In the past, one of the most prominent differences between doctors and nurses has been that one group has traditionally been dominated by women, while the other has been dominated by men. This is something that has changed significantly in recent decades, and will continue to do so in the years to come.
It is easy to argue that there has been a significant change in the nurse-doctor relationship over the years. Much of this has been attributed to changing healthcare systems, an increased role of the multi-disciplinary team approach to patient care, and various other advancements in organisational systems. But what role has the increasing number of female physicians had on this change? Or, for that matter, the increasing presence of male nurses on the wards? For some reason, we don’t think too much about this. Do we really think that we as a society have advanced to the point where gender doesn’t matter? We might have – for the most part at least – agreed that it shouldn’t matter, but this does not translate to our actual behaviours, subtle as they may be.
In this blog, I want to begin to explore how the nurse-doctor relationship is changed if the doctor is female, and to consider how this impacts our daily work life.
One of the things that struck me working as a house officer in my first year was how different my experiences with the female nurses were – as a female doctor – compared with the experiences of my male partner, at the time also a first year house officer. Neither experience was bad – not at all – but they were undeniably different. It went beyond basic personality differences and this got me wondering about the more general role of gender in the professional nurse-doctor relationship.
People don’t talk about this much, because it is not a particularly comfortable topic. We don’t like to think that our gender is an issue at work, particularly amongst colleagues who often double as friends. Women don’t like to bring it up because talking about it somehow automatically (and laughably) makes us ‘feminists’. And yet, when I do bring it up in conversation, no female doctor has ever disagreed with me. Everyone has her own story (often stories) to tell about an ‘unusual’ or unexpected experience with a female nursing colleague, where it is agreed that the incident either would not have happened at all, or would have happened quite differently had the doctor been male. These experiences are not necessarily negative (and could well be quite the opposite), but they do exist. And they can shift and influence working relationships more than we realise.
We trained at a time where women comprised at least 50% of the med school class. We were not a minority throughout our training and in our experience with the profession, women have been well represented. We didn’t go through med school at a transition time – sure, women are still grossly under-represented at the consultant level, and in management positions, but often we don’t actually look that far ‘above’ us. What we see is limited to people at our level – i.e. our classmates, and our fellow house surgeons, registrars, etc. Here, we have only witnessed equal representation – if not even more women than men. So, there hasn’t exactly been a huge gender imbalance evident as we went through our training. Given this, how is it that we can feel a gender imbalance once we start working on the wards? It can be quite a conflicting feeling to suddenly feel different, when up until this point in our careers (i.e. at the point you leave med school), we have all been the same.
I have had my medical decisions blatantly ‘overruled’ by female nurses on more than one occasion. My male partner has not. Why is this? Is it mere coincidence? I have also had my medical decisions questioned by nurses, even when the rationale for those decisions was unquestionably sound and documented in almost ridiculous detail. My male partner has had his decisions questioned, but never to the same extent. Again, could it be coincidence? Is this trend in fact a good thing? Does it mean that nurses perceive female doctors to be more approachable, and therefore more able to be questioned? Is it less risky for nurses to ‘challenge’ a woman? Or, are we just less likely to stand up for ourselves? Is there something more to it – something along the lines of a power struggle? Or, is there another, entirely separate explanation?
Most, if not all of us have overwhelmingly good, positive relationships with our nursing colleagues and somehow can’t see that being a female doctor working with female nurses would be an issue even when the overall situation is fine. It seems that if there is no major, pressing problem, then we are happy to keep on keeping on. But, just because we don’t readily discuss this, it does not mean that there are not some underlying issues there.
When we – female doctors – compare ourselves to our male colleagues, we expect similar performance, outcomes, opportunities and rewards as the roles and responsibilities are the same. When we compare ourselves to nurses, many of whom are of a similar age and background to us, we expect to have a similar social standing and experience. We share the social experience, and the work environment, but actually our work is very different. There is some conflict here. At least with the male doctors, the professional role and – like it or not – the ‘social role’ are both different, so it is perhaps easier to separate them both. But, for women it might be harder to do this. Where does the professional line get drawn, when in actual fact all we want to do is get along and work together in a productive, efficient way? The professions are not the same, but the gender (and gender role) is. Does this create an issue? Does this even enter the equation?
Where do female physicians best ‘fit in’? With the other doctors, who are men? Or with the female nurses? We identify with them because of gender, but the professional roles and expectations can’t help but influence the overall relationship. The obvious and ideal answer would seem to be that we fit in with both groups and yet I’m not sure I buy it. On the wards, I often see women simultaneously trying to fill the ‘role’ / expectation of both a doctor and a woman.
If the nurse-doctor relationship is in fact influenced by the doctor’s female gender, isn’t it time we started to talk more openly about it and also to confront the real reasons behind this? From here, we can then find a way to make this (more consistently) work to our, and more importantly, the patient’s advantage.
