Nursing and Oppression
Introduction
As Marilyn Frye (1983) puts it, the word oppression is a strong word as it can repel and attract. Somehow, oppression manifests itself in various contexts one of which is nursing. It is of my best belief that the nurses and the nursing practice are dangerously oppressed because of economic, gender and social reasons. I agree that nurses possess oppressive behaviors and that nursing profession is one of the most oppressed professions in the world today. In this paper, I will be discussing how nurses are being oppressed by other superior profession and how nurses oppress themselves in the process. Likewise, I will also address how nurses are being oppressed because of their lack of public voice. The paper does not aim to concentrate on the perennial complaints centering the nursing shortage, instead it will focus on varied reasons why I consider nurses and nursing practice as oppressed as it can get.
The professional autonomy of nurses embraces passivity basically because of its undying bid for political and professional empowerment. It is a common knowledge that nurses perform their work in accordance to other superior groups, doctors, that is. The nature and cause of nursing as an occupational group is highly reliant on a multi-occupational interface. Notably, hospitals are created and exist for the doctors and not the other way around although I should recognize the fact that the nurses are part of a professional team seeking to produce better health outcomes. The ethos is that apart from being part of a team we should also consider the fact that nurses are part of an employing organization hence subjected to rules, plans and priorities of such organization (Traynor, 1999). This proves that oppression is an informal yet individualistic phenomenon wherein direct experience is the basis.
As such, the continued growth in nursing is explicitly controlled by elements surrounding the profession. Nurses are expected to contribute to maximize the quality of patient care, meet all regulatory requirements, maximize competency, meet cost-effective goals of the organization and maintain relationships. Governance and advancement of professional nursing practice requires the promotion of public safety. But this is not without difficulties because of the fact that nurses passes through other dominant groups when performing roles including most especially hospital administrators. Hospital CEOs, for example, are more concern on quality issues that are often tended on medical care excluding nursing care, leading to ‘crossing the line of no return’ when needed. What I am trying to argue is that the necessity of building relationship is more concentrated on the part of the nurses because it is their inherent roles, instead of asking the question: what roles do these CEOs have in giving the nurses the sense of support medically and otherwise?
Thereby, nurses are evidently challenged and oppressed of relationships with hospital CEOs. Same goes with the physicians where nurses concern building a collaborative environment that may not be necessarily sought by the physicians. The idea is that nurses are being trapped in ‘compassion fatigue’ not because of the work itself but because of failure in building effective relationships with physicians. A continual devaluation of the nursing practice, I could never regard creating sustainable relationships with physicians a leverage in the hospital setting toward better professional outcomes especially when the effort is only exerted by the a single, less dominant group. For example, would it mean anything if a nurse will communicate with physicians who cannot even return an eye contact? The desire of the physicians to create a collaborative relationship is blurry because of the fundamental differences between the two professions (Cowen and Moorhead, 2007). From a personal observation also, it is the nurse who always explicitly manifests the desire to create such two-way relationship and not the physicians, which is in nature dehumanizing to the profession. In making sense of it, nurses are being oppressed because of the lack of initiatives to create proactive and responsive nursing practices particularly in the milieu of the upper hierarchy.
Imperfect as it may seem, nurses are part of a hierarchy wherein equality in power and influence is unequally distributed. For instance, international groups, which functions in the best interests of nurses, assert and enhances the [perceived] effectiveness of nursing practice as an expertise through producing informations and evidences that will back the arguments that changes in the profession is indeed needed. In the process, however, nurses are being exposed to risks of becoming redefined and controlled by such changes (Andrist et al, 2006). A concrete example is the implementation of mandatory overtime in most hospitals to compensate with the chronic nursing shortage, which jeopardizes the quality of life of nurses as well as the quality of life of the patient hence, being oppressed through the process. This is oppression due to the fact that nurses are given inferior roles that are expected to always follow the hospital norms. This has its roots on the undying debate of superiority between the sexes and we all know that the nursing profession is dominated by women.
Nursing leadership and hospital administration – whether poor or effective – are two distinct yet irreconcilable elements that contribute in nursing repression. Effective nursing management is the element that shapes effectual nursing leadership. In reality, however, the management of nurses in hospitals has a tendency to be overlooked in exchange of other priorities such as personal interest. Some of the blame could be put in nursing executives whom instead of advocating personal competence, equality and intelligence among nurses; they tend to cover up for the mistakes and unacceptable behaviour of their co-nurses. Even in nursing schools, nursing students are not taught to be as empowered as physicians and other “powers that be” inside hospital environments. Students are taught that they are part of the professional team without putting much emphasis on the importance on the triangulation of roles of hospital administration, physician and nurses.
Nurses are oppressed also because the profession itself is not as coherent as other may think. An important aspect to note also is the fact that lateral violence in nursing is inexistence although nursing leaders may deny this. Aside from the problem of failing to recognize the symptoms of lateral violence, this experience is relatively in its infancy and has no concrete solutions yet. Simply, lateral violence could be described as nurse-on-nurse aggression and inter-group conflict (Stanley et al, 2007). What is more pressing is that lateral violence targets the psychological aspect rather than the physical aspect. According to Griffin (2004), there are at least ten common forms of lateral violence that a nurse could came across with in the entirety of the nursing profession: on-verbal innuendo, verbal affront, undermining activities, withholding information, sabotage, infighting, scapegoating, backstabbing, failure to respect privacy, and broken confidences.
I have observed that nurses who experience lateral violence tends to employ lateral violence on other nurses perhaps as an outlet to express anger and frustration. As such, powerlessness and frustration are manifestations of nursing oppression especially when the dissatisfaction is directed to others not just with co-nurses. In the broader sense, the existence of lateral violence is a challenge to the nursing practitioners with particular emphasis that must be given on lateral violence and oppressive nursing behaviors continue to exist until at this very moment. I am unwilling to argue that lateral violence is an unforeseen consequence of the pressures to produce the highest quality patient care instead I will argue that the continuity is based on economic aspects which include nursing shortage, reorganization and changing managerial requirements, all of which are beyond the control of nurses.
Somehow, at least for me, lateral violence could be perceived as a tolerable strategy to modify the behaviors of nurses especially entry-levels. Preventing the act was never a priority for nursing executive and leaders even to nursing unions. This is because of the economic environment that nursing situated upon. For example, the requirement of hospitals to produce revenues through a limited budget does not necessarily translate to address the stress felt by the nursing executives to meet such an objective. The paradox is that because 90% of nurses are women, then they should understand each other in way but the opposite is more evident. Therefore, stressors and pressures could result in lateral violence. Since the continuous lateral violence is a manifestation of oppression in the workplace, low morale, eroded trust and negative atmosphere were developed, resulting to leaving the workplace which could be seen as a solution of ending the violence.
A profession that is engendered as a women profession, nurses has two choices to escape the hostile environment or to commit acts of passive aggressive especially when communication initiatives are futile. Lack of self-esteem is common among nurses and is being exacerbated by ineffective communication and silencing. Nurses as submissive individuals also are inept at communicating with their management, physicians, nursing executives and co-nurses since this can be seen as crossing the line, which in turn may threaten employment before the nurse could decide to escape. As such, nurses lack the public voice which could describe their contribution to the patient care and they are silent about their importance to patient care as well. Avoiding and compromising are two among the most abused strategies in nursing workplaces in order to prevent conflict and to maintain the status quo in the workplace.
Conclusion
In sum, nurses are still considered oppressed because of various reasons. Nurses lack the power and control in the workplace especially because healthcare is primarily settled in hospitals where physicians and hospital administration dominate. Nurses are still viewed as ‘handmaiden’ of these groups: directly for physicians and indirectly for hospital management. Nursing profession is marginalized in the process because of its high reliance on other occupational groups and as employees. One of the issues that proved that nurses are oppressed is their fears to cross the lines and face the consequences of their actions. As such, nurses always try to build relationships that will maintain their status in the workplace even though these relationships are often one-sided.
As part of the hierarchy, they are expected to perform roles other than their traditional roles. Further, there are challenges that contribute to their being oppressed such as the lack of effective nursing management which is evidenced by lateral violence and the failure to recognize and intervene. Such denigration also shows that nurses are educated to act as nurses and not as a participant of a broader healthcare provider system. Nevertheless, people, nurses or not, should always remember that oppressed nurses means oppressed nursing cares.
References
Andrist, L. C., Nicholas, P. K. and Wolf, K. A. (2006). History of Nursing Ideas. Jones and Bartlett Publishers: US.
Cowen, S. and Moorhead, S. (2006). Current issues in nursing. Elsevier Health Sciences: New York.
Frye, M. (1983). The Politics of Reality. The Crossing Press: Trumansburg, N.Y.
Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6): 1-7.
Stanley, K. M., Dulaney, P. and Martin, M. M. (2007). Nurses ‘Eating our young’—it has a name: Lateral Violence. South Carolina Nurse.
Traynor, M. (1999). Managerialism and Nursing: Beyond Oppression and Profession. Routledge: London.
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