The global media's relentless linking of sexual images to the profession of nursing reinforces long-standing stereotypes. Even though those images are often "jokes" or "fantasies," the stereotypes they promote discourage practicing and potential nurses, foster sexual abuse in the workplace, and contribute to a general atmosphere of disrespect. Even humor and fantasy images affect how people act. That's why advertisers spend billions on them. Desexualizing the nursing image is a key part of building the strength the profession needs to overcome the current shortage, which is taking lives worldwide, and to meet the challenges of modern health care.
Most people probably don't think the average nurse goes to work in lingerie, looking for sex. But the fusing of lingerie with nurses' work uniforms in popular media images, and the exposure of sexy "nurses'" bodies in these images, still associates the profession with sex in the public mind. One recent U.K. study found nursing was the most sexually fantasized-about job. And suggesting that nurses are primarily sex objects in turn conveys the idea that nursing work consists of satisfying the sexual needs of patients and/or physicians, or at best, that nursing is so unimportant that nurses have the time and energy to focus on sex while supposedly caring for patients. Some people may just regard nurses as being more sexually available than average. We're not kidding.
Other people may simply see nurses as looking to meet a physician--even an already married one--to take them away from the dead end job of nursing, a stereotype that was actually expressed in late 2004 by Dr. Phil McGraw on his popular television show. When a profession is associated with sex, there is no bright line between "sex" and "romance." This association may be subtly reinforced even in relatively sophisticated products like "ER," which would be unlikely to present a blatant "naughty nurse" image, but in which the lone major nurse character often spends most of her time managing romances with physicians. Thus, even members of the public who don't think nurses actually have sex at work may be influenced to believe that looking for romance is a big part, if not the biggest part, of why they are at work. That is not a feature that is generally associated with serious professionals.
Naughty nurse and other stereotypical images add to the chronic underfunding of nursing research, education and clinical practice. This is because health care 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 consciousness. Such images discourage talented men and women from entering and remaining in the profession. When you combine this lack of respect, the intense college-level training nursing actually requires, and the difficulty and stress of nursing practice, it is no surprise that the profession remains in the midst of a global shortage driven by rampant short-staffing.
Many who display stereotypical images of nurses doubt that such images can really harm the nursing profession. However, as public health professionals at the University of Southern California's Hollywood Health and Society project and elsewhere can attest, popular media items clearly do affect how people think and act with regard to health issues. For instance, a 2000 JWT Communications study found that US youngsters in primary and secondary school got their most striking impression of nursing from the fictional television show "ER," and consistent with that show's physician-centric messages, the youngsters found nursing to be a technical field "like shop," a job reserved for "girls" and one too lowly for private school students. Nursing is none of these things. In addition, a Kaiser Family Foundation study found that "ER"'s message is so influential that one-third of the show's viewers use information from the show to make health care decisions.
So what's wrong with being perceived as sexy? Nothing--as long as that's not your dominant image in the workplace. Recent research suggests that more sexualized work attire actually lessens respect for female workers in responsible jobs like management, causing others to see them as less competent and intelligent. Of course, the naughty nurse image seems to have little to do with a belief that real nurses are sexy, and perhaps more to do with a desire to have anonymous sex with hotties dressed in lingerie-like "nurse" uniforms. It may be diverting for some to think that nursing is populated by disposable bimbos, which may also help them handle the idea that female nurses have some power over them in clinical settings.
But the disposable bimbo image does not appeal to most career seekers. Nursing remains over 90% female. Of course this sexualized female image is not the only reason, but it is part of an overwhelming social understanding of nursing as "submissive" and "female." This is the difference between sexual images of female nurses and, say, female FBI agents. The FBI is not in crisis because it does intensely demanding mental and physical work that few people really respect, in large part because of the idea that its agents are brainless handmaidens and bimbos. Nursing is.
Of course, it may be hard to see how one apparently minor "naughty nurse" depiction can affect the real world. But each such image is part of a wave of images from the global entertainment, advertising, hospitality, and apparel industries, from Fortune 500 companies to isolated sandwich shops, suggesting nursing is about hot females bestowing sexual favors. In the aggregate, it's just common sense that decades of this kind of broad societal disrespect will have an impact, and will be a factor in people avoiding and leaving that profession. Of course, it's not the only factor; the handmaiden stereotype is probably more damaging because it's more credible and widespread, and nursing would be a difficult, stressful job even if it was well understood.
Some argue that nursing's poor public image has nothing to do with the nursing crisis, because it's really all about poor working conditions and inadequate faculty resources. But that's like arguing that cancer death has nothing to do with cigarettes, because it's really all about cancer. Many things cause cancer, but cigarettes are one of them. For nursing, the lack of resources was not handed down from some divine place. It was the result of human decisions. Those decisions were made on the basis of what the decision-makers (government, hospital executives, the public) thought about how important nursing was relative to other things they might do with the resources available.
It's also common to see suggestions that objections to the constant association of nursing with sex indicate prudishness or a lack of humor. But the Center has never objected to sexual images generally--only to the use of nursing as a marker for dim, submissive, sexually available females. So this is not about whether sexual images degrade all women, but about their frequent application to a specific professional group. And the suggestion is not just that nurses are silly ***** (ha ha! just joking!), but that their job is about that. Research shows that nurses suffer an inordinate amount of sexual and other abuse at work (see AP
articles). Although it's difficult to prove the extent to which that is caused by naughty nurse stereotyping, that doesn't require that we ignore what would be the obvious results--if a profession is an object of sexual mockery and contempt, it's going to encourage sexual abuse, and the profession is unlikely to receive the human or material resources it needs. If a profession is constantly associated with female sexuality, it's not going to attract and retain many men.
We assume few skeptics would require extensive evidence of ill effects if the media stopped "jokingly" suggesting that nurses were giggling bimbos, and started in on the female family members of the skeptics themselves. Even if the media barrage was "silly" (ha ha! just joking!), would the women in that family be taken as seriously in doing high-stress, life-and-death jobs with extensive public contact? Would they get all the resources they needed? Wouldn't they get more than their share of sexual abuse? Wouldn't they sometimes wish they weren't part of the family? Sure, those close to them might know there was no truth to the media image. But it's not like most in society would know them to be serious professionals. Most would just know what they heard in the media--that the women in that family were kind of a bad sex joke.
The Center takes no position on the prevalence of sexual imagery in modern society. But we do object to the close association of that imagery with a traditionally female profession that must now fight through a critical shortage to keep millions of patients alive and on the road to recovery. In many cases, stereotypes do not simply go away of their own accord--they must be confronted and rejected. And the "naughty nurse" has proven its staying power for decades.
Of course, we realize that sexual fantasies do not go away simply because images become less prevalent, and that deep-seated sexual desires are presumably not subject to anyone's control. Some aspects of current human sexuality may be practically unchangeable, perhaps because they have a strong evolutionary basis, or for some other reason. But we doubt that something as culturally and temporally specific as the "naughty nurse" image of recent decades is biologically predetermined or immutable, at least on a society-wide basis. It seems to us that the image is largely the result of specific cultural information, though it may incorporate some broader elements, such as the eroticism of apparent innocence. What is seen as "sexy" may vary in different contemporary communities, and we're not sure all of them have a special thing for the naughty nurse. And some aspects of human attraction may evolve over time, perhaps in response to changes in the perceived needs of the species. For instance, common standards of human beauty do not appear to be the same today as in past centuries. We think it would be in humanity's long-term interest to start considering new ways to think about nurses.
One could also argue that the work of nurses is so intimate that it will always be subject to some level of sexual fantasy. But the jobs of others that are now subject to this kind of stereotyping (such as flight attendants) do not involve intimate contact. Instead, the common theme seems to be that they are traditionally female jobs that are seen--we said seen--to involve simple personal service. On the other hand, traditionally male professions that may involve intimate contact and/or personal service do not seem to suffer in the same way. People may imagine physicians sexually, but they are not generally presented with revealing images of physicians as silly and available. On the contrary, physicians are often seen as perhaps the ultimate marital prize, and it is hard to imagine the profession suffering from this kind of image in terms of recruiting, retention, or resources.
At ground level, the devaluation of nursing translates into an underpowered 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 to survive with a life-threatening condition. It's time for her to change into something a little more comfortable.