When I made the decision to go back to school and become a nurse, I anticipated that some would be surprised. For the last few years I’ve been dedicated to seasonal work, traveling the globe and hopping from job to job — not exactly a lifestyle conducive to settling back into academia. I have been quick to explain my reasons: being a nurse will grant me international mobility and more meaningful skills than I currently possess. It’s the kind of useful trade that will help me wander the world, rather than root me in one place.
What I wasn’t prepared for, though, were some of the surprised reactions I got, not to my decision to stay in one place and go back to school, but to the profession of nursing itself. These were just a few of the comments I heard:
“That’s a little … traditional, isn’t it?”
“Why wouldn’t you just become a doctor?”
And my favorite comment, from — of all people — a medical student: “How do you feel about going into a second-tier profession?”
With growing dismay, I began to gather the basic picture that some people had of nursing. They thought that I was going to go back to school to learn how to hold medical instruments, hand them to doctors, to take orders and not to think.
Contrary to some conceptions, nursing is not a lower tier of medicine. Nursing is a profession separate from medicine — a separate field of health care. To ask a nursing student, “Why wouldn’t you just become a doctor?” is a little bit like asking a writer why they don’t just become an editor. Yes, they work together, and often they work in the same building. But beyond that, they’re different jobs.
Many misconceptions stem from the enormous changes in nursing over the last century. Nursing has evolved and expanded from the basics of changing bandages and bedding. Until 1909, you couldn’t even get a bachelor’s degree in nursing — the expectations and training for nurses were that much lower. Today, though, nurses are emerging with doctorate level degrees; Ph.D.s (Doctor of Philosophy in Nursing), DNSs (Doctor of Nursing Science) and DNPs (Doctor of Nursing Practice) are breaking ground in research as well as practice. In many states, nurse practitioners have complete autonomy and independence from physicians, and they are steadily moving into the field of primary care.
I first became aware of the extent and scope of higher-level nursing research and practice through the dean of the Johns Hopkins School of Nursing, Dr. Martha Hill. Dean Hill is anything but your stereotypical “handmaiden to a physician.” In 1997 she became the first nonphysician and only nurse to be elected president of the American Heart Association. She serves on the Institute of Medicine Council and has served on the institute’s Board on Health Sciences Policy. Internationally known for her research in preventing and treating hypertension, Dr. Hill is a leader in integrating patient, provider, and system level interventions, and in working to im-prove care and outcomes for vulnerable and underserved populations — all important aspects of health specific to the institution of nursing.
I’d say it’s pretty clear to all who have worked with Dean Hill that nursing is not a “second-tier” profession.
Much of the general conception of nurses, doctors, and their respective social status rests on the long history of a gendered division between the two professions. For years, the math was simple: doctors were men, nurses were women. At one point, it was even more defined; nurses were not only women, they were single women — no nursing school in the United States would admit married students until well into the 1940s. Predictably, the first to venture across the gender line between doctors and nurses were women. Now, slowly, men are crossing it, choosing nursing as a career. Even so, the profession continues to be dominated by women.
When I hear nursing viewed as a career for individuals who weren’t smart enough or hardworking enough to become doctors, I suspect that the attitude is connected to the historically gendered nature of the job. The media do nurses no favors, either: popular television shows ranging from “House” to “General Hospital” routinely portray nurses as far less knowledgeable and skilled than they actually are. Last week a colleague fumed over an episode in which the doctor explained a common condition to an ICU nurse. “As if she wouldn’t have already known that,” she said, irate. “They make nurses look like brainless instruments.”
The world of nursing, like much of health care, is a changing place. The relationship between nurses and doctors has a history of being contentious, but acknowledging the value and capacity of nursing doesn’t need to challenge the authority of doctors. Rather, the nurse-doctor relationship can be a collaborative one, only grow-ing in possibilities as the scope of nursing expands.
Moving into a female-dominated environment will be quite a change for me. Some of my most recent jobs include operating heavy equipment at the South Pole, a very different environment. But I hope that nursing will take me to some of the other far-flung corners of the world — and open doors to future exploration.
Meg Adams, who grew up in Holden and graduated from John Bapst Memorial High School in Bangor and Vassar College in New York, shares her experiences with readers each Friday. For more about her adventures, go to the BDN website: bangordailynews.com or e-mail her at firstname.lastname@example.org