On gender identity and empathy

June 30, 2013 at 9:30 am | Posted in Opinions, Politics | 2 Comments

Those of you who’ve come here from Twitter will know that I use as my avatar a picture of Nurse Ratched from the film One Flew Over the Cuckoo’s Nest. Some of you might also have read my “about” page here and realised that I’m not actually a mental health nurse, nor am I a woman, and nor am I quite that evil.

Most casual Twitter followers and repliers, however, are not that observant – Or maybe just not that invested; it seems to me that Twitter mostly relies less on engaging with a personality (apart from certain celebrities), more on responding to what’s been said right here, right now. I could write an essay on communication theory and why innocently intended tweets can still lead to a huge amount of butt-hurt and whining from people who are far too delicate to survive on the internet, but I’ll do that another day.

I’m increasingly finding that even amongst those like me who choose to remain anonymous, the trend is to either pick a gender-neutral avatar, or to pick one that is of the tweeter’s own gender – You can often tell by the self-descriptions, or by following links to blogs. This seems (in my experience, and I can’t back this up with data) to be a particular feature of anonymous male tweeters; there’s something that stops men in particular from using avatars of the opposite sex. I wonder if that’s a subconscious acknowledgement of gender privilege. Honestly, I don’t know, but it’s interesting.

Anyway, my point is that the vast majority of people who read my tweets probably presume I’m a woman, and many of them respond in ways that they mistakenly think are appropriate to that. You probably won’t read a lot of those responses, because a lot of it is in DMs, and because I block the offending tweeters as soon as I see them. And I call them “offending” tweeters for good reasons.

It’s fascinating to be regularly mistaken for a woman. Really, it is. Working as I do in a female dominated profession, with mostly female bosses, I had no idea how much people condescend to women. There’s a steady stream of “darlings”, and “sweethearts”, and “cupcakes” – You read that right. I have, without irony, been addressed as “cupcakes”. I’ve had my (very qualified, thoroughly educated, highly experienced) thoughts and ideas questioned and dismissed by lay-persons (lay men, obviously) solely because they thought that I was a woman and that therefore my thinking was inferior to their man-thoughts. I regularly experience overt flirtation and sexually inappropriate messages (because all nurses are like Barbara Windsor in Carry On Matron, clearly).

The Angry Nurse is not my first anonymous online persona. I wrote for and moderated Unreasonable Faith as Custador, with a male avatar, for about four years. I had far, far more readers there than I do either here or on Twitter – At its peak, UF clocked over a quarter of a million unique hits per week, and my posts tended to be popular. Conversely, I have less than 250 Twitter followers and less than fifty people per week currently read this blog. The only thing that has changed other than my pseudonym is the gender of the avatar I’m using. Out of the millions of people who read what I wrote as Custador, only one of them was ever sexually inappropriate, belittled my ideas because of my gender, or felt the need to address me with titles like “cupcake”. For completeness, that one was a self-described “radical feminist” who took extreme offense when I questioned whether regularly posting photos of herself on the internet dressing as a schoolgirl and then stripping to graphic nude, was really a feminist thing to do (note: I did not slut-shame her or question her right to do so, only her association of it with feminism).

Conversely, as The Angry Nurse, behind a female mask, I have had perhaps a few thousand people read my ideas over the course of about six months. And the issues I’ve described above have occurred dozens of times. It’s like background radiation pervading the environment of my discussions, and to me, it’s fascinating. But I can escape it whenever I want to, because regardless of my picture of Nurse Ratched, I’m not a woman. I can have my male privilege back at the press of a button. I keep reminding myself that actual women are not so fortunate.

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On rape culture and why it’s men who have to change it.

June 19, 2013 at 9:41 am | Posted in Opinions, Politics | Leave a comment

This is a re-blog of a post I wrote some months ago for Unreasonable Faith while I was still blogging for them under the name of Custador. Since a large chunk of my discussions these days seem to revolve around feminism, I thought it was appropriate to re-blog it here, on my own blog.

This post will discuss rape, including specific instances of rape, both historical and fictional.

I want to take a little side-track from talking about religion today. I want to talk about something else instead.

I know it’s not really what we do here at UF, but I think what we do do boils down to talking about ideas; today I’d like to talk about feminism. Or at least I think I’d like to talk about feminism; the definition of that word seems to change depending upon who you talk to; I’ve always considered it to mean something like “the promotion of equality between the genders”, but I’ve had more than one person (mostly frothy-mouthed Men’s Rights Movement types, admittedly) telling me that it’s about “empowering women”, and has nothing at all to do with equality. Personally I think that women worldwide are starting off with a socially imposed gender disadvantage anyway, so empowering women pretty much does mean the same thing as promoting gender equality at this point. But however. Your mileage may vary, and I’m happy to be educated about what feminism means if anybody would care to take the time. I freely confess, I don’t know what the “waves” of feminism are/were, I’m largely ignorant about feminist history, and I don’t know who most of the great feminists throughout history have been (except I once dated a girl who was named after Ememline Pankhurst and my mother thinks Germaine Greer and Janet Street Porter are awesome).

But really, those issues are kind of peripheral to what I want to talk about today. I want to talk about something that I disagree with a feminist spokesperson about. But I’ll come back to that in a while.

First I want to set some context. It’s context that I suspect that all of our female readers will already be aware of, but which may come as a surprise to at least some of our male readers (though let’s not get started on the Male Privilege Argument, which I think we have done to death on the forums).

The context I want to set is this: We live in a rape culture. If you doubt me, then let me give you some examples:

1) The movie Observe and Report, which contains a “comedy” rape, in which the main character initiates sex with an unconscious woman (who he has drugged), but we’re supposed to think it’s okay because she wakes up and, while clearly still under narcotic influence, gives consent after the fact. I don’t even know where to start tearing Seth Rogan a new arsehole for that one, but I refuse to provide a link to a clip of it.

2) Convicted rapist Mike Tyson plays himself in cameo roles in movies like The Hangover and The Hangover 2.

3) Roman Polanski, a darling of Hollywood who won’t go anywhere near Hollywood (or even America) for fear of being arrested for drugging and having forcible sex with a fifteen year old girl while she was saying no and telling him to stop.

The next few examples I want to give are taken from an article in The Independent titled “2012: the year when it became okay to blame victims of sexual assault”.

“At Caernarfon Crown Court earlier this month, a 49-year-old man was convicted of raping a teenage girl. Jailing the rapist, the judge told him: “She let herself down badly. She consumed far too much alcohol and took drugs, but she also had the misfortune of meeting you”.”

A Crown Court judge, victim blaming over a rape.

“In August, the MP George Galloway publicly dismissed allegations of rape and sexual assault against Julian Assange. The WikiLeaks founder, he said, was guilty simply of ‘bad sexual etiquette’ when he began to have sex with a sleeping woman who had previously consented; his actions were ‘not rape as anyone with any sense can possibly recognise it’.”

Notwithstanding that George Galloway is a complete idiot, I don’t even know where to start with this one. I’ve got quite a lot of sense, personally, and I have no hesitation in saying that if that really is what happened, then that was rape.

“In April, after the footballer Ched Evans was convicted of raping a woman who was too drunk to consent, his victim faced an appalling backlash of online abuse. Twitter users called her a “money-grabbing slut” and circulated her name so widely that she was forced to change her identity.”

I don’t know if anybody else followed the Ched Evans case, but it was a much needed victory for the relatively new and largely untested UK law which explicitly states that having sex with a person too intoxicated to consent is rape. He had sex with a woman so drunk that she was virtually comatose, having had a friend pick her up and bring her back to his hotel for that specific purpose. And the great British football loving public responded with a round of vitriolic victim blaming so severe that she’s had to move to a new part of the country and adopt a new identity.

Let’s not even bother quoting any of the US Republican party’s record on rape. It’s too long, and has been done to death in recent months.

And now onto the part I want to disagree with somebody over.

Christina Diamandopoulis from the charity Rape Crisis was quoted in The Independent as saying “We have to get together as women … to grow the seeds of the fightback, which has already started, with organisations such as Rape Crisis, Object, Everyday Sexism, Mumsnet and others. Together, women have moved mountains before – we can do it again.”

No. Sorry, but no. To imply that women will stop rape, to my mind (however unintentionally), perpetuates the harmful myth that women are responsible for rape. That is, on the whole, untrue. I’m not saying that women don’t have a role to play, they clearly do: It’s a role that they share with men, though – Educating our children so that they don’t passively accept rape culture, voting with their wallets by not contributing financially towards media which denigrates women and promotes patriarchy and rape culture, and by pressuring our political representatives to at least have a clue what rape culture is and why it’s bad.

But the reason that I disagree with Ms. Diamandopoulis’ sentiments is this: The one and only person responsible for a rape, is the rapist. And rapists, in the overwhelming majority of cases, are men.

It’s not women who need to adopt a change in attitude, it’s men. I think as men we can probably all think of instances where we’ve laughed amongst ourselves at jokes that we would absolutely never tell in the presence of a woman. I can certainly think of instances from my own youth where my attitude to women was not so much questionable as downright disgusting. I’ve given unthinking support to male friends who were accused of rape, without even stopping to think that maybe they did it. I’ve certainly had sex with women whilst we were both very drunk, and not thought to ask myself if they would have wanted to do it sober. I’ve hung around in groups of male friends discussing women like they were trophies to collect. And to my fellow men I say this: I know damned well that my experiences are not uncommon. The vast majority of us have done (or still do) these things.

And that is what needs to change to end rape culture: The things that we men do and say and are, when only men are present; the ways we interact with each other, the things that we find acceptable; the standards that we relax when we are with “the boys”.

So to that end, I’d like to make a little pledge:

I will never condone rape or support rape culture in any way. I will object, loudly, when a rape joke is told. I will not tolerate objectification of women, amongst my male friends or amongst anybody else. I will do my best to be aware of my male (and white, and straight, and middle class) privilege, and to not take advantage of it. If and when I have children, I will try to educate them to critically appraise the media to which they are exposed and be aware of the gender messages within it. I will not spend money on any product, company or media which I am aware of having promoted rape culture or gender disparity, regardless of whether they have done so deliberately.

I think that pretty much covers everything I wanted to say today. Once again, I extend my usual open invitation to educate me. Go go go!

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On Short-sighted Executives

February 28, 2013 at 1:29 pm | Posted in Nursing, Politics | Leave a comment

Nurses in Britain will probably have at least some peripheral awareness that national negotiations are currently in progress to determine our Agenda for Change terms and conditions (i.e. what we get paid).

What a lot will not be aware of, however, is that our colleagues working for 19 NHS trusts in the South West of England are facing real terms cuts to their pay and conditions, thanks to the South West Pay Cartel – Basically, 19 trusts in the South West have banded together in an attempt to adopt a regional pay structure. This despite the Health Minister telling the Cartel that regional pay is a terrible idea, and they have no legal right to leave the Agenda for Change T&Cs.

Well, this is depressing.

I think I need to address the people who live in the South West of England at this point. It’s an older population than most parts of England, because many people retire there, and the economy is not vibrant, so many young people leave to work elsewhere. In other words, it is disproportionately dependant on the NHS, because older people = more use of healthcare.

So to the people of the South West: Let me tell you what is going to happen where you live, if regional pay is adopted there, and pay is cut as a result (it will be, that’s been the transparent goal of the Cartel from day one).

Medical schools, nursing schools and schools for allied practitioners such as physiotherapists, occupational therapists, radiologists, turn out a class of fresh, eager new professionals every year. And those professionals look for jobs. Do they look for work in a part of the country they know to be more expensive than average in terms of living cost, and where they know they’ll get paid less? No. They do not.

Existing healthcare professionals in the South West will suddenly be faced with a choice: Stay and get paid less, or go and get paid more. What happens? Those who can move away, move away. It’s not hard to get a job as a qualified healthcare professional. Really. I get sounded out or asked to apply for one at least once a month. We can work anywhere; our qualifications are universal, and our professional registrations are good enough for the whole world.

So at this point, no newly qualified professionals will be moving to the South West, and a lot will have left, leaving hospitals desperately short-staffed. What do they do? The only thing they can do; they’re legally obliged to maintain safe staffing levels, so they get agency staff at an average cost of £146 per hour to cover the shortfall.

So what do you, the patient, get? You get inconsistent care, where you rarely see the same nurse twice during your hospital stay. You get a lack of continuity because the nurses looking after you are not a part of the team, and they have no real incentive to make sure your needs and requirements are handed over to the next nurse on shift.

What do the trusts get? Well, let’s just look at nursing a minute, because that’s what I know: A newly qualified nurse on Agenda for Change terms costs employers around £11 per hour in all. That’s about £125 for a twelve hour shift (note: That’s not what the nurse takes home, that’s what they cost the employer including pay). An agency nurse, on the other hand, costs £146 per hour (the best paying agency offers a flat rate of £32 per hour, the rest goes to them), or around £1750 for a twelve hour shift.

In other words, by cutting pay for nurses the South West Pay Cartel will ensure that everybody, including themselves, loses out financially. The only people who win will be nursing agencies and their very well paid employees.

And let’s not forget the bigger picture: We need newly qualified staff, who’ve been trained in the newest and best ways of doing things, to come and tell us when we’re doing something in an old-fashioned way. Medicine should be evidence based, and evidence improves and changes. We don’t all have the benefit of being able to sit down and plough through the journals every day to stay up to date, so those new staff are a crucial part of keeping our practice up-to-date.

I think what scares me the most is how very obvious this all is. Executives at those trusts are in dire need of opening their eyes, taking off their financial blinkers, use whatever metaphor you like. They’re going to bankrupt their trusts, and they’re going to do real harm to patients in the process.

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On Stafford, and Judgementalism

February 13, 2013 at 10:56 am | Posted in Media, Nursing, Politics | 2 Comments

I guess I can’t really blog about nursing and not mention the Stafford Hospital report. For anybody who’s been living under a rock, the tl;dr version is: Care was not good enough at the Stafford Hospital, and unnecessary deaths resulted.

Ouch. I can only imagine how nurses at that hospital feel right now. Frightened. Embarrassed. Defensive. Angry. Probably a cocktail of all those and more. But that report has been pored over and analysed and quote-mined to death; the only thing that I want to say about it directly is: The report’s author has already admitted that he was wrong to name the whole hospital as the problem, when in point of fact the issue was isolated to two wards – And he even narrowed it down to specific staff on those two wards.

And yet, on the basis of this report, nursing in Britain is going through what feels like a witch hunt. This isn’t a nice time to be living through, speaking as a nurse. The media cannot wait for us to screw up and sell more papers for them, and the government are eager to push any agenda which makes the NHS as-is look inferior, because they’re ploughing ahead with privatisation by stealth (if you doubt that, read the full text of the Health and Social Care Act, then come back to me) and want to minimise resistance from the general public.

What’s worse is, nursing can’t get a mention on social media without a barrage of comments from uninvolved lay-persons who think they know how to fix all of nursing’s woes. From dead reckoning, at least ninety percent of the people making such comments can be summed up as “Bring back Matron!”, even though Matron never actually went away in the first place. Personally I think that there is a small but very vocal minority of sexually deviant people who fantasise nightly about Hattie Jakes in a white tabard and starched cardboard hat, and who want to populate our hospitals with her.

My point here is this: Nursing is a profession that people have so little respect for (until they actually see us in action) that they feel perfectly comfortable with telling us how to do our work, in spite of their own absolute ignorance. Dunning-Kruger effect – They’re too stupid to know that they’re stupid.

Of course, in amongst the Hattie Jakes fans, there are always one or two comments along the lines of “my mum laid in her own faeces for hours!”. Actually, that’s a really good example to use because it’s so common and yet usually such obvious tosh. How would you know that your mother had been laying in faeces for hours unless you were actually there to see it? And if you were there to see it, why didn’t you nag somebody until they came and cleaned your mother up? Now, I’m not saying that anybody visiting a hospitalised relative should ever be in a position to have to provide care, but honestly? If I was visiting my elderly grandmother in hospital and nobody had cleaned her up after a few minutes and repeated requests? I would just do it myself. And I know that’s not really a fair generalisation, because I am a nurse, and cleaning poo from elderly people is very much in my job description, but I think the point remains valid.

People in general don’t seem to provide care for elderly relatives as much as they used to. There is a very sad tendency to expect the NHS and/or Social Services to do everything. And that really isn’t the point of socialised health and social care.

I have encountered my share of families who pick up on every single detail of their relative’s care, and get angry and upset and claim that it isn’t good enough even when it’s absolute gold standard. They’ve all had one common feature: Guilt. In general, it’s often the family of an end-stage terminal patient who’s been an inpatient for weeks or months, but whose family have never been to visit until the day they’re phoned and told that their relative is fading fast and now would be a good time to come and say goodbye. That’s the point when you know as a nurse that you’re in for a challenge, because the family are justifiably upset that their relative is dying, and they’re feeling guilty about not visiting while he/she was still actually conscious and able to interact with them. They lash out at staff, and it’s our job to take it and to never, ever judge them. We don’t know why they never visited, and it’s not our business.

It’s also our job to deal with patients who are confused and/or demented. I personally know four or five nurses and auxiliaries in the last year alone, who have been assaulted severely enough by dementia patients, to have needed time off work to recover. This is something that is poorly understood: If a person has dementia so advanced that they form no new memories and have few or no original memories, then as far as that person is concerned, they are always in a strange place, surrounded by strange people. A lot of they time they won’t even know who they are, let alone the people in blue who want to come and give them a wash. Fear and anger are natural responses to that, so sometimes as nurses we get physically assaulted. I’ll leave aside the issue of people who assault us because they’re just plain horrible people, because that is rare outside of the ED.

Now, I don’t want to play the martyr here. Honestly, I don’t; I think that’s a terrible and manipulative thing to do. Everybody who ever trained as a nurse knew very well that they were getting into a hard, physical job which comes with a lot of responsibility and very little financial reward. We all knew from the outset that we’d be working twelve hours without a break, often followed by four hours of unpaid overtime. We all knew that our home life would suffer for our choice of profession. We knew that we were going to get insulted, spat at, berated and punched.

We knew all of that. But we never agreed to be whipping boys and girls for every politician and bored journalist in Britain. And that, sadly, is what we are becoming.

If I get any message across in this post, I hope it’s this: On the basis of a report about specifically identified staff on two wards in one hospital, the government and media now seem to be on a mission to destroy the working reputations of more than a million clinical staff working across almost four hundred NHS trusts. They’ve totally ignored patient’s opinions (the last CQC survey showed that 91% of patients who responded rated the care that they received as excellent, very good or good), and they’re completely blanking the vast majority of clinical staff, particularly nurses, who deliver that excellent care against stacked odds.

So if you’re a nurse or an HCA or an NA or an AP or even (whisper it) a doctor, then hold your head up. The vast majority of your patients think that the vast majority of you are brilliant. And really, do any of us care what anybody else thinks?

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