As women, we’ve come a long way since the first Women’s Equality Day in 1971. We’ve fought tirelessly to gradually secure more rights for women, and worked overtime in efforts to reduce the overbearing gender disparities which exist both in the workplace and in society. But we still have a long way to go.
We can start by looking at some of the women-dominated fields. Vestiges of the patriarchy still remain, even in professions where we are the majority. In healthcare, women make up 76% of all workers. We’re responsible for 80% of overall growth across the healthcare industry for the past two decades. But you would not guess this from our (lack of) representation in executive offices, on boards, or in the media. You wouldn’t guess it when comparing our paychecks to those of our male counterparts.
But it goes deeper than representation. Consider nursing, a healthcare profession that has historically been dominated by women like me – women account for 87% of the nursing workforce.
In the first few decades of the 20th century, most nurses were independent contractors, or “private duty nurses.” The foremothers of nursing – women like Florence Nightingale and Mary Breckinridge – set us up to have quite a bit of power. To be able to practice autonomously, to seek and secure our own employment, to be pillars of health and wellness in our communities – that’s what it meant to be a nurse. For a while, we were on equal footing with men in our industry.
As the healthcare system evolved through the decades, that power began to dissipate. Physicians, mostly men then and mostly men today, started to collectively assert their power through institutions, policies, and associations. Over time, a very clear delineation was made: women get to be nurses, men get to be doctors, and the value of the former is less than that of the latter.
Yet, it was women – nurses – who were constantly at the bedside of their patients, who were delivering the majority of care, who were bearing the brunt of the work. While there are more women physicians and more men in nursing than ever before, the patriarchal designs of yore have left impressions on the healthcare system that last to this day.
One reason is because they were codified when the Medicare and Medicaid Act was signed into law in 1965. Healthcare’s predominant payment system is structured to make everything in the hospital billable, from services to goods to a physician’s time. If a patient needs a bandage, that’s a line item on their bill. Nursing – the time registered nurses dedicate to their patients, the services we provide – are not directly billable.
The cost of the services nurses provide, as the authors of this study point out, are folded into the line item for room and board. It’s the same fixed cost for every patient. In other words, almost everyone in the hospital has economic power and a way to leverage it except nurses.
This leaves us vulnerable to the will of the system, both in and outside of the hospital. Bereft of a measure of economic value, we have relatively little of the lobbying power required to change things. Nobody, including policy-makers, questions when physicians – a male-dominated profession – offer their services as independent contractors, and they do so often – as consultants, as freelancers within private practices, as per diem workers in urgent care clinics.
There have been some grassroots efforts to rally nurses, but nothing ever seems to gain or keep momentum. What power we do have has been fractured into limited bodies and factions like regional groups, associations for specific nurses in explicit areas of care, and unions.
As nurses, we go to our demanding jobs, we manage our familial responsibilities, we try to squeeze whatever valuable personal time we can from what remains of our day. We try not to think of our devaluation in a system that relies on us. But maybe we ought to.
A recent study, for example, found female registered nurses still somehow make less than our male counterparts. The study went so far as to say female nurses are less likely to negotiate salary compared to male nurses. Given the current demand for nurses – and the commitment by many healthcare organizations to invest in their nursing staff as the pandemic wanes – nurses are well-positioned to negotiate better salaries.
Everyone outside of the healthcare system knows the value of a nurse. We’ve been heralded as frontline heroes, applauded for our services, placed on pedestals as pillars of our communities. Year after year, our profession is ranked as one of the most trusted and most ethical. And yet, we are still engaged in a war for fundamental tenets of equality.
Every nurse has received some sort of whimsical token of recognition from their employer for Nurses Week – the t-shirts, the mugs, the little baggies of treats. It’s insulting. It’s time for us to start speaking up for a system that recognizes that value beyond tacky “appreciation gifts” for Nurses Week and gimmicky holidays.