Woman; 405; New Image for Nurses. Part 1

Eat. Good evening and welcome to woman. This is the first of two programs on the nursing profession and I think you're going to be very surprised at what you're going to hear. With me is Dr. June Rothberg Dr. Rothberg is dean of the School of Nursing at Adelphi University. She's immediate past president of the American Association of Colleges of nursing. June is a co-founder of endcap the nurses Coalition for action in politics. Also with us is Dr. Jean Spiro. Doctor Spiro is dean of the School of Nursing at the State University of New York at Buffalo. She is chairwoman of the Board of Review a baccalaureate and higher degree programs of the National League for Nursing.

My third guest is Dr. Joanne Ashley author of hospitals paternalism and the role of the nurse which is a very controversial book about the nursing profession. Dr. Ashley is an associate professor of nursing at Northern Illinois University. She's also on the board of trustees of endcap. Welcome to all three of you. And Joanne what has been the place of nursing. While within the health field for a number of years now we've had scandals. And right now they are there you know being opened up to the public. But the greatest scandal has been. That man in the health field would have been very greedy. Mostly for profits and exploiting. The public. And nurses have placed nurses in the position of being what I call coolies and doggies. Now coolly in countries where you know they have well-defined caste systems. Is really your very lowest your person who has the very lowest status. Now when I use the term darkie I mean this.

Nurses have been treated like little more than domestic asses. Now the public hasn't known this because the public has been lied to for a century by you know dominant persons in the health field and it's time. We tell the truth now that a very controversial statement. I think maybe June and Jane had made a comment on it. I'm ready. Well I hadn't really expected that. I think there's probably some. Degree of truth but I have to say that there is a fair degree of exaggeration nurses have not been treated as professionals. Their contribution to the health care system has not been given enough merit. But I don't think I can buy donkeys and coolies. I didn't think you would. And I sued them because you know nobody has to agree with me you know that.

Well the point is really isn't it that there's a broad spectrum of political thought going on within the profession. Yes and maybe Joanne is here and you two or maybe in there or maybe one of you is somewhere in the middle. And that's really the important thing there is a dialogue happening. What about health care and the general public definition of health care and their attitude toward what they what they can expect from our health care system. What about the definition first. Well I think you're talking about the public's definition of health care I think that's almost immediately translated into medical care. Which has to do you know primarily with the diagnosis of pathology. I think that within nursing speak about health care we're talking about health promotion and disease prevention. So you would say that would do you think the public. Definition of health care includes nursing. I mean I hate to start messing with the terms medical care and health care but I mean what they're really talking about is medical care but do you think they have included nursing to the extent to which nursing participates in their care.

Well perhaps not to the extent that we would like them to include nursing. Now Act AG like to interrupt here because the public doesn't know what nursing care is. Hospitals do not provide it the most that people get in hospitals is technical nursing. Hospitals will not pay for professional nursing attention and free nurses to give it. Now you pay for it. The public pays for it but it's not there. Also in nursing homes there's no professional nursing going on like nurses are taught. To give an arse you know you're seeking. Well we see what we think our nurses in nursing homes right. Right. But they're not. You know it's part of their practical nurses or nurses aids or housekeepers or housekeepers the law requires the there be some minimal amount and there needs to be somebody every 24 hours but it doesn't specify it and it can be so superficial as to be nonexistent and that unfortunately is probably the basic reason that the level of care in nursing homes

today is as bad as it is. All of that there are very very few or almost no professional nurses available. And the point is it's not that the nurses are not out there to be employed it's that most of these. All the institutions are profit making and they are not willing to pay for the salaries of professional nurses. And yet they're robbing the public. It's a system of robbery is what I call an. Exploitation. Gross I think that when you you included to competence in your statement you talked about nursing homes. Yes which is what you in his response talking about when I go there talk about professional nursing in hospitals and I think that and you know we have to deal with what your definition is. I'm talking about any American health care system which is what the public needs to look at very carefully. It's the American medical care system. It's not health care it's been disease oriented too long. Nursing has had such a low status that it's. It hasn't. Nurses have been able to function. They hop from job to

job to job because they're measurable in these institutions. That really I say here our health care system doing it's a menace to health. You know it's a threat to health. You're not safe hardly going to a doctor or a hospital I would suggest if you're at all labeled a creep around stay home stay home. You'd be safer. Now get a good nurse like him. Thank you. We can't sit here really and say to him Don't I know that it's it's an absolute necessity that we correct the defects. Now we've got to look at physicians and say what's wrong with you people. That would take out healthy organs just because you're greedy for money. Now I call that and I may be different but I call that evil. I believe there is evil in people and in this country and in this country is filled with it. Now there is something wrong with somebody. They're not healthy.

Let's talk about their relationship to physicians to nurses and let's go back one of the appealing things about your book was the historical information. There was lots in the book that you know I had never imagined was true. And let's talk about the early training of nurses first and went on to give people some idea the hospitals schools of nursing were really established because at a time when hospitals were rolling into businesses CNA hundreds hospitals truly were sort of charitable you know in a way. But around the 1890s or along in there. The prominent people sat in Madison hospital Miss Rader said look this is a lucrative business. Last night hospitals and a really well-run businesses Well they needed labor. You know the productive force nursing schools were established for you know to provide labor a source of production and this has been for centuries the role of women cheap labor of domestic gas. So this is just

been the truth of our history and I had to and I had to look that in the face and say Look. I've been in this profession and that's this health care system is part of my country. I do need to. Talk about what's going on today as far as nurses training. And if you can a little bit relate it to what happened and how it's changed nursing education I should really say not nurses training. Well one of the. One of the very real contributions of of Joanne's book is the fact that for many of us it documented what was real what was happening than many of us didn't know about it. We. Felt it but we did not have any specific proof there were. We didn't know the references that are cited and are so clearly relevant to this. There has been a movement against the Hospital School of Nursing. It has gone on for many many years and the battles were a long and bloody and they're not over with yet. However there has been a change it's occurred

principally since the 1940s it's moved up with a fair degree of acceleration where all 10 years ago the predominant number of. Student nurses were graduating from schools which were hospital affiliated. That is no longer the case. The graduations now are. Less from hospitals schools of nursing. More from Associate Degree programs which are two year junior college programs and a very very hard rising curve of graduations from baccalaureate programs which are four years in length. The merit of both of the latter types of programs the baccalaureate the Associate Degree is that they are truly educational they are not principally service oriented which is the thing that joy and is is talking about in particular. I want to interrupt you do. You know we do encourage nurses

nurses or well-educated people many of them have gone to school for 15 years because they've had to struggle and that wasn't always the case was it I mean people did not think it was necessary to be educated but the point is why educate someone when where they work are not going to recognise it. They're not going to get paid for it they're not going to be employed in nursing. Of all professions women are most highly educated women are discriminated against because there's no there's no societal force that forces hospitals to paying arses for going to school. Now something's wrong with the logic there. After a young woman or a young man this day and age struggles to get through school why not. Like any decent business why not recruit the best prepared. To do what they're educated to do. Well Joan again I don't have your way and I would have to disagree with you. You know some of what you say I think is essentially true. But I think that there are hospitals who do pay and compensate nurses based on their education and also their

experience so I don't think it's as black and white you know what I think you know what I would tell the public are women are nurses. Go into any hospital and take a poll. Go into your local hospital at your hospital say listen how many professional nurses have you got working here by professionally and I have nurses that have a baccalaureate degree and so then are you talking about registered nurses. I'm just trying to they're all registered being registered nurse means that you have to hold the licensure which simply means that you have taken the qualifying examination which certifies you for a minimal safe practice. All right now I think what Joanne is doing is she is making a distinction that those of us in the nursing profession understand it's part of our jargon. She is talking about professional nursing and I asked you before in terms of what do you mean by professional nursing. Because O'REILLY Sometimes we see women who have white uniforms on and they're not nurses and the public sometimes thinks they are so we we must now they think that the public is confusing that they are 18 and is the same thing really as the date.

But in nursing because nursing is a woman's field everybody wears the label of Ari and it means nothing it's never met any. It was just something tacked on to nurses to give them a little bit of prestige one time. Legally it meant nothing. So now we have three levels in nursing and they all wear the label Aryan it doesn't tell the public anything you don't tell me anything it's meaningless. All right so what do you mean professional professor. A professional person. The major part of their time and their work is spent in intellectual activity. They're making judgments. Now that gets me you may say well what's intellectual about nursing because people do well let me tell you the knowledge base in nursing. But if your auditor is you know everybody does that act up to. The knowledge base and nursing is broader than the knowledge base base in medicine. Nurses learn you know the the physiology the physical sciences. The psychological the sociological. And we also need ethics in liberal arts because humans are sort of you know well they're spirits they have a spirit.

So nurses have to know the psychosocial factors influencing health care medicine physical sciences biological sciences and many of them you know they they don't know that much about the other parts of the human being because they're not educated to know they're just beginning to move in the direction that nursing has always. You know been going. We study the total human being. Medicine has studied the organs. If you want to really look at it that way. Now it's strange that they know all about these organs they'll take out healthy ones isn't it. But a nurse would never do that because that's not her function her function is to to get to know you. And to use all of this knowledge that she's got in her head and try to give you human nourishment and that's how I define nor was she legally. Legally licensed to take out organs. Right. I want to pursue this but I want to do it another way I want to go through the back door. Where did you will study there's. Under what circumstances.

Under an apprenticeship system in a hospital school of nursing which. Perceived itself as part of an overall family. And the family was the hospital and the school and you didn't see a stranger. And I unfortunately at this stage in my life I am old enough to remember back to that system where nurses stood by a liar and male physicians to precede them in elevators because they were higher status people. It was in my experience as a student nurse that we did the very very daring thing. We no longer stood when a physician entered the chart room. And that was our very very Lawrence sized Declaration of Independence. Now you have to understand that out in polite society men always rose for women. In this context the whole thing was reversed and that's a very very good example it's just a vignette of what the system was like. Physicians hospital

administrators. Were the power base. They were the people of high status nurses were wives mothers daughters lovers. What I know is and I know I know I do they I'm sorry I don't perceive it that way Joanne and I will I really won't allow you to distort my memories of your original experience and I was fairly comfortable in that it was warm and it was supportive. And I think to a large extent we rended at. That point a relatively high level of care. How many hours a week did you work. Back 40 but at least at my school we were our classes were part of that 40 hours it was not time over and above the 40 hours of work but I have to tell you I rented an awful lot of direct nursing care. As in exchange for the education that I got and I attended a relatively progressive school of nursing

in which we did get a sociological base and we did get a psychological base and I can assure you that many other hospital schools at that time did not do it. What was a school. It was Lennox Hill Hospital which no longer has a school of nursing. And although I am sorry about it in one sense I'm happy about it in another sense because I think. Nurses have to be educated in institutions of higher learning along with other people. Oh right that's one of the issues now is yes again there's a clear issue and I'm right that the move is toward standardization. Yes a national standardization. Well there is I think why the professional association and there have been position papers written. To that effect. Now where is the opposition coming from for that move. Well the opposition I think is coming from a variety of sources the opposition is coming from of course those hospital. Diploma schools and their representatives and the hospital administrators that are still in existence. I

would suspect that there is a strong. Motive operate of the opposition that's also coming from physician groups. And I am sorry to say that I think that there is some opposition from within the nursing profession itself. But what form is that opposition taking. Well I think that when John was talking about you know her three year training program her education. And I went through a similar system. One aspect of it that is very fascinating largely because you don't know what's happening to you when it's happening is that you are socialized into that system you are socialized into believing this is the way it is to be. I was thoroughly socialized into believing that I was the very best nurse that could possibly be produced and that there was no other school in existence that was as good as the school that I was in. And much of what you said her experiences were of course mine in terms of you stood up for certain selected people. You did not

debate an issue. You were following orders and I was thoroughly socialized into that until I went on and got myself reso she lies to be re-educated. Now I think for many nurses who have gone through that kind of an educational system. As June said she was comfortable I was comfortable too. Until I began to learn better. I was comfortable too. Until I did my research and found out the truth. Now there is a very. She mentioned the term socialization. Physicians you know they go to school to medical school. They are socialized to feel. Think that the nurse is there to serve them. A servant. They've got one built in that call this that relationship between men and women were healthy and nurses and doctors. The myth we've lived with the myth of the hole in marriage between nursing in medicine two professions marriage. We were the wife. I mean we you know we played that role socialized into it.

Do you not know what year she graduated from hospital school I graduated in 1961. Now that's just been a decade or so ago when you think about it. But I stood up for doctors opened doors for them. And you see I resent. A great many forces in society that would let. Such a dangerous system of education survive in this country for a century. Education how you educate people are very important. You know really nurses have lived and died not being educated. To the fullest extent of their potential in the point of it is you see they didn't live as a human being. When people control your life in front your education. People who don't view you as human. Listen you're in trouble. You say X. I have thought about this for a long long time and I just do feel very strongly it has not been fair. You see nurses have not lived in that. We haven't been treated like we lived in a democracy. You say. I call it a form of despotism

that is by the way still very operative in the health care system. The American public too has been just as exploited and nurses so. So no matter what your political differences do you all agree that the fact that nurses have been somewhat oppressed has damaged our health care system you and therefore your work has not yet been entitle to. That's the very definitely. Now why. Was my question why have you all not spoken up before. It's this situation's been going on for a long time. Don't you have some qualms about what the profession has not done. Well but I. OK I think you are jumping to a conclusion that is not you know in actual fact I think that the nursing profession head as. You know done things about this. I think what we have been talking about before and that is the movement towards baccalaureate education for nurses. And you know Master preparation for nurses and even doctoral preparation for nurses. So I think that

there has been some movement there. I think perhaps one of our biggest problems has been is that we are a politically naive group and we at least we have been I think until relatively recently. And I know in our attempts to deal with this issue have fallen short of what they should have been to gain the public's attention and the public support the opposition has been enormous has it not. Yes yes it will yes. And I think it's very very similar to what's happening with the with the entire women's movement. And as I think back now I think there were a number of us who became peripherally aware of what was happening in in the field and. Thought perhaps it was our own craziness that we were sensitive to this and resentful of it. And began to look at it in the whole perspective of men and women and perceive what was happening but almost took it as well there's nothing we

can do about it and you have to know that nurses as a group are relatively passive and very slow to action and I think that's been part of the socialization. But women are more. That's precisely the fact it's because they are women predominantly 98 percent. When the women's movement. Started its own level of activity its own sense of consciousness raising. I think it began to awaken a number of us and I think probably we began to look at our lifestyles and our professional or unprofessional situations if you want to. Characterize them as the US in those terms in feminist terms and the feminist rhetoric made sense to us. And I suppose I. Really even though you were receptive to the women's movement the women's movement has not been supportive of the nursing and that was my greatest disappointment I have.

Felt very much sold out in no uncertain terms that the woman's movement rather than dealing with nursing as a symptom. Of the problem of women. All too often accused us of being the cause or the willing participant in all of the Depression all of women's rights that they perceived to have been occurring all over and all. I have felt sold out in no uncertain terms by this attitude of the women's movement. I would go even so far to say that. The leaders in the women's movement have been taken in by the very same stereotypical images. About nurses that they say are unhealthy amount of women. Yes. There was an article in news magazine. I'm sorry I can't remember exactly when the article appeared but it was super critical of nursing. You read it you know.

We're dealing here though with an element of ignorance you say. Let us not blame women for being like we are. There's an element of ignorance. The women writing articles about mirrors do not know the facts. And they they do live by myths stereotypes that kind of thing. We got to correct because this includes the public too. Women are part of the public. We're society. And we do have to overcome this element of ignorance and get our own facts and present things to the public openly you see as a health care being a far more serious matter. Then let's say a woman's movement. Women we must emerge as adults as humans in a society. And correct because our very status poor as it has been is a health problem. And as I was saying to you earlier Sandy women might as well forget it until they liberate the nursing profession and nurses

and get their rights straightened out. We'll never see women liberated because that's an index the nursing profession is in the index of the status of women in a society. Well would you agree we have 15 seconds I think with 30 seconds that education is got to be your top priority. Yes positively. Edmund I don't I'm not talking about education of nurses but of the general public. Oh yes yes. That the meeting is going to help us do that. Because look how we're pretty sure you don't on television we creep around following doctors I know have seen Thank you all for being here. We'll be back next week. This program was produced by a w o n e which is solely responsible for

its content. Your funding was provided by public television stations. Additional support was provided by unrestricted general program grants from the Corporation for Public Broadcasting and the Ford Foundation a.