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Strangeways, Here We Come: University of Alberta medical students have something important to say about nurses--especially their breasts!

July 8, 2005 -- The Edmonton Journal published a fair piece by Jodie Sinnema on May 19 about the recent controversy surrounding the lyrics of a "Nurses' Song" performed by University of Alberta medical students at their annual "Medshow." It seems that nursing professors, the university provost, and even the medical school dean found something objectionable about the song's assertions that nurses were "whores" and "bitches" whose "incompetence" threatened to "make our patients die." But at least the medical students felt nurses were qualified to "fill up my coffeepot" and "give good head," and the refrain urged nurses to "show me those boobs." The song seems to reflect virulent misogyny, ignorance of nursing, and professional insecurity, a perfect storm of dysfunction that persists in many clinical settings, harming patients and contributing to nursing burnout and the global nursing shortage. To the extent the song and the medical students' apparent non-apology are indicators of their career trajectory, it's bad news for patients and colleagues. But the students' conduct does suggest that the business outlook may be good for local malpractice and personal injury lawyers--and possibly even those who work in the criminal justice system!

Read more below or go to the update on this letter-writing campaign.

The Edmonton Journal piece is headlined "Medical students' show offends nurses." It reports that the university's dean of nursing, Genevieve Gray, has asked the university provost to conduct an investigation of the "raunchy, sexist lyrics" in the song. The "Medshow" is an annual three-day fundraiser for the medical school's graduating class held at a local theater in late March. The piece notes that it is "considered infamous by some for its perennial risqué material, but is liked by others who see the black humour as a way to release stress while studying to become doctors." The "Nurses' Song" was reportedly sung to the tune of one of the songs from "Jesus Christ Superstar."

Most of the Journal piece consists of quotes from distressed university officials. Dean Gray found a written "apology" from the medical students unacceptable, noting that it was "pretty weak": "They made no attempt to really come and make time to see me or talk to me about this and what they really said was, 'Well, look, if you don't like it, tell your students not to actually come to the show next year.'" Gray noted that the song was "a very serious depiction of nursing and women." She did not think the school should be "sending medical graduates into the workforce who have these attitudes," and she minced no words about her preferred outcome: "Quite frankly, I don't think those students ought to be on board with us."

University provost Carl Amrhein is quoted as saying that the lyrics were "way beyond the line of being acceptable," and that the dean of medicine was "waiting to receive a clear, written plan from the students on how they will be accountable for their actions next year." Tom Marrie, the dean of medicine, did ask the students to offer an apology to the dean of nursing. He is also quoted as saying that the show "doesn't reflect well on us as a faculty of medicine" and that he "wasn't proud" of the students, though "they are a really good bunch of kids in almost everything else they do." The article does not include any comment from the medical students responsible for the song, or any other medical students. Such comments might have shed light on how the song developed, and how widely shared its sentiments are. We would be especially interested in the views of female medical students.

Both the provost and the medical dean appear to be talking about how to avoid similar debacles in the future, including cancelling the show. But the article contains no information about any plans to educate or discipline the students responsible for this year's show or future medical students. Indeed, the Provost and a medical school public relations official recently told the Center that since the Medshow was created by a student group, any disciplinary action would also be directed at the group. Of course, it is difficult to imagine that a group of transient medical students would care much about any action directed at some student group, as opposed to, say, something that would appear on their permanent records, or that might otherwise come to the attention of future employers or colleagues.

But enough of this. Let's get to the University of Alberta medical students' song lyrics, which the Center has obtained. They are reproduced below in full:

Nurses' Song

Nurses we are overjoyed
To meet you face to face
You've been getting quite a name
All around the place
Being bitches
Screwing up meds
Now we understand you're whores
But at least you give good head

So you are a nurse
You're a wonderful nurse
Prove to me that you're the best
Let me look upon your breasts
If that you will do
Then my hats off to you
Come on show me those boobs

Nurses you just won't believe
The shit you've stirred up here
Your incompetence is all
So very fucking clear
Oh telling Doctors
What they ought to try
When in fact your management
Would make our patients die

So you are a nurse
You're a competent nurse
Show me all that you were taught
Go fill up my coffeepot
And then go berserk
When I ask you to work
Come on show me those boobs

Nurses like to bitch and moan
They often go on strike
They somehow think their job is more
Than just the village bike
Oh... if you really
Want to get respect
Come right here
And tell me why
The vitals aren't done yet

So you are a nurse
Yes a superstar nurse
Prove that you're as good as me
Do this Neurosurgery
Or maybe instead
You should just change the bed
Come on show me those boobs

DISCLAIMER: We couldn't have
done it without you nurses.

Bracing, isn't it? This seems like male insecurity in its crack form--the braying, self-pitying ignorance, the profound, menacing misogyny, the ego run amok. We doubt any physician or medical student who was secure in his abilities would feel such an insatiable need to tear into nurses' character and professional skills. Consider the lyrics' constant, imperious demand for the breast, like that of a pampered but colicky baby boy.

And consider this scenario. A young man has spent his life being treated as an academic golden boy, constantly told that he is the best, smartest and most valuable person around. Imagine the reaction when his family, friends and complete strangers learn that he will attend medical school. At medical school, however, he is introduced to a rigidly hierarchical, arguably sadomasochistic system in which he is the lowest player--a system in which he is overwhelmed with difficult academic work and tossed into demanding clinical settings in which he knows little of any use. In those settings, he not only confronts esteemed physicians to whom he must defer--however abusive some may be--but also a variety of nurses, some of whom may have been practicing for decades. Some of these nurses, stretched to the breaking point trying to save lives in a short-staffed system that shows them little regard, may not have gotten the memo about how this medical student is the most wonderful thing anyone who knows him has ever seen. Instead, they may simply see someone who doesn't have a clue what he's doing in a hospital, but who is firmly convinced of his own mastery and superiority, and of the ignorance and inferiority of all nurses. Not exactly a recipe for success, is it? Of course, this kind of interaction is hardly unique to the health care setting. History offers many examples of groups who feel disempowered directing aggression toward groups they perceive to be inferior and even weaker.

We understand that these song lyrics probably do not reflect the views of most medical students. We assume most would not be part of something this hateful. But we are not surprised that this occurred, especially given the venom some medical students have sent our way. Nor are we surprised at the apparently inadequate reaction of the university and the medical school, nor at the medical students' apparent failure to apologize.

Let's look at some of the specific song lyrics. The name calling and sex talk reflect the naughty nurse stereotype, but a very aggressive version. This level of verbal abuse, even under the cover of a "joke," would certainly make a rational person wonder if physical abuse was far away. The care-related stereotyping is also interesting. Note the resentment of nurses who would have the effrontery to tell "Doctors what they ought to try." However, those who wrote this were apparently not doctors. What the lyric may really mean is that the medical students can't stand the idea that even nurses--those ignorant "village bikes"--seem to think they know more about patient care. Of course, one of nurses' most important duties is to do just what bothers these students most: to weigh in on physician care plans and advocate for better ones if needed. Countless lives are saved through nurses' detection of medication errors alone. But the song is obsessed with the fact that some nurses actually think they're experts; thus, the mocking references to "superstar nurse" and so on. The suggestion that "your management would make our patients die" is a curious one for a medical student to make to a nurse. In most cases, veteran nurses know far more about the proper management for patients than medical students, who tend to be assigned the most menial tasks in most rotations. But in order to put nurses in their place, it's important to rub their faces in the stereotypes of just those apparently menial tasks. Thus, the song instructs nurses to--at least when they find time in between breast exposures--fill up the coffeepot and change the bed.

The song also reflects impatience with nurses' purported failure to do their more technical work properly. These nurses screw up the meds and don't get the vitals done on time. No doubt this has occurred, especially given the short-staffing that is now endemic. But we loved the implication that nurses are doing their work for the benefit of medical students, rather than their own practice for their patients. Indeed, the students can't quite seem to believe that the nurses don't hop to it "when I ask you to work," "going berserk," bitching and moaning and even going on strike, as if they had any legitimate complaints, or anything to do besides cater to the demands of medical students. In fact, nurses do not report to medical students or to physicians. Nurses are autonomous professionals who work in collaboration with physicians and others on the health care team. We won't bother asking the students to appreciate the superhuman patient loads many nurses confront today, loads that have contributed to the shortage and that will hamper the students' own practice.

The medical students reserve what they no doubt view as the coup de grace for last: "Prove that you're as good as me / Do this Neurosurgery." Of course, the medical students can't do neurosurgery either, and neither can the vast majority of physicians. But none of them can do nursing unless they've graduated from a multi-year college-level nursing program. And it's hard to believe that anyone responsible for this maladroit song would be able to do that.

In fact, the attitudes in the song reflect serious threats to nursing practice and to patient wellbeing, and they may violate medical ethics as well. Research shows that poor relations with physicians, including physician disruptive behavior, are one of the leading causes of nursing burnout, and a factor in the nursing shortage that threatens patients in Canada and worldwide. Moreover, physicians who do not respect or listen to nurses pose an even more direct danger to their patients. This is because as noted above, a critical part of nurses' jobs is to alert the health care team to changes in patient conditions or problems with care plans, and to advocate for better care when needed. Have any doubts that ignoring nurses' patient advocacy can kill people? Five words: Jayant Patel and Jonah Odim. For those not familiar with these heartbreaking cases, these were surgeons whose incompetence allegedly contributed to many deaths (in Australia and Winnipeg, respectively), despite the increasingly dire warnings of nurses. In addition, one of nurses' critical roles in hospitals is informal teaching of young physicians. Physicians who do not listen do not learn, and they make mistakes, sometimes very serious ones. Perhaps in recognition of this, provisions of the Canadian Medical Association's Code of Ethics require physicians to learn from health colleagues and to treat them with respect. Practicing physicians should be concerned that their new colleagues have the views expressed in this song. Nurses, of course, may reasonably be concerned about their emotional and even physical wellbeing.

The Edmonton Journal article's description of Medshow as a way for the students to relieve the stress of medical school is a telling one. Unfortunately, the medical students just might be confronting a bit of stress after they graduate as well. If this is how they react to it--with what would almost certainly be considered sexual harassment in an employment setting--their patients and colleagues will suffer, to say the least.

We salute Dean Gray for her courage.

Our executive director's initial letter to the University of Alberta is below.

Please see the update on our letter-writing campaign here and also see some of the original letters written by our supporters on our discussion board. Please post your own letter to add to the discussion.

Dear Provost Amrhein and Medical School Dean Marrie:

On behalf of the Center for Nursing Advocacy, an international nonprofit whose board and membership includes many Canadians, I am writing to express my grave concern at the reported conduct of the University medical students responsible for the "Nurses' Song" at this year's "Medshow." We understand that the song included assertions that nurses were "whores" and "bitches" whose "incompetence" threatened to "make our patients die," though the medical students did at least feel that nurses were qualified to "fill up my coffeepot," to "give good head," and to "show me those boobs."

We urge you to take the corrective measures below to protect nurses and the public from the serious threats to nursing practice and patient wellbeing posed by the attitudes reflected in this song. Physicians who treat nurses as ignorant sex objects with no business speaking up about care plans are likely to provide dangerously poor care, as recent reports in the world media have made clear. Moreover, such physicians are a major cause of nursing burnout, which is itself a key factor in the nursing shortage that threatens lives worldwide. We note that such conduct also appears to violate Canadian medical ethics.

First, we urge you to ask that all of those responsible for the song (all writers and performers) be directed to issue unqualified, written public apologies--unique, individual apologies made in individual capacities--to all nurses. If any person fails to do so promptly, we believe that his permanent academic record, and any future release of that record, should include a letter about this incident by Dean of Nursing Genevieve Gray.

In addition, we urge you to require any of those responsible who are still students or employees of the University to attend in-depth counseling in gender relations/sexual harassment and the basic nature of nursing, including the autonomy and professional qualifications of nurses, and their obligation to engage in patient advocacy. This training should occur under the direction of Dean Gray or her successor Dr. Beth Horsburgh. We suggest that it include shadowing hospital nurses for at least 24 total hours.

Finally, we urge you to establish and maintain mandatory training programs to educate all future medical students in these areas, again in close consultation with Deans Gray and/or Horsburgh. Such training might focus on the specific roles nurses play in patient outcomes, the effects on their practice of recent resource limitations, including nurse short-staffing, and the fact that nurses are autonomous professionals with their own scope of practice who do not report to physicians. It might also include a version of the shadowing element noted above. It is critical that every pernicious view reflected in this song be addressed. We understand the medical students currently receive some training in collaborating with other health professionals. This training does not appear to have been sufficient.

We doubt that any disciplinary action directed solely at a student group will have meaning to transient medical students or physicians, or real impact on the underlying attitudes that resulted in this incident. Likewise, actions related to Medshow will do little to address the real problem. Only public, individual discipline and significant educational changes will prevent such unfounded but toxic attitudes from threatening the public in the future.

I attach below a detailed analysis of the "Nurses' Song" which appears on the Center for Nursing Advocacy's web site. We would be happy to discuss further how important it is to our future health that the attitudes reflected in this song be confronted and eliminated. Thank you.

Sandy Summers, RN, MSN, MPH
Executive Director


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