The doctor–nurse relationship: how easy is it to be a female doctor co-operating with a female nurse?
Introduction
One of the most striking differences between doctors and nurses has been that of gender. Over generations and until the middle of the 1970s, the medical profession has been predominantly male-dominated, while nursing has been regarded as one of the most archetypal female occupations. Hence, the doctor–nurse relationship has mainly been one of male versus female. While the medical profession is still male-dominated, there has been an increasing entry of women into medicine in Norway, as in other Western countries. In 1997, 29% of active Norwegian physicians were female (Norwegian Medical Association, 1997).1 Male entry into nursing, on the other hand, has been considerably less significant. Nursing has always been and continues to be a predominantly female occupation. In Norway only 8% of all nurses are male.2
There is a vast amount of literature addressing the doctor–nurse relationship; much of which is anecdotal (Sweet & Norman, 1995). Studies on the doctor–nurse relationship have employed a variety of research methods, particularly interviews and observations (Hughes, 1988; McMahan, Hoffman, & McGee (1991), Porter (1992); McMahan, Hoffman, & McGee, 1994; Sweet & Norman, 1995; Svensson, 1996). The doctor–nurse relationship has been characterised as a dominant–subservient relation with a man–woman constellation, and gender has been found to be of considerable importance when explaining the position of nurses (Gamarnikow, 1978; Carpenter, 1993). Some authors have discussed the relationship between doctors and nurses when both are males (Savage, 1987; Porter, 1992; Mackey, 1993; Sweet & Norman, 1995), but few have addressed the relation between members of the two occupations when both are females (Porter, 1992; Mackey, 1993). How easy is it to be a female doctor co-operating with a female nurse? The purpose of this article is to illuminate how female doctors experience their relationship to female nurses: how do doctors interpret issues of gender in this relationship and does gender affect power relations between the two categories?
The first part of the article briefly describes the traditional doctor–nurse relationship with reference to the historical development of nursing and recent work on profession and gender. The second part presents a theoretical framework for analysing the doctor–nurse relationship of today. After describing the methods, we will present doctors’ opinions of how female nurses interact with male versus female doctors, the doctors’ own interpretations of this, and the strategies some female doctors make use of in their relationship with nurses. The last part of the article suggests an interpretation of the results.
Section snippets
The traditional doctor–nurse relationship: a historical background
The doctor–nurse relationship has been characterised as essentially patriarchal (Dingwall & McIntosh, 1978) and as a dominant–subservient relationship (Gamarnikow, 1978; Carter, 1994). It has been argued that it is impossible to obtain an understanding of the doctor–nurse relationship without an awareness of relationships between men and women in society through time (Carpenter, 1993; Sweet & Norman, 1995). The sexual division of labour within medicine has been seen as a logical extension of
“Femininity” as a “new” trait in the medical profession
In one of his classical articles on the sociology of work, Everett C. Hughes argues that there tends to grow up about a status,6 in addition to its specifically determining traits, a complex of auxiliary characteristics which come to be expected of its incumbents:
If one take a
Material and methods
The empirical material consists of two sets of data, one derived from qualitative interviews with 15 physicians, the other from a nation-wide survey of 3589 randomly selected physicians in Norway.
The qualitative interviews took place over a period of three months during 1996. Fifteen physicians were interviewed, 4 men and 11 women of different ages, specialities, and positions. The same interview guide was used in all interviews. It was based on 15 open-ended questions, designed to find out
Implications of changing gender relations — a surprisingly difficult relationship
How female physicians perceive their relationship with the nursing staff depends on the actual division of labour, on their earlier experiences with such relations, on which group they use as their reference group, and on their expectations of their professional role. In medical school, expectations and self-conception as doctors are built up. A doctor's role is expected to involve both obligations and rewards. Besides high status and salary, the reward system includes the authority to make
How do doctors interpret issues of gender in the doctor–nurse relationship?
The difficulties female doctors experience in their relationship with nurses are partly tied to a feeling of lack of respect and of receiving less help with their work, and partly to a feeling that it is sometimes difficult to find one's place within the hierarchy of the health care system. But the informants do not only describe their own feelings about this. A majority also have a clear idea of the reasons for such attitudes and behaviours. The doctors’ interpretations have a number of
Strategies in order to get assistance
Some female doctors described the strategies they use in order to receive the needed assistance from nurses. In part, this includes the establishment of friendship with the nurses, and in part this involves carrying out nursing tasks themselves. The following statement illustrates the former approach:
…I don’t think men need to become friends with them, but I have to. I have to be nice and cheerful and make friends with them if it's going to work. It's not because they don’t respect me, but…
Three elements in an explanation
Although a vast amount of literature on the doctor–nurse relationship has addressed gender issues, comparatively little attention has been paid to the relationship when both doctor and nurse are females. The present paper suggests that female physicians feel that their relationships with female nurses differ from those between their male colleagues and female nurses. This agrees with a study of physicians in the Nordic countries (Korremann, 1994),13
Conclusion
It is likely that recent controversies in the doctor–nurse relationships can be interpreted as reflections of structural changes both in the society at large and within the health care system. The status convergence between the two occupations combined with an increasing awareness of sex-roles may trigger an increasing sensitivity in the interaction. Nurses may want to resist doctors’ traditional ways of marking the boundaries and doctors may feel nurses are getting ‘cheeky’.
The fact that this
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