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Letter to the Editor

Fiction Versus Reality: Nursing Image as Portrayed by Nursing Career Novels

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Maureen Anthony, PhD, RN
Jill A. Turner, BSN, MLIS
Megan Novell, MA

Abstract

Nursing career novels, published in the 1930s and extending through the 1960s provided girls with nurse role models and encouraged young women to choose nursing as a career. In view of their popularity, we wondered how these books depicted nurses and the profession of nursing. We examined 18 nurse career novels by different authors published between 1932 and 1970 to determine how nurses and nursing were portrayed at various times. A literature review suggested a guiding framework, with four themes related to motivation to become a nurse; image of nursing; stereotypes; and nurse/physician relationships. This article discusses our endeavor by reviewing the study purpose and methods, and we discuss the results in the framework of the four themes. Our discussion notes that many of these novels described examples of nurses contributing in times of great social uncertainty, such as during wars. They contained characters who were independent thinkers and successful nurses, caring for patients and saving lives. We conclude that the novels could have easily inspired young women of the time to choose nursing as a profession, and discuss the challenge to motivate men and women of today who seek purposeful, intellectually fulfilling work in a changing, uncertain world.

Citation: Anthony, M., Turner, J.A., Novell, M., (May 31, 2019) "Fiction Versus Reality: Nursing Image as Portrayed by Nursing Career Novels" OJIN: The Online Journal of Issues in Nursing Vol. 24, No. 2, Manuscript 4.

DOI: 10.3912/OJIN.Vol24No02Man04

Key Words: nurse image; nursing career novels; nurse-physician relationship; nurse stereotypes

The goal of the books was to encourage young women to choose nursing as a career.Nursing career novels are a genre of books written for teens, starting with the Sue Barton and Penny Marsh series in the late 1930s, and extending through the 1960s with the popular Cherry Ames books. The goal of the books was to encourage young women to choose nursing as a career. As such, these young adult novels provided girls with role models who sought personal achievement through careers as nurses despite societal limitations, love interests, and competing family obligations. The novels aimed to cast nursing in an exciting and desirable light, motivating young women to consider the possibilities a career in nursing could offer. Many of the books were set in the uncertain times of the Great Depression and World War II. The nurse and student nurse characters in these novels were depicted as courageous and unrelentingly focused on the care of their patients. They would have been a stabilizing force for young women in those turbulent times.

The way in which nurses were depicted in these novels provides a glimpse into the public image of nursing during these timeframes. A positive public image of nursing can attract prospective students to the profession, while an unfavorable public image of nursing can have a negative impact on admissions to schools of nursing, as well as on the profession of nursing’s collective self-concept and self-esteem (Takase, Kershaw, & Burt, 2002).

Many of the books were set in the uncertain times of the Great Depression and World War II.Year after year, nursing is rated as the most trusted profession in terms of honesty and ethical standards by the Gallup poll (2017). In view of this enduring vote of confidence on the part of the public, why does the nursing profession continue to struggle with professional image? Authors ten Hoeve, Jansen, & Roodbol (2014) published a discussion paper on the public image of nursing which suggested our professional invisibility is to blame. What we do is not what the public thinks we do. The authors concluded that an organized, concerted effort is needed to inform the public of what nursing actually entails. Nursing career novels of the past had the potential to tell society what it is that nurses do.

...an organized, concerted effort is needed to inform the public of what nursing actually entails. Nursing career novels of the past had the potential to tell society what it is that nurses do.Unfortunately, nurses are burdened with a number of stereotypes (Huston, 2017). The angel of mercy stereotype most likely began with Florence Nightingale, who was widely revered by the people of England for providing care and comfort to the wounded soldiers in Crimea. Although a seemingly positive stereotype, it conceals the education and knowledge needed to be a nurse. Nurses are also depicted as the love interest of physicians or patients, or worse as the sexy “naughty nurse,” with no meaningful contribution to patient care. When viewed as merely the handmaiden to the physician, nurses become the sidekick of the almighty physician, with no need for education or independent critical thinking. Finally, there is the battle-axe, such as Nurse Ratched of the movie One Flew over the Cuckoo’s Nest, or the unhappy spinster nurse intent on making life miserable for everyone. Portraying nurses as any of these stereotypes could be detrimental to the collective self-concept and self-esteem of the profession.

Literature Review

Earlier publications recognized the potential benefit of this genre but proposed the need for updates that reflected the current nursing practice of the times.There is little in recent literature about nursing career novels. Earlier publications recognized the potential benefit of this genre but proposed the need for updates that reflected the current nursing practice of the times. Richter and Richter (1974) suggested the emphasis on nurses’ training as rigorous, rigid, and intellectually stifling may have actually dissuaded young readers from considering nursing as a career. In 1977, Hott interviewed Helen Wells, who wrote most of the Cherry Ames books. She learned that the publisher prohibited Wells from introducing minority characters in the books, and would not allow Cherry Ames to have a serious love interest or to marry, as that would have ended her career. Hott proposed diverse characters and topics such as political activism, consumer advocacy, and collective bargaining in a modernized Cherry Ames series. In 1993, Quell also argued the Cherry Ames series needed to be updated, moving Cherry into the “high-tech world of the modern medical center” (p. 51), or perhaps a spin-off of the popular “Baby-Sitters Club” series to be titled “The Junior Nurses Club” which would capture the attention of young readers.

In their book The Changing Image of the Nurse, Kalisch and Kalisch (1987) included Cherry Ames in a chapter on World War II heroines. They described Cherry as “a sympathetic and compassionate nurse, although she can be stern with patients and other nurses if a patient’s health is jeopardized” (p. 115). The authors identified two professional issues that Cherry dealt with effectively: the physical and emotional strain of nursing and the conflict between nurses’ humanitarian instincts and strict regulations that stand in the way of common sense solutions.

Nursing in the Sue Barton series was depicted as a means for women to gain financial freedom and some degree of professional status.Nursing in the Sue Barton series was depicted as a means for women to gain financial freedom and some degree of professional status (Philips, 1999). The fictional character Sue Barton was unusual in that she married, although her husband “Dr. Bill” was absent from most of the story lines, allowing Sue to continue with her nursing career unencumbered by marital obligations. In Sue Barton Visiting Nurse, Sue met the real nurse heroine, Lillian Wald, when she was a student at the Henry Street Settlement in New York. Philips found the image of the nurses at the Settlement to be strong. They are recognized as “central to health care, rather than a subordinate service to male doctors” (1999, p. 74).

Simon (2016) characterized Cherry Ames as a young woman focused on career rather than marriage. This may have resonated with young readers of the early books in the series, who would likely have experienced economic insecurity first-hand during the great depression. While Cherry chose an historically feminine profession, she differed from the older nurses she encountered. Her goal went beyond helping people and contributing to the war effort. There were other career opportunities open to women during World War II, but nursing allowed Cherry to leave home and use her intelligence to become more capable and self-confident.

Finlay (2010) analyzed the Cherry Ames series in the context of World War II patriotism and sacrifice. The author referred to Cherry Ames as “disembodied,” or caring for wounded soldiers and children without marrying or bearing children herself. Her devotion to her patients allowed her to forgo the usual path of marriage and childbearing but remain a heroine. Cherry was described as “intrinsically selfless, nurturing, and patriotic,” attributes traditionally considered ideal for women.

Study Purpose and Methods

Were the nurse characters in these books independent thinkers who inspired future nurses?In view of their popularity in the 1930s to 1960s, we wondered how these books depicted nurses and the profession of nursing. Were the nurse characters in these books independent thinkers who inspired future nurses? Or was it possible the portrayals were such that they may have dissuaded young women from becoming nurses, especially those who did not want to be subservient or take orders?

Literature about nurse career novels has focused largely on Sue Barton and Cherry Ames. In our content analysis, we utilized a guiding framework from the literature review to examine a broader range of nursing career novels by different authors. One of the authors owned a large collection of nursing career novels. To avoid duplication of themes in books by the same author, we each read and analyzed 18 nursing career novels written by unique authors. Books were read by three reviewers: a PhD prepared nurse, a university librarian with a nursing degree, and an adjunct English professor. All books were published between 1932 and 1970.

Results

We identified and discussed themes related to our literature findings, specifically: motivation to become a nurse; image of nursing; stereotypes; and nurse/physician relationships. Findings for each of these themes are discussed below.

Motivation to Become a Nurse
Most of the characters in these books described their motivation to be a nurse as rooted in caring for a sick family member, or an altruistic desire to ease suffering, or to help others. Interestingly, physicians played a key role in the decision to become a nurse. Four of the characters in the books described becoming nurses because their fathers were physicians (Boylston, 1960; Kirby, 1963; Trewin, 1963; Wells, 1944) and three were encouraged by the family physician to become nurses (Anderson, 1942; Christopher, 1964; Laklan, 1965). Sue Barton (Boylston, 1960) was discouraged from becoming a nurse by those who said she would be “scrubbing floors.” Her father, a physician, disagreed and encouraged her to enter nurses’ training, the typical description for nursing education of the time. This negative attitude toward nursing by the public was also seen in Linda Kent Student Nurse (Deming, 1952), when Linda’s father, a university president, frowned at his daughter’s desire to go to nursing school. Linda so badly wanted to be a nurse that she entered a bachelor of science in nursing program rather than a hospital diploma program to prove to him that nursing was a worthy, academic career choice (Deming, 1952).

Interestingly, physicians played a key role in the decision to become a nurse.Three of the nurse characters specifically said they chose nursing because they wanted a career. Cherry Ames wanted a “profession of her own” (Wells, 1944, p. 6), and Ann Porter (Anderson, 1942) didn’t think women “should be useless” and also wanted a career she could keep if she got married, as did Linda Kent (Deming, 1952). Only one book depicted a character who chose a nursing career for the sole purpose of marrying a doctor (Stoltz, 1951). In that book, Gretchen wanted a “doctor of her own” and entering nursing school seemed the most efficient means to that end.


Image of Nursing

Physical appearance. Most of the nurses in these novels had similar physical characteristics. They were all female and mostly white. One exception was Mary Ellis Student Nurse (Newell, 1958) in which Mary Ellis and Julie Saunders were young, female, single, and African-American. They were two of “only three [African American] girls in the school” (Newell, p. 55). Another exception was Nurse Three: A Very Special Girl (Kirby, 1963) which included Navajo nurses in both floor and supervisory roles in the workforce of the Indian Service Hospital. Rose was a young practical nurse whom Tracy, the main character, encouraged to go to nursing school since she was “simply tops as a practical nurse, and would be a natural as a trained one” (Kirby, p. 50). The student nurses were all young with one exception. Margaret Swain, nicknamed “Oldie” by her classmates, “was ‘old’ - the oldest member of the class, thirty-three” (Deming, p. 96).

Uniforms. Physical appearances were important and were mentioned in reference to both looks and attire. Uniforms were a crucial aspect of the nursing image. Lou Ellen Archer in Four Hands for Mercy had such an immaculate stiff-starched apron that it gave her “the air of having invented the profession” (Dolim & Kakacek, 1965, p. 5). The student nurses in Cherry Ames Student Nurse spent time perfecting their uniforms, [pinning] and [straightening] one another,” bemoaning a wavy hemline, and gazing “at one another’s uniforms with admiration” (Wells, 1944, p. 40). Jean Hunter and her friends spent several hours readying their uniforms. The next morning, Jean took a moment to admire how “very trim they looked in their white aprons, with blue capes over their shoulders” (Trewin, 1963, p. 27). Linda Kent was impressed by the “nice appearance of the class … the … uniform was becoming to the majority, and the fact that they were dressed alike made them feel the strength of a common purpose” (Deming, 1952, p. 99).

Nurses were required to look a certain way to convey the appropriate image; nursing was serious work and therefore frivolity was prohibited.Nurses were required to look a certain way to convey the appropriate image; nursing was serious work and therefore frivolity was prohibited. No fancy hair styles or make-up were permitted in Cherry Ames Student Nurse (Wells, 1943). The nursing instructor in Jean Becomes a Nurse used the first day of class to inform the students, “No nurse looks nice with varnished nails and lipstick. Cream and powder are never objectionable, but I assure you, patients hate being washed and looked after by nurses with red talons" (Trewin, 1963, p. 29). Sue Barton and her classmates were informed by the superintendent of nurses that “personal adornment and personal pleasures must be put aside. Professional dignity and traditions must be maintained” (Boylston, 1960, p. 25), and in Nurse in Blue, the Chief Nurse “didn’t like much make-up” (Taber, 1943, p. 37).

Physical beauty was regarded as a drawback in several of the novels. While General Duty Nurse (Hancock, 1945) implied physical beauty was incompatible with nursing, Mary Ellis Student Nurse (Newell, 1958) seemed to require it. Sally in General Duty Nurse was told “how it happens that anyone as lovely as you are ever trained to become a nurse… I don’t get it” (Hancock, p. 91), whereas Mary Ellis was determined to assist her fellow student to become a nurse by advocating for plastic surgery to fix a facial disfigurement (Newell, 1958).

The nursing cap symbolized everything the students dreamed of when they set out to become nurses.The nursing cap was the ultimate symbol of all the characters aspired to be. The capping ceremony took place after students successfully completed the probationary period. It was a very meaningful, emotional experience for the characters in these novels. The coveted cap meant they had made it through the difficult probationary period and assumed the status of student nurse. Connie in Sue Barton Student Nurse mused that, although the caps weren’t becoming, “…we yearn for them to the point of frenzy” (Boylston, 1960, p. 89). When Julia in Four Hands for Mercy received her cap, she thought of it as “the stiff white crown of nursing” (Dolim & Kakacek, p. 45). Dora in General Duty Nurse considered nursing to be “plain, drudgery with little compensation” but always had a vision of herself “in cap and snowy uniform bending over the sick, easing pain with gentle hands” (Hancock, 1945, p.123). The nursing cap symbolized everything the students dreamed of when they set out to become nurses. It bestowed dignity and respect, and distinguished them from probationers and other hospital staff. It was the most consistent theme in the novels we reviewed.

Nurses in many of these novels were independent, willing to act autonomously, and assertive when it came to their patients’ welfare.Personality. In addition to physical characteristics and outward appearance, the novels’ characters shared similar personality traits. Nurses in many of these novels were independent, willing to act autonomously, and assertive when it came to their patients’ welfare. Linda Kent (Deming, 1952) demonstrated all three traits throughout the novel. She stood up to her father when he tried to talk her out of becoming a nurse; she irresponsibly sent one of the housekeeping staff home to check on a sick daughter without gaining permission from the supervisor; and Linda assertively advocated for more modern equipment for her patients while nursing in Labrador.

Julie in Four Hands for Mercy (Dolim & Kakacek, 1965) took charge and performed a Cesarean section on her brother’s rabbit when the veterinarian was out of town. Nancy Naylor Flight Nurse (Lansing, 1945) had many experiences in which she demonstrated independence, autonomy, and assertiveness. She survived being lost in the jungle for two weeks, made decisions to administer narcotics, fluids, and oxygen as needed, and went “everywhere and anywhere that she could be most useful” (Lansing, 1945, p. 103).

Kristine Grant was described as an “iron-jawed nurse” (Marshall, 1942, p. 213) for her determination to help her patients. She rebuked both a supervisor and an orderly when a patient’s oxygen tank never arrived, “Is everybody in this hospital asleep or on vacation? Good heavens, don’t you realize I’ve got a dying man on my hands?” (p. 27). Nancy Dale: Army Nurse (Radford, 1944) was caught up in a terrorist act when her train was the target of German saboteurs. She assertively took charge of tending the wounded, even giving orders to Major Reed, a doctor. Cherry Ames (Wells, 1943) ran the risk of expulsion when she borrowed a life-sized simulation doll from the nursing training area to cheer up a little girl who was a patient on one of the wards.

Training. Nurse training was described as rigorous, particularly during the probationary period before students received their caps. Guided by strict rules, probationers were constantly reminded of their low place in the power hierarchy. As a nurse warned Cherry Ames and friends, “Misplace one sponge – or put the thermometer back in the wrong place – and … Oh the poor lambs! Just asking to be slaughtered!” (Wells, 1944, p. 42). Similarly, in Sue Barton Student Nurse, Miss Cameron observed the probationers as they demonstrated various techniques. “A single item of equipment forgotten, a single move made at the wrong time, brought down all Miss Cameron’s wrath on the unhappy probationer (Boylston, 1960, p. 80).

Nurse training was described as rigorous...Despite the ever-present strict rules and regulations, there were usually kind nurses and physicians who balanced out the experience. Miss Mac in Cherry Ames Student Nurse was knowledgeable, efficient, and had “laughter in her eyes” (Wells, 1944, p. 50). Mrs. O’Hara was kind and supportive when Terry blamed herself for a patient’s death (McDonnell, 1970), and Sister Tutor kept the students’ interest with amusing stories during lecture (Trewin, 1963).

The notion of nursing as service to others was a theme found in all the books.Stereotypes
The “Angel of Mercy.” Nurses in these stories were depicted as self-sacrificing, subjugating their own needs to attend to their patients. As one instructor told the student nurses, “Nursing means giving yourself to others” (Christopher, 1964, p. 36), and on capping day, an instructor concluded her speech with “Nursing is love in action" (Dolim & Kakacek, 1965, p. 45). The notion of nursing as service to others was a theme found in all the books. Linda Kent’s father, in discouraging her from entering nursing, reminded her: “Your patients must come first you know” (Deming, 1952, p. 25), and when Nancy’s mother became ill in Nurse in Training, she was told “We have to put the hospital ahead of our personal feelings” (Laklan, 1965, p. 120).

The “Love Interest.” While many of the novels hinted at romances between nurses and physicians, the nurse characters in these books were focused on their careers. There were often dances with interns, or a flirtatious, handsome doctor on the wards, but nothing that interfered with the goal of becoming or being a nurse. Kristine Grant in Nurse into Woman (Marshall, 1942) was the love interest of both the pneumonia patient and the chief of medicine, but she was depicted as an independent, assertive nurse. Cherry Ames (Wells, 1944) was smitten with young Dr. Clayton, but never let her feelings interfere with her work. Sally, in General Duty Nurse (Hancock, 1945), was so focused on nursing that she rebuffed a physician who attempted to kiss her and kept men at a distance. She was so often urged to marry that she invented a boyfriend whose plane went down in the war as her reason for not being interested in marriage. In the end though, she did surrender to the attention of Dr. Hallock, and they became engaged.

The “Handmaiden to the Physician.” Nursing was not usually portrayed as a profession separate from medicine. For example, in Linda Kent Student Nurse, Dr. Connor mentioned he would be writing test questions for her “comprehensives” (Deming, 1952, p. 135). In some of the novels, physicians assigned the main characters to care for seriously ill patients (Marshall, 1942; Taber, 1943). Nurses often rose when physicians entered the room and stood back to allow physicians to enter the elevator first (Anderson, 1942). Nurse Janet in Nurse in Blue struggled with urging her boyfriend to request another doctor who she thought would save his life, saying “A nurse wasn’t supposed to make any decisions. She was supposed to be a nurse” (Taber, 1943, p. 211).

...war time nurses were portrayed as much more independent and assertive.On the other hand, war time nurses were portrayed as much more independent and assertive. Nancy Naylor Flight Nurse acted autonomously, making independent decisions about patient care. “She was able to tell in an instant when plasma or oxygen must be given to save a man’s life" (Lansing, 1945, p. 140). In Nancy Dale: Army Nurse, Nancy “didn’t flare up in anger or burst into tears, but looked the major squarely in the eyes” (Radford, 1944, p. 24).

The “Battle Axe.” While main characters were never portrayed in a negative light, almost all of the books included an unpleasant nurse or student nurse. This was sometimes central to the plot of the book, and sometimes a side story. In General Duty Nurse (Hancock, 1945), Norma’s disdain for the main character Sally is apparent. Sally ignored the constant gossip and incivility, and in the end, Norma confessed that she was jealous of Sally and begged her forgiveness. In Cherry Ames Student Nurse (Wells, 1944), an entire chapter was devoted to her nemesis, Vivian Warren. A haughty know-it-all, Vivian did everything to make herself look good and Cherry look incompetent. Cherry recognized Vivian’s bullying as a sign of fear, and confronted her. Vivian confessed she was from a poor and dysfunctional family and nursing school was her way to a better life; she was petrified of failing. Cherry befriended her after this confession.

Nurse Ruth in Nurse into Woman (Marshall, 1942), went so far as to falsely name the main character’s boyfriend as father of a patient’s baby. She, too, admitted jealousy was the root of her uncivil behavior. In Nancy Dale: Army Nurse (Radford, 1944) the main character suspected a sarcastic nurse named Tini of conspiring with the Nazis. Nancy was assertive with Tini, and did not hesitate to report her to the upper command. Tini was found to be unwittingly supplying information to the enemy and was dismissed. Lois was the name of the problem student nurse in Robin West: Freshman Nurse. Her sarcasm and disagreeable nature throughout the book resulted in her expulsion (Christopher, 1964).

Nursing instructors were often portrayed as bad-tempered spinsters. In Mary Ellis Student Nurse, Miss de Monde, the nursing arts instructor bent on making student nurses miserable, was known by the students as “the Demon” (Newell, 1958, p. 28). In Robin West: Freshman Nurse, the usual instructor was replaced by “a crusty old nurse who looked at freshmen as if they were so many annoying bugs” (Christopher, 1964, p.88). Mrs. Mew, in The Organdy Cupcakes, never failed to think the worst of student nurses and her “air of unspoken superiority” was known to render even interns speechless” (Stoltz, 1951, p. 9). Nurse Jones in Jean Becomes a Nurse had “cold critical eyes,” a “severe face,” and a “frosty stare,’ and “found fault with everybody” (Trewin, 1963, p. 41).

Nurse/Physician Relationships
Nurse-physician relations were inconsistently displayed in the chosen novels.Nurse-physician relations were inconsistently displayed in the chosen novels. Some novels featured relationships that were central to the plot and continued throughout the books, and others incorporated very little interaction between nurses and doctors. The interactions, even if brief, ranged from domineering and bullying to respectful and collegial.

Three novels, Jean Becomes a Nurse (Trewin, 1963), Nurses Three: A Very Special Girl (Kirby, 1963), and Nancy Dale: Army Nurse (Radford, 1944) incorporated very little notable nurse-physician interaction. While Nancy Naylor Flight Nurse (Lansing, 1945) contained very little physician presence, the limited interaction that occurred displayed physician respect for the nurses' abilities and knowledge. In one passage, Nancy stopped a surgical amputation to request a second opinion. The surgeons acquiesced, and the second surgeon took over to perform a repair rather than a removal. In one chapter, a physician remarked to Nancy “there’s no use trying to fool a nurse about a patient’s condition” (Lansing, 1945, p. 157).

Most of the novels depicted positive relationships between nurses and physicians. Nurse into Woman (Marshall, 1942) and Nurse in Blue (Taber, 1943) were two examples of physicians displaying respect for the profession of nursing. Nurse into Woman contained such physician comments as, “with pneumonia, it [nursing] is … seven-eighths of the battle” (Marshall, 1942, p. 19) and, “nursing and nature are responsible for a patient’s recovery” (Marshall, p. 92). Physicians offered praise to the nurse and, in turn, a nurse, “half worshipped the doctor” (Marshall, p. 75).

Nurse in Blue included a physician commenting, “Nursing is what he needs, not doctoring” (Taber, 1943, p. 152). The physician complimented the main character Janet’s work and credited nursing for the recovery of the patient. Nurse-physician relations within Jean Craig Graduate Nurse (Lyttleton, 1950) and Four Hands for Mercy (Dolim & Kakacek, 1965) were very collegial. In Jean Craig Graduate Nurse, not only do the nurses and physicians dine and socialize together, but the physicians even volunteered to provide patient care while the nurses attended a wedding shower.

A few novels contained passages that depicted nurse-physician respect incorporated directly into nurse training. In Cherry Ames Student Nurse (Wells, 1944), student nurses were required to stand in the presence of physicians and graduate nurses. Nurse into Woman declares “a nurse never keeps a doctor waiting” (Marshall, 1942, p. 68), and Sue Barton Student Nurse explained that a nurse rises “not to the man, but to his profession” (Boylston, 1960, p. 25). Sue Barton Student Nurse also took a swipe at one physician’s demand for respect by stating, “He’s got a terror for a wife. This is the only place where he can get any respect. I suppose it goes to his head a little” (Boylston, p. 93). Whether the physicians demanded respect from the nurses or the nurses offered their respect was unclear.

Four novels included nurse-physician relationships central to the storyline and continued throughout the book. These relationships were depicted in a disparate fashion, occasionally within the same novel. Mary Ellis; Robin West Freshman Nurse; General Duty Nurse; and Cherry Ames Student Nurse incorporated both positive and negative physician-nurse relationships. Robin West Freshman Nurse included a family physician who was “nice” (Christopher, 1964, p. 118), and a mean, intimidating physician, Dr. Stark, who “makes all the nurses jump” and “eats student nurses for dessert” (Christopher, p. 47). At one point in the novel, he misinterpreted Robin’s actions and berated her in front of the whole floor for “disrupting a patient with an ulcer” (Christopher, p. 49).

Cherry Ames Student Nurse (Wells, 1944) was another novel which included divergent physician-nurse relationships. This book included both a family friend and physician, Dr. Joe, who mentored and encouraged Cherry to pursue nursing, and an intern, Dr. Clayton, who helped Cherry find her way on her first day and offered her encouragement after she was chewed out by the surgeon Dr. Wylie while assisting him with a dressing change. Dr. Wylie, the book explained, “eats students alive” (Wells, p. 25). He intimidated Cherry on her first day by dressing down her appearance, mistaking her naturally rosy cheeks for rouge, and setting up her fear of him for the rest of the novel. In the end, Cherry stood up for herself and proved herself to Dr. Wylie by putting her patients first and even saving one of his patient’s lives.

General Duty Nurse (Hancock, 1945) contained contrasting nurse-physician relationships, yet some of the adversarial relationships could be interpreted facetiously. Margaret, a nurse, did not have a very high opinion of interns. “I know internes”, she says, “… don’t trust ‘em” (Hancock, p. 22). Sally, the main character, at the start of the novel was wary as well. She remembered an occasion when a former intern dated a nurse while engaged to someone else. While Bess Hamilton, another nurse, commented, “You men are all alike –pigs- never filled up” (Hancock, p. 26); her manner could be interpreted as an older woman mockingly admonishing a handsome young physician.

In Mary Ellis Student Nurse (Newell, 1958), the character of Dr. Meyers provided both the negative and positive physician interaction. Dr. Meyers was described as an “old bear”, provoking student nurses to “hide in the linen closet” when they saw him approaching (Newell, p. 47). Toward the end of the novel, readers discovered Dr. Meyers was simply misunderstood. Once Mary Ellis facilitated his adoption of a baby, Dr. Meyer and his wife invited Mary to dinner in an act of gratitude.

The Organdy Cupcakes (Stoltz, 1951) displayed occasional friction between nurses and physicians. While the nurses liked the female Dr. Bradley, a nurse character stated that doctors were afraid “nurses [would] be too well trained”; there was a discrepancy between what a doctor thought a nurse should be and what a nurse was trained to do (Stoltz, p. 15). Additionally, Stoltz bucked the traditional nurse-physician relationship stereotypes. Rather than the attending physician scorning student nurses, in this novel, the head nurse disdained the younger physicians (Stoltz, p. 9).

Many of these novels contained the stereotypical romantic nurse-physician interactions.Many of these novels contained the stereotypical romantic nurse-physician interactions. Ann Porter Nurse dated Dr. Coran (Anderson, 1942); Aerospace Nurse dated Chris Marshall, flight surgeon (McDonnell, 1970); Linda Kent Student Nurse was headed towards romance with Dr. Woods Woodworth (Deming, 1952) as was Sue Barton Student Nurse with intern Dr. William Barry (Boylston, 1960); General Duty Nurse Sally was engaged to surgeon Dr. Jim Hallock (Hancock, 1945); Tracy Scott dated Dr. Dick Hardwick and Inez Moriarity got engaged to Dr. Dusty Meriweather in Nurses Three: A Very Special Girl (Kirby, 1963); and Nurse into Woman Kristine Grant was engaged to chief of staff Dr. Bowman (Marshall, 1942).

Discussion

Many of these novels were written during times of great uncertainty. The country had not yet recovered from the Great Depression, and WWII was in full force, creating societal stress and insecurity. Nurses and student nurses were depicted as a stabilizing force in tumultuous times, both unruffled and courageous. They enrolled in schools of nursing and supported the war effort by enlisting in the military or staffing civilian hospitals to fill the void left by those who enlisted.

Nurses and student nurses were depicted as a stabilizing force in tumultuous times, both unruffled and courageous.Nancy Dale (Radford, 1944) is an exemplar of grace under fire. While leaving on the train to join the army, Nancy overheard two men on the train speaking in German and sprang into action when eight cars derailed. She administered emergency aid to injured passengers. She alerted a major about suspected spies on the train, and, after being admonished for not alerting someone earlier, earned his respect when she replied “Had I been at a hospital, or in camp, I would have reported my suspicions to the right authorities. Under the circumstances, sir, what would you have done?” (Radford, 1944, p. 33). Nancy was eventually sent to Australia, where she was happy to be closer to her brother, who was missing in action somewhere in the south Pacific. When the ship she was on was attacked, she ended up in a life boat with two other nurses and three brawling soldiers. All three men met their deaths, but Nancy and the nurses survived despite dehydration and near starvation. In the end, her brother was rescued and they were reunited.

The description of nurses’ training as rigorous and rigid, and nurses as the handmaiden of the physician may have dissuaded readers from a career in nursing, but these images were offset by the independence and courage the main characters displayed when the welfare of their patients was at stake. The fact that the students or nurses were instructed to blindly follow rules and not to make independent decisions made their assertiveness in advocating for patients all the more admirable and heroic. Similarly, the harshness and severity of some instructors and nurses was balanced by the encouraging kindness of others.

Military service in particular provided opportunities...not found in most careers open to women during the years these books were popular.In addition to the emotional rewards derived from caring for others, nursing was portrayed as an opportunity for travel, adventure and excitement. It provided a path for the main characters to leave home to live at the hospital, travel, or join the war effort. Tracy, in Nurses Three, drove across the country from her home in New York to southwest United States to work at an Indian Health Service Hospital (Kirby, 1963), and Linda Kent moved to Labrador to practice after graduation (Deming, 1952). Military service in particular provided opportunities for travel to foreign lands, adventure, heroism, autonomy and respect, attributes not found in most careers open to women during the years these books were popular.

We found the angel of mercy stereotype to be widespread. This image can obscure the education, knowledge, and skills needed to practice nursing (Price & McGillis Hall, 2014). While this may have been a barrier for some, it has also been reported that the opportunity to care for people is an enticement to prospective students when deciding on nursing as a career (Eley, Eley, Bertello, & Rogers-Clark, 2012). We also found that, although the nurse as love interest of the physician was a theme found in most of the books, it did not dissuade the main characters from their career goals. The element of romance may have made the books more popular with young girls, but the main characters did not waver from their focus on school, patient care, or military service.

It appears that it was important to the authors to depict the reality of nursing in their novels rather than glossing over the issue of incivility.Of interest is that so many authors who were trying to entice young women into nursing included the negative “Battle Axe” stereotype and the issue of incivility into their novels; almost all included a “mean” nurse or nursing instructor. Student nurses or nurses who were the main character in the novels were often the target of incivility, but handled this in an admirable way. In most cases, it was an opportunity for them to show maturity and leadership, probing and pondering the root of the problem. It appears that it was important to the authors to depict the reality of nursing in their novels rather than glossing over the issue of incivility. Thus, they were allowing prospective nursing students to be aware of this reality, but presented suggestions for dealing with the issue if encountered, and perhaps even providing naïve steps toward resolving the problem completely.

The profession of nursing has struggled for years to be viewed as more than a vocation. The novels we reviewed documented the journey toward professionalization utilizing the symbol of the coveted cap. It was a visible testament to the specialized knowledge, rigorous academic training, and service to humankind of nurses (Deming, 1952; Stokowski, May 3, 2011). The cap defined nurses throughout these novels, and the students yearned to possess the proof of their status as a professional nurse. If a nurse broke the rules and violated her professionalism, she could have her cap revoked (Anderson, 1942; Stokowski, May 3, 2011). It was the equivalent of having one’s nursing license suspended or rescinded today. The pride with which nurses viewed their caps, symbolic of the high standards to which members of the profession aspired, can be seen through the way the cap was described in 1929 as "a crown studded with diamonds of honesty, sapphires of kindness, rubies of sympathy, amethysts of dignity, and emeralds of courage. It is woven with threads of kindness, sympathy, courage and silence" (Kilby-Kelberg, 1974, p. 898).

At present, nurses do not have a uniquely distinguishable representation of our profession.Physicians have the white coat which is presented to them in an elaborate ceremony at the start of their professional training, but nurses today no longer have that distinct symbol used to define the profession for years. At present, nurses do not have a uniquely distinguishable representation of our profession. Patient satisfaction feedback indicates the anonymity of the nursing staff within a hospital is a common complaint (Stokowski, May 3, 2011; Houweling, 2004). Some nursing students receive pins shortly before graduation celebrating their entrée into the nursing profession; however, not all nursing schools offer pinning ceremonies or award their graduates pins. Therefore, pins are unlikely to become the universal symbol of nursing that replaces the nursing cap. Additionally, pins are small and easily overlooked, as are name tags with credentials, another identifier that has been proposed (Stokowski, August 10, 2011).

In 2004, a uniform patch displaying the acronym “RN” was presented as a possible approach to the problem of identifying nurses among the sea of scrubs (Mason & Buhler-Wilkerson, 2004); this has not been met with enthusiasm either. A promising solution is to designate white scrubs as the exclusive uniform color for nurses. Porr et al. (2014) found patients associated nurses’ professional image with white uniforms, highly associating all-white uniforms with confidence and competence. In another anecdotal illustration, a unit in the John F. Kennedy Medical Center in Atlantis, Florida decided to experiment with the nursing uniforms when trying to increase patient satisfaction scores. Nurses began wearing white uniforms and nursing caps. "The patients loved it … especially the older ones who remembered nurses in caps. And surprisingly, the physicians loved it, too. They knew exactly who to go to -- the person wearing the cap” (Stokowski, May 3, 2011, para 9). While donning the nursing cap was a temporary measure, the white uniforms were such a hit that the dress code was changed to require white scrubs for nurses.

Conclusion

The novels, for the most part, depicted nurses at that time in history in a positive, realistic manner, and displayed both the challenges and rewards of the profession. Many changes would be necessary if these novels were to be updated for today’s youth. Nurses are more autonomous, performing procedures at a much higher acuity than in the past and acting on a discipline specific body of evidence. Aberrant physician orders are questioned without nurses fearing the loss of their jobs, and while respect between the two professions exists, the deference nurses displayed toward physicians is no longer mandated by nursing education, nor is it warranted. Physicians and nurses are partners and act in concert to coordinate and provide patient care, each performing their assigned roles.

Many changes would be necessary if these novels were to be updated for today’s youth...other methods are needed to introduce nursing as a career choice.With nursing career novels no longer popular, other methods are needed to introduce nursing as a career choice. Innovative programming, such as the Nightingale Experience might be an option. The Nightingale Experience is a partnership between a Magnet healthcare system and a school of nursing. Area high school counselors are each asked to recommend two to four students with high grade point averages for the Nightingale Experience (Deges, Hale, Wilsker, Guidroz, & Price, 2017). Nursing students are chosen to be group leaders to guide the high school students through the skills lab and the simulation center at the school of nursing, followed by six stations at the magnet hospital. While young adult career novels were much larger in scale and could reach many more prospective students, interactive opportunities such as the Nightingale Experience may be more realistic and effective to recruit young men and women to the profession.

These novels could have easily inspired young women to choose nursing as a profession. They contained characters who were independent thinkers and successful at what they did - caring for patients and saving lives. Although the novels glamorized nursing in some ways by including romantic relationships between the nurses and physicians and emphasizing the “Angel of Mercy” stereotype, they also presented a realistic image of the rigors of nursing education and the importance of nursing as a profession. They revealed to young women that nursing education was demanding, but urged them to accept the challenge.

...the profession continues to offer challenging, fulfilling opportunities for men and women who seek purposeful work in a changing, uncertain world.The challenge today is different in many ways, but the task of communicating the contribution of nurses to the public remains. The profession has experienced dramatic changes in the decades since nurse novels introduced young women to nursing. Nursing has become more complex and sophisticated, the relationship between nurses and physicians has evolved into a collaborative model, and men have entered the profession in larger numbers. The world that these midcentury nurse novels describe is no longer the world that nurses of today enter, but for one significant constant - the profession continues to offer challenging, fulfilling opportunities for men and women who seek purposeful work in a changing, uncertain world.



Authors

Maureen Anthony, PhD, RN
Email: anthonmj@udmercy.edu

Maureen Anthony is a professor of nursing at the University of Detroit Mercy and editor-in-Chief of Home Healthcare Now. Her area of research interest is professional issues in nursing. She has conducted research and published in the areas of patient safety, simulation, incivility in nursing, nurses’ professional concerns, and migration of Guyanese nurses.

Jill A. Turner, BSN, MLIS
Email: turnerja1@udmercy.edu

Jill A. Turner is a former nurse and a practicing health sciences librarian at the University of Detroit Mercy. She has co-authored several articles for nursing journals. Jill served as an officer in the Army Nurse Corp. She is an avid reader.

Megan Novell, MA
Email: novellme@udmercy.edu

Megan Novell is an administrator in in the university libraries and teaches English literature and women’s and gender studies at the University of Detroit Mercy.

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© 2019 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2019


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