-saving skill,
but also the somewhat bogus young physician Cooper, who initially struggled
with Jackie’s blunt critiques. June 2012 episodes found Jackie expertly running
the ED during a staffing crisis, leading fellow nurse Sam to marvel that she
“might be a genius.”7
Call the Midwife offers a dramatic look at the exploits of Anglican and lay
nurse-midwives caring for poor women and babies in London’s East End in
the late 1950s. The show can be sentimental, but the nurses are vital health
workers, with tough, expert senior midwives guiding the nervous newer ones.
The nurses visit pregnant women to monitor their progress, deliver babies
under awful conditions, and advise new mothers and their communities, all
in an environment without birth control where women seem to function as
baby factories and one-person day care centers.8 In one April 2013 episode, the
midwives expertly managed the difficult delivery of an older woman whose
twin was extremely hostile to modern health care. Meanwhile, lead character
Jenny, temporarily practicing in a hospital, proved a quick study in the oper-
ating room (OR) while effectively diagnosing and informing her nurse supe-
rior of an abusive surgeon’s dangerous neurological problems.9 In a May 2013
6 8
episode, nurse Chummy expertly diagnosed preeclampsia in a pregnant

acquaintance, taking a urine sample after swollen ankles aroused her
suspicions.10
During its one season on the air, Mercy also included powerful portrayals
of nursing skill. Like Jackie, lead character Veronica Callahan was an assertive
clinical leader who had some trouble with rules. In the September 2009 series
premiere, after Veronica saw a car crash cause a motorist to suffer a tension
pneumothorax, she quickly saved his life by decompressing the collapsed lung
with a knife and a coffee straw. Veronica counseled and advocated for a dying
older patient, empowering her to tell her adult children that she wanted to
stop treatment, even though this same bitter patient had at one point asked
what nurses were good for, prompting Veronica to respond: “Well, we do try
to keep the doctors from killing you.” In another September 2009 episode,
the smart novice nurse Chloe Payne (who had a masters degree from Penn!)
persuaded a skeptical physician that a patient actually was hearing the sound
he said was driving him to seek drugs. In the May 2010 series finale, Chloe
diagnosed airport malaria despite resistance from another physician. Too
bad the finale also had Chloe vowing to attend medical school following a
romantic rejection from a cardiologist. That’ll show him! That nursing really
is inferior.11
HawthoRNe also featured good examples of nurses’ health expertise, par-
ticularly the authority of nurse managers—who barely exist on other shows—
although its portrayals were wildly inconsistent and weaker toward the end
of its run. Christina Hawthorne was a commanding chief nursing officer, and
ultimately chief operating officer, who also had time to dispense expert clini-
cal care when a crisis arose and to fight for patients with resistant physicians
and family members. In one July 2009 episode, Hawthorne went around a
powerful surgeon to offer a patient the option of treatment from another
surgeon who had more experience in doing a difficult operation. She also
determined that the mysterious cause of a teenager’s Adderall overdose was
a prescription from his pushy physician father. Like the other nurse shows,
HawthoRNe even included some promising saves by a novice nurse character.
Nurse Kelly Epson was often embarrassingly timid, but in an August 2009
episode, her advocacy and alertness to the shifting story of a stroke victim’s
daughter about when symptoms began saved the victim from a dangerous
treatment. In a July 2011 episode, Kelly identified and acted courageously to
counter the outbreak of an antibiotic-resistant organism (methicillin-resis-
tant Staphylococcus aureus [MRSA]). She even built an isolation ward, alerted
the Centers for Disease Control and Prevention, and defibrillated a patient.12
69
Although ER featured rampant physician nursing and occasionally deni-

grated the nursing profession, the show also included some impressive por-
trayals of nursing skill. Typically these involved the lone major nurse character,
who in the show’s final years was Samantha (Sam) Taggart, a tough nurse who
displayed confidence and skill in performing or advocating for critical care
procedures. An October 2008 episode found her fighting back against conde-
scending physician attitudes, at one point successfully taking over an urgent
intubation from a flailing intern. In a February 2007 episode, the physicians
had trouble intubating another critical patient. Taggart pushed the sides of
the patient’s chest to force air back up through the trachea, explaining that
“the bubbles will show you where to place the tube.”
A handful of late 2005 ER episodes featured the expert, hard-core nurse
manager Eve Peyton. In one scene, busy attending Luka Kovac repeatedly
brushed off Peyton’s requests that he come help a flailing resident physician with
a fiberoptic intubation for a hypoxic accident victim with severe head trauma.
When Kovac finally arrived, the resident and the rest of the code team were
watching Peyton insert a laryngeal mask airway. The patient quickly improved.
Peyton suggested that Kovac consider educating his residents about using the
laryngeal mask airway and told him, “Take it from here, Doctor. I’m going to
go find a bedpan that needs emptying.”13
The irreverent sitcom Scrubs was similarly dominated by physician char-
acters, but it too included some passing indications of nursing knowledge.
Most involved the show’s one major nurse character, Carla Espinosa, who
at times was presented as a nurse manager. An April 2006 episode showed
Espinosa catching intern errors and teaching the interns how to avoid them.
In one scene, she even expertly took charge of handling a patient’s seizure.
A March 2006 episode featured a brief but aggressive defense of nurses’ tech-
nical expertise, as Espinosa demonstrated her encyclopedic knowledge of the
conditions and care plans of specific patients.14
Portrayals of nursing skill on shows that are not hospital-focused are
rare. From 2009 to 2014 NBC’s sitcom Parks & Recreation included nurse
Ann Perkins, who occasionally displayed knowledge and skill both in the
clinical setting and as a local public health official. In an April 2013 episode,
Ann not only acted to treat her reluctant city colleague Ron’s streptococ-
cal infection by pushing him to go to the hospital, but she also insisted on
addressing his overall health, getting him to eat bananas to raise his potas-
sium levels. The physician who saw Ron at the hospital was eager to write
him a prescription and move on.15 The global hit Downton Abbey (ITV/
7 0
PBS) mostly portrayed World War I–era nursing as very low-skilled, but the
first season, broadcast in 2011 in the United States, did include brief depic-
tions of nurse Isobel Crawley, the Downton heir’s mother, as a formidable
health system organizer with skills that in some ways rivaled those of the
local physician.16 And in an August 2008 episode of TNT’s Saving Grace,
a tough but sensitive veteran nurse played the central role in the care of
a badly burned boy, displaying advanced clinical knowledge and interper-
sonal skills.17
A few documentaries have given viewers a good sense of nursing. 24 Hours
in A&E has shown emergency nurses at London’s King’s College Hospital,
like the charismatic senior sister Jen Du-Prat, to be bright, articulate profes-
sionals who play a central role in patient care, using very good psychosocial
and managerial skills. A couple documentaries on Discovery Health Channel
also showcased nursing knowledge, although their audience was limited.
Lifeline: The Nursing Diaries, a three-part documentary from 2004, followed
nurses at Massachusetts General and New York-Presbyterian hospitals. The
first part, “The Rookies,” produced by master documentary maker Richard
Kahn and Linda Martin, may be the best single hour of a nursing documentary
that we’ve seen. It shows highly skilled nurses saving lives, educating patients,
and supporting families in intensive care units (ICUs).18 Helen Holt’s Nurses,
from 2002, was an engaging five-part documentary about Johns Hopkins
nurses in oncology, critical care, psychiatric care, pediatrics, and the neonatal
intensive care unit (NICU).19
A few recent feature-length films have conveyed something of nurs-
ing skill. Mike Nichols’s Angels in America, based on Tony Kushner’s play,
included one of the best depictions of nursing in feature film history, plac-
ing the profession at the center of AIDS care. Shown on HBO in 2003, the
six-hour exploration of faith, politics, and sexuality was set at the start of the
AIDS era. Nurse Belize used skill, cynical wit, and tough love to keep his
stricken friend Prior alive and sane. Meanwhile, at the hospital, Belize pro-
vided the AIDS-stricken power broker Roy Cohn with a measure of comfort,
dignity, and expert advice, even as they traded invective across a chasm of
mutual loathing.20
The 2004 overhaul of George Romero’s zombie classic Dawn of the Dead,
by director Zack Snyder and screenwriter James Gunn, was a funny post-9/11
vision of radical fundamentalism overrunning bourgeois society. Character
Ana Clark, a smart, tough, resourceful nurse, helped lead some survivors
trapped in a suburban mall. She cared for the group’s wounds and used
her nursing skill to discover vital zombie information.21 Neill Blomkamp’s
71
dystopian 2013 film Elysium also included a nurse, lead character Max’s child-
hood sweetheart Frey. She displayed some skill and strength, patching up
Max after a knife wound, although her overall role in the plot was far more
passive than Ana’s in Dawn of the Dead.22
Although the popular Meet the Parents films were not exactly advertise-
ments for nursing, the 2010 installment, Little Fockers, included clear signs of
nursing expertise along with the frat-boy overtones. In that film, main char-
acter Gaylord (Greg) Focker was an articulate nursing manager who directed
a medical-surgical unit, wrote scholarly articles, and showed some clinical
expertise, mainly helping his father-in-law Jack with the effects of a heart
condition.23
“Startling Discoveries”: Nursing Skill in the News Media

Most of the effective recent portrayals of nursing skill have appeared in the
print press. These do not generally have the broad impact of television or
movies, although they may reach influential demographics.
Experts, Life Savers, and Leaders

Occasionally the news media presents nurses as healthcare leaders. In
December 2012 the New York Times ran Daniel Slotnick’s strong obituary for
Vernice Ferguson, who supervised more than 60,000 nurses and “fought for
greater opportunities, higher wages and more respect for nurses as a longtime
chief nursing officer” at what became the US Department of Veterans Affairs.
Slotnick noted that when the African-American Ferguson graduated from
the nursing program at New York University in 1950 with an academic prize,
the director of nursing reportedly refused to shake her hand.24
In June 2012, the Baltimore Sun published a detailed obituary by Frederick
Rasmussen for Elizabeth Scanlon Trump, the driven cofounder and longtime
nursing director of the University of Maryland’s Shock Trauma Center, argu-
ably the finest trauma center in the world. The piece portrayed Trump as “the
first trauma nurse.”25
In March 2012 the San Francisco Chronicle printed a remarkably good
profile of new University of California San Francisco nursing dean David
Vlahov—on the front page. Julian Guthrie’s piece traced Vlahov’s develop-
ment as a nurse, including his work as a prison clinician and a nursing profes-
sor, his time at the Centers for Disease Control and Prevention, his founding
of an AIDS clinic in East Baltimore, and his years on the New York City
Board of Health.26
7 2
Other pieces have highlighted the expertise of direct care nurses. A

September 2012 tribute to the nurses at the University of Southern California’s
Keck Hospital by Los Angeles Times columnist Steve Lopez had some of that
old-time help ‘n’ comfort imagery. But it also stressed that an alert nurse had
saved Lopez’s life by performing cardiopulmonary resuscitation (CPR) after
his heart stopped following knee-replacement surgery. Lopez gave readers a
sense of nurses’ professional training and skills, including counseling patients
and “translating doctor-speak.”27
In April 2007 the Wall Street Journal published a piece by editor John
Blanton, who had gone back to school and become a nurse in a post-9/11
search for meaning. Focused on the crushing workload and fear of error
Blanton faced as a new burn unit nurse, the article described what he did for
patients and why it mattered:
With easily shattered confidence, I could start an IV, administer medi-

cations, bathe a bed-bound patient and change linens, change dressings,
insert all sorts of catheters and tubes, read lab results and electrocar-
diograms. I knew to be vigilant against infection, pneumonia, pressure
ulcers, medication errors and the many other lurking threats to hospi-
tal patients. On the burn unit, pain control loomed large. I also knew,
as both executor of treatment plans and patient advocate, to keep a
close eye on what doctors ordered. They make mistakes, too.28
In October 2005 the Boston Globe ran Scott Allen’s four-part special report
about the intense eight-month ICU training of new nurse Julia Zelixon by
veteran nurse M. J. Pender. Readers got a vivid sense of the complexity and
importance of nursing. Pender’s analysis of the patients’ conditions and needs
was relentless, as the nurses worked to manage different medications, tubes,
and monitors. Each patient reportedly needed twenty hours of nursing care
daily, the vast majority of it provided by nurses on their own. At one point
Pender stopped a physician from speeding a transfusion to an especially criti-
cal patient, fearing that it would dilute the medication dripping through the
same intravenous line. An anesthesiologist noted that he often feels “we’re
here more as consultants to the nurses.”29
Perhaps most rare are items about what nurses, as skilled professionals, do
not do. In 2004, Garry Trudeau’s widely distributed comic strip Doonesbury
introduced tough Walter Reed character Nurse Jewel, who cared for
Lt. B.D. after he lost part of his leg in the Iraq war. In a June strip, Jewel told
B.D. that the hospital’s nurses “love our soldiers” but that “because we’re so
73
good at all the things we do here . . . occasionally a patient is tempted to think

of us as his personal concierge service. This is a mistake.” B.D. responds, “I can
tell.” Jewel: “Then let the fun begin! Drain your wound?”30
What We’re Missing: Reporting on the Shortage

Although many media pieces about the nursing shortage have focused on num-
bers, some items show why it matters that patients don’t have enough nurses.
A May 2012 report by Patti Neighmond on National Public Radio’s Morning
Edition described a poll of patients showing widespread nurse understaffing
in US hospitals. After twelve hours of trying to care for too many patients
nonstop, one nurse said she drove home exhausted but white-knuckled, wor-
rying about the danger to patients. A nurse explained that if she was too busy
to detect subtle condition changes, such as that a patient’s “jugular vein is just
slightly distended, or you check their nail beds and they’re a little bit dusky,”
a patient could decline quickly.31
Will Moredock’s March 2007 cover story on the shortage in the Charleston
City Paper included an admirably detailed look at what Medical University of
South Carolina Hospital ICU nurse Misty Deason actually did for patients.
Moredock seemed surprised by how much nursing mattered; he described
studies showing that nurse staffing and education levels affect patient out-
comes as “startling discoveries.” He marveled at the credentials of his expert
sources, nursing leaders with PhDs.32
A cover story by John Pekkanen in the September 2003 Reader’s Digest
revealed a system of US hospitals on the verge of breakdown, as angry family
members struggled to get the attention of overwhelmed nurses and patients
died needlessly because there simply weren’t enough nurses.
Every time a nurse enters a patient’s room, she observes his or her color,
demeanor, state of mind and speech. Any subtle change can signal
trouble. [Deceased liver donor] Mike Hurewitz failed to get this sort
of assessment—and none of the devices he was hooked up to could
perform that job.33
Of course, things are worse in some settings. In July 2004 the New York
Times ran a powerful report by Celia W. Dugger about the catastrophic
effects of the emigration of nurses from AIDS-ravaged Malawi to developed
nations. At the labor and delivery ward at Lilongwe Central Hospital, she
noted, “a single nurse often looks after 50 or more desperately ill people.” One
nurse found a baby on his mother’s breast, desperate to breathe; she reached
74
him in time to suction his tiny mouth until he was able to breathe on his own.
But one night, after the dayshift nurse had “steadfastly” tried to keep the pre-
mature babies in the nursery alive, “a tiny baby girl, blue and dead, lay next to
her sister, eyes open, tiny fists clenched, mouth yawning.”34
Some reports have focused on the shortage of nursing in schools. In
October 2013, Salon posted a strong piece by Jeff Bryant questioning US
schools’ recent tendency to balance security and budget concerns by hiring
more guards but continuing to cut nurses and other health workers.35 He
focused on the tragic case of Philadelphia sixth grader Laporshia Massey,
who died of an asthma attack when her school had no nurse. Likewise, in
February 2004, Salon posted a powerful piece by nurse Elisabeth Ochs, who
detailed her efforts to care for 800 elementary school students, an increas-
ing number of whom suffered chronic conditions, such as asthma and obe-
sity.36 In a June 2013 op-ed in the Seattle Times, nurse Kathleen Bartholomew
argued strongly that Washington schools need more nurses; the state had
only one nurse for every 2,031 students. Bartholomew cited the case of a ten
year old who had died because no one in her school knew CPR or that her
EpiPen was nearby. Bartholomew also described nurses’ skills in addressing
substance abuse and mental health issues, serious concerns in schools today.37
A Nurse Did What? Public Health Nurses in the News

Even apart from shortage pieces, the media sometimes takes an interest in
the work of public health nurses outside clinical settings. Perhaps the work
of these nurses is striking because many don’t expect to see nurses improve
outcomes using real skill by themselves.
The school-nurse-as-one-time hero article has become its own minor
genre. In December 2007 the Dallas Morning News ran a piece by Chris
Coats about a tenacious school nurse who had pushed through physician
skepticism until an eight-year-old student was correctly diagnosed with leu-
kemia in time to benefit from life-saving treatment.38 In October 2006, the
Kansas City ABC television affiliate KMBC reported that a local high school
nurse had been “credited with saving a student’s life” by diagnosing a brain
aneurysm.39 New York City school nurse Mary Pappas drew media acclaim
for setting in motion the April 2009 government response to the H1N1
flu epidemic, identifying and managing hundreds of students’ symptoms at
her Queens school. But Pappas also gave a “riveting” account of her experi-
ences and plans to contain H1N1 at a federal summit on the issue, as Lauran
Neergaard reported in an excellent July 2009 Associated Press item.40
75
Other public health nurses have also gained some attention. In November
2011 the Harrow Times (UK) ran Suruchi Sharma’s piece about hospital
nurses who had organized a “mouth cancer exhibition” to help the local
Asian community get “clued up” about the health risks posed by tobacco
products.41 And there have been stories about the Nurse-Family Partnership
(NFP), a cost-effective US program in which nurses make home visits to
poor first-time mothers and their children. A February 2006 issue of The
New Yorker included Katherine Boo’s lengthy and powerful “Swamp Nurse,”
which told how, despite huge obstacles, rural Louisiana nurse Luwana Marts
and her NFP colleagues question, teach, and cajole their patients toward
better lives.42
Ninety Pounds and the Truth: Nursing Research and Innovation

Some recent press items have highlighted the work of nurses on the cutting
edge. In April 2010 the Manchester Evening News (UK) reported that nurses
at Stepping Hill Hospital had won a national award from The Nursing Times
for showing that using a particular skin wash greatly reduced the risk of devel-
oping the virulent staphylococcal infection MRSA from hospital devices,
such as intravenous catheters.43 A January 2006 item by Alan McEwen on
the Scotsman site described a life-saving initiative by Edinburgh nurse Scott
McLean to enable paramedics to treat heart attack victims with “clot-busting”
thrombolytic drugs.44
Nurse researchers occasionally make news. A June 2010 New York Times
piece by Milt Freudenheim on geriatric care discussed the work of nursing
scholars Mary Naylor and Terry Fulmer, who design new systems to pro-
vide cost-effective care for the growing elderly population.45 A March 2009
BBC News story by Jane Elliott described the achievements of pioneering
1950s nurse researcher Doreen Norton, who showed how to properly treat
deadly bedsores.46 In March 2006 Geoffrey Cowley’s long Newsweek piece
about UNAIDS director physician Peter Piot briefly told how, two decades
earlier, “ebullient, 90-pound” Kenyan nurse Elizabeth Ngugi pioneered pro-
grams that empowered poor Nairobi sex workers to adopt safer sex prac-
tices. Ngugi’s methods prevent thousands of HIV infections each year.47
A March 2004 Parade magazine cover story profiled six “superstars” of health
research, including Loretta Sweet Jemmott, a professor at the University of
Pennsylvania and “the nation’s leading expert on HIV prevention in teens.”48
Some articles have highlighted the emerging practice at urban trauma
centers to have specially trained forensic nurses take the lead in caring for
sexual assault victims and gathering evidence for criminal prosecutions. In
7 6
October 2006 Newsweek posted “ ‘CSI’ Nursing,” a Web exclusive by Anne

Underwood that introduced readers to forensic nursing, including an inter-
view with New Jersey sexual assault forensic examiner nurse Beryl Skog.49
“No One Wants to Hear from a Nurse”: The Nurse as Media Health Expert
In a November 2006 ER episode, nurse character Sam Taggart declined a
chance to speak to a local television news crew about the ED’s work because
“no one wants to hear from a nurse.”50 This attitude is sadly common among
real nurses, who often seem determined to keep their heads down. One
reporter from the New York Times responded to our critique of her physician-
centric coverage of the January 2011 shooting of Congresswoman Gabrielle
Giffords by lamenting that although the reporter had tried, she could not get
the nurses involved to talk to her.51
Even so, nurses have on occasion appeared as experts. In the New York
Times, a lengthy July 2013 “Ask an Expert” piece featured York College
nursing professor and advanced practice nurse Julia Bucher, who gave
articulate and sensitive advice to those whose relatives have cancer.52
Surgeon Pauline Chen, who writes the paper’s “Doctor and Patient” col-
umn, sometimes relies on nurse experts, as she did in a July 2012 column
about threats to nurses’ physical and mental health.53 The Times has also
published oncology nurse Theresa Brown’s pieces on health care and nurs-
ing, starting in 2008 on the “Well” blog and more recently in Brown’s
“Bedside” columns.54
There are other isolated examples. In January 2014 the CNN web-
site ran an opinion piece by Johns Hopkins nursing professor and ethics
expert Cynda Rushton about issues surrounding a pregnant Texas woman
who was reportedly brain dead but being kept alive against her family’s
wishes because she was pregnant.55 A December 2010 Ghana News website
item relied entirely on expert comment from senior nurse midwives, who
described the importance of prenatal care and the threat of unsafe abor-
tions.56 In November 2006 the New Zealand Herald ran a story by Cherie
Taylor that relied mainly on “diabetes nurse and educator” Shona Tolley
in discussing efforts to address diabetes among the Maori and other indig-
enous peoples.57
77
“Is This All Nurses Do?” Media Contempt for

Nursing Skill
Direct expressions of contempt for nursing expertise remain common in
some of the most popular and influential media products of our time.
Hollywood Tells the World Nursing Is for Losers

Grey’s Anatomy and House have attacked nursing more aggressively than any
US television shows in decades, although the newer sitcom The Mindy Project
is in the running. ER and Scrubs were far less likely to disparage nursing skill
directly, but they did so, as have many non-healthcare shows.
Grey’s Anatomy: “You’re the Pig Who Called Meredith a Nurse”

Although most clinical scenes in Grey’s Anatomy have no nurses, the few that
do generally present nursing as a matter of fetching physicians, or holding or
moving things for physicians, usually at the edge of the frame. So the “nurses”
tend to consist of forearms and background blurs. The few nurse characters
who do speak tend to be bitter or fawning lackeys.58
The show’s March 2005 premiere stressed that smart, tough, attractive
women like its surgeon stars do not become nurses. In one scene, physician
intern Alex diagnosed a postoperative patient as having pneumonia. He told
the older, far less attractive nurse to start antibiotics. The nurse bleated, “Are
you sure that’s the right diagnosis?” He responded, “Well, I don’t know, I’m
only an intern. Here’s an idea, why don’t you go spend four years in med
school and let me know if it’s the right diagnosis. She’s short of breath, she’s
got a fever, she’s post-op. Start the antibiotics.”
Alex then told intern Meredith Grey, “God, I hate nurses.” Meredith
noted that it might not be pneumonia. Alex: “Like I said, I hate nurses.”
Meredith: “What did you just say? Did you just call me a nurse?” Alex: “Well,
if the white cap fits.” Meredith stalked off. Later Alex responded to a page
from this same nurse, who argued that the patient was still short of breath. He
blew her off: “Don’t page me again.” The pathetic nurse watched in silence as
he left. Later the chief of surgery endorsed Meredith’s views. The nurse had
sensed vaguely that something was wrong, but it took a real professional—
Meredith—to do anything about it.59
The show’s second episode, in April 2005, offered more explicit contempt.
Meredith’s friend, hotshot intern Cristina, told Alex, “You’re the pig who
called Meredith a nurse . . . I hate you on principle.”60
7 8
In an October 2009 episode, the show returned to the same theme. Star
neurosurgeon Derek “McDreamy” Shepherd assigned Meredith’s younger sis-
ter Lexie, an intern, the job of safeguarding McDreamy’s own health during
an upcoming marathon surgery. A male physician mocked Lexie: “Have fun
playing nurse. It sounds . . . neat!”61
The female physicians’ reactions to these slurs effectively endorse the
assumptions that underlie them. Of course, it would not occur to Meredith,
Cristina, or Lexie to say anything in defense of nurses. What they care most
about is that they not be regarded as nurses themselves.
Grey’s has presented nurses as lost in the face of serious care problems
and nursing as disgusting work that the interns get as a punishment. In a
November 2005 episode, Cristina dismissed a nurse from a patient’s room,
saying that the physicians would let her know if a bedpan needed changing.
Rather than responding directly, the nurse paged Cristina to do a series of
grotesque bodily fluid tasks.62 This plotline suggested that the problem with
antinurse slurs is not that they’re inaccurate, but just that, as the chief resident
noted, it’s “stupid” to “piss off the nurses”—the petty, vindictive cleanup crew
of health care. A November 2006 plotline likewise used the “nurse’s job” of
“digging through crap” as a symbol of professional disaster. Cristina’s chief
resident punished her by making her sift through the stool of a boy who had
swallowed Monopoly pieces. Later the boy started vomiting. Nurse Tyler
paged Cristina, who quickly diagnosed a perforated bowel and directed the
clueless Tyler to page the chief resident.63 A January 2007 episode portrayed
attending physician Mark Sloane inflicting seemingly grotesque, trivial nurs-
ing tasks on interns Meredith and Alex as a punishment. As always, there was
no hint that the tasks might be important to patient outcomes.64
Grey’s has made a few efforts to address concerns that it portrays nurses
as unskilled drones, but these have been isolated or deeply flawed. A January
2006 Grey’s episode with a minor plotline about a nursing strike had a few
good lines about short-staffing, but on the whole it suggested that the lack of
nurses mostly created burdens in administration and trivial bedside care.65 In
the January 2007 Grey’s in which Sloane inflicted icky nursing tasks on the
interns, the attending also vaguely praised nurses as “smart,” “helpful,” and
“already good at their jobs”—which is a lot easier, of course, when there isn’t
much to your job.66
Late 2007 episodes of Grey’s introduced OR nurse Rose, temporary love
interest of McDreamy. Rose was actually capable of light banter and basic
OR computer repair, an achievement that the show promoted as helping
McDreamy “save a life.” So if nurses do help save lives, it must be when they
79
happen to have some other useful skill besides nursing. The May 2008 season
finale had Rose telling Derek she preferred his usual discussion of “boring
science stuff ” to his brooding about a clinical trial—“science” sounds like
a bewildering subject for those little nurses!67 After McDreamy inevitably
resumed his relationship with Meredith, a September 2008 episode showed
the upset Rose accidentally cut McDreamy’s hand with a scalpel, then flee in
embarrassment to a job in pediatrics.68
Sadly, none of these plotlines showed how nurses improve outcomes
as part of their normal work. Perhaps the show came closest in a couple of
episodes airing in late 2010 and early 2011 that included hunky “Nurse Eli”
(no last name), the boyfriend/sex toy of star surgeon Miranda Bailey. At a
few points Eli played a more robust role in care than any other Grey’s nurse
has, advocating somewhat shrilly for patients and even using his “experience”
to stumble upon a practice of removing surgical drains at the right time to
reduce postoperative infections. But Eli was more of an intuitive traditional
healer than a modern science professional, and the show quickly gave the
credit for the drain discovery to Bailey.69 Ultimately she ended the relation-
ship with Eli—nurses are never more than a temporary dalliance—and went
back to her physician ex-boyfriend.
The show carried on as before. In the May 2013 season finale, Bailey strug-
gled to regain surgical confidence after a couple patients died, and she tried to
make herself useful by taking blood to the OR. The chief of surgery mistook
her for a nurse and had to apologize.70 That’s how far she had fallen!
House: “Clean-Up on Aisle Three!”

As on Grey’s, nurses appeared occasionally on House to perform basic tasks,
like moving a gurney. But they were even more likely to be silent, peripheral
clerks who scurried out of the way of physicians and even patients, to whom
they never spoke. Whereas the direct attacks on nursing in Grey’s have mostly
been delivered by junior physicians, on House they usually came from the bril-
liant lead character, who saw nurses as unskilled morons. None of House’s
slurs were disproved, so viewers were likely to conclude that they were as ruth-
lessly correct as his other diagnoses.71
A notable May 2005 episode told how House lost partial use of his leg to
muscle cell death after a clotted aneurysm led to an infarction. At one point
House was in his ICU bed recovering from an operation to restore circulation
in his leg. The monitor showed wide-complex tachycardia. House impatiently
told the nurse to give him more calcium gluconate. The nurse responded
that he had just gotten 5 ml. He insisted. The nurse replied: “I’ll talk to your
8 0
doctor.” House told her that would take too long, as he had wide-complex
tachycardia and would soon go into cardiac arrest. Her response: “I could get
in trouble.” House, exasperated and about to lose consciousness, informed the
nurse that he was not asking for a narcotic. After House passed out, attending
physician Lisa Cuddy rushed in, asking the nurse what happened. The nurse
said that House had wide-complex tachycardia. “Who diagnosed it?” Cuddy
asked. “He did,” the nurse responded. The nurse handed Cuddy the defibrilla-
tion paddles, which Cuddy used to save House.72
In less than one minute of screen time, the episode did an amazing amount
of damage. First, any ICU nurse would have immediately seen from the mon-
itor that House had wide-complex tachycardia. Yet House had to insist that
he was having that problem, and Cuddy’s question as to who diagnosed the
tachycardia assumed it could not have been the nurse. A real ICU nurse would
have been the one who told House he needed more calcium gluconate, called
the code team, defibrillated, and initiated CPR. House’s remark about drug
seeking wrongly suggested that nurses are unaware that calcium gluconate is
not a narcotic. Without knowledge, initiative, or concern for her patient, all
the House nurse could do was await the arrival of the almighty Cuddy.
The Greg House character also offered insights on nursing. In one price-
less November 2005 scene, House temporarily relieved a patient’s thymoma
symptoms with a Tensilon injection, then went off on a “playing God” riff.
When the drug wore off, as expected, the patient fell to the floor. “This,” said
House, “is exactly why I created nurses.” Then he called out into the hallway,
“Clean-up on aisle three!”73
In a May 2008 episode, after House sustained a head injury, the show had a
home health nurse test his pupils with a penlight while he slept. House woke,
and the nurse introduced herself as Nurse Dickerson. House: “I don’t need
your name. And I got your profession from your supercompetent technique
of melting my retinas.”74
In a telling November 2006 episode, physician Foreman prepared to take
a sample of spinal fluid from a patient. When the patient’s eleven-year-old
sister offered to help, Foreman agreed, noting that it’s “quicker than calling a
nurse.” When Foreman instructed the girl to hold her brother’s legs still, she
asked, “Is this all nurses do?” Foreman responded, with a wry smile, “My boss
[House] doesn’t trust ‘em to do anything else.”75
Not every nurse character that appeared on House was timid or useless,
but the show never really strayed from its basic approach to nursing skills.
In a February 2011 episode, a critical patient was coughing up a lot of blood.
A nurse was trying to catch the blood in a container, but she said nothing to
81
the patient. Fortunately, an all-physician team arrived to save the day. The
agitated nurse gave her report: “I don’t know what’s wrong. He was stable for
a while, and then all of a sudden—!”76
The Mindy Project: “Just a Big Loser”

The Mindy Project, which focuses on a small obstetrics practice in New York
City, is a disaster for nursing. Mindy Kaling’s lookin’-for-love character and
the show’s other obstetrics and gynecology (OB/GYN) physicians are quirky
and immature, but there is no doubt that they provide skilled health care,
while the three minor nurse characters are inept, bizarre, delusional, and pos-
sibly dangerous. (We know—it’s just a joke!) As with the female surgeons on
Grey’s, it offends Mindy when others mistake her for a nurse, as was evident in
an October 2013 episode in which a male physician did just that.77
The practice’s first nurse was Beverly, a hostile, drug-abusing, possibly psy-
chotic older woman fired in an October 2012 episode. Recruiting a replace-
ment, Mindy and a physician colleague interviewed one nurse who had good
academic and work credentials, which Mindy actually pointed out. The nurse
reacted by boasting, without irony, that she “should have been a doctor.”78
The physicians settled on Morgan Tookers, a well-intentioned ex-convict
with lots of kooky ideas but little evident health expertise. Morgan has become
the show’s main nurse character. Morgan specializes in sincere comments that
reveal his idiocy, as in the April 2013 episode in which he noted that he would
not be “paying $10 to check a $5 coat” and at another point bragged that
his laptop was “the biggest laptop you’ve ever seen.”79 In an October 2013
episode, Morgan unwittingly ate what were obviously drug-filled cupcakes
at a music festival.80 Then he hurt himself by jumping into what he thought
was a pool but was actually a lawn. When Morgan later moaned that he was
a drug addict, Mindy reassured him that he was “not cool enough” for that,
but instead was “just a big loser.” In another episode that month, Morgan con-
soled a heartbroken Mindy by noting that he himself had been dumped by
women 36 times.81 In a November 2013 episode, when one of the physicians
could not continue leading a birthing class, Morgan was unable to rescue the
class with any actual health knowledge; instead, he claimed to be there to
name the patients’ babies—he named two “Grover.”82
Meanwhile, in a February 2013 episode, Mindy’s practice rehired Beverly,
this time as an office assistant, although she soon proved to be clueless about
even the most basic office technology.83 In March 2013, Mindy found Beverly
moonlighting in a restaurant and guiltily promoted her to some kind of
executive assistant position, in which Beverly continued to inject occasional
8 2
bizarre comments.84 In one April 2013 episode, Mindy considered convert-

ing to Christianity for her boyfriend, and Beverly observed: “I’ve changed
my tune for any number of guys. I’ve been Jewish, super-Jewish, Buddhist,
People’s Temple, Heaven’s Gate, People’s Temple again, normal . . . ”85
During a period in which Morgan had temporarily left the practice, the
OB/GYNs hired a third nurse, Tamra, an African-American woman who has
at times functioned as a demented insult comic reminiscent of Perry Cox from
Scrubs, except without Cox’s expertise, authority, or fundamental sanity. In a
May 2013 episode, Tamra persisted in calling the macho OB/GYN Danny
“girl.”86 In a September 2013 episode, after Mindy returned from a mission in
Haiti with a shorter haircut, Tamra failed to recognize her: “Unh-uh, I told
you, we don’t want no candy bars, little boy.” Mindy pointed out that she had
worked at the practice for years and had actually hired Tamra.87 Tamra has
been plenty capable of foolish behavior. In a January 2014 episode, she mis-
takenly ordered 1,000 boxes of examination gloves (rather than 1,000 gloves)
for the small practice.88
Other Hollywood Television Shows: “Any Idiot Can Be a Nurse”

Many other shows have also presented nurses as unskilled. Nurses make
easy targets for insults and jokes, because writers can count on much of the
audience sharing a sense of nursing as trivial work for dimwits and wannabe
physicians.
The Grey’s spinoff Private Practice, set mainly at a Los Angeles “wellness
clinic” and a nearby hospital, generally followed the Grey’s model of brilliant
physicians and anonymous wallpaper nurses, but with one twist: the first
three seasons included cute surfing receptionist Dell Parker, a nurse who was
studying to be a midwife. Despite his good intentions, Dell initially seemed to
know little more than a layperson, and it was not clear why any nurse would
work as a receptionist, making a fraction of the salary. (Maybe this is what
“RN” stands for in Hollywood: Receptionist Nurse.) Dell did become a mid-
wife and occasionally displayed some skill, even delivering a few babies, but
he also seemed to retain an office administrator role. When the show killed
him off in May 2010, it added drama by highlighting his elation at having just
been admitted to medical school. Toward the very end of its run, the show
also included a few clinical scenes with physician Sam Bennett’s girlfriend, the
strong, smart labor and delivery nurse Stephanie. But her skills appeared to
consist mainly of anticipating physician needs, and in the January 2013 series
finale, Sam dumped Stephanie and returned to his physician ex-wife.89
83
ER always had one competent major nurse character, but it also deni-
grated nursing skill and professional status. In one September 2006 episode,
new physician Abby Lockhart was the mother of a premature infant in the
NICU. The NICU nurses were utterly incompetent. One, a lactation con-
sultant, was oblivious to Lockhart’s distress. The nurse tried to get Lockhart
to breastfeed, proclaiming inanely that “breast is best!” and advising that the
breast shield goes “between the boob and the tube!” instead of providing any
helpful guidance. The other NICU nurse blithely dismissed the concerns of
Lockhart’s mother about a critical heart monitor alarm. Mom had to virtually
yell at the nurse to go get the physicians—the real life savers.90
ER also told viewers that nursing was inferior more directly, by having
authoritative physician characters make virulent antinurse comments and by
suggesting that smart nurses excel by going to medical school. A May 2004
episode did both. In that one, then-nurse Lockhart passed her medical boards,
a fitting end to a season in which the show had exhaustively chronicled her
medical school experiences. The episode also included a scene in which new
nurse character Sam Taggart asked Lockhart if she could cover a nursing shift
for Taggart. Attending Kerry Weaver snapped, “Find another nurse. [We]
can’t have one of our interns changing bedpans during their residency.” The
nurses had no notable reaction.91 Abrasive physician characters on such shows
often make scathing statements about nursing. When there is no rebuttal, as
on House, it suggests that the comments are harsh but true.
In fact, data show that nurses are one hundred times more likely to attend
graduate school in nursing than in medicine.92 But ER never presented that
as an option for its nurse characters until—after we had been making these
points to the producers for years—October 2008 episodes indicated that
Taggart was starting a nurse anesthetist program. That was a fine idea. But
the show still had its characters (particularly nurses) celebrate what it saw
as Lockhart’s elevation to physician status and, in a May 2008 episode, even
celebrate her new attending physician status.93
Scrubs also suggested that nursing is low-skilled assistive work. In a nota-
ble February 2007 episode, chief of medicine Bob Kelso simply took over
as “head nurse” while Carla Espinosa was on maternity leave. Kelso’s foray
into “nursing” included silly girl talk and trivial scheduling tasks. To mock
nurse Kelso, attending Perry Cox ordered Kelso to get him some fresh scrubs
from housekeeping.94 Of course, the idea that Kelso could step directly into
any nurse’s job is absurd because of nurses’ unique knowledge and skills, as
explained in Chapters 1 and 4.
8 4
In a February 2005 Scrubs episode, during a hospital quarantine, Espinosa

told her surgeon husband Turk, “We’re shorthanded,” and asked him to
redress a patient’s bedsores. Turk said, “That’s nurse stuff,” and added that
he did not “have the expertise.” Espinosa responded that “any idiot can be
a nurse.” Turk: “I know.” Espinosa shoved him, saying, “I knew you thought
that. I knew it.”95 We see that Espinosa objects to Turk’s rudeness, but that
does not disprove what he said.
The HBO sitcom Getting On, which follows the hapless staff at a geriatric
care facility, makes a serious effort to show how challenging that setting is for
the nurses and of course for the patients. Nurse Dawn Forchette does know
something about health care, at times displaying an understanding of patient
conditions; in the first season finale, she had a better sense of when a patient
would die than did physician Jenna James. But Dawn also seems to have prob-
lems with infection control, and she is such a weak, pitiful character that it’s
hard to imagine that viewers see her as a serious professional.96 In another
December 2013 episode, when James was berating Dawn for not understand-
ing the importance of the physician’s fecal studies, James accused the nurse
of never even having heard of the New England Journal of Medicine. Dawn’s
response, a blank stare, seemed to confirm her ignorance.97 “Nurse” Didi
Ortley appears to be a licensed vocational nurse (with one year of training),
although she once called herself an “orderly” (six to eight weeks of training).98
Didi has common sense and a good rapport with patients, but she seems to
know very little about health care.
Many other health-oriented shows have suggested that it doesn’t take
much to be a nurse. In a December 2013 episode of MTV’s nurse reality show
Scrubbing In, one cast member failed to get her dream job at a Beverly Hills
plastic surgery practice after showing up at the interview with a resume that
misspelled her title as registered “nuse.”99 School nurses are a popular target.
In the January 2011 series premiere of Off the Map, a hot young US physician
who had recently arrived at a remote South American clinic staffed mainly
by hot young US physicians complained that a colleague was lucky to have a
critical patient to care for, because the first physician just “handed out Band-
Aids today . . . like a school nurse!”100 Nurses have virtually never appeared
on USA Network’s Royal Pains (2009–); when one did briefly in an August
2013 episode, she was a patient’s romantic interest named Daisy who was nice
but none too skilled.101 In the June 2009 series premiere of that show, after
brilliant physician and lead character Hank Lawson was blackballed by a New
York hospital, he lamented, “No institution will touch me. I can’t even get a
job as a school nurse!”102
85
Popular shows that do not focus on health care are no better. In an October
2009 episode of Fox’s Glee, character Terri applied for a school nurse job in
order to keep an eye on her teacher husband Will, even though her healthcare
training consisted of a CPR course. The principal and the ensuing plotline
suggested that a school nurse ought to have more training, but Terri still got
the job and put the students at risk.103 Glee returned to the same basic theme
four years later when an October 2013 episode had a college student named
Penny, who had not yet begun nursing school, giving vaccinations and other
school nurse care as “an internship.” The show made clear that Penny was dan-
gerously incompetent and it implied that a real nurse would be better, but she
was still identified as “Nurse Penny” and the effect was again to make a joke
of school nursing.104 A December 2013 episode of the ABC sitcom Modern
Family revealed that Dylan, the sweet but notoriously clueless sometime boy-
friend of main character Haley Dunphy, was attending nursing school.105 And
in a May 2004 episode of ABC’s sitcom 8 Simple Rules, hospital nurse Cate
tried to extricate herself from a meeting with a school principal. When she
said patients would die if she was not at work, the principal gave her a skepti-
cal look. Cate admitted patients would not die, but said they might wet the
bed. The laugh track encouraged viewers to find this remark hilarious.106
In Hollywood’s view, any type of nursing is worth leaving. NBC’s drama
Heroes featured hospice nurse Peter Petrelli, but the fall 2006 series premiere
presented hospice nursing as a dead-end job for dreamy, unduly self-sacrific-
ing losers, stressing the contempt of Peter’s successful family, who saw the
work as just sitting with the dying. Peter soon dropped nursing.107 On The
Glades, hospital nurse Callie occasionally displayed real knowledge, but she
was always a part-time medical student, and 2013 episodes stressed how eager
she was to continue with medical school, so it was not clear that any of her
skill could be attributed to nursing. What seemed to matter to the show was
that physicians held her in high esteem.108
“More Than a Nurse”: How the News Media Disrespects Nurses

Even the most respected news media sources belittle nursing. In October
2006 the Boston Globe website posted a poll in its business section after a suc-
cessful nurses’ strike at a local hospital. The item said that the strike was about
a plan to reduce what were, according to the hospital, “excessively generous”
contracts under which the “average nurse . . . working a 40-hour week makes
$107,000 a year.” The site then asked if the nurses “deserve this six-figure salary
for what they do.”109 We doubt the paper would have questioned a “six-figure
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salary” for lawyers, advertising executives, or newspaper editors. But for nurses
to make such a salary evidently suggested to the editors that our society has its
priorities wrong, because “what they do” is pretty simple.
In November 2005, National Public Radio’s Morning Edition ran a report
by science correspondent Brenda Wilson about developing world physicians
migrating to wealthier nations. At one point Wilson, reporting from a com-
munity health center in a Kenyan village, said that “because there are not
enough doctors, the center is run by a clinical officer.” To explain the expertise
of these officers, Wilson said they are “not quite a doctor but more than a
nurse.”110
Also in November 2005, Good Housekeeping included seventy-five “sur-
prising” health tips from “doctors” nationwide. One “Dr. X” offered hot
ED tips, like telling patients to lie to the triage nurse about when symptoms
began—never to say it was more than four hours earlier—in order to be seen
faster. However, he advised, “tell the doctor exactly when symptoms began.”111
But in fact, effective triage requires accurate information, which can mean
the difference between life and death. And saying that symptoms began more
recently will not necessarily indicate greater severity or get you seen faster.
Many people get news from The Daily Show with Jon Stewart. In October
2012 the show ran a segment about reintegrating veterans into the civilian
workforce that featured two former US military medics, who appeared to
have significant experience stabilizing wounded soldiers, following EMT
Basic training. To show that the medics’ experience was not being adequately
recognized, Stewart insisted that they were vastly overqualified to be school
nurses. Even though he noted that one school nurse position he had found for
the medics required a bachelor of science in nursing, Stewart mocked school
nurses as being all about “kickball” and “tummy aches.”112
News media diversions can also undermine nursing. In February 2007,
one New York Times Crossword Puzzle included the following as one of its
clues: “I.C.U. helpers.” The “correct” answer was “RNs.”113 Helpers? Nurses let
Puzzle Master Will Shortz know this was wrong, but the Puzzle nevertheless
returned to the theme in April 2009, seeking “nurse” with the clue “hospital
attendant.”114 The references may seem trivial, but when the premier cross-
word in the world says that the nurses who play the central role in high-tech
ICU care are just peripheral bit players, it has a real effect.
A subtle problem is the news media’s tendency to suggest that nurses
who are not providing direct care at the bedside are not nurses. In other
words, nursing is not a science profession that confers enduring status or
that one might pursue through health management, research, advocacy, or
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policy-making. John Colapinto’s generally strong December 2010 New Yorker

profile of Duchenne muscular dystrophy advocate Pat Furlong portrays her
as a smart, ruthlessly effective health leader fighting the disease that claimed
her sons, but it also calls her a “former nurse.”115 In April 2006 the Long Beach
Press Telegram ran a piece about Judy Fix, who had saved the life of an injured
motorist at the roadside. The headline: “Ex-Nurse Didn’t Forget.” Fix was
referred to as an “administrator” at Memorial Medical Center and a “former
nurse.”116 In fact, Judy Fix was the hospital’s chief nursing officer and senior vice
president of patient care services, managing 1,800 RNs. The media would not
refer to Memorial’s chief of medicine as an “ex-physician.” What’s the differ-
ence? The view that nursing involves simple physical labor and not education,
leadership, or professional expertise.
“Don’t Forget to Pack a Nurse”: Even Good Intentions

Can Go Wrong
In recent years many media items have tried to pay tribute to nurses.
Unfortunately, even these efforts can suggest that nurses are not so much
skilled professionals as they are durable, hardworking, and useful in the way
of a handy tool.
In a May 2005 edition of the Mercury (South Africa), Xoliswa Zulu’s
“Have You Thanked a Nurse Today?” marveled at nurses’ endurance and abil-
ity to tolerate foul-smelling wounds and bedpans. But readers did not get a
sense that nurses are educated professionals.117
Even efforts to highlight nursing knowledge do not always show much
respect for it. A November 2011 segment of The Dr. Oz Show called “NURSES’
SECRETS That Can Save Your Life,”118 like the Reader’s Digest cover story
“50 Secrets Nurses Won’t Tell You”119 from that same month, had some good
information. But both items were marred somewhat by the condescending
focus on “secrets.” That approach presented nurses less as college-educated
professionals than as a group of employees who had hung around healthcare
settings long enough to have picked up basic tips ‘n’ tricks, some of which
might strike people as pretty minor and hardly “life-saving.”
The New York Times has, in trying to convey the value of nursing, compared
nurses to inanimate objects. In a basically helpful November 2002 “Cases”
piece in the Times, physician Abigail Zuger suggested that an elderly patient
of hers who had died might have survived if not for the nursing shortage. The
headline was “Prescription, Quite Simply, Was a Nurse.”120 In September 2005
the Times ran a piece by Alina Tugend about the trend toward hiring private
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nurses to compensate for hospital short-staffing. The headline: “Going to the

Hospital? Don’t Forget to Pack a Nurse.”121
If It’s Important Work, Credit Anyone but a Nurse

In many entertainment and news media products, nursing work is seen
to have real value. It saves patients’ lives and improves outcomes. That
would be great—except that the work is presented as having been done by
someone other than a nurse.
Physician Nursing: Prime-Time Physicians Do Nursing Work

Aside from the 2009 nurse shows, every recent US hospital drama has fea-
tured rampant physician nursing: the shows’ structure makes it inevitable.
Virtually every major character is a physician, and the prevailing practice is
that the drama must run through these characters. But because the real physi-
cian role is actually somewhat limited, physician characters are often shown
doing dramatic work in which real-life nurses take the lead. Thus, physician
characters handle bedside surveillance and interventions, psychosocial care,
patient advocacy and education—and all decision-making.
Grey’s Anatomy may have more physician nursing than any other recent
Hollywood drama. In the May 2013 season finale, after a big storm knocked
out the hospital’s power, guess who gave all the skilled care to twelve critically
ill infants in the NICU? Supposedly, just two nurses managed to make it to
the hospital in the storm—evidently the six NICU nurses who would have
been on duty at the time of the storm just abandoned their tiny patients—
so the surgeon characters and the worried parents ventilated and otherwise
cared for the babies. The impression was that physicians provide all meaning-
ful NICU care, disinformation that was especially ironic because the episode
seemed to be based in part on the heroic real-life evacuation of New York
University hospital’s NICU during Hurricane Sandy—which was conducted,
of course, by the nurses who actually play the primary role in NICU care.122
Physician nursing was also abundant in several November 2010 epi-
sodes of Grey’s.123 One actually included a limited portrayal of a nurse as a
strong, knowledgeable advocate—for her own critically ill son. But residents
Meredith Grey and Alex Karev seemed to be the only hospital workers who
gave any significant physical or psychosocial care to the boy. No practicing
nurse appeared. The plotline was a good example of the show’s occasional
89
practice, seen a couple of times on House as well, to have nurses briefly display
health knowledge when appearing as patients or family members in isolated
episodes, perhaps as a token effort to mollify critics without upsetting the
natural all-physician order. In another Grey’s episode that same month, senior
surgeon Miranda Bailey ordered resident Jackson Avery to closely monitor a
postoperative patient with a pancreatic fistula. Avery complained that Bailey
had him “watching a post-op for fluid into a bag every two minutes.” In real
life, nurses monitor patients for fluid loss and other subtle signs of decline,
and they initiate rescue measures if needed.
In one May 2008 episode, cardiac surgeon Erica Hahn provided emo-
tional care to a distraught transplant candidate in isolation. Alex Karev gave
the patient intravenous medication. When the patient’s lung collapsed, Alex
alone intervened to save her, issuing a command to the ether to get Hahn.
A nurse-blur responded, “Right away, Dr. Karev!”124 Meredith Grey provided
all psychosocial care to a soldier with a brain tumor. She managed the tension
between this soldier’s father and his male lover. After the surgery, Meredith
monitored the patient’s intracranial pressure. Later the patient coded, and a
nurse handed Meredith the paddles so she could defibrillate. Alex even got
the transplant patient’s family into protective gear so they could enter the
isolation bubble with her. In real life, every one of these actions would be
performed primarily or completely by a nurse. Finally, resident Cristina Yang
gave a bitter speech about another surgeon’s winning a medical award with-
out crediting her help. She complained that she was “the unseen hand to his
brilliance,” an astonishing echo of the episode’s own crediting of physicians
for work nurses really do.
In a December 2005 Grey’s episode, hours after a quintuplet birth, each
of the five major intern characters sat in the NICU keeping watch over his
or her own quint, with no nurses in sight. The physician characters also pro-
vided cobedding for the quints and emotional support for the quints’ dis-
tressed mother. Another subplot involved a patient Alex “killed” when he
“told a nurse” to administer an incorrect dosage of hypertonic saline, thus
dehydrating the patient’s brain.125 No one suggested that the nurse had a duty
to scrutinize prescriptions to prevent dangerous errors, which Alex’s prescrip-
tion clearly was.
House also generally had physicians do everything important in the hospi-
tal. In fact, like the Grey’s surgeons, House’s team did the meaningful work of
many other types of health workers—not just nurses—including the work of
physicians with other specialties.126
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In the May 2008 House season finale, when a patient had multiple organ
failure, House’s team of diagnosticians did a typical range of critical nurs-
ing tasks. They infused solutions and intravenous medications. They set up
and maintained a cardiac bypass without nurses. They did ambu-bagging,
which nurses, respiratory therapists, or anesthesia professionals usually
do. They provided all monitoring and psychosocial care. They performed
nurse-free surgeries. They induced hypothermia with cooling blankets. They
alone performed resuscitation and effected an interhospital transfer of the
critical patient. All of these actions are unthinkable without nursing
involvement.127
In a May 2006 House episode, the physicians did virtually all monitoring,
psychosocial care, and therapeutic care. The most amusing part was a nurse-
free scene in which physician Robert Chase walked a patient with major facial
swelling around after his surgery and even took him to the toilet! Perhaps a
physician has done this, but we’ve never heard of it.128
TNT’s Monday Mornings, which only lasted one season in early 2013, is
a good example of the many television dramas that come and go quickly but
still leave millions of viewers with the idea that physicians provide all the hos-
pital care that matters. The show, based on a novel by CNN medical reporter
and physician Sanjay Gupta, focused on the tense morbidity and mortality
conferences held at a Portland, Oregon hospital. All major characters were
physicians. Nurse characters were rarely seen, much less heard, and health care
seemed to consist of smart physicians interacting with patients, families, and
each other. Junior physicians, not nurses, advocated for patients and woke
attendings in the middle of the night. In the April 2013 finale, a man wait-
ing in the ED stopped a nearby surgeon, complaining that he’d been waiting
more than two hours. The surgeon, acting as triage nurse, assured the man
that they’d be with him as soon as they could!129
On ER, where nurse characters had far more realistic roles than their
counterparts on most other dramas, there was still plenty of physician nurs-
ing, and wallpaper nurses often watched physicians do work that nurses really
do. In a May 2007 episode, nurse Sam Taggart generally came off as a tough,
skilled patient advocate, but the care of a physicist with septic shock featured
relentless physician nursing. In the ED, Taggart called for the hospital’s rapid
response team to help this unstable patient. The team was composed solely
of physicians and medical students. In fact, rapid response teams generally
consist mainly of nurses and respiratory therapists.130 An anonymous nurse
helped OR resident Neela Rasgotra push the physicist’s gurney from the
surgical ward to the ICU. But the nurse did not seem to be managing the
91
patient’s second-to-second care, as real nurses do during these trips. When

ICU attending Kevin Moretti approached, the nurse departed without a
word. The patient crashed, and while Moretti, Rasgotra, and a medical stu-
dent resuscitated her, a bit of a nurse did appear at the edge of the frame a
couple of times. The episode also included an intern taking a patient to CT
scan alone, a serious ambulance admit with no nurse involvement, and physi-
cian medication administration.131
Physician nursing infects nonhospital shows as well. Episodes of NBC’s
Law and Order: Special Victims Unit broadcast in November 2004 and
September 2010 featured a special spin on physician nursing. In these epi-
sodes, commendably, a sexual assault forensic examiner nurse actually cared
for a rape victim. Those specially trained nurses, not physicians, do typically
take the lead in providing critical care and forensic work for sexual assault
victims at major trauma centers. Sadly, the 2004 episode depicted one of the
show’s two main detective characters directing and doing the key work. In
real life, the police probably would not even have been present. But here, the
nurse character came off as an awkward and insensitive assistant, as the detec-
tive explained what was going on, took photographs, and provided the only
real emotional support the patient received.132 In the 2010 episode, the nurse
seemed more autonomous, but she was a callous evidence collector who did
not say a word to the distraught rape victim, even when she caused the victim
pain. The detective provided all psychosocial care.133
Physician Nursing: The News Media Knows Who Saves Lives

Physicians Get the Credit
Many news accounts, particularly those written by physicians, assign credit
for nursing work to physicians. In May 2007 the New York Times ran a long
piece by reporter Lawrence K. Altman, MD, about New Jersey Governor Jon
Corzine’s recovery from a serious automobile crash: “In Corzine’s Recovery,
Doctors Cite Grit and Luck.” Corzine spent eighteen days in Cooper
University Hospital, eleven of those in the ICU—where elite nurses take
the lead 24/7, running high-tech machinery, managing a complex regimen
of treatments, and monitoring patients for the slightest changes in condi-
tion. Yet in the midst of many statements about what physicians thought and
did, the only specific credit any nurse got in this article was for lip-reading
Corzine’s requests for medication and water while he was on the ventilator.
The article noted, “At Cooper, doctors typically take turns caring for trauma
patients every day.”134 The writer must have meant that different physicians
9 2
are assigned to such patients on different days, but for most readers, this state-
ment would likely confirm the prevailing misconception: physicians do all
the important “caring” at the bedside for critical patients like Corzine.
Later that same month, the US Department of Transportation sponsored
a public service announcement featuring Governor Corzine urging television
viewers to use seat belts. Corzine credited “a remarkable team of doctors and
a series of miracles” with saving his life. The public service announcement
was a good public health effort, but it ignored the nurses and other “team”
members who likely provided most of the skilled care that saved his life.135
Of course, the public service announcement creators are not alone in their
limited view of what saves lives. The title of physician Sanjay Gupta’s 2009
book is Cheating Death: The Doctors and Medical Miracles That Are Saving
Lives Against All Odds.
In October 2004 a long, unsigned article in the Wall Street Journal on
allowing family presence during major hospital procedures recognized that
nurses had been most active on that issue and even featured quotes from nurs-
ing experts. Unfortunately, even that article repeatedly suggested that phy-
sicians perform major procedures alone, so the nurses are largely observers
who have time to worry about how the family may react. The piece referred
to steps to alleviate “one of medicine’s most trying ordeals: That wait in the
hall while doctors are working on a loved one.” Later, the report noted that
a Boston hospital had begun allowing family members to stay during codes
when “doctors may need to shock the patient or open up the chest to massage
the heart.” And one of the reported benefits of family presence? “Families can
give on-the-spot medical information to trauma doctors.”136
A March 2012 piece in Haaretz (Tel Aviv, Israel) included a special spin on
physician nursing: reporting that does not tell readers which type of health pro-
fessional is responsible for important healthcare work, but that is likely to leave
the impression that it’s a physician or other nonnurse. In this piece, Dan Even
reported that a new study by scholar Sigal Shafran-Tikva examined the factors
that can lead to violence by Israeli hospital patients. Unfortunately, the report
failed to mention that Shafran-Tikva is a nurse, leaving readers to guess her pro-
fession based on their understanding of health care.137 Perhaps those publicizing
the study themselves downplayed the nursing element so the research would be
taken more seriously, but the net effect was to bury nursing expertise.
Physicians Get the Blame

The media commonly assigns all blame for clinical healthcare problems to
physicians. It would be natural for nurses not to object. But they should,
93
because this practice signals that the media regards physicians as the ones
who provide all important care and decision-making. Being seen as an inte-
gral part of the healthcare picture means receiving credit when things go well
and being held responsible when things do not.
A September 2008 New York Times article by Laurie Tarkan discussed
emergency patients’ poor understanding of their care. Patient education is
a key nursing responsibility, and nurses generally spend far more time on it
than physicians do, if staffing allows. But this piece gave no hint of that fact,
instead relying on multiple statements from five named physicians. Not one
nurse was consulted, although nurses did get a mention—in discussion of a
“dual discharge” approach in which a physician discusses care with patients
and a nurse “follows up with computerized discharge instructions.”138
In June 2004 the New York Times published a column by Bob Herbert
about malpractice claims against an OB/GYN physician. The piece sug-
gested that a critical problem for one baby born with severe brain damage was
improper checking of a fetal monitoring strip while the physician was absent.
Herbert stated, with unmistakable contempt, that the physician “blamed the
ensuing tragedy on the nurse.”139 In fact, the apparent monitoring and assess-
ment error described would generally be a nurse’s job.
In December 2005 the Baltimore Sun ran Fred Schulte’s massive series
“Masking Malpractice Cases.” The gist was that Maryland’s system for over-
seeing physician practice was failing to protect patients. The article focused
on the small number of physicians who have had unusually high numbers of
malpractice claims or payments. Readers would plainly see the Sun’s report
as addressing the full universe of healthcare errors. Yet there are four times as
many registered nurses as physicians,140 and although nurses are not seen as
the litigation targets physicians are, there is no reason to think nurse errors are
any less numerous or consequential. Healthcare errors are the third leading
cause of death in the United States,141 and nurses are deeply involved in the
care in which such errors occur. In fact, research shows that nurses prevent the
majority of potential hospital errors.142 But in this entire Sun report, whose
text exceeded 9,500 words, neither the word “nurse” nor the word “nursing”
appeared even once.143
A couple of thoughtful reports on hospital errors in early 2010 did use fatal
nursing mistakes as examples, although the pieces still consulted physicians to
a greater extent than nurses, and so they were likely to leave the impression
that physicians had more responsibility. Liz Kowalczyk’s February Boston
Globe report described events surrounding the tragic death of a Massachusetts
General Hospital patient whose heart monitor alarm had been left off. The
9 4
reporter included a few helpful quotes from the hospital’s chief nurse, but
none from national nurse experts or direct care nurses who deal with those
monitors constantly. Instead, the piece relied on physician safety experts and
engineers involved in improving the safety of such technologies.144 Laura
Landro’s piece in a March edition of the Wall Street Journal discussed efforts
to treat the health workers involved in errors fairly, focusing on the well-
known case of Wisconsin nurse Julie Thao, who mistakenly gave a pregnant
patient a fatal dose of a painkiller. The piece included a little indirect com-
mentary from Thao, but all the expert quotes were from physicians and non-
nurse safety experts, rather than the nurses who have more direct knowledge
of medication errors.145 Perhaps as a result of inadequate input from nurses,
neither piece mentioned the extent to which nurse-related errors are due to
inadequate staffing or nurses’ relatively low level of power, which discourages
nurses from speaking up about problems.
Nursing Just Happens

Many press pieces effectively suggest that important nursing care has been
done by hospitals or machines, or else that it has simply occurred, with no
actor named. A December 2012 Associated Press report did not just say that
“doctors” were assessing the condition of then-Secretary of State Hillary
Clinton following her hospitalization for a blood clot. Rather, the piece also
passively stated that Clinton was “under observation” and “was being treated
with anti-coagulants.”146 In fact, nurses take the lead in “observing” patients,
and nurses give medications and carefully monitor their effects.
An October 2011 issue of The New Yorker included a piece by Ken Auletta
about Jill Abramson’s ascendancy to the editorship of the New York Times.
Auletta described injuries Abramson suffered after a truck knocked her down
and rolled over her, breaking bones and causing “extensive internal injuries.”
Physicians were the only health workers mentioned; supposedly, “surgeons
administered blood transfusions,” although of course nurses would have
done that, and later surgeons “told [Abramson] that she needed to spend six
weeks in bed.” But Auletta also said that “an ambulance rushed” Abramson to
Bellevue Hospital’s trauma center, and “many months of painkillers, excruci-
ating rehab, and physical therapy followed, as she progressed from wheelchair
to crutches to cane.”147 Note the lack of nurses, first responders, and physical
therapists. The ambulance must have driven itself and taken care of Abramson
on the way! No one conducted the physical therapy; it just “followed.” And
Abramson apparently had only painkillers for professional company during
95
her weeks in bed. But in reality, nurses provide hundreds of hours of skilled,
life-saving care to patients with severe injuries like these.
In February 2006 National Public Radio’s Morning Edition ran a report by
Richard Knox about the lack of intensive care resources that would be needed
to handle a bird flu pandemic: US hospitals would not have enough ventila-
tors or “hospital beds.”148 The report wrongly implied that care for patients
would revolve mainly around whether physicians granted access to the ven-
tilators or beds, and it quoted only physicians—as if either the physicians
provide all the associated care, or the ventilators and hospital beds do it them-
selves. In fact, nurses and respiratory therapists carefully monitor patients’
tolerance to ventilators, wean them off the machines, and teach them how to
breathe afterward. Without nurses, ventilators and beds save no one.
Innovation: Which Nonnurse Thought of That?

Some recent reports discuss the work nurses do on innovative health projects,
often outside the usual clinical settings. But even these pieces may present the
nurses as carrying out work engineered by others. Of course, it may be that a
specific project was designed by someone else. But nurses are not empty ves-
sels into which others have poured expertise. Nurses have long been expert in
community health and holistic preventative care, as explained in Chapter 1.
It often seems that the nursing care model gains attention only when it is
embraced by physicians or others with more social status.
Consider recent reports on the work of the Nurse-Family Partnership
(NFP) to improve the health of poor mothers and children, such as an August
2007 CBS Evening News report by Katie Couric.149 We have seen no major
mainstream article that cites the NFP program’s debt to the long tradition of
home-based nursing care, so the whole idea that “nurse-visitors” can improve
maternal–child health may seem to have originated with NFP founder David
Olds, a developmental psychologist. The pieces have also failed to convey
how much of the nurses’ success is due to their nursing skill, not just to Olds’s
program design or the nurses’ personal attributes, trusted image, or on-the-
job experience.
In October 2006 an Associated Press piece by Alicia Chang reported that
insurers increasingly rely on “health coaches” to help patients manage chronic
conditions at home, thereby cutting costs and improving outcomes.150 The
report barely managed to note that most of the coaches are nurses, so it
failed to discuss why nurses are uniquely qualified to play such roles. Instead,
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it credited a Colorado physician for the specific care “model” it discussed,

which may imply that this kind of work is a recent physician innovation.
Ghosts in the Machine: Nurses Go Missing in the Media

The media often simply ignores nursing, even when reporting on skilled work
in which nurses play a central role, such as hospital care or foreign aid work.
Nurses are not generally recognized as career health care “heroes,” and they
are rarely consulted as health experts.
Lost in Hollywood
Popular Hollywood products often ignore the role nursing would really play
in their area of interest. For example, Grey’s Anatomy includes many clinical
scenes in which no nurses appear, even though the patients are in critical con-
dition and would require a great deal of skilled nursing.151
Ignoring nursing also results in a failure to portray recent nurse-led
advances in care that television producers would almost certainly take great
interest in if the developments had originated with physicians. For instance,
in hospital dramas, family members are forever freaking out to see their loved
ones in distress, then causing disruption. Physician characters often command
nurses to remove the family. We have never seen a nurse character advocate
for family to stay, or discuss the trend toward allowing family presence, which
nursing research has shown to have real benefits.152 Likewise, although recent
episodes of Grey’s and other shows have focused on NICUs, they have largely
failed to reflect recent nurse-led developments in kangaroo care (keeping the
infant at its mom’s or dad’s chest for certain periods), cobedding for multiples,
or breastfeeding. A November 2009 Grey’s episode did finally portray kanga-
roo care, but no nurses were involved; surgeon Miranda Bailey initiated the
care, and it was actually provided by junior physician Alex Karev.153
Most documentaries, reality shows, and daytime shows about health care
have taken a similar physician-centric approach. Since 2008, the popular daily
syndicated daytime talk show The Doctors has generally lived up to its name.
Airing in nations around the world, this Dr. Phil spin-off features a “dream
team” of four physicians dispensing advice and opinions on topics ranging
from cosmetic plastic surgery to various practical health issues, including
many in which the physician hosts seem to have little expertise, such as home
birth and midwifery. Although nurses are expert in patient education, they
have so far had no significant role on The Doctors.154
97
Terence Wrong’s multipart ABC News documentaries Hopkins 24/7

(2000),155 Hopkins (2008),156 Boston Med (2010),157 and NY Med (2012 and
2014)158 have been mainly about glorifying surgeons. The Hopkins documen-
taries ignored nursing almost completely, and although the more recent series
did occasionally feature emergency nurses, those segments were really just
diversions. For the most part, the focus was not on the nurses’ skill but on
their personal lives and the difficult behavior of the patients they confront.
The 2008 documentary feature Living in Emergency: Stories of Doctors
Without Borders profiled four developed world physicians who worked on
Médecins Sans Frontières/Doctors Without Borders aid missions in war-torn
Congo and Liberia. The film offered some valuable insights on foreign aid
work, but it ignored Médecins Sans Frontières’ nurses and logistics officers,
all of whom play key roles in the Nobel Prize–winning group’s work. Indeed,
nurses are the most numerous Médecins Sans Frontières health profession-
als,159 but this film was almost entirely about physicians, who did virtually
all of the talking and acting.160 In the end, the film’s distorted treatment of
emergency aid mirrored that of Médecins Sans Frontières’ name.
Lost in the News

News items often ignore nurses or nursing, even when covering areas in which
nurses play key roles. An October 2011 issue of The New Yorker included “A
Child in Time: New Frontiers in Treating Premature Babies,” by Harvard
physician Jerome Groopman. In this “medical dispatch,” physician work was
dominant and only physicians were consulted as NICU experts (along with
one social worker, briefly). No nurses were even named.161 Granted, one key
focus was physician research, but nurses also perform key research on the care
of premature babies and they spend much more time providing skilled care to
those babies than does anyone else. NICU nurses did appear here and there
in Groopman’s account, but he described them doing assistive things that lay
people could also do: swaddling babies, sitting with families, handing things
to people, and placing candles.
In a June 2004 “Cases” item in the New York Times, Richard A. Friedman,
MD, discussed whether July is a perilous time to visit US hospitals because of
the influx of recent medical school graduates with little experience. Friedman
admitted that it was rational to be concerned about “July syndrome” but
argued that there is little basis to think care suffers, because of “vigilant
supervision” by attending physicians. In fact, a great deal of the “vigilance”
is supplied by nurses, who also play a key role in teaching the interns how to
practice safely. But the word nurse did not appear in this piece.162
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When nurses spearhead groundbreaking research or policy proposals, they

are often ignored by elite media sources. In September 2009, John Hopkins
University issued a press release about the pain management research of its
nursing scholars Gayle Page and Sharon Kozachik. United Press International
ran a short item in response, noting that the nurses have “determined through
research that pain management is not only a matter of compassion, but a
medical necessity for patients to heal.”163 It was a rare example of press cover-
age of nursing research. Indeed, although the United Press International item
was noted on a few health-oriented websites, we saw no other mainstream
press coverage.
In October 2004 the Columbia University School of Nursing issued a
press release about its striking plan, published in Nursing Economics, to pro-
vide universal health coverage in the United States at an annual cost of about
$2,000 per person. Despite the obvious link to the impending general elec-
tion, more than a week later the only major press coverage appeared to be a
short item by Laura Gilchrest on the CBS Marketwatch website.164 It is hard
to avoid the conclusion that the Columbia plan was ignored because of the
professional status of those who created and published the plan.
Nurses Evacuated from Disaster Areas

It’s remarkable how invisible nursing often is in news accounts about responses
to mass casualty events, considering the central role nurses actually play.
One notable exception was Elizabeth Cohen’s short April 2013 piece on
the CNN website about the experience of nurses Stephen Segatore and Jim
Asaiante, who provided emergency care on-site after the Boston Marathon
bombing. Although there were few specifics on the nurses’ skills beyond
tourniquets and intravenous lines, the piece did quote them and make clear
that their trauma experience had been critical to their work as members of
a team of event health workers who saved lives that day.165 Of course, other
CNN reports, like a July 2013 follow-up piece about a victim who lost her leg,
focused only on physicians as experts and care providers.166
An extensive April 2013 New York Times report on the bombing response
was a tour de force of elite news physician-centrism. “Doctors Saved Lives, If
Not Legs, in Boston,” by Gina Kolata, Jeré Longman, and Mary Pilon, focused
on the care given on-site and initially at local hospitals. In a 1,500-word piece
that aimed to describe the full range of care given that day, the word “nurses”
appeared twice; once, notably, in the statement that “at least eight doctors and
what seemed to be 20 or more nurses were stationed in the tent.” Yet despite
99
all those nurses, the piece did not name or quote any. Instead, it quoted six
physicians and a chaplain (briefly), repeatedly telling readers what “doctors”
alone did and said, as if only that mattered. The reporters were not short on
space; at one point, they noted that a surgeon was so tired he took a nap. This
same surgeon woke up to explain that “surgeons were notified, emergency-
room physicians were notified, operating-room personnel were notified,
everyone was notified.”167 Yeah, guess that about covers it, dude.
In early 2007 NPR’s Morning Edition aired interviews with disaster health
experts. In February it ran an interview with a former US Coast Guard offi-
cer, who said at one point that a community had to ask whether it could
handle hundreds of thousands of casualties, “all requiring triage and other
kinds of life-and-death care.” Show host Steve Inskeep asked if that meant
asking whether such a place had “hundreds of vacant beds . . . hundreds of
idle doctors?” In a March interview, when the chief of medical affairs at a
New Orleans hospital noted that a lack of “health care providers” was ham-
pering efforts to restore area hospitals to full capacity after Hurricane Katrina,
Inskeep wondered whether even hospitals that had remained open “don’t
have enough doctors available.” In fact, most of the critical care in such emer-
gencies, such as triage, is provided by nurses. At least the guest experts in both
stories sooner or later worked nurses into the conversation.168
In September 2005 many outlets ran an Associated Press piece by Marilynn
Marchione about hospital care immediately after Katrina. The Yahoo! head-
line was typical: “Doctors Emerging as Heroes of Katrina.” The Associated
Press report portrayed physicians as having done virtually everything of note
for patients at New Orleans hospitals after the storm. Apart from a passing
reference to RNs and EMTs, and one sentence about a Pennsylvania para-
medic, the piece was all physicians all the time, with many references to what
“doctors” did, as well as multiple quotes and descriptions of no fewer than
eight named physicians and a medical student. Not one nurse was mentioned,
although nurses played a central role in keeping patients alive under the
extreme conditions during and after Katrina.169
Can We Be “Heroes”?
The media often salutes the careers of healthcare “heroes.” Nurses are rarely
recognized in that way, consistent with the view that life-saving is not a regu-
lar feature of nursing, although nurses may be honored for saving lives outside
of their usual practice settings.
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In November 2005, Time magazine published a massive report on global

health. Slightly more than half of the total report was devoted to profiles of
eighteen “heroes” whose “energy and passion are making a difference” in the
fight against disease worldwide. Of the fifteen healthcare professionals pro-
filed, twelve were physicians. Not one “hero” was recognized for her nursing,
although a profile of a nutritionist noted that she had a nursing degree. Only
one brief mention in the whole report could be considered a tribute to the
work of the world’s estimated 16 million nurses to stem disease. That was in
the concluding essay by rock star Bono.170
In July 2004 Discovery Health Channel aired the Discovery Health
Channel Medical Honors. The star-studded special saluted thirteen
“medical heroes” for “bringing awareness to many challenging health and
medical issues of our time.” The thirteen honorees consisted of eight physi-
cians, a biosciences researcher, a nonprofit leader, a political science professor,
a health system CEO, and an advertising executive. No nurses made the cut,
but nurses were represented—by actress Yvette Freeman, who played nurse
Haleh Adams on ER and who appeared at the ceremony as a presenter.171
You go, nurses!
When nurses do appear as “heroes,” it’s often because they have surprised
people by saving lives in unexpected ways. In November 2012, the ABC cur-
rent affairs show 20/20 included a segment about the New York University
NICU nurses who transported their fragile patients to safety after power
failed at their flooded hospital during Hurricane Sandy. The segment, part of a
feature about dramatic rescues during the storm entitled “The Heroes Among
Us,” did include references to the nurses’ knowledge and skill, although the
nurses were generally treated more like bystanders who stepped up in a trag-
edy rather than highly trained health professionals.172
It also seems to be amazing when nurses save lives by themselves on plane
flights. In January 2014 the Southern California NBC affiliate Channel 4
reported that nurses Linda Alweiss and Amy Sorenson had recently provided
“cardiac life support” to a pilot having a serious heart attack on a cross-country
flight.173 Similarly, Nicole Brodeur’s helpful May 2005 Seattle Times column
told how ED nurse Joanne Endres saved a man having a heart attack on a
plane flight. The theme of that column, “Flying Solo, Nurse Is Enough,” was
that the public does not understand what nurses do. Brodeur proved it by
quoting a passenger who said of Endres, “She just knew what to do. . . . And
there wasn’t even a doctor there!”174
101
Nurses? Healthcare Experts?

The media regularly fails to consult nurses in healthcare items, even on topics
about which nurses are expert. A January 2009 article by Gina Kolata in the
New York Times described a supposedly radical physician innovation: getting
ICU patients up and walking around as a way to improve recovery. The piece
featured extensive commentary by five physicians. Kolata noted in passing
that this new “tactic” required the help of nurses and therapists. In fact, nurses
have been walking patients around to improve recovery in ICUs for decades
without the need of any physician request. But the Times piece failed to quote
a single nurse.175
In May 2006 a huge Time cover story by Nancy Gibbs and Amanda Bower
stressed that not even health workers are safe from the health threats posed
by . . . hospitals. The story, “Q: What Scares Doctors? A: Being the Patient,”
presented an all-physician vision of hospital care, based on expert comment
by twelve physicians. It excluded nurses. At one point, the writers wondered
who the “sentinels” and “advocates” in hospitals would be now that family
physicians have supposedly been excluded from the role. Hint: that’s what the
nurses who make up the majority of professional hospital staff do, or would do
if they had the staffing and other resources.176
In 2007, Google formed a Health Advisory Council, a group of eminent
health “experts” that would help the dominant media company consider how
to “contribute to the health care industry.” The council of more than twenty
prominent health figures included thirteen physicians and many members
without any formal health care training. No nurses.177
Can Any Helpful Person or Thing Be a Nurse?

The media uses the term nurse broadly. It often refers to female caregivers
as “nurses” no matter how little health training they have. For example, the
Hollywood films The Skeleton Key178 (2005) and The Grudge179 (2004) were
widely promoted as having “nurse” characters, but the characters were actually
nonnurse caregivers. A nursing assistant who played a key role in the powerful
2012 documentary The Waiting Room was described as a “nurse” not only by
some reviewers, but also by the film’s director Peter Nicks in an interview.180
Of course, the verb form of nurse has long been used to describe unskilled
tending, especially by females. And as we explained in Chapter 1, the term
nurse can accurately be applied to professionals with a range of educational
backgrounds.
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Even so, the media has some obligation to consider the effects of its use of
the term. It might start by making sure that those it calls “nurses” actually are
nurses. Let’s try the nouns first, and maybe we can work our way up to the verbs!
I, Robot, Will Be Your Nurse

Sometimes the media refers to new healthcare technology as a “nurse,” as in
“robot nurse” and “electronic nurse.” In some cases, developers or marketers
themselves call their products “nurse.” These products may assist with nurs-
ing tasks, but equating machines with college-educated health professionals
is unhelpful.
The press often suggests that “robot nurses” may be critical to the future
of health care. A March 2011 Associated Press item reported that Purdue
University researchers were developing a “robotic scrub nurse” that could
recognize five hand gestures!181 In March 2009 Agence France-Presse reported
that Japan hoped that “robo-nurses” would soon play a key role in caring for
its aging population.182 In January 2007 the Scotsman ran Angus Howarth’s
“Robot Nurses Could Be on the Wards in Three Years, Say Scientists.” The
piece reported on a project by European Union–funded scientists to develop
machines to “perform basic tasks” at hospitals. These include cleaning up
spills, guiding visitors around, and perhaps distributing medicines and taking
temperatures. The article proposed other imaginative names for the machines,
such as “nursebots” and “mechanised ‘angels.’ ”183
Other assistive health technology may also receive the title “nurse.”
Tim Bajarin’s March 2009 column “Meet Nurse iPhone” in PC Magazine
extolled the virtues of new applications that turn Apple’s popular phone
into a “surprisingly competent medical assistant,” enabling timely transmis-
sion of health information.184 Similarly, in March 2006 the website of Wis10
(the Columbia, SC, NBC affiliate) posted an item by Chantelle Janelle,
“Health Alert: Electronic Nurse.” It described a $70 machine used to help
real nurses do home health monitoring by asking patients basic questions.185
You Just Haven’t Earned It Yet, Baby Nurse

Many in-home newborn nannies market themselves as “baby nurses,” regard-
less of whether they have any health training. The media has repeated the
term, even shortening it to “nurse.” This practice continues even though some
jurisdictions have made “nurse” a restricted title, in order to protect the public
from unlicensed practitioners.
103
In an April 2010 episode of the CBS sitcom Accidentally on Purpose, the

pregnant main character Billie hired an attractive “baby nurse” named Nicole.
Characters twice referred to Nicole simply as a “nurse,” and at one point we
heard that she had a “nursing degree from Cal.” But few if any “baby nurses”
are registered nurses, and there was no suggestion that Billie’s baby would
need the advanced skills a real neonatal nurse would provide. At first Nicole
did seem professional, but she turned out to be a manipulative nymphoma-
niac, seducing two friends of the baby’s father for a three some practically on
sight. So, she was less a real nurse than a real naughty nurse.186
In February 2007 Vickie Elmer’s item in the “Jobs” section of the
Washington Post repeatedly referred to the infant caregiver it profiled as a
“baby nurse,” even though the provider had virtually no health care training.
In response to criticism, the Post pointed out that there is a historic associa-
tion between infant caregiving and the word “nurse,” as in “nursemaid.”187
But to use “nurse” this way today sends a dangerous message about profes-
sional nursing. Indeed, in August 2005 the New York Daily News ran a piece
about the lack of regulation and awareness of the minimal training “baby
nurses” have, focusing on the case of Noella Allick, who reportedly “confessed
to violently shaking and seriously injuring two babies in her care.” The article
rightly suggested that a key problem is that anyone can call herself a “nurse.”188
New York State later made “nurse” a protected title.189 But the term “baby
nurse” remains common.
I Say You’re a Nurse, and the Shortage Is Over

In clinical settings, many people—including some physicians—refer to any
female who is not a physician as a “nurse.” Such “nurses” may include techni-
cians, medical assistants, nurses’ aides, and clerks. Hospitals may see no reason
to clarify matters, because most have placed unlicensed assistive personnel into
nursing roles to save money. But when a patient asks an apparent “nurse” with
only a few weeks’ training to explain his condition, and the “nurse” cannot do
so, the patient may conclude that nurses as a group are not highly skilled.
The media reflects and reinforces this tendency to equate “nurse” with
“female health worker.” For instance, in a 2005 episode of the popular Dr. Phil
television show, the host—a psychologist—repeatedly referred to a nurse’s
aide as a “nurse.”190 In a January 2006 CVS drugstore company television
advertisement, a pharmacist explained that he had spent several hours teach-
ing a patient’s husband to administer her twenty different medications. The
pharmacist twice said that the husband was now “a nurse.”191 Modern drug
1 0 4
regimens are complex, and the health financing system has left many families
with the impossible task of trying to nurse themselves. But this advertisement
wrongly suggested that pharmacists could train nurses and that training a
nurse might take only a few hours.
Or none. In November 2011 posters appeared in the Washington, DC
Metro system as part of an extensive “Care Not Cuts” campaign, a lobby-
ing effort by the US long-term care industry to prevent federal reimburse-
ment cutbacks. One advertisement featured text reading: “Today, you’re an
accountant. Tomorrow, you’re dad’s nurse.”192 An August 2009 article in the
Philippine Daily Inquirer, headlined “Daughter Kris Was Aquino’s Nurse,”
suggested that one of the daughters of former President Corazon Aquino had
cared for her dying mother so faithfully that one friend said she had “attended
to her mother’s bedside needs like a professional nurse.” But there was no
indication that Kris, a television host, had any actual health care training.193
This sense that anyone can be a nurse goes hand in hand with ideas to
resolve the shortage by recruiting those with few other options. In March
2006 the news magazine Der Spiegel ran a piece by Guido Kleinhubbert
about a new German government program to train prostitutes to become
“care workers for the elderly,” including “nurses.”194 It is possible they were to
be nurse’s aides. But policymakers and press pieces have also suggested that
solutions to the developed world’s nursing shortage lie in recruiting those on
public assistance,195 desperate nurses from poor nations,196 or foreign phy-
sicians who can’t pass their physician licensing examinations.197 Excellent
nurses may come from any of these categories, but the sense we get from many
of these press stories is that these ideas make sense because being a “nurse”
requires little critical thinking or knowledge.
Media creators have also presented plans to address the shortage or
achieve other policy goals by “streamlining” educational requirements to get
more nurses into practice faster. For example, in an October 2012 presiden-
tial debate, President Obama stated that former military medics who wanted
to become nurses had to “start from scratch,” so we should “change those
certifications.”198 Of course veterans and others should receive appropriate
credit for prior education, but ideas that effectively result in less education for
nurses are not in the interests of nurses or their patients. A June 2005 article
by Joel Dresang in the Milwaukee Journal-Sentinel approvingly described a
large Wisconsin program to address the nursing shortage that included ideas
to “streamline” nursing coursework.199
Simply finding new groups of people to plug the holes in the nursing work-
force does nothing to fix the reasons those holes exist, which include poor
105
working conditions and a lack of real understanding of nursing skills. Would

media creators uncritically discuss plans to address a physician shortage by
“streamlining” medical school or recruiting those with few other options?
Notes
1. CFNA, “NBC’s ‘Passions’ Solves Nursing Shortage: Monkeys Can Do the Job!,”
TAN (September 12, 2003), http://tinyurl.com/jww254k.
2. Daniel Simons and Christopher Chabris, “Gorillas in Our Midst: Sustained
Inattentional Blindness for Dynamic Events,” Perception 28 (1999): 1059–1074,
http://tinyurl.com/ykg833m; video available at http://tinyurl.com/2pl5d.
3. Keith Payne, “Your Hidden Censor: What Your Mind Will Not Let You See,”
Scientific American ( June 11, 2013), http://tinyurl.com/kzf9t6b.
4. Liz Brixius and Linda Wallem, writers, Paul Feig, director, “Comfort Food,” Nurse
Jackie, Showtime (March 22, 2010); TAN, “Blade Runner” (March 22, 2010),
http://tinyurl.com/mapznaw.
5. Clyde Phillips, writer, Randall Einhorn, director, “Happy F**king Birthday,” Nurse
Jackie, Showtime (April 14, 2013); TAN, “Cunning, Baffling, Powerful” (April 14,
2013), http://tinyurl.com/kgrdrne.
6. Rick Cleveland, writer, Craig Zisk, director, “Tiny Bubbles,” Nurse Jackie, Showtime
( July 13, 2009); TAN, “Who Must Do the Hard Things?” ( July 13, 2009),
http://tinyurl.com/k3n88ug.
7. TAN, “Nurse Jackie Episode Reviews” (2013), http://tinyurl.com/kqm3k6b.
8. TAN, “Call the Midwife Episode Reviews” (2012), http://tinyurl.com/m3bf4lw.
9. John Martin, Heidi Thomas, and Jennifer Worth, writers, Roger Goldby,
director, “Season 2, Episode 3,” Call the Midwife, BBC/PBS (February 3, 2013),
http://tinyurl.com/cm8tpvg.
10. Heidi Thomas, writer, Minkie Spiro, director, “Season 2, Episode 8,” Call the
Midwife, BBC/PBS (March 19, 2013).
15. Megan Amram, writer, Craig Zisk, director, “Animal Control,” Parks & Recreation,
NBC (April 11, 2013), http://tinyurl.com/kjqo6ve.
16. TAN, “A Tale of Two Nurses” ( January 27, 2013), http://tinyurl.com/pzv2juv.
17. TAN, “I Just Do” (2008), http://tinyurl.com/nqk9f2t.
18. CFNA, “Lifeline: The Nursing Diaries,” TAN (2004), http://tinyurl.com/
ob9df8c.
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19. Greg Rienzi, “TV Documentary Explores Nursing,” The Gazette Online 29, no.
42 ( July 31, 2000), http://tinyurl.com/q8kqald; CFNA, “Nurses,” TAN (2002),
http://tinyurl.com/qzjaldh.
20. Tony Kushner, writer, Mike Nichols, director, Angels in America, HBO Films (2003);
CFNA, “Angels in America,” TAN (April 4, 2004), http://tinyurl.com/mqcbd3l.
21. George Romero and James Gunn, writers, Zack Snyder, director, Dawn of the
Dead, Universal Pictures (2004); CFNA, “Dawn of the Dead,” TAN (2004),
http://tinyurl.com/py9holr.
22. Neill Blomkamp, writer and director, Elysium, TriStar Pictures (2013); TAN,
“Elysium” (October 17, 2013), http://tinyurl.com/olqoxef.
23. John Hamburg and Larry Stuckey, writers, Paul Weitz, director, Little Fockers,
Tribeca/Everyman Pictures (2010); TAN, “Little Fockers” (August 4, 2011),
http://tinyurl.com/oko5yzw.
24. Daniel Slotnik, “Vernice D. Ferguson, Leader and Advocate of Nurses, Dies at 84,”
New York Times (December 21, 2012); TAN, “Fear No Evil: Whatever the Boys
Have” (December 21, 2012), http://tinyurl.com/qhfr7vy.
25. Frederick Rasmussen, “Elizabeth S. Trump: Longtime Director of Nurses at
Maryland Shock Trauma Center Worked Closely with Founder Dr. R Adams
Cowley,” Baltimore Sun ( June 9, 2012); TAN, “Fear No Evil: The First Trauma
Nurse” (December 21, 2012), http://tinyurl.com/pohupcn.
26. Julian Guthrie, “David Vlahov Is New UCSF Nursing School Dean,” San Francisco
Chronicle (March 11, 2012); TAN, “You Just Have to Listen” (March 11, 2012),
http://tinyurl.com/ncsmen2.
27. Steve Lopez, “A Note of Gratitude to Nurses: An Alert Nurse’s Quick Action Saves
the Columnist’s Life and Opens His Eyes to His Medical Team’s Dedication and
Compassion,” Los Angeles Times (September 1, 2012); TAN, “All Pros” (September 1,
2012), http://tinyurl.com/9h56qwm.
28. John Blanton, “Care and Chaos on the Night Nursing Shift; In a Search for Purpose,
an Editor Changes Careers; ‘He’s Asking for You Again,’” Wall Street Journal
(April 24, 2007); CFNA, “There and Back Again,” TAN (April 24, 2007), http://
tinyurl.com/ndu5dx8.
29. Scott Allen, “A Crash Course in Saving Lives,” Boston Globe (October 23–26,
2007), http://tinyurl.com/axoun4o; CFNA, “As I Lay Dying,” TAN (October
23–26, 2007), http://tinyurl.com/mnm2zkh.
30. Gary Trudeau, “Doonesbury” ( June 25 and 28, 2004), http://tinyurl.com/
pqdkekm and http://tinyurl.com/mx4jtzg; CFNA, “Nurse Jewel Shows B.D. the
Tough Love,” TAN ( July 3, 2004), http://tinyurl.com/ndmswyl.
31. Patti Neighmond, “Need a Nurse? You May Have to Wait,” National Public Radio
(May 25, 2012), http://tinyurl.com/7kf9eab; TAN, “Are Your Knuckles White?”
(May 25, 2012), http://tinyurl.com/nhdpoas.
32. Will Moredock, “Critical Condition: S.C.’s Nursing Shortage Could Use Some
Intensive Care,” Charleston City Paper (March 14, 2007), http://tinyurl.com/
107
mpdgzfv; CFNA, “Startling Discoveries,” TAN (March 14, 2007), http://tinyurl.

com/pko6wuj.
33. John Pekkanen, “Condition Critical: With Nurses Leaving in Droves, a Stay at
the Hospital Gets Scarier Every Day,” Reader’s Digest (September 2003): 84–93,
http://tinyurl.com/keeggj9; CFNA, “Reader’s Digest: Nursing Shortage Is
‘America’s Biggest Health Care Crisis,’ ” TAN (September 2003), http://tinyurl.
com/m6ouj9e.
34. CFNA, “Exodus,” TAN ( June 29, 2006), http://tinyurl.com/oalpeeg.
35. Jeff Bryant, “‘School Nurse Cuts Killed My Daughter’: Laporshia Massey Died
Because Our Priorities Are Wrong,” Salon (October 18, 2013), http://tinyurl.com/
n7df67t.
36. Elisabeth Ochs, “Help Us,” Salon (February 5, 2004), http://tinyurl.com/
pr4duqv; CFNA, “Homeland Security,” TAN (February 5, 2004), http://tinyurl.
com/ocq23cd.
37. Kathleen Bartholomew, “Students in Washington Schools Need Nurses,” Seattle
Times ( June 11, 2013), http://tinyurl.com/lj54b79.
38. Chris Coats, “Christmas Angel Saves 8-Year-Old Boy,” Dallas Morning News
(December 21, 2007), http://tinyurl.com/ow8o2fj.
39. Jim Flink, “School Nurse Helps Save Student With Aneurysm,” KMBC, Kansas
City (October 20, 2006); CFNA, “Assessment,” TAN (October 20, 2006),
http://tinyurl.com/pgwro3t.
40. Lauran Neergaard, “NYC School Nurse Recounts Swine Flu Triage,” Associated
Press ( July 9, 2009), http://tinyurl.com/mql8kud; TAN, “Post-Its and Other
Priorities: Every School Needs a Nurse” ( July 9, 2009), http://tinyurl.com/
nqdpj2g.
41. Suruchi Sharma, “Nurse Tells Asian Community to Get ‘Clued Up’ about Tobacco
at Northwick Park Hospital,” Harrow Times (November 25, 2011), http://tinyurl.
com/mev326u; TAN, “Wicked Local Public Health Advocates: Getting Clued
Up” (December 2011), http://tinyurl.com/q5xqvaq.
42. Katherine Boo, “Swamp Nurse,” The New Yorker (February 6, 2006),
http://tinyurl.com/mvs5fe; CFNA, “The Overcomer: Nurse-Family Partnerships
in the Louisiana Bayou,” TAN (February 6, 2006), http://tinyurl.com/pcmov73.
43. Amanda Crook, “MRSA Award for Nurses,” Manchester Evening News (April 17,
2010), http://tinyurl.com/ou736nv.
44. Alan McEwen, “Pioneer Nurse Wins Award for Life-Saving Heart Scheme,”
Scotsman ( January 3, 2006), http://tinyurl.com/o46fumn; CFNA, “Pioneer
Nurse Wins Award for Life-Saving Heart Scheme,” TAN ( January 3, 2006),
http://tinyurl.com/o8ezbrm.
45. Milt Freudenheim, “Preparing More Care of Elderly,” New York Times ( June 28,
2010), http://tinyurl.com/qf5q677; TAN, “Nurse and Patient: How to Survive”
(October 21, 2010), http://tinyurl.com/oezjzs3.
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46. Jane Elliott, “How One Nurse Helped Stop Killer Bedsores,” BBC News (March 21,
2009), http://tinyurl.com/cq935f; TAN, “Think Different: BBC News Article by
Jane Elliott, March 21” (March 2009), http://tinyurl.com/yh997r4.
47. Newsweek, “The Life of a Virus Hunter” (May 14, 2010), http://www.newsweek.
com/life-virus-hunter-110499; CFNA, “90 Pounds and the Truth,” TAN (May 15,
2006), http://tinyurl.com/put3fg6.
48. Dianne Hales, “The Quiet Heroes,” Parade (March 21, 2004), http://tinyurl.com/
pz4m986; CFNA, “Parade Profiles Leading Nursing Scholar,” TAN (March 21,
2004), http://tinyurl.com/pmf87hu.
49. Anne Underwood, “Inside Forensic Nursing: Crime and Care,” Newsweek (October
6, 2006), http://tinyurl.com/n7f3eeg; CFNA, “Who Are You?,” TAN (October
6, 2006), http://tinyurl.com/o6h99p2.
50. CFNA, “We Want to Hear from a Nurse,” TAN (November 2, 2006), http://
tinyurl.com/nvyaow3.
51. TAN, “Sung and Unsung: Nurses Won’t Talk” ( January 25, 2011), http://tinyurl.
com/puvslg5.
52. Julia Bucher, “Advice for Caregivers of Relatives with Cancer,” New York Times
( July 3, 2013), http://tinyurl.com/nxce4y6; TAN, “Diplomacy: This Message is
Important to Share” ( July 3, 2013), http://tinyurl.com/o6rcwda.
53. Pauline Chen, “When It’s the Nurse Who Needs Looking After,” New York Times
( July 5, 2012), http://tinyurl.com/7w2dd2p; TAN, “Oh, Inverted World” ( July 5,
2012), http://tinyurl.com/lm3q8nl.
54. Theresa Brown, accessed March 23, 2014, http://www.theresabrownrn.com.
55. Cynda Hylton Rushton, “Take Pregnant Woman off Ventilator?,” CNN Opinion
( January 8, 2014), http://tinyurl.com/pv5fzwu.
56. Ghana News Agency, “Unsafe Abortion Leading Cause of Birth Complications -
Nurse” (December 31, 2010), http://tinyurl.com/mwos7kn; TAN, “Ask the Senior
Midwife” (December 31, 2010), http://tinyurl.com/o9pe37a.
57. Cherie Taylor, “Diabetes about Lifestyle - Not Race: Rotorua Nurse,” New Zealand
Herald/Rotorua Daily Post (November 14–15, 2006), http://tinyurl.com/jw92vwv;
CFNA, “Lifestyle,” TAN (November 14, 2006), http://tinyurl.com/p3tlwug.
58. TAN, “Grey’s Anatomy Analyses and Action,” accessed March 26, 2014,
http://tinyurl.com/pgayg7h.
59. Shonda Rhimes, writer, Peter Horton, director, “A Hard Day’s Night,” Grey’s
Anatomy, ABC (March 27, 2005); CFNA, “ABC’s Grey’s Anatomy: So Chunky
with Hollywood’s Contempt for Nursing, You’ll Be Tempted to Use a Fork. But
Use a Scalpel!,” TAN (March 27, 2005), http://tinyurl.com/nay5lvy.
60. Shonda Rhimes, writer, Peter Horton, director, “The First Cut is the Deepest,”
Grey’s Anatomy, ABC (April 3, 2005); CFNA, “You’re the Pig Who Called
Meredith a Nurse . . . I Hate You on Principle,” TAN (April 3, 2005),
http://tinyurl.com/nk7jvm2.
109
61. William Harper, writer, Allison Liddi, director, “I Saw What I Saw,” Grey’s
Anatomy, ABC (October 22, 2009); TAN, “Grey’s Anatomy: Have Fun Playing
Nurse!: Complaining of Pain” (August 2010), http://tinyurl.com/k8r85ea.
62. Stacy McKee, writer, Adam Davidson, director, “Something to Talk About,” Grey’s
Anatomy, ABC (November 6, 2005); CFNA, “The Drunk and the Ugly,” TAN
(November 6, 2005), http://tinyurl.com/o7ob6nt.
63. Mark Wilding, writer, Dan Minahan, director, “Where the Boys Are,” Grey’s
Anatomy, ABC (November 9, 2006); CFNA, “Digging through Crap,” TAN
(November 9, 2006), http://tinyurl.com/q5oxkmr.
64. Eric Buchman, writer, Michael Grossman, director, “Great Expectations,”
Grey’s Anatomy, ABC ( January 25, 2007); CFNA, “The Soft Bigotry of Low
Expectations,” TAN ( January 25, 2007),http://tinyurl.com/ptkrlyy.
65. Tony Phelan and Joan Rater, writers, Adam Davidson, director, “Tell Me Sweet
Little Lies,” Grey’s Anatomy, ABC ( January 22, 2006); CFNA, “Sweet Little Lies,”
TAN ( January 22, 2006),http://tinyurl.com/pbauv6b.
66. Eric Buchman, writer, Michael Grossman, director, “Great Expectations,”
Grey’s Anatomy, ABC ( January 25, 2007); CFNA, “The Soft Bigotry of Low
Expectations,” TAN ( January 25, 2007), http://tinyurl.com/ptkrlyy.
67. Shonda Rhimes, writer, Rob Corn, director, “Freedom 2,” Grey’s Anatomy, ABC
(May 22, 2008), http://tinyurl.com/pkaomsr.
68. Shonda Rhimes, writer, Rob Corn, director, “Dream a Little Dream of Me (1),”
Grey’s Anatomy, ABC (September 25, 2008).
69. TAN, “Who’s the Man?” (October 13, 2011), http://tinyurl.com/onha8uc.
70. Stacy McKee, writer, Rob Corn, director, “Perfect Storm,” Grey’s Anatomy, ABC
(May 16, 2013), http://tinyurl.com/lcuw6y6.
72. CFNA, “What’s the Differential Diagnosis for Chronic Handmaiden-itis with
Persistent Physician Nursing? Quick! The Patient is Dying!,” TAN (May 24,
2005), http://tinyurl.com/o5ejlfq.
73. CFNA, “And on the Eighth Day, the Lord Physician Created Nurses, to Clean up
the Mess,” TAN (November 15, 2005), http://tinyurl.com/o4qdogh.
74. David Foster, Peter Blake, Garrett Lerner, and Russel Friend, writers, Greg Yaitanes,
director, “House’s Head (Part 1),” House, Fox (May 12, 2008).
75. CFNA, “Is This All Nurses Do?,” TAN (November 21, 2006), http://tinyurl.com/
p4mw8yw.
76. TAN, “Helpful and Caring and the Whole Sponge Bath Thing” (February 22,
2011), http://tinyurl.com/nlasf6l.
77. Mindy Kaling and Matt Warburton, writers, Michael Weaver, director, “Music
Festival,” The Mindy Project, Fox (October 1, 2013).
78. Mindy Kaling, Ike Barinholtz, and David Stassen, writers, Michael Spiller, director,
“Hiring and Firing,” The Mindy Project, Fox (October 2, 2012).
1 1 0
79. Mindy Kaling and Tucker Cawley, writers, Rob Schrab, director, “Pretty Man,” The
Mindy Project, Fox (April 4, 2013); TAN, “Clicking and Clacking” (May 14, 2014),
http://tinyurl.com/oj3w76y.
80. Kaling and Warburton, “Music Festival.”
81. Mindy Kaling and Tracey Wigfield, writers, Neal Brennan, director, “Magic
Morgan,” The Mindy Project, Fox (October 8, 2013).
82. Mindy Kaling and Charlie Grandy, writers, Beth McCarthy-Miller, director, “Sk8er
Man,” The Mindy Project, Fox (November 5, 2013).
83. Mindy Kaling, Ike Barinholtz, and David Stassen, writers, BJ Novak, director,
“Mindy’s Minute,” The Mindy Project, Fox (February 19, 2013).
84. Mindy Kaling and Adam Countee, writers, Claire Scanlon, director, “Mindy’s
Birthday,” The Mindy Project, Fox (March 19, 2013).
85. Mindy Kaling and Jack Burditt, writers, Wendey Stanzler, director, “Triathlon,”
The Mindy Project, Fox (April 30, 2013).
86. Mindy Kaling and Tracey Wigfield, writers, Michael Weaver, director, “Frat Party,”
The Mindy Project, Fox (May 7, 2013).
87. Mindy Kaling, writer, Michael Spiller, director, “All My Problems Solved
Forever . . . ,” The Mindy Project, Fox (September 17, 2013).
88. Mindy Kaling and Charlie Grandy, writers, Rob Schrab, director, “Danny
Castellano Is My Personal Trainer,” The Mindy Project, Fox ( January 7, 2014).
89. TAN, “Private Practice Episode Analyses” (2013), http://tinyurl.com/lecehka.
90. CFNA, “Between the Boob and the Tube,” TAN (September 28, 2006),
http://tinyurl.com/lk84eaf.
91. CFNA, “The Swan, M.D.,” TAN (May 13, 2004), http://tinyurl.com/qd9vfn7.
92. CFNA, “Nurses Are About 100 Times More Likely to Attend Graduate Nursing
93. Virgil Williams, writer, Anthony Hemingway, director, “Tandem Repeats,” ER,
NBC (May 8, 2008).
94. Bill Lawrence and Mike Schwartz, writers, Linda Mendoza, director, “His Story
IV,” Scrubs, NBC (February 1, 2007); CFNA, “ ‘Scrubs,’ Lift Us up Where We
Belong,” TAN (February 1, 2007), http://tinyurl.com/nh2t6a5.
95. Bill Lawrence and Ted Quill, writers, Michael Spiller, director, “My Quarantine,”
Scrubs, NBC (February 8, 2005); CFNA, “Can Any Idiot Be a Nurse? Don’t
Forget the Sponge Baths and Happy Endings!” (February 8, 2005),http://tinyurl.
com/qaanymw.
96. Jo Brand, Joanna Scanlan, Vicki Pepperdine, Mark V. Olsen, and Will Scheffer,
creators, Getting On, HBO (2013-).
97. Mark V. Olsen, writer, Howard Deutch, director, “If You’re Going to San Francisco,”
Getting On, HBO (December 1, 2013).
98. Mark V. Olsen, writer, Miguel Arteta, director, “Born on the Fourth of July,”
Getting On, HBO (November 24, 2013).
111
99. Dave Caplan, Mark Cronin, and Shannon Fitzgerald, executive producers,
“The Surprise Visit,” Scrubbing In, MTV (December 26, 2013), http://tinyurl.
com/mtd4vx9.
100. TAN, “Admiring Their Credentials” ( January 12, 2011), http://tinyurl.com/
oe9eox7.
101. Andrew Lenchewski, John P. Rogers, and Jessica Ball, writers, Ed Fraiman,
director, “Pins and Needles,” Royal Pains, USA Network (August 14, 2013).
102. Andrew Lenchewski and John P. Rogers, writers, Jace Alexander, director, “Pilot,”
Royal Pains, USA Network ( June 4, 2009); TAN, “Post-Its and Other Priorities”
( July 9, 2009), http://tinyurl.com/nqdpj2g.
103. Ryan Murphy, writer, Elodie Keene, director, “Vitamin D,” Glee, Fox (October 7,
2009); TAN, “Vitamin F” (October 7, 2009), http://tinyurl.com/p4xzp2z.
104. Ian Brennan, writer and director, “Tina in the Sky with Diamonds,” Glee, Fox
(October 3, 2013).
105. Megan Ganz, writer, Beth McCarthy-Miller, director, “The Big Game,” Modern
Family, ABC (December 4, 2013); TAN, “Problems with Nursing” (December 4,
2013), http://tinyurl.com/kz43lrn.
106. Seth Kurland, writer, Lynn M. McCracken, director, “The Principal,” 8 Simple
Rules for Dating My Teenage Daughter, ABC (May 11, 2004); CFNA, “8 Simple
Rules for Portraying Nurses in Your Hollywood Sitcom,” TAN (September 3,
2004), http://tinyurl.com/ohkbuwm.
107. CFNA, “Falling without Style,” TAN (October 9, 2006), http://tinyurl.com/
nhjg6cv.
108. Marlene Bokholdt, “Working as a Nurse,” TAN (September 2011), http://tinyurl.
com/np8qoe4; TAN, “Hell of a Doctor” (August 2013), http://tinyurl.com/
l2gfpxd.
109. Christopher Rowland, “Chaotic but Brief UMass Strike,” Boston Globe (October
27, 2006) http://tinyurl.com/l67d6hm; CFNA, “ ‘Do They Deserve This
Six-Figure Salary for What They Do?,’ ” TAN (October 26, 2006), http://tinyurl.
com/p5y7bml.
110. Brenda Wilson, “Developing Countries See Health Care ‘Brain Drain,’” National
Public Radio (November 3, 2005); CFNA, “NPR Science Correspondent
Explains It All for You: Kenyan Clinical Officers Are ‘Not Quite a Doctor, but
More than a Nurse,’ ” TAN (November 3, 2005), http://tinyurl.com/klcav6o.
111. CFNA, “Tip No. 76: For Even Quicker Attention, Drive Your Hummer Straight
into the ER. Then Offer the Triage Nurse a Chocolate if He’ll Let You See
the Physician Before All Those Little Pedestrians!,” TAN (November 2005),
http://tinyurl.com/q4r8r9n.
112. TAN, “You Will Be Required to Deal with Bruising” (October 24, 2012),
http://tinyurl.com/kj78oom.
113. CFNA, “4. Crossword Helper (3 Letters),” TAN (February 27, 2007),
http://tinyurl.com/mbf6za.
1 1 2
114. TAN, “Hospital Attendant” (April 27, 2009), http://tinyurl.com/nfabnfr.

115. John Colapinto, “Mother Courage,” New Yorker (December 20, 2010),
http://tinyurl.com/d79aa7n; TAN, “The Talk of the Town” (December 2011),
http://tinyurl.com/mu88h9u.
116. CFNA, “Nurse or Leader: Pick One,” TAN (April 1, 2006), http://tinyurl.com/
q2luguv.
117. CFNA, “Serenading the Unsung Heroines in South Africa,” TAN (May 12,
2005), http://tinyurl.com/qfcfzbr.
118. TAN, “Ridiculously Easy Tricks Help Local Nurses Save Lives!” (November 21,
2011), http://tinyurl.com/q7xcm5k.
119. TAN, “The Experts” (November 2011), http://tinyurl.com/p3wjkdc.
120. Abigail Zuger, “CASES: Prescription, Quite Simply, Was a Nurse,” New York
Times, November 19, 2002, accessed March 21, 2014, http://tinyurl.com/
pwt5c2j.
121. CFNA, “In Juggling Your Hectic Business Schedule Prior to Your Stay Here
at Ritz Memorial, Did You Forget to Pack One of Those Little Essentials, Like
Toothpaste, Shampoo, or a Nurse? If So, Our Concierge Is Pleased to Provide
Them with Our Compliments,” TAN (September 17, 2005), http://tinyurl.com/
q3ng6hy.
(May 16, 2013); TAN, “Heroes Among Us” (November 3, 2012), http://tinyurl.
com/nzbknp4.
123. TAN, “Right Away, Doctor!” (November 2010), http://tinyurl.com/q982g5q.
124. CFNA, “Looking for Mr. McSteamy,” TAN (May 8, 2008), http://tinyurl.com/
oj3ybyy.
125. CFNA, “Plot Devices in Scrubs,” TAN (December 11, 2005), http://tinyurl.
com/nhlj8nd.
127. Peter Blake, David Foster, Russel Friend, and Garrett Lerner, writers, Katie Jacobs,
director, “Wilson’s Heart,” House, Fox (May 19, 2008).
128. CFNA, “Golem,” TAN (May 23, 2006), http://tinyurl.com/o9ydmvo.
129. Amanda Johns, David E. Kelley, Karen Struck, writers, based on the novel of
Sanjay Gupta, Bill D’Elia, director, “Family Ties,” Monday Mornings, TNT (April
8, 2013); TAN, “Picking Battles” (April 2013), http://tinyurl.com/n65ovcn.
130. Carol C. Scholle and Nicolette C. Mininni, “How a Rapid Response Team
Saves Lives” Nursing2006 36, no. 1 ( January 2006): 36–40; Laurel Tyler, Diane
Sanders, Nancy Dahlberg, and Carol Wagner, “Rapid Response Teams” (slide
presentation), Washington State Hospital Association (2006), http://tinyurl.
com/kuu4rlo.
131. Lisa Zwerling, writer, Laura Innes, director, “Sea Change,” ER, NBC (May 10, 2007);
CFNA, “Nothing More than a Persistent Illusion,” TAN (September 13, 2007).
113
132. Margorie David, writer, Ted Kotcheff, director, “Doubt,” Law and Order: Special
Victims Unit, NBC (November 23, 2004); CFNA, “Take Care of Yourself !,”
TAN (November 23, 2004), http://tinyurl.com/oe4d32x.
133. Jonathan Greene, writer, Helen Shaver, director, “Behave,” Law and Order: Special
Victims Unit, NBC (September 29, 2010); TAN, “The Sexual Assault Nurse”
(September 29, 2010), http://tinyurl.com/ovl3cje.
134. CFNA, “Physicians Save Corzine; Other Work Occurs,” TAN (May 13, 2007),
http://tinyurl.com/oenh2by.
135. CFNA, “Living with His Mistake,” TAN (May 2007), http://tinyurl.com/
otzqc4b.
136. Wall Street Journal, “Hospitals Let Families Witness Procedures: Staying with
Patient in ER or ICU Can Have Benefits, but Some Doctors Object” (October
12, 2004); CFNA, “Family Presence and Nursing Presence,” TAN (October 12,
2004), http://tinyurl.com/pnnzjhv.
137. Dan Even, “Medical Staff Partly to Blame for Patients’ Violence, Israeli Study
Finds,” Haaretz (March 13, 2012), http://tinyurl.com/lctyj82; TAN, “A
Seemingly Innocuous Incident” (March 13, 2012), http://tinyurl.com/o2rxnxg.
138. Laurie Tarkan, “E.R. Patients Often Left Confused After Visits,” New York Times
(September 15, 2008), http://tinyurl.com/pdrba7f.
139. CFNA, “I Can’t Even Say I Made My Own Mistakes. Really—One Has to Ask
Oneself—What Dignity Is There in That?,” TAN ( June 20, 2004), http://tinyurl.
com/nd578gk.
Statistics: May 2012 National Occupational Employment and Wage Estimates,”
http://tinyurl.com/q2ywzuv, and “Physicians and Surgeons,” accessed January 15,
2014, http://tinyurl.com/77ghlzk.
141. Leah Binder, “Stunning News on Preventable Deaths in Hospitals,” Forbes
(September 23, 2013), http://tinyurl.com/mk4zraj.
142. Lucian L. Leape, David W. Bates, David J. Cullen, Jeffrey Cooper, Harold
J. Demonaco, Theresa Gallivan, and Robert Hallisey, “Systems Analysis of Adverse
Drug Events,” Journal of the American Medical Association 274, no. 1 (1995):
35–43, http://tinyurl.com/m7dwymb; Geri L. Dickson and Linda Flynn,
“Nurses’ Clinical Reasoning: Processes and Practices of Medication Safety,”
Qualitative Health Research 22, no. 1 (2011): 3–16, http://tinyurl.com/qe7ywza.
143. Fred Schulte, “Masking Malpractice Cases,” Baltimore Sun (December 20, 2005),
http://tinyurl.com/kee5txa; CFNA, “If Only We Could Find a 10,000-Word
Major Metropolitan Newspaper Article on Nursing Malpractice, That Would Be
So Great!,” TAN (December 20, 2005), http://tinyurl.com/o8pl6cs.
144. Liz Kowalczyk, “MGH Death Spurs Review of Patient Monitors,” Boston Globe
(February 21, 2010), http://tinyurl.com/y99fbua; TAN, “Background Noise”
(March 16, 2010), http://tinyurl.com/ns95szd.
1 1 4
145. Laura Landro, “New Focus on Averting Errors: Hospital Culture,” Wall Street
Journal (March 16, 2010), http://tinyurl.com/mtuflpe; TAN, “Disabling the Off
Switch” (March 16, 2010), http://tinyurl.com/ney7lwq.
146. Matthew Lee and Marilynn Marchione, “Hillary Clinton Hospitalized with Blood
Clot,” Associated Press/BusinessWeek (December 31, 2012), http://tinyurl.com/
myzoy4m; TAN, “I’m Not There” ( January 2013), http://tinyurl.com/p396p7h.
147. Ken Auletta, “Changing Times,” New Yorker (October 24, 2011), http://tinyurl.
com/3lb6nuh; TAN, “The Talk of the Town: Times Not Changing Enough”
(December 2011), http://tinyurl.com/nhyfu7v.
148. Richard Knox, “Health Officials Consider Strategy for Possible Bird Flu
Pandemic,” National Public Radio (February 10, 2006), http://tinyurl.
com/9ccbb; CFNA, “The Ventilated Elite,” TAN (March 12, 2006), http://
tinyurl.com/pkw39u5.
149. Christine Lagorio, “The Nurse-Family Partnership,” CBS Evening News with
Katie Couric ( July 11, 2007), http://tinyurl.com/k86lz4v.
150. Alicia Chang, “Health Coaches Helping Patients Avoid Return Trips to
Hospital,” Associated Press/Union Tribune (October 12, 2006), http://tinyurl.
com/l3pz3z4; CFNA, “Put Me In, Health Coach!,” TAN (October 12, 2006),
http://tinyurl.com/leobqq2.
(May 16, 2013), http://tinyurl.com/lcuw6y6.
152. Janice Mangurten, Shari Scott, Cathie Guzzetta, Jenny Sperry, Lori Vinson,
Barry Hicks, Douglas Watts, and Susan Scott, “Family Presence: Making Room,”
American Journal of Nursing 105, no. 5 (May 2005): 40–48.
153. Stacy McKee, writer, Jessica Yu, director, “Invest in Love,” Grey’s Anatomy, ABC
(November 5, 2009).
154. Andrew Scher, Carla Pennington, Jay McGraw, Jeff Hudson, executive producers,
The Doctors, syndicated television show, accessed March 26, 2014, http://www.
thedoctorstv.com.
155. Terence Wrong, executive producer, Hopkins 24/7, ABC (2000).
156. Terence Wrong, executive producer, Hopkins, ABC (2008); CFNA, “Cinema
Faux,” TAN ( June 26, 2008).
157. Terence Wrong, executive producer, Boston Med, ABC (2010); TAN, “Physicians
Are Awesome” ( July 22, 2010), http://tinyurl.com/o7m9olh.
158. Terence Wrong, executive producer, NY Med, ABC (2012, 2014).
159. CFNA, “Infirmieres Sans Frontières,” TAN (December 3, 2006), http://tinyurl.
com/jwa9goe.
160. Mark Kaplan, director, Mark Kaplan, Naisola Grimwood, and Daniel
Holton-Roth, producers, Living in Emergency: Stories of Doctors Without Borders,
Red Floor Pictures (2009); TAN, “Living in Emergency: Stories of Doctors
Without Borders” (March 23, 2010), http://tinyurl.com/qdf64yr.
115
161. Jerome Groopman, “A Child in Time: New Frontiers in Treating Premature

Babies,” The New Yorker (October 24, 2011), http://tinyurl.com/mv7rwhk;
TAN, “The Talk of the Town” (December 2011), http://tinyurl.com/mu88h9u.
162. Richard Friedman, “Their Coats Are White, but Their Hands Are Green,”
New York Times ( June 29, 2004), http://tinyurl.com/lo49wt5; CFNA, “The
‘July Syndrome:’ Who’s Minding the Interns?,” TAN ( June 29, 2004), http://
tinyurl.com/nmcpd6n.
163. United Press International, “Nurses: Pain Affects Everything Else” (September
14, 2009), http://tinyurl.com/m6rswre; TAN, “Nurses: Pain Affects Everything
Else” (September 14, 2009), http://tinyurl.com/ov2n282.
164. CFNA, “Maybe I Wrote in Invisible Ink,” TAN (October 29, 2004), http://
tinyurl.com/o68u9pm.
165. Elizabeth Cohen, “Nurses Relied on Trauma Experience to Help Bombing
Wounded,” CNN (April 16, 2013), http://tinyurl.com/kxy4wns; TAN,
“Everyone Worked in Tandem” (April 17, 2013), http://tinyurl.com/k4mun2n.
166. Poppy Harlow and Sheila Steffen, “Woman Gets New Leg—and New Life—
After Boston Bombings,” CNN ( July 17, 2013), http://tinyurl.com/mhmqht7.
167. Gina Kolata, Jeré Longman, and Mary Pilon, “Doctors Saved Lives, if Not Legs,
in Boston,” New York Times (April 16, 2013), http://tinyurl.com/lslx8hd.
168. Steve Inskeep, “Disaster Would Overwhelm Hospitals, Author Warns,” National
Public Radio (February 22, 2007), http://tinyurl.com/msgs6ea; CFNA,
“Mourning Edition,” TAN (March 1, 2007), http://tinyurl.com/p5ncv6m.
169. Marilyn Marchionne, “Doctors Weathered the Storm and Became Heroes,”
Associated Press/USA Today (September 9, 2005), http://tinyurl.com/k4johsc;
CFNA, “Nurses Evacuated from AP Report on Katrina,” TAN (September 9,
2005), http://tinyurl.com/oxf73du.
170. Nancy Gibbs, “Saving One Life at a Time,” Time (October 30, 2005),
http://tinyurl.com/oubx8sn; CFNA, “We Can Be ‘Heroes,’ ” TAN (November 7,
2005), http://tinyurl.com/odkbjbq.
171. Mark Poertner, executive producer, David Stern, producer and director, Discovery
Health Channel Medical Honors, Discovery Health Channel (2004); CFNA,
“Nation’s Elite Honors 13 ‘Medical Heroes’; Heroic Nurses’ Invitations Lost in
Mail?”, TAN ( July 8, 2004), http://tinyurl.com/pst2gny.
172. Gail Deutsch, Mark Dorian, and Adam Sechrist, producers, “Heroes Among Us,”
20/20, ABC (November 2, 2012), http://tinyurl.com/mqk3wfm.
173. Patrick Healy, “‘Heroic Actions’ by SoCal Nurse Save Pilot Mid-Flight,” NBC4
News ( January 10, 2014), http://tinyurl.com/mmkllwa.
174. Nicole Brodeur, “Flying Solo, Nurse Is Enough,” Seattle Times (May 3, 2005),
http://tinyurl.com/lqygpob; CFNA, “ ‘And There Wasn’t Even a Doctor There!,’ ”
TAN (May 3, 2005), http://tinyurl.com/3qdez2a.
175. Gina Kolata, “A Tactic to Cut I.C.U. Trauma: Get Patients Up,” New York Times
( January 12, 2009), http://tinyurl.com/khnz56j.
1 1 6
176. Nancy Gibbs and Amanda Bower, “Q: What Scares Doctors? A: Being the Patient,”
Time (April 23, 2006), http://tinyurl.com/kzlccsd; CFNA, “Q: What Scares
Nurses? A: Who Cares?,” TAN (May 14, 2006), http://tinyurl.com/on2ldfq.
177. Google, “New Advisory Group on Health” ( June 27, 2007), http://tinyurl.
com/29ptre.
178. Ehren Kruger, writer, Iain Softley, director, The Skeleton Key, Universal
Studios (2005).
179. Stephen Susco, writer, Takashi Shimizu, director, The Grudge, Columbia
Pictures (2004).
180. Craig Phillips, “The Waiting Room: Interview with Filmmaker Peter Nicks,” PBS
(October 17, 2013), http://tinyurl.com/ma3vfz9.
181. TechNewsDaily, “Toyota Debuts ‘Robot Nurses’ to Aid the Disabled” (November
3, 2011), http://tinyurl.com/mp46wr8; TAN, “That Leg Brace Graduated First
in Its Nursing School Class!” (November 3, 2011), http://tinyurl.com/qfkulnl.
182. Agence France-Presse, “Japan Plans Robo-Nurses in Five Years: Govt.” (March 25,
2009), http://tinyurl.com/ckc84m.
183. Angus Howarth, “Robot Nurses Could Be on the Wards in Three Years, Say
Scientists,” The Scotsman ( January 22, 2007), http://tinyurl.com/lrxd4rg;
CFNA, “Interaction and Intelligence,” TAN ( January 22, 2007), http://tinyurl.
com/mln6lp6.
184. Tim Bajarin, “Meet Nurse iPhone,” PC Mag (March 23, 2009), http://tinyurl.
com/d5qgjn.
185. WisTV, “Health Alert: Electronic Nurse” (March 31, 2006), http://tinyurl.
com/mkkcv4f; CFNA, “$70 Machine Claims to Be ‘Nurse’; Background Check
Underway,” TAN (March 31, 2006), http://tinyurl.com/o24wk28.
186. Kevin Bonani and Jenn Lloyd, writers, Ted Wass, director, “Face Off,” Accidentally
on Purpose (April 7, 2010); TAN, “Nympho Nurse #3” (April 7, 2010), http://
tinyurl.com/oglwt4u.
187. Vickie Elmer, “Bringing Balance to Life with New Babies,” Washington Post
(February 25, 2007), http://tinyurl.com/mq9c73d; CFNA, “The Nursemaid
Who Wouldn’t Disappear,” TAN (February 25, 2007), http://tinyurl.com/
mdnju89.
188. Pete Donohue and Caitlin Kelly, “Scandal of ‘Baby Nurses,’” New York Daily
News (August 28, 2005), http://tinyurl.com/mnk5ms4; CFNA, “Nursing the
Baby Nurses,” TAN (August 28, 2005), http://tinyurl.com/ku4gekk.
189. American Nurses Association, “Title ‘Nurse’ Protection: Summary of Language
by State,” accessed March 25, 2014, http://tinyurl.com/kne4ko3.
190. CFNA, “Feel Good, Inc.,” TAN ( July 14, 2005), http://tinyurl.com/n6opthx.
191. CFNA, “CVS Pharmacist Returns from Matrix; Can Now Download Entire
Nursing Curriculum into Your Brain in Four Hours!,” TAN ( January 24, 2006),
http://tinyurl.com/mwvx9bj.
117
192. St. John & Partners, “Today You’re An Accountant. Tomorrow You’re Dad’s
Nurse” (November 2011), http://tinyurl.com/pnp75zl.
193. Fe Zamora, “Daughter Kris was Aquino’s Nurse,” Philippine Daily Inquirer
(August 1, 2009), http://tinyurl.com/mseq8j.
194. Guido Kleinhubber, “Prostitute Retraining Program: From Johns to
Geriatrics,” der Spiegel (March 14, 2006), http://tinyurl.com/c92bhjp; CFNA,
“Der Spiegel: ‘From Johns to Geriatrics,’ ” TAN (March 14, 2006), http://tinyurl.
com/mrngpkn.
195. Nancy Pindus, Jane Tilly, and Stephanie Weinstein, “Skill Shortages and
Mismatches in Nursing Related Health Care Employment,” Urban Institute
(April 2002), http://tinyurl.com/kv82hjr; VHA Health Foundation, “Welfare
to Work” (March 2001), http://tinyurl.com/kz8kt6n. See also Eric Westervelt,
“One Approach to Head Start: To Help Kids, Help Their Parents,” National
Public Radio (April 23, 2014), http://tinyurl.com/mohaqeh.
196. Yu Xu, “Are Chinese Nurses a Viable Source to Relieve the US Nursing Shortage?,”
Nursing Economics 21, no. 6 (2003): 269–274, http://tinyurl.com/lbjgvfb.
197. Alan Tomlinson, “Foreign Doctors Fill Florida’s Nursing Gap,” National Public
Radio (February 17, 2004), http://tinyurl.com/mdfqd5u; CFNA, “Foreign
Physicians as One Answer to the U.S. Nursing Shortage: From ‘Giving Orders’
to ‘Receiving Orders’?,” TAN (February 17, 2004), http://tinyurl.com/l7ynnmr;
Adam Geller, “Filipino MD Picks Life as Nurse in U.S.,” Associated Press/USA
Today ( January 1, 2007), http://tinyurl.com/kkzgpoy; CFNA, “Somebody
Changed: AP Article,” TAN (March 14, 2007), http://tinyurl.com/qjrb2zl.
198. TAN, “You Are Required to Deal with Bruising” (October 24, 2012), http://
tinyurl.com/kj78oom.
199. CFNA, “Dear Applicant: We Are Pleased to Inform You That You Have
Been Accepted into Our Nursing Program! Your Diploma Is Enclosed,” TAN
( June 12, 2005), http://tinyurl.com/mcq28yl.
4
YES, DOCTOR! NO, DOCTOR!
Most of society regards physicians as the captains of the healthcare

ship and nurses as their helpful crew. In fact, nursing is an autono-
mous profession, as we explained in Chapter 1. Some media prod-
ucts reflect this reality, but many, particularly influential television
shows like Grey’s Anatomy, reinforce the damaging myth that phy-
sicians manage nurses. The handmaiden stereotype often appears
together with the unskilled image discussed in Chapter 3, but they
are distinct problems.
Of course, the media has not simply invented the idea that
nurses are physician subordinates. Many physicians themselves
believe they manage nurses. The May 2008 issue of California
Lawyer magazine featured a piece by a physician who had attended
Stanford, become a lawyer, and worked at a major national law
firm.1 L. Okey Onyejekwe Jr.’s piece described his residency at
Columbia, from 2000 to 2003:
I was a 25-year-old resident trying to establish authority in

an emergency room where many of the nurses and staff had
been practicing since before I was born. Despite being the
least-experienced, lowest paid, and youngest person in the
ER, I was responsible for managing the ER staff and for
the health and well-being of numerous patients.
In fact, as a new resident, Onyejekwe was not “responsible for

managing the ER staff.” He was one member of a team, reporting to a
physician manager. The nurses and others reported to their respective
managers. Actually, one of nurses’ most important professional roles
is to act as an independent check on physician care plans to protect
patients and ensure good care. Another key nursing role is to educate
physicians, especially residents, about how to recognize changes in
patient conditions and respond with appropriate treatments. These
roles are rarely acknowledged by physicians or the media.
4 Yes, Doctor! No, Doctor! •
119
So why would a new physician think it was his job to “manage” veteran
health staff ? We doubt he had a medical school course entitled “The New
Physician’s Burden: Managing All Other Health Professionals.” We assume
his thinking was based on professional and cultural assumptions that nurses
and other staff are relatively unskilled subordinates—and so physicians do
and must manage all of health care. These ideas are deadly. They contribute
greatly to healthcare errors and poor outcomes. Nurses are the patient advo-
cates, the last line of defense. If they are viewed as subordinate, they cannot
do their jobs effectively.
Of course, physicians still have greater social and economic power, so
it is often difficult for nurses to resist their plans. Nurses’ input may not be
welcome. In December 2004 the Times of India reported that, after a nurse
pointed out to a physician that he had failed to place a used syringe in the
proper receptacle, offended physicians chose to “start a fight” with the nurses.
Police were called in to restore order.2
An October 2010 cover story in Reader’s Digest on hospital errors included
an essay by nurse Sunnie Bell, who recounted how a patient had died after an
esteemed senior physician ignored Bell’s repeated warnings that the patient
appeared to have a bowel obstruction.3 Another essay in that issue was by
Johns Hopkins physician Peter Pronovost, a healthcare errors expert who
promotes the use of checklists and other safety measures. Pronovost stressed
that nursing empowerment was a key element of reform, and he argued that
some hospital procedures should require nursing agreement.4
Sometimes nurses have been able to protect patients despite limited
recognition of nursing autonomy. In December 2013, the Irish Examiner
reported that a nurse had told a panel investigating alleged incompetence by
a physician about a 2009 incident in which the nurse had “snatched a scalpel
from [the] doctor’s hand, moments before he was about to cut into an elderly
patient’s vein in order to take a blood sample.”5 In March 2006 the Associated
Press cited a police report that the chief of neurosurgery at an Oakland hos-
pital had been “arrested after allegedly throwing a drunken fit when a nurse
refused to let him operate.”6 Recall our friend Dan Lynch from Chapter 1, the
nurse who fought successfully to persuade his heart patient’s surgeon that a
new heart valve had a potentially fatal problem.
Aside from the direct harm to patient care, the “handmaiden” stereotype
sets nurses up as mere assistants. The image contributes to poor relations with
patients and physicians, who sense they can abuse nurses with impunity, a
major factor in nursing burnout and the nursing shortage. In November 2005
South Africa’s Cape Argus reported that research in South Africa, the United
1 2 0
Kingdom, and the United States suggested that nurses experience dispropor-
tionately high physical and psychological abuse by patients and colleagues,
especially physicians. The article noted that 80 percent of nurses surveyed in
a recent South African study had said that private sector nurses were leaving
the profession because of abuse, largely by male physicians.7 In June 2009 the
Colorado Springs Gazette reported that an operating room (OR) nurse had
filed a lawsuit against a local hospital after allegedly being demoted for com-
plaining that a senior surgeon had assaulted her, in one instance by throwing
and hitting her with a patient’s bloody pericardium (the layer of tissue that
surrounds the heart).8 In February 2010, as the New York Times reported, a
Texas jury acquitted nurse Anne Mitchell after a four-day trial for misusing
official information in reporting a physician’s allegedly unsafe practices to the
state medical board. Mitchell and a nurse colleague had also been fired from
their hospital, but evidently that wasn’t enough. The Times explained that
the physician, the local sheriff, and the prosecutor who brought the case had
close ties.9
The handmaiden stereotype affects who pursues nursing careers. Few
ambitious people want to take years of rigorous science courses and endure
extraordinary workplace burdens just to be assistants to the professionals who
receive all the glory.
Are You Sure Nurses Are Autonomous? It Sure Looks like

Physicians Call All the Shots
Well, it sure looks that way on television. That’s what we’ve been heavily con-
ditioned to see. Figure 4.1 shows how most of society views the relationship
of nurses and physicians.
Yet nursing is a self-governing profession and a distinct scientific disci-
pline. Nurses have a unique, holistic patient advocacy focus; a unique scope of
practice under law; and a unique body of knowledge, including special exper-
tise in such areas as public health, wound care, and pain management. As
members of an autonomous profession, nurses are educated by nursing schol-
ars, typically in nursing science degree programs at colleges. They use text-
books authored by those scholars. More than 50,000 US nurses have PhDs
or other doctoral degrees, and more than 375,000 US nurses have at least a
master’s degree in nursing.10 Highly educated nurses—not physicians—are
the theoretical and practical leaders of the nursing profession. The actual rela-
tionship of the two disciplines in terms of knowledge is shown in Figure 4.2.
121
Figure 4.1 Many people think that nurses are supervised by physicians and that nurses
know only a tiny subset of what physicians know.
As Figure 4.2 illustrates, there is a significant overlap with medicine,

but nursing is not a subset of the medical profession. In the United States,
nurse-controlled state boards administer rigorous nurse licensing examina-
tions, and practicing nurses have independent malpractice liability and codes
of ethics. State laws typically describe nursing practice in broad terms that do
not depend on physicians. California’s Nursing Practice Act defines nursing
as care that promotes health and “require[s]‌a substantial amount of scientific
knowledge or technical skill.”11 This Act provides that the profession includes
patient care, disease prevention, health assessment and intervention, and the
administration of medications and other procedures “ordered” by physicians
or other advanced practitioners. These state laws make clear that nursing
manages itself. They define nursing practice to include a wide range of critical
1 2 2
Figure 4.2 Who really knows what? Nurses and physicians have their own knowledge
bases, which overlap. Each has knowledge the other does not.
prevention and care functions that do not depend on physicians or anyone

else. Of course, physicians have more practical power. Reasons include the
economic benefits physicians receive in healthcare financing structures, phy-
sicians’ generally higher levels of education and political clout, long-standing
class and gender disparities, and the social esteem physicians enjoy. Figure 4.3
shows the basic relation of nursing to medicine in terms of power.
Nurses administer treatments prescribed by advanced practitioners, and
some language in these nursing practice acts (e.g., “ordered” in the California
law) may suggest a subordinate relationship as to those tasks. In media por-
trayals, nurses often follow physician “orders” automatically, as if they were
mandatory military orders. But these are really prescriptions or care plans,
not orders. The very use of the term “orders” should end, because it does
connote subservience, as Chuck Reuter and Virginia Fitzsimons argue in an
excellent op-ed in the August 2013 issue of the American Journal of Nursing.12
123
Figure 4.3 Who’s really in charge? Nurses and physicians are members of separate,
autonomous professions. Neither is in charge of the other. They have separate practice
acts, codes of ethics, and supervisory and oversight structures. Unfortunately, they are
unequal in power, as the different size of these circles reflects.
Nurses have ethical and legal obligations to assess all planned care. They are
not relieved of malpractice liability simply because they were administer-
ing treatment as prescribed. Nurses’ patient advocacy may include persistent
negotiation with advanced practitioners, refusing to participate in care plans
they deem unsafe, and if necessary getting appropriate authorities to stop
such actions.
Do nurses find any of that easy to do, given current power structures? No.
Speaking up is especially hard for nurses who have recently emigrated from
1 2 4
developing nations to wealthier ones. These nurses may have a tenuous immi-
gration status and families who depend greatly on their continued income.
Some may not have been trained to assert themselves with physicians.
Does nurses’ advocacy sometimes fail because physicians have more
power? Of course. Hospitals have fired nurses for advocating for patients,
particularly when that advocacy has run counter to the desires of powerful
physicians who are seen as revenue generators. Some years ago a Canadian
nurse friend of ours was fired from a Caribbean hospital for telling a tourist
patient that she should return to the United States for an operation, rather
than allow a dangerously inept local surgeon to do it. Physicians pressured
nursing managers to fire the nurse, and sadly, the managers gave in to the pres-
sure. But that still does not make nurses subordinate to physicians.
In fact, nurses have significant practical autonomy in clinical settings. In
hospitals, where most US nurses practice, nurses are hired, fired, and man-
aged by other nurses. Hospital nurses are typically led by a chief of nursing,
who reports to the hospital’s chief executive. We have never heard of a chief
of nursing who reported to the chief of medicine. Physicians lack expertise
in many areas of nursing, and it would make little sense for them to manage
nurses. The same basic structure is found in nursing homes. In public schools
and other public health positions, nurses are effectively autonomous within
the scope of their professional duties. Even the nurses who practice in out-
patient offices are operating autonomously within the scope of their nursing
practice, although they may be employees of a business owned by physicians
or others. Nurses must follow their legal and ethical obligations regardless of
their employer’s identity.
Courts have begun to awaken to the fact that nursing is a distinct scien-
tific profession with its own standards and scope of care. For decades, US
courts tended to wrongly regard nursing as a subset of medicine. Accordingly,
physicians were permitted to testify as to the standard of nursing care in mal-
practice actions, as Ellen K. Murphy noted in a November 2004 article in
the Association of periOperative Registered Nurses Journal.13 But in Sullivan v.
Edward Hospital (2004), the Illinois Supreme Court concluded that a physi-
cian was not qualified to testify as to a nursing standard of care because he was
not a nurse. This case was specific to the Illinois statutory and judicial context,
but Murphy rightly described it as “judicial recognition [of ] nurses’ long-time
assertion that nursing is an independent profession with a unique body of
knowledge and not simply a subcategory of medicine.”14 In a later case, Smith
v. Pavlovich (2009), an Illinois appeals court concluded that a physician was
not qualified to testify about the standard of care of an advanced practice
nurse.15
125
The American Association of Nurse Attorneys explained why only

nurses should be allowed to provide expert testimony as to nursing care in a
September 2004 position paper:
Nursing is a profession, unique, identifiable and autonomous. As a pro-

fession, nursing has the authority and responsibility to define its stan-
dards of practice. . . . It is clear that the profession of nursing, though
closely related to the practice of medicine, is, indeed, distinct with its
own licensing scheme, educational requirements, areas of specializa-
tion, Code of Ethics, models, theories and contract with society. . . .
The nurse is not a “junior doctor” nor is the nurse a mere “underling”
of the physician. To so hold would negate the existence of nursing as
a profession and would render the Nurse Practice Acts of every state,
commonwealth and territory meaningless. It is unlikely that any physi-
cian, unless he/she has completed a nursing program and has practiced
as a nurse, can offer competent, reliable expert opinion on these nurs-
ing standards.
The notion that nurses report to physicians has several sources.

Historically, nurses deferred to physicians, for reasons that include the dispar-
ity of power between the genders. Many nurses remain reluctant to challenge
physicians or to assert themselves generally, as Bernice Buresh and Suzanne
Gordon showed in their groundbreaking book From Silence to Voice.16 More
than 90 percent of nurses are still female, and overall gender equality has not
been achieved. At the same time, assertive women do have a wide range of
career choices, and many avoid nursing because they want to break gender
boundaries, not be confined by them. In addition, physicians’ combination
of economic power and social status remains unmatched. Physicians have
more years of formal education than most (although not all) nurses. Most
physicians are not well-informed about nursing, and many believe they are
in charge of patient care. Consistent with this authoritarian vision, physician
disrespect, disruptive behavior, and even abuse remain issues in many care set-
tings, as Gordon showed in Nursing Against the Odds (2005).17
Assumptions about physician supervision run so deep that some nurs-
ing advocates seem to doubt that nursing is autonomous, including Suzanne
Gordon and Dana Beth Weinberg, who wrote Code Green: Money-Driven
Hospitals and the Dismantling of Nursing (2003).18 In reaching these flawed
conclusions, some of these advocates rely on the views of workplace sociolo-
gists rather than nursing leaders. But there is a difference between having
less power and being subordinate, which suggests that one party reports to
1 2 6
another in a formal sense (i.e., a master-servant relationship). Physicians are

no more the conceptual “masters” of nurses than the United States is the mas-
ter of India. Just as human rights do not cease to exist simply because they are
not fully observed, nursing autonomy does not cease to exist simply because
it is subject to daunting practical constraints.
Even some prominent nurses do not seem to understand nursing auton-
omy. In a March 2013 post on the New York Times site, oncology nurse Theresa
Brown discussed the choices nurses face when they disagree with a physician’s
care plan. Brown stated that there is a “legal, established hierarchy between
doctors and nurses” and that physicians are “ultimately responsible for clini-
cal decisions,” apparently because nurses implement physician “orders.”19 In a
May 2011 Times op-ed about physician bullying, Brown opined that “if doc-
tors are generals, nurses are a combination of infantry and aides-de-camp.”20
Brown’s pieces are generally helpful, but her views on autonomy are not.
Career seekers who have the qualities nursing requires value autonomy
greatly. It is not hard to see why they would have little interest in the subor-
dinate images they often see in the media. They must understand that nurses
can be healthcare leaders and that nurses’ autonomous practice has saved
countless lives, despite the prevailing belief that it does not exist. Nursing has
been a kind of shadowy superhero, saying little and doing much: the Dark
Knight Nurse. But that must change if the profession is to meet the health
challenges ahead.
Media Portrayals of the Nurse as an

Autonomous Professional
The most influential entertainment media regularly presents nurses as physi-
cian handmaidens who are peripheral to serious health care. But some news
and even entertainment items do convey a sense that nurses operate with
autonomy.
Nursing Authority in Television and Film

Bitches and Autonomous Professionals
Very little entertainment television presents nurses as autonomous. It’s true
that all three of the US nurse shows introduced in 2009, as well as the United
Kingdom’s Call the Midwife, have generally portrayed nurses as operating on
their own without the need of direct physician supervision. But only Call the
Midwife has avoided suggestions that nurses report to physicians.
127
On Call the Midwife, nurse-midwives provide autonomous care and health

advice to patients in a poor London neighborhood in the 1950s. Most clinical
scenes involve the midwives seeing patients on their own in the community.
Physicians do appear occasionally, particularly at a clinic for pregnant women
that the midwives open periodically, but overall the focus is on the nurses, in
a reversal of the standard Hollywood model. The senior midwives guide the
junior ones, and all report to the wise, authoritative yet tactful mother supe-
rior, Sister Julienne. In the series premiere, broadcast in the United States in
September 2012, local police tried ineffectually to stop a street fight between
two women, one of whom was a pregnant patient of the midwives. The com-
manding Sister Evangelina appeared and brought the proceedings to a halt
with one sharp question, then escorted her patient away. It is difficult to imag-
ine this senior midwife uttering an obsequious “right away, doctor!”21 In an
episode broadcast in the United States in April 2013, lead character Jenny
encountered an abusive surgeon while working at a local hospital. The epi-
sode showed the surgeon’s undue power, but it did not suggest that Jenny
reported to him. Instead, she took her concerns about his abuse and his dan-
gerous errors to her nurse manager.22
Nurses on Nurse Jackie also generally follow their own practice model,
managing patients’ physical and psychosocial care. The emergency depart-
ment (ED) nurses report to manager Gloria Akalitus, a nurse whose exact
role is unclear but who seems to have some supervisory authority over the
pharmacy and to some extent even the physicians. Jackie mentors the gifted
newer nurse Zoey Barkow, a valuable illustration of nursing autonomy that
mirrors the common physician training focus of more conventional hospi-
tal shows. Jackie has also helped to train new physicians, particularly Fitch
Cooper, arguing against misguided care plans, showing him how to relate to
patients, and even, in early 2013 episodes, how to do a better job training a
seemingly incompetent junior physician. In June 2012 episodes, Jackie actu-
ally took over the ED in the midst of a staffing crisis, running it expertly until
the hospital CEO and physician Mike Cruz fired her.23
Unfortunately, in recent seasons the show has repeatedly suggested that
physicians direct nurse staffing and care. Spring 2011 episodes had physi-
cian Eleanor O’Hara removing nurses from cases based on her perceptions
of where they fit best,24 something nurse managers do and physicians have
nothing to do with. In 2012, Cruz demoted Akalitus and the show had no
nurse managers at all, as if Cruz was playing that role.25 The 2013 plotlines
featured Zoey, who has always deferred too much to physicians, doing vari-
ous nonnursing tasks for them. A May 2013 episode showed her transcribing
Cooper’s dictation, a horrendous handmaiden touch.26 In June 2013 episodes,
1 2 8
she spent a lot of time helpfully organizing the office of the chief of ED medi-
cine Ike Prentiss, a symptom of subordination that was not relieved when it
was revealed that the two were also having sex.27
HawthoRNe addressed nurse-physician power relations more than the
other nurse shows, partly through its focus on a chief nursing officer, but also
in its frequent portrayals of interactions between staff nurses and physicians.
Christina Hawthorne was in command of her nursing staff, and showing
viewers the nursing authority structure has great value. Christina also stood
up to physicians and the hospital CEO, fighting hard for nurses and patients
alike (unrealistically, she often provided direct care). But the show also sug-
gested more than once that she reported to the chief of surgery.28
The HawthoRNe staff nurses generally followed their own practice model.
But those nurses were often weak and submissive. The contemptuous surgeon
Brenda Marshall repeatedly argued that the nurses had to do whatever she
said, and although the show at times indicated that she was a poor physi-
cian, it did not really refute her views of nurse-physician relations. In the
June 2009 premiere, nurse Ray Stein knew that Brenda’s insulin prescription
would endanger a diabetic patient and he challenged it. But faced with her
abuse, he wrongly told himself that he had to do what physicians said, and
he gave the drug anyway. The patient soon crashed.29 By the summer 2011
episodes, Brenda had mellowed somewhat. But a long plotline in which the
gifted young nurse Kelly Epson moved from pediatrics to the OR reduced
Kelly to a silly neophyte begging Brenda to hire and mentor her.30
Nurses on Mercy also seemed to be engaged in their own health practice
in caring and fighting for patients. Veronica Callahan resisted some physician
care plans. In the September 2009 series premiere, she advocated successfully
to give a dying cancer patient the option to stop treatment.31 The next month,
Chloe Payne pushed relentlessly (with no physician involvement) to locate
scarce rabies vaccine for a patient in desperate need.32 The show also included
occasional appearances by Helen Klowden, who was increasingly portrayed
as a nurse manager. In a November 2009 episode, nurse Sonia Jimenez urged
a high schooler to follow the student’s own instincts about whether to have
sexual reassignment surgery. The student’s parents complained to Helen, who
defended Sonia.33
But there were also indications that nurses report to physicians. In early
episodes, when Veronica lost control, she got in trouble with physician man-
agers. In the premiere, the apparent chief of medicine threatened to “fire”
her.34 In an October 2009 episode, Veronica refused chief of ED medicine
Dan Harris’s command to discharge a homeless veteran whose hepatitis
129
Veronica wanted to treat. Harris asked Veronica: “Can you read the letters on
my [ID] badge? Mine has an M and a D, yours has an R and an N. I tell you
what to do.” Veronica responded by throwing a cinder block through Harris’s
car windshield, but that did not prove his statement wrong.35 In a May 2010
episode, nurse Angel Garcia begged Harris to let him stay on a case, as if phy-
sicians controlled nurse staffing.36
ER at times showed its nurse characters working with a degree of inde-
pendence, although the show has also been one of the most persuasive pur-
veyors of the handmaiden image. Nurse manager Eve Peyton, who appeared
in some late 2005 episodes, managed the ED nursing staff with authority and
resisted physician care plans when necessary, although her management style
did cause other characters to see her as a “bitch.” Peyton upset chief resident
Archie Morris by holding a nursing staff meeting, and she embarrassed him
with her superior clinical knowledge when he tried to break it up. Later a
chastised Morris told fellow physicians that he could not interfere because
nurses are “autonomous professionals.”37 Peyton’s departure in December
2005 was deeply flawed, as we will see in Chapter 8, although she was at least
fired by the “nursing supervisor.”38 Major nurse character Sam Taggart often
operated with some autonomy, advocating strongly for patients with physi-
cians and others. In one December 2006 episode, she took the lead in caring
for a homeless patient found on the street in the freezing Chicago winter after
another local hospital had dumped the patient. Sam forced that hospital to
deliver the grateful patient to her parents’ house an hour away.39
The sitcom Parks & Recreation has included a few good illustrations of
nursing autonomy. In recent seasons nurse Ann Perkins, the best friend of the
lead character, was the public relations director for the city health department.
Ann seemed to operate more or less on her own. Her public health efforts did
run up against the dysfunction that surrounded her. In one September 2011
episode, she asked the telegenic city manager Chris to star in a public service
announcement about diabetes, although the show audience’s main takeaway
was likely how Chris acted as if he was making an Oscar contender.40
Another show that displayed significant nursing autonomy was the mini-
series RAN: Remote Area Nurse, which aired on Australia’s SBS-TV in early
2006. The drama’s public health nurse Helen Tremaine was the only licensed
health professional living on a Torres Strait island, and she provided a range of
care on her own. Tremaine pushed back against a visiting physician’s attempts
to tell her what to do with an at-risk pregnant patient—“Since when does a
registered nurse outrank a qualified physician?”—though there remained a
sense that he was the ultimate health authority.41
1 3 0
Some television documentaries have effectively conveyed nursing

autonomy. The United Kingdom’s 24 Hours in A&E has shown emergency
nurses managing challenging patients at London’s King’s College Hospital
and providing a wide range of care on their own. In an installment broad-
cast in the United States in November 2011, senior sister Jen seemed to be
more or less running the unit. One of her main tasks was trying to keep
rival gangs apart while allowing them some access to their wounded com-
rades.42 The recent Showtime documentary series Time of Death included
a few good, if limited, portrayals of autonomous hospice and oncology
nurses. In the November 2013 series premiere, an oncology nurse gave a
patient good advice about helping her children cope with her impend-
ing death at the same time as the nurse was expertly administering che-
motherapy.43 The Discovery Health Channel documentaries Lifeline: The
Nursing Diaries44 (2004) and Nurses45 (2002), discussed in Chapter 3,
showed skilled nurses working autonomously at major US hospitals, sug-
gesting that physicians do not direct nursing care. One 2003 episode of the
National Geographic Channel’s Doctors Without Borders: Life in the Field,
a series about the nonprofit organization, actually focused primarily on
the independent work of its nurses. The episode included the stories of a
veteran nurse running a healthcare system in an Ivory Coast prison, as well
as nurses fighting tuberculosis during a refugee crisis in Sierra Leone and
in a depressed region of Uzbekistan.46
Confronting the Zombies

A few of the recent films discussed in Chapter 3 also suggested nursing auton-
omy through strong major nurse characters providing vital health care with
little or no physician involvement. In the Meet the Parents installment Little
Fockers, lead character Greg Focker had the usual comic misadventures, but
he also directed a medical-surgical unit and provided important care on his
own, including acting quickly to save his father-in-law after an apparent heart
attack.47 In Zack Snyder’s apocalyptic zombie film Dawn of the Dead, nurse
character Ana was the lone health professional patching up and caring for her
band of survivors.48 In Mike Nichols’s HBO adaptation of Tony Kushner’s
play Angels in America, nurse Belize appeared to be the only real health prac-
titioner on his New York AIDS ward. When physician Henry came to have
his patient Roy Cohn admitted one night, Henry was annoyed that Belize did
not jump to attention. Henry sniffed that nurses were supposed to wear white.
Belize responded that physicians were supposed to be home in Westchester,
asleep.49
131
Nichols explored some similar territory in his 2001 HBO adaptation of

Margaret Edson’s play Wit. The film portrayed the tough but emotionally
homeless scholar Vivian Bearing’s confrontation with a life-threatening ill-
ness. Nurse Susie Monahan was not an intellectual, but she did want to pro-
vide Vivian with professional health care. That brought her into conflict with
the self-indulgent research physicians pushing Vivian’s chemotherapy and
heroic measures to prolong her life. Despite their differences, the two women
formed an important bond. Audra McDonald’s performance as Susie was a
bit too meek, but she displayed a fiery core in stopping the physicians from
going against Bearing’s wishes.50 (McDonald moved on to play a heroic physi-
cian on Private Practice.)
Recent films about World War II have also offered glimpses of nursing
autonomy. Joe Wright’s 2007 film adaptation of the 2003 novel Atonement
followed Ian McEwan’s characters into the carnage of World War II, and in
doing so it included a look at British wartime nursing. The movie added visu-
als to the book’s powerful account of hospital care, showing the formidable
authority of the senior nurses and the courage required of all the nurses caring
for the horrifically wounded soldiers.51 Neither the film nor the book con-
veyed much of the expertise that nursing requires, but both presented nurse-
centered visions of care in which physicians played virtually no role.
True Colors in the News Media

Some of the lengthy press accounts of nursing discussed in Chapter 3 are also
effective portrayals of nursing autonomy. Julian Guthrie’s March 2012 San
Francisco Chronicle profile of University of California San Francisco nurs-
ing dean David Vlahov traced the career path of a healthcare leader with no
suggestion that it depended on physicians.52 John Blanton’s April 2007 Wall
Street Journal piece describing his experience as a new burn unit nurse gave
readers a detailed account of nurse-driven care, with the physician role lim-
ited to a reference to the need to “keep a close eye on what doctors ordered.”53
The value of these accounts is not that they suggest physicians’ work does not
matter, but that they show that nursing care is based on nurses’ own unique
scope of practice.
Likewise, items that consult nurses as experts send the message that they
are independent health authorities. For example, although the New York
Times remains far more likely to consult physicians, in July 2013 the paper
ran a long “Ask an Expert” column featuring York College nursing professor
and advanced practice nurse Julia Bucher. She gave practical, sensitive advice
1 3 2
to readers caring for relatives with cancer.54 In May 2013, the Times had a
short “Room for Debate” feature about the ethics of force-feeding inmates
on hunger strike at the Guantanamo Bay prison. One of the five “debaters”
was Ann Gallagher, director of the International Centre for Nursing Ethics
at Surrey University, who argued that it is ethical for nurses to decline to
force-feed inmates.
Two December 2004 items presented nurses as the driving force in out-
patient clinics. South Africa’s Star ran a piece by Kerry Cullinan about the
challenges faced by nurse managers at the legendary Alexandra Clinic, which
handles chronic illnesses and labor and delivery in an overcrowded town-
ship.55 A column by Phillippa Stevenson in the New Zealand Herald paid
tribute to palliative care nurse Cynthia Ward, founder of True Colours, a
health service that “aims to support families at and from the moment their
child is diagnosed with a chronic, serious or life-threatening illness.”56
Some press pieces showcase the autonomous work of public health
nurses. Of course, stories about school nurses may do that. An August 2013
Associated Press report by Carolyn Thompson stressed the independent
leadership role of modern school nurses in disease prevention and detection,
managing chronic conditions, and mental health.57 An August 2011 United
Press International item reported that research to be published in the Journal
of School Health had shown that a curriculum developed by Cincinnati
Children’s Hospital nurse and “suicide prevention expert” Cathy Strunk
significantly reduced rates of attempted suicide.58 With regard to older
patient populations, in May 2013 BBC News published a report by Adam
Brimelow about a nurse-run Dutch home care firm that employs thousands
of district nurses. Those nurses work in “self-steering teams” to provide holis-
tic, cost-effective care, reducing hospital and nursing home stays; the nurses
complement their community-building with a weekly health radio show.59
Similarly, in July 2007 the Copenhagen Post ran a piece about a “mobile nurse
task force”—that is, two nurses on bicycles—who diagnose and treat most
of their elderly patients’ problems at the patients’ homes, avoiding traumatic
and costly hospital visits.60 In January 2004 the Toronto Star ran Scott Simie’s
piece about the work of “street nurse” Cathy Crowe, one of Canada’s most
prominent advocates for the homeless.61
Although Hollywood’s depictions of military nurses have focused on the
past, the news media has offered more current accounts of military nurses
practicing with autonomy. In June 2012 PBS aired a segment as part of its
“Need to Know” series in which William Brangham profiled three San Diego
nurses who provide ongoing outpatient care to veterans who have returned
133
home with posttraumatic stress disorder and other problems. The profile of
nurse scientist Jill Bormann, who was investigating the use of mantram ther-
apy to manage posttraumatic stress disorder, was especially impressive.62 In
March 2007 NPR ran a Leading Ladies profile, “Clara Adams-Ender: Army
Achiever.” Cheryl Corley interviewed the retired general, who headed the
Army Nurse Corps from 1987 to 1991. General Adams-Ender discussed her
career, although the profile had little to say about nursing.63 In fact, General
Adams-Ender had apparently established the first neonatal intensive care
unit in Germany, but NPR failed to mention it. Still, the piece did show that
nurses can lead at the highest levels.
“Nurse, Hand Me My Laptop”: Media Portrayals of the

Nurse as Handmaiden
The handmaiden image infects even media directed at children. In Holly
Hobbie’s 2008 book Fanny, an inventive girl made her own “Annabelle” doll
after her mother refused to buy her glamorous Barbie-like “Connie” dolls like
those her friends had. When the friends all decided to play veterinary hospi-
tal, “Dr. Annabelle performed operations on every stuffed animal . . . while
the glamorous [Connie] nurses assisted.” “Dr. Annabelle” listened to a teddy
bear with a stethoscope. The “nurse” dolls looked pretty but useless in skimpy
white dresses.64
In June 2009 the Examiner websites posted a transcript of an interview
in which The View co-host Whoopi Goldberg explained the professional
aspirations of Brenda, the lead character in the Sugar Plum Ballerinas chil-
dren’s books Goldberg had written. Goldberg said that Brenda’s desire to be
a physician is not unusual today, because girls these days have seen “ER in
reruns” and have not “been told what they couldn’t do,” in contrast to girls of
Goldberg’s generation, who “all heard, ‘You have to be a nurse first. You have
to be a helper. You can’t be a doctor. Be a helper.’ ”
In November 2007 Seattle’s Group Health ran Internet advertisements
for its “Ask the Doc” service, in which patients communicate with advanced
practitioners by email. The tag line: “Nurse, hand me my laptop.” Yes, maybe
laptops are the new stethoscopes. But get your own laptop, buddy, we’re busy
saving lives. Of course, nurses do hand physicians things when care requires.
However, these advertisements suggested that nurses are gofers whose use of
advanced care technology consists mainly of handing it to physicians, the real
health experts. But in hospital settings and many others, nurses are the main
1 3 4
patient educators. Nurses at Group Health itself regularly communicate with

patients by email!
Those nurses persuaded Group Health to pull the advertisement. Ms.
Goldberg returned our calls and discussed our concerns that her comments
presented nurses as handmaidens, indicating that she would bear them in
mind going forward. But the popular media sends these same messages every
day. Influential entertainment television shows often portray authoritative
physicians telling submissive nurses what to do. These scenarios reinforce the
prevailing notion that nursing is all about doing physicians’ bidding, espe-
cially since the great majority of nursing is rarely shown.
Grey’s Anatomy: “You’re the Man”

No one could possibly think from watching the hundreds of episodes of
Grey’s Anatomy that have aired since 2005 that nurses were anything but
physician subordinates. The vast majority of nurses who appear are silent ser-
vants. Time and again, the show has told viewers that the nurses report to
physicians. Nurses on Grey’s have occasionally displayed resentment and petty
vindictiveness when abused by their physician masters.65 But that is not the
same as being an autonomous professional.
Grey’s nurses have, very rarely, questioned physician care plans. In a
December 2013 episode, a hospital patient crashed. The weak junior surgeon
Leah Murphy rushed in with a nurse and informed the nurse that the patient
was having a myocardial infarction, ordering her to get an electrocardiogram
and crash cart. The nurse mutely complied. Soon, the bullying junior surgeon
Shane Ross insisted on operating. First Murphy and then the nurse urged
Ross to wait for a senior surgeon. The nurse caved after Ross barked that he
would wait, but then the nurse would have to explain to the attending physi-
cian that the patient had died “because you wouldn’t let me help him.” In
the OR, the patient began bleeding heavily. Murphy and then an OR nurse
suggested bypass. But Ross insisted on trying to stitch up the perforation,
and they allowed him to do so, even as he became desperate and lost con-
trol, clearly in over his head. Finally, Murphy found senior surgeon Richard
Webber to help; only he could pry Ross away. In terms of nursing advocacy,
these two scenes were among the strongest in the show’s long run. But these
nurses were still just gentle patient safety speedbumps, echoing Murphy’s cau-
tious impulses. The physicians were in charge.66
Even the episodes with the more assertive nurse Eli, discussed in Chapter
3, reinforced the handmaiden image in the end.67 Consider a March 2011
135
episode in which Eli pressed surgeon Miranda Bailey to explain to a patient

the risks of participating in a clinical trial—right in front of the patient! Later,
Bailey claimed that Eli had violated the hospital’s “doctor-nurse protocol.”
Although the lovebirds made up near the end of the episode, that happened
after Eli made this forceful speech:
Miranda Bailey, we are not inside the hospital. Inside the hospital,
you’re the man. That’s the protocol. But outside, I’m the man. I . . .
am the man. Me. You can call me Cro-Magnon, or old-fashioned, but
that is not gonna stop me from taking you home to my bed tonight
and showin’ you what kind of man I am. Now, how’s that? Does that
protocol suit you?
Rather than vomiting, Bailey looks impressed. But having a nurse character
endorse the idea that physicians are “the man” inside the hospital is, well,
Cro-Magnon.
In an October 2009 episode, the Grey’s hospital merged with another
hospital, and chief of surgery Richard Webber—who also seemed to func-
tion as the hospital’s chief of medicine and CEO—made staff cuts. With no
suggestion that nurse managers exist, Webber let many nurses go, including
the pathetic nurse Olivia.68 Surgeon Derek “McDreamy” Shepherd offered to
give Olivia a reference, since he doubtless knew her nursing skills well after
years of supervising her! (Of course, not really.)
In a May 2008 episode, Seattle Grace’s nurses boycotted all surgeries of
plastic surgeon Mark “McSteamy” Sloane because he had loved and left too
many of them. The nurses actually complained to their union, and a union
representative showed up to get Webber to force all physicians and nurses to
submit the names of their sexual contacts. Among other things, that was a
clear suggestion that the chief of surgery managed nurses. Finally, chief resi-
dent Miranda Bailey called about forty of the nurses together in the hospital
atrium to publicly chastise them and get them back to work. Bailey called
Sloane a “whore” but stressed that he was a good surgeon and the nurses all
knew his reputation, so “let us all close our knees and get back to our jobs.”
Not a single nurse could reply. Bailey shouted “Disperse!” and the nurse-sheep
ambled back to their pastures.69
The January 2007 episode in which Sloane praised nurses also had him
punishing the interns by dumping nurses’ apparently disgusting work—
debriding bedsores—on the interns. (Few real nurses would find this dis-
gusting; it is an important professional responsibility.) Presumably, Sloane
1 3 6
supervised both the interns and the nurses. His statement that the nurses were
“helpful” actually reinforced damaging assumptions. Of course “helpful” is
a good thing in general, but this comment in context suggested that nurses
are helpful in the physician mission of providing all meaningful health care,
rather than in providing autonomous nursing care. “Helpful” is pretty faint
praise for life-saving health professionals. Would anyone suggest that physi-
cians, as a class, are “helpful?”
In a September 2006 episode, nurse Tyler smugly informed intern Cristina
that he was part of a team that had just saved a life in a code.70 But Tyler said
that only to justify his failure to earn the $20 Cristina had paid him to act as
a lookout so she could have sex with her boyfriend in his hospital bed. Tyler
seemed to get the last laugh, but he was still a lackey who accepted $20 tips
for tasks other than his real job. Later, Tyler paged intern George O’Malley to
tell him that a cancer patient had been shoplifting and was planning to leave
without having her operation. Then Tyler stepped back to let George handle
the important psychosocial issues. Plainly, Tyler worked for George, not the
patient.
The January 2006 nurses’ strike episodes repeatedly told viewers that
the nurses report to the chief of surgery.71 These episodes made a few points
about short-staffing and forced overtime. But the episodes presented the
nurses as bitter serfs and suggested that nursing is mostly about paperwork,
room assignments, and trivial patient quirks. The chief of surgery’s “assis-
tant” Patricia was described as someone who “used to” be a nurse. But now,
Patricia managed the nursing crisis. After all, the show has no nurse manag-
ers. Patricia lectured some temporary nurses about how the patient charts are
organized by room number, then addressed nearby attending surgeons Burke
and Shepherd: “You know why I stopped being a nurse? Doctors. Doctors
who don’t know how to pitch in.” These two surgeons told the chief he should
resolve the strike, but the chief said it would take $2 million per year to hire
the extra nurses needed. Finally, the chief admitted to Patricia that “we” need
the nurses, and, at her suggestion, he ended the strike by forgoing the pur-
chase of a surgical robot he had recently ordered.
An April 2005 episode presented a scrub nurse as a loyal subordinate of
the surgeons. The nurse, a dying pancreatic cancer patient named Elizabeth
Fallon, was formidable and savvy.72 She had worked for decades with Ellis
Grey, the legendary surgeon mother of lead character Meredith. Ellis recalled
that Fallon was an “excellent” nurse, but Fallon was also seen as a career phy-
sician appendage, focused on gruffly charting the progress of the physicians
around her. Fallon’s remark that she was “Ellis’s scrub nurse for eighteen years”
137
was an insult to perioperative nurses, who are professionals with their own
science-based scope of practice. Nurses work with surgeons, not for them.
House: Help! Golems Are Loose in the Hospital!

Nurse characters on House probably spoke and did even less than nurses on
the other major Hollywood hospital shows, and as a result, the show’s hand-
maiden portrayal may have been the most absolute. The vast majority of nurse
appearances involved a character popping up out of nowhere to absorb a phy-
sician command, like the golems of Jewish folklore—mute, brainless human-
oids crafted from inanimate material for basic tasks by the wisest and holiest,
notably early rabbis.73 Recall from Chapter 3 that House himself joked dur-
ing a “playing God” monologue in a November 2005 episode that cleanup
tasks were why he had “created nurses.”74 Nurses could also be timid bureau-
crats; from time to time House showed a nurse acting as a silent administra-
tive assistant to “dean of medicine” Lisa Cuddy. A very minor exception was
Nurse Jeffrey, a snarky, effeminate nurse who appeared in three episodes in
the show’s final years and made some effort to match House’s obnoxious com-
ments. But serious clinical practice was not a focus of Jeffrey’s scenes.75
In the April 2008 episode with the nurses’ strike plotline, House glibly
announced that he did not “use nurses.”76 House could have said he doesn’t
“practice” with nurses, or (translating into House-speak) that he wouldn’t let
those fools with Daffy Duck on their clothes get near his patients. But “use”
suggests that nurses are just physician tools. The show confirmed this attitude
in an exchange between House and Cuddy in which both physicians indi-
cated that Cuddy was in charge of the striking nurses. In fact, dealing with the
nurses would presumably be the job of the chief nursing officer. But House
had no nurse managers.
A May 2007 episode showed the main facets of nurses’ role on the show.
The complete dialogue of the nurse characters in the episode was as fol-
lows: “Yes, doctor.” “Right away.” “I was just trying to get a urine sample, and
he went crazy!”77 These are the words of handmaidens who perform menial
assistive tasks but panic in an emergency, relying on physicians to supply all
thinking, expertise, and courage. At one point House entered Cuddy’s office.
She sat at her desk, as a nurse stood beside her. House: “You girls can gos-
sip later.” A moment later, when the nurse had not left, House addressed
her: “When I said you girls can gossip later, I was throwing you out in a
polite way.” Cuddy handed some paperwork to the nurse and made a face
suggesting, “You know how he is, we’ll come back to this later.” The nurse left
1 3 8
without a word. After Cuddy and House bantered a while, Cuddy sent House
away: “Send in Nurse Unger on your way out.” Yes, House trashed everyone,
but physician characters like Cuddy were smart and able, and they dealt it
back to House in spades. The nurses slinked away like wounded mice.
A May 2006 episode offered excellent examples of the show’s “golem” por-
trayal, with nurses effectively conjured into existence to perform unskilled
tasks.78 At one point physician Chase was with a patient and her father.
Giving the patient a chelating agent intravenously to help her body dispose of
unwanted iron, Chase explained the procedure to the father. The nurse who
would actually perform and explain this task was not there. The patient went
into respiratory distress, and a monitor beeped. Chase calmly said, “Crash
cart.” Within five seconds, two nurses were in the room with a crash cart.
One of the nurses handed Chase an intubation tool and he saved the patient’s
life. Throughout, the nurses said nothing. Later House was alone with this
patient and her father. No one else was shown in the room. The intubated
patient suddenly had a breathing problem. House wanted to eject the father,
ostensibly so he could do some scary procedure (actually he just wanted to
continue berating the patient). House turned to a nurse, who simply was not
there before, and commanded, “Get him out of here.” The nurse mutely com-
plied. After all, she served House, and there was but one House.
ER: “I’m the Doctor. This Is My Call.”

ER ended its long run several years ago, but it remains one of the most power-
ful modern sources of the handmaiden image. That’s because the series’ hun-
dreds of episodes have been shown around the world for so long, because its
relatively realistic portrayal of hospital care is so persuasive, and because the
skilled handmaiden image is so central to the show’s nursing portrayal.79
Although ER’s nursing depictions improved in the show’s final years, the
handmaiden image continued to appear. In one December 2008 episode,
after nurse Sam Taggart had taken time off to care for her injured son, chief
of emergency medicine Cate Banfield offered to give Taggart more time—
clearly indicating that nurses report to the chief ED physician.
November 2007 ER episodes also suggested that nurses report to physi-
cians. One had chief of ED medicine Kevin Moretti implementing new triage
policies and actually telling Taggart, “Sam, you’re supposed to be covering
triage right now.” Taggart complied. In another scene, intern Tony Gates and
Taggart led some nurses through the ED explaining new policies, includ-
ing treating pain at triage and recording the Wong-Baker pain score. Gates:
139
“Put it in your charts, the docs will be checking.”80 These scenes told viewers
that physicians direct nurses and that physicians direct triage. In fact, nurse
managers do that. And it is nurses who have led the way in pain management,
despite decades of physician resistance.
Another plotline in the November 2007 episodes was about a precocious
thirteen year old named Josh, who was dying of an incurable neurological
disorder.81 The boy wanted to avoid the ventilator, and Gates cleared that idea
with his attending and the hospital’s ethics office—but not the boy’s mother
or Taggart. When Taggart saw this plan presented to the boy’s mother as
a foregone conclusion, she objected. Outside, Gates informed the veteran
nurse how nasty ventilators are, no doubt based on his superior knowledge
of ventilator care and his more holistic approach. (We’re kidding.) Gates
contemptuously told Taggart that they would not be intubating. Taggart
started to call the ethics line, but Gates said he’d already discussed it with
ethics, then grabbed the telephone from Taggart and slammed it down, yell-
ing, “Stop! I’m the doctor. This is my call. Now you can either mix this mor-
phine drip or you can take yourself off this case, because we’re done here.”
Taggart stalked off.
Thus, as was usually the case when ER physicians dismissed nurses like
this, Taggart had no answer, leaving the impression that although Gates was
harsh, what he said was correct—major care decisions we indeed “his call.”
The story showed Taggart as a spirited patient advocate and educator, but
also as a somewhat myopic subordinate who could be excluded from key care
discussions and who ultimately had to give way to the end-of-life wisdom
of the physicians. This incident also seemed to be a turning point in Gates’s
development. Uppity nurse Sam thought she could question Dr. Gates’s deci-
sions because he was just a resident, but Gates was growing fast, learning to
be a real physician.
Even the late 2005 Eve Peyton episodes included handmaiden messages.
For example, the December 2005 episode in which Peyton got fired began
with new chief of ED medicine Luka Kovac sending three ED nurses home—
and calling them “support staff ”—because he foresaw a light shift.82
In an astonishing October 2003 episode, ED nurses staged a walkout
when they learned that the hospital planned to reduce their hours and hire
supposedly cheaper traveling nurses and new graduates who would work for
“minimum wage” (don’t ask). In response to the walkout, chief of ED medi-
cine Robert Romano summarily fired six nurses. Then-nurse Abby Lockhart
told Romano that he “can’t fire nurses.” Romano said he could if they walked
off the job. To this Lockhart had no real response. There was no evident
1 4 0
involvement from any nursing manager. In another scene, ED physician Susan

Lewis forbade Lockhart to tell a teenage girl that she had a fatal heart/lung
condition, at the behest of the girl’s parents. The girl was panicked because she
was getting clues that something serious was wrong, but no one would tell her
the truth. Lewis impatiently reminded Lockhart that Lewis was the patient’s
physician, Lockhart was the patient’s nurse, and so Lockhart had to do as
Lewis said. Lockhart had—you guessed it—no response except to look hurt.83
Shut Up and Follow Orders: Nursing on Other Healthcare Shows

Other healthcare shows have done no better than the major ones in portray-
ing nursing autonomy, and in some cases they have been worse.
Clinical scenes on The Mindy Project usually occur in an outpatient set-
ting, at a New York obstetrics and gynecology practice. Because Mindy Lahiri
and her physician colleagues own the practice, they employ the nurses who
work there, Morgan, Beverly, and Tamra. Of course, this is the way many
health practices have traditionally operated. So it has always been a special
challenge for television shows to portray the nurses who work in such settings
as autonomous professionals, rather than the office assistants they are com-
monly understood to be. It’s fair to say that those who make Mindy don’t even
know there is a challenge; a January 2014 episode found Morgan and Tamra
bickering inanely over which of them a managing physician would permit to
use a certain “phlebotomy desk.”84 Although the Mindy nurses are too bizarre
and/or nasty to fit the traditional handmaiden image, there is no question that
they are silly order-takers who exist solely to serve the physicians, and they
rarely interact with patients about clinical matters. Granted, that is probably
best for the patients, given who these nurses are.85 In fact, it’s becoming unusual
to see this many registered nurses in an outpatient setting, since most practices
now save money by employing more staff with less training—although those
staff may still be mistaken for nurses, in part because of shows like this.
Private Practice also showed the difficulties with portrayals of nurses in
the outpatient setting. The show’s early episodes, in late 2007, presented nurse
Dell Parker as a receptionist at a Los Angeles clinic owned by a diverse set of
physicians. Dell was plainly an assistant to the physicians, with no unique
scope of practice. Because he was studying to be a midwife, he was eager
to learn what the main character, star obstetrics and gynecology physician
Addison Montgomery, could teach him. However, in the series premiere
Dell was no more than a willing but ignorant layperson. Well, he did hold a
patient’s hand on his own initiative and notice that she had passed out.86
141
In later years, the show suggested that Dell had promise as a midwife, par-
ticularly after he actually became one and managed a few solo deliveries. But
on the whole he remained essentially a helper, continuing to act as an office
administrator. Although several episodes in the show’s final season included
the more assertive nurse Stephanie, other nurses in that season were even
more extreme versions of the show’s usual handmaidens. In a December 2012
episode, two nurses caring for pregnant physician CEO/chief of medicine
Charlotte King were inept—unable to start an intravenous line correctly or
even get a pillow—and absolutely terrified of Charlotte. Although Stephanie
claimed in passing to be the “floor manager,” she also correctly described her-
self as Charlotte’s “beck and call girl.”87
To the extent Hart of Dixie has clinical scenes, they are mainly set in the
small town general practice of Zoe Hart, a young New York physician who
has taken over her dead father’s family practice in Bluebell, Alabama.88 In the
show’s first season, some episodes included down-home nurse Addie Pickett.
In an October 2011 episode, Addie was introduced as a nurse with 15 years
of experience and knowledge of Zoe’s father’s practice. She donned gloves to
help Zoe and collected laboratory results. But mostly Addie acted as Zoe’s
adoptive older sister, giving her advice about how to fit in with the locals,
such as by going to the hair salon to gossip and show that she’s real! Addie was
a positive character, but her role reinforced the idea that physicians control
health care, with basic assistance from nurses who have practical knowledge
based on their years on the job.
The patheticomic HBO series Getting On has sent mixed messages about
nursing autonomy. The weak nurse character Dawn Forchette has often been
pushed around by the physician Jenna James, to whom Dawn is far too defer-
ential. Despite that, in one December 2013 episode, Dawn actually told off an
emergency physician, somewhat quaveringly, after he had dumped a homeless
patient on the geriatric unit. When the emergency physician pushed back,
James stood up for Dawn and apparent licensed vocational nurse Didi Ortley.
Yet in doing so, James called her colleagues “my nurses.”89
Getting On has had nurse managers. In the November 2013 premiere, a
nursing supervisor challenged James’s use of the nursing staff to collect sam-
ples for her fecal study. In retaliation, James got the nursing supervisor trans-
ferred to another part of the hospital.90 That is sadly plausible because of the
weakness of some nurse managers, but the show failed to make clear that it
would at least be a nursing decision. The nursing supervisor for the rest of the
first season, Patsy De La Serda, tried to project professionalism and authority.
And it was clear that he supervised the nursing staff and did not report to
1 4 2
James. But Patsy was woefully ineffective, as his name would suggest, and the
show mocked his customer service sloganeering, abysmal people skills, and
self-pitying vulnerability. Patsy’s clashes with James about unit policy seemed
to end in nil-nil draws, because both characters were so dysfunctional and
lacking in real concern for others.
Scrubs, which was generally set in a hospital, presented its physician char-
acters as directing nurses and nursing care.91 It repeatedly told viewers that the
nurses ultimately report to the chief of medicine, although it also suggested
that nurse Carla Espinosa, who provided direct care, was a “head nurse.”
February 2009 episodes highlighted the problem of physician disrespect of
nurses, but in these same episodes, Carla reported to chief of medicine Perry
Cox on nurse staffing issues, including nursing schedules.92 One physician
told a nurse that the “M.D.” on his I.D. badge meant he “makes the deci-
sions.” (Maybe badges are the secret source of physician power!) The episode
suggested that the badge statement was unhelpful, but that the underlying
assumption about physician authority was correct. With Carla gone for the
show’s final season, the few nurse characters were standard Hollywood hand-
maidens. In a December 2009 episode, a mute nurse in a code scene waited
for the physicians to tell her to get a crash cart, fiddled with the patient’s
bed covers, and then scurried out of the way so the physicians could save the
patient by themselves.93
An extraordinary November 2003 Scrubs episode purported to teach
Carla that nursing is all about shutting up and doing what physicians tell you.
In that episode, Carla advised resident physician Elliot to give a patient a cer-
tain drug, which Elliot did. The patient developed a paradoxical reaction, and
Elliot was furious. She told Carla that Elliott’s job was to ignore Carla and do
whatever Elliott thought was right. Carla’s fiancé, surgical resident Turk, told
Carla how a surgical nurse with twenty years experience had recently tried to
tell him what kind of suture knot to tie. Turk said he had kicked the nurse
out of the OR and made her cry, because in the hospital, physicians are in
charge. Turk said the job of nurses is to follow physician “orders,” because
ultimately the physicians are responsible for the patients (and presumably
nurses are not). Carla accepted this. A later scene found Elliott and Carla at
a patient’s bedside. When Elliot asked for a certain treatment, Carla meekly
obeyed, smiling, clearly relieved to have learned her proper role as physician
helpmate. There was no irony in this megalomaniacal fantasy, which was espe-
cially insidious because Carla endorsed it.94
Strong Medicine was a hospital show that focused on two female physi-
cians but also included nurse midwife character Peter Riggs, who at times
143
displayed limited autonomy. But even his intermittent appearances were

undermined by a persistent vision of physicians as the masters of all health
care. Other nurses—when they appeared at all—were almost always face-
less servants, silent and submissive. One January 2002 episode about a
nursing strike actually did show that nurse short-staffing was deadly and
that physicians could not easily do nurses’ jobs. But even that episode
clearly conveyed that the physicians were in charge. As one striking nurse
said (wrongly), physicians are management and nurses are labor. Riggs led
the striking nurses, negotiating directly with a physician who appeared
to be both chief of medicine and hospital CEO, but no nurse manager
ever appeared.95
Apart from the 2009 nurse shows, the slew of short-lived recent US hos-
pital dramas have shown no improvement. Recent US shows lasting one
season or less that show brilliant physicians directing meek nurse handmaid-
ens include Monday Mornings; Emily Owens, MD; Do No Harm; The Mob
Doctor; A Gifted Man; Off the Map; Miami Medical; and Three Rivers. On
these shows, which focused on surgery and trauma, the producers managed
to present most clinical interactions with no nurses at all. But when nurses
did appear, they were generally deferential order-takers. In an October 2009
episode of Three Rivers, no nurse uttered a word that reflected knowledge of
patient conditions, but we did count three submissive “yes, doctor!”s from
invisible nurses and forearm nurses.96 In a February 2013 episode of Emily
Owens, MD, after two nurses complained helplessly that a difficult patient
had disconnected her intravenous line and disappeared, the lead physician
character had to instruct them to call the police and have maintenance come
clean up the mess in the room.97
Even on the minority of these shows that included a regular nurse char-
acter, the best the nurse could do was to be a respected aide-de-camp of the
dominant physicians. On The Mob Doctor, lead physician Grace Devlin’s
best friend was nurse Rosa Quintero, but Rosa’s role consisted mainly in
looking worried about Grace’s mysterious Mob activities and covering up
for her at the hospital.98 Miami Medical’s Tuck Brody was the strongest
nurse character on any of these shows, a real swaggerer with some clini-
cal knowledge and authority over other nurses. But he still seemed to serve
mainly as an executive assistant and head cheerleader for the trauma sur-
geons he himself glorified as “rock stars.” Meanwhile, many of the show’s
more minor nurse characters were mute ciphers, handing the physicians
gloves and wheeling gurneys.99
1 4 4
“I’ll Go Get the Doctor!”: Nursing on Non-Healthcare Shows

As you might expect, some of the worst handmaiden portrayals of nursing
appear on shows that are not mainly about health care. In a September 2013
episode of NCIS: Los Angeles, two agents who had been tortured arrived at
a hospital. In the ED, silent nurses stood by to receive impressive-sounding
physician orders for drugs, tests, and even the timing of a gurney transfer
in which the commanding physician was not participating. At the time of
this episode, the show had producers who had previously worked on ER and
other hospital dramas.100
An April 2008 episode of ABC’s Desperate Housewives presented a nurse
as a mousy physician lackey who could be bribed into revealing sensitive
patient information with a free lunch.101 In the episode, character Gaby’s boy-
friend Carlos was an inpatient with an eye injury, which only Carlos knew
would mean permanent blindness. Another of Carlos’s girlfriends, the notori-
ous Edie, visited him in the hospital. But Edie got angry with Carlos and left.
Walking down the hall, Edie spotted a nurse eating a sad sandwich. Edie asked
when Carlos would get his sight back. Nurse: “I don’t know . . . Mr. Solis’s
condition is very serious. . .” Edie: “Serious? What’s wrong?” Nurse: “Well . . .
you know, you should really talk to the doctor about this. I don’t even think
his girlfriend knows.” The nurse suggested she had “said too much already,”
but then she succumbed to Edie’s offer to treat her to lunch at a “great little
French bistro.” Edie easily got information out of the unsophisticated nurse
and used it against Gaby and Carlos. The timid nurse could not speak with
any real authority, even to say the law and her own ethics limited her ability
to speak about the patient. Instead, she tried to pass the buck to the physician
who had real power and expertise.
Late 2007 episodes of Larry David’s HBO sitcom Curb Your Enthusiasm
also portrayed nurses as handmaidens. In an October episode, “The N Word,”
a black surgeon overheard Larry relating a story in which another white man
had used that racist word. The furious surgeon, wrongly assuming Larry was
the bigot, took revenge on the next white man in his path by shaving the head
of his patient, who happened to be Larry’s friend Jeff. In the OR, a nurse
weakly tried to stop the surgeon but ended up obediently handing him the
clippers after the surgeon ordered her to do so. Another nurse tried to cover
up what the surgeon did, suggesting to Jeff ’s wife that it was accidental, before
the surgeon ordered the nurse to leave the room so he could apologize.102
A July 2005 episode of HBO’s Six Feet Under suggested that nurses basi-
cally help the smart physicians who provide all important care. In the episode,
145
character Nate Fisher was taken to a Los Angeles area hospital after col-
lapsing from a brain hemorrhage. Nate had an operation to stop the bleed-
ing, although he remained in a possibly lengthy coma. Meanwhile, family
and friends gathered, including Brenda, his pregnant wife. The family dealt
almost entirely with seemingly skilled physicians about Nate’s condition. But
there was a telling nurse interaction the morning after the operation, when
Nate was on a medical-surgical floor with only Brenda present. Nate sud-
denly woke up. Brenda called for the nearby nurse. The nurse saw Nate and
responded, “I’ll go get the doctor!” No smile, no support, no assessment, no
patient interaction, and no ability to respond to change. The nurse fled the
room. She was a terrified flunky.103
News Media Helpers

The entertainment media is the leading source of explicit handmaiden imag-
ery, but echoes of it can be found in the news media, which often at least
implies that physicians direct all hospital care. Even some articles that high-
light nursing skill, such as Scott Allen’s October 2005 Boston Globe report
about the training of a new intensive care unit nurse, fall into this trap to
some extent.104
For example, recent press reports show that nurses saving lives outside of
the clinical setting is news, as we noted in Chapter 3, but if there is a physician
present, the nurses will likely be seen as the physician’s assistants regardless of
what actually happened. In July 2011, the Raleigh, North Carolina area televi-
sion affiliate WRAL posted a fairly good item by Ken Smith reporting that a
nurse driving down a local highway had stopped and helped to save the life of
a police officer who had been gravely injured when a truck struck his motor-
cycle. The nurse, who was quoted, directed others to make tourniquets and
made sure the officer’s airway remained clear.105
But news items about another save the previous month were more prob-
lematic. On June 29, 2011, the Sun Journal of Lewiston, Maine, reported that
a man had had a heart attack while attending a lecture about heart problems at
a local hospital. Daniel Hartill’s piece at least credited not only the cardiolo-
gist giving the lecture with saving the man, but also several named nurses in
the audience. Based on this report, the nurses seem to have done all of the
actual saving, including defibrillation, without much input from the physi-
cian. Still, the piece got extensive quotes from the physician, and it offered
a photograph of the nurses surrounding him doing “their ‘Charlie’s Angels’
impression,” pretending their hands were guns, suggesting that the physician
1 4 6
had directed their exploits. The June 29 MSNBC item about the incident was
less subtle, leading with a headline that included the phrase “Maine cardiolo-
gist saves the audience member’s life,” although the piece did at least note that
a “team of nurses” was part of the effort. A June 30 NPR item said that the
patient “was surrounded by cardiac nurses who grabbed a defibrillator and
saved his life,” but the item also claimed that “Dr. Phillips oversaw the rescue.”
Perhaps it’s natural that the person giving the heart lecture would get more
credit than those in the audience, but no piece quoted any of the nurses, and
overall the reports show how media assumptions work to reinforce the hand-
maiden image.106
Or consider a story posted in September 2006 on the ABC News web-
site about dangerously long ED waits. An Illinois woman was reportedly
found dead in an ED waiting room two hours after a nurse had told her to
wait.107 The coroner found that the woman had shown “classic symptoms
of a heart attack” and the coroner’s jury ruled the death a homicide. The
piece highlighted the serious potential consequences of triage errors, and it
also linked the apparent problem in that case to ED overcrowding. But the
report seemed to wrongly assume that physicians are ultimately responsible
for all ED care. It relied solely on comments from the American College of
Emergency Physicians. (We guess ABC News couldn’t quite find room on
its website for comments from the Emergency Nurses Association; data stor-
age is expensive.) A statement attributed to the president of the American
College of Emergency Physicians advised dissatisfied patients to talk to the
triage nurse, but if that “doesn’t work,” to “ask to speak to the emergency phy-
sician.” This advice gives the mistaken impression that ED nurses report to
physicians. In fact, patients in such a situation should generally ask to speak
with the charge nurse, the clinical nurse specialist, or the ED nurse manager.
Nurses are the triage leaders—and the nursing leaders.
Notes
1. L. Okey Onyejekwe Jr., “Doctor of Law and Medicine,” California Lawyer (May
2008), http://tinyurl.com/okt3s2z.
2. TNN, “Doctors, Nurses Clash at NRS Hospital,” Times of India (December 10,
2004), http://tinyurl.com/ldtut3v.
3. Joe Kita, “Doctors Confess Their Fatal Mistakes,” and Sunnie Bell, “I Didn’t
Question a Doctor I Knew Was Wrong,” Reader’s Digest (October 2010),
http://tinyurl.com/ppjs3z6, http://tinyurl.com/m5hkvgd; TAN, “Death by
Disrespect” (October 2010), http://tinyurl.com/qcurmta.
147
4. Peter Pronovost, “I Could Have Caused Permanent Brain Damage,” Reader’s Digest
(October 2010), http://tinyurl.com/ob6pohh.
5. Kevin Keane, “Nurse Snatched Scalpel Off Doctor about to Cut Vein,” Irish
Examiner (December 14, 2013), http://tinyurl.com/p9twqv4; TAN, “Nurse X
Confronts a Cutting-Edge Technique” (December 14, 2013), http://tinyurl.com/
n55kq58.
6. Jordan Robertson, “Deputies Tackle Neurosurgeon Outside Oakland Operating
Room,” Associated Press (March 2006), http://tinyurl.com/mfr8tta; CFNA,
“McDrunky,” TAN (March 9, 2006), http://tinyurl.com/oogtblv.
7. Di Caelers, “Nearly Half of Our Nurses Suffer Abuse” (November 10, 2005),
http://tinyurl.com/oxb4bes; CFNA, “A Short Herstory of Violence,” TAN
(November 10, 2005), http://tinyurl.com/oxf3ldg.
8. John Ensslin, “Nurse Sues Memorial, Claims Surgeon Threw Human Tissue at
Her,” Colorado Springs Gazette ( June 26, 2009), http://tinyurl.com/kh6mdqk;
TAN, “Can We Get Cultures on That?” ( June 26, 2009), http://tinyurl.com/
odyp44l.
9. Kevin Sack, “Whistle-Blowing Nurse Is Acquitted in Texas,” New York Times
(February 11, 2010), http://tinyurl.com/mdvy889; TAN, “Remain in Light”
(February 11, 2010), http://tinyurl.com/o9khkr7.
10. US Department of Health and Human Services, Health Resources and Services
Administration (HRSA), “The Registered Nurse Population: Findings from
the 2008 National Sample Survey of Registered Nurses” (2010), http://tinyurl.
com/7zgyet7; Jane Kirschling, “Designing DNP Programs to Meet Required
Competencies—Context for the Conversation” (2012), http://tinyurl.com/
oajvwx8.
11. California Nursing Practice Act, Business & Professions Code § 2725, accessed
March 23, 2014, http://tinyurl.com/orpl2dc. See generally Cal. Bus. & Prof. Code
§§ 2725–2742 (Nursing—Scope of Regulation), http://tinyurl.com/6sxdroo.
12. Chuck Reuter and Virginia Fitzsimons, “Physician Orders,” American Journal of
Nursing 113, no. 8 (August 2013): 11, http://tinyurl.com/nxetllw.
13. Ellen K. Murphy, “Judicial Recognition of Nursing as a Unique Profession (OR
Nursing Law),” Association of periOperative Registered Nurses Journal (November
2004), http://tinyurl.com/ktwgqt4.
14. Sullivan v. Edward Hospital, 806 N.E.2d 645 (Ill. 2004), http://tinyurl.com/4gckg.
15. Smith v. Pavlovich, 914 N.E.2d 1258 (Ill. App. Ct. 2009), http://tinyurl.com/
ox46fsf.
University Press, 2013).
17. Suzanne Gordon, Nursing Against the Odds: How Health Care Cost-Cutting,
Media Stereotypes, and Medical Hubris Undermine Nursing and Patient Care
(Ithaca: Cornell University Press, 2005).
1 4 8
18. Dana Beth Weinberg, Code Green: Money-Driven Hospitals and the Dismantling of
Nursing (Ithaca: Cornell University Press, 2003).
19. Theresa Brown, “Healing the Hospital Hierarchy,” New York Times (March 16, 2013),
http://tinyurl.com/dxlcs2r.
20. Theresa Brown, “Physician, Heel Thyself,” New York Times (May 7, 2011), http://
tinyurl.com/lav3rxw.
21. TAN, “The Stuff of Life” (October 29, 2012), http://tinyurl.com/pcpkq5b.
22. Heidi Thomas and John Martin Johnson, writers, Roger Goldby, director, “Episode
3, Season 2,” Call the Midwife, BBC/PBS (February 3, 2013), http://tinyurl.com/
lrz6l2t.
23. TAN, “Nurse Jackie Episode Analyses,” accessed February 2, 2014, http://tinyurl.
com/kqm3k6b.
24. TAN, “Thank You Nurses!: These Nurses That Stay in One Place . . . They’re Off
Their Game” (May 2, 2011), http://tinyurl.com/o5duqvr; TAN, “Every Day Is
Doctor Day” ( June 6, 2011), http://tinyurl.com/npbesmy.
25. TAN, “Cunning, Baffling, Powerful” (April 14, 2013), http://tinyurl.com/kgrdrne.
26. Daniele Nathanson, writer, Jesse Peretz, director, “Teachable Moments,” Nurse
Jackie, Showtime (May 26, 2013).
27. Gina Gold and Aurorae Khoo, writers, Randall Einhorn, director, “Forget It,”
Nurse Jackie, Showtime ( June 2, 2013).
29. TAN, “Chief Nursing Officer” ( June 16, 2009), http://tinyurl.com/o5ce4yw.
30. TAN, “Christina Saved Her Life” (August 2011), http://tinyurl.com/ncmz5dv.
31. Liz Heldens, writer, Adam Bernstein, director, “Can We Get That Drink Now?,”
Mercy, NBC (September 23, 2009); TAN, “Traffic Is Backed Up in the Tunnel
Heading into Respect” (September 23, 2009), http://tinyurl.com/kaqvmo7.
32. Toni Graphia, writer, Adam Bernstein, director, “Hope You’re Good, Smiley Face,”
Mercy, NBC (October 7, 2009), http://tinyurl.com/mcf3tcv.
33. Veronica Becker and Sarah Kucserka, “I’m Not That Kind of Girl,” Mercy, NBC
(November 18, 2009); TAN, “Putting Ideas in Her Head” (November 18, 2009),
http://tinyurl.com/pnlpnkj.
35. TAN, “An R and an N” (October 21, 2009), http://tinyurl.com/q8k63xt.
36. TAN, “It Droppeth as the Gentle Rain from Heaven” (May 2010), http://tinyurl.
com/psomrge.
37. CFNA, “Peyton Place,” TAN (October 20, 2005), http://tinyurl.com/p8239cy.
38. CFNA, “A Lump of Coal,” TAN (December 8, 2005), http://tinyurl.com/
kk2h69z.
39. CFNA, “Midnight in the Garden of Nurses and Murses,” TAN (February 2007),
http://tinyurl.com/paeq4lo.
40. Greg Daniels, Michael Schur, and Norm Hiscock, writers, Randall Einhorn,
director, “Ron & Tammys,” Parks & Recreation, NBC (September 29, 2011).
149
41. John Alsop, Sue Smith, and Alice Addison, writers, RAN: Remote Area Nurse,
SBS (Australia) ( January 2006), http://tinyurl.com/pecma9w; CFNA, “Dogged,
Petulant, Bloody-Minded Renegade . . . Nurses,” TAN ( January 4, 2006), http://
tinyurl.com/nq75wkb.
42. Tom McDonald and Nick Curwin, executive producers, 24 Hours in A&E, Channel
4/BBC America, accessed March 22, 2014, http://tinyurl.com/3onwxsw; TAN,
“24 Hours in A&E Episode Reviews,” accessed March 22, 2014, http://tinyurl.
com/k7wjryz.
43. Dan Cutforth, Jane Lipsitz, and Alexandra Lipsitz, executive producers, Time of
Death, Showtime (2013–2014), http://tinyurl.com/onzor26.
44. Richard Kahn and Linda Martin, directors, Lifeline: The Nursing Diaries: Part 1: The
Rookies, Discovery Health Channel (2004); CFNA, “Part 1: The Rookies,” TAN
(December 16, 2004), http://tinyurl.com/ob9df8c.
45. Greg Rienzi, “TV Documentary Explores Nursing,” The Gazette Online 29, no. 42
( July 31, 2000), http://tinyurl.com/q8kqald; CFNA, “Nurses” TAN (2002),
http://tinyurl.com/qzjaldh.
46. Glenda Hersh, John Bowman, and Stephen Weinstock, executive producers,
“Cool Hand Luc,” Doctors Without Borders: Life in the Field, National Geographic
Channel ( July 2, 2003); CFNA, “Geographic’s ‘Doctors Without Borders’ Episode
Focuses on . . . Nurses!,” TAN ( July 9, 2003), http://tinyurl.com/kl3fjc2.
48. James Gunn, screenplay, Zack Snyder, director, Dawn of the Dead, Universal
Pictures (2004); CFNA, “Dawn of the Dead,” TAN (April 7, 2004), http://tinyurl.
com/py9holr.
mqcbd3l.
50. Margaret Edson, playwright, Emma Thompson and Mike Nichols, screenplay,
Mike Nichols, director, Wit, HBO Films; CFNA, “Wit,” TAN ( January 5, 2003),
http://tinyurl.com/q2rfz8s.
51. Ian McEwan, Atonement, Nan Talese/Doubleday (2001); Christopher Hampton,
screenplay based on the novel by Ian McEwan, Joe Wright, director, Atonement,
Working Title Films, Relativity Media (2007); CFNA, “Atonement” (film review),
TAN ( January 13, 2008), http://tinyurl.com/ooxmyvm; CFNA, “Atonement”
(book review), TAN (May 10, 2003), http://tinyurl.com/l54xzko.
52. Julian Guthrie, “Nursing School Dean Brings His Career of Caring,” San Francisco
Chronicle (March 11, 2012); TAN, “You Just Have to Listen” (March 11, 2012),
http://tinyurl.com/ncsmen2.
53. John Blanton, “Care and Chaos on the Night Nursing Shift; in a Search for
Purpose, an Editor Changes Careers; ‘He’s Asking for You Again,’ ” Wall Street
1 5 0
Journal (April 24, 2007); CFNA, “There and Back Again,” TAN (April 24, 2007),
http://tinyurl.com/ndu5dx8.
54. Julia Bucher, “Advice for Caregivers of Relatives with Cancer,” New York Times
( July 3, 2013), http://tinyurl.com/nxce4y6; TAN, “Diplomacy: This Message Is
Important to Share” ( July 3, 2013), http://tinyurl.com/o6rcwda.
55. Kerry Cullinan, “Now They Have Sheets on the Beds, but No Money,” South Africa
Star (December 6, 2004), http://tinyurl.com/ngxcgeb; CFNA, “Nurses Power
Legendary South African Clinic,” TAN (December 6, 2004), http://tinyurl.com/
qfmy8pr.
56. Philippa Stevenson, “Nurse Ward Helps Families See the Colour of Caring,”
New Zealand Herald (December 7, 2004), http://tinyurl.com/ozo86tf; CFNA,
“True Colours,” TAN (December 7, 2004), http://tinyurl.com/l5ekgyf.
57. Carolyn Thompson, “School Nurses Have Come a Long Way Since 1902,”
Associated Press (August 20, 2013), http://tinyurl.com/ngnrcng.
58. UPI, “Program: Teen Depression, Suicide Drops” (August 13, 2011), http://
tinyurl.com/kbayl8l; TAN, “Surviving the Teens” (August 2011), http://tinyurl.
com/osmv6dw.
59. Adam Brimelow, “Dutch District Nurses Rediscover ‘Complete Care’ Role,”
BBC News (May 27, 2013), http://tinyurl.com/nj9tsq6.
60. Copenhagen Post, “Nurses Make House Calls on Bike” ( July 7, 2013), http://tinyurl.
com/ltlzfx4.
61. Scott Simmie, “Street Nurse Earns Prestigious Honour,” Toronto Star ( January 22,
2004); CFNA, “Street Nurse Earns Prestigious Honour,” TAN ( January 22, 2004),
http://tinyurl.com/mppmcc6.
62. William Brangham, producer, “Nursing the Wounded,” Need to Know, PBS ( June 22,
2012), http://tinyurl.com/7rxmhm2; TAN, “Heroes Among Us” (November 3,
2012), http://tinyurl.com/nezoh9j.
63. NPR, “Clara Adams-Ender: Army Achiever” (March 27, 2007), http://tinyurl.
com/oaoqxrd; CFNA, “Army Achievers,” TAN (March 27, 2007), http://tinyurl.
com/pkznojr.
64. Holly Hobbie, Fanny (New York: Little, Brown and Company, 2008); TAN,
“Fanny” ( June 4, 2010), http://tinyurl.com/klpmcpv.
65. TAN, “Grey’s Anatomy Episode Analyses and Action,” accessed March 22, 2014,
http://tinyurl.com/pgayg7h.
66. William Harper, writer, Tony Phelan, director, “Get Up, Stand Up,” Grey’s Anatomy,
ABC (December 12, 2013), http://tinyurl.com/q2eawfp.
67. TAN, “Who’s the Man” (October 13, 2011), http://tinyurl.com/onha8uc.
68. Tony Phelan and Joan Rater, writers, Michael Pressman, director, “I Always
Feel Like Somebody’s Watchin’ Me,” Grey’s Anatomy, ABC (October 1, 2009),
http://tinyurl.com/oawjco3.
151
69. Tony Phelan and Joan Rater, writers, Julie Anne Robinson, director, “The
Becoming,” Grey’s Anatomy, ABC (May 8, 2008); CFNA, “Looking for Mr.
McSteamy,” TAN (May 8, 2008), http://tinyurl.com/oj3ybyy.
70. Krista Vernoff, writer, Jeff Melman, director, “I Am a Tree,” Grey’s Anatomy, ABC
(September 28, 2006); CFNA, “We’re All 17 Years Old,” TAN (September 28,
2006), http://tinyurl.com/pxne9to.
71. Zoanne Clack, writer, David Paymer, director, “Break On Through,” Grey’s
Anatomy, ABC ( January 29, 2006); CFNA, “Weird Scenes Inside the Gold Mine,”
TAN ( January 29, 2006), http://tinyurl.com/nzl6ohf.
72. James Parriott, writer, Adam Davidson, director, “No Man’s Land,” Grey’s Anatomy,
ABC (April 17, 2005); CFNA, “The Scrubbed Nurse,” TAN (April 17, 2005),
http://tinyurl.com/mbrs72r.
73. Alden Oreck, “Modern Jewish History: The Golem,” Jewish Virtual Library,
accessed January 30, 2014, http://tinyurl.com/5f9gt.
74. Sara Hess, writer, Fred Gerber, director, “Spin,” House, Fox (November 15, 2005);
CFNA, “And on the Eighth Day, the Lord Physician Created Nurses, to Clean Up
the Mess,” TAN (November 15, 2005), http://tinyurl.com/o4qdogh.
75. TAN, “House Single Episode Reviews” (February 2011), http://tinyurl.com/
py4b5ug.
76. David Shore and David Hoselton, writers, Deran Sarafian, director, “No More
Mr. Nice Guy,” House, Fox (April 28, 2008); CFNA, “I Don’t Use Nurses,” TAN
(April 28, 2008), http://tinyurl.com/no4vmg4.
77. Leonard Dick, writer, Daniel Sackheim, director, “The Jerk,” House, Fox (May 15,
2007); CFNA, “Yes, Doctor. Right Away. I Was Just Trying to Get a Urine Sample,
and He Went Crazy!,” TAN (September 7, 2007), http://tinyurl.com/o32szd4.
78. CFNA, “Golem,” TAN (May 23, 2006), http://tinyurl.com/o9ydmvo.
80. CFNA, “Orders,” TAN (November 8, 2007), http://tinyurl.com/necev3r.
81. Ibid.
kk2h69z.
83. CFNA, “Stop Me Before I Empathize Again,” TAN (October 9, 2003), http://
tinyurl.com/qf2gugj.
85. TAN, “The Mindy Project Reviews,” accessed March 24, 2014, http://tinyurl.com/
pu8wxuv.
87. TAN, “The Beck and Call Girls” ( January 22, 2013), http://tinyurl.com/qxlcfpp.
88. TAN, “Hart of Dixie Reviews,” accessed March 24, 2014, http://tinyurl.com/
onhnqbx.
1 5 2
89. Jo Brand, Vicki Pepperdine, Joanna Scanlan, Mark V. Olsen, and Will Scheffer,
creators, Getting On, HBO, accessed March 24, 2014, http://www.hbo.com/
getting-on.
90. Mark V. Olsen, writer, Miguel Arteta, director, “Born on the Fourth of July,”
Getting On, HBO (November 24, 2013).
92. Bill Lawrence and Debra Fordham, writers, Mark Stegemann, director, “My
Lawyer’s in Love,” Scrubs, NBC (February 3, 2009); TAN, “What Does That
M.D. Mean?” (February 3, 2009), http://tinyurl.com/pyjb4s4.
93. Bill Lawrence, Steven Cragg, and Brian Bradley, writers, Gail Mancuso,
director, “Our Role Models,” Scrubs, NBC (December 8, 2009); TAN,
“Fiddling with the Covers while Rome Burns” (December 8, 2009), http://
tinyurl.com/q66o9vm.
94. Mark Stegemann, writer, Ken Whittingham, director, “My Fifteen Seconds,”
Scrubs, NBC (November 20, 2003); CFNA, “Scrubs Defines Nursing: It’s All
About Shutting Up and Following Physician ‘Orders,’ ” TAN (November 20,
2003), http://tinyurl.com/py7rrdo.
95. CFNA, “Strong Medicine Episode Reviews,” TAN (2006), http://tinyurl.com/
o5q2awp.
96. TAN, “Three Rivers Episode Analyses” (2009), http://tinyurl.com/pm7wszo.
97. Paul Sciarrotta, writer, Jann Turner, director, “Emily and . . . the Leap,” Emily
Owens, MD, The CW (February 5, 2013).
98. Josh Berman and Rob Wright, creators, The Mob Doctor, Fox (2012–2013),
http://tinyurl.com/nq8e5c4.
99. TAN, “Miami Medical Episode Reviews” (April 2010), http://tinyurl.com/
pveg9xt.
100. Frank Military, writer, Terrence O’Hara, director, “Ascension,” NCIS: Los Angeles,
CBS (September 24, 2013)
101. Alexandra Cunningham and Lori Kirkland Baker, writers, David Grossman,
director, “Sunday,” Desperate Housewives, ABC (April 13, 2008); CFNA,
“Desperate Nursemaids,” TAN (April 13, 2008), http://tinyurl.com/
nm9vze7.
102. Larry David, writer, Tom Kramer, director, “The N Word,” Curb Your Enthusiasm,
HBO (October 28, 2007); CFNA, “The N Word,” TAN (November 11, 2007),
http://tinyurl.com/nuvh6gy.
103. Alan Ball and Nancy Oliver, writers, Daniel Minahan, director, “Ecotone,” Six
Feet Under, HBO ( July 31, 2005); CFNA, “An A + in Getting the Doctor,” TAN
( July 31, 2005), http://tinyurl.com/njxdxs9.
104. Scott Allen, “A Crash Course in Saving Lives,” Boston Globe (October 23–26,
2007), http://tinyurl.com/yje5d62; CFNA, “As I Lay Dying,” TAN (October
23–26, 2007), http://tinyurl.com/mnm2zkh.
153
105. WRAL, “Virginia Nurse Helps Save Injured Cary Officer” ( July 17, 2011), http://
tinyurl.com/3uva9xm; TAN, “Kicking In: He Needed Me” ( July 17, 2011),
http://tinyurl.com/pc8ek85.
106. TAN, “Kicking In: Overseeing the Rescue” ( July 17, 2011), http://tinyurl.com/
k3n3wvc.
107. ABC News, “Illinois Woman’s ER Wait Death Ruled Homicide” (September
17, 2006), http://tinyurl.com/nbv9t; CFNA, “Errors and Omissions,” TAN
(September 17, 2006), http://tinyurl.com/noz2vsu.
5
THE NAUGHTIEST NURSE
In the early 1990s an inebriated homeless patient assaulted an emer-

gency department nurse at a public hospital in San Francisco. The
patient grabbed the nurse’s breast. In the late 1990s the same thing
happened to that nurse while she was working at a major private
hospital in Washington, DC—except that the assaulting patient
was an inebriated United States ambassador to a foreign nation.
The nurse was Sandy.
She is not alone. In October 2009 the Salt Lake Tribune
reported that a Utah man had allegedly grabbed the breast of a hos-
pital nurse he found “cute.”1 The man was at the hospital for the
impending birth of his child. Police said that the nurse he assaulted
was wheeling the mother of his unborn baby to the delivery room.
The man was arrested, so he missed the birth.
In December 2010, an MSNBC item reported that an
Allentown, Pennsylvania man had twice grabbed an emergency
room nurse’s buttocks, but claimed he did so to say “thank you”
for her care.2 After the nurse gave him some negative feedback, the
man apparently told her: “Well, you’re a nurse, right?” In other
words, you’re a slut and it’s part of your job to provide sexual ser-
vices, or at least to endure sexual abuse.
Contrary to the “naughty nurse” image, nurses do not wish
to be sexualized, harassed, or assaulted. But they are—a lot. In a
December 2005 study, University of Missouri communications
professor Debbie Dougherty found that more than 70 percent
of the nurses she surveyed in four US states had been sexually
harassed by patients.3 In March 2006, Dougherty told a writer for
the Monster website that she was “surprised” at the aggression the
nurses faced: “Patients threatened to attack nurses sexually and
called them prostitutes.” A 2009 study indicated that 56 percent of
Japanese hospital nurses had been sexually harassed at some point
in their careers.4 A 2012 study in Pakistan found that more than
5 The Naughtiest Nurse •
155
31 percent of nurses at three Karachi hospitals had experienced “physical

violence, and verbal and sexual harassment” in the preceding year, but only
3 percent reported the incidents, because they “feared retaliation and lack of
support.”5
Indeed, abused nurses often do not receive adequate support from their
hospital employers. In February 2009 the New York Daily News reported that
a Queens jury had awarded a nurse $15 million after Flushing Hospital had
allegedly allowed a physician to sexually abuse her and other nurses for years,
even though hospital officials were aware of the physician’s history of mis-
conduct.6 The physician finally lost his admitting privileges after two 2001
incidents, including one in which he had allegedly chased the nurse through
the halls, cornered her, and “aggressively groped her below the waist.” Some
employers seem to view that kind of abuse as part of nurses’ jobs. Just get
over it!
In all this excitement, even a few nurses seem to have forgotten the real
nature of their work. In March 2010, Reuters reported that a Dutch nurses
union had launched a national campaign to remind everyone that sexual ser-
vices were actually not part of nurses’ jobs.7 Apparently, a young female nurse
had complained that a disabled patient had demanded that she provide sex
as part of his care, then threatened to have her fired when she refused. What
might have given him the idea that sexual services were part of nursing? Well,
there is that global naughty nurse stereotype, but the complaining nurse also
said she saw “some of her peers performing sexual acts with the patient.”
Sexual abuse has a negative impact on patient care, as a December 2005
Associated Press item about Dougherty’s study explained.8 A nurse trauma-
tized by abuse cannot provide her best care. She is less likely to provide good
psychosocial care and to notice important changes in patient conditions, but
more likely to make errors, miss work, burn out, and leave the bedside.
Much of global society continues to regard nurses as sex objects. A 2006
Agence France-Presse item reported that a recent poll had found that 54
percent of British men had sexual fantasies about nurses—more than about
any other profession.9 Nursing led a list of traditionally female, service-ori-
ented jobs; it was followed by maids and flight attendants. By contrast, the
poll found that women’s popular fantasies focused on traditionally male jobs
associated with heroism and/or socioeconomic power, including medicine.
Leading that list were “firemen,” about whom 47 percent of British women
dreamed. For men, it seems, to be the object of fantasies is a mark of power
and prestige. For women, it is a mark of perceived submissiveness and low
status.
1 5 6
In May 2009 the New York Times reported that clinics in Prague were
offering inducements including free plastic surgery in order to recruit scarce
nurses, because many had left the Czech Republic for better paying jobs else-
where in Europe. The report made clear that Czech nurses were evaluated
in part by how sexually attractive they were. One nurse reported that at one
nursing job interview, a male recruiter had asked her to walk in a straight line,
as if she was seeking a modeling position.10
The naughty nurse remains a common cultural reference. In March 2007, on
Live with Regis and Kelly, Kelly Ripa repeatedly promised to be a “sponge bath
nurse” in her “little nursey costume” for cohost Regis Philbin, who was under-
going bypass surgery.11 Ripa’s comments were enthusiastically amplified in press
stories about Philbin’s condition, from the Associated Press to the New York Post.
Some celebrities seem a bit obsessed with the naughty nurse. After nurses
persuaded shoe company Skechers to stop including images of pop star
Christina Aguilera dressed as a naughty nurse in global advertising campaigns
in 2004,12 Aguilera posed for photographs in a naughty nurse costume the
following year at her Las Vegas Halloween party.13 As People reported and the
photographs confirmed, she was “playing doctor” with her scrubs-clad music
executive fiancé. Take that, little nursies!
In December 2006, sometime Italian prime minister and media mogul Silvio
Berlusconi found a novel way to thank his nurses at the Cleveland Clinic, where
he had just had a pacemaker implanted: “Italian nurses are better-looking. . . .
These ones scare me a bit. Don’t even think about leaving me alone at night with
one of them.”14 Don’t worry—we wouldn’t! Of course, the public got valuable
detail about Berlusconi’s vision of nursing from January 2011 reports about the
investigation into his alleged corruption and sexual misconduct. The London
Evening Standard reported that he had hosted parties at which young women
were asked to don naughty nurse attire for “lesbian stripper acts.”15
Some consider nursing to be comparable to sex work. In August 2004 the
Times of London reported that in “some Asian cultures, nursing is consid-
ered on a par with prostitution.”16 In June 2006 the Inter Press Service News
Agency quoted the press secretary of the Pakistan Nurses Association as not-
ing that “the majority of patients and their relatives regard us as sex symbols.”17
That story described sexual assaults by patients and physicians about which
nothing was done. One nurse found that “not even paramedics” would marry
her because, she explained, her hospital colleagues “think I am a prostitute.”
One striking expression of this problem was Dame Helen Mirren’s June 2010
comment, in promoting a film about a Reno brothel on CBS’s Late Show with
David Letterman, that “a lot of girls who work in that [prostitution] industry
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actually come from the nursing industry, which kind of makes sense, because
they’re used to naked bodies. It’s not intimidating to them, you know, the
body and the bodily functions, if you like.”18
The media plays a central role in perpetuating the global vision of nurses as
prostitutes or half-dressed nymphomaniacs. From the time the modern naughty
nurse image emerged in the 1960s, as discussed in Chapter 2, the prevalence of
the image has been staggering. It appears in television shows, pop music videos,
sexually-oriented products, and the news media. Major corporations have used
the image to sell such products as beer, vodka, razor blades, cosmetics, shoes,
men’s underwear, milk, cell phone service, gum, vodka, and beer. In October
2011, the family-oriented Williamsburg, Virginia theme park Busch Gardens
celebrated Halloween with a show featuring naughty nurse dancers; later, the
“nurses” reportedly sold park patrons shots from their “syringes.”19
How sexualized is the media image of nurses? Table 5.1 shows how nurs-
ing compares to other professions.
Table 5.1 Google results for selected English language phrases—

July 2014133
“Sexy ________” “Hot ________” “Naughty ________”
“Lawyers” 13,200 16,600 2,050

“Doctors” 97,800 131,000 33,300
“Nurses” 1,150,000 1,290,000 1,200,000
The naughty nurse image is not limited to straightforward indications that

nurses are total bimbos. It encompasses more subtle messages that nurses, who
are primarily women, are mainly focused on the romantic pursuit of men, par-
ticularly physicians. In November 2004 psychologist Dr. Phil ran a segment
on his syndicated show about the damage a physician had done to his family
by having an affair with a nurse. Dr. Phil offered these pearls of wisdom:
I spent a lot of years in the health care delivery system, and I watched
doctors and nurses play footsie back and forth. And I watched doctors
whose wives worked, put them through medical school, all this, and
they come up there with a cute little nurse and they start playing foot-
sie with her. I’ve seen lots of cute little nurses go after doctors, because
they’re going to seduce and marry them a doctor, because that’s their
ticket out of having to work as a nurse.20
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Dr. Phil’s statement is a persuasive, insider’s vision of nurses as physician gold

diggers—the “little” things’ bodies are the only way they have to escape their
dead-end jobs. Similarly, in an August 2010 report by the news service Al
Bawaba about a protest over an Egyptian naughty nurse television character,
Dr. Nihad Abd Al Salam of the International Nurses Academy observed that
the Egyptian media reinforces the widespread perception that nurses are “girls
with bad reputations who try to seduce doctors and rich patients.”21 In A Young
Doctor’s Notebook, the Sky Arts show about rural Russia in 1917 airing in the
United States in late 2013, veteran midwife Pelagaya at first seemed to feel it
was part of her job—a mildly annoying one—to provide the Young Doctor
with a sexual release.22 By the show’s second season, the unfortunate Pelagaya
seemed to be more interested in the caddish Doctor than he was in her.
Why are nurses so naughty? As explained in Chapters 1 and 2, nurses have
struggled since the founding of the modern profession to put society at ease with
the idea of females providing intimate care to men. The profession’s image has
long teetered between extremes of femininity, from the angel to the harlot. It may
be that some cannot get past the “Madonna and whore” dichotomy: as females
who provide intimate care, nurses must be one or the other. The research suggests,
and even a cursory look at the Internet confirms, that male sexual fantasies often
focus on traditionally female professions that are seen as involving basic personal
services. These workers may be perceived as submissive females who are more
sexually available or ripe for abuse because they have no strong, independent pro-
fessional identity—not much else going for them. Some have also suggested that
regarding nurses as sluts may help vulnerable male patients handle the fact that
female nurses have some power over them. Illness and incapacity are frightening,
and some may express that fear by diminishing the nearest available women.
Whatever the reasons, such social contempt discourages practicing and
potential nurses, undermines nurses’ claims to clinical and educational
resources, and encourages workplace sexual abuse. The naughty nurse image is
a factor in the global nursing crisis, and overcoming it is a critical part of resolv-
ing the shortage. Nurses have urged the media to reconsider its rampant use
of the image. We just hope there’s some other way to sell men beer and stuff.
“Penny Shots for Naughty Nurses”:

Why the Naughty Nurse Matters
In April 2008 nursing student Emily Pirie reported that a bar on Pittsburgh’s
South Side had been running the following promotion: “Penny Shots for
Naughty Nurses.”23
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The naughty nurse image might be good for some free drinks and social
activities tonight, but nurses and their patients pay in the long run. One way
they pay is in the loss of respect and resources nurses really need—pennies
for nurses!
Naughty nurse images add to the chronic underfunding of nursing research,
education, and clinical practice. Healthcare decision makers—many of whom
are sadly uninformed about what nursing really is—are less likely to devote scarce
resources to a profession that has become so degraded in the public mind. This
negative image also holds little appeal for career seekers. The naughty nurse isn’t
just promiscuous. She’s either submissive and dim, or comically aggressive or
evil. And she’s always female. If a profession is constantly associated with female
sexuality, it’s not going to attract and retain many men. Nursing remains at least
90 percent female.24 When you combine the lack of respect, the low appeal to
the more powerful gender, the intense training nursing actually requires, and
the difficulty and stress of real nursing practice, it’s no surprise that the profes-
sion remains in the midst of a global shortage. This is the difference between
sexual images of female nurses and, say, female FBI agents, or for that matter,
male firefighters. Those challenging professions are not being undermined by
the idea that their members are sex-crazed twits. Nursing is.
Of course, there’s nothing wrong with being seen as sexy—as long as that’s
not your dominant image in the workplace. An article published in Psychology
of Women Quarterly in 2005, based on research by Lawrence University pro-
fessor Peter Glick, suggested that more sexualized work attire actually lessens
respect for female workers in responsible jobs like management, causing oth-
ers to see them as less competent and intelligent.25 In 2009, Melissa Wookey
and colleagues found that dressing sexually harmed people’s perception of
the social competence of professional women, although apparently it did
not cause similar harm to nonprofessionals.26 Thus, to the extent nurses are
correctly seen as professionals, constantly associating them with sex lessens
respect for them. If sexual imagery does not lower the opinions of nurses held
by those who do not see nurses as professionals, that may be because those
opinions are so low to begin with.
Consider the inordinate amount of sexual abuse that nurses suffer at work.
It’s hard to prove the extent to which such abuse is caused by naughty nurse
stereotyping. But if a profession is an object of frequent sexual mockery and
contempt, that status will invite sexual abuse, especially from those who are
mentally altered, such as by drugs or mental illness.
Some say that naughty nurse imagery is just a “joke” or “fantasy” and no
one believes nurses really are that way. Of course most people probably don’t
1 6 0
think the average nurse goes to work in lingerie, looking for sex. And it may
be hard to see how one naughty nurse image could matter. But each image is
a tiny part of a global wave of media imagery, all suggesting nursing consists
of hot females satisfying the sexual needs of patients and/or physicians, or
at best, that nursing is so unimportant that nurses have time to focus on sex
while caring for patients. In the aggregate, decades of that message will have
an impact. Few people would accept “just joking” as an excuse for stereotyp-
ing other disempowered groups.
Even humor and fantasy images affect how people act, as explained in
Chapter 2. In fact, a study by researchers at the University of Granada (Spain),
published in the Journal of Interpersonal Violence in 2010, found that men
who had listened to a series of “sexist jokes” later displayed more tolerance
for violence against women than those who had not listened to the jokes.27
In a related vein, psychologist and anthropologist Gil Greengross explains
the “normative window theory of prejudice” proposed by Chris Crandall and
colleagues: When the prejudice against a given group is shifting in society,
and you hold negative views about a group, “hearing disparaging jokes about
them releases inhibitions you might have, and you feel it’s ok to discriminate
against them.”28 Under Thomas Ford and Mark Ferguson’s “prejudiced norm
theory,”29 which Tendayi Viki and colleagues have evaluated favorably,30
delivering prejudice in a joke (disparagement humor) discourages criticism
of the discriminatory message, encouraging the receiver to accept that mes-
sage as the norm; repeated joke exposures create a greater tolerance of future
discriminatory events in those who are already prejudiced. Ford asserts that
“the acceptance of sexist humor leads men to believe that sexist behavior falls
within the bounds of social acceptability.”31 Ford and colleagues at Western
Carolina University published a 2008 study in the Personality and Social
Psychology Bulletin suggesting that exposure to sexist humor also decreased
the amount of money sexist men were willing to give to a women’s organiza-
tion.32 It’s not hard to relate that finding to the low funding nursing receives
compared to medicine.33
Some also claim that objections to the constant association of nursing
with sex indicate prudishness. But there is a big difference between objecting
to sexual images generally and objecting to the use of nursing as a marker for
shallow, servile, sexually available females.
Of course, sexual desires and fantasies do not instantly go away just because
certain media images become less prevalent. But we doubt that something as
specific in time as the naughty nurse image of recent decades is biologically
predetermined or unchangeable, at least on a society-wide basis. It seems to us
161
that the image is largely the result of specific cultural information, although
it may incorporate some broader elements, such as the eroticism of appar-
ent innocence. Some aspects of human attraction may evolve over time. For
instance, common standards of human beauty do not appear to be the same
today as in past centuries. It is in humanity’s long-term interest to consider
new ways to think about nurses.
One could argue that the work of nurses is so intimate that it will always
be subject to some level of sexual fantasy. But the work of physicians is inti-
mate, and they don’t seem to suffer from the idea that they are submissive and
sexually available.
At ground level, the devaluation of nursing translates into an underpow-
ered profession that may not be strong enough to save your life when you need
it to do so. The naughty nurse isn’t going to catch deadly medication errors,
intervene when a patient is about to crash, or teach a patient how to survive
with a life-threatening condition. It’s time for her to change into something a
little more comfortable.
Call Me Magdalene: Is Nursing the World’s

Oldest Profession?
Naughty nurse images circle the globe. As the rest of this chapter shows, virtu-
ally all are just variations on the tired bimbo nurse imagery that has perme-
ated pop culture since the 1960s. However, recently there have been fairly
thoughtful media explorations of the naughty nurse image. Well, actually, we
can think of just two examples. But hey—there are two!
One is Richard Prince’s “nurse paintings,” which were the subject of
prominent exhibitions worldwide throughout the 2000s and early 2010s.
Prince starts with the covers of mid-twentieth-century pulp novels that show
the standing figure of a white-uniformed nurse. Then he covers much of the
nurses’ faces with white mask-like paint blobs. In many cases, red paint bleeds
off different parts of the figures. Parts of the original book cover backgrounds
emerge in vague, often ominous forms. Thus we get Nympho Nurse, Tender
Nurse, and the especially gory Man Crazy Nurse #2—which sold at Christie’s
New York for $7.4 million in May 2008. Some nurses object to Prince’s paint-
ings, and the artist could be accused of using misogynist iconography to score
cheap pop art shock points. But it is hard to miss the irony driving the works.
Prince’s nurses are effectively gagged; they are defined by the large, aggres-
sively ridiculous book titles, and they are alone in a world of scary shadows
1 6 2
and blood. Trapped in their oppressive clothes and our oppressive attitudes,
the pulp nurses may reflect the plight of today’s real nurses and of women
generally. The blood spots on their bodies are stigmata of caring. The masks
point to critical problems today’s nurses face, namely their invisibility and dif-
ficulty in speaking up. In some of the paintings, the nurses’ eyes burn out over
the masks, suggesting sentient beings struggling to assert a genuine identity.34
A related example is the alternative band Sonic Youth’s 2004 album Sonic
Nurse, which used Richard Prince’s nursing imagery to explore troubling
aspects of women’s lives. The CD package art has images of the nurse paint-
ings. Maybe Sonic Youth saw nursing as a busy intersection on the boulevard
of broken female dreams. The album title may also suggest that the band is not
unlike a nurse, assessing a given environment and, in some sense, intervening.
The song “Dude Ranch Nurse” is based on a Richard Prince painting that in
turn seems to be drawn from a 1953 Cherry Ames novel, one in a series of
nursing adventures aimed at schoolgirls. The band’s Kim Gordon sings that
the “dude ranch dream has fallen apart,” but still, “I could love him.”35
Unfortunately, the vast majority of naughty nurse imagery won’t be tell-
ing the public anything useful about nursing. Consider some examples from
recent advertising, television and film, sexually oriented media, pop music,
and news media.
Catching “Lusty-Nurse Fever”: The Nurse in Global Advertising

The naughty nurse is especially adept at selling products to young men. But
it seems she can sell anything, including women’s shoes. She has even vol-
unteered to promote nonprofit endeavors, from hospitals to health aware-
ness campaigns.
The naughty nurse is eager for men to buy alcohol, even though real
nurses spend much of their time handling the damage caused by alcohol
abuse. Maybe it’s all about nursing job security! First, of course, there’s beer.
During the mid-2000s, Coors’s Canadian division relied heavily on naughty
nurse imagery in its Coors Light Trauma Tour, a marketing campaign based
on sponsorship of extreme sports events. Naughty nurse models appeared in
visual advertisements and interacted with spectators at the events.36
Meanwhile, the maker of Gzhelka vodka (which appears to be the Russian
government) crafted our favorite naughty nurse ad ever. In the television
spot, which apparently started airing in 2006, an attractive young female
nurse entered a hospital room. The ominous theme from the 1968 thriller
Twisted Nerve played; the evil character Elle Driver had whistled that theme in
163
Quentin Tarantino’s Kill Bill (2003) when, disguised as a nurse, she prepared
to assassinate the film’s hospitalized Bride character by lethal injection. But the
Gzhelka nurse had something else in mind. She set up an intravenous bottle
of vodka to infuse into her unconscious male patient. Once the vodka started
infusing, the patient became very aroused under the sheet. The nurse mounted
and had energetic intercourse with the still-unconscious patient. Onscreen
text said there was “no prescription needed,” and the nurse asked why anyone
would need medicine at all.37 Note the cool public health themes of a nurse/
prostitute pushing huge quantities of vodka as a sexual aid and overall health
promoter.
The naughty nurse has also sold young males drinks with more serious claims
of health benefits. In 2008 Canada’s Neilson Dairy marketed its Ultimate fla-
vored cow milk products with a campaign that was remarkably similar to the
earlier Coors Light Trauma Tour. Naughty nurse models appeared in adver-
tisements and at an extreme sports tour. Neilson advertisements matched the
“nurses”—the “Ultimate Recovery Team”—with sports-related sexual innu-
endo.38 In August 2008 we and the Registered Nurses Association of Ontario
helped Neilson recover from its naughty nurse workout, persuading the com-
pany to remove the nurse element from the campaign.
We’ve noticed that the naughty nurse wants her man to be well-groomed
and sweetly scented before she provides her, you know, “nursing services.”
In late 2006 a print advertisement campaign for Schick’s Quattro Titanium
razor featured an injured male skateboarder in a research facility bed. He was
surrounded by white-coated researchers—and three naughty “nurses” giv-
ing him “more intensive care.”39 Schick placed the advertisement in Sports
Illustrated and also distributed it at college bookstores, perhaps as an inspira-
tion to nursing students. In a late 2005 television spot, Gillette’s TAG Body
Spray caused a provocatively-dressed “nurse” to develop “highly contagious
lusty-nurse fever” and climb into bed with a male patient wearing the prod-
uct.40 In September 2007 Cadbury Schweppes Canada ran television adver-
tisements for Dentyne Ice chewing gum that showed female nurses being
lured into bed with male patients the instant the men popped the product
into their mouths. The tag line: “Get Fresh.”41
The naughty nurse also wants to show you a good time at restaurants, bars,
and sporting events, often as part of an ironic health-related theme. In January
2014, the RocketNews24 site reported that a McDonald’s outlet in Taiwan
had started the new year with female staff dressed in “sexy” “nurse” outfits
that featured short dresses “and thigh-high stockings.” That prompted “many
1 6 4
hopeful men to [take] the chance while it was their turn at the counter to ask
if the girls had boyfriends.”42
Of course, “nurses” can’t be underdressed at “breastaurants.” For example,
in March 2011, the popular chain Hooters declared “National Hooky Day” in
honor of the start of the US men’s college basketball tournament. The com-
pany’s website featured photos of naughty nurse “Ashleigh,” who wanted to
send you a “Doctor’s Note” so you could take the day off work to recover
from “Basketball Fever” and enjoy a free appetizer. In a related television com-
mercial, Ashleigh quickly diagnosed broadcasting legend Dick Vitale with
this fever and treated him with the free appetizer. Then Vitale, bellowed:
“Hooters! It’s the cure, baby!”43
But no national restaurant group could top the Heart Attack Grill. In
2005 the Phoenix-area restaurant began using scantily dressed naughty nurse
waitstaff. The restaurant flaunted its antihealth menu, which included “qua-
druple-bypass” burgers and “flatliner fries.” The “nurses” did “role playing”:
helping diners with “heart attacks,” sitting on their laps, and pushing the over-
fed in wheelchairs. Grill owner “Dr. Jon” Basso’s “role” was to remain fully
dressed, in a laboratory coat and tie. The Grill was a striking example of the
naughty nurse image, so in October 2006 we generated global press coverage
about it. Since then, the culinary landmark has survived moves to Dallas and
finally to Las Vegas, as well as the (actual) early deaths of two Grill spokes-
men44 and other diet-related casualties. But Basso and the “nurses” are still
there. In 2014, the nurses were “spanking” customers who didn’t finish their
food, with a “spank cam” on the Grill’s website recording the events.45
As you might expect after all that hard work, when night falls the naughty
nurse wants to party. In 2004 Los Angeles’s Club Good Hurt began attract-
ing patrons with local bands and “nurse” bartenders. In 2013, the club’s web-
site advised potential customers to “let our Signature Naughty Nurses[TM]
write your prescription for one of our Prescription Cocktails[TM], like the
Transfusion, and find out the true meaning of a Good Hurt.”46 Really—
trademarking the “signature naughty nurses”? What an honor. By 2009 the
City Steam Brewery Café was selling its Naughty Nurse Amber Ale, the pop-
ular brew pub’s “best seller,” throughout the Hartford, Connecticut area.47
At a professional basketball game in February 2012, when the Dallas
Mavericks hosted the New Jersey Nets, the Mavericks Dancers entertained
the crowd and a large television audience at half-time by dressing in naughty
nurse outfits and doing a sexually-oriented dance to the tune of Robert
Palmer’s “Bad Case of Loving You.”48
165
Virgin Mobile often calls on the naughty nurse. Starting in 2008, Virgin
Mobile India’s “Think Hatke” (Think Differently) campaign included an
advertisement in which a supposedly immobilized male hospital patient
tricked a scantily-dressed female “nurse” into reaching around in his pants
pockets, searching for his cell phone, to help him answer a call strategically
placed by the patient’s friend.49 There was no word on whether Mohandas
Gandhi, whose image appeared in the classic 1980’s Apple “Think Different”
campaign, would also appear in this innovative new marketing. In 2005,
Virgin Mobile Canada introduced a multimedia campaign with naughty
nurse models who would supposedly help customers avoid “The Catch,”
a venereal disease associated with rival companies. Virgin tycoon Richard
Branson frolicked with some of the “nurses” at the March 2005 kickoff event
in Toronto.50
The 2004 Skechers campaign, which was called “Naughty and Nice,” fea-
tured Christina Aguilera wearing Skechers footwear in three different adver-
tisements, including one in which she appeared both as a dominatrix naughty
nurse and as the nurse’s patient. Nurse Christina seemed ready to inject patient
Christina with a huge metal syringe connected to a big needle. This campaign
ran in youth magazines and point-of-sale retail displays around the world,
although nurses persuaded the company to drop the nurse advertisements.51
But the naughty nurse would be hurt if you thought she was all about
money. Behind that sexy bra beats a passionate heart of caring! She helps
healthcare-related companies. In March 2010, the Daily Mail (UK) reported
that the Diamond Bus Company in the West Midlands was using a large
naughty nurse advertisement to promote its route to a hospital. Nurses and
government health officials asked Diamond to pull the advertisement, but the
company refused, stating that it had been “vetted” by a group of nurses who
agreed it was “funny.”52 And in July 2005 Reuters reported that the Spanish
cosmetic surgery firm Corporación Dermoestética had used “50 mini-skirted
models” dressed as nurses at its stock market launch.53 It was unclear whether
the models would also be caring for the firm’s patients.
In other cases, the naughty nurse’s work is more altruistic. Lionsgate’s
SAW movies, released from 2004 to 2010, were reportedly the most success-
ful horror film franchise of all time. To promote the films’ releases, the com-
pany sponsored blood drives and advertised them with eye-catching posters
featuring sexy/scary naughty nurse imagery. The company boasted of the lives
the blood drives saved, but the nurse images it used degraded the very profes-
sionals who use the blood collected to save those lives.54
1 6 6
In November 2009 the naughty nurse actually appeared in a major public

awareness campaign by the Lung Cancer Alliance, a prominent US charity.
In the lead campaign video, “Dr. Lung Love” rapped about the danger lung
cancer poses to women, as hot “nurses” caressed and danced suggestively with
him. The nurses wore scrubs, in contrast to the Pitbull video on which the
Lung Cancer Alliance video was based, which had sexy women in lingerie but
no nursing element. But the Lung Cancer Alliance video still presented female
nurses as the submissive sexual playthings of commanding male physicians.55
“Ranking Nurses in Order of Do-Ability”:

Modern Hollywood’s Tribute
The naughty nurse has been a plot device on some of the most widely seen
recent television dramas. In a February 2011 episode of NCIS: Los Angeles
(CBS), a helpful and attractive Nurse Debbie was the subject of two playful
“ready for my sponge bath!”-type remarks from a wounded detective named
Deeks. Debbie did not act provocatively, and she was not even present for the
sponge bath comments; they were a stock dramatic device the show’s writ-
ers used mainly to further Deeks’s ongoing flirtation with a female detective
colleague—a peer.56 In an October 2007 episode of Desperate Housewives, the
sexy character Gaby donned naughty nurse attire as a cover to rub lotion on
her husband and covertly heal a case of pubic lice that she had given him.57
The most notable recent prime-time television examples of naughty nurse
imagery have been on Grey’s Anatomy. It’s not just the occasional “comic”
appearance, as in an October 2011 episode with a woman dressed as a “sexy
zombie nurse” who arrived at the hospital after being injured at a comics
convention.58 On Grey’s it goes deeper. Nurse characters have often been
vehicles through which the show’s pretty female physicians confront latent
fears about female subservience and sexual virtue. December 2005 episodes
displayed the fury of intern Izzie because the object of her affection, intern
Alex, had had call-room sex with less attractive nurse Olivia. Alex wanted to
talk, but Izzie snapped that he was “too busy screwing nurses to talk—just get
out.” At another point, intern Cristina marveled that “hell hath no fury like
a girl whose non-boyfriend screws a nurse.” Izzie also accused Alex of having
cheated on her with the “skanky syph nurse,” a reference to the fact that Alex
had previously given Olivia syphilis, which Olivia later passed on to intern
George. Olivia had not known about the Alex and Izzie romance, and she was
meekly apologetic to Izzie. In response, Izzie projected seething contempt.59
167
These episodes reveal the interns’ fears of sexual degradation and even
of a kind of class miscegenation. Alex has not just cheated on Izzie, he has
“screwed” a nurse, the low-rent embodiment of everything a smart, ambi-
tious modern woman must avoid. Let’s face it: some people just don’t belong.
Consider that Izzie called Olivia a “skanky syph nurse” even though it was
actually Alex who gave Olivia syphilis. And although Olivia slept with two
interns, intern Meredith had apparently been getting drunk and sleeping with
a different guy every night. Izzie did briefly call attention to this, but no one
used the expression “skanky syph doc.”60
The show has also relied on the nurse-grasping-for-physician-love
theme, as in the May 2008 plotline in which jilted nurses boycotted Mark
“McSteamy” Sloane’s surgeries, as discussed in Chapter 4.61 Even the Rose
plotline that aired in late 2007 and 2008 presented the nurse as wide-eyed
about romance with neurosurgeon Derek “McDreamy” Shepherd. Rose con-
fessed to being intimidated by the “legend” of the prior romance between
Derek and Meredith, and in one intensely embarrassing April 2008 episode,
Rose expressed amazement that she was actually dating the great man: “I’m
trying to play it cool. I am playing it so, so cool. I love him!”62
House has not bothered with nurses enough to have as many naughty
nurse images as Grey’s. But a February 2011 episode did include a visualization
of a story House told in which a nameless female nurse served as a physician
sex object. In House’s semi-apocryphal story, told to a class of precocious fifth
graders and parents, part of House’s physician team was at a patient’s bedside.
One male physician asked an attractive nurse if she wanted to have an affair,
and another physician asked if she wanted to have a threesome. The nurse
looked a bit intrigued, but a female medical student objected.63 As with the
NCIS detective, House’s real goal in telling the story may have been to tweak
others, especially females. Nurses’ apparent sexual availability is convenient!
A February 2007 episode invited viewers to chuckle at the witty House’s sug-
gestion that if a physician friend would just stop annoying him, they could
be “ranking nurses in order of do-ability.”64 In a November 2005 episode, the
resourceful House coerced a reluctant surgeon into performing a risky liver
transplant by threatening to tell his wife what the surgeon had secretly been
doing with lots of nurses.65 Skanky syph nurses, we bet!
Sitcoms are a natural home for the naughty nurse. For example, in a
January 2014 episode of The Mindy Project, physician character Jeremy played
“nookie hookie” from work, an activity that seemed to involve partying with
two attractive young lingerie-clad women. When a fellow physician tried to
persuade Jeremy to return to work, he demurred, noting that “my nurses have
1 6 8
a few more tests to run.”66 That’s really all we got, so we were left to won-
der: Were they really nurses? Or was that just a joke with a health care theme?
Either way, it’s naughty nursing.
In the September 2011 pilot of NBC’s Whitney, the lead character tried
to seduce her boyfriend Alex with a revealing naughty nurse outfit. It worked
well until Alex fell while trying to get out of his pants, hit his head on a table,
and lost consciousness.67 In an October 2010 episode of ABC’s Modern
Family, the naughty nurse was one of a series of Halloween costumes worn
by the teenage character Haley Dunphy that her mother found too sexually
explicit.68
An April 2004 episode of Will & Grace was a naughty nurse land-
mark. The episode focused on the frivolous Jack graduation from
“nursing school.” At the tiny ceremony, one of the nurse speakers was a very
attractive woman whose sheer white uniform was unbuttoned below the level
of her bright blue bra. Jack began to read the speech he got to deliver because
he was voted “most popular,” but he decided in the middle that he would
follow his original dream of being an actor. Later Will delivered the rest of
the speech privately to the blue bra nurse, who was moved by its “follow your
dream” theme to muse, “Maybe I will get back into porn.”69
The naughty nurse has even appeared briefly in one of the 2009 nurse
shows. The June 2009 series premiere of HawthoRNe introduced an attrac-
tive nurse character named Candy Sullivan who saw it as part of her job to
provide manual sex to injured Iraq war veterans, as a “thank you” for their
service.70 Even the show seemed embarrassed, backing away quietly from the
plotline several episodes later, and Candy was later shown to be a competent
nurse. By contrast, although Nurse Jackie and Mercy have featured lead char-
acters who were adulterous, no reasonable viewer could interpret those smart,
strong women as “naughty,” certainly not by current television standards.71
MTV’s reality show Scrubbing In, which focused on travel nurses in
California, included plenty of sexual situations and discussions. In an October
2013 episode, several female nurses giggled about finding some “hot doctors.”
Other scenes touched on pressing public health issues of the day (e.g., “I have
big fake boobs!”; “Did you guys bring your vibrators?”).72 In a December 2013
episode there was skinny dipping, including naked “chicken fighting,” with
some flirtatious behavior involving one nurse and another who was engaged
to marry someone else!73 Of course, although nurses should be permitted
the same social activities as anyone else, associating the profession with frank
sexual imagery can reinforce the naughty nurse image.
169
Beyond prime time, the landscape is hardly better. Even David Letterman,
who gave nurses credit following his heart bypass surgery in 2000,74 has been
unable to resist the naughty nurse’s charms. In December 2005, his CBS Late
Show included a segment about an injury to his hand. Robert Hotchkiss, a real
hand surgeon, strode out followed by two models dressed as “nurses” in short
white dresses and caps. Hotchkiss examined the wound and bantered with
Dave. The “nurses” giggled. Preparing for Hotchkiss to remove the stitches,
Dave asked if there would be any disrobing. Paul Shaffer interjected, “Just the
nurses!” The physician was the witty expert. The “nurses” were sex props.75
It’s no surprise that the naughty nurse appears on soap operas, which fea-
ture a toxic stew of nurse stereotypes, including vacuous handmaidens, gos-
siping twits, and, uh, monkeys. From 2004 to 2005, the CBS daytime drama
As the World Turns featured nurse character Julia Larrabee, memorialized in a
December 2004 TV Guide piece entitled “ ‘Nurse Skank Strikes Again.”76 The
character was a “needy, man-hungry nurse” whom fans hated for breaking up
some of the soap’s most popular couples.
But some might be surprised that the naughty nurse has appeared on
respected daytime talk shows. In November 2010, the globally popular pro-
gram The Dr. Oz Show offered viewers a short segment about Angel Williams,
who lost 200 pounds by dancing. Williams, dressed in a short white nurse’s
dress, told host Mehmet Oz she was going to “get sexy” and unbuttoned the
top of the dress as she prepared to lead him in some dancing. She also told Oz
that she and a group of similarly attired dancers would be “your nurses—we’re
gonna keep America moving for you.” Oz himself referred to the dancers as
Williams’s “fellow nurses.”77 No doubt the show thought it would be fun to
present these women as Oz’s sexy nurse backup dancers—doesn’t every celeb-
rity physician have those? After a Truth About Nursing campaign, Oz did
publicly apologize to nurses.
The naughty nurse has even seduced animated television programs for
children. On Steven Spielberg Presents Animaniacs (1993–1998), the very
voluptuous character “Hello Nurse” was a “sex kitten” in a tight white
dress who apparently aroused even the very young. Main characters Yakko
and Wakko used the hilarious “Hellooooo Nurse!” cat call when attractive
females appeared.78
The sexually available nurse remains welcome in major Hollywood film
productions. Consider Ron Howard’s successful Rush (2013), which drama-
tized the real-life rivalry between two leading 1970s Formula One racers, the
free-spirited British playboy James Hunt and the brilliant, driven Austrian
Niki Lauda. In one scene, Hunt arrives at an emergency department for a
1 7 0
minor patch-up and immediately seduces an attractive young nurse—the two

hook up on the spot in a treatment room.79 Just a bit of history? Apparently
not; reviews suggest the nurse scene is not part of the historical record.80
The naughty nurse isn’t afraid of horror films, in which the naughty image
has often been mixed with malevolence, as in the Saw III promotions. You
might think nurses are harmless sluts—the conventional view—but here,
they’re forces of evil, seeming to embody male fears about female sexuality
generally and female nurses in particular.81 In the 2014 erotic thriller Nurse
3D, the main character was an attractive female nurse—and a sadistic, sexually
aggressive killer with severe psychological issues who targeted cheating men.82
Nurses figured in the successful Silent Hill horror film franchise, which was
based on popular Konami video games about a haunted town. In the video
games, the “nurses” were monsters, deformed manifestations of human fears
who only occasionally presented sexually.83 But in the films Silent Hill (2006)
and Silent Hill: Revelation 3D (2012), the nurses were provocatively-dressed
as they blindly struck out at others and even killed each other—capturing the
effect of naughty nurses pretty well.84 Candy Stripers (2006) was about a hos-
pital full of sexy, horny “candy striper nurses” who had been infected with an
alien virus, which they spread through . . . close contact.85 Sick Nurses, a low-
budget 2007 Thai film, featured seven hot nurses as what one review called a
“harem” to a young hospital physician who provided cadavers to body-parts
dealers.86 The nurses liked to take most of their clothes off. But when one
nurse got a little too jealous of the physician attention another was receiving,
a ghostly horror plot developed. Scary!
Night Shift Nurses: Nursing in Sexually-Oriented Products

The naughty nurse often practices her love in products whose purpose is
mainly sexual. This includes pornography in all its forms, as well as lingerie
and Halloween costumes.
The naughty nurse thrives in hard-core pornography worldwide. Hundreds
of nurse-themed feature films are available. They include I Love Nurses
(2013),87 Transsexual Nurses 10 (2012),88 Naughty Nympho Nurses (2011),89
Naughty Nurse Nancy (2009),90 Lesbian Big Boob Squirting Nurses (2008),91
Asian T-Girl Latex Nurses 4 (2007),92 Trailer Trash Nurses 7 (2003),93 Nasty
Backdoor Nurses (2001),94 and Night Shift Nurses (1989)95—this last one is
also the title of a popular fetishistic Japanese hentai (pornographic anima-
tion) series begun in 2000.96 Some Internet sites are devoted to hardcore
nurse imagery. In early 2014, examples included www.hotnakednurses.com,
www.sexynurse.tumblr.com, www.lovelynurses.com, and www.linfirmiere.
171
com (the nurse). The images range from female models shedding clothes to
multiple actors (including male “doctors”) engaging in intercourse and other
sex acts. The women wear, or almost wear, skimpy “nurse” outfits or lingerie,
usually white—no patterned scrubs here! Hundreds of general porn sites and
networks include large naughty nurse sections. It seems that no female porn
star’s resume is complete without some nurse imagery. Maybe it’s like doing
Shakespeare is for mainstream Hollywood stars.
The naughty nurse is also popular in less graphic sexually-oriented prod-
ucts, including “lad’s magazines,” newspapers, and digital media that may not
include full nudity. Yes, of course there are naughty nurse applications, featur-
ing photos of models in the standard naughty nurse attire, like the imagina-
tively named “Naughty Nurses” app that Ocean Red released in 2011.97 Apple
introduced apps called “A Naughty Nurse”98 (2009) and “Sexy Nurses”99
(2009) for the computer company’s iPhone and iTouch units.
Print publications rely on the naughty nurse. In August 2005, the cover
of the Australian magazine Ralph featured Gianna, a former contestant on
the local Big Brother television program, in a bra and panties “nurse” outfit.100
Gianna made a different naughty nurse outfit a major feature of her time on
the reality show. At the end of 2006, 2007, and 2010, the Sun (UK)—the
most widely-circulated English-language daily newspaper in the world—ran
promotional tie-in pieces for Babes and Boys’ annual naughty nurse calen-
dars.101 The Sun pictorials featured the usual lingerie-nurse outfits, but a key
theme was that the models really were nurses. One “student nurse” told the
Sun she posed for “a bit of a laugh” and “a bit of extra money.” Plus, “People
always joke about nurses looking saucy so it’s fun to be the real thing.”102
The naughty nurse is also poised to spring out of women’s closets. A
North Carolina company called 3 Wishes Lingerie has offered a variety of
nurse-related items for many years. In late 2013 its online selection of outfits
included the Bedroom Nurse, Bad Nurse, Night Nurse, Nurse Goodhands,
and Doctors Orders.103 In January 2005, the Australian Nursing Federation
persuaded retailer Bras N Things to end advertising for one naughty nurse
outfit, although it remained for sale in the lingerie chain’s more than 150
stores. As of early 2014, the retailer’s website still offered a Nurse Feelgood
Costume.104
In fact, a naughty nurse costume may have altered the course of Western
civilization! The Daily Mail reported in July 2013 that the British royal couple
Kate Middleton and Prince William had repaired their broken relationship
in 2007 when Kate wore a “naughty nurse” outfit to a “Freakin’ Naughty”
costume party at William’s military barracks.105
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Every year at Halloween, major US retailers sell many naughty nurse cos-
tumes. Don’t miss Party City’s “Adult Hospital Honey Nurse Costume”106
or Spirit Halloween’s “Nurse Heartbreaker Costume!”107 In early 2014, the
wholesale supplier Alibaba consistently had more than 3,000 different types
of naughty nurse costumes for sale.108 Yes, it’s just for “a bit of a laugh.” But it
still undermines nursing. The Southern Poverty Law Center’s highly regarded
Teaching Tolerance campaign has urged the public to reconsider the use of
stereotypes even in Halloween costumes.109
Promiscuous Girls: The Nurse in Pop Music

The naughty nurse is a bit of a pop music groupie, and she lets musicians use
her to sell or accompany their music, even if the music itself makes no men-
tion of nurses. The mixing of nursing and sexuality runs across musical styles
and goes at least as far back as reggae artist Gregory Isaacs’s “Night Nurse”
from 1982. Sample lyrics:
Night nurse
Only you alone can quench this here thirst
My night nurse, oh gosh
Oh, the pain is getting worse
I don’t wanna see no doc
I need attendance from my nurse around the clock
For there’s no prescription for me
She is the one, the only remedy.110
The song has been covered by Simply Red (1998)111 and Sinead O’Connor
(2009),112 among others.
In January 2010, pop star Mariah Carey released a video for “Up Out My
Face” to promote her remix album Angels Advocate. The video featured Carey
and rapper Nicki Minaj in skimpy “nurse” outfits, with white stockings and
high heels. The song is actually a bitter kiss-off to a former lover, so it would
seem to reverse the standard naughty nurse theme of sexual availability. But
the point of the video seems to be to show the ex-lover just what he will be
missing. At a couple points in the video, Minaj applied her stethoscope to
Carey’s chest, as if checking her heart rate.113 The Truth About Nursing started
a campaign to protest the video that received international press coverage but
got no response from Carey. As of July 2014, the video’s VEVO view count
was more than 39 million.114
173
In March 2009 the veteran metal band Mötley Crüe announced its
upcoming summer tour at a New York press conference that featured women
in naughty nurse outfits and a classic Cadillac ambulance. The band evidently
wanted to highlight the fact that it would be playing its popular 1989 album
Dr. Feelgood all the way through at each show.115
Julie Taymor’s 2007 film Across the Universe, a musical about the upheav-
als of the 1960s featuring Beatles songs, included a number in which Salma
Hayek played a small group of identical “nurses,” all wearing a little black
nurse’s dress. The sexy Hayeks appeared in a hospitalized male character’s hal-
lucination and helped him sing “Happiness Is a Warm Gun,” as they danced
around somewhat provocatively. Finally, one Hayek injected the bedridden
man with a syringe containing a little blue naked woman. The nurses’ main
line: “Bang, bang, shoot, shoot!”116
In 2005 the UK electronic-alternative-pop duo Goldfrapp set a video for
their single “Number 1” at a plastic surgery clinic where everyone but singer
Alison Goldfrapp had a human body and a dog’s head. In director Dawn
Shadforth’s video, Goldfrapp acted like a dog, danced with the clinic staff,
and spun the song’s tale of animalistic sexual obsession. The “nurses” were
all females in short dresses who handed things to the all-male “physicians.”
The camera dwelled on the nurses’ bottoms—on which the physicians, at one
point, playfully placed their stethoscopes.117
Country rock singer Keith Anderson’s song “XXL” (2005) is an ode to
the virtues of the big and tall, including their ability to get hot babes. The
song describes the singer’s birth: “Took two nurses to hold me and one nurse
to slap me.” The music video, directed by Trey Fanjoy, featured the famously
well-endowed Mötley Crüe drummer Tommy Lee as the leering “doctor.”
Tommy’s laboratory coat said “Dr. Feelgood” (there he is again!). In the deliv-
ery room, Tommy was on intimate terms with three naughty nurses, who
posed, pouted, and spilled out of their tiny dresses—as they all cared for the
“XXL” infant and his mom.118 Paging Dr. Freud to obstetrics!
Of course, an actual porn star can add naughty nurse realism. The
punk-pop band blink-182’s hit 1999 CD Enema of the State featured photo-
graphs of porn star Janine.119 On the front cover, the front of her white nurse’s
uniform was open to reveal a red bra, as she pulled on a blue examining glove.
On the back cover, Janine sat on a stool dressed in a short naughty nurses’
uniform, holding a huge syringe and needle. The band members, facing her,
were dressed only in their underwear, looking concerned. In the photographs,
Janine seemed both seductive and threatening—not unlike some recent hor-
ror film nurses.
1 7 4
“The Nurse,” a song from the White Stripes’ 2005 album Get Behind Me
Satan, offered a more subtle take on the nurse as romantic object. The Detroit
garage rock duo’s song isn’t naughty, but it does use an unholy mix of nurs-
ing imagery to complain about betrayal. Songwriter Jack White sings, “The
nurse should not be the one who puts salt in your wounds.” He also men-
tions promises this “nurse” has broken, and laments that the “maid that you’ve
hired could never conspire to kill,” not wanting to believe it.120
White’s metaphors compare the faithful care one would expect from a
nurse to that of a close friend, presumably a female lover. Wouldn’t it be tragic
if a “nurse,” rather than taking care of you like that “night nurse” we’ve heard
about, instead hurt you? Yeah, man. Nurses are obligated to protect their
patients, but that doesn’t mean their expert care is like romance. A man may
need a “maid,” as Neil Young once sang, but he isn’t getting a “nurse” every
time he gets a lover.
Hot or Not? Sexy Nurses in the News Media

You might think the naughty nurse would hesitate to appear in the news
media. But she still pops out of articles about kooky hospital policies, discus-
sions of celebrities and current issues, and even comic strips.
The mainstream press is always ready to leap on a nurses-and-sex story.
It gets the chance when health facilities seem to be either promoting or dis-
couraging naughty nursing. In February 2012, press entities around the world
gleefully reported that Stockholm’s South General Hospital was seeking to
hire “TV-series hot nurses.” That allowed the media to embrace the naughty
nurse image while seeming to be just telling the story of a notable hospital
recruiting tactic. Lee Moran’s Daily Mail (UK) piece not only reported on
the summer job advertisement, but it also included an unrelated naughty
nurse image (helpfully labeled “picture posed by model”), just to show curi-
ous readers what a “TV-series hot nurse” might look like. Nurse managers
at the Swedish hospital stressed that they were just trying to “catch people’s
attention”—mission accomplished!—and that professional nursing qualifica-
tions were all that really mattered in their hiring.121
In March 2008 news sources worldwide reported that a clinic in Spain
had told its nurses they would be docked pay if they failed to dress in mini-
skirts. These reports were partly wrong, as the clinic was only requiring the
nurses to wear traditional outfits with a modest-length skirt and cap. That
was regressive enough. But press sources (such as ABC News) embraced the
miniskirt angle.122
175
Similarly, the Ananova Internet news site has aggressively covered efforts
by hospitals in Southeast Europe to get unruly nurses back into skirts. In
September 2006 the site’s “Nurses in Romania to Wear Miniskirts” reported
that “doctors” in a Romanian town had asked “officials” to order female
nurses and physicians to wear miniskirts, ostensibly because it would be more
“elegant.”123 Somehow, the female physicians did not make the headline. In
October 2005 the Hindustan Times (India) site posted an Ananova-based
item reporting that a Croatian hospital had ordered nurses to “go back to
wearing skirts instead of trousers after complaints from patients.” The hospi-
tal director was quoted as noting that the skirts’ length, “be they mini skirts
or otherwise,” was up to the nurses. The Hindustan Times ran this lead: “It
has long been suspected that pretty nurses doing their ‘nightingale’ rounds
in their freshly-starched skirts, more often than not, bring a cheer to even the
most woefully-ill patients, and now it seems that believers in this theory were
right all along.” The headline: “Patients Want Pretty, Skirt-Clad Nurses!”124
However, in September 2006 the Daily Mail (UK) was compelled to
report a sad setback for the naughty nurse. “Nurses Face Ban on Thongs
and Cleavage” explained that an Essex hospital was considering requiring
nurses to make sure they didn’t expose cleavage or underwear. In case any-
one missed that message, the Daily Mail included an image of the Christina
Aguilera naughty nurse advertisement for Skechers, with this caption: “Sorry
guys: don’t expect to see the likes of Christina Aguilera in this nurses uniform
at Southend Hospital.”125
People magazine’s December 2010 year-end issue included Poison singer
and reality television star Bret Michaels as one of its “most intriguing” peo-
ple in a two-page layout dominated by a photo of Michaels surrounded by
four naughty nurse models.126 The nurse element was a reference to his well-
publicized recovery from a brain hemorrhage and other health problems, but
naughty nursing was nothing new for Michaels. In a blog post following an
emergency appendectomy in April 2010, he had reported that he had “hot
nurses” taking care of him, referring to the “nurse fantasy” that “every man
has.” Maybe that kind of imagery helps reduce the sense of illness-related vul-
nerability that could threaten a celebrity whose image is built on strength.
But People magazine “reache[d]‌more adult readers (more than 45 million as
of fall 2009) with each issue than any consumer magazine ever,” according to
its publisher Time Inc.127 After the Truth About Nursing contacted the com-
pany, the editor of People apologized, published our letter to the editor about
the photograph, and promised to avoid such imagery in the future.128
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News media humorists are not above using the naughty nurse to extract
cheap laughs. In an April 2008 edition of Fox News Channel’s early morn-
ing show Redeye, host Greg Gutfeld and his guests conducted a loving, if
ironic, celebration of the Spanish clinic’s misreported “miniskirt” policy.
Gutfeld displayed photographs of naughty nurse models and then asked
his guests, including a physician, who could be against the clinic’s mini-
skirt policy. Guess what? No one was! Gutfeld asked if “attractive nurses in
short skirts might lift the spirits of male patients and increase their chances
of getting better.” Guest Diana Falzone, co-host of Devore & Diana on
Maxim Sirius radio, replied, “You know what, I believe that. Every woman
no matter what size or shape has something to flaunt. Especially the Latina
women. They have big butts. So I say, wear the miniskirts and just save
some lives.”129
In June 2007 syndicated radio host Stephanie Miller and sidekick Jim
Ward managed to work naughty nurses into a discussion of proposed fed-
eral immigration legislation. When a caller suggested that a provision easing
restrictions on the entry of foreign nurses would undermine unions, Miller
seemed sympathetic but also noted jokingly that “Jim will not be happy if a
lot of naughty foreign nurses get in.”
Ward: Naughty nurses by the boatload.

Miller: (with sound effect of a whip cracking) Jim cannot . . . no. We must
stop the naughty Scandinavian nurses (whip), porn nurse from infiltrating
America (whip).
Ward: And French maids. Mmm-hmm.130
Miller and Ward were playing with the stereotypes, but not question-
ing them. Like the whip sound, they are just standard comic effects to be
exploited—although, even after five decades and thousands of repetitions,
that naughty nurse joke is still a killer.
Not even the comics page can escape sexy nurses’ plans for world media
domination. In March 2008 Matt Janz’s syndicated Single and Looking
strip featured a character asking his friend Zoog whether he’d like to live
to be a hundred years old. Zoog: “Sure, Sammy . . . There’s something hot
about a young nurse giving me a sponge bath.”131 In December 2006 John
McPherson’s syndicated Close to Home comic showed an emergency medical
technician, with an ambulance, giving a stretcher-bound patient a choice:
“Mercy Hospital” was “20 minutes closer,” but the nurses at “Saratoga
Hospital” were “really hot.”132 A piece by Charles Fiegl in the Post-Star of
177
Glen Falls, New York, about the strip reported that McPherson had based it
on his recent stays at nearby Saratoga Hospital, in the hope that real nurses
there would email him so he could “take them out to dinner.” Asked for com-
ment, one nurse from that hospital reportedly said she and her colleagues
really were “very hot,” which is “how we get our patients to come to Saratoga,”
although she added that the nurses there “also provide great care.”133
Whenever a real nurse describes her profession mainly in terms of physi-
cal attraction—as hot or not—the naughty nurse smiles. It’s time for a
penny shot!
Notes
1. Melinda Rogers, “Man Misses Birth of His Child after Fondling Nurse, Police Say,”
Salt Lake Tribune (October 9, 2009), http://tinyurl.com/lo5azqk; TAN, “Today’s
Childbirth Class Topic: Resisting the Urge to Grab Your L&D Nurse’s Breasts!”
(October 12, 2009), http://tinyurl.com/lvjbzrt.
2. Teresa Masterson, “Nothing Says ‘Thank You’ Like a Tush Grab or Two: Man Says
He Was Trying to Show Gratitude but Faces Assault Charge for Groping Nurse
Twice,” MSNBC (December 2, 2010); TAN, “You’re a Nurse, Right?” (December
2, 2010), http://tinyurl.com/mff95n3.
3. Tammy McGuire, Debbie Dougherty, and Joshua Atkinson, “Paradoxing
the Dialectic: The Impact of Patients’ Sexual Harassment in the Discursive
Construction of Nurses’ Caregiving Roles,” Management Communication Quarterly
19, no. 3 (2006): 416–450, http://tinyurl.com/y9c92lc; Mildred L. Culp,
“Patients Harassing Nurses? Oh, Yes! How Nurses, Administrators and Society
Can Respond,” Nursing in Virginia Magazine (Spring 2006), http://tinyurl.com/
lkotkyp; John Rossheim, “How Nurses Can Fight Sexual Harassment,” Monster
(March 2006), http://tinyurl.com/yh4ozv3.
4. Y. Hibino, Y. Hitomi, Y. Kambayashi, and H. Nakamura, “Exploring Factors
Associated with the Incidence of Sexual Harassment of Hospital Nurses by
Patients,” Journal of Nursing Scholarship 41, no. 2 (2009): 124–131, http://tinyurl.
com/yzok6cb.
5. New York Daily News, “Pakistani Nurses Vulnerable to Sexual Harassment” (August
5, 2012), http://tinyurl.com/klwqa3c; TAN, “Thanking the Nurse” (August 5,
2012), http://tinyurl.com/pmfs55o.
6. Nicole Bode, “Flushing Hospital Nurse Gets $15 Million Award in Sexual
Harassment Suit,” New York Daily News (February 23, 2009), http://tinyurl.com/
ljjagx7.
7. Ethan Sacks, “Dutch Nurses Need Public Service Campaign, Stat! Don’t Have
to Perform Sexual Acts for Patients,” New York Daily News (March 12, 2010),
1 7 8
http://tinyurl.com/mgfq6sb; TAN, “Drawing the Line” (March 12, 2010),

http://tinyurl.com/lksyatf.
8. Associated Press, “Inappropriate Patient Behavior Tough on Nurses: Sexual
Harassment a Widespread Problem, Health Officials Say,” MSNBC (December 15,
2005), http://tinyurl.com/kora4ym; CFNA, “AP: ‘Inappropriate Patient Behavior
Tough on Nurses,’ ” TAN (December 15, 2005), http://tinyurl.com/mgnjmd9.
9. Agence France-Presse, “Nurses and Firemen Top Fantasy Poll,” The Age (August 24,
2006), http://tinyurl.com/k8vcx7e; CFNA, “Nurses Are No. 1. . . . In Male Sexual
Fantasies,” TAN (August 24, 2006), http://tinyurl.com/n4pyw25.
10. Dan Bilefsky, “If Plastic Surgery Won’t Convince You, What Will?” New York
Times (May 24, 2009), http://tinyurl.com/kcel3mx; TAN, “We Are Offering Free
Breasts” ( July 14, 2009), http://tinyurl.com/m6mrtyh.
11. Kelly Ripa, Live with Regis and Kelly (March 12 and 15, 2007); CFNA, “Kelly
Ripa Is Your Sponge Bath Nursey in Her Little Nursey Costume! Did We Mention
She Was a Nursey? With a Sponge? Ooh! She Missed a Spot over Here!,” TAN
(March 15, 2007), http://tinyurl.com/n8d7xct.
12. CFNA, “Skechers Pulls Christina Aguilera ‘Nurse’ Ad after Receiving More than
3,000 Letters from Nursing Supporters,” TAN (August 17, 2004), http://tinyurl.
com/lfz2ebb.
13. Getty Images, “Christina Aguilera Celebrated as a Sexy Nurse with Jordan Bratman
in Las Vegas in 2005” (2005), http://tinyurl.com/msf8c7g.
14. CFNA, “Italian Nurses Are Better-Looking . . . These [U.S.] Ones Scare Me a Bit.
Don’t Even Think About Leaving Me Alone at Night with One of Them,” TAN
(December 22, 2006), http://tinyurl.com/lp66x2w.
15. Nick Pisa, “Nurses Attack Silvio Berlusconi over Striptease,” Evening Standard
( January 20, 2011), http://tinyurl.com/lbxx59e; TAN, “Neverland” ( January 23,
2011), http://tinyurl.com/kb5ea6q.
16. The Times, “Racists Hit Drive for Nurses” (August 24, 2004); CFNA, “At Least
They’ve Avoided that Angel Stereotype: Asian Nurses Confront Racist Abuse and
Views That Their Profession Is ‘On a Par with Prostitution,’ ” TAN (August 24,
2004), http://tinyurl.com/l335jpg.
17. Ashfaq Yusufzai, “Pakistan: Nurses Get Little Training or Respect,” Inter Press
Service ( June 3, 2006), http://tinyurl.com/mfnodp2; CFNA, “ ‘Colleagues at
the Hospital Think I Am a Prostitute,’ ” TAN ( June 4, 2006), http://tinyurl.com/
l2wsshs.
18. Dame Helen Mirren, Late Show with David Letterman, “Season 17, Episode
152” ( June 14, 2010); TAN, “Nursing at the Love Ranch” ( June 14, 2010),
http://tinyurl.com/lzolweq.
19. TAN, “Busch Gardens Teaches Kids about Nurses” (October 2011), http://tinyurl.
com/lw2arck.
179
20. Phil McGraw, “Anatomy of an Affair,” Dr. Phil (November 18, 2004), CFNA,
“Kicking Dr. Phil’s Ass to the Curb,” TAN (November 18, 2004), http://tinyurl.
com/mxj9d2r.
21. Albawaba, “Nurses Union Demands Ghada Abd Al Riziq’s Drama Be Stopped”
(August 16, 2010), http://tinyurl.com/lzd3rrf; TAN, “Bad Reputation” (August 16,
2010), http://tinyurl.com/khes382.
22. Mark Chappell, Shaun Pye, and Alan Connor, writers, based on the short stories
of Mikhail Bulgakov, Alex Hardcastle, director, “Season 1, Episode 3” and “Season
1, Episode 4,” A Young Doctor’s Notebook, Ovation/Sky Arts (December 20 and 27,
2012), http://tinyurl.com/n2cbe6o and http://tinyurl.com/k4ebqe3.
23. Emily Pirie, personal email (April 20, 2008).
24. US Census Bureau, “Men in Nursing Occupations: American Community
Survey Highlight Report” (February 2013), http://tinyurl.com/mjxgvue.
25. Peter Glick, Sadie Weber, Cathryn Johnson, and Heather Branstiter, “Evaluations
of Sexy Women in Low and High Status Jobs,” Psychology of Women Quarterly
29, no. 4 (December 2005): 389–395, http://tinyurl.com/kzhz5gu; Eric Noe,
“Can Sexy Women Climb the Corporate Ladder? A New Study Suggests that
Bold, Revealing Clothing May Keep You from Getting a Promotion,” ABC News
(December 2, 2005), http://tinyurl.com/y937x4a.
26. Melissa L. Wookey, Nell A. Graves, and J. Corey Butler, “Effects of a Sexy
Appearance on Perceived Competence of Women,” The Journal of Social Psychology
148, no. 2 (2009): 116–118.
27. Mónica Romero-Sánchez, Mercedes Durán, Hugo Carretero-Dios, Jesús L. Megías,
and Miguel Moya, “Exposure to Sexist Humor and Rape Proclivity: The
Moderator Effect of Aversiveness Ratings,” Journal of Interpersonal Violence 25,
no. 12 (December 2010): 2339–2350, http://tinyurl.com/n8jc37a.
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1 8 0
33. TAN, “Just How Undervalued and Underfunded Is Nursing?,” accessed January 31,
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181
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58. Stacy McKee, writer, Tom Verica, director, “What Is It about Men,” Grey’s
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59. Krista Vernoff, writer, Peter Horton, director, “Grandma Got Run over by a
Reindeer,” Grey’s Anatomy, ABC (December 11, 2005); CFNA, “Plot Devices in
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60. Krista Vernoff, writer, Peter Horton, director, “Grandma. . ..”
61. Tony Phelan and Joan Rater, writers, Julie Anne Robinson, director, “The
Becoming,” Grey’s Anatomy, ABC (May 8, 2008); CFNA, “Looking for Mr.
McSteamy,” TAN (May 8, 2008), http://tinyurl.com/oj3ybyy.
62. Zoanne Clack, “Where the Wild Things Are,” Grey’s Anatomy (April 24, 2008),
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63. Thomas L. Moran, writer, Greg Yaitanes, director, “Two Stories,” House, Fox
(November 21, 2011); TAN, “Helpful and Caring and the Whole Sponge Bath
Thing” (February 22, 2011), http://tinyurl.com/nlasf6l.
64. Matthew V. Lewis, writer, Deran Sarafian, director, “Insensitive,” House, Fox
(February 13, 2007); CFNA, “They Dare to Be Do-Able,” TAN (February 13,
2007), http://tinyurl.com/l96xcq2.
65. Peter Blake, writer, David Semel, director, “The Mistake,” House, Fox (November
29, 2005); CFNA, “What Do Nurses Do All Day?,” TAN (November 29, 2005),
http://tinyurl.com/lo9ff26.
1 8 2
67. Whitney Cummings, writer, Andy Ackerman, director, “Pilot,” Whitney, NBC
(September 22, 2011); TAN, “Whitless” ( July 2011), http://tinyurl.com/cmt47df.
68. Jeffery Richman, writer, Michael Spiller, director, “Halloween,” Modern Family,
ABC (October 27, 2010), http://tinyurl.com/q3ghqwk.
69. Sally Bradford, writer, James Burrows, director, “Speechless,” Will & Grace, NBC
(April 22, 2004); CFNA, “Will & Grace: The Nurse As Twit, Loser, and Porn
Actress,” TAN (April 22, 2004), http://tinyurl.com/o8nse2p.
70. John Masius, writer, Mikael Salomon, director, “Pilot,” HawthoRNe, TNT
( June 16, 2009); TAN, “Chief Nursing Officer” ( June 16, 2009), http://tinyurl.
com/o5ce4yw.
com/kqm3k6b; TAN, “Mercy Episode Reviews” (2010), http://tinyurl.com/
kj3t63s.
72. Dave Caplan, Mark Cronin, and Shannon Fitzgerald, executive producers,
“Scrubbing in the OC,” Scrubbing In, MTV (October 24, 2013), http://tinyurl.
com/kvqdsbr.
73. Dave Caplan, Mark Cronin, and Shannon Fitzgerald, executive producers, “Crazy
from the Heat,” Scrubbing In, MTV (December 13, 2013), http://tinyurl.com/
l86n3uy.
74. Caryn James, “Here’s David: Letterman Returns, True to Form,” New York Times
(February 22, 2000), http://tinyurl.com/mb55494.
75. The Late Show with David Letterman, CBS (December 19, 2005); CFNA,
“The Gash Cam,” TAN (December 19, 2005), http://tinyurl.com/ly74f66.
76. CFNA, “TV Guide’s ‘Nurse Skank Strikes Again’ Inspires Center to Announce
Soap Nurse Sweepstakes!,” TAN (December 12, 2004), http://tinyurl.com/
p9n3hsj.
77. The Dr. Oz Show, syndicated television show (November 4, 2010); TAN, “Thinking
Right, Thinking Bright” (November 4, 2010), http://tinyurl.com/py6oao2.
78. John P. McCann, Randy Rogel, and Tom Ruegger, writers, Barry Caldwell, Jon
McClenahan, and Audu Paden, directors, “Wakko’s 2-Note Song/Panama Canal/
Hello Nurse . . . ” Animaniacs (February 24, 1996), http://tinyurl.com/pqehhyo;
IMDb, “Hello Nurse” (1999), http://tinyurl.com/oz9a6fa.
79. Peter Morgan, writer, Ron Howard, director, Rush, Universal Pictures (2013).
80. Alex von Tunzelmann, “Rush: A Thrilling but Untrusty Ride,” The Guardian
(September 18, 2013), http://tinyurl.com/pykjbpj.
81. Laura Sweet, “The Saw VI Blood Drive Posters & All the Ones from Years Past,” If
It’s Hip, It’s Here (August 8, 2009), http://tinyurl.com/kj2nwtl; CFNA, “Blood
Simple,” TAN (October 27, 2006), http://tinyurl.com/nyorh4s.
82. Douglas Aarniokoski and David Loughery, writers, Douglas Aarniokoski, director,
Nurse 3D, Lionsgate (2014), http://tinyurl.com/m4tvzu6; TAN, “Nurse 0D:
Nurse 3D Finally Released” ( January 27, 2014), http://tinyurl.com/mg4kqqa.
183
83. Keiichiro Toyama, writer and director, Silent Hill Video Game, Konami (1999)
http://tinyurl.com/mua5jfn.
84. Michael J. Bassett and Laurent Hadida, writers, Michael J. Bassett, director, Silent
Hill: Revelation 3D, Open Road Films (2012); Roger Avary, writer, Christophe
Gans, director, Silent Hill, TriStar Pictures (2006); Silent Hill, “Silent Hill
Revelation 3D Clip—Nurse Scene,” YouTube video, http://tinyurl.com/
nqgngkw.
85. Jill Garson and Kate Robbins, writers, Kate Robbins, director, Candy Stripers,
Screen Gems (2006), http://tinyurl.com/oyw3qkz.
86. Piraphan Laoyont and Thodsapol Siriwiwat, directors, Sick Nurses (Suay Laak
Sai), Magnolia Home Entertainment (2007), http://tinyurl.com/lxvsf2r.
87. PornStar Empires, I Love Nurses (2013), http://tinyurl.com/ladzzgs.
88. White Ghetto, Transsexual Nurses 10, Avalon Enterprises (2012), http://tinyurl.
com/matzwdw.
89. NaughtyNymphoNurses.com, accessed March 27, 2014.
90. Diana DeVoe, director, Naughty Nurse Nancy (2009), http://tinyurl.com/
lhncvso.
91. Excalibur Films, Lesbian Big Boob Squirting Nurses, Totally Tasteless (2008),
http://tinyurl.com/qctzqsy.
92. Pandemonium Movies, Asian T-Girl Latex Nurses 4 (2006), http://tinyurl.com/
lmr6j3a.
93. Jerome Tanner, director, Trailer Trash Nurses 7 (2003), http://tinyurl.com/
kyrxua4.
94. Max Steiner, director, Nasty Backdoor Nurses, LBO Entertainment (2001),
http://tinyurl.com/mbn4zcz.
95. Jim Holliday, John Leslie, writers, John Leslie, director, Night Shift Nurses, VCA
Pictures (1989), http://tinyurl.com/po7j9pf.
96. Absolute Anime, “Anime Profile: Night Shift Nurses,” http://tinyurl.com/o7bx8y9.
97. Ocean Red, “Naughty Nurses APK,” Android.DownloadAtoZ.com (December
29, 2011), http://tinyurl.com/kqbctag.
98. iPhoneapps.com, “A Naughty Nurse” (September 29, 2009), http://tinyurl.com/
n435wqf.
99. iPhoneapps.com, “Sexy Nurses” ( July 28, 2009), http://tinyurl.com/k5qj2os.
100. “Big Brother’s Gianna,” Ralph (August 2005); CFNA, “Can Naughty Nurse
Imagery Launch a Career?,” TAN (August 2005), http://tinyurl.com/k69gokt.
101. “A Naughty but Nurse Calendar,” The Sun ( January 12, 2011), http://tinyurl.
com/krg4mbo; Asian News International, “Naughty Nurses in U.K. to Get
Pulses Racing with Saucy Calendar Shoot,” Oneindia (December 14, 2010),
http://tinyurl.com/mbrhfam; Lucy Hagan, “Meet the X-Rayted Nurses,” Sun
(November 28, 2006), http://tinyurl.com/owcssyv; Lucy Hagan, “Naughty
Hospital Staff,” The Sun (November 29, 2006), http://tinyurl.com/jvngkd2.
102. CFNA, “People Always Joke about Nurses Looking Saucy so It’s Fun to Be the
Real Thing,” TAN (November 29, 2006), http://tinyurl.com/kek574m.
1 8 4
103. 3Wishes.com, “Nurse Costumes,” accessed March 27, 2014, http://tinyurl.com/

hc7y7.
104. Bras ‘N’ Things, “Nurse Feelgood,” accessed March 27, 2014,http://tinyurl.com/
qadmaml.
105. Marcia Moody, “Secrets of the Royal Romantic Reunion that Changed the Course of
History: What Really Made Kate and Wills Rekindle Their Love—and Transform
the Monarchy Forever,” Daily Mail (July 6, 2013), http://tinyurl.com/q68aexc.
106. Party City, “Adult Hospital Honey Nurse Costume,” accessed March 27, 2014,
http://tinyurl.com/mmz9eta.
107. Spirit Halloween Costumes, “Nurse Heartbreaker Adult Women’s Costume,”
accessed March 27, 2014, http://tinyurl.com/lv37csm.
108. Alibaba, “Adult Nurse Costume,” accessed March 27, 2014, http://tinyurl.com/
pnrbp67.
109. Southern Poverty Law Center, “What Do Halloween Costumes Say?,” accessed
March 27, 2014, http://tinyurl.com/ktmgnew.
110. Gregory Isaacs and Sylvester Weise, composers, Gregory Isaacs, performer, “Night
Nurse,” from the album Night Nurse (1982), http://tinyurl.com/ltqqh6v, http://
tinyurl.com/m3u4mxb.
111. Gregory Isaacs and Sylvester Weise, composers, Simply Red, performer, “Night
Nurse,” from the album Blue (1998), http://tinyurl.com/auhrued.
112. Gregory Isaacs and Sylvester Weise, composers, Sinead O’Connor, performer,
“Night Nurse,” from the album I Do Not Want What I Haven’t Got (special
edition) (1990, 2009), http://tinyurl.com/k58db2y; http://tinyurl.com/
kdxo9ga.
113. Mariah Carey featuring Nicki Minaj, performers, Nick Cannon, video director,
“Up Out My Face,” accessed March 27, 2014, http://tinyurl.com/y8ovjmo; TAN,
“Mariah Carey: ‘Up Out My Face’ ” (February 22, 2010), http://tinyurl.com/
ygu9wcf.
114. Mariah Carey featuring Nicki Minaj, performers, Nick Cannon, video director,
“Up Out My Face,” accessed March 27, 2014, http://tinyurl.com/y8ovjmo.
115. Jay Smith, “Crüe Fest Lineup Revealed,” Pollstar (March 16, 2009), http://
tinyurl.com/meq4tm7; TAN, “A Short History of Dr. Feelgood” (March 16,
2009), http://tinyurl.com/lohm82u.
116. Dick Clement, Ian La Frenais, and Julie Taymor, screenplay, Julie Taymor, director,
Across the Universe, Columbia Pictures (2007), http://tinyurl.com/dz5hhn.
117. Alison Goldfrapp and Will Gregory, composers, Goldfrapp, performer, Dawn
Shadforth, video director, “Number 1,” from the album Supernature, Mute Records
(2005); CFNA, “Goldfrapp: ‘Number 1,’ ” TAN (March 27, 2006) http://tinyurl.
com/pzseh2k.
118. Keith Anderson and Bob DiPiero, composers, Keith Anderson, performer, Trey
Fanjoy, video director, “XXL,” from the album Three Chord Country and American
Rock & Roll, Arista Nashville (2004); CFNA, “Keith Anderson: ‘XXL,’ ” TAN
(December 12, 2005), http://tinyurl.com/lmwzyak.
185
119. blink-182, Enema of the State, MCA Records (1999); CFNA, “blink-182, ‘Enema
of the State,’ ” TAN ( July 11, 2003), http://tinyurl.com/kay9bgp.
120. Jack White, composer, The White Stripes, performer, “The Nurse,” from the
album Get Behind Me Satan, V2 Records (2005); CFNA, “Boy You Have No
Faith in Nursing,” TAN (April 21, 2006), http://tinyurl.com/kmgw6sx.
121. Lee Moran, “ ‘TV Series-Hot Nurses Need Only Apply’: Swedish Hospital Spices
up Summer Recruitment Search for Sexy Staff,” Daily Mail (February 22, 2012),
http://tinyurl.com/mvqd5qh; TAN, “Too Darn Hot” (February 2012), http://
tinyurl.com/mp9hzzf.
122. Público.es, “Las Enfermeras de una Clínica de Cádiz Denunciarán a la Empresa si
las Obliga a Usar Falda” (March 25, 2008), http://tinyurl.com/m48t9e6; CFNA,
“Wear Skirts, Caps and Aprons . . . Or Lose 30 Euros,” TAN (March 28, 2008),
http://tinyurl.com/klbj7qk.
123. Ananova, “Nurses in Romania to Wear Miniskirts” (September 29, 2006);
CFNA, “Ananova Is All over That Miniskirted Nurse Beat,” TAN (September 29,
2006), http://tinyurl.com/ldobzar.
124. Hindustan Times, “Patients Want Pretty, Skirt-Clad Nurses!” (October 4, 2005);
CFNA, “Patients Want Pretty, Skirt-Clad Nurses!,” TAN (October 4, 2005),
http://tinyurl.com/lmymwrv.
125. Daily Mail Online, “Nurses Face Ban on Thongs and Cleavage” (September
2006), http://tinyurl.com/lym5bfh; CFNA, “Daily Mail: ‘Nurses Face Ban on
Thongs and Cleavage,’ ” TAN (September 19, 2006), http://tinyurl.com/l2lan78.
126. Justin Stephens, photographer, “Most Intriguing: Ultimate Survivor Bret
Michaels,” People (December 27, 2010): 100–101, http://tinyurl.com/mj4qz9q;
TAN, “Open Up and Say . . . Naah!” (March 7, 2011), http://tinyurl.com/l98sh9x.
127. People, “Stats,” accessed May 10, 2009, http://tinyurl.com/lv4z4cz.
128. TAN, “Open Up and Say . . . Naah!” (March 7, 2011), http://tinyurl.com/l98sh9x.
129. Tom O’Connor, writer, “Episode Dated March 31, 2008,” Red Eye, Fox (March 31,
2008); CFNA, “Wear the Miniskirts and Just Save Some Lives!,” TAN (April 1,
2008), http://tinyurl.com/l7moqow.
130. The Stephanie Miller Show, syndicated radio show ( June 1, 2007), http://tinyurl.
com/8yelu; CFNA, “We Must Stop the Naughty Scandinavian Porn Nurses from
Infiltrating America!,” TAN ( June 13, 2007), http://tinyurl.com/jw9mhk5.
131. Matt Janz, Out of the Gene Pool, Go Comics (March 22, 2008), http://tinyurl.
com/m27u8qt.
132. John McPherson, Close to Home, Go Comics (December 18, 2006), http://
tinyurl.com/l9noyth.
133. Charles Fiegl, “Cartoonist Hits ‘Close to Home,’ ” Post-Star (December 18, 2006),
http://tinyurl.com/kxpl92f; CFNA, “Getting Close,” TAN (December 19,
2006), http://tinyurl.com/kgxa266.
134. TAN, “Google Results for Selected English Language Phrases—July 15, 2014,”
http://tinyurl.com/k4uktc9.
6
W H O W A N T S Y E S T E R D AY ’ S G I R L ?
In June 2008, in Washington, DC, a female attorney we know

described a problem with a friend’s preschool age daughter. This
poor girl insisted that she wanted to be a nurse! Her mother, a PhD
married to an MD, PhD, was aghast. Mom tried valiantly to per-
suade her daughter that, if the daughter wanted to work in health
care, she should do the “feminist” thing and be a physician, like
Daddy. Our attorney friend shared the mother’s bewilderment.
In April 2008, a Chicago artist was having dinner with two
nursing leaders. The artist spoke sadly about the downward trajec-
tory of her daughter’s career aspirations. When her daughter was in
elementary school, she had wanted to be a physician. But in middle
school, her daughter decided she wanted to be a nurse. The artist’s
theme was that society still pushes women into traditional pursuits
that limit them. She concluded by noting that her daughter had
had four kids and become a stay-at-home mom.
Too much of society continues to believe that nursing is not
good enough for smart, ambitious modern women—that it’s only
for yesterday’s girls (we use the diminutive “girls” deliberately). The
mass media continues to reinforce that view. It’s not just random
comments, like Whoopi Goldberg’s 2009 remark that modern girls
know they can aspire to be physicians and not just “helpers.”1 All of
the most popular Hollywood hospital shows of recent years have
sent similar messages, particularly Grey’s Anatomy, on which young
female physician characters seem to regard the word “nurse” as the
greatest insult they could receive. Recent Hollywood films have
emphasized that today’s girls can do better than their unfortunate
mothers who got stuck in nursing. The news media has conveyed
similar ideas, telling women how they can escape traditionally
female jobs like nursing and pursue real careers.
The value that society places on nursing reflects the value it
places on “women’s work.” Ann Richards, the late governor of
6 Who Wants Yesterday’s Girl? •
187
Texas, was quoted in an exhibit at The Women’s Museum in Dallas to the

effect that recorded history has traditionally been about “men and their activ-
ities,”2 as if those activities alone have influenced the course of human events.
The Women’s Museum closed in 2011 and Leslie Wagner noted in a March
2013 column in the Dallas History Examiner that the reason was largely a
lack of financial support “from men with deep pockets, men who do not con-
sider women’s contributions to society as important as those of other men.”3
Efforts are now underway to build a National Women’s History Museum
in Washington, DC.4 But the overall failure of the media to fully examine
women’s contributions in fields like nursing is a critical reason that women’s
historic and ongoing role in society remains undervalued.
The enduring view of nursing as inconsequential “women’s work” under-
lies the profession’s struggle to get adequate resources. To begin with, global
nursing salaries reflect this undervaluation. The International Council of
Nurses has explained:
Once established, relationships between wages paid to different jobs

change very little over time, so historical inequities tend to remain
unless deliberately changed. . . . Many job evaluation systems are
gender-biased and fail to capture or value the work of nurses and other
women workers, thus perpetuating existing wage inequities . . . Analyses
confirm that many nurses continue to be underpaid because skills and
competencies used in the practice of nursing were not regarded as
job-related skills but as qualities intrinsic to being a woman.5
Nurses in the United States may not feel as underpaid as nurses in most other
nations. But research suggests that in much of the world, nurses’ low wages
relative to other professions are critical factors in attrition and international
migration.6 When we lived in Cambodia in the mid-1990s, nurses earned
poverty wages. According to Apheda, an Australian trade union agency, 2002
data show that Cambodian nurses then earned the equivalent of US$591 per
year, which meant that they had to work about 40 minutes for a pound of
rice (one-half kilo) and 17 hours for a half-pound (250 gram) jar of instant
coffee.7 Low nursing salaries also affect more developed nations. Former
International Council of Nurses leader Christine Hancock has noted that
nurses in Luxembourg are paid better than those in nearby developed nations,
leading to inflows of nurses from those nations. Yet the nurses are still “not
paid as well as postmen in Luxembourg,” so they are “frustrated and deval-
ued.”8 Depressed nursing salaries are just one effect of the undervaluation
1 8 8
of nursing. When decision-makers undervalue the profession, they allocate

fewer resources for clinical practice, education, research, and residencies.9
Of course, these resource issues are common in traditionally female
professions. Research shows that the higher the percentage of women in an
occupation, the lower the salary.10 Studies by Juliane Achatz, and another
by Trond Peterson and Ishak Saporta, refer to the devaluation of an entire
field as “evaluative discrimination.”11 Although many individual women
have now pursued and succeeded in fields once considered “men’s work,”
such as medicine, their individual gains have done nothing to resolve the
undervaluation of “women’s work.” On the contrary, this feminist flight—
and particularly the media that celebrates it—may even intensify the disre-
spect for the abandoned fields by suggesting that “women’s work” is a type
of bondage that strong women now can and should escape. Yet the tradi-
tional work of women has generally been about creating, developing, and
preserving human life, with a focus on the next generation. It’s hard for us
to think of endeavors that deserve more respect and resources, but it’s very
easy to think of endeavors that get more. Reducing that disparity is a key
part of the unfinished business of feminism: to help society understand
and value the work that women have long done.
In light of the traditionally female makeup of nursing, it’s no shock that
men who pursue the profession still encounter resistance. In an extensive
2005 survey of men in US nursing, “eighty-two percent noted that nursing
is plagued by common misconceptions that emphasize the view that nursing
is a female profession dominated by women, that men are not suited to it
because they are not caring, and that men in nursing are gay.”12 In 2000 the
advertising agency JWT Communications conducted a focus group study of
1,800 school kids in ten US cities that found that when the conversation on
careers changed to nursing, the males in the group stopped paying attention,
saying that the conversation no longer applied to them.13 In February 2008
nurse Robert Zavuga published “Check Bias Against Male Nurses” in the
New Vision (Uganda). Zavuga noted that people call him a “male nurse” as if
that were an oddity.14 One nurse we know says that when someone says he is
a “male nurse,” he tells them that he applied to become a “female nurse,” but
the classes were all full. The problem with using the term “male nurse” when
the subject is not the maleness itself is that it wrongly suggests that the man’s
work differs from the work of female nurses.
Popular media on men in nursing is certainly not free of stereotypes. In
Hollywood products, men in nursing may be mocked for failing to embody
gender norms, perhaps through terms like “murse,” which is a cute contraction
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of “male nurse.” Or they may simply be more likely to be presented as gay

than they are in reality. In a September 2013 study in the Journal of Advanced
Nursing, researchers at the University of Western Sydney analyzed one sea-
son each of five hospital dramas: Grey’s Anatomy, Private Practice, and all
three of the 2009 nurse shows.15 They found that although the shows did
try to “expose” some common stereotypes about men in nursing, they also
reinforced them, with male nurse characters “often subject to questions
about their choice of career, masculinity and sexuality and their role usu-
ally reduced to that of prop, minority spokesperson or source of comedy.”
Two of the three male nurse characters who initially appeared in the 2009
nurse shows were gay. Male nurse characters have also served as vehicles
for “feminist” role reversal—hunky modern men whose subordination to
female physicians is clear. On Private Practice, nurse Dell worked as a clinic
receptionist.16 Even positive news items, like a March 2009 CBS News report
about a heroic nurse who took 27 bullets to shield others during a North
Carolina shooting rampage, often use the term “male nurse” when there is
no legitimate reason to do so.17
Yet this same media is more open to men in nursing than might be
expected. Hollywood has included some surprisingly strong portrayals, such
as the Belize character in Angels in America,18 Mo-Mo on the first season of
Nurse Jackie,19 and Will Royal on Combat Hospital20 (yes, all three characters
were also racial minorities). Helpful press stories have detailed the work of
men in nursing and efforts to attract men as a way to address the global short-
age. Some of these recruitment efforts assure us that “real men” can be nurses
and so may themselves reinforce harmful gender stereotypes.
The view that nursing is for women with limited options undermines
nursing recruitment, retention, and practice. A 2004 survey found that
many US high school guidance counselors told bright students that they
were “too smart” for nursing and should instead pursue fields like medi-
cine or business.21 In December 2005 the New Zealand Herald ran a piece
by Vikki Bland with the hopeful title “Nursing in Terminal Decline.” The
piece reported that “few secondary school pupils are interested in nursing.”
Some career advisers reportedly viewed nursing as “less than ideal from a
feminist or masculine perspective” and steered promising students away.
An adviser tried to talk New Zealand Nurses Organization chief Geoff
Annals’ own daughter out of pursuing nursing in favor of medicine.22 Even
those who do become nurses have internalized these social attitudes, which
continue to disrupt their sense of professional well-being and self-respect.
Who wants to be yesterday’s girl?
1 9 0
In the United States, both men and women have become more interested
in entering nursing in the last decade, as discussed in Chapter 1. However,
nursing schools have often lacked the faculty, infrastructure, and other
resources they need to train the students they attract.23 A society enduring
a weak economy seemed to have gotten the message that nursing had plenti-
ful jobs but not the message that training skilled nurses requires significant
resources. In 2006 one US nursing leader noted that a friend had described
a wedding at which another guest mentioned that her son wanted to pursue
nursing. But, said the woman, her son had been put on a three-year waiting list
for nursing school. This mother of a future man in nursing complained: “This
is ridiculous. They could train a nurse in six weeks.” Right. A surge in interest
from job seekers will not help nursing in the long run if the public still fails to
understand that nursing is a serious modern profession for men and women.
Of course, neither women nor men should be excluded from careers on
the basis of gender. Women should be able to pursue medicine or any other
work. But too much of the media regards traditionally female jobs like nurs-
ing as menial and insignificant, defining success in terms of the power and
status available in some traditionally male jobs.
The Work Feminism Forgot

Today even media created by women, such as Grey’s Anatomy, often expresses
overt contempt for nursing, seeming to reflect what journalist Suzanne
Gordon has called “dress for success” feminism. In the 2004 article “How
Hollywood Portrays Nurses” in the nursing journal Revolution, Gordon and
nurse Ruth Johnson explained that media feminists, in their rush to embrace
traditionally male fields like medicine, have failed to learn the importance
and complexity of “caregiving” fields like nursing.24 As the authors noted,
nursing professor Ellen Baer had decried the “feminist disdain for nursing”
many years earlier, in a 1991 New York Times op-ed piece.25 Even some chil-
dren’s books reflect that disdain. Holly Hobbie’s Fanny (2008), discussed in
Chapter 4, surrounds a strong female “physician” doll with glamorous assist-
ing “nurse” dolls.26 Many media feminists treat nurses with the same explicit
condescension that women in general once experienced. In some ways, nurses
are the new women.
There have been press items describing the work of strong, able women
in nursing, including some of the better pieces discussed in Chapters 3 and
4. But apart from the 2009 nurse shows, recent fictional portrayals of nursing
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as being worthy of a strong woman tend to focus on the distant past. The
recent BBC series Call the Midwife is a great portrayal of nursing in many
ways, but of course the show is set in the 1950s.27 Joe Wright’s 2007 film adap-
tation of Ian McEwan’s 2003 novel Atonement likewise suggested that nursing
was a way for women to break out of some of their traditional roles in the
World War II era.28 The Sky Arts television series A Young Doctor’s Notebook,
set in revolutionary-era Russia, has included portrayals of veteran nurses who
are strong and knowledgeable in clinical matters, guiding the troubled main
character as best they can in their difficult care setting.29 Anne Perry’s mys-
tery novels about Victorian-era detective William Monk, published from
1990 through at least 2013, feature tough, intelligent nurse Hester Latterly.
Latterly, who worked with Florence Nightingale in the Crimea and in later
novels runs a clinic for poor women, is far more assertive than some charac-
ters think she should be.30
In other words, nursing might have been the feminist thing in the 1860s,
or even the 1940s and 1950s. But you’ve come a long way, baby! You don’t
have to be a nurse anymore.
Hollywood Feminism
Major health-related television shows reflexively suggest that women achieve
in health care only by pursuing medicine. It has been an obvious subtext in
Grey’s Anatomy, The Mindy Project, House, Private Practice, and other shows
that have focused closely on the professional development of their female
physician characters.
Grey’s Anatomy presents a full landscape of female achievement in health
care—from new physicians to senior physicians. Nurses represent what
women have to settle for if they are not bright and ambitious like the show’s
physician heroes: a life of nodding along to physician commands. Recall the
many expressions of contempt for nursing from the show’s female interns,
including the seething reactions of Meredith Grey and Cristina Yang after
intern Alex called Meredith a nurse in the March 2005 premiere, as discussed
in Chapter 3. The female physicians’ priority is not to understand nurses but
to distinguish themselves from what they see as an uneducated servant class.
Consider the episodes equating nurses’ work with grotesque bodily functions,
as well as nurse Rose’s reference to neurosurgeon Derek Shepherd’s discussion
of “boring science stuff.” We guess that nutty science stuff is just for smart phy-
sician girls like Meredith!31
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Grey’s makes its mean-girl contempt clear in nonclinical portrayals as well.

Unlike the female physicians, the nurses are generally not substantial, inter-
esting people. Instead they are ciphers with whom Alex and Sloane have sex
when something is not going right in their relations with other physicians.
That’s why, as Cristina once remarked about Izzie, “hell hath no fury like a
girl whose non-boyfriend screws a nurse.” Although nurse Rose was a positive
character in some ways, she was no real competition for Meredith.
The Mindy Project follows the personal life of a flawed yet quick-witted
obstetrician/gynecologist (OB/GYN) named Mindy Lahiri, but it is also
concerned with her professional development as a woman of color. Several
plotlines have explored Mindy’s relations with the two white male physicians
who co-own her practice but seem to take her less seriously at least partly
because of her gender. A May 2013 episode found Mindy trying to mentor a
female Columbia medical student, to help another young female succeed in a
traditionally male profession. For all its wackiness, the show has never ques-
tioned that obstetric physicians are skilled professionals worthy of respect;
creator Mindy Kaling’s late mother was an OB/GYN physician. But the
show’s female nurse characters are one-dimensional jokes: the office admin-
istrator Beverly is an inept loon from, well, yesteryear, and the young Tamra,
although capable of flippant remarks, is mostly a bizarre, shallow serf. Neither
has displayed healthcare skill, and the portrayals encourage viewers to regard
female nurses with the same light-hearted contempt the show does.32
ER clearly wanted to encourage women to pursue medicine and to assume
leadership roles. A February 2004 TV Guide cover story about the show
asked us to “consider the increased enrollment of women in medical schools
since ER’s 1994 debut.” The show’s physician advisor Fred Einesman noted
that “once ER went on the air, emergency medicine became the most popular
residency and the number of women who applied went up dramatically.”33
In accord with the show creators’ pride in promoting female physicians, ER
highlighted the challenges they face, while sending negative messages about
nursing as a female career choice. In one April 2005 episode, intern Abby
Lockhart confronted an elderly male patient who seemed to respect only
older male physicians. The abusive patient, assuming Lockhart was a nurse,
snapped that he did not “want some nurse calling the shots around here.” So,
did the episode’s two female writers—one a physician—have Lockhart mount
a spirited defense of nursing, the profession in which she herself spent many
years saving lives? Not exactly. Lockhart responded, with measured but clear
indignation, “I am not a nurse. I’m a doctor.”34 What might she have said?
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“Today I am practicing as a physician. But as a nurse my opinions about your

care options would be just as valuable.”
“You’re absolutely right—no nurse or physician should decide what happens
to you. That is your right. As it happens, I am a nurse and a physician.”
“Ah . . . I gather you don’t like our nurse-centered model of care.” (picking up
a phone) “Hello, is this Psych?”
“Don’t worry about nurses calling the shots, sir. The nurses only help the
patients we want to live.”
A surprising bright spot for women in nursing was the Ann Perkins char-
acter on Parks & Recreation. At least until the character left the show in early
2014, Ann was the best friend of lead character Leslie Knope, a local govern-
ment official who also served as a city councilwoman. The show might eas-
ily have drawn a sharp contrast between Leslie’s political rise and Ann being
stuck in nursing, but it did not. Leslie did urge Ann to apply for an open posi-
tion as the city health department’s public relations director, and Ann took
the job part-time, but she remained in direct care nursing at a local hospital.
The sitcom is a mockumentary about zany government workers, and Ann had
her weird features. But as one of the show’s relatively normal characters, she
also displayed intelligence, health knowledge, autonomy, and strong advocacy
in both the public health and clinical settings.35
The three 2009 nurse shows all featured strong, smart female lead charac-
ters, as discussed in Chapters 2 and 3. HawthoRNe showed that a nurse can
be a leader with clinical and administrative authority.36 On Mercy, as an NBC
advertisement helpfully noted, Veronica Callahan didn’t just give shots, she
often called them.37 Jackie Peyton, despite her faults, is a clinical rock star.38
But the shows have done little to convey that nursing is a profession for the
most academically advanced women; all have suggested that nurses are essen-
tially oppressed blue collar workers. Mercy did seemingly refer to nursing
education once, in a passing reference to Chloe Payne’s masters degree.39 It
took Nurse Jackie almost six full seasons to tell viewers that some nurses have
graduate degrees, in a June 2014 episode in which Zoey Barkow decided to
apply to a masters program to become a nurse practitioner.40
The reaction of female critics to the 2009 nurse shows was telling. By the
time Mercy premiered in September 2009, some critics had already seen quite
enough of its pronurse stance. Ginia Bellafante’s contemptuous September
2009 New York Times review pronounced the nurse characters in the “angry
little soap” to be bridge-and-tunnel women who had fallen pretty far from
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ER’s nurses, who got to marry George Clooney’s physician character and even
join their “superiors” by attending medical school!41 In October 2009 Salon’s
Heather Havrilesky savaged Mercy’s “mercilessly self-righteous” vision of
nurses “wagging their fingers” at “cartoonishly self-concerned” physicians.42
But all three of the nurse shows actually went out of their way to highlight
positive physician conduct—the lead physician in each was smart, able, and a
close ally of the lead nurse—and to show that the nurses were flawed. Perhaps
these critics doubted that there really are smart, educated nurses who fight for
patients and challenge poor physician care.
Hollywood movies often reveal similar views. Gordon and Johnson’s 2004
Revolution article cited Richard LaGravenese’s Living Out Loud (1998), in
which a woman named Judith dropped out of medical school to marry a
medical student.43 Years later Judith’s physician husband left her for a younger
physician. The film found the unfulfilled Judith practicing home health nurs-
ing. But she finally achieved rebirth in part by returning to medical school.44
Critics and women’s studies scholars saw that as a “feminist” victory.45
More recent films have told young females that nursing is a dead-end job
that the sad women of the past may have had to settle for instead of medicine.
But today, girls can actually achieve something worthwhile in work and in
life! Yay.
Doug Atchison’s Akeelah and the Bee (2006) told the story of an
eleven-year-old girl from a struggling Los Angeles school who aimed for
the National Spelling Bee.46 Akeelah’s widowed mother, Tanya, was barely
keeping it together raising the family by herself. Tanya tried to keep her
daughter focused on schoolwork by citing her own lost opportunities. But
Tanya shocked Akeelah by telling her that her mother actually went to col-
lege before dropping out and becoming a nurse—evidently, college is not
something nurses need. The movie’s young achiever message: work hard, fear
not, and things like nursing will not happen to you. Akeelah also reinforced
the idea that persons of color—like women—achieve by joining tradition-
ally esteemed professions, but not by questioning widely shared assumptions
about what kind of work has worth.
Davis Guggenheim’s Gracie (2007) took a similar approach. In that ear-
nest 1970s-era sports drama, a New Jersey student was determined to honor
the memory of her dead brother by taking his place on their high school soc-
cer team.47 But she faced obstacles including a chauvinist father who wouldn’t
coach her, mocking peers, and a resistant school. Gracie’s mother was an
unhappy school nurse who urged her moping daughter to fight to make the
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soccer team, using her own life as a cautionary tale. Turns out, Mom wanted
to be a surgeon! Gracie was incredulous. Her mother explained:
I wanted to be in the emergency room. So, uh, now I’m a nurse. That’s
as close as I could get. So if you want to limit yourself, that’s fine. But
don’t let other people do it for you.
Duly motivated by the fear that she might otherwise be condemned to a life
of nursing, Gracie fought to realize her dream. Not surprisingly, promotional
efforts and reporting on Gracie described the mother as having had to “settle”
for being a nurse.”48
Of course, it’s not irrational to assume that if an oppressed group is con-
fined to a few specific jobs, none of those jobs is worthwhile. Not irrational;
just wrong. Those who “limited” women to jobs like nursing in the past did
not necessarily understand the jobs’ true nature any better than “feminists” do
today. Little did they suspect that nursing is not trivial scut work, but a vital
scientific profession whose members save lives and improve outcomes.
Escaping the Pink Ghetto: The News Media Tells You How!
There certainly have been press pieces about strong modern women in nurs-
ing. But we’re not aware of any directly suggesting that a nursing career would
advance the interests of society as a whole, the female gender, or any particu-
lar female as much as would a medical career. On the contrary, some in the
news media have suggested that females who want a real modern career avoid
nursing—a view that seems particularly common among those who claim to
be advancing the interests of women.
In December 2005, Carol Kleiman’s career column in the Chicago Tribune
examined how women can escape the “low wages” and “lack of a career path” in
the “pink ghetto” of traditionally female jobs, including nursing and teaching,
and move into “demanding,” “professional” careers like law and accounting.49
The author and the consultant who was her main source, Jonamay Lambert,
seemed unaware that a world without skilled nurses and teachers would also
lack the lawyers and accountants they value so highly. If nurses do have too lit-
tle money or power, is the solution to urge them all to flee, or to improve their
wages and working conditions? Obviously, many nurses have fled the bedside.
It seemed that those responsible for this piece would be thrilled if they could
help even more women escape. Of course, fewer nurses means more death.
1 9 6
But as the noted employment consultant Ebenezer Scrooge once observed,

death is a good way to “decrease the surplus population.”50
In the July 2004 New Yorker piece “To Hell with All That,” Caitlin
Flanagan compared her mother’s return to her career in nursing during the
author’s childhood to the career-versus-home dilemma that many mothers
face today.51 The article showed a general appreciation for what Flanagan’s
mother’s work meant to her, and the piece even gave some sense that her
mother’s success at nursing school meant something. But it also seemed to
reflect a lack of respect for nursing as a profession.
It’s even harder today than it was in my mother’s era, because the mod-
ern professional-class mother is not pursuing the kind of women’s work
for which my mother and her friends had been trained, and to which
they eventually returned: nursing and elementary-school teaching and
secretarial work and the like. These were posts that could be aban-
doned and returned to without a significant loss of stature, and were
usually predictable in terms of both hours and workload. . . . Today’s
career moms are often trying to make partner or become regional sales
manager or executive editor, jobs that require a tremendous number of
hours and a willingness to allow urgent appeals, via BlackBerry or cell
phone, to interrupt even the best-laid plans for family time.
Strictly speaking, Flanagan is comparing jobs decades ago with women’s

current career options. But readers are likely to come away with their ugli-
est present-day stereotypes confirmed. In fact, graduate-prepared nurses,
including scholars, policy makers, executives, and advanced practice nurses,
typically do lose status if they “abandon” their careers, even if they are not
aiming for “regional sales manager.” In addition, the nurses who struggle with
short-staffing and mandatory overtime would be surprised to hear that their
jobs are “predictable” in hours and workload. Flanagan’s implication is that
truly able women today do not do traditional “women’s work” like nursing,
which is not a “modern professional-class” career, but a “post” that now rests
in the dustbin of smart-girl history.
Even pieces that aim to show respect for nursing may confuse the profes-
sion with generic femininity. In September 2009 the Salon website ran an item
by Prairie Home Companion radio host Garrison Keillor about his stay at the
Mayo Clinic following a minor stroke. Keillor said his nurses were “smart” and
“utterly capable,” with the psychosocial skills to get patients through tough
times. But the female nurses also had “the caring gene most men don’t,” and in
one Keillor sensed “some human tenderness . . . as if she thought, I could be the
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last woman to hold that dude’s hand.” Keillor referred to a “dark-haired beauty
named Sarah” who not only “coache[d]‌him on self-administered shots of hep-
arin,” but also inspired him to plunge the needle in without hesitation, since
“no man is a coward in the presence of women.” Keillor saw that his nurses had
skills, but he seemed to respond at least as much to their gender and physical
attributes. The piece also mentioned Keillor’s physicians, including at least one
female, but oddly, we heard nothing about their appearance!52
Nursing also suffers by omission in reports about careers for women. Since
the notorious 2005 remarks by former Harvard president Lawrence Summers
(no relation) about women in science,53 the media has been full of stories
about women’s status in “science and engineering” fields. For instance, a long
December 2006 piece by Cornelia Dean in the New York Times discussed the
progress women have made in such fields. This article was more concerned with
those who have become university professors in fields like molecular biophys-
ics than it was with the applied sciences or health care. But the piece did note
that half of US medical students are now women. One of the women quoted at
length was a New York psychologist. Yet there was not a word about nursing,
or the thousands of women with nursing doctorates who are now teaching and
conducting scientific nursing research at US universities.54 In a July 2008 inter-
view with the Baltimore Sun, National Organization for Women President Kim
Gandy lamented the continuing gender segregation in jobs: “Why are so few
women in STEM careers—science, technology, engineering and mathematics?
Those are the careers of the future, where the real money is.” In other words,
nursing is not a science. What matters is getting more women into traditionally
male fields where the “money” is, not revaluing traditionally female ones like
nursing which are not, evidently, the “careers of the future.”
The Male Nurse Action Figure: The Media

Confronts Men in Nursing
Men have provided health care to others for thousands of years, but today
fewer than 10 percent of US nurses are male, and that generally appears to be
the case worldwide.55 Only one in ten US men has even contemplated nursing
as a career.56 Still, the percentage of US men in nursing has risen from 2.7 per-
cent in 1970 to 9.6 percent in 2011, according to US Census data.57 Increasing
the number of male nurses is a critical part of helping the profession gain the
power and diversity it needs to overcome the current global shortage. In 2011
the American Assembly for Men in Nursing launched the “20 X 20 Choose
Nursing Campaign,” a public relations effort to increase the enrollment of
men in US nursing programs to 20 percent by the year 2020.58
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The social view that nursing is “women’s work” has particular importance
for men in the profession. Even the English language reflects that traditional
view. People still use “nursing” to mean breastfeeding. The terms “matron”
and “sister” remain common ones for nurses in some nations, including the
United Kingdom. In 2002 Johns Hopkins University School of Nursing
changed its pink student identification cards to green to make men more
comfortable wearing them. Many people wrongly believe that all male nurses
are gay, or that they’re not smart or motivated enough to be physicians, as the
research discussed above showed.
These attitudes have a real impact. Roslyn Weaver led the 2013 study of
Hollywood’s portrayals of male nurses published in the Journal of Advanced
Nursing. She told Reuters that “when men in nursing are almost invisible in
popular culture or are stereotyped as incompetent or somehow ‘unmasculine,’
then men who choose to enter nursing can find it difficult to combat,” and
“perhaps reflecting this, there are often higher attrition rates for male students
than female students in nursing.”59 A 2003 NurseWeek study found that nearly
a third of male nurses said they had experienced “sexual harassment or a hos-
tile work environment related to the conduct of physicians.”60
Fictional media creators clearly have had trouble resisting the male nurse
as object of ridicule. Some portrayals have used male nurses for their nov-
elty value, notably for the feminist role reversal described previously: nothing
makes the new breed of female professionals look more powerful than having
a cute male nurse to order around. In Hollywood and advertising products,
the sexual identity of male nurses is often an issue in a way it simply would not
be for other characters. But even Hollywood has generally resisted the worst
stereotypes. There have been portrayals of strong male nurses, although rarely
prominent or long-lasting ones. The news media has also reported effectively
about men practicing nursing and about efforts to recruit men to help resolve
the shortage. These efforts do often stress that “real men” can be nurses, argu-
ably reinforcing exclusionary gender stereotyping, as Thomas Schwarz sug-
gested in his 2006 piece in the American Journal of Nursing, “I Am Not a
Male Nurse: Recruiting Efforts May Reinforce a Stereotype.”61
A video advertisement for the “jerky snack” Slim Jim that ran in 2013 was
a striking illustration of the fictional media’s apparent ambivalence toward
men in nursing. The advertisement featured a self-identified “murse” dis-
tributing the product in a hospital waiting room to men suffering from dif-
ferent forms of “male spice loss.” That malady was the subject of a broader
advertising campaign ostensibly aimed at helping men who had abandoned
accepted macho pursuits in favor of weird, vaguely feminine activities. The
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nurse mocked the “patients” by publicly labeling them (e.g., “tantric yoga
guy”) and throwing their prescribed snacks to them (naturally, they couldn’t
catch). Still, he projected traditional masculinity, with his authoritative voice
and military fatigue pants, and he did things that were supposed to amuse the
young male target audience.62 On the whole, the advertisement was laughing
with the nurse, not at him. Traditionally male health workers, including phy-
sicians, played similar roles in other “spice loss” campaign spots. So, despite
the “murse” term and the gender-role intolerance, the advertisement could be
seen as a small step toward normalizing the idea of men in nursing with the
campaign’s target audience.
Some recruiting materials have struck a good balance. A clever, irreverent
rap recruiting video created in 2004 by nurse Craig Barton and other staff
at the University of Alabama at Birmingham showed emergency department
nurses of all genders grinning and strutting toward the camera, as Barton
rapped about specific and at times technical aspects of the nurses’ work.63
Gender did not seem to be an issue. Another interesting item was Archie
McPhee’s Male Nurse Action Figure, which was sold from 2004 to 2011. Of
course it would have been better to simply call him a “nurse:” we can tell he’s
male. And there was a tongue-in-cheek element, as in other McPhee items.
But the product said nothing directly about sexual identity. Instead, the pack-
age noted that men who become nurses “are blazing the trail as role models
and mentors for generations to come. Thank a male nurse today!”
Nurses and Murses: Men in Hollywood Nursing

Hollywood has paid considerable attention to men in nursing given that
these nurses still make up fewer than 10 percent of the total. Some portrayals
have been good, although even some generally helpful ones have had fun with
the male nurse stereotype. That has often occurred through juvenile wordplay,
like calling someone a “murse” or giving the nurse character a name that sug-
gests a lack of conventional manliness.
Belize, the tough, skilled, imperfect nurse in the film Angels in America,
is perhaps the best recent Hollywood portrayal of a man in nursing.64 As
explained in Chapters 3 and 4, Belize was a 1980s AIDS nurse caring for dying
power broker Roy Cohn. The closeted Cohn noted that Belize was his “nega-
tion,” an openly gay black nurse who would “escort me to the underworld.”
Cohn lashed out at Belize from the first moment. Yet when Cohn admit-
ted to his own need for human contact, Belize was honest with him about
his likely fate. He advised Cohn to avoid the radiation the physicians would
2 0 0
push on him. When Cohn wondered why he should trust a nurse instead
of his “very expensive, very qualified WASP doctor,” Belize snapped, “He’s
not queer. I am.” With luck viewers won’t think that is the sole reason for
Belize’s expertise. Belize also advised Cohn, who had pulled strings to get into
an early AZT drug trial, to beware of the “double blind,” which might result
in his getting a placebo instead of the real drug. Belize was convinced, as many
AIDS activists were, that things were moving far too slowly, while thousands
died. In his view, he was protecting his patient from a dysfunctional health-
care and political system. Belize was gay, but not stereotypical.
Perhaps the best-known film portrayals of a man in nursing have been
the hugely popular romantic comedies Meet the Parents (2000), Meet the
Fockers (2004), and Little Fockers (2010). In these films, the lead character
was Chicago “male nurse” Gaylord Focker. First off, of course, there was his
name, which included the word “gay.” What a laugh riot!
In Meet the Parents, Gaylord, who preferred to be called Greg, first faced
off with prospective father-in-law-from-hell Jack Byrnes in an attempt to win
Jack’s blessing for a marriage proposal to his daughter Pam. Jack, an intense,
WASPy retired CIA agent, turned a family visit into an interrogation and
son-in-law fitness test for the easygoing, Jewish Greg. Since part of Jack’s skep-
ticism about Greg related to his career choice, common misperceptions of
nursing were a recurring theme. Despite condescending challenges to Greg’s
intellect and manhood from Jack and others, including the physician who
was about to marry Jack’s other daughter, Greg stood his ground. He refused
to quit nursing despite pressure from Jack. He explained why he became a
nurse despite high MCAT scores, why he found nursing more fulfilling
than he would have found medicine, and that nursing is in fact a paid pro-
fession, not volunteer work, as Pam’s ex-fiancé implied. The character might
have done more to rebut the stereotypes, but at least the film rejected them.
Greg’s tormentors were generally presented as ignorant and status-obsessed.
So although the film was built around Greg’s misadventures, he was a smart,
resourceful nurse who endured real adversity to win the woman he loved.65
Unfortunately, Meet the Fockers took several steps backward for nursing.
Greg had finally earned a place within Jack’s “circle of trust,” and he would
soon be able to marry Jack’s daughter Pam, provided that all went well at
a weekend get-together at the home of Greg’s touchy-feely parents. Greg
remained a positive character. However, the film implied that nursing is for
people who are good-hearted but not very ambitious. Greg’s father proudly
displayed a “Wall of Gaylord,” which celebrated his son’s past achievements—
mainly certificates of completion and awards for ninth-place finishes. Greg’s
201
parents said they never pushed him too hard, because it was more impor-
tant that he become a good, loving person. Jack sneered at this celebration
of Greg’s “mediocrity,” noting that competition has been a critical element in
keeping America strong. The film was not endorsing Jack’s views, but it did
regard nursing as a good vehicle to show that the heart matters as much as, or
more than, the mind.66 The stereotype that nursing is for people who are nice
but kind of slow is particularly damaging for men, who (like Greg) must often
explain what they are doing in nursing.
Little Fockers was far better. Greg again overcame misunderstandings and
small failures to show Jack why he was the right man for Pam and the two kids
they now had. By this time Greg had become a nursing manager who directed
a medical-surgical unit, wrote articles for the “AMA Journal,” and dealt with
drug representatives, including an attractive, articulate nurse who persuaded
Greg to moonlight by promoting an erectile dysfunction drug to physicians.
That nurse turned out to be a glib party girl who tried to seduce Greg. The
film did remind viewers of society’s preconceptions about men in nursing;
the director of a private school assumed that Greg and Jack were life partners
partly because Greg was a nurse. But no one really questioned Greg’s choice
of nursing. Indeed, he showed real healthcare skill on more than one occasion
in the film. In the end, Greg Focker was a regular guy and a talented health
professional who was, yes, prone to comic misfortune.67
Television portrayals of men in nursing are similarly mixed. Most of the
major Hollywood healthcare shows have occasionally included male nurse
characters. Sometimes those nurses have been bitter lackeys with no sig-
nificant clinical role. That was certainly the case with Grey’s Anatomy nurse
Tyler, the smug, petty bureaucrat who appeared in a number of episodes in
the show’s early years and who, as in 2009–2010 episodes, viewed his role as
doing as little as possible to help the physicians.68 Tyler did return in an April
2014 episode as an apparent nurse manager who claimed to be “in charge of ”
a critical care unit. But he was still doing his best to obstruct heroic young sur-
geons, refusing to lock down the unit during a flu outbreak or to provide any
nurses for a surgeon’s three patients (in Hollywood, as we have seen, nurses
are optional).69 At least the show made no issue of his gender, which was not
true with House’s Nurse Jeffrey, the effeminate nurse who tried to push back a
bit against House’s toxic commentary, notably in a November 2009 episode
in which House told him that he could not remember if “I mocked you yet
for being a male nurse.”70
Other characters in this category have been more substantial and more
clinically involved, with no real questioning of their gender, but they have still
2 0 2
acted essentially as aides-de-camp. On Miami Medical, which aired in spring

2010, Tuck Brody was a “head nurse” who projected some authority and skill,
although he was ultimately an assistant to the surgeons.71 Similarly, on the
summer 2011 show Combat Hospital, Commander Will Royal was an unusu-
ally assertive nurse manager, but to a large extent he was a logistics manager
for the trauma physician stars.72
Among the more significant portrayals on hospital shows, arguably the
most interesting have been the hunky straight nurses who report to author-
itative female physicians in apparent feminist role reversals. Grey’s had the
2010–2011 episodes with Nurse Eli. He was a swaggerer who did display some
strength and skill in advocating for patients, but as discussed in Chapter 4, he
ultimately admitted to his girlfriend, surgeon Miranda Bailey, that “inside the
hospital, you’re the man.”73
Other nurses in the role reversal category have been more evolved. The
only regular nurse character on Strong Medicine was nurse midwife Peter
Riggs, who acted as a foil to the two female physicians who dominated the
show. Riggs was gorgeous, sensitive, holistic, übersexual—check his motor-
cycle! At times he seemed to operate with some autonomy, counseling and
treating patients, but his subservience to the show’s physicians was clear. In
one episode Riggs confronted a powerful OB/GYN who had performed
an unnecessary C-section, resulting in a hysterectomy. But she threatened
to have Riggs fired, and Riggs’s boss, physician Luisa Delgado, had to save
him from the OB/GYN’s wrath. In the February 2006 series finale, Riggs did
affirm that he would rather be a nurse than a physician, resisting pressure from
his girlfriend, physician Kayla Thornton, to go to medical school. She called
it his “way out of nursing.” The show acknowledged other male nurse stereo-
types; Riggs’s own mother thought he was gay. But his main role seemed to be
to invert the paradigm of the powerful male physician surrounded by pretty
female nurses.74
With the cute receptionist and eventual midwife Dell Parker, Private
Practice discarded most of what was good about the Peter Riggs formula.75
The show initially presented Dell as a nurse with some aptitude but with-
out serious skill or experience, and it also mocked his midwifery studies.
Like Riggs, Dell was the evolved yet junior male who served the power-
ful female professionals. Unlike Riggs, Dell was mostly an empty vessel
until near the end of his time on the show. There are few male midwives
in real life, but both significant Hollywood midwife characters have been
men—because they had little to do with reality and everything to do with
the superficial “feminist” vision of the media creators. Dell’s admission to
203
medical school just before his death, although obviously empowering in

Hollywood terms, still reinforced the wannabe physician stereotype that
real male nurses face.
Even The Mindy Project has included male midwives, specifically two New
Agey men who run a holistic midwifery practice that competes with Mindy’s
traditional OB/GYN practice. It is not clear if the midwives are nurses.
A December 2012 episode presented them as “stealing” Mindy’s patients, but
she got the patients back by telling them that midwives have no significant
health training or skill, lies the show presented as hard but inescapable truths.
Still, the lead midwife was the strong, quick-witted Brendan, who point-
edly noted that midwifery predated obstetrics, and in later episodes he dated
Mindy. It is telling that the show, like Strong Medicine and Private Practice,
chose male midwives. Female midwives would not have furthered the show’s
gender goals, which here involved getting the Mindy character the respect of
male physicians—and viewers. And let’s not forget Mindy’s Morgan Tookers,
a good-hearted but odd and pathetic nurse with little apparent health knowl-
edge who instinctively defers to the physicians.76
The nurse-focused shows premiering in 2009 introduced many male
nurse characters, but they were minor and virtually all of the real expertise
and advocacy came from the females. The best of the men was Nurse Jackie’s
Mohammed (Mo-Mo) de la Cruz, a strong, witty, and skilled gay man who
seemed to be Jackie’s best friend in nursing during the first season. In one
June 2009 episode, Mo-Mo provided adroit psychosocial care to a boy who
had been badly injured in a playground fall, at one point singing softly to
him. But sadly the character left after the first season. In the 2011 season,
the show included nurse Kelly, a tough, savvy African-American man with
serious skills, but in light of his use of drugs, he was a threat to Jackie’s sobri-
ety and she eventually got rid of him.77 The show’s most prominent male
nurse character has been Thor, a large, amusing, effeminate gay man who is
intensely loyal to Jackie—almost a lapdog—but who rarely displays much
clinical expertise or strength. Recent seasons have also included the straight,
cool South Asian nurse Sam, a man who, like Jackie, is a recovering drug
addict (yes, the show has perhaps leaned a little too hard on the drugs-in-
nursing theme). In a May–June 2010 plotline, Sam broke physician Fitch
Cooper’s nose after Cooper slept with Sam’s girlfriend, who broke up with
Sam because he was a nurse. That suggested Sam was no pushover at least in
his personal life. But since then he has been mostly a Jackie sidekick, display-
ing no great skill.78
2 0 4
Mercy had Angel Lopez, a gay man who made witty remarks about the
action around him and seemed to have some health knowledge. But he was
very deferential and generally amounted to a less developed version of Thor.
In a May 2010 episode Angel did provide some good technical and psychoso-
cial care to an old friend who had been badly beaten by a local gang, defibril-
lating and even spotting a clot in the chest tube that was preventing her lung
from expanding. But his advocacy with the emergency department physician
wasn’t very strong, and the same plotline suggested that the physician con-
trolled which cases Angel worked on. It was rare that Angel played even this
limited clinical role.79
HawthoRNe’s Ray Stein was straight, he showed some skill, and he made
a couple spirited defenses of nursing, but in general he was pretty pathetic. In
the June 2009 premiere, Ray tried to protect a diabetic patient from the nasty
physician Marshall’s incorrect insulin prescription. But Ray ended up giving
the dose anyway, lamenting that he had to “follow doctors’ orders” because
“that’s what nurses do.” The patient crashed. So Ray was not much of a patient
advocate. He was also insecure because he really wanted to be a physician,
but his test scores were too low—reinforcing the damaging stereotype that
male nurses want to be physicians but are not smart enough. At times Ray
also seemed hapless; he was outmaneuvered by everyone from manipulative
patients to Larry in accounting, and during the second season, he actually had
an affair with Marshall. Ray did not appear in the show’s last season, but that
was no great loss for men in nursing.80
One of the most troubling recent portrayals of a man in nursing has been
Patsy De La Serda, the nursing supervisor of the marginalized geriatric care
unit where the HBO sitcom Getting On is set. Virtually all of the show’s main
characters are deeply flawed, but some of Patsy’s flaws feed stereotypes about
the strength and sexuality of men in nursing. Patsy seems to think he is a
serious professional. But the show suggests that he is bogus, full of the latest
corporate talk about customer service and workplace sensitivity, yet grossly
insensitive himself, weak and self-pitying, and not great with patients. His
obesity receives derision. Patsy has also used his pathetic subordinate, nurse
Dawn, for drunken sex. Yet Patsy is, or is pretending to be, confused about
his sexual orientation.81 In one December 2013 episode, Dawn reported that
she and Patsy had gone to a gay bar to find out if he was gay. Results were
inconclusive.82
ER included some fairly good portrayals of men as staff nurses. The show
always included at least one male as a recurring minor nurse character, the
straight Malik McGrath and, for a time, the gay Yoshi Takata. Both were
205
presented as competent.83 ER episodes in late 2006 and early 2007 included

traveling nurse Ben Parker, as discussed in Chapter 4.84 Parker was a love
interest for major nurse character Sam(antha) Taggart, which at least sug-
gested that nurses are not just potential physician appendages. We found
that plotline refreshing because nurses have rarely even talked to each other,
much less dated, on Hollywood shows other than the recent nurse-focused
ones. But Parker also seemed designed to present a tough, secure, skilled man
in nursing. In a November 2006 episode, he controlled a violent patient,
while nearby male physicians admitted they had been, as one said, “shown
up by a murse.”85
Scrubs illustrated the range of Hollywood portrayals of male nurses. Early
2003 episodes featured confident, witty nurse Paul Flowers (yes, a male nurse
named Flowers). Female physician Elliot dated Paul, but she struggled with
her self-esteem when she belatedly learned that he was a nurse, not a physician.
Paul also faced anti-male nurse bigotry from other physicians; they called him
a “murse” who did “women’s work,” possibly the earliest prominent use of the
term “murse.” But Paul easily rose above the slurs, and the show made sure
viewers knew the stereotypes were stupid.86 On the other hand, the ridicu-
lous February 2007 Scrubs plotline in which chief of medicine Bob Kelso
became a substitute nurse manager while nurse Carla was on maternity leave
effectively endorsed the same kind of stereotypes. The show mocked Kelso for
engaging in girly nurse activities, like gossiping with other nurses. Attending
physician Perry Cox ordered Kelso to fetch fresh scrubs and to “put on a bra,
[because he was] distracting some of the other doctors.”87
Appearances by male nurse characters on nonhealthcare dramas range
from pretty good to atrocious. Early 2014 episodes of ABC Family’s Switched
at Birth included the confident, skilled nurse practitioner Jorge as a romantic
interest of Daphne, one of the main characters. Daphne met Jorge while doing
community service at a Kansas City clinic, where he was her direct supervi-
sor. In one February episode, Jorge explained to Daphne that he had chosen
nursing because of his mother’s experience while dying of cancer. Jorge said
that physicians had “put her through hell, trying to fix her,” but the nurses had
“treated her like a person,” taking care of her mind, body, and spirit.88 Daphne
responded that Jorge had “the same gift” with patients.
From 2010–2012 the legendary UK science fiction series Doctor Who
included nurse Rory Williams, a companion of the alien Time Lord. Rory
was perhaps overshadowed by his wife, the more important companion Amy
Pond, but he was a competent, steady character who displayed wit and resil-
ience in the face of mind-bending challenges.89
2 0 6
However, other male nurse characters have reinforced the worst stereo-
types. In a December 2011 episode of ABC’s Desperate Housewives, major
character Gaby tried to get into the rehabilitation facility where her husband
was a resident by flirting with the man who controlled access. But she failed
when the man simply pointed to his chest and said “male nurse”—meaning
that he was of course gay and so not interested in Gaby. The nurse was articu-
late, but he did nothing a layperson could not do, and the first thing he did
when Gaby approached was to complain that she was keeping him from read-
ing The Help.90
An August 2010 episode of TNT’s drama Rizzoli & Isles set a standard
for male nurse mockery that would be hard to surpass.91 The show is about an
odd couple of Boston crime fighters: the swaggering, deep-voiced homicide
detective Jane Rizzoli and her super-smart, girly-girl medical examiner friend
Maura Isles. In the episode, Isles set Rizzoli up with a handsome yoga class-
mate named Jorge whom Isles said was in “medicine.” To Rizzoli’s chagrin, he
turned out to be a nurse, and a man who was determined to play a stereotypi-
cally female role in the relationship and to be a “stay-at-home daddy”—all of
which was the target of an episode’s worth of jeering from Rizzoli, despite
Isles’s half-hearted pleas that maybe a nice, supportive guy was what the some-
what abrasive detective needed. The episode mocked nursing as only “techni-
cally” a part of “medicine,” but it was more concerned with exploring gender
roles. The plot involved the murder of a woman outside a lesbian bar. Viewers
were invited to compare same-sex relationships to the Rizzoli-Isles friendship,
including its possible romantic overtones, and to Rizzoli’s relation with Jorge,
which Isles finally ended by telling him that Rizzoli actually was a lesbian.
Jorge was an ugly caricature of a traditional woman: submissive, touchy-feely,
chirpy, picky, smothering. Rizzoli’s traditionally male traits have drawn affec-
tionate ribbing, but they have been a source of power, a force for good. By
contrast, Jorge’s “feminine” traits were shown to be silly and annoying, and
his work was dismissed.
Men who actually are nurses have occasionally appeared on entertainment
television, although their roles have been limited. One of the nurses who
received some attention in the 2010 ABC documentary Boston Med was Mike
O’Donnell, an articulate Massachusetts General emergency nurse who was
shown providing supportive care and vacationing with his fellow “murses”
(really). But viewers did not see O’Donnell display a great deal of health
expertise.92 Three of the nine nurses on MTV’s reality show Scrubbing In were
men. Of course, the show was almost entirely about personal conflicts and
romantic misadventures. But a December 2013 episode did include a short
207
segment in which nurse Adrian displayed technical knowledge in providing

skilled patient education—partly in Spanish!—to a woman with diabetes.93
I Want to Be a Macho Man: Male Nurses in the News

The news media’s recent coverage of men in nursing is perhaps the least bad
aspect of the media’s overall treatment of nursing. Some pieces have candidly
discussed the “male nurse” stigma. In October 2013, the Los Angeles Times
published an in-depth profile by Ari Bloomekatz about new nurse David
Fuentes, who went from a very tough childhood to practicing in the inten-
sive care unit at UCLA Santa Monica. The piece focused on Fuentes’s per-
sonal background. But it also addressed the growing number of men in the
profession, as well as the stereotypes they confront, quoting UCLA Dean
Courtney Lyder: “Nursing doesn’t have a gender. Society and media have por-
trayed nursing as feminine. It’s not.” There were indications of Fuentes’ skill in
addressing patients’ needs, such as checking blood and oxygen flow, monitor-
ing pain, speaking softly but directly to the patients, and spending “the whole
night standing guard.” The article even included Mel Melcon’s photograph of
Fuentes working with an intensive care unit patient’s arm while looking at the
monitor, doing something technologically challenging, a rare example of a
still image that conveys something of the skill involved in nursing.94
Similarly, in July 2013 USA Today published an article by Lexy Gross enti-
tled “More men join nursing field as stigma starts to fade,” featuring a profile of
Tennessee nurse Ryan McFarland. The piece, originally from The Tennessean,
included the standard data about nursing’s slowly changing demographics,
some valuable historical perspectives, a general description of how nursing
differs from medicine, and, of course, a discussion of the stereotypes. Ryan
said his friends thought that since he “played sports in high school,” he would
“take on a more manly job. But this is a manly job. There are so many things in
this field that aren’t easy—most people don’t have the stomach for it.”95 That’s
fine as far as it goes; having what the piece called the “fortitude” to confront
“bedpans” and “moving patients from bed-to-bed” matters. But it would
have been better to stress that the work is appropriate for anyone because it
involves life-saving skills and professional autonomy.
A July 2007 profile by Christina Chin in the Star (Malaysia) described the
reaction of nursing student Irwin Choo’s parents on learning that he wanted
to pursue nursing: “His mother wept and his engineer father was dead against
it. But their reaction is not uncommon—not many parents would be thrilled
that their son has chosen to enter the medical profession as a male nurse!” The
2 0 8
reporter asked other male nursing students about the “general perception that
male nurses are ‘soft’ (effeminate)” and that “ ‘male nurse’ doesn’t exactly reek
of the ‘cool factor.’ ” In each case, she elicited confident and rational rebuttals
from the students.96
Press items that describe the work of men in nursing can be helpful
whether or not they stress gender. The April 2013 CNN piece by Elizabeth
Cohen about the efforts of two experienced nurses who provided emergency
care after the Boston Marathon bombing, discussed in Chapter 3, made no
mention of their gender—they were plainly “nurses,” not “male nurses.”97 In
June 2006 the Belfast Telegraph published Jane Bell’s portrait of “alcohol liai-
son nurse” Gary Doherty. “I’m Not a ‘Male Nurse’—I’m a Nurse and Proud
of It” did use gender as a hook, but it generally kept the focus on Doherty’s
pioneering work handling endemic alcohol-related problems at a north
Belfast hospital.98
In May 2004 Garry Trudeau’s comic strip Doonesbury featured US mili-
tary nurse Lieutenant Chance Lebon. Lebon cared for tough regular charac-
ter B.D., a soldier who had lost part of his leg to a rocket-propelled grenade
in Iraq. Lebon handled B.D.’s initial chagrin at having a male “night nurse”
by steamrolling through it, guiding B.D. through hospital life, skillfully
coordinating B.D.’s interactions with loved ones, and making irreverent
comments that reminded B.D. that he remained part of the human com-
munity. Lebon told his patient that he would not be much of a challenge,
since he had lost “only one limb.” The nurse was hoping for a “basket case.”
B.D. said he was hoping for Ashley Judd as his nurse. When B.D. declined
to be set up as a celebrity for the nearby press, despite his civilian status as a
college football coach, Lebon marveled that he must put “his pants on one
leg at a time.” B.D. wondered if that was from “the nurse’s joke manual.”
Lebon: “Number 14.”99
Still other pieces discuss affirmative efforts to attract more men to the pro-
fession to help resolve the shortage. In June 2006 the Southeast Missourian
ran a revealing story by Scott Moyers reporting that Southeast Missouri
Hospital had held a “guys-only nursing camp” to interest male high school
students in the profession. The nurse recruiter who organized the camp said
participants were “brave enough to say ‘I’m interested in nursing.’ ”100 The
students shadowed “male nurses” at work. Jared Lacy, seventeen, said he had
gotten “a little” grief about wanting to be a nurse, but his “insecurities” faded
when he learned about the salary. He added, “To see somebody come in here
sick and to help them get healthy again . . . well, I want to be a part of that.”
Of course, given peer pressure, few men have gone to nursing school right
209
out of high school. A nurse anesthetist who participated in the camp said he
“doesn’t worry about telling people what he does.” How does he handle it? “I
muster my deepest voice and say: ‘I’m a nurse.’ ” However, female nurses don’t
have to dramatically alter their voice pitch when telling people what they do.
An August 2005 piece on the New Kerala website implicitly suggested
that transnational migration stemming from the nursing shortage itself might
help close the gender gap. The story discussed the apparent surge in interest in
nursing among the men in the Indian state of Kerala, noting that local males
were being lured by the “lucrative nursing options” overseas, with 20 percent
of current Indian nursing school graduates going abroad.101
Some areas may face even deeper issues in recruiting men. In August 2009
the Times of India reported that a female judge in Madras had upheld the
Tamil Nadu state government’s decision to bar men from the state’s nursing
diploma program on the grounds that the new course syllabus included mid-
wifery (in which men can evidently play no role) and that there were already
enough “male nurses” in the few practice areas where they were needed, such
as jails and orthopedics. The underlying assumption seemed to be that nurs-
ing is essentially a female profession.102
A May 2007 Gulfnews.com piece by Nina Muslim discussed efforts to
increase the number of men in nursing in the United Arab Emirates, which
appeared to rely heavily on foreign nurses. The report said that getting
more men into nursing was especially important because they do not face
the “taboo” on women having physical contact with men in “conservative
Muslim” societies. The article reported that there were almost no male nurses
in civilian hospitals because there were few nursing programs “for men.”
Emirates Nursing Association president Saeed Fadhel said that there was “no
stigma” in men becoming nurses, although the piece suggested there was a
broader stigma—for anyone with other options.103
A September 2004 piece by Colleen Kenney in the Nebraska Lincoln
Journal Star described one of the more inventive efforts to recruit men to
nursing. “Hunky Nurses Pose for Pin-up Calendar” reported that twelve
men who were nurses appeared (clothed) in a 2005 calendar published by
the Nebraska Hospital Association. The goal was “to help get more men into
nursing and to show it’s a job for a regular guy.” The article emphasized the
calendar guys’ “male” activities, such as playing football, lifting weights, and
shooting turkeys with arrows. One nurse noted that people tend to assume
that he is doing a woman’s job, that he is gay (a word it seems he can’t quite
bring himself to utter), or that he is or soon will be a physician. But the piece
2 1 0
did not suggest that it’s wrong to look down on male nurses who are gay or
effeminate. Just don’t confuse us with them.104
These stories point to a dilemma in nursing’s issues with gender. There is
a huge incentive to address the shortage by any means necessary, even if that
means cutting some corners, including in how we promote the profession.
We might hope that nurse recruiting efforts would tell people it’s OK for
men to be nurses, whether or not they fit traditional notions of masculinity.
For example:
First male nurse: Some of us are gay.

Second male nurse: Some of us aren’t.
Female nurse: Whatever . . . What we all have in common—
First male nurse: Is that we save lives and improve public health
every day—
Second male nurse: In a challenging modern scientific career. So—
Female nurse: Do you have what it takes to be a nurse?
Can nursing persuade the public to reconsider its assumptions not only
about what work matters, but about who men and women are? Maybe it
can—if we put our pants on one leg at a time and muster our deepest voice.
Notes
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2. The Women’s Museum, Dallas, exhibit audio (visited April 2011).
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Ann Richards,” Dallas History Examiner (March 16, 2013), http://tinyurl.com/
muhprqp.
4. National Women’s History Museum, “About Us,” accessed March 26, 2014, http://
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5. International Council of Nurses, “Position Statement: Socio-Economic Welfare of
Nurses” (2009), http://tinyurl.com/kvl2dkp.
6. Mireille Kingma, “Nurses on the Move,” in Nurses—Past, Present, and Future: The
Making of Modern Nursing, ed. Kate Trant and Susan Usher (London: Black Dog
Publishing, 2010), 61.
7. Union Aid Abroad—APHEDA, “Global Nursing Industry Comparative,” accessed
March 26, 2014, http://tinyurl.com/mbe8lp7.
211
8. Mireille Kingma, “Nurses on the Move,” in Nurses—Past, Present, and Future: The
Making of Modern Nursing, ed. Kate Trant and Susan Usher (London: Black Dog
Publishing, 2010), 81.
9. TAN, “Just How Undervalued and Underfunded Is Nursing?,” accessed March 26,
2014, http://tinyurl.com/k7m4wep.
10. Anne Busch and Elke Holst, “Gender-Specific Occupational Segregation, Glass
Ceiling Effects, and Earnings in Managerial Positions,” Deutsches Institut für
Wirtschaftsforschung ( January 2011), http://tinyurl.com/kax6ek6; Paula England,
Comparable Worth: Theories and Evidence (Aldine Transaction, 1992), http://
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Power and Comparable Worth,” Work and Occupations 17, no. 4 (1990):
449–482, http://tinyurl.com/m4al298; Liebeskind, U., “Arbeitsmarktsegregation
und Einkommen: Vom Wert “weiblicher” Arbeit,” Kölner Zeitschrift für Soziologie
und Sozialpsychologie 56, no. 4 (2004): 630–652.
11. Trond Peterson and Ishak Saporta, “The Opportunity Structure for
Discrimination,” American Journal of Sociology 13 (2004): 852–901, http://tinyurl.
com/nqvrjb3; Juliane Achatz, Hermann Gartner, and Timea Glück, “Bonus oder
Bias? Mechanismen Geschlechtsspezifischer Entlohnung,” Kölner Zeitschrift für
Soziologie und Sozialpsychologie 57, no. 3 (2005): 466–493, http://tinyurl.com/
lzph7e6.
12. Karen A. Hart, “Study: Who Are the Men in Nursing?” Imprint (November/
December 2005): 32–34, http://tinyurl.com/ygua27x.
13. JWT Communications, “Memo to Nurses for a Healthier Tomorrow Coalition
Members on Focus Group Studies of 1,800 School Children in 10 U.S. Cities”
(2000), http://tinyurl.com/l2q5mma.
14. Robert Zavuga, “Uganda: Check Bias Against Male Nurses,” New Vision
(November 25, 2008), http://tinyurl.com/ktz56zs.
15. Roslyn Weaver and Ian Wilson, “Australian Medical Students’ Perceptions of
Professionalism and Ethics in Medical Television Programs,” BMC Medical
Education 11 (2011): 50, http://tinyurl.com/l3z8ss2.
17. CBS News, “Heroic Nurse, Shot 27 Times, Saved Lives” (March 30, 2009), http://
tinyurl.com/kqv2bs6.
mqcbd3l.
com/kqm3k6b.
20. TAN, “Commander” (September 2011), http://tinyurl.com/n8z5zum.
21. Karen A. Hart, “Breakthrough to Nursing National Survey Results,” Imprint
(February / March 2006): 29–33, http://tinyurl.com/yhc3qep.
2 1 2
22. CFNA, “New Zealand Herald: ‘Nursing in Terminal Decline,’ ” TAN (December 3,
2005), http://tinyurl.com/lvohzdw.
23. American Association of Colleges of Nurses, “Nursing Faculty Shortage,” accessed
March 26, 2014, http://tinyurl.com/ky5qbaj.
24. Suzanne Gordon and Ruth Johnson, “How Hollywood Portrays Nurses,”
Revolution: The Journal for RNs & Patient Advocacy 5, no. 2 (March–April 2004):
14–21, http://tinyurl.com/q2mwbal.
25. Ellen D. Baer, “The Feminist Disdain for Nursing,” New York Times (February 23,
1991): 25.
26. Holly Hobbie, Fanny (New York: Little, Brown and Company, 2008); TAN,
“Fanny” ( June 4, 2010), http://tinyurl.com/klpmcpv.
com/m3bf4lw.
28. Christopher Hampton, screenplay based on the novel by Ian McEwan, Joe
Wright, director, Atonement, Working Title Films/Relativity Media (2007);
CFNA, “Atonement” (film review), TAN ( January 13, 2008), http://tinyurl.com/
ooxmyvm.
29. Kenton Allen, Dan Cheesbrough, Matthew Justice, Jon Hamm, Saskia Schuster,
Lucy Lumsden, executive producers, A Young Doctor’s Notebook, Sky Arts/Ovation,
accessed March 25, 2014, http://tinyurl.com/k8ghrlf.
30. Anne Perry, The Sins of the Wolf (New York: Random House Publishing Group,
1994); CFNA, “The Sins of the Wolf,” TAN (September 27, 2007), http://tinyurl.
com/n5nyjmv.
31. TAN, “Grey’s Anatomy Analyses and Action,” accessed January 29, 2014, http://
tinyurl.com/pgayg7h.
pu8wxuv.
33. Mary Murphy, “The Women Who Revived ‘ER,’ ” TV Guide (February 14, 2004),
http://tinyurl.com/lvtmaqh.
34. Lydia Woodward and Lisa Zwerling, writers, Paul McCrane, director, “Ruby
Redux,” ER, NBC (April 28, 2005); CFNA, “Judas in a Lab Coat: ‘ER’ Takes on
That Whole ‘Female-Physician-Mistaken-for-a-Nurse’ Thing,” TAN (April 28,
2005), http://tinyurl.com/ksyumg7.
35. Greg Daniels and Michael Schur, creators, Parks and Recreation, NBC, accessed
June 24, 2014, http://tinyurl.com/pmy4zqz; Neil Drumming, “Goodbye to Ann
Perkins: Can Parks and Recreation Still End on a High Note?,” Salon ( January 29,
2014), http://tinyurl.com/mf4k9as.
com/kqm3k6b.
213
Mercy, NBC (September 23, 2009); TAN, “Traffic Is Backed up in the Tunnel
Heading into Respect” (September 23, 2009), http://tinyurl.com/kaqvmo7.
40. Carly Mensch and Heidi Schreck, writers, Seith Mann, director, “Sidecars and
Spermicide,” Nurse Jackie, Showtime ( June 15, 2014).
41. Ginia Bellafante, “From Iraq Hellfire to Hospital Halls, TV Nurses Wage a
Battle for Respect,” New York Times (September 23, 3009), http://www.nytimes.
com/2009/09/23/arts/television/23mercy.html; TAN, “Did You Just Call Me a
Nurse?” (October 21, 2009), http://tinyurl.com/kj2onpb.
42. Heather Havrilesky, “The Best and the Worst of the New TV Season,” Salon
(October 21, 2009), http://tinyurl.com/lhwbtxe; TAN, “Did You Just Call Me a
Nurse?” (October 21, 2009), http://tinyurl.com/k77ybxe.
43. Suzanne Gordon and Ruth Johnson, “How Hollywood Portrays Nurses,”
Revolution: The Journal for RNs & Patient Advocacy 5, no. 2 (March-April 2004):
14–21, http://tinyurl.com/q2mwbal.
44. Richard LaGravenese, writer and director, Living Out Loud, Jersey Films/New
Line Cinema (1998).
45. Linda Lopez McAlister, “Living Out Loud” Review (1998), http://tinyurl.com/
q22ve89.
46. Doug Atchison, writer and director, Akeelah and the Bee, 2929 Entertainment/
Lionsgate (2006); CFNA, “Akeelah and the Bee,” TAN ( June 7, 2006), http://
tinyurl.com/kmhqced.
47. Lisa Marie Petersen and Karen Janszen, writers, Davis Guggenheim, director,
Gracie, Picturehouse/Elevation Filmworks (2007); CFNA, “Gracie,” TAN
( June 29, 2007), http://tinyurl.com/luhzk8a.
48. Cynthis Fuchs, “Gracie,” PopMatters ( June 1, 2007), http://tinyurl.com/lf8jyry.
49. Carol Kleiman, “Pink-Collar Workers Have Own Barriers to Break,” Chicago
Tribune (December 6, 2005), http://tinyurl.com/kwa3o5u; CFNA, “Pink Ghetto
Unfabulous,” TAN (December 6, 2005), http://tinyurl.com/lja57ty.
50. Charles Dickens, “A Christmas Carol,” Literature.org (December 19, 1843), http://
tinyurl.com/yevsrpm.
51. Caitlin Flanagan, “Domestic Life: To Hell with All That,” New Yorker ( July 5,
2004), http://tinyurl.com/khultv8; CFNA, “You’ve Come a Long Way, Nurse’s
Baby,” TAN ( July 5, 2004), http://tinyurl.com/k57b584.
52. Garrison Keillor, “Nice 67 Y.O. Male Has Brush with Mortality,” Salon (September
16, 2009), http://tinyurl.com/kmrfcn5; TAN, “Staying Awake and Alert”
(September 16, 2009), http://tinyurl.com/m5mppru.
53. Sam Dillon, “Harvard Chief Defends His Talk on Women,” New York Times
( January 18, 2005), http://tinyurl.com/mq6pxts.
54. CFNA, “You Want a Career in Science? Then Why Are You Applying to Nursing
School?,” TAN ( July 1, 2007), http://tinyurl.com/m6wa2b9.
2 1 4

56. Cathryn Domrose, “Mending Our Image,” NurseWeek ( June 26, 2002), http://
tinyurl.com/l6j486c.
58. Don Anderson, “Man Enough: The 20 X 20 Choose Nursing Campaign,” Minority
Nurse (2011), http://tinyurl.com/k2jy8uc.
59. Roslyn Weaver, Caleb Ferguson, Mark Wilbourn, and Yenna Salamonson, “Men in
Nursing on Television: Exposing and Reinforcing Stereotypes,” Journal of Advanced
Nursing 70, no. 4 (April 2014): 833–842, http://tinyurl.com/mjz8qmy.
60. Joan Sosin, “Indecent Proposals: Nurses Experiencing Harassment, Discrimination
in the Workplace Are Reminded That the Law Is on Their Side,” NurseWeek
(February 28, 2003), http://tinyurl.com/mnz7xnf.
61. Thomas Schwartz, “I Am Not a Male Nurse: Recruiting Efforts May Reinforce a
Stereotype,” American Journal of Nursing 106, no. 2 (February 2006): 13, http://
tinyurl.com/k9nplkm.
62. TAN, “Jerky” (August 2013), http://tinyurl.com/kquykha.
63. CFNA, “Rap Recruiting Video,” TAN (2004), http://tinyurl.com/l7oo4tf.
mqcbd3l.
65. John Hamburg and Jim Herzfeld, writers, Jay Roach, director, Meet the Parents,
Dreamworks SKG/Universal Studios (2000); CFNA, “Meet the Parents,” TAN
(December 30, 2002), http://tinyurl.com/mtp2qqq.
66. Jim Herzfeld and Marc Hyman, writers, Jay Roach, director, Meet the Fockers,
Tribeca Productions (2004); CFNA, “Meet the Fockers” ( January 12, 2005),
http://tinyurl.com/mf6sdpf.
68. TAN, “Grey’s Anatomy: Have Fun Playing Nurse!” (August 10, 2010), http://
tinyurl.com/kg4cumk.
69. Zoanne Clack, writer, Nicole Cummins, director, “You Be Illin’,” Grey’s Anatomy,
ABC (April 3, 2014).
70. David Shore and David Hoselton, writers, Greg Yaitanes, director, “Ignorance is
Bliss,” House, Fox (November 23, 2009).
71. TAN, “Miami Medical Episode Reviews” (2010), http://tinyurl.com/pveg9xt.
72. Jinder Chalmers, Daniel Petrie Jr., and Douglas Steinberg, Combat Hospital, Global/
ABC (2011); TAN, “Commander” (September 2011), http://tinyurl.com/n8z5zum.
73. TAN, “Who’s the Man?” (October 13, 2011), http://tinyurl.com/onha8uc.
215
74. TAN, “Strong Medicine Single Episode Analyses” (2006), http://tinyurl.com/

o5q2awp.
75. TAN, “Private Practice Individual Episode Analyses” (2013), http://tinyurl.com/
lecehka.
pu8wxuv.
77. TAN, “Thank You Nurses!” (May 2012), http://tinyurl.com/kp5kder.
78. TAN, “All the Work, None of the Pay, Zero Glory” ( June 7, 2010), http://tinyurl.
com/kesj4x7.
81. Jo Brand, Vicki Pepperdine, Joanna Scanlan, Mark V. Olsen and Will Scheffer, creators,
Getting On, HBO, accessed March 24, 2014, http://www.hbo.com/getting-on.
82. Mark Olsen and Will Scheffer, writers, Howard Deutch, director, “The Concert,”
Getting On, HBO (December 29, 2013).
84. Lisa Zwerling and Karen Maser, writers, Steve Shill, director, “Crisis of Conscience,”
ER, NBC (February 15, 2007); CFNA, “Midnight in the Garden of Nurses
and Murses: Crisis of Conscience,” TAN (February 2007), http://tinyurl.com/
m6bq5ou.
85. Karen Maser, writer, Laura Innes, director, “Tell Me No Secrets . . . ” ER, NBC
(November 30, 2006); CFNA, “Midnight in the Garden of Nurses and Murses: Tell
Me No Secrets,” TAN (February 2007), http://tinyurl.com/q43xt9l.
86. Bonnie Sikowitz and Hadley Davis, writers, Ken Whittingham, “His Story,”
Scrubs, NBC ( January 30, 2003); CFNA, “Men at Work: Is ‘Scrubs’ Hurting or
Helping Male Nurses?,” TAN ( January 30, 2003), http://tinyurl.com/mzdgt2o;
Janae Bakken and Debra Fordham, writers, Marc Buckland, director, “My Karma,”
Scrubs, NBC (February 20, 2003); CFNA, “Second ‘Scrubs’ Episode with Rick
Schroder Continues Positive Depiction of Male Nurse,” TAN (February 21, 2003),
http://tinyurl.com/lkgngn5.
87. Mike Schwartz, writer, Linda Mendoza, director, “His Story IV,” Scrubs, NBC
(February 1, 2007); CFNA, “ ‘Scrubs,’ Lift Us up Where We Belong,” TAN
(February 1, 2007), http://tinyurl.com/nh2t6a5.
88. Linda Gase and Henry Robles, writers, Melanie Mayron, director, “It Hurts to Wait
with Love If Love Is Somewhere Else,” Switched at Birth, ABC Family (February 3,
2014).
89. Tardis Data Core, “Rory Williams,” accessed March 25, 2014, http://tinyurl.
com/2wurtwa.
90. Sheila R. Lawrence, writer, David Warren, director, “Putting It Together,” Desperate
Housewives, ABC (December 4, 2011); TAN, “Seriously? Male Nurse.” (December
4, 2011), http://tinyurl.com/ko46osz.
2 1 6
91. Alison Cross, writer, Michael Zinberg, director, “I Kissed a Girl,” Rizzoli & Isles,
TNT (August 16, 2010); TAN, “I Kissed a Male Nurse Girl” (August 16, 2010),
http://tinyurl.com/kt7zf5u.
92. Terence Wrong, executive producer, Boston Med, ABC (2010); TAN, “Physicians
Are Awesome” ( July 22, 2010), http://tinyurl.com/o7m9olh.
93. Dave Caplan, Mark Cronin, and Shannon Fitzgerald, executive producers, “God
Save the Queen,” Scrubbing In, MTV (December 13, 2013).
94. Ari Bloomekatz, “A Nurse Who Is Healing Patients and Himself,” Los Angeles
Times (October 9, 2013), http://tinyurl.com/okjkle2.
95. Lexy Gross, “More Men Join Nursing Field as Stigma Starts to Fade,” Tennessean,
republished in USA Today ( July 10, 2013), http://tinyurl.com/k8ade96.
96. Christina Chin, “Nursing a Dream,” The Star ( July 9, 2007), http://tinyurl.com/
pmd6kou.
97. Elizabeth Cohen, “Nurses Relied on Trauma Experience to Help Bombing
Wounded,” CNN (April 16, 2013), http://tinyurl.com/kxy4wns; TAN,
“Everyone Worked in Tandem” (April 17, 2013), http://tinyurl.com/k4mun2n.
98. Jane Bell, “I’m Not a ‘Male Nurse’—I’m a Nurse and Proud of It,” Belfast Telegraph
( June 28, 2006), http://tinyurl.com/lzg2huk; CFNA, “A Time to Dance,
A Time to Mourn,” TAN ( June 28, 2006), http://tinyurl.com/nye8pe7.
99. Garry Trudeau, “Doonesbury” (May 21, 2004), http://tinyurl.com/lxtgeyb;
CFNA, “Chance the Good,” TAN (May 29, 2004), http://tinyurl.com/
m5mhjgn.
100. Scott Moyers, “Camp Urges Males to Consider Career in Nursing,” Southeast
Missourian ( June 28, 2006), http://tinyurl.com/k6xyv8q.
101. New Kerala, “Kerala Male Nurses Storm Traditional Female Bastion” (August 23,
2005), http://tinyurl.com/n8oxeh6; CFNA, “Could Shortage-Driven Migration
Change Nursing’s Gender Gap?,” TAN (August 23, 2005), http://tinyurl.com/
kq69n44.
102. The Times of India, “HC Upholds Govt’s Decision Not to Admit Boys in Nursing
Course” (August 20, 2009), http://tinyurl.com/k8fajum; TAN, “Boys Don’t
Nurse” (August 20, 2009), http://tinyurl.com/knoa5bv.
103. Nina Muslim, “Emirati Men Urged to Become Nurses,” Gulf News (May 14,
2007), http://tinyurl.com/mqnpgdf; CFNA, “Stigma,” TAN (May 14, 2007),
http://tinyurl.com/pp4yb3n.
104. Colleen Kenney, “Hunky Nurses Pose for Pin-Up Calendar,” Lincoln Journal Star
(September 18, 2004), http://tinyurl.com/l4ltqda; CFNA, “Nursing that Pesky
Y Chromosome,” TAN (September 18, 2004), http://tinyurl.com/moqfdj5.
7
YOU ARE MY ANGEL
One night in the late 1980s, we were at a party on DC’s Capitol

Hill. A female law student, meeting a nurse friend of ours for the
first time, asked what the nurse did for a living. Upon learning the
answer, the law student brightened and replied, “Isn’t that sweet!
That’s what I wanted to be when I was in kindergarten!”
The nurse—who had worked all the previous night using her
bachelor of science degree to save sick children’s lives—was amused.
Two decades later, nurses are still widely regarded as angels of
mercy, noble spiritual beings, or loving mothers. The New York
Times’ annual “Tribute to Nurses” has included real stories of nurs-
ing achievement, but the advertising supplement has promoted
them with a focus on touching, feeling, and warming hearts.1
When television psychologist Dr. Phil tried to make amends for his
nurse-as-gold-digger comments, his praise for nursing relied largely
on soft helping imagery.
Compassion and caring are important parts of nursing. But
the extreme emphasis on “angel” qualities reinforces the prevail-
ing sense that nurses are all about touching and feeling rather than
thinking or using advanced skills. It suggests that nurses, as virtuous
spiritual beings, have little need for clinical resources, education,
rest, or security. The angel stereotype deters men and women (con-
sider that law student) from entering the profession. It implies that
nurses should meet certain moral and sexual standards that are not
a proper part of the modern workplace. It is another in the matched
set of feminine stereotypes that plague nursing, along with the
naughty nurse and the battle-axe. Collect them all! Nursing has.
The angel image is not just something society has forced on
nurses. Many nurses and their supporters continue to embrace
and perpetuate it. Johnson & Johnson’s ( J&J) long-running
Campaign for Nursing’s Future, which aims to address the nursing
shortage, has run sentimental television advertisements about “the
2 1 8
importance of a nurse’s touch” and similar concepts.2 However, it is unlikely

the nursing crisis has occurred because the public forgot those aspects of
nursing. Nurses have had input on the advertisements, and many nurses
have defended them. Similarly, many stories that nurses present to the public
about their work rely heavily on emotional themes, as in popular books like
Chicken Soup for the Nurse’s Soul (2001).3 In Lee Gutkind’s introduction to I
Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse
(2013),4 the respected Creative Nonfiction editor described the book’s stories
this way:
[A]‌ll of the essays have a common theme: No matter how difficult

nurses’ lives or how secret their suffering, becoming a nurse entails
movement into another dimension of strength and character and per-
sistence; it is a path of irreplaceable and often unacknowledged service
to society and humanity. All nurses will understand the message inher-
ent in the title of this book. It is the theme of survival, the theme of
maturity, the theme of selflessly treating and healing all patients in any
way possible, whether the credit that is due is forthcoming or not.
Those themes have value. But extolling nurses’ “service,” their “secret suffer-
ing,” and their working “selflessly” even without getting the “credit” they are
due reflects another “common theme”: the angel stereotype.
Of course, the angel image has deep roots. Nursing was traditionally seen
as a religious vocation, and the perception of moral purity gave women social
license to provide the intimate care nursing involves. That care requires great
strength and inspires genuine appreciation. But the angel image operates not
only to exclude nursing from consideration as a serious modern profession
but also to discourage nurses from advocating for themselves—and their
patients. Like Jacob in the Bible, nurses must wrestle and overcome the angel.5
What’s Wrong, Angel?

The angel image of nursing pleases some, but it has fatal flaws.
The image fails to convey the college-level knowledge base, critical think-
ing skills, and hard work required to be a nurse. If nurses are angels, then per-
haps they can care for an unlimited number of patients, although research
shows fewer nurses means higher patient mortality.6 Maybe nurses can endure
inordinate levels of workplace stress and abuse from patients and colleagues,
7 You Are My Angel •
219
as recent research suggests they do.7 Maybe nurses can work mandatory
overtime, because they don’t have children at home who need care, food, or
clothing. Angels don’t need rent money; they live in heaven. Angels don’t eat
or go to the bathroom, so they can work thirteen-hour shifts without even
a moment’s break, as many nurses must do today. Angels don’t even need
manna from heaven, which is a good thing, because many nurses don’t have
time to eat it! The stereotype suggests that nurses are loving nurturers who
need no say in healthcare decision-making or policy. If nurses suffer in such
conditions, some may view it only as evidence of nurses’ virtue, not a reason
to alter the conditions. Likewise, it may be unclear why angels need well-paid
professors or years of college-level education: after all, they’re mostly just
holding hands and lifting spirits.
In everyday conversation, it is more common for women than men to be
described as angels. This fact may discourage men from entering nursing. The
angel and related maternal stereotypes also complement the “naughty nurse”
and the repressed battle-axe images. All define nurses by dubious visions of
female sexual extremes, from Madonna to whore, rather than by nurses’ pro-
fessional skills or effort. Indeed, some feel that putting nurses in these boxes is
a way for vulnerable male patients to reassert their traditional power over the
females who now appear to control their lives in the hospital.
In the popular imagination, angels are pure and gentle. But patient advo-
cacy may require that nurses assertively challenge an established system or
proposed course of action. Florence Nightingale was no “angel.” The com-
mon image of Nightingale holding a lamp may suggest faithful virtue at the
bedside, but in fact she was a bright, aggressive, flawed human being who
made lasting scientific and social contributions.8 That lamp was not just a
beacon of hope, but a tool and symbol of the relentless 24/7 surveillance and
intervention that is the nursing practice model, as we explained in Chapter 1.
Monitoring patients and rescuing them when needed is one way nurses keep
people alive.
In Buresh and Gordon’s From Silence to Voice (2013) and in Gordon’s
Nursing Against the Odds (2005), the authors document the roots, nature,
and effects of what they call the “virtue script” of nursing, as we also discussed
in Chapter 1.9 The authors show how nineteenth-century reformers created
a respectable job for women by using that moral script and assuring physi-
cians that nurses were no threat to them. Indeed, nurses’ historic oppression
by physicians parallels the oppression of women by men. The authors argue
that because of nurses’ socialization in the virtue script and the imperative to
“say little and do much,” most nurses still display a bone-deep self-effacement
2 2 0
and fear of controversy. Even many nursing scholars, Buresh and Gordon
note, define the profession mainly in bland relational terms. Angel imagery
buries nurses’ real knowledge and skill, and that may suit some physicians,
who receive the credit and resources nursing would otherwise claim. But the
authors contend that nurses must overcome their fears and stop disrupting
their own “definitional claims” by reinforcing stereotypes. Similarly, in the
2006 essay collection The Complexities of Care: Nursing Reconsidered (edited
by Sioban Nelson and Suzanne Gordon), nursing scholars argue persuasively
that the prevalence of “caring discourse” within nursing is a key factor in soci-
ety’s failure to value nurses’ knowledge and skills.10 The unsurprising result is
that the beleaguered profession often does not get the resources it needs to
provide good patient care or protect the well-being of nurses themselves.
We sometimes hear that leaving the angel behind would mean abandoning
compassion in nursing, and that that special quality is what sets nurses apart.
We agree that nurses must be compassionate. But when nursing is described
mainly in terms of female love and devotion, the public views nursing in the
same way—not as the work of highly skilled professionals of both genders,
but as the work of nuns, or a kind of paid mothering service. Of course, the
emotional support nurses give is actually psychosocial care shaped by their
training and experience. It does have real health benefits, and it is not some-
thing that just any nice person could do.
We think what sets nursing apart is the combination of technical prow-
ess, psychosocial skills, and mental toughness that good nurses have. But
the media tends to ignore the “harder” aspects of nursing, such as nurses’
advanced skills and the stress they endure. Gordon notes that while she values
nurses’ emotional support, if given a choice between a compassionate nurse
and one who could save her life, she would take the life saver. The public must
understand that side of nursing in order for the current crisis to be resolved.
Nursing has topped the Gallup public opinion poll measuring the “hon-
esty and ethical standards” of different professions every year since nursing
was added to the poll in 1999, except in 2001 when firefighters led the list fol-
lowing the 9/11 tragedy.11 Those results go hand in hand with the prevailing
vision of nurses as devoted and angelic. But if everyone loves nurses so much,
why has a global shortage rooted in a lack of resources and understanding
been taking lives worldwide since 1998? Because, we think, what those polls
measure has little to do with the real respect that determines how scarce eco-
nomic and social resources are allocated. Yet even some nursing leaders have
embraced the “honest and ethical” label as a reason that policy makers should
221
address nurses’ concerns. It seems to us that patients trust nurses to hold their
wallets while they’re in surgery but not to save their lives. Some professions
near the bottom of the Gallup list—such as law and advertising—do not
seem to lack willing workers, good working conditions, or social status. We
wonder how many of the people who trust nurses so much would react if their
child announced that he or she wanted to be a nurse.
In July 2004 the American Journal of Nursing published an op-ed by
Margaret Belcher entitled “I’m No Angel: I Am a Nurse—and That’s
Enough.”12 Belcher wrote that while nurses liked imagery focusing on com-
passion, such imagery did not make her proud. She argued that the emphasis
on self-sacrifice has led to burnout and compassion fatigue. With unusual
courage and insight, Belcher got to the heart of the “angel myth”:
I have the education and experience to do for others what they can-
not do for themselves. But it’s the intimacy of the work that feeds
the angel myth. I listen to patients, touch them, reassure them, help
them eat and drink, assist them with bodily functions. They are often
ashamed of their need for help, and they’re grateful to be treated with
respect. . . . I don’t exist on a higher plane because I work at the bed-
side. . . . But to call nursing a job rather than a calling isn’t to diminish
it. I will not stop touching lives if I refuse to call the work magic. I will
not be a failure if I give up self-sacrifice for self-care. Nurses have not
learned this lesson well. If we indeed were to put ourselves first, per-
haps there wouldn’t be a nursing shortage.
As we often hear on airplane flights, we must put on our own oxygen masks
before we can help others.
Many “angel” comments from patients and families seem to result from
the nurse’s cleaning up poop in a way that preserves the patient’s dignity.
Responding to unpleasant tasks and patient abuse with control and respect
may encourage people to call nurses angels. But attributing this difficult work
to spiritual grace does the humans who actually perform it a disservice. At the
same time, nurses are rarely called angels for detecting a deadly symptom or
advocating for a life-saving intervention.
As we explained in Chapters 2 and 4, studies from around the world have
confirmed that nurses face a high level of abuse from colleagues and patients.
Research often points to institutional reluctance to address such abuse. Nurses
commonly receive inadequate support. Of course, abuse of women is often
2 2 2
discounted. But nurses in particular may be expected to simply “get over it”
because they are spiritual beings with a vocation who do not suffer like others
do. Angels don’t get posttraumatic stress disorder.
As Belcher noted, there remains plenty of support for the angel within
nursing. In fact, a December 2007 editorial in the popular RN magazine
urged nurses to “put an end to angel bashing.”13 The author asserted that the
image arose from nurses’ helpful behavior with patients and that getting rid
of the image would require nurses to stop being helpful. Some responding
letters suggested that the angel is better than some of the alternatives and
that jettisoning the image would entail moving to the other extreme. Nurses
would lose their focus on “caring” and become harsh technicians. However,
neither the image nor the reality of nursing must be confined to stereotypical
extremes. We believe that the public is capable of seeing nurses as the three-
dimensional beings they are: strong, skilled professionals of both genders
who excel at both technical tasks and the psychosocial work often described
as “caring” and “compassion.”
‘Bless This Angel of Mercy’ Nurse Collectible Figurine!

Angel imagery continues to infect the media’s treatment of nursing. These
images range from casual references to in-depth portrayals, from daytime tele-
vision to the print press. Let’s look at some notable examples.
Angels Everywhere
For some in the media, the word “angel” is interchangeable with “nurse.” In
January 2007 the Scotsman ran Angus Howarth’s “Robot Nurses Could Be
on the Wards in Three Years, Say Scientists.”14 The piece reported that the
“mechanised ‘angels’ ” would “perform basic tasks such as mopping up spill-
ages, taking messages and guiding visitors to hospital beds.” These “angels”
aren’t exactly working at the core of patient care, are they? In January 2005
the Guardian (UK) website posted Jamie Doward’s “Row Erupts over Secret
Filming of Hospital Filth,” about a television documentary for which two
nurses used hidden cameras to document “appalling conditions” at two British
hospitals. The documentary was named Dispatches: Undercover Angels.15
When it comes to nursing, angel imagery remains a staple for a wide vari-
ety of media creators. Television personality Dr. Phil tried several times to
make amends for his 2004 comments suggesting that many nurses were out
223
to marry physicians in order to avoid “having to work as a nurse,” which we

discussed in Chapters 3 and 5. In a December 2004 statement he assured
viewers that the “men and women” in nursing are “dedicated,” “devoted,”
“extremely well-trained,” and “the backbone of the medical profession.” He
also noted that no matter “how much technological advance we make with
machines to monitor patients, machines can’t do the loving, nurturing care
that a nurse can do, can’t have the judgment, can’t have the wisdom and can’t
be replaced by machines.” Machines do help nurses assess patients and plan
care. But Dr. Phil’s statement suggests that maybe technology really does do
everything except for nurses’ “devoted” “loving” and “nurturing.” Most of his
comments paint nursing as a physically demanding support vocation focused
on emotional care.16
In April 2005 the Dr. Phil show aired “Stories of Survival,” which featured
two victims of violence who were living with permanent facial disfigurement.17
They were a former deputy sheriff named Jason and Dr. Phil’s sister-in-law
Cindi Broaddus. The idea was to help Jason and his family, using Cindi as an
inspirational example. Another guest was nursing assistant Daphne, who had
helped Cindi during her recovery. Dr. Phil, Cindi, and Clarice Marsh, direc-
tor of pediatric nursing at UCLA, offered brief testimonials for nursing as the
underappreciated “backbone” of health care, as Dr. Phil again put it. In fact,
the media commonly describes nurses as the “backbone” of the health system,
as NPR Morning Edition host Renee Montaigne did in a May 2012 report
on nurse understaffing.18 But we’re still waiting to hear a media reference to
nurses as the “brains” of the system.
The 2005 Dr. Phil episode mostly suggested that nurses are virtuous, hard-
working hand-holders. Clarice Marsh did say that nurses are “incredibly intel-
ligent” and that their work is “multi-faceted.” She also said that in nursing
“the art is the relationship” and that nurses form a “bond” that can’t be found
anywhere else. Dr. Phil said Daphne was a “wonderful example” of that. Yet
nursing assistants, who have minimal training, are not nurses. Dr. Phil said he
did not think Cindi would have made it without the “tremendously inspired
and dedicated” nursing staff. Cindi agreed that nurses were “wonderful, won-
derful.” But no one explained specifically what nurses do for patients. During
her four minutes on screen, Daphne did not utter one word that was audible
to viewers. The last shot in the segment was a close-up of the nursing assistant
and Cindi holding hands.19
The print press is hardly immune to that kind of imagery. In June 2010 the
Seattle Times published a piece by Sharon Randall, a nationally syndicated
columnist, that was built around the comic idea that Randall was acting as
2 2 4
a “home nurse” in caring for her child when he was a newborn as well as for
her husband after a recent operation.20 Randall threw in positive accounts
of the care she and her child had received from real nurses, those “compas-
sionate” “angels” whose work is apparently defined by “loving kindness” and
“tender mercy,” phrases she used twice. Randall made clear that she was a very
imperfect “nurse.” But it was evident that the reason she fell so short was
temperament, rather than education. So her equating of her unskilled care
with actual nursing reinforced the idea that nursing requires little skill. The
subtext—which no one would take as a joke—was that what makes a real
nurse is kindness, patience, and endurance.
For years the New York Times has published an annual “Tribute to Nurses”
advertising supplement and it has given related awards, in recent years for
achievement in areas including research and leadership. But to gather the sto-
ries it includes, the paper has also used language like this, from April 2007:
The New York Times invites you to share your personal story in The
Nursing Diaries. Whether heartwarming or humorous, we want to
know your inspirations, challenges, lessons learned and experiences
that have left a footprint on your heart forever.21
A footprint? Despite that (presumably unintentional) nod to the stress of

nursing, the stories that the Times has collected with that kind of language
have tended to reinforce the sense of nurses as virtuous angels rather than
life savers. Note the paper’s use of the word “heart” twice in a single sentence.
In September 2006 the Liberty Times (Taiwan) profiled Chuan Ya-lan, a
young nurse who had “become lauded by the Taichung Hospital as an angel
for her service.”22 Chuan showed “an extraordinary degree of patience with
the patients, and everyone comment[ed] how nice she [wa]s.” Indeed, Chuan
was “a model in terms of having the compassion and expertise required of a
nurse.” A manager said many new graduates could not cope with the “heavy
workload and stress” of handling at least eight patients at a time, and most
resigned “after a relatively short period.” But Chuan “never complained
about the workload.” This piece’s “angel” focus (despite the passing reference
to “expertise”) suggested that nurses are relatively unskilled spiritual beings
who can be expected to make inhuman sacrifices. We might see a willingness
to assume an enormous patient load without complaint as laudable devo-
tion—or as a sign that nursing is too weak to stand up for itself or its patients.
A nurse may be able to endure a patient load of eight or more, but as research
shows, her patients cannot.23
225
Even generally helpful press pieces may not be able to resist the angel.
In January 2014, the NL News Now site of St. John’s (Newfoundland and
Labrador) posted an article by Wesley Harris about protests over the elimina-
tion of a local clinic nurse position. The piece was headlined “She Was Like
Our Guardian Angel.” A local official reportedly justified the move with “sta-
tistics to show that the skill set of the registered nurse in the Hermitage Clinic
wasn’t always the best use of resources—in other words Tammy Hollett often
did clerical duties (taking appointments, filing, etc).” The official also sug-
gested that the clinic’s physician might now do some of the things Hollett
had done, “like EKG’s and blood pressure.” Protester Melita Goods said she
had often visited the clinic with her diabetic husband, noting that “Tammy
was like a guardian angel to us.” Even where, as here, the angel imagery seems
to have been drawn from a comment from a news source, the media should
consider whether amplifying such comments is fair—especially when other
information makes clear that nurses have a valuable “skill set” that enables
them to do things like EKGs and blood pressure. As we have noted, celebrat-
ing nurses as “angels” rather than cost-effective professionals who improve
outcomes has not proved sufficient to protect them from the kind of cost-
cutting described in the piece itself.24
In March 2009, the Kampala-based magazine The Independent published
an article by Mubatsi Asinja Habati about the challenges of nursing in Uganda,
and in particular, the good work of veteran midwife Irene Nabukeera.25 The
article said that nursing could be “very stressful,” the pay was not high, and
there was a risk of contracting deadly diseases. However, Ugandan nurses who
decline to go abroad to work “find that saving lives makes up for the stress.”
Despite a lack of many specifics, the piece did give a sense of how important
and difficult nursing work is in a nation without many clinical or educational
resources. Unfortunately, the title of the article, “Nurses—Uganda’s Angels,”
reinforced the idea that nurses are spiritual beings that may not really need
those resources.
Of course, some pieces revel in the idea that nurses are pure spiritual
beings. In June 2005 the Age (Melbourne) ran “Saint Be Praised,” Brian
Courtis’s profile of actress Georgie Parker and her television character, a
nursing manager on the popular Australian hospital drama All Saints.26 One
good passage suggested that television’s heroic health worker narrative may
actually undermine efforts to ensure adequate health care funding, but the
piece reinforced stereotypes that have the same effect. Parker, the “saintly
practitioner of the blessed art of medical melodrama,” was leaving All Saints
after years of “compassionate caring” as “much-loved nurse Terri Sullivan.”
2 2 6
The character’s “enigmatic, soulful and spiritual bedside manner produced

miracles” for patients. “Critics loved her, and now network beatification must
surely follow.” (In fact, beatification is one step toward sainthood; canoniza-
tion is the actual making of the saint. There’s a whole course on this in nursing
school.) The report concluded that “St. Terri” had earned her place in the
“stained-glass windows of soap opera.”
Be that as it may, overt angel imagery has not played a significant role in
recent television dramas. Maybe producers just don’t think it would make for
compelling, persuasive drama for key viewer demographics today. The recent
nurse-focused shows have not focused on handholding, instead showing that
nurses have advanced technical skills and that they can push back against poor
physician care. Granted, one Mercy nurse was named Angel Lopez.27 In the
June 2009 premiere of Nurse Jackie, nurse Zoey Barkow told Jackie she was
an “angel,” startling the normally unflappable veteran.28 One reviewer actually
found the crusading lead character in HawthoRNe too “saintly,” despite the
prickly manager’s endless conflicts with everyone from physicians to nurses
to her teenage daughter.29 The nurse midwives of Call the Midwife, some of
whom are nuns, have at times been surrounded by a sort of holy glow as they
rescue poor mothers in distress.30 But aside from the endlessly wise Sister
Julienne, the midwives also argue, snipe, make mistakes, struggle with a lack
of resources, date men, and most importantly, display healthcare expertise
and autonomy. On the whole, the flawed, street-smart characters in recent
nurse-focused dramas have been no more “angelic” than the physician heroes
of other shows.
But commercial media sources still rely on angel imagery. In February
2005 Tickle, then the “leading interpersonal media company,” offered an
online test called “Who’s Your Inner Nurse?”31 The lighthearted test offered
respondents a series of stereotypes. One question invited nurses to report that
patients found them gentle, cheerful, dependable, or selfless. We guess there
wasn’t quite enough room for “expert” or “savvy.” Another question gave test
takers the chance to specify that they wouldn’t “make [their] rounds without”
their “stickers and lollipops.”
Speaking of lollipops, starting in 2008 and continuing until at least early
2014, an Angela Moore jewelry catalog featured Nurse Nancy bracelets com-
posed of four different types of balls strung together.32 The balls showed a
smiling nurse in a white uniform giving a balloon to a girl, a ladybug next to
a stethoscope, a nurse’s cap with a thermometer, and a stuffed bear holding
flowers next to a lollipop. In 2008, the promotional text asked readers to buy
the jewelry to “celebrate the ladies who give lollipops and band aids a whole
227
new meaning.” We contacted Angela Moore about this imagery, and by 2014
the text had improved somewhat: “Here’s a special theme to celebrate the
wonderful nurses who promote health and do such valuable work. Talented,
terrific and leaders to love!” However, the bracelet’s soft and fuzzy images
remained the same.
But that’s nothing. For years, companies like Precious Moments have
offered figurines that present nurses as noble, selfless, sweet, tender, loving,
wonderful, maternal, faithful, special, devoted, cuddly, comforting, gentle,
delicate, blessed, adorable saints—and those are the edgy ones. In 2004 the
marketing copy for Precious Moments’ Bless This Angel of Mercy Nurse
Collectible Figurine noted that it would be just the thing for the “special
nurse” who gives you “comforting attention and care.”33 As for the Special
Delivery Nurse Figurine, a teddy bear nurse holding a teddy bear newborn:
Faithful Fuzzies Nurse is “Beary” Special . . . No matter how long her

shift is, you won’t hear this faithful nurse complain, because cradling
this little miracle in her arms is reward enough for her sincere devo-
tion. That’s because her job requires the “gentle art of caring”—it’s
more than hard work, it’s “heart” work!34
This virtuous “nurse” had no complaints no matter how bad conditions were!
The Sending Love from Above Figurine nurse dispensed a “dose of ‘loving,
caring and sharing’ ” wherever she went, from her “delicate angel wings” to
her “adorable nurse’s bag filled with pink pearlized heart-shaped messages of
faith and love.”35 In 2013 Precious Moments was still selling products along
these lines, including the Loving Touch Nurse36 and, of course, the You’re an
Angel nurse.37
Don’t get us wrong: we don’t object to this imagery in isolation any
more than we do to sexual imagery. Fusing it with the profession of nursing
is the problem.
Nurse or Mom?
Some press items present the nurse as professional mother, no matter how
skilled or authoritative she may be, or how good the story may otherwise be.
In October 2007 Time magazine profiled US Navy Commander Maureen
Pennington, the “first nurse to lead a surgical company during combat
operations.” Caroline Kennedy’s “Beyond the Call of Duty” highlighted
Pennington’s leadership, communication, and cross-cultural skills. But even
2 2 8
so, the piece focused on vague helping imagery. A physician’s assistant said
Pennington was “like a mom to all of us.” Pennington herself said she under-
stands Marines: “Being a mother, I know you also have to be willing to be
hated in order to be loved. I knew it was up to me to make sure that there were
rules and structures in place because people need those too when the world is
falling apart.”38 OK, but even a tough, able mother would not necessarily have
Pennington’s advanced science training and clinical skills. Although we heard
all about what kind of mom she was, there was nothing in the story about her
education. In fact, she had a master’s degree in nursing.39
Similarly, in January 2006 the Detroit Free Press ran a generally good story
by Patricia Anstett about Wayne State University nurse practitioner Mary
White. Although the piece focused on White’s innovative methods, which
included health-oriented Jeopardy! contests and “condom bingo” in the dor-
mitories, it unfortunately also noted that White is “a nurse first and foremost,
with all the loving compassion the term typically conveys.” Yuck. Later, read-
ers were told that White was “all pro, plus surrogate mom.” One sophomore
referred to White as “like a mom to me now.” White herself described her
appeal to the students this way: “I’m the mom image, but I’m safe because I
don’t lecture them.” But Mom does not know how to titrate life-saving medi-
cations. And Mom is not hosting condom bingo.
The Fallen Angels

The media also takes an intense interest when nurses fail to be noble angels,
when they are seen as too demanding or uppity, when they’re promiscuous or
irreverent, or when they’re malevolent “angels of death.” Despite the obvious
differences, in all of these cases nurses have failed to follow the virtue script.
The Strivers Who Have Forgotten Their Place

Some nurses seem to misplace their heart-shaped messages of faith and love.
In August 2009 the UK press carried many items about a recent report
detailing cruelty and neglect by some nurses. A Times column by Minette
Marrin argued that the problems stemmed not from a lack of resources but
from a “cultural collapse” within nursing.40 Marrin attributed that decline
partly to efforts to increase nurses’ “professional status with a university
degree,” which had led them away from “old-fashioned bedside” care. The
headline was “Fallen Angels: The Nightmare Nurses Protected by Silence.”41
Marrin returned to the theme with a November 2009 piece in the Sunday
Times attacking a government plan to require that all nurses have a three- or
229
four-year university degree by 2013. Marrin argued that the plan would have
“disastrous” effects primarily because it would exclude those who would make
“excellent” nurses even though they were “not particularly academic” or “not
particularly bright.”42
Similarly, in August 2011 the Telegraph published “Nursing Is No Longer
the Caring Profession.” Christina Odone’s piece argued that a controversial
UK program in which nurses were to wear “do not disturb” tabards while on
drug rounds to reduce errors was emblematic of a system in which nurses saw
patients as a “nuisance” to be “ignored” as the nurses worked their way up to
a “desk job.”43 Odone, like Marrin, could tell that the real culprit was nurses’
aspirations to higher education. In particular, compulsory university degrees
“professionalised” what had been a “vocation,” so that the former “angel[s]‌of
the ward” became too uppity for “soothing fevered brows and administering
TLC.” In fact, compassion and diligence are essential qualities for nurses, and
allegations of abuse and neglect must be addressed. But nurses are not angels
giving simple custodial care. They need university education because they
need advanced skills to save lives and improve outcomes.
In mid-2006 anonymous UK physicians published op-eds designed to
discourage the government from allowing nurses to move into clinical roles
that have traditionally been the province of physicians. “Are Nurses Angels? I
Don’t Think So”44 ran in the Daily Mail, and “Why Nurses Are No Angels”45
appeared in the Independent and the Belfast Telegraph. These paternalistic
essays urged the National Health Service to stop assigning nurses new roles,
a practice that had supposedly 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. Maybe their
halos would reappear.
Christie Blatchford’s column “Militant Angels of Mercy,” in a June 2003
edition of Canada’s National Post, yearned for the days when nurses were
“kind” and “loved, if not always respected.”46 Blatchford claimed nurses had
not received much public support for their work battling SARS because too
many had become “outright shiftless or worse, just plain mean.” One problem
was that nursing had “come to be deemed a capital-P profession, as opposed
to a calling,” so that people became nurses as much for “opportunities or pay
or perquisites” as to help the ill. Maybe Blatchford would prefer a system in
which patients perished because the nurses were angelic but unskilled vol-
unteers: at least we’d die smiling! Blatchford linked the alleged decline in
nursing care to nursing militancy. But she failed to reconcile this self-seeking
2 3 0
militancy with the ongoing nursing crisis, which has included a global short-
age and often atrocious working conditions.
Promiscuous Girls
Needless to say, nurses may also fall from grace through sex and drugs. Thus,
if someone were to create a television series about hot young female nurses
hooking up, it might be called No Angels.
Oh wait—that actually happened. In February 2004 the Times (UK)
published nurse Vici Hoban’s piece about a new Channel 4 drama called
No Angels. The show had aimed to “explode the myth of angels by the bed-
side” and provide “a witty and truthful exposé of nursing” in the modern
National Health System.47 But the first episode showed the nurses “laugh-
ing 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.”48 The show lasted three seasons. In September 2004 Reuters
reported that No Angels was “up for translation into a Stateside version.”49 But
that show did not appear, and we heard no more until September 2013, when
Variety reported that ABC had landed a version of the show to be run by sev-
eral US sitcom veterans. The item noted that the “laffer centers on a raucous
group of female nurses who work together and live in the same house.”50 Let
the laffs begin!
The Angel of Death

Sadly, as in any profession of millions, there are a very small number of dan-
gerously troubled nurses. Not surprisingly, coverage of their bad acts tends to
highlight their deviation from the virtue script.
In November 2004 Reader’s Digest ran Max Alexander’s generally fair cover
story on Charles Cullen, a nurse who had pled guilty in New Jersey to having
killed thirteen patients with drug overdoses, and who by his own account may
have killed twenty-seven more. Cullen was shown to have a history of troubled
relationships, mental illness, and substance abuse. The headline was “The Killer
Nurse,” and the internal subhead was “Why No One Stopped the Angel of
Death.” Of course, the contrast between the usual angel stereotype and Cullen’s
actions made for a great story. Similarly, in April 2013, CBS’s 60 Minutes aired
the first televised interview with Cullen. Even the legendary news show could
not resist the angel, titling its report “Angel of Death: Killer Nurse Stopped, but
Not Soon Enough.”51 Because the interview was news, it got coverage in places
like The Daily Mail, whose headline quoted the phrase “ ‘Angel of Death.’ ”52
231
The Cullen story appears to have inspired a December 2004 episode

of NBC’s short-lived prime-time show Medical Investigation, a drama that
followed a team led by heroic National Institutes of Health physicians.
The show generally presented nurses as peripheral handmaidens, but they
finally got some attention in “The Unclean.” In that episode, after suspi-
cious deaths at a Baltimore hospital, the investigators searched for infec-
tion control problems. They finally realized that some “angel of death”
had been infecting patients with a bloody sheet. Although the physicians
were initially suspicious of a weasely nurse, he turned out to have been the
whistle-blower (although he got no credit). The team ultimately found that
the “angel of death” was in fact a meek, helpful nurse who had gained access
to experimental bacteria and, like the real-life Cullen, had left a trail of sus-
picious patient deaths at her prior jobs. The show did not explore why she
might have done it.53
That reticence was missing from an astonishing April 2004 op-ed in the
Philadelphia Inquirer. In “Nursing Compassion to Health,” NYU forensic
psychiatrist Michael Welner actually argued that Cullen’s murders were the
result of the modern emphasis on “material” benefits in the training and hir-
ing of hospital workers.54 To reverse this trend, healthcare facilities should
“focus on hiring those with the most compassionate personalities.” Apparently
Cullen was not an aberrant sociopath, but just an extreme example of what
nurses have become.
Employment ads solicit health-care workers based on material ben-

efits. Whom, then, will such ads aim to attract? Not the nuns of yester-
year. . . . So we need to integrate vigorous empathy training and stress
management into medical and nursing education. . . . Tomorrow’s
professionals need to be prepared for the adverse climate of providing
health-care services within institutional frameworks that are insensi-
tive by design.
So the answer to “insensitive” care systems lies not in restructuring health-

care financing or better oversight, but simply in hiring nicer people with bet-
ter stress management skills! Nurses are spiritual beings that don’t need the
substantive training and resources on which other professions rely to ensure
high performance. It was not clear if Welner’s emphasis on selflessness and
compassion in health care extended to his own lucrative New York consult-
ing practice, the Forensic Panel. Since the time of the Inquirer piece the
Panel’s website has extolled the advanced credentials of Welner and the other
2 3 2
consultants at “the preeminent consultation practice in America.” One of its

FAQs gives a nuanced answer to the vexing question “Are the services of the
Forensic Panel costly?”55
The Angel Within

Arguably the most striking angel imagery appears in statements by nurses
and their advocates. Consider that each year on May 12, the anniversary of
Florence Nightingale’s birth, nurses around the world celebrate Nurses Day;
in the United States, there is a whole Nurses Week!56 Of course, this is the
classic form of sentimental recognition for groups that don’t get enough real
respect or resources the rest of the year. As one might expect, on these occa-
sions there is a flood of angel stereotyping.
Perhaps it’s not surprising that nonnurses who want to express support
for nurses conceive of nursing in terms of divine virtue, given the profession’s
history. It seems to be the first thing that occurs to many patients. In a widely
reported June 2013 speech about mental health awareness, US Vice President
Joe Biden mentioned his personal experience with neurosurgery and opined
that “if there’s any angels in heaven, by the way, they’re all nurses.”57 When
the Cincinnati Children’s Hospital invited people to thank its nurses dur-
ing Nurses Week 2013 by posting Facebook messages, there was a predict-
able gush of angel commentary from parents (e.g., “They really are Gods
Angels!!!!”).58 In that same week, Huffington Post blogger Lisa Lori thanked
her son’s pediatric intensive care unit nurses for providing “comfort” and
“love,” holding hands, hugging, crying, and enduring verbal abuse—but not
for their life-saving skills.59 In a February 2008 article in the Chronicle Herald
(Nova Scotia), “Let ‘Angels’ Spend More Time Nursing,” a grateful cancer
patient said his nurses were “the closest I have ever met to angels.”60 And in a
June 2007 piece from Boston’s State House News Service, “Nurses Demand
Stronger Protections Against On-the-Job Violence,” the husband of a nurse
who had been assaulted referred to nurses as “angels in scrubs.”61
Hospitals often use angel imagery, stressing the emotional, nontechni-
cal aspects of nursing. Maine Coast Memorial Hospital’s Nurses Week page
informs us that “Nursing is the gentle art of caring” and “Nurses are Angels
in comfortable shoes.”62 For Nurses Week 2012, Saint Peter’s University
Hospital in New Brunswick, Canada, launched a program called “Angels of
Caring,” in which patients and their families nominate nurses or other staff
to be recognized through a donation to the hospital.”63 Each December New
Jersey’s Shore Medical Center honors members of its staff (overwhelmingly
233
nurses) with “Guardian Angel” awards—a name that at least hints at nurses’
real role as sentinels for patients.64 The University of Texas Medical Branch
celebrated Nurses Week 2012 by giving out “Silent Angel Awards,” with the
“silent” element seeming to reinforce the longstanding imperative for nurses
to remain docile and not seek further recognition or resources.65
Nurses themselves continue to embrace this kind of imagery. The 2012
feature film Nurses: If Florence Could See Us Now, directed by nurse Kathy
Douglas, offered some helpful information about the diversity and rewards
of nursing practice. But it was dominated by vague, emotional imagery, with
little about what nurses do specifically to improve patient outcomes. The
movie featured footage from interviews with more than one hundred US
nurses, but what the director chose to include in the film focused on passive
handholding. Interviewees emphasized what a “privilege” it is to be a nurse,
noting that the profession involves “bearing witness” to pain and suffering,
without much indication that nurses are key players in averting that suffering.
The film seems unlikely to teach laypersons much about nursing that they do
not already know.66
Some nursing groups have had themes for Nurses Day that emphasize
nurses’ substantive achievements, but even those groups have not been consis-
tent. In 2010 the Geneva-based International Council of Nurses (ICN) used
“Delivering Quality, Serving Communities: Nurses Leading Chronic Care.”
In recent years, ICN themes have been based on United Nations health devel-
opment goals, such as “Closing the Gap: Millennium Development Goals 8,
7, 6, 5, 4, 3, 2, 1” (2013)67—no one could find the angel in there. However,
from 2000 to 2002, each ICN theme included the emotional phrase “Always
there for you.”68 ICN also sells the “Florence Nightingale Teddy Bear” to raise
funds for its worthy Girl Child Education Fund, which pays for the educa-
tion of orphaned daughters of nurses in the developing world.69 “Florence”
the teddy bear is better than Precious Moments products—at least she has
a lamp, bag, and bandages, like she actually does something useful—but she
still associates professional nursing with cuddly children’s dolls.
The American Nurses Association (ANA) adopted as its 2003 Nurses Week
theme the angel-tastic “Nurses: Lifting Spirits, Touching Lives.”70 In 2000 the
ANA’s “Nurses: Keeping the Care in Health Care”71 implied that nurses focus
on “care” while someone else (guess who!) takes the lead on “health.” The group’s
2011 theme, “Nurses Trusted to Care,” was emotional and vague.72 Fortunately,
more recent ANA themes have been much better: “Nurses: Advocating,
Leading, Caring” (2012),73 “Nurses: Delivering Quality and Innovation in
Patient Care” (2013),74 and “Nurses: Leading the Way” (2014).75
2 3 4
The angel also appears in nursing specialty groups’ promotional efforts.

In October 2013, the International Association of Forensic Nurses (IAFN)
unveiled a new logo and tagline. The tagline was all right (“Leadership. Care.
Expertise.”). So was the image of a magnifying glass (science!). But the mag-
nifying glass was focusing on a Greek cross and a heart. IAFN explained in
a press release that the redesign project was led by Shoestring, a “nonprofit
branding and public relations agency,” and that “the heart inside the magnify-
ing glass represents the care and compassion of the dedicated nurses in the
field.”76 Many IAFN members felt that some rebranding was in order.77
Perhaps most ironic is the tendency of media aimed directly at resolving the
nursing shortage or recruiting nurses to use angel imagery, particularly when
that seems to serve a different institutional agenda. In 2002 J&J initiated the
massive Campaign for Nursing’s Future to address the nursing shortage and
increase interest in nursing careers. The company financed an extensive nurs-
ing website, raised funds for faculty fellowships and student scholarships, and
sponsored the helpful 2004 recruiting video Nurse Scientists: Committed to
the Public Trust.78
But the J&J campaign project with the greatest influence was undoubt-
edly the television advertisements. The theme of the early advertisements
was “the importance of a nurse’s touch.”79 The spots included a few elements
suggesting that nurses had some skill, and the young nurses who appeared
were diverse. But the soft-focus advertisements relied mainly on angel and
maternal imagery. The three spots that began airing in 2005 all featured the
same semi-cooing female narrator, the kind of voice used to advertise cuddly
products for babies. The opening: “At Johnson & Johnson, we understand the
importance of a nurse’s touch.” The closing: “Nurses: we need you more than
ever. A message of caring from Johnson & Johnson.” One advertisement used
the word “touch” five times in thirty seconds.
The focus on “caring” and “touching” in such images clearly serves the
business interests of a major pharmaceutical company. J&J has long tried to
project a baby-soft image to consumers, even as the company has made head-
lines for things like suing the American Red Cross for trademark infringe-
ment,80 and in 2013, paying billions in fines for illegally marketing drugs81
and billions more to settle claims that it had knowingly sold defective hip
implants,82 among other serious publicity problems.83 In April 2013, the
New York Times reported that J&J had launched an emotional new “brand-
ing campaign” called “For All You Love”—with an advertisement featuring
family scenes and voiceover about what “love is”84—“perhaps to distance
itself from the bad press of product recalls and pending litigation.”85 Similarly,
235
fusing the J&J brand with the angel stereotype of nursing reinforces the idea
that the company is as honest and ethical as nurses are seen to be.86 But that
convergence does nursing no favors.
In 2007 J&J unveiled two new spots.87 Those advertisements did not
abandon angel imagery, particularly in the use of gooey music with lyrics
about being “born to care,” which suggested that nursing is more of a divine
vocation than a profession requiring intensive training. But both spots did
emphasize that nurses are not just angelic hand-holders. They made clear that
nurses save lives and improve outcomes, even offering specific examples, like
defibrillation. One advertisement paid tribute to nurse educators, showing
the impact they have through their students.
Three more J&J advertisements appeared in 2011.88 These spots, like those
released in 2005 and 2007, conveyed something helpful about nursing skill.
But each advertisement focused mainly on the emotional support nurses give
patients, and each concluded with the vaguely uplifting message “NURSES
HEAL.” One featured an authoritative emergency nurse reacting quickly to
a trauma case, but even that one was dominated by the nurse’s returning of
a lucky charm to the patient. The other two advertisements, in which a hos-
pice nurse and a pediatric nurse used good psychosocial skills to help patients
through hard times, were also likely to strike viewers as being mostly about
hand-holding.
More recently, the J&J Campaign sponsored a program called “Amazing
Nurse 2013” that aimed to identify and show the public exceptional nurses.
But despite passing references to knowledge and skill, the main themes were
angel-oriented. The program website explained:
In celebration of [nurses’] dedication, we want to highlight Amazing

Nurses who make a difference in your life and the lives of those around
you. Nurses take care of and heal so many of us - now let your Amazing
Nurse know how much you care.89
In June 2013, the J&J Campaign’s “Nursing Notes” Facebook page promoted
the Amazing Nurse program with a poster that read: “Nursing is not just an
art, it has a heart. Nursing is not just a science, but it has a conscience.” Oh,
right, and is nursing not just about caring, but also teddy bearing?90 In January
2014, the Campaign’s Facebook page featured a poster telling us that nursing
is “truly about caring hearts in action.”91
In 2007 the University of Michigan ran radio advertisements featuring
men describing why they became nurses at the university.92 The spots seemed
2 3 6
to be directed at recruiting nurses and nursing students, although they may

also have been part of the university’s capital campaign. The nurses came
off as substantial people whose work has real meaning. Sadly, the advertise-
ments relied on generalized, emotional angel imagery. We heard about the
nurses setting up a summer camp for disabled kids, getting smiles, loving
what they did and not looking at it as a “job,” “helping” kids fight cancer,
inspiring and being inspired. But nowhere did listeners hear what nurses
actually do for patients.
In March 2009 the National Organisation of Nurses and Midwives
of Malawi began a campaign to persuade the nation to provide the funds
needed to train and retain more nurses and midwives. The campaign was
launched to try to help a profession hobbled by low pay and workplace
abuse, as well as a critically high level of nurse migration and the resulting
“brain drain.” Unfortunately, the campaign was called “Soon There Will Be
No Angels on Earth.”93
For Nurses Week in May 2011, the major US managed healthcare group
Kaiser Permanente ran a sixty-second radio advertisement that may have been
the most extreme presentation of angel imagery that we have ever seen. The
spot called nurses “noble” and “selfless,” then went on about their “colossal”
“capacity to care,” their “superhuman” “sympathy,” their “heart” of “compas-
sion,” their “love,” and how the self-effacing givers endure their exhausting,
disgusting jobs without complaint. There was a passing reference to being
“tough,” but the advertisement also stressed that “mothers nurse their chil-
dren.” The angel imagery here was so undiluted by any hint that nurses are
educated professional humans that it arguably worked to undermine the
claims of Kaiser’s 45,000 nurses to adequate resources, to persuade them that
their obligation was to endure the unendurable. Some nurses loved the adver-
tisement; maybe it’s hard to see what’s wrong with a series of gushing compli-
ments, especially when they play into what society has long told nurses sets
them apart. But as long as nurses are defined solely by their “gargantuan heart
all squishy with compassion thumping away”—yes, the Kaiser advertisement
script really said that—nurses will not get the respect or resources they need.94
Transcending the Angel: What Can Be Done?

Because angel imagery is so deeply embedded both in the public conscious-
ness and nursing culture, overcoming it will be a challenge. But it can be done.
Nurses can have a public image that acknowledges the value of caring and
237
compassion, but that also shows respect for nursing as a skilled modern pro-
fession. Any of the media items discussed elsewhere in this book that present
nurses as educated, life-saving professionals counter the angel stereotype.
The recent nurse-focused television dramas have subverted the angel to
some extent, particularly the flawed but virtuosic lead character in Nurse
Jackie. In an April 2013 episode, Jackie intubated a head trauma patient
when no physician was available.95 Despite that display of technical skill, the
patient’s family member called Jackie an “angel.” In response Jackie gave a tiny,
polite smile and quickly turned away, muttering “Far from it,” an apparent
reference to her own ongoing struggle with drug abuse.
In May 2005 the California Nurses Association (CNA) vowed to cele-
brate Florence Nightingale’s birthday by staging a protest at the San Francisco
offices of J&J.96 CNA’s press release argued that the company had supported
recent efforts to limit the political participation of nurses and other public
employees, and asserted that it had donated huge sums to defeat measures
designed to lower drug prices in California. The union said its protest hon-
ored the “legacy of the original nurse activist.” Whatever the merits of CNA’s
specific position, its protest contradicted the inaccurate image of Nightingale
and the nurses who have followed her as cuddly saints.
In October 2006 the Boston Globe posted a poll on its website after a
successful nurses’ strike in Worcester. As we noted in Chapter 3, the text
described contracts under which the “average nurse . . . working a 40-hour
week makes $107,000 a year,” and the poll asked whether the nurses “deserve
this six-figure salary for what they do.”97 The nurses’ union, the Massachusetts
Nurses Association, urged nurses to respond to the poll by explaining why
they were worth the money. The union reminded nurses, “You work in one of
the most dangerous professions (you’re injured as much as construction work-
ers, you’re assaulted more than prison guards), you deal with deadly infectious
diseases; you hold life and death in your hands every minute of every shift.”
The Los Angeles poetry magazine Rattle placed a “Tribute to Nurses” in
its Winter 2007 issue.98 The forty-five–page section included only nurses’
own work. You might think the “tribute” approach would lead editors right
to the angel image, but Rattle offered insightful essays and well-crafted, irrev-
erent poems that captured modern lives and deaths without sentiment. The
poems suggested the scope of patients’ lives through their physicality, their
frailties, their suffering. To some extent we also saw nurses’ complex, difficult
inner lives. The tribute presented nurses not as angels but as keen observers
and courageous workers who help us in our darkest hours.
2 3 8
In 2004 nurse Craig Barton and other emergency department staff at the
University of Alabama at Birmingham created an irreverent one-minute rap
recruiting video.99 The video was a clever and infectious slice of the life of an
urban emergency department nurse. In the video, nurses moved toward the
camera, strutting and grinning, as Barton rapped about their work. We heard
about starting intravenous lines and handling a heart patient with a “positive
history” who needs “a twelve-lead EKG.” More lyrics: “Ka-boom! We’re the
UAB emergency room! And we treat every single patient from the womb to
the tomb!;” “We’re ER nurses! Medications we disburses!;” “We expect the
unexpected! That’s why we’re well-respected!;” and “Yo, we’re savin’ lives up
in here!” Barton’s engaging focus on nurses’ life-saving, technical skill, and
team spirit was a welcome alternative to the sentimental imagery in many
recruiting efforts. This one kept it real.
In the third season of the BBC Sherlock Holmes adaptation Sherlock,
broadcast in early 2014, the godlike genius’s sidekick Dr. John Watson mar-
ried nurse Mary Morstan, with whom Watson worked at a clinic. (Spoiler
alert!) Morstan did not get the chance to do too much clinically. But she
was a clever, savvy woman who seemed to display a confident knowledge
of patient conditions—not to mention being finally revealed as a formida-
ble ex-CIA assassin who nearly killed Holmes yet ultimately remained an
ally of the Baker Street duo. Nothing says “no angel” quite like that sort of
plotline.100
Notes
1. New York Times & Monster, “Tribute to Nurses” (2006), http://tinyurl.com/
kptwyej.
2. TAN, “Johnson & Johnson Nurse Television Commercials” (2011), http://tinyurl.
com/pc42jyt.
3. Jack Canfield, Mark Victor Hansen, Nancy Mitchell-Autio, and LeAnn Thieman,
Chicken Soup for the Nurse’s Soul: Stories to Celebrate, Honor and Inspire the Nursing
Profession (Deerfield Beach: Health Communications, Inc., 2001).
4. Lee Gutkind, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming
a Nurse (Pittsburgh: In Fact Books, 2013), http://tinyurl.com/bpmzb9f.
5. Genesis 32:22–32, The Bible, English Standard Version, accessed March 28, 2014,
http://tinyurl.com/kdamkrc.
March 26, 2014, http://tinyurl.com/ancmo7r.
7. Dianne M. Felblinger, “The Impact of Violence in the Nursing Workplace and
Women’s Lives,” Journal of Obstetric, Gynecologic, & Neonatal Nursing 37, no. 2
239
(March/April 2008): 218, http://tinyurl.com/l9rtt63; Dianne M. Felblinger,

“Incivility and Bullying in the Workplace and Nurses’ Shame Responses,” Journal
of Obstetric, Gynecologic, & Neonatal Nursing 37, no. 2 (March/April 2008):
234–242, http://tinyurl.com/lsehhn4; John S. Murray, “On Bullying in the
Nursing Workplace,” Journal of Obstetric, Gynecologic, & Neonatal Nursing 37, no. 4
( July/August 2008): 393, http://tinyurl.com/mpqaddf.
8. Victoria Sweet, “Far More Than a Lady With a Lamp,” New York Times (March
3, 2014), http://tinyurl.com/l6rbu8l; Florence Nightingale Museum, “Florence’s
Biography,” accessed June 17, 2014, http://tinyurl.com/mppnene.
University Press, 2013); Suzanne Gordon, Nursing Against the Odds: How Health
Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nursing and
Patient Care (Ithaca: Cornell University Press, 2005).
10. Sioban Nelson and Suzanne Gordon, eds., The Complexities of Care: Nursing
Reconsidered (Ithaca: ILR Press, 2006).
11. Gallup, “Honesty/Ethics in Professions,” Poll of December 5–8, 2013, accessed
March 26, 2014, http://tinyurl.com/lcer8a; TAN, “Are Nurses Angels of Mercy?,”
accessed March 26, 2014, http://tinyurl.com/l96jpyb.
12. Margaret Belcher, “I’m No Angel: I Am a Nurse—and That’s Enough,” American
Journal of Nursing 104, no. 7 ( July 2004), http://tinyurl.com/q2tr7lc.
13. Terri Metules, “Let’s Put an End to Angel Bashing: It’s Far Scarier to Think of
What We Would Have to Do to Get Rid of the Angel Image,” Modern Medicine
(December 1, 2007), http://tinyurl.com/lvslpug.
14. Angus Howarth, “Robot Nurses Could Be on the Wards in Three Years, Say
Scientists,” The Scotsman ( January 22, 2007), http://tinyurl.com/lrxd4rg; CFNA,
“Interaction and Intelligence,” TAN ( January 22, 2007), http://tinyurl.com/
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CFNA, “Feel Good, Inc.,” TAN ( July 14, 2005), http://tinyurl.com/n6opthx.
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(May 25, 2012), http://tinyurl.com/7kf9eab; TAN, “Are Your Knuckles White?”
(May 25, 2012), http://tinyurl.com/nhdpoas.
19. “Stories of Survival,” Dr. Phil ( July 14, 2005), http://tinyurl.com/mc4w796;
CFNA, “Feel Good, Inc.,” TAN ( July 14, 2005), http://tinyurl.com/n6opthx.
2 4 0
20. Sharon Randall, “Confessions of a Home Nurse,” Scripps Howard News

Service/Seattle Times ( June 10, 2010), http://tinyurl.com/mhuodzw; TAN,
“Confessions of a Non-Nurse” ( June 10, 2010), http://tinyurl.com/mog8eua.
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com/kqd8qc3.
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com/k32jlsv.
January 29, 2014, http://tinyurl.com/ancmo7r.
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( June 19, 2005), http://tinyurl.com/mdpj4sd.
27. Liz Heldens, creator, Mercy, NBC (2009–2010), http://tinyurl.com/qzmwxvr;
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( June 8, 2009); TAN, “The Henchman of God” ( June 8, 2009), http://tinyurl.
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29. Joanne Ostrow, “ ‘Dark Blue’ Promising as TNT’s Summer Hit,” Denver Post
( July 3, 2009), http://tinyurl.com/ksze6cq.
com/m3bf4lw.
31. CFNA, “Tickle: Is the Best Thing About Nursing ‘Meeting Hot Doctors?’ Ha Ha!
Just Joking!,” TAN (February 8, 2005), http://tinyurl.com/n3k56bo.
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http://tinyurl.com/kabv3ls.
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com/o4c6alf.
241
38. Caroline Kennedy, “Power of One: Beyond the Call of Duty,” Time
(October 25, 2007), http://tinyurl.com/k6ao7qv; CFNA, “The Commander,”
TAN (October 25, 2007), http://tinyurl.com/kos766y.
39. Naval Hospital Bremerton, “Command Leadership,” US Navy, accessed March 26,
2014, http://tinyurl.com/k8jb4q4.
40. Minette Marrin, “Oh Nurse, Your Degree Is a Symptom of Equality Disease,”
The Sunday Times (November 15, 2009), http://tinyurl.com/pdkgd5g; TAN,
“Fighting Equality Disease” (November 15, 2009), http://tinyurl.com/m239pxv.
41. Minette Marrin, “Fallen Angels: The Nightmare Nurses Protected by Silence,” The
Sunday Times (August 30, 2009), http://tinyurl.com/q3khrhu; TAN, “Fighting
Equality Disease” (November 15, 2009), http://tinyurl.com/lxx32t5.
42. Minette Marrin, “Oh Nurse, Your Degree is a Symptom of Equality Disease,”
The Sunday Times (November 15, 2009), http://tinyurl.com/pdkgd5g; TAN,
“Fighting Equality Disease” (November 15, 2009), http://tinyurl.com/m239pxv.
43. Cristina Odone, “Nursing Is No Longer the Caring Profession,” The Telegraph
(August 28, 2011), http://tinyurl.com/3e73la9.
44. The Daily Mail, “Are Nurses Angels? I Don’t Think So” ( July 18, 2006), http://
tinyurl.com/n7vzq3x; CFNA, “These Days There’s Far Too Much Emphasis on
Academia and an Overwhelming Desire to Achieve an Equal Status with Doctors,”
TAN ( July 25, 2006), http://tinyurl.com/mgw3chm.
45. The Independent, “Why Nurses Are No Angels” ( June 20, 2006), http://tinyurl.
com/lmj2r2f; CFNA, “These Days There’s Far Too Much Emphasis on Academia
and an Overwhelming Desire to Achieve an Equal Status with Doctors,” TAN
( July 25, 2006), http://tinyurl.com/mgw3chm.
46. Christie Blatchford, “Militant Angels of Mercy,” The National Post ( June 7, 2003),
http://tinyurl.com/m4sdajc; CFNA, “National Post’s Blatchford: Bring Back the
Handmaidens,” TAN ( June 26, 2003), http://tinyurl.com/mf6vu6e.
47. Vici Hoban, “A New Nursing Drama Leaves Former Nurse Vici Hoban Ill at Ease,”
The Times (February 28, 2004), http://tinyurl.com/m4sld5v.
48. Simon Heath, Helen Gregory, executive producers, No Angels, Channel 4
(2004–2006), http://tinyurl.com/mkyeukh.
49. Hollywood Reporter, “ ‘No Angels’ Set to Nurse U.S. Viewers” (September 21, 2004),
http://tinyurl.com/msw78wb.
50. AJ Marechal, “ ‘My Name Is Earl’ Alums Set Nurse Comedy at ABC,” Variety
(September 26, 2013), http://tinyurl.com/ldx5pmm.
51. Tom Anderson, Graham Messick, and Michelle St. John, producers, “Angel of
Death: Killer Nurse Stopped, but Not Soon Enough,” 60 Minutes, CBS (April 29,
2013), http://tinyurl.com/kz4egqa.
52. Daily Mail, “ ‘Angel of Death’ Nurse Who Murdered at Least 40 Patients to
Become One of America’s Worst Serial Killers Speaks from Prison for the First
Time to Chillingly Claim: ‘I Thought I Was Helping’ ” (April 29, 2013), http://
tinyurl.com/cngeylo.
2 4 2
53. Mark Dodson, writer, Elodie Keene, director, “The Unclean,” Medical Investigation,
NBC (December 3, 2004); CFNA, “Hungry Ghosts,” TAN (December 3, 2004),
http://tinyurl.com/k67f4w8.
54. Michael Welner, “Nursing Compassion to Health,” Philadelphia Inquirer (April 30,
2004), http://tinyurl.com/n5yrzq8; CFNA, “NYU Physician – Charles Cullen
Killing Result of Widespread Materialism, No Compassion,” TAN (April 30,
2004), http://tinyurl.com/nxh6z3p.
55. The Forensic Panel, “Frequently Asked Questions: Are the Services of The Forensic
Panel Costly?,” accessed February 16, 2014, http://tinyurl.com/kpkee3s.
56. American Nurses Association, “National Nurses Week,” accessed March 27, 2014,
http://tinyurl.com/crzyprh.
57. US Vice President Joseph Biden, Remarks at the National Conference on Mental
Health, The White House ( June 3, 2013), http://tinyurl.com/m4otmbc; TAN,
“Come with Me If You Want to Live” ( June 3, 2013), http://tinyurl.com/kqqkov9.
58. Cincinnati Children’s Hospital Medical Center, “In Celebration of National
Nurses Week” (May 9, 2013), http://tinyurl.com/m5p9o34.
59. Lisa Lori, “Happy Nurses Week,” Huffington Post (May 10, 2013), http://tinyurl.
com/kv4fh4h.
60. Cancer Advocacy Coalition of Canada, “Not Just About Money: The Cancer
Advocacy Coalition’s 2007 Report,” businesshealth ( July 2008), http://tinyurl.
com/odf5yoq.
61. “Nurses Demand Stronger Protection Against On-the-Job Violence,” Seachange
Bulletin ( June 27, 2007), http://tinyurl.com/qzq42yf.
62. Maine Coast Memorial Hospital, “National Nurses’ Week May 6th–May 12th,”
accessed March 27, 2014, http://tinyurl.com/kejmcz3.
63. Jennifer Bradshaw, “Saint Peter’s University Hospital Celebrates National Nurses
Week,” New Brunswick Patch (May 9, 2012), http://tinyurl.com/mw5qye8.
64. Shore Medical Center, “Shore Medical Center Honors Guardian Angels at Annual
Pinning Ceremony” (December 18, 2013), http://tinyurl.com/lhr3vvq.
65. The University of Texas Medical Branch, “Celebrating Nurses and Hospital Week”
(May 23, 2012), http://tinyurl.com/kht7n2q.
66. Kathy Douglas, director, If Florence Could See Us Now, First Run Features (2012),
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67. International Council of Nurses, “Closing the Gap: Millennium Development
Goals 8, 7, 6, 5, 4, 3, 2, 1” (May 10, 2013), http://tinyurl.com/mw9n25f.
68. International Council of Nurses, “2002 - Nurses Always There for You: Caring for
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243
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2 4 4
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8
W I N N I N G T H E B AT T L E - A X E ,
LOSING THE WAR
Nurse Linda S. Smith once entered the room of a young male inpa-
tient to give him his medications. The patient “grinned and naugh-
tily paraphrased the words he had just read on one of his [get-well]
cards: ‘Nurse, are you coming in to give me one of those famous
sponge baths? If you are, I’m ready!’ ” On his nightstand, one card
showed a sexy young nurse offering sponge services. That much is
hardly news—just another hostile work environment linked to the
naughty nurse image.
But when Professor Smith and her students at Oregon Health
and Science University later conducted a study of such greeting
cards, they found more than the expected naughty nurse themes.
There was also a focus on what an August 2003 Oregon Public
Broadcasting piece about the study called the “sadistic shot giver.”
As Smith wrote in Nursing Spectrum:
Patients may believe the greeting card image that [the nurse]
will cause fear and anxiety, often threatening to inflict
pain while using devices such as syringes, thermometers,
or whips. . . . Disguised as humor, this disrespect and lack
of understanding echoes back to the hard, commanding,
uncaring image of Nurse Ratched in the movie One Flew
Over the Cuckoo’s Nest.1
Nurse Mildred Ratched is indeed the modern archetype of the

nurse as battle-axe. Milos Forman’s classic 1975 film adaptation
of Ken Kesey’s novel captured the antiauthoritarian spirit of the
1960s counterculture. In the movie, Randle McMurphy was a char-
ismatic roughneck who engineered a transfer from a work farm,
where he had been serving a sentence for assault, to an Oregon
state mental health facility he thought would be easier. He joined
2 4 6
a unit of men with psychiatric problems. Ratched dominated the unit, lead-
ing the patients in what at first seemed like actual group therapy and offering
calm, rational explanations for an array of rules. But McMurphy gradually
realized that Ratched was a cunning sociopath who psychologically tortured
those she was ostensibly helping, aided by the meek Nurse Pilbow. Ratched
manipulated the young patient Billy through his fear of his mother, mak-
ing Billy feel that his interest in sex was evil. Meanwhile, as absentee male
physicians debated whether McMurphy was really ill, McMurphy worked to
undermine Ratched’s authority. He led the patients on forbidden adventures
involving wine, women, and song, which plainly promoted more healing than
Ratched’s joyless regime. As McMurphy’s refusal to conform instilled a sense
of independence in the other patients, Ratched resorted to increasingly harsh
measures to maintain control, with tragic results.
Nurse Ratched was a repressive soul killer. Even her name evokes words
like “rat,” “wretched,” and “hatchet.” The film offered no positive counterex-
ample or explanation for her behavior, such as burnout after years in a difficult
care setting. Ratched could be a warning about the potential for abuse in the
nursing profession, but she can’t be separated from the film’s views of women
generally. They were either emasculating, antisex mother figures like Ratched;
spineless mice like Pilbow; or easy, giggling facilitators like McMurphy’s girl-
friend, whose name was Candy. The movie indicted establishment power struc-
tures, suggesting that real men must reclaim their power and freedom from
the oppressive modern state. But the film seemed to place the blame mostly
on Mom, who just won’t let boys be boys. Of course it doesn’t make much
sense: women were not the main creators of those power structures. But no
one said misogyny was rational. Evidently, Ratched is what happens when you
do give women control. What kind of place is it where a nurse has more power
than the physicians? A twisted, unnatural place, dominated by the Other.
The other important modern battle-axe was the Margaret “Hot Lips”
Houlihan character who first appeared in the film M*A*S*H. Robert
Altman’s innovative 1970 movie about a US Army surgical unit in the Korean
War, based on the 1968 novel by Richard Hooker, mockingly dissected those
involved in the military’s effort there. The dark comedy was another anti-
authoritarian classic with a viscerally misogynistic approach. The nurses who
appeared fell into the categories of naughty, handmaiden, and/or battle-axe.
Major Houlihan, the unit’s new chief nurse, was a martinet aghast at the
unmilitary conduct she found. She and the inept surgeon Frank Burns tat-
tled to the military brass in Seoul, and they began a cringe-inducing affair,
although he was married. In response, the film’s heroes, the cynical surgeons
8 Winning the Battle-Axe, Losing the War •
247
Hawkeye and Trapper, engineered a nasty invasion of privacy that humili-

ated Burns and Houlihan. Then our heroes implemented a plan to determine
Houlihan’s true hair color that the film found hilarious, but which has some-
thing in common with gang rape. After that, “Hot Lips” was more docile,
Trapper praised her nursing, and she seemed to earn some redemption by
joining the surgeons’ boyish fun.
In the popular M*A*S*H television series that followed (1972–1983), the
depiction of nursing was better. The show’s nurses were still mostly assistants
and easy romantic foils for the surgeons, who received virtually all the credit
or blame for patient outcomes. But the series showed some actual nursing,
and there was little doubt about Houlihan’s authority over the nurses, her
nursing skills, or her commitment to the patients. As the series went on, she
grew increasingly sympathetic. Unlike Ratched, Houlihan made a clear posi-
tive difference for patients. However, especially in the early years, she was still
a fairly pathetic figure, grasping at power and petty discipline—and a man
to fill the void in her career-dominated life, a struggle that was the subject of
endless mockery. Houlihan was far more than a battle-axe, but the influential
character still suggested that strong nurses are control freaks driven by half-
repressed romantic urges.
Ratched and Houlihan set the standards for a certain type of fictional
nursing image in later decades: the older female nurse as bitter crone and
vindictive bureaucrat, often with at least a hint of sexual frustration or
even aggression. In general, the battle-axe inverts both the maternal/angel
image and the naughty image, as Figure 8.1 illustrates. She is yet another
one-dimensional female extreme, a way to put women in their place if they
are doing something you don’t like. It may be that this image has resonated
because of patients’ feelings of vulnerability and anxiety at being at the mercy
of female caregivers who would normally be in a subservient social position.
The classic battle-axe has appeared in many Hollywood products, often as the
nasty enforcer of hospital rules that are presented as oppressive or trivial, even
though some are actually vital to the patient’s recovery.
A recent variation on the classic battle-axe is the malevolent hottie, a sexu-
ally aggressive young “nurse” who poses a real or mock threat to patients or
others, as we noted in Chapter 5. This fictional image, which we might call
the “naughty-axe,” has appeared in connection with films, advertisements, and
video games. Perhaps foreshadowed by the naughty elements of “Hot Lips”
Houlihan, the naughty-axe seems to invert only the maternal stereotype. The
naughty-axe does not oppose sex. But because the image does associate sexual-
ity with danger, it is true to the underlying spirit of the classic battle-axe.
2 4 8
Figure 8.1 Nursing’s Sex-Related Stereotypes: A Bermuda Triangle of Professional

Imagery.
In 2012, part of the Oregon State Hospital where One Flew Over the
Cuckoo’s Nest was filmed became a Museum of Mental Health that provides a
forum to reconsider past treatment of psychiatric patients.2 But nurse battle-
axe imagery has persisted in the media, largely unquestioned. Why is that,
since women have far more power in the workplace now? Do some nurses
really act like vindictive martinets? Of course some do, as in any profession.
That is especially unsurprising for an underpowered profession in the midst
of a long staffing crisis. But battle-axe portrayals typically provide little bal-
ance or context to explain why some nurses might act that way. By contrast,
there are many admiring depictions of powerful female physicians. And por-
trayals that do question female physicians’ use of power often make clear how
hard it still is for women to assert authority without being seen as “bitches.”
So although modern society may be at least ambivalent about punishing
women generally for exercising power, it remains acceptable to punish women
for being powerful nurses—a practice even “feminists” engage in, as explained
in Chapter 6. So the nurse battle-axe image is a safe outlet for feel-good regres-
sive values. Enjoy that misogyny responsibly!
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Tyrants, Bureaucrats, Monsters:

Hollywood Celebrates Nursing Authority
Prime-time US television has rarely shown a positive nurse character with
genuine authority. The recent nurse-focused shows have, at least, gener-
ally avoided battle-axe imagery. Nurse Evangelina on Call the Midwife is an
authoritative senior nurse who has displayed what might be seen as battle-axe
traits, harshly seizing upon flaws in some of those around her.3 But in con-
trast to classic battle-axes, Evangelina is fiercely devoted to her patients. Her
toughness seems to be rooted in her high standards for care and her own
history of fighting her way out of poverty. She is eventually revealed to be
good-hearted. In addition, the actual midwife supervisor, Sister Julienne, is
strong and skilled but also wise and gentle, if anything an idealized vision of a
nursing manager. Sister Julienne expertly manages senior midwives like Sister
Monica Joan, who has periods of dementia, while mentoring junior ones, like
lead character Jenny Lee, who may be struggling in their practice. At the same
time, Sister Julienne ensures that patients receive the best care possible under
difficult circumstances.4
The lead character in HawthoRNe was a commanding and even combative
chief nursing officer, and at times she alienated administrators and physicians.
But like Sister Evangelina, Hawthorne ruffled feathers in fighting for the
well-being of patients and staff, and she did not display the battle-axe quali-
ties of bureaucratic vindictiveness and hostility toward patients.5
Ironically, the only real battle-axe imagery on the recent nurse shows has
appeared on Nurse Jackie, despite its generally strong portrayal of nursing.
In the first season, Jackie Peyton’s emergency department nurse manager,
Gloria Akalitus, was a seemingly heartless killjoy obsessed with enforcing
rules regardless of their effect on patients. In one July 2009 episode, she pre-
vented a responsible 10-year-old girl from sitting with her mother, who had
lupus, because of a hospital age limit.6 The show often punished Akalitus.
In that same episode, while yelling about a Taser someone had left on the
floor, Akalitus accidentally Tasered herself. In a June 2009 episode, she
drank Jackie’s coffee, not realizing it had been spiked with Jackie’s painkill-
ers; Akalitus spent the rest of the episode slurring and embarrassing herself.
Some managers are harsh and bureaucratic, and these staff nurse revenge fan-
tasies may be amusing. But they reinforce the damaging notions that nurses
can’t wield administrative authority and that managers are not real nurses. In
another June 2009 episode, Jackie invited Akalitus to be a “nurse again for
one second” in assessing a patient, as if the manager was no longer a nurse.7
2 5 0
Fortunately, Akalitus became far more nuanced in later seasons, reveal-

ing genuine concern for others beneath the gruff exterior. She repeatedly
supported Jackie in her struggles with drug abuse and even acted to protect
patients, as in a May 2013 episode in which she caught a patient’s condition
that the chief emergency physician had missed.8 Jackie herself countered the
battle-axe image in projecting sensitive clinical authority, and in June 2012
episodes, actually running the emergency department with impressive skill.9
But the initial Akalitus portrayal is more typical. In the April 2013
finale of TNT’s Monday Mornings, one of the heroic surgeon characters
was critically ill in the intensive care unit (ICU) following an operation.
When she awoke, all her surgeon colleagues naturally rushed to her bed-
side. Leave it to an older ICU nurse named Gladys—the only nurse named
in the episode—to try to limit visitors to two at a time! An authoritative
senior surgeon calmly overruled Gladys, telling her to pick her battles. He
might as well as have told her not to be such a battle-axe.10
Grey’s Anatomy has also presented senior nurses as vindictive bureaucrats
who are working against the young surgical heroes. In one November 2005
episode discussed in Chapter 3, hotshot intern Cristina Yang stole an inter-
esting case from the psychiatric ward. But cranky veteran nurse Debbie ques-
tioned Cristina: “This room is supposed to be unoccupied. Whose patient
is this? . . . Who transferred him? I don’t have any paperwork, any transfer
documents.” Yang dismissed Debbie by noting that the physicians would let
her know if a bedpan needed changing. The nurses retaliated by paging Yang
to do disgusting scut work.11
This absurd fantasy about workplace roles was likely a misguided effort to
show nurses respect. But it did not suggest that disrespecting nurses is wrong
or unsafe, merely that, as chief resident Miranda Bailey noted, it’s “stupid” to
antagonize the nurses. Debbie might have been shown humiliating Cristina
by catching the intern’s error and saving a patient’s life. Or she might have
simply explained what nursing really is. Instead, Debbie’s revenge was that of
a petty bureaucrat who really is all about bedpans. And Cristina had the last
laugh. Recall Winston Churchill’s response to Bessie Braddock, a Member of
the UK Parliament who reportedly once told him, “Winston, you are drunk,
and what’s more you are disgustingly drunk.” According to his bodyguard,
Churchill replied, “Bessie, my dear, you are ugly, and what’s more, you are dis-
gustingly ugly. But tomorrow I shall be sober and you will still be disgustingly
ugly.”12 Cristina may have been a little drunk on ego and ambition, but in the
morning of future episodes, she remained a pretty, esteemed surgeon. Debbie
was still a disagreeable battle-axe who cleaned up the mess.
251
As we saw in Chapters 3 and 4, several late 2005 ER episodes did fea-

ture the strong nurse manager Eve Peyton, a clinical expert with a doctorate
who seemed to care about patients. But Peyton was a strict micromanager;
one staff nurse suggested that she was a “bitch.”13 Peyton’s departure marked
a crude and implausible swerve into extreme battle-axe territory. In one
December 2005 episode, Peyton got dumped by her boyfriend; decked an
offensive patient dressed as Santa Claus and poured urine on him, with no
physical provocation and no regret; was fired on Christmas Eve; and bid fare-
well to the staff with standard PhD-type phrases, such as “bite me,” “screw
yourselves,” and “you all suck.”14 Maybe this all seemed funny because many
still consider nurses to be “angels.” But the episode is a bit less amusing when
you consider that emergency nurses are many times more likely to be the vic-
tims than the causes of workplace violence15—something ER rarely showed.
There was no significant ER nurse character to balance Peyton. Major
nurse character Sam Taggart was expert, but she was not that senior and had
no obvious authority. By comparison, ER’s depictions of harsh physician
managers Kerry Weaver and Robert Romano were countered with many por-
traits of wise, humane ones, such as Susan Lewis, Mark Greene, and Elizabeth
Corday. On her way out, Peyton ranted that she “tried to elevate this stu-
pid ER.” But she was less a frustrated reformer than a nurse who had the
temerity to push back against her ER-assigned role as physician subordinate.
Apparently it’s fine for women to be assertive in traditionally male professions
like medicine. But aggressive nurses are too much of a threat to the natural
order, it seems, and perhaps to the “feminist” doctrine that able women who
choose healthcare careers must become physicians. So any assertive woman
who chooses nursing must be a bitter, dangerous loon, frustrated in love—a
battle-axe.
A memorable battle-axe also appeared in a January 2004 ER, when medi-
cal student Abby Lockhart did a rotation in the neonatal ICU (NICU). This
unit seemed to be staffed mainly by physicians and medical students, rather
than the nurses who would staff it in real life. In this physician-intensive care
unit, one of the two nurses who emerged from the wallpaper left the impres-
sion that veteran NICU nurses are fussy tyrants bent on terrorizing medical
students. A NICU attending physician introduced nurse Virgie as a twenty-
year veteran whose mission was to protect the babies from medical students.
That is one thing NICU nurses do, but Virgie was hostile, rule-bound,
and—contrary to the attending’s introduction—apparently not concerned
about the patients. Virgie refused Lockhart’s request that she give, without
advance physician authorization, medication to a deteriorating infant to stop
2 5 2
his full-body seizures. When Lockhart (who was also a nurse) did it herself,
Virgie whined that she would report Lockhart to the attending physician.
Virgie made no effort to intervene and stop the patient’s seizures. Instead she
stood by, focused on her charting as her patient teetered in crisis. Virgie also
confronted Lockhart for having changed a diaper without weighing it, ruin-
ing her count of “ins and outs.” Lockhart apologized but noted that the diaper
was now in the trash. Virgie snapped “Not good enough!” and insisted that
Lockhart find and weigh it. We got no explanation that ins and outs are criti-
cal measures of a newborn’s health. The episode also included Tom, a kind,
cooperative nurse who deferred to the students: so much for protecting the
babies. In any case, Virgie dominated the episode’s vision of nursing.16 Not
good enough!
Another notable battle-axe appeared on ABC’s short-lived MDs,
which aired in 2002. The drama tried to transplant the basic premise of
M*A*S*H—two renegade surgeons thwarting a bad system to save lives—
to a twenty-first century San Francisco hospital. Physicians provided all
important care, but the show did not ignore nurses: one major character
was “Nurse ‘Doctor’ Poole,” who used her PhD—in management—to
act as a heartless enforcer for the evil HMO that controlled the hospital.
Poole was a Frankenstein made from the worst parts of Nurse Ratched and
Margaret Houlihan, a bean-counting monster who relished denying patients
needed care. Like Ratched, Poole used her training to control patients and
undermine their health. Like Houlihan at her worst, Poole was obsessed
with enforcing rules and frustrated by subversive surgeons who wouldn’t
conform. Poole, like Houlihan, even had a pathetic affair with a married
cohort. Of course, some real nurses have been co-opted by the managed
care system, but far more fight constantly to protect their patients from it.
The crowning touch was Poole’s “Doctor” label, which the show itself put
in quotes. MDs mocked the very idea of a nurse with a doctorate and linked
it with the perceived backwardness of managed care.17 What kind of system
allows a nurse to pretend to be a doctor?
The nurse battle-axe also pops up on nonhealthcare shows. The September
2011 premiere of NBC’s Whitney included the lead character’s misadventures
in a naughty nurse costume, as discussed in Chapter 5. But Whitney and her
boyfriend also encountered a “real” nurse when they arrived at the emergency
department to see about the minor injury he sustained while trying to get
with his sexy girlfriend. The real nurse mocked Whitney as a “stripper,” which
was actually good considering her outfit, but the nurse also barred Whitney
from staying with her boyfriend because they were not married. Thus, to the
253
extent the nurse showed authority, she did so as a petty hospital bureaucrat,
preventing a loved one from seeing a patient.18
The September 2005 season premiere of CBS’s Cold Case focused on an
investigation involving a pro-life school nurse. Nurse Laura manipulated a
high school couple into having their baby—lying to them about the effects of
and legal requirements for abortion—and set in motion forces that destroyed
their lives. Nurse Laura also had a record of arrests for assaulting clinic work-
ers, and the show presented her as a moralizing hypocrite, herself having an
affair with a married teacher (recall Houlihan and Poole).19
Two months later an episode of NBC’s Law and Order focused on the
death of an abusive mother who had been jailed for allegedly killing a man
who reported her to child protective services. The mother’s death was caused
by a reaction to an intrauterine device given to her by nurse Gloria, who was
secretly sterilizing women she deemed unworthy of having children. The
show’s district attorneys prosecuted Gloria. Both shows included strong
female law enforcement characters.20
These crime shows retooled Nurse Ratched for the modern era.
Neo-Ratched still embodied institutional oppression and sexual intoler-
ance: both nurses in these plots used their authority to deny troubled women
the right to make their own reproductive choices. Unlike Ratched, the nurses
were motivated by understandable goals. But far beyond merely taking a prin-
cipled stand against abortion or child abuse, these nurses abdicated their ethi-
cal duties and actually hurt women—something Ratched did not do. Nursing
seemed to be a backwater populated by zealots with no use for the lawful ave-
nues democracies offer to effect social change. Neo-Ratched was a throwback
dragging other women back with her, doing a job that enlightened women
like our law enforcement heroes had left behind. Once again, only women
who pursue traditionally male professions are worthy of real power.
A March 2006 episode of HBO’s The Sopranos found Mafia boss Tony
Soprano gravely wounded and in a coma on a hospital ventilator. Tony’s fam-
ily and subordinates kept watch. Nurses appeared from time to time, but
Tony’s wife Carmela and daughter Meadow took a far more active role in his
care. They talked to the unconscious Tony, they touched him, and Meadow
even climbed into bed next to him. Because none of the episode’s nurses got a
name, we’ll assign them numbers.
At one point Nurse 1 chastised Silvio, Tony’s consigliere, at the nurse’s
station: “Sir, it’s family only in the unit.” Silvio said he would be out of her
hair in a minute. Nurse 1: “I keep telling you people—I’m gonna have to call
the hospital administrator.” At another point, we saw Nurse 1 working at the
2 5 4
bedside, emptying blood out of a drain. She exited, looking bitter and eye-
ing Meadow and mob guy Paulie: “Only one person at a time, please.” After
she left, Meadow confirmed, “She’s a ball buster.” At another point Carmela
entered the comatose Tony’s room as Nurse 2 was adjusting his tubes. Nurse
2 snapped, “Don’t get in bed with him again—you dislodged his drains.”
Carmela: “That was my daughter, and I can’t help but think that physi-
cal affection means something.” Nurse 2 shook her head as if Carmela was
deranged. Later, after Tony had been out of the coma for some time, Carmela
entered his room to find him sitting propped up in a chair. She asked Nurse 3,
“You’ve got him up?” Nurse 3: “I know how it looks, but he should be upright
as much as possible.” Nurse 3 did not explain why. Instead, she checked some-
thing and left quickly.21
Nurse 3 was not too bad, but on the whole, the episode portrayed ICU
nurses as nasty, rule-bound bureaucrats who actually impede psychosocial
care. There was no context to explain why that might be, no indication of
poor workplace conditions, no indication even that the nurses found that
dealing with a group of mass murderers made them a little edgy. Viewers were
unlikely to see the importance of any of the rules the nurses enforced. No one
explained. Of course, pulling out drains could result in serious complications,
but nurses should and do still help families find ways to provide physical affec-
tion to patients. In fact, however realistic it was, this episode suggested that
Tony was brought back from the edge of death by awareness of his loved ones’
presence. In effect, the message was that nurses could learn something about
psychosocial care and family presence from the Mafia family. Maybe Carmela
and Meadow could have given the nurses some clinical training! One nurse
who would not need such training is the expert Jackie Peyton, who is played,
like Carmela, by actress Edie Falco. Did this 2006 Sopranos episode inspire
Falco to pursue nursing full time?
The battle-axe has also haunted other great shows. For example, the clas-
sic science-fiction series The X-Files adapted Ratched for its own purposes in
a May 1997 episode. In that one, after the typical set-up of mysterious deaths
and paranormal visitations, it turned out that a bitter, older psychiatric facil-
ity nurse had murdered several young women one of her patients had doted
on. Apparently the nurse killed the women in order to punish the patient for
feeling a love the nurse never could.22 The Ratched reference underlined one
of the show’s own well-known mantras: trust no one!23
Nor are serious films above deploying the battle-axe. One striking example
is Nurse Noakes, a minor character in Cloud Atlas (2012), directed by the
Wachowski siblings and Tom Tykwer based on a novel by David Mitchell.
255
The film had several related plotlines that took place over different time peri-
ods in Earth’s past, present, and future. Nurse Noakes was the oppressive,
unattractive supervisor of the nursing home Aurora House, a sinister present-
day facility that confined aged “loved ones” who were no longer wanted by
their unscrupulous relatives. In one plotline, the hapless book editor Timothy
Cavendish was tricked into the facility by his devious brother as revenge for
an affair Timothy had had with the brother’s wife. Noakes menaced Timothy,
hitting him and threatening to make him eat soap. At one point, Tim pleads
with his brother to be released and apologizes for the affair, but his brother
says there is no need for that, his exile is enough, “although I do have my fin-
gers crossed for a scenario involving you, Nurse Noakes, and a broom handle.”
Timothy and a few other resident-inmates finally managed to escape to a local
pub, where they got away from Noakes in the confusion of a huge brawl in
which Noakes got the thumping she evidently deserved.24
Noakes was female, but she was played by actor Hugo Weaving. That
reflected the directors’ decision to have their actors play multiple roles across
gender, racial, and time lines, which seemed to emphasize both the unity and
the divergence in the course of human events. However, it also underlined
the Otherness of the Noakes character, arguably suggesting that the nurse was
sexually frustrated or at least confused, and perhaps that was at the root of his/
her evil. Of course, the “broom handle” comment made the potential sexual
assault more immediate and explicit. But the character was similar enough to
Ratched that it still worked as a useful shorthand. Viewers could be counted
on to get the idea quickly: “Oh yeah, Ratched-type nurse who delights in
torturing those she is supposedly helping in an involuntary institutional set-
ting—poor Timothy must escape.” He isn’t the only one.
On a related note, recall that recent horror films have relied on naughty-
axe imagery, which in one neat package provides the fear and sexuality that
often drive those films, as discussed in Chapter 5. As we noted, nurse char-
acters of this type figured in the recent Silent Hill films. Those nurses were
at times presented sexually, but they were also deformed monsters who
manifested human fears—not a bad definition of a battle-axe.25 A more rec-
ognizably human naughty-axe appeared in Nurse 3D, which was released in
mainstream US theatres in 2014.26 That film was a violent thriller about a
vengeful nurse who, as the film’s promotion coyly noted, used her sexuality
to lure “dishonest” men for “severe” punishment. To be more specific, she was
a hospital nurse manager and a sadistic, sexually aggressive serial killer who
targeted men for cheating on their wives, in addition to murdering pretty
much anyone who got in her way (tag line: “your pain is her pleasure”). That
2 5 6
plotline seems to tap into male fears of female sexuality, doesn’t it? Characters
like these differ from the classic battle-axe in that they are presented as sexu-
ally active and attractive, of course, but they achieve a similar effect: to link
nurses who actually have power with malevolence.
Hovering Like Ghouls: Battle-Axes in Other Media

The battle-axe appears in a variety of recent media, in both her classic and
naughty-axe forms. For instance, in 2014 the online Spirit Halloween store
was selling a “Nurse Mercy” costume that really did not seem to involve a
lot of mercy. The malevolent-looking model wielded a big syringe as she
displayed the costume’s “blood-spattered apron” and jagged dress hem.27
In 2005 the Kentucky company Diversified Designs ran an advertisement
for its CompuCaddy computer stands in such magazines as Health Data
Management. In the advertisement, a furious nurse pointed her finger and
bared her teeth. She wore a severe, traditional white uniform, and her name
tag read “HELEN WHEELS, R.N.” The caption: “The morning shift would
like a word with you!” Helen was mad because her computer stand battery was
dead: the idea was that CompuCaddy would help prevent that crisis because
its batteries last longer.28 Of course, any nurse in Helen’s situation might be
displeased, but the character’s “hell on wheels” name and general presentation
suggested that she was an ogre to be avoided under any circumstances.
But that’s nothing. In T. Coraghessan Boyle’s short story “Chicxulub,”
nurses are cold functionaries who represent the mindless brutality of the uni-
verse. No, really. The story appeared in The New Yorker in March 2004 and
in Boyle’s 2005 collection Tooth and Claw. It compares the potential loss of
a couple’s beloved teenage daughter to the ever-present possibility that a big
rock will strike the Earth and end civilization. The father/narrator describes
the night he and his wife are called to the hospital following a serious car acci-
dent. Arriving at what appears to be the emergency department, the couple
approaches the “admittance desk.” The young “Filipina” nurse there greets
the distraught parents by demanding, “Name?” She has “opaque eyes and the
bone structure of a cadaver; every day she sees death and it blinds her. She
doesn’t see us.” Retrieving information from her computer with her “fleshless
fingers,” the nurse refuses to tell them anything more than that their daugh-
ter is still in surgery. The father wonders why he “despise[s]‌this nurse more
than any human being [he’s] ever encountered”—this woman “with her hair
pulled back in a bun and a white cap like a party favor perched atop it, who
257
is just doing her job?” Why does he want to “reach across the counter that
separates us and awaken her to a swift, sure knowledge of hate and fear and
pain? Why?”
The desperate couple proceeds to surgery, “and here is another nurse, grim-
mer, older, with lines like the strings of a tobacco pouch pulled tight around
her lips.” The couple asks if their daughter will be all right. “ ‘I don’t have that
information,’ the nurse says, and her voice is neutral, robotic even. This is not
her daughter.” The father can’t handle this “maddening clinical neutrality”
and he explodes, suggesting that it’s the nurse’s job to know what’s going on
after the couple has been dragged in and told their daughter has been hurt.
The nurse “drills” the father with a look. She steps away from her desk, reveal-
ing herself to be “short,” “dumpy,” and “almost a dwarf.” She leads the couple
to a room, saying, “Wait here. . . . The doctor will be in in a minute.” Then she
disappears, leaving them alone there for “a good hour or more.” Won’t some-
one rescue this poor couple from the clutches of modern nursing? Someone
will, as a young surgeon finally appears and offers the only decent words the
parents have heard at this hospital. Then he leads them through what sounds
like an ICU, where patients are surrounded by machines with “nurses hover-
ing over them like ghouls.”29
Of course, nurses who work in stressful conditions can behave badly, but
the extreme battle-axe vision that this sympathetic narrator presents is hard to
miss, and Boyle gives us no real reason to question it. Yes, the father is upset.
But consider the dramatic ascent from the ugly, hateful nurses to the sensitive
physician who will actually give the parents information and who has appar-
ently been trying to save the couple’s daughter all by himself. The nurses guard
their computers or hover like “ghouls,” protecting themselves by brutalizing
distraught family members. They are inhuman bookkeepers of death.
The naughty-axe image also figures in various pop culture products. In par-
ticular, the hottie as “sadistic shot giver” wielding an enormous phallic syringe
seems to be a cool way for pop musicians to move product. As we explained
in Chapter 5, a 2004 Skechers advertising campaign featured naughty nurse
Christina Aguilera brandishing an enormous syringe connected to a big
needle.30 The band blink-182 used a porn star as a naughty nurse flaunting
another huge syringe in the artwork of a 1999 album.31
But naughty-axes don’t just look threatening, they also kick ass. Two popu-
lar recent wrestling video games have featured sexy “nurse” images. In Yuke’s
WWE SmackDown! vs. Raw 2006, gamers competing in barely-dressed female
“nurse” and other modes could slap, kick, and grapple, toss each other on a
bouncy bed, rip each other’s clothes off, and spank each other. Yeah, baby.32
2 5 8
Konami’s Rumble Roses games, released in 2004 and 2006, featured an

evil naughty nurse character named Anesthesia. She had devastating moves
and was also, needless to say, using the body parts of her victims to create a
malevolent cyborg to help her rule the world.33 Of course, as we’ve noted,
real nurses are the health workers most likely to be the victims of workplace
violence.34
At the risk of being labeled battle-axes, we have to say that the continu-
ing appearance of battle-axe imagery suggests that, for many, nursing remains
caught in an ugly cultural time warp. Female nurses with any power must be
threatening, sexually frustrated, and/or disagreeable. Yes, the media tells us,
some women today can handle real authority—women with the brains and
education to pursue a traditionally male profession. But a good nurse’s role
is submission.
Notes
1. Linda S. Smith, “Image Counts: Greeting Cards Mail It in When It Comes to
Accurately Portraying Nurses,” Nursing Spectrum, Southern ed. (October 1, 2003),
http://tinyurl.com/ye38eqg.
2. Kirk Johnson, “Once a ‘Cuckoo’s Nest,’ Now a Museum,” New York Times (March
31, 2013), http://tinyurl.com/k765vqd.
com/m3bf4lw.
4. TAN, “Call the Midwife Episode Reviews.”
6. Taii K. Austin, writer, Steve Buscemi, director, “Daffodil,” Nurse Jackie, Showtime
( July 6, 2009); TAN, “Take the Blue Pill” ( July 6, 2009), http://tinyurl.com/
o9e4m2h.
7. Mark Hudis, writer, Craig Zisk, director, “Chicken Soup,” Nurse Jackie, Showtime
( June 22, 2009); TAN, “The Good, the Bad and Zoey’s Stethoscope,” http://
tinyurl.com/m7zzgt.
8. Cindy Caponera, writer, Randall Einhorn, director, “Good Thing,” Nurse Jackie,
Showtime (May 12, 2013).
9. TAN, “Cunning, Baffling, Powerful” (April 14, 2013), http://tinyurl.com/kgrdrne.
10. Amanda Johns, David E. Kelley, Karen Struck, writers, based on the novel of
Sanjay Gupta, Bill D’Elia, director, “Family Ties,” Monday Mornings, TNT (April
8, 2013); TAN, “Picking Battles” (April 2013), http://tinyurl.com/n65ovcn.
11. Stacy McKee, writer, Adam Davidson, director, “Something to Talk About,” Grey’s
Anatomy, ABC (November 6, 2005); CFNA, “The Drunk and the Ugly,” TAN
(November 6, 2005), http://tinyurl.com/o7ob6nt.
259
12. Richard M. Langworth, “Drunk and Ugly: The Rumor Mill,” The Churchill Centre
( January 31, 2011), http://tinyurl.com/l9ektwf.
13. CFNA, “Peyton Place,” TAN (October 20, 2005), http://tinyurl.com/p8239cy.
kk2h69z.
15. Deborah D. May and Laurie M. Grubbs, “The Extent, Nature, and Precipitating
Factors of Nurse Assault among Three Groups of Registered Nurses in a Regional
Medical Center,” Journal of Emergency Nursing 28, no. 1 (2002): 11–17, http://
tinyurl.com/ks7cdj9 and http://tinyurl.com/l9rruax.
16. Lisa Zwerling, writer, Laura Innes, director, “NICU,” ER, NBC ( January 15,
2004); CFNA, “Physician-Intensive Care Unit,” TAN ( January 15, 2004), http://
tinyurl.com/obgpkk8.
17. Gary Tieche, creator, MDs, ABC (2002–2003); CFNA, “MDs,” TAN (February 8,
2003), http://tinyurl.com/qxqf8e3.
18. Whitney Cummings, writer, Andy Ackerman, director, “Pilot,” Whitney, NBC
(September 22, 2011); TAN, “Whitless” ( July 2011), http://tinyurl.com/cmt47df.
19. Meredith Steihm, writer, Mark Pellington, director, “Family,” Cold Case, CBS
(September 25, 2005); CFNA, “Ratched Redux: Family,” TAN (December 4,
2005), http://tinyurl.com/lzx72az.
20. David Slack, writer, Constantine Makris, director, “Birthright,” Law and Order,
NBC (November 2, 2005); CFNA, “Ratched Redux,” TAN (December 4, 2005),
http://tinyurl.com/mvqx59f.
21. Matthew Weiner, writer, Jack Bender, director, “Mayham,” The Sopranos, HBO
(March 26, 2006); CFNA, “Family Presence and Psychosocial Care of the
Comatose ICU Patient, Cont. Nursing Ed. HBO-068, Instructors: Carmela and
Meadow Soprano,” TAN (March 26, 2006), http://tinyurl.com/nzj8x7h.
22. John Shiban, writer, Jim Charleston, director, “Elegy,” The X-Files, Fox (May 4,
1997); Todd VanDerWerff, “The X-Files: ‘Elegy,’ ” A.V. Club (March 5, 2011),
http://tinyurl.com/lh957d4.
23. TV.com, “The X-Files,” accessed February 16, 2014, http://tinyurl.com/6rfxc77.
24. Lana Wachowski, Tom Tykwer, and Andy Wachowski, writers, based on the novel
by David Mitchell, Tom Tykwer and Andy Wachowski, directors, Cloud Atlas,
Warner Bros. (2012); Wikia, “Nurse Noakes,” accessed February 16, 2014, http://
tinyurl.com/kt9bzs9.
25. Roger Avary, writer, Christophe Gans, director, Silent Hill, TriStar Pictures (2006),
http://tinyurl.com/2s3ne5; Jill Garson and Kate Robbins, writers, Kate Robbins,
director, Candy Stripers, Screen Gems (2006), http://tinyurl.com/l3xywv4;
Piraphan Laoyont and Thodsapol Siriwiwat, directors, Sick Nurses (Suay Laak Sai),
Magnolia Home Entertainment (2007), http://tinyurl.com/lxvsf2r.
26. Douglas Aarniokoski and David Loughery, writers, Douglas Aarniokoski, director,
Nurse 3D, Lionsgate (2014), http://tinyurl.com/m4tvzu6; TAN, “Nurse 0D:
Nurse 3D Finally Released” ( January 2014), http://tinyurl.com/mg4kqqa; TAN,
2 6 0
“Sexy Killer Nurse Movie Nurse 3D Starts Filming” (August 2011), http://tinyurl.
com/44cryfc.
27. “Nurse Mercy Adult Women’s Costume,” Spirit Halloween, accessed May 9, 2014,
http://tinyurl.com/kyy3225.
28. CFNA, “ ‘Helen Wheels, R.N.’—CompuCaddy Pulls Battle-Axe Ad,” TAN ( July
25, 2005), http://tinyurl.com/l2jqaom.
29. T. Coraghessan Boyle, “Chicxulub,” The New Yorker (2004), http://tinyurl.com/
yhocdov; CFNA, “Chicxulub,” TAN (September 18, 2005), http://tinyurl.com/
k5yr6t4.
30. CFNA, “Inject Me,” TAN (August 2004), http://tinyurl.com/konqwjc.
31. blink-182, Enema of the State, MCA Records (1999); CFNA, “blink-182, ‘Enema
of the State,’ ” TAN ( July 11, 2003), http://tinyurl.com/kay9bgp.
32. CFNA, “Not Sure If You’d Rather Hit Nurses or Have Sex with Them? Do Both!,”
TAN (December 1, 2005), http://tinyurl.com/ottdl8x.
33. CFNA, “Not Sure If You’d Rather Hit Nurses. . .”
34. Rose Chapman, I. Styles, L. Perry, and Shane Combs, “Examining the Character-
istics of Workplace Violence in One Non-Tertiary Hospital,” Journal of Clinical
Nursing 19 (2010): 479–488, http://tinyurl.com/m77bhcx; Fran Lowry, “Nurses
Are Frequent Targets of Workplace Violence,” Medscape (February 4, 2010),
http://tinyurl.com/ksfow8d.
9
ADVANCED PRACTICE NURSES
Skilled Professionals or
Cut-Rate “Physician Extender s”?
In late 2005 Mattel, the world’s leading toy maker, released a small
collectible duck doll called the Nurse Quacktitioner.1 Dressed in a
white laboratory coat and a white cap with a red heart on it, the doll
sold at Target, Walmart, and other major toy retailers. Whatever
Mattel’s intent, the name suggested that nurse practitioners (NPs)
are “quacks,” untrained persons who pretend to be physicians.2
Mattel said it had no idea that this doll would be taken as an attack
on NPs, whose main professional stereotype has been that they are,
uh, untrained persons who pretend to be physicians. The company
explained that the name included the word “quack” because ducks
quack, a point that had completely eluded the more than 2,000
nurses who objected to the doll. Mattel refused to remove the doll
before the end of its planned run, even after we convinced Walmart
to sell the dolls back to Mattel.3
Meanwhile, physicians in the United Kingdom learned of the
controversy, and many sent letters of support—to Mattel, urging
the company to keep selling the doll because it would foster con-
tempt for NPs. The physicians argued that NPs are indeed unquali-
fied practitioners (well, quacks) used to cut costs at the expense of
quality care.4
Not to be outdone, Disney later weighed in with its own anti-NP
insult in a product aimed at impressionable children. Disney XD’s
tween television series Lab Rats focuses on a trio of bionic teenag-
ers who live incognito with their brilliant inventor father and fight
Evil. In an August 2013 episode, the father’s exiled brother and for-
mer business partner returned to take revenge and use the teenagers
for nefarious ends. At one point, the father mocked his brother by
2 6 2
noting that he had turned into “Dr. Evil . . . or should I say Nurse Practitioner
Evil, since you flunked out of med school!” No one on the show disputed the
idea that NPs are losers who can’t hack medical school.5
In fact, a large body of research shows that the care of NPs and other
advanced practice registered nurses (APRNs) is at least as effective as that of
physicians.6 In the 1960s nurses began training as advanced practitioners in
primary care and other fields that included work traditionally done by physi-
cians.7 Advanced practice nursing evolved mainly to provide care to disad-
vantaged persons who were not receiving physician care. APRNs, most with
at least a master’s degree, now provide care in many specialties.8 They practice
mainly in the United States but increasingly also in other nations.9 APRNs
are especially likely to provide care to underserved urban and rural popula-
tions.10 Like other nurses, APRNs use a holistic care model that emphasizes
prevention, health maintenance, and overall quality of life.11 APRNs are
adept at identifying subtle problems and managing serious chronic condi-
tions. Thus, expanding APRN care is a key part of the reforms of the 2010
Affordable Care Act (ACA), which increased funding for APRN education
and APRN-run health clinics as part of its overall effort to improve health in
a cost-effective way.12 A massive 2010 report from the National Academy of
Sciences’ highly regarded Institute of Medicine (IOM) called for the expan-
sion of APRN practice for the same reasons. The report was called The Future
of Nursing: Leading Change, Advancing Health.13
In the United States there were more than 200,000 advanced practice
nurses employed in 2012. More than 105,000 are practicing NPs, specializing
in many fields. There are more than 34,000 certified registered nurse anesthe-
tists (CRNAs), and they make up 53 percent of the anesthesia providers in
the United States. More than 5,700 certified nurse midwives (CNMs) pro-
vide obstetrics and gynecology (OB/GYN) care and deliver babies using a
natural care model, one many other developed nations use to achieve better
patient outcomes at lower cost. More than 70,000 graduate-prepared clinical
nurse specialists (CNSs) provide clinical leadership to direct care nurses.14
In the new millennium, direct care nurses suffered the effects of the global
shortage. Nurse midwives struggled to cope with increasing practice costs.
CNSs had grown in number and improved care greatly through the early
1990s, but hospitals eliminated many CNS positions in the managed care
era, undermining clinical leadership in nursing.15 Still, the practice of NPs
and CRNAs continued to expand. NP-staffed health clinics based in retail
stores—like those selling the Nurse Quacktitioner—have grown quickly.16
Nursing leaders now plan to establish the existing four-year doctorate of
9 Advanced Practice Nurses •
263
nursing practice (DNP) degree as the standard for all new APRNs by 2015.17
These last two developments sparked fierce resistance from some physician
groups. However, cost-effective NP-directed care offers not only a way to
enhance access to care for underserved populations, but also an advanced
hybrid practice model that could change the future of health care for everyone.
Media portrayals of APRNs have been mixed. Hollywood has offered a
few well-meaning television portrayals suggesting that NPs are moderately
skilled assistants to physicians. But at their worst, television depictions have
expressed overt contempt for APRNs, and many recent shows have suggested
that able RNs want to become physicians. Some news stories have provided
helpful information about APRN practice. There has been reporting on the
cost-effectiveness of APRN care in the ACA era, on physician efforts to limit
APRN practice, and on the growth of the DNP degree. But APRNs are
largely ignored as general health experts, and the media’s relentless sugges-
tions that practitioner care is provided only by “doctors” continue unabated
in news pieces and advertising. Doubt it? Just “ask your doctor”! Some press
accounts have wrongly suggested that APRNs are capable only of treating
minor problems. Deference to physicians remains so strong that often, the
media allows physicians to express uninformed criticism of APRN care with-
out even consulting APRNs or the relevant research.
However, some physicians are receptive to the idea that APRNs make
valuable contributions to modern health care. In 2002 the US Department
of Health and Human Services (HHS) launched an annual campaign to
increase visits to primary care providers. It was called “Take a Loved One to
the Doctor Day.” We led nurses in trying to persuade HHS to change the
name to one that would not exclude the APRNs who provide vital primary
care to the very minority populations the campaign targets. In July 2005
HHS—with the leadership of Assistant Secretary for Minority Health Garth
Graham, MD, MPH—actually changed the name to “Take a Loved One for
a Checkup Day.” HHS used that name in ensuing years, although HHS has
recently played a less active role in the campaign. HHS did give its campaign
partners discretion to use the old name, and popular ABC Radio host Tom
Joyner and some others still insist on using the “Doctor Day” label.18 (We find
that a bit confusing, since “every day is a doctor day,” as Jackie Peyton drily
noted in a June 2011 episode of Nurse Jackie.) But some do use “Checkup
Day” for the minority health campaign.19 Some similar events have long
been on the right track, like “National Women’s Checkup Day,” also spon-
sored by HHS and so named since 2002.20 Next up: “Improve a Loved One’s
Understanding of APRNs Day!”
2 6 4
Who Are APRNs and How Good Is Their Care?

APRNs are skilled health professionals who provide advanced care, including
diagnosis and treatment traditionally done by physicians, in a great variety of
settings. These range from major teaching hospitals to small clinics, and from
the military to public health services.
Because APRNs take a holistic approach, they are especially skilled at
cost-effective preventive care, the management of chronic disease, coordi-
nating care among different providers, and long-term health maintenance.
Many APRNs focus on underserved poor communities where physicians
choose not to practice, so APRNs are a vital health resource for millions who
would otherwise receive little or no health care. APRNs’ work has become
even more critical in light of dramatically rising healthcare costs and as fewer
physicians choose to pursue less lucrative primary care practices. On the other
hand, some nursing advocates have argued that the growth in APRN practice
has drawn nurses away from the bedside and from teaching positions, exacer-
bating the nursing shortage. In an era in which severe short-staffing has made
bedside practice difficult, these are understandable concerns.
The first NP program (in pediatrics) was developed by public health nurse
Loretta Ford, EdD, and pediatrician Henry Silver, MD, at the University
of Colorado in 1965.21 Today NP specialties include family practice, inten-
sive care, emergency care, oncology, cardiology, mental health, and surgery,
among many others. As described by the American Association of Nurse
Practitioners,
Nurse Practitioners (NPs) have been providing primary, acute and spe-
cialty healthcare to patients of all ages and walks of life for nearly half a
century. NPs assess patients, order and interpret diagnostic tests, make
diagnoses, and initiate and manage treatment plans—including pre-
scribing medications. They are the healthcare providers of choice for
millions of patients. An NP is truly Your Partner in Health.22
Nurse anesthetists provide high-quality, cost-effective anesthesia services.

Nurse midwives give advanced OB/GYN and prenatal care, and they deliver
babies under a care model that treats the birth process as a natural one, rather
than an illness. CNSs provide vital clinical leadership to direct care nurses and
direct care in some community settings. They practice in a variety of special-
ties, including pediatrics, geriatrics, emergency care, critical care, and psychi-
atric care. The US National Association of Clinical Nurse Specialists explains:
265
In addition to providing direct patient care, Clinical Nurse

Specialists influence care outcomes by providing expert consulta-
tion for nursing staffs and by implementing improvements in health
care delivery systems. Clinical Nurse Specialist practice integrates
nursing practice, which focuses on assisting patients in the preven-
tion or resolution of illness, with medical diagnosis and treatment
of disease, injury and disability.23
In the United States APRNs are licensed by each state, bound by legal and
ethical duties, and subject to malpractice actions. Their legal rights to practice
without collaborating with physicians vary by state. APRNs are eligible for
Medicare and Medicaid reimbursement, and they can prescribe most medi-
cations. In some states, APRNs run successful independent health practices,
although the extent of their rights to prescribe medication and to receive
insurance reimbursement has been hotly disputed.24
Some people regard physician training as superior to that of APRNs.
Physician training in the United States includes a four-year undergradu-
ate degree with some rigorous science courses and a demanding four-year
graduate medical degree, in addition to several years of training in residency
programs. On the other hand, APRNs have a four-year bachelor’s degree in
nursing science and two or more years of intense graduate education in nurs-
ing science.25 Many now undertake one-year residencies26 and all receive the
informal training in the first years of practice that any serious professional
receives. In most cases, they also have years of highly relevant experience prac-
ticing as RNs before their graduate education. Many APRNs have doctorates.
APRNs follow an effective care model that emphasizes health maintenance
and addresses all facets of human well-being, not simply a specific condition
or symptom.
Nevertheless, some physician groups have questioned the safety of APRN
care and fought to restrict the scope of APRN practice, claiming that APRNs
require physician “supervision,” as some state laws still provide.27 Many phy-
sicians, and even some APRNs, refer to APRNs as “physician extenders”28
or “mid-level providers.”29 These contemptuous terms suggest that APRNs
are the extremities of physicians, perhaps helping them reach things on a
high shelf, and also that only physicians are “high-level.” Presumably RNs are
“low-level.” Of course, the term “advanced practice” nurse itself may suggest
that RNs are not advanced, and so that term could probably be improved.
We are aware of no scientific basis for physicians’ safety claims about
APRNs. In fact, a vast body of research indicates that APRN care is at least as
2 6 6
good as that of physicians.30 Some studies have found differences, but overall
these suggest that if anyone’s care is better, it is that of APRNs.
A review of 107 studies conducted between 1990 and 2008, published in a
2011 issue of the journal Nursing Economic$, determined that for a wide vari-
ety of patient care, outcomes for APRN-led teams that included physicians
were at least as good on all measures as physician-led teams with no APRNs.31
Nurses outperformed physicians on such measures as controlling blood pres-
sure, controlling blood glucose and lipid levels, reducing length of hospital
stay, enabling patients to function better in activities of daily living, and giv-
ing patients a higher perceived level of health, as well as on many important
measures related to childbirth, including achieving lower rates of cesarean
sections and episiotomy and higher rates of breastfeeding. Physicians did not
outperform advanced practice nurses on any of the eighteen health indicators
measured.
A study by the Research Triangle Institute, published in Health Affairs in
2010, looked specifically at the care of nurse anesthetists.32 The study analyzed
inpatient mortality and complication rates from nearly half a million hos-
pitalizations covered by Medicare between 1999 and 2005. The researchers
found no evidence that nurse anesthetists working without physician “super-
vision” posed any greater risk to patients than did physician anesthesiolo-
gists. Indeed, as the American Association of Nurse Anesthetists has noted,
“Numerous outcomes studies have demonstrated that there is no difference in
the quality of care provided by CRNAs and their physician counterparts.”33
In 2003 the American Journal of Public Health published a study of low-
risk obstetric patients funded by the US Agency for Health Care Research and
Quality. The study compared two groups of patients, one of which received
95 percent of their care from CNMs and 5 percent of care from OB physi-
cians, whereas the other received care only from physicians. The two groups
had comparable rates of morbidity, preterm birth, and low birth weight, but
in other respects the nurse midwife team had better outcomes at a lower cost,
because patients spent less time as inpatients and had fewer cesarean sections,
episiotomies, inductions, and vacuum- or forceps-assisted vaginal births.34
In 2002, Horrocks, Anderson, and Salisbury published a meta-analysis
of thirty-four clinical studies in the British Medical Journal indicating that
patients were more satisfied with their care if it was delivered by an NP than if
by a physician. NPs read X-rays equally well, identified more physical abnor-
malities, communicated better, and taught patients how to provide self-care
better. NPs also spent more time with patients than did physicians (14.9 ver-
sus 11.2 minutes).35
267
Nursing leaders are on schedule to make the DNP degree the standard
APRN degree by 2015, as noted previously.36 The DNP degree includes four
years of graduate education, plus a one-year residency, after the bachelor’s
degree. In addition to providing fodder for hilarious “Dr. Nurse” wordplay
in media reports,37 the idea appears to be to expand the knowledge base of
APRNs and to promote greater parity with primary care physicians in formal
education. Of course, as we have explained, research shows APRN care is at
least as good as physician care even though most APRNs do not yet have
doctoral-level education. Some nurses have expressed concerns that the move
to the DNP standard could effectively require current APRNs to obtain more
graduate education, that it implies current APRN abilities are inadequate,
and that it could lead to the “medicalization” of APRN practice.
Predictably, the plan has also encountered strong resistance from some
physician groups.38 They argue that further “blurring the lines” between the
professions will endanger patient health. In June 2008 the American Medical
Association (AMA) House of Delegates passed resolution 214, which stated
that DNPs should be supervised by physicians and that the National Board
of Medical Examiners should not offer a certifying examination for DNPs.39
(The National Board of Medical Examiners went ahead with the examination
and posted a long list of FAQs explaining why on its website.)40 But the AMA
delegates rejected a proposed resolution (232) seeking to limit the use of the
terms “doctor” and “residency” in clinical settings to physicians, dentists, and
podiatrists. The American Nurses Association objected to that resolution and
gave this account of the AMA meeting about it:41
Unfortunately, the use of the term “doctor” by doctorally-prepared

health care providers really struck a raw nerve with many physicians. A
parade of impassioned AMA members cited a “barrage of surrogates”
and “assault by wannabes” . . . the purported inadequacy of 500 hours
of clinical training for a DNP; the capacity for “grievous harm,” bor-
dering on homicide. . . . One delegate stated that AMA needs to take a
hard stance against “dabblers” and “encroachers.”42
The rejected proposal would have prevented not just nurses but also psy-
chologists, social workers, and others from describing their own qualifica-
tions. Maybe the problem was that the proposal did not go far enough. To
really protect the physician brand, we suggest barring the very issuance of
doctorates in any field but medicine. Nurses aren’t the only ones who need
to learn their place!
2 6 8
“Doctor” jokes aside, we believe that APRNs have developed a hybrid care
model with the potential to revolutionize advanced practitioner care. Are
they the ones to help liberate the public from the current healthcare morass?
“Midwifs” and Minor Ailments: APRNs in Hollywood

Entertainment television has taken some notice of APRNs. In fact, some
shows have presented ostensibly positive visions of APRNs, but they have
also suggested that APRNs treat only simple conditions in an environment
rightly controlled by physicians. No major television product has really con-
veyed the nature or value of the APRN practice model. Probably the most
notable recent portrayals have been the nurse-midwife characters on Strong
Medicine and Private Practice, a show that repeatedly mocked nurse mid-
wifery. Many shows, including ER43 and Private Practice,44 and even Mercy45
and HawthoRNe,46 have suggested that ambitious nurses want to become
physicians, even though in reality nurses are one hundred times more likely to
attend graduate nursing school.47 In its last season ER did indicate that nurse
anesthetist student Sam Taggart would have considerable skill and autonomy
as a CRNA.48 Recent films have generally ignored APRNs, although there
have been helpful minor depictions in Mike Nichols’s Angels in America49 and
Abby Epstein’s Business of Being Born documentaries.50 In addition, episodes
in the first season of the documentary series 24 Hours in A&E showed NPs
providing skilled emergency care, although without really explaining who
NPs are or how they differ from physicians.51
Strong Medicine’s nurse-midwife character Peter Riggs has probably been
serial US television’s best portrayal of an APRN.52 He did not figure heavily in
most episodes, and he did not spend much time actually delivering babies or
seeing outpatients, as a real nurse midwife would. But he did seem to operate
with some autonomy, treating patients in a clinic run by primary care phy-
sician Luisa Delgado. One September 2005 episode had Riggs establishing
and skillfully running a “baby boot camp” for gangbanging boyfriends of his
patients who were not meeting their fathering responsibilities.53 Riggs clearly
took a holistic approach to care, which the show both honored and mocked.
Riggs reported to Delgado and the show’s other physicians, and he generally
deferred to them in clinical matters, with minor exceptions. In one episode,
Riggs did confront a powerful OB-GYN physician who had performed an
unnecessary cesarean section, resulting in a hysterectomy. But as a result of
Riggs’s advocacy, Delgado had to save his job, as discussed in Chapter 6. In
269
the September 2005 episode mentioned previously, Riggs briefly argued with
a major surgeon character about which of them had delivered more babies
and so would be more qualified to deliver the baby of their friend Delgado.
In the February 2006 series finale, Riggs resisted pressure from his girlfriend,
a physician resident, to go to medical school.54 Riggs said he preferred to be a
nurse, although he gave only the vague reason that medicine would not make
him “happier.” Viewers got no sense that he regarded advanced practice nurs-
ing to be as valuable as medicine generally.
Peter Riggs had his moments, but as we’ve seen, the Dell Parker character
on Private Practice was mostly an APRN disaster.55 At first Dell was a recep-
tionist with a “nursing degree” who was studying midwifery; even after he
become a midwife, he still seemed to have office administrative duties. Early
episodes mocked midwifery, as superstar OB/GYN Addison Montgomery
uttered the word “midwif ” as if she had never heard of such an outlandish
pursuit. In the September 2007 series premiere, Dell asked her if he could
help with a delivery for “field experience for my midwife training”—as if his
clinical training consisted of whatever ad hoc assistance he could offer clinic
physicians, rather than the midwife-directed graduate degree training he
would get in real life.56 Addison repeatedly rejected his help. Dell eventually
lost it:
Dell: You don’t take me seriously. . . . You think I’m some dumb surfer boy,
you think I’m eye candy. You have no respect for me or my midwifery
skills.
Addison (struggling not to laugh): I have total respect for you and
your . . . midwifery skills? Is that even a word—midwifery?
Dell (petulantly): It’s a word. (Pause.) It’s definitely a word!
Of course the show was poking fun at the elite surgeon surrounded by
Southland nuts, but it was also laughing at Dell’s midwifery. Even accounting
for Addison’s arrogance, which the show celebrated by pretending to con-
demn, it’s unlikely that an OB/GYN physician would really be unfamiliar
with the word midwifery. But Addison didn’t know about it, we were meant
to assume, because it’s largely irrelevant to serious maternal-child health care.
And receptionist Dell was not likely to cite the studies showing that nurse
midwives’ care is at least as effective as that provided by OB/GYNS such as
Addison.
In later seasons, the portrayal of Dell improved somewhat. He occa-
sionally showed some tentative clinical aptitude, usually under Addison’s
2 7 0
supervision, as when he performed a vacuum-assisted delivery in a February

2009 episode.57 In a January 2010 episode, he managed to perform a solo
delivery and showed psychosocial skill, although the show made fun of the
natural birth model the mother insisted on following. Even Dell seemed to
find it odd.58 In March 2010, Dell got to deliver a baby by himself in the field.
Because he successfully executed a risky maneuver to free the baby, who was
stuck in the birth canal, physician Cooper later credited Dell with saving
two lives.59
But Dell remained essentially a subordinate, and the show did not pro-
vide helpful information on advanced practice nursing, to say the least. On
the contrary, a March 2009 episode showed a distraught Dell hooking up
with young women by pretending to be a physician. That earned amused deri-
sion from the elite physician characters—and from us, because the plotline
reinforced the harmful wannabe-physician stereotype that real APRNs con-
front.60 Of course, Dell’s elation at having been admitted to medical school
just before his May 2010 death had the same effect. In a May-June 2010 issue
of TV Guide, show creator Shonda Rhimes explained that Dell was “a mid-
wife in a world of doctors. Babies can only be delivered in so many episodes.
Dell got lots of coffee, answered lots of phones.”61 Rhimes lauded Chris
Lowell, who played Dell, by noting that “an actor of his caliber should be
doing Shakespeare, not handing people charts.” In other words, nurses and
midwives don’t do much of interest, which is why Dell spent so much time
doing receptionist work and why he eventually had to go. But at least he went
to that great medical school in the sky!
One of the few other notable APRN characters appeared in late 2004 on
CBS’s Dr. Vegas, a flashy, short-lived drama about a Las Vegas casino physician
named Billy Grant. Grant’s casino clinic sidekick was NP Alice Doherty, who
did show some health knowledge and a willingness to push for more holistic
care.62 At one point she argued successfully for alcoholic rehabilitation for an
abusive patient when Grant wanted to treat the man’s minor wounds and cut
him loose. However, Doherty was basically just a skilled assistant to Grant.
The show’s final episode delivered a remarkably direct attack on NP practice.
Doherty, struggling to handle her unrequited love for Grant, got drunk with
the son of the casino manager’s old friend. Then, when this son injured him-
self, Doherty brought him back to the clinic and forged Grant’s signature on
an OxyContin prescription. Meanwhile, her date stole the prescription pad,
and a hotel guest later OD’d and almost died. Grant saved the day by telling
the police that he had authorized Doherty to write the prescription. But the
271
plotline suggested that NPs are flighty females who can’t be trusted with the
power of the prescription pad.
Even the most realistic of other hospital shows, ER, never quite had a
major APRN character. Nurse character Sam Taggart did start a nurse anes-
thetist program in the show’s final season. A few plotlines sent helpful mes-
sages about her career path, although we did not learn that it was a graduate
program or where she was studying. In an October 2008 episode Taggart
explained to a condescending physician intern that Taggart would indeed be
handling her own anesthesia cases when she finished the program.63 The epi-
sode also indicated that her knowledge of anesthesia had already surpassed
that of her boyfriend, physician resident Tony Gates. In December 2008 epi-
sodes, Taggart impressed senior physicians by using her growing knowledge
to improve critical care, at one point persuading the chief of surgery to let her
use an innovative combination of drugs and interpersonal methods to extu-
bate a patient early.64 The NP character Lynette Evans appeared in nine ER
episodes from 1998 to 1999.65 But as discussed in Chapters 3 and 6, ER often
suggested that nurses achieve by going to medical school.
In recent years popular Hollywood shows have continued that theme. On
The Glades, the lead detective character’s fiancée Callie Cargill was always a
bright, skilled nurse—and an off-and-on medical student.66 Summer 2013
episodes found Callie “dying” to get back to medical school while doing a fel-
lowship with a crusty senior surgeon. Once he warmed to Callie, the surgeon
became fond of saying that she would make “a hell of a doctor”—and he left
her a great deal of money when he died so she could finish medical school.
Even nurse-focused shows have relied on the wannabe-physician stereotype. On
HawthoRNe, nurse Ray Stein was pining for medical school right up until his
final episodes on the show in July 2010, although he had failed his MCAT exami-
nation the first time.67 In a May 2010 episode of Mercy, the bright young nurse
Chloe Payne got praise from one physician for “thinking like a doctor” after she
diagnosed a case of airport malaria. In the series finale, Chloe vowed that she
would attend medical school, apparently to show another physician that she was
worthy of his affections—a truly pathetic final note for an otherwise impressive
nurse character.68
In any case, on most recent hospital shows, APRNs are conspicuously
absent. No advanced practice nurse has appeared on the 2009 US nurse
shows. Perhaps this reflected the nurse shows’ overall sense of the nurse
characters as being smart and pragmatic, but not necessarily having a lot of
formal education, as the physician characters did. HawthoRNe said nothing
about its chief nursing officer character’s educational background. Although
2 7 2
a September 2009 episode of Mercy revealed that Chloe Payne had a masters
degree, she practiced as an inexperienced RN, not an APRN.69
However, in a June 2014 episode of Nurse Jackie, the excellent Zoey
Barkow announced that she wanted to get a masters degree and become an
NP. Jackie was very supportive and—being Jackie—soon told a patient that
Zoey already was an NP, giving the younger nurse the chance to try to evalu-
ate him as an NP might. Zoey seemed to do well in diagnosing and counsel-
ing the patient about his dangerous high blood pressure.70
To our knowledge no APRNs have ever appeared on Grey’s Anatomy, but
the show did eventually get around to expressing contempt for them. In a
January 2010 episode, surgeon Derek Shepherd confronted fellow surgeon
Miranda Bailey about a postoperative patient who was getting weekly follow-
up visits with Bailey herself. In fact, she was covering up an error made by
the chief of surgery.71 Shepherd noted that the patient was “getting some
high-class care. Six visits with a surgeon? A nurse practitioner can do this.”
Shepherd’s premise, of course, was that surgeon care is much better. In noting
that NPs “can” do the follow-up care, he meant that even they are capable of
it. In fact, he had previously called that care “easy.” The idea was clearly that
this is simple care requiring little expertise, not that it is a job for NPs because
they are so good at monitoring patients and explaining how to cope with a
difficult recovery.
Both House and Scrubs actually had nurse characters confront the idea
of becoming NPs, although both shows sent damaging messages about NP
education. A February 2007 House episode included nurse Wendy, then-
girlfriend of House’s underling physician Foreman.72 Foreman cleverly broke
up with Wendy by telling her that he’d make “a few calls” and get her into an
elite hospital-based NP program in a distant city. This plotline would likely
suggest to viewers that the most prestigious NP preparation is nondegree
training to which entry can be had at the whim of physicians, rather than
NP-directed graduate degree programs at major universities with rigorous
admissions requirements.
The treatment of NP education on Scrubs was oddly similar. In a November
2002 episode, surgeon Turk signed up his future wife, nurse Carla Espinosa,
for an NP program as a surprise gift.73 Unlike Foreman, Turk was trying to
do something nice, and the episode made clear that Carla was well qualified
for the program: attending physician Perry Cox said so! But Carla chose not
to pursue it so she could spend more time with Turk. Like Foreman in the
House episode, Turk apparently had the power to simply enroll Carla in NP
training. In both episodes, the nurses’ boyfriends seemed to assume that any
273
nurse would leap at the chance to pursue NP training. The nurse characters
did not leap, for their own reasons, but neither defended the value of bedside
nursing either.
One revealing portrayal of an NP on a nonhealthcare show was that of
Jorge on ABC Family’s Switched at Birth. Jorge supervised main character
Daphne during her community service at an urban clinic. He occasionally
displayed autonomy and health expertise, for instance in caring for a pediat-
ric asthma patient in a March 2014 episode.74 He also vied with the medical
student Campbell for Daphne’s romantic attention. But Daphne began to
explore premed programs, with no mention of nursing, even though virtu-
ally all of her clinical interactions were with Jorge, not Campbell. Everyone
was impressed by Daphne’s new interest in becoming a physician, and the
clinic’s head physician encouraged her to pursue it despite potential obstacles
(she is deaf ). It did not seem to occur to anyone, including Jorge, that the
bright, promising Daphne might consider a nursing career. On the romantic
side, Campbell also seemed to come out on top, although Daphne at least
struggled more with that decision than she had about the medical school
choice. Jorge did maintain his dignity, both as a serious health professional at
the clinic and as an apparently unsuccessful suitor.
In September 2004, the syndicated television quiz show Jeopardy!
included a clue about NPs. On the show, contestants receive the answer to
a question, and they must provide the correct question to win points. In this
episode, there was an “answer” stating, “Minor ailments can be treated by NPs
(nurse practitioners) & PAs (these).” The contestant responded “correctly”
by saying, “What are physician’s assistants?”75 This answer wrongly suggested
that major ailments, such as cardiac disease, cancer, and diabetes, are beyond
NPs. Nurses contacted the show with their concerns, and in June 2005 an
episode featured this clue: “The Golden Lamp Awards are bestowed for the
best portrayals of these health professionals in the media.”76 These were the
awards the Center for Nursing Advocacy was giving annually at that time to
recognize good and bad portrayals of nursing (we now call them the Truth
About Nursing awards). Although we might have preferred a clue that com-
municated more of the substance of nursing, the way the clue played out illus-
trated the very attitudes that lead to poor understanding of the profession.
Upon the reading of the clue, one contestant—a medical student—quickly,
almost gleefully, responded, “What are doctors?”
Hollywood films have generally taken little notice of APRNs. However,
Mike Nichols’s HBO adaptation of Tony Kushner’s Angels in America, dis-
cussed in previous chapters, did include the NP Emily, a minor character
2 7 4
who directed the major character Prior’s AIDS care. No physician was shown
treating Prior. Emily expertly assessed his condition, monitored his treat-
ment, and helped him confront his fears. Emily did not share Prior’s cultural
knowledge—she had not heard of the Bayeux Tapestry—but her steadfast
positivity made Prior’s friend Louis look painfully inadequate.77
Abby Epstein’s documentaries The Business of Being Born (2008) and
More Business of Being Born (2011), produced by and featuring former talk
show host Ricki Lake, offered compelling arguments that the United States
return to an empowering midwifery-driven home birth model. The first film
presented US obstetric care as a dysfunctional business that has consigned
midwives to the periphery so that physicians who don’t understand natural
birth can perform dangerous, unnecessary interventions, while the rest of the
developed world achieves better outcomes for less money using midwives for
most births.78 The four follow-up films released in 2011 featured conversations
with pioneering lay midwife Ina May Gaskin; celebrities discussing their birth
experiences; and explorations of such topics as birth centers, doulas, cesarean
sections, and vaginal birth after cesarean.79
The films were not the portrayals of nursing that they might have been.
The first film did include a powerful portrait of New York City nurse mid-
wife Cara Muhlhahn, who came off as a birth expert as she visited patients
and delivered babies at home. Muhlhahn was articulate and passionate in
explaining her role as “guardian of safety” and “witness to [the mother’s]
process.” But the films largely ignored the work of nurse midwives in hos-
pitals and never explained how nurse midwives differ from lay midwives.
The 2011 films did briefly include a few knowledgeable nurse midwives, but
mainly to explain policies at the hospital birth centers of which the films
were critical. The nurses were identified only by name and “CNM,” so view-
ers may not have known who they were. Overall the later films presented the
birthing world as a divide between generally interventionist physicians and
enlightened lay midwives who embrace natural birth. So the films failed to
convey that nurse midwives have long combined advanced health skills and
a holistic approach to birthing. Maybe the general disregard of nurses was
conscious: Is nursing too closely associated with female subjugation for some
progressives to embrace it?
One recent bright spot for APRNs on television has been the UK docu-
mentary series 24 Hours in A&E, which has included some helpful portray-
als of NPs treating patients in the emergency setting. For example, episodes
broadcast in the United States in November 2011 featured NPs Nancy and
Kim providing authoritative physical and psychosocial care to an older
275
woman with an ear infection as well as patients who had had nasty encounters
with panes of glass.80
The Doctorate of Splinter Diagnosis: APRNs in the News

and Advertising Media
The news media’s treatment of APRNs has been mixed. They have received
some good recent coverage as a new wave in health care, and even as an alter-
native to the physician care model, particularly in light of the reforms associ-
ated with the ACA and the perceived shortage of primary care physicians.
Positive articles have focused on the work of NPs and nurse midwives, mar-
veling at APRN autonomy, patient satisfaction, and even skill. Nurse anesthe-
tists do not appear to have received as much fair coverage, and CNSs seem to
receive little coverage of any kind.
But most media items about the work of advanced health practitioners
simply ignore APRNs, discussing the work of “doctors” even when APRNs
play a critical role in the care at issue. Prominent marketing for drugs still typi-
cally advises the audience to “ask your doctor” about the advertised product.
Even many news items about APRN care show contempt for it, often rely-
ing solely on uninformed criticism from physicians rather than the relevant
scientific research. Physician objections seem to have intensified as APRNs
work increasingly in middle-class care settings in which physicians themselves
have an economic interest. The objections may grow stronger to the extent that
health-financing reforms increase the number of patients seeking primary care.
Fair Reporting on APRNs

Recent reports have described in positive terms the growing role of NPs in
primary care. Some even discuss the research demonstrating the high quality
of APRN care.
In October 2012 The New York Times posted Tina Rosenberg’s excellent
“The Family Doctor, Minus the M.D.,” an articulate and well-reasoned plea
for the United States to expand the authority and scope of practice of APRNs,
as part of the paper’s “Fixes” series.81 Rosenberg argued forcefully that expand-
ing APRN practice would improve access to care and likely reduce healthcare
costs. She suggested that physician groups’ opposition appears to be driven
more by concerns about lost income and authority than by any well-founded
concern for patients. Her main focus was the hundreds of NP-run health
2 7 6
clinics, like a couple of clinics in Indiana that are part of Purdue University’s
School of Nursing. These clinics serve mostly uninsured patients who come
for “family care, pediatrics, mental health and pregnancy care,” including
“chronic problems: obesity, diabetes, hypertension, depression, alcoholism.”
Rosenberg explained NPs’ educational credentials and noted that they “do
everything primary care doctors do, including prescribing, although some
states require that a physician provide review.” She also observed that “like
doctors, of course, nurse practitioners refer patients to specialists or a hos-
pital when needed.” Rosenberg discussed the apparent shortage of primary
care physicians and noted that those physicians are not well-distributed, with
very few working in rural areas or the poor parts of major cities, treating the
underinsured.
Rosenberg addressed head-on the concern that a nurse-run clinic is “sec-
ond-class primary care,” stating flatly that “it is not.” First, she noted, the actual
alternative for many is no primary care at all, because there are so few physi-
cians in some areas. So patients might eventually end up in the emergency
department, but often much sicker than necessary. Rosenberg continued:
Just as important, while nurses take a different approach to patient

care than doctors, it has proven just as effective. It might be particu-
larly useful for treating chronic diseases, where so much depends on
the patients’ behavioral choices. Doctors are trained to focus on a dis-
ease—what is it? How do we make it go away? Nurses are trained to
think more holistically. The medical profession is trying to get doctors
to ask about their patients’ lives, listen more, coach more and lecture
less—being “patient-centered” is the term—in order to better under-
stand what ails them.
In other words, the medical profession is trying to get physicians to act

more like nurses. Jennifer Coddington, a pediatric NP who was “co-clinical
director” at the Indiana clinics, explained to Rosenberg that she spent a lot
of time teaching patients and families about how to manage diseases, mind-
ful of their educational and economic levels. Rosenberg also described the
research on APRN care, citing the 2011 Nursing Economic$ review compar-
ing physician-led and NP-led clinics; she noted pointedly that there were “no
measures on which the nurses did worse.”
In October 2004 the Wall Street Journal published another extraordi-
narily good article of this type by Andrew Blackman: “Is There a Doctor in
the House? Perhaps Not, as Nurse Practitioners Take on Many of the Roles
277
Long Played by Physicians.”82 Long before the IOM report and the current
ACA debates, Blackman reported that nurse-run primary care practices “may
be critical to the future of health care in the U.S.” The story suggested that
NPs’ holistic, thorough, preventive approach may be uniquely suited to an
aging population with long-term illnesses. In particular, the piece explained
how the nurses’ focus on patients’ environments, psychological factors, and
practical issues leads to solutions to long-term problems. Blackman discussed
hurdles that NPs have yet to overcome, including legislative limits on their
autonomy. Noting concerns that NPs might miss a diagnosis, the article con-
cluded that “studies have shown that when it comes to patient outcomes,
nurse practitioners are just as good as doctors.”
At the core of Blackman’s piece was its description of the Columbia
Advanced Practice Nurse Associates (Capna), a pioneering NP-run practice
founded in 1994 by the Columbia University School of Nursing. Capna was
the first nurse-run US clinic to win full privileges to admit patients to hos-
pitals and the first to gain insurance compensation at the same rate as physi-
cians.83 One Capna patient praised the comprehensive, unhurried approach
of the NPs. She faulted the physicians she had seen before for being rushed
and having “no bedside manner.” Another patient compared NP-physician
collaboration to his own experience as a business school graduate in partner-
ship with a lawyer. The patient suggested that perhaps “the future of health
care is to find a way to combine the different skills of each one.” However,
Blackman’s piece made clear that the NPs were not just filling gaps but win-
ning over patients who could easily be seeing physicians instead. Columbia
nursing dean and Capna founder Mary Mundinger emphasized that she
chose an exclusive Madison Avenue address for one Capna office precisely so
the NPs could compete directly with physicians.
Indeed, any piece with Mundinger in it is likely to include some strong
pro-APRN advocacy. In December 2009 the New York Observer published an
extensive profile of the “controversial” leader, who was then retiring as dean
after a quarter century of fighting to strengthen advanced practice nursing.
Dana Rubinstein’s article had flaws, but it was a thoughtful examination of
how far nurses have come and what the future might hold.84 The piece noted
that Mundinger “argues that, if anything, primary care physicians are overedu-
cated.” It included an anecdote about the time she had spoken to the Federation
of State Medical Boards and a primary care physician asked if he had “wasted”
his time going to medical school. Mundinger: “I wanted to say, yeah.”
Other reports have emphasized APRNs’ focus on underserved popula-
tions. In April 2004, the Atlanta Journal-Constitution ran a very good article
2 7 8
by Patricia Guthrie about local NP Dorothy Gallaway.85 Gallaway’s clinic pro-

vided low-income families with primary care and preventive health services,
such as vaccinations, family planning, sexually transmitted disease diagnosis,
and treatment of high blood pressure and asthma. Gallaway said the clinic
was also “seeing more insured patients because they like nurse practitioners.”
In November 2003, in an enthusiastic piece about the growing role of NP-run
primary care centers, Philadelphia Daily News columnist Ronnie Polaneczky
described a clinic in a public housing development where NPs “do everything
primary-care physicians do.”86 Polaneczky cited research showing that the
nursing center patients saw their practitioners more often than patients in
traditional care settings, but they used emergency departments 15 percent less
and had shorter hospital maternity stays, lower prescription costs, and better
preventive child health programs.
Some pieces have presented APRNs as innovative leaders in developing
new care models. In January 2013 Minnesota Public Radio aired an excel-
lent report by Laura Yuen about sexual abuse of runaway girls that featured
NP Laurel Edinburgh.87 Broadcast on National Public Radio’s All Things
Considered program, the report noted that Edinburgh had “helped create the
beginnings” of the Ramsey County Runaway Intervention Program a decade
earlier. Her research had shown that the program improved outcomes. The
piece reported that Edinburgh had devised a set of questions that St. Paul
police used to screen runaways for signs of physical and sexual abuse. Several
recent items, including one by Joseph Shapiro that ran on NPR in July 2009,
have explained the work of transitional care nurses, many of whom are NPs.88
These nurses help patients navigate the healthcare system after hospital stays,
preventing needless readmissions and saving money. Shapiro’s very helpful
piece focused on professor Mary Naylor’s Transitional Care Model program
at the University of Pennsylvania, showcasing NPs’ psychosocial and health
management skills.
Nurse midwives have received some attention, perhaps because of recent
interest in different approaches to birthing. In July 2008, the Post and Courier
(Charleston, South Carolina) ran Jill Coley’s report on the Charleston Birth
Place as a new alternative for mothers who want a natural birth but also
access to emergency care if needed.89 The Birth Place’s owner, nurse midwife
and family NP Lesley Rathbun, noted that a “culture of fear” has developed
around birth in the United States, with women in labor “screaming” in the
popular media. In January 2006 Rhode Island’s Providence Journal ran a
profile of nurse midwife Mary Breckinridge by Stanley M. Aronson, dean
of medicine emeritus at Brown University. “Kentucky’s Intrepid Nurses on
279
Horseback” discussed Breckinridge’s globally influential work in founding

and leading the Frontier Nursing Service, which has provided care to poor
mothers and children since 1925.90 The piece said that today, Brown medical
students “may spend up to three months in rural service supervised by these
indomitable nurse midwives.”
There has also been some good coverage of threats to APRN practice. In a
powerful May 2007 cover story in the Washington Post Magazine, Phuong Ly
described the struggle of midwifery pioneer Ruth Lubic to keep birth centers
for low-income urban women open, despite rising malpractice rates.91 The
piece explained that over the previous several decades, Lubic had established
nurse midwife-staffed birthing centers in New York City and Washington,
DC and “defied doctors to transform the way American women give birth.”
In July 2005, the Savannah Morning News posted Don Lowery’s story about
a local primary care physician serving an eight-month sentence in federal
prison, apparently in part for signing blank Schedule II substance prescrip-
tion refills for NP colleagues to use.92 Such NP prescription was then unlaw-
ful in Georgia. The physician reportedly wrote the prescriptions so that the
rural clinic where he practiced could handle its huge patient load. The follow-
ing year Georgia NPs finally gained statutory prescription authority.93
Some news outlets have reported on the plan to make the DNP the stan-
dard APRN degree by 2015. In April 2008 the Wall Street Journal ran Laura
Landro’s “Making Room for ‘Dr. Nurse.’ ”94 The piece presented the DNP,
pioneered at Columbia University, as a “possible solution” to the perceived
shortage of primary care physicians. Patient Judith Gleason praised the pre-
ventive care and keen diagnostic skills of the DNPs at Capna. But the piece
fell short in suggesting that NPs “fear the doctoral programs might be raising
the bar too high for their profession,” which implied either that nurses think
they can’t handle doctoral training or that nursing is not important enough
to warrant it.
Although it’s still rare, the media has even consulted APRNs as health-
care experts. In January 2013 the Richmond, Virginia CBS television affiliate
WTVR (Channel 6) ran a short segment in which CVS Minute Clinic NP
Anne Pohnert debunked common myths about the flu. Pohnert explained
simply and clearly that you can’t get the flu from the flu shot and that it’s
important to get the vaccine every year.95 Pohnert’s segment was remarkable
not just because it represented an appearance by a nurse as a health expert
but because the station made a point of mentioning that Pohnert practiced
at CVS. In the early days of quick clinics, the major corporate players almost
seemed to apologize for staffing their clinics with NPs. But the references to
2 8 0
CVS here suggested that the company was actually promoting its clinics with
the expertise of NPs, at least in this case.
In June 2010, the Houston Chronicle ran a “Sunday Q&A” feature by Cindy
George in which University of Texas NP and nursing professor Elda Ramirez
gave advice on coping with the very hot days her region experiences.96 Like
Pohnert, Ramirez displayed an ability to convey practical health information
in a direct, engaging way. Her advice ranged from hydration strategies to how
to avoid leaving children in vehicles: “In the summertime, a lot of grandpar-
ents or other people have the children who don’t normally have that respon-
sibility. Have a backup system. . . . Have a picture of the baby right by the
speedometer or on the rearview mirror. Always have something that reminds
you: I have the baby. And if you’re going in the store, always take the kid out.
Don’t be lazy.”
The News and Advertising Media Often Ignores or Disrespects APRNs

APRNs are rarely mentioned or consulted in health items that are not specifi-
cally about them. A constant assumption in the advertising and news media’s
treatment of health issues is that only “doctors” provide advanced practitio-
ner care and that only “doctors” need be consulted in discussion of that care.
That is the case even in areas in which APRNs in fact play a critical role, such
as primary care, obstetric care, and public health.
A striking example of the absent APRN is Deirdre Kennedy’s April
2008 National Public Radio report about the expanding use of online
“doctor-patient” communication.97 As is typical, the five-minute piece referred
relentlessly to “doctors,” as if the 200,000 US APRNs did not exist. But nurs-
ing did get one disdainful mention: At one point, Kennedy noted that some
“doctors” were using a physician-designed Web portal that asked patients pre-
liminary questions about their conditions, using “branching logic.” Kennedy
referred to this computer system as an “electronic advice nurse.”
Advertising is not traditionally the place to look for progressive ideas,
and the subject of APRN care is no exception. With the growth of APRN
practice, some may see profit-making potential in reinforcing the false idea
that only physicians have real health care expertise. In early 2013 a television
commercial aired in the southern United States for American Family Care, an
aggressively expanding chain of urgent care clinics that planned to have more
than 110 locations in twenty-eight states by the end of 2013.98 The advertise-
ment featured two people texting back and forth about where to seek health
care. At the end, one texter recommended that the other go to American
281
Family Care because there patients get to see “a doctor, not a nurse.” Despite
those reassuring words about the company’s high-quality care, in March 2014
its website’s “staff openings” section listed five open Family Nurse Practitioner
positions in Alabama—in the “Physician Services” Department.99
When news items do discuss APRN care, they too may indicate that
APRNs are poor substitutes for physicians. Many pieces have relied for
expert comment solely on physicians, who seem to assume that APRNs can’t
handle serious conditions simply because they have not been educated as
physicians. Often, reports do not even give APRNs the chance to respond
to uninformed attacks on the care they give. A November 2002 Redbook
article entitled “Advice Docs Give Their Own Families” included a physician
warning: “Don’t let yourself be brushed off onto a Nurse Practitioner.”100
The piece presented no NP response. Here again, it must be enough to just
“ask your doctor”!
Even more substantial news reports may fall into this trap. In an October
2010 Kaiser Health News article posted on the MSNBC website, Andrew
Villegas and Mary Agnes Carey gave a fairly detailed account of the 2010
IOM report’s significance for APRNs.101 The piece included physician
leaders’ claims that APRNs are unqualified to practice independently, with
specific quotes from representatives of the AMA and the American Society
of Anesthesiologists. Yet the piece quoted no nurses on that subject—in an
article about a report urging nursing empowerment. The piece did include
general quotes from IOM panel member Donna Shalala on the need to
use all resources to meet healthcare needs, but that did not counter the
physician attacks.
Sometimes physicians themselves create such media. An August 2008
Washington Post piece by physician Benjamin Natelson bemoaned the decline
in physicians’ ability and willingness to make difficult diagnoses, which the
author attributed mainly to modern healthcare economics. Natelson wrote
that a “partial solution to the growing gap in primary care providers” is “phy-
sician extenders,” who are “trained to deal with commonly occurring, easy-
to-diagnose problems: a flu, hay fever, a splinter, even severe chest pain.”102
However, he claimed, those “extenders” usually have not “had enough train-
ing to give them the know-how to sort through a complex medical history to
arrive at a diagnosis that isn’t immediately evident. When they’re stuck, they
have to call the physician, and by then, the 30-minute visit is very often over.”
Natelson wrongly conflated years of formal education with the ability to diag-
nose, and diagnosis with all of health care, as in House. In fact, NPs have used
their advanced listening skills to diagnose many life-threatening conditions
2 8 2
that physicians did not. But more generally, NPs achieve good patient out-
comes because they are adept at the full range of what practitioners should
do, including preventive health and patient education. Ironically, another NP
asset is just what Natelson seems to disdain: NPs’ willingness to consult with
others when they do not know something. Plus, with those graduate science
degrees, NPs are super at splinters!
Nurse anesthetists have received critical reviews from high-end plastic
surgeons in the media. In June 2004 Vogue ran a piece by Ariel Levy about
cosmetic surgery that quoted Santa Monica surgeon R. Patrick Abergel,
whose patients included Hollywood stars, as follows: “It’s not illegal for sur-
geons to administer anesthesia themselves, and a lot do—or they work with
nurse anesthetists. Both are unsafe.”103 Of course, the actual research proves
otherwise. As with the American Family Care advertisement discussed pre-
viously, we have to wonder if elite plastic surgeons may be doing a bit of
medical upselling, justifying high fees in part through their association with
anesthesiologists.
Coverage of the proliferation of clinics in supermarkets and drugstores
has rarely conveyed much respect for NPs. For example, in a March 2014
segment about the ACA (Obamacare) on the Fox News show The O’Reilly
Factor, host Bill O’Reilly denigrated the clinics because they were not staffed
by physicians: “If I want a strep throat diagnosis, I don’t want Lenny who just
came out of the community college.”104 Guest Ezekiel Emanuel, a physician
who helped design Obamacare, responded: “Excuse me, those are nurse prac-
titioners, it’s not Lenny out of a community college.” Emanuel did not explain
NP education, and rather than defending NP diagnostic skill, he went on
to emphasize that such diagnosis is straightforward. Still, with luck viewers
would at least understand that NPs have more education than an associate’s
degree. Emanuel did stress that physicians are not required for every aspect
of health care. In any case, the exchange showed that uninformed disdain for
APRNs remains widespread in influential media.
A July 2006 Houston Chronicle report, Brett Brune’s “In-Store Clinics
Not a Cure-All, Doctors Warn,” described the AMA’s efforts to limit
the rapid expansion of retail clinics.105 Physician Michael Speer of the
Texas Medical Association allowed that the idea of the clinics had “some
degree of merit” for things like flu shots, simple abrasions, colds, and
other “minor illnesses.” But he suggested that (in the reporter’s words) “if
stitches are needed or a cough gets deeper, it’s time to go to a doctor.” The
Chronicle’s main source on NP skill was AMA board member Dr. Rebecca
Patchin, who at the time was using her status as a “former nurse” to bolster
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misleading press attacks on NPs in retail clinics. In the Chronicle, Patchin

said the AMA wanted
to make sure the public understands when it’s appropriate to use a

store-based clinic and when they should utilize an emergency room
or a doctor’s office. . . . When I was a nurse, I didn’t know as much as I
know now. . . . The extra years of training as a physician provide added
experience, exposure and depth of knowledge regarding patients, ill-
ness, disease process and treatment.
But that is not a fair comparison of NPs and MDs because Patchin was
never an NP. Patchin also asserted that physicians (in Brune’s words) “have at
least five more years of education than nurse practitioners.” This formulation
wrongly equates NPs’ undergraduate education, which includes two years of
healthcare education, with physicians’ undergraduate education, which does
not include healthcare education. It also wrongly counts physician residen-
cies as education but not NP residencies, the early years of NP practice, or the
many years of prior RN practice that most NPs have. Like all who claim that
NPs are unsafe, Patchin ignored the wealth of research showing the contrary.
In an apparent stab at balance, the Chronicle piece included reaction from
a retail clinic company CEO. He said that most customers have no primary
care provider but that they are discouraged from making the clinics their
“medical home” for anything other than “routine episodic care.” Of course
quick clinics should be clear about their scope of care. But like most com-
ments by retail clinic executives in similar articles, this one did not convey
that NPs are skilled professionals who can themselves provide comprehensive
primary care in a setting that allows for it. There was no recognition that the
type of vaccinations and basic screenings the retail clinics provide have saved
millions of lives around the world. No NP was consulted for the piece, sug-
gesting that physicians are the only health experts with anything useful to say
about NP care. And there was no hint that retail-based clinics can be viewed
not just as a clever business initiative, but as a promising new basic care model.
An August 2009 article by Julian Drape on the Western Australia news web-
site WAtoday was headlined “Nurse Clinics are ‘Supermarket Medicine.’ ”106
That was the view of the only expert quoted, Australian Medical Association
president Andrew Pesce, who objected to one company’s plan to open 180
pharmacy-based clinics staffed by NPs. Pesce also offered this analysis: “Nurse
practitioners tend to be highly trained in a narrow area of health care and
are not skilled or experienced in providing holistic care.” Really? Perhaps the
2 8 4
NPs also tend to be greedy and arrogant! The only response to Pesce in the
report came from Health Minister Nicola Roxon, who did not defend NP
skill, but emphasized that the NPs would have to make “collaborative agree-
ments” with physicians.
Similarly, in November 2005 NBC’s Today show included a short, trou-
bling segment about retail clinics by reporter Janice Lieberman.107 While
stressing that the clinics offer convenience and affordability for basic care,
the report also degraded the NP care available “on the cheap” at what it called
“quickie” clinics. It ignored NPs’ vital role in more comprehensive primary
care and suggested that autonomous NP care presents safety risks, relying
on a quote about the supposed need for “supervision” of the “non-physician
providers” from AMA president Edward Hill. The only audible NP response
the NBC News product offered its audience consisted of an NP, identified
as “Kathy,” saying “ready?” to indicate that she was set to give Lieberman a
flu shot.
In September 2009 Today returned to the APRN beat with a report by
Peter Alexander that aired with the title “The Perils of Midwifery,” though
NBC later changed the online title to “The Perils of Home Births.”108
The biased report focused on the death of a baby under the care of Cara
Muhlhahn, the prominent nurse midwife who appeared in The Business of
Being Born. Relying on interviews with the grieving parents, the report used
this one tragic death to question the safety of home births and (as the ini-
tial title showed) midwifery. The piece did show another couple who had a
good home birth experience, and it stated the basic argument Abby Epstein’s
film makes against hospital births, including comment from one of the film’s
home birth advocates. But the report ignored the research demonstrating the
high quality of nurse-midwife care, and it included no expert comment from
midwives or their associations. It presented physicians as the only source of
true healthcare expertise.
Even press items that support APRN practice may convey subtle dis-
dain. In a May 2012 piece on The Atlantic website, “Why Nurses Need More
Authority,” physician John Rowe argued with some force that allowing
APRNs to do more would improve primary care and probably reduce health-
care costs.109 He also suggested that the objections from physician groups
were unfounded. Noting that the physician groups “argue that physicians
with more years of training under their belts must necessarily know more
than an APRN ever could,” Rowe responded that “of course they know more,
but it is well established that they do not know more about providing the core
elements of basic primary care.” However, as we have seen, APRNs typically
285
have six to eight years of university-level education, four to six of it in nurs-

ing, and most have spent years in clinical practice. It is absurd to suggest that
medical training means that a physician knows more than an APRN “ever
could.” Rowe also asserted that letting APRNs “handle routine care frees up
physicians to focus on diagnostic dilemmas and more complex management
issues while dramatically reducing waiting times for care,” expanding on an
earlier reference to APRNs treating “uncomplicated” acute illness. In fact,
APRNs—who have an advanced holistic practice model and excellent inter-
personal skills—are quite capable of going beyond “basic” and “routine” care
to handle complex diagnoses and care management.
Indeed, consider a 2010 article that KJ Lewis posted on the University of
Central Florida’s Today site about Arden Monroe-Obermeit, who appeared as
a morgue technician on the Discovery Channel reality show Dr. G: Medical
Examiner. Monroe-Obermeit was about to enter the university’s DNP pro-
gram.110 The article reported that her new career path was inspired partly by
an NP who had diagnosed her Cushing disease when many physicians could
not.
Some news items praise APRNs in a way that denigrates other RNs. The
April 2008 Wall Street Journal piece about the development of the DNP
degree included a chart comparing the education and practice of DNPs,
master’s-prepared APRNs, and RNs.111 Under the heading of “Professional
Authority,” the chart listed the APRNs’ prescription authority; for the RNs,
it stated “None.” Nonsense. RNs cannot prescribe drugs, but that does not
mean they have no professional authority, as the nurse practice acts discussed
in Chapter 4 make clear.
In February 2005 the Australian ran a generally good piece by Adam
Cresswell about the growing role of Australian NPs in managing chronic
heart failure. “The rise of the super nurse” emphasized the positive effect
of the holistic nursing model on patient outcomes.112 But the term “super
nurse,” even more than “advanced practice nurse,” may suggest that RNs are
nothing special.
Similarly, a January-February 2005 issue of U.S. News & World Report
featured a massive special health report entitled “Who Needs Doctors?”113
Describing how other professionals are increasingly providing care that used
to be the exclusive province of physicians, the report took an unusually positive
look at the work of APRNs. But parts of the report suggested that APRNs are
worthy of attention because they’re doing things physicians do, whereas other
nurses remain engaged in their subservient, limited traditional work. One NP
was quoted as saying that when she started out (in about 1980) “nurses were
2 8 6
not told we could think for ourselves” and “just did what a doctor planned
out for us,” which is incorrect. Some nurses may have internalized the idea
that they have not been thinking for themselves, but autonomous thinking
has been a critical part of nursing practice since at least Nightingale’s time,
as we discuss in Chapter 4. The feature stated that “through the 1980’s, the
idea of nurses doing more than just assisting doctors gained acceptance” as
patients began seeking out nurses as their primary care providers. That state-
ment obviously implies that RNs simply assist physicians, which is false. For
centuries, nursing has been an autonomous science profession with its own
distinct sphere of practice. That is true even though nursing has traditionally
had less power than medicine, as we discuss in Chapter 4, and not enough
nurses have yet embraced their autonomous decision-making, as we discuss
in Chapter 11.
Thus, even in some pro-APRN media pieces, a troubling theme
remains: Now that APRNs can do work that physicians have been doing, who
needs RNs?
Notes
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3. CFNA, “Mattel on the ‘Nurse Quacktitioner’: Problem? What Problem? Oh—and
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com/lde6v7w.
4. CFNA, “Some U.K. Physicians to Mattel: Keep That Anti-Nurse Hatred Coming!,”
TAN ( January 9, 2006), http://tinyurl.com/ohjwq8u.
5. Bryan Moore and Chris Peterson, writers, Victor Gonzalez, director, “Bionic
Showdown,” Lab Rats, Disney XD (August 5, 2013), TAN, “Nurse Practitioner
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6. Robin P. Newhouse, Julie Stanik-Hutt, Kathleen M. White, Meg Johantgen,
Eric B. Bass, George Zangaro, Lily Fountain, et al., “Advanced Practice Nurse
Outcomes, 1990–2008: A Systematic Review,” Nursing Economic$ 29, no. 5
(September-October 2011): 230–250, http://tinyurl.com/l58y243; TAN, “Do
Physicians Deliver Better Care than Advanced Practice Registered Nurses?,”
http://tinyurl.com/yd7r3yv.
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287
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2 8 8
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Redux,” ER, NBC (April 28, 2005); CFNA, “Judas in a Lab Coat,” TAN (April 28,
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44. Fred Einesman, writer, Mark Tinker, director, “In the Name of Love,” Private
Practice, ABC (May 6, 2010); Debora Cahn, writer, Jeannot Szwarc, director, “The
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47. CFNA, “Nurses Are About 100 Times More Likely to Attend Graduate Nursing
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2 9 0
50. Abby Epstein, director, The Business of Being Born, Ample Films, Barranca
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2 9 2
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96. Cindy George, “Don’t Sweat It: Here Are Tips to Survive the Heat,” Houston
Chronicle ( June 13, 2010), http://tinyurl.com/lf8snzb; TAN, “Don’t Be Lazy”
(August 2, 2010), http://tinyurl.com/kt2bvm9.
97. Deirdre Kennedy, “Doctor-Patient ‘Web Visits’ Spur Privacy Concerns,” National
Public Radio (April 3, 2008), http://tinyurl.com/63wcrg.
98. TAN, “American Family Care Clinics: You Get to See a Physician, Not a Nurse!”
(May 31, 2013), http://tinyurl.com/pkfg5pz.
99. American Family Care, “Staff Openings,” accessed March 1, 2014, http://tinyurl.
com/nbm6rh8.
100. CFNA, “Redbook Magazine: ‘Don’t Let Yourself Be Brushed Off onto a Nurse
Practitioner,’ ” TAN (November 2002), http://tinyurl.com/m86lv5v; Jolynn
Tumolo, “NP Spotlight: Redbook Article Raises the Ire of Nurse Practitioners,”
Advance for Nurses (October 21, 2002), http://tinyurl.com/kxz4o2o.
101. Andrew Villegas and Mary Agnes Carey, “Nurses Need a More Independent
Role, Report Argues,” Kaiser Health News, NBC News (October 5, 2010), http://
tinyurl.com/mcmvkxh; TAN, “A Terrible Thing to Waste” (November 18, 2010),
http://tinyurl.com/kzxnkud.
102. Benjamin Natelson, “Lost in a System Where Doctors Don’t Want to Listen,”
The Washington Post (August 3, 2008), http://tinyurl.com/5zf4gx; CFNA,
“ ‘Physician-Extenders’ Lack ‘Know-How’ to Diagnose Complex Stuff, but Are
Really Good at Taking Out Splinters,” TAN (August 3, 2008), http://tinyurl.
com/m7l36na.
103. CFNA, “Prominent Hollywood Plastic Surgeon Tells Vogue Readers That Use
of Nurse Anesthetists Is ‘Unsafe,’ ” TAN ( June 2004), http://tinyurl.com/
mg8qzw2.
104. Bill O’Reilly, “American Doctors and Obamacare,” The O’Reilly Factor, Fox News
(March 4, 2014), http://tinyurl.com/mlyjn42.
105. Brett Brune, “In-Store Clinics Not a Cure-All, Doctors Warn,” Houston Chronicle
( July 9, 2006), http://tinyurl.com/mcpwesn; CFNA, “But When I Became a
Physician, I Put Away Nursing Things,” TAN ( July 9, 2006), http://tinyurl.com/
lsdfc3w.
106. Julian Drape, “Nurse Clinics Are ‘Supermarket Medicine,’ ” Australian Associated
Press (August 13, 2009), http://tinyurl.com/k4n5tcv; TAN, “Nurse Clinics Are
‘Supermarket Medicine’ ” (August 13, 2009), http://tinyurl.com/k8rxtw8.
2 9 4
107. CFNA, “Fast, Cheap, and Out of Control,” TAN (November 14, 2005), http://
tinyurl.com/kmqzu62.
108. Peter Alexander, “The Perils of Midwifery,” renamed “The Perils of Home Births,”
Today Show, NBC (September 11, 2009), http://tinyurl.com/lycjspz; TAN,
“Love and Commerce” (September 11, 2009), http://tinyurl.com/lyy76ny.
109. John W. Rowe, “Why Nurses Need More Authority,” The Atlantic (May 7, 2012),
http://tinyurl.com/lb6zxr9; TAN, “Fixes” (October 24, 2012), http://tinyurl.
com/m9tp37t.
110. Kimberly Lewis, “Former ‘Dr. G’ Cast Member Becomes Nurse,” UCF Today
(August 2, 2010), http://tinyurl.com/2e6ao4e; TAN, “Don’t Be Lazy: Dr. M-O”
(August 2, 2010), http://tinyurl.com/l44zjxq.
111. Laura Landro, “Making Room for ‘Dr. Nurse,’ ” Wall Street Journal (April 2,
2008), http://tinyurl.com/md9zlkl (chart not included in current online article).
112. Adam Cresswell, “Rise of the Super Nurse,” The Australian (February 12, 2005),
http://tinyurl.com/m89hlgv; CFNA, “The Australian: ‘Rise of the Super
Nurse,’ ” TAN (February 12, 2005), http://tinyurl.com/krdo9p6.
113. U.S. News & World Report, “Who Needs Doctors?” ( January 31, 2005—
February 7, 2005), http://tinyurl.com/kxbnb8j; CFNA, “U.S. News & World
Report: ‘Who Needs Doctors?’,” TAN ( January 31, 2005–February 7, 2005),
http://tinyurl.com/lv45u9o.
III S E E K I N G B E T T E R U N D E R S TA N D I N G
OF NURSING—AND BETTER
H E A LT H C A R E
10
HOW WE CAN ALL IMPROVE
U N D E R S TA N D I N G O F N U R S I N G
One afternoon we drove in the rain along the winding Rock Creek
Parkway in Washington, DC. Suddenly we saw a commotion
ahead. A car had just slid off the road and flipped upside down.
A small crowd had gathered, but paramedics had not yet arrived.
We stopped, and Sandy got out to help, having practiced emer-
gency nursing at major trauma centers for many years.
Sandy approached the overturned car. The driver was sus-
pended upside down by her seat belt. She was conscious but under-
standably anxious. A group of about ten people, mostly men, was
frantically trying to figure out how to remove the driver from
her car. Sandy spoke loudly: “I’m a nurse. Do you need help?”
The crowd ignored Sandy and continued preparing to move the
woman. If the woman had had a serious neck injury, moving her
without immobilization precautions could have caused paralysis
or even death. Sandy said loudly, “Is anyone else here a health pro-
fessional?” Again no one replied. So Sandy said, “OK then, I’m an
ER nurse, I’m in charge here.”
Very reluctantly, the crowd gave Sandy enough room—barely—
to push through to examine the upside-down patient in the car.
A few men in the crowd demanded that Sandy let them get the
woman out. Sandy had to back them off several times as she assessed
the woman’s neck and general condition. She had no apparent seri-
ous injury, so Sandy let the crowd take her down.
Every day, people in situations like this depend on nurses to
advocate for them. But in this case, as in many others, the nurse was
barely able to protect the patient. It’s hard to escape the conclusion
that this danger arises from the public’s misunderstanding of nurs-
ing. The crowd at Rock Creek conveyed confusion, even anger, that
a nurse would purport to direct them on a life-threatening health
condition, even though no one else present had health expertise.
2 9 8
Perhaps the crowd, like surgeon character Cristina Yang on Grey’s Anatomy,
would have been happy to let Sandy know if a bedpan needed emptying! But
if Sandy had announced that she was a physician, it is hard to imagine the
crowd having the same reaction.
We have shown how the media reinforces the undervaluation of nurs-
ing. In 2006 a Brazilian nursing professor wrote us to say that she shared our
concerns about the show House, which was popular in Brazil and around the
world. The professor said nursing was very different in Brazil, where, she said,
nurses do not report to physicians but to a nurse manager.1 Of course, US
nurses also report to senior nurses, not to physicians. But House and other
Hollywood shows offer a persuasive enough vision of US health roles that
even the nursing professor believed the inaccuracy.
We have also seen that public disrespect for nursing has grave conse-
quences for nurses and patients. Disrespect underlies many of the more
immediate causes of the deadly nursing shortage. It leads governments and
foundations to allot meager funding for nursing education and research.
That in turn undermines the nursing profession, leaving too few qualified
nurses and nursing educators, and people die. We rightly spend billions on
alleviating deadly diseases, but we spend relatively little on the poor nursing
infrastructure that allows the diseases to spread in the first place. Disrespect
leads hospital administrators to replace registered nurses (RNs) with techni-
cians, who can’t tell when a patient is deteriorating, so patients suffer, even
die. Disrespect leads patients to ignore nurses’ health advice, and the patients
suffer, even die. Disrespect undermines nurses’ sense of their own autonomy
and worth, deterring them from advocating for themselves and their patients.
We can change this situation. Poor public understanding of nursing, and
the resulting harm to public health, is not inevitable. Of course changing the
way the world thinks is a challenge, but even the most ingrained social biases
can change over time. Nurses have already managed to improve understand-
ing, in ways large and small.2 Nurses have persuaded or helped some media
creators to produce more accurate news articles and even entertainment
media. Nurses have convinced advertisers to reconsider degrading naughty
nurse depictions. We’ve seen how in 2005 nurses persuaded the US govern-
ment to change the name of the Take a Loved One to the Doctor Day cam-
paign to Take a Loved One for a Checkup Day, a name that does not exclude
the advanced practice RNs who provide primary care to the minority popula-
tions the campaign targets.
But understanding does not improve only when we change media prod-
ucts that reach millions. All of us can have a powerful effect simply through
10 How We Can All Improve Understanding of Nursing •
299
the way we think and act every day. Sandy was raised in a family with a strong
focus on mechanical and computer science, but she considered nursing to be
undesirable handmaiden work until, as a teenager, she worked at a nursing
home. She was awed by the skill and autonomy she saw in the nurses there.
She began nursing school. Not all nurses would have inspired that choice.
That those nurses did is a testament to their professional strength and vision.
Everyone should play a role in increasing understanding of nursing. Of
course nurses must take the lead, as we’ll discuss in detail in Chapter 11.
Nurses must believe in themselves and project that belief to others. Nurses
should work to persuade the media to provide a more accurate picture of the
profession and they should consider creating new media themselves.
But nurses cannot improve understanding by themselves because they
are underpowered, even in their own spheres of expertise. The Institute of
Medicine’s landmark 2010 report, The Future of Nursing: Leading Change,
Advancing Health, correctly argued that nurses should play a far greater role
in healthcare decision-making.3 Few nurses serve as hospital CEOs or as direc-
tors on hospital boards, even though hospitals exist mainly to provide nursing
care. A March 2012 analysis by the Truth About Nursing suggested that of the
directors of the top seventeen US hospitals as selected by U.S. News & World
Report, only a handful were nurses.4 We know of no major hospital board on
which nurses are even 5 percent of the members; often there are no nurses
at all. In 2012 the Center to Champion Nursing in America, a project of the
AARP and the Robert Wood Johnson Foundation, launched an initiative to
put more nurses on hospital boards of directors, and they have been making
some progress!5 MinuteClinic, the CVS retail clinic group with more than
750 US locations in early 2014, did at that time include two nurses (and two
physicians) on its eight-member management team.6 But overall, few nurses
hold powerful positions in government or the private sector. In addition, few
nurses have significant input on influential media.
Many other segments of society can help nurses by influencing both media
portrayals of nursing and people’s understanding of nursing generally. We
can all listen to nurses and watch what actually happens when we interact
with the healthcare system: What are the nurses doing? Do the media we
see reflect that? Tell a friend! What are our assumptions and actions when it
comes to nursing, including our language; do we credit physicians for things
nurses really do? How can we apply our new understanding to push for more
resources and respect for the skilled nurses almost all of us will one day need?
Some parts of society have special influence. In particular, those who cre-
ate media should try harder to provide a fair picture of nursing. Creators of
3 0 0
news and entertainment media can learn from nurses about what they really
do. Nurses make great expert sources, because a key part of nursing education
is learning how to convey complex health information to lay people. In addi-
tion, advertisers should consider the effects of nursing stereotypes and try to
find alternative ways to sell their products.
Private sector health executives should ensure that their public speech
reflects an understanding of nursing. Managers of hospitals and other clini-
cal facilities should promote nursing as they do medicine, and publicize their
efforts to strengthen the profession. Insurers and drug companies can adver-
tise without suggesting that health care revolves solely around “doctors.”
Government leaders and other health policy makers should also work to
communicate an understanding of what nurses really do. They should publi-
cize their efforts to invest in nurses’ clinical practice, education, and research,
and place qualified nurses in visible positions of authority. Foundations
should consider creating prizes and museums to build public appreciation for
nursing.
Nurses’ healthcare colleagues can also play a key role. Physicians must
learn about what nurses really do for patients, and they should do what they
can to stop the crediting of physicians for work that nurses really do, from
Hollywood to your bedside. Other health workers should ensure that they
are not mistaken for nurses.
What will the future look like when the global public truly values the
nursing profession? Understanding that nurses save lives will itself save lives—
by enabling nurses to get the resources and respect they need to do their work.
Adequate resources for clinical settings are only the beginning. Through their
holistic, preventative focus, nurses can intervene before conditions become
severe, so that patients don’t end up dead or in expensive hospitals. Teams
consisting of community health nurses and advanced practice nurses, work-
ing in local settings, can prevent or manage a great deal of the illness the world
now suffers. With such programs, malaria might kill millions fewer children,
because the nurse teams could work to eliminate standing pools of water and
increase use of mosquito nets. Obesity-related problems like heart disease and
diabetes might no longer cripple health systems if nurses were educating and
advocating in the community for better diet and exercise. Millions of critically
ill infants might be home with their families because nurses would have the
resources to teach mothers how and why to breastfeed. Emergency depart-
ments might no longer burst with patients waiting twenty hours for care,
because nurses would be keeping many patients out of the hospital system.
301
Here is a prospectus for a global investment in nursing:
Value of nurses saving thousands of additional lives every day:

Trillions of dollars.
Value of nurses teaching millions more people how to live healthier lives:
Trillions of dollars.
Value of nurses keeping families, workplaces, communities, and nations
strong:
Priceless.
Everyone can do something to increase knowledge of what nurses really do

and thereby improve health. Below are some ideas, conveniently organized
for specific categories of people. Clip ‘n’ save!
I’m a Citizen of the World. What Can I Do?

We can all learn more about nursing—what it is and is not. When you are
in the healthcare system, or meet a nurse, try to learn what nurses really do.
We can all look critically at what the media tells us about nursing. Does that
news story or show treat nursing fairly? If not, is that acceptable in the midst
of a nursing crisis? We can all consider the messages that we ourselves send,
through things as basic as our clothes and our language. What each of us does
matters particularly now, because with the Internet, virtually anyone can cre-
ate media accessible to the rest of the world, all day, every day.
“What Do You Do All Day, Anyway?”

When you meet a nurse, try asking what was exciting or worthwhile about the
care he or she provided to patients in recent days. Try to focus on what the
nurse actually did for the patient: How did he improve the patient’s outcome?
Did she save (or lose) a life? The nurse will get a chance to practice explain-
ing what nursing involves and perhaps gain reassurance that it matters. You’ll
probably learn something new about nursing and health care generally.
“You Could Be a Doctor!”

Let’s say you are a patient or family member who is impressed by a nurse’s com-
petence. Or perhaps a nurse tells you a fascinating story and you are floored by
3 0 2
his skilled, autonomous interventions. (Stay with us, this often happens when
people really listen.) Try to resist the urge to tell him, “You could be a doctor!”
We know that people mean that as a compliment, but it suggests that any nurse
who displays knowledge or skill is exceptional and ought to be a physician,
because nurses do not need such qualities. In fact, knowledgeable, skilled nurses
are not the exception but the rule. Nurses must have those qualities to detect
and overcome subtle threats to patient health and thereby save lives. So a better
way to compliment that excellent nurse might be, “Please stay in nursing!”
Don’t Believe the Hype

We can all look more critically at what the media presents to us. The next time the
news media consults only physicians for a story about something in which nurses
are expert, like hospital conditions or community health, consider why nurses were
ignored—and what the story is not telling you as a result. Research shows that
even the entertainment media affects our thinking, as we explained in Chapter 2.
So when a hospital drama shows physicians providing all skilled hospital care, ask
yourself how likely is that to occur. Would nurses be providing much of that care?
Ask media creators why they do not give a fair account of nursing. It’s fun!
Try to Resist That Naughty Nurse’s Charms

Naughty nurse pornography, lingerie, and costumes remain popular, although
they reinforce a tired, damaging stereotype. Sexual fantasies cannot be simply
wished away, of course, but we can consider new ways to think about nurses. We
urge those who profit from naughty nurse products to seek other ways to prosper.
Say you’re invited to a Halloween party. You could wear some naughty
nurse costume. But the naughty nurse really is a corpse bride, because she
scares away the resources nurses need to save lives. So consider telling some
other tale from the crypt.
What’s My Name?
Language is powerful. Unfortunately, too many common words and phrases,
with deep roots in our culture, reinforce damaging assumptions and stereo-
types about nursing. Many of these usages degrade nurses’ professional iden-
tity or credit others for their work. Of course, purposely changing language
is difficult, but you can start with yourself. You may expand your mind—and
improve your health. Table 10.1 outlines some troubling usages and suggests
alternatives.
Table 10.1 How Word Choice Can Help Nursing
Common word Better words or Why consider the change?
or phrase phrases
Angel Nurse When we refer to nurses as “angels,” we imply

that they are unskilled spiritual beings who
don’t need salaries, rest, or resources. “Angels”
can take care of ten patients on sixteen-hour
shifts and never make a deadly mistake.
Humans can’t.
Baby nurse Newborn Many people refer to infant caregivers as
nanny or “baby nurses,” but these workers do not have a
caregiver nursing education, and most have little or no
health education.
Doctor Physician Using “doctor” to describe only physicians
elevates them above other health workers
and gives the false impression that physicians
are the only health workers who can earn a
doctoral degree.
Doctor or Health Most of us have spent a lifetime being told to
physician (to provider “ask your doctor” about healthcare products
refer to those and confronting forms that ask us to name our
who provide “doctor” or “physician.” These usages should
primary or other change so as not to exclude advanced practice
practitioner care) nurses.
Former nurse Nurse Like physicians, nurses do not stop being
nurses when they stop providing direct care.
Nursing involves thinking, not just physical
tasks at the bedside. Thus, when a nurse is
managing other nurses, teaching nursing,
doing research, creating policy, or advocating
for change, he or she is still a “nurse.”
Medical center Hospital Many vital health professionals besides
physicians work in hospitals. Yet because
only physicians practice “medicine,” the term
“medical center” suggests hospitals are all
about physicians.
(continued)
Table 10.1 (Continued)
or phrase phrases
Medicine (to Health care Medicine, which physicians practice, is one

mean all health type of health care, but many others are also
care) important. Health professions like nursing
are not subsets of medicine but distinct,
autonomous fields.
Nurse (to Nurse’s aide, Only nurses should be called “nurse.” When
mean anyone nursing nonnurses are called “nurse,” people interacting
who provides assistant, with them may reasonably conclude that
nonphysician patient care nurses know far less about health care
care) technician, or than they really do. Many family members
whatever they admirably provide care for their loved ones,
really are but that does not make them “nurses.”
Nursing or wet Breastfeeding Using “nursing” or “wet nursing” to mean
nursing (to mean breastfeeding subtly suggests that nursing
breastfeeding) is something we can do without health
education, and of course that only women can
be nurses, which is not the case.
Order Prescription or Nurses don’t take “orders” from physicians. If
care plan nurses do not agree with a physician plan, they
are legally and ethically obligated to work for a
better plan.
She (to refer He, or he or she Some nurses prefer female pronouns,
to a nurse of because most nurses are women, and women
indefinite predominate in few professions. But one
gender) way to undermine the prevailing social bias
that nurses are all female is to use “he” when
discussing nurses of indefinite gender.
Student nurse Nursing student Nursing students are awesome, but they are
not yet nurses, and describing them as such
lessens the value of the term “nurse.” So just as
we do not refer to medical students as “student
physicians,” we should not refer to nursing
students as “student nurses.”
Work as a nurse Practice nursing Nurses are health professionals who “practice”
nursing, just as physicians practice medicine.
(continued)
305
Table 10.1 (Continued)

or phrase phrases
Advanced ? We ourselves use “advanced practice nurse,”

practice nurse for lack of a better way to describe the group
that encompasses nurse practitioners, nurse
midwives, nurse anesthetists, and clinical nurse
specialists. But the term wrongly suggests that
other nurses are less than “advanced.” Can you
help find a better term?
Nurse ? The term “nurse” has been linked so closely
and for so long to unskilled tending, especially
by females—from “nursing a baby” to
“nursing a drink”—that we wonder if it can
ever properly name a modern, nongendered
profession. Can you help find a better term?
I’m a Member of the Media. What Can I Do?

As the global population ages, it becomes even more interested in health. If
you create media about health care, we urge you to learn all you can about
what nurses really do. Whether you write or edit for a newspaper, a maga-
zine or book publisher, a website, an advertising agency, or Hollywood,
please listen to nurses when they point out inaccuracies, distortions, and
other damaging messages about their profession. The input will improve
your work.
No media creator is immune from sending unhelpful messages about
nursing, because our social assumptions are so deeply embedded and
awareness of nursing’s media issues remains so limited. Consider the
Wolters Klower company Lippincott Williams & Wilkins (LWW),
which publishes many excellent materials in nursing and other health
fields. But LWW also has a publication and series of texts it markets
under the name Nursing made Incredibly Easy.7 We understand the appeal
to overwhelmed nursing students, but would a major company publish a
series of texts called Medicine made Incredibly Easy? Brain Surgery made
Incredibly Easy?
3 0 6
Because of the media’s influence on how people think, media creators

should pay special attention to the language issues discussed previously.
For example, it remains common for the entertainment media to refer to
minimally trained nurse’s aides as “nurses,” which is a problem even when
the characters are positive, because such references still undervalue nursing
knowledge and skill. One example is “Nurse John,” a character in the 2009
film Precious.8 An unusual twist on this problem appeared in the recent
HBO series Getting On, which follows the staff at an extended care facility.
One major character is Didi, who is sometimes called a “nurse”9 and who
appears to be a licensed vocational nurse (with about one year of nursing
education). But in the November 2013 series premiere, Didi seemed to refer
to herself as an “orderly,”10 which is a term sometimes used to describe nurs-
ing assistants with perhaps six to eight weeks of training.11 The show went
to the trouble of having the character wear an “L.V.N.” I.D. badge—why
would it also suggest that the term “nurse” could be applied to someone
with six to eight weeks of training?
Report on the Nurse at the Bedside

The bedside nurse saves lives and sees it all, and some reports have given
readers a sense of that. But the news media has barely skimmed the surface.
Nurses save lives in countless ways, managing high-tech interventions, catch-
ing subtle but deadly errors, and spearheading public health programs. Don’t
forget nursing errors: the media generally assumes that only physician errors
matter, but in fact nurses affect patient outcomes just as much, and so their
care deserves the same scrutiny. Nurses spend far more time with patients
than anyone else, and they see people at their best and their worst. Nursing is
vital and exciting. News consumers would be interested in what nurses do and
what they know, if only the consumers heard more about it. Be receptive to
what nurses tell you, and ask them questions. Too many reporters and editors
rely on inaccurate assumptions about nursing, or on physicians, who, sadly,
often don’t know much about nursing either. Physicians dominate media like
the New York Times and CNN, creating many stories themselves. But when
nurses get the chance—as the Times has given oncology nurse Theresa Brown,
who began contributing in 2008 to Tara Parker-Pope’s “Well” blog and later
to Brown’s Opinionator series “Bedside”—they too can create compelling
and informative pieces.
307
Discover 2.5 Million Women in Science

There are scientific breakthroughs all the time—and they’re published in
peer-reviewed nursing journals like LWW’s American Journal of Nursing. The
news media’s audience would be interested in many of these, such as the stud-
ies about how hospital conditions affect patients, the latest advances in pain
control, and innovative health initiatives addressing problems like HIV and
diabetes. Nursing should be presented as the cutting-edge health science it
is, and the profession’s leaders, like those discussed in Chapter 1, should be
considered among the world’s health leaders. The media sometimes runs sto-
ries about women in science, but these reports typically overlook the 2.5 mil-
lion female RNs in the United States, including the 340,000 with master’s or
doctoral degrees.12 In fact, nurses have long done fascinating, groundbreaking
work. The work of nursing pioneers like nurse midwife Mary Breckinridge and
public health nurse Lillian Wald remains influential even today. Informing
your audience about these nursing pioneers may pique interest in the profes-
sion’s current leaders.
Consider Nurses as Expert Sources in All Health Stories

Nurses make great media health experts. They combine advanced health
knowledge with the ability to communicate important health ideas to lay
people, as part of their focus on patient education.
Unfortunately, nurse experts often struggle to be heard. Some news out-
lets consult nurses when the topic is some aspect of nursing, such as the nurs-
ing shortage. But nurses rarely appear as experts when the topic is health in
general. The website Help A Reporter Out (www.helpareporter.com) posts
queries from reporters looking for sources, and those seeking health exper-
tise often seem to assume that only a physician can help them. Nurse Wendie
Howland has long monitored the site and she recommends nurses when the
topic is one in which nurses are at least as expert as physicians.
Virtually no hospitals have public relations officials devoted to promoting
their nurses in the media, as almost all do for physicians. But Georgia Peirce
of Massachusetts General Hospital is one such publicist. When reporters call
Peirce looking for an expert, she often suggests a stellar nurse who has exper-
tise in the area of interest. Nevertheless, the reporters usually insist on a physi-
cian despite her recommendation.
Similarly, physicians remain the overwhelming favorite choice for health-
care speaking engagements—even when the audience is a large group of
3 0 8
nurses. In 2013, one nursing school representative in Texas told us that she
had repeatedly asked a speaker’s bureau for a nursing leader to speak at a con-
ference, only to be repeatedly offered physician speakers. Indeed, many nurses
themselves plan nursing conferences featuring physicians as the most promi-
nent speakers. It is as if the nurse planners do not know that engaging nurse
experts could fill their speaking slots, or they do know but believe physicians
have the real health expertise or would be more appealing even to an audience
of nurses.
When the media doesn’t see nurses as experts, and so does not present
them that way, the public shares that view. The public does not understand
why nursing requires many resources, and it takes nurses’ health advice less
seriously, in clinical settings and otherwise. The public also comes to see health
through a physician-centered lens, as something that involves the diagnosis
and treatment of illness. If the media used more nurses as expert sources, the
public might develop a stronger sense of health as attaining and maintaining
wellness. Consulting nurse experts would create richer media, help reshape
debates on health, and offer new ideas to repair the broken healthcare system.
The few media programs that do routinely use nurse experts show how
effective the practice can be. One that may use nurse experts more than any
other is HealthStyles, the weekly radio show on New York’s WBAI, hosted
since 1986 by nurses Diana Mason, former editor-in-chief of the American
Journal of Nursing, and Barbara Glickstein. On that show, nurse experts dis-
cuss health topics we don’t often hear elsewhere, such as the movement in
care of the dying from a “do not resuscitate” focus toward plans to “allow
a natural death.”13 Vancouver nurse Maureen McGrath hosts the Sunday
Night Sex Show on local station CKNW, relying on nurses and other experts
to address a range of topics related to sexual health. In 2008 nurses Casey
Hobbs and Shayne Mason started Nurse Talk, a radio show sponsored by the
union National Nurses United that is irreverent but also addresses health pol-
icy and issues direct care nurses face.14 Nurse Donna Cardillo has appeared
on television to explain health issues to the public;15 Cardillo has also served
as an expert blogger at DrOz.com.16 And nurses Barbara Dehn17 and Nancy
Reame18 have appeared on iVillage to discuss maternal-child issues.
Make Clear That Nurse Experts Are Nurses

When nurse experts do appear in media items, their status as nurses is often
hidden. When the media identifies an expert only as “Dr. Pugh” most peo-
ple assume the expert is a physician. This actually works against nursing by
309
reinforcing the sense of physicians as the only health experts and suggesting
that yet another health expert is not a nurse. Even when a nurse expert’s PhD
is noted, few realize he or she is a nurse unless the piece says so. The media
should identify experts as nurses so that the profession receives credit for
the knowledge they provide. When one nurse expert we know appeared on
a major national talk show, producers told her she had to choose only one
identifier—her RN or her PhD. We understand that anyone who has earned a
PhD would want to be identified with it. But we believe it is more important
for the nursing profession that the RN appears than the “Dr.” or the PhD.
People will know the nurse is expert and well-educated by the way she or he
speaks. But they won’t know she or he is a nurse unless that is specified.
Create Television Shows about Nurses

Although real nursing is dramatic and exciting, relatively few television shows
have featured nurses as main characters. Instead, they have presented nurses
as peripheral to serious care and have focused almost solely on physician char-
acters—who are shown spending much of their time doing what nurses do in
real life. Grey’s Anatomy is the most obvious recent example, but there have
been dozens of such shows, from short-lived flops to long-running hits, such
as House, ER, St. Elsewhere, and M*A*S*H.
There have been a few recent exceptions. As we explained, in 2009 three
new nurse shows appeared on US television, and Nurse Jackie has survived at
least six seasons. But Mercy was canceled after one season, and HawthoRNe
survived only three seasons as a summer cable show with a limited audience.
Call the Midwife has aired at least three seasons, although each has had fewer
than ten episodes. MTV’s recent Scrubbing In has given nursing the kind of
attention it doesn’t need.19 In any case, the rarity, limited reach, and inconsis-
tent value of these exceptions prove the rule.
But Aren’t Hollywood’s Current Nurse Advisers Enough?

Nurses have served as advisors to many popular Hollywood shows, such as
Grey’s Anatomy and House, but their main role seems to have been teach-
ing the actors playing physicians how to behave credibly on set. Obviously,
“nursing advice” that has no evident impact on how the show actually depicts
nursing does not help the profession. As with the news media, physicians
dominate in providing the advice that drives the story lines. Even the recent
nurse-focused shows, apart from Call the Midwife, have at times reinforced
3 1 0
the handmaiden and other stereotypes. Only meaningful advice on scripts by

nurses who understand nursing’s media issues can help, and producers must
be more open to it.
In Chapter 2 we described how a nurse who is an international expert in
her specialty got a telephone call from producers of a popular television hos-
pital show. After she gave the producers the information they wanted, she
tried to educate them about why they should include more nursing in their
show. That was a great effort, but not surprisingly that one interaction wasn’t
enough to change the show. In fact, although the producers were stunned to
learn that our friend was a nurse—an expert and a nurse!—they still told her
that they and their audience were interested only in physicians.
But How Can I Sell Things Without Using Nursing Stereotypes?

With imagination, you can advertise your product without resorting to tired
and demeaning stereotypes. It’s true that the naughty nurse has been an adver-
tising mainstay, and other advertisements have presented nurses as handmaid-
ens or relatively unskilled. But that need not be so. If advertisers wonder if
they are using nursing imagery in a responsible way, they should consult with
those familiar with nursing’s image issues.
One recent example of an advertisement that conveyed respect for nursing
was a full-page magazine advertisement the University of Phoenix ran in The
New Yorker in April 2011. The advertisement featured a woman in a business
suit looking upward and the headline: “Offering a faculty of industry profes-
sionals to inspire tomorrow’s health care leaders.” The woman was identified as
“Diane Wilson, MSN/MHA, College of Nursing, Chief Operating Officer,
Community Tissue Services.”20 The advertisement explained the University’s
“cutting-edge” healthcare management curriculum, noting that because
many of our students are experts in their fields, they can share industry
insights gained through years of experience. It’s an approach to educa-
tion where accomplished students like Diane Wilson, already a CEO
before enrolling, can debate new ideas on how to build a more reliable,
efficient and sustainable health care system for all of us.
“Community Tissue Services” is a major Ohio-based nonprofit tissue bank.

Ironically, the tissue bank—Wilson’s own employer—apparently failed to
identify her as a nurse in its online leadership profiles until early 2014, when
it did finally include a helpful biographical sketch of her.21
311
Some advertisers have been commendably flexible when nurses bring issues
to their attention. Advertisers do not wish to alienate consumers, and some,
like Skechers, have curtailed advertisements that relied so heavily on nursing
stereotypes that they could not be salvaged.22 Others, including Walmart23
and CVS,24 have modified advertisements to eliminate nursing stereotypes,
with no apparent loss of effectiveness. For example, in 2007 Heineken brand
Dos Equis launched an amusing set of beer advertisements in a mock-serious
tribute to a character presented as “the most interesting man in the world.”25
The advertisements showed him bench-pressing two chairs in which sat
attractive, giggly women in short white dresses with nurses’ caps. In response
to our concerns, Heineken digitally altered the spots to change the color of
the dresses and eliminate the nursing caps. We encourage other advertisers to
show similar flexibility and imagination.
“I Wouldn’t Stereotype Nurses—My Mom’s a Nurse!”

Please don’t be one of those media creators who claim that they could not
possibly create media that harms nursing because they’re related to nurses
or really love nurses. Just as it makes no difference that a nurse was involved
in creating a television show if that show harms nursing, it makes no dif-
ference that a media creator is close to nurses if his show, advertisement, or
other product stereotypes them. For instance, even though House regularly
degraded nursing, a show representative once suggested to us that the show
couldn’t harm nursing, in part, because the mother of show creator David
Shore was a nurse, and she just loved the show! We have heard from other
media creators that their shows couldn’t harm nursing because close relatives
of the show creators are nurses (as with Dr. Phil26 and Sean Hannity,27 both of
whom have sisters who are nurses) or the creators previously expressed appre-
ciation for nurses (as with David Letterman).28 But there’s no reason to think
the effects of these shows change because of the relatives or intentions of the
creators. We urge media creators to consider whether the images they actually
present to the public conform to their positive sentiments about nursing.
I’m a Private Sector Healthcare Executive. What Can I Do?

If you are an executive at a hospital or other organization that provides health
care (like the Red Cross or Doctors Without Borders), or at a health insur-
ance company or pharmaceutical company, there is much you can do to help
3 1 2
nurses improve understanding of their profession. Whether you realize it or

not, you play a key role in shaping how the media treats nursing and how the
public sees it.
Hospitals and Other Health Facilities Should Promote Nursing

Hospital and other clinical care executives should take steps to learn what
nurses really do. Then they should promote the hospitals’ nursing to the
media, on their websites, and in other ways. Hospital nurses play a central
role in patient outcomes and cost control. Long-term care institutions are
essentially nursing facilities; thus the name “nursing homes.” Of course, many
urgent care and retail “quick” clinics rely primarily or exclusively on advanced
practice nurses. Because your facility’s nursing is at least as important as its
medicine, nursing deserves to get at least as much attention. In January 2014,
Valley Health Services of Herkimer, NY, actually issued a press release to let
the community know about the clinical background and plans of the facility’s
new cardiac rehabilitation nurse, a recent BSN graduate! As a result a local
newspaper, The Telegram, ran a short but helpful story on the nurse’s arrival.
Sadly, that kind of effort to promote nursing is rare. The Truth’s 2012 anal-
ysis of the top seventeen US hospitals as ranked by U.S. News & World Report
also examined the hospitals’ websites, and it revealed an almost complete fail-
ure to publicize the expertise of nurses.29 In stark contrast to the attention
lavished on physicians and medical care, the sites typically offered little about
nursing care or the hospitals’ nursing leaders, beyond some basic informa-
tion directed at recruiting nurses themselves. We searched the websites for
information or links to information about nursing from the main, “about
us,” “patient information,” “patient services,” and health specialties pages. We
found those pages to be devoid of any mention of nursing, except that the bot-
tom of Duke’s “about us” page included the header “Nursing,” and beneath it
the link, “Get information about nursing at Duke.” That was almost certainly
aimed at prospective nurses, and we doubt many patients would click on it,
but at least it did lead to a page with short biographies of the hospital’s nurs-
ing leaders. A couple of hospitals mentioned their membership in the Magnet
Recognition Program of the American Nurses Credentialing Center, but
those pages were also aimed at prospective nurses, not the patients who might
be interested if they knew that research showed that nurses are more likely to
save their lives at a Magnet hospital.30 Typical hospital web pages that were
directed at patients were like the extensive “Why Choose Mayo Clinic” page,
which had 521 words about the expertise of the Clinic’s physicians but not a
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single word about nursing.31 The site’s discussions about a long list of medi-
cal “departments” did not include anything on nursing.32 Likewise, urgent
care and retail clinics did not initially seem eager to acknowledge that their
care was mainly provided by nurses,33 although that seems to have started to
change somewhat recently.34
Executives should also promote nursing within hospital and clinic walls,
to physicians, to patients, and to the nurses themselves: many need remind-
ing of their own importance! Encourage physicians to follow nurses for a few
days, just as physicians accompany paramedics in periodic “ride-alongs” in
ambulances. Give patients information about what your nurses do and why,
the qualifications of your nurses, and the hospital’s efforts to strengthen nurs-
ing. Download, print, and hang our “I Am Your Registered Nurse” poster,
which explains a nurse’s role in simple terms, so patients and visitors can see
it.35 Adjust forms, records, and software so that staff and patients are not com-
pelled to provide the names of physicians when the relevant provider may
actually be an advanced practice nurse. Similarly, change the word “orders”
to “prescriptions” to help disabuse physicians of the notion that they are in
charge of nurses.
Help your nurses tell everyone who they are. In today’s clinical settings,
many different staff wear similar uniforms, and in some cases this trend has
obscured the practice of replacing nurses with cheaper unlicensed personnel.
Instead, facilities should encourage nurses to wear distinctive uniforms and
use other identifiers, like RN patches.36 Some have argued persuasively that
a true professional does not need a patch with big letters on it. But we think
that at this point in the development of public understanding of nursing,
nurses need some way to ensure that they receive the credit (and blame) they
deserve, so that awareness of their true role in heath care grows.
Of course, there is one widespread exception to the general rule of nurs-
ing invisibility at hospitals: the annual Nurses Day or Nurses Week in May.
However, as we suggested in Chapter 7, we are ambivalent about those cel-
ebrations. Their heavy reliance on angel imagery undercuts the sense of nurses
as skilled professionals, and the events arguably reflect the once-a-year “pat
on the head” often given to underpowered jobs as a substitute for real respect
and resources. In a June 2011 episode of Nurse Jackie, the main character dis-
missed the celebrations as “patronizing.”37 If hospitals do observe Nurses Day
or Week, they should focus on nursing skill, not hearts and flowers.
3 1 4
Invest in Public Relations for Nursing

Every hospital should have a public relations professional to promote the
facility’s nurses—their stories, research, and community activities—and to
direct media inquiries to nurses when their expertise is called for. Yet we
know of only one hospital that has a public relations officer who works solely
on promoting the nursing profession. If you know of others, please tell us!
Georgia Peirce is the public relations person for nursing at Massachusetts
General Hospital.38 She is not a nurse, but she persuaded the Boston Globe to
follow nurses in the hospital and to create one of the best newspaper accounts
of nursing practice that we have seen in the last decade.39 The result was the
excellent four-part October 2005 series about the hospital’s intensive care
unit (ICU) nurses, especially a formidable veteran who was training a new
nurse, as described in Chapters 3 and 4. Reporter Scott Allen and photogra-
pher Michele McDonald followed the nurses intermittently for nine months.
Their series, which remains available online, educates society about the vital,
skilled, and difficult work that nurses do.
To make the Globe series happen, Peirce spent time picking the right
medium and the right writer. She geared her pitch around a high-autonomy
area for nursing, the ICU. She focused on nurses in a mentor/apprentice role,
so that it would be easier for the reporter to learn what was going on inside
their heads. That might otherwise have been difficult, because nurses are still
socialized to defer and mask their skills. It took Peirce many weeks to over-
come the Globe’s skepticism, but after she persuaded the reporter to come
observe, he found plenty of interest and he agreed to pursue the story.
Publicize Efforts to Improve Nurses’ Working Conditions

If you’re an executive at a healthcare institution during today’s nursing crisis,
you probably want to improve the morale of your nursing staff and reduce
turnover. The best way to do that is to strengthen nursing. Reversing the
denursification of health care can save hospitals money and save patients’
lives.40 But if you publicize what you’re doing—as some hospitals have
publicized their Magnet status—through advertising and other media, you
can also improve understanding of nursing. You will not only present your
institution in a positive light but also explain nursing to society and encour-
age others to take similar steps. That was the effect when Philadelphia’s
Hahnemann Hospital decided to end the use of nursing assistants and adopt
an all-RN staffing model, as the February 2012 coverage of that move in The
315
Philadelphia Inquirer showed.41 Inquirer reporter Stacey Burling described

how the all-RN staffing in a pilot program improved care by enabling better
front-line surveillance, thereby reducing the number of bedside emergen-
cies, patient falls, bedsores, and trouble with blood thinners, while at the
same time improving patient satisfaction, especially with pain control. That
kind of specific information is valuable to nursing because it improves pub-
lic understanding—and ultimately valuable to patients, who deserve to be
monitored and evaluated by nurses.
Specific ideas to publicize include:
• increasing RN-to-patient ratios and eliminating the use of assistants and

“techs” for nursing tasks;
• helping nurses improve their education levels, including through tuition
reimbursement, and providing rigorous continuing education and profes-
sional development programs;
• empowering nurses by including them in authoritative positions and roles,
including on your governing board and ethics committees, as well as in
morbidity and mortality conferences, patient-family meetings, and nurse-
driven daily rounds;
• creating multiyear nursing residencies;
• ensuring that each unit has 24/7 coverage by clinical nurse specialists; and
• instituting zero tolerance for abuse policies.
There are many more suggestions on the Truth About Nursing’s website
page about Magnet status.42 If you implement changes like these, tell the
world: you’re helping to resolve the nursing crisis.
Public Health Organizations Can Help Promote Nursing

Nurses play central roles in some of the most respected and well-known non-
governmental health institutions, and it is vital that these institutions convey
respect for nursing as well. But some groups could do far more. For instance,
in mid-2008 the American Red Cross—127 years after nurse Clara Barton
founded the organization—eliminated its chief nursing officer position as
part of budget cutbacks.43 Fortunately, the Red Cross reinstated the position
in April 2009,44 although it does not appear to be in the organization’s top
leadership group.45 The Red Cross website’s history page notes that Clara
Barton founded the organization, but not that she was a nurse!46 The site’s
969-word biography of Barton does mention, near the very end, that “she
3 1 6
nursed, comforted, and cooked for the wounded”—using “nurse” in the lay-
person sense.47
Consider the Nobel Prize–winning Médecins Sans Frontières (MSF) or
Doctors Without Borders. This international aid group was founded by a
small group of physicians and journalists, but today more nurses than physi-
cians work for MSF, and nurses have played leadership roles in the organiza-
tion. Yet its name sends the public the message that the physicians provide
most or all of its health care. That message is especially influential because the
group receives tremendous media attention for its work on disasters world-
wide; not surprisingly, news and entertainment media that refer to MSF reg-
ularly suggest that it is essentially a group of physicians. We and other nursing
advocates have asked MSF to consider a more inclusive name, such as Soins
Sans Frontières (Health Care Without Borders). So far, MSF has refused.48
Healthcare Billing
Typically, skilled nursing care provided in US hospitals is not billed and reim-
bursed as a distinct item but is instead included in “room and board” charges.
However, health insurance companies and the health institutions they reim-
burse should keep the nursing out of the mashed potatoes. Nursing care
should be billed and reimbursed as a professional service, just like the work
of physicians and others. When nursing is lumped in with the bed sheets and
hospital food, people are encouraged to see nurses as interchangeable wid-
gets, not professionals who provide a distinct health service. Early nurses pro-
vided the full range of care that patients needed, including physical therapy,
occupational therapy, speech-language therapy, and social work.49 Although
nurses are still responsible for basic care in those fields, over time the fields
evolved and became distinct professions, most of which now bill indepen-
dently for their specialized work. Nursing is no less skilled. Allowing nurses
to bill separately would open up a dialogue that would encourage decision
makers, the media, and the public to learn about and articulate the nature of
nursing work.
Drug Companies Should Ask Their Nurses

As we all know, advertising for medications and other healthcare products
typically advises consumers to “ask your doctor” whether the product is right
for them. That phrase reflects the assumption that only physicians have exper-
tise in such products and prescription authority, but neither of those ideas is
317
correct. Nurses, especially advanced practice nurses, are the primary care pro-
viders for millions of health consumers, and these tremendously influential
advertising campaigns should recognize that. In 2008 the American Academy
of Nurse Practitioners launched a campaign to persuade pharmaceutical com-
panies to change the language in their commercials to “ask your provider.”50
As health products makers, drug companies also have a special respon-
sibility to advertise in a way that recognizes the contributions of the nurses
who actually administer most of their products in hospital settings. In 2006
a Bristol Myers-Squibb television commercial featured Sharon Blynn reciting
a poem on fighting cancer that included the line “Doctors who tell jokes in
the chemo room are beautiful.”51 However, virtually all chemo room work is
done by nurses. Although Johnson & Johnson deserves credit for putting tens
of millions of dollars into its campaign to help resolve the nursing shortage, as
we have explained in previous chapters, it should also work to reduce its heavy
reliance on damaging angel and handmaiden imagery. Like hospitals, influen-
tial drug companies can enhance their own images by promoting nursing, but
in doing so they should communicate that nurses are highly skilled profes-
sionals who save lives and improve patient outcomes. We have also asked the
company to refrain from advertising on shows that degrade nursing, such as
Grey’s Anatomy, but as of early 2014, it has refused.52
I’m a Government or Health Policy Maker. What Can I Do?

We urge government and health policy makers to learn the value of nursing
and convey their knowledge wherever they can. They should publicize the
urgency of the nursing shortage and their efforts to address it, which will tell
the public that nursing has value. Major foundations should consider fund-
ing various initiatives to improve understanding of nursing, including prizes,
museums, and popular media programming.
Governments Should Communicate the Value of Nursing

The government has great power to direct the flow of information to the media
and the public. Government leaders should use that power to convey the true
nature and importance of nursing. In 2009, President Barack Obama repeat-
edly used nurses in his efforts to promote the health reforms that eventually
became the Affordable Care Act of 2010.53 Much of Obama’s praise for nurses
reflected an unusual understanding of the profession, including nurses’ work
3 1 8
to advocate for patients and help underserved communities, although some

comments did focus on nurses’ caring and virtue, rather than their life-saving
skills. Public health campaigns are also useful in getting the word out.
Occasionally national policy can affect the nursing image directly. In
2010, Wales launched a new program under which all 36,000 Welsh nurses
and midwives were to wear a national uniform, in solid colors determined
by their specialties and levels of authority.54 The idea was to make it easier
for confused patients to see who was who, a chronic problem because of the
proliferation of different workers with similar uniforms in modern hospitals.
Another notable recent idea is nurse Teri Mills’s proposal to establish a
National Nurse position within the US Public Health Service. The main
purposes of the National Nurse would be to promote public health through
media-driven preventative health education and the deployment of com-
munity health nurses, as well as to highlight the key role that nurses play in
health care and the threat posed by the nursing shortage. Mills has pursued
this initiative for many years and it has been introduced in Congress, most
recently in 2013. The National Nurse would appear to offer a promising way
to increase public understanding of the profession.55
Governments Should Give Nurses a Seat at the Table

Leaders should also appoint qualified nurses to visible positions of authority,
as President Bill Clinton did in choosing nurse Kristine Gebbie as the first
“AIDS czar” in 199356 and Obama did in appointing nurse Mary Wakefield
to head the Health Resources and Services Administration in 2009.57 As the
American Nurses Association’s then-president Rebecca Patton said in 2009,
if nurses don’t have a seat at the policy-making table, they will be part of the
menu.58 Increasing the role of nurses in decision-making was also an impor-
tant recommendation of the Institute of Medicine’s 2010 report The Future of
Nursing.59 Taking such steps makes for better health policy, but it also shows
the public that nurses have valuable knowledge and skills.
Governments Should Publicize Efforts to Address the Shortage

Government and other health policy leaders at all levels should communicate
their efforts to support nursing and address the nursing shortage. That would
not only attract support for the initiatives of these leaders but also highlight
the importance of nursing and inspire the private sector to follow suit.
319
Specific improvements that public sector health leaders should consider

include:
• investing far more in nursing education, clinical practice, residencies, and

research, because nursing currently gets only a tiny fraction of the govern-
ment resources that medicine does;60
• passing minimum nurse staffing legislation to address the denursification
of clinical settings, as well as measures to limit mandatory overtime and
provide whistle-blower protection;
• vastly increasing funding for community health nursing projects, such
as school nursing and nurse-family partnerships, which would enhance
health, reduce costs, and educate the public about nursing; and
• making it a major public priority to resolve the nursing shortage, includ-
ing the formation of working groups and policy discussion at the highest
levels.
Leaders should regularly address these issues in their interactions with the
media, and discussions about the Affordable Care Act provide a good vehicle
to do so.
Foundations and Other Health Policy Makers Should Honor

Nursing and Include the Profession in Policy Initiatives
Health policy makers, including major foundations, should consider bold
measures that could radically change the way the media and the public sees
nursing. In a 2006 Baltimore Sun op-ed, Sandy and Kristine Gebbie argued
that nurses deserve a Nobel Prize or comparable annual award.61 We noted
that nursing leaders have long been at the forefront of health research and
clinical practice, reinventing health systems, pioneering new therapies, and
improving community health, from AIDS treatment to neonatal care. The
Nobel Prize in Nursing would shine a light on the profession’s achievements
and help show how important it is that nursing get the resources it needs to
overcome the global shortage.
Foundations should also consider creating an International Museum of
Modern Nursing to educate the public about nursing. We envision an inter-
active science museum that would show that nursing is an exciting profes-
sion whose members use the latest technologies to help people regain and
maintain health. Visitors would be invited to put themselves in the place of
nurses on the front lines, in settings ranging from the extreme high-tech of
3 2 0
teaching hospital ICUs to humanitarian relief projects around the world. The
museum would also demonstrate that nurse scholars work on the cutting edge
of global health research.62
Foundations can fund television shows and educational materials about
nursing, including documentaries and scripted dramas. Foundations might
also consider creating videos to educate the media, physicians, career seek-
ers, and students about nursing. A November 2013 report by the Foundation
Center indicated that US foundations had given $1.86 billion in media-related
grants from 2009 to 2011, with marked growth in giving to new media and
large grants to public radio and television—on which Call the Midwife airs.63
Foundations and health policy makers should include nurses in advisory
groups and in joint efforts to shape health policy. In 2007 Google created
a Health Advisory Council with twenty-five members, and although many
were physicians, not a single one appeared to be a nurse.64 The powerful
media company refused requests to place nurses on the panel despite our
letter and many follow-up telephone calls.65 Health initiatives like this can-
not succeed without the input of nurses. Of course, including nurses in such
high-profile positions would tell the public that nurses are health experts
whose work has value.
Nurses are often missing from joint health policy efforts that directly
implicate nursing concerns, even though the physician and public health
communities are included. For example, in September 2011 the Pew
Charitable Trusts organized a joint letter to Members of Congress warning
of the link between the overuse of antibiotics in food animal production
and drug-resistant infections in humans. Original signatories included
the American Medical Association, the American Academy of Pediatrics,
the American College of Preventive Medicine, and the American Public
Health Association.66 Not a single nursing group signed at that time,
although nurses are deeply involved in these preventive public health
issues. As of early 2014 the number of organizations signing had reached
453, and there were 37 national and state nursing organizations among
them. That was still only about 25 percent of the health organizations that
signed (not all organizations were health-related), even though nursing is
the largest health profession. Of course, it may be that some nursing orga-
nizations were asked and declined—nurses have long had an unfortunate
habit of keeping their heads down—but the underrepresentation of nurses
in efforts like this is so common that it is critical for all who advocate for
better health to ensure that nurses are part of the picture.
321
I’m a Health Worker but Not a Nurse. What Can I Do?

Nurses’ healthcare colleagues, particularly physicians, can help nurses improve
public understanding.
Physicians
Physicians wield unmatched authority over how the media presents health
care and how the public sees it. Unfortunately, much of the worst media about
nurses, such as Hollywood dramas, is created in collaboration with physicians.
Physicians write for and advise television shows, and they consult on many
media programs and news articles. It’s no shock that these media generally
show little interest in nursing. But the collaborating physicians often cause
or allow the media to give physicians credit for the work that nurses really do
and to present nurses as low-skilled physician subordinates.
We need physicians to try to understand nursing better. It appears that few
physicians learn much about what nurses really do in medical school or after-
ward. With only common social and professional stereotypes to go on, many
physicians wrongly assume they are “in charge” of nurses and that nursing care
is rudimentary. The media they create reflects that.
There are exceptions, almost all in the print media. Physician Pauline
Chen has written some pieces for the New York Times that reflect an unusual
awareness of the value of nursing.67 Physician Richard Gunderman and
Michigan nurse practitioner Peg Nelson have teamed up to write end-of-life
care articles in The Atlantic since at least 2009. In December 2013 the maga-
zine published “Midwives for the Dying,” a piece that consisted mainly of
Gunderman interviewing Nelson, as a palliative care expert, on how to give
excellent end-of-life care.68 Later that month, the New York Times posted phy-
sician Barron Lerner’s generally helpful blog review of a book about nurse
“Sister” Elizabeth Kenny, a pioneer in polio care.69 And in March 2014, phy-
sician Victoria Sweet published a very thoughtful piece in the Times about
Florence Nightingale’s work. Sweet admitted that she once thought of
Nightingale in handmaiden and angel terms, but she later learned that the
“Lady with the Lamp” actually transformed health care through research and
advocacy in areas like hospital design, health statistics, and of course nurs-
ing. Sweet observed that Nightingale was “a fighter” whose study of hospitals
led her to conclude that “patients get the best care when no single power is
ascendant, rather when there is the ‘perpetual rub’ between doctor, nurse and
administrator.”70
3 2 2
One promising way to improve physicians’ understanding is through

structured interactions during their training, such as joint classes in which
nursing and medical students learn together. Even a video explaining the
basics of nursing would help medical students understand the profession bet-
ter. Consider the joint program of Dartmouth’s medical school and hospital
in which medical students shadow nurses for six lengthy sessions. The stu-
dents ask nurses questions and meet later to discuss what they have learned.
As Ellen Ceppetelli, the nursing codirector of the program, said, “You cannot
collaborate with people unless you see them as competent.”71 In 2012, nurse
Megan LeClair conducted research at the University of Wisconsin show-
ing that even a four-hour shadowing program of that type was effective in
improving physician views on collaborating with nurses.72
Medical Technicians and Nursing Assistants

Some healthcare personnel who are not nurses allow patients and physicians
to call them nurses, and some even call themselves nurses. The result is that
nurses lose control of their image. Only those whose title includes “nurse”
should call themselves nurses.
Receptionists and Appointment Clerks

Personnel who provide support to health professionals play a role in shap-
ing how nurses are perceived. Some ask patients things like, “Would you like
an appointment with Dr. Kumwenda or with Eve, our nurse practitioner?”
Please refer to advanced practice nurses with honorifics if you do the same
for physicians. In this example, you might call Eve “Dr. Peyton” if she has a
doctoral degree, or “Nurse Practitioner Peyton” if she does not.
Using the ideas in this chapter, nurses’ colleagues and supporters can
help increase understanding of the profession. That will help nurses get the
resources they need to resolve the nursing crisis and meet the health chal-
lenges of the twenty-first century.
Notes
1. Renata Flavia, Personal email exchange (September 10, 2006).
2. TAN, “Our Success Stories,” accessed March 2, 2014, http://tinyurl.com/mxjfpnk.
323
4. TAN, “Nursing Representation on the Websites and Boards of Directors at the

Top 17 Hospitals Ranked by U.S. News and World Report in 2012” (March 2012),
http://tinyurl.com/n8hp4kr.
5. Susan Reinhard and Susan Hassmiller, “The Future of Nursing: Transforming
Health Care,” AARP International: The Journal (February 2012), http://tinyurl.
com/lnavaja.
6. CVS MinuteClinic, “Management Team” (March 2, 2014), http://tinyurl.com/
k7qo834.
7. Lippincott Williams & Wilkins, “Nursing made Incredibly Easy,” accessed March
2, 2014, http://tinyurl.com/ycuntu7.
8. Geoffrey Fletcher, screenplay based on the novel Push by Sapphire, Lee Daniels,
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3 2 4
20. TAN, “The Talk of the Town” (December 2011), http://tinyurl.com/mu88h9u.

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325
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3 2 6
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11
HOW NURSES CAN IMPROVE THEIR
OWN IMAGE
For understanding of nursing to improve, nurses and nursing stu-

dents must exert more influence on their own image. They must
educate society and the media about what nurses really do and
why it matters, so that the profession can attract the resources and
respect it needs to resolve the global nursing crisis. No one else can
do this—nurses are the key.
Everyone in nursing can help. Consider the work of nursing
scholar Diana Mason, who has spent decades advancing public
understanding of nursing in ways that range from cohosting the
HealthStyles radio show to pushing the mainstream media to cover
nursing research when she was editor of the American Journal of
Nursing; nurse life care planner Wendie Howland, who has tire-
lessly monitored the Help a Reporter Out website to suggest
nursing experts for reporters who might otherwise consider only
physician sources; nurses Milka Stojanovic (at the time a nursing
student) and Tyler Kuhk, who used a variety of social media to gen-
erate massive support for the petition in protest of the damaging
MTV reality show Scrubbing In in 2013.
The first hurdle in this advocacy is self-image. Some nurses will
need to focus first on believing in their own profession and in their
power to effect meaningful change for it. Then nurses should con-
sider ways they can project a professional image in their everyday
interactions, from the way they act to the way they dress. Nurses
will then be ready to analyze and change the media. Nurses should
learn ways to improve how the media portrays nursing. And nurses
should consider how to create their own media, to tell the public
directly why nursing deserves more respect and support.
There is often more than one way to see a given issue or
media product. But nurses must find common ground and work
together, because it’s the only way they’ll effect change. Consider
3 2 8
what Benjamin Franklin said at the signing of the US Declaration of

Independence: “We must, indeed, all hang together, or most assuredly, we
shall all hang separately.”1
Nurses Have the Power

After many decades of damaging media and social disrespect, improving nurs-
ing’s image will not be easy. But it must be done. The first thing is to believe
that it can be done, and more basically, to believe in nursing. Nurses have the
power to change the way society sees their profession.
Take Credit for Nursing’s Life-Saving Work

Nurses must take credit for the value of their work. We’re not saying nurses
should become braggarts, but too many nurses seem to think they must avoid
any credit or attention, whether from a lack of confidence or a belief that pro-
fessional modesty is the greatest virtue. However, to borrow former US Vice
President Dick Cheney’s famous 2001 remark about energy conservation,2
nursing modesty “may be a sign of personal virtue, but it is not a sufficient
basis for a sound, comprehensive [public] policy.” Some nurses don’t even
seem to respect their own profession. Perhaps they have internalized society’s
undervaluation of nursing and are expressing frustration at their position in
the one acceptable direction: at each other. In fact, some nurses tell reveren-
tial stories about physician colleagues, but not about nurse colleagues. Nurses
save lives every day too. Until it’s clear that people understand that, nurses
should make sure they do. If nurses would rather not tell people about the
value of their own work, they should consider letting others know about the
heroic work that their nurse colleagues are doing.
To encourage more credit for nurses, we created a bumper sticker that
says “Save Lives. Be a Nurse.” It is a recruitment message, but we designed it
primarily to tell people the most important thing they need to learn about
nurses—nurses save lives. Is it boasting? Perhaps, but not unjustifiably. The
Truth About Nursing will send a bumper sticker to anyone who asks for one.3
Take Responsibility
The media generally suggests that physicians are responsible for all of health
care, including errors. Some articles blame physicians for the errors nurses
11 How Nurses Can Improve Their Own Image •
329
make. Many nurses seem happy to let this go—happy to have dodged the bul-
let. But these pieces effectively tell people that nurses are marginal players
who report to physicians; they undermine the sense of nursing as an autono-
mous profession with its own legal and ethical duties. To be seen as true pro-
fessionals, nurses must accept credit when things go well and responsibility
when things do not.
Take the Lead

Some nurses believe that they can rely on others to fix problems within nurs-
ing. Some have actually suggested to us that physicians or their professional
groups will or should lead the way. But the troubling role many physicians
and their groups have played so far in nursing practice and in media about
nursing suggests that is extremely unlikely. Of course, physicians and others
can help nurses improve their image, as discussed in Chapter 10, but nurses
must lead the way.
Your Voice—Yes, Just Yours—Can Make a Critical Difference

One nurse can change the world. When operating room nurse Francine Brock
of Placentia, California, visited Las Vegas in 2006, she saw IGT’s Nurse Follies
slot machine, which features naughty nurse and battle-axe imagery. She wrote
to Wynn Las Vegas. The casino quickly began converting its eight to ten Nurse
Follies slot machines to another theme, at a cost of $2,000 per machine. Of
course, not every change can be made this way. But if nurses believe in the
power of their voices, so might others.
Projecting a Professional Image Every Day

Everything nurses do reflects on the nursing profession. Of course no nurse
can be expected to carry that burden 24/7, but we urge nurses to consider how
their everyday actions affect how nurses are viewed.
Accentuate the Positive: Promoting Nursing in Hard Times

The first rule of novelist Chuck Palahniuk’s Fight Club may have been to not
talk about Fight Club, but the first rule of Nurse Club is you do talk about
it. We know that working conditions for nurses across the globe are difficult
3 3 0
now. But however understaffed and overworked nurses may be, building up
the profession requires nurses to talk about it and emphasize what is good
about it. Nurses have to set aside feelings about difficult workplace conditions
and instead focus on how they’ve made a tangible difference in someone’s
life—interactions with patients and the life-saving actions they have taken,
the things that make nursing so incredibly fulfilling. Workplace conditions
can and will change when nurses work together to strengthen nursing. A big
part of that collective action is attracting a new generation of nurses who are
enthusiastic about their profession and eager to join in saving lives. The Truth
About Nursing’s recruitment page offers career seekers information about the
many ways in which nursing is a great choice.4
Recall the story in Chapter 6 about the Chicago artist who told two nurses
that she was sad about the downward trajectory of her daughter’s career aspi-
rations, from medicine to nursing. Sandy was one of the nurses. Sandy’s nurse
friend was speechless. But when there was an opportunity, Sandy said, “You
know, there’s this perception in society that being a nurse is less valuable than
being a physician, but that’s actually not true.” Sandy and her nurse friend
went on to describe some of the things nurses do to help patients live bet-
ter lives. The artist began to learn about nursing. Increasing understanding of
nursing begins with you teaching the person in front of you.
Identify as a Nurse
Many nurses introduce themselves to patients and colleagues by their first
name, or they don’t introduce themselves at all. This sure is down-to-earth,
but sadly, it can also undermine respect for nurses. Nurses don’t need to
be formal and cold to convey that they are serious professionals. Consider
this: “Hi, Ms. Jones. My name is Rich Kimball. I’ll be your registered nurse
until seven a.m. If you have any problems or questions about your illness or
your care, just ask for me, and I will help you, OK?”
Who Put Cartoon Characters All over My Uniform?

Nurses should consider whether their uniforms convey that they are pro-
fessionals. We love Hello Kitty and SpongeBob Squarepants, but not on
nursing uniforms. In 2006 host Matt Lauer of The Today Show remarked
that nurses “look like they’re going on vacation” in their scrubs.5 Physician
Patricia Raymond published a 2004 piece in the Sacramento Bee respectfully
331
chastising nurses: “You’re the only thing between [your] patients and death,
and you’re covered in cartoons.”6
Nurses’ uniforms should also make clear that nurses are nurses. When
nurses wore caps, patients could identify them. But caps were annoying and
carried deadly infections, so most nurses ditched them in the 1980s. Now
many bedside positions are filled by far less educated personnel, and every-
one dresses in scrubs. Patients don’t know who is who—or who can address
their questions and concerns. In 2004 both the Pittsburgh Post-Gazette7 and
the Kansas City Star8 ran articles focusing on patients’ right to know who is
providing their care, and it has become common for lists of hospital patients’
rights to include the right to know the roles of different caregivers.9
To address this problem, we have embraced the registered nurse (RN)
patch created by J. Morgan Puett and Mark Dion as part of a 2004 exhibit on
nursing uniforms at the Fabric Workshop and Museum in Philadelphia.10 In
2005, with permission from the artists, we created additional nurse patches,
all in bold red and white, to help identify who’s who. (You can get them by
visiting truthaboutnursing.org/patch.) We have also seen some hospital iden-
tification badges with a big, bold “RN,” which has the same effect. As noted
in Chapter 10, not everyone favors this kind of RN identifier, but it is one way
for nurses to make sure others know who they are.
Another way to identify nurses is by uniform color. In recent years some
institutions have gone back to all-white nurse uniforms. While we applaud
the effort to reclaim a professional image, nurses work with a lot of body
fluids and substances like charcoal. White uniforms do show stains and
may evoke the unhelpful angel image discussed in Chapter 7. Also, people
often use chlorine bleach on whites, which degrades the environment that
nurses should protect for their patients. In addition, some men do not favor
all-white outfits, and it is vital that nursing not create additional barriers to
increasing the number of men in the profession. A January 2013 report by
the New York City NBC television affiliate Channel 4 described the displea-
sure of nurses at one local hospital group at being required to wear just white
scrub tops. Distinct solid colored scrubs might be a better option. Consider
the system of nursing uniforms that Wales introduced in 2010, with different
shades indicating different specialties and levels of authority, as discussed in
Chapter 10. In 2012, nursing student Ani Burr wrote an opinion piece for
Scrubs Magazine describing how she felt “like the Michelin Tire man” in her
all white uniform. In a later rotation in pediatrics, where all-white was con-
sidered too scary for kids, Burr changed to teal-colored scrubs. She reported
3 3 2
that kids, parents, and healthcare colleagues suddenly treated her like part of
the team and less like an outsider.11
Acceptance by others in the workplace is critical for anyone, but nurses
must balance that general need with their profession’s unique ones. A lack
of clear RN identifiers might lessen awareness of the need to have RNs make
nursing assessments—and make it easier for decision-makers to replace nurses
with unlicensed caregivers, which has been happening since the early 1990s.
Some nurses have told us that their employers actually forbade nurses to wear
RN identifiers because that would signal to patients just how few RNs were
on the floor.
When Texas nurse practitioner Margaret Helminiak accepted a new job,
the business manager of the practice offered to buy her scrubs “like we do for
the medical assistants.” Helminiak thanked him, but declined: “No, I don’t
wear scrubs. I didn’t go to school for eight years to be mistaken for one of the
medical assistants.”12 She wears a laboratory coat with “Nurse Practitioner”
embroidered on it.
Nursing Out Loud

Nursing is more about thinking than it is about busy hands. But society
doesn’t realize it when nurses keep all their thinking to themselves. Unlike
physicians, nurses cannot count on the assumption that they are thinking.
Accordingly, nurses should consider nursing out loud. Patients, families,
and colleagues would learn far more about nursing if nurses would say more
of what they are thinking, consistent with patient confidentiality and sen-
sitivity. For example: “Ms. Keating, when I listen to your lungs, they sound
like they are half-filled with fluid. You probably know this is related to your
congestive heart failure, but I’m concerned that the fluid is decreasing your
oxygen level. Are you having trouble breathing? It seems that you are, so I’m
going to look into your fluid balance and see if you might need some more
diuretics to get rid of the fluid around your lungs. Let me also check your
blood oxygen level to see if some nasal oxygen would help you breathe more
easily. Do you feel up to taking a walk? That would help you get oxygen to all
the tiny distant pockets in your lungs, prevent pneumonia, and strengthen
your heart and lungs.”
When nurses think out loud, others get a sense of nurses’ education and
skill. Nursing professor Rhea Sanford suggests that if nursing students and
new nurses practice out loud, they can “transfer classroom knowledge into
quality clinical practice” and assess their own performance, while “providing
333
needed education to their patients.”13 She incorporates “nursing out loud”

into her curriculum on the Planetree patient-centered model of care.14 In fact,
some hospitals’ hourly rounding programs require nurses to introduce them-
selves and explain what they are doing.
Walk the Walk

Nurses live stressful lives, and understandably, some cope in unhealthy ways.
Unfortunately, unhealthy behavior may undermine the public’s sense of
nurses as health professionals. Some nurses have a difficult relationship with
food.15 When nurses become overweight, they may not seem like people who
embrace healthy living. So patients and the public may doubt their cred-
ibility on any health issue, not just nutrition. If you need help attaining a
healthy weight, consider an easy plan we put together to help you at www.
truthaboutnursing.org/healthy. It is also important to get enough exercise
and try to stop smoking. If you exercise, you can teach exercise principles and
motivating techniques to your patients. In addition, patients may not regard
nurses who smoke as serious health professionals.16
Act for Change

When nurses are off duty, their actions still say something about nursing. We
urge nurses to consider acting as a health resource for their families, friends,
and communities. Nurses can offer friendly advice on a wide range of health
issues. They can also advocate for public health issues at their kids’ school and
in other settings. Doing so educates those who nurses help and those who
nearby that nurses have health expertise.
Nurses can also advocate for public health. Consider working for health
financing reform; more school nurses; or better dietary policies in schools,
restaurants, and grocery stores. Sometimes nurses’ professional organizations
lead the way, and nurses might look to them for ideas. For example, consider
the US National Association of Pediatric Nurse Practitioners’ public opposi-
tion to corporal punishment, which got good coverage on the Examiner.com
website in August 2011,17 or the New Zealand Nurses Organisation’s endorse-
ment of World Smokefree Day, which got helpful coverage from Dunedin’s
Channel 39 in May 2010.18 Nurses might try helping to improve the environ-
ment, reduce greenhouse gases, or find alternative sources of energy. Nurses
might even signal their personal virtue by conserving energy. Or work to
address preventable global diseases. Nurses who fight for global health send
3 3 4
the message that they believe in their profession and that they fight for their
patients’ needs whether they are at the bedside or elsewhere. We’re not saying
nurses have to run for Congress or Parliament or something—although that
might not be a bad idea, because we do need more nurses in power.
Educate Physicians and Medical Students

Nurses already teach physicians a great deal about health care in clinical set-
tings, but they could do more to tell them about nursing. In addition to nurs-
ing out loud, nurses might reach out to local medical schools to promote the
interprofessional training and shadowing programs discussed in Chapter 10.
Nurses also might consider what nurse practitioner Margaret Helminiak
does: “When my physician colleague calls for a nurse but really means a medi-
cal assistant, I go into the room and tell her, ‘You called for a nurse. I am the
only nurse here. Everyone else is a medical assistant.’ ”19
Equal Rights for Equal Work

Nurses should address physicians as physicians address them. If a physician
calls a nurse by his or her given name, the nurse should call the physician
by the same. If a physician asks to be called “Dr. Jones,” the nurse should be
called “Nurse Smith.” If only senior physicians receive an honorific, senior
nurses should be treated the same way. This makes it clear to all—including
the media—that physicians are not nurses’ masters or betters. Really. Nurses
and doctors are colleagues, each worthy of respect.
Explaining Nursing’s Role to Patients

Nurses often have difficulty acting as the patient advocates they have been
trained to be, especially when that role brings them into conflict with phy-
sicians. We propose a basic statement that nurses might consider making
available to their patients and colleagues. The statement could go some-
thing like this:
I Am Your Registered Nurse

During your stay here, it is my duty to protect you from all harm. That means
any harm from your illness and its symptoms, from external forces includ-
ing the care environment, and from other people. As an autonomous health
335
professional who reports only to senior nurses, it is my job to protect you from
poor or misguided health care from any source. I am your advocate. I vow to do
my best to protect you as if you were a member of my family.
The Truth About Nursing has developed a downloadable poster of this state-
ment, which we encourage nurses to hang in every patient’s room!20
Educating the Media about Nursing

Once nurses have embraced their power to create change and considered
what they can do every day to improve the image of nursing, they should take
a look at what the media is saying about their profession. Does it reflect the
stereotypes we have discussed in this book? Next we discuss some ideas we
have found useful in helping the media improve.
Develop Media Expertise and Get Coverage for Nursing

Nurses must stand up and be someone when the media is interested in health
care in which nurses play a role—not simply defer to physicians, or slink into
corners, as some nurses do. Here are some basic suggestions for nurses, pro-
spective nurses, or anyone interested in the topic.
1) Read From Silence to Voice. The excellent book by Bernice Buresh and
Suzanne Gordon is the how-to manual for nurses seeking to relate to the
media.21 Every nurse should read it.
2) Observe experts on major media outlets. Every day, experts in various
fields present their views on television and radio networks, and in print
media articles. Consider how these experts relate to journalists, how they
present their basic positions and respond to questions. Consider how well
prepared they are. Then practice presenting your points. Have a friend
pose possible questions and practice responding to them.
3) Study examples of good coverage of nursing wherever they appear.
Many press items worldwide have effectively highlighted nursing prac-
tice or research. A short December 2013 item in the Southern Reporter
(Scotland) reported that a “pioneering” care model in the early rec-
ognition of patient decline developed by nurses at Borders General
Hospital had attracted the attention of Danish specialists.22 An August
2012 article in the Peterborough Examiner (Ontario) reported that
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nurses at the local Kawartha Sexual Assault Centre had launched the
“Don’t Be That Guy” awareness campaign, primarily to convey to men
that having sex with a woman who is too drunk to consent is rape.23
In October 2008, the New York Times published a report about the
research of Kristine Williams and colleagues at the University of
Kansas, who found that use of “elderspeak” (“dear,” “sweetie,” “honey”)
causes patients to become aggressive and sends a message of incompe-
tence, which starts them on a downward health trajectory.24 In March
2006 the Mainichi Daily News published a piece about research by
Japanese nurses who showed that when patients listened to relaxing
enka music during cardiac catheterizations, it lowered their blood pres-
sure by forty-four points—thereby decreasing the risk of potentially
lethal punctures to their blood vessels.25 Consider the information
nurses gave the media to get this coverage.
4) Make it a priority to help media creators understand nursing when
they ask. When the media contacts us, we put everything else aside and
talk for as long as they wish. We treat every reporter as if he or she writes
for the New York Times or The Economist. We follow up immediately by
sending documents or other resources to supplement the information we
provided and answer any additional questions the media may have. In
addition to providing input on stories about nursing in the media, we have
been quoted in pieces discussing the nursing shortage, nursing uniforms,
Magnet status, men in nursing, sexual abuse in nursing, how military
medics might become nurses, and other topics. We also refer the media to
other nurses with expertise.
5) Step up and respond, promptly. The media moves quickly and media
opportunities are usually fleeting. We once had a great television oppor-
tunity lined up for the director of a state nursing association, but she “had
a meeting” that afternoon and couldn’t do it. The issue was controversial,
but this director could have used the chance to present her perspective
and let viewers know that nursing leaders are responsive health profes-
sionals with opinions about public policy issues. In 2009 and 2010, after
the small wave of new Hollywood nurse shows hit, NYU physician Marc
Siegel consulted Sandy several times for expert comment on the shows
as part of his occasional Los Angeles Times column “The Unreal World,”
which analyzed the realism of health-related entertainment television.
These consultations entailed very quick turnarounds, but Sandy made it a
priority to provide prompt and professional responses, parts of which did
appear in the columns.26
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6) Establish relationships with local media and persuade them to cover

nursing. Invite your local media people to lunch or coffee, and tell
them about the diverse work of nurses. Set up a luncheon or roundtable
at which local nursing leaders talk to the media about their innovative
practices or research. Invite the media to nursing meetings and seminars.
Establish a Be a Nurse for a Day program so the media can follow nurses
at work. Nurse researchers should consider the last step in their publica-
tion process to be coverage in the lay media. Send the media your research
and tell them why their readers would find it compelling. Nursing journal
editors should seek coverage from mainstream health journalists.
7) Nurses did that! Nurses should tell their best stories, but make sure the
role of nurses is clear. The media needs to learn more about the dramatic
work of nurses. The Truth About Nursing has a story idea database on its
website, and we encourage nurses to submit their most dramatic stories—
good and bad. Too often we hear that important care just “happened” (as
if the hospital walls did it) or that “we” did it—both of which obscure the
fact that nurses did it.
8) Consider formal training. If you will be appearing before the media
with any frequency, we recommend in-person media training. The Truth
About Nursing’s website has more information on how to obtain it.27
9) Be nurse-identified. Sometimes nurse experts appear in the media, but the
piece simply identifies them as a PhD or as “Dr. Bivens”—without men-
tioning that the expert is a nurse. This leads the public to credit physicians
or other nonnurses for this nurse’s expertise or work. If forced to choose
between RN and PhD identifiers, please choose the RN. In August 2012
nursing scholar Elizabeth Winslow, who has done important work on the
overuse of preoperative fasting, published a piece in the American Journal of
Nursing urging nurse scholars to ensure that both academic and mainstream
publications identify them as RNs.28 Some famous people downplay their
status as nurses. Three Cups of Tea author Greg Mortenson, who works to
improve the education and health of girls in Pakistan and Afghanistan, is
a nurse. But as of mid-2014, we still did not find that fact in the detailed
biography at his book’s website.29 As Nursing Spectrum editor Pam Meredith
wrote in a 2002 editorial, “Pick up that RN flag and wave it.”30
10) Don’t let HIPAA paralyze you. The Health Insurance Portability and
Accountability Act (HIPAA) is designed to keep patient information con-
fidential.31 It does not forbid nurses to speak about their work. Overreacting
to HIPAA can mean that nursing will be cut out of the media picture.
One Johns Hopkins media professional involved with the 2008 ABC
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documentary Hopkins told us that the hospital used a standard release

form to comply with HIPAA. He said that 95 percent of patients readily
consented, in a process that sometimes took as little as twenty seconds.32
The hospital also put the television crew that filmed Hopkins through
the hospital’s standard HIPAA training program, so they could get their
own consents. Of course, even if nurses do not get patients to sign release
forms, they can still talk to the media about their work and patient care,
as long as they disclose no information that identifies any specific patient.
Catch the Media Being Good

Although we spend significant time trying to persuade the media to do a
better job, we also try to provide as much positive reinforcement as we can.
When we do see an accurate, enlightening depiction of nursing, we try to
thank those responsible, sometimes in a detailed analysis on the Truth About
Nursing’s website, but if that is not possible, even in a short email. Every nurse
should consider doing the same.
A more formal way of reinforcing good portrayals of nursing is through
awards, such as the annual Truth About Nursing Awards, a list of the best
and worst media portrayals of nursing we’ve seen in the previous year.
When we led the Center for Nursing Advocacy, we called them the Golden
Lamp Awards. Naturally, most people like to be recognized for good work.
When Tim Green, editor of the poetry magazine Rattle, began to prepare
a special nursing issue, he asked us how he could make the issue worthy
of one of our “ten best media depictions of the year” awards. He listened
carefully to our views, although we played no role in his editorial choices.
The issue’s nurse-penned poetry was powerful, insightful, and devoid of
stereotypes—and it did win a Golden Lamp for one of the best portrayals
of 2007.33
Different Ways to Persuade the Media to Reconsider Products

We have often asked media creators to reconsider their products, from
Hollywood shows to print advertising. In some cases, we have persuaded
media creators to address our concerns with relatively little effort. Other
campaigns have required major efforts, including thousands of letters and
global media coverage. Here are some ways to reach media creators in differ-
ent situations.
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Telephone Calls
Sometimes the only tool required to affect media content is the telephone.
In most of our campaigns to improve poor portrayals of nursing, we first call
media makers. Constellation Brands launched a multimedia naughty nurse
advertising campaign for Hydra vodka water in 2006.34 We called the com-
pany’s vice president of corporate communications, who quickly decided to
remove the nurse elements from the campaign.
When Bloomingdale’s department store ran a radio advertisement in
November 2007 featuring a “nurse” seducing a “physician” with a cashmere
sweater, we called the company’s senior vice president of public relations, who
asked for something in writing. We sent an email about a half hour later. Two
hours later, after the close of business on a Friday, Bloomingdale’s told us that
it had begun calling radio stations to prevent the advertisement from running
over that busy holiday season shopping weekend.35
After People magazine ran a photograph of Poison singer and reality TV
star Bret Michaels surrounded by naughty nurses in a December 2010 issue,
as noted in Chapter 5, we had a telephone conversation with the magazine’s
editor. He apologized, promised to avoid such imagery in the future, and
published the Truth About Nursing’s letter about the damage such imagery
caused.36
Of course, telephone calls alone are not always enough. In those situa-
tions, we move to letters or letter-writing campaigns.
Letters and Emails

Sometimes it just takes one email to make a difference. In September 2006 we
asked ALR Technologies to change the informal name of its ALRT500 home
health management device from Electronic Nurse to a name that did not sug-
gest that the machine could replace a real nurse. In an email, we explained
that the device does not make professional judgments and take skilled actions
based on years of college-level science education, as nurses do. The company
soon apologized and removed the nickname.37
Letter-Writing Campaigns
When the above efforts fail, it’s usually time to turn up the heat. Letter-writing
campaigns have been pivotal in many of our efforts to improve media on nurs-
ing. Sometimes a few letters are enough to get some result. When the quiz
show Jeopardy! wrongly implied in 2004 that nurse practitioners treat only
“minor ailments,” a handful of letters were enough to persuade the produc-
ers to place a question on the show designed to improve understanding of
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nursing.38 In July 2010, we learned of a casting call for Cali Nurse, a reality
show planned by Lambert Productions that seemed likely to suggest that
nurses and nursing students were good-hearted, fun-loving cuties looking for
“dates with McDreamy.”39 It took just 78 emails for us to get a constructive
call with the company’s executive vice president, who promised to keep our
concerns about stereotypes in mind as production moved forward. We sent
copies of the first edition of this book to the production team; the show never
appeared.
Some media creators require more than a few letters. When Skechers
launched its global advertising campaign featuring Christina Aguilera as
a dominatrix naughty nurse in 2005, the company was unresponsive to
our calls. However, after our supporters sent 3,000 emails over two weeks,
Skechers removed the advertisements.40 In August 2008 the Registered
Nurses Association of Ontario (RNAO) sent a letter asking Canada’s Neilson
Dairy to end use of naughty nurse models in advertisements and at a related
extreme sports tour. RNAO’s one letter did not move the company, but more
than a thousand letters from RNAO supporters did. A week later the com-
pany apologized and promised to remove the naughty nurse imagery.41
In October 2013, MTV introduced the nurse reality show Scrubbing In.
The show did not exactly fulfill the promise of Cali Nurse (no one dated
McDreamy!). But as discussed in Chapters 2 and 5, Scrubbing In did offer
plenty of degraded sexual imagery and reality show drama, with virtu-
ally no impressive clinical interactions. Milwaukee nursing student Milka
Stojanovic started a Change.org petition to cancel the show and, with help
from Ontario nurse Tyler Kuhk, ultimately got more than 30,000 signatures.
At the same time, several prominent nursing groups called for the show’s can-
cellation, including the Canadian Nurses Association, the Emergency Nurses
Association, the RNAO, the American Nurses Association, and National
Nurses United. The Truth About Nursing added a petition with an analysis of
the show that gained 500 more signatures.42 MTV executives contacted the
Truth About Nursing and in the end agreed to air the remaining episodes at a
less prominent time, re-edit later episodes, and take steps to convey accurate
information about nursing, including working with us to create a web page
about becoming a nurse and a “day in the life” web feature about a skilled
New York City nurse.43
Press Releases
When we launched our campaign in 2006 to ask the Heart Attack Grill in
Arizona to remove the nurse theme from its waitresses’ sexy costumes, we
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started with telephone calls to the restaurant’s owner. These interactions

proved too much for him. We moved to emails and a letter-writing campaign,
but those were not effective either.44 Next we issued a press release to every
print and broadcast media outlet in Arizona and to major media outside the
state. A local television station picked it up, and the story quickly appeared
in thousands of broadcast and major print media news outlets around the
world.45 Not everyone agreed with our position, and so far we have still not
persuaded the Grill to end its use of the naughty nurse. But tens of millions
of people heard our message about how nursing stereotypes affect nursing,
helping to educate the public about the profession’s value.
Consider the November 2010 weight loss segment of The Dr. Oz Show
in which some “nurses” “got sexy” and danced with Oz, also discussed in
Chapter 5. Our campaign about that generated hundreds of powerful letters,
but it did not move the show to any real action. So we issued a press release.46
The Associated Press did a story, which was soon picked up by 2,200 news
entities across the world, including the New York Times, the Los Angeles Times,
Online Nigeria, the Times of India, New Zealand Yahoo, and the Arabic
language Wael El-Ebrashy. Oz issued a statement that closely resembled an
apology and he promised to do better in the future.47 A year later, his show
broadcast the substantial, well-meaning “NURSES’ SECRETS” segment dis-
cussed in Chapter 3.
Unorthodox Approaches
There are many ways to get the media’s attention. For instance, in 2006 we sent
a “worst portrayal of nursing” award to rock star Jack White, along with our
analysis of his 2005 White Stripes song “The Nurse.”48 We explained how his
lyrics associated a “nurse” with romantic love, mothering, and housekeeping.
In response, White sent Sandy a satirical “Metaphorical Ignorance Award.”
White evidently did not grasp that we were actually objecting to his use of
metaphor to reinforce nursing stereotypes: we did not imagine that his song
was saying a real nurse rubbed salt in his physical wounds. But having gotten
his attention, we issued a press release about our mock-award exchange and
got coverage for our issues in the Los Angeles Times, Salon, and elsewhere.49
Options are greater for those with greater resources. In March 2014 the
Nova Scotia Government and General Employees Union, which represented
nurses at the Capital Health hospital group, ran television advertisements
during a contract dispute to explain that patient safety is at risk when nurses
are forced to care for too many patients.50 The California Nurses Association
(CNA) has used a wide variety of creative tactics, some controversial, to
3 4 2
get its messages out. In the mid-2000s, after California governor Arnold
Schwarzenegger opposed implementation of nurse staffing legislation that
CNA had fought to pass, the union protested at his appearances across the
United States and used various advertisements to tell the public about the
dangers of high nurse-to-patient ratios.51 After CNA won its campaign for
minimum ratios,52 it set its sights on universal health coverage.53 In May 2008,
CNA ran an advertisement in the Washington Post referring to Vice President
Cheney’s excellent federal government health insurance: “If Dick Cheney
were anyone else, he’d probably be dead by now.”54 In June 2011, National
Nurses United, the union CNA helped to found, held the first of many vig-
orous street protests calling on Congress to impose a 1 percent tax on Wall
Street transactions to fund health care and other needs, predating the Occupy
Wall Street protests held later in the year.55 Not everyone applauded these
positions and tactics, but they drew attention to CNA’s issues.
Persuading Media Decision Makers in Direct Interactions

Let’s say you want to affect what a specific media creator is telling the public
about nursing right now. How would you do it? We have some suggestions.
Identify and Reach the Decision Maker

Many corporations have customer service telephone numbers, but those who
staff them usually have little decision-making power, and they often seem to
be trained to deflect concerns about their media rather than address them.
We have found them receptive in only one instance, when the head of cus-
tomer service at Coors in the US worked with us to convince the company’s
Canadian division to discontinue naughty nurse advertising in late 2006.56
When we reach the person who has the power to decide how a specific
media product is made or shown to the public, that person will often listen
and work with us. But identifying the decision maker is not always easy. That
person’s identity depends on the medium. For the news media, the person
you want is usually the reporter or an editor. In commercial advertising, it’s
usually the vice president of marketing, consumer affairs, or corporate com-
munications. In television, it is generally the executive producers. In film, it is
usually the director and the writer.
In 2002, when we first tried to persuade the US government to reconsider
the name of its Take a Loved One health campaign, Sandy called the main
telephone line of the Department of Health and Human Services’ Office of
Minority Health. She was transferred to a low-level official. We got nowhere.
343
In 2004 we tried again, and this time we found the decision maker—the direc-
tor of the Office of Minority Health—but his assistant would not set up a
telephone call with him. So we launched a letter-writing campaign, and more
than 300 supporters sent him emails.57 The director’s assistant then agreed to
set up a call between the director and Sandy. In a constructive discussion, he
vowed to explore a better name for the campaign, and it was later changed.
In 2006 CVS ran television advertisements suggesting that a pharmacist
had transformed a patient’s spouse into a “nurse” after a few hours of training
in how to give medications.58 We called CVS and were transferred to about
fifteen different people and subdivisions of CVS over the course of four or
five days. Finally we reached the company’s vice president of customer service.
He was very helpful in working with us to remove the nurse element of the
advertisement.
In 2007 Seattle’s Group Health launched advertisements for its “Ask the
Doc” service that included the tag line “Nurse, hand me my laptop,” sug-
gesting that nurses are there to fetch things for physicians. Several nurses at
Group Health, led by Carolyn Elliot, lobbied the company’s marketing peo-
ple to remove the spot, but they were told they had failed to appreciate the
ad’s “humor.” The marketing director was “hopeful that [nurses] can let this
go and we can all remember that we’re all on the same team.” So the nurses
lobbied the CEO. He pulled the advertisement.59
In 2013, the urgent care chain American Family Care (AFC) aired televi-
sion advertisements assuring the public that AFC patients got to see “a doc-
tor, not a nurse,” a baseless insult to advanced practice nurses, as noted in
Chapter 9.60 Sandy placed about seven calls, one per day, to the corporation’s
director of marketing. That person did not return the calls. Then Sandy called
the CEO and left a detailed message. Finally, AFC’s “chief medical officer,”
a physician, returned her call. After a long discussion in which the physician
insisted that the physician care was better because physicians typically get
more formal education, and Sandy explained that decades of actual evidence
showed that advanced practice RN care was at least as effective,61 the phy-
sician said AFC would pull the advertisement. Granted, he also said AFC
would likely replace it with one that still told patients they would get to see
a physician, which is not much better. It was not the most satisfying interac-
tion, but at least we had found the decision-maker we needed.
Although assistants and receptionists do not have decision-making author-
ity, it is vital that you treat them with respect. That is not just because it’s the
right thing to do, but also because assistants often control access. Although
your goal is generally to get to their bosses, you should treat the assistants as
3 4 4
if they were the decision makers. If you persuade them that your concern has
merit—or at least that you are serious and will not waste their boss’s time—
you have a better chance of getting past them and maybe even influencing
their presentation to their bosses to favor your view.
In general, if you’re getting nowhere with the person you’re dealing with,
don’t hesitate to politely go over his or her head. Just keep contacting people
until you find the person who can make the decision. Be persistent!
Be Persistent!
If there is one tactic in getting the media to listen that supersedes all other
tactics, it is relentless persistence. Make it clear that you will not go away until
the person or organization you are dealing with fixes the media problem. It
does not always work, but often it does.
In October 2013 nursing student Milka Stojanovic started a Change.org
petition to persuade MTV to cancel Scrubbing In, as noted previously. But
Milka did not just start the petition and wait; she undertook a multi-pronged
social media offensive. That involved emailing the petition link to her aca-
demic contacts, Facebook-messaging major nursing schools, and posting the
link on discussion forums everywhere from the MTV website to a leading
social-networking site for nurses—which soon banned her for supposedly
spam-posting the link. Then she really boosted the campaign by targeting
prominent nursing blogs on the Tumblr platform and contacting those whose
Tumblr tags indicated they had issues with the show. Milka also noticed that
the show was starting to generate a lot of Twitter activity, including prodi-
gious tweeting by nurse Tyler Kuhk, who even managed to engage with some
of the show’s cast members. Tyler also discussed the show with well-placed
contacts at the Ontario Nurses Association, which started a campaign, as did
other prominent Canadian and US nursing organizations. These collective
efforts led to online and television reports in Canada—and more than 31,000
signatures on Milka’s petition. MTV noticed.
In November 2009 the Lung Cancer Alliance (LCA) launched a major
public awareness campaign built on a satirical rap video featuring a “Dr. Lung
Love” character surrounded by naughty nurses, as explained in Chapter 5.62
Early that month, the Truth About Nursing posted an analysis and started a
campaign, which generated more than 100 letters to LCA. At the same time,
we began calling LCA daily, trying to reach the group’s executive director.
When that route was fruitless, we began calling the group’s board, which
included some prominent figures from the fields of health care and govern-
ment, leaving detailed voicemail messages. After a couple of weeks, we finally
345
got a letter from LCA’s executive director. She detailed LCA’s good works and
past support for nursing, and she said she understood nurses’ concerns about
the “perceived misrepresentation.” But LCA did virtually nothing to address
them. So we urged supporters to call her directly. At the same time, we had
issued a press release, and Modern Healthcare, the influential magazine for
healthcare executives, soon ran a substantial story about our concerns. Before
the end of the month, LCA had quietly removed the video from its website.63
In 2007 Cadbury Schweppes Canada ran television commercials featur-
ing female nurses hopping into bed with male patients who chewed Dentyne
Ice gum.64 We called to discuss the advertisement. The company’s director
of corporate communications in Canada was notably unreceptive to our
concerns. (“We test marketed it and no one complained that it was offen-
sive!”). For over a week we had daily conversations that yielded no positive
result. So we launched a letter-writing campaign. The RNAO joined us and
launched its own letter-writing campaign. But even after a combined 1,500
letters from our two groups, the communications director would not budge.
In the meantime Sandy found the work telephone numbers of the top seven
Cadbury Schweppes executives in the world and began calling them daily,
connecting exclusively with their voicemail. She left them lengthy, detailed
messages about the complex role media undervaluation plays in the global
nursing shortage. After a week, the CEO of Cadbury Schweppes called Sandy
from London to apologize, discuss her concerns, and to tell her he was pulling
the advertisement.65
Study the Media Product and Anticipate Arguments

Before contacting media creators, look closely at the media product. Are
parts of it ironic? Is it actually criticizing a stereotype rather than endorsing
it? Media creators are more likely to listen if you show that you understand
their work but still have an issue with it. Likewise, if a counter-argument is
almost certain to be made, it may make sense to address it up front. This tactic
may lessen resistance, or at least show that you have thought carefully about
the issue. For example, when dealing with naughty nurse imagery, you can
count on being told that it’s “just a joke,” though “jokes” are one of the most
common ways to spread harmful stereotypes, as discussed in Chapter 5. We
try to convey that we get the joke, or would appreciate a joke that was not so
tired and offensive. When we contacted Fox News Channel’s Redeye about an
April 2008 show celebrating the naughty nurse stereotype, we presented our
analysis in a satirical letter pretending to praise the show for embracing the
stereotype.66 Our press releases about such imagery, like the one we did about
3 4 6
the naughty-axe film Nurse 3D in February 2014, typically include humorous

elements to show that we understand the joking element in the imagery.67
Play Good Cop/Bad Cop

Advocates may confront choices about whether to focus more on the “inside
track” (such as by offering gentle private suggestions that might move power-
ful media creators slightly in the right direction) or the “outside track” (such
as by offering rigorous public analysis of the meaning and effects of specific
media products, which makes collaboration with creators less likely). We have
adopted different approaches in different contexts, although we are better
known for the outside approach. Of course, not everyone has to approach
things the same way. We’ve noticed that nursing has no shortage of “inside
track” adherents.
In some cases, a combination of these approaches may be effective. We
started asking ER to improve its portrayal of nursing in 2001. For some time
in the early 2000s, it was rare for the minor nurse characters to appear on the
show. In contrast to the many physician characters, the one major nurse charac-
ter had little clinical role, and she spent most of her time engaged in romances
with physicians or enduring family tragedies. We had a lengthy, cordial confer-
ence call with an ER producer and the show’s “medical” adviser in late 2001,
but it was pretty clear the show did not want our advice on an ongoing basis.
So we began sending the show our critical analyses of its episodes and urging
our supporters to pressure it to improve, and we did so until the show ended in
2009.68 We understand that the show did not like these efforts, but a stronger
major nurse character named Sam Taggart was introduced in late 2003, and
she was ultimately featured in many of the show’s best nursing plotlines.69
In March 2005 we urged advertisers to withhold their advertisements
until ER improved. The next month, the senior vice president of global medi-
cal affairs for pharmaceutical giant Schering-Plough, physician Hans Vemer,
responded to our campaign by asking the show to help address the nursing
shortage by developing “stories that highlight accurate roles, responsibilities,
skills and contributions of today’s modern nursing profession.”70
We understand that Sojourn Communications, a Hollywood-based com-
munications company, played a key role in helping ER develop the Eve Peyton
plotlines of late 2005, which addressed some of our concerns about nursing
skill and autonomy; indeed, some scenes might easily have been crafted by
us. Peyton’s exit drew heavily on the battle-axe image, but on the whole the
episodes were helpful.
347
After 2005, ER at times made a point of displaying nursing autonomy and

skill. In the show’s final season, Taggart even started a nurse anesthetist pro-
gram, breaking the show’s tradition of having major nurse characters aspire
to medical school when they pursue graduate studies. There was little more
about nursing leaders or managers, and the physician-centric show still fell
well short of a good portrayal of nursing, but on the whole, it made a clear
improvement.71
Move Fast
It is often easier to get the attention of media figures if you’re able to connect
with them soon after a troubling portrayal appears. That’s especially true of
talk radio. In June 2007, when radio host Stephanie Miller and sidekick Jim
Ward had some fun with naughty nurse stereotyping, we sent them an analy-
sis, and they promptly read and mocked parts of it on the air. Within minutes,
a supporter called Sandy and she quickly called the show, which allowed her
on the air briefly to explain her concerns.72
In January 2006, on Sean Hannity’s radio show, one caller asked a US sol-
dier who had been an inpatient at Walter Reed Army hospital whether there
were any “hot nurses” there. The soldier reportedly replied that there were
“a few pretty ones” but that most were “motherly.” A supporter immediately
notified us, and Sandy called Hannity’s office. Twenty minutes later, Sean
Hannity called us back, and we talked about nursing stereotypes for some
time. Hannity made supportive comments about nurses on the air in the fol-
lowing days.73
Use the Media’s Own Process

Some media creators have procedures for challenging their conduct. For exam-
ple, in 2007 Heineken began running Dos Equis advertisements in which “the
most interesting man in the world” bench-pressed two young women in short
white dresses and nurses’ caps.74 Following the advice of a Heineken corporate
relations officer, we appealed to an independent board that handles such mat-
ters for Heineken, using codes of marketing that Heineken follows. Among
other things, we argued that the spot violated the Heineken International
Commercial Communication Code, which required that advertisements
“be prepared with due regard for our social responsibility” and that they not
“impugn human dignity and integrity.” The review board, which included
former US vice presidential candidate Geraldine Ferraro, agreed that the
advertisement should be changed. Heineken then digitally altered the wom-
en’s clothing to remove the nurse elements and proceeded to air that version.
3 4 8
Collaborate
In various campaigns, we have collaborated with the American Nurses
Association, Canadian Nurses Association, National Nurses United, the
American College of Nurse Midwives, and the RNAO, as well as many other
groups and individuals. Collaboration has enabled us to mount much larger
and more effective campaigns. It was clearly a critical factor in the MTV cam-
paign, as well as in our work successfully challenging the US government’s
Take a Loved One to the Doctor campaign and the Dentyne Ice advertise-
ment. In January 2014, after the American Academy of Nurse Practitioners
had joined us and more than 1,500 Truth About Nursing supporters in pro-
testing the mockery of nurse practitioners on Lab Rats, Disney agreed to alter
the troubling episode to eliminate the insult to nurse practitioners in future
airings and to take steps to avoid similar issues in the future.75 Sometimes we
have been able to get help from companies outside the nursing community, as
we did when Schering-Plough wrote to ER. When Mattel released its Nurse
Quacktitioner doll, we convinced Walmart to sell the dolls back to Mattel, as
a way of adding pressure on Mattel. Unfortunately, Mattel did not agree to
the buy-back.76
Suggest Alternatives
Media creators may be receptive if they are presented with an alternative way
they can achieve their goals without reinforcing nursing stereotypes. In the
2013 Scrubbing In campaign, we proposed several things that MTV might do
besides simply canceling the show, which was a long shot given the network’s
investment and the advanced stage the show had reached, with all filming
complete. We urged MTV to try to maximize the use of clinical segments,
and the network agreed to do what it could with the few episodes on which
editing was not complete, although we can’t claim to have seen great improve-
ment. Among our ideas was that MTV provide information to its young audi-
ence about nursing careers and practice. The network obliged by working
with us on the online efforts described previously. We also asked MTV to
consult with us should it decide to produce a second season of Scrubbing In
or any other program featuring nurses, so we could try to help them create a
better portrayal of nursing. MTV agreed to do so.77
In 2005 Walmart placed an advertisement in nursing journals featuring a
“nurse” and the tag line “It doesn’t take a brain surgeon to recognize a good
deal on scrubs.” We contacted Walmart to object to the suggestion that nurses
aren’t all that smart. The company not only agreed to change the advertising
copy, but also took us up on our offer to help.78
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Sometimes it can be helpful to propose a specific alternative course to the

media, even if there is little chance the media creator will adopt it. After read-
ing our analysis of a damaging January 2007 episode of Grey’s Anatomy, nurse
Mandy Mayling of Los Angeles wrote and sent the show an alternative script.
The inventive script showed how the episode might have featured at least as
much drama while accurately representing nursing.79
Expect Resistance
Change can be scary. So changing the way people think is not easy or quick.
Since the beginning, we have faced vigorous opposition from some media
creators and supporters. Naughty nurse fans can be especially committed, but
Hollywood shows and pop musicians also enjoy a good deal of blind loyalty.
Some wonder how we keep going in the face of this. But we believe that US
nurses and supporters have a special obligation to reduce negative stereotyp-
ing of nursing because US media often has so much global influence. We
recall Mahatma Gandhi, who described the path to social change this way:80
First they ignore you;

Then they laugh at you;
Then they attack you;
Then you win.
Nursing has been largely absent from serious discussions of health care
in the media for decades. It’s not exactly encouraging to be laughed at or
attacked, but we believe those are huge steps up from being ignored. In some
cases these reactions have been a prelude to achieving our immediate goal of
improving a given media product—and, we believe, our larger goal of chang-
ing the way people think about nursing. In December 2013, Forbes posted a
piece by contributor Leah Binder that recognized writing on health care that
produced “disruptive innovation,” creating change by “gor[ing] somebody’s
ox.”81 Binder, CEO of the respected hospital-safety organization The Leapfrog
Group, titled her piece “The Best Disruptive Writings of 2013—Health Care
Edition.” She recognized the Truth About Nursing’s work under the heading
“Gored Oxen Four: Conventional Wisdom About Delivering Care.”
Organize Chapters of the Truth About Nursing

As of early 2014, the Truth About Nursing has local chapters throughout
the United States and in 14 other nations, but we are always looking to start
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more. Chapters meet periodically and consider ways to encourage local media
to improve its treatment of nursing. One active Truth About Nursing chap-
ter has been our Las Vegas affiliate, under the leadership of copresidents Dee
Riley and Michele Nichols. In May 2010 the chapter held an event at the Jet
Nightclub in the Mirage Hotel to protest a naughty nurse costume contest.
Our members cheerfully spoke with club patrons about the value of nursing
and the problems with the naughty nurse image. In November 2011 the chap-
ter held a peaceful protest outside the Heart Attack Grill, which by that time
had made its way to Las Vegas with its naughty nurse servers. Members handed
out hundreds of flyers to Grill customers and passersby.82 If nurses in every
media market worked together to implement the ideas in this book, media all
over the world would change the way it treats nursing. There is more informa-
tion about starting a chapter on the Truth About Nursing’s website.83
Message in a Bottle: Create Your Own Media

Nurses know best what nursing is and what nurses do, so they should explain
their work to the world directly. Some nurses have actually become media
professionals, and some media professionals have become nurses, both of
which we encourage. But you don’t need to be a media professional to create
compelling media: you can use a personal blog to improve understanding.
Depending on their interests, nurses might use written work; visual, perfor-
mance, and tactile media; and video, broadcast, and film.
Writing about Nursing

Writing has many benefits as a way to help others understand nursing. It
allows for precise, detailed explanation that can be very helpful for a profes-
sion that needs to convey complex skills and thought processes.
Letters to the Editor

Letters to the editor are a great place for anyone to start. Letters can be as
short as one paragraph, and they are easier to get published than some other
types of traditional print media. Letters are often used to persuade the media
to do better, but they can influence the public in their own right. For example,
in March 2011 the widely read People magazine published Sandy’s short letter
explaining why the publication’s recent printing of a photograph of reality
television star Bret Michaels surrounded by naughty nurses was a problem.84
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A February 2006 issue of Good Housekeeping included an effective letter from

nurse Berni Martin protesting a feature from a past issue that had included a
health tip from an anonymous emergency department physician that readers
should lie to triage nurses in order to be seen faster.85
Not all letters need to respond to specific past media items; some discuss
issues of the day. In May 2005 the Wawatay News in Ontario published a
Nurses Week letter to the editor by Canadian federal health nurse Lyn
Button of the Sioux Lookout Zone. The letter provided special insight into
what nurses do for patients in remote rural communities. 86
Don’t be discouraged if your first letter doesn’t get published. Many of
ours don’t get published either. But some do, and none would ever get pub-
lished if we were discouraged by every rejection. Be persistent!
Op-eds
We urge nurses to write op-eds (opinion-editorial pieces), which can show
that nurses have valuable perspectives on a wide variety of health issues. In
October 2010 the Washington Post ran an excellent op-ed by nurse practitio-
ner Veneta Masson explaining why she no longer got annual mammograms.87
Reviewing the research, Masson found no evidence that the test saved lives,
but she noted the severe harm many had suffered from unnecessary treat-
ment following false-positive results. In August 2009 nurse Linda Record
Srungaram wrote a strong op-ed for the Houston Chronicle arguing that Texas
nurses needed better whistle-blower protection, noting that two nurses had
actually been indicted after filing a complaint about a physician with the
state medical board.88 (After a long ordeal, the nurses were not convicted.)89
Nurse Kathleen Bartholemew’s powerful March 2009 piece in the Seattle
Post-Intelligencer urged the public to reconsider the allocation of healthcare
resources, citing recent layoffs at a local hospital.90 In December 2005 the
Milwaukee Journal Sentinel published Gina Dennik-Champion’s persuasive
op-ed supporting pending legislation to authorize medical marijuana use.91
That same month the Toronto Globe and Mail ran a moving op-ed by Calgary
maternity nurse Raewyn Janota, who described the care she provided to a
couple whose baby was stillborn.92
Getting op-eds published can be challenging, especially if you are trying
for a major periodical or have a message that editors do not expect. When we
got our op-ed arguing for a Nobel Prize in nursing published in the Baltimore
Sun in December 2006, it was the culmination of three years of work. We
revised the draft many times, sought out a noted coauthor (ultimately per-
suading the prominent nursing professor Kristine Gebbie to join us), and
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submitted the op-ed to many publications before we succeeded. So be tena-

cious, revise, seek advice, and keep pitching your message.
Feature Articles
Nurses don’t need to depend on reporters to cover them, because they can
write about their own work! One common way to do that is through features,
which describe interesting events or ideas that are not breaking news. In March
2010 nurse Laura Stokowski published a powerful “Letter to Hollywood” on
Medscape, the prominent website for health professionals, outlining the com-
mon myths about nursing that Hollywood promotes and explaining what
nurses really do for patients.93 Another example is John Blanton’s excellent
April 2007 Wall Street Journal article about his post-9/11 journey from WSJ
editor to intensive care unit nurse and back again.94
Advertisements
Placing advertisements in the mainstream print media can be expensive. We
have managed to get significant media coverage without paying for it (and
needless to say we have also tried and failed to do so many times). For most
nurses that is probably the best avenue for media attention. However, those
with resources have placed paid advertisements that give the public helpful
information about nursing. In 1997 the British Columbia Nurses’ Union put
out an advertisement featuring a photograph of a nurse taking her patient’s
pulse. The text read: “He thinks he’s having a conversation about the hospi-
tal jello. She’s actually midway through about 100 assessments.”95 Of course,
there was no room to articulate everything nurses assess, plan, and decide, and
at the right time we might hope the nurse would also consider some “nurs-
ing out loud.” But the advertisement told the public that nursing is complex
and important, with a sly reference to the continuing invisibility of nursing
expertise.
Nonfiction Books
Many nurses have written nonfiction books to explain their nursing experi-
ence or help people with their expertise. Writing and publishing a book can
be a serious project, but books can have a lasting impact. Consider keeping a
journal of dramatic events that have happened to you over the previous shift.
Do this for a year—or for a week, depending on where you work—and you
may have enough fodder for a book!
Memoirs can be an effective way for nurses to tell people about nursing.
Echo Heron is well known for dramatic nonfiction books about her work,
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starting with the best-selling Intensive Care: The Story of a Nurse (1988).96
Claire Bertschinger published Moving Mountains (2005) about caring for
children in the 1980s Ethiopian famine—work that reportedly inspired the
1985 Live Aid benefit.97 More recent memoirs about the work of strong,
autonomous nurses include Jennifer Culkin’s A Final Arc of Sky (2009), an
account of critical care and emergency flight nursing that was both power-
fully written and very specific in its descriptions of nursing expertise,98 and
The Nightingale of Mosul (2010) by Susan Luz (with Marcus Brotherton), in
which a high-ranking military reserve nurse related her adventures in Iraq and
challenging nursing positions around the world.99
Some nurses have written books to educate the public about health issues.
Nurse Pat Carroll’s What Nurses Know and Doctors Don’t Have Time to Tell
You (2004) effectively explained important health principles to the lay public,
although it was marred by a title that managed to both celebrate and denigrate
nurses.100 Nurses Gloria Mayer and Ann Kuklierus have written four influ-
ential “plain talk” books for the public, including 1999’s What to Do When
Your Child Gets Sick, which is sent to the parents of every newborn child in
California and South Dakota courtesy of the state.101 Nurse Serita Stevens, a
prolific author and screenwriter, wrote Forensic Nurse (2004) to explain that
growing field to the public.102 Nurse Cheryl Dellasega, an expert in relational
aggression, writes books to help women, girls, and nurses improve their rela-
tionships, including Forced to Be Family (2007).103
Nurses can also contribute to books edited by others. For example,
Nurse—Past, Present, and Future: The Making of Modern Nursing (2010),
edited by Kate Trant and Susan Usher, is a short but striking book of text and
photographs. With short essays and stories by nurses from around the world,
the book combines basic concepts and cutting-edge issues to highlight the
history, diversity, and importance of modern nursing.104
Novels
Novels can be a very powerful way to convey the nursing experience. One
of the highest-profile novelist nurses is Echo Heron, who has written several
hospital thrillers, including Fatal Diagnosis (2000).105 Nurse Elizabeth Ann
Scarborough wrote The Healer’s War (1989), a mystical novel about a US
military nurse in the Vietnam War that won the Nebula Award for best US
science fiction or fantasy novel of the year.106 Nurse Richard Ferri’s Confessions
of a Male Nurse (2005) was a funny account of a gay man in nursing, although
we were uneasy with the way it presented the main character’s love affair with
a physician, which seemed to suggest that medicine had far greater value than
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nursing.107 Other nurses have written novels, but few prominent ones seem to
focus on nursing. The world is waiting for yours!
Other Literature and Storytelling

Nurses participate in compelling dramas every day: write about them! There
are many avenues for nurses who want to write about nursing. Veneta Masson
has published books of poetry that reflect her years as a nurse in Washington,
DC; the most recent was Clinician’s Guide to the Soul (2008).108 The poetry
magazine Rattle’s 2007 special issue on nursing also included many impres-
sive nurse poets who explored the healthcare experience from a nurse’s per-
spective. In December 2008 forensic nurse and poet Carmen Henesy got
publicity for a poem begging San Francisco Mayor Gavin Newsom not to
slash funding for nurses who treat child-sex abuse victims.109 Nurses can also
tell the public something of what they do through short fiction, which is pub-
lished in a variety of magazines.
Even satirical pieces can convey something of the nursing experience. In
2005 we issued a satirical April Fool’s Day press release about a groundbreak-
ing study published in the Journal of the American Medical Association con-
cluding that nurses are skilled, autonomous professionals who do vital work
to improve public health. We included fake reaction from a variety of promi-
nent media sources who professed shock. The “study”—which we invented—
was entitled “Who Knew?”110
Kids’ Literature
A compelling series of children’s books about modern nursing could be
very effective, especially since many children’s books, like Holly Hobbie’s
Fanny (2008),111 suggest that medicine is the really desirable healthcare
career—particularly for ambitious girls. We need books to highlight
the value of nursing for toddlers, preschoolers, elementary kids, tweens,
and teenagers.
One series of novels that inspired many children to become nurses
was the Cherry Ames series, originally published from 1943 to 1968.112
Springer Publishing reissued the series in 2005–2007, but the gender and
nurse-physician relations are antiquated and unlikely to impress today’s
young readers. Nurse Serita Stevens wrote Charlie London, RN in 2004 to
try to update the Cherry Ames series.113 The main nurse character was bright
and positive, but we found that her reverence for physicians undermined the
message about nursing. We need works that show nursing is as valuable and
challenging as medicine.
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Of course, J. K. Rowling’s Harry Potter books do include the very minor

nurse character Madam Poppy Pomfrey, who is skilled at healing in a super-
natural setting. But we need nurses to put nursing center stage.114 Maybe
Harry Potter could become a flight nurse; that broom would be pretty quick
to accident scenes!
The Internet: Websites, Blogs, and Discussion Boards

In 2012 the Internet was estimated to have more than 2.4 billion users world-
wide, including most of the public in the developed world, and there were
estimated to be 634 million websites.115 Virtually all the written media forms
discussed previously are now available online. The Internet is the main way the
Truth About Nursing interacts with the media and the public. The Internet
offers countless communication avenues that might help nurses tell the public
what they do.
Many nursing discussion boards and blogs are available to all Internet
users. They are important ways to spread information about nurses to the
public. Some do a good job of exploring current nursing issues. However,
some popular nursing discussion boards do not always convey to members
of the public who stumble upon them that nurses are well-educated profes-
sionals. Of course, these are places nurses go to vent and discuss their very real
work difficulties. But we urge nurses to consider if their posts would inspire
decision makers to give nursing the resources it needs.
Websites have become an essential communication tool. Some
nurse-created sites try to give the public information about what nursing is,
including the Truth About Nursing’s www.truthaboutnursing.org. Johnson
& Johnson’s Campaign for Nursing’s Future has significant information
about nursing on its website, www.discovernursing.com.
Nurses should consider creating or enhancing websites to explain nursing,
including the sites of their employers and professional groups. Websites are
now the public face of an organization. Nursing schools often profile their fac-
ulty, letting the public know about professors’ credentials and interests. But
it is still rare to find much about nurses on hospital websites, as we explained
in Chapter 10 in discussing the Truth About Nursing’s 2012 analysis of the
sites of leading US hospitals.116 As we noted, few websites highlight nursing
care or the people who deliver it in any detail, much less the detail devoted
to physicians. Site sections that do describe nursing seem to be aimed mostly
at nurses themselves. For example, we have seen no websites that advertise a
hospital’s Magnet status as a draw to patients—we have only seen it used as a
nursing recruitment tool.
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Massachusetts General Hospital’s site (www.massgeneral.org) does list

the credentials of a small number of nursing leaders in some detail and it
describes the work of many nursing teams, units, and programs. However,
the descriptions appear with those of other nonphysician professions under
“Patient Care Services.” They appear to be directed at nurses rather than
patients. They are brief and bland, paling in comparison to the extensive,
high-production-value promotion of the hospital’s medical departments,
which boast about the qualifications and care of physicians. The site also has a
page with links to information about the hospital’s Magnet Recognition, but
little effort to make it comprehensible to anyone outside nursing; it’s hard to
imagine a lay person spending time there.117
Make sure that your institution’s website conveys to the public the key role
nurses play in patient care. To develop a website, ask media relations profes-
sionals for help. You might profile each nursing service and individual nurses.
The public should be able to learn who is doing the nursing, including the
nurses’ educational background and credentials, as well as contact informa-
tion so families and the public can get answers to their questions. Include
headshots and contact information for each nurse, not just the top executives.
What innovations have your nurses played a role in? Have their achievements
been in the news or recognized by nursing groups? Explain how your insti-
tution is working to improve nursing care. Consider including photographs,
audio, and video. Be sure it is easy to get to the nursing material from the site’s
main page. It may be more effective to integrate information about nursing
in the site areas that promote the institution’s health field–specific institutes,
centers, and departments—you know, where the sites tend to boast about
their great physicians and suggest the physicians are doing or directing every-
thing that matters. Some sites have a “Find a Physician” link from the main
page. Consider adding a “Find a Nurse” link right next to it, so visitors can
contact any nurse in the hospital.
Many people look for general health information on the Internet. Nurses
can create websites to educate their patients or communities about health,
and in doing so, illustrate nursing expertise. In today’s managed care environ-
ment, many patients get home after a hospital visit with little idea how to
manage their conditions. They may not understand how to use their crutches,
monitor their wounds, test their blood sugar levels, exercise, or avoid foods
that put them at risk. Even when hospital nurses manage to give patients this
information, patients may forget or simply be overwhelmed. The Internet can
be a great way to fill this need and perhaps prevent future hospitalizations.
If you do set up an informational website, consider becoming certified by
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Health on the Net Foundation, an international nongovernmental organiza-

tion that guides consumers to reliable health websites.118
Visual, Performance, and Tactile Media

Nurses can also use many exciting types of media to show the world what
they do and why it matters. Memorials, exhibits, and other media can help
shape the public’s view of nursing and its history. We have already proposed
an international museum of modern nursing, which nurses should play the
key role in establishing.
Some nurses have taken the lead in developing effective visual displays.
When nurse Diane Carlson Evans realized that the two US Vietnam war
memorials in Washington, DC, failed to include nurses’ contributions, she
spent nine years lobbying legislators and the public. The result was the US
Vietnam Women’s Memorial, dedicated in 1993, a statue of three nurses and
a patient involved in a hopeful rescue operation.119
In 2003 nurses at the University of Pennsylvania played a key role in orga-
nizing the Philadelphia Fabric Workshop and Museum’s exhibit “RN: The
Past, Present and Future of the Nurses’ Uniform.” This exhibit was the source
of the RN patches discussed previously, which enable nurses to identify them-
selves to patients and colleagues.120
Some have tried to capture the nursing experience in photographs. It can
be hard for still images to convey what most people really need to learn about
nurses: that they are life-saving professionals with advanced skills. Without
the full context, it’s also easy for some photographs of nurses providing emo-
tional support to their patients to reinforce the angel stereotype. Still, pho-
tographs are worth trying, especially when accompanying words can provide
that context.
In 2005 and 2007, the American Journal of Nursing sponsored Faces of
Caring: Nurses at Work, a contest designed to capture the best photographs
of nurses.121 Some winning photographs were among the best still images of
nurses we have seen. Only some of the photographs were taken by nurses
themselves; we encourage more nurses to take photographs of their col-
leagues at work.
And in 2012, photographer Carolyn Jones published The American Nurse,
a coffee table book of portraits that received a lot attention from nurses and
even a PARADE magazine feature in May 2013.122 On the whole, the por-
traits and brief accompanying interview text gave a sense of the wide-ranging
work of nursing, and a few even suggested how nurses use their skills to help
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patients. Jones also made a fine feature-length documentary film called The
American Nurse: Healing America (2014) about five of the profiled nurses.123
The nurses came off as strong, committed people who think holistically and
make their own clinical decisions. Nurses who have made their mark in pop
music include Naomi Judd, as well as John Darnielle of the Mountain Goats.
But we are not aware that many nurses have created music that addresses nurs-
ing directly, as Sonic Youth’s Sonic Nurse (2004) did.124 Nurses should con-
sider it. They Might Be Giants’s Here Comes Science (2009) shows that clever
pop music can teach listeners about science.
Plays and other spoken performances are compelling media that more
nurses should consider. Nurse! was a one-woman off-Broadway play sponsored
by the New York State Nurses Association.125 Based on actual nurses’ strikes,
the 2003 play’s characters faced the dilemma of working mandatory overtime
or losing their jobs. Some nurses also do comedy performances that convey
some of the nursing experience. Hawaii’s Hob Osterlund, a clinical nurse spe-
cialist in pain management, has a comic alter ego called Ivy Push who hosts
the “Chuckle Channel,” which aims to improve patient health through laugh-
ter.126 Neonatal intensive care unit nurse Greg Williams does nurse-themed
stand-up comedy in Atlanta, Georgia, and around the nation.127
Stamps and other collectible items can help nursing. A number of nations
have paid tribute to the profession in stamps, and not surprisingly, Florence
Nightingale has appeared on many of these stamps. The US Postal Service has
also issued stamps honoring nurses Clara Barton, Mary Breckinridge, Dorothea
Dix, Phoebe Pember, and Clara Maass, as well as nurse-author Louisa May
Alcott, nurse-pilot Amelia Earhart, nurse-abolitionist Harriet Tubman, and
the nursing profession as a whole.128 In October 2008 the American College
of Nurse-Midwives worked with the Postal Service to create a stamp series
about nurse midwife care.129 Since the Postal Service began allowing others to
design their own stamps, several vendors now sell them. Zazzle’s collection of
nurse stamps is certainly not free of generic and angel-oriented options, but it
also includes stamps with messages like “Nursing is the hardest job you’ll ever
love” (featuring a stack of textbooks with impressive titles) and “I can fix it! I’m a
nurse!” We’re also happy to say someone (not us) offers “save a life: be a nurse.”130
We encourage nurses to create or lobby for more stamps to help educate the pub-
lic about nursing. Of course, what the stamps alone can convey is limited—the
1976 US stamp honoring yellow fever research nurse Clara Maass said only “She
gave her life”—but a message like that can entice people to learn more.131
Even toys and games can teach about nursing. When our son was four
years old, he told us that boys couldn’t be nurses. We were mortified. So we
359
gave him the Archie McPhee “Male Nurse Action Figure,” and he changed
his mind. Sadly, Archie McPhee no longer makes these action figures, so we
encourage you to make one!132
Nurses should also consider designing board games and video games to
educate kids about nursing. Nurses might design a counterpart to Milton
Bradley’s legendary Operation game. How about Post-Operation, in which
“nurse” players prevent dehiscence and evisceration, cardiovascular collapse,
infections, and other complications by observing shifting patient conditions
and responding with quick actions? Or a new version of the video game
Grand Theft Auto in which nurse players take on the challenge of teaching
a gravely wounded crime boss how to do his complex self-care, embrace
a healthy lifestyle, and motivate his low-life cronies to set up a community
health program? Welcome to Vice-Free City!
Video, Broadcast, and Film

The broadcast media (television and radio) and film are traditionally harder
for novice creators to make use of than are some other media. But with the
explosion of information technology in recent decades, nurses can now create
and post on the Internet helpful video and audio with far less effort.
Video
Videos can now be created and made available to the world with minimal
equipment and technical expertise. Web videos posted on YouTube are
extremely popular, especially among young people we need to recruit to nurs-
ing. Nurse-created video could range from short recruiting videos to longer
discussions of nursing or general health topics. One example is the University
of North Dakota’s 2008 CD Follow your dreams – Make a Difference – Become
a Nurse, which included several short videos and other features to attract
potential nurses from the American Indian and Alaskan Native communi-
ties. Unfortunately, recent children’s videos—most notably the ones aimed at
girls—have been especially likely to present medicine as the only career worth
pursuing in health care. So countering that myth would be especially helpful.
Nurses have already created some compelling Web video. One of the best
short works we’ve seen is the irreverent 2004 rap video created by emergency
department nurse Craig Barton at the University of Alabama, as we men-
tioned in Chapter 7.133 In 2004 Liz Dubelman posted a gripping, innovative
“VidLit” (literature-based flash animation) based on nurse Veneta Masson’s
poem “The Arithmetic of Nurses,” about a home care nurse’s work with a “sick
3 6 0
old man.”134 Masson’s matter-of-fact text charted the human spirit strain-
ing to break through physical decay and social neglect. In 2006 students at
Binghamton University posted a recruiting video called “We’re Bringing
Nursing Back,” based on Justin Timberlake’s electrofunk hit “SexyBack,”
with new lyrics that extolled nursing.135 The video had its problems—it failed
to get across that nurses use advanced skills to save lives—but the students
deserve credit for an audacious effort to attract career seekers. And consider
the 2012 video “Mama Said Be a Nurse,” a gleefully immature ode to nurs-
ing school graduation that student C-Ham and her cohorts at Azusa Pacific
University set to LL Cool J’s rap classic “Mama Said Knock You Out.”136 We
can’t endorse everything in there, but among the questionable bits the video
included bursts of wit and technical nursing information that would surprise
anyone who thought nurses were unskilled handmaidens.
In October 2011 the Truth About Nursing created and posted on YouTube
a short video called “Nursing: Isn’t That Sweet?!”137 Made using Xtranormal
software, the five-minute video explores nursing stereotypes through a look
at what happens when a nurse named Wendy encounters her old high school
classmate Jim, many years later. The two characters have a spirited exchange
of views!
Radio
Radio remains a very effective way to communicate, especially now that
even a small station’s programming can be delivered globally on the Web.
Almost every community has radio stations, and every station needs a health
show hosted by nurses. The gold standard of nurse-hosted radio shows is
HealthStyles, hosted by Diana Mason and Barbara Glickstein, on WBAI in
New York.138 It features nurses as experts on nearly every show, and when
physicians are on, the hosts treat them as colleagues, not gods. In addition,
nurse Maureen McGrath hosts the Sunday Night Sex Show, a wide-ranging
look at sexual health and related issues on Vancouver’s CKNW that features
nurses and other experts.139 McGrath told us that she has invited many nurses
to appear, “but they are shy to come on. Physicians, on the other hand, wel-
come the invite.” Even so, one of McGrath’s 2014 shows that did have a nurse
expert was “Please Knock Before You Enter: Sexuality and Intimacy in Care
Homes.” Further south, the irreverent California nurses Casey Hobbs and
Shayne Mason host Nurse Talk, which offers health advice, including the idea
that “laughter is the best medicine.”140
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Television and Film

As we have seen, television and film remain powerful forces throughout the
modern world. In recent years there have been some films and television
shows with helpful portrayals of nursing. Examples include Nurse Jackie, Call
the Midwife, 24 Hours in A&E, Angels in America, and the Nursing Diaries
installment by Richard Kahn.141 Nurses were instrumental in the creation of
some of these media. However, as we have explained, most influential tele-
vision and film products—such as popular Hollywood television dramas—
remain very troubling. Nurses with the resources and skills should consider
taking a more active role in producing, writing, and advising on broadcast
media.
Some nurses have already made feature films. Florida nurse David Burton’s
2009 documentary InGREEDients examined the perils of trans fats. Nurse
Kathy Douglas directed Nurses: If Florence Could See Us Now (2012). As dis-
cussed in Chapter 7, that film included some good information about nurs-
ing, although it was dominated by vague caring language and generic uplift,
and it had fairly little about nurses’ specific skills or tangible contributions to
patient outcomes.142
Other nurses have made television programming. In November 2013
Oregon nurse Sonya Justice launched a new television show called The
Reel Nurses Talk Show (or RNTV) on Portland Community Media and
YouTube.143 The interview-oriented show conveys valuable information on
such topics as pain management and hospital-acquired infections, using
nurse experts exclusively. Justice has said that she also wants to counter global
stereotypes of nurses as flunkies. Nurse practitioner Ruth Tanyi produced
and hosted a television series about diabetes called Bad Sugar, broadcast on
California’s KHIZ-TV in 2006 and 2007.144 Tanyi explained how to avoid or
at least control the disease by focusing on lifestyle, including diet, rest, and
exercise. Nurses are well placed to convey the health expertise these projects
require—and in the process, to show the public that they are health experts.
Nurses should also consider developing ideas and writing scripts for the
full range of entertainment programming. Almost anything can affect how
nursing is perceived, from reality shows to adult and teenage dramas to chil-
dren’s programs, such as Sesame Street and Dora the Explorer.
Consider the popular Disney preschool show Doc McStuffins, which
started in 2012. The show features an African-American girl (Doc) who wants
to be a physician like her mother and gets ready by fixing her ailing toys and
dolls, which come to life when Doc is there. Each episode sends a basic health
message, usually in a narrow, physician-centric “diagnosis and treatment”
3 6 2
framework.145 But wait! One of the dolls, Hallie the Hippo, is “Doc’s nurse.”
At different points the Hallie character reflects most of the major nursing ste-
reotypes, from low-skilled handmaiden to motherly angel to crusty battle-axe.
Her main job often seems to be fetching the Big Book of Boo-Boos for Doc.
The show’s creator has noted that she originally saw the Hallie character as a
“fumbling, bumbling mess,” though the voice actress has supposedly brought
more confidence to the role.146 The show has been lauded for its positive
role-modeling, telling girls of color that they can be physicians.147 Presumably
it would not occur to most in the media that such a contemptous portrayal of
nursing aimed at the next generation in its formative years is harmful. We can
do better, and we must.
It’s Up to Us
When the public does not understand the value of what nurses do—when
nurses seem to have written in invisible ink—nursing cannot get the respect
and resources it needs, and people suffer and die. We can all help resolve this
global public health crisis, especially by improving the media portrayals that
play such a critical role. We can change things. We live in a world in which
women and racial minorities can hold the highest public offices, a reality that
would have shocked many people a hundred years ago. These changes are the
result of sacrifice, relentless persistence, and hard work. As we said at the start
of this book, achieving that kind of change may seem to require a “superhu-
man” effort, but that simply means it takes a long time to complete.
Together we can create a world in which parents encourage bright children
of both genders to become nurses, a world that gives nursing the resources
needed to save the lives of millions. We can create a world that understands
what one nurse’s aunt learned, in a story the nurse later told us:
I remember my aunt, who was an author, telling me I “could do

better than that,” and be a physician or a writer, as I so love to write.
She would often say, “Why be just a nurse? You are wasting yourself in
such a lowly profession.” But you know, when she was dying of breast
cancer, I stayed at her house with her (she lived alone) for her last two
weeks. I felt honored to be able to be there as her favorite niece . . . and
as her nurse. The night before she died she said this: “What would I do
without you? Thank God you are a nurse.” This was the last thing she
said to me.
363
Notes
1. Charles William Heathcote, “Franklin’s Contributions to the American Revolution
as a Diplomat in France,” US History.org (February 22, 1956), http://tinyurl.com/
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Today Show, NBC (September 21, 2006).
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7. Virginia Linn, “Concerns Over Patient Confusion Spawn a Small Movement
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3 6 4
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3 6 6
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146. Ari Karpel, “How the Creator of ‘Doc McStuffins’ Bucked the Norm and Created
‘Cheers’ for Preschoolers,” Fast Company (March 20, 2012), http://tinyurl.com/
mdbz7z3.
147. Lynn Elber, “ ‘Doc McStuffins’ TV Show Gives Black Girls, Aspiring Doctors
Hope,” Associated Press ( June 12, 2012), http://tinyurl.com/cfhya9e.
ABOUT THE TRUTH ABOUT NURSING
Registered nurses are the critical front-line caregivers in health care today.
For millions of people worldwide, nurses are the difference between life and
death, self-sufficiency and dependency, hope and despair. Yet a lack of true
appreciation for nursing has led to a shortage that is one of our most urgent
public health crises. The nursing shortage has claimed countless lives and is
overwhelming the world’s health systems. It is no exaggeration to say that the
future depends on a better understanding of nursing.
The Truth About Nursing is an international nonprofit organization
working to meet that challenge. It pursues an advocacy program started by
five graduate students at Johns Hopkins University School of Nursing in
2001. The Truth About Nursing tells the media and the public what nurses
really do. It analyzes the media’s treatment of nurses, helping nurses stand
together to end harmful depictions and encourage accurate ones. Better pub-
lic understanding of nursing will lead to more social, political, and financial
support for the profession, which will in turn relieve the nursing shortage and
improve the health of all people.
To contact the authors or the Truth About Nursing, visit www.truth-
aboutnursing.org.
All royalties from this book go to support the Truth About Nursing.
ABOUT THE AUTHORS
Sandy Jacobs Summers has served as executive director of the Truth

About Nursing since its founding, pursuing work she started in 2001
with other graduate nursing students at Johns Hopkins University. She
frequently speaks to the media and at conferences. In 2002, Summers
earned master’s degrees in community health nursing and public health
from Johns Hopkins. She holds a BSN degree from Southern Connecticut
State University. Prior to her graduate work, Summers practiced nursing
for fifteen years in the emergency departments and intensive care units of
major US trauma centers, including public hospitals in San Francisco, New
Orleans, and Washington, DC. In the mid-1990s, she worked in Phnom
Penh, Cambodia, where she taught nursing teachers at the Central Nursing
School. She also practiced intensive care nursing for a year at a hospital on
St. Thomas in the US Virgin Islands.
Harry Jacobs Summers has been senior adviser to the Truth About
Nursing since its founding, also serving as the group’s main writer. He has
an undergraduate degree from Columbia University and a law degree from
Georgetown University. Summers studied for a year on a Fulbright scholar-
ship in New Zealand. He also taught commercial law to government officials
for three years in Phnom Penh, Cambodia. Since 1998 he has been a litigation
attorney at the Federal Election Commission in Washington, DC.
Sandy and Harry have coauthored articles on nursing and the media for
major nursing journals, textbooks, and mainstream publications. They live in
Baltimore with their two children.
INDEX
A
AARP, 299 described, 264–268
ABC, xxii, xxvii, 100, 144, 168, 206, effective care by, 262
230, 252 fair reporting on, 275–280
ABC Family, 205, 273 focus on underserved populations,
ABC News, 96, 146, 174 277–278
ABC Radio, 263 as healthcare experts, 279
Abergel, R. Patrick, 282 holistic nursing care model, xxviii,
Abramson, Jill, 94–95 262, 264, 270, 276, 277, 283
abuse. See also aggression in Hollywood, 268–275
from colleagues and patients, 14, 54, hybrid care model with potential
119–120, 154–155, 158–159, to revolutionize advanced
218–219, 221–222 practitioner care, 268
nurses abusing patients, 229–231 ignored as general health care
responding to, with control and experts, 263
respect, 221 as innovative leaders in developing
sexual abuse. See sexual assault new care models, 278
sexual harassment. See sexual IOM report’s significance for, 281
harassment licensed by each state in the US, 265
sources of, 54 losing status if they “abandon” their
violence. See violence careers, 196
zero tolerance policies for, 315 news and advertising media ignoring
“ACA.” See Affordable Care Act or disrespecting, 280–286
(2010) news items praising in a way that
Accidentally on Purpose, 102 denigrates other RNs, 285
Achatz, Juliane, 188 nurse midwives. See nurse midwives
Across the Universe film, 172–173 nurse practitioners. See nurse
Adams-Ender, Clara, 133 practitioners
advanced practice registered nurses playing leadership roles in clinical
(APRNs), 261–286 nursing, 6
care at least as good as that of as primary care providers for millions
physicians, 265–266 of health consumers, 317
3 7 8
• Index
advanced practice registered nurses Most Interesting Man in the World,

(cont.) 311, 347
press items supporting APRN practice naughty nurse, 162–165, 174, 298
conveying subtle disdain, Neilson Dairy, 163
284–285 “Nurse, hand me my laptop,” 133–134
providing high-quality care in many persuasive effect of advertising, 40, 47
health care specialties, 10 radio, 27, 235, 236, 339
suggesting that other nurses are less SAW movie, 165
advanced, 305t Schick, 163
supervision, supposed need for, 284 Seattle Group Health, 133–134
threats to practice, 279 Skechers, 156, 165, 175, 257, 311, 340
wannabe-physician stereotype, 31, 82, Slim Jim, 198
203, 267, 270–271 Stockholm South General’s “TV-series
advertisements hot nurse,” 174
advocating for improved, xxiii–xxiv suggesting that nurses are gofers, 133
American Family Care, 280, 282 TAG Body Spray ad, 163
annual spending on, 38 “Tomorrow you’re dad’s nurse,” 104
APRNs in, xxviii, 280–286 University of Michigan, 235–236
“ask your doctor” ads ignoring Virgin Mobile, 164
APRNs, 275, 280 writing, 352
Bloomingdale’s, 339 YouTube study on, 47
“Care Not Cuts,” 104 advertisers
chemo room with Sharon Blynn, 317 advertising products without
CompuCaddy “Helen Wheels, resorting to tired and demeaning
RN,” 256 stereotypes, 310
conveying respect for nursing, 310–311 considering effects of nursing
Coors, 162 stereotypes, 300
CVS, 103 not wishing to alienate consumers, 311
de-emphasizing nursing skill, 19 advocacy. See patient advocacy,
Dentyne (Cadbury-Schweppes), 163, nursing: advocacy, entertainment
345, 348 advocacy
Diamond Bus Company, 165 Affordable Care Act of 2010 (“ACA” or
Dodge Caravan, 40 “Obamacare”), 18, 282, 317, 319
Gzhelka vodka, 162–163 expanding APRN care, 262, 275
how advertisements affect thinking, plotlines to promote understanding
40 of, 43
Johnson & Johnson, xxvii, 47, 217–218, Age (Melbourne), 225
234–235 Agence France-Presse, 102, 155
Kaiser Permanente gargantuan heart, aggression. See also, violence, abuse,
xxvii, 236 sexual assault, sexual harassment
Malawi nursing, 236 Cheryl Dellasega, an expert in, 353
Index •
379
due to elderspeak, 336 Alvarez, Lizette, xxi

by the media against nurses, 77 Alweiss, Linda, 100
by nurses against patients, 245–258 Amazing Nurses, highlighting, 235
by nurses as a threat to the natural American Academy of Nurse
order, 351 Practitioners, 317, 348
by patients, 154 American Assembly for Men in
by physicians, 155 Nursing, 198
by physician groups, 39 American Association of Nurse
Aguilera, Christina, xxiv, 156, 165, Anesthetists, 266
175, 257, 340 American Association of Nurse
AIDS Attorneys, 125
causing workforce shortages, 16 American Association of Nurse
delivery of care in Kenya, 11 Practitioners, 264
featured in media depictions, 43, 50, American College of Emergency
70, 73, 130, 199–200, 273–274 Physicians, 146
Kristine Gebbie, first “AIDS Czar,” 318 American College of Nurse-Midwives, 358
nurses providing care, 11, 72 American Family Care (AFC),
Aiken, Linda, 11, 15, 18 280–281, 343
Akeelah and the Bee, xxvii, 194 American Hospital Association, 12
Al Bawaba news service, 158 American Journal of Nursing, 5, 122, 198,
“alcohol liaison nurse,” portrait of, 208 221, 307, 308, 327, 337, 357
Alcott, Louisa May, 358 American Journal of Public Health, 266
Alexander, Max, 230 American Medical Association (AMA)
Alexander, Peter, 284 asserted control over network
Alexandra Clinic, 132 television shows, 35
Alibaba, wholesale supplier, 171 resolutions 214, 267
Allen, Scott, 72, 145, 314 American Medical Informatics
Allick, Noella, 103 Association, video interviews of
all-RN staffing model, 18, 314–315 34 nurse pioneers, 11
All Saints, 225–226 The American Nurse: Healing America,
All Things Considered, 278 357–358
ALRT500 home health management American Nurses Association (ANA),
device, 339 233, 267
ALR Technologies, 339 American Nurses’ Credentialing
Al Salam, Nihad Abd, 158 Center, 18
alternatives, suggesting to media American Recovery and Reinvestment
creators, 348–349 Act (2009), 18
alternative script, writing and sending to American Red Cross, 10, 234, 315
a show, 349 Ananova Internet news site, 174
Altman, Lawrence K., 91 Anderson, Keith, 173
Altman, Robert, 36 Angela Moore jewelry catalog, 226–227
3 8 0
• Index
angel imagery, xxvii, 217–238 Army Nurse Corps, 133

angel of death, 230 army nurses, media appearances, xxi, 35,
“angel,” interchangeable with “nurse” 36, 133, 246, 347
in media, 222–227 Aronson, Stanley M., 278
angel of mercy, xxvii, 34, 217, 222, 224, arterial blood pressure line (art line), 3
227, 229 Asaiante, Jim, 98
deterring men and women from Asian cultures, nursing on a par with
entering the profession, 217 prostitution, 156
fatal flaws of, 218–222 “Ask an Expert” column, 76, 131–132
finding alternative names for, 303t “Ask the Doc” service, 133, 343
infecting media’s treatment of assailants, visitors and family
nursing, 222–236 members as, 54
“mechanised ‘angels’,” 102, 222 assaults. See violence, sexual assaults
not playing a significant role in recent assertive women, avoiding nursing, 125
television dramas, 226 assistants, treating with respect, 343–344
nurse failing to be noble, 228–232 assistive caregivers, job titles of, 13
nursing institutions continuing to Associated Press, 43, 53–54, 75, 94, 95,
embrace, 52 99, 102, 119, 132, 155, 156, 341
overcoming, 236–238 Association of periOperative Registered
roots of, 218 Nurses Journal, 124
in statements by nurses and their As the World Turns, 169
advocates, 232–236 asthma attack, school girl’s death
“Angel of the Battlefield,” 10 from, 74
Angels Advocate, 172 Atchison, Doug, 194
Angels in America, 30, 70, 130, 189, Atlanta Journal-Constitution, 277
199–200, 268, 273–274 The Atlantic, 284, 321
“Angels of Caring” program, 232 Atonement
angel stereotype. See angel imagery film adaptation, 131
animated television programs for novel, 191
children, naughty nurses on, 169 audience, expecting to see stories of
Annals, Geoff, 189 physicians on TV, 29
Anstett, Patricia, 228 Auletta, Ken, 94
Apheda, Australian trade union agency, 187 Australian, 285
Apple, 165, 171 Australian hospital nurses, physically
appointment clerks, role in shaping how assaulted at work, 54
nurses are perceived, 322 Australian Medical Association, 283
April Fool’s Day press release, 354 Australian NPs, role in managing chronic
APRNs. See advanced practice registered heart failure, 285
nurses (APRNs) Australian Nursing Federation, 171
Arab News, 66 autonomy in nursing, 118–146. See also
Archie McPhee, 359 handmaiden stereotype
arguments, anticipating, 345–346 autonomous profession, nursing as,
“The Arithmetic of Nurses” poem, 360 xxvi, 4, 120–126, 286
Index •
381
autonomous professionals, media One Flew Over the Cuckoo’s Nest,

portrayals of the nurse as, 245–246
126–133 Silent Hill, 255
autonomy defined, 120–126 Sopranos, 253
charts explaining, 121t–123t as a threat to the natural order, 251
awards, for nurses, 45, 224, 233, 273, 319, video games. See video games
338 Whitney, 252–253
Azusa Pacific University, 360 X-Files, 254
BBC, 33, 43, 75, 132, 191, 238
B Be a Nurse for a Day program, 337
Babes and Boys’ annual naughty nurse “Bedside” columns, 76
calendars, 171 Belcher, Margaret, 221, 222
“baby nurses,” 102–103, 303t Belfast Telegraph, 208, 229
“backbone” of health system, Bell, Jane, 208
nurses as, 223 Bell, Sunnie, 119
“Bad Case of Loving You,” xxvi, 164 Bellafante, Ginia, 193–194
Bad Sugar, 361 Ben Casey, 35
Baer, Ellen, 190 Berlusconi, Silvio, 156
Baer, Neal, 43–44 Bernstein, Hanne Dina, 5, 6
Bajarin, Tim, 102 Bertschinger, Claire, 353
Baltimore Sun, 45, 71, 93, 197, 319, 351 Biden, Joe, 5, 232
bars featuring “nurses.” See restaurants Big Brother, 171
Bartholemew, Kathleen, 74, 351 Binder, Leah, 349
Barton, Clara, 9–10, 315–316 Binghamton University, 360
Barton, Craig, 199, 238, 359 bird flu pandemic, 95
Basso, Jon, 164 birthing, approaches to, 278
battle-axe stereotype, xxvii, 36, 245–258 birth process, as natural, 264
Call the Midwife, 249 “bitch,” management style of nursing,
“Chicxulub,” 256–257 126, 129, 248, 251
Cloud Atlas, 254–255 Blackman, Andrew, 276–277
Cold Case, 253 Bland, Vikki, 189
ER, 251–252 Blanton, John, 72, 131, 352
Grey’s Anatomy, 250 Blatchford, Christie, 229
greeting cards, 245 Bless This Angel of Mercy Nurse
“Hot Lips” Houlihan/ M*A*S*H, Collectible Figurine, 227
246–247 blink -182, 173, 257
inverting both the maternal/angel blogs, nurse-generated, 355
image and the naughty image, Blomkamp, Neill, 71
219, 247, 248f Bloomekatz, Ari, 207
Law and Order, 253 Blynn, Sharon, 317
MDs, 252 BMJ Quality & Safety, 16
naughty-axe, 247, 255–258 board games, designing to educate kids
Nurse Jackie, 249–250 about nursing, 359
3 8 2
• Index
The Bold and the Beautiful, 50 Burling, Stacey, 314–315

Bono, 100 Burr, Ani, 331
Boo, Katherine, 75 Burton, David, 361
Borders General Hospital, 335 Busch Gardens, 157
Bormann, Jill, 133 The Business of Being Born, 268, 274, 284
Boston Globe, 72, 93, 145, 237, 314 Button, Lyn, 351
Boston Marathon bombing, 98, 208
Boston Med, 32, 96, 206 C
Bower, Amanda, 101 cable television, in rural India, 38
Bower-Joffe, Kelly, xxiii Cadbury Schweppes Canada, 163, 345
Boyle, T. Coraghessan, 256 California, mandatory minimum nurse
Braddock, Bessie, 250 staffing ratios, 17
branching logic, 280 California Lawyer, 118
Brangham, William, 132–133 California Nurses Association (CNA),
Branson, Richard, 165 237, 341–342
Bras N Things, 171 Cali Nurse, casting call for, 340
“breastaurants,” 164 Call the Midwife television series, xxii,
breastfeeding 31, 33
merging terminology for with nursing authoritative senior nurse, 249
profession, 198, 300, 304t dramatic look at nurse-midwives,
nurses with expertise in 39, 96, 266 67–68
Breckinridge, Mary, 10, 278–279, 307 good effects of, 310
Brewington, Kelly, 45 great portrayal of nursing, 191
Brimelow, Adam, 132 nurse midwives surrounded by a sort
Bristol Myers-Squibb, television of holy glow, 226
commercial on fighting portraying nurses as working on their
cancer, 317 own, 126–127
British Columbia Nurses’ Union, 352 sense of nursing autonomy, xxvi
British Medical Journal, 266 Cambodia, nurses earning poverty
British men, sexual fantasies about wages, 187
nurses, 155 Cambodian soap opera, 43
broadcast media, creating, 359–362 Campaign for Nursing’s Future, xxvii, 19,
Broaddus, Cindi, 223 217–218
Brock, Francine, 329 Campbell, Carol Ann, 45
Brodeur, Nicole, 100 Campbell, Jacquelyn, 11
Brotherton, Marcus, 353 camps. See “guys-only nursing camp”
Brown, Theresa, 76, 126, 306–307 Camus, Albert, xxix
Brown University, 278 Candy Stripers, 170
Brune, Brett, 282 Cape Argus, 119–120
Bryant, Jeff, 74 Capital Health hospital group, 341
Bucher, Julia, 76, 131–132 cardiac life support, to a pilot on a
Buresh, Bernice, 8, 125, 219, 335 cross-country flight, 100
Index •
383
Cardillo, Donna, 308 Change.org petitions, 340, 344

Cardoso, Rodrigo, 30 Channel 4/(UK), xxii, 230
career advisers, viewing nursing as “less Chapman, Rose, 54
than ideal,” 189 Charleston City Paper, 73
career aspirations, daughter wanted to be Charlie London, RN, 354
a nurse, 186, 330 Cheating Death: The Doctors and Medical
careers for women, nursing suffering by Miracles That Are Saving Lives
omission in reports about, 197 Against All Odds, 92
career-versus-home dilemma, mothers chemo room work, done by nurses, 317
facing today, 196 Chen, Pauline, 76, 321
“Care Not Cuts” campaign, 104 Cheney, Dick, 328, 342
Carey, Mariah, 172 Cherry Ames novels, 35, 162, 354
Carey, Mary Agnes, 281 Chicago Tribune, 195
caring Chicken Soup for the Nurse’s Soul, 218
“caring discourse,” prevalence of, 220 “Chicxulub,” 256–257
focus on, 234 chief nursing officers, 33, 87
important to nursing, 217 chief of nursing, hospital nurses typically
Carnegie Foundation, 19 led by, 124
Carroll, Pat, 353 children’s books, about modern
cartoon characters, on uniforms, nursing, 354
330–332 children’s videos, presenting medicine as
CBS, 102, 156–157, 168–169, 230, 253, the only career worth
270, 279 pursuing, 359
CBS Evening News, 95 Chin, Christina, 207–208
CBS Marketwatch, 98 China Beach, 36
Center for Nursing Advocacy, xxiii Choo, Irwin, 207–208
Golden Lamp Awards, 273, 338 chronic diseases, treating, 276
Center to Champion Nursing in Chronicle Herald (Nova Scotia), 232
America, 299 Chuan Ya-lan, 224
Ceppetelli, Ellen, 322 “Chuckle Channel,” 358
certified nurse midwives (CNMs). See Churchill, Winston, 250
nurse midwives Cincinnati Children’s Hospital, 232
certified nursing assistant. See nursing City Stream Brewery Cafe, 164
assistants CKNW, Vancouver, 360
certified registered nurse anesthetists “Cleanup on aisle three!,” on House, 80
(CRNAs), 6, 262, 264, 266, 268, Cleveland Clinic, 156
282. See also advanced practice clinical leadership, to bedside nurses, 11
registered nurses clinical nurse specialists (CNSs), 262,
Chalke, Sarah, 43 264–265. See also advanced
C-Ham, 360 practice registered nurses
Chang, Alicia, 95 clinical settings, nurses having significant
change, acting for, 333–334. See 295–362 autonomy in, 124
3 8 4
• Index
Clinical Transplantation, 48 Community Tissue Services, 311

clinical virtuosity, illustrations of compassion, important to nursing, 217
nurses’, 33 The Complexities of Care: Nursing
Clinician’s Guide to the Soul, 354 Reconsidered, 220
clinics Confessions of a Male Nurse by Richard
in Prague offering inducements Ferri, 353–354
including free plastic surgery, 156 conflicts. See also abuse
in supermarkets and drugstores, 282 putting patients at risk, xxviii, 41
Clinton, Bill, 318 Congo, foreign aid documentary, 97
Clinton, Hillary, 94 Coors, 162, 342
Close to Home comic strip, 176 Copenhagen Post, 132
Cloud Atlas film, xxvii, 254–255 Corley, Cheryl, 133
Club Good Hurt, 164 Corman, Roger, 36
CNMs. See nurse midwives Corporación Dermoestética, 165
CNN, xxi, 15, 17, 76, 98, 208, 306 Corzine, Jon, 91–92
CNSs (clinical nurse specialists), 262, costumes
264–265. See also advanced battle-axe, 256
practice registered nurses gorilla costume, study featuring, 66
Coats, Chris, 74 naughty nurse, xxvi, 156, 158, 168,
Coddington, Jennifer, 276 170–171, 252, 340, 349
Code Green: Money-Driven Hospitals protesting, 350
and the Dismantling of Nursing, resisting, 302
13, 125 restaurant waitstaff. See restaurants
Cohen, Elizabeth, 98, 208 Couric, Katie, 95
Cohn, Roy, 199–200 Courtis, Brian, 225
Colapinto, John, 87 Cowley, Geoffrey, 75
Cold Case, 253 Crandall, Chris, 160
Coley, Jill, 278 Cresswell, Adam, 285
collaboration, in various campaigns, 348 Crichton, Michael, 44
colleagues, nurses and physicians as, 334 Crimean War, 8–9
collectible items, helping nursing, 358 critical thinking, being a “nurse”
Colorado Springs Gazette, 120 requiring little, 104
Columbia Advanced Practice Nurse CRNAs. See certified registered nurse
Associates (Capna), 277 anesthetists
Columbia University, 10, 11, 279, 373 Crowe, Cathy, 132
Columbia University School of Nursing, Culkin, Jennifer, 353
98, 277 Cullen, Charles, 230
Combat Hospital, 32, 189, 202 Cullinan, Kerry, 132
comics, sexy nurses in, 176 Curb Your Enthusiasm, 144
commercial media sources, relying on custodial care, nurses as angels giving, 229
angel imagery, 226 CVS, 103, 279–280, 299, 311, 343
community health nursing projects, Czech nurses, evaluated by sexual
increasing funding for, 319 attractiveness, 156
Index •
385
D disaster health experts, interviews

Daily Mail (UK), 165, 174, 175, 229, 230 with, 99
The Daily Show with Jon Stewart, xxv, 86 Discovery Channel reality show, 285
Dallas History Examiner, 187 Discovery Health Channel, 70, 130
Dallas Mavericks Dancers, in naughty Discovery Health Channel Medical
nurse outfits, xxvi, 164 Heroes, 100
Dallas Morning News, 74 discussion boards, giving information
Darnielle, John, 358 about nursing to public, 355
Dartmouth medical school and Disney, 261, 348, 361–362
hospital, 322 Dispatches: Undercover Angels, 222
da Silva, Pedro Alcântara, 30 “disruptive innovation,” creating change
David, Larry, 144 by, 349
Dawn of the Dead, 70–71, 130 Diversified Designs, CompuCaddy
daytime drama, viewers learning about computer stands, 256
diseases, 50 Dix, Dorothea, 9
daytime talk shows, naughty nurse DNP. See doctorate of nursing practice
appeared on, 169 (DNP) degree
Dean, Cornelia, 197 “Doc Hollywood,” 44
Deason, Misty, 73 Doc McStuffins, 361–362
decision makers, identifying and reaching “doctor,” using only to describe
in media, 342–344 physicians, 303t
decision-making, increasing the role of “Doctor and Patient” column, 76
nurses in, 318 doctorate of nursing practice (DNP)
defibrillations, nurses performing in real degree, 11
life, 53 becoming standard for APRNs by
Dehn, Barbara, 308 2015, 267, 279
Dellasega, Cheryl, 353 development of, 285
de Marillac, Louise, 8 establishment of, 262–263
Dennik-Champion, Gina, 351 The Doctors, 96
Dentyne Ice chewing gum, 163, 345, 348 “doctors’ orders,” following, 204
de Paul, Vincent, 8 Doctors Without Borders, 97, 316
Der Spiegel, 104 Doctors Without Borders: Life in the
Desperate Housewives, 144, 166, 206 Field, 130
Detroit Free Press, 228 Doctor Who, 205–206
Devore & Diana, 175 documentaries, giving viewers a good
diabetes, 76 sense of nursing, 70
Diamond Bus Company, 165 Dodge Caravan commercial, 40
Dickens, Charles, 8, 34 Doherty, Gary, 208
Dion, Mark, 331 Do No Harm, 143
direct care nurses, highlighting the “Don’t Be That Guy” awareness
expertise of, 72 campaign, 336
disaster areas, nurses evacuated Doonesbury, 72–73, 208
from, 98–99 Dos Equis, 311, 347
3 8 6
• Index
Dougherty, Debbie, 154 Elliot, Carolyn, 343

Douglas, Kathy, 233, 361 Elliott, Jane, 75
Doward, Jamie, 222 Elmasry, Faiza, 45
Downton Abbey, 70 Elmer, Vickie, 103
Drape, Julian, 283 Elysium film, 71
Dresang, Joel, 104 emails, nurses sending to make a
“dress for success” feminism, 190 difference, 339
Dr. Feelgood album, 172 Emanuel, Ezekiel, 282
Dr. G: Medical Examiner, 285 emergency department physician,
Dr. Kildare films, 35 suggesting readers lie to triage
The Dr. Oz Show, 87, 169, 308, 341 nurses, 351
Dr. Phil, 103, 157–158, 217, 222–223, 311 emergency nurses
drug companies, marketing should managing challenging patients, 130
include nurses, 316–317 tough and expert, 32
Dr. Vegas, 270–271 Emergency Nurses Association, 146
“dual discharge” approach, 93 emergency patients, poor understanding
Dubelman, Liz, 359–360 of their care, 93
“Dude Ranch Nurse” song, 162 Emily Owens, MD, 32, 33, 37, 143
Dugger, Celia W., 73 Endres, Joanne, 100
Duke, Paul, 14 Enema of the State, 173
Dutch nurses union, 155 “entertainment advocacy,” xxiii
entertainment education, 42
E entertainment media
Earhart, Amelia, 358 affecting public views of health
Edinburgh, Laurel, 278 care, 40–50
Edson, Margaret, 131 physicians understanding, 44
educational requirements, “streamlining,” referring to nurse’s aides as
104 “nurses,” 306
education levels, helping nurses improve, “unhealthy messages” in, 41
315 entertainment television
ED waits, dangerously long, 146 influence on healthcare views, 48
staff management, 118 taking some notice of APRNs, 268
Egyptian naughty nurse television as a uniquely powerful health
character, 158 communication tool, 42
8 Simple Rules, 85 Epstein, Abby, 268, 274, 284
Einesman, Fred, 192 ER
elderly population, cost-effective creator of, 44
care for, 75 effects on public views about health
elderspeak, use of, 336 care, 49
“electronic nurses,” 102, 280, 339 encouraging women to pursue
Electronic Nurse, 102, 339 medicine and assume leadership
elementary school students, efforts to roles, 192–193
care for, 74 handmaiden image on, 138–140
Index •
387
main impression of nursing from, 46 reduction efforts, 119, 229, 306

mention of a CRNA, 268 on Scrubs, 69
never quite having a major APRN story on, 119
character, 271 surgical errors, life-threatening, 54
occasionally showing serious nursing third leading cause of death, xxiii, 93
skill, 36 Etherington, Carol, 11
one competent major nurse “evaluative discrimination,” 188
character, 83 Evans, Diane Carlson, 357
as physician-centric, 32 Even, Dan, 92
physician nursing on, 90–91 Examiner, 133
physicians dismissing nurses, 139 exercise, nurses getting enough, 333
portrayal of nursing in, 346–347 experts
portrayals of men in nursing, 205 consulting nurses as, 131–132
portrayals of nursing skill, 69 identifying as nurses, 309
producer Neal Baer, 43–44 expert testimony, as to nursing care, 125
showing nurse characters working with
a degree of independence, 129 F
strong nurse manager and battle-axes, Fabius, Laurent, xxi–xxii
251–252 Fabric Workshop and Museum,
eroticism, of apparent innocence, 161 Philadelphia, 331
errors in health care, xxiii, 6, 93–94, 119 Faces of Caring: Nurses at Work,
due to short-staffing and a weakened photography contest, 357
nursing profession, xxv, xxviii, 4, Faithful Fuzzies Nurse, 227
6, 15, 53–54, 155, 161 Falco, Edie, 254
examples of by nurses, 4, 6, 93–94, Falzone, Diana, 175–176
146, 306 family presence, trend toward allowing,
nurses making because of overwork, 92, 96, 254
72, 73 Fanjoy, Trey, 173
on Grey’s Anatomy, 89, 250, 272 Fanny children’s book, 133, 190, 354
hospital systems leading to, 6 A Farewell to Arms film, 35
intern errors, nurses catching, 69 Fatal Diagnosis, 353
Julie Thao, 6 female jobs, “pink ghetto” of
media ignoring role of nurses in traditionally, 195
preventing, 65, 89, 93, 250, 306 female physicians
misunderstanding of nursing autonomy confronting fears about female
by physicians as cause of, 119 subservience and sexual virtue, 166
nurses taking responsibility for, ER promoting, 192
328–329 portrayals of powerful, 248
nurses’ relation to, xxiii, 53–54, 93–94 reactions to slurs at nursing on Grey’s
Peter Pronovost, 119 Anatomy, 78
physicians make none on AMA- female professions
crafted dramas, 35 resource issues common in, 188
by physicians, 127, 272 traditionally, xxiv
3 8 8
• Index
females, providing intimate care to Forced to Be Family, 353

men, 158 Ford, Loretta, 264
female sexual extremes, defining nurses Ford, Thomas, 160
by dubious visions of, 219, 248t Forensic Nurse, 353
female stereotypes, 186–210 forensic nursing, 11
plaguing nursing, 217 appearing in the media, 76, 91,
portraying nursing with a mix of 353, 354
toxic, xxv International Association of Forensic
femininity, one-dimensional visions Nurses, 234
of, 34 Forensic Panel, 231–232
feminist disdain, for nursing, 190 Forman, Milos, 36, 245
feminist flight, intensifying disrespect for “former nurse,” not using as a term for a
abandoned fields, 188 nurse, 303t
feminist role reversal, 189, 198, 202 foundations
“feminist” thing to be a physician, 186 building public appreciation for
Ferguson, Mark, 160 nursing, 300
Ferguson, Vernice, 71 creating a museum of modern
Ferraro, Geraldine, 347 nursing, 319
Ferri, Richard, 353 funding television shows and
fictional media, effects of, 40–50 educational materials about
fictional television, playing significant nursing, 320
role in shaping public images, 40 honoring nursing and including the
Fiegl, Charles, 176 profession in policy
Fight Club, 329 initiatives, 319–320
films. See also horror films, television Fox News Channel, 175, 345
conveying nursing skill, 70 Fox network, xxii, 29, 31, 85, 282
ignoring APRNs, 268 Franklin, Benjamin, 328
little notice of APRNs, 273 Freeman, Yvette, 100
nursing authority in, 126–131 Freudenheim, Milt, 75
nursing skill on, 66–71 Friedman, Richard A., 97
portrayals of nursing, 361 Friends, 50
A Final Arc of Sky, 353 From Silence to Voice, 8, 125, 219, 335
“Find a Nurse” link, 356 Frontier Nursing Service, 10, 279
Fischer, Mary A., 45 Fuentes, David, 207
Fitzsimons, Virginia, 122 Fulmer, Terry, 75
Fix, Judy, 87 Furlong, Pat, 87
Flanagan, Caitlin, 196 The Future of Nursing: Leading Change,
“Florence Nightingale Teddy Bear,” 233 Advancing Health, 17, 262, 299, 318
flu, myths about, 279
Flushing Hospital, 155 G
Follow your dreams - Make a Difference - Gallagher, Ann, 132
Become a Nurse, 359 Gallaway, Dorothy, 278
Forbes, 45, 349 Gallup public opinion poll, 220
Index •
389
games, teaching about nursing, 359 Gordon, Kim, 162

Gandhi, Mahatma/Mohandas, 165, 349 Gordon, Suzanne, 8, 44, 53, 125, 190,
Gandy, Kim, 197 219, 220, 335
Gans, Rachel, 38, 40–42, 46 government leaders,
Gaskin, Ina May, 274 learning the value of nursing, 317–320
gay. See men in nursing: presented as gay understanding what nurses really do, 300
Gebbie, Kristine, 318, 319, 351 government licenses, for practicing
gender, dilemma in nursing’s issues nursing, 5
with, 210 governments
gender-based discrimination, continuing communicating the value of
in many countries and nursing, 317–318
cultures, 16 giving nurses a seat at the table, 318
gender equality, not achieved, 125 publicizing efforts to address shortage
gender imbalance, in modern nursing, 10 of nurses, 318–319
gender segregation, in jobs, 197 Gracie, xxvii, 194–195
George, Cindy, 280 graduate-prepared nurses. See advanced
Georgetown University, 373 practice registered nurses
Get Behind Me Satan, 173 Graham, Garth, 263
Getting On, 32, 84, 141–142, 204, 306 Greece, Parabolani order in third century
Ghana News, 76 C.E., 8
Gibbs, Nancy, 101 Green, Tim, 338
Giffords, Gabrielle, 76 Greengross, Gil, 160
A Gifted Man, 32, 44, 143 greeting cards, themes of, 245
Gilchrest, Laura, 98 Grey’s Anatomy
Gillette advertisement, 163 alternative script proposal, 349
Girl Child Education Fund, 233 attacks on nursing, 77–79
The Glades, xxviii, 31, 271 drama in insurance coverage issues, 43
Gleason, Judith, 279 elite surgeon characters, xxii
Glee, 85 expressing contempt for APRNs, 272
Glick, Peter, 159 female achievement in health care,
Glickstein, Barbara, 308, 360 191–192
Glik, Deborah, 38, 39, 41, 42 female medical students watching, 49
global shortage. See nursing shortage female physician offended by being
Globe and Mail, 351 called a nurse, xxv, 186
Goldberg, Whoopi, 133–134, 186 handmaiden image on, xxvi, 47,
gold-diggers, nurses as, 157–158 134–137
Golden Lamp Awards, 273, 338 helping people of color, 44
Goldfrapp, Alison, 173 ignoring nursing, 96
golems, of Jewish folklore, 137, 138 male nurse, 201, 202
good cop/bad cop, playing, 346–347 misportrayals in, 33
Good Housekeeping, 86, 351 modern women, nursing not good
Goods, Melita, 225 enough for, xxvii
Google’s health advisory council, 101, 320 naughty nurse imagery on, 166–167
3 9 0
• Index
Grey’s Anatomy (cont.) 118–146. See also autonomy

nurse advisors, 309–310 affecting who pursues nursing
nurses grasping-for-physician-love careers, 120
theme, 167 assistants, setting nurses up as, 119
nurses as peripheral, 309 media portrayals of, 133–146
organ donation, 43 roots of, 8
physician nursing on, 88–89 Hannity, Sean, 311, 347
physicians managing nurses, 118 “Happiness Is a Warm Gun,” music
senior nurses as vindictive video, 173
bureaucrats, 250 Harris, Wesley, 225
surgeon stars providing all significant Harrow Times, 75
care, 31 Harry Potter, 31, 355
Groopman, Jerome, 97 Hartill, Daniel, 145
Gross, Lexy, 207 Hart of Dixie, 141
Group Health, 133–134, 343 Harvard School of Public Health, 12,
The Grudge, 101 49–50
Guardian, 222 Havrilesky, Heather, 194
“Guardian Angel” awards, 233 HawthoRNe, xxii
Guggenheim, Davis, 194 chief nursing officer, lead character as,
guidance counselors. See high school 33, 249
guidance counselors expertise, examples of nursing, 68–69
Gulfnews.com, 209 leader, nurse as, 193
Gunderman, Richard, 321 male nurse, 204
Gunn, James, 70 naughty nurse in, 168
Gupta, Sanjay, 90, 92 nurse-physician power relations, 128
Gutfeld, Greg, 175 “saintly,” lead character as, 226
Guthrie, Julian, 71, 131 staff nurses following their own
Guthrie, Patricia, 278 practice model, 128
Gutkind, Lee, 218 wannabe-physician stereotype, 271
“guys-only nursing camp,” 208 Hayek, Salma, 172–173
Gzhelka vodka, 162–163 HBO, 30, 141, 144, 253, 273, 306
The Healer’s War, 353
H Health Advisory Council, at Google,
H1N1 flu epidemic, government 101, 320
response to, 74–75 Health Affairs, 15, 20, 266
Haaretz (Tel Aviv), on physician health agencies, outreach efforts of, 42
nursing, 92 health care
Habati, Mubatsi Asinja, 225 billing, 316
Hahnemann Hospital, 18, 314 colleagues, helping nurses improve
Hall, Lydia, 10 public understanding, 321–322
Halloween, See costumes equaling physician care, 46
handmaiden stereotype, xxvi, 36–37, errors. See errors in health care
Index •
391
experts, nurses as, 100–101 health stories, considering nurses as

“heroes,” media saluting careers of, expert sources in all, 307–308
99–100 HealthStyles, 308, 327, 360
leaders, news media presenting nurses heart, in nursing imagery, xxiv, xxviii, 48,
as, 71 224, 227, 234–236, 261, 332
media long fascinated with, 30 Heart Attack Grill, 164, 340–341, 349
resources, allocation of, 351 heart disease victims
team, physicians portrayed as the nurses failing to properly treat, 6, 83,
whole team, 39 93–94
technology, referred to as a nurses saving and treating, 3–4, 13, 71,
“nurse,” 102 72, 75, 100, 130, 145–146, 285
using term instead of medicine, 304t Heineken, 311, 347
healthcare errors. See errors in health care Heineken International Commercial
health coaches, helping patients manage Communication Code, 347
chronic conditions, 95 Helminiak, Margaret, 332, 334
health communication, field of, 38 Help a Reporter Out website, 307, 327
Health Communication, 48 helpful
health facilities, promoting nursing, as faint praise for life-saving health
312–313 professionals, 136
health financing reform, working for, persons, nurses as, 101–104, 136
333. See also Affordable Care Act Henry Street Settlement, first visiting
Health Insurance Portability and nurse institution, 10
Accountability Act. See HIPAA Henesy, Carmen, 354
health issues, books educating the public hentai, 170
about, 353 Herbert, Bob, 93
health messages, reaching the public Here Comes Science, 358
with, 42 heroes, nurses appearing as, 100
Health on the Net Foundation, Heroes television show, 85
becoming certified by, 357 Heron, Echo, xv–xvii, 352–353
health policy makers higher education, nurses’ aspirations
honoring nursing and including the to, 229
profession in policy initiatives, high school guidance counselors. See also
319–320 recruitment efforts
working to communicate an telling bright students they are “too
understanding of what nurses smart” for nursing, 189
really do, 300 Hill, Edward, 284
health providers, using instead of Hindustan Times, 174–175
“doctor” or “physician,” 303t HIPAA, 337–338
Health Resources and Services historical inequities, tending to
Administration (HRSA), 318 remain, 187
health science, nursing as cutting- edge, 307 history, traditionally about “men and
Health Services Research, 16–17 their activities,” 187
3 9 2
• Index
Hitchcock, Alfred, 35 hospital, better term than “medical

HIV/AIDS. See AIDS center,” 303t
Hoban, Vici, 230 hospital dramas
Hobbie, Holly, 133, 190, 354 all-physician vision of care, 101
Hobbs, Casey, 308, 360 major physician characters, 52
holistic practice model physician nursing, 88–91
APRNs using, 262, 264 relatively realistic portrayal on ER, 138
followed by nurses, xxiv hospital employers, abused nurses not
on Nurse Jackie, 67 receiving adequate support
preventative care, focus on, 4 from, 155
Hollett, Tammy, 225 hospital errors. See errors in health care
Hollywood. See also films, television, hospital identification badges, 331
specific names of shows and films hospitals
APRNs in, 268–275 existing mainly to provide nursing
effect on public’s view of health care, care, xxv, 299
40–50 firing nurses for advocating for
feminism, 191–195 patients, 124
inaccurate depiction of nurses, 44 getting nurses on boards, 299
men in nursing 199–207 health threats, posed by, 101
overall failure to portray nursing promoting nursing, 312–313
fairly, 51 in Southeast Europe getting unruly
sexually available nurses in films, 169 nurses back into skirts, 174
television shows causing real harm, 43 US on the verge of breakdown, 73
telling the world nursing is for losers, using angel imagery, 232
77–88 websites, 355–356
Hollywood, Health & Society project, hospital shows
42, 44 APRNs absent, 271
Holt, Helen, 70 mocking nursing, xxii
home health nursing, 194 nurses on most, xxii
homosexual. See men in providing cases and characters in
nursing: presented as gay conflict, 30
“honest and ethical” label, nurses hostile workplaces, 12
embracing, 220–221 Hotchkiss, Robert, 168–169
Hooker, Richard, 36, 246 hot nurses. See naughty nurse image
Hooters, 164 House, xxii
horizontal violence or aggression. all major characters physicians, 52
See abuse attacks on nursing, 79–81
horror films. See also films creator David Shore, 45
naughty nurse not afraid of, 169–170 as damaging to nursing, 31
relying on naughty-axe imagery, handmaiden image on, xxvi, 137–138
255–256 male nurse, 201–202
hospice nursing. See nurse misportrayals in, 33
characters: hospice naughty nurse images, 167
Index •
393
nurse advisors, role of, 309–310 “inside track,” versus “outside track,” 346
nurse characters confronting idea of Inskeep, Steve, 99
becoming NPs, 272 Institute of Medicine (IOM), 2010
physicians doing everything report on nursing, 17, 262, 299,
important, 29, 89–90 318
writer is a physician, 44 intensive care. See ICU
Houston Chronicle, 280, 282–283, 351 Intensive Care: The Story of a Nurse, 353
Howard, Ron, 169 International Association of Forensic
Howarth, Angus, 102, 222 Nurses (IAFN), 234
Howland, Wendie, 307, 327 International Centre for Nursing
Huffington Post, 232 Ethics, 132
humor. See jokes International Council of Nurses (ICN),
Hunt, James, 169 16, 187, 233
Hurewitz, Mike, 73 International Nurses Academy, 158
Hurricane Katrina, hospital care Internet sites
immediately after, 99 devoted to hardcore pornographic
Hurricane Sandy, evacuation of nurse imagery, 170
New York University hospital’s nurses writing on, 355–357
NICU during, 88 Inter Press Service News Agency, 156
intubation techniques, incorrect on
I television shows, 49
“I Am Not a Male Nurse: Recruiting “iParticipate” project, 43
Efforts May Reinforce a Irish Examiner, 119
Stereotype,” 198 Isaacs, Gregory, 172
“I Am Your Registered Nurse” poster, 313 iVillage, 308
ICU (intensive care unit) nurses, 70, I Wasn’t Strong Like This When I Started
72–73 Out: True Stories of Becoming a
account of, 14, 72–73, 145 Nurse, 218
as nasty, rule-bound bureaucrats, 254
attack on salaries of, 85 J
real knowledge of, 80 Janelle, Chantelle, 102
taking lead in, 30 Janota, Raewyn, 351
training of new, 72, 145 Janz, Matt, 176
inattentional blindness, research on, 66 Japanese hospital nurses, sexually
Independent, 225, 229 harassed, 154
India Japanese study on patients relaxing
experienced nurses leaving, 20 to enka music during cardiac
nurse giving injections with used catheterizations, 336
needles, 54 Jemmott, Loretta Sweet, 11, 75
third century, school for male Jeopardy!
caregivers, 7–8 clue about NPs, 273
infant caregivers. See “baby nurses” implied that nurse practitioners treat
InGREEDients, 361 only “minor ailments,” 339
3 9 4
• Index
Johns Hopkins, 338 Journal of the American Medical

changing pink student ID cards, 198 Association, 15, 49
HIPAA adherence with media Journal of Broadcasting and Electronic
coverage, 337–338 Media, 46
Hopkins, 32, 96–97 Journal of Communication, 50
Hopkins 24/7, 96–97 Journal of Health Communication, 49
Nurses, 70 Journal of Interpersonal Violence, 160
nursing experts, 11, 76, 97–98 Journal of Nursing Management, 54
School of Nursing, 98, 198 Journal of School Health, 132
students creating the Truth About Joyner, Tom, 263
Nursing and the Center for Judd, Naomi, 358
Nursing Advocacy, xxiii, 372 “July syndrome,” in hospitals, 97
Voice of America story, 45 junior physicians, advocating for
work to reduce healthcare errors, 119 patients, 90
Johnson, Ruth, 190 Justice, Sonya, 361
Johnson & Johnson ( J&J) JWT Communications, 188
Campaign for Nursing’s Future, 19,
234–235, 355 K
gooey music in advertisements, 235 Kahn, Richard, 70, 361
heavy reliance on angel and Kaiser Family Foundation, 38, 42, 49
handmaiden imagery, xxvii, 19, Kaiser Health News, 281
217–218, 234, 317 Kaiser Permanente, xxvii, 236
“nurse’s touch,” xxvii, 217–218, Kaling, Mindy, 192
233–234 Kalisch, Beatrice, 15
paying fines for illegally marketing kangaroo care, nurse-led developments
drugs and selling defective hip in, 96
implants, 234 Kansas City Star, 331
research on “respect” for nursing, 47 Kaplan, Marty, 43
television advertisements, 234–235 Kawartha Sexual Centre, 336
jokes, 159–161 Keillor, Garrison, 196–197
“doctors who tell jokes in the chemo Kennedy, Caroline, 227
room,” 317 Kennedy, Deirdre, 280
how joke exposures increase tolerance Kenney, Colleen, 209
of future discrimination, 159–161 Kenny, Elizabeth, 321
naughty nurse as “just a joke!,” xxvi, 81, Kesey, Ken, 36, 245
82, 159–161, 167, 171, 175–176, Kim, Susie, 11
345 Kimball, Richard, xxiii
unskilled/idiot nurse as “just a joke,” Kingma, Mireille, 17
81, 85, 192, 224 King Saud University, 66
using jokes and satire to relate to the King’s College Hospital, 33, 70, 130
media, 345–346 Kleiman, Carol, 195
Jones, Carolyn, 357–358 Klein, Linda, 45
Journal of Advanced Nursing, 189, 198 Kleinhubbert, Guido, 104
Index •
395
KMBC, Kansas City, 74 related to nursing, 17–18

Knox, Richard, 95 state laws, making clear that nursing
Kolata, Gina, 98, 100–101 manages itself, 121–122
Korean war, surgical unit in, 246 whistleblower. See whistleblower
Kowalczyk, Liz, 93–94 Lerner, Barron, 321
Kozachik, Sharon, 98 Letterman, David, 168–169, 311
Kuhk, Tyler, 327, 340, 344 letters to the editor, writing, 350–351
Kuklierus, Ann, 353 “Letter to Hollywood,” 352
Kushner, Tony, 70, 130, 273 letter-writing campaigns, 335–349
Levy, Ariel, 282
L Lewis, KJ, 285
Lab Rats, xxviii, 261–262, 348 Liberia, foreign aide documentary, 97
Lacy, Jared, 208–209 Liberty Times (Taiwan), 224
“Lady with the Lamp,” 9, 321 Liddane, Lisa, 44
LaGravenese, Richard, 194 Lieberman, Janice, 284
Lake, Ricki, 274 Lifeline: The Nursing Diaries, 70, 130
Lambert, Jonamay, 195 Lilongwe Central Hospital, 73–74
Lambert Productions, 340 Lincoln Journal Star, 209
Landro, Laura, 94, 279 Lionsgate, 165
language, changing common related to Lippincott Williams & Wilkins
nursing, 302, 303t–305t, 305 (LWW), 305
Larrabee, Julia, 169 Little Fockers, 71, 200, 201
Late Show with David Letterman, Live with Regis and Kelly, xxvi, 156
156–157, 168–169 Living in Emergency: Stories of Doctors
lateral aggression. See abuse Without Borders, 97
Lauda, Niki, 169 Living Out Loud, 194
Lauer, Matt, 330 LL Cool J, 360
Law and Order: Special Victims Unit, 44, Loeb Center, 10
91, 253 London Evening Standard, 156
Lawrence University, 159 Long Beach Press Telegram, 87
Leading Ladies, 133 Longman, Jeré, 98
The Leapfrog Group, 349 long-term care institutions, as essentially
LeClair, Megan, 322 nursing facilities, 312
Lee, Tommy, 173 Lopez, Steve, 72
legal and ethical obligations, nurses must Lori, Lisa, 232
follow, 124 Los Angeles Times, 72, 207
legislation loving mothers. See mothers: loving
Affordable Care Act. See Affordable Loving Touch Nurse, 227
Care Act Lowell, Chris, 270
mandatory overtime. See mandatory Lowery, Don, 279
overtime Lubic, Ruth, 11, 279
minimum nurse-patient ratios. See ratios Lung Cancer Alliance (LCA), 165–166,
Office of the National Nurse, 318 344–345
3 9 6
• Index
Luxembourg, nurses paid better, 187 Marcus Welby, 35

Luz, Susan, 353 “Marcus Welby syndrome,” 35
Ly, Phuong, 279 marine nurses, 228
Lyder, Courtney, 207 Marketplace, 43
Lynch, Dan, 3–4, 6, 119 Marrin, Minette, 228
Marsh, Clarice, 223
M Martin, Berni, 351
M*A*S*H film, important modern Martin, Linda, 70
battle-axe, 246–247 Martin Chuzzlewit, 8, 34
M*A*S*H television series, depiction of Marts, Luwana, 75
nursing, 36, 247 Mason, Diana, 308, 327, 360
Maass, Clara, 358 Mason, Shayne, 308, 360
“Madonna and whore” dichotomy, 158 Massachusetts General Hospital, 307,
Magnet Recognition Program of the 314, 356
American Nurses Credentialing mass casualty events, 20, 25, 65, 98
Center, 18, 312 Massey, Laporshia, 74
Maine Coast Memorial Hospital Nurses Masson, Veneta, 351, 354, 360
Week page, 232 master-servant relationship, 126
Mainichi Daily News, 336 Mattel, 261, 348
Malawi Maxim Sirius radio, 175
campaign to increase funding for Mayer, Gloria, 353
nursing, 236 Mayling, Mandy, 349
effects of the emigration of nurses McDonald, Audra, 131
from AIDS-ravaged, 73–74 McDonald, Michele, 314
Male Nurse Action Figure, 199, 359 McDonald’s, 163
male nurses. See men in nursing McEwan, Ian, 131, 191
male sexual fantasies, focusing on McEwen, Alan, 75
traditionally female professions, McFarland, Ryan, 207
158 McGrath, Maureen, 308, 360
“Mama Said Be a Nurse,” 360 McLean, Scott, 75
“Mama Said Knock You Out,” 360 McPhee, Archie, 199
Manchester Evening News, 75 McPherson, John, 176
Man Crazy Nurse #2, 161 MDs, 252
mandatory overtime Médecins Sans Frontières (MSF), 97,
angel imagery encouraging, 219 130, 316
dangers of overtime, 6, 319 media
legislation prohibiting, 17–18 angel imagery, 234
media featuring, 136, 358 campaigns, 19, 335–349
nurses struggling with, 6, 196, 219 catching being good, 338
mantram therapy, managing contempt for nursing skill, 77–88
posttraumatic stress disorder, 133 created by “feminists” hostile to
Marchione, Marilynn, 99 nursing, xxvi–xxvii
Index •
397
creating your own, 350–362 training, in-person, 337

defining success in terms of traditional tributes to nurses, 87–88
male jobs, xxvii media creators
decision makers, persuading in direct believing their work has a positive
interactions, 342–349 social impact, 51
discouraging primary school students considering whether images presented
from pursuing nursing careers, 47 conform to positive sentiments
educating about nursing, 335–350 about nursing, 311
expertise, developing, 335–338 helping them understand nursing
experts, nurses as, 76, 307 when they ask, 336
feminists, failed to learn the learning all they can about what
importance of “caregiving” nurses do, 305
fields, 190 paying special attention to language
ignoring nurses’ contributions to issues, 306
health, xxii procedures for challenging conduct,
ignoring the “harder” aspects of 347
nursing, 220 related to nurses, 311
influencing nursing, 37–54 Medical Investigation, 231
literacy movement, 39 medicalization, of APRN practice, 267
men in nursing, 197–210 medical marijuana use, legislation to
not seeing nurses as experts, 308 authorize, 351
nurses going missing, 96–101 medical profession, trying to get
“nurses,” obligation to consider effects physicians to act more like
of use of the term, 101–102 nurses, 276
opportunities, usually fleeting, 336 medical schools
portrayal of nursing affecting health, promoting interprofessional
29–54 training and shadowing
portrayals of APRNs, 263 programs, 334
portrayals of nurses as autonomous smart nurses excelling by going to, 83
professionals, 126–133 medical students
product, studying, 345–346 shadowing nurses, 322
promoting specific desirable video explaining basics of nursing, 322
behaviors, 38 women, now half in US, 197
referring to all female caregivers as medical technicians. See nursing
“nurses,” 101–104 assistants
reinforcing undervaluation of medicine, as one type of health care, 304t
nursing, 298 Meet the Fockers, 200–201
responding promptly to, 336 Meet the Parents, 71, 130, 200
role in forming and reinforcing Melcon, Mel, 207
popular attitudes about health men in nursing
care, 33 anti-male nurse bigotry, from
stereotypes. See stereotypes physicians, 205
3 9 8
• Index
men in nursing (cont.) wannabe-physician stereotype, 271

encountering resistance by pursuing Meredith, Pam, 337
nursing, 188 Miami Medical, 32, 143, 202
not entering nursing in significant Michaels, Bret, 175, 350
numbers, 12 Middle Ages, religious orders
entertainment media mocking, xxvii establishing groups of trained
high attrition rates for male nursing caregivers, 8
students, 198 Middleton, Kate, 171
Hollywood’s portrayals of, 188–90, mid-level providers, APRNs as, 265
197–207 midwifery. See also nurse midwives
“murse,” 188, 198–199, 205–206 as irrelevant to serious maternal-child
as nurse characters, on nonhealthcare health care, 269
dramas, 205 predating obstetrics, 203
as nurse manager, among trauma midwives, types of, 274
physician leads, 32 migration, of developing world nurses,
as objects of ridicule, 198 12, 16–17, 73, 86, 123, 176, 187,
presented as gay, 32, 188–189, 198, 209, 236
200, 202–206, 210, 353 military medics
problem with using “male nurse,” 188 becoming nurses, Obama
recruiting men to the profession, discusses, 104
198, 208–209 as overqualified to be school nurses, 86
“stay-at-home daddy,” 206 military nurses, 7
stereotypes about, 189, 198, 207 army nurses. See army nurses
wannabe physician stereotype, books about, 353
203–204 Doonesbury, 208
mentor/apprentice role, nurses in, 72, Hollywood depictions of, 36, 202,
145, 314 227–228, 246–247
Mercury (South Africa), 87 news media depictions of, 133,
Mercy, xxii, 33 227–228, 347
ambitious nurses aiming for medical Miller, Stephanie, 176, 347
school, xxviii Mills, Teri, 318
character adulterous but not Milwaukee Journal-Sentinel, 104, 351
“naughty,” 168 Minaj, Nicki, 172
male nurse, 204 The Mindy Project, 192
naughty nurse, 168 attacks on nursing, 81–82
nurse calling shots, 193 focusing on physicians, xxii
nurse named Angel Lopez, 226 handmaiden image on, xxvi, 140
nurses engaged in their own health idiotic nurses on, 31
practice, 128–129 male midwives, 203
portrayals of nursing skill, 68 naughty nurse image, 167
RN with a masters degree, 272 physician offended by being called a
self-righteous vision of nurses, 194 nurse, xxv
Index •
399
Minnesota Public Radio, 278 Museum of Modern Nursing

MinuteClinic, nurses in management team, creating to educate the public about
299, See also retail-based clinics nursing, 319
Mirren, Helen, 156 proposed, 357
missed nursing care, 15–16 music and musicians. See also music videos
Mitchell, Anne, 120 blink -182, 173, 257
Mitchell, David, 254 Jack White, 173–174
The Mob Doctor, 143 John Darnielle, 358
Modern Family, 85, 168 Johnson & Johnson, gooey music
Modern Healthcare, 345 of, 235
Monday Mornings, 90, 143, 250 Mötley Crue, 172
Monroe-Obermeit, Arden, 285 Naomi Judd, 358
Monster website, 154 naughty nurses in pop music, 172–174
Montaigne, Renee, 223 “Night Nurse,” Gregory Isaacs, Simply
moral script. See virtue script Red, Sinead O’Connor, 172
Moran, Lee, 174 research on use to reduce complications
More, 45 and improve health, 336
More Business of Being Born, 274 Sonic Youth, 358
Moredock, Will, 73 therapy to improve patient outcomes,
Morgan, Susan, 43 336
Morning Edition, 73, 86, 95, 99, 223 They Might Be Giants, teaching about
Mortenson, Greg, 337 science, 358
The Most Interesting Man in the World music videos
advertisements, 311, 347 “Dr. Lung Love”, by Lung Cancer
mothers Alliance, 165–166, 344–345
as bitter nurses, xxvii, 186, 194–195 “Happiness Is a Warm Gun” in Across
avoiding nursing, 40, 196 the Universe, 172
loving, xxvii, 217, 236, “Number 1” by Goldfrapp, 173
nurses as, 227–228 “Up Out My Face” by Mariah Carey
receiving nursing care, xxv, 10, 67, 75, and Nicki Minaj, 172
95, 226, 278–279, 300 “XXL” by Keith Anderson, 173
Mötley Crüe, 172 Muslim, Nina, 209
Moving Mountains, 353
Moyers, Scott, 208 N
MSNBC, 146, 154, 281 Nabukeera, Irene, 225
MTV, 32, 48, 84, 168, 207, 327, 340, 348 Nairobi sex workers, adopting safer sex
Muhlhahn, Cara, 274, 284 practices, 75
Mundinger, Mary, 277 Natelson, Benjamin, 281
Murphy, Ellen K., 124 National Academy of Sciences, 262
“murse,” 188, 198–199, 205–206. See also National Board of Medical Examiners,
men in nursing certifying examination for
Museum of Mental Health, 248 DNPs, 267
4 0 0
• Index
National Geographic Channel, 130 prevalence, global, xxvi, 157

“National Hooky Day,” 164 protests against, 338–351
National Institutes of Health, nursing real nurses embracing, 155
research in the budget, 19 resisting charms of, 302
National League for Nursing, 19 restaurants using. See restaurants
National Nurse, legislative proposal for on television, 103, 156
position in the US Public Health use of to recruit nurses, 156
Service, 318 Naughty Nurse Amber Ale, 164
National Nurses United, 15, 308, 342 navy nurses, media appearances, 227–228
National Nursing Shortage Reform and Naylor, Mary, 75, 278
Patient Advocacy Act bill, 17 NBC, xxii, 91, 100, 167, 231, 252, 253,
National Organisation of Nurses and 284
Midwives of Malawi, 236 NCIS: Los Angeles, 144, 166
National Organization for Women, 197 Nebraska Hospital Association, calendar
National Post, 229 guys, 209–210
National Public Radio (NPR), 12, 15, 30, “Need to Know” PBS series, 132–133
73, 86, 95, 99, 133, 223, 278, 280 Neergaard, Lauran, 75
“National Women’s Checkup Day,” 263 Neighmond, Patti, 73–74
National Women’s History Museum, 187 Neilson Dairy, 163, 340
“Naughty and Nice,” Skechers Nelson, Peg, 321
campaign, 165 Nelson, Sioban, 8, 220
naughty nurse image, xxvi–xxvii, 35–36, neonatal ICU (NICU) nurses
154–176 absent on Grey’s Anatomy, 88
adept at selling products to young incompetent on ER, 83
men, 162 as martinets bent on terrorizing
advertisements. See advertisements: medical students, 251
naughty nurse New York University after Hurricane
apps, 171 Sandy, 100
bars using. See restaurants New Kerala website, 209
celebrities embracing, 156 news media
contests, 350 accounts of military nurses practicing
costumes. See costumes with autonomy, 132
effects of, 154–155, 158–161 APRNs in, 263, 275–281
genesis of the image, 158 assigning credit for nurses’ work
as “jokes.” See jokes to physicians, “hospitals,” or
link to sexual harassment, 154 machines, xxv
male fantasies about, 155 coverage of men in nursing, 207–210
marketed to children, 157, 163, 340 creators learning from nurses, 300
models, in visual advertisements, 162 disrespecting nurses, 85–88
naughty-axes, 247, 248t, 255–257 diversions undermining nursing, 86
paintings of, 161 handmaiden imagery, 131–133,
partying at night, 164 145–146
Index •
401
health-related articles, nurses “Room for Debate” on ethics of

appearing in, 30 force-feeding Guantanamo Bay
humorists, using naughty nurse to prisoners, 132
extract cheap laughs, 175 Theresa Brown pieces, 76, 126,
ignoring nurses on nursing issues, 97–98 306–307
impact on the public’s understanding “Tribute to Nurses” advertising
of key health issues, 38 supplement, 224
naughty nurses in, 174–176 New York University, 10
nursing skill in, 71–76, 306–307 New Zealand Herald, 76, 132, 189
physician nursing in, xxv, 91–95 New Zealand Nurses Organisation, 333
suggesting that females wanting a real NFP. See Nurse-Family Partnership
modern career avoid nursing, 195 Ngugi, Elizabeth, 11, 75
suggesting that nurses not providing Nichols, Michele, 349
direct care are not nurses, 86–87 Nichols, Mike, 70, 130, 131, 268, 273
Newsom, Gavin, 354 Nicks, Peter, 101
Newsweek, 14, 75, 76 NICU. See neonatal ICU (NICU)
New Vision (Uganda), 188 Nightingale, Florence, 8–9, 34, 219, 321
New York Daily News, 53, 103, 155 autonomy in nursing began with, 286
The New Yorker, 75, 87, 94, 97, 196, birthday as basis for nurses week, 232
256–257, 310 birthday as basis for protest, 237
New York Observer, 277 as a character in Anne Perry’s mystery
New York Post, 156 novels, 191
New York State Nurses Association, 358 founder of modern nursing, 8–9, 34
New York Times, 71, 73, 75, 76, 93, 94, 97, media featuring, 321
98, 101, 120, 126, 131, 156, Nightingale Training School for
193–194, 197, 217, 234, 275, Nurses, 9
306, 336 no angel, 219
article about traumatic brain injuries, xxi stamps featuring, 358
clinics in Prague offering nurses free teddy bear in name, 233
plastic surgery, 20 The Nightingale of Mosul, 353
comparing nurses to inanimate Nightingales television show, 36
objects, 87 “Night Nurse” song, 172
crossword puzzles, 86 Nip/Tuck, 32
equating physicians with all of health NL News Now, 225
care, 30 Nobel Prize, suggested for nursing, 319
“Fixes” piece about nurse practitioners, noble calling, nursing as, 34
30 nonfiction books, writing, 352–353
op-ed showing feminist disdain for nonnurses, described as “nurse,” 304t
nursing, 190 non-physician providers. See
Pauline Chen pieces, 76, 321 advanced practice registered
piece about recovery from a serious nurses
automobile crash, 91 Norman Lear Center, 42, 43
4 0 2
• Index
“normative window theory of advanced nursing skills, xxv, 32, 67

prejudice,” 160 angel image, 226, 237
Norton, Doreen, 75 autonomy, xxvi, 127–128
Notes on Nursing (Nightingale), 9 battle-axe imagery, xxvii, 249–250
Nova Scotia Government and General character adulterous but not
Employees Union, 341 “naughty,” 168
novels, writing to educate the public male nurses, 189, 203–204
about nursing, 353–354 nurse becoming an NP, 272
NP program, first, 264 Nurses Week, 313
NPR. See National Public Radio nurses having graduate degrees, 193
NPs. See nurse practitioners (NPs) nursing skill portrayed on, 67
nurse. See also nurses, nursing suggesting that nurses report to
advisors to television, 35, 45, 309–310 physicians, xxvi, 127–128
anesthetists. See certified registered nurse managers
nurse anesthetists examples of in the media, 68–71,
APRNs. See advanced practice 127–129, 132, 141, 174, 201, 202,
registered nurses 205, 225, 226, 234, 249, 251, 255
as a formidable health system not supportive of staff nurses, 14, 54,
organizer, 70 124
identifying as, 330 nurses reporting to, 298
midwives. See certified nurse midwives should support nurses, xxviii, 300
shadowing programs, xxviii, 208, nurse midwives, 262, 264. See also
322, 334 advanced practice registered
as a term of usage, 305t nurses
“The Nurse” song, 173, 341 better outcomes at a lower cost, 266
Nurse 3D naughty-axe film, 170, 255– birthing centers staffed by, in
256, 346 New York City and Washington,
“nursebots.” See “robot nurses” DC, 279
nurse characters. See also specific childbirth care, increasing US use
television shows of, 10–11
hospice, 85, 130, 235 compared to lay midwives, 274
positive. See positive nurse characters Dell Parker from Private Practice, 31,
school nurses, 31, 85 82, 140–141, 202–203, 268–269
nurse-controlled state boards, 121 expert comment from, 76
nurse experts Peter Riggs from Strong Medicine, 37,
clarifying status as nurses, 309 142–143, 202, 268–269
consulting, 308 providing a full range of skilled
struggling to be heard, 307 nursing care, 33
Nurse-Family Partnership (NFP), 75, 95 recent news media attention, 278–279
nurse-focused shows, 66–71, 203, 310. See stamp series about, 358
also positive nurse characters nurse migration, 17
Nurse Follies slot machine, 329 Nurse Nancy bracelets, 226–227
Nurse Jackie, xxii Nurse! play, 358
Index •
403
Nurse - Past, Present, and Future: The featuring physicians as speakers at

Making of Modern Nursing, 353 their conference, 308
nurse practitioners (NPs). See also highly educated leaders of the nursing
advanced practice registered profession, 120
nurses on hospital shows, xxii
clinics run by, 30, 262, 299 improving their own image, 327–362
competing directly with physicians, 277 intervening before conditions become
described, 264 severe, 300
doing everything primary care knowledgeable and skilled, 302
physicians do, 276 knowledge in relation to physicians,
as quacks, 261 120–121, 122f
specialties, 264 making complex judgment calls, 6
spending more time with patients, 267 monitoring patients for subtle signs of
using advanced listening skills, decline, 89
281–282 more likely to pursue graduate
willingness to consult with others, 282 education in nursing, 31, 83
winning over patients, 277 most numerous Médecins
Nurse Quacktitioner toy, 261, 348 Sans Frontières health
nurse-run clinic, not “second-class professionals, 97
primary care,” 276 not taking “orders” from
nurses. See also nurse, nursing physicians, 304t
affecting patient outcomes as much as as oppressed pink collar workers,
physicians, 306 193, 195
appearing as experts, 76 as patient advocates. See patient
as battle-axes, xxvii, 245–258 advocacy
bearing responsibility for poor as physician gold diggers. See
understanding of their gold-diggers
profession, 52 portrayed as peripheral servants of
bullied on the job, 54 heroic physicians, xxv, 134
as cleanup crew of health care, 78 power to change the way society sees
complimenting, 302 the profession, 328–329
continuing to embrace and perpetuate “practicing nursing” terminology,
the angel image, 217 304t
creating television shows about, 309 preventing healthcare errors, 93
determined to keep their heads down, 76 replacing with monkeys, 65
as dramatic mirrors, xxii report to senior nurses, xxiv
duties of, 7 researchers, making news, 75
duty to scrutinize prescriptions to role in producing, writing, and
prevent dangerous errors, 89 advising on broadcast media, 361
encouraging to wear distinctive saving lives, 4, 300
uniforms and use other as science professionals, xxiii
identifiers, 313 serving as hospital CEOs or as
feeling invisible, 30 directors on hospital boards, 299
4 0 4
• Index
nurses (cont.) associating with cuddly children’s

shortage of. See nursing shortage dolls, 233
as skilled professionals, 66–76 as autonomous profession, 4, 120–126
small number of dangerously believing in, 328
troubled, 230–232 as breastfeeding, 198, 304t
some prominent ones not burying expertise, 92
understanding nursing camps, 208
autonomy, 126 care. See nursing care
on stamps, 358 contempt for, xxv
telling their best stories, 337 crisis in, 39
thinking out loud, 332 defending, 192–193
as three-dimensional beings, 222 defined, 121–124
as unskilled, 65–104 devaluation of, translating into an
using “he” to discuss, 304t underpowered profession, 161
vital role in health care, xxi disrespect leading governments and
Nurses documentary, 70, 130 foundations to allot meager
Nurse Scientists: Committed to the Public funding for, 298
Trust, 234 educated by nursing scholars, 120
Nurses Day. See Nurses Week education, moved from hospitals to
Nurses for a Healthier Tomorrow, 19 universities, 10
Nurses: If Florence Could See Us Now, effects of undervaluation of, 53
233, 361 empowerment, key element of reform
Nurses sitcom, 36 for hospitals, 119
nurse staffing legislation. See ratios errors. See errors in health care
The Nurses television series, 35 faculty, critical shortage of, 12, 19, 190
nurse stereotypes. See stereotypes failure to represent itself well, 51
nurse’s touch, importance of, 217–218, female, overwhelmingly, 51
221, 227, 233–234 getting media coverage for, 335–338
Nurses Week, 232–234, 313, 351 history of, 7–11
fosters angel stereotyping, xxvii, ignored in television shows, 96–97
232–234, 236 illustrating expertise, 356
on Nurse Jackie, 313 improving understanding of, 297–322,
use to generate media coverage, 313 327–362
Nurse Talk radio show, 308, 360 as just happening, 94–95
nurse-to-patient ratios. See ratios, lack of respect for as a profession, 196
short-staffing learning more about, 301
NurseWeek, 198. See also Nursing media influencing, 37–54
Spectrum mocked by hospital shows, xxii
nursing not good enough for smart, ambitious
acting as a check on physician care modern women, 186
plans, 118 out loud, 332–333
advocacy, 86, 277, 321, 327–362 positions cut in 1990s, 13
Index •
405
promoting in hard times, 329–330 not billed and reimbursed as a distinct

prospectus for a global investment in, item, 316
300–301 nursing careers
public’s misunderstanding of, 297–298 interest increasing due to dismal
residencies. See residencies economy, 19
research funding, 19 media affecting those considering, 46
research innovation, 75–76 Nursing Economic$, 47–48, 98, 266,
roles, placing unlicensed assistive 276
personnel into, 103 “Nursing: Isn’t That Sweet?!,” 360
scholars getting little funding from the Nursing made Incredibly Easy, 305–306
US government, 19 Nursing Notes journal, 9
schools lacking infrastructure, faculty, “Nursing Notes” Facebook page, 235
and resources, 190 Nursing Practice Act, California, 121
schools refusing admittance to men, 6 nursing shortage, xxii–xxv, xxix, 11,
school websites, 355 73–74, 103–104, 119, 317–319
shortage. See nursing shortage abuse and burnout fueling, 12,
skill, media contempt for, 77–88 14–15, 73
strikes, 78, 85, 136–137, 143, 237, 358 affected by angel stereotype, 221,
student, not yet a nurse, 304t 234, 317
studying examples of good coverage affected by naughty nurse, 158–159
of, 335–336 affected by nurses becoming
underpaid faculty, 19 APRNs, 264
work being performed by others, 65 attracting men to relieve, 189, 198,
work being crediting to physicians, 91 208–210
workforce, rapidly aging, 12 deadly, xxiii
writing about, 350–357 disrespect as underlying cause of, 298
Nursing Against the Odds, 8, 13, 125, 219 efforts to quell, 217
nursing assistants, 13, 223, 304t, 306 global, 11–21
confusing with RNs, 322, 332, 334 made worse by AIDS, 16
replacing RNs with assistants and major public priority to resolve, 319
technicians, 298, 314, 315 media pieces, 73–74
role in Precious, 306 migration affecting, 209
role in The Waiting Room, 101 National Nursing Shortage Reform
nursing authority. See also battle-axe and Patient Advocacy Act bill, 17
stereotype, nurse managers Office of the National Nurse, 318
Hollywood celebrating, 249–256 plans for addressing, 104, 317–318
in television and film, 126–131 publicizing efforts to address, 317–319
nursing care as reason to persuade the media to
based on nurses’ own unique scope of change, 345–346
practice, 131 Nursing Spectrum, 245, 337. See also
left undone because of stressful work NurseWeek
environment, 16 The Nursing Times, 75
4 0 6
• Index
NY Med, 32, 96–97 orderly, 306. See also nursing assistants

Nympho Nurse, 161 “orders”
connoting subservience, 122
O not using to mean a prescription or
Obama, Barack, 104, 317–318 care plan, 304t
“Obamacare.” See Affordable Care Act by physicians, xxvi
of 2010 Oregon State Hospital, 248
obesity-related problems, nurses O’Reilly, Bill, 282
educating and advocating for The O’Reilly Factor, 282
better diet and exercise, 300 organ donation
obituaries, of nursing leaders, 71 negative views from television, 48
obstetric care, in US as a dysfunctional portrayals of, 43
business, 274 Osterlund, Hob, 358
obstetrics and gynecology (OB/GYN) “outside track,” versus “inside
physicians track,” 346
malpractice claims against, 93 overtime. See mandatory overtime
in The Mindy Project, 81 overweight, nurses as, 333
as skilled professionals worthy of Oz, Mehmet, 169
respect, 192
Ocean Red, “Naughty Nurse” app, 171 P
Ochs, Elisabeth, 74 Page, Gayle, 98
O’Connor, Sinead, 172 pain management
Odone, Christina, 229 nurses leading the way in, 139
O’Donnell, Mike, 206 research, 98
Off the Map, 32, 37, 84, 143 Pakistan, nurses experiencing violence
Olds, David, 95 and harassment, 154–155
oncology nurses Pakistan Nurses Association, 156
featured in Nurses, 70 Palahniuk, Chuck, 329
ignored in Sharon Blynn chemo room Palmer, Robert, xxvi, 164
ad, 317 Pappas, Mary, 74–75
pieces on health care and nursing, 76 Parade magazine, 75, 357
Theresa Brown. See Brown, Theresa parents
on Time of Death, 130 angel commentary from, 232
One Flew Over the Cuckoo’s Nest, xxvii, children disrespecting their parents’
36, 245 nursing careers, 196
Ontario Nurses Association, 344 disrespecting the field of nursing that
Onyejekwe, L. Okey, Jr., 118 their children have chosen, 186,
op-eds (opinion-editorial pieces), writing, 190, 200, 207–208, 362
to educate the public, 351–352 guiding children away from nursing,
operating room (OR) nurses. See xxvii, 189, 194–195
perioperative nurses proud of their children for going into
Operation game, 359 nursing, 201, 362
Index •
407
Parker, Dell, 31, 82, 140–141, Pesce, Andrew, 283

202–203, 269 Peterborough Examiner (Ontario),
Parker, Georgie, 225 335–336
Parks & Recreation Peterson, Trond, 188
character in direct care nursing, 193 Pew Charitable Trusts, 320
illustrations of nursing anatomy, 129 Peyton, Jackie. See Nurse Jackie
nurse Ann Perkins, 69–70 pharmacists, 103
Party City, 171 PhDs
Passions, orangutan as a private duty identifier for nurse experts in media
nurse, 65 pieces, 309
Patchin, Rebecca, 282–283 nursing leaders with, 73
patient abuse. See abuse: responding to MDs, PhD nurse as heartless enforcer,
patient advocacy, xxiv, 17, 321 252
being done by physicians, 88 Philadelphia Daily News, 278
duty in nursing, 120, 123–124, 219, 321 Philadelphia Fabric Workshop and
illustrations of nurses’, 33, 67–68, 119, Museum, 357
134, 193, 203, 204, 269 Philadelphia Inquirer, 231, 314
patient care assistant or technician, Philbin, Regis, xxvi, 156
13. See also nursing assistants Philippine Daily Inquirer, 104
patient education, 93 photographs, capturing the nursing
Patient Protection and Affordable Care Act experience with, 357
(2010). See Affordable Care Act physical health, threats to nurses’, 76
patients physician bullying, op-ed about,
explaining nursing’s role to, 313, 126
334–335 physician-centric media, undermining
nurses teaching and advocating for, 4 nursing practice and
nurses protecting, 119, 200 education, 32, 34
right to know who is providing care, 331 physician characters
staying with 24/7, 53 doing dramatic work in which real-life
Patton, Rebecca, 318 nurses take the lead, 52, 88
Paupore, Nick, xxi making scathing statement about
PBS, xxii, 132, 230 nursing, 83
PC Magazine, 102 saving lives by themselves, 32
Peirce, Georgia, 307, 314 on US television outnumbering nurse
Pekkanen, John, 73 characters, 31
Pender, M. J., 72 “physician extenders,” 265, 281
Pennington, Maureen, 227–228 physician groups attacking APRNs, 267,
People, 156, 175, 350 282–285
perioperative nurses, 120, 137 physician nursing
Perry, Anne, 191 infecting nonhospital shows, 91
persistence, relentless, 344–345 in news media, 91–95
Personality and Social Psychology relying heavily on, 37
Bulletin, 160 physician “order.” See “orders”
4 0 8
• Index
physicians training, compared to training for

abuse of nurses by, 120 APRNs, 265
arguing that NPs are unqualified trying to understand nursing better,
practitioners, 261 321–322
cannot do or manage nursing work, 4 Pilon, Mary, 98
creating media, 281 pink ghetto, escaping, 195–197
developing world, migrating to pink student identification cards,
wealthier nations, 86 changing for nurses, 198
dominating discussions of health Piot, Peter, 75
policy issues on US hospital Pirie, Emily, 158
dramas, 46 Pistulka, Gina, xxiii
dominating media, 306 Pittsburgh Post-Gazette, 331
educating, 118, 334–335 Planetree patient-centered model of
entertainment media focusing on, 50 care, 333
fighting with nurses, 119 planned care, nurses obligations to assess
getting the blame, 92–94 all, 123
having more practical power, 122 Plastic & Reconstructive Surgery, 48
with high numbers of malpractice plastic surgery reality shows, 48
claims, 93 plays featuring nurses
insufficient support from, 51 Angels in America, 70, 130
knowledge relationship with nurses, Nurse! one-woman off-Broadway
120–121, 122f play, 358
lacking expertise in many areas of Wit, 131
nursing, 124 poetry, reflecting years as a nurse, 354
learning about what nurses really do Pohnert, Anne, 279
for patients, 300 Polaneczky, Ronnie, 278
as “the man,” 135 Pompeo, Ellen, 45
as managing nurses, 118–146 pornography, naughty nurses in, 170–173
managing their public image, 39 Portuguese newspapers, nurses as sources
modern girls aspiring to be, 186 of information, 30
narrow, internally focused positive nurse characters, xxii
approach, 52 24 Hours in the A&E, 130
number of, 6 Angels in America, 130
nurse characters absorbing abuse Call the Midwife, 67–68
from, 45 Eve Peyton on ER, 69, 129, 139, 251, 346
nurses deferring to, 125 HawthoRNe, 33, 68, 128
objections to APRNs, 275 Mercy, 68, 128
remaining favorite choice Nurses, 70, 130
for healthcare speaking Nurse Jackie, 67
engagements, 308 Remote Area Nurse, 129
testifying as to the standard of nursing “The Rookies,” Nursing Diaries,
care in malpractice actions, 124 70, 361
Index •
409
Sam Taggart on ER, 268, 271 helping nurses improve understanding

positive nurses on television dramas of their profession, 312–317
positive reinforcement, providing to publicize efforts to strengthen
media, 338 nursing, 300
Post and Courier, 278 products, persuading media to
Post-Star (Glen Falls, New York), 176 reconsider, 338–342
power, relation of nursing to medicine in profession, nursing as. See nurses, nursing
terms of, 122, 123f professional image, projecting every day,
“practice nursing” terminology, 304t xxviii, 327, 329–334
Prairie Home Companion, 196 professional mother, nurse as, 227–228
Precious film, 306 professionals, media portrayals of nurses
Precious Moments, offering figurines of as serious, 66–76
nurses, 227 professional service, nursing care should
prejudice be billed and reimbursed as, 316
delivering in a joke, 160 professional women, dressing sexually, 159
against a given group, 160 promiscuous, nurses as, 230
“prejudiced norm theory,” 160 Pronovost, Peter, 119
press releases, 340–341 prostitutes
preventive public health issues, nurses global vision of nurses as, 157
deeply involved in, 320 training, to become “care workers for
primary care, reports on growing role of the elderly,” 104
NPs in, 275 Providence Journal, 278
primary care practices, physicians Psychology of Women Quarterly, 159
choosing not to pursue less psychosocial care, in nursing, 5, 89, 220
lucrative, 264 public awareness campaign, naughty
primary care providers, solution to the nurse appearing in, 165–166
growing gap in, 281 Public Broadcasting Service. See PBS
“Prime Time Doctors: Why Should You public health
Care?,” 41 Hollywood’s positive effect on, 43
Prince, Richard, 161–162 nurses advocating for, 333
Prince William, 171 public health nurses. See also school
print news media, nurses as skilled nurses
professionals in, 66–76 in the news, 74–75
private nurse, as detective, 35 showcasing autonomous work of, 132
Private Practice, xxvii, 42–43, 268 public health organizations, promoting
APRN character, 269–270 nursing, 315–316
group of pretty, smart physicians, 31 public officials, not allocating
male nurse, 189, 202–203 sufficient funds for nurse
nurse studying to be a midwife, 82 staffing, 39
portrayals of nurses in the outpatient public relations, for nursing, 314
setting, 140–141 public relations officials, promoting
private sector health executives nurses in the media, 307
4 1 0
• Index
public sector health leaders, specific Randall, Sharon, 223–224

improvements to consider, RAN: Remote Area Nurse, 129
318–319 rapid response teams, members of, 90
Puett, J. Morgan, 331 rap video
Purdue University, 102, 276 ED recruiting video by Craig
Barton, 359
Q “Mama Said Be a Nurse,” 360
Quattro Titanium razor, 163 Rasmussen, Frederick, 71
Quick, Brian, 46 Ratched, Nurse Mildred, 36, 245–247
“quickie” clinics, 284. See also retail-based Rathbun, Lesley, 278
clinics ratios, nurse-patient. See also
short-staffing
R legislation, 17–18
Radio importance of minimum, 319
advertisements. See advertisements publicizing need for, 342
American Public Media’s ways to improve work
Marketplace, 43 environment, 315
as an effective way to Rattle, 237, 338, 354
communicate, 360 Raymond, Patricia, 330
health shows, hosted by nurses, Reader’s Digest, 14, 45, 73, 87, 119, 230
xxix, 360 Reame, Nancy, 308
HealthStyles, with Diana Mason Rear Window, 35
and Barbara Glickstein. See “receptionist nurses,” xxvii, 31, 82, 140,
HealthStyles 189, 202, 269, 270, 322,
National Public Radio. See National receptionists
Public Radio should not give misimpression they
Nurse Talk radio show, 308 are nurses, 322
nurses appearing as experts on, 278 treating with respect, 343–344
nurses using radio to educate the recruitment efforts in nursing
public, 132, 278, 335, 359, 360 aimed at men, 198, 199, 208
Prairie Home Companion host Craig Barton rap video, 199
Garrison Keillor, 196–197 Discover Nursing website, 355
Sean Hannity show, 311, 347 Truth About Nursing’s webpages and
Stephanie Miller show, 176, 347 free materials, 330
Sunday Night Sex Show with Maureen “Nursing, Isn’t that Sweet?” video, 360
McGrath, 308, 360 Redbook, 281
Tom Joyner, 263 red cross, first use as a sign of health
Ralph, 171 care, 8
Ramirez, Elda, 280 Redeye morning show, 175, 345–346
Ramsey County Runaway Intervention The Reel Nurses Talk Show (RNTV), 361
Program, 278 registered nurse patch. See RN patch
Index •
411
registered nurses (RNs). See also nurses, Riggs, Peter, 37, 142–143, 202, 268–269
nursing Riley, Dee, 349
benefits to raising the number of, 15 Ripa, Kelly, xxvi, 156
choosing not to work in nursing, 14 Rizzoli & Isles, xxvii, 206
education of in US, 6 RN magazine, 222
identifiers, 332, 337 RN patch, 313, 331, 357
knowledge of, 34 RNs. See registered nurses (RNs)
numbers of worldwide, 6 “RN: The Past, Present and Future of the
Registered Nurses Association of Nurses’ Uniform,” 357
Ontario (RNAO), 163, 340 Robert Wood Johnson Foundation, 12,
relationships, establishing with local 41, 299
media, 337 Robinson, Matthew, 43
religious vocation, nursing as, 218 “robot nurses,” 102, 222
research by nurses. See also nursing RocketNews24, 163
inadequate funding, 19 romantic pursuit, nurses focused on,
sending to media, 337 157–158
Research Triangle Institute, 266 Romero, George, 70
residencies, for nurses, 18–19, 315 Rosenberg, Tina, 30, 275–276
restaurants and bars featuring nurses Rowe, John, 284–285
City Steam Brewery Café, 164 Rowling, J. K., 31, 355
Club Good Hurt, 164 Roxon, Nicola, 284
Heart Attack Grill, 164, 340–341, 350 Royal Pains, 84
Hooters, 164 Rubinstein, Dana, 277
Jet Nightclub in the Mirage Rumble Roses, 258
Hotel, 350 Rush film, 169
McDonald’s, 163 Rushton, Cynda, 76
nurses working to improve
health at, 333 S
Resuscitation, 49 Sacramento Bee, 330
retail-based clinics. See also nurse sadistic nurse. See battle-axe
practitioners Safety in Numbers, 12–13, 17–18
AMA’s effort to limit rapid Saint Benedict, 8
expansion of, 282 Saint Camillus, 8
promising new basic care model, 283 Saint Peter’s University Hospital, in New
Reuter, Chuck, 122 Brunswick, Canada, 232
Reuters, 155, 165, 198 Salon, 74, 194, 196
Revolution, 190, 194 Salt Lake Tribune, 154
Rhimes, Shonda, 44, 270 Sanford, Rhea, 332
Richards, Ann, 186–187 San Francisco Chronicle, 71, 131
Richards, Linda, 10 Saporta, Ishak, 188
Rideout, Vicky, 45 Savannah Morning News, 279
4 1 2
• Index
“Save Lives. Be a Nurse.” bumper passing indications of nursing

sticker, 328 knowledge, 69
Saving Grace, 70 physician characters directing nurses
SAW movies, 165 and nursing care, 142
SBS-TV, Australia, 129 as physician-centric, 32
Scarborough, Elizabeth Ann, 353 suggested nursing is low-skilled
Schering-Plough, 346, 348 assistive work, 83–84
Schick, 163 Seattle Post-Intelligencer, 351
school nurses Seattle Times, 74, 100, 223–224
on Cold Case, 253 Segatore, Stephen, 98
effect on economic development, 20 self-image, as first hurdle in
front-line surveillance, 20 advocacy, 327
on Glee, 85 “self-steering teams,” nurses working
in Gracie, 194 in, 132
in Harry Potter, 31 Sending Love from Above Figurine
invented by Lillian Wald, 10 nurse, 227
mocked and attacked by the media, sex, nurses having time to focus on, 160
xxv, 84–86 sexist humor, 160. See also jokes
need to strengthen, 20, 319, 333 sex objects, regarding nurses as, 155. See
positive stories about, 74–75, 132 also naughty nurse image
public health role, 132 sex-related stereotypes, of nursing, 248f
shortage of, 20, 74 sexual abuse. See sexual harassment, and
Schultze, Fred, 93 sexual assaults
Schwarz, Thomas, 198 sexual assault nurse examiners. See
Schwarzenegger, Arnold, 342 forensic nurses
science fields, women in, 197, 307 sexual assaults, xxvi, 156, 158. See also
science professionals, nurses as, xxiii sexual harassment, violence,
Scotsman, 75, 102, 222 forensic nursing
Scrooge, Ebenezer, 196 against nurses by patients and
Scrubbing In reality show, 32, 84 physicians, 156
giving nursing unneeded nurses not reporting because assaults
attention, 309 are not prosecuted, 156
male nurses on, 207 nurses preventing, 336
partyin’ portrayal of young nurses, xxiv nurses treating. See forensic nursing
petition to cancel, 327, 340, 344, 348 sexual degradation, female physician fears
travel nurse focus, 168 of, 166
Scrubs Magazine, 331 sexual harassment. See also sexual assaults,
Scrubs, 37, 82 violence
creator of, 44 encouraging workplace, xxvi, 158
drama in insurance coverage issues, 43 in greeting cards, 245
male nurses, 205 of Japanese nurses, 154
nurse characters confronting idea of negative impact on patient care, 155
becoming NPs, 272–273 nurses suffering at work, 154, 159
Index •
413
of Pakistani nurses, 154–155 as reason not to become an APRN,

of US nurses, 154–155 264
sexual identity, of male nurses, 198 of school nurses, 20, 74, 319, 333
sexuality, associating with danger, 247 severe, globally, 16
sexualized media image, of nurses, 157, on Strong Medicine, 143
157f Shortz, Will, 86
sexualized nurses, See naughty nurse Showtime, xxii, 130
image Sick Nurses, 170
sexually-oriented products, nursing in, Siegel, Marc, 336
170–171 “Silent Angel Awards,” 233
sex work, nursing comparable to, 156 Silent Hill films, 170, 255
“SexyBack” electrofunk hit, 360 Silver, Henry, 264
sexy nurses. See naughty nurse image Simie, Scott, 132
“Sexy Nurses” app, 171 Simply Red, 172
Shaffer, Paul, 169 Single and Looking comic strip, 176
Shafran-Tikva, Sigal, 92 Sisters of Charity, 8
Shalala, Donna, 281 sitcoms. See also television
Shapiro, Joseph, 278 effect on health-related views and
Sharma, Suruchi, 75 actions, 46
Sherlock, 238 natural home for the naughty
shoestring branding and public relations nurse, 167
agency, 234 Six Feet Under, 144
Shore, David, 311 16 and Pregnant, 48
Shore Medical Center, 232–233 60 Minutes, 230
short-staffing of nurses skanky nurses. See naughty nurse image
as cause of abuse of nurses, 54 Skechers, advertisement, xxiv, 156, 165,
as cause of burnout, 12, 14–15, 73 257, 311, 340
as cause of death for nurses, 15–18 The Skeleton Key, promoted as having
as cause of death for patients, 15 “nurse” characters, 101
as cause of missed nursing care, 15–16 Skog, Beryl, 76
as cause of unsafe care, 14–15 Sky Arts television network, 158, 191
central to nursing crisis, 12 Slim Jim, commercial, 198–199
in developing countries, 16, 19, 73–74 Slotnick, Daniel, 71
as effect of replacing RNs with sluts, regarding nurses as, 158. See also
unlicensed workers, 13, 15 naughty nurse image, sexual
errors caused by, 15 harassment
examples of, xv, 13–19 Smith, Ken, 145
global shortage of nurses, 11–20. See Smith, Linda S., 245
also nursing shortage Smith v. Pavlovich (2009), Illinois
on Grey’s Anatomy, 78, 136 appeals court, 124
in news articles, 88, 196, 223 smoking
patients compensating for, 87–88 in movies, 41
ratios. See ratios nurses stopping, 333
4 1 4
• Index
Snyder, Zack, 130 St. Elsewhere, 36

soap operas STEM (science, technology, engineering
learning about a health issue from, 50 and mathematics) careers,
naughty nurses appearing on, 169 nursing as one, 197
social assumptions, about nursing deeply Stepping Hill Hospital, 75
embedded, 305 stereotypes. See also specific stereotypes
social change, described, 349 such as: handmaiden, unskilled,
social contempt, discouraging practicing battle-axe, angel, female,
and potential nurses, 158 gold-digger
social media offensive, multi-pronged, about nursing, 34, 51, 300, 302,
344 310, 348
social power, nurses lacking, 54 of disempowered groups, 160
society, viewing relationship of nurses roots of, 34–37
and physicians, 120, 121f on soap operas, 169
Sojourn Communications, 346 Stevens, Serita, 353, 354
Sonic Nurse, 162, 358 Stevenson, Phillippa, 132
Sonic Youth, 162, 358 Steven Spielberg Presents Animaniacs,
The Sopranos, 253–254 169
Sorenson, Amy, 100 Stojanovic, Milka, 327, 340, 344
South Africa, research in, 119–120 Stokowski, Laura, 352
Southeast Missourian, 208 “street nurse,” work of, 132
Southeast Missouri Hospital, 208 stressful conditions, nurses working in,
Southern Connecticut State 16, 218–219, 225, 257
University, 372–373 Strong Medicine, 37, 142–143, 202,
Southern Poverty Law Center, 171 268–269
The Southern Reporter (Scotland), 335 Strunk, Cathy, 132
South General Hospital, Stockholm, 174 student nurse, using “nursing student”
South Korea, nursing shortage, 20 instead, 304t
Special Delivery Nurse Figurine, 227 sub-Saharan Africa nations, nursing
Speer, Michael, 282 shortage, 20
Spirit Halloween, 171, 256 Sullivan v. Edward Hospital (2004),
spiritual beings, nurses as, 225 Illinois Supreme Court, 124
sponge bath, as sexualized nursing task, Summers, Harry Jacobs, xxiii, 373
xxvi, 156, 166, 176, 245 Summers, Lawrence, 197
Sports Illustrated, 163 Summers, Sandy, xxiii, 13, 45, 154, 297,
Springer Publishing, 354 299, 319, 330, 336, 341–343, 345,
Srungaram, Linda Record, 351 347, 350, 372–373
Stainton, Christine, xxiii Sun (UK), 171
stamps, promoting nursing, 358 Sunday Night Sex Show, 308, 360
Star (South Africa), 132 “Sunday Q&A” feature, 280
Star (Malaysia), 207–208 Sunday Times (UK), 54, 228–229
State House News Service, Boston, 232 Sun Journal, Lewiston, Maine, 145
Index •
415
support staff, ER physician describing affecting conduct greatly, 38

nurses as, 139 affecting popular attitudes about
surgeons health care, xxv
glorified in advertising, 40, 348 conveying a substantial amount of
glorified on Grey’s Anatomy, 77–79, health information, 46
134–137 creating shows about nurses, 309
glorified in M*A*S*H, 246–247 documentaries, conveying nursing
glorified on Miami Medical, 143 autonomy, 130
glorified in news accounts, xxi–xxii, dramas, naughty nurse plot device on,
98–99 166–170
glorified in Terence Wrong’s dramas, reaching a wider audience
documentaries, 32, 97 than news programs, 41
relations with nurses, 53–54, 119, 120 effects on understanding of
Surrey University, 132 nursing, 40–50
Sweet, Victoria, 321 medical dramas, contributing to
Switched at Birth, 205, 273 agenda-setting, 45
Snyder, Zack, 70 nurses using to advance
understanding, 361–362
T nursing authority on, 126–131
TAG Body Spray, 163 nursing skill on, 66–71
Taichung Hospital, 224 physicians, doing nursing work, 29
Take a Loved One to the Doctor Day physicians writing for and
health campaign, 263, 298, 348 advising, 321
name changed to “Take a Loved One presenting nurses as handmaidens,
for a Checkup Day,” 263 134–145
US government reconsiders the name portrayals of nursing, 31–33, 65, 361
of, 342–343 presenting nurses as unskilled, 82–89
Tamil Nadu state government, decision remaining the dominant global
to bar men from the state’s medium, 31
nursing diploma program, 209 Tender Nurse painting, 161
Tanyi, Ruth, 361 The Tennessean, 207
Tarantino, Quentin, 162–163 Testa, Jessica, 45
Tarkan, Laurie, 93 Texas Medical Association, 282
Taste of Life, 43 Thao, Julie, 6, 94
Taylor, Cherie, 76 They Might Be Giants, 358
Taymor, Julie, 172 “Think Different” campaign, 164–165
Teaching Tolerance Campaign, 171 “Think Hatke” (Think Differently)
Teen Mom and sequels, 48 campaign, 164–165
The Telegram, 312 Thompson, Carolyn, 132
Telegraph, 229 3 Wishes Lingerie, 171
television Three Cups of Tea, 337
advertisements. See advertisements Three Rivers, 143
4 1 6
• Index
Tickle media company, 226 “I Am Your Registered Nurse”

Timberlake, Justin, 360 poster, 313
Time Inc., 175 interacting with media and public
Time magazine, 99, 101, 227 through the Internet, 355
Time of Death documentary series, 130 letter-writing campaigns, 335–349
Times (UK), 228, 230 media analyses and campaigns
Times of India, 119, 209 online, xxix
Times of London, 156 “Nursing. Isn’t That Sweet?!” video on
TNT television, xxii, xxviii, 31, 33, 70, YouTube, 360
90, 206, 250 organizing chapters of, 349–350
Today show, 284, 330 recruitment webpage and
Tolley, Shona, 76 materials, 330
Tooth and Claw story collection, 256 statement on role of nursing, 335
Toronto Star, 132 website, xxiv, 355
touching, focus on, xxvii, 217–218, Tubman, Harriet, 358
233–234 Tugend, Alina, 87
toys, teaching about nursing, 359 Turow, Joseph, 35, 38, 40–42, 46
transitional care nurses, work of, 278 TV Guide, 31, 44, 49, 169, 192, 270
transnational migration. See 20/20 current affairs show, 100
migration “20 X 20 Choose Nursing
Trant, Kate, 353 Campaign,” 198
travel nursing, 32, 168, 205, 24 Hours in A&E, 33, 70, 130, 268,
triage 274–275, 361
errors, 146 24 Hours in the ER. See 24 Hours in A&E
physician directing, 138–139, 146 “Two Cups: The Healing Power of
physicians performing this nursing Tea,” 5
role, 25 Tykwer, Tom, 254
surgeon acting as triage nurse, 90
telling patients to lie to the nurse, 86, 351 U
value of, xvi, 7, 13, 99 UCLA, 223
“Tribute to Nurses,” New York Times, Uganda, challenges of nursing in, 225
217, 224 “unconscious screeners,” biased, 66
“Tribute to Nurses,” Rattle, 237 understaffing. See short-staffing of nurses
Trudeau, Garry, 72, 208 undervaluation of nursing, 12, 39, 53,
True Colours, 132 187, 188, 298, 328, 345
Trump, Elizabeth Scanlon, 71 Underwood, Anne, 76
Truth About Nursing, xxiii uniforms, for nurses, 313, 318, 330–331.
about, xxiii–xxiv, 372 See also costumes
analysis of top seventeen US hospitals, United Arab Emirates, increasing the
299, 312, 355a number of men in nursing in, 209
awards, 273, 338 United Nations health development
bumper stickers, 328 goals, 233
Index •
417
United Press International, 98, 132 US Department of Health and Human

universal health coverage, 98, 342 Services (HHS), 263, 342
University College Dublin (Ireland), 47 US Department of Labor, 12
University of Alabama at Birmingham, US Department of Transportation, 92
199, 238, 359 Usher, Susan, 353
University of Alberta, 49 US National Association of Clinical
University of California, Los Nurse Specialists, 264–265
Angeles, 223 US National Association of Pediatric
University of California, San Nurse Practitioners, 333
Francisco, 71, 131 U.S. News & World Report, 285, 299, 312
University of Central Florida, 285 US Postal Service, stamps honoring
University of Colorado, 264 nurses, 358
University of Dundee (Scotland), 47 US Vietnam Women’s Memorial, 357
University of Granada (Spain), 160
University of Kansas, 336 V
University of Maryland Shock Trauma Valley Health Services, of Herkimer, NY,
Center, 71 312
University of Michigan, 235 Van Dusen, Allison, 45
University of Minnesota, 10 Variety, 230
University of Missouri, 154 Vemer, Hans, 346
University of North Dakota, 359 video games
University of Pennsylvania, 11, 75, designing to educate kids about
278, 357 nursing, 359
University of Phoenix, 310 naughty-axe, 170, 247, 257–258
University of Southern California, 42, wrestling games featuring nurses,
49, 72 257–258, 359
University of Texas, 233, 280 videos
University of Western Sydney, 49, 189 American Medical Informatics
University of Wisconsin, 322 Association nurse interviews, 11
unlicensed caregivers, 13. See also Craig Barton rap, 238
nursing assistants creating and making available to the
unplanned content, 38 world, 359–360
“The Unreal World,” Los Angeles Times educating the public about nursing,
column, 336 320, 322, 350, 356, 359–360
“Up Out My Face” video, 172 games. See video games
urban communities, improving health of Johnson & Johnson, 19, 234
underserved, 11 Julie Thao on health care errors, 6
urban trauma centers, forensic nurses “Dr. Lung Love,” Lung Cancer
taking the lead, 76 Alliance, 165–166, 344–345
US Agency for Health Care Research music. See music videos
and Quality, 266 naughty-axe stereotype, 170, 247,
USA Today, 207 257–258, 359
4 1 8
• Index
videos (cont.) Wagner, Leslie, 187

“Nursing, Isn’t That Sweet?!,” Truth waiting list, for nursing school, 190
About Nursing, 360 The Waiting Room, 101
recruiting, 234, 360 Wald, Lillian, 10, 307
“VidLit” (literature-based flash Wales, nursing uniforms, 318, 331
animation), 360 wallpaper nurses
YouTube study on stereotypes, 47 on ER, 90, 251
The View, 133 on Grey’s Anatomy, 82
Viki, Tendayi, 160 on Private Practice, 82
Villegas, Andrew, 281 Wall Street Journal, 72, 92, 94, 131, 276,
violence. See also abuse, aggression, sexual 279, 285, 352
assault Wall Street protests, taxing to fund
against nurses, 92, 155 health care, 342
emergency nurses many times more Walmart, 261, 311, 348
likely to be the victims of, 251 wannabe physician stereotype, 31, 82,
media coverage of on-the-job, 232 203, 267, 270–271
not being reported, 54, 155 Ward, Cynthia, 132
nurses committing, 251, 258, 336 Ward, Jim, 176, 347
nurses most at risk for in a hospital Washington Post, 53, 103, 281, 293,
setting, 7 342, 351
as part of the job, 7, 54 Washington Post Magazine, 279
reducing violence against women, 11, 38 WAtoday website, 283
tolerance for, increasing after listening Wawatay News, in Ontario, 351
to sexist jokes, 160 Wayne State University, 228
video games showing nurses WBAI, New York, 308, 360
committing, 258 WBUR, Boston National Public Radio
Virgin Mobile affiliate, 30
The Catch campaign, 165 Weaver, Roslyn, 47, 198
Think Hatke campaign, 164–165 Weaving, Hugo, 255
virtue script, 8, 219, 228, 230 Weinberg, Dana Beth, 13, 125
virtuous nurse, no complaints from, “Well” blog, 76, 306
xxvii, 35, 217, 223–224, 227 Welner, Michael, 231
visual displays, developing effective, 357 “We’re Bringing Nursing Back,” 360
Vitale, Dick, 164 Western Carolina University, 160
vital sign machines, often not to be wet nursing, finding different term to
trusted, 13 mean breastfeeding, 304t
Vlahov, David, 71–72, 131 What Nurses Know and Doctors Don’t
Vogue, 282 Have Time to Tell You, 353
Voice of America, 45 What to Do When Your Child Gets Sick, 353
whistleblower
W legislation, 17
wages, of different jobs changing little media featuring nurses blowing,
over time, 187 14–15, 53
Index •
419
need for legislation, 319, 351 publicizing efforts to improve,

nurse who exposed colleagues for 314–315
refusal to treat homeless man, 53 short-staffed. See short-staffing of
nurses who blew the whistle, 7, 53, nurses
120, 231, 351 violent. See violence, abuse
NPR piece on staffing, 15 workplace sociologists, views of nursing
Paul Duke’s piece in Newsweek, 14 autonomy, 125
Reader’s Digest article, 14 World Smokefree Day, 333
White, Jack, xxiv, 173, 341 World War II, nursing in films about, 35,
White, Mary, 228 131, 191
White Stripes, 173, 341 wrestling video games, featuring nurses.
Whitman, Walt, 10 See video games
Whitney, 167–168, 252–253 Wright, Joe, 131, 191
Will & Grace, 168 Writers Guild of America, 43–44
Williams, Angel, 169 writing, about nursing, 350–357
Williams, Greg, 358 Wrong, Terence, 32, 96
Williams, Kristine, 336 WTVR (Richmond, Virginia), 279
Wilson, Brenda, 86 WWE SmackDown! vs. Raw 2006, 257
Wilson, Diane, 310–311
Winslow, Elizabeth, 337 X
Wis10 website, 102 The X-Files, 254
Wit, 131 Xtranormal software, 360
Wolters Klower company, 305 “XXL” musical video, 173
Women’s Museum, Dallas, 187
“women’s work,” 186–216 Y
nursing seen as, 186–188, 198, 205 Yahia, Taqwa Omer, 66
traditional, 196 Yale University, 10, 48
undervaluation of, 187 Young, Neil, 174
view of nursing as inconsequential, 187 Young, Saundra, xxi
Wood, Tony, xxi A Young Doctor’s Notebook, 158, 191
Wookey, Melissa, 159 You’re an Angel nurse figurine, 227
words and phrases, reinforcing damaging YouTube website. See also videos
assumptions about nursing, 302, stereotyping nurses as stupid and/or
303t–305t sex objects, 47
working conditions of nurses, 11–12, 104, videos posted on, 359
120, 195, 198, 218, 230, 236, 258, Yuen, Laura, 278
329–330
abusive. See abuse Z
conflicts, xxviii, 41 Zavuga, Robert, 188
efforts to improve, 16–20, 218–221, Zelixon, Julia, 72
329–330, 342 Zimbabwean nurses, brain drain of, 20
mandatory overtime, 18, 196, 219, Zuger, Abigail, 87
319, 358 Zulu, Xoliswa, 87

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S AV I N G L I V E S

Sandy Summers, RN, MSN, MPH

Harry Jacobs Summers

Oxford New York

Oxford is a registered trademark of Oxford University Press

Published in the United States of America by

© Sandy Summers and Harry Jacobs Summers, 2015

All rights reserved. No part of this publication may be reproduced, stored in

You must not circulate this work in any other form

Library of Congress Cataloging-in-Publication Data

But another illustration is wasted

What some take for magic at first glance

Aimee Mann and Clayton Scoble

PART ONE: Dangerous Ignorance: Why Our Understanding of

1. Who Are Nurses and Where Have They Gone? 3

PART T WO : The Great Divide: The Media versus Real Nursing

3. Could Monkeys Be Nurses? 65

“No One Wants to Hear from a Nurse”: The Nurse as Media

“Nurse, Hand Me My Laptop”: Media Portrayals of the Nurse as

Promiscuous Girls 230

PART THREE: Seeking Better Understanding of Nursing—and Better

10. How We Can All Improve Understanding of Nursing 297

But Aren’t Hollywood’s Current Nurse Advisers Enough? 309

Equal Rights for Equal Work 334

About the Truth About Nursing 373

nursing stereotypes, such as a global Skechers campaign featuring Christina

nursing. Many popular Hollywood hospital shows of recent years, particu-

As we discuss in Chapter 9, advanced practice registered nurses (APRNs)

take rigorous examinations to secure the government licenses they need to

What exactly do all these nurses do?

• Nurses identify and address life-threatening infections.

Real nursing is exciting. That’s why major hospital shows on television,

A Few Notes on Nursing History

care to wounded British soldiers near Constantinople. She soon became

Figure 1.1 How Nurses Save Lives.

graduate-prepared clinical nurse specialists began providing clinical leadership

The Nursing Shortage

effect on patient outcomes—literally killing millions of people every year.

(2008) by Suzanne Gordon, John Buchanan, and Tanya Bretherton;

of denursification in hospitals. Most hospitals need many more nurses than

In May 2012, National Public Radio reported that understaffing remained

systems in poor nations. In a June 2007 article in Health Services Research,

as provide whistleblower protections to nurses. However, passage remains

National Association of Clinical Nurse Specialists, “Clinical Nurse Specialist”

Nurse” (August 5, 2012), http://tinyurl.com/pmfs55o; TAN, “Angels on Earth”

99. Department of Health and Human Services, National Institutes of Health,

In 2007 a friend of ours got a telephone call. Producers of a popular

The entertainment media is even more troubling. It’s true that

included many valuable illustrations of nurses’ clinical virtuosity and patient

Virtue and Vice: Some Roots of Nursing’s Media Stereotypes

nurses became a staple of pornography and exploitation films by B-movie

Does What’s in Our Brains Matter? How the Media

Come on. Even if the media ignores nursing or presents it inaccurately,

television drama, sitcom, or commercial affect people that way? People

Certainly TV dramas reach a much wider audience than most news

that, hospital dramas represent an important part of viewers’ curricu-

Fine, I get that public health and communications scholars, physicians,

A 2008 University of Dundee (Scotland) study found that media imagery

University of Western Sydney found that about 94 percent of 386 medical

right after exposure to the disease following an ER episode dealing with

mpdgzfv; CFNA, “Startling Discoveries,” TAN (March 14, 2007), http://tinyurl.