Washington Post aims to debunk myths about U.S. nursing
A fairly good February 2022 feature, “Five myths about nursing,” addresses some misconceptions about the profession. The piece focuses on ideas that have only arisen during the Covid era, such as that nursing is “lucrative” and that nurses are “superheroes.” But it also discusses some enduring threats to nursing practice.
February 3, 2022 – Today the Washington Post had a generally helpful installment of its weekly “five myths” feature titled “Five myths about nursing – It’s not always better to be treated by a doctor than a nurse.” Rebecca Simik’s piece addressed the beliefs that U.S. nursing is “lucrative,” that it is “no longer a desirable job,” that it’s “better to have a doctor treat you than a nurse,” that “the pandemic has made nurses’ jobs dangerous,” and that nurses are “superheroes.” These are a mix of longstanding myths, views that have only developed during the Covid pandemic, and things that are not completely true or false, contrary to what the “myths” formulation may imply. The “better to have a doctor” one is wrong, of course. But the discussion about it is problematic because it sets up a false comparison—as if nurses and physicians compete in doing the same thing, rather than operate with complementary but distinct scopes of practice. The explanation of whether the work has become dangerous rightly clarifies that it has been dangerous for a long time, relying in part on a recent MSNBC guest essay about damaging naughty-nurse stereotypes by Truth director Sandy Summers. On the whole, the feature provides good information about the basic features of nursing today, with many citations to recent research and nursing experts. We thank Simik and the Post.
Still deeply misunderstood
The feature’s introduction says nursing is “still deeply misunderstood” and that the work is “often undervalued compared with that of doctors.” The piece links these issues to the fact that the workforce is almost 90% women. The rest is a one-by-one look at the myths.
“Myth No. 1: Nursing is lucrative.”
Needless to say, few people would have thought this prior to 2020. But the item correctly notes that during the pandemic, articles have highlighted the demand for nurses and the high pay travel nurses can command, in some cases $5,000/week, “even more than doctors make.” However, the piece stresses, most RNs make a “solidly middle-class salary,” with a 2020 average of around $75,000 annually, according to the Bureau of Labor Statistics, and ZipRecruiter data indicating an average of about $70,000. That is critical information, especially when considering the many challenges nursing practice entailed even before the Covid era, as the remainder of the feature explains. Beyond that, it’s doubtful that making $250,000 annually is “more than doctors make,” with some recent estimates indicating otherwise. And simply reporting travel nurse pay rates does not convey the unusual stresses of that work. It can entail a series of high-pressure short-term relocations to far-flung locales, a vertical learning curve even for those with the advanced qualifications the work requires, long down-times in between contracts while the traveler searches for a new contract, and often difficult relations with the permanent hospital staff. Finally, although it’s possible to read the “even more” language as a suggestion that physicians actually deserve more money, we’ll choose to interpret it as just a reflection of the fact that medicine is well-known to be one of the most lucrative fields there is.
“Myth No. 2: Nursing is no longer a desirable job.”
This is another complex one. U.S. nursing does remain desirable in many ways, because it offers reasonable pay for saving and improving lives under a unique, autonomous practice model. At the same time, nursing has been very troubled since well before the pandemic, with a shortage of nurses willing to endure the understaffing, stress, risk, and other workplace conditions that Covid has made even worse. The item focuses on the “exodus” of nurses away from the bedside during the pandemic. But it rightly notes that interest in the profession does remain high based on data on educational enrollments, applications to nursing programs, and the number of foreign nurses waiting for permission to work in the U.S. The piece might have noted that the profession’s ability to utilize this continuing interest has been greatly limited by the longstanding shortage of nursing faculty, an issue that has roots in the failure to offer them adequate compensation and support.
“Myth No. 3: It’s better to have a doctor treat you rather than a nurse.”
This idea does reflect a myth, although the way it’s stated oversimplifies the situation. The piece correctly notes that it’s widely assumed physicians are best at “all medical procedures, including starting IVs or drawing blood,” as reflected in TV shows like Grey’s Anatomy and House “that almost exclusively portray doctors as the only members of a treatment team.” The piece also cites cartoons mocking nurse practitioners (NPs) and comments by physician Sandra Lee (“Dr. Pimple Popper”), who questioned why a WebMD piece on sun poisoning was written by a nurse rather than a dermatologist. But as the “myths” feature notes, nurses do educate patients and families about a wide range of conditions and how to manage them. In addition, the item explains, many “procedures” done by nurses, like placing urinary catheters or removing sutures, are only done by physicians in medical school. And the piece cites a Lancet study showing that NP care in the ED was at least as good as that of “junior doctors.”
This discussion is headed in the right direction, and we appreciate that the article subhead directly counters the myth of universal physician superiority. But the piece still undervalues nursing. The criticism of Hollywood’s physician-centric distortions is right on target. Nurses are indeed focused on and expert at patient education. But they are not worthy just because they have more experience with many discrete health care “procedures,” as much as the entertainment media does credit physicians for doing them. Nurses are autonomous, college-educated health professionals with a distinct scope of practice, one that emphasizes prevention, a holistic approach to care, patient advocacy, and yes, patient education. Nursing autonomy would have been a particularly helpful point for this item to make, because providing examples of nursing skill, though laudable, still does not dispel the widespread “myth” that physicians manage nurses. Nurses deserve equal respect and resources because their contributions are just as valuable to patients as those of physicians. Finally, a wealth of research shows that NP care is at least as good as that of physicians across many fields; it’s not just one study comparing them to “junior doctors.”
“Myth No. 4: The pandemic has made nurses’ jobs dangerous.”
Here the text of the item seems to recognize that the stated “myth” contains a misconception, but that it’s not actually the misconception that seems to be there. First, the piece does note that the pandemic has in fact presented the new dangers to nurses of threats and violence from patients who oppose vaccines or are subject to other delusions. (Oddly, it does not mention the threat of the Covid virus itself, both in the obvious risk of deadly infection as well as the burnout that can come with seeing so many patients die in an overwhelmed and highly constrained care setting.)
But the main theme of the discussion is the key point that “these jobs were dangerous well before covid-19.” The piece cites a lot of data showing the high rates of workplace violence nurses have long faced, to the extent that it has been one of the most dangerous jobs in the nation. The feature also notes that about 86% of practicing nurses are female, and the profession remains subject to “over-sexualized stereotypes,” such as the “naughty nurse” costumes at Halloween. It cites an October 2021 MSNBC opinion piece by the Truth About Nursing’s director:
Sandy Summers, a registered nurse, argues convincingly that these images fuse “caregiving with easy sex,” creating a dangerous atmosphere of disrespect.
And the item provides data showing the high rates of sexual harassment nurses experience. These are helpful notes, although we would have also emphasized the threats that have been posed to nurses by decades of having to work in dangerously understaffed settings, which can lead to physical injury, moral distress, and burnout, as well as threaten the quality of care.
“Myth No. 5: Nurses are superheroes.”
Up until the pandemic, we thought nursing would be lucky to be subject to this misconception, as it is so far from the traditional stereotypes of the profession as one for low-skilled physician helpers, angels, sex objects, and battle-axes. And as this piece notes, during the pandemic nurses have developed a reputation for resilience in the face of rampant death and tremendous stress. Among the items the piece cites are the Banksy superhero drawing that we ourselves praised as a helpful reversal of traditional conceptions. But we do see how the “hero” narrative can function as lip service that masks critical failures to provide nurses with the support they need, including adequate staffing, PPE, security, decent management practices, and mental health resources. And as the Post notes, “living up to this superhero image is impossible.” Even before the mental health challenges of the pandemic, research showed that nurses face great mental health challenges. The piece cites research including a 2020 University of California at San Diego study that found a higher rate of suicide among nurses than the general population. We also note that a Mayo Clinic study published in October 2021 found that nurses, pre-pandemic, had more suicidal thoughts than other workers but were less likely to tell anyone. The piece closes by describing efforts to address this including Code Lavender, an alert system in which a rapid-response team can help hospital staff or patients after traumatic incidents.
See the article by Rebecca Simik, “Five myths about nursing: It’s not always better to be treated by a doctor than a nurse,” posted February 3, 2022 on the website of The Washington Post.