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The
Community
Psychologist

Volume 48 Number 1
Winter 2015

Special Feature

Toward a New Nursing Identity:  Organizing in the Face of Ebola

Written by Claire Cahen (ccahen@antioch.edu)

In 2013, the U.S. Bureau of Census estimated that women made up 90% of the Registered Nurse work force (U.S. Bureau of the Census, 2013). The profession remains as feminized as ever.  Journals of nursing are filled with studies capturing and decrying the gendered stereotypes of the field (Kelly, Fealy, & Watson, 2012; Hallam, 2000; Bridges, 1990).  Kelly, et al. (2012) found that images of nursing on YouTube today largely echo those of other means of mass media:  they represent nurses as “sexual playthings” and “witless incompetent” women.  Other studies, still, suggest another popular depiction: nurse as nurturing and “self-sacrificing” woman (Gauthier & Kjervik, 1982). 

Yet, with the Ebola virus crossing U.S. shores, the narrative of nursing has changed.  In the second week of October, Nina Pham became the first Registered Nurse to contract the Ebola virus on U.S. soil (Yan, 2014).  She had cared for Ebola patient Eric Duncan, who contracted Ebola in Liberia, but passed away from the virus at Texas Presbyterian Hospital, in Dallas (Yan).  A few days later, another RN who had treated Duncan, Amber Vinson, was also diagnosed with the virus (Botelho & Hanna, 2014). These two women set the stage for the nursing identity to be recast. 

The initial reaction to Vinson and Pham fell in line with what studies show the public believes about nursing.  National Nurses United (NNU), the RN union, had already staged a “die-in”, on September 24th, to protest the lack of U.S. hospital preparedness in treating Ebola (Pierceall, 2014).  The action received little attention.  When Pham fell sick, the response from the Center for Disease Control (CDC) was to blame her for “breach of protocol” (as cited in Steenhuysen, 2014). When Vinson also fell sick, nurses suddenly took their place as self-sacrificing American heroes.  The CDC apologized for suggesting any incompetence amongst healthcare workers (Nutt, Berman, & Dennis, 2014).  Texas Presbyterian Hospital executives recognized the nurses for their bravery (Nutt, Berman, & Dennis, 2014).   President Obama asked to meet with and personally thank Nina Pham (Lupkin, 2014). ABC, NBC, CNN and more released exposes on the two nurses. The stories that appeared, after the nurses became stable, talked about Pham’s reunion with her dog, and Vinson’s present of a free engagement ring. They also highlighted Pham and Vinson’s loyalty to their patients, and passion for caring (Lupkin, 2014; Fox & McClam, 2014; Ford, 2014).

The two nurses thus caught the attention of the mass media.  But a more important transformation happened beneath the feel-good articles: the nursing identity became fundamentally political. Nurses became whistleblowers on a private, for-profit healthcare system that is unwilling to invest to prevent and contain a potential pandemic like Ebola.  Consider that the story that ran concurrently with that of Nina Pham’s diagnosis was one of Pham’s colleagues decrying their hospital’s lack of preparedness (Macht, 2014).  NBC Today ran a thirty- minute live interview with Texas Presbyterian RN Briana Aguirre. She stood terrified, yet resolute, in front of the camera (Macht).  She told the country that she could not defend her hospital’s actions (Macht).  She revealed that, upon Duncan’s diagnosis, the hospital did not provide nurses with proper hands-on training, and gave nurses suits to wear that left their necks exposed (Macht).  Hospital officials also ignored a nurse’s demand that Duncan be put in isolation (Macht). RNs called the CDC to no avail: the agency could not give clear instructions on how to safely deal with the patient, or whether it was safe for the nurses treating Duncan to subsequently travel (Match).  No one was prepared, and Aguirre’s colleagues suffered. 

Aguirre was not alone in blowing the whistle on Texas Pres. More of her colleagues reached out to the nursing union, NNU, and asked the organization to release a statement confirming what Aguirre had alleged (NNU , 2014).  They then set up a conference call, where 11,000 people participated, to discuss what could be done to protect RNs and patients from Ebola, in spite of hospital and federal inaction (NNU).  The union, which represents 185,000 RNs nationwide, launched a petition to the White House, and Congress, asking for strengthened national Ebola guidelines to be released and enforced in all hospitals (NNU).  RNs at Kaiser and University of California facilities across California staged informational pickets to protest corporate healthcare’s paralysis in the face of the virus (Parr, 2014). 

And this time, the nurses’ organizing did not fall on deaf ears.  Governor of California, Jerry Brown, arranged a meeting between state government, Cal/OSHA officials, and union members to discuss what could be done to improve patient and staff safety.  Less than a month later, on November 14th, Cal/OSHA (2014) announced new Ebola standards that would go “beyond federal requirements.”  These standards are the ones NNU had originally demanded, and include requiring all California acute care facilities to purchase full-body protective suits, and respirators, as well direct training on use of this gear (Cal/ OSHA, 2014).   The new standards also protect “whistleblower” RNs who expose any hospital’s lack of Ebola preparedness (Cal/ OSHA). 

This victory is monumental for RNs.  It reflects a turning point for nurses.  Nurses are taking their place as a united line of defense for a comprehensive and preventative healthcare system.  RoseAnn Demoro (2014), executive director of National Nurses United, wrote an article in the Washington Post getting to the core of this shift:

“Ebola is exposing a broader problem: the sober reality of our fragmented, uncoordinated private health-care system. We have enormous health-care resources in the United States. What we lack is a national, integrated system needed to respond effectively to a severe national threat such as Ebola.”

The threat of the Ebola virus seems to have galvanized Registered Nurses to be advocates for reform.  They are standing up to hospitals that cut corners, in the name of profit-making.  They are advocates for real standards of care.  Aguirre’s “I can no longer stand by my hospital” (as cited in Macht, 2014) has become a resounding: “As Registered Nurses, we can no longer stand by our healthcare system.”

            The RN union has been organizing for healthcare reform for decades (NNU, 2014).  In this sense, their outcry is nothing new.  However, Cal/OSHA’s adoption of NNU standards for Ebola treatment represents the first time in recent memory where RNs were accorded such macro-level bargaining power.  Let us not forget that, only three years ago, Wisconsin Governor Scott Walker exempted the male-dominated professions of police officers and firefighters, but not RNs, from his budget cuts (Farnham, 2014).  Today, the tables have turned.  Even federal government is now consulting with the women of the RN union (NNU Organizer Theo Figurasin, personal communication, November 13, 2014).  The formal institutions of this country have recognized that RNs are not “self-sacrificing caregivers,” “sexual playthings,” or “incompetent” (Kelly et al., 2014). They are militant, angry, and organized for healthcare justice. 

            The question remains of how long this shift in public attitude toward nursing will last.  One of the most heartbreaking aspects of Aguirre’s testimony was her admission that, for blowing the whistle, she may never be able to practice as an RN again.  The reality is that the majority of RNs in this country are non-union, and have no protections or bargaining power in their hospitals.  They are thus understandably scared.  Is the enemy, then, not a degrading, and sexist public eye, but a system that punishes those who speak out?

 

References

 Botelho, G., & Hanna, J. (2014, October 28). Nurse's discharge leaves one Ebola case in U.S., though larger battle continues. Retrieved November 14, 2014, from http://www.cnn.com/2014/10/28/health/us-ebola/

Bridges, J. M. (1990)Literature review on the images of the nurse and nursing in the media. Journal of Advanced Nursing(15), 850-854. Retrieved from PsycINFO

California Department of Industrial Relations. (2014). Cal/OSHA Updates its Guidance for Protecting Workers in Inpatient Health Care Settings from Ebola. San Francisco, CA: California Department of Industrial Relations.

Cured of Ebola, Nina Pham anxious to see family, dog - NBC News. (2014, October 24). Retrieved November 20, 2014, from http://www.nbcnews.com/storyline/ebola-virus-outbreak/cured-ebola-nina-pham-anxious-see-family-dog-n233171

DeMoro, R. (13, October 13). U.S. hospitals not prepared for Ebola threat. Retrieved November 20, 2014, from http://www.washingtonpost.com/opinions/roseann-demoro-us-hospitals-not-prepared-for-ebola-threat/2014/10/13/4351ffc2-52cf-11e4-892e-602188e70e9c_story.html

Farnham, A. (2011, February 28). Cops vs teachers: Who's worth more in tight times? Retrieved November 20, 2014, from http://abcnews.go.com/Business/firemen-cops-versus-teachers-nurses-state-budget-crises/story?id=13003968

Ford, D. (2014, October 17). From bridal shop to Ebola ward: Who is Amber Vinson? Retrieved November 20, 2014, from http://www.cnn.com/2014/10/16/us/amber-vinson/

Gauthier, J., & Kjervik, D. (1982). Sex-role identity and self-esteem in female graduate nursing students. Sex Roles, 8(1), 45-55. doi:10.1007/BF00287673.

Hallam, J. (2000)Nursing the Image: Media, Culture and Professional Identity. Routledge, London and New York. Retrieved from PsycINFO

Kelly, J., Fealy, G., & Watson, R. (2012). The image of you: Constructing nursing identities in YouTube. Journal of Advanced Nursing, 68(8), 184-1813.

Landivar, L. (2013). Men in nursing occupations. Washington, D.C.: U.S. Census Bureau.  Retrieved from http://www.census.gov/people/io/files/Men_in_Nursing_Occupations.pdf.

Lupkin, S. (2014, October 24). Ebola-free Nurse Nina Pham visits president Obama. Retrieved November 20, 2014, from http://abcnews.go.com/Health/ebola-free-nurse-nina-pham-visits-president-obama/story?id=26406480

Macht, D. (2014, October 16). Dallas nurse slams hospital: "We never talked about Ebola" Retrieved October 16, 2014, from http://www.nbcnewyork.com/news/national-international/I-Can-No-Longer-Defend-My-Hospital-Dallas-Nurse-Says-No-Special-Ebola-Precautions-279406722.html?_osource=SocialFlowFB_NYBrand

NNU. (2014, October 15). NNU national conference call on Ebola preparedness. Retrieved October 15, 2014, from https://soundcloud.com/national-nurses-united/nnu-national-conference-call-on-ebola-preparedness

NNU. (2014, October 15). NNU Petition. Retrieved October 20, 2014, from http://www.nationalnursesunited.org/page/-/files/graphics/1014_Ebola_Letter_Obama.pdf

NNU. (2014, October 15). The Blog. Retrieved October 20, 2014, from http://www.nationalnursesunited.org/blog/entry/statement-by-registered-nurses-at-texas-health-presbyterian-hospital-in-dal/

Nurses stage Ebola 'die-in' on Las Vegas Strip. (2014, September 24). Retrieved September 24, 2014, from http://www.lasvegassun.com/news/2014/sep/24/nurses-simulate-ebola-deaths-vegas-strip/

Nutt, A., Berman, M., & Dennis, B. (2014, October 13). CDC chief: After Dallas nurse's Ebola infection, U.S. must 'rethink' protocols. Retrieved November 20, 2014, from http://www.washingtonpost.com/national/health-science/cdc-chief-after-dallas-nurses-ebola-infection-us-must-rethink-protocols/2014/10/13/5317a9a8-530f-11e4-809b-8cc0a295c773_story.html

Parr, R. (2014, November 13). Nurses demand better Ebola protection at Oakland rally. Retrieved November 20, 2014, from http://www.contracostatimes.com/breaking-news/ci_26924615/nurses-demand-better-ebola-protection-at-oakland-rally

Steenhuysen, J. (2014, October 13). U.S. CDC head criticized for blaming 'protocol breach' as nurse gets Ebola. Retrieved November 20, 2014, from http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013

Yan, H., Baldwin, B., & Burnett, E. (2014, October 16). More than a nurse: Who is Ebola patient Nina Pham? Retrieved November 16, 2014, from http://www.cnn.com/2014/10/14/health/ebola-who-is-nina-pham/

Claire Cahen is a student in the Masters in Psychology program at Antioch University.  She has been involved in the labor movement since 2009, and worked as a union organizer for the California Nurses Association in 2013-2014.

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