Respect is key to the functioning of a healthcare team, to our own self-image as nurses, and to the health of the nursing profession as a whole.  

 

When considering what makes a healthcare team function at its highest potential, I am of the mind that respect is the fuel that drives this crucial engine. When people feel respected, they feel clearly that their opinions are important, that their presence is crucial to the team’s function, and they are assured that their efforts on behalf of the team are not in vain. Respect is not the only engine that makes the team function optimally, but its absence will certainly undermine any other positive aspects of teamwork that may be present.

For nurses, the first and most crucial characteristic of respect is respect for self. We must initially feel that our “nurseness” is worthwhile and valuable, that our being a nurse is intrinsically a positive state, and that we have something to offer to patients, to doctors, to other nurses, to other members of the team, and to society as a whole.

Believing in nursing is part and parcel of self-respect, and we must be sure that our own internalized images of nurses are affirming ones. The media can certainly influence our own self-image in many ways, and nurses are not immune to the media’s influential psychological power. When nurses are portrayed in the media, it is often in a negative light, focusing perhaps on nurses on strike, a sensationalized story of a “killer nurse” or “nurse gone bad”, or a negative portrayal of nursing unions and organizations. Photographic and cartoon images of nurses frequently use the humiliating nursing cap---that bygone relic of our historical collective servitude---to represent our profession. To add insult to injury, images and mentions of Nurse Ratched---perhaps the most famous fictional nurse of all---are ubiquitous, reminding us that negative portrayals are never more than a moment away.

Paradoxically, historically inaccurate portrayals of Florence Nightingale as an “angel of mercy”, for instance, also undermine our esteem as nurses. The media’s warped sense of nurses as only providing “caring and compassion” rather than an actual scientifically-based and life-saving practice also undermines our sense of ourselves as professionals. We are not simply “pink-collar workers” who do “women’s work”. We are highly trained and educated individuals who are an intrinsic part of the healthcare system. We are, in fact, the largest organ within the healthcare organism.

Speaking of the media, in their seminal book From Silence to Voice: What Nurses Know and Must Communicate to the Public , authors Bernice Buresh and Suzanne Gordon clearly communicate what has become all too obvious: when reporting on healthcare issues, the media will almost always look to doctors for quotes and opinions. Since nurses are still largely seen by the public (and the media) as doctors’ handmaidens rather than as professionals in our own right, nurses are rarely consulted as expert professionals. This oversight---and the lack of nurses’ presence as figures of authority and intellectual import in all aspects of the media---impacts nursing’s public image, but it also impacts how we value ourselves and each other, and this is where the rubber meets the road of respect.

It has been said for decades that “nurses eat their young”. While I have no idea who originally said such a thing, my assumption is that this phrase developed through the experiences of novice nurses, who, when thrown to the wolves of the hospital wards, were summarily devoured by hardened and jaded nurses whose own lack of self-esteem and respect for other nurses was palpably apparent.  Stories abound of student nurses whose preceptors demonstrate precious little compassion and patience for their novice apprentices, cementing the notion that more experienced nurses will, in fact, destroy the self-esteem of new nurses before they have even graduated from nursing school.

So, my friends, if we cannot show patience and kindness towards the newest members of our profession (who will, in fact, perhaps care for us when we are in need of a nurse), how can we even begin to demand respect from other members of the healthcare team? One must believe that, in many cases, such treatment will only cause these new nurses to themselves become jaded before their time, thus creating a vicious cycle of impatience and lack of mutual respect, further poisoning the well of good intentions that originally fed our collective desire to be caregivers in the first place. Such cycles of alienation can only damage us personally, and damage the profession as a whole.

Doctors and Nurses

When it comes to respect between doctors and nurses, stories abound of doctors’ collective arrogance in terms of interactions with nurses. In teaching hospitals, it can be painfully obvious that senior physicians and chief residents inculcate bad habits into the minds of first-year residents and interns, demonstrating by poor example that nurses are truly to be seen and not heard. Rare is the hospital which will allow nurses to actually attend rounds with those gaggles of white coats that make their way around the units, quizzing and teaching fledgling doctors while visiting patients in their rooms. While some doctors might remember the name of a unit nurse or ask a nurse for his or her opinion vis-à-vis the status of a particular patient, it appears to me that most physicians making rounds on a hospital floor see the nurses as faceless clinicians who carry out their orders and record relatively useless data on flow sheets and charts.

Speaking of names, I have always puzzled over the fact that we address doctors as “Dr. So-and-So”, rarely addressing a doctor by his or her first name. Whereas, doctors will always address a nurse by his or her first name, a power dynamic which harkens back to being a student in high school or grade school. Isn’t this an unspoken power dynamic? Why is this the case? Why such disparity? Did we not also earn a higher degree and study our hardest to earn the distinction of being a nurse?

Hospital nurses are truly the front line against infections, post-surgical complications, medication reactions, and clinical deterioration, but this is rarely acknowledged. A truly progressive hospital would create a system by which doctors, nurses, medical residents, interns and nursing students all round on patients together as a team, with each voice equally as important in the overall conversation. But this vision is just that---a vision---and when it comes to reality, doctors round on patients, and nurses do the work which makes it possible for patients to progress through their plan of care safely and effectively. Doctors may write the orders, but the professional skills of highly trained nurses are intimately bound to the potential for doctors’ orders to be carried out and ultimately have their desired effect on the patient.

But I digress. Some doctors do indeed show respect for nurses’ contributions to the care of patients, and I myself have been particularly lucky in this regard. As a nurse, when a positive, productive, and mutually respectful relationship is created with a doctor, there is an internal relaxation that takes place, a letting go which I believe is born of the notion that one can finally feel that one is being truly seen as a nurse, and this respect goes a long way. My professional relationships with doctors who respect me truly bolster my esteem and self-respect. When particularly kind doctors entertain my ignorance on certain subjects yet still treat me as an equal, I feel valued. In the midst of this type of respectful relationship, I realize that while I may lack the breadth and depth of medical education that the doctor has undergone, I bring an equally important type of intelligence and education to bear, and we all benefit when these disparate yet crucial fields of knowledge are honored and respected.

We nurses must, before we do anything else, realize the importance of our work as nurses, and honor the knowledge, skills, and experience that we have accrued over the years.

Second, we must realize that the next generation of nurses must be treated with respect and patience. Yes, it is crucial that our knowledge and expertise be passed along, but it must be passed with kindness and compassion, otherwise we also pass along our cynicism and our judgment, something that the new generation can perhaps do without.

Third, we must educate our friends, family, patients, and the media at large about what a crucial role nurses play in healthcare. We can educate others on what nurses actually do, and how nurses’ professional education and training makes many nurses experts in their chosen field. Nurses are not just handmaidens. We are skilled professionals who contribute significantly to the success of patient care.

Fourth, we must gently but earnestly request and demand the respect we deserve from physicians and other members of the healthcare team. Without such mutual respect, we go nowhere.

Lastly, it all does come back to self-respect, to the memory of why we became a nurse, why we choose to care for others in an often splintered and unmanageable healthcare system. If we can truly connect with the meaning of being a nurse and of why we choose to remain in this laudable profession, we can foster the self-respect that will also foster the respect of others. 

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NurseKeith is a nurse, writer, blogger, and consultant. Please feel free to visit his blog, Digital Doorway .

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