Screenwriter Bo Goldman’s first encounter with nursing was with a German labor and delivery nurse who attended his newborn brother. Her name was Benz. "This was just before the war, with Hitler on the horizon," Goldman said. "She was terrifying. She was huge and scary. ... She was obsessive about sanitation. The baby was always clean. The blanket was always clean and everything had to be clean." Some images are hard to shake.

When asked to think of a nurse in the movies, many likely still think of Nurse Ratched in "One Flew Over the Cuckoo’s Nest," the screenplay for which Goldman won an Oscar. The character, played by Louise Fletcher, has become almost synonymous with the disciplinarian medical professional—a nurse whose unyielding worldview and sadism, when unchecked, could provoke a homicidal meltdown in her emotionally regressed patients.

To bring the character from Ken Kesey’s novel to the screen, Goldman based Nurse Ratched in part on his imperious mother-in-law, he said, not Benz. But he was quick to add that the images in the movies, in any case, do not necessarily jibe with his feelings about real-life nurses. He said that in every profession there are "artists" and "practitioners." He admires artists.

"I think that one of the saddest things in the world," Goldman said, "is that two of the most noble professions—teaching and nursing, particularly nurses who work in hospices and with terminal patients—get paid [almost nothing] for that calling."

Although Hollywood movies usually live or die by the strength of their characters (flawed or not), nurses often have chafed at the way they are depicted.

"I don’t think that movies accurately portray nurses as they really are," said Susan Woods, Ph.D., RN, FAAN, associate dean of academic programs at the University of Washington School of Nursing. "We have nearly 6 percent who are men. We have nurses who are researchers, scientists and teachers. I don’t think there’s anything [in film] that portrays the scope of what a nurse does."

With nursing shortages acute enough to warrant congressional attention, some organizations have turned their attention to image. Nurse advocates say that negative images have started to prove costly, especially the idea of a nurse as a technical professional who only works with her hands, crippled by her inability to take
the lead.

Screenwriters, of course, tend not to look too closely at technical aspects of professions; they mine emotional potential. Nurses carry a lot of emotional freight. After all, they work with the dying. They intimately handle people’s bodies.

"When I think of the idea of a nurse, I think of somebody caring," said Walter Bernstein, another veteran Hollywood screenwriter whose sister-in-law is a head nurse in Miami. "The devotion that nurses supply, doctors often lack. Many doctors don’t see the patient as anything more than his or her disease, rarely as the whole person. I found in my experience that good nurses do see the person."

Lingering stereotypes
Nurse archetypes go back much further than today’s shortage. Some have their origins as far back as the 19th century, Bernstein said. "It started in silent movies," he said. "The nurse figure is a potent one because she has power. You are lying there in bed. You’re at her mercy. Or his."

Although Nurse Ratched is the cultural yardstick, other stereotypes linger as well. There’s the sexpot nurse and there’s the selfless nurse type, inspired by Florence Nightingale.

Comedic nurses often are overtly sexual, their skill for caring twisted into some absurd adolescent fantasy. B-movie producer Roger Corman created a cottage industry based on this notion in his "sexy nurse" movies from the 1970s. In the late 1980s, the American Nurses Association protested the NBC show "Nightingales," which portrayed its professionals as nubile sex kittens, said Anne Hudson Jones, Ph.D., a professor of literature and medicine at the University of Texas Medical Branch at Galveston.

The sexy image comes from turn-of-the-century burlesque shows, said Tom Gunning, a film historian at the University of Chicago.

"A lot of comedians started out in burlesque," Gunning said. "You get that very early coming into film. There’s a film called "Wanted: A Nurse" from 1906. It’s a play on the nursing image as something sexy. That continues in comedy through today."

Then there’s the saint type—her every gesture one of monastic self-sacrifice and discipline. The epitome of this kind of nurse is the version of Florence Nightingale in the 1936 film "The White Angel," said Jones, who compiled several essays on the subject for her 1988 book Images of Nurses: Perspectives from History, Art and Literature (now out of print).

"The White Angel" came out in the 1930s," Jones said, "along with a spate of other films that put medicine and physicians in an idealistic light." "The White Angel" was endorsed by the ANA and praised as an educational effort, but didn’t have much commercial impact, Jones said.

In the 1996 film "The English Patient," Juliette Binoche plays Hana, a nurse whose devotion to her patient leads her to stay with him under dangerous wartime circumstances. The character could be considered one aspect of the Florence Nightingale type, although she does not have the military mindset.

Bernstein depicted a self-sacrificing nurse as the protagonist to tell a story about the Tuskegee syphilis study in "Miss Evers’ Boys," a 1997 HBO film. Based on a true story, the film dramatizes an experiment in which several African-American syphilis patients are studied (but not treated) under a program funded by the U.S. government. Although the nurse (played by Alfre Woodard) finds the experiment immoral, she stays on because the patients have come to depend on her.

"She was the one with the moral dilemma," Bernstein said. "She could rationalize what she was doing because she claimed she was helping. … At the same time, she was under very heavy influence of doctors. If that’s what the doctor said, that’s what you did."

Boys on the side
Male nurses, meanwhile, are perennial nonstarters in mainstream film, who suffer the slings and arrows of ridicule. When he meets his girlfriend’s macho, hard-nosed father for the first time, Ben Stiller’s character as a male nurse in "Meet The Parents" finds that being called Florence Nightingale is not always a good thing. At least if you’re a man.

Perhaps the film’s family is the real object of satire. But 50 years ago, "male nurse" could easily be read in a film as homosexual. This kind of shorthand is an important tool of screenwriters.

"I always thought of [Nurse Ratched] as a nurse second and a control freak first," Goldman said. "She was a terrifying woman, an emasculating and castrating creature."

He also says characters with such striking qualities help summon dichotomies in human nature. "I think that every lawyer is a criminal and in any doctor there is a sadist," he said. "In every nurse—never mind Florence Nightingale or Mother Teresa—is a sadist’s accomplice."

Saved by the tube?
Television, ironically, has provided both the best and worst depictions of real-life nurses. On the one hand, there are shows such as NBC’s short-lived "Nightingales," with its locker-room shenanigans.

But then, on the same network, there’s "ER." The latter program, applauded by nurse viewers, not only portrays characters of unusual depth and nuance, but one of its leads, a nurse played by Julianna Margulies, declined an opportunity to go to medical school because she saw that she could make more of a difference in her own field.

Of course, character being paramount, it also should be noted that she tried to commit suicide in the pilot episode.

"I think ["ER"] shows the role nurses can play in the emergency room and how important they are," Woods said. "It also shows the role nurses can play in patient advocacy, community advocacy."

"Our prime nurse right now is Abby [played by Maura Tierney]," said R. Scott Gemmill, a writer/producer with "ER."

"Abby had a drinking problem. She is someone who is a smoker. We get heat from the network for portraying anyone who smokes. Yet it’s very real. A lot of nurses are smokers. That’s how they deal with things.

"Our nurses aren’t all stereotypical. They don’t play sex bombs. They come in all sizes and colors."

To make characters three-dimensional means showing them with flaws and all, Gemmill said.

"Some [nurses] are maybe a little hardened by the job," he said. "That’s what makes it interesting. We don’t think you have to portray them all as these perfect little Florence Nightingales. Not everyone can have a perfect day. You do make mistakes and you do bite people’s heads off. That’s what’s interesting and that’s what drama is about."