The Normalization of Silencing: The Interplay between Nurses' Experience of Working Conditions and Gender Equality Ideals

Abstract

Despite Iceland’s reputation as one of the most gender equal countries in the world and the idea that gender equality is an intrinsic part of Iceland’s national identity, the country’s labor market is highly gender segregated. This is particularly the case in female-dominated sectors such as education and the caring professions. As a case in point men make up about 5% of nursing staff in Iceland, which is low compared to countries with similar levels of gender equality, such as the other Nordic countries. As a female-dominated profession, nursing has long been linked to vocation and altruism, where the commitment to help and care for others is considered one of the most fundamental attributes of the professions’ identity. The feminized construct of care may be a key factor in discouraging men in Iceland from entering the nursing profession. Moreover, working conditions of nurses in Iceland have been characterized by understaffing and high rates of attrition due to work-related health problems. Considering the gender imbalance in the nursing profession, the aim of this dissertation is to explore nurses’ perceptions of the interplay between their working conditions and gender equality ideals in Iceland, focusing on power relations and occupational well-being. The dissertation is based on data collected through semi-structured interviews with 31 nurses working at the National University Hospital of Iceland, 24 women and 7 men. The interviews centered on the participants’ expectations for the job and what prompted them to become nurses. Working arrangements, the impact of working conditions on their health, communication and cooperation with colleagues and supervisors and possibilities for autonomy and professional development were also topics of discussion. In the first article the theoretical approach describes the multiple and often incompatible tasks of nurses. The other two articles draw on social constructionist and poststructuralist feminist theories. Analysis of the interviews was guided by reflexive thematic analysis, and the results were presented in three articles. The first article addresses various dimensions of power dynamics in the nurses’ work, considering the demanding working conditions, interactions and cooperation with other professions and the effects of the gender imbalance. The findings reveal that the working life of the participants is characterized by deep-rooted traditions concerning gender and roles in the hospital hierarchy. As a symbol of the power imbalances and restricted autonomy which they experience, nurses’ working space and professional boundaries are spatially and symbolically neglected by other professionals. The result is the nurses feel that their professionalism is undermined. To deliver necessary professional care, they make compromises at the expense of their own health. This sometimes borders on being unethical, while the nurses seek a balance between their professional conviction and expectations of the organization. In their opinion, attracting iv more men nurses could enhance equality and positive atmosphere. Working on wards with a balanced gender ratio is for them a liberating experience. The second article focuses on effects of gender-based stereotypes on career choices and work life of the participants, in which these stereotypes turn out to have substantial influence. The women describe how they glid ‘naturally’ into nursing while the men faced that ideas of masculinity classified them as deviant. The men also had to define for themselves the content of nursing and caring to justify their place in the profession. Stereotyping also strongly influence on-the-job experiences of woman nurses, whose work contributions and knowledge tend to be less valued than those of the men nurses due to notions that associate women with weakness and submission. The woman nurses believe that men nurses can be positive role models for them in being assertive and speak their mind when they are subjected to oppressive behavior. The third article addresses how nurses’ prior expectations for the job compare to their actual work life. The findings reveal how stereotypes about feminine submission prevail on the wards where only women nurses work. Strict rules require the nurses to stay on the ward for the entire shift, resulting in gender isolation from participating in the general space of the hospital. They experience a lack of trust and support from their superiors, and that the hospital management practices put the hospital's interests above the nurses' well-being. This experience of indifference has harmful effects for nurses, their clients and many parts of society. It is a major cause of nurses leaving work and influences their experience of discrepancy between their aspirations for the job and reality of work. Most of the female participants had found it difficult to make ends meet financially and workload had negatively affected them and their families. The results from the articles indicate that the feminization of nursing as subservient helps explain the associated gender imbalance and disempowerment nurses experience at work. Attracting more men nurses could enhance gender equality but may prove difficult due to gendered stereotypes of nurses. It is also a task that requires extensive societal discussion on the power of stereotyping and the definition of gender equality. Considering the nurses' poor working conditions, hospital management must revise the occupational policy and qualification requirements of managers and supervisors. The situation may be different in other nurses’ workplaces. In this dissertation, my assumptions are that a profession’s gender equality status must be understood/examined in the context of working conditions, health protection, professional recognition, autonomy and respect. The findings indicate that the participants experience unhealthy working conditions and a lack of support from their supervisors and the hospital management. Strong hierarchical power, sustained by stereotypical essentialist ideas, limits nurses’ professional recognition. The findings also indicate that the feminization of nursing disempowers women nurses and deters men from entering the nursing profession. It can therefore be concluded that the participants do not enjoy the rights and conditions that are prerequisites for gender equality.