I’m fortunate to be a female resident in urologic training; only about 25% of urology residents are women. Even better is that my experience as a resident, while challenging, has been positive overall. For the most part, I don’t feel that I’ve been treated differently from my male co-residents, and I appreciate that.

Despite this, however, I’ve noticed a prevalence of challenging interactions with hospital staff, including nursing assistants, nurses, and technicians. Most of these challenges, interestingly, seem to occur with female nurses. Sometimes my requests are questioned, or my medical knowledge goes ignored.

In these frustrating moments I wonder, can female doctors and nurses be friends? Can’t we respect and support each other? Why am I seemingly being punished by my fellow women?

Facing Gender-Based Challenges

For years, I didn’t know the vocabulary to ascribe to my feelings, or whether I was imagining these observations or their connection to my gender. Then, I heard Dr. Caprice Greenberg’s Association for Academic Surgery 2017 Presidential Address, “Sticky floors and glass ceilings.”

The entire talk is enlightening, but what caught my attention was that Dr. Greenberg gave a voice to my sentiments:

“When you behave at odds with your gender schema, there is a backlash effect, and this is well-documented across a number of different disciplines. Women are interpersonally penalized for violating gender schemas. Multiple studies show that both men and women assign lower status and salaries to women who engage in self-promotion, have task-oriented speaking styles, have an authoritative leadership style, administer discipline, and initiate salary negotiation.” — Dr. Greenberg

Gender schemas? Implicit bias? Microaggression? I admit that when I first heard the lecture, I could not define any of these. Yet, as a female in urology, most of my professional life is “at odds with my gender schema,” so I quickly became interested.

I discovered that there is validity to my thoughts about gender-based challenges at work. But, why did it seem to occur more frequently with other women than with men? Is it simply a sampling bias, since, after all, there are more female than male staff in the hospital?

I took a deep dive into qualitative psychological research. In summary, I found that:

• Female nurses hold female physicians to higher professional standards but paradoxically are more hostile towards assertive female physicians (who are trying to live up to those high standards).

• On the opposite side of the research, one study cited that over 80% of female physicians feel that they have unfavorable treatment from nurses as compared to their male colleagues.
• The silver lining to this is that female nurses feel more comfortable communicating with female doctors than male doctors.

Starting a Dialogue

We need to begin a dialogue on this. If not for our own mental health, then to provide better care to our patients. I know that physician attitudes makes nurses less likely to report vital patient information or ask questions, which affects patients care.

What can we do to help counter our own implicit bias and to foster a respectful workplace? One study found that “being treated with civility, courtesy, and respect” is valued by both nurses and doctors. Nurses expressed that physicians that listen are perceived as more respectful and doctors expressed that nurses that work to problem solve without “hostility or verbal abuse” demonstrate respect.

To start a dialogue of my own, I decided to get a nursing and nurse practitioner perspective. I called my childhood friend, Lauren Zielinski, CNM, MSN, RN.

Here are the highlights from our conversation:

Q: From your experiences working with residents and trainees, what advice can you offer about supporting each other in the workplace, what works, and what doesn’t?

A: “What works: Acting like the team you all are. I have throughout my career felt blown off, disrespected or talked down to by resident physicians, not only as a nurse but also as a consulting midwife. It’s plain rude and unacceptable for humans to treat each other poorly, from both angles: physician to nurse, NP to physician, and so on.

“Take a moment to understand the other’s day to day. All of our jobs are incredibly complicated, not to mention high pressure. Shift perspectives from time to time and try to understand what everyone is juggling.

“Be friends! Take a moment to sit down in a lull and just hang out for a second. Even just a few minutes from shift to shift will earn light years of respect and mutual understanding.”

Q: Do you have any other comments about your experience being a female in a healthcare leadership role?

A: “I truly believe that, systemically, we have a big problem in medicine. The system is set up in a hierarchical manner that breeds hostility. Nurses are reminded every day that while they are literally sweating, bending over backwards, charting like mad, unloading miraculous amounts of compassion, healing with their hands, balancing their time amongst many patients and keeping everyone alive, that they are still technically ‘one rung below’ MDs on the totem pole in the traditional system.

“Developing open appreciation, kindness, and thankfulness for one another is a step in the right direction to eliminating the hostility nurses feel towards other women in leadership roles.”

I agree with Lauren’s sentiments, as does the literature. Treating each other with respect may help quell these hostilities. We should also acknowledge the human experience that is “implicit bias” and understand it. Try taking the Implicit Association Test through Harvard’s Project Implicit. And to quote Dr. Roberto Montenegro’s essay in JAMA, “My name is not “Interpreter, ” I echo his call to clinicians:

“I challenge us to reflect on how we perceive each other and ourselves in relation to each other (e.g., by ethnicity, class, sexual orientation, ability) in order to shift the conversation of microaggressions from taboo to mutual understanding.” —Dr. Montenegro

Lauren Zielinski, CNM, MSN, RN, is currently a Midwife fellow at Baby and Company Birth Center in Denver, CO. She is founder of a grassroots women’s health movement called New Moon Rising Events.

Giulia Ippolito Lane graduated from Texas A&M Health Science Center College of Medicine (’13) and is a current Urology resident at the University of Minnesota (‘18). She is matriculating into a Female Pelvic Medicine and Reconstructive Surgery fellowship in July 2018. She is also a 2018 Doximity Scholar. Follow her on twitter @GiuliaILane.

Lauren Zielinski, CNM, MSN, RN, is currently a Midwife fellow at Baby and Company Birth Center in Denver, CO. She is founder of a grassroots women’s health movement called New Moon Rising Events.