Media images and screen representations of nurses

Abstract

The ways that nurses are depicted in the media raise a variety of issues for the profession of nursing. As nurses, we know who we are and what we do in our clinical roles, but when we watch television shows and films, we usually do not see ourselves in the nurse characters on screen. More often, what we do see is an absence where the presence of a nurse should be. Frequently, a physician is depicted on screen doing the work that an RN would do in reality. Other times we might see a stereotyped version of a “nurse” going along with a storyline that reflects a sharply inaccurate portrayal of reality. Likewise, although nurses are rarely depicted in the print or news media, when they are, the message that is cast does not always jibe with the realities of nursing in the 21st century. Stereotypes are easy to invoke, and nurses wonder why a more accurate approach is not embraced by image makers such as writers, journalists, producers, or directors involved with films, television shows, news programs, and the print media. As nurses, we want the public to understand the vital role that nurses play in health care today, so accuracy of portrayals of nursing in media is crucial.Living in Los Angeles, it has not been uncommon for me to meet media professionals of all types as part of daily life including producers, directors, actors, make-up and wardrobe specialists, cinematographers, editors, costume designers, and screenwriters. When I served as a consultant to directors Sergio Arau and Yareli Arizmendi for their film “Day Without a Mexican,” we discussed their creation of scenes that involved a nurse in a hospital. Through this experience and many conversations with various media professionals and artists at parties, picnics, church functions, and even the grocery store, I realized that the media world was a fluid world of ideas and possibilities. However, since my move to Los Angeles in 1998, I have never met a media professional who was aware of the challenging issues related to the representations of nurses in film and television until I informed them. In concert, when I raised the topic with professional nurses, I was usually met with irritation, frustration, and lack of understanding of the media or the creative process involved in depicting nurse characters on screen.These factors led me to propose the idea of a symposium on media and nursing to Dean Courtney Lyder of the UCLA School of Nursing. He immediately gave his enthusiastic support, as did Heidi Crooks, Chief Nursing Officer at the UCLA Health System. The idea was now in motion—we were going to bring together film, media, and nursing experts for a public forum titled “Media Images and Screen Representations of Nurses.” Nothing like this had been done before and we felt that UCLA was the right place for a meeting of this type because of our renowned School of Theater, Film, and Television; School of Nursing; and Medical Center; as well as our proximity, both physically and culturally, to Hollywood. The goal was to identify the core issues and analyze the many factors at play to deepen the dialogue on media images and screen representations of nurses. We wanted to engage screenwriters, filmmakers, and producers. We wanted to raise the sophistication of the discussion among us so nurses could be more informed of the complexity of the situation, the history of the problems, and the potential for analysis and critique. We wanted attendees to become activated, informed, and equipped to increase their readiness to engage peers in the media world when opportunities arose, rather than simply being a critic on the sidelines complaining about how nurses are depicted on screen. Without a vision for what the problem is or how it is propagated, nurses and activists are at a disadvantage when trying to prompt meaningful change. So on May 12, 2011, our symposium became a reality. Participants included clinicians from nursing and medicine, writers, producers, directors, actors, reporters, activists, researchers, scholars, students, working professionals, and administrators.The papers in this volume reflect some of the presentations given at the 2011 UCLA Symposium and/or some of the issues raised. They weave together an understanding of past, present, and future in terms of events that have occurred, problems that require analysis, and predictions to ponder related to media images and screen representations of nurses.In the first paper, media scholar Joe Turow from the University of Pennsylvania, gives us crucial historical background by drawing from his book, Turow, 2010Turow J. Playing Doctor: Television, Storytelling, & Medical Power. University of Michigan Press, Ann Arbor, MI2010Google Scholar, to focus specifically on nursing on television in the United States. Turow leads us back to the 1950s and 1960s to examine how a constellation of factors converged to consistently put white male physicians in leading roles on medical shows that by default left nursing as marginal, secondary if not tertiary, and even unnecessary. We learn how financial, social, cultural, and gendered forces fueled the way that screenwriters, producers, and directors portrayed characters using storylines, plots, and camera angles to emphasize and protect the prowess of physician characters. Turow's careful analysis of rare early attempts to put nursing in the center of television plots gives crucial details about the inner workings of Hollywood decision making as he extends his discussion to more contemporary shows that portray nurses. Through Turow's scholarship, we are challenged to ponder how organizations like the American Medical Association exerted their influence to protect the media image of physicians in the past, with lingering effects today. When Turow turns the lens toward nursing and nursing organizations, we are challenged to consider our role as nurse advocates today.UCLA professor of English and Cinema and Media studies, Kathleen McHugh, continues our focus on television and what she calls a “complex media syndrome” affecting how nurses are portrayed. After analyzing the common stumbling blocks that challenge image makers when creating nurse characters (ie, gender, caring, drama), she considers contemporary shows that feature nurses. Then, taking up an underlying theme that kept surfacing at the 2011 symposium, McHugh deepens her analysis by focusing specifically on Showtime's award winning and controversial show, Nurse Jackie. Within her analysis, McHugh discusses how the complex character of Jackie Peyton defies stereotypes and resists generalization. She then considers television's engagement with an issue near and dear to nursing's core: the issue of “caring” and the politics involved in representing care rendered by nurses on television. The context of America's contemporary focus on health care reform, concerns about insurance coverage nationwide, and worries about the looming nursing shortage.The next paper showcases an interview by Kathleen McHugh with film producer Richard Harding on his upcoming movie, “The Benghazi Six.” Through this interview, we get a glimpse of what motivated this film producer to tackle a project that portrays the life-saving work of nurses. Harding speaks about the riveting true story that forms the basis of the film, how 5 Bulgarian travel nurses and 1 Palestinian physician were wrongly accused of infecting more than 400 children with HIV in Libya and were sentenced to death multiple times. They were tortured by Muammar Ghaddafi's regime and then released in 2007 after 9 years of imprisonment. It is Harding's commitment to social justice that contributed to his goal to create films that document injustice. This award-winning producer explains how his desire to portray the nurses realistically and accurately was deepened by the dialogue at the 2011 UCLA Symposium, showing the significance of the exchange among filmmakers, media scholars, nurses, and activists in particular, nurse activist Sandy Summers, executive director of The Truth About Nursing. Inspired by the interview, Dean Afaf Meleis and her co-author, Caroline Glickman of the University of Pennsylvania School of Nursing, take up the plight of foreign nurses in a commentary that follows. Through these 2 works, we gain insight into international issues of power and powerlessness, grapple with the call to confront injustices faced by nurses worldwide, and witness the value of multidisciplinary dialogue on media and nursing.Continuing the focus on film, Elisabetta Babini, from the Department of Film Studies at the Florence Nightingale School of Nursing and Midwifery, King's College London, analyzes 2 1950s films, one made in Italy and the other in the US. The leading character in each film is a nurse who is also a nun. Babini's cross-cultural analysis of the reception of each film in their respective countries takes into account not only the careers of the leading actresses, Silvana Mangano and Audrey Hepburn, but the public perceptions of nursing, femininity, identity, and Catholicism. Integrating elements of feminist film theory, gender and cultural studies, and the social history of nursing, Babini demonstrates the importance of scholarly analysis to understand aspects of the history of nursing that have rarely been addressed. In this case, Babini addresses media images and melodramatic screen representations of nurses in film across decades and cultures to bring timely insight.Moving to the realm of media images of nurses in advertisements, UCLA nursing professor Linda Sarna and her co-author Stella Bialous from Tobacco Policy International, take up the issue of the historical use of photos of nurses to sell cigarettes from the 1890s to the present day. By analyzing more than 10,000 images of nurses in relation to smoking or cigarettes, Sarna and Bialous provide an example of scholarship that foregrounds how the profit-seeking marketing motives of tobacco companies completely disregarded the values of the nursing profession by creating and using photos that imply full endorsement of cigarette smoking by nurses. Such blatant disregard for the identity of nursing as a health-promoting profession stands as a chilling example of corporate, for-profit motives of industries that value product sales over the ethics and goals of the discipline of nursing.The final presentation at the 2011 UCLA Symposium involved an on-stage interview I moderated with two unique individuals, Theresa Brown and Larry Deutchman. Each made their way into image-making media organizations, where they are facilitating change from the inside out. Here, we learn through Brown, a writer and nurse, how her creative talents and her hard-earned skills as a scholar of English literature and composition equipped her to write about her clinical experiences as a nurse. Her writing has attracted a national audience through her book, Brown, 2010Brown T. Critical care: A new nurse faces death, life, and everything in between. HarperOne, NY2010Google Scholar, and her regular contributions to the New York Times blog, Well, with such notable readers as President Obama. Indeed, she was invited to the White House in 2009, where she heard the President quote from her own blog entry about health care reform and a patient who spent his last days struggling to figure out how he would pay his mounting hospital bills. Other op-ed pieces by Brown are frequently published in the Sunday New York Times. Through Deutchman, the Executive Vice President of Marketing and Industry Relations at Entertainment Industries Council, Inc. (EIC), we are introduced to the principles and policies that have successfully guided EIC to influence writers, producers, and actors on television shows and films to more accurately portray health issues. As “insiders” in Hollywood, EIC has created the acclaimed “PRISM” awards to reward productions that accurately portray health care issues in television episodes. Both Brown and Deutchman inspire us to consider the path to make change in media images of nurses, by starting from the inside out. Such a path requires partnerships with agencies like EIC but also requires talent and education in media, filmmaking, writing, and broadcasting. As members of the nursing profession, we are challenged not only to collaborate with researchers and image creators in the media world but to develop innovative ways to “grow our own” so that nurses can also be writers like Theresa Brown and visionaries like Larry Deutchman who are making change happen every day.Together, the papers in this volume address the media images of nurses from multiple angles. It is the politics of how caring is being represented that is at play, as McHugh incisively points out. Representations are offered and images are consumed by the public, not just through television, but also film, commercials, advertisements, and the print media. Stories are projected about who does what kind of caring for whom and when, why, and how. This is a topic of great concern not only to individual nurses, but to the entire nursing profession worldwide. At both the 2011 UCLA Symposium and here in this volume, the mixing of multidisciplinary voices, the sharing of diverse ideas, and the analysis of meaning that stems from media images of nurses stands as an investment in nursing's future because it deepens our understanding of our past and present. If our goal is for the public to understand the vital role that nurses play in health care today, dialogue of this complexity and depth must continue, to fortify and inspire meaningful change in media images and screen representations of nurses today and in the future. The ways that nurses are depicted in the media raise a variety of issues for the profession of nursing. As nurses, we know who we are and what we do in our clinical roles, but when we watch television shows and films, we usually do not see ourselves in the nurse characters on screen. More often, what we do see is an absence where the presence of a nurse should be. Frequently, a physician is depicted on screen doing the work that an RN would do in reality. Other times we might see a stereotyped version of a “nurse” going along with a storyline that reflects a sharply inaccurate portrayal of reality. Likewise, although nurses are rarely depicted in the print or news media, when they are, the message that is cast does not always jibe with the realities of nursing in the 21st century. Stereotypes are easy to invoke, and nurses wonder why a more accurate approach is not embraced by image makers such as writers, journalists, producers, or directors involved with films, television shows, news programs, and the print media. As nurses, we want the public to understand the vital role that nurses play in health care today, so accuracy of portrayals of nursing in media is crucial. Living in Los Angeles, it has not been uncommon for me to meet media professionals of all types as part of daily life including producers, directors, actors, make-up and wardrobe specialists, cinematographers, editors, costume designers, and screenwriters. When I served as a consultant to directors Sergio Arau and Yareli Arizmendi for their film “Day Without a Mexican,” we discussed their creation of scenes that involved a nurse in a hospital. Through this experience and many conversations with various media professionals and artists at parties, picnics, church functions, and even the grocery store, I realized that the media world was a fluid world of ideas and possibilities. However, since my move to Los Angeles in 1998, I have never met a media professional who was aware of the challenging issues related to the representations of nurses in film and television until I informed them. In concert, when I raised the topic with professional nurses, I was usually met with irritation, frustration, and lack of understanding of the media or the creative process involved in depicting nurse characters on screen. These factors led me to propose the idea of a symposium on media and nursing to Dean Courtney Lyder of the UCLA School of Nursing. He immediately gave his enthusiastic support, as did Heidi Crooks, Chief Nursing Officer at the UCLA Health System. The idea was now in motion—we were going to bring together film, media, and nursing experts for a public forum titled “Media Images and Screen Representations of Nurses.” Nothing like this had been done before and we felt that UCLA was the right place for a meeting of this type because of our renowned School of Theater, Film, and Television; School of Nursing; and Medical Center; as well as our proximity, both physically and culturally, to Hollywood. The goal was to identify the core issues and analyze the many factors at play to deepen the dialogue on media images and screen representations of nurses. We wanted to engage screenwriters, filmmakers, and producers. We wanted to raise the sophistication of the discussion among us so nurses could be more informed of the complexity of the situation, the history of the problems, and the potential for analysis and critique. We wanted attendees to become activated, informed, and equipped to increase their readiness to engage peers in the media world when opportunities arose, rather than simply being a critic on the sidelines complaining about how nurses are depicted on screen. Without a vision for what the problem is or how it is propagated, nurses and activists are at a disadvantage when trying to prompt meaningful change. So on May 12, 2011, our symposium became a reality. Participants included clinicians from nursing and medicine, writers, producers, directors, actors, reporters, activists, researchers, scholars, students, working professionals, and administrators. The papers in this volume reflect some of the presentations given at the 2011 UCLA Symposium and/or some of the issues raised. They weave together an understanding of past, present, and future in terms of events that have occurred, problems that require analysis, and predictions to ponder related to media images and screen representations of nurses. In the first paper, media scholar Joe Turow from the University of Pennsylvania, gives us crucial historical background by drawing from his book, Turow, 2010Turow J. Playing Doctor: Television, Storytelling, & Medical Power. University of Michigan Press, Ann Arbor, MI2010Google Scholar, to focus specifically on nursing on television in the United States. Turow leads us back to the 1950s and 1960s to examine how a constellation of factors converged to consistently put white male physicians in leading roles on medical shows that by default left nursing as marginal, secondary if not tertiary, and even unnecessary. We learn how financial, social, cultural, and gendered forces fueled the way that screenwriters, producers, and directors portrayed characters using storylines, plots, and camera angles to emphasize and protect the prowess of physician characters. Turow's careful analysis of rare early attempts to put nursing in the center of television plots gives crucial details about the inner workings of Hollywood decision making as he extends his discussion to more contemporary shows that portray nurses. Through Turow's scholarship, we are challenged to ponder how organizations like the American Medical Association exerted their influence to protect the media image of physicians in the past, with lingering effects today. When Turow turns the lens toward nursing and nursing organizations, we are challenged to consider our role as nurse advocates today. UCLA professor of English and Cinema and Media studies, Kathleen McHugh, continues our focus on television and what she calls a “complex media syndrome” affecting how nurses are portrayed. After analyzing the common stumbling blocks that challenge image makers when creating nurse characters (ie, gender, caring, drama), she considers contemporary shows that feature nurses. Then, taking up an underlying theme that kept surfacing at the 2011 symposium, McHugh deepens her analysis by focusing specifically on Showtime's award winning and controversial show, Nurse Jackie. Within her analysis, McHugh discusses how the complex character of Jackie Peyton defies stereotypes and resists generalization. She then considers television's engagement with an issue near and dear to nursing's core: the issue of “caring” and the politics involved in representing care rendered by nurses on television. The context of America's contemporary focus on health care reform, concerns about insurance coverage nationwide, and worries about the looming nursing shortage. The next paper showcases an interview by Kathleen McHugh with film producer Richard Harding on his upcoming movie, “The Benghazi Six.” Through this interview, we get a glimpse of what motivated this film producer to tackle a project that portrays the life-saving work of nurses. Harding speaks about the riveting true story that forms the basis of the film, how 5 Bulgarian travel nurses and 1 Palestinian physician were wrongly accused of infecting more than 400 children with HIV in Libya and were sentenced to death multiple times. They were tortured by Muammar Ghaddafi's regime and then released in 2007 after 9 years of imprisonment. It is Harding's commitment to social justice that contributed to his goal to create films that document injustice. This award-winning producer explains how his desire to portray the nurses realistically and accurately was deepened by the dialogue at the 2011 UCLA Symposium, showing the significance of the exchange among filmmakers, media scholars, nurses, and activists in particular, nurse activist Sandy Summers, executive director of The Truth About Nursing. Inspired by the interview, Dean Afaf Meleis and her co-author, Caroline Glickman of the University of Pennsylvania School of Nursing, take up the plight of foreign nurses in a commentary that follows. Through these 2 works, we gain insight into international issues of power and powerlessness, grapple with the call to confront injustices faced by nurses worldwide, and witness the value of multidisciplinary dialogue on media and nursing. Continuing the focus on film, Elisabetta Babini, from the Department of Film Studies at the Florence Nightingale School of Nursing and Midwifery, King's College London, analyzes 2 1950s films, one made in Italy and the other in the US. The leading character in each film is a nurse who is also a nun. Babini's cross-cultural analysis of the reception of each film in their respective countries takes into account not only the careers of the leading actresses, Silvana Mangano and Audrey Hepburn, but the public perceptions of nursing, femininity, identity, and Catholicism. Integrating elements of feminist film theory, gender and cultural studies, and the social history of nursing, Babini demonstrates the importance of scholarly analysis to understand aspects of the history of nursing that have rarely been addressed. In this case, Babini addresses media images and melodramatic screen representations of nurses in film across decades and cultures to bring timely insight. Moving to the realm of media images of nurses in advertisements, UCLA nursing professor Linda Sarna and her co-author Stella Bialous from Tobacco Policy International, take up the issue of the historical use of photos of nurses to sell cigarettes from the 1890s to the present day. By analyzing more than 10,000 images of nurses in relation to smoking or cigarettes, Sarna and Bialous provide an example of scholarship that foregrounds how the profit-seeking marketing motives of tobacco companies completely disregarded the values of the nursing profession by creating and using photos that imply full endorsement of cigarette smoking by nurses. Such blatant disregard for the identity of nursing as a health-promoting profession stands as a chilling example of corporate, for-profit motives of industries that value product sales over the ethics and goals of the discipline of nursing. The final presentation at the 2011 UCLA Symposium involved an on-stage interview I moderated with two unique individuals, Theresa Brown and Larry Deutchman. Each made their way into image-making media organizations, where they are facilitating change from the inside out. Here, we learn through Brown, a writer and nurse, how her creative talents and her hard-earned skills as a scholar of English literature and composition equipped her to write about her clinical experiences as a nurse. Her writing has attracted a national audience through her book, Brown, 2010Brown T. Critical care: A new nurse faces death, life, and everything in between. HarperOne, NY2010Google Scholar, and her regular contributions to the New York Times blog, Well, with such notable readers as President Obama. Indeed, she was invited to the White House in 2009, where she heard the President quote from her own blog entry about health care reform and a patient who spent his last days struggling to figure out how he would pay his mounting hospital bills. Other op-ed pieces by Brown are frequently published in the Sunday New York Times. Through Deutchman, the Executive Vice President of Marketing and Industry Relations at Entertainment Industries Council, Inc. (EIC), we are introduced to the principles and policies that have successfully guided EIC to influence writers, producers, and actors on television shows and films to more accurately portray health issues. As “insiders” in Hollywood, EIC has created the acclaimed “PRISM” awards to reward productions that accurately portray health care issues in television episodes. Both Brown and Deutchman inspire us to consider the path to make change in media images of nurses, by starting from the inside out. Such a path requires partnerships with agencies like EIC but also requires talent and education in media, filmmaking, writing, and broadcasting. As members of the nursing profession, we are challenged not only to collaborate with researchers and image creators in the media world but to develop innovative ways to “grow our own” so that nurses can also be writers like Theresa Brown and visionaries like Larry Deutchman who are making change happen every day. Together, the papers in this volume address the media images of nurses from multiple angles. It is the politics of how caring is being represented that is at play, as McHugh incisively points out. Representations are offered and images are consumed by the public, not just through television, but also film, commercials, advertisements, and the print media. Stories are projected about who does what kind of caring for whom and when, why, and how. This is a topic of great concern not only to individual nurses, but to the entire nursing profession worldwide. At both the 2011 UCLA Symposium and here in this volume, the mixing of multidisciplinary voices, the sharing of diverse ideas, and the analysis of meaning that stems from media images of nurses stands as an investment in nursing's future because it deepens our understanding of our past and present. If our goal is for the public to understand the vital role that nurses play in health care today, dialogue of this complexity and depth must continue, to fortify and inspire meaningful change in media images and screen representations of nurses today and in the future.