The Privilege of Physicians
Recently, I participated in a nursing focus group. A woman doing her doctoral dissertation on the lived experiences of healthcare professionals came to my Doctor of Nursing Practice class to hear the Nursing perspective.
We had a conversation about why we became nurses and how we chose our specialties. When the facilitator asked about our frustrations with the profession, hands shot into the air.
“Anything not explicitly under the purview of another profession becomes the nurse’s responsibility. We’re expected to do it all!”
“Hospital leadership wants us to do more and more with less and less resources.”
“We take the brunt of all the patient and family frustrations - even with things we can’t control.”
“As a nurse, I'm not treated with half the respect a physician receives.”
This last one struck a chord. In this professional setting, nurses expressed feeling devalued. It was a common sentiment.
Doctoral students - many of whom have been in nursing for 10+ years - don’t complain. This is not a group of low motivated, entitled grumblers who use complaining as a means to avoid work.
These nurses are researching and producing doctoral-level academic work, while at the same time, fulfilling their obligations at the hospital. These nurses don’t complain. They assess.
One nurse brought up the signals we receive merely from the hospital’s physical environment. In his facility, physicians have a lounge with couches, flat screen televisions, and a fridge stocked with free food. Nurses share a crowded break room with nursing support staff. There is a table with chairs, a packed-to-the-gills-with-lunchboxes fridge and a single, slow microwave.
Another classmate is a Quality Director for a hospital system. Her role involves attending Root Cause Analysis investigations held after a medical error or sentinel event occurs. She shared that she finds herself constantly defending the actions of nurses during these investigations. They are typically the first to be blamed.
More nurses chimed in with stories of rude interactions with physicians. They describe incidences when they were dismissed after they had brought safety concerns to surgeons during a procedure. They describe managers who avoid dealing with problematic Attending Physicians, but quickly terminate nurses who are difficult to work with.
A classmate (Executive Director of a national nursing organization) expressed frustration in a different area: “Nurses are the ones going to rallies and testifying to Congress. We show up. But then Press time comes and all the quotes are from physicians. We are invisible.”
Another nurse contributed this: “This is not a Nurse vs Physician issue. Physicians and nurses both suffer.” He went on to mention physicians' long hours at work with little sleep, the stress of the job, and the abuse new doctors face during residency.
The discussion then moved on to bullying in healthcare and nurses’ perpetuation of unhealthy hazing rituals.
But I stayed pondering the Nurse vs Physician dynamic that exists in healthcare.
Physicians don’t have it easy. But they do work in a position of privilege, relative to nurses.
Physicians have it hard. But that does not justify nurses being the symptom bearers of the whole system.
Physicians have it hard. Nurses have it hard. Nursing assistants have it hard. Techs have it hard. Administrators have it hard. But physicians have the privilege.
What if we said, “Men have problems too, so women shouldn’t complain about systemic sexism.” Or, “Middle class and wealthy people have problems too, so people living in poverty shouldn’t challenge the social hierarchy.”
Yes, physicians do work long hours, and some face bullying while in residency. But that does not absolve them of the responsibility to stand up for nurses, of challenging the healthcare hierarchy, as the most privileged group.
Yes, middle class people have struggles, but I also have a responsibility as a person in the more privileged group to stand up for those less privileged than I am. I have a responsibility to offer those with less opportunity a seat at the table, and work towards building a more just economy.
“To whom much is given, much is required.”
Yes, physicians, you may be having a hard time, but you also have unmatched status and authority. Think about how much power you have in your institution and in greater society. You have a responsibility to stand up for nurses and all others as partners in the healthcare team.
The nursing role has changed considerably since its early days. The responsibilities of nurses continue to grow. Nursing is an autonomous profession. We have our own licensure exam, our own set of competencies and guidelines for professional practice.
Yet, we’re treated as half-baked doctors.
Our society tells the story that graduating medical school, finishing residency, and becoming a medical doctor is the pinnacle of career success. Those who do anything different, anything ‘less’, couldn’t hack it.
They tell us becoming a nurse wasn’t a choice of Physician or Nurse. (Or RT, OT, pharmacy, PT, social work, etc.) They tell us it was an inevitability. We couldn’t hack it. We took the easier road.
I call BS. Nurses are not failed doctors. Doctors are not smarter nurses. And if you subscribe to this way of thinking, it’s not your fault. You were taught that. I was taught that. We ALL were taught that.
That’s how society works. It reinforces long-held myths and biases, regardless of the truth, because we believe them. Do some self-reflection. Recognize how uncontested social norms influence how you conceptualize yourself and your coworkers. Just because you didn’t ask to be prejudiced, you are not absolved from doing the work to right the system.
And nurses, if you’re reading this thinking, “I like my physician colleagues. I don’t want to stir up any trouble,” it’s time for some real talk. You may think that society’s healthcare hierarchy narrative doesn’t impact you. You think you can go about your job and be just fine, but you’re wrong.
The healthcare hierarchy negatively affects nurses' self-concept and self-esteem. If we’re told over and over again that we’re not as smart as physicians, that we don’t work as hard, that we don’t deserve a couch in the lounge or a hospital-sponsored Apple Watch, or an espresso machine, but they do… Of course, some of us start to believe it.
The amount of times I have heard, “I’m just the nurse” or “Ask the physicians; they’re so smart” from nurses makes my blood boil. You are a competent, fully capable professional. People’s lives are in your hands. You are respected when you demand respect.
The power imbalance between health professions is dangerous. Nurses - whose actual job it is to catch subtle changes and details in a patient’s condition and inform the team - are too scared to speak up. System failures aren’t recognized when there is a nurse placed conveniently at the “sharp edge” of the healthcare team to blame.
Nurses do not sit on boards and are not included in discussions about system improvements - systems they know intimately. Valuable perspective is lost.
Give up the Nurses versus Physicians narrative. We’re all on the same team. It’s about nurses calling on our physician colleagues to have our backs.
Physicians, do it for your team. Do it for your patients.