Continuing Daily Struggles

Despite the increasing autonomy that rising levels of education have brought, asserting professional status remains a daily struggle for many nurses. Doctors continue to determine much of nurses’ everyday working conditions: who works when, where, and for how much money. And doctors sometimes include abusive treatment as part of these conditions: In one recent survey, 74% of nurses reported demeaning comments or insults from doctors, and 26% reported that doctors had thrown objects at them in the last year.

Even when doctors don’t abuse nurses, they often underscore the status dif- ference between them. Most doctors expect to be referred to by their title—“Dr. Smith”—while referring to nurses by their first names or simply as “my nurse.” They rarely read nurses’ notes on patients’ charts, eat with nurses in hospital cafeterias, include nurses in discussions on hospital rounds, or invite nurses to important meetings about patients. Meanwhile, in what is referred to as the doctor–nurse game, experienced nurses are still expected to subtly instruct inexperienced doctors in how to treat patients without revealing the doctors’ ignorance to onlookers. For example, an experienced surgical nurse might subtly suggest what the doctor should do by placing certain instru- ments on the table or by telling the patient step by step what the doctor is about to do. Similarly, nurses often do the work of doctors—prescribing drugs, tests, or physical therapy—when doctors are unavailable, but the doctors often reinforce their own status by telling others that the nurses are simply following the doctors’ known preferences. Even when patients’ lives are saved by nurses’ quick actions, doctors typically receive the credit from patients, administrators, and other doctors.

Changing Gender Roles and Professionalization One important factor that may affect nursing’s ability to gain professional status is the changes in gender roles in the broader society. Since the 1980s, as women gained entry to other fields, in- telligent and motivated women increasingly chose to enter medicine, pharmacy, or biological research instead of nursing. For the same reason, nursing attracted fewer white students and middle- or upper-class students.