The Most Trusted Profession
Nursing ranks as the most trusted profession in Gallup’s annual poll for the seventeenth year in a row with a score of 84. Doctors and pharmacists come in a distant second and third with scores of 67 and 66, and the list fades from there. Politicians are tied with car salesmen, continuing their grip on last place with a score of 8.
The honor of being part of the most trusted profession should not be taken lightly. Patients are keenly aware that we spend the most time with them, our motives are not tainted by financial gain, we usually care, and we’re positioned to share an honest, enlightened opinion. In theory, nurses are really cool people–great for relationships, good with confidences, least likely to inflict unnecessary pain, and excellent for decorating hospital marketing brochures with bright scrubs and big smiles. (And we usually pose for free, you know, because they asked.) We may be all these things. In a cruel twist of irony, some of the same qualities that consistently win us first place on the most trusted chart also make us ripe for exploitation: We’re eighty-five percent female, programmed to please, and unlikely to fight back.
Risk for Exploitation - Why??
85% Female Profession
First, just being an eighty-five percent female profession still makes us vulnerable to inequality. "On the Basis of Sex," a recent movie about Supreme Court Justice Ruth Bader Ginsburg, stages a brilliant moment. Felicity Jones, who plays Ginsburg, is arguing a sexual discrimination case before an all-male panel of judges. One of them looks down on her and declares in a voice laced with condescension, “The word 'woman' does not appear even once in the U.S. Constitution." She stares him down and quips, “Neither does the word ‘freedom,’ your honor.” It’s a moving moment of assertive confrontation on her pathway to becoming the first female Supreme Court Justice. It’s a reminder of how far we’ve come.
Women have made major strides. We just finished Women’s History Month. We even have a Women’s Equality Day. There’s a myriad of opportunities open to us, but we still glaringly lag male counterparts in easily measured areas like equal pay for equal work and representation in government office. A friend of mine in Spokane, WA, works at a major hospital where the nurses are threatening to strike. One item of contention is the $41 million in salary paid to the fourteen executives at the top while the workers are facing eroding benefits. A breakdown of the executives’ salaries posted on social media shows an equal number of men and women, but the women make half of what the men get. Statistics vary, but females employed in the U.S. make about twenty percent less than males. The discrepancy is still about five percent for doing the same work. The number of females elected to government office continues to increase, but women still only hold about one in five elected positions. If money and power are any indication, an essentially female profession is still inherently vulnerable.
A Desire to Fix Things
Second, our innate desire to rescue, fix things, and make people happy increases our risk of exploitation. There’s a profoundly odd inverse relationship between love (caring) and power in human relationships. As power increases, love decreases, or, as love increases, power decreases. Most of us learned this lesson the hard way during our early teen years when we first fell in love. After a few weeks or months of infatuated bliss, we were slammed with the devastating realization that the other person no longer cared. We may have found ourselves desperate to save the relationship, willing to do anything to try to please the one who had stopped caring, making us vulnerable to manipulation and various forms of abuse. The one who cares the least obviously has the most power.
Nurses are correctly described as caregivers. We don’t need a lot of concocted programs or checklists to push us to improve patient satisfaction. We’re usually programmed to please. It’s in our genes. Most often, it’s why we signed up. So, what happens when we’re short-staffed, equipment isn’t working, supplies are missing, and patients become demanding or even belligerent? Our first response is to skip breaks, work with full bladders, walk faster, and try harder, often postponing or neglecting our own needs to make sure others–patients, visitors, and our bosses–have what they need or even what they just want. Many of us work while sick or injured ourselves, giving for the sake of others. As sensitive people who care, we’re inherently vulnerable to “takers” who don’t care beyond their commitment to their own welfare.
Nurses - Not Fighters
Finally, nurses are generally not fighters. While this is an obvious corollary to our basic instinct to fix things, there are other constraints firmly entrenched. New nurses are increasingly entering the profession deeply in debt. The push for increasingly higher levels of education has a hidden benefit for employers–a submissive workforce. Student loan debt averaged about $33,000 in 2018. More than ever before, new RNs just need the job. A young, smart coworker was venting to me in the breakroom a few weeks ago about a new policy removing our ability to override several frequently used medications. Her observations were valid, and her rationale had merit. When I suggested that she send an email to management, she quickly backed down. “Are you kidding me? I can’t afford to rock the boat. I’m a single mom with $48,000 in student loans. My kids come first. I’m bought and paid for.” A lot of great ideas never get past venting in the breakroom.
The ultimate restraints are the legitimate needs of the patients entrusted to our care. Even when the workload is grossly unrealistic because we had a couple of call-offs, we still imagine that the people in those rooms are like our own family. Some of them really need us, and we don’t want to fail the ones who do. In the ER, we have no control over how fast patients pour in. As EMS stretchers line up in the hallway and patients back up in the lobby, we’re forced into working dangerously–again, and we shift into a nearly frantic survival mode of putting out fires. We just try harder, work faster, and, yes, cut corners (putting ourselves at risk) when survival depends on it. At times our productivity is super-humanly-amazing, off the charts–and simultaneously enabling.
Those who profit from the accepted inequities in our system bank heavily on our dedication to our patients. If bus drivers, teachers, IT specialists, or professional athletes strike, it’s an irritation or an inconvenience. If we strike, even if enough temporary replacements are pulled in, patients could die. If enough of us went on strike at once, a lot of people would die. There are some significant pockets of resistance, and a few major battles have been won, but generally, our profession of non-fighters has demonstrated remarkable restraint. Those in power expect that we’ll continue the established path of pacifism.
Paradoxically, the greatest constriction of standing up for ourselves, the welfare of our patients, is also our best bargaining chip when we do take on the powers propagating the exploitative system. I sometimes think of our current nursing profession like a wife in an abusive relationship, fearing for our own safety and that of our children, those entrusted to our care. The battered wife knows there may be casualties if she resists, but at some point, she chooses to take the risk. As a profession, we cannot condone harm to innocent, needy people. At some point, honor demands we take a stand.
The core problems plaguing our profession run much deeper than staffing levels. This year, there are massive rumblings about fixing our national disgrace. The U.S. remains the only industrialized country on the planet that does not provide some form of universal access to healthcare. We are the only system enabling rampant profiteering at the cost of human lives, pretending that healthcare is a commodity like a new car or pearl necklace. Storm clouds are gathering, and two serious questions for the rest of our Nation are looming large on the horizon.
Who causes the greatest harm to our patients? And who will step up to rescue them?