Literature Review

This literature review thematically examines how traditional gendered roles and expectations continue to shape contemporary understandings of nursing, using an analysis of the Leeds General Infirmary’s Nurse Training Register (1856–1888) as a historical foundation. It shows that nurse training in Victorian Britain both reflected and amplified gender ideologies, especially nurses’ subordinate status within patriarchal medical hierarchies. The legacy of these early structures manifests in many forms today, as modern nursing continues to struggle with issues of gender discrimination and expectations, and professional undervaluation.

This study will examine the above topic in response to a set of research questions:

RQ1. In what ways did traditional gender roles shape the professional experiences of nurses?

RQ2. How do gender expectations influence how we understand nursing as a profession?

RQ2a. How do gender expectations contribute to burnout among female nurses?

RQ2b. How do they influence career progression in nurses?

The impact of traditional gender roles on the professional experiences of nurses

Modern scholars agree that the emergence and professionalisation of Victorian nursing are directly connected to gendered ideologies that moulded women’s work and social roles (Hawkins, 2010; Young, 2019). Hawkins (2010) argues that nursing as a career was based less on technical skill and more on ideals of feminine morality, which paint nurses as moral guardians symbolising domesticity. Summers (1988) and Nelson (1997) similarly examine how institutional caregiving was legitimised through women’s presumed inherent abilities such as obedience, chastity, and emotional labour.

Moreover, as Dingwall et al. (1988), Hallett and Fealy (2009), and Hawkins (2010) deliberate, Victorian hospital training cultures epitomised patriarchal norms that required nurses to play subordinate roles within male-dominated medical hierarchies.

Despite being highly regarded, Florence Nightingale was critiqued by modern scholars (Baly, 1987, Helmstadter, 1996 as cited in Hawskin, 2009; Rafferty 2002) for creating hierarchies that placed nurses in submissive and powerless positions that were subject to immense scrutiny, compared to male doctors whose respectable status earned them the exemption from conformities, which led to limiting nurses’ professional autonomy.

How gender norms continue to shape modern understanding of nursing.

Current literature has shown that problems outlined in historical studies persist in the profession today. Carter (1994) argues that despite modern nursing being a legitimate profession, nurses, being predominantly female, continue to struggle with the legacy of patriarchal hierarchies, which establish societal norms surrounding the role of women and sustain their subordination in caring roles. Nursing is a typical example of the “glass escalator” phenomenon (Williams, 1992), referring to the structural advantages men experience within female-dominated professions, which accelerate their career progression (Williams, 1992). Despite comprising only approximately 10% of the nursing workforce, men occupy nearly half of the top leadership positions (Brandford & Brandford-Stevenson, 2021). However, research on this issue is limited (Brandford & Brandford-Stevenson, 2021), despite its significant impact on women in nursing. Chu’s study (2024) shows that as emotional labour and sympathy toward patients are essential qualities of a nurse, many nurses experience compassion fatigue and burnout, exacerbated by a lack of mental health support and empathetic recognition from the hospitals and large medical system.

Methodological approach

Nonreactive manual data scraping has been deployed to thoroughly explore the topic and analyse historical artefacts. This method involves collecting data without the knowledge of those being studied, ensuring their behaviour remains unaffected by the research process (Janetzko, 2016). Data from the collection was manually scraped and digitised to produce visualisations that provide valuable insights into historical nurses’ experiences. Due to handwriting illegibility, we use cursive reading apps to acquire fragmented clues and piece together coherent narratives for each nurse. However, as these apps’ development is still in its infancy, information gaps and misinterpretations are inevitable. Digitisation also significantly compromises the collection’s authenticity and contextual depth (Fickers, 2021). Therefore, engaging with historical digital representations calls for advanced critical interpretation and analysis methods to decode and understand the layered complexities embedded in historical data (Fickers, 2021). Similarly, online nonreactive data scraping was used to gather a dataset from a Reddit thread as part of research on modern-day nursing. However, ethical concerns about this approach necessitated data processing to remove personally identifiable information, which, in turn, impacted the objectivity of the original dataset (Janetzko, 2016).

Interactive fiction is utilised to contextualise and reinterpret the data through participatory, non-linear storytelling. A “storygame” (Montfort, 2005) is what we consider our interactive narrative to be, in which the connection between user agency and narrative design creates an immersive experience like gameplaying (Montfort, 2005; Salter, 2021). In the context of our research, Twine helps contextualise the data through engaging storylines with multiple outcomes, which makes it more accessible. However, as outlined by Mukherjee (2023), the heavily pre-scripted structure of this approach limits players to a predetermined set of choices, which removes their ability to understand the topic beyond the boundaries established by the creator.