Antiquity Image of Nursing

The earliest literary reference to nursing chronicles the actions of two nurse midwives in approximately 1900 bc in Exodus 1 of the Old Testament, which indicates that the practice of two midwives became the vehicle through which the Israelites, the Jewish race, and the resultant Judeo-Christian heritage survived. From the sixth century until the 1800s, nurses were imaged as untrained servants, soldiers, women of religious orders, or wealthy people performing acts of Christian charity (Kalisch and Kalisch, 1995; Kampen, 1988). These meager artistic renderings of nurses convey images that continue to be familiar to contemporary nurses.

Victorian Image of Nursing

In 1844 when Nightingale was “called” to become a nurse, Charles Dickens immortalized a different kind of nurse through Sairy Gamp, the nurse for whom nursing was endured because of the lack of other opportunities. For Sairy Gamp, a drunken, physically unkempt, uncaring nurse in Martin Chuzzlewit, nursing provided a way to profit from the sick and dying. Reflecting the concern of Victorian England for untrained caregivers, Dickens advised Sairy of the advantages of “a little less liquor, and a little more humanity, and a little less regard for herself, and a little more regard for her patients, and perhaps a trifle of additional honesty” (Dickens, 1910, p. 894).

Fortunately Sairy’s literary arrival was followed by Longfellow’s portrayal of the heroic Nightingale in Santa Filomena (1857). As important as Nightingale was to the improved health care of British soldiers and to the development of modern nursing, the ever-increasing positive images of Nightingale occurred solely because she was able to succinctly demonstrate the aggregate outcomes of nursing practice. Nightingale was one of the earliest users of the emerging body of knowledge called statistics and developed the pie chart that remains in common use. Notably, nursing emerged at a time of turbulent social change and reform in Great Britain.

Early Twentieth-Century Nursing

Toward the end of the Nightingale period at the turn of the century, nurses in war settings vividly capture the attention of artists. The most compelling image is Bellows’ 1918 canvas, Edith Cavell Directing the Escape of Soldiers from Prison Camp (Donahue, 1910). World War I Germany shocked the world with its 1915 firing squad execution of Edith Cavell, founder of the first nursing school in Belgium, who aided soldiers escaping prison camps. The art of heroic nursing expressed in several famous paintings reflected the reality of World War I nurses who were also the recipients of three Distinguished Service Crosses, 23 Distinguished Service Medals, 28 French Croix de Guerres, 69 British Military Medals, and 4 U.S. Navy Crosses (Donahue, 2010). Notably, American nurses who served in World War I were not commissioned in the military services. One in every three nurses served in World War I.

The 1930s Nurse as Angel of Mercy

On a grander scale, Warner Brothers’ film The White Angel (1936) chronicled the professional life of Florence Nightingale (Jones, 1988). Endorsed by the American Nurses Association (ANA), The White Angel clearly portrayed Nightingale’s persistence and head-to-head confrontation with medicine. Anticipating that the medical staff would deny her nurses rations, she brought provisions for them. When the medical staff locked her out of the hospital, Nightingale sat outside in the snow until patients and soldiers required physicians to admit these nurses. The White Angel conveyed to the public that nursing is a holy vocation, nurses have professional credentials, and their career choice is opposed because women belong at home (Jones, 1988). A subtle inference of the film is that Nightingale was smart enough to overcome the obstacles of medicine.

In 1938, Rich’s tall and imposing white limestone statue, the Spirit of Nursing, was placed in Arlington National Cemetery to honor military nurses. Similarly, Germany’s 1936 stamp commemorated nursing with a larger-than-life nurse compassionately overlooking people (Donahue, 2010).

The 1940s Nurse as Heroine

Considered to be the most positive movie about nursing, So Proudly We Hail is the 1942 story of nurses in Bataan and Corregidor. The film, starring Claudette Colbert, portrayed a small group of nurses rerouted to the Philippines after the attack on Pearl Harbor. Soon cut off from supplies and replacements as the Japanese took over the Philippines, these nurses provided care with few supplies and no staff to the thousands of soldiers in the Philippines. When the last nurses were to be evacuated from the occupied islands, a number of nurses voluntarily stayed behind, made the march to Bataan, and were interned as prisoners of war. Norman’s We Band of Angels: the Untold Story of American Nurses Trapped on Bataan by the Japanese (1999) tells via their diaries and interviews the gritty, difficult, and heroic story of these nurses who served on Bataan.

Nursing was depicted positively on a 1940 Australian stamp as a larger-than-life figure looking over a soldier, a sailor, and an aviator; on Costa Rica’s 1945 stamp of Florence Nightingale and Edith Cavell; and in the 1945 commissioning of the USS Higbee, a Navy destroyer named in honor of a Navy nurse (Donahue, 2010).

After nursing’s glorious contributions to World War II, nurses returned home to find low salaries, long hours, too few staff, and too many patients. However, nursing continued to be glamorized through the Cherry Ames book series, the Sue Barton series, and other romance novels.

Nursing in the Antiestablishment Era of the 1960s

Ken Kesey developed the modern version of Sairy Gamp through the character of Nurse Ratched in One Flew Over the Cuckoo’s Nest (1962). This best-selling novel later became a play and motion picture (1975) that won six Oscars, including Best Picture. Entrusted with the care of the mentally ill, Nurse Ratched, a militaristic nurse in a starched white uniform, was the ultimate power figure who punished patients to cure their psychosis through conformity to a “system” (Jones, 1988). However, the reality of the turbulent period of the 1960s is that nursing was one of President Lyndon Johnson’s first salvos in the war on poverty. The Nurse Training Act of 1964 was funded at $250 million ($1.78 billion in 2011 dollars) (calculator.net). Although nurses also dramatically shaped the future of health care through the development of coronary care units, intensive care units, hemodialysis, and Silver and Ford’s first nurse practitioner program in Colorado, a U.S. Bureau of Labor study indicated that salaries of nurses at the time were woefully inadequate in comparison with other, far-less-trained American workers (Kalisch and Kalisch, 1995).

Nursing in the Sexual Revolution of the 1970s

Media images of the nurse in the 1970s were formed amid a sexual revolution and a growing antimilitary American culture. War would again provide the media backdrop. The 1976 stamp, Clara Maas, She Gave Her Life, commemorated the 100th birthday of Maas, a 25-year-old nurse who died after deliberately obtaining two carrier mosquito bites so that she could continue providing care to soldiers with yellow fever in the Spanish-American War (Donahue, 2010). Her modern-day counterparts would be nurses in M^∗A^∗S^∗H, the hit television series that ran from 1972 to 1983.

The nursing profession viewed M^∗A^∗S^∗H as professionally destructive because of the negative portrayal of Hot Lips Hoolihan and the nurses of the 4077th Army MASH (Mobile Army Surgical Hospital) unit in Korea. The sexual exploits of nurses and physicians and the uncaring Margaret provided few positive images. However, for the American public who were receiving a daily dose of M^∗A^∗S^∗H in the news footage of Vietnam on nightly news, M^∗A^∗S^∗H presented a glimmer of reality. Continuous front-line exposure to the massive trauma of young men did not immunize these nurses from caring or from the horrors of what they were seeing. They coped with these horrors with a sense of humor and irreverence toward “the system.” Nurses serving in Vietnam would later be imaged in the television series, China Beach.

Nursing in the 1980s to 1990s

Portraying an actual event, the complexities of nursing are realistically described in the play and television movie, Miss Evers’ Boys. Through the character of Miss Evers, the play tells the true story of Nurse Evers, who was hired to recruit and retain young African-American men into the infamous Tuskegee experiment designed to describe the long-term effects of untreated syphilis. Although the study began in 1932, penicillin became the treatment of choice for syphilis in 1947. When subjects asked Nurse Evers to obtain the new treatment of penicillin for them and she sought to do so, the physician investigators required her to discourage them from treatment. Subjects were told they would be dropped from the study and forego the benefits of free treatment, a free ride to the clinic, one hot meal per day, and, in case of dying, $50 for their funeral. Subjects were never told they had syphilis, only that they had “bad blood.” The study, which was funded for 40 years by the U.S. Public Health Service, ended in 1972 only because it became publicly known through the press. Ironically, Nurse Evers was the only consistent staff person throughout the 40 years of the study. As the narrator of the story, Nurse Evers introduces non-nurses to the dilemmas of nursing practice during that era and the consequences of misplaced faith and trust in other health care disciplines. Notably an outcome of the Tuskegee study was the requirement for institutional review boards to prevent this from occurring again.

In 1997, three films used war and nursing as a backdrop: The English Patient, Love and War, and Paradise Road. In all of these films, the nurse is a knowledgeable, nonjudgmental caregiver.

Artistic views of nursing during this period focused on caring. In the Vietnam War Women’s Memorial, the central figure is the nurse in battle fatigues cradling the head of a soldier for whom she is providing care. Evident in the bronze statue is the fatigue of the nurse and her care for this dying soldier.