'A hard man is good to find': conceptual origins of the sexy nurse

For an explanation of this post, see The Sexy Nurse Report series.

Where does the sexy nurse stereotype come from, and, if it's wrong (it is), what is the typical nurse like?

In other posts, I've described the origin of The Sexy Nurse (that is, the portrayal of promiscuous nurses in short, white skirts, high heels, and little caps with bouffant hair, pouting lips, etc) as a psychological phenomenon: men who fantasize about a nurse who, essentially, provides sexual favors as part of a continuum of accommodation and caregiving for the man while he is laid up in a hospital bed. As a male who never had this fantasy, even before entertaining the notion of actually working in health care, it's hard for me to see it as anything than an expression of laziness. It is as though the fantasy for these men is that, finally, they have an excuse to lie in bed and be passive while receiving sexual gratification at the same time. Ugh.

However, this psychological explanation of The Sexy Nurse fantasy doesn't provide a conceptual explanation for its basis. Why do men fantasize about nurses in this particular way?

defining the Sexy Nurse fantasy

Let's be clear: there is a fantasy. If you troll through some Internet pr0n trying to figure out how men fantasize about nurses, you will find three main themes on which variations arise: (1) the accommodating nurse, (2) the dominatrix nurse, and (3) lesbian nurses. If you go the Kristen Archive of erotic stories (definitely NSFW... in fact, maybe also not safe for home in some states!) or the Fleshbot blog (NSFW) and look for narratives about nurses, these are the three themes you'll find*.

(1) The accommodating nurse: An accommodation fantasy is one in which a nurse's typical duties in providing comfort and care morph into sexual involvement with a male patient. The implication seems to be that any physical contact can turn into sexual intimacy. In Donna the Night Nurse, the author of this erotic story has cleverly created a fantasy within a fantasy. An injured man is laid up in the hospital and cannot perform Activities of Daily Living such as feeding himself. His nurse is not a stereotypical Sexy Nurse, but as he is laying in his bed, he does fantasize about her being nude except for a white nurse's cap. Later in real life, after bathing him, she finds him aroused and begins providing him with sexual favors:
As the weeks passed, I was healing nicely and thoroughly enjoying my hospital stay. Donna was giving me extra treatments almost every night and was surprising me with things like double chocolate cake and nights when she would slip into my bed after she had removed her uniform.
Two points that are important to note here are that the author describes his job on an oil rig, and the nurse takes the active role in initiating sexual contact. Although one should probably take authors' autobiographical comments in erotica with a grain of salt, it is still significant that the author identifies as a worker, someone who doesn't usually get to spend time in bed.

(2) The dominatrix nurse: Dominatrix might not quite be the correct term. Disturbingly, in these erotic stories, there are a number that contain outright rape of incapacitated patients. In visual pornography, rape seems to be replaced with BDSM (bondage/sado-masochism). And these fantasies seem usually to be lesbian in focus. In the film Nurse Alexis, one nurse ties another down with tape:

It's sterile, easy to use, and handy when you need a tourniquet in a flash. Or if you need some bondage in a flash. When you think about it, the nurse and the dominatrix can learn much from each other.

India Summer doesn't have anything to learn though—she knows all about bondage and control and power. She's just letting Emy Reyes use her. How else will Emy become a good nurse?
(3) The lesbian nurse: Lesbianism, or actually WSW, is a common male fantasy, likely to arise in any context. Home health nurses make an appearance in the story "A Burning Fever":
It was a nurse, but dressed like no nurse I had ever seen before. She wore a white nurse's uniform, but the skirt was very short, barely covering her thighs, and the neckline plunged down to the top of her breasts in a deep vee. She was extremely attractive - funny, it must have been the fever; I didn't normally think of other women as attractive...
What's missing? The common element in all these Sexy Nurse fantasies is the absence of either a proactive or dominant male patient*. In no accommodation fantasy does the patient rouse himself into taking advantage of the nurse or even initiating sex a la an old movie slap slap kiss, as in On the Waterfront...

The point is not that a male display of dominance would be a more "normal" sexual coupling but that in the context of sickness/disability and the nurse-patient relationship, "normal" male wooing is not plausible, leaving a display of dominance as the only avenue for a fantasy involving a proactive male partner. And yet, these are not the fantasies that men have. In fact, the incompatibility of The Sexy Nurse fantasy and the dominant male is even made explicit in one erotic story that begins
I have since recovered from my earlier submissiveness and, in fact, assumed the opposite role to some extent. But I have never forgotten my earlier years and the education I received from... Nurse Adrian.
Needless to say, a male patient does not take a dominant role in the dominatrix or lesbian fantasies either.

the Sexy Nurse: stereotype vs. fantasy

I note that The Sexy Nurse is usually considered a stereotype. The Center for Nursing Advocacy called it "an enduring stereotype of workplace sexual availability that contributes to the global nursing crisis." This statement is made in response to a Dentyne Ice gum commercial that shows a nurse becoming attracted to a patient when he starts chewing Dentyne. Hmmm. Far be it from me to disadvocate (is that a word?) for nurses, but this might be overstatement. I seriously doubt that many women are disuaded from entering nursing because of an advertisement for Dentyne gum that shows nurses as sex symbols. (Is our lack of community fashion shows due to the negative impression women have of runway models?) The idea that nursing is competing for labor with medicine, academia, etc, is rather naive. And frankly, the women who are going to be turned off by being objectified are either religious in outlook or career- and status-driven overachievers who aren't going to consider nursing anyhow.

And anyhow, what about this stereotype business? As anyone who actually works in the hospital will tell you, there are in fact male patients who will cop a feel as well as cads who will actually ask for sexual favors. What are we to make of these men? Are they blank slates who have been brainwashed by media imagery into believing that female health care workers are in the habit of jacking off male patients? Or are they simply the same boors and cads who would be engaging in grab ass in a local pub? I am inclined to think the latter, because... now pay very close attention to what's next...

We have already examined the Sexy Nurse fantasies of men as presented in erotica and found that the thing that ties them together seems to be the active role of the Sexy Nurse and the passive role of the male patient in initiating and carrying out sexual contact. Therefore, a male patient who steals a kiss, grabs ass, or requests a handjob from female staff (all things that have happened while I've been working) is NOT acting out on a Sexy Nurse fantasy! He is simply a middle-aged cad who meets a pretty young woman who is treating him nicely. He would probably grab ass or make comments to a waitress who was very attentive to him as well. This is not a problem of media creating stereotypes out of male fantasies.

belief vs. desire

I would like to distinguish between stereotypes and archetypal fantasies. A stereotype is a predisposition--a belief--about a category of people. A fantasy is an expression or narrative of sexual desire. And from Jung, we have the idea of archetypes, or "instinctive trends" that help to provide meaning. The relationship between these terms is difficult to define, I think.

To say that (heterosexual) women desire sex with men is a stereotype. It is a stereotype that is probably held by a very large percentage of the population, and it is probably accurate when applied to a very large percentage of (heterosexual) women.

Nobody is really bothered by this stereotype about women because it is held by and applicable to large enough percentages of the population that it simply exists in people's minds as an assumption about life, a truth. But it is in fact a stereotype. This is important to recognize. People go through life using stereotypes to tell them how things and people should or will act. Nobody questions stereotypes when they have large enough universal applicability.

That women desire sex with men with large penises is also a stereotype. It is probably held by a large, but smaller, percentage of the population, and is probably accurate when applied to a large, but smaller, percentage of women.

That women desire sex with black men with enormous penises is also a stereotype. It is probably held by a somewhat smaller percentage of the population, and is probably accurate when applied to a somewhat smaller percentage of women.

Somewhere between "women desire men" and "women desire well-hung black men" a truth that anyone can say in public elides into a pejorative "stereotype" that will at the least make people uneasy if you say it. This exact point of ellision is controlled in large part by the surface areas of the circles that describe this Venn diagram--"women", "women who desire men", and "women who desire well-hung black men". The exact calculation I wouldn't know how to make.

If one looks at the content of erotic fantasies, as represented in a site such as the Kristen Archives or EroticStories.com, it is clear that while people spin their own personalized fantasies of sex, fantasies also trend toward certain themes--eg, differences in age, adultery, multiple partners, etc. Whether these themes are themselves archetypal or in fact represent a variegation of detail on yet deeper sexual archetypes** I don't know. And it doesn't matter. For the purpose of this essay, it need only be recognized that there are archetypal erotic fantasies.

The relationship of stereotypes to archetypal fantasies, I do not know, but there must be one. For people who believed that women had an instinctive aversion to black men and no preference in penis size, the very large number of erotic stories and pr0n films depicting interracial sex would seem not only non-erotic, but ludicrous.

Is the opposite true? Do men who are aroused by interracial erotica necessarily have a stereotype that women desire well-hung black men? I'm not sure, but it seems very likely to me. Of course, as with all things psychological, the specifics are very murky. Perhaps a man who likes interracial erotica stereotypes women as cheaters, or stereotypes women as prefering large penises, or stereotypes women as prefering dominant personalities, or perhaps all three. But these stereotypes do not have equal claim to believability. The stereotype that women are born cheaters is much harder to hold in the face of lived facts than a stereotype that women prefer dominant men. Both may, in fact, have equal truth value, but they are not equally as observable.

This is far from the final word on stereotypes and fantasy. Consider that two men might both believe women are born cheaters while one eats up cuckolding erotica and the other gets sick to his stomach whenever his wife leaves the house. A fantasy is not simply a re-telling of a stereotype, it is an integration of stereotypes that provides meaning, meaning in this case being erotic salience.

So how does my Blacks-on-Blondes commentary relate to the Dentyne Ice commercial?

I think it should by now be obvious that The Sexy Nurse is not a stereotype, although she may be a fantasy. In the face of lived facts--trips to the hospital, TV shows, meeting neighbors, etc--it would be too difficult for anyone to actually believe that The Sexy Nurse was characteristic of today's nursing profession. And the Dentyne Ice commercial confirms this:
The 30-second spot shows two male patients in beds in a semi-private hospital room. One is a young hottie with a long leg cast, the other an overweight elderly gentleman. Hottie grins mischievously and presses call the button. Then he hobbles to a rolling table across the room, picks up a package of Dentyne Ice, puts one in his mouth, and hobbles back to bed, groaning.

An attractive young female nurse enters, wearing a short-sleeved white nursing dress. We can't see the dress length, but the neckline is unzipped to reveal some cleavage. The nurse asks, casually: "Did you call?" The patient responds smugly, knowing he's about to score: "Hi...I'm Derek." The nurse sits on his bed and moves very close, staring at him with obvious erotic intent: "Tanya...hi." The two are about to kiss when they remember the other patient and look over. The elderly man looks at them expectantly. The nurse quickly draws the blue curtain to separate the two halves of the room.

So the elderly man puts a piece of Dentyne Ice in his mouth. Instantly a second female nurse of roughly his age and comparable physical attributes appears. She smiles and says "Hi!" and she seems about to sit on his bed. The spot cuts to the closing image of the product package, with the tag line delivered by a young woman in voice over: "Dentyne...Get Fresh."

The joke is on us, the viewer! As we get sucked into the fantasy, some of our stereotypes such as nurses as young women and young people as sexually adventursome come into play and are suddenly overturned by the appearance of an older woman. Furthermore, our desire and our suspension of disbelief that makes fantasy possible is revealed to us when we reject interest in the older woman dressing in the same counter-factual Sexy Nurse clothing with plunging neckline.

However, although the Sexy Nurse fantasy may not be a stereotype, it may be based on other stereotypes that are harder to contradict based on people's lived experience.

nurse stereotypes; sexy nurse stereotypes

Wikipedia has a list of nurse stereotypes:
* 1.1 Angel
* 1.2 Battleaxe
* 1.3 Handmaiden
* 1.4 Homosexual male
* 1.5 Matron
* 1.6 Nymphomaniac
* 1.7 People who weren't accepted to medical school
Some of these don't apply to The Sexy Nurse. The gay male may be a stereotype of male nurses, but it doesn't apply to stereotyping female nurses. People who weren't accepted to medical school doesn't apply (and I don't believe this is a widespread stereotype of nurses, either).

Of the remainder--Angel, Battleaxe, Handmaiden, Matron, Nymphomaniac--I see all as having differing relationships to The Sexy Nurse and to each other. For example, one could conceptualize them all as different manifestations of the Virgin-whore dichotomy, inhabiting different poles in the characteristics of compassion and sexuality (two characteristics themselves seen as mutually exclusive aspects of personality), as shown in the following diagram:
However, I don't think this diagram in fact captures the relationships accurately.

The Nymphomaniac stereotype essentially is equal to The Sexy Nurse, and as I stated above, I don't believe it is a true stereotype of nurses. The sociologically-minded may insist on pointing out that in "the old days" nurses were culled from the ranks of prostitutes, and this could be the origin of a stereotype of nurses as whores. However, this knowledge is confined today to the very few people who know anything about the history of nursing. Most people today make no association between health care professionals and sex workers.

Keep in mind that we are referring here to public perceptions, and not the medical diagnosis "nymphomania", which dates to the Victorian era but has been removed from the Psychological Association's DSM-IV. As related in Nymphomania: A History, (see page 139) there was a large up-swing in the public's recognition of "nymphomaniacs" during the 1960s and 1970s as public obscenity laws allowed the publication of erotica and pornography. But today, how many women do you know who are referred to as nymphos? I have heard of one. This meme of female sexuality has died out. Even during the height of its popularity, the idea of nymphomaniac nurses was more an excuse to put T&A on paper than an expression of the Sexy Nurse fantasy themes we have explored above. For example, here is a reader review of the book Nympho Nurses, published in 1969:
The female lead, Virginia, is a secretary for a Freudian psychotherapist, and nowhere near a nurse, nor a nympho but simply a sexually liberated 23-year-old woman in the 1960s. Some bright editor... sure was paying attention here. “She works for a doctor — she must be a nurse!”
No, the nymphomaniac meme is dead, and the nympho nurse stereotype, if it ever existed, is dead, too.

So if we remove nymphomaniac, we are left with Angel, Battleaxe, Handmaiden, and Matron. Of these, I believe the "Matron" may or may not have been a stereotype, but if it was, it was tied to historical conditions that have passed--namely, the days when nurses were trained on the job in certificate programs, when nurses lived in dormities as single women, when nurses had to wear closely defined uniforms, etc. I cannot recognize the Matron as a stereotype today.

It is my contention that the Sexy Nurse is an archetypal fantasy that relies on integrating the remaining three stereotypes--Angel, Battleaxe, and Handmaiden--which I see as true, ongoing stereotypes of nurses held by the public and presented in the media. As such, the proper way to conceive of the relationships is shown in the following diagram:Note that there is no stereotype for the lesbian nurse fantasy. As I mentioned above, for men, fantasizing about WSW is widespread and not confined to any other genre or theme of erotica. Men do not require any stereotype about nurses to fantasize about WSW nurses (although I note that often the dominatrix and lesbian fantasy themes are mixed in Sexy Nurse fantasies). If we were investigating the Sexy Cab Driver, then there would be lesbian cab driver fantasies; if the Sexy Chef, then lesbian culinary erotica; etc.

I have already given examples above of the types of fantasy connected with each theme. Let me simply re-inforce the reasonableness of the Angel-accommodation and Battleaxe-dominatrix couplings by pulling two images of Sexy Nurses off the web that demonstrate both:In this image, the Sexy Nurse's dialogue balloon "does this help?" captures the quintessence of both the altruistic Angel stereotype and the sexual accommodation seduction fantasy.In this image, the Sexy Nurse brandishes a syringe and needle--symbol of the sadistic Battleaxe stereotype--implying the upcoming painful IM shot that the nurse will administer regardless of the patient's protestations. Coming from a nurse dressed like this one, we can expect the shot will be followed by a spanking, also regardless of the patient's protestations.

As for the Handmaiden-doctor seduction coupling, see the footnote below.

the Sexy Nurse personality: are nurses really whores?

Working in the hospital with nurses was the first time I heard the joke phrase "a hard man is good to find". This play on words drew uproarious laughter from the nurses present at the nurses' station when it was uttered. An observer might draw unwanted conclusions from this little scene, though, as it would seem to confirm all the Sexy Nurse nymphomaniac fantasies that men have of nurses' reactions to male genitalia. Is it possible that nurses really are whores?

No, but you might be forgiven for thinking otherwise. In addition to noticing whether patients are fit or fat and what their personal hygiene is like, nurses pick up on unmentionables and sometimes share them***. I have heard nurses both criticizing and singing the praises of male patients' genitalia. I have heard them spreading the news when a well-muscled fellow is admitted. I have seen middle-aged nurses vying over patient assignments when a handsome 20-something is in one of the unit beds.
Frankly, doctors are not like this. They go to school for 4 years to learn how to see human physiology as a giant BioChem equation. Then they go to school for another 4 years to learn how to objectify and compartmentalize the body and dissociate their emotions from their analytic tasks. Then they're beat down in residency with overwork and lack of rest. I've never heard a doctor make a non-medical comment about a patient unless it was about their personality.

Nurses often enter the hospital world of naked bodies as 20 year olds with only 2-3 years of school. Nursing instructors are still dispensing advice to students on what to do if a patient gets an erection, and nursing schools are still graduating nurses whose primary exposure to and physical contact with men has been with patients. Nurses usually have little interest in physiology beyond what they need to know to do their jobs, and they really do see the patients as whole persons more than the medical profession. It would be a surprise if nurses were able to put aside whole categories of emotional reactions as easily as doctors.

If you doubt what I'm saying, just re-read the above description of the Dentyne Ice commercial released by the Center for Nursing Advocacy. The author of this press release has described the younger male patient as a "hottie." This is not the character's name or role, it is the author's impression and description of the commercial, and it's been released by the Center as a critique of media portrayals of sexualized nurse-patient relations!

But the fact that nurses are also women doesn't mean nurses are a bed bath away from groping their patients any more than a police officer is a pat-down away from groping an arrest. The very conditions under which this professional work takes place strips it of erotic energy for the professional. Moreover, what I'm describing is inside information, not accessible to the public and, therefore, cannot be the conceptual basis on which the Sexy Nurse fantasy is built.

One place the public has contact with nurses is personal life. Perhaps the psychology of the Sexy Nurse fantasy is built on concepts developed from people befriending and dating nurses? Are they real tigers outside the hospital? Not in my experience. Although I have found nurses sometimes self-identify as "hard-working, hard-partying" (more widespread in emergency and critical care nurses), this is not really the case. The nurse as hard-drinking independent girl exists alongside the tortured alcoholic artist, the musician who takes shots between sets at his gig, the policeman who drops into the pub for a cold one after his shift, and the journalist/novelist who keeps a shot-glass and bottle of whiskey next to his typewriter. And of course we are familiar with the martini-drinking army surgeons of M*A*S*H. These are all stories that stressed-out professionals tell about themselves when their jobs start to take over their lives. It doesn't mean that they're really any more vice-prone, licentious, or fast-living than anyone else.

I think the real conceptual basis on which the psychology of the Sexy Nurse rests is the difference in physical contact that occurs inside and outside the hospital. The difference between how I interact physically with a stranger in the health care system and a stranger in the supermarket are qualitatively different. When you're inside the health care system, this is obvious and normal to you.

A man learns, I think, that if he goes to a bar and a woman is interested in him, she pays attention and may touch him. A woman who interacts with a man by touching or hanging onto his arm or shoulder in a bar is sending a signal. If she isn't making a pass at him, she is at least sending a signal that he holds some interest for her.

Anyone in health care understands that when a nurse touches a man on the arm, shoulder, or anywhere, it sends no such signal. Most people outside the health care system understand this as well. However, it is very possible that not everyone does. In fact, for a man who has been conditioned to associate touch with intimacy of some degree, it may be nigh on impossible not to get signals crossed.

In my opinion, the conceptual origins of the Sexy Nurse are to be found in the fact that nurses touch men and do not exhibit shame or revulsion. Outside the health care system, this characteristic would be interpreted as an invitation to some degree of intimacy, even if only increased conversation. It is true that nurses and health care are different. It is difficult to work in health care and be embarassed about aspects of human life. This is a fact that any nursing instructor may be heard to say to nursing students, and it is very true. An inside nursing joke that "a hard man is good to find" does not represent the fact that nurses are whores, but it does represent the fact that nurses have reduced shame in the face of the realities of human life. It is this reduced shame, and the experience of it by patients, that leads to fantasies about the possible outcomes of touch and physical closeness that arise between nurses and patients.

conclusion: why a bloke's against a bloke

So basically I've concluded that rather than a real nursing stereotype, the Sexy Nurse is a foolish fantasy that is based on misperceptions on the part of non-health-care-workers, especially men, about the relationship between physical contact, shame, and sexual and emotional intimacy between nurses and patients.

There are multiple objections that can be made to the presentation of the Sexy Nurse in media. There is an argument that it is bad for patients and health care workers. But mostly, I think, women find it unnerving to think that men sexualize them in the course of health care. Frankly, I do as well.

All women need to be aware that men can and will sexualize almost anything. This has entered pop culture lingo as "Rule 36," and it is true. This may bother women, but it doesn't bother me in principle. This is what men are and how Nature in its Providence provides for babies. However, as a man, I am disturbed that men would sexualize their own sickness.

Sickness is not a man's strong suit, mating-wise. Although the occasional patient may be attractive to the occasional nurse, in general, a man who can't even sit up by himself because he's had his chest cracked open and sewn shut again doesn't hold much appeal. Working with nurses, I can confirm that a hospital unit is full of things that seem to need a stroke, smack, jiggle, or grind. But as a patient, I would be embarassed to notice this, as my condition would put me in a rather bad position. When men can't recognize this and instead fantasize--as in the Donna the Night Nurse fantasy above--being brought chocolate cake and handjobs, I find myself calling into question their masculinity.


* fantasy footnote: It should be noted that there is a fourth theme that provides an exception to the rule that the Sexy Nurse fantasy relies on a fantasy of submissive, or at least passive, male sexual role. The fourth theme is doctor seduction. Doctor seduction may occur when a doctor seduces a nurse but is more akin to the true Sexy Nurse fantasy when a nurse seduces a doctor. However, in both these instances, the fantasy power dynamic is changed as a seduced doctor is desired by the nurse for reasons of status and not as an extension of her caregiving role. For example, this book Naked Nurse, whose cover blurb says "she admired his skill in surgery; and his lust in bed."
I'm fairly sure Naked Nurse was aimed at male audiences and not at women. However, the doctor seduction theme is relatively absent from erotica aimed at men. I assume this is because most men would have difficulty empathizing with the doctor role. In fact, as a doctor is a high-status role out of the reach of most men, I suspect doctor seduction is actually a turn-off for most men. It is notable that most of the doctor seduction erotica is actually romance work aimed at women. For example, Nurse Fairchild's Decision seems to be on the same surgery handmaiden theme as Naked Nurse, but obviously a different emphasis with the blurb "She had won her place in a big New York hospital, but would her passionate young heart betray her?":
Cover Girl Nurse, "Was she really a dedicated nurse, or still just a glamour girl?":
Nurse With A Dream, "After Nurse Kyria's adventure with a society playboy, could she go back to her smalltown hospital and the doctor who loved her?"
More doctor seduction theme Sexy Nurse erotica at Vintage Nurse Romance Novels blog. I need hardly point out that these trashy novellas are aimed at young women who might be considering careers in nursing, or women who fantasize about a nursing career. If nursing advocates want to dispell the notion that nurses are unserious goldiggers looking for doctor husbands, they need to look in their own backyards first and criticize women who actually fantasize about meeting high-status men...

** archetype footnote: I wonder whether, for example, pedophilia is a perverse archetype of sexual desire or whether it might be a dysfunctional variegation of another sexual archetype such as seduction or initiation.

*** taking a peak footnote: To be fair, the nurses in my current unit, the ICU, are much more serious and less gossipy than what I ran into on other units.