Often portrayed in mass media as subservient female helpers to the male physician, American nurses fought in the last half of the twentieth century to be recognized as skilled care-givers whose roles include assessment and diagnosis of health situations as well as the care-giving process itself, which may establish intimate and crucial bonds with patients. In the early twenty-first century nursing remains predominantly female (roughly 95 percent) and white (90 percent), although male and minority participation are growing.

Demands for recognition have been accompanied by increasing professionalization as hospital two-year apprentice-based programs have been replaced generally by two- and four-year programs in colleges and universities. The nursepractitioner, who may operate in basic healthcare settings where physicians are not readily available, represents another strengthening of nurses’ roles since the 1960s. Meanwhile, medical service workers have taken over roles not related to healthcare expertise (office management, maintenance services, etc.).

The 2.6 million registered nurses in the US have a strong lobbying and professional association in the American Nurses Association, which has sought to situate nurses within ongoing healthcare reforms and public consciousness. Recognition of nurses in military settings like Vietnam has also increased. Nonetheless, while medical shows and movies in the 1990s developed images of stronger nurse characters, with more gender and racial diversity, these shows often make nursing roles secondary, caught in romantic as well as medical subplots.