“So, why nursing?”
“How does a girl like you end up in nursing?”
“Why didn’t you become a doctor?”
“Are you planning to go back to med school later?”
I have conversations like this a lot. It’s something people seem to consider fair game to ask me. I’m not sure if this is something that every nurse gets asked, or whether it’s mainly a factor of the people I hang out with (male nerds, a lot of the time) and the fact that I’m visibly a nerd as well, and thus assumed to be intelligent.
No one says this out loud, so I’m extrapolating, but the hidden assumption seems to be that nursing school is an inferior version of medical school. If you’re interested in the medical field and you’re smart and motivated, you become a doctor. If your grades aren’t good enough, you become a nurse. If you’re a nurse, and you seem like someone whose grades weren’t good, people don’t ask, because that would be tactless. If it seems obvious that your grades were good–for whatever reason, I don’t even know what people are judging on here, since it’s not like people often have a reason to discuss your high school grades–asking is fair game, because you did a confusing and strange thing.
I love nursing, and have absolutely no regrets about choosing it, which I did at age fifteen. I’ll talk about the object-level reasons I chose nursing, which aren’t any better than the reasons an average fifteen-year-old uses to choose a career, and then about the meta-level reasons why I think my choice was a perfectly good one.
I read a book when I was in grade ten. It was the biography of a nurse, Tilda Shalof, who worked in critical care. I read it and thought: “Yes. This.” She was my hero. She and her colleagues were badass. She told poignant stories about patients, and it seemed to me like an incredibly precious opportunity to be a character in those stories. I pictured myself six years in the future, and felt a visceral urge to just skip over the intervening years and get to the part of my life that really counted.
I’m guessing that what really mattered here was having a role model. If I’d read a book about a doctor doing their day-to-day work, that might have stuck too. But I think that the things nurses see and do are particularly tuned to hit my emotional buttons. I wanted to be the one that family members felt comfortable hugging, or crying on. The one holding a frightened patient’s hand and comforting her at two in the morning. The first time I did this in real life, it felt like a moment in a story coming true, and I spent a week thinking about it.
There were other reasons why I chose nursing. It was a faster, more guaranteed route to a job. Four years, out and done. It was maybe a slight rebellion against my parents and their years in academia. I was annoyed by people telling me that I ought to go into a profession where “we needed more women”, and so maybe it was a slight rebellion against those teachers and relatives and guidance counsellors, too.
The reason I give most people is that “I’m twenty-two and I’m already working full time earning a salary, with no debt.” It’s a practical reason. Not my true, ultimate reason, but believable.
But looking back, after six years of being exposed to dozens of ideas about rationality and feminism and many other things, I think that the fact of asking the question reveals a lot about the implicit beliefs of the asker.
One. Status is something to pursue, and nurses are low status. Well, okay. Except that, have you been at work with me? It doesn’t feel to me like there’s a status hierarchy with me at the bottom. I’m there, will my skillset, and the doctors are there with their skillset, and quite honestly most of the times they are awful at quite a lot of the things I do. They don’t know how to mix IV medications, what’s compatible with what, etc. They don’t know about logistics. The manager of the unit is a former nurse, because most doctors suck at logistics. No shame to them; developing that skill set would mean taking time away from the skills they do have, which are just as essential.
(The first hospitals were run by nurses, actually. Well, nuns. Doctors eventually climbed on with them, because institutions are convenient).
Most fundamentally, doctors don’t have time. The ICU doctors I work with are in charge of a 12 bed unit, plus consults on the floor or in the ER. I have two patients. I can know every single relevant thing about those two patients. Fluctuations in neurological status, pain control, bowel movements–these are things that doctors can’t be expected to keep track of. I’m a filter. I notice what’s abnormal, I decide if it’s important, I make the call whether to alert the doctor at two am or wait until rounds the next day. If you ask me, that’s a position with an awful lot of power.
So what it feels like to me isn’t a status hierarchy at all, but more of a machine with different parts. You can’t make a car out of only wheels, with no axles or frame or engine; and you can’t make a hospital with only doctors, at least not at the level of scale we need today. You need pharmacists, physiotherapists, respiratory therapists–who the hell else knows what all the buttons other than the ‘SILENCE’ button on the ventilator do–occupational therapists, dieticians, not to mention the porters and the cooks and the cleaning staff. Oh, and you need a lot of nurses. Some of the people go to school longer, and get paid more. I get paid about the same as an RT, more than a personal support worker [PSW], less than a doctor. But the doctor-knowledge set isn’t a superset of the nursing knowledge set. They’re partially overlapping circles, like a Venn diagram.
Some doctors do act like they’re at the top of a status hierarchy that has nurses at the bottom. Their loss. If they round without the nurse there, it’ll take them a week to realize that the patient hasn’t had a bowel movement since admission.
It may be that I’m just oblivious to the hierarchical kind of status. Maybe it’s a male thing. some of my friends who have made the status point would in fact feel uncomfortable in my position, rubbed the wrong way by some kind of subtle signals that I’m happily blind to. Well, that seems like a bug with their brain, not with mine.
Two. Nursing is a female profession. I don’t think that very many people would make the argument that “traditionally female professions aren’t as valuable as traditionally male professions” out loud, but that belief is implicit in anyone telling me that “we need more women in science and engineering.” Because all the women working as primary school teachers and childcare workers aren’t doing anything valuable for society?
It feels like the project of convincing society that women are just as valuable as men in the workforce, is being premised on a definition of ‘value’ that centres around traditionally male jobs, as opposed to taking underrated, traditionally female jobs and trying to award them the status they ought to have for the social value they provide.
Of course it’s a bad thing if girls feel pressured not to go into science or engineering, because they’re “boy jobs”, too challenging, too competitive and girls can’t do math. Etc. And there’s something to the consequentialist argument that Miranda-the-engineer could be a role model for other girls. I suppose that’s what my high school teachers were trying to get at.
But why can’t Miranda-the-nurse be a role model for other girls AND boys?
This probably seems like a bit of a rant. It’s not like all I get out of being a nurse is whining that I ought to be a better feminist. I get a ton of respect and kudos from a lot of people for being a nurse. I get empathy points and conscientiousness points and gets-shit-done points. I get a lot of conversations like this: “You’re a nurse? Are you liking that? You love it? Awesome, that’s great that you have a job you really love.”
Except for a certain subset of my friends, maybe 10-15% percent, who fit into a certain class of nerdy, ambitious, self-conscious about status, and mostly male.
I don’t think the thoughts actually going through my geeky male friends’ heads are “nursing is a lame women’s job and medicine is a high-status traditionally male job; why did my otherwise intelligent and reasonable friend become a nurse?” But I do think that a less explicit version of that thought might be happening, of the form “Miranda’s cool, and doctors are cool, Miranda would make an awesome doctor.”
So what are my current reasons for being a nurse?
I love my job. I look forwards to going to work in the mornings. Every day, I get to step into a chapter of someone’s life. Usually a fairly exciting chapter. My life would make a surreal TV show.
Not all of the time, but often, there’s a warmth and camaraderie in working with nurses that fills a void in me. Someone once told me that nursing is like going back to high school with a bunch of gossipy girls. Well, and so? Apparently part of my monkey brain is starved for gossip, or at least for the kind of nearly-content-free conversations that are almost pure signalling of social acceptance. Chatting about salad recipes is a sort of verbal grooming, even if it takes place while working together to bathe a sedated intubated patient.
I can throw my heart and soul into my work–for an arbitrary number of hours of my choice. Part-time nursing is a fully legitimate thing. Switching specialties, too. My hours are annoying sometimes, but constrained. I can have a life outside of work, to write blog posts and novels and try to be a community builder.
If I get tired of nursing, it will be because a part of me is tired of the medical field, period. The sad endings, the times when you can’t fix it, the frustration of understaffing and lack of resources… I’m not sure why, if I did want to move on, I would choose to move on to a slightly different viewpoint that looks out over the same set of problems with pretty similar resources to solve them. If I want a second practical career, or if I decide that accomplishing my goals requires more money than I can earn as a nurse, I’m a lot more likely to take six months off and teach myself programming. If I’m willing to go for an impractical career, I can think of a dozen options.
For the moment, I’m a nurse, and proud. I’m not an awesome nurse yet; from the feel of the learning curve, I think that’ll take about two years in a given specialty; but I have good days. I may not stay in nursing for forty years, but if I leave, it won’t be because I want more status or respect than nurses have.