Author’s Note #1: This post has been sitting around in my draft bin for some time now. But since it is Nurses Week, it seems an appropriate time to take it out of the bin, dust it off, and post it. Author’s Note #2: I deleted the political innuendo that was in the original version of the post, but really didn’t belong. It has been hard getting this post to say what I wanted it to say.
Medical forums such as Sermo contain lots of fear and loathing of nurses, especially in their more potent manifestation, the nurse practitioner. Nurse practitioners are referred to as noctors (for “nurse doctors” or, more pejoratively, “not doctors”). Reading the comment sections of these sites, one would get the impression that large armies of noctors are inexorably advancing into traditional doctor territory, putting doctors out of work while at the same time threatening the lives of patients due to their less than doctorly level of training. Although this criticism of nurse practitioners can be couched in financial terms (nurse practitioners taking away jobs from doctors), I think there is more to it than that. I feel some of this criticism of nurses is rooted in sexism and a concern about the overturning of traditional gender roles. This is based not only on my own observations of interactions between nurses and doctors in the hospital that range from cringe-worthy to horrific, but also on the history of nursing as a profession. From its origins, nursing has been haunted by the spectre of sexism.
Old gender roles die hard and even today most nurses are women and most doctors are men. The origins of nursing are rooted in organized religion and the military, patriarchal systems in which women have traditionally held inferior roles. The first nurses were nuns. When I did a rotation in medical school at the Royal Infirmary in Edinburgh in the 1970s, the nurses were referred to as “sisters” and, rather than wearing the traditional white that was prevalent in the States at the time (before the wide-spread adoption of scrubs) the nurses wore an outfit that was dark navy and similar to the habit of nuns. Early nurses like Florence Nightingale aided wounded soldiers in the Crimean War. The strong connection between the military and nursing survives to this day in the concept of doctors “giving orders” to nurses. In the old military sense, doctors rank higher than nurses, hence the giving and accepting of orders. For some doctors, seeing nurses fulfill traditional doctor roles such as providing primary care or writing prescriptions is an overturning of the natural order of things, a mutiny of sorts. And this is difficult for old school doctors to accept.
But, the world is changing — especially the world of medicine. In this changing world nurses share many of the same frustrations as doctors. Nurses have to learn new technology like electronic health record systems, take inane online safety courses mandated by hospitals, deal with increasing regulation and face an increasingly skeptical public. These changes in medicine are the result of multiple forces that have been unleashed on our humble profession — forces that are only dimly understood with consequences that are difficult to foresee. Nevertheless I would estimate that in at least 99% of all possible futures more and more primary care will be delivered by health care professionals who aren’t doctors. I don’t think we should fight this. We should embrace it and make it work. Perhaps by combining forces doctors and nurses can achieve more than we have in the past, when we have fought our own separate battles against the forces degrading our professions, to little avail.
I spent summers in high school working as an orderly in a nursing home, so maybe I have a different perspective from most doctors who haven’t had that experience. Direct patient care is a very tough job. Unlike hospital administrators, insurance salesmen, drug salesmen, and government regulators, nurses share with doctors the distinction of being on the front-lines of direct patient care. They are not our enemies. They are our allies.
So, Happy Nurses Week to all my friends in the world of Nursing!