Roberta Heale, Associate Editor of EBN, @robertaheale
In her most recent editorial, Alison Twycross, Editor of EBN, @alitwy asks it if it’s time to take a stand on nurses’ working conditions? https://ebn.bmj.com/content/21/3/59 The editorial points to the working environment of nurses in the UK, exacerbated by issues of recruitment and retention. Unfortunately, there are issues in nursing across the globe. One study shows that nurses, especially those younger and new to the profession, are the most likely to leave their current position and leave nursing altogether. Many nurses cite a poor work environment and demanding practices as key reasons to leave (Flinkman, Isopahkala-Bouret & Salantera, 2013). Another reason was the stereotype of the nurse which contributed to hierarchy between physicians and nurses and influenced the public’s perceptions of nurses. In one example, a participant of the study said her friend told her she was ‘too bright and talented’ to be a nurse. Stereotypes of nursing are steadfast and have a strong influence on the ability of nursing to make positive changes in the profession.
Nursing has its modern roots in the 1800s. Florence Nightingale, while working to legitimize nursing through the establishment of formal nursing education and research, was deeply embedded in belief systems of the Victorian age. The view of women in society was integrated into the view of nursing, which she developed and promoted, in which she described nursing as a calling where…“nursing should not be done merely for remuneration or because it is a popular a vocation. Indeed, the work of nursing is so important that it should be thought of as a religious vow.” (Selandars, 2010, p 83).
A modern view of nursing as a calling, including religious symbolism, persists. In one study, words used to describe nursing are altruism, devotion, dedication, caring, being there, trust and loyalty (Raatikainen, 1997). In a more recent study, student nurses identified their belief that nursing is a calling and were drawn to the image of a nurse as an ‘angel in white’ (Rhodes, Morris & Lazenby, 2011). This continues to be a popular stereotype of the contemporary nurse. This, along with the view of women as caregiving, self-sacrificing and naturally nurturing, continues to undermine the view of women as knowledgeable and intelligent and, subsequently, impact society’s view of nursing (Buresh & Gordon, 2000). There is a lack of understanding of what nurses do. They are largely seen as dispensable, and are devalued by health administrators, physicians and even the general public. This impacts such things as policies toward appropriate work environments, fair and equitable remuneration as well as recruitment and retention strategies (Buresh & Gordon, 2000).
Nursing is an overwhelmingly female profession and as Chinn (1999) posits “…that nursing as a social category has acquired gender traits that are associated with ‘feminine’, regardless of the sex of its individual members (p. 462).” The conclusion of power focused feminist analysis of nursing is that all women, to some extent, have less power, authority, political clout and autonomy than men (Tong, 2015). The cause of women’s oppression is found in the lingering social norms and formal laws that pose as barriers to women. Nurses in a female dominated profession are expected to be submissive and are viewed as complainers if they challenge the status quo (Tong, 2015).
The view of nurses in society is deeply ingrained and continues to undermine progress and positive change. The question is how will we, as nurses, overcome barriers arising from the paradigm that defines us? Nurses need to take control of our image, and our power. Little will change in nursing work environments until this happens.
Flinkman, M., Isopahkala-Bouret, U. & Salantera, S. (2013). Young registered nurses’ intention to leave the profession and professional turnover in early career: A qualitative study. ISRN Nurse, Aug 20, 2013. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762080/
Buresh, B. & Gordon, S. (2000). From Silence to Voice. what Nurses know and must communicate to the public. Ottawa, Canadian Nurses Association.
Chinn, P. L. (1999). Gender and nursing science. In C. E. Polifroni & M. L.Welch (Eds.), Perspectives on philosophy of science in nursing: An historical and contemporary anthology (pp. 462–466). Philadelphia, PA: Lippincott.
Raatikainen, R. (1997). Nursing care as a calling. Journal of Advanced Nursing, 25(6), p 1111-1115. DOI: 10.1046/j.1365-2648.1997.19970251111.x
Selanders, L. (2010). The power of environmental adaptation, Florence Nightingale’s original theory for nursing practice. Journal of Holistic Nursing, 28(1), 81-88.
Tong, R. ( 2015) . Feminist ethics: some applicable thoughts for advanced practice nurses. In Butts, J. B. & Rich, K. L. (Eds.), Philosophies and theories for advanced nursing practice (pp. 159-175). Burlington, MA: Jones & Bartlett.