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Professional dominance and the oppression of the nurse: The health system hierarchy By Hannah Ferguson and Dr Judith Anderson
The healthcare system has come a long way from its traditional roots of hierarchal and subservient relationships between physicians and other healthcare professionals.1
T
he nursing profession is one that is often perceived, even by nurses, as the caring profession, and often stays removed from the political scene. Together these features contribute to its ongoing struggles with subordination and power dynamics between themselves and other healthcare professions, predominately medicine.2 (When one profession holds dominion over another, it silences the other, creating oppression; the nursing profession are often regarded as an oppressed group.2,3 The following paper analyses, through personal reflection, oppressed group behaviours of the nursing discipline within the context of patriarchal oppression. THE INCIDENT A 23 year old male, was transferred to the medical ward from the emergency department (ED) following a mechanical fall from a bicycle. Imaging reports showed two fractured ribs with no other underlying injuries; however, the patient complained of significant pain and therefore a cumulative dose of 100mcg fentanyl intravenously, 25mcg fentanyl subcutaneously and 5mg oxycodone had been administered in the ED. The patient was awaiting a head CT* to rule out head injury. The patient appeared drowsy but orientated and the Registered Medical Officer [RMO] in attendance stated they were not concerned regarding the amount *Computed tomography scan
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of pain relief administered, advising to let the patient “sleep it off”. Later I noticed the patient’s lips looking blueish. I was able to rouse him by calling his name, his colour returned, and he was orientated to his surroundings. Oxygen saturations were 90% trending up and respiratory rate 11. I applied oxygen 2L/min via nasal prongs believing pain relief to be the cause and notified my Team Leader [TL] and RMO. The RMO assessed the patient and requested that I remove the oxygen as the patient had been “oxygen free in ED and it is counter-productive in people who do not need it”. I explained that I was concerned the patient’s oxygen requirements were unmet as I had witnessed his lips turn blue to which the RMO responded ‘allegedly’. My TL in attendance explained I was a new nurse and that they would assist me with the patient’s ongoing care. I removed the oxygen from the patient but kept the oximetry on to monitor oxygen saturation. The patient drifted off to sleep and the alarm bells on his oximetry rang, I attended the patient again: he was blue around the lips, his oxygen saturations 76%. I called for assistance but was able to rouse the patient using painful stimuli, my TL witnessed this episode and initiated