Does the New Generation of Nurses need to go back to the future?

Why is it that nursing can be so readily sidelined by the very sector it numerically dominates?

By Peter Kieseker

About Peter

Peter has worked for many years in health, education, disability, welfare and international aid. He has led multiple emergency aid teams in Somalia, Sudan, Kenya, Cambodia, Serbia and Kosovo and is published in the Australian Peacekeeping Manual in the topic area of “Non Government agencies working with Military Forces in Emergency Situations”. While his daughter was growing up Peter used his generalist education and experience to work as a freelance consultant and trainer. This has included
training assignments in Papua New Guinea, Indonesia, Solomon Islands, Fiji, China, Taiwan, Singapore, Nigeria and New Zealand.

Something seems badly wrong in the registered nursing profession.

In the very same Nursing Review (December 2011) that wrote about the bicentenary of nursing in Australia, Linda Shield’s article entitled “Invisible nurses have to find their voice” wrote of how The
Weekend Australia, November 5, 2011, had a 22-page supplement “Health of the Nation”
that ‘completely ignored’ input from nurses. Linda further wrote that the word “nurse”
occurred only three times in the whole 22 pages, despite nurses making up 55% of
Australia’s health workforce.

Why is it that after 200 years of being central to Australian’s well being nurses have failed to
make a mark? Why is it that nursing can be so readily sidelined by the very sector it
numerically dominates? Why is it that not only graduate nurses but also highly experienced
and qualified nurses with decades of devotion and experience are ignored? Perhaps one
reason is nursing’s tendency to self sabotage itself by negativity, as exemplified by the
horizontal violence that is an unpleasant reality.

Another reason however seems to be nursing’s failure to achieve professional status. Nursing lacks the respect and authority it deserves, and as a consequence it is being disregarded by ‘proper health professionals’, as occurred in “Health of the Nation”. This nurse believes this lack of status is a key reason why RN’s are so often disregarded.

Registered nurses have allowed the dilution of their professional status to the point that
they are accorded little respect. The concept of status in question is not one of ego but as
defined in the Oxford Dictionary as “relative importance in relation to others”. The ignoring
of nurses in “Health of the Nation” seems to loudly proclaim that our status is insignificant
and of little importance compared to other health workers. As RNs we know our implicit
status comes from our knowledge and skills. The trouble is few others seem to recognize

Registered nursing, perhaps driven by values of equality and fairness, is belittling itself by
discounting those elements that create status ascription. The price nursing is paying for this
is to be seen as lacking rank, and hence irrelevant to the health debate.
Many factors contribute to status. While some status can come from degrees and
experience this should not be assumed as automatic. It is not, although perhaps naively the
nursing profession has expected such.

As pointed out by noted writers on influence, such as Cialdini and Mills, a universally acknowledged status attributor is authority, and amongst the greatest authority producing agents are titles and symbols. Rightly or wrongly semantics and symbols have power to influence. The status of doctors is ascribed automatically by the title, Doctor.

Even junior doctors, not yet qualified, are ascribed such status. And for further status attribution doctors resort to titles such as registrar and consultant. In nursing however one of the principle elements degrading the status of registered nurses is our actual title: nurse.

The title has been so widely applied that today it is devalued to the point of being almost
meaninglessness as a professional nomenclature. Linda Shields cites this as the “blurring of
roles between registered nurses and healthcare assistants”. It sometimes seems that nearly
everyone is a nurse. We have EEN’s, EN’s, AIN’s and a whole plethora of other ‘nurses’, even
self-named home nurses who provide full time care to family members. All use the title

This is not meant to degrade the wonderful work done by non-RN nurses; it is simply to
point out that such a widely used title – nurse – means in the laypersons mind – and
seemingly in the mind of many health professionals – that there is little demarcation made
between all these many types of nurses. As a result the title nurse, be it an RN or a totally
unqualified home nurse, is often ascribed the status of the lowest common denominator. It
is no wonder RNs are very quick to denote themselves as separate, and especially so it they
can claim titles such as NP, CN or RN specialist nurse.

The community, and many medical professionals, seem to equate nursing more to feeding
and cleaning than to the highly involved roles performed by RNs. Indeed with everyone
being a nurse, and with RNs often needing to complete these most basic nursing functions,
it is no wonder that little differentiation of status is awarded to RNs. We never want to
reach a place where basic nursing is considered below an RN, but somehow we need to
ensure that this is not the dominant impression.

Registered nursing has moved into an era of technological and medical complexities and carries massive responsibilities and accountabilities for patient welfare. This is clearly not being recognized in pay packets, but more concerning is that it is not even being recognized by others in the health industry. Off course we once had symbols that demarcated the RN. It was our uniform and badges. In days gone by one clearly knew the status of the person caring for them; the uniform said it all. It was with great pride that a student nurse added stripes to their uniform and caps as they moved through the 3 years of hospital training.

And on the big day of becoming an actual nurse, an RN, silly caps gave way to even sillier vales. But when the valed sister walked onto the ward patients and others knew that the true professional had arrived. Today we nurses all dress alike, and rarely can patients, doctors or even other staff members tell who is who. The all powerful status attribution signs of rank have been lost.

Doctors still maintain their status symbol no matter how dressed – the seemingly surgically attached stethoscope – but for nurses it is a guessing game as to their place in the system. RNs gave up their titles of rank and status when they up gave ‘sister’, and gave up status symbols and ‘badges of rank” when we gave up our distinctive uniform. Some attempts seem to be being made via the very prominent RN name tags being marketed by RCNA.

But lay persons discrimination is poor; we need more.

As a new generation of nurses we may need to go back to the future and re-establish a
symbolism that speaks loudly and clearly to all that here is a professional that deserves to
be – and for holistic patient welfare, needs to be – considered; a professional who deserves
to have a place in issues such as the “Health of the Nation”. We don’t need to reintroduce
the vale (it would certainly not suite we male nurses, and neither do we want to again be
‘Mister Sisters’), but we do need something least we continue to be sidelined in and by our
very own industry.


Cialdini, Robert 2006 Influence : The Psychology of Persuasion
Mills, Harry 2000 Artful Influence

Written for The Nurse Break by Peter Kieseker

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