Nurses on film: a story of unequal representation

Informational films showing life in British hospitals reflected new postwar realities, yet speaking parts for Caribbean nurses – a significant section of the workforce – were few.

16 November 2023

By Xavier Alexandre Pillai

Understanding Aggression (1960)

Since its inception 75 years ago, the NHS has used film as its vital mode of media communication. As the demographics of the health service changed, this moving-image output adapted to include, train and appeal to a new, more international workforce. These films reflected a new postwar reality but could not obscure the societal problems that had begun to mirror themselves within the health service.

Postwar Britain relied on the talent and hard work of citizens of commonwealth nations, not only throughout hospitals in Britain but also in directing and performing in the informational media that emerged from the Central Office of Information.

Understanding Aggression, an internal training film commissioned by the Ministry of Health created in 1960, was directed by New Zealander Margaret Thomson. Similarly to her 1954 film, The Troubled Mind, Understanding Aggression creates a holistic image of mental hospitals. We see the dreamlike sequences of psychotic episodes meant to immerse the audience in the mental trauma of the patient, sweeping shots of the natural beauty, flora and fauna that surround nursing hospitals, and the dramatic, romantic possibilities of the sororal school environment.

London Line was a long-running magazine programme commissioned by The Foreign and Commonwealth Office, tailored to the new (predominantly Black commonwealth nations in Africa and the Caribbean) and old commonwealth (the white commonwealth nations). It’s the only example of a programme from the time to feature a roster of Black presenters. The series presented an ahistorical vision of the relationship between Britain and its former colonies. In a 1973 episode entitled Mineral Wealth in Africa, the programme framed the unequal relationship between resource-rich nations of the global north and their enrichment of raw materials from the African continent as an example of how Africa ensured its position as a world-leading exporter. This sleight of hand was deployed throughout the series, intending to entice African migration to Britain by presenting the opportunity to work for British national industries as a chance to develop skills in areas with high levels of technological innovation. These programmes often suggested that migrants would eventually deploy these skills at home.

Modern Day Nightingales is a story from London Line made in 1978 in the maternity ward at Guy’s Hospital in Southwark. While a busy team of nurses adopt the latest medical interventions, in the background we see – sitting over an incubation chamber in a maternity ward – the figure of a lone Black nurse.

In the documentary world of London Line and Thomson’s stylised representations of the profession, there is an indelible imprint of nursing’s racial hierarchies. Thomson’s films were unusual for portraying the multinational origins of the profession. Attention is paid to the make-up of the nursing team as an Irish matron greets our recruit.

Caribbean nurses in these films have few speaking parts; although they made up a significant part of the workforce – 12% of all nurses were from overseas, of which more than 66% came from the Caribbean. On-screen, they were habitually underrepresented and, in the workplace, troublingly absent in roles where they could advance their careers. In 1978, in the specialised heart unit at Guy’s Hospital, for instance, we see no Black nurses.

Long-term care of the chronically ill was over-assigned to black nurses, who were tasked with taking on the more labour-intensive aspects of care in the 1960s. This meant transporting patients, lifting and carrying them to their beds.

There was a two-tiered system within nursing: SEN (state-enrolled nursing), a more practical vocational training route, where Caribbean nurses were often encouraged to apply and even those who qualified for the professional track as an SRN (state registered nurse) were often placed in the SEN track.

Intended to offer alternative entries into nursing, it was also used to institute a colour bar. With the SEN qualification, when some nurses returned to their home countries, they struggled to work in the profession as they intended. Highly specialised roles in nursing were typically limited to white nurses, and Black nurses often found opportunities to perform specialised care scarce. It wasn’t easy to find advancement within their roles. Barriers to advancement and opportunities for Black nurses are still a persistent issue.

In assessing changes in the profession, we can look towards the past for key examples of why we must encourage fair opportunities for all workers within the NHS.

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