Anatomy of the Image of the Nurse:
Dissonant and Ideal Models*

Beatrice J. Kalisch, Ed.D., R.N., F.A.A.N., and
Philip A. Kalisch, Ph.D.

All professions, including nursing, rest on a cultural base. Berger and
Luckman argue that the sociology of knowledge concerns itself more with
common sense than with theoretical abstractions.3 Everyone must exist
within some kind of structure, some kind of ordered world, and so people
create a "reality" for themselves about nurses and nursing which is based on
things they "know," regardless of the ultimate validity or inaccurateness of
their "knowledge." The cultural lag implicit in current public 'knowledge"
about nursing will exist until, and unless, it is directly challenged by new
"knowledge." For example, the generally accepted "knowledge" of male/
female interaction of the 1950s has become unacceptable to the culture of
the 1980s; a new "knowledge" has replaced the old, perhaps only substitut-
ing one set of stereotypes for another, but definitely altering the tone.

Socialization, the process of learning basic values and orientations that
prepare individuals to fit into their cultural milieu, contributes to the
cognitive system a collection of interrelated items of knowledge and beliefs
about the profession of nursing. A predominant consistency between the
knowledge, ideas, and beliefs about nurses and the actual role, work, and
nature of nursing yield an ideal or consonant image. The absence of such
consistency and the ensuing internal contradictions provide a cognitively
dissonant image of nursing. When this theoretical model is applied to a
perceived incongruity between a person's attitudes and his or her behavior,
there is evidence that people tend to reduce such dissonance by making ap-
propriate changes in their attitudes and beliefs.2

The mass media are instrumental in the image formation process.
Originally, mass media research did not put much stress on the socialization
function, because it was thought that this was primarily performed by
parents and the schools. Studies conducted in the 1970s finally put the
spotlight on the media as a primary factor in socialization, showing that a

Beatrice Kalisch is Titus Distinguished Professor of Nursing and chairperson, Parent-Child
Nursing, School of Nursing, University of Michigan. Ann Arbor. Philip Kalisch is interim
director, Center for Nursing Research, and professor of history, politics, and economics of
nursing. School of Nursing. University of Michigan, Ann Arbor.

*This paper is based partly upon studies supported by research grant NU 00579 from the Divi-
sion of Nursing, Bureau of Health Professions, Health Resources Administration. U.S. Depart-
ment of Health and Human Services. Co-investigators of the image of Nursing in the Mass
Media Project are Beatrice [. Kalisch and Philip A. Kalisch,

. large proportion of information that children acquire about the nature of
their world comes from the mass media. It reaches them either directly
through exposure to the electronic and print media, or indirectly through
mass media exposure of their families, teachers, acquaintances, and peers.
This information presents specific facts as well as general values. The media
indicate the elements which make for power, success, and happiness in
society and provide models for behavior.3

Public opinion polls show that most of the new orientations and beliefs
that adults acquire during their lifetime also are based on information sup-
plied by the mass media.4 People do not necessarily adopt the precise at-
titudes and opinions that may be suggested by the media, but the informa-
tion provides the ingredients they use to adjust their existing attitudes and
opinions to keep pace with a changing world.5 One must therefore credit the
mass media with a sizeable share of continuing socialization and resocializa-
tion about all aspects of life including nurses and nursing.

The media have an enormous impact on the formation of images. Ken-
neth Boulding names the basis for human behavior the "image" in order to
emphasize that it is a subjective knowledge structure, not necessarily reflec-
ting actuality in all of its components. Images are mental representations
that influence how people see allaspects of life, including nurses and nurs-
ing; they help people in achieving tangible goals, making judgments, and
expressing themselves. Public images are the basic bond of any society and
are produced by sharing messages. Persons exchange images between each
other by using symbols in both interpersonal and mass communication. Ac-
cording to Boulding, behavior depends on the image; and in his view,
messages change images, which in turn account for changes in individual
behavior patterns.6

Social construction of reality is a result of the process of image forma-
tion, stimulated by messages transmitted by various forms of communica-
tion. In effect, the entire public perception of truth about nursing is a
paradigm based on a socially created legitimacy. When used as tools for ad-
vancing interests, public images create and reinforce distinctions between
groups. As evaluative standards, public images create and reinforce distinc-
tions in occupational prestige and entitlement to certain scarce resources.
When nurses are constantly portrayed in negatively stereotyped ways, these
images affect their lives and their aspirations as well as delimit the scope of
their work.

Mass media products seethe with myths and heros. They guide deci-
sions, inform perceptions, and provide examples of appropriate behavior.
For example, most Americans' current image of health care owes its origins
to the heroic and self-perpetuating media messages about the miracles of
modern medicine of the 1930s and 1940s, in which any health problem
could be cured if only the victim could get the assistance of "doctors" at
some place like the Mayo Clinic. This general belief was reinforced by the
miracles of medical intervention; broken bones were mended, eyesight



restored, infections cured, and miraculous surgery performed. Nurses,
however, are well aware (even though the public is not) that rates of mor-
bidity and mortality have little relationship to the quality and quantity of
the amount spent on health care. Life expectancy is not the longest in the
country with the most advanced bio-medical research or even in the coun-
try with the greatest per capita expenditures on health care. Instead, a grow-
ing part of the health care community has come to conclude that general
health, morbidity rates, and life expectancy are more influenced by genetic
heritage, life style habits, and environmental factors, which receive far
fewer dollars.

We initiated the study of the image of the nurse in the mass media in
search of the evolving social perception of the nurse and the accompanying
symbolic system that expresses the implicit concepts of what nursing means.
We have regarded the products of mass media as cultural indicators of the
commonly accepted themes, symbols, concepts, styles, and sentiments
associated with nursing in the mass society of the past century. In in-
vestigating the treatment of the nurse within the context of mass culture, the
concept of genre provided the best point of departure. It refers to a central
organizing conceptual category by which all media representations of a
similar form, type, structure, function, kind, or style may be grouped for
comparison, contrast, evaluation, or study. The generic mass media trad-
tion of nursing, therefore, consists of all those media products which
display conventions, themes, motifs, stereotypes, or archetypes pertaining
to nurses and their work. The resultant study of the meaning of the various
images within the social context yields the "iconography of nursing."8

Tracking the somtimes fugitive mass media products of the past cen-
tury and a half that pertain to nursing yielded evidence from the print media
(200 novels, 143 magazine short stories, poems, and articles, and 20,000
newspaper clippings) as well as the newer non-print media (204 motion pic-
tures, 122 radio programs, and 320 television episodes). Both quantitative
and qualitative methods were employed in a content analysis of the data
which facilitated the reduction of this evidence into five dominant image
types that are fundamentally characteristic of the five successive periods of
time—(1) the Angel of Mercy [1854-1919], (2) the Girl Friday [1920-1929],
(3) the Heroine (1930-19451, (4) the Mother [1946-1965], and (5) the Sex Ob-
ject [1966-1982].9 These images epitomize the mode of thought and feeling
about nurses that was inherent in the prevailing mass media entertainment
and information messages of the day and as such constitute the nurse
stereotypes fundamentally characteristic of their particular periods. As
iconographical indicators, these nurse image types fall at several intervals
within the range from "ideal" to "dissonant" and proved to be of varying ef-
fectiveness for their particular eras in molding popular conceptions about
nurses and nursing within their unique cultural milieus.

I. Angel of Mercy, 1854-1919

In the mid-nineteenth century, two opposing conceptions of the nurse
image were epitomized by two media-created "nurses": Satry Gamp, the
alcoholic hag immortalized by Charles Dickens in Martin Chuzzlewit and
Florence Nightingale, the real-life heroine immortalized by newsman
William Howard Russell in his articles in the London Times. Indeed, both
figures contributed to the rapid revision of nursing's public image of the
1850s; Miss Nightingale's service to the profession is self-evident, but the
caricature of Mrs. Gamp helped to clear the way for Nightingale's seminal
contribution to nursing. S. Squire Sprigge, a physician author of Dickens'
own day, noted that:

With regard to the nurses. Dickens . . . helped in a very pronounced
degree to rescue society from the ministration of the hopeless class into
whose hands the calling of nursing was committed. Society owes Dickens
a double debt, for having buried the nurse-hag under indistinguishable
laughter."

Sairy Gamp embodied the nurses of the day who lived and worked in
appalling surroundings; whose work was considered a particularly repug-
nant form of domestic service for which little or no education and special
training were necessary; and whose living was meager indeed. Young ladies
of the middle classes were revolted by the idea of becoming nurses, a reac-
tion easily understood in view of the conditions of the time.

The major transformation in the new image of the nurse was of course
due to the work of Florence Nightingale. No other nurse—perhaps no other
woman—has so quickened the imagination and gratitude of a people as did
Nightingale. Her achievements at Scutari Hospital were astounding, and
her later career, though somewhat less dramatic, was no less innovative or
significant for the fields of nursing, health, and hospital planning. Her effect
upon the profession of nursing was immeasurable; indeed, for decades the
names were, and in many ways still are, synonymous. Nightingale gave to
the nursing profession both an unprecendented degree of public respect and
acceptance and a new and abiding symbol of excellence.

Unsurprisingly, she often found herself a subject for creative artists,
and poets in particular drew inspiration from her work. Most of these poets
wrote specifically of Miss Nightingale; yet her influence was so pervasive
that one invariably finds a close correspondence between the direct poetic
image of Nightingale and the generally more implicit image of nursing. In
1857, American poet Henry Wadsworth Longfellow wrote a personalized
tribute to Nightingale in his well-known poem 'Santa Filomena,' published
in the Atlantic Monthly. Here the poet speaks explicitly of the "lady with a
lamp," and, by identifying her with Saint Filomena, Longfellow makes use
of the popular conception of Nightingale as the "saint of the Crimea."

The poem opens with a statement of the inspiriting and enlightening



quality of "noble" deeds and thoughts. The presence, real or imagined, of
"deeper souls" lifts the spirit from mean notions and superficial cares. This
seraphic imagery is emphasized by the reenactment of a scene which had
been popularized for British readers through a celebrated newspaper ac-
count of Scutari Hospital:

And slow, as in a dream of bliss
The speechless sufferer turns to kiss
Her shadow, as it falls
Upon the darkening walls.

We are told here that she passed like a vision, as if a "door to heaven," left
momentarily ajar, were suddenly shut. Longfellow calls Nightingale "A no-
ble type of good, Heroic womanhood"—a woman fit to carry the symbols
once borne by Saint Filomena: the palm of peace, the lily of Christian love
and mercy, and the spear of courage and determination. Longfellow's sym-
bols of saintliness serve to reiterate the metaphors of nobility, heroism, and
self-sacrifice.11

Modern nursing owes its origins to Florence Nightingale's work and the
attendant "Angel of Mercy" media image which provided an effective ideal
in garnering public support for the first nurse training school at London's
St. Thomas' Hospital in 1859. The Saturday Review of January 21, 1860,
for example, expressed undiluted praise for Nightingale's Notes on Nursing
("it is prevaded by power and wisdom and true goodness"), for her nursing
work (her expedition to Scutari is called "the single bright spot in one of our
gloomiest national reminiscences"), and for Miss Nightingale's character (as
readers are told that Englishmen will always remember "with pride and
gratitude how the exigencies of a great crisis were bravely and successfully
met by her genius, experience, and resolution").11

Nightingale's struggles to define the nursing profession took place
against the background of intense mid-nineteenth century debate over the
position, rights, and potential of women. Victorian women were ex-
emplified by what has been called the cult of 'True Womanhood": this so-
called Victorian code drew upon the almost universal conviction that
women were weaker than men physically, emotionally, and intellectually,
and were dependent on males for social position, security, and direction.
Many a daughter of a Victorian family, however, covertly scorned the
domestic docility of her mother and, in her own quest for freedom and ex-
citement, secretly envied and identified with men. Thus at a time when the
masculine professions were all but closed to women, entry into the profes-
sion of nursing itself represented an attractive step toward emancipation
from the confinement of the domestic sphere and well-intentioned but often
ineffectual "good works."

Once Florence Nightingale brought respectability to the nursing profes-
sion, a new image of the nurse began to appear. Nurses were portrayed as
noble, moral, religious, virginal, ritualistic, and self-sacrificing. A majority

of late 19th century authors contrasted the newer "trained nurse' with the
discredited and older familiar "Sairy Gamp" type of nurse. For example, in
St. Bernard's: The Romance of a Medical Student by Edward Bersoe (1887),
the refined and sensitive nurse heroine is contrasted with a thoroughly igno-
rant and weak-willed nurse who unashamedly persuades her patients into
going through the tortures of amputations and other surgery they do not
need in order to give the medical students the opportunity to practice their
skills. The heroine is depicted by the author as one of those "gentlewomen
who have adopted the noble profession of nursing from the love of God
and their neighbor." Her innate sensibility eventually forces her to leave this
hospital, but she goes on to establish a Nightingale School of Nursing.13

Between the early 1890s and the First World War, the durable but
adaptive nature of the "Angel of Mercy" nurse image was successfully in-
corporated into a major shift in the feminine image of the day. This "New
Woman" was typified by the popular "Gibson Girl," the creation of the ar-
tist Charles Dana Gibson in a series of drawings in Life magazine in the
1890s. That the Gibson Girl was the image of women which captured the
imagination of a generation of Americans is evidenced by the proliferation
of artifacts, plays, and songs which accompanied her popularity in Life
magazine. Staring cooly into the distance, only rarely gazing at her reader
or pictorial admirer, she conveyed a mysterious elegance. Physically, her
presence not only dominated Gibson's drawings, but she literally dwarfed
her male counterparts. Statuesque, long-limbed and long-necked, her
physical bearing conveyed authority; her thrown-back, upright carriage
and lowered eyelids projected power and control over self and others.

Nursing was the only occupation identified with this lofty female ideal
(as based on our visual analysis of several hundred of Gibson's still extant
drawings), attesting to the acceptability of the profession for well-bred
women in a time when women working outside of the home was viewed
negatively and solely for "misfortunates" who did not have a man to take
care of them. Positive imagery surrounding "trained nurses" contributed to
the rapid growth of the profession as the census bureau found that the 1,500
professional nurses of 1880 rose to 4,600 in 1890, climbed to 11,800 in 1900,
and soared to 82,000 in 1910. The characterization of nursing during this
era emphasized the noble, self-sacrificing angel of mercy component of nur-
sing's image and its expression of the quintessence of femininity.

World War I saw the last glorious outpouring of the "Angel of Mercy"
imagery that had persisted as the predominant mold since the time of
Nightingale. The nurse was the envy of all American women as rampant
media-inspired patriotism instilled the desire to play an active role near the
fighting front. Hundreds of society women sought to pressure Congress to
allow them to go overseas to serve as nursing aides at their own expense. In
the media, nurses were consistently presented as noble and heroic. An in-
spirational, saintly, other-worldly aspect of nursing the wounded was seen
in countless portrayals. Tor example, several recruitment posters and

8



magazine covers featured nurses imposing themselves between recumbent,
wounded soldiers and the threatening, robed figure of Death lurking in the
foreground. A typical drawing, inscribed "The Angel of Life in the Valley of
Death," featured an ethereal, illuminated nursing figure standing and poin-
ting the way for a group of fallen soldiers in no-man's land.

Nurse Edith Cavell, executed by a German firing squad on October 12,
1915, became the first popular martyr of World War I. Canonization occur-
red not through the time-consuming Roman curia, but more immediately,
through the press and the several films Hollywood quickly made about her
life and death. Not incidentally, Cavell's media fame created so strong an
impression on the popular imagination that her sacrifice strongly influenced
the many fictional accounts of heroic nurses in war-theme films. In many
ways, the Cavell case reinvigorated the "Angel of Mercy" image with a
heavy dose of "moral purity" symbolism. So powerful was the moral aura
surrounding the work of the nurse that many vamps and other fallen
women characters depicted in the entertainment media of the day regained
their virtue by becoming nurses.

The typical World War I film told of how a young American male
volunteered for service in the war, how his nurse sweetheart joined up to be
near him, and how, fortuitously, the hero was wounded and found by his
sweetheart-nurse who restored him to health. Furthermore, the strong pro-
pagandistic attitudes of filmmakers usually guaranteed that there would be
a few scenes of a brutal and animalistic German officer threatening to rape
the nurse.

In these World War I media portrayals, a model of an "Angel of
Mercy" with new values was depicted. The nursing identification provided
one effective way to mask the novelty of female independence with tradi-
tional female values. These nurse portrayals gave the viewing public the
needed encouragement to accept an expanded sphere of female efforts.
Nurse characters demonstrated, countless times, that women could provide
enormous wartime support and make their own decisions, without jeopar-
dizing the pre-war social arrangements. They prefigured a transformation
that was to take place for American women as a whole. Almost all the nurse
characters came from sheltered, prosperous backgrounds; and the decision
to become a nurse emerged consciously. Perhaps the greatest change in
female standards to be observed in these portrayals was a consistent
devaluation of other women who were providing no useful war service.

II. Girl Friday, 1920-1929

The 1920s proved to be a transitory period in the reshaping of the
public image of the nurse. World War I had made it possible for women to
enter new areas of activity, and 1919 brought the passage of the Woman
Suffrage Amendment in the United States. By 1920 the number of working

women had virtually doubled since the turn of the century so that women
represented more than one-fifth of the total working population. A quest
for private fulfillment, motivated by the new advertising industry and na-
tional prosperity yielded an upheaval in social mores, often called "The
Flapper's Revolution." The shedding of Victorian inhibitions led women to
abandon clothing taboos and proscriptions on social behavior as the female
ideal of the 1920s, popularly known as the "Flapper," wore bobbed hair,
decorative cosmetics, and short-skirted, shapeless clothing. This woman
was so drastically different from her predecessors that she seemed practic-
ally new-born. She was delineated as one who enjoyed all kinds of sports,
who danced regardless of her age, who dieted to maintain the slim figure
currently in fashion, who sometimes smoked cigarettes, and who went to
beauty parlors regularly.

In opposition to much of the Flapper's values, the public image of the
nurse and of nurse training in general suffered considerable deterioration
during the 1920s. From the time of Nightingale up through World War I,
nursing was popularly regarded as a select occupation of noble proportions,
strongly imbued with military-religious traditions and distinctive rituals.
Increasingly, in the twenties, standards in nursing education declined as far
too many hospitals opened and expanded schools, ruthlessly exploited stu-
dent labor as a means of staffing their wards at the lowest possible cost, and
generated a flurry of negative newspaper and magazine articles on the poor
working conditions surrounding nurse training.

Accompanying this deprofessionalization in nursing was the shift in
American social ideology from one that was rural, homogeneous, fun-
damentalist, and traditional in point of view, to one that was urban,
cosmopolitan, heterogeneous, and adventuresome in viewpoint. Nursing
was slow in adapting to the mass ideology and its popular image drifted into
a dissonant state vis-a-vis the new female ideal of the "Flapper."

The dominant public image of the 1920s media nurse was the "Girl Fri-
day" type, a transitory representation that grew out of the interface bet-
ween the variable changes operative in nursing as well as society's moral
climate and values. The emphasis was on the nurse as a reliable working
woman whose career lasted only until her wedding day as her nursing duties
were primarily used to showcase an on the job romance with her future hus-
band. Prince Charming was often her employing physician (as in Sinclair
Lewis' 1926 Pulitzer Prize winning novel Arrowsmith and Mary Roberts
Rinehart's 1924 film version of K—The Unknown) or the son of a million-
naire who happened to be momentarily in need of a nurse, as was true in
such films as The Glorious Fool (1929) and Why Worry? (1923). As work-
ing girl companions, these nurses were single and often emanated from a
lower class background. For the most part, they were faithful, dependent,
cooperative, long suffering, and subservient Girls Friday.

The 1920s, then, saw two female image systems struggle for supremacy
and public adherence. Nursing became the victim, willingly or unwillingly,



of the image molders of an older set of values that had become increasingly
rigid and sour in the face of powerful challenges to their survival as the
dominant, even if ineffectual, communicators to the public. The "Girl Fri-
day" image of the 1920s promoted nurses' professional inequality and
sought easy, optimistic resolutions to any personal or professional pro-
blems their fictions treated. They were subservient, cooperative,
methodical, dedicated, modest, and loyal. But a handful of media products
simultaneously reflected, unconsciously or otherwise, the malaise of this
role along with the untenably narrow boundaries of the handmaiden nurse
role, and also offered a glimpse of a new recommitment to the profession
that was just on the horizon.

III. Heroine, 1930-1945

During the abysmal days of the 1930s, an economic paralysis spread,
snuffing out the jobs of one quarter of the labor force. Despite this low
point in American economic history, the public image of the nurse was in
the process of being elevated to an all time high in the embodiment of the
heroine representation. The mass media recognized nursing as a true profes-
sion which required education and the development of skills and knowledge
for its practice. Nurses were depicted as brave, rational, dedicated, decisive,
humanistic, and autonomous.

The most powerful medium of the 1930s and 1940s was the motion pic-
ture, which held unchallenged sway over the national imagination as 85
million Americans went to 17,000 theatres each week to see the depiction of
things lost or things desired. The positive imagery created-about nursing by
this medium is evidenced by the fact that one of the few nursing films ever
to be nominated for the Academy Award for Best Picture was The White
Parade, a 1934 motion picture based on Rian James' 1932 novel. A reviewer
for the journal Trained Nurse documented the film's effectiveness as both a
work of entertainment and a communicator of accurate information about
nursing:

This interpretation of nursing catches the feeling of altruism so
characteristic of youth and gives it wings in a form that is harnessed to
practical service. Moreover it breaks down the thin wall between comedy
and tragedy that is so present in reality until smiles and tears chase across
the film and the audience feels itself a part of this life within hospital
walls.14

A similarly positive contribution to the heroine image was A.J.
Cronin's popular novel, Vigil in the Night, which was quickly made into a
movie starring Carole Lombard. This motion picture emphasized the vir-
tues of courage, self-sacrifice, dedication, and compassion. Reminiscent of
the scenes of Florence Nightingale in the Crimea, the nurse heroine takes the

initiative of creating a children's isolation ward for victims of a highly con-
tagious and virulent disease against the hospital administrator's wishes.

Stories of such nurse heroines as Florence Nightingale, Edith Cavell,
and Sister Kenney became the subjects of extensive biographical treatment.
For example, in 1936, Kay Francis, then the most popular star under
Warner Brothers contract, played Miss Nightingale in The White Angel.
The audience was brought to a full awareness of the colossal demands
Nightingale and her nurses faced, and how they were successful in sur-
mounting the obstacles that were placed in their way by unappreciate physi-
cians. In The White Angel, a woman and nurse is portrayed as a heroic
crusader who successfully defeats the forces of convention, and the nursing
profession is associated with the highest level of humanitarianism.

Another unique role, the "private duty nurse as a detective," made an
impressive debut in numerous magazine short stories, mystery novels, and
feature films. In film the popular Hollywood actresses of the new decade
who played nurse-detectives were bolder and brassier than the actresses that
had portrayed the movie nurses of the 1920s. Starring as nurse-detectives
were Barbara Stanwyck, Joan Blondell, Ann Sheridan, and Aline Mac-
Mahon, among others. These women were strong-willed, independent
types who used their professional abilities with intelligence.

Two other popular themes which often involved nurse characters in
media of the 1930s were adventure dramas about airplane or ship travel.
Novelists and filmmakers apparently believed that any crisis, danger, or
romance occurring on land would be twice as exciting if it happened in mid-
air or in the middle of an ocean. Hence, for a decade, the creative arts com-
munity presented numerous films, novels, and short stories with titles such
as "Ship's Nurse," "Mercy Plane," "Flight Angel," and "Air Hostess." The
fact that the airlines actually hired graduate nurses to augment the pilot and
copilot as stewardesses in the early years of commercial flying led to a
number of daringly adventurous portrayals of nurses in the media. Most
people in the 1930s audience were unfamiliar with air travel, so it is impor-
tant to consider how these nurse characters must have appeared to the
public at that time. There they were, brave women who not only dared to
go up in those dangerous flying machines but also handled any emergency
that seemed (inevitably) to arise. They delivered babies in mid-air and
assisted at emergency operations. If the pilots were disabled, the nurse
would land the plane safely. Only slightly less heroic were the ships' nurses
who also displayed the same kind of courage, resourcefulness, and romantic
attractiveness as they performed emergency surgery and fought raging
cholera epidemics. Like other 1930s media portrayals, these representations
depicted the nurse as a brave, adventurous, romantic figure, a power for
good and an inspiration to others.

On December 7, 1941, the Japanese bombed Pearl Harbor and attacked
U.S. troops in the Phillipines. The nation mobilized, and as a consequence,
the lifestyles of American women were jolted considerably, largely because

11 12



extensive new employment opportunities opened up for them. Women were
encouraged to fulfill their patriotic duty and enter occupations which before
had been considered for men only. As a result, the female labor force in-
creased 57 percent during the war years, boosting the proportion of women
in the labor force from 25 percent in 1940 to 37 percent in 1945. This in-
crease was greater than that of the previous four decades combined.

The coming of the Second World War and its social effects both inten-
sified the heroic propensities of the nursing profession and subtly altered the
way in which nurses were presented. The popular image of wartime nursing
was markedly less sentimental during World War II than had been the case
in World War I. Recruitment posters pictured nurses in dignified, serious
poses, wearing the much admired uniforms of their profession and the
military service. Striking recruitment posters such as one featuring a young
nurse in a fatigue uniform with a rifle and I.V. bottle in the background,
gave clear recognition of the nurses' essential role and proximity to the
fighting front. Publicity given to real life heroism such as that of the nurses
trapped on Bataan and Corregidor brought the public to accept the notion
of active, physically courageous women, standing side-by-side with the
fighting men.

Hollywood accurately captured the sense of the nurse's dangerous
work in several memorable films produced during the war. Most famous
were the star-studded, fictionalized accounts of nurses trapped in the
Philippines. One example is So Proudly We Hail released in 1943, which
starred Claudette Colbert, Paulette Goddard, Veronica Lake, and Barbara
Britton as Army nurses who endured massive military defeat on Bataan and
Corregidor before a last-minute evacuation. The highlights of the film
showcased a group of female nurses adjusting to combat situations with
equanimity, maintaining their own discipline, providing needed leadership
in many situations, and performing feats of physical bravery. The sound of
bombs exploding accompanied all the main action. One nurse saved the
lives of her fellow nurses by carrying a live grenade in her surrender to the
enemy. Another nurse refused to seek shelter during a raid, remaining by
the side of the surgeon during an operation; she was killed by enemy fire.
Yet a third received severe burns when she tried to rescue a friend: with
burned hands she paddled her way out into the bay to take her friend to the
evacuation boat. Through it all, the nurses remained confident and op-
timistic as they took care of their patients.

The same heroic nurse image was broadcast via the newly powerful
medium of radio which during the 1930s and early 1940s, provided the in-
timate, in-home information and entertainment functions now replaced by
the television. One of the most durable programs was NBC's One Man's
Family, a Norman Rockwell creation heard in 28 million homes on
Wednesdays at 8 p.m. The announcer always began by declaring that the
show was "dedicated to the mothers and fathers of the younger generation
and to their bewildering off-spring." Between the time that it went on the air

for the first time in 1932 to the final broadcast twenty-seven years later.
One Man's Family helped idealize the nursing profession by incorporating it
into the lives of two members of the extended Barbour family, one of whom
was a World War II Cadet Nurse who subsequently joined the Army Nurse
Corps. Through such mass media portrayals, the real work and physical
stamina evidenced by military nurses during the Second World War did
reach the consciousness of the American people, and the public found no
difficulty in accepting these women as heroines.

IV. Mother, 1945-1965

Nothing about the late 1940s, the decade of the 1950s, and the early
1960s was more paradoxical than the role women played in it. After sharing
the camaraderie of the fighting services and the hardships of the war on
equal terms, surely women would not go meekly back home to function
solely as wife and mother? But they did, with a fervor that would have
amazed the feminists of their grandmothers' generation. Birth rates soared
and career women sank in prestige to the level of drop-outs in the great
breeding stakes. In the two years following the termination of hostilities,
the number of females in the labor force declined by about two million, or
from 37 percent of all women in 1945 to 32 percent in 1950.

For married women, opportunity meant not working in the
marketplace. Since the family was credited with being the most important
institution in a democratic society, women's caretaking functions were seen
to demand their full attention, offering a pleasurable and important role to
the wife and mother as well as a benefit to the husband-father and an invest-
ment to society. In the early years, the baby boom carried aimo5t all women
before it. The vogue for large families—for third, fourth, even fifth and
sixth babies—spread. Not since before 1914 had such large families been
typical. As a consequence, the United States population increased by
twenty-eight million in ten years, at a rate even raster than India's. The mar-
riage age steadily dropped until half of American brides married by the time
they were twenty. Why was this? Partly because the Happy Housewife
beamed at the world from countless advertisements, looking out of her
gadget-lined nest. But more important was the fact that the social climate
was imbued with a new Puritan ethic, not the work ethic but the breeding
ethic. This was even true for the college educated woman, since the most
important task to which a woman's higher education could be put was, by
wide agreement, raising the next generation. By the mid-fifties more than
half the women at American universities were dropping out of college in
order to marry and help their husbands to get through.

It is interesting to note that unlike the post-World War I era, nursing
remained a high status occupation for women after World War II. The April
1948 issue of the Personnel and Guidance journal rcported a study which



was conducted to determine the social status of twenty-nine women's oc-
cupations. Responses to questionnaires asking what occupation is "most
looked up to," which is second, and so on, were obtained from two groups
of high school students and two groups of college students. The tabulated
results showed that in median rank order the professional nurse was second;
the physician had first place and the teacher, sixth.15

Reinforcing the regressed role of women were the new fashions of the
day. According to fashion publicists, after two decades of the 'American
Look," marked by slim hips, casual appearance, and reasonably short
skirts, Paris couturier Christian Dior brought onto the stage what he
called the "New Look"—the long skirted, hourglass fashion. By the early
1950s, these fashions reached their height in the "baby doll" look. It was
characterized by a cinched-in waist, a full bosom, and long bouffant skirts
held out by crinoline petticoats. Not since the Victorian era had women's
fashions been so confining.

On the popular level, the new emphasis on domesticity was
everywhere apparent. By the end of the 1940s, most female heroines in the
mass media were again happy housewives. Epitomizing society's belief that
women functioned best as sweethearts, sirens, or wives, most female film
stars of the 1950s were sweet, innocent, and characterless, like Debbie
Reynolds and Doris Day. By the mid-1950s, television, which was begin-
ning to beam its message into countless American homes, also portrayed the
woman as a contented homebody, often flighty and irresponsible. The em-
phasis on domesticity was pronounced in long-running, popular television
shows, like "I Love Lucy" and "Father Knows Best."

Nurse characters in most television dramas of the 1950s, while never
intentionally distorted, more often than not were portrayed as sympathetic
as women and dependent as nurses. The qualities lauded almost always
came from the traditional womanly treasurehouse of virtue: good nurses
were maternal, nurturing, sympathetic, passive, expressive, and domestic.
Although occasional references were made to a nurse's education, the actual
nurses depicted exhibited very little knowledge and skill. Nurses were never
portrayed as uneducated or inarticulate, but neither were they admired for
their intellectual competence or professional qualifications. Ann Talbot, of
Dr. Hudson, appeared to be a thoughtful woman, but her value consisted
mainly in her ability to be supportive of the doctor's temperament. Donna
Stone of The Donna Reed Show and Martha Hale of Hennessey
manipulated their menfolk with feminine charm and guile and operated on
emotional reactions rather than objective assessments. The nurse chosen to
personify the profession in Medic's 1955 tribute to nursing exemplified the
importance of self-sacrifice and generosity required of a truly successful
nurse. School nurse Nancy Remington of Mr. Peepers, admirable as a
young woman, was never shown doing any nursing.

As a sin of omission, producers rarely presented real portraits of up-to-
date nursing practice. Lines of authority between nurses never emerged; for

example, on Dr. Hudson, reference was made to a nursing director, but
Hudson himself appeared to make the real decisions regarding the nursing
staff—authorizing transfers, arranging for nurses to quit, disciplining
nurses, etc. Nurse characters always gave up their profession for marriage
and family. The viewer knew that Ann Talbot loved Dr. Hudson and, had
she married him, would have been expected to quit nursing in order to be a
full-time mother to his young daughter Kathy. Even without marriage, she
performed many domestic, motherly functions for Dr. Hudson. Similarly,
Donna Stone had left nursing after marriage, Martha Hale exited the profes-
sion after marrying Chick Hennessey, and marriage spelled the end of
Nancy Remington's career as a school nurse.

The long-suffering "mother" image of the nurse continued to dominate
television images of nursing into the early 1960s. The introduction of Dr.
Kildare and Ben Casey on television in 1961, which began a national craze
for things medical, established certain conventions for health care drama
that have never been successfully challenged. The depiction of nursing in
these shows gave a grossly distorted view of the work of nurses. The nurses
largely carried out menial tasks (e.g., running errands, answering the
phones, delivering messages, and pushing carts), while the physician
characters were shown doing the nursing care (e.g., the administration of
drugs, the monitoring of seriously ill patients, and the provision of
psychosocial support). Miss Wills of Ben Casey personified the typical TV
nurse of the 1960s. She was motherly, expressive, sympathetic, and ever-
ready to do the doctor's bidding. While she performed no skilled nursing
tasks, she did answer the telephone and gave Dr. Casey his messages in a
most maternal manner. She also lent enormous support to Dr. Casey's
brilliant work.

Among the motion pictures appearing between 1946 and 1965 that
strongly equated nurses with the maternal role were such blockbusters as
Jolson Sings Again (1950), With a Song in My Heart (1952), Magnificent
Obsession (1954), Not As a Stranger (1955), South Pacific {1958), Opera-
tion Petticoat (1959), Exodus (1960), and Captain Newman, M.D. (1963).
In all these major features as well as scores of minor films, the dominant
nurse image was that of "mother" to a man, a husband, or children.
Evidence of any professional expertise associated with nursing was almost
non-existent in the American cinema of this era.

An ideal preparation for marriage and motherhood was popularly
ascribed to nursing in the period 1946-1965. For example, among popular
magazines, Hygeia promised in 1947 that ''the girl who is trained as a nurse
has several advantages over girls in other occupations when it comes to con-
tact with the susceptible male."16 The following year the Ladies Home Jour-
nal asked, "Who Has Heard the Nightingale?"" In 1953 and 1954, the Satur-
day Evening Post announced in one major feature story that "Nurses Are
Lucky Girls!," claiming that "nurses have the best chances of marrying" of
any professionals,18 and subsequently ran another story about a maternity

15



nurse entitled "I've Had a Thousand Babies."19 In 1956. Charm told readers
that the "piteous cry of Nurse" brought "to the hospital bedside a trim, effi-
cient, sympathetic woman,"20 A shift in imagery was in the making by 1962
when The Reporter called nurses "Medicines Forgotten Women"21 and In
1965 when Science Newsletter ran an article declaring "More Glamor, Pay,
Glory, Needed to Attract Nurses."22

The "mother" image declined in importance during the mid-1960s.
Women, in general, were sensing as never before that they had capabilities
far greater than were being used entirely in the traditional feminine role, A
major contribution to this development of a modern philosophy of women's
role was The Second Sex by Simone de Beauvoir, first appearing in transla-
tion in the United States in 1952 but belatedly becoming popular in 1961
and 1962. Women were now inspired by her most famous statement, "One
is not born a woman, one becomes one," to conclude that the inferior status
of the "second sex" was not a natural phenomenon but a man-made one.23

Once the contraceptive pill became available and accepted and made any
further baby boom unlikely, years of frustrated and dammed-up feminism
were ready to burst in the new wave of women's liberation.

In 1963, Betty Friedan published The Feminine Mystique, a journalistic
polemic which dealt with "the problem that has no name"; and while it was
not, strictly speaking, a book about liberation and equality, it discussed the
discontent and dead-endism that an increasing number of women were ex-
periencing and started the wheels turning in many women's heads. To Betty
Friedan, the American home, filled with its creature comforts, was a gilded
ghetto, a velvet concentration camp. She wrote: "A baked potato is not as
big as the world, and vacuuming the living room floor—with or without
makeup—is not work that takes enough thought or energy to challenge a
woman's full capacity."24i By 1966 millions of women and thousands of
nurses had been changed by the movement, but nurses seemed left behind in
media accounts of these developments.

V. Sex Object, 1966 to date

As the "mother" image of the nurse declined in the mid-1960s, the
vacuum that it left was filled by the most negative media image since
Charles Dickens' pre-Nightingale character Sairy Gamp—the nurse as a sex
object. In the majority of media portrayals from the mid-1960s to the pre-
sent time, an obsession with nurses' sex lives has dominated ail other
thematic elements and yielded a representation of the nursing profession
which is often blurred and twisted to fit bizarre objectives. In these por-
trayals, nurses are depicted as sensual, romantic, hedonistic, frivolous, ir-
responsible, and promiscuous. And, unfortunately, the more the nurse is
presented as a sex object, the less she is shown being engaged in actual pro-
fessional nursing work.

The primary plot development in these stereotypical depictions has the
nurse becoming emotionally and sexually involved with her patients. A pa-
tient's welfare becomes the nurses private mission, and in the process of
aiding his physical and psychological recovery, she readily becomes his sex-
ual partner. Another common representation involves the portrayal of sex-
ual liaisons between nurses and physicians. These almost always cast the
nurse in a subordinate and usually demeaning role. For instance, in order to
assure that the head nurse will not learn of her medication error, a nurse
agrees to have sex with a young physician; another nurse allows a
psychiatrist to talk her into believing that she is potentially deviant, and
then is seduced by him in the name of a cure.

The nurse as a sex object is the pervasive theme throughout novels and
motion pictures of the period 1966-1982. Even the origins of the most
durable "nurse" of the entertainment media world of the past generation.
Margaret "Hot Lips" Houlihan! originated as a sex object role in the 1968
novel and the 1970 motion picture M*A*S*H. Hawkeye sums up his reac-
tion to the nurse's views when he informs her, patronizingly, that because
of her being a Regular Army Clown, he will not favor her with an invitation
to his bed. To elaborate their distaste for her prudery and military manner
and in an effort to destroy the last of Hot Lips' self-confidence, the physi-
cians stage the humiliating shower scene. The other nurses join in the fun,
sharing the physicians' delight in witnessing the head nurse's downfall. The
attractive nurse found in bed with the commanding officer epitomizes the
concept of what a good nurse should be—sexually attractive and willing to
sacrifice herself to a good cause.

The depiction of nurses as the sexual mascots for the medical team
recurs again and again throughout the period 1966-1982. At the "sexploita-
tion film " level, nursing has been the most frequent occupational identifica-
tion utilized in film titles since the mid-sixties. Of 91 R- and X-rated films
with occupationally linked titles, "nurse" has been used in 21 % of the cases,
followed by wife (16%), hooker/prostitute (12%), cheerleader (8%), and
stewardess (8%). Furthermore, the word "nurse" in the titles of such films as
The Sensuous Nurse (1980), Night Call Nurses (1972), Nurses for Sale
(1977), Head Nurse (1979), and Naughty Nurses (1973) needlessly degrades
the profession's image.

Nurses have also been largely portrayed as sex objects on the television
entertainment programing of the past decade. For example, early episodes
of M * A * S * H featured nurses as off-duty sexual playmates while Operation
Petticoat and Black Sheep Squadron similarly featured military nurses. All
these series emphasized the sexual attractiveness of the nurse characters.
The nurses of Black Sheep Squadron were a gratuitous device designed to
provide sexual interest as they were all shapely and young and seemed out
of place at a front-line air field devoid of medical officers or hospital. Trap-
per John, one of the more successful current series, continues this imagery
with nurse "Ripples." Emphasis on the nurse as a sex object would not be so



damaging to the image of nursing if there were countervailing images of
nurses as true professionals. But the quantity of nurse characters incor-
porated into the mass media products each year has continued to decline in
the late 1970s and early 1980s as female physicians and other women profes-
sionals are now accorded all the glamour and heroic proportions that once
were accorded media nurses.

Unlike the sex object depiction of nurses, the media entertainment roles
accorded other women did improve in the late 1970s and early 1980s. The
films Julia, The Turning Point, An Unmarried Woman, and Norma Rae
opened within twelve months of each other, and the media exultantly dub-
bed it 'The Year of the Woman." A year later the New York Times declared
that after "long neglect, Hollywood is fascinated with women—their
careers, their individual destinies, their relationships with each other, their
passions, and, of course (but no longer exclusively), their relationships with
men." By the early 1980s, even television was portraying a few intelligent
and independent women in other professions, such as public defender Joyce
Davenport on Hill Street Blues.

VI. The Careerist—An Ideal Image of the 1980s and 1990s

The fabrication of a more ideal nurse image of the 1980s, the careerist,
is essential to persuade the public (as well as many nurses) that how things
are is not how they ought to be and that the place provided for nurses in the
media is much less than the place nurses ought to have. Let us accept the
fact that, for better or worse, mass communications about nursing are a
necessary form of social exchange that interact with the environment sup-
porting it. The pragmatic concern of this paper has been with how com-
munication has created nurse images and the values ascribed to these im-
ages. Nurse images are a part of the mind-affected world where values,
meanings, and purposes are realized or made manifest. To the extent that
the mass media serve an agenda-setting function, we are calling for their
conscious employment in effecting a transformation of the image of the
nurse which emphasises equality, commitment to career, and renunciation
of nursing as a physician-dominated occupation demanding an impossible
degree of obedience. Substitution of androgyny for traditional rigid female
imagery in media nurse representations would effectively provide alter-
native role models that would begin to open nursing up as a strong career
option for both sexes.

The image implications of the popular opinion that equates the nurse
with the quintessence of traditional womanhood has come to the fore largely as
the result of the women's movement. A parallel assumption exists that since
women have traditionally been subordinated to men, the principal sign of
the "new woman's" emancipation is entrance into the "male" world of
work. Public support through acceptance of appropriate imagery has

helped promote impressive gains; women in 1981 comprised one-third of
the first year medical students, one-third of all business students, and the
percentage of female engineering graduates has soared from 1 percent to
1970 to 10 in 1981. Meanwhile the number of school of nursing applicants
and graduates continues to decline despite widespread career opportunities.
Before the turn of the century and during the first half of this century, a
woman's decision to become a nurse represented a blow for independence:
but for a woman of today, entrance into the nursing profession is too often
regarded as one more surrender to the narrowing of personal ambition and
an unadventurous acceptance of the stricture of sex role specialization. This
negative effect is due to the perpetuation of the outmoded occupational
stereotype that the ideal nurse is dependent and ineffectual in her attempts
to direct her own destiny. Such stereotypes deter prospective nurses from
entering the field, as well as limiting the aspirations and opportunities
available to professional nurses, since employers, patients, other health care
providers, and nurses themselves are all influenced by media images. The
dearth of viable role models of progressive media nurses serves to
perpetuate the traditional images of nurses as angels of mercy, girls Friday,
mothers, and sex objects while at the same time quietly disposing of
nursing's heroine connotation.

The transition to a careerist nurse image will necessarily be a time of
conflict and contradiction, as well as growth and change. When outmoded
images begin to shatter, both old and new alternatives compete for ascen-
dancy. As millions of women have moved out of the home into the labor
force to comprise a figure of 53 percent of all adult women (up from 31 per-
cent in 1950) and total 43 percent of the total American work force (up from
28 percent in 1950), they have been accompanied by the creation and diffu-
sion of new female imagery. One aspect of that new imagery has been pro-
vided by a host of new magazines. Six of these—New Woman, Savvy, Self,
Spring, Working Mother, and Working Woman—set growth records for
woman's magazines. It took several years to develop appropriate images tor
the new working woman. For example, the first issue of Working Woman
(1976) had not one but nine working women on the cover. How did one
stereotype a working woman? With a steno pad? With coveralls? In a
uniform? Carrying a briefcase? A housewife-type with horn-rimmed
glasses? By the end of the 1970s, however, most of the magazines for work-
ing women had settled on an idealized image of a dauntless, attractive
business executive in a tailored suit, string tie, and feminine-looking brief-
case. Little of this idealized image is appropriate for registered nurses, who
comprise the nation's second largest profession.

We have seen, if only through a glass darkly, the fragmented vision of
five images of American nursing. Most of us who have experienced
socialization as nurses can readily identify parts of ourselves and our social
conditioning in these images. We have all played the Angel of Mercy,' the
"Girl Friday," the "Heroine," the "Mother." and the "Sex Object." We've



been living with definitions of ourselves and assigned cultural roles in which
we have had no hand, yet we have offered amazingly little resistance. Why?
This is the real question. At least part of the answer lies in the self-fulfilling
nature of stereotypes. Research shows us that members of a group which
are stereotyped often subscribe to the stereotype's expectations. Thus
nurses, perhaps on an unconscious level, have contributed to the
maintenance of dysfunctional stereotypes. It is perhaps a commentary,
however, on our lack of professional self-identity and self-esteem that we
have so readily adapted our "selves" to images that are so strongly
derivative of outmoded military, religious, and female ascribed values.
What is needed now is to create a new ideal nurse image for the 1980s and
1990s—the Careerist—an intelligent, logical, progressive, sophisticated,
empathic, and assertive woman or man who is committed to attaining
higher and higher standards of health care for the American public.

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21
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23