Caring for Cash: How Nursing Impacts Ideas of Femininity, Family, and Self

By Rebecca Fried

            Nursing is still considered a female gendered labor by many in the public spectrum. Despite the rise of male nurses, the field is still over 85% female. Working within a field that is so gendered, the question arises of what impact this may have on one’s perception of gender. Nursing has also been subjected to many stereotypes, which the media plays on. Is there validity behind the image of the “unhealthy chain-smoking nurse” or the “angel nurse”? This research seeks to expand upon how the role the nurse plays in the office is projected on to other parts of her life. Four nurses were given in depth interviews with questions regarding their lives, their families, and their coworkers.  

Methods

            This research has been conducted in a qualitative manner. In depth interviews were given to five nurses. These interviews lasted from approximately 45 minutes to over two hours. The format of the interviews was loosely based. The participants were given the opportunity to speak about anything that came to mind, regardless of topic. The research sought to determine the answers for four primary questions:

  1. How has the field of nursing changed the perception of femininity for the interviewees?
  2. How are the role male nurses play interpreted by female nurses?
  3. What impact does working in a “caring” field play in one’s home life?
  4. Is there validity behind the media enhanced portrayal of nurses?

The interviews were then transcribed and coded for contextual purposes. The results of the interviews validated many of the hypotheses that were constructed during the initial research time. It was hypothesized that the roles nurses play in the work atmosphere impacts the manner in which nurses interpret their construction of gender.            

Femininity

            There are several aspects within the identity of femininity that must be first examined before one can truly understand this level of the female nurse identity. If we peruse the subject in the context of the psyche, one could determine the direct association of the profession with Maslow’s Hierarchy of Needs. This theory indicates that the basis of all human existence relies on the fulfillment of the physiological needs. Before one can even contemplate the realm of self-actualization, the basic building blocks of life; food, water, shelter must be fulfilled for one to grow as a human being. “Furthermore, all these basic needs may be considered to be simply steps along the path to general self-actualization, under which all basic needs are can be subsumed.” (Maslow 1968, 153) Nursing is a part of this first building block in the manner in which the nurse assesses the physical needs of a patient at any given time of the day.

            With Maslow’s Hierarchy in mind, one can then determine the true sense of the impact that this occupation has had on the self-determination of one’s gender identity. First, one must determine what it means to be feminine. When one examines the definition that a dictionary will give; feminine and female were simply biological descriptions of the sex. This does not determine the cultural meaning of the term feminine. It raises the question of what it means to be female. What precisely is femininity?

            Femininity is not a natural quality that an individual is born with. If examined as a discourse, one may argue that femininity in itself is an act: a replication of observed tendencies. Smith argues that “femininity can be examined as an actual practice, as a social form of consciousness that takes place in real time, in real places within the defined set of material circumstances” (Hallan 2000,12). There is the famous quote that it takes a village to raise a child, well it takes a culture to create a gendered identity. From a young age, girls are taught to behave and present themselves in a certain manner. They are presented toys to mimic the actions of their mother: play kitchens, wardrobes full of adult-style wear, and baby dolls. These devices serve to propagate the ideals a woman is expected to uphold: caring for household and family needs. This affirms the notion of the nature/culture divide. Women can be viewed as the mediating connection between nature and culture in modern day society.

            With this discourse in mind, an examination of women and the role of caring may be exercised. There remains a strong connection between the female gender and the role of nurturer, as that found in the writings of Skeggs. “Women and caring have strong cultural associations in Western culture, which can lead to assumptions that caring is a natural or essential attribute of those born female, a genetic inheritance rather than a socially learnt pattern of behaviour.” ( Hallan 2000, 13) Caring is essentially a reproduction of various cultural attributes. This is concurrent with the responses of many of the subjects of this research when questioned about the role of caring in nursing. Elizabeth, a registered nurse for over twenty years explained her decision to enter the field as “I really just wanted to help people. I like caring for them.” Her sister Mary Ann, a nurse for over fifteen years echoed a similar reply. “There just seems to be something right in helping someone in their time of need.”

            When one examines the role of caring and gender, it has been continually presented as one in the same. Women and caring have a strong tie that has been embedded in the construction of society. However to assert that being a female makes one “naturally” more attuned to caring for others is a poor social construct. Caring is not a biological determinant but rather a learned behavior.

 

Men Folk       

 

Perhaps one of the more interesting roles within nursing is the anomaly of the male nurse. The contemporary association with nursing is the female nurse; the Florence Nightingale type. However, male nurses have always been present in the medical field. “The gendered divisions in healthcare situate nursing as women’s work but there have always been male nurses- in psychiatric nursing, in the prisons, and in the armed forces.” (Hallan 2000, 100) The male nurse today is still considered an infrequent sight by many. Hallan describes the duty of nursing as “An ethnos of service and public duty pervaded notions of professional identity, perpetuating a vocational ideal of nursing as a women’s mission.” (Hallan 2000, 93) Essentially the construction of the field historically is that of female domination. However, with the changing demographics and beliefs regarding gender roles, men are breaking through the gender line but they are still by far a minority. The Health Resources and Services, Division of Nursing estimate that men represent approximately 5.5% of the Registered Nurse population.

 Many of the nurses interviewed stated that they had indeed worked with male nurses before. Elizabeth’s specialty created a bit of a problem for her work with male nurses.

“I’ve worked with male nurses. I think the problem in the unit [neonatal], in the unit they’re fine because there is not the problem of being checked. Umm, by the nurse. By the male nurses. Well, on the floor [labor and delivery] if you are the post-partum nurse you must check after a delivery have a bundle check and your incision checked. Your umm vaginal incision checked to make sure it is not inflamed or anything. So you have to do that to make sure there is no inflammation and some women feel embarrassed to have a male nurse to that because this area is so diverse. They do not because of their religion doesn’t like having a male nurse do this. It is against their religion.”

 

Within the spectrum of interactions between the genders, she claims that the female nurses treat the male nurses exactly the same as another female nurse. Carmen, a nurse for over forty years in both the United States and her native Puerto Rico, has never worked with a male nurse, neither has Mary Ann.

            Male nurses, while still seen as a rare sight by many, have progressed in the field of nursing. The role of the male nurse in society creates a division in the way that nurses were previously viewed. Though still a minority in the field, males are slowly gaining recognition for their contributions to the field.

 

Families

 

            When one is examining the role of femininity, the impact on the family should not be overlooked. Nursing is considered a “caring occupation.” When one considers the implications that could potentially have on the perceptions of parenthood, the findings could be numerous. However, many of the individuals interviewed conceded that their roles as nurses assisted them in the raising of their children. Karen says, “I feel more assured to face issues that most mothers do not have a clue about. It has helped me a lot more relaxed. My kids have said they liked that.” Elizabeth saw a direct correlation with her role and the development of her children. “Well, I see it [the impact of her role as a nurse] in all my children, in the three children in different ways. They all have a caring [pause] way about themselves.”

            Two of the women interviewed, Elizabeth and Karen, had partnerships that permitted their work and their family life to exist at separate levels. Their husbands would take on the responsibilities for the children so that they may go to work. Elizabeth described the solution that she and her husband came to with regards to caring for their children: he would work during the day and she would work at night. “Well, their dad was home at night. If you’re asking me how I liked working the night shift, I didn’t. One of us had to work.” Karen’s husband had a job that permitted him to take the children with him to work when she was in school.

            This presents the interesting perspective of the caring industry; how one balances a profession that is seen as “caring” with a gender role that is also seen as “caring.” How does one separate the two?  The individuals interviewed appeared to find that the two areas of their live complemented one another well and perhaps gave a tremendous insight that others outside of the profession could never understand.

 

Dichotomies

 

            Historically, nursing has been one of the primary means for a woman to be employed outside of the home. However, one should examine the implications of the role of nursing has due to the very nature of the business: caring for cash. It is one of the ways that a woman may use her “natural” talents to generate income. It is also one of the manners that has aided the creation and spread of the stereotypes of nurses. The types of nurses that exist within this spectrum correlates with the binary code that follows the female form: the virgin and the whore.

“The binary stereotypes of femininity, the virgin and the whore, take on a set of particular characteristics in nursing images that have their origins in early nineteenth century ideas about the ‘essential’ nature of the feminine. The ‘good’ nurse is invariably seen as a form of self-sacrificing angel who gives up everything to dedicate her life to caring for the sick; the ‘bad’ nurse is her exact opposite, misusing her position of power and authority to satisfy her own needs and desires, whether they are material, sexual, or merely sadistic.” (Hallan 2000, 20)

The perception of a glowing nurse in a starched white uniform hardly fits a real world image of the profession. Being a good nurse does not necessarily mean that one follows the binary code of the virgin. The good nurse is no longer the Catherine Barkley from A Farewell to Arms type of nurse. She no longer has time to patiently wait upon the sick, wiping sweat from a fevered brow. Today’s nurse is overextended in her position. The hours that one must work and the amount of patients that a nurse must attend to on the floor are beyond her means. Karen explains: “Fatigue is a major problem. Especially when you work in a neonatal unit, they would fall asleep with an infant in their arms.” Many nurses opt to work nights simply because of the pay increase. Elizabeth describes her first experience at the hospital she worked for the longest:

At first when I worked at Baptist, I worked weekends and I worked with a group of people who were in the same situation as I was. They were all young moms. And umm [pause] we were in a real nice situation. We worked twelve hours and we were paid for thirty-six hours, which was a very nice situation.”

However the hospital changed the agreement and the hours became even longer for these individuals.

“And then we had to work two shifts during the week and one on the weekend.  And the way they would schedule us horribly. It would never be connecting days. It would be like a Tuesday and a Thursday and then Saturday, so you never caught up on sleep. Because I would be up one night, down one night, up one night, down one night, up one night. So you never caught up. You couldn’t handle that, you know.”

            The creation of the nurse stereotype has been greatly impacted by this dichotomy. The private behavior of nurses inverts the idea of gender stereotypes presented by the media. The glowing nurse is actually an exhausted, overworked individual. However, this identity adheres to the social construction of motherhood/femininity. Mothers are constructed to be beautiful, patient, and loving when in reality, for the first few years of a child’s life, most women are perpetually exhausted; both physically and mentally.

 

 

Building a Hierarchy

 

            Within the field of nursing lies a continuum of never-ending possibilities regarding the structural foundation of each department within an office or hospital. “Nursing is a hierarchical structure in which culture and education capital affect the career opportunities of those entering the profession.” (Hallan2000, 24) As well, the perception of the bad nurse/good nurse dichotomy follows in this division as well.

            According to Habenskin and Christ, there are three main types of nurses, which may predict the hierarchical path the individual may choose depending on which style of nurse they fit. The first nurse is the professional. The professional is the individual who is obsessed with the exact methods and rules that one follows as well as the scientific makeup to those rules. This individual is usually not the best person to work hands on with the patients. The second type of nurse is the traditional nurse. This is the type of nurse who fits the Catherine Barkley model of the nurse; ever doting and ever loving. The professional model is the individual who receives the most hype regarding their role on the floor. They are the ones who are most likely promoted to a managerial role. (Hallan 2000)

            On a hospital floor, the hierarchy is extremely obvious. Karen describes: “Nurses were generally good with each other but there were different levels and each level had different interactions and different needs.” Beyond the ranks, the head nurse is the individual in charge. The head nurse of a floor is typically one who was a worker on the floor but received a promotion that projects them to a position that is higher than their fellow co-workers. This could potentially cause strife between the workers, not because of the promotion but because of the expectations for change. Elizabeth described the situation of a co-worker’s promotion to floor manager: We were hoping that she would really make a difference. We were hoping that she would make the section more family-friendly than what it has been. But she hasn’t done that yet.” The expectation placed on someone who has been promoted is high because it is expected that the individual would have a better idea of the needs of the workers.

            Promotion in a hospital ward has both the ability to create hostility and instigate necessary changes for the workers. The expectations for those promoted are high and due to the intense bureaucracy that surrounds the medical profession, it is extremely hard to create change. The hierarchy is an essential part of a complex system, such as the one found in a hospital, whether it is desired or not.

 

“Party Hard”

 

            Within contemporary media, the perception of the nurse has strayed far from the origins of the starch-white uniform. With the aid of television, a not so wholesome image of the nurse was projected into mainstream America, which does not stray far from many of the experiences of the interviewed nurses. Addiction is a social problem that impacts every sector of the country and that impacts the lives of several of the individuals interviewed. The drugs constantly mentioned in the interviews were tobacco, alcohol, and prescription pain medications.

The use of tobacco amongst nurses is a major controversy. The physical damage to the body that is caused by tobacco products is widely known and recognized. The percentage of smokers in America is on the decline, yet the percentage of nurses who spoke has been estimated to be approximately the same 18% as the rest of the country. According to Jenny Radsma’s research at the University of Maine Fort Kent, she found the percentage of nurses who smoke to be far above the goals of the anti-smoking campaigns. “The UMFK nursing professor [Jenny Radsma] cites statistics which show that up to 18 percent of nurses are believed to be tobacco dependent, well above the "Healthy People 2010" target of less than 12 percent of the population who smoke.” (www.umfk.maine.edu) 

            The nurses interviewed gave varying accounts of their perceptions of the smoking nurse stereotype; however none of the individuals interviewed were currently smokers however. Elizabeth mentioned a former co-worker, Kacie. “But she would chain-smoke like a freight train” Mary Ann’s medical office has taken steps to aid its workers of nicotine addiction. “No one is permitted to smoke on the property. If someone want to have a cigarette they literally have to walk five minutes away to the far end of the lot, plus we’re not permitted to smell of smoke at work so many end up quitting. The doctors are really fabulous about helping anyone out with that.” Carmen was a smoker for over thirty years, finally quitting after retirement. Carmen says, “It was too difficult to not smoke during our breaks at work. It was always rush, rush, rush and we needed some way to calm down.”

            Alcohol is a major issue that repetitively appeared in regards to how nurses unwind. Both Mary Ann and Elizabeth related many stories to the use of alcohol. “A lot of nurses use alcohol. That’s umm the drug of choice. They really use alcohol.” Elizabeth referred to the holiday parties the neonatal unit would throw at restaurants. “We would go out for Christmas parties together. And we umm could never go back to the same place again because we celebrated so well that we got thrown out. We were really a rowdy group. We had a good time whenever we went out.”

            Illicit use of drugs is another means of escape for some nurses. Karen found this to be the most prevalent vice that the nurses she has worked with had. “That is a major problem. Painkillers especially. Percocets. Police coming to give lie detector tests. I haven’t seen the alcohol bit but a lot of addiction to pain medication. Percocets. As a Nurse Practioner, they were my patients.” A study by the University of Maryland found that 32% of registered nurses that participated in a survey of over four thousand RNs were light to moderate drug users. The substances varied from marijuana to cocaine to prescription medications.  The state nursing magazine in Florida has begun to give the percentages of individuals in the field who were sent to rehabilitation programs. Elizabeth explains this new method of awareness: “But I know of drugs being used and having them being [pause] being used with the nurses because there is a Florida newspaper printed up for nurses and it is sent to the nurses. Umm I don’t know if it’s every month or every quarter but I just received one and it lists the nurses. It’s like a gossip page. It lists the number of nurses that have been sent to be rehabilitated and how many have been permitted to work again after going through the rehab.”

            Substance abuse is a major problem in every facet of society. The perception of nurses as pure beings fails to take into account that they are also human. Without a healthy means of releasing the stress associated with their profession, many will turn to other means which may be detrimental to their health and possibly create legal issues.

 

“You don’t start out with the sense of humor”

            An outlet that would be considered a more positive outlet would be the sense of humor. Elizabeth perhaps put it best: “We don’t have bad senses of humor. We have horrible senses of humor.” Humor is typically seen as an essential asset to a nurse who during a shift must deal with various different tasks and potential interactions with fellow healthcare workers. An article from the January 2005 edition of Psychology Today discusses this phenomenon. "The act of producing humor, of making a joke, gives us a mental break and increases our objectivity in the face of overwhelming stress," says Rosenberg. For people in jobs that require quick and accurate decision-making, humor's distancing effect makes it easier to maintain focus and competency.” The use of dark humor permits one to overcome fear and to attain a degree of separation that is needed in the field.

Humor may be seen as a catalyst to diffuse potentially serious scenarios. Working in the field of medicine can possibly create a sense of urgency to life, which cannot be sustained for long. By using humor, the nurses are given a means of escape. Everyone gave examples of the humor. Here are a couple:

            Karen: “What’s the difference between a nurse and a physician’s assistant? A nurse calls urine pee”

            Elizabeth: We aren’t the only nurses that would sit around talking about corpses or uh terrible accidents over lunch.

            The use of humor is a healthy means of dealing with the stresses that the nurses must battle daily. It is a method of not permitting their profession from interfering on a deeper psychological level in their lives.

 

Conclusion

            Nursing is an arduous profession that creates its own form of gender. The construction of nursing is that of a feminine field despite the connotations that then lie on those who do not fit into the stereotypes. The concept that being part of a professional field will be the determining factor of your gender is a bit extreme. Caring is a large part of the job for a nurse, but it is not the only determinant to the career.

            The interviews conducted aided in the dismissal of the extremes in regard to the stereotypes surrounding the profession. In reality, stereotypes are typically a small percentage of individuals. It is wrong for an entire profession to be determined by the actions of few.

            It must also be taken into consideration the role that gender plays in the construction of the nursing profession. Despite making remarkable progress in the fight for gender equality, women still have the label of “gatherer”, which are often times dismissed as a lesser role to that of the male “hunter”. One must remember, however, that the majority of sustenance came from the gatherers. Nursing, as a caring field, has had a major impact in the lives of the individuals interviewed. It is not necessarily the construction of femininity that has aided in the impact, but rather the manner in which the individuals have learned coping mechanisms which can be applied to everyday life. That lesson is perhaps one of the greatest lessons a human can learn.

 

 

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