The Truth About Nursing

The new Netflix series “Ratched” will reportedly be an origin story based on the archetypal battle-axe nurse character from the film One Flew Over the Cuckoo’s Nest. Unfortunately, the Nurse Ratched character embodies the battle-axe stereotype of nursing, the idea that any female nurse in authority must be a repressed maternal tyrant bent on torturing patients and emasculating innocent, freedom-loving men. This misogynous portrayal, which links female power with insidious oppression, has spawned countless copies and variations in ensuing decades. The battle-axe and other media stereotypes have played a key role in the global nursing shortage that takes countless lives every year, especially through under-staffing; the world needs millions more nurses than it has been willing to pay for. In fact, nurses as a class are not sociopathic monsters, but college-educated science professionals of all genders who monitor, evaluate, educate, advocate for, and save patients. Research shows that having too few nurses increases patient mortality--and that popular media stereotypes play a role in undermining nurses' claims to respect and resources. It’s critical to ask those involved with “Ratched” to avoid reinforcing a devastating stereotype, and if the show happens, to introduce some nuance in the title character and feature other nurse characters with some of the positive traits of real nurses, such as expertise, courage, decency, and a healthy sexuality. Thank you!

The Registered Nurses Association of Ontario (RNAO) has told the media that London Health Sciences Centre fired chief nursing officer Vanessa Burkoski, RN, MScN, NP, DHA, because of her role as president of RNAO, which had recently issued a report criticizing denursification at the province’s hospitals. The June 2016 article "An Ontario nursing group contends Vanessa Burkoski was fired to silence her about changes affecting patient safety,” includes an account by Dr. Burkoski in which the large hospital's CEO Murray Glendining repeatedly offered her a cash settlement to resign quietly, which she declined to do.  In the article, RNAO chief executive Doris Grinspun reportedly says that the “boss of London’s largest hospital has sacked his chief nurse to stop her from speaking out against changes that put patients across Ontario in harm’s  way.” The article explains that according to Grinspun, Glendining fired Burkoski not for her work at the hospital, “where she received stellar reviews,” but because she was the RNAO president in May 2016 when it “produced a report that exposed how Ontario hospitals had harmed patients by replacing registered nurses with cheaper and less educated health care workers.” Grinspun says that other Ontario hospital leaders have tried to silence chief nurses who raised this kind of concern, and “patients suffer the consequences because chief nurses are the safety valves.” The Windsor Star quotes Burkoski as saying that no other RNAO President has ever been fired for serving in that role in its 90-year history. “As CNEs (chief nurse executives) we can’t become shrinking violets when our bosses intimidate us or threaten us, because it’s dangerous for patient care and patient outcomes,” she reportedly said.  Please encourage Ontario Health Minister Eric Hoskins to investigate this apparent termination and its effect on patient safety.

On September 14, 2016, soccer star Abby Wambach discussed Title IX on National Public Radio's Fresh Air. Ms. Wambach asserted that the historic legislation was not intended mainly to strengthen women's sports, but instead "there was a ton of women who wanted to become doctors, they didn't want to just be a nurse.” Neither Wambach nor Fresh Air host Terry Gross gave any indication that they disagreed with the assumptions underlying that description: that medicine is a much more important, substantial profession than nursing, and so any ambitious modern female would naturally choose to be a physician rather than a nurse. Even if this was in fact the way Title IX supporters thought, presenting such views with no apparent distance tends to reinforce them because they are still so commonly held. By contrast, Wambach does not describe ignorant views of gender equality without any indication of whether she agrees--instead, she expresses strong disagreement. We realize many feminists assume that jobs to which women were traditionally confined must be less valuable and desirable than the ones dominated by men, and nowhere is this more striking than with nursing and medicine. But as applied to nursing, these views are very damaging, because they contribute to the undervaluation and underfunding of the profession that is costing lives worldwide. Nurses are autonomous professionals who use (or try to use) their college science degrees to save lives and improve outcomes in a wide range of settings. Nursing is just as important as medicine. In fact, many nurses are "doctors"--of nursing. Of course women should be able to pursue any field they wish on an equal basis. But the failure to recognize the value of the traditionally female field of nursing is especially ironic in a discussion of gender equality. And NPR's Fresh Air claims to reach more than 5 million listeners weekly.  Please join us in urging Abby Wambach, Terry Gross, and NPR to clarify whether they agree with the uninformed views about nursing that the September 14 comments reflect, and if not, to take steps to address the damage caused by the unquestioned presentation of those views to Fresh Air's listeners. Thank you!

Memorial Heights Emergency Center in Houston posted a billboard portraying nurses as eye candy in its quest to lure patients to its outpatient facility--one owned by physician Akash Bhagat, who thinks so little of nurses as professionals that he boasted on a radio program that his facility refused to hire nurse practitioners because they are trained "at a different level." 

  In the episode of Disney's Lab Rats broadcast on August 5, 2013 (“Bionic Showdown”), inventor Donald Davenport mocks his brother Doug by noting that Doug has turned into “Dr. Evil,” “or should I say Nurse Practitioner Evil, since you flunked out of med school!” That is a baseless and damaging message about nurse practitioners because research shows that even jokes affect what people think and that advanced practice nurses provide care that is at least as good as physician care.

People have the right to show the public the kind of conduct we see on Scrubbing In. But when that conduct is so closely associated with nursing, it can be troubling, because of the profession's poor image. Nursing has endured decades of negative media images, including the enduring ideas that nurses are unskilled and sexually available. These stereotypes form the foundation of the disrespect and underfunding that has led to the global nursing shortage, which kills millions of people every year. And because of nursing's poor image, it matters which nurses are chosen to appear on a show like Scrubbing In and what they are seen to be doing on the show. We cannot assume that the public, particularly the impressionable young MTV demographic, will know that there are millions of highly qualified professional nurses out there regardless of what appears on this show. So the show is a public health problem.