Good Girls Aren’t Bossy (and Neither Are Nurses)

Nursing is one of the classic ‘four’ of women’s professions — a throwback, if you will, to the days when women could choose between nursing, working as a secretary, teaching, or motherhood. And although the stereotype of the barking, sergeant type of nurse may still stand, the truth is, nursing is a profession where there is still a lot of “submission” expected. In the past six years I have worked as a nurse, and in the four years of nursing school I endured, I have worked in doctor’s offices, critical care units, medical-surgical units, pediatric units, nursing home units, and most recently, in labor and delivery.

I’ve seen a lot as a nurse, from watching a man’s heart literally beat in his open chest to witnessing countless babies be born. Although it is a profession that has added a lot to my life, the truth is: It takes a very special type of person to be a nurse. And overwhelmingly, that “person” is expected to be someone who stands up but also shuts up.

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Hospital nursing is a completely different world than many of us are used to, and it’s one that looks precisely like nothing you would ever see on TV. (If you don’t believe me on this one, try to watch any medical drama with an actual nurse and see if she can stop herself from yelling out things like, “That’s not how you do CPR!” or “Oh, really, like a doctor would ever give that med!”) But I digress.

My point is, it’s hard to understand what working as a nurse can look like until you’re actually there. It’s also tough because while I recognize that every hospital is different and every nurse is different, the typical expectation for a nurse is to be at ounce autonomous but not too much so.

It is a nurse’s responsibility to take an order from a doctor. So say, for example, I take a medication order from a doctor over the phone or I read an order that the doctor has put into the computer remotely. If I think that something is amiss with the order (perhaps it looks like too much to give that patient, or I question if it’s the right drug for the job), but I still give the order because, hey, I’m not the doctor, right? If it turns out to actually be the wrong order, can you guess whose shoulders the responsibility falls on? Yup. Not the doctor’s, who gave the order and went to medical school — the nurse’s.

And here’s where things get tricky. What do you think the nurse should do when she questions the order initially?

Should she:

A) immediately pipe up to the doctor and say bossily, “Hey Doc? Pretty sure that’s enough medication to kill this patient. You sure that’s what you want?”

B) silently tweak the order to what she knew the doctor meant to write because, after all, it’s her responsibility in the end? Or …

C) call the doctor back, gently but firmly stating she would like to “confirm” the order, while also reminding the doctor of the patient’s deadly allergy to the medication he just prescribed?

In almost every situation I have worked in — and this could be the result of a small-town hospital where a traditional system of docs over nurses still prevails — it is always the nurse’s responsibility to correct the doctor, but ensure that she is doing it in a way that is not too “bossy” or “offensive.” Because if she does, she will definitely be labeled as someone who “thinks she knows it all” or someone who is “difficult to work with.” Even if she was right all along. And honestly, in every floor of any hospital, I can guarantee it’s the nurses running the show. It’s the nurses on the front lines, the nurses who know when a patient is taking a turn for the worse, or how he/she is responding to a certain medication.

And while many a good doctor will recognize that and be willing to work with a nurse, asking her for her honest opinion and encouraging dialogue, I have seen over and over doctors brush off nurses, ignoring their order requests, or carelessly overlooking their reports. And I hate to say it, but the treatment comes from both male and female doctors, although I have noticed a difference in how male nurses can be treated. Male nurses aren’t afraid to speak up more and voice their opinions about a patient, are more apt to joke with a doctor, and certainly proceed with a lot more confidence in patient care than I have witnessed many of their female counterparts do. It’s not true for every nurse everywhere, of course, but in many ways, nursing has almost seemed like that old children’s proverb: that a good nurse should be seen — she can do her work, she can keep her patient alive, she can “gently” correct a wrong order — but should she every really be heard?

When I was in nursing school a mere seven years ago, as students we heard about how “nurses eat their young,” and unfortunately, in some cases, I found that to be completely true. Older, more senior nurses would bark orders at me, belittle me, and treat me like I knew nothing and was a nuisance on the floor.

And when you really think about why they acted that way, I believe it comes back to the suppression that many of them had faced during their professional careers. After all, most of them have practically more knowledge than a doctor, especially a fresh-out-of-medical-school doctor, and yet they can still be treated like they rank “lower” than other medical professionals. So in turn, they degrade the next “lower” worker to them.

Luckily, I have also worked with some really, truly phenomenal nurses who took me under their wings and showed me what it’s like to be a caring and confident professional woman in the world of hospital nursing. And I do really feel that those women represent a new future — a future when the olden days of doctors barking orders at nurses and nurses scurrying along to do their bidding, hoping they won’t get in trouble, will be gone.

Because the best nurses I have seen are the ones who aren’t afraid to stand up to a doctor (who is, after all, just a person), to make their opinions be known, and to be completely professional about it. The ones who can smile in the knowledge that they are truly doing what’s best for their patients and not let any negativity get to them — they are true to themselves, and that makes a difference.

They know at the end of the day that they have to make the decisions they’ll be able to live with. Yet they also know that the women who can’t make the stand — the women who can’t feel confident in their skills and expertise — will be the ones who suffer.

And I know this from personal experience because, honestly, I haven’t been able to find that place within myself — the place that says it’s OK to be honest and truthful at work and not put on a mask of what I think a “good” nurse should be.

I’ve struggled with my identity as a nurse, and I’ve wrestled with my own insecurities until finally I was able to realize that much like the incredibly strong women I have looked up to as role models in nursing, there is no one definition of what makes a good nurse — or a good woman.

We come in all shapes, sizes, and colors. And some of us may just happen to be a little more “bossy” than others.

 Image via Flickr/Classic_Movie_Gals

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