Gendered and dated ideas of the nurse as a subservient and accommodating individual must go, so that more nurses can stay.
Nurses are passionate, knowledgeable professionals who make a significant difference to patients’ lives and wider societal health outcomes.
Despite this, the Australian nursing workforce is haemorrhaging staff and for those remaining, the working environment is increasingly unmanageable.
The recently reported disinterest among university students in the nursing degree suggests there is little respite on the horizon.
Overstretched and burnt-out nurses translate to unavoidable patient suffering and neglect, a situation abhorred by an intensely dedicated nursing workforce.
The offer of free degree places in Victoria may tempt some individuals to ‘try out’ a nursing degree — but this solution however ignores the elephant in the room: nursing has become an unattractive career prospect in dire need of redirection and reimaging.
Today’s highly educated nurse graduates work within a profession steeped in misogynistic origins.
The idea of nurses as martyrs persists and are, in some ways, celebrated: nurses are ‘angels’ who sacrifice their own needs for others.
Consider our unquestioned acceptance of nurses who left their homes and families to provide ‘live-in’ care for patients in nursing homes and hospitals during the early COVID-19 crisis.
Despite strenuous efforts to recruit more men into the profession, nursing remains predominantly female, with around 90 per cent of nursing students and staff being women.
Regarding the profession as an extension of women’s “natural caring role” has long justified the reality of comparatively low pay among graduate health professions.
Expectations of the “female attribute” of self-sacrifice can be seen in the requirement of nurses to work unsociable hours, their lives predetermined by when they are off duty.
While patients naturally require 24-hour nursing care, shifts are primarily planned to meet the needs of the hospital, running for up to 10 days without a break and subject to change at short notice.
This may be convenient for governments and administrators juggling budgets and personnel, but it’s increasingly unacceptable to those at the receiving end.
An examination of the origins of nursing reveals how this situation, incongruous with contemporary society, has emerged.
Religion has played a key role on the image of the nurse as modest and self-effacing.
Until the 1960s, nursing sisters were single women, ostensibly married to the profession.
Those who went on to marry a man were cast out, the idea being they could not obey both “masters” sufficiently.
While nursing became secular in the 19th century, religion continues to cast an enduring shadow on the image of the nurse as only too happy to fulfil their duty to others, irrespective of personal cost.
In some ways, nurses remain married to the profession, the idea of “off duty” implying “on-duty” is the nurse’s default state.
The social status of Nightingales’ first professional nurses reflected that of women in general society.
Their lives, working and private, were dictated by their vocation and by the wider patriarchal society.
Until recent decades, students were required to live in designated accommodation in hospital grounds, where the home sister monitored and curtailed their lives, relationships and behaviours.
Students were required to request a pass to go out in the evening and had to avoid any activity, such as ice-skating, that could cause injury and require time off work.
Until recently, the military roots of Nightingale’s professional nurse was evident in the starched uniform with epaulet stripes denoting rank.
A further symbol of hierarchy and service was the hat, similarly striped according to status.
While uniforms now reflect practicality and safety instead of service, the military influence remains evident in the rigidity and hierarchy of the profession and the interactions of its staff.
Bullying behaviour is an extension of a hierarchical system that thrives among oppressed individuals and is common in female dominated professions.
Unsurprisingly, it is well known in nursing; the phrase ‘Nurses eat their young’ is a reference to the treatment of students during training.
What is also well known is the impact of this behaviour on nurses’ mental health and drop out from the workforce in general.
As graduates with highly developed problem solving, critical thinking and people skills, nurses are in demand across a range of careers and professions including higher education, project management and pharmaceutical industries.
Faced with an unmanageable working situation, even the most committed nurses are considering jumping ship.
Action is needed now to mitigate the issues that threaten the workforce.
How do we promote a sense of pride in nursing and rejuvenate its image as an exciting opportunity for individuals motivated by the idea of career as a compassionate, autonomous, and skilled practitioner?
Leaders, educators and politicians must wake-up to the issues rooted in nursing history and tradition that now stifle the profession and threaten its viability.
Gendered and dated ideas of the nurse as a subservient and accommodating individual must go, so that more nurses can stay.
Dr Lesley Andrew,
Senior Lecturer, School of Nursing and Midwifery
Edith Cowan University
This article was originally published in The West Australian.
