Nursing Ambivalence

The Poor Poet, by Carl Spitzweg, 1839. (Neue P...
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As Phillip Lopate says, “If you have ambivalence, you already have two paragraphs.”

I have always been ambivalent about nursing: more than two paragraphs worth of ambivalence. There have been numerous times in my life when I have listed out the pros and cons of nursing. It started, of course, when I first began contemplating nursing as a viable career option, when I found myself a Harvard graduate school dropout and without job prospects. My ambivalence accelerated greatly while I was in nursing school: I despised nursing school and almost flunked out until I got to the graduate nursing school part where people—and their testing methods—were somewhat saner. It has continued throughout my 27 years as a nurse. The unexamined life is not worth living. Unexamined nursing is not worth doing.

Recently, my ambivalence about nursing increased. I sought career counseling with an excellent expert in this area. Three sessions and five standardized career tests later, her conclusion was that I have neither the aptitude nor the personality to be a nurse. According to the test results and her interpretation of them, I was meant to be an artist—an activist artist to be precise. My mother, who was an artist, turned over in her grave with this news. As I spent a lot of hard-earned money on the career counseling, I decided to take it seriously. But with a son in graduate school, I have no intention of chucking nursing to become a starving artist. So I am back to sorting out the pros and cons of nursing.

Here’s my current list, in no particular order.

Positives of nursing: I like nursing’s emphasis on caring vs. curing. I like the down-to-earth, no-nonsense aspect of it—the dirtiness and realness of it as opposed to the loftier, detached way that doctoring can have. I especially like public health/community nursing, working with underserved populations where they live. I like that nursing is generally closer socio-economically to “real” people than is medicine. Solidarity can ward off disdain. I like the diversity of working opportunities—the range of what you can do with a nursing degree. I like that it is easier to move into various different jobs and roles and even to get out of working as a nurse, and still have the nursing part inform other work. I like that nursing is generally well regarded by the public—at least in terms of trustworthiness. I like that it requires less time and money to become a nurse (compared with becoming a physician).

Negatives of nursing: There are too many women in nursing: cat fights, back-stabbing, high school-type bullying gossip (and yes, even in nursing education). Too much estrogen is not a healthy thing. We need more men in nursing for so many reasons. I don’t like the sanctimonious, dogmatic, missionary, religious, preachy, bossy ways of nursing. I don’t like the Pollyanna-propensity of nursing. I don’t like the servant role it assumes in reference to physicians and even to patients—the self-effacing, self-sacrificing, subservient way of nursing. I dislike this more than I do the sexy naughty nurse/angel in white motif (Not politically correct, but I also see the humor in these—a future blog post topic). I think I am enough of a feminist to see through these gendered stereotypes. But I am also enough of a feminist to recognize that traditional female roles are not something to reject out of hand—that it is possible to be a feminist nurse, just as it is possible to be a feminist mother, or a feminist teacher, or a feminist flight attendant. I don’t like the anti-intellectualism of much of nursing. I dislike the dominant discourse/narrative within nursing of whining victim—the inferiority complex. I dislike that nursing has developed its identity around the medical model, that it compares itself to and tries to differentiate itself from the physician role. This can lead to some bizarre and flakey things like nursing care plans, nursing diagnoses (“alteration in bowel elimination” instead of “diarrhea” anyone?), and therapeutic touch. It also has reinforced an emphasis on hospital-based nursing, and the rigid health care hierarchy inherent in that factory type model—keeping nurses in the ‘functional doer’ role.

For me, measured in sheer number of words in my lists, the cons of nursing win.

Early in my career as a nurse practitioner, I interviewed for a job with a crusty but astute psychiatrist, an expert in substance abuse disorders at a public east-coast university hospital. He interviewed me three times over the course of more than a month. I didn’t get the job and I couldn’t figure out why. A physician friend of mine who worked with the psychiatrist told me he’d concluded, “She’s not enough of a nurse to be a nurse practitioner.” It hurt my feelings at the time, and is a rankling statement that has stayed with me over the years. At the time, I thought he meant that I hadn’t been a nurse long enough to merit becoming a nurse practitioner. I was overly sensitive to that sort of thing since I had gone straight through nursing school to become a nurse practitioner. It was the only type of nurse I wanted to be—but I caught flack for it by other nurse practitioners, other nurses, and physicians. It wasn’t as common a track as it is now, although my accelerated nursing program students tell me they still get hassled about their lack of experience as nurses. But now I am wondering if what the psychiatrist really meant was that I did not have the personality of a nurse—that I was too ambivalent about nursing in general—to make a good nurse for his research project.

And the irony, of course, is that I teach nursing. Luckily, I have yet to be asked to teach any courses that require nursing care plans, nursing diagnoses, or therapeutic touch. As with teaching nursing research, I’d have to decline. I’d rather be a starving artist.

5 thoughts on “Nursing Ambivalence

  1. Love your blog!

    Funny thing…I would have loved to have been an artist or designer but the practical side of me had me venture into nursing. Have been nursing now for 35 years. I feel the same way you do re: this post. You were able to put into words exactly how I have been feeling all along. 🙂

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  2. Oh boy…hard to hear as a new Master’s of Nursing student, especially as I was ambivalent graduate school in a nursing focus! I agree, but what I have liked about your postings and style is that you have opened up a new area for nurses to ponder. You have taken nurses out of the role we have been taught for so long and made us think as individuals…outside of the box.You have found your area of nursing (created your own area) and made this a part of what it can mean to be a nurse. For examples, nurses should speak up and be players in health policy issues. Another example is our role is not just to do what we have been “ordered”; rather we have to think creatively. There are many nurses out there that like the traditional role of the nurse. I am so glad they exist. But for those like myself, I am grateful that you are leading the way to expand and shape what it means to be a nurse.

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  3. Interesting thoughts. I am trying – without success to find any articles discussign the downside to nursing care plans – is it possible to provide nursing care without them? Nada – you would think I was looking for aliens

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    1. Thanks for your observation on nursing care plans and the apparent lack of evidence supporting their continued use. You got me going on this topic, so I will be adding a blog post on it today or tomorrow…

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  4. I am a student who took your course last year. I am glad you were one of my teachers. I am glad you wrote this post.

    As someone who did not grow up with an ideal of becoming a nurse, I appreciate others seeing the stupidity of forcing nursing to become something it doesn’t need to be. Nursing has so much potential and it’s frustrating to see it define itself by looking at other professions instead of growing out of its own potential and “heart” (patient advocacy, health promotion and disease prevention, holistic approach, more time with patients, etc). I also don’t think overlap in duties is a bad thing. (ie why do we have to say “alteration in elimination” instead of diarrhea…as if that makes a better nurse and not “straying” down the road of medicine. It also does not help us choose a “recommendation” to offer in the order of “SBAR” (ask your colleagues). I also think it’s ok for both the nurse and the physician to be able to do a dressing change/you name it.) I think overlap is a great thing as long as we learn to work interprofessionaly.

    Oh, so much more to say. Nice post.

    Stay flexible and I hope you stick with. We need you.

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