This week I am delighted to introduce our guest blogger, Professor Margaret McAllister, a friend and warmly regarded colleague. Margaret is a gifted story teller and researcher whose written works and conference presentations are both engaging and provocative. In this post Margaret dispels some of the myths associated with ‘the good nurse’ and challenges educators to consider the use of negative stories in their teaching.
Illness and resilience stories humanise the healthcare experience, and because they are often imbued with layers of meaning, can prompt critical reflection. This reflection can go several ways – we can be motivated to think back on the story and perhaps our own lives, and we can be urged to think ahead towards the future, perhaps changing the way we think or act. This is the transformative power of compelling stories. Another benefit of stories is that they come in multiple modes and so, when available, we can access them by reading, viewing, or listening.
Tracy Levett-Jones and I have partnered up with colleagues on several occasions to share stories and teaching approaches designed to deepen learners’ engagement [1, 2]. Stories don’t have to be factual to have impact; well-drawn fictional tales can teach us important lessons on being human – think of To Kill a Mockingbird, and Good Will Hunting, for example.
I and several other scholars have argued elsewhere that the media don’t always get it right in conveying the complexity of nursing practice and mainstream films and tabloid newspapers can be criticised for perpetuating unhelpful stereotypes about nurses and doctors. In 2004 the Telegraph screamed, “Are young nurses too posh to wash?” which really didn’t do too much good for nursing’s long struggle to achieve university status equivalent to our colleagues in medicine, physio, occupational therapy, and the like. The hidden stereotype in such a claim is that to be a nurse you don’t need a university education and indeed it is something to be ashamed of.
Another ongoing stereotype about nursing, sometimes effectively achieving sympathy and gratitude in the public, is the idea that nurses are angelic – omnipotent and omniscient – knowing the answer to every query, and able to anticipate a patient’s every need. This is a fairly unreasonable stereotype and a difficult one to live up to! It is also dehumanising as nurses aren’t angels, they are human beings, capable of doing good, but also capable of making mistakes.
As Siobhan Nelson and Suzanne Gordon argue , the idea of the good nurse (the virtue script) is imbedded into peoples’ consciousness – including nursing students and nurses. The virtue script is a code that structures and limits the role nurses can perform. By portraying nurses (and nurses portraying themselves) as angelic, the sole focus is on their ability to nurture. This has some important, and often negative, ramifications.
Patients tend to look to the nurse expecting to have their needs met. They willingly surrender themselves to the authority of the nurse and allow themselves to be moved, washed and medicated. Nurses expect this surrender and, when all goes smoothly in this transaction, nurses feel positive about their role, themselves and their place in the world. The problem, however, is that this is a mythic story that holds little valid relation to reality, and so it is a dangerous script to promulgate. This is a narrative that feeds into beliefs about women’s work and nursing that is regressive. As such, Nelson and Gordon  argue that:
When asked to describe or justify their work, nurses all too often rely on traditional caring discourse that presents the nurse as the good, trusting, compassionate figure, failing to recognize the knowledge and skill that nurses must have in order to care for patients.
This brings me to my next point– illuminating stories for health professionals don’t always have to be uplifting to have impact. The story that Tracy previously shared about Vanessa Anderson is a case in point. There is much that we can learn from negative cases, particularly if we are open enough to receive the message.
I share some other stories that cast nurses in a not-so-good light, in a new manuscript about to be published , and I think these are important counter-points to this shallow virtue script. In the interest of brevity, I’ll outline just one example here. In Kristy Chambers’ memoir of being a nurse entitled Get Well Soon! My (un)brilliant career as a nurse , she dismantles the idea that all nurses have a calling to their work. Far from it; as this witty young woman wrote:
My quest for a career started early, when I was four years old and gave myself a haircut to see if I liked that sort of thing. I liked it plenty, but my mother did not. Much later in life, after moonlighting as a maid and enduring myriad other unsatisfying positions, I fell into nursing, the way one may fall into a pile of sheep shit at two in the morning (which I have also done).
This description of Chambers interests prior to nursing lampoons the idea that nurses universally share a background as children with nurturing temperaments, who then pursue a clearly designated path to nursing. For Chambers, coming to nursing was an unhappy accident.
Chambers also unsettles the idealised image of the usual location in which nursing takes place – the hospital. Rather than present it as a mysterious, scientifically-informed site, that is action-packed with clever, highly trained people rushing to save lives at every turn, she represents the hospital as often dreary and bureaucratic … a place where time endlessly drags on. It is neither a romantic nor exciting entrée into working life:
The first week at the hospital was one of the dullest of my life, a long and tedious orientation with mandatory content on occupational health and safety issues and hospital protocol. The speakers were euthanising, the sandwiches were soggy and the coffee was international roast, which tasted like arse. To add insult to injury, I was given my new uniform. It consisted of a fugly blue-and-white floral dress that people called the “libra fleur” because it looked like the outside of a tampon box, a shirt in the same foul material, and navy slacks for cooler weather. (p. 45-46).
Here, Chambers challenges and mocks an enduring signifier of virtuous nursing – the uniform. Once a symbol that connoted purity, hygiene, regulation, order and professionalism, the pristine white nurses’ uniform is now only a fantasy.
One of the benefits of examining popular representations of nursing beyond the virtue script is that, new dimensions to nursing can be made visible. Kristy’s memoir positions nurses as self-deprecating, witty but also sometimes clumsy and callous. She’s not a perfect angel; nor is she a monster like the other extreme in which the media sometimes casts nurses – think of the iconic Nurse Ratched, or the unhinged Annie Wilke in Stephen King’s Misery.
In locating examples of images of nurses not performing the virtue script previously hidden aspects of nursing can begin to be understood with greater complexity. This is important, not just for nurses themselves in terms of more realistic representations, but also for society more widely. I think we need more stories of nurses showing their confident and outspoken sides, because after all, nurses in the 21st century need to think on their feet, multi-task, and communicate effectively – rather than be not silent and demure.
Professor Margaret McAllister (CMHN, RN, BA, MEd, EdD) is Professor of Nursing at Central Queensland University, Australia. Her research and teaching focus is in mental health and nursing education. She has co-authored several books: Stories in Mental Health, The Resilient Nurse and Solution Focused Nursing. In 2010, her work was recognised in a national citation for outstanding contributions to nursing education.
- McAllister, M., Levett-Jones, T., Petrini, M., & Lasater, K. (2016). The viewing room: A lens for change. Nurse Education in Practice, 16(1), 119-124.
- McAllister, M., Levett-Jones, T., Stone, T., & Lassater, K. (2015). The reading room: Exploring the use of literature as a strategy for integrating threshold concepts into nursing curricula. Nurse Education in Practice, 15(6), 430-436.
- Nelson, S., and S. Gordon. (2006). The Complexities of Care: Nursing Reconsidered. Ithaca, New York: ILR Press.
- McAllister, M., & Brien, D. (in press). Narratives of the “not-so-good nurse”: rewriting nursing’s virtue script. Hecate: A women’s Interdisciplinary Journal
- Chambers, K. (2013). Get Well Soon: My Unbrilliant Career as a Nurse. St Lucia: University of Queensland Press.