Professor Marion Lynch is a nurse and a trustee of Paintings in Hospitals. Marion joins our 60 Years, 60 Voices series to investigate how nurses are portrayed and to ask if we need a new image of nursing...

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How are nurses seen? 2020 is to be the Year of the Nurse, a year of commemorating the bicentenary of the birth of Florence Nightingale and celebrating improvements in health. However, many across the world still struggle to access healthcare, to improve their lives and to maintain their own health. Even in the UK, there remains a lack of equality in these gains right across the population and an impending shortage of people able and willing to work in health and social care. This is a particular issue for nursing. There are about 29 million nurses in the world which make up 50% of the worldwide health workforce. The UK has 320,000 of these which is approximately 1/3 of the workforce. We already have 40,000 vacancies. The predicted gap points to us needing nine million more nurses by 2030 worldwide.

Recruiting nurses does more than address workforce gaps. The All-Party Parliamentary Group 2016 Triple Impact Report on Nursing highlights how investment in nurses improves health, gender equality and supports a country’s economic growth. It is, therefore, self-evident that any country in need of a health and wealth gain will need more nurses. The World Health Organisation has plans to support recruiting, training and retaining the whole healthcare workforce. These plans aim to assure the quality of care, quantity of staff and equality of distribution between and within countries. However, policy and plans do not portray the whole picture. Workforce numbers can be compared to painting by numbers: while it may look okay on paper there is more to painting than colouring within the boxes.

How are nurses portrayed? We decided to seek out the art of nursing. A search in Paintings in Hospitals’ collection, a google search and interviews with senior and student nurses highlighted that we have an image problem. There are no portraits of nurses in the collection, there are limited representative images within art on the internet and limited awareness of such art within the profession.

Images of the statistician and nurse Florence Nightingale dominate any search, whether as a portrait or a painting of her at work holding the famous lamp. Another image of nursing, two nurses holding a sheet by Edvard Munch, does not really provide the inspiration needed to join our profession. There are many photographs, mostly of military moments of care.

A less clinical picture but still military is the photograph by Alfred Eisenstaedt portraying a U.S. Navy sailor kissing a nurse. People rarely know that this was a nurse. The photograph became a statue and toured the world. In 2019 the statue was vandalised to draw attention to the #MeToo campaign, highlighting that the nurse was grabbed for this kiss not asked for this kiss. As with many aspects of culture, while art portrays passion or passivity, politics and power often frame the female form. Such an aggressive voicing of dismay against art highlights how art can engender extreme feelings that may endanger artefacts and individuals. Art is not passive.

Mary Seacole by Martin Jennings in front of St Thomas' Hospital, London

In 2016 a statue of Mary Seacole by Martin Jennings was installed opposite the Houses of Parliament in London and brings us back to women at work in war. We found no art that put nurses anywhere other than in war, in a hospital or next to a bed. Disturbingly the sexualised image of nurses also puts them in the bed in contrived sexualised comic images that are neither sexy nor funny. Full stop.

We decided to undertake some interviews with nurses at TEDxNHS 2019, asking them what pictures they knew of, and what images they would hope for. Their answers confirmed our findings that most images of nurses were from a war, in a ward and of women in support of a patient or a professional. Everybody mentioned the portrait of Florence Nightingale, equating this to an image of a strong woman famous for statistics, sanitation and saving soldiers. This image brings to the fore the work of a woman who was one of the first safety and quality leaders in healthcare advocating cleanliness to save lives. Her work asserted that the whole of a health team should be held accountable for high-quality care. She described her work with images, maps of the wards and pie charts.

Some mentioned the statue of Mary Seacole and lamented, now they thought about it, the lack of modern images. All wished nurse images to portray knowledge, kindness and compassion; some mentioned strength and a few mentioned uniform. All sought a professional look but noting that nurses no longer exist in any particular clinical setting.

We concluded that the current images in art do not portray the current way nurses look, work and want to be seen. It is interesting to explore but is it important? What nurses look like was brought to the fore in the London Marathon in 2019. Jessica Anderson was refused the record for fastest runner in a nurse uniform because she was wearing trousers not a skirt. Insultingly an ill-fitting fancy dress outfit, artfully adorned by someone who has never looked after an ill person in their life, was seen as what nurses really look like. This image issue goes deeper than the uniform, this was about how society sees nurses. The decision was eventually overturned but not before our interest in creating a new image was peaked.

There is already a campaign to alter the image. The Nursing Now campaign to promote mini scrubs in schools encourages young people to think about nursing as a career. The androgynous mini scrubs portray an image slightly different from the current dresses, tunics and trousers and very different from past traditional uniforms with belts and badges. The interviews highlight how some mourn the passing of badges and belts and the sense of pride and identity these brought. Whether in baggy scrubs or silver buckles, image is important. Talking of this image issue may make the invisible cultural and societal aspects of nursing visible and enable us to challenge the assumptions and change the future. What would a new image be?

A New Image?

How could we portray nurses in a new way and in a manner that is neither passive nor aggressive? How can we bring the values of the past into a vision for the future?

I have seen a sculpture by a talented young woman called Lauren Smith that does this for me. This sculpture was not designed to portray any particular person or profession; no fuss, no fame, just an idea for an examination. It is everyone.

This is a sculpture of a helping hand reaching out without reference to time or place, person or power. The torso is female, as most nurses are, the face is androgynous, a face that can be mine or yours, the hand is a universal gesture of help and support.

Willow, copper and steel sculpture by Lauren Smith

Her stark materials are willow, copper and steel, the products needed to provide a new view of a profession. Willow is shock resistant, is undented by anything thrown at it, yet is flexible and crucially analgesic. Across ages and cultures, willow has been chewed and viewed as a cure for all manner of pain, whether for headaches or back pain. Salicylic acid or Aspirin owe their origins to willow.

Copper wire is clean. Copper is anti-microbial and studies have shown that using copper surfaces reduce the microbial burden of high touch surfaces in the hospital environment. This means they are safer and cleaner.

Steel wire is strong, bringing individual elements together to create strength, facilitating the elements to be stronger together than apart.

So here we have a 21^st-century image, a helping hand reaching out without reference to time or place, person or power. A piece of art created in the image of all of us, a sculpture created from materials that are uniting and strengthening. It is made from natural products with analgesic and antiseptic properties, products of nature, science and industry-tested in today’s world and proven to improve care.

Edgar Degas said, “Art is not what you see, but what you make others see.” From this sculpture, I see a nurse. I see me.

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Professor Marion Lynch is a nurse, a trustee of Paintings in Hospitals, and a Deputy Medical Director within NHS England, South East. From a family of nurses, Marion’s first role was on a Haematology Unit at the John Radcliffe Hospital in Oxford, caring for teenagers with Leukaemia. A portfolio career with academic opportunities, including receiving her Doctorate, has led to roles including Programmes Lead for Patient Leadership at the NHS Leadership Academy in the Thames Valley. Marion is also a Visiting Professor in Dementia Care at the University of West London. She is also the Founder of the Fiona Foundation for Kids, a charity providing special care for children living in the Mathare slum in Nairobi, Kenya. Find out more about Marion by following her on Twitter (@drmarionlynch).