Amie Archibald-Varley and Sara Fung are nurses and co-hosts of The Gritty Nurse podcast.
Take a minute and name a few famous or influential physicians. How many names did you come up with?
Now let’s try something different: take a minute to think of a few famous or influential nurses.
Was it just one name that came to mind? And was it Florence Nightingale?
Why is it that when we think of expertise and wisdom in health care, we struggle to think beyond physicians? For centuries, the health care profession has elevated the pronouncements of doctors above all others. Their words have been presented with a similar reverence in film, in television and in the mainstream media. But there are real-world consequences for this overarching trend when it comes to decision-making and implementing changes in our modern health systems: we have often overlooked the invaluable insights of nurses.
Nurses have traditionally been depicted as handmaidens or physicians’ assistants. Nightingale herself is often portrayed as an archetypal maidservant, the “lady with the lamp” tending to soldiers by candlelight in the mid-19th century.
Nursing is a profession dominated by women (although the landscape is changing slowly), and so gendered stereotypes have contributed to the perception that nurses are not equal health care team members and do not have as much to offer in terms of updating or innovating policies related to patient care.
Today’s nurses are also socialized to believe in this hierarchy, and many carry false perceptions of themselves and their place in the health care system. Even in the movies, we are never given the leading role – nursing characters are often seen but not heard from. The historical underpinnings of the roles nurses are told they should play, as well as the patriarchal power and dominance structures imposed on the nursing profession, have long tarnished the relationship between nurses and their fellow health care team members. The relationship struggles continue to this day, as health care team dynamics can still be rife with power games, politics and hierarchical attitudes.
For too long, nurses have been silenced, overlooked and underappreciated. Nurses have been given limited autonomy in health care decision-making and around the political table. We saw this play out at the beginning of the pandemic: Task forces, committees and panels were created to tackle issues related to short staffing, pandemic preparedness and policy change and design. Many physicians, scientists and politicians sat at these tables. Although nurses are considered the largest group of public-health-sector workers – and have a constant presence at patients’ bedsides, seeing and intimately understanding when an approach to patient care works and when it doesn’t – there were few, if any, nurses at these task-force tables.
The reliance on a single type of voice for expertise and wisdom in health care has limited the level of care patients deserve. Nurses have been sounding the alarm for years concerning what we have seen, experienced and researched when it comes to patient care and outcomes. It was only when a nursing shortage started to cripple health care systems in Canada – a shortage that nurses have been warning about for years – that the public and the mainstream media began to listen to our voices.
A new movement is starting – one in which nurses are determined and demanding to be heard, and that recognizes the powerful potential of nurses’ wisdom. We need to shift the public perception of nursing, moving away from the idea that nurses are angelic saviours and instead recognizing nurses and health workers with agency.
There has been very little progress in the past century in highlighting the stories of nurses (beyond Florence Nightingale), and so we decided to write a book that sheds light on and celebrates the expertise, knowledge and wisdom of nurses, gained over centuries from various nursing leaders and pioneers of the profession. In reflecting on the humour, expertise, creativity, innovation and power of those in the nursing profession, we hope the public – and nurses themselves – will better understand the impact that nurses’ voices can have in transforming health care.
We need to change the dynamics between nurses and their health care team members, particularly physicians, and we need mainstream media to share different stories – ones that empower nurses and see them truly as partners and leaders in health care. This will benefit not just patients, but the entire health care system. The time has come to move beyond the hierarchical model of health care. By recognizing the unique wisdom of nurses, we unlock the full potential of the health care system.
At the top of this article, we asked you to name an influential nurse. We hope you’ll hear what we have to say, and perhaps even add two new names to your list.