Is nsg school part of the problem with the profession?

plumrn, BSN, RN · Oct 16, 2004

I'm not sure that nursing school instills that in us. I think it is more of a fear of losing your status, if not your job, if you rock the boat. Healthcare is a business, like anything else, and if an employee pushes them more than they'll take, they may just say 'you're out of here'. Having a job with steady income, insurance, etc., is security that is hard to risk for most people.

boulergirl, CNA · Oct 16, 2004

I've wondered about that myself!! How are nurses expected to develop a backbone if they've always been taught to keep their mouths shut?

Tony35NYC · Oct 16, 2004

I agree with what you said about some nurses who complain to co-workers instead of standing up for themselves. As a student, I don't yet know enough about hospital politics to comment on it one way of another but these issues do come up repeatedly during pre-and post- clinical conference, and the instructors are always telling us about the importance of being strong advocates for ourselves.

One clincal instructor said she believes the nursing profession is good, but that there are too many nurses out there who think of themselves as 'less than' when it comes to management and the physicians. She's been a nurse for more than 30 years, and, she says, although the nursing profession has come a long way from the days of the starched white uniforms and the "Yes,doctor/no, doctor/right away, doctor" thing; mentally, many nurses are still back there. She said that, too often, nurses don't support one another, and that the backstabbing and catty behavior towards each other only makes things worse for all nurses because it gives management more leverage to use against them. I mean, you read about travellers crossing picket lines to replace nurses who're on strike over really important issues and you can't help but wonder about things like that...

True, medicine is a business, and like any other business the bottom line is to make a buck. It is also true that sometimes it is politically expedient to keep our mouths shut. But I don't think the issue is with nursing school, its with us. If we think of nursing only as a job with insurance and a steady pay check instead of thinking of it as a profession, how can we blame management and the docs if they treat us like cattle?

JacelRN, BSN, RN · Oct 16, 2004

That is a very interesting idea. :wink2:

I would agree that we as nursing students are taught to just jump through the hoops until graduation and bear through any difficulties with the upper management of instructors and department heads. I found in being assertive and advocating for myself and my ongoing learning, that my nursing instructors themselves would alienate me or look less favorably on me, and we know that there are those instructors who plainly go on personality to whether you will make a suitable nurse.

I can agree with the OP that I feel nursing school instills some "don't fight it now, you'll have a chance latter" attitudes when it comes to being advocates for our own rights and needs. This might be due to the fact that they are afraid of confrontational nurses but instead, it tends to limit the true strength of a good argument to deal with tough issues that nurses will face once they graduate.

I also agree with plumrn. Once graduated, I felt a lack of support systems to fend for myself and a concern over what my job may suffer. I did argue important ideas that were being missed by my management, but to no avail. Nothing was done about them. On the other hand, sadly when I made my first ever med error, she was quick to have a talk with me about my mistake and how the doctor was involved and angry over the situation. Without anything going wrong, it seems we as nurses don't have any head way. If and when we try and fight for something proactively, it appears to fall on deaf ears. I again think it is due to lack of support systems for nursing.

Wonderful topic.

JacelRN

Energizer Bunny · Oct 16, 2004

hmmmmm.....well, I've already been an advocate for much of our class and brought problems TO our instructors. I think if I had a problem with an instructor, I would voice it. I don't see an issue there.

talaxandra · Oct 16, 2004

I think there are a combination of factors at play here.

First, of course, is the historical aspect - nurses were not only female in a patriarchal world, but nursing was closely associated with both religious orders and the military, so obedience was not only expected but demanded.

Second, there is a persistant belief that nursing is a 'calling' - this is evident not only among the patient population (if I had a dollar for every patient who told me I was a 'born nurse'...) but also among nurses themselves. On this board there have been many threads were the ideal of nursing has been espoused - for example, nurses are not seen as being 'good', 'worthy' or 'proper' nurses if they are interested only or primarily in money, regardless of how well they perform their job.

This spills over into areas like unionism - many nurses seem to see campaigning for more money or better conditions as distasteful, however they feel about it on a personal level. Nurses in general also believe that they have a duty to their patient which outweighs duty to themselves/colleagues/potential patients - this is why withdrawal of labour is such a contentious issue. I have heard nurses support medical withdrawal of labour (for better conditions) but state that they could never leave their patients.

Third, I think you're right - as medical students learn they have to robustly defend the positions they take, and can disagree with their instructors without fear of penalty (with exceptions, to be sure); nursing education has less tolerance for dissent, and nursing culture in general reflects this.

I believe the biggest contributing factor is gender - girls are taught to take criticism personally, to be compliant, and to get their way covertly. Boys are taught that criticism is about how they behave, not who they are, and to be overt in their demands. Despite the growing gender balance in medicine and nursing, the dominant culture seems to mould the entrants, rather than be changed. Women who become doctors often take on these traditionally masculine qualities, many male nurses work within the dominant paradigm.

MarySunshine · Oct 16, 2004

Excellent post, Talaxandra!! One thing I have noticed is that even the professors who take dissenting opinions well have a very "well, unfortunately, that's just the way it's always been..." attitude. My backbone certainly has grown no stronger in nursing school.

EmilyCCRN · Oct 16, 2004

Does anyone think that nursing school sets us up for this kind of treatment? We are taught from day one that we are advocates for our patients, but many students wouldn't dare voice a difference of opinion or stand up for themselves to instructors who let personality differences get in the way of the learning experience. Students are just expected to take it, go with the flow, don't stand out as being different or difficult. As a result, they complain to others and let resentment simmer instead of addressing the problem.
I'm not saying nursing school is a horrible experience or that instructors aren't valuable--I have a lot of respect for the tough job that instructors have. It just seems like we're asking for problems when we expose students to years of "don't rock the boat" and then send them out into the wonderful world of nursing to fend for themselves.

I'm only halfway through my first term of school, but it sounds like I am lucky with respect to the way my school instructors and administration handle things. The chairperson of our nursing department spoke to us the first day -- she let us know that if we ever had problems with an instructor and didn't feel that we could talk to them about it, then we can come to her. She then went on to say that if we didn't feel that we got an adequate response from her, then we can escalate it to the director of the health sciences department, then the assistant dean, and then the dean. Also, our clinical instructor told us to immediately let her know if we run into any problems with the staff at the hospital. She said that she would make sure to resolve the issue, even by escalating it if necessary. They might just be paying us lip service, but at least we weren't immediately presented with the idea that we "don't count" and should keep our mouths shut if we have a problem.

Euskadi1946 · Oct 16, 2004

My motto has always been you have not lived or died until you have gone through nursing school and I still have nightmares about it. However, I'm still very grateful to our instructors for being extremely hard on us and teaching us that we are first and foremost, patient advocates. Many of our instructors did teach us to stand up for ourselves and to refuse assignments which we felt were unsafe. I love nursing and especially the floor nursing but will never go back to floor nursing because it is still unsafe and I worked too blasted hard to get my license. I am now in case management and although I miss the hands on contact and the pay, at least I know that I can be a good nurse to my patients in another capacity without putting their lives and my license in jeopardy.

jenac · Oct 18, 2004

Third, I think you're right - as medical students learn they have to robustly defend the positions they take, and can disagree with their instructors without fear of penalty (with exceptions, to be sure); nursing education has less tolerance for dissent, and nursing culture in general reflects this.
I believe the biggest contributing factor is gender - girls are taught to take criticism personally, to be compliant, and to get their way covertly. Boys are taught that criticism is about how they behave, not who they are, and to be overt in their demands. Despite the growing gender balance in medicine and nursing, the dominant culture seems to mould the entrants, rather than be changed. Women who become doctors often take on these traditionally masculine qualities, many male nurses work within the dominant paradigm.

My whole life- I was taught to stand up for myself. To do my best, always. Did I take criticism to heart? Yep-still do. But I will stand up when I feel others are wrong. In nursing school- I personally had a horrible time with my Med-Surg instructor. She was the first to claim it was a personality comflict, even going so far as refusing to act as a reference for me professionally due to her "personal feelings" about me, yet I passed anyway. Did I rock the boat? Nope-and I'm an LPN today because I kept my mouth shut and took her abuse. Witnessed abuse. Virtually every day- I had one student or another, even staff nurses during clinicals comment on how hard this particular instuctor was on me. I once took care of a former student's husband-to which he told me I was doing great and not to let her chase me away. Would I have ever stood up to her? No way-not if I wanted to make it through. I watched her antagonize and bait so many others. I watched her turn a blind eye on blatant mistakes from her "favorite". This particluar woman had the power to make or break me. I went home almost every day in tears- but I kept my mouth shut. Would I do the same if I met her on the street today? Definately not. Does that mean I will take the same abuse now? Not for a second. But-the experience has taught me how to deal with rude, obnoxious physicians. And it has made me a better nurse for it.

Roland · Oct 18, 2004

My whole life- I was taught to stand up for myself. To do my best, always. Did I take criticism to heart? Yep-still do. But I will stand up when I feel others are wrong. In nursing school- I personally had a horrible time with my Med-Surg instructor. She was the first to claim it was a personality comflict, even going so far as refusing to act as a reference for me professionally due to her "personal feelings" about me, yet I passed anyway. Did I rock the boat? Nope-and I'm an LPN today because I kept my mouth shut and took her abuse. Witnessed abuse. Virtually every day- I had one student or another, even staff nurses during clinicals comment on how hard this particular instuctor was on me. I once took care of a former student's husband-to which he told me I was doing great and not to let her chase me away. Would I have ever stood up to her? No way-not if I wanted to make it through. I watched her antagonize and bait so many others. I watched her turn a blind eye on blatant mistakes from her "favorite". This particluar woman had the power to make or break me. I went home almost every day in tears- but I kept my mouth shut. Would I do the same if I met her on the street today? Definately not. Does that mean I will take the same abuse now? Not for a second. But-the experience has taught me how to deal with rude, obnoxious physicians. And it has made me a better nurse for it.

Why?, Why?, Why? Does your story seem so common? I personally, know two or three nursing students who have experienced nursing instructors who acted very much like the situation you describe, and it simply doesn't make sense to me. By and large you don't see this in the rest of academia. Sure some professors are good, some bad, and some just plain goofy, but rarely are they described as unpleasant, manevolent beings in the manner that seems almost common with nursing insturctors. Come on all of you nursing instructors out there tell me the truth. Do they put you guys through some sort of "secret training" that's not even discussed on Allnurses where you are taught to make your tests impossible, your demands unreasonable, and your attitude's negative? I've often wondered what would happen if a regular University, Biology, Chemistry or Physiology professor somehow started teaching in the school of nursing. Would they tell the person after their first test "hey Dr Smith consider this a formal warning, you need to start asking questions that people can't answer with knowledge not available to thirty year veterans or psychics. Your test's are hard, but you had quite a few A's and B's, and that's not what we are all about in this Dept. By the way stop being so clear of what you expect from your students. Did you realize that you actually covered the material in class which you asked about on your examination? What were you thinking? We like to emphasize conflicting instructions, messages, and attitudes in this Dept. We find it creates maximum stress, and after all that's what we're all about around here. If they can't handle our approach how are they going to make it at an average hospital?"

Of course they sometimes use an approach very much like this in the military, but at least they are very clear that, that is what they are going to do (place you under maximum stress, and be general butt heads). In addition, the "stress learning" approach has been de-emphasized in recent years due in part to decades of research which have shown that it interferes with the learning process. I wonder how many patients die each year because nurses have been "conditioned" not to question authority in part from their nursing school experience? After all if we are taught that their is a price to pay for disagreeing with instructors how are we ever going to be prepared to stand up to a chief surgical resident or DON, is the situation warrants? Do any of you remember that girl at Duke who died due to a simple error of blood/organ typing? Now maybe no one (including the nurses) noticed the error. However, maybe, just maybe someone did notice something amiss, but remembered their days at nursing school where pointing out errors would bring chastisement or worse. Indeed, I would argue that one of the primary functions of nurses is to act as a "check and balance" in the medical system against physician, HMO, and hospital error, negligence, and malfeasance. However, I can't remember this opinion ever being expressed in any nursing text that I've read in school or otherwise.

I would also point out that there are many (perhaps the majority) of excellent instructors. I have a clinical instructor right now that I would follow into Hell. She is demanding, but also understanding. In addition, she brings out the best in me and inspires me to learn more than I would otherwise dream possible.