A few months in to our first year of nurse training at separate hospitals, my friend and I met for lunch. “I’d always assumed that nurses were lovely people,” my friend lamented as we swapped stories on the divisive hierarchy, personal politics and odd behaviour of some of the nurses we had encountered. Our education that nurses were neither saints nor angels of mercy was swift. Yet, back then, in 1989, hospital matrons were single women married to the job, and we were expected to attend the hospital chapel on a Sunday, whether we had religious leanings or not. This scent of sainthood, which lingers around the profession, has a history and, as I will discuss, can facilitate enabling environments for nurses to act non-professionally and–more alarming–to act nefariously.
Through the example of Florence Nightingale (1820 –1910) we can see the degree that the professionalization of nursing has required religious validation. Raised in a Unitarian household comforted by generational wealth and liberal beliefs, Nightingale’s early education included material “traditionally reserved for boys such as mathematics’’ (McEnroe, 2020: 1475). Her prodigious aptitude for this subject foreshadowed her multidisciplinary approach to healthcare, which gained traction throughout her leadership at Scutari Hospital during the Crimean war (1853 – 1856). Nightingale garnered universal admiration and support after applying her talent as a statistician at Scutari, offering quantitative evidence that a greater number of soldiers died from disease as opposed to injuries inflicted during battle. Despite her methodical practice in this area which “[…] contributed to the development of evidence-based health care” (McEnroe, 2020: 1477) and set the standard for modern nursing, the British press employed epithets including “The Angel of Crimea” and “The Saint of Scutari” (Herbert, 1981) to describe Nightingale. Contrarily, her faith lay in opposition to biblical doctrine of the saintly and seraphic. Rather, she is considered by Kerfoot (2012) as a “modern mystic, someone who combined her beliefs with empirical science for the intent of humanity” (2012: 22). Nevertheless, Nightingale’s conviction that she had received a calling from God to undertake her work enshrined her as an effective role model within a religious, patriarchal society.
The 19th century saw an “expansion of scientific knowledge and the increased use of complex technological procedures […] linked to the growth of schools of nursing” (Egenes, 2017: 13), establishing nursing as a profession. However, “until the 1960s, nurses who worked in hospitals were expected to resign from their positions when they married” (2017: 21). Today, senior female nurses in the U.K are referred to as “Sister” while their male counterparts enjoy the term “Charge Nurse,” a practice which contributes to the perception of nursing as “still labour[ing] under the Christian ethos and dogma which combines the ethic of service with the traditional view of women as inferior” (Bryant and Colling, 1990: 164). Nelson (1997: 230) discusses such attitudes as consequential to the historical promotion of “the lady nurses” such as Nightingale. Indeed, the prevailing cultural image of Nightingale is one of a respectable Victorian lady, tightly bound in crinoline and holding aloft a lamp. As Ellis (2008: 404) argues “Most people – even those in ‘the trade’ – think of her as ‘the lady with the lamp,’ the heroine who went out to the Crimean War.”
The angel and hero construct synonymous with nursing, according to Stokes-Parish et al (2020: 462), “reinforces the perception that nursing is an innately feminine, nurturing role.” This statement compliments the media narrative which surrounded the trial of Lucy Letby (October 2022 – August 2023) a former neonatal nurse who was sentenced to a whole-life term in prison after being found guilty of the murder of seven babies and the attempted murder of six, over the space of one year at the neonatal unit where she worked. The British media initially focused on Letby’s appearance: white, young, “average,” and “ordinary” (Halliday and Grierson, 2023). This image filled the front pages of national newspapers, signposting the contrast between appearance and behaviour. Her incongruous doe-eyed gaze served as a mirror to a nation’s belief that any nurse, at any point in history, is assumed to be a safe pair of hands, whether carrying a lamp or holding a prenatal baby.
It could be argued that Letby is a fallen hero not due to any individual attributes but gifted to her by cultural attitudes. Despite the academic trajectory of nursing post WWII, research persists that “to be a ‘good’ nurse […] centres on possessing personal virtues that enable an individual to act, think and feel in morally excellent ways” (Price and McGillis Hall, 2014: 1506). However, the recommendation that a nurse be moralistic may incline towards an assumption that any nurse already is. A mother of a new-born patient in the unit where Letby worked, described her as “a calm, comforting nurse”, and, interestingly, “a ray of light” (Evans, 2023). This motif of light, prominent within the public discourse on nurses, transposed to “superhuman” at the beginning of the Covid pandemic. As Nightingale’s basic but highly-effective infection control practices were rebooted, the nurse-as-hero-in-battle narrative was further deployed. Through a critical analysis of the hero discourse specific to nursing during the Covid 19 pandemic, Mohammed et al (2021) emphasize the risk of such sentimentality: “the normalization of nurses’ exposure to risk, the enforcement of model citizenship, and the preservation of existing power relationships” undermine nursing as a profession.
Lucy Letby had been removed from her nursing duties by 2020. Nevertheless, it is easy to imagine her using her “NHS heroes” discount to buy a pizza, new shoes or get early access to the supermarket. We may envisage the queue at the checkout parting as she walked by in her scrubs, flashing her lanyard. Heads would bow and words of gratitude be muttered as commitments were made to bash a pot and pan on the doorstep or tape home-painted rainbows to the front window. Any nurse who carried a God complex would surely elevate themselves in this climate. The hero-rhetoric has been literalized by the Catholic Church: over the past three years, the Church has beatified four nurses, including three volunteer Red Cross nurses, enthroned as Catholic martyrs in Spain, 84 years after they were raped and shot by anti-clerical Republicans at the start of the 1936-9 Civil War. Cardinal Marcello Semeraro employed the women’s refusal to abandon both their faith and their patients as “an example of closeness to the needy, especially in this time of pandemic” (Luxmoore, 2021). By drawing a direct correlation between martyrdom and nursing, he reflected the universal gratitude for healthcare workers’ “sacrifice” during the pandemic as a spiritual act, rather than occupational skill.
Sacrifice may also be defined as penance, yet Letby’s penance was long-delayed by a customary faith in health care professionals. Letby incriminated herself via words of self-flagellation on a series of post-it notes. She described herself as “evil” while her employers failed to listen to much milder words of concern. When court proceedings against Letby commenced, journalists Liz Hull and Caroline Cheetham reported from the trial, hosting a podcast offering interviews with detectives, victims and experts. Upon close listening, there are assumptions of nurses’ virtue throughout, in testimonials, in the interviews, and even by the hosts. Dr John Gibbs, one of seven consultants who campaigned hospital executives to investigate Letby, discusses the slow process of suspecting a nurse: initially, Letby’s presence at each death was “felt to be coincidence and bad luck for – at that time – poor Lucy Letby” (Cheetham and Hull: 14:05). This sympathy was bolstered by “the senior nurses on the unit [who] were very defensive of her” (Cheetham and Hull: 9:36). Notwithstanding the deaths of two further babies, when the consultants pressed management to investigate Letby, they remained conflicted: “we consultants felt …we don’t know how she’s done it or even if definitely she has harmed the patients, but she’s got to get off the unit while this is sorted out” (Cheetham and Hull: 28:36). During a subsequent meeting with management, the consultants were stunned when instructed to write letters of apology to Letby for distress caused to her. When a further review involved the police, proceedings against Letby began to escalate. Gibbs draws attention to a significant finding from this inquiry: after Letby was removed from the neonatal unit, the subsequent investigations by the Royal College of Pediatricians and a further neonatologist were not “properly designed, equipped or competent to look at criminal activity” (Cheetham and Hull: 25:29). Without police involvement, it is possible that Letby may have returned to work on the unit. Gibbs relates “I think the managers […] probably could not accept and just could not believe that a member of staff could be killing a series of patients in the hospital” (Cheetham and Hull: 42:50).
Throughout the podcast series, Cheetham and Hall’s incredulity at the manner in which Letby was enabled to harm in plain sight was palpable. Furthermore, they had sat through the long, harrowing trial before conducting interviews with those intimately involved, including parents of the children murdered. However, even they couldn’t help reiterating the same tropes. They concluded their interview with Gibbs by stating “you go in to this profession to save lives and the nurses on a neonatal unit […] are superhuman and Lucy Letby’s actions should in no way diminish that” (Cheetham and Hall: 44:09). Cheetham and Hall overall maintain their journalistic rigour. Therefore, their instinct to reinforce the belief that nurses, specifically, are otherworldly in their abilities, illustrates the power of cultural messaging that nurses are not people doing jobs but somehow “superhuman.”
This particular case will remain in the public eye for some time as the UK government announced an inquiry to investigate the circumstances behind the murders and attempted murders. The aim is to “ensure vital lessons are learned and to provide answers to the parents and families impacted” (Department of Health and Social Care, 2023). Letby was unwilling to offer an explanation for her actions when cross examined in court or interviewed by police. This trait furthered a socio-cultural monstering of Letby. Previously, she was a literal poster girl for the hospital in which she worked: the face at the front of a fundraising campaign featured across the media days after she had murdered twin boys. It would appear that the only way to publicly process her behaviour is to set her as far apart from the preferred stereotype of a nurse as possible. In so doing, the majority of nurses, who continue to strive in the day-to-day middle ground of professional endeavour, remain unrecognised and underserved.
Works cited
Bryant, Janet L., and Kathleen Byrne Colling. “Broken wills and tender hearts: Religious ideology and the trained nurse of the nineteenth century.” Florence Nightingale and her era: a collection of new scholarship (1990): 153-167.
Cheetham, Caroline and Hull, Liz. “Toxic Culture.” The Trial of Lucy Letby, Episode 57, Mail Metro Media, Acast, 25 August 2023, https://podcasts.apple.com/gb/podcast/the-trial-of-lucy-letby/id1653090985
Department of Health and Social Care. Government orders independent inquiry following Lucy Letby verdict. United Kingdom Government, August. 2023, https://www.gov.uk/government/news/government-orders-independent-inquiry-following-lucy-letby-verdict
Egenes, Karen J. “History of nursing.” Issues and trends in nursing: Essential knowledge for today and tomorrow (2017): 1-26.
Ellis, Harold. “Florence Nightingale: creator of modern nursing and public health pioneer.” Journal of perioperative practice18.9 (2008): 404-406.
Evans, Holly. “Lucy Letby, How the “Average Nurse” Turned into One of Britain”s Most Netorious Serial Killers.” The Independent, 22 August 2023, https://www.independent.co.uk/news/uk/crime/lucy-letby-parents-home-crime-sentence-b2397177.html
Halliday, Josh and Grierson, Jamie. “Lucy Letby the “beige” and “average” nurse who turned in to a baby killer.” The Guardian, 18th August, 2023 https://www.theguardian.com/uk-news/2023/aug/18/lucy-letby-the-beige-and-average-nurse-who-turned-into-a-baby-killer
Hebert, Raymond G., ed. Florence Nightingale: saint, reformer or rebel?. Malabar, FL: Krieger, 1981.
Kerfoot, Donna. “Florence Nightingale: Mystic or Moralist?.” Historical Papers (2012).
Luxmoore, Jonathon. The Tablet “Beatified Nurses “offer example” for Pandemic.” The Tablet, 08 June 2021, https://www.thetablet.co.uk/news/14201/beatified-nurses-offer-example-for-pandemic [Accessed 7th September 2023]
McEnroe, Natasha. “Celebrating Florence Nightingale’s bicentenary.” The Lancet 395.10235 (2020): 1475-1478.
Mohammed, Shan, et al. “The “nurse as hero” discourse in the COVID-19 pandemic: A poststructural discourse analysis.” International journal of nursing studies 117 (2021): 103887.
Nelson, Siobhan. “Reading nursing history.” Nursing inquiry 4.4 (1997): 229-236.
Price, Sheri L., and Linda McGillis Hall. “The history of nurse imagery and the implications for recruitment: a discussion paper.” Journal of advanced nursing 70.7 (2014): 1502-1509
Stokes‐Parish, Jessica, et al. “Angels and heroes: The unintended consequence of the hero narrative.” Journal of Nursing Scholarship 52.5 (2020): 462.
Image source: Florence Nightingale: a nurse looking up at a vision of Florence Nightingale as ‘the lady of the lamp’. Colour process print after R. Kirchner, 1917. Wellcome Collection. Source: Wellcome Collection.