Modern health care overrun by privileged, arrogant snobs...what's up with those nurses?
June 12, 2005 -- Today the New York Times ran a very long piece by Isabel Wilkerson about the struggle of Chicago single mother Angela Whitiker to escape a life of poverty, drugs and violence through a new career in nursing. It's not the usual media depiction, which might suggest that nursing is for those who want to "help people," or even an attractive job option in the midst of today's shortage. No, here nursing is about enduring endless class conflict to make big money. Ms. Whitaker had to put up with the contempt of "snob[bish]" middle-class nursing students who already "knew everything." Now she has a hard, "messy" job with "uppity" fellow nurses, demanding physicians, nursing assistants who "resent her place of privilege," and family members who expect advice on conditions like edema and diabetes, as if she were a physician or something. There is no indication that nursing provides any benefit to patients, or to nurses themselves (except the paycheck). We appreciate the piece's lack of nursing romanticism, and its unusual view of how nursing seems to those near the bottom of the socioeconomic ladder. But we also feel that its vision of nurses as snotty, marginally skilled, mercenary clock punchers is a bit unbalanced.
"Angela Whitaker's Climb" is a follow-up to a 1993 piece by Ms. Wilkerson about Ms. Whitiker's eldest son, then a "fourth grader with a man's obligations," which ran as part of the Times series "Children of the Shadows. Today's "story of [Ms. Whitiker's] 12-year slog to the middle class" leads off with an account of the extreme stress Ms. Whitiker felt on the day of her nursing boards, "the biggest test of her life," an "entrance exam into the American middle class." The piece then traces her long journey out of the "welfare class" to reach that point. Years ago, she had begun a "pre-nursing program" at the South Side's Kennedy-King Community College, but poverty and her relations with men who "never seemed to hang around that long" forced her to drop out. She worked dead-end jobs, and her family lived in dangerous places. Eventually she became involved with a police detective, who helped her to return to Kennedy-King. The story spends some time on her struggle to succeed in the college's nursing program, stressing that she "felt she had to work extra hard because she felt so outranked in the classroom." Ms. Whitiker "endured the stares of the middle-class teacher's pets who looked down on her for the circuitous route that got her there." She notes: "They were snobs whose moms were nurses and they knew everything...I had to show them that I was somebody, that because I had five kids, that I made bad decisions, that I didn't have a father--and so what?--I was determined to show them I can do this." Tests created so much anxiety that she would vomit beforehand. Though she apparently failed some tests, she also made the dean's list, and in 2001, she graduated as vice president of her class, with academic awards in biology and pharmacology. The piece devotes a small section to what the receipt of her nursing board exam test results meant to her: "In that moment, she came closer than at any other time of her life to upper-middle-class young people awaiting word from the Ivy League school of their dreams."
However, because she could not afford to go beyond her associate's degree, her job prospects were limited "even in a high-demand field like nursing." She lacked the "contacts" necessary for a Chicago teaching hospital job that would offer "better training and higher pay," settling instead for one at a "small inner city hospital." There, working nights, she made $83,000 in 2004. But she has had "high stress assignments" in telemetry and the ICU, and it is "hard work, messy, often thankless." Moreover, the "pecking order...surprises and frustrates her." Physicians "seem to expect her to work magic on their orders," and certified nursing assistants "resent her place of privilege." She is unmoved: "If you want my job, you need to suffer and cry like I did." Ms. Whitiker "tried hanging out" with other nurses, "[b]ut some were bourgeois and uppity," with "a sense of comfort and confidence she did not possess." She went to a party and "some of them started smoking marijuana," which was a "fun little escape for them," but with Ms. Whitiker's past drug experience, she got up to leave. Meanwhile, though nursing was at first like "hitting the lottery," family, friends and even patients now "have their hands out," looking for a piece of her winnings. Not only that, but being a middle class nurse also seems to mean "taking on family members as unofficial patients with their edema and diabetes." Ms. Whitiker notes that "[w]hen you're the only nurse in the family they think you're a doctor." She has high hopes for her younger children, who have done well in school and (unlike two older brothers) are not caught up in the drug trade. She is hoping that they will resist the urge to join the military, and that one will become a lawyer, and that another will "consider becoming a doctor."
We just had a few questions. We hate to be all middle class and stuff, but is there anything positive in the entire theoretical or practical world of nursing besides that $83,000? Do nurses ever improve patient outcomes? Has anyone ever thanked a nurse? Do nurses ever support each other? Have they ever advised friends or family on health problems? Have they ever done anything to assist those who are not middle class, like staff community health centers or dangerous ED's? Are any of them, you know, decent human beings who don't look down their noses at poor people trying to succeed? We're just curious, because this piece presents nurses as snobby, arrogant, privileged, bourgeois, uppity, frivolous, recreational drug-using, mercenary clock punchers who must endure a hard, messy, thankless job, perhaps because they don't actually know much. Although nursing school seems to involve suffering, crying, vomiting, fear and loathing, and even academic awards, that must be just a form of hazing. The article portrays physicians as having the real knowledge, and they're the ones who might be able to help family members with problems like edema and diabetes. Indeed, though we appreciate the piece's account of some of the rigors of nursing school, it's not clear from the article that it is hard for the "middle-class teacher's pets" whose mothers were nurses and who "knew everything." Maybe it's just hard for people like Ms. Whitiker. Likewise, we might be impressed with the Ivy League comparison if it did not seem condescending: we're meant to understand that Ms. Whitiker was so badly off that just becoming a nurse was as big a deal as getting into an Ivy League school would be for an upper-middle-class person. (Actually, Yale, Columbia and Penn all have nursing programs, and not all Ivy League students come from the "upper-middle-class.") In addition, while nurses certainly can present attitude problems for their fellow nurses, to focus closely on that but ignore disruptive physician conduct--a major source of nursing burnout--seems bizarre; are the nurses at this hospital so much more "uppity" than the physicians? Anyway, despite the article's vision of the harsh emptiness of nursing itself, the job does at least appear to be an economic foothold from which to launch your kids toward supposed real professions: medicine and law.
In fact, nursing school is hard for everyone, and nurses are well qualified to advise family members how to manage health problems like edema and diabetes. Unlike medicine, nursing places a heavy emphasis on patient education, and nursing's holistic focus is especially effective in helping people manage chronic conditions. Ironically, the piece's one positive comment on nursing seems overstated: a salary of $83,000 would probably require more than just night shifts, but also significant overtime for a nurse with an associate's degree working at a small community hospital. Teaching hospital nursing positions are not typically given out through some old boy network of "contacts," but on the basis of qualifications. Moreover, though nurses are middle class, many have spent their lives working in difficult conditions for little money in order to improve the health of underserved communities. We don't doubt that it is a great challenge for Ms. Whitiker to fit in and prosper in her current work environment, and to cope with middle class prejudices, which seem especially sad coming from nursing professionals who are themselves so often the objects of contempt. And the vision of nursing offered here fits well with the story's theme of ceaseless struggle. But it is extraordinarily distorted.
We thank Ms. Wilkerson and the Times for an interesting look at nursing and for resisting some stereotypes, but we wish they had provided more perspective on the profession during a time of global crisis.
See the article "Angela Whitiker's Climb" by Isabel Wilkerson from the June 12, 2005 edition of the New York Times.
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