The problem with the superhero narrative during COVID-19

The coronavirus pandemic has led to public and private outpourings of appreciation for nurses and doctors. In the UK, for instance, the Clap for Carers tribute, which started as an online campaign and resulted in public noisemaking for ten evenings from late March through to late May 2020, was a sustained acknowledgement of the valued work that nurses and doctors are doing. Many politicians, royal figures, celebrities and social media influencers supported the campaign. What began as recognition of NHS staff soon extended to all key workers, not only those involved in healthcare, but workers in many fields, helping society during such dangerous times. Rapidly, this gratitude ritual went global, with public applause taking place in China, Italy, France, Turkey, the USA, India and elsewhere (BBC News, 2020).

In this WHO International Year of the Nurse and Midwife, it would seem that nurses are finally getting the recognition they deserve. Even doctors have volubly expressed the bravery and dedication of nurses. ‘Nurses are the real heroes’, said Kolovani, an Albanian doctor working with patients with Covid-19.

They carry out the most difficult tasks and most of the workload. Nurses, most of whom are women, are our greatest supporters, working endless shifts with special protective equipment on, which is very hard to keep on while working. Their work never ends, from making up the beds of patients, to performing therapies, taking tests and filling in documents. I am so deeply grateful to them. (UNWomen, 2020)

The world-famous street artist, Banksy, reinforced such adulation by creating an artwork that depicts a boy playing with a nurse superhero toy, while the figures of Batman and Spiderman sit discarded in a bin (Morris, 2020). Such imaging of nurses is, of course, well-meaning, a recognition of the important work that nurses do. It is also very flattering for nurses (Stokes-Parish et al., 2020).

Interestingly, this representation of nurses as superheroes is not new, and arguably, is trawled out whenever there are crises, or the world is in peril. A vivid example is found in a Belgian Red Cross propaganda poster from World War 1 depicting a wounded soldier being lovingly tended to on the battlefield by a nurse who has flown to him on her angel wings. As the soldier lies slumped on the ground, resting against a rough wall, the nurse, immaculately uniformed in long white apron and veil, is slim, feminine and pretty. She curves around him in succour. In an image which draws heavily on Christian symbolism, she lays her hands on his wounded head. The deeply emotional and powerful message of this poster is that, should there be suffering caused in battle, care and comfort will be close at hand. This idea and its iconography were copied and used by several nations during their massive campaigns to recruit more soldiers for the front line (Meier, 2014).

The other message within the image is that nurses are angels – heroic, self-sacrificing and able to patiently and effectively minister care to all those in need. At the same time, then, as recruiting soldiers, this and other such images not only supported the work of the Red Cross, but also worked to recruit nurses to the war effort.

As many have noted, this image – repeated as it has been in further campaigns, as well as in novels, films, songs, poetry and advertising – has become a trope, that of the good nurse (McAllister & Brien, 2020). This trope goes back to the days of Florence Nightingale, and links good nursing to ideas of the good woman in the nineteenth century, that is, women who were gentle, subservient and ever-available carers (Patmore, 1866). This stereotyping also serves to devalue the training skills and knowledge – and often brute hard physical work – involved in nursing, for it focuses on care as a feminine, and feminised, vocation (Gordon & Nelson, 2006; Stokes-Parish et al., 2020).

Whilst nursing is inarguably a valuable and honourable profession, nurses are not, and have never been, all good (McAllister & Brien, 2020). Although as McAllister and Brien (2016) explain, nurses are highly trained ethical professionals, some nurses ignore this training and transgress rules. While most nurses are diligent, others can be lazy, and there are even examples of nurses who have purposefully entered the profession in order to harm and even kill those in their care (Field, 2008). It is, thus, important to remember that nurses are not angels and they are not superheroes. Nurses are not superhuman. They are human beings, as good and as flawed, as strong and as vulnerable, as any other person and any other group.

A sobering statistic on their vulnerability, reported by the International Council of Nurses in June 2020, is that over 600 nurses had died from Covid-19 worldwide, a figure which had doubled from the month before (ICN news June, 2020).This was, no doubt, an under estimation and no more recent reliable figures of nurse casualties have been released since then. One real worry thus associated with nurses understood as superhuman heroes is ignoring, or at least underestimating, the very real health dangers they are themselves facing. As Daly et al. (2020) have commented, too many times in this pandemic, nurses have been largely silenced, and their needs ignored or exploited. Many nurses have lacked access to personal protective equipment, they are exhausted and distressed. With many already leaving the profession before the pandemic, this ongoing disaster threatens to deplete the supply of nurses to even lower levels.

Thus, the sound of evening applause can be heard to echo hollowly. In order to elaborate the very real problems with the depiction of nurses as superhuman, we outline just three of these here.

One, lauding nurses as heroic in the news, in public expressions and on social media offers a temporary salve for the ongoing dire situation of the global shortage of, and poor working conditions facing, nurses. This is a problem that nursing organisations and scholars have been decrying for years, and yet minimal potential solutions have been enacted (Drennan & Ross, 2019). Nurses continue to earn poor wages compared to others who have achieved, and often paid highly for, a university degree, and they endure stressful and dangerous working conditions (Wilson et al., 2018). Examining Banksy's artwork, it is not hard to imagine that the boy playing with the doll may soon tire of this idol and move onto yet another action hero figurine. Similarly, artwork, headlines and campaigns featuring nurses as superheroes can easily be forgotten, and their ongoing needs and struggle for wages, conditions and status discarded and dismissed (Daniel, 2020).

Two, not all nurses are being honoured in this way, or even noticed for their bravery or skills. Within Australia, the nurses being depicted as heroic in the media are those working in ICU or Emergency departments in hospitals, and yet most of the nursing staff facing active cases of Covid-19 are actually located in aged care facilities. Indeed, in the aged care context, the care nurses are providing has been subtly criticised, and poorly interrogated.

This dismissal does not recognise, however, that across the sector, more than half of all aged care residents are in homes with unacceptable levels of staffing (Eager et al., 2019). According to 2016 data, since 2003 there has been a reduction in employment of RN's from 21% to 14.6% (Chang et al., 2019). Nursing roles have been dismantled and distributed to unskilled and underskilled, and grossly underpaid, care workers who possess varied qualifications and experience. Over 70% of the residential aged care workforce, for instance, is comprised of personal care attendants (Eager et al., 2019), not nurses. Despite this workplace diversity, many of these staff working in aged care are erroneously called ‘nurses’ by residents, visitors, the media and others because of widespread public ignorance of the professional roles within aged care in general, and the work of nursing in particular.

Another nursing domain that rarely basks in the glow of the superhero narrative is mental health nursing. Just as disturbingly, the public have little knowledge of what a mental health nurse does, and further, the stigmatisation associated with mental health patients is often carried over to mental health nurses by association (Chang et al., 2019). The recent Hotel Quarantine Inquiry (Victorian Government, 2020), for instance, revealed that general nurses were employed to provide mental health assessment and care within the hotels and yet some lacked any formal qualifications in mental health. This showed that even public health officials had little knowledge or regard for mental health as a speciality of nursing, and instead assumed that any nurse can perform any task (Covid -19 Hotel Quarantine Inquiry, 2020). Not only is this an error of logic, it is a strange combination of idealisation and enslavery. This is a trap that even nurses themselves can fall into, as for instance when they assume that education and other training is not required for specialised skills. All of this thinking stems from the internalisation of the good nurse trope.

Three, and perhaps most worryingly, portraying nurses as superheroes – as saviours who may be able to swoop in and save the populace from the effects of COVID-19– absolves everyone else from taking responsibility for the containment of the virus. Horrifyingly, there has been a significant backlash from the public to the public health messages about maintaining social distancing and mask wearing (Greenhalgh et al., 2020). Serious outbreaks of Covid-19 have occurred because of unwillingness to comply with this advice. Many people are simply not taking the pandemic seriously or acting safely. Yet, when such people become ill, they are extremely grateful for the health care they receive. This reckless passivity reveals a disturbing paradox – the public may trust nurses to provide health care when illness occurs, yet they do not internalise the health care practices being modelled and espoused that would help minimise their chances of becoming ill.

Although the work of nurses during this pandemic should be valued and appreciated, and undoubtedly, many nurses are taking heroic action by putting the own lives at risk in order to save others, the glib headlines celebrating nurses ought to give us all cause for concern. For while there is celebration of these nurses, their advice is unheeded and many nurses are dying. These human beings are vulnerable and, thus, deserve protection as well as respect.

The light has never before shone so brightly on the flaws in our healthcare system and illuminated so clearly that systemic change is essential. Apart from recognising the value of nursing work with adequate wages and conditions, public health policy and practices depend on good followership as much as good leadership (Daly et al., 2020). Good followership requires that the public need to take responsibility for self-care, and in this, nurses could be playing a more active role. A national public health campaign from the Chief Nurse and the Australian College of Nursing could be mounted, so that the public can recognise that nurses are united and determined in their effort to support the community and keep it safe. The public want to hear from nurses and we should not be silent. As we have argued elsewhere, heroism is about taking courageous action in the face of danger (MacDonald et al., 2018). Its antithesis is to be passive. In this pandemic, nurses should not be bystanders – they should be confidently speaking out about public health.

Telehealth outreach could be utilised more actively, wherein nurses leverage the enduring trust the community has in the profession to reinforce the public health messages of staying covid safe. Nurses should be leading teams, such as the services provided in hotel quarantine, and in doing so, assertively educating and supporting security guards, hotel staff and nursing assistants who may not be familiar with the safe donning and doffing of PPE.

It is in the performance of such roles, in speaking up and being heard, that the true nature of nursing heroism will be demonstrated.