Behind the Scrubs: a nursing Magazine’s Representation of Race and Gender

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Behind the Scrubs: A Nursing Magazine’s Representation of Race and Gender

Monica Velarde


Saint Mary’s College

December 15, 2008

Advisor: Susan Alexander


Behind the Scrubs: A Nursing Magazine’s Representation of Race and Gender


The nursing profession today continues to be dominated by one race and one gender. Because of the changing demographics of the United States, the healthcare industry consciously tries to attract “minority nurses” into the field. Advertisement is one such way to promote the profession. In this study, one particular magazine, Minority Nurse, which brands itself as a “minority magazine” for nurses is analyzed to assess how nurses from minority and dominant groups are represented.

Behind the Scrubs: A Nursing Magazine’s Representation of Race and Gender
The increased diversity of the United States’ population necessitates an examination of one social institution, healthcare. As people live longer and as the demographics of the United States changes, there is an increased need for healthcare providers familiar with diverse cultures. Nurses, as one type of health care providers, are often portrayed in the media. Although there are differences in stereotypes of nurses, there is one demographic about the profession; it is dominated by Whites and by females. Currently, there is an attempt to attract more minority nurses, in both race and gender, into the profession. The United States is increasingly a more diverse nation and, thus, a more diverse workforce in the healthcare institution can be beneficial and can establish better patient/health care provider relationships.

The purpose of this study is to analyze the representation of nurses in a magazine that brands itself as a “minority magazine” in order to assess if and how such magazines include minority populations in the United States. This project is sociological because it examines the social construction of race and gender in the nursing profession, and how those two components are represented through media.

Nursing as a Profession

As a profession, nursing focuses on providing care for another, a traditional female trait. A pioneer of nursing, Florence Nightingale says, “a nurse is any person in charge of the personal health of another” (Cowen and Moorhead, 2006:7). As the needs of the patients have changed over the years, so have the responsibilities of nurses. According to Choy (2003:45) in the mid-nineteenth century, “nursing was primarily the work of white, native-born, poor, and older women who entered nursing at the end of their working lives, often for lack of other options.” The work of Florence Nightingale was to establish the demographics of the American nurse. First introduced in 1873, the hospital training schools for nurses “aimed to reform nursing into suitable employment for young 'gentlewomen' with the virtues and qualities of middle-and-upper-class womanhood in Victorian America” (Choy, 2003:45). The nursing profession has been considered a female occupation since the 1800’s, and today women continue to dominate the nursing field.

In a 2004 research conducted by the U.S. Department of Health and Human Services, there are an estimated 2.9 million registered nurses (RNs) in the United States. Of that number, approximately 5.8% or 168,000 are male nurses. Health and Human Services also estimates that about 81.8% of nurses are White (non-Hispanic). The categorization of minority racial groups is as follows: 4.2% are Black; 3.1 % are Asian, Native Hawaiian or other Pacific Islander; 1.7% were Hispanic or Latino with any race specified; and 0.3 % are American Indian or Alaska native. In terms of age, male RNs tend to be younger (at 44.6 years) than their female counterpart (at 47.0 years). Minority RNs as a whole are also younger (at 45.4 years) than White RNs (at 47.1 years). However, African-Americans are the oldest at 47.2 years, while Asian, Native Hawaiian or Pacific Islanders are the youngest at 43.9 years of age.

A prominent issue looming over the healthcare industry is the shortage of healthcare providers, especially nurses. According to Kalisch and Kalisch (2003:470), “as the nation moved into the earliest years of the 21st century, it was clear that one of the greatest shortages of nurses in U.S. history was in the process of formation...the growth factor [of nurses] slowed to just a 5.4% increase from 1996 to 2000.” A 2002 research conducted by the U.S. Department of Health and Human Services projects that there will be a shortage of 400,000 RNs by 2020. Thus, job growth is expected in the coming years. In 2008, the U.S. Department of Labor identified registered nurse as the occupation with the “largest numeric increase” in job growth in the 10 year span of 2006 to 20016 with a projection of 587,0000 new jobs.

Another issue challenging nurses today is adapting to the changing demographics of the United States; Americans are increasingly more racially diverse and older. In 2008, the U.S. Census Bureau stated that minorities will become the population majority in 2050 with 54% of the population. Also, the number of those who are 65 years and older will double to 88.5 million in 2050; today, that number is only 38.7 million. Thus the nursing profession has been making extraordinary attempts to attract those who are racially diverse as well as younger people to enter the field.
Current Research

Numerous studies suggest the significance of nursing as an occupation in American society. Extensive research have been done exploring gender issues in the nursing profession such as gender hierarchy within the health profession especially concerning the gender hierarchy and composition of nurses versus doctors. Gordon (2005:34) notes that anthropologist T.M. Luhrmann believes that “modes of dress are very important to doctors. Doctors want to signal unambiguously that they are not nurses.” Much like dress, language also serves as a status indicator. Gordon finds that whereas “many physicians tend to call [registered nurses] by their first names, [doctors] expect to be addressed by their last name and title.” Gordon concludes such gender and status distinctions illustrate the higher status of doctors in American society thus creating a gender hierarchy in the medical profession. Norwood's (2001) analysis of popular magazines, suggests that physicians continue to be primary the image of healthcare and health-related advice.

Other research explores the representations of nurses in media. This continues to be an important issue for nurses due to the variety of stereotypes which exist in the occupation. According to Darbyshire and Gordon (2005:74), “the images and perceptions of nursing, both within the profession, and in society in general, are important for several reasons. We live in an era where image and the marketing of image have never been more important.” Muff (1982:120) identifies three “good” nurses' stereotypes and four “bad” stereotypes. The “good” stereotypes portray the nurse either as an Angel of Mercy which “depicts women as nurturant protectors,” the Handmaiden to the physician which “reinforces the idea nurses lack intelligence” and are passive, and the Woman in White which symbolizes purity and virginity. The “bad” stereotypes include the nurse as the Sex-symbol which “perpetuates male fantasies that nurses are sexually promiscuous”, the Old Maid, which Muff sees as “derogatory labeling [and] is the penalty for having threatened masculine prerogatives or personalities”, and the Token Torturer, “an agent of painful and destructive treatment to the patient.” Muff finds the “most potent stereotype of all is that Nurses are women; men need not apply.” Aber and Hawkins' (1992) study of 35 nursing and 4 medical journal advertisements concludes that nurses are depicted as sex-objects and as handmaidens to physicians—further evidence of the reinforcement of both “good” and “bad” nurse-stereotypes.

Contemporary Advertisements

Because this study analyzes images in advertisements, a brief review of the general literature on gender and racial minority follows. The construction of gender in advertisements is significant because the images “lays down more, perhaps, than class and other social divisions an understanding of what our ultimate nature ought to be and how and where this nature ought to be exhibited” (Goffman, 1979:8). Gender images are examined to understand gender roles. The depiction of gender in media can have a profound impact on how individuals in a society view themselves and one another. “Advertising is also gendered in that much of it address our physical sense of self, our knowledge of the world through our bodies. It addresses our need to articulate our social identities through our physical appearances” (Barthel, 1988:8).

The construction of racial minorities’ images in advertisements is also subject to analysis. Knobloch-Westerwick and Coates (2008) conducted a study in which representations of minority models in magazine advertisements popular with minorities were analyzed. The study concludes that “magazine clusters with high readership in ethnic groups also feature significantly more models of this group in their advertising” (2008:12-13). The study also reveals the growing number of African-American representations in advertisements. “This group [African-Americans] is now overrepresented in mainstream advertising relative to its percentage in the population” (2008:14). The high number of African-Americans is present in all most all the magazine clusters, and was only under-represented in ads popular with Latinos. This study adds to the previous literature because this project analyzes minority representation of nurses through advertisements in a self-proclaimed “minority magazine”
Social construction theory considers how society constructs concepts like race and gender are socially constructed, and how work is gendered in part because of such social constructions. Social construction theory provides insight on several significant aspects of the research on the representations of minority groups in a magazine that specifically caters to minorities. This theory applies in understanding the effects of social construction on image representation and vice-versa. Social construction theorists Peter Berger and Thomas Luckmann present the idea that society is a socially constructed human product that is still an ongoing production.
The Social Construction of Reality (1966)

Berger and Luckmann (1966) explore the factors that contribute to everyday knowledge or even common sense knowledge that affects behavior. This “everyday knowledge” can be referred to as social reality. They argue that the foundation of what man deems a reality is based on experience and the interpretation of those experiences, which Berger and Luckmann describe as “everyday life presents itself as a reality interpreted by men and subjectively meaningful to them as a coherent world” (1966:19).

Berger and Luckmann introduce the notion of “habitualization.” This concept is described as “any action that is repeated frequently becomes cast into a pattern which can then be reproduced with an economy of effort and which, ipso facto, is apprehended by its performer as that pattern” (Berger and Luckmann, 1966:53). In other words, first there comes the action performed by the person, and gradually the behavior is repeated until it becomes a pattern. With habitualization, the action can be further reproduced again in the future. For example, in the 1800s nursing began to be constructed as a woman's profession because nursing assumes qualities associated with females such as nurturing and caring.

The idea of institutionalization results from habitualization. Although an individual can habitualize an activity, institutionalization requires interactions from multiple people within the society. “Institutionalization occurs whenever there is a reciprocal typification of habitualized actions by types of actors....what must be stressed is the reciprocity of institutional typifications and the typicality of not only the actions but also the actors in institutions” (Berger and Luckmann, 1966:54). Through institutionalization the social meaning of the behavior comes to be understood. Berger and Luckmann explain that “it is impossible to understand an institution adequately without an understanding of the historical process in which it was produced” (1966:54-5). These institutions have so much power and control that, to Berger and Luckmann, it becomes nearly impossible for individuals to resist them. Thus with habitualization and institutionalization, reality is socially constructed because people's knowledge and belief of what they see as reality stem from human actions and the meaning given those actions that have gradually been ingrained in society. To summarize, Begerger and Luckmann rationalize that “society is a human product. Society is an objective reality. [Thus] man is a social product” (1966:55)

Gender Advertisements (1979)

Goffman (1979) relates the theory of social construction to advertisements particularly when relating to gender stating, “the task of the advertiser is to favorably dispose viewers to his product, his means, by and large, to show a sparkling version of that product in the context of glamorous events” (1979:26). Images associated with advertisements are what Goffman refers to as “public pictures,” which include individuals with no common social relationship or social interaction, and are only linked by similar political jurisdiction appeal, in hopes of attracting a wide audience. A type of public picture is the “commercial picture” or commercial photograph which serves to sell products.

By comparing the advertiser to society, Goffman demonstrates how images contribute to our understanding of social constructions and social expectations. He notes, “the job the advertiser has of dramatizing the value of his product is not unlike the job a society has of infusing its social situations with ceremonial and with ritual signs facilitating the orientation of participants to one another” (1979:27). In capturing an image to sell a product, advertisers are also capturing what society views as ideal.

So both in advertisements and life we are interested in colorful poses, in externalization; but in life we are, in addition, stuck with a considerable amount of dull footage. Nonetheless, whether we pose for a picture or execute an actual ritual action, what we are presenting is a commercial, an ideal representation under the auspices of its characterizing the way things really are (Goffman 1979:84)

Social construction theory is applicable to the project because it examines the construction of gender and race in the nursing profession. In the “real world,” nursing is socially constructed as a White female’s profession. This project analyzes how race and gender are socially constructed through a magazine that specifically labels itself as a minority magazine. Before conducting the study, initial questions regarding social construction of race and gender in nursing were asked such as: Would the image of the White female nurse be reinforced and if so how? Or is there a “minority nurse” image such as Asian female or Black male?
This study is a content analysis of advertisements in a magazine that targets and serves minority nurses. A content analysis is “research in which one examines patterns of symbolic meaning within written text, audio, visual, or other communication medium” (Neuman 2007:363). Previous studies have used content analysis to explore portrayals of nurses in advertisements in popular magazines (Aber and Hawkins 1992; Norwood 2001). The data for this study comes from Minority Nurse magazine. Minority Nurse is a quarterly magazine where “African-American, Hispanic, Asian, Native American and Filipino nurses turn for the latest information on education, career development and minority health” (

The sample was derived from 29 magazines dating from Spring 2000 to Fall 2008. Each issue was obtained from the editor of the magazine; the issues analyzed were the back-copies that the editor had available. Although Minority Nurse has been published since 1993, the editor only had access to issues beginning in 2000, which is when she took editorship. For each magazine, the front cover, inside of the front cover, the back cover, the inside of the back cover, and the first page of each issue were examined; in total 145 whole pages of advertisements were analyzed. In several issues, two separate advertisements on one page; however, each page was analyzed not each advertisement. Additionally, any duplicates of advertisements were omitted.


For each page, a coding sheet was used for analysis. The coding sheet looked at several different aspects of advertisements such as color, graphics, advertisement purpose, gender, race, social role, location, and mode of dress. Color, graphics, and advertisement purposes were analyzed for basic information. There were two choices for color: in color and black and white. For graphics, there were four choices: no people, people was checked if real-life images of people were present, people-animated if the image of people’s race and gender were recognizable but they were either drawn computer animated; people-collage if there was a compilation of non-animated people were but only location and dress were unidentifiable. The seven choices for type of advertisements were: Minority Nurse which also applied to the front cover, university, training program, hospital, United States armed forces, hospital system, and other.

The social role, location, and mode of dress for identified individuals were categorized by gender and race (for example, Female: Asian or Male: Other). For Social Role, identified individuals were coded as: nurse, healthcare provider, patient, and other. For purposes of this study, anytime an individual was dressed in a white coat or scrub, but the advertisement did contain the word “nurse,” the individual was coded as a healthcare provider. For location, individuals were being coded for being in: a hospital; computerized background which was picked if there was no background, home, other. As for dress, the choices include: scrubs/coat, and specifying which one it is, professional suit, everyday and other. (See Appendix A).
Strengths and Weakness

One potential strength of this is study is that because only one magazine was analyzed, gathering and organizing data was more accessible compared to analyzing various magazines. For example, the layout of the pages became predictable after analyzing the first few pages, which made coding easier to do. Also an overall strength of content analysis was having the ability to take as much time to analyze and review the sample. A weakness to the study was that the data set was limited due to the back issues available.

Of the 145 magazine pages that were analyzed, 19 pages have advertisements that are duplicated at least once. In all, 38 pages are duplicates of the 19 images; thus 107 pages of original images were available for analysis. The organization that has the most duplicates of magazine advertisements are those from the United States armed forces, either the Air Force or Navy. The first ad for the United States armed forces comes from the Spring 2003 issue. The Navy, which has two different advertisements in the magazine, is the most advertised company for the magazine aside from the magazine itself. One of the advertisements is duplicated five times and the other is duplicated eight times. In total, the Navy alone has 15 pages (10.3%) of advertisements in 145 pages analyzed—13 of which are in the back covers.

A total of 29 front covers were analyzed from the Spring 2000 to the Fall 2008 issues. Ten out of the 29 magazine front covers do not have images of people. Instead, they are computer-generated images or singular objects such as a red ribbon (Fall 2006). As for the back covers, 15 of the 29 (51.7%) are advertisements for the United States armed forces. Only 3 out of the 107 images are not related to healthcare: 2 advertisements were for performers and the other is for a cell phone.

Representation of nurses

The number of and the type of nurses that are represented in the Minority Nurse magazine is a significant aspect of the study. A total of 168 nurses were identified in the 107 pages of advertisements. In analyzing race alone, Black nurses account for the majority of

identified nurses with 81 out of the 168 (48.2%). This was followed by Whites (24.4%), Asians (17.2%), Latinos (7.1%), and those from the Other category (3.0%). The data shows women still constitute the majority of nurses represented in the advertisements with 132 identified (73.8%).

Overall, the group that is most visible are Black female nurses with 63 identified (37.5%). This is followed by White female (19.0%), Asian female (11.9%), Black male (10.7%), Asian male (5.3%), White male (5.3%), Latina female (3.6%), Latino male (3.6%), Other female (1.8%), and Other male (1.2%). Black female nurses are also more likely to be the “face” of an advertisement, defined as being the only image of a nurse on the page. Black female nurses as the “face” of the advertisement appear in 24 pages (22.4%), next are Black male nurses (6.5%), White female nurses (3.0%), Asian female nurses (2.4%), Latina female (0.6%), Latino male (0.6%). The remaining 64.5% of pages have more than one nurse in the advertisement. In advertisements where others appeared with Black female nurses, usually the Black female nurse is highlighted. This can be seen in the advertisements for Henry Ford Health System, in which a similar layout is used for all three of their advertisements. However, a Black female nurse was the h



ighlight of all of the advertisements:

The comparisons of U.S. population, RN population (from the 2004 U.S. Department of Health and Human Services survey), and Minority Nurse data set in terms of race are compared in Graph 1. In this graph, racial representation of nurses is more similar to the general United States population compared to the representation of nurses in data set from Minority Nurse magazine. There is also an overrepresentation of Blacks and Asians from the Minority Nurse data set compared to the RN population and the United States population.


Representation of patients

A total of 19 pages showing patients were identified. Whites made up the majority of the patients with 12 (63.2%), followed by Blacks with (31.6%), and Latino (5.2%). There were no Asians identified as patients. Females constituted more patients than males with 11 (57.8%). About 37% of the pages contained advertisements where Black nurses were with White patients. This was the most visible combination of nurse/patient relationship in regards to race. The rest were nurses with patients with their own race, or another combination.

The large number of advertisements from the United States armed forces was an unexpected finding. The first advertisements appeared in Spring 2003 and shows a link between the Iraq War (which started in March 2003), and the increased need for nurses in the armed forces. However, only two branches of the armed forces advertised, the Navy and Air Force. According to a 2007 San Francisco Chronicle news article, the Navy and Air Force have fewer personnel in Iraq than the Army or Marines. Due to a shortage of troops to finish two wars, military commanders have made “the decision to send thousands of airmen and sailors into nontraditional assignments such as convoy duty reflects growing personnel shortages as the armed forces try to sustain the highest troop levels of the war” (San Francisco Chronicle). Fewer Navy or Air Force troops were initially deployed to Iraq, thus soldiers in the Army or Marines have higher casualty rates. Perhaps the female nurses identified in the advertisements from the Navy and Air Force reveal that the United Sates armed forces are trying to attract women to less dangerous branches, which may reveal a continued stereotype that women are not as capable as men in a combat situation.

The data also indicates a higher percentage of males in the population sample of Minority Magazine than the overall male RN population; however, there are still more females in advertisements than males indicating that the magazine still reinforces the idea that nursing is a female-dominated field. Another interpretation is that the term “minority” is viewed by the magazine as in terms of race and ethnicity as opposed to gender. In American society, women are viewed as a political minority despite having a larger population than men, but this is not reflected in this magazine.

The overrepresentation of African Americans and underrepresentation of Latinos in advertisements was another significant finding of this research. There are some implications with the representations of African Americans and Latinos in the magazine. According to a 2008 U.S. Census press release, “the Hispanic population is projected to nearly triple, from 46.7 million to 132.8 million during the 2008-2050 period. Its share of the nation’s total population is projected to double, from 15 percent to 30 percent. Thus, nearly one in three U.S. residents would be Hispanic.” Although Latinos are the largest minority group in the United States today, few Latinos are entering the nursing profession Perhaps the small number of advertisements representing Latinos unintentionally sends a message that nursing is not a profession Latinos should seek.

Another unintentional message sent in the advertisements showing Black females as the “face” of a nursing magazine while most patients are White reinforces the “Mammy stereotype” of Black females. Mullings (1994:269) describes the Mammy as “the servile, loyal, obedient woman who nurtures and protects the Euro-American family…the Mammy image functioned to endorse, rationalize, and justify slavery.” The resilience of this stereotype gives evidence that cultural ideologies of the past still persists today, even in a magazine for a minority audience. Blacks’ overrepresentation in this magazine promotes the notion that Blacks represent “the minority.” Despite Census data indicating that Latinos are the largest racial minority in the U.S., Blacks are imaged as the minority.

Being constantly labeled as the “minority” can have some implications for Blacks. For one, Blacks have experienced and continue to experience tremendous discrimination and inequality. According to Yancey (2003),

I argue that [Latinos and Asians] are in the process of assimilating into the dominant society—much like the European ethnic groups of an earlier time. This assimilation means that these groups are gaining more privileges of majority group status, relative to the alienation experienced by African Americans. If this is true, then despite the degree of discrimination Latino and Asian Americans continue to face, there should be a perception that they currently face less discrimination than African Americans (p. 52).

By being constantly labeled the “minority,” Blacks may find it difficult to be fully accepted into American society. They may be imaged as the “other,” or the deviant from the mainstream. In other words, being Black does not just mean being “American,” rather there will always be the hyphenated identity of “African- American.”

Although this study looked at gender and race representation in the nursing profession, the findings could be compared to other professions where it is dominated by one gender and/or one race. The year 2008 saw a White female running for president, another White female running for vice-president, and the eventual election of a half-Black and half-White President of the United States. Throughout the United States’ history, only White men have been elected into the highest government office. Throughout the election, the media have questioned and scrutinized the candidates’ backgrounds in order to try to “label” them. In a profession where one gender and one race dominate, people who do not fit the “norm” will often be dissected. The media is one avenue in which a person may be dissected and represented. This study hopes to encourage changes in the way minorities are represented in Minority Nurse to attract more minorities into the nursing profession. Perhaps there should be a decrease in an overrepresentation of African Americans and an increase in the portrayals of Latino nurses to meet the needs of the growing Latino population in the United States.


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Coding Sheet
Season Year Cover

  • In color ___

  • Black and White ___


  • No people ___

  • People ___

  • People-computerized ___

  • People-collage ___

Advertisement for:

  • Minority Nurse ___

  • University ___

  • Training Program ___

  • Hospital ___

  • United States Armed Forces ___

  • Hospital system ___

  • Other

Total: Male _____ Female _____ Gender N/A _____

Total: Asian _____ Black _____ Latino _____ White _____ N/A _____



Healthcare Provider


Other (describe)


Female: Asian

Female: Black

Female: Latina

Female: White

Female: Other

Male: Asian

Male: Black

Male: Latino

Male: White

Male: Other

Gender N/A: Asian

Gender N/A: Black

Gender N/A: Latino

Gender N/A: White

Gender N/A: Other




Computerized background


Other (describe)


Female: Asian

Female: Black

Female: Latina

Female: White

Female: Other

Male: Asian

Male: Black

Male: Latino

Male: White

Male: Other

Gender N/A: Asian

Gender N/A: Black

Gender N/A: Latino

Gender N/A: White

Gender N/A: Other




Professional suit


Other (describe)


Female: Asian

Female: Black

Female: Latina

Female: White

Female: Other

Male: Asian

Male: Black

Male: Latino

Male: White

Male: Other

Gender N/A:Asian

Gender N/A: Black

Gender N/A:Latino

Gender N/A:White

Gender N/A:Other


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