This is the second half of our discussion with Charlotte and Kat, a feminist mother-daughter nursing duo. The first installment, release on UK Mothers Day, discussed their journeys to feminism and nursing. Here the conversation continues as they grapple with sexism in the workplace and the issues facing nurses of the future.
Kat, you’re now a band 6 in surgery – congratulations! - so you take on managerial aspects of running the ward as well as providing patient care. How do you find your feminism plays out in that role?
K There is a lot of sexism in healthcare and as a band 6 people look to follow you.I think that I bring my feminism into that because I want other nurses to feel that they can challenge things that they think are wrong and that I will support them.
In your experience, how confident are nurses in challenging poor practice or difficult behaviour?
K: Yes, from the perspective that there is a lot of hierarchical behaviour.
C Yes definitely, I see that all the time nurses not wanting to challenge - like you say, there is this hierarchy. Even in the elderly care and medicine, that may be seen as less hierarchical that surgery. I do sometimes wonder as nursing is so diverse by comparison to maybe medicine, that we are less confident in speaking out or that our voices aren’t heard.
I work with a consultant who always says that in elderly care she tries to flatten the hierarchy. She’s very conscious and aware of that. We do things like when we do the safety and falls huddles they take about ‘flipping the hierarchy’ because the healthcare assistants are the ones that really know the patients and trying to empower them to bring their knowledge in the huddles. We work really hard to flatten the hierarchy because it is engrain in healthcare work.
How is it in surgery?
K Horrendous. I was thinking about this, I have been criticised recently that when the consultants go on their ward round that I’m not smiling. The fact is that I go on their ward rounds and I do know the patients’ obs, I do know if they’ve spiked a temperature, I know all the things that I need to know, but I’m criticised because I’m not smiling at them when they come on.
That’s to a certain extent an emotional labour from you that you’re there to brighten their morning, as if you’re not there to do a job, but that you’re there to make the surgeons feel better.
K As you know, that’s not me.
C Also, that’s expected of women in life! How many times do you get ‘give us a smile’? To look pretty for you? Fuck off.
What are your experiences where you can see sexism playing out at work?
C It’s hard to think of specifics
K You just see it all the time
C You do just see it all the time. I do think that you see discrimination in healthcare a lot, and it always surprises me. Especially as nurses, you’re always taught to non-judgemental, it’s understanding that we look after people. Terrible things happen to people all the time, y’know they might end up in terrible circumstances so take the time to get to know the patient. Like, nobody wants to become a drug addict, nobody wakes up one day and decides to get pregnant to have an abortion. So why do we hold such terrible views of people?
I’ve seen it before where we had a trans* woman on the ward, this is going back years ago, people did not know how to even speak to her! I was like ‘she’s a person, she’s a woman, go speak to her!’ the wrong pronouns were used, if at all. It was horrendous it was awful.
I worked somewhere where I cared for a patient who passed away and we had to adapt our normal procedures to meet the patient and family’s cultural needs. I think it also challenged some of my colleagues expectations of what grief looks like cross culturally. I remember how different it was from training in a cosmopolitan city hospital where we were used to meeting the needs of a more diverse population.
I think it depends on the pre-conceptions of the team looking after the patient as to how well those needs are met. You still see things go on that make you wince.
K Yeah, I think going back, you do see sexism all the time in healthcare and I think that’s exhausting because sometimes you do feel like you don’t have the energy because it does happen so frequently and in micro-aggressions.
C yeah lots of micro-aggressions definitely. Even just watching male staff members speaking to female staff like they have some entitlement to them, and when I think of some of the unsolicited behaviour that goes on…
And does that behaviour go unchallenged?
C yeah definitely it’s creepy.
That’s proper Weinstein culture!
K Sometimes it’s really hard being a feminist in that culture at work, you feel exhausted most of the time.
C Yeah, it’s tiring a lot of the time.
Do you address that at work or deal with it on a personal level?
C I think a bit of both. I work with some people and their behaviour is accepted, I let it go because I don’t think I can change that alone. But some things I will definitely call out - then you start to get this reputation of being a “femenazi.”
K “Feminist Killjoy.”
C Then you think I’ll dial it down for a bit. I’ve had ‘she can make anything into a feminist issue’
But everything is a feminist issue!
So Kat, you’ve work with L how is another co-founder of The FNN who almost takes the opposite view to Charlotte, that she will call out everything and anything because she doesn’t feel she should have to put up with things that make her feel uncomfortable; even if it exhausts her, even if it makes her enemies. Being in the same service have you noticed any impact from you or her being more vocal on issues?
C I think that is the right way, I don’t disagree with that.
K I think that’s great. I have called things out and noticed change, but then I wonder is the change consistent or just because I’m there? Inappropriate comments get said and I think ‘I’m at work!’ that wouldn’t be ok out of work but I really don’t need another thing to deal with. I have called people out on that but I don’t know if they change their behaviour just because I am there.
Sometimes I think is it my job to keep going on and on, even though it is the right thing to do, I do wonder ‘why do I have to do this?!’ it is exhausting.
What do you see the next generation of nurses coming up against? Do you think that nursing is going to change?
C I don’t think nursing is changing enough really. I’m amazed that students are still doing some of the assignments that I did in 1995. We spend too long analysing our image and identity, and attitudes towards and from nurses need to change. There’s a really good article I read called Why Nurses Eat Their Young? And we do that, and I’ve seen a lot of student nurses over the years. I was just post Project 2000, with the diploma students and they were vilified, then the undergrad degree students and now I’m hearing ‘why do you need a Masters to be a nurse?’ it’s awful how student nurses are treated. Even though the evidence is out there, if nurses are better educated the better healthcare they provide. I just see student nurses being treated exactly the way I was.
What would you change?
C I think possibly the curriculum needs to be changed to help nurses gain more knowledge and be empowered. I don’t think we need to analyse our role the way that we do, maybe more around patient experience of illness and healthcare. As nurses we are the people who are with the patient more than any other profession, and we need to learn from them too. Changing our attitudes to students on the wards as well, they spend 50% of their time in clinical placement and if we are complaining about our new qualified nurses the only people we have to blame are ourselves.
K I think there is a bigger picture than that we’re so understaffed everywhere, we don’t have the time to support our student nurses properly. It is really shit being a student nurse, you’re working nearly full time on top of that you have assignments and you’re not paid properly – some are now paying to become nurses! It feels a bit like student nurses get battered down from the start.
C Nurses need time to mentor students on the wards. I rarely have a student nurse sometimes they get to spend the day with me and I love that but it is really time consuming. I’m committed to providing an education in practice and nurses need to be given the time to do that.