Are nurses angels? Um, no.

I'm profiled in Pittsburgh Magazine and...my five year mammogram was clear!

Last week I was in Montreal, speaking at the 23rd International Congress on Palliative Care. I gave two talks, one of which was to a breakout session for nurses. The panel organizers asked me to speak on “Time to Retire the Angel Metaphor: Reflections on Knowledge and Skill in Caregiving Work.”

I can attest that it is fairly common for hospice nurses to be called angels. It has happened often to me, and when I demur, people insist. I have tried to take the angel label as a compliment, since I know that is the intention behind it, but I have to admit that being called an angel grates on me, in large part because I’m not an angel. That is not modesty, but fact: I’m not supernatural, not one of God’s messengers, don’t have wings, and certainly have never been seen with a halo. It’s actually obvious that nurses are humans, not angels, but the metaphor endures.

For my talk in Montreal I decided to interrogate the wish expressed by those who call nurses angels. I found a class at Harvard on, believe it or not, angels, which appear in several of the world’s major religions, including Islam and Zoroastrianism. The course description says angels “link…immortal and mortal worlds,” and that seemed apt to the job of many nurses. Physicians could be said to perform the same function, but nurses are the primary clinicians for hospice patients and also typically for patients dying in the hospital. I have kept watch over a dying patient with family members and I have many nurse colleagues who have done the same. It’s hard emotional work and I can see why some people end up locating nurses in a spiritual realm following that kind of intense health care experience.

The problem is, we aren’t angels. We’re often overworked and underpaid, doing a job that requires a high level of clinical expertise, empathy and compassion, all while not getting a chance to eat or sometimes even go to the bathroom, for twelve hours at a time.

In addition to those well-known challenges in nurses’ work environments, nurses also face the threat of violence on the job. According to the American Nurses Association, one in four nurses reported being physically assaulted in 2019. NIOSH, the National Institute for Occupational Safety and Health, offers a course through the CDC called “Workplace Violence Prevention for Nurses.” A shooting at a hospital in Dallas on Saturday left two nurses dead (and also shows that violence against health care workers in general is on the increase, according to the “Healthcare Chief Executive” website).

I bring up the problem of violence against nurses because it dramatically gives the lie to the angel metaphor. If nurses were angels, people would probably be afraid to attack them. But more important, if nurses were angels they would be invulnerable to the damaging effects of human violence, whereas sadly, they, we, are not. Also, as the nursing meme below shows, nurses often feel blamed for the verbal and physical abuse directed against them, unlike members of any other profession. Angles perform sacred work—they are not disrespectfully second-guessed by management, especially after being hurt.

Thanks to @nurses.life_rn on Instagram

I posed this question at the end of my talk:

“Are we so uncomfortable with the idea of personifying empathy & compassion that we turn the people who do it into supernatural beings?”

I also pointed out that during Covid the analog of the “Angel” metaphor was calling clinicians “Superheroes.” The nurses I heard from hated being labeled superheroes even though they understood that people meant it as a compliment. But whether health care workers, and nurses in particular, are labeled “Angels” or “Superheroes,” being categorized as superhuman fundamentally denies the reality of the job and its emotional complexity: nursing is physically hard, can be dangerous, and sometimes we do help people die.

At the end of my talk, an audience member asked if I could suggest a replacement for the angel metaphor. My instinctive reaction was to question why any kind of metaphor is needed for nurses. “Do doctors have a metaphor that stands in for them?” I wondered aloud. They don’t, or at least not one that anyone in the room could think of right then. I suggested that we let nurses be nurses, because the truth is, it’s our professional humanity that makes us good at the job, no wings or haloes required.

If you have a thought on the Angel metaphor, or anything I’ve said here, please comment.

Pittsburgh Magazine Profile

I was recently profiled in Pittsburgh Magazine and you may enjoy reading the article here. It includes a health update that I haven’t mentioned before because I’m still figuring out what specifically I want to say about it. But that’s no reason to keep such good news secret—I had my five year mammogram a few weeks ago and it was clear! Five years is the magic number and I had hoped I would feel that after five years, cancer and I were done. It’s not that simple, unfortunately, and I plan to write about it, but I’m still ruminating. Stay tuned…

Comments are welcome here, too.

Fall is upon us. Big hugs with hot chocolate to all,

Theresa

I had a great time in Montreal and in addition to my talk to nurses, was part of a plenary panel on presenting palliative care to the public. I said that palliative care is “where fear meets love.”