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A Paradox
A PARADOX Lester E . Lackie, R.N.
“It is a paradox that despite the considerable responsibility assumed by professional nurses for the treatment and care of patients, their organizational role in hospitals and elsewhere is so lacking in the autonomy and authority characteristically associated with professional status.”’ A clue to this paradox may be found in the development of nursing as a career. The nurse is subservient to the doctor. (Not long ago, she was trained to stand at attention when a doctor entered the room.) She gives nursing care to the patient under the direction of the doctor. Nurses have probably been willing to accept this role because of their sex. They are predominantly women who look to the dominant male for orders and have the “mothering” instinct to care for the young and sick, and it is this instinct which keeps them satisfied with bedside nursing. Thus, a woman may fulfill her personal need for selfsatisfaction through helping others. In the past, the qualifications for the nurse have been few. But qualifications and educational background have improved slowly through the years with great strides taking place primarily since the 1900’s. The nursing profession has developed in the hospital setting. Here, nurses are found to be cheap labor. They traditionally would assume tasks that others refused to do. They are controlled by many others. Besides the doctors, they are under the authority of the Administrators, Board of Governors, School Lester Lackie, R.N., is a graduate of Los Angeles County General Hospital School of Nursing. Currently OR Supervisor, Glendora Community Hospital, Glendora, California, Mr. Lackie’s views on ”Men in Nursing” appeared in the June issue of the
Journal.
August 1969
of Nursing, Director of Nursing, and Public Health Service. The nurse lacks the independence and freedom of action in the pursuit of her profession that others have. For instance, the doctor uses the hospital for the benefit of himself and his patients, but is allowed independent action in the practice of his profession. In one area, that of public health, nurses have relative freedom of action and carry out their work away from the physical presence of doctors. With advanced technology and the increase of medical specialties, many new allied occupations have developed in the medical field to aid the physician in his work. From the specialty of radiology have come X-ray technicians; from orthopedics, physiotherapists: from anesthesia, oxygen therapists; from pathology, laboratory technicians, to name only a few specialties and their allied occupations. None of these groups has equal status with the M.D., nor does any claim a professional title. Nursing is one of the few assisting occupations regarded as a profession. Although they have not achieved equal status with physicians, Anselm Strauss feels that nursing was able to achieve the title of profession because it developed as a field before these other groups.2 Strauss feels that this might not have been the case if nursing were just beginning as a field today. The effects of her background on each individual nurse have been tremendous. Nursing is now in a struggle for independence and recognition as a true profession. Tradition has always been a strong factor in the lives of nurses and they do not welcome change, even if they know it’s for their own good. Nursing educators feel that we must change in order to
73
survive: “New insights, new orientations, new goals must replace traditional values. Nursing cannot afford to hold ‘the past so dear that it is costly to the future.’ ”3 At this time, however, the majority of nurses have been trained in the traditional way. About 80 per cent of all nurses are graduates of the diploma program and are hospital-oriented. They feel their background is adequate, and they have continued their education only in an informal way. Educators are going to have to guide these nurses into the educational stream so that their progress can continue. If 80 per cent of nurses run down the modern program to the youth, progress in the nursing profession cannot take place. As Abe Lincoln said, “A house divided against itself cannot stand.” Nurses have done a searching self-appraisal since the end of World War I1 and have sought a solution to this conflict between the two types of nurses. The profession-oriented nurse is characterized as not being “motivated by any blanket dedication to an ideal. Accepting the principle that good health is better than bad, her focus is not specifically upon the patient to be healed, but upon the special things that must be done and the special mode of operations that must be evolved if the problem of healing is to be met more adequately and intelligently. . . . Health being a critical problem in American society, no longer popularly felt best to be achieved by the ministrations of a mother and of the local healers, special categories of people need to be charged with the responsibility of standing in their stead, or of doing the job in a better, if different way. The professionalizing nurse accepts the responsibility and, for the services she promises to perform, in turn asks for special or exceptional treatment by society. This, spelled out, means professional prerogatives, one of which takes the form of organization of fellownurses into separate, prestigeful, and relatively autonomous group^."^
74
The tradition-oriented nurse, however, is described as the type of nurse who is motivated “by an ideal long since recognized and venerated in society, personified in the name of Florence Nightingale. The basis of the motivation consists in a sense of dedication, the components or terms of which are so taken for granted as seldom to be examined.. . The traditionalizing nurse does not ask to be judged in her actions by competent colleagues, but by an alignment of her actions against those which have traditional legitimation. Her work is an extension of the healing arts long practiced in home and community, and the focus of her attention is the patient, as an individual and a personality. Her function within a pattern of complete and unquestioning deference to the doctor is simply to bring into force all her nursing skills in the healing of the patient. Within the limits specified by the folk wisdom of nursing, she dissolves a major portion of her personality in each nurse-patient ~ituation.”~ The question now is how to bring the two major factions of nurses together for the common good. The ANA is our best starting point. This organization’s only interest is nurses and their effect on the general health field. Many nurses belong, but, unfortunately, few participate. As an example of how nurses can work together, the Commission of Nursing Education and the Commission of Nursing Service are going to meet to discuss the fundamental concepts of graduate education. These groups are working to reach an understanding and plan for the future.
.
It is also important to understand and clarify the nurse’s role in the future. Older nurses feel their security is being threatened. They fear change. They have not been trained to assume the more organizational role of newer professional graduates. There is a great lack of communication. Though material is available in print, it is not always read or interpreted correctly. In order to clarify trends in nursing, I feel there is a need for
AORN Journal
more personal contact through general meet- given to attracting our leaders to this field. In order for nursing to assume the ings in all areas of nursing where questions can be asked and answered. autonomy and authority along with the Another problem in helping nursing achieve responsibility associated with professional its full professional role is the lack of highly status, many changes will have to take place. educated nurses in the hospital field. The more Among these changes are higher education for highly educated nurses are engaged in public nurses and a change in the image of nursing health, education, and research. They have in the minds of the public, other nurses, and had little actual hospital training. Since the people in allied fields. Progress along these largest single body of nurses is employed in lines will help modem nursing take its place hospitals, I think more attention should be in society as a true profession. REFERENCES 1. Davis, Fred, The Nursing Profession: Five Sociological Essays, p. vii. 2. Ibid., p. 102. 3. Rogers, Martha E., Educational Revolution in
Nursing, p. viii. 4. Vaillot, Sister Madeleine Clemence, Commitment to Nursing, A Philosophic Investigation, pp. 2-3. 5. Ibid., p. 3.
A PRAYER Lord, Thou knowest better than 1 know myself that 1 a m growing older and will someday be old. Keep me from the fatal habit of thinking 1 must say something on every subject and on every occasion. Release m e from craving to straighten out everybody’s afairs. Make m e thoughtful but not moody; helpful but not bossy. W i t h m y vast store of wisdom, it seems a pity not to use it all but Thou knowest, Lord, that 1 want a f e w friends at the end. Keep m y mind free from the recital of endless details . . give m e wings to get to the point. Seal my lips on m y aches and pains. They are increasing, and love o f rehearing them is becoming sweeter as the years go by. 1 dare not ask for grace enough to enjoy the tales of others, but help m e to endure them with patience. 1 dare not ask f o r improved memory but a growing humility and a lessening cocksureness when m y memory seems to clash with the memories of others. Teach me the glorious lesson that occasionally 1 may be mistaken. Keep m e reasonably sweet. 1 do not want to be a saint-some of them are hard to live with-but a sour old person is one of the crowning works of the devil. Give m e the ability to see good things in unexpected places and talents in unexpected people. Give me the grace to tell them so. Amen.-Author Unknown.
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August 1969
.
75
“It is a paradox that despite the considerable responsibility assumed by professional nurses for the treatment and care of patients, their organizational role in hospitals and elsewhere is so lacking in the autonomy and authority characteristically associated with professional status.”’ A clue to this paradox may be found in the development of nursing as a career. The nurse is subservient to the doctor. (Not long ago, she was trained to stand at attention when a doctor entered the room.) She gives nursing care to the patient under the direction of the doctor. Nurses have probably been willing to accept this role because of their sex. They are predominantly women who look to the dominant male for orders and have the “mothering” instinct to care for the young and sick, and it is this instinct which keeps them satisfied with bedside nursing. Thus, a woman may fulfill her personal need for selfsatisfaction through helping others. In the past, the qualifications for the nurse have been few. But qualifications and educational background have improved slowly through the years with great strides taking place primarily since the 1900’s. The nursing profession has developed in the hospital setting. Here, nurses are found to be cheap labor. They traditionally would assume tasks that others refused to do. They are controlled by many others. Besides the doctors, they are under the authority of the Administrators, Board of Governors, School Lester Lackie, R.N., is a graduate of Los Angeles County General Hospital School of Nursing. Currently OR Supervisor, Glendora Community Hospital, Glendora, California, Mr. Lackie’s views on ”Men in Nursing” appeared in the June issue of the
Journal.
August 1969
of Nursing, Director of Nursing, and Public Health Service. The nurse lacks the independence and freedom of action in the pursuit of her profession that others have. For instance, the doctor uses the hospital for the benefit of himself and his patients, but is allowed independent action in the practice of his profession. In one area, that of public health, nurses have relative freedom of action and carry out their work away from the physical presence of doctors. With advanced technology and the increase of medical specialties, many new allied occupations have developed in the medical field to aid the physician in his work. From the specialty of radiology have come X-ray technicians; from orthopedics, physiotherapists: from anesthesia, oxygen therapists; from pathology, laboratory technicians, to name only a few specialties and their allied occupations. None of these groups has equal status with the M.D., nor does any claim a professional title. Nursing is one of the few assisting occupations regarded as a profession. Although they have not achieved equal status with physicians, Anselm Strauss feels that nursing was able to achieve the title of profession because it developed as a field before these other groups.2 Strauss feels that this might not have been the case if nursing were just beginning as a field today. The effects of her background on each individual nurse have been tremendous. Nursing is now in a struggle for independence and recognition as a true profession. Tradition has always been a strong factor in the lives of nurses and they do not welcome change, even if they know it’s for their own good. Nursing educators feel that we must change in order to
73
survive: “New insights, new orientations, new goals must replace traditional values. Nursing cannot afford to hold ‘the past so dear that it is costly to the future.’ ”3 At this time, however, the majority of nurses have been trained in the traditional way. About 80 per cent of all nurses are graduates of the diploma program and are hospital-oriented. They feel their background is adequate, and they have continued their education only in an informal way. Educators are going to have to guide these nurses into the educational stream so that their progress can continue. If 80 per cent of nurses run down the modern program to the youth, progress in the nursing profession cannot take place. As Abe Lincoln said, “A house divided against itself cannot stand.” Nurses have done a searching self-appraisal since the end of World War I1 and have sought a solution to this conflict between the two types of nurses. The profession-oriented nurse is characterized as not being “motivated by any blanket dedication to an ideal. Accepting the principle that good health is better than bad, her focus is not specifically upon the patient to be healed, but upon the special things that must be done and the special mode of operations that must be evolved if the problem of healing is to be met more adequately and intelligently. . . . Health being a critical problem in American society, no longer popularly felt best to be achieved by the ministrations of a mother and of the local healers, special categories of people need to be charged with the responsibility of standing in their stead, or of doing the job in a better, if different way. The professionalizing nurse accepts the responsibility and, for the services she promises to perform, in turn asks for special or exceptional treatment by society. This, spelled out, means professional prerogatives, one of which takes the form of organization of fellownurses into separate, prestigeful, and relatively autonomous group^."^
74
The tradition-oriented nurse, however, is described as the type of nurse who is motivated “by an ideal long since recognized and venerated in society, personified in the name of Florence Nightingale. The basis of the motivation consists in a sense of dedication, the components or terms of which are so taken for granted as seldom to be examined.. . The traditionalizing nurse does not ask to be judged in her actions by competent colleagues, but by an alignment of her actions against those which have traditional legitimation. Her work is an extension of the healing arts long practiced in home and community, and the focus of her attention is the patient, as an individual and a personality. Her function within a pattern of complete and unquestioning deference to the doctor is simply to bring into force all her nursing skills in the healing of the patient. Within the limits specified by the folk wisdom of nursing, she dissolves a major portion of her personality in each nurse-patient ~ituation.”~ The question now is how to bring the two major factions of nurses together for the common good. The ANA is our best starting point. This organization’s only interest is nurses and their effect on the general health field. Many nurses belong, but, unfortunately, few participate. As an example of how nurses can work together, the Commission of Nursing Education and the Commission of Nursing Service are going to meet to discuss the fundamental concepts of graduate education. These groups are working to reach an understanding and plan for the future.
.
It is also important to understand and clarify the nurse’s role in the future. Older nurses feel their security is being threatened. They fear change. They have not been trained to assume the more organizational role of newer professional graduates. There is a great lack of communication. Though material is available in print, it is not always read or interpreted correctly. In order to clarify trends in nursing, I feel there is a need for
AORN Journal
more personal contact through general meet- given to attracting our leaders to this field. In order for nursing to assume the ings in all areas of nursing where questions can be asked and answered. autonomy and authority along with the Another problem in helping nursing achieve responsibility associated with professional its full professional role is the lack of highly status, many changes will have to take place. educated nurses in the hospital field. The more Among these changes are higher education for highly educated nurses are engaged in public nurses and a change in the image of nursing health, education, and research. They have in the minds of the public, other nurses, and had little actual hospital training. Since the people in allied fields. Progress along these largest single body of nurses is employed in lines will help modem nursing take its place hospitals, I think more attention should be in society as a true profession. REFERENCES 1. Davis, Fred, The Nursing Profession: Five Sociological Essays, p. vii. 2. Ibid., p. 102. 3. Rogers, Martha E., Educational Revolution in
Nursing, p. viii. 4. Vaillot, Sister Madeleine Clemence, Commitment to Nursing, A Philosophic Investigation, pp. 2-3. 5. Ibid., p. 3.
A PRAYER Lord, Thou knowest better than 1 know myself that 1 a m growing older and will someday be old. Keep me from the fatal habit of thinking 1 must say something on every subject and on every occasion. Release m e from craving to straighten out everybody’s afairs. Make m e thoughtful but not moody; helpful but not bossy. W i t h m y vast store of wisdom, it seems a pity not to use it all but Thou knowest, Lord, that 1 want a f e w friends at the end. Keep m y mind free from the recital of endless details . . give m e wings to get to the point. Seal my lips on m y aches and pains. They are increasing, and love o f rehearing them is becoming sweeter as the years go by. 1 dare not ask for grace enough to enjoy the tales of others, but help m e to endure them with patience. 1 dare not ask f o r improved memory but a growing humility and a lessening cocksureness when m y memory seems to clash with the memories of others. Teach me the glorious lesson that occasionally 1 may be mistaken. Keep m e reasonably sweet. 1 do not want to be a saint-some of them are hard to live with-but a sour old person is one of the crowning works of the devil. Give m e the ability to see good things in unexpected places and talents in unexpected people. Give me the grace to tell them so. Amen.-Author Unknown.
. ..
August 1969
.
75