Asking Who “Gets To Be” in Nursing

Something that has been on my mind here lately is the question of who does or does not “get to be.”…. You can insert whatever adjective or title that you wish behind that little phrase. I’ve especially been thinking about this as it relates to my profession, nursing. Particularly on who holds the societal and systemic power to define and decide who “gets to be” and “what “they” get to be in nursing. I want to acknowledge that the idea of “Being” can mean many different things to many people and cultures. As it relates to this post, being, to me, is more than being present or having possession of something that makes you apart of a larger community. Being is not synonymous with existing. Rocks exist but can’t necessarily “BE.” Being, for me, involves having ownership of oneself as we relate to others and relate various aspects of self in relation to others. I also don’t think my definition of being is limited to what I said here.

A little aside, we must understand that nursing is a fantastic amalgamation of many different things. So many make the mistake of narrowing what nursing is and what it can be. First and foremost, nursing is about people and the things and processes that exist where people exist. This being the case, nursing is concerned with most forms and sectors of knowledge. For example, we are determined to restrain nursing as being solely (or even primarily) within the realm of healthcare. It is my belief that this “boxed in” thinking lacks imagination and creativity that we desperately need in the profession. Nursing is as much a social service as it is a clinical one. Nurses are as invested in understanding and mitigating the impact of the ecological changes on the lives of the people we provide services to as much as we are in understanding how medications impact an individual’s life. There are nurses already infusing nursing with other disciplines and sciences, such as Elle Hahn, the BREATHE effort at the University of Kentucky. There are Nurse-Midwives in California contributing to citizen science projects like the B-SAFE study, which aims to study wildfires’ impact on pregnant folks and their babies. Because of its focus on people, nursing is well-positioned to interact with various disciplines and realms of knowledge, even outside of the health and life sciences. It is my personal belief that nursing’s liberation from what it has been limited to in the past lies in embracing this idea that we belong in many different places and that ALL nurses should be empowered to create NEW WAYS OF BEING, not just in healthcare or healthcare as it exists currently. As a profession, nursing has been bound and gagged for a long time, and we need to be able to express our creativity and explore new ideas. We (the collective we) have historically been limited and told what we “Get to be” and HOW we “get to be” (or exist), and we hold some of the blame for this, but this is another topic that I will discuss later.

As a Black man and second-generation nurse, my experiences and positionality have enlightened me to some unpleasant truths about nursing, some bitter pills, you might say, about who “gets to be.”Being Black, navigating processes and institutions that question my right to be present and have an opinion, and take up space is a daily aspect of life. As a Black man who is a nurse, I fall into two minoritized or historically excluded (as Dr. Monica McLemore is known to say) groups in nursing; this comes with its own additional challenges. I will outline some of them below:

1. Firstly, we love to guard who does and does not get to be a nurse. So many times, when having discussions about equity and increasing access to nursing education, I hear folks lead with, “well, everyone shouldn’t be a nurse.” This framing is problematic for several reasons, one of those being that the primary individuals who say such things are those a part of the dominant group in nursing, white women (and men). This framing places gatekeeping at the forefront. Meanwhile, racism and the centering of whiteness continues to be an ongoing issue in nursing education and healthcare at large (Bell, 2020) & (Bailey et a.l., 2017). So in our efforts to weed out folks (see my thoughts on terms and practices like this here), we are still admitting folks, such as racists, misogynists, and bigots, into nursing. We have NOT historically had broad and systemic mechanisms and efforts in place that weed out folks with these deadly characteristics, though folks who have been doing this work certainly exist. So, no, I do not believe in starting a conversation with “well, everyone shouldn’t be a nurse” because that statement fails to acknowledge that all nurses aren’t inherently “good” for the profession or the people we seek to serve the world. It also fails to recognize our profession’s historical (and present) role in UPHOLDING colonialism, racism, and white supremacy (Waite & Nardi, 2017). This mindset also centers the dominant presence in nursing, again white women (and men), as the authority of who does or does not make a “good” nurse or potential nurse. Who or what gives them this power? Why aren’t there more of us questioning this more often? The answer to those questions could be a whole other post.
2. When those of us who come from historically-excluded and/or marginalized groups manage to overcome the ever-present barriers to entering and existing in nursing, we then have a new set of challenges and obstacles. This happens because nursing, like many other disciplines in academia and healthcare, always seeks to create and reinforce hierarchies that allow some to feel more involved or important than “others.” Often those “others” are folks who come from historically-excluded or oppressed groups. We see this manifest in the ceaseless war on accessible nursing education. An example of this is the pitting of the associate degree in nursing (A.D.N) versus the bachelor of science in nursing degree (B.S.N), both of which produce registered nurses (RNs). Further, we see minimization of the importance of licensed practical/vocational nurses (LPNs/LVNs), and the versus battles goes on up to doctoral nursing degrees, Doctor of Nursing Practice (D.N.P) versus Doctor of Philosophy in Nursing (Ph.D.). When degree options have been exhausted, we then search for other things to demonstrate superiority. What school did you attend? Was your program online or in-person? The search for superiority is never-ending and tiresome.
3. We jealously guard who gets to be viewed as a scholar, scientist, theorist, leader, innovator, and change-maker on nursing. This is particularly disturbing, as our profession itself battles with external persons and institutions who try to limit whether we get to be viewed as scientists, scholars, leaders, or even autonomous. The ability to be considered to be a scientific discipline undeniably comes with a measure of societal power and influence, to paraphrase the Pew research group (2015). In addition to the esteem that comes with being designated a science, the designation also impacts funding and money allocated to nursing. In efforts to establish itself as a science in the eyes of the world, nursing often leaves behind many in our profession, as well as the communities we serve, in my opinion. Nursing and the academy often do a poor job of acknowledging ways of knowing and understanding that are outside of the historically white norm. Ph.D. candidate Anthony James Williams wrote an important article for Inside Higher Ed that discusses how the act of theorizing by Black Scholars can differ from their white counterparts, yet is no less valid (2018). A dear friend of mine, Dr. Jess Dillard-Wright, introduced me to the idea that all nurses theorize all the time and are theorists in their own right. This shocked me, but it also makes A LOT of sense. However, because this thinking is not shared or validated by the academy, many nurses don’t feel this way about themselves or their work. From the perspective of science, another conundrum arises in my mind. If we assert that nursing is science (also an art), then this science must belongs to us all. By all, I mean from the advanced practice registered nurse (APRN), to LPN colleagues, and those with or without a graduate-level nursing degree. Nursing science must belong to us all, but sadly this sentiment is not evident throughout the profession, in my experience. Nursing science is, as with many other profession, made to feel distant and out reach for many of us. It seems to be only for those with certain positions or certain letters behind their names.
4. The power of deciding what is a priority for the various aspects of the professions is not equally distributed. We have evidence that tells us of the disproportionate number of Black nurses in leadership (Jefferies et a.l., 2018). Those in nursing leadership positions or education hold an undeniable influence over nursing, even if it is localized to a particular unit or shift within an organization. Because of the “power” and influence that people in these roles have, it’s no surprise that historically excluded folks (read: Black Indigenous People of Color (BIPOC)) continue to be found scarcely in these roles in nursing (Kolade, 2016). Particularly in academia, I rarely see myself reflected in the academic and nursing education settings in which I exist as a Black person. Considering my identity as a Black Man, the deficit is even more pronounced. This has many reasons, which have been discussed by others and which I hope to delve into more myself one day.
5. The “how” in all of these conversations about who “gets to be” matters too. A part of the tax of being a part of a historically excluded group is having our ways of expressing our truths, and knowledge FREQUENTLY questioned, delegitimized, and stigmatized. The urge to assimilate our ways of knowing and fit what academia tells us are acceptable forms of knowledge building and dissemination. This means that even when writing an informal blog post where I’m sharing my opinion, I battle with the urge to “sound more scholarly,” something I’m still working to overcome at the time – being more comfortable with being heard in my own, in all of its manifestations from African American Vernacular English (AAVE) to my love for uncommon words that express precisely what I want to say.

So, that was a little all over the place, but you know what, it’s ok. I’m earning to accept, more and more, that it’s ok to not always think in clear and clean-cut lines, a colonialist notion, I’m sure. I believe it is one’s ability to partially think outside of the box that allowed Professor Kimberlé Crenshaw to deliver to us the analytical framework and term known as intersectionality (Crenshaw, 1993). I believe that in thinking about things more abstractly, we discover new connections that solely linear thinking would have us dismiss or not see. I’ll end my ramble of thoughts on who “gets to be” in nursing on this note, that in our constant limiting of who gets to be, we’ve limited what COULD exist. By determining who “gets to be” and HOW they get “to be, ” we have become blinded to what folks already ARE and what extraordinary qualities and greatness they already possess outside of the position, benchmarks, and titles, we’ve been taught to view as primary markers of value. Happy Nursing!