Ashley Taylor

Cultural Anthropology 1010

Introduction

Nurses are the cornerstone of healthcare but society as a whole does not understand
the role of the registered nurse. According to the Journal of Nursing, “They know that a caring
nurse can give comfort and solace to someone in need. The public perceive a nurse as just
someone who assists the doctor during and after treatment of the illness assisting the patient
in keeping up his personal hygiene, giving the medications as prescribed by the doctor, dressing
the wounds when there is a need ensuring the welfare of the patient.” The Bureau of Labor
Statistics, in May of 2018, stated there were approximately 2, 951,960 registered nurses in the
United States. Within the total number of registered nurses are many sub specialties.

One of the most well-known areas of specialization is critical care within the emergency
department. The emergency department is a unique sub-culture within healthcare (Person,
Spiva & Hart). These nurses are portrayed as calm under pressure, tough skinned individuals
who are not overly emotional but very competent and highly skilled in their nursing practice.
Are these generalizations myths or facts?

There has been anthropologic research on the culture of nursing but not as much on the
sub-specialty of emergency nursing. It is a fascinating area of practice for nursing with a lot of
generalizations. The desire was to find if the generalizations had some truth and if not, what
the culture of emergency nursing was really about. Many of the character traits initially
observed seemed to follow the generalizations but when giving it a closer look, there were
many new revelations.

Methods

The study of this culture stated with exploration on the internet and in journals,
gathering data, and then observation. Permission was received and paperwork completed to
comply with federal privacy laws and legal statues, and observation of this sub-culture of
emergency nursing was started at Intermountain Medical Center Emergency Department in
Murray, Utah. Orientation to the emergency department was accomplished by one of the unit
charge nurses. It was suggested that my observations follow the flow of the emergency
department from the greeter desk, through triage (which is sorting of the patients), and then to
patient care in the department. Time was also spent with the lead nurses in the unit called
team leads or charge nurses.

Initially time was spent in observation of the staff in the unit. It is necessary to get a
basic understanding of the environment in order to understand the culture. The unit map of
flow was provided and explained. Next, nurses were interviewed and all asked the same
questions.

Three different days of observation were done at various hours of the day. The first day
of observation was accomplished on typically the busiest time in the emergency department.
Two hours of observation was accomplished in the evening on a Monday. Observation was
done at the greeter desk and waiting room of the emergency department.

The second opportunity for two hours of observation, during the middle of the day from
11:00 a.m. to 1:00 p.m., was accomplished in the main parts of the emergency departments.
Nurses in that area were asked clarifying questions as well as ethnography questions.

The last 2-hour period of observation occurred on Monday afternoon. On this occasion I
observed the leadership roles of the charge nurse and team lead nurses. It was challenging to
understand all that was happening. Clarifying questions as well as culture questions were again
asked.

The culture of emergency nursing is very complex. The nurses were happy to educate
and help with understanding. Not only is nursing complex but the healthcare in general is
facing challenges and appears to be complex as well.
 Body

Health and Illnesses

Health within the hospital is very diverse. There are a lot of different illnesses and
conditions that are treated within the hospital including organ transplants, cancer, trauma or
injuries, childbirth, heart surgery, and stroke with many more. They have specialized units of
where to put specific people that have the same illness there so that in return they may not get
others sick that have different types of illnesses.

Each sickness there I find quite sad because they are all dealing with something that is
completely out of their control rather than a mere cold. I hoped each time I learned about
where and which sicknesses have the most effect on the hospital and people

Human Rights

Every nurse to come to a similar point of view when it comes to human rights
agreements and the legislation. It is slowing expanding importance to people needing nursing
care and to nursing staff to achieve better outcomes for everyone.

They strongly support the ideals and principles placed in the Universal Declaration of
Human Rights which is the primary statement of worldly agreed human rights. It should be a
common standard of success for all people and nations.

Human rights and protection are vital. Everyone supports the position of its worldly
globally nursing body. The human rights approach is essential, both in health and policies and
services that mean nurses need to actively attend to people’s right every moment of every day.

Nurses own a duty of care to their patients and need to pay full responsibility to their
actions in protecting the patients “human rights.” Though, nurses’ own rights are significant.
They should be able to carry out their job in a safe working environment without any ridicule or
violence. Nurses are duty holders in the eyes of law and rights holders according to the rights
within the hospital.

As a national nursing body, they support the constant flow of a human-rights based
approach to health care. The nurses uphold to taking this approach in their own work by
altering nursing and the health policy; by developing communicating and practice standards to
make it better.

Gender

Gender within the emergency department is very diverse. While women are the main
variety among the gender as far as nurses go, there is very little men there. Male nurses
represent a small number of the working nurses in the United States.

The popular judgement that nursing is not for men seem to be major obstacles of
bringing more men to the nursing field in which you can only see women. Often, you can see
many male nurses in lower positions as to the women getting high leadership statuses and in
special intensive care, emergency operating rooms

Attitudes, gender roles, care issues and nurse shortages, and motivation can influence
the men in nursing to a great extent. Most nursing fields only recruit men due to the level of
education and sex, making it harder for them to be admitted.

As in perception, studies show that men need to be admitted more often due to the
gender flourishing along with the females, giving more variety and the men what they wish to
do in life.

In issues, women declare that men should not be able to care for people due to how
they appear and the bewilderment that some men would even do such a thing.
 In a recent research study, it is shown that a male’s motivation is due to the ridicule and
negative talk they receive daily. They have shown the difficulties can be overtaken by the
gender expectations of male nurses and improve their knowledge and expectations.

Art and Media

Art and media in the emergency nursing is very interesting. Their humor within the
hospital is different from what anyone would expect. It is in their artwork plastered and
hanging up on the walls of the E.R. or hall of the hospital. Most art that you can see is very
expressive of people helping one another or environment settings such as sunsets, oceans,
forests, landscapes and so on. Anything that basically represents the environment.

Within that artwork on the edges; the frame, are things doctors and nurses would use in
their work every day. A while back, I went to the E.R. during-near Christmas and they had a tree
there. It isn’t the normal fake pine tree. It is a pine tree made from plastic gloves and tampons.
Don’t ask me why. They have a rather weird sense of humor, but at the same time it is rather
funny that they would consider such things to make a tree instead of other things. Less weird
than seeing tampons on a wall.
 Religion

Religion within the hospital is filled with various people who believe in different
religions. Hindu, Christianity, Muslim, etc.….

When it comes to religion inside the hospital, there are many views on what the
patients and doctors or nurses think and want to believe in. And when it came to the religious
factor in the hospital, everyone was respectful of one another and enjoyed conversing with one
another, putting aside their beliefs and differences which you really don’t see in society
anymore which is very rare to see nowadays considering how society constantly discriminates
religions and how people think.

Religion within the hospital is very diverse from the outside world. Within the hospital
are various rooms that represent as a different culture where one can go and relax and pray to
their God or Gods and Goddesses.

I went inside some of the rooms and they were very- beautifully decorated in what their
culture represents. Pictures, crosses, candles and even clothing which is very detail oriented.
Over all, it is amazing to see two and many more religions within the hospital, both patients and
those who work their compromises which helps them

Class and Inequality

Emergency department nurses will be first to talk about inequality in healthcare. When
it comes to patient care, those with higher social status and money often get preferential
treatment. Nurses say they treat all patients in the same manner but hospital administration
communicates that this is an important person and must be treated with the best care. Those
patients that have financial assets can get the type of care they desire. Those within the middle
class, many times, struggle to maintain health insurance because of increasing health insurance
premiums. The low-income families have healthcare coverage due to Medicaid. Many times
these low incomes families use the emergency department as their primary care, bringing in
the whole family to address non-emergency health complaints. One nurse described a family
that he recently cared for that was seen for a long-lasting cough, ingrown toenail, a skin rash,
and headache.

Emergency department nurses will also talk about “frequent flyers”. A “frequent flyer” is
a patient that comes to the emergency department frequently instead of seeking care through
a primary care and other appropriate physician. The nursing staff, over time, realize that they
become biased due to seeing this patient so frequently. The nurses tend to minimize the
patient complaints because they have heard it previously. It is similar to the boy who cried wolf
too frequently and then when the wolf came the village did not believe him.

Emergency department nurses also know the problems of little or no resources in the
mental health area. Patients that are suicidal, homicidal and have psychiatric problems
sometimes wait for inpatient beds for days because it is not an area that is well funded by
government or private healthcare insurance, so resources are tight.

Nurses are affected by inequality within their ranks. While the majority of nurses are
female, nursing administration has a greater number of males in those positions than females.
Male nurses, once at the administrative level, have been shown to receive a higher pay then
their female counterparts (see appendix A). Male nurses are discriminated against although
when practicing at the bedside in labor and delivery in a large percentage of cases. Women
want a female nurse when it comes to gynecology and obstetrics, even though they have a
male physician.

Economy, Politics and Power

Many nurses enter healthcare because they want to make a difference in the lives of
others and feel it is a privilege to serve in this capacity but then find that healthcare is a highly
politicized environment, not neutral like they initially thought. Healthcare organizations are
companies with politics like any other company. Many of the healthcare reforms in recent years
try to control the cost of nursing care by limiting the resources in the largest workforce in
healthcare. Nurses are asked constantly to do more with less and perform at the highest level
of efficiency. Once they achieve this level, they are pushed to do more. Most nurses fail to
realize that because they are the largest workforce within healthcare, they have power to
influence.

Nurses have power in other ways. Nurses can use their power to influence changes and
to enhance the health and wellbeing of the community, one patient at a time. Nurses can
challenge the current understanding and practices and look for best practices in their work
which positively affect patient outcomes.

Another area of power can be the nurse – patient relationship. Nurses are involved in
caring for the sick and injured patient, as well as promoting healthy lifestyles. Nurses have
power because patients put their trust in nurses and assume that nurses will do what is best.
Nurses also have a position of power over their patients due to the knowledge of the body,
disease processes, and the healthcare system. Knowledge is power and just the ability to impart
or withhold information puts nurses in a powerful position when it comes to the nurse – patient
relationship. Now the nurse has not only knowledge but also the patient’s trust. Nurses have
the moral obligation to advocate for their patients which most nurses take very seriously.
Nurses, as a group, can work towards changing processes that improve health and society.

Conclusion

Emergency room nurses are portrayed as calm under pressure, tough skinned
individuals who are not overly emotional but very competent and highly skilled in their nursing
practice. I did find some of these perspectives to be accurate. The nurses I observed seemed
to have very good coping skills. I found them laughing frequently or making light of a hard
subject which I found to be a coping mechanism with their high stress environment, where
their actions could mean life or death. The nurses also appeared very knowledgeable about
their work and all possible diagnoses. Emergency room nurses work very quickly and can
accelerate that speed at any moment. I also found that they could do many things at one time.
When I interviewed the nurses, whether they were female or male, young or old, and a variety
of cultures, they all said they became a nurse for about the same reason, that of making a
difference in another person’s life and making a difference in society.

I found some of the generalizations to be incorrect. The emergency nurse is protrayed

as a tough, unemotional professional doing a job. I found in my observations that the nurses
really cared for others, including hard to please patients. I found them to be patient and kind.
I saw sadness as well as other emotions with a bad outcome. They appear tough on the
outside but they hide their emotions in front of patients but I did see them letting out those
emotions with other nurses. I gained a great respect for the job they do, their professionalism
and their desire to help others.
 Bibliography

An Ethnographic Study: The Culture of an Emergency Department. Person, John; Spiva,

LeeAnna; Hart, Patricia. Kennesaw State University.
https://www.wellstar.org/education/documents/nursingresearchconference/slides/personslide
s092112.pdf

Occupational Employment and Wages, May 2018, Bureau of Labor Statistics. United States
Department of Labor. https://www.bls.gov/oes/current/oes291141.htm

The Real Public Perception of Nurses. The Journal of Nursing, December 1, 2007 / ISSN 1940-
6967. https://www.asrn.org/journal-nursing/249-the-real-public-perception-of-nurses.html
 Appendix

Appendix A: https://media.jamanetwork.com/news-item/pay-gap-between-male-and-female-
rns-has-not-narrowed
Appendix B: Nurses working quickly in the emergency department