Off the Charts

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

Back in the late 60s, when I was trying to figure out what I wanted to be when I grew up, one particular piece of advice kept popping up: “Become a nurse. That way, if anything happens to your husband, you’ll be able to get a job and support your family.”

This month we celebrate National Women’s History Month. The theme is Women’s Education–Women’s Empowerment. I think back to that advice and how it captures the journeys of both nursing and women over the last 45 years.

That one piece of advice reflected so many beliefs of the time. The husband (and there should be a husband for any self-respecting woman) is the breadwinner. A woman doesn’t really want to work and shouldn’t work; her role is to take care of husband and home. She doesn’t need the fulfillment of a career—only the ability to pay the bills if she suddenly finds herself alone.

Nursing was the safety net job. Not something to pursue for its own sake—for the intellectual, emotional, and financial rewards it could offer. Women who did pursue it found themselves earning their own paycheck—but still subjugated, the handmaiden to the physician.

Thankfully, that has changed. Women pursue all kinds of careers and are surpassing men in numbers of higher education graduates. Few people would still argue that the woman’s place is in the home, and girls are encouraged to grow up to pursue their own dreams and be successful in their own right. Despite this progress, we still have a long way to travel for true gender equality. Boardrooms and legislative bodies are still disproportionately filled with men. Women still earn only 77% of what men do, a difference that has improved a mere six percent in 20 years.

Nursing has followed a similar trajectory. It is no longer a safety net occupation and nurses are no longer viewed as the handmaiden to the physician. Nursing school application numbers are way up, with many applying as second degree students after pursuing other careers. There is greater recognition of the high level of knowledge and skill nursing requires. We have our own scientific body of knowledge and we control and monitor our own practice. We are involved in life-changing research and interventions across the globe and our impact on quality of care and patient outcomes is well established.

Yet, despite recent progress (for example, see Shawn Kennedy’s blog post about Lt. General Patricia Horoho, the new Army Surgeon General), we are still underrepresented in boardrooms and executive positions of health care organizations and institutions. Our image still suffers from sexism and outdated perceptions of what nurses actually do. And we earn less than other health care professionals even when we have similar levels of education and responsibility (check out nursing faculty salaries compared to those of physician faculty).

The history of women and the history of nursing have always been intertwined, and may always be, even with the number of men who are nurses. The two groups’ struggles against oppression run parallel. Despite the scientific and technical nature of our work, nurses continue to deal with the legacy of—as Reverby stated so succinctly in Ordered to Care: The Dilemma of American Nursing, 1850–1945—their “order to care in a society that refuses to value caring.”

Women struggle with a similar dilemma. They are still the primary caretakers at home of children, and now aging parents as well, even while pursuing careers and accomplishments outside the home. And they are still facing critical judgments about it, from themselves and others. Read the rest of this entry ?