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Nurses Seek to Upgrade Their Profession in a Changing Medical World : Image Problem Contributes to Lower Status

February 17, 1985|ANN JAPENGA | Times Staff Writer

The choice was not an unusual one in some working-class families 20 years ago.

According to the values of her parents, Barbara Limandri could become a nun, a nurse or a schoolteacher. A stint at Catholic school convinced her that she was not nun material, Limandri said. And she did not wish to spend her days herding toddlers.

So Limandri became a nurse.

A scholar who researches women in crisis and a member of a radical feminist nurses' organization, Limandri, now 36, is a contradiction of her family's notion of what a nurse should be. But since she grew up in the nurse-nun-teacher days, it's sometimes hard for her to reconcile her activism and her career choice.

A Feminist Nurse?

"I'm a nurse, for crying out loud," Limandri said during a recent interview at UC San Francisco where she's a doctoral student in nursing. "How can I be a nurse and be a feminist at the same time? How can I be a nurse and attend a Take Back the Night march (an annual rally protesting violence against women)?"

Limandri's quandary--how does my traditional occupation jibe with my image of myself as an aware, involved individual?--is a dilemma familiar to nurses everywhere in the '80s:

--A rural nurse practitioner working in Northern California remembered that she once advised a childhood friend that "only dumb people" become nurses.

--A psychiatric nurse practicing in San Francisco said she had read about Cherry Ames (the nurse-heroine of a series of popular children's books in the '50s) when she was growing up. "I decided this Cherry Ames character was too sweet for words, and I was not going to be this person."

----Patricia Underwood, president of the California Nurses Assn., said that based on the stereotype that nurses are either chaste angels of mercy, or sex objects: "It looks like we're in a subservient practice that no mother would want her child to go into if she's at all a humanist.

"Image is our major problem and has been as long as I've been in nursing--25 years," added Underwood, a clinical professor at UC San Francisco's School of Nursing. "The way that patients, physicians and legislators see us produces great problems. And a whole lot of that has to do with the fact that we're a women's profession." (Although the number of men in nursing is increasing slowly, 97% of all nurses are women.)

More and more nurses are obtaining master's and doctoral degrees; and some are entering specialities in much the same way doctors have done for years. But it's not the growing complexity of the job that most often comes to mind when people think of nurses--it is their ability to provide solace, classically thought of as a woman's duty.

Just as emotional leanings are sometimes used to cast doubt on the competence of women in politics and other fields, nurses have found their capacity for caring used against them. The implication, Underwood said, is that a nurse cannot be compassionate and technically competent at the same time.

The devaluation of nurses' work has been graphically reflected in the budget structure of hospitals. While patients normally receive an itemized bill for every cotton ball and syringe used during a hospital stay, nursing care still usually falls under the category "room rent," according to Underwood.

Studies currently in progress at several universities will attempt to determine--in monetary terms--just what a nurse's attention is worth. Once these guidelines for "costing-out" nursing service are established, Underwood said, health care providers will be able to gauge exactly how much a nurse contributes to a patient's recovery.

'Full-Fledged Partners'

American Nurses Assn. President Eunice Cole and other nursing leaders hope such studies will help to speed nurses' battle to become what Cole called "full-fledged partners in the health care delivery system."

Because of a shift in medical economics, measures such as costing-out nursing care have attained greater importance. Prospective pricing, a new federal payment plan for Medicare patients, went into effect in 1983 and is expected to be fully in swing by 1987. The system is intended to control costs by putting a ceiling on the amount Medicare will pay for specific conditions. Hospitals that provide service for less than the specified amount will be able to pocket the difference.

With the race on to cut expenses and shorten patient stay, nurses suddenly find themselves in a position of influence.

Increase Efficiency

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