Nobody’s handmaiden: how nurses are taking on the top jobs despite opposition.

Jun 29, 2021

For so many years, nurses have been viewed as doctors handmaidens, as subordinate professionals. Indeed, the way in which the medically-dominated Medical Benefits Schedule Review Taskforce (MBSRT) treated the 14 evidence-based, patient-focussed, recommendations of its own Nurse Practitioner Reference Group (NPRG) – namely, by rejecting all of them – suggests that for some medical practitioners, these images are still current enough for them to feel they can treat the nursing profession with disdain.

In the slow vaccine roll out we still see that while professional and skilled nurses give the injections they still have to supervised by a doctor. How absurd and demeaning for nurses!

But the times are changing. Registered nurses are now baccalaureate prepared and most go on to undertake specialist post-graduate clinical education, with the majority of nurses working in academia holding a PhD and leading major research teams that often include medical practitioners.

What is also becoming evident is that a career in nursing sets nurses up to go on to significant leadership positions, often in health services management but also in academia and in the private sector. Perhaps it was ever thus – certainly nursing was once seen of one of only a handful of careers traditionally suitable for women, so perhaps many of those nurses, having got a foot in the door of industry, often went on to senior positions in other industries.

However, here is the difference between then and now. Then women who took on senior roles in other industries might have mentioned quietly that they were “once a nurse” but they wouldn’t be making a big deal about it. They certainly wouldn’t have been saying they were proud to be a nurse, or thatnursing is a phenomenal profession and one in which you can pivot and change identity and move from setting to setting”. These were the words spoken by Professor Trish Davidson, the new Vice-Chancellor at the University of Wollongong and former Dean of Nursing at Johns Hopkins University, Baltimore. In the interview with the Australian Financial Review Professor Davidson proudly owns her nursing background and indeed recommends it as a strong career choice. Her research interests are centred on developing innovative person-centred care delivery with a focus on the inter-relationship between cardiovascular science and vulnerable populations. In the interview she also makes it clear that this person-centred care, a strong nursing development, influences far more than just nursing care today. She observes:

When I started in nursing, a biomedical approach was the dominant model of healthcare. If I had said to a cardiologist in the 1970s that depression was a risk factor for heart disease, they would have looked at me and said I was crazy. They would have said to just get over it. “But now we know there is so much more to health; it is about the circumstances in which we are born, live and die.”

Look around Australia and you will find nurses in many senior health roles, a phenomenon that is mirrored in the UK. In NSW alone, at least six of the Local Health District and/or Network CEOs are nurses, and they will be the first to tell you. At least two of the CEOs of our major Safety and Quality organisations in Australia are nurses, as are a significant number of the senior executives in the various jurisdictional Ministries of Health. These women (and men) bring their nursing expertise to an understanding of how the health services really work. Furthermore, nurses are also taking on senior positions in the private sector. Susan Martin, the General Manager of Johnson & Johnson Australia and New Zealand, made the comment in an interview in 2018 that nursing “gave [her] the opportunity to fulfil her passion for both health care and travel, her skills being put to use in Australia, London and New Zealand.” We also now have a number of nurses in state and Federal politics. Dr Helen Haines, the Federal Member for Indi, had this to say in her maiden speech:

In 1986, after completing my nursing and midwifery education in Melbourne, I moved from north Carlton to central Chiltern, having been lured to the north-east by my sweetheart, the handsome Phil Haines, agricultural scientist from the Rutherglen Research Institute. I became matron at the Chiltern Bush Nursing Hospital. I was 26; a very young matron in a very small hospital in a very small place with a very small lake, a lake overlooked by one of the former homes of Henry Handel Richardson; a lake familiar to Black Jack McEwen and to another favourite son of Chiltern—and well known in this House—Mr Barrie Cassidy.

The next three years I spent in that job gave me plenty of great stories and a keen understanding of place-based solutions to the challenges of rural health. The hospital kitchen crammed with locals making jam, peppered with a surprise visit from the health inspector. Jacky Byron, who could recount watching the lads march off to the Boer War, would arrive daily by bicycle to deliver freshly caught fish from the lake for his cobber, Martin Balsarini, a light horseman who rode in the charge of Beersheba. There were midnight call-outs for a variety of reasons with the local GP and the local policeman, including an encounter with a villain on the run hiding in the hospital casualty room. The matron, the sergeant and the doctor—we were quite the trio.

The privilege of intimacy that we experience as nurses teaches us to appreciate the resilience, the endurance and the courage in everyday people. We learn that these everyday people that we meet, from every conceivable walk of life, are capable of greatness and adaptability in the face of change and suffering. That in turn teaches us to be humble and non-judgemental and to appreciate difference, rather than sameness. Add qualities such as humility and fairness to the skills we develop in multi-tasking and multiple communications and it is clear to see why these prominent leaders quoted above believe that their nursing education has prepared them so well for senior leadership roles. For someone like me, who has never moved out of a nursing role, the wonderful fact is that these women (and men) own their nursing backgrounds today and are proud to call themselves nurses. Handmaids no longer. Amen to that.

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