Stigma deters Duke undergraduates from pursuing nursing

For all the interest in pre-med studies at Duke, undergraduates interested in health-related professions rarely consider nursing as a field of interest.

Although the U.S. News and World Report ranks the School of Nursing seventh in the nation, most undergraduate students have never considered nursing as a career option because of associated stigmas. Students lack an interest in nursing because it is considered less prestigious than other medical career paths, a perception which may be reinforced by the type of academic advising students receive. This perception, however, may be changing along with broader trends in health care delivery.

“Across the country, especially in elite schools, health professions advisors often do not address nursing because of their own limited understanding of the career possibilities in nursing,” School of Nursing Dean Catherine Gilliss wrote in an email Tuesday. “Popular stereotypes, reinforced by television portrayals of nurses, work against many capable students’ understanding of how nursing could be a fulfilling career.”

Gilliss said a recent graduate of the School of Nursing’s Accelerated Bachelor of Science in Nursing program, who was a human biology major at Stanford University, inquired about nursing and was told, “Stanford grads do not become nurses.”

Perceiving nursing as less credible occupation is not uncommon.

“There is a pretty similar national trend that most pre-med students have never even considered nursing,” said Michael Relf, assistant dean for undergraduate education at the School of Nursing.

He added that many high school guidance counselors, parents and relatives have traditionally told intelligent students interested in medicine, “Oh, you are too smart to be a nurse.”

Speaking from personal experiences, he added that nursing is typically viewed as a female profession, so men are particularly steered away from the profession as well.

She added that because she never asked for any related information about nursing school, none of her advisers ever suggested this possibility. She noted, however, that she would be open to current nursing students’ opinions and experiences about their decisions to become nurses.

“To be honest, I think one of the reasons [that nursing is unpopular] is the pay—financial reasons—that’s the main thing I can think of as the stigma around it,” Gunaratne added.

Relf noted that the average annual salary for a regular nurse is about $55,000, but added there are opportunities within the nursing profession to earn higher salaries.

“For nurses who want to continue their education to become a nurse anesthetist, the salary is probably around $110,000 to $125,000,” Relf said. “Nurse practitioners and nurse midwives earn an annual salary around $90,000—those salaries are certainly above the median income of the U.S. population.”

Current nursing student Zoe Baer, who graduated from Duke in 2008, was admitted to the School of Nursing this past September. She majored in Arabic and cultural anthropology during her undergraduate years and became a teacher in the Middle East and later New York City after graduation. She did not consider nursing until last year.

“I decided nursing for many reasons,” Baer said. “Nursing seemed a little bit more attractive because I could be on the front lines with people, learn more about them and be able to change a lot more about their life.”

Baer worked last year as an AmeriCorps member helping to set up clinics and shelter systems throughout New York City during the day and took classes to meet the prerequisite requirements for nursing school at night. She was inspired and pushed by her mentor, a male nurse practitioner, who believed that nursing offers a more holistic approach to medicine because nurses can help solve the disease as well as other ailments.

Roy noted that some students consider physician assistant school because of more regular-hour workdays that allow students to fulfill familial obligations. These factors may also play a role in students’ decisions to become nurses. The curriculum for medical school and nursing school is “similar and different,” Relf said.

“Whereas med school has the infamous organic chemistry, calculus and physics, more fundamental [courses for nursing school] are anatomy, physiology, microbiology, and we encourage courses on human growth and development and nutrition,” he said.

Baer said she feels that although nurses are not currently considered to be as capable or as knowledgeable as doctors, popular perceptions of nurses are beginning to change.

The health care reform brought by the Affordable Care Act will allow advance-practice nurses to become key health care providers because they are more versatile, Relf said. For example, a specialized oncologist will treat patients’ cancer and a nurse practitioner can manage their common problems after the cancer has been stabilized.

The health care delivery model can become more cost-effective and thus more accessible for patients if it is primarily managed by nurse practitioners or physician assistants, because they have enough knowledge to care for patients on a more regular basis and are less expensive than specialized physicians.

“Nursing is part of a growing sector in the U.S. economy and the role of nurses is expected to expand further in the face of the Affordable Care Act,” Gilliss said. “It has never been a better time to be a nurse.”