Nursing the baby nurses
August 28, 2005 -- Today the New York Daily News ran a lengthy and fairly good piece, "Scandal of 'baby nurses,'" about the lack of regulation and awareness of the minimally-trained infant caregivers who market themselves as "baby nurses." The piece, by Pete Donohoe and Caitlyn Kelly, stems from the recent high-profile case of Noella Allick, the New York infant caregiver who has reportedly "confessed to violently shaking and seriously injuring two babies in her care." The piece rightly suggests that a key part of this specific problem is that anyone can call herself a "nurse," though it does not explore the deeper implications for global health posed by the endemic abuse of the word "nurse." In fact, the media commonly refers to female care givers as "nurses" no matter how little training they have, and whether they actually provide health care or not. Products doing so range from news pieces like those on the "baby nurse" case (including one in the Daily News last week by Donohoe himself) to marketing for popular Hollywood films (such as the "The Skeleton Key" and "The Grudge") to more arcane products in the media's vast sex-and-violence marketplace (such as the Japanese anime video series "Amazing Nurse Nanako"). This kind of confusion may be exploited not just by minimally trained caregivers, but even by some hospitals that may see a benefit in leading patients to believe they are getting care from "nurses" without having to actually pay for nurses. Legislation to make the word "nurse" a "protected title," which the Daily News reports is pending in New York, may have some positive effect. But the abuse of the word is so entrenched and widespread, and its common associations with breastfeeding and generic nurturing remain so strong, that some may wonder whether the profession of nursing should consider finding a new name.
In today's story, the Daily News reports that parents who hire "baby nurses" like Allick are entering "an undisclipined, unregulated world filled with false promises, pumped-up references and worthless credentials." The piece has some good quotes about the problem from government officials, those involved in the "baby nurse" business, and--surprise!--real nurses. Janet Wyatt, executive director of the national Pediatric Nurse Certification Board, says she has never heard of the term "baby nurse," and that only registered nurses can take her organization's extensive certification exam. Likewise, a "frustrated" Nancy Webber, spokeswoman for the New York State Nurses Association, is quoted as saying that "[p]eople can call themselves nurses when they're not RN's or LPN's." (The Daily News gets bonus points for inserting these two nurses' quotes right after a paragraph noting that "experts" interviewed by the paper had agreed that parents generally don't know what they're getting into when they hire "baby nurses.") The piece goes on to say that the government considers people like Allick to be "baby-sitters" who are "not subject to regulation," though the piece later clarifies that what this really means is that allegations against them are treated like any other form of child abuse or neglect. The News contrasts this "regulatory indifference" toward "baby nurses" with the formal state regulation of RN's and LPN's. Of course, the paper's apparent surprise at this may reflect continuing difficulty in accepting that people like Allick really are essentially "baby-sitters," and that they have little to nothing in common with highly trained licensed nurses. Allick herself is reported to have "quickly objected" to being called a "nanny" by police, insisting that she was a "trained baby nurse" because she knew CPR and had taken a three-day course in infant and child health.
The piece also explores the "baby nurse" industry in New York, where a number of agencies place "baby nurses" and "baby-nurse schools abound." The Daily News says it found the Manhattan home care agency at which Allick took her course in 2000; the course was apparently taught by an RN. The article also includes a short quote from veteran local newborn nurse Christine Holmes, who notes that anyone can say "I can take care of kids," but there is no good way to verify that beyond calling former employers--which the parents who hired Allick evidently did. The piece rightly focuses on the importance of truth in advertising; it's easy to imagine that parents might be less worried about giving their newborn to a stranger if that stranger had the word "nurse" on their resume. The piece notes that in New York State, nurses and their "trusting patients" don't yet have the kind of title protection that other licensed professionals like physicians do, although Assemblyman Richard Gottfried (D-Manhattan) has reportedly introduced a bill to change that. The piece deserves credit for making this point, though it does not reflect awareness of the damage done to the nursing profession because of the common notion that you can become a nurse with minimal training, and it does not explain how much training it takes to be an RN or LPN. Nor does the piece show any awareness of the key role the media itself plays in reinforcing these dangerous misimpressions.
Indeed, the Daily News itself was among the worst offenders last week when this story first broke. In Donohoe's own August 22 piece, "She wouldn't wake up...I shook her hard," we get a sensational portrait of Allick as a "hulking 'monster' nurse" who "allegedly attacked" the two infants. (The "monster" description comes from the father of one of the injured infants.) This piece repeatedly describes Allick as a "nurse," though the piece itself notes--in the seventh paragraph--that Allick is "not a licensed nurse but apparently had certificates in basic infant care and CPR." The piece deserves credit for including helpful information on shaken baby syndrome, though not for a bold-type paragraph at the end asking readers to call Manhattan prosecutors if they have "any information about the 'monster' nurse." But the Daily News was by no means alone in blaring references to Allick as a "nurse." The Center understands that the August 24 edition of NBC's "Today" show, which averages about six million viewers, likewise included more than one reference to the "baby nurse" at the center of this tragic case.
It's critical to stress that this is not just a matter of nurses objecting to being tagged with heinous crimes they did not commit, though the media's use of the word "nurse" to include tens of millions of additional care givers would naturally increase the number of potentially notorious "nurses." Rather, the deeper problem is that referring to almost any female care giver as a "nurse"--whether the specific image is negative or positive--reinforces the common view that nurses are marginally trained female domestic workers whose main job is providing comfort and basic necessities. This is tremendously damaging to a profession that requires years of college level science education, but that is currently in the midst of a critical global shortage, key features of which are the continuing reluctance of men to enter it and the relentless disinformation about it coming from the media. Nurses save lives every day. Even the best "baby nurses" do not. In this sense, influential media images of more positive "nurses" who are not really nurses can be just as damaging as the Daily News and "Today" pieces.
Take recent popular Hollywood horror movies. Nurses obviously make attractive horror movie protagonists, since such films tend to feature innocent, vulnerable-seeming females, and this fits well with one strand of nurse stereotyping--it's easy to identify with the pretty young "nurse" who's trying to be helpful but has no idea of the evil she's getting into. (Of course, the contrary battleaxe stereotype can be equally compelling--since people expect nurses to be good-hearted and trustworthy, if perhaps a bit slow, dangerous crazies like Nurse Ratched ("One Flew Over the Cuckoo's Nest") and Annie Wilkes ("Misery") strike a different chord.) Earlier this month, Universal released "The Skeleton Key," released "The Skeleton Key," which would go on to gross almost $80 million worldwide in its first month of release. This horror movie centers on a young woman played by Kate Hudson (above right) who is hired to provide hospice care for a dying man in a spooky old Louisiana house. Many press accounts, and even the film's own web site, refer to this character as a "nurse," yet it appears that she is in fact an undefined "hospice worker" who hopes to study to become a nurse. Last year, in Sony's successful "The Grudge" (which grossed about $187 million worldwide), Sarah Michelle Gellar (right) played a lead character that a number of accounts--and again, the film's own promotional materials--referred to as a "nurse." But she apparently was only a student volunteering at a health center for college credit.
In both of these films, the home care-providing leads were evidently positive characters who managed to show some mettle in confronting supernatural evil. But referring to them as "nurses" suggests that almost anyone with an inclination can be a nurse, without significant training or expertise. Of course, even a trend of choosing actual nurse characters for such roles is arguably worrisome in that it tends to associate the profession with the female gender and with apparent vulnerability. An impressive counterexample is Sarah Polley's lead character in Zack Snyder's recent remake of "Dawn of the Dead" (right). In that movie, the nurse character was not perfect, but she displayed serious survival, leadership and nursing skills in helping a small band of suburbanites try to stave off the by-now-familiar zombie apocalypse.
Another common assumption in the media and society is that any female who appears to assist a physician is a nurse, whether she actually has any health care expertise or not. One especially unfortunate example is the recent Japanese anime video series "Amazing Nurse Nanako," whose star does not really appear to be a "nurse," but more of a klutzy maid who assists the evil Dr. Kyoji Ogami in his plans for world domination (see items 1, 2). Nanako is evidently one of a series of clones created to advance Ogami's cybernetic work, but her main dramatic function appears to be to provide what is delicately known in the world of anime as "fan service." Apparently, the series features many scenes in which events conspire to reveal to viewers Nanako's breasts, panties and so on, and some accounts say that she suffers sexual abuse at the hands of Ogami. Of course, the presentation of a "nurse" primarily as a sexual target is a problem. But the important points for the current discussion are the incorrect assumptions that Nanako must be a nurse if she assists Ogami (which relies on the deeper incorrect assumption that nursing consists of assisting physicians), and further, that "nurses" and "maids" are more less interchangeable, which obviously plays into the enduring handmaiden image of nurses.
Also see our FAQ, "Do nurses need a new name?"