Wednesday, August 13, 2008

Handmaidens, Helpmeets, and the Problem of Nursing

There's a lot of discussion about the OMGWTF Nursing Shortage and of how to get younger, more diverse folks into nursing. What I've seen lately proposed as solutions make sense, but they don't get to the root of the problem: Nurses are seen as handmaidens and helpmeets to doctors rather than as scientific professionals in their own right, who often practice with a surprising degree of autonomy.

Two illustrations of that, from the educational angle: I have a colleague who never fails to mention that she finished pre-med school at the top of her class, passed the MCAT, and was accepted to medical school, but took to nursing as a sort of Med-Lite second-best when she decided she wanted to have kids and a husband. Further back, when I was starting nursing school, every single dadratted classmate I had, practically, said with starry eyes that she "wanted to *help* people!" as a reason for getting into the business.

Now, helping people is a fine undertaking. I do a lot of it myself every day, though I think of it in terms of educating my patients or working with other disciplines in the hospital to help those patients heal. And going from med school to nursing is a fine thing, too, (though I disagree with the reasons here), as it gives you a different perspective on the science of nursing.

But nursing is way, way more than helping people and being a sort of handmaiden to a big, strong, masculine-smelling doctor. By not emphasizing the technical, intellectual, skilled aspects of nursing practice, we're losing a lot of possible nurses to PA school or computer science courses. "They Dare To Care" is a touching ad campaign, but it doesn't showcase what we do every day as practitioners of a science that is equal to but different from medicine.

I'm not going to list out here what I do every day that could be considered intellectually challenging and deserving of respect; I've done that over and over in previous posts. Instead, let's look at the Helpful Handmaiden misconception and see how it impacts nursing as a whole:

First, public perception of nursing focuses too much on the "caring", touchy-feely aspect of the work. This discourages people like me, who are a little crusty and a little crotchety, from entering the profession, for fear of encountering a bunch of fuzzy-headed huggers with little or no spine. It took working with nurses for me to realize how wrong that stereotype was.

Second, take that public perception again, and narrow it down: Nurse equals handmaiden, which equals subordinate role, which means that any man in nursing must be happy with a subordinate role, which means any man in nursing must be gay. And a bottom, to boot. With that stereotype, you may now kiss still more of your potential nurses goodbye, as they go into manly sciences like software development and electrical engineering.

Third, let's take the Helpful Handmaiden Model onto the college campus: If nurses are primarily caregivers and assistants, then there's not much to teach students, is there? Therefore, we can pay a pittance to our nursing instructors and not lose out. 

Let's be blunt, here: Being a nursing instructor, especially in a small department like the one at the school where I got my degree, must suck. College instructors don't have cushy jobs as it is--growing up in a family of academics taught me that--but being told you're responsible for lesson plans and teaching three courses a semester, *plus* two clinical groups, *plus* being required to sit on various committees and boards, is particularly challenging in terms of time and creativity. 

To add insult to injury, the school where I went required at least a master's degree in nursing to teach lower-level classes. A PhD in nursing was preferred for upper-level classes. That's a lot of education...and I, as a brand-new, fresh-out-of-the-gate nurse with no experience, made double what the instructor of my first nursing courses made. After six years, I'm making more than the best-qualified instructor at that school, for considerably less effort.

In short, if you want decent nursing instructors and enough of them, you have to treat nursing with the respect it deserves. Helpful Handmaidens don't get no respect, but careful, observant scientists do.

Fourthly and finally, let's take that Helpful Handmaiden into the hospital and see what that stereotype does to us as a profession. 

If nurses are primarily interested in Helping People, and if they're assistants to Big Manly Doctors, it means that they therefore are selfless martyrs. Selfless martyrs don't mind being saddled with too many patients, being told to work mandatory overtime, and being shorted vital equipment, supplies, and support staff. Selfless martyrs, after all, welcome the opportunity to make do and mend and do everything themselves.

Now let's imagine what would happen if we had the concept of nurses as scientists and advance troops on the line of patient care: We'd get staffing. And supplies. And a say in how hospital policy is developed. And support staff, so we don't have to clean rooms and take out trash. And lower patient ratios, so we could actually, you know, *monitor* and *educate* patients and provide better care. We'd get better-qualified professors in nursing departments who could actually afford to make a living. The phenomenon I encountered, that of an instructor so burned out on nursing practice that he or she couldn't stand to be in the hospital any more (and communicated that dissatisfaction to the students) wouldn't be as common. And, finally, we'd get a more interesting, diverse, experienced crowd going to school. 

How do we get to the point where the handmaiden stereotype is dead? Activism, education, being loud and pushy (frankly) with hospital administrators, and--most importantly in my view--never downplaying what we do. 

I am not "just" a nurse. When people say, "You seem awfully tough for a nurse", I respond, "Nurses are tough." When somebody asks me why I didn't go to medical school, I tell them that I prefer nursing both because of the range of knowledge I have to master and the flexibility it gives me with my patients. When a patient tells me I'm "too smart" to be a nurse, I ask them seriously if they want a moron coordinating their care. And every time I meet a nurse-to-be, I hand out my email address and tell 'em to contact me if they want help, advice, or just to blow off steam. 

It'll take a while to change the stereotype. It'll take a lot of work, too, but it's the only way to reverse the trend of younger nurses getting burned out and leaving the field as older nurses hang on out of guilt. Helpful Handmaidens are handy to have around the house, but they don't get stuff done. Pushy Smart Tough Professionals do.


Anonymous said...

You rock! Great post.

Anonymous said...

This analysis of the problem is brilliant:

Selfless martyrs don't mind being saddled with too many patients, being told to work mandatory overtime, and being shorted vital equipment, supplies, and support staff.

And are you kidding me? Patients actually tell you that you are "too smart" to be a nurse? How .. what ... [sputter] do they not understand that respecting the person behind the needle is a basic self-preservation skill? Clearly they're "not smart enough" to be patients.

Anonymous said...

The perfect post before med-surg starts next week. I was having my doubts about going on with this.

Thank you for pushing me forward!!

Kelly said...

I couldn't have said it better myself...even though I've tried many of my posts. haha. You have a way with words and I always enjoy your posts. Keep it up!

Sara said...

Wow, I'm so happy I stumbled across this post! I've been having my doubts lately about switching to nursing as a second career (although, I never really had a first career...), but this post has really helped me remember why I want to be a nurse. It's not necessarily for the "caring," although that's important. It's for the science, the technology, the critical thinking and the action-oriented nature of the profession. Thank you a million times over.

alison said...

These are good points, Jo. Can I add something: one of the hazards of billing nursing as a 'fluffy' caring profession is that it attracts people who don't have the science skills required. They find nursing school hard and I would guess, practice even harder.

[I'm an environmental scientist, but I spent a lot of time at college helping out dorm-mates who were in nursing school and were out of their depth in cell biology, maths, and pharmacology - many of them had not done any science subjects in highschool]

Beth Coll Anderson said...

"...I'm not going to list out here what I do every day that could be considered intellectually challenging and deserving of respect; I've done that over and over in previous posts."

Could you point me towards some of these posts? I've been feeling more and more like a handmaiden these days and could use a reminder of what I do as a nurse that could be considered intellectual.

Crazed Nitwit said...

I start my training in an LPN program on Monday at the age of 46. I'm very smart and I like the facts nurses play many roles in patient care~advocates, coordinating care, the challenge of educating the patient enough so they can take care of themselves at home, and a few other things that are slipping my mind. I earned my AA as I did my pre-reqs for the LPN program and the pre-reqs to ladder up later on.

This is a very good post and I agree with you completely.


Anonymous said...

Thanks, Jo. Your blog has helped me so much.

I'm starting an accelerated BSN program, and I admit I'm hesitant. I certainly don't want to be a handmaiden. I want to be a competent, skilled professional that is more competent b/c my prior life experience and education enrich my practice. I've been a professional worthy of respect in the field of public health and social work, and I already have a graduate degree and I'm also a massage therapist and doula. But, starting nursing has sent me into a kind of identity crisis.

More complex: my husband is a med student and he can't understand why I'm struggling with this new role. I'm constantly told I'm "too smart" to be a nurse and told to go to med school, and have, more than once, been told what a good fit we'll be; I can be "his" nurse! (Vomit!!!)

I need an experienced nurse with perspective and positivity to be my mentor. I'm on the lookout, if you have any ideas or are looking for a new mentee :)

Jo said...


Email me!

Anonymous said...

I'm a male BSN student, and this is a great post (late to the party, I know. :P)

The most common question patients and classmates (45 of them, 39 of whom are female) is: "Why don't you want to be a physician?" I find it odd that even female nursing students wonder why a man doesn't prefer medicine over nursing. I usually answer vaguely, because I'm tired of explaining my goal of an advanced degree in nursing, in order to practice even more autonomously, how I enjoy the way nurses interact with patients and how I view that relationship as important and necessary, my role as a patient advocate, blah blah blah. Now I just say I prefer nursing to medicine, end of story, my prerogative.

Nursing as a profession desperately needs advocates. The public at large doesn't really know what an RN does. Patients usually can't tell the difference between a tech, an LPN, and an RN; they just assume everyone is a nurse (and they usually assume I am a physician.)

Nurses need to be better to each other, as well. I swear I have never seen more infighting or curled upper lips in a workplace. I've seen the way older nurses eat their young (a major problem, in my opinion). The concept of mentoring seems to be entirely foreign to the nursing profession. It's more like: "Let's see how ragged I can run the new person before they snap," and if that attitude is limited to the facilities in which I do clinical, I'll eat my hat.

It's strange in ways I have extreme difficulty qualifying to be a male nursing student. I don't even know where to begin.

Nurses should demand the respect they've earned and always remember to educate anyone who will listen about what a nurse really is. No nurse is a handmaiden to big studly physicians, but I sure as hell do not play that role. Any physician that ever tries to treat me like a glorified butt-wiper is gonna get a boot lodged up his or her ass.

claire said...

I love this post! I totally agree with your views. :)

I quote: When people say, "You seem awfully tough for a nurse", I respond, "Nurses are tough."

That is definitely true! Your post was so inspiring, it made me think deeper into my soon-to-be profession (I'm in my senior year of nursing and I'll be graduating on April)

Kudos to you. :D

Anonymous said...

Well said..

I needed to read this post after a nasty shift. I beyond tired of public preception of nurses as handmaiden -servant routine.

Been a nurse for 10 yrs, ER past 5 years.

It never seizes to amaze me that while you are 'hand deep in blood/or sh*t' etc to stabilize/or assess the patient, or taking care of other patients (or god forbid, try to save a life>>code).

The patient/or their family go ape'sht, b/c you didn't get them a warm blanket, make tea, or respond immediately when they 'ring' that call bell.

But they have plenty of time to call the charge nurse/manager or public relation b/c you are not 'servant' enough.

Guess who management supports?

I love being a nurse, giving care and can say, I am very good at my job.

BUT absolutely hate the 'maid routine'.

This an emergency, a hospital,not a hotel.

This customer service that hospital takes is way too far. It is enough for me want to walk away.

Maybe, I'll try being a maid..less stress.

Yes, I can't get you that warm blanket, make that pot of someone can take care of your MI, being septic, circling the drain.etc.. if I was a less of a nurse