By LaTonya J. Trotter
Stephanie had always planned to be a physician. She never wavered as she marched through the premed curriculum at college. But in the years after graduation, she began to have doubts. While applying to medical schools, Stephanie was working at a clinical research center. She had shadowed physicians before, but working alongside them made her notice the mundane rather than the esoteric: physicians worked very long hours. “Oh my God,” she thought, “I’m a woman! I want to have children!” How would she manage motherhood with such high demands? She began to reconsider medicine. And to consider nursing.
Nursing had never had much appeal for Stephanie. But at the research center, she had an up-close view of a different kind of nursing work: that of nurse practitioners (NP). Becoming an NP seemed to offer the possibility of independently caring for patients without fighting her way through medicine. It was a professional choice. It was a respectable choice. And it seemed to promise a better balance between work and family. “I wanted to be able to have a flexible timeline and a flexible career,” she explained. “And that’s what nursing is. Flexible.”
Women have made great strides in terms of workplace equality. Yet there remain clear obstacles regarding career advancement. While some women encounter glass ceilings, the maternal wall is a more pervasive stumbling block. Employers expect and reward workers unfettered by family responsibilities. Faced with these expectations, men and women often find themselves making gender specific choices: men invest in work and women invest in family. For women wanting to invest in both, workplace flexibility has become the policy equivalent of the Holy Grail: highly sought after but difficult to find. Inflexible workplace policies dead-end some women’s careers while pushing others out of paid employment altogether. The observation that women continue to crowd into female professions like nursing is usually attributed to women’s preference for caring labor. What if these choices were as much about opportunity as gendered predispositions? Is this a win for gender equity? Or gender inequality by another name?
In my Gender & Society article, I explore the career biographies of NPs and NP students in order to understand the role of nursing’s institutional arrangements in women’s labor market decisions. I focus on NPs because they are a highly educated subgroup of nurses that have cleared a series of credentialing hurdles to order to make careers. In some ways, nursing is a shining example of how flexible arrangements not only help workers manage family commitments but actively encourage career aspirations. Nursing’s flexibility begins with education. Nursing is one of the few professions that make it possible to accrue educational credentials in cohesive fragments. Forty-one-year-old Hana described a fifteen-year trajectory that started with a two-year community college degree. That was enough to begin working as a registered nurse (RN). A few years later, Hana enrolled in a structured bridge program that allowed her to leverage her two-year degree towards completion of a bachelor’s degree in nursing. Moreover, the bridge program enabled her to pursue her bachelor’s part-time while working as a full-time nurse. Ten years later, Hana took advantage of similar accommodations to complete her master’s degree to practice as an NP. “I call myself a kind of Cinderella story,” she told me. “I came up from community college all the way up to the Ivy League.”
Nursing’s flexibility facilitated motherhood as well as social mobility. Women entering high status professions often delay childbearing. The demands of advanced schooling and early career leave little room for parenting. The ability to build a career over a longer time horizon meant that motherhood might change the rhythm of a career, but it did not stop it. A similar level of flexibility was mirrored in nursing work. Hospital nursing’s reliance on 12-hour shifts over 3 days gives full-time workers more days at home to spend with children. For NPs who spend part of their careers as hospital RNs, this allowed them to more effectively juggle work, family, and eventually, graduate education.
For individual women, these institutional arrangements provided a private solution to balancing work with family life. However, these solutions have broader consequences for gender inequality. Because these arrangements were sequestered within a predominately female occupation, they reproduced gendered expectations about women’s investments in family life. Flexible scheduling ensured that women retained primary responsibility for family caregiving. Moreover, nursing’s flexibility reproduced flexible women who could switch specialties, change jobs, or delay graduate education to accommodate the inflexible jobs of partners and spouses. Flexibility became both an opportunity and an obligation. Nursing’s accommodating arrangements are themselves a product of the historical legacy of gender inequality. The continued existence of two-year RN programs is the preference of employers, not the profession. As a female dominated profession, its aspirations remain tempered by hospital demands for an inexpensively trained workforce.
My work suggests an additional explanation for why women continue to crowd into careers like nursing. Women may gravitate toward caring work, but they also care about creating careers. Nursing’s flexibility stands in contrast to the inflexibility women encounter in other parts of the labor market. My work also serves as a caution for relying on workplace policies alone to solve the dilemmas of working women. Without subsidized, national programs for parental leave and child-care, women alone will be pressed to “choose” flexibility. When only women are the beneficiaries of such arrangements, they quickly become segregated into “mommy tracks” or “women’s professions.” The unequal benefits that follow can too easily be attributed to women’s preferences rather than as the product of gender inequality.
LaTonya J. Trotter is an Assistant Professor of Sociology at Vanderbilt University. She is an ethnographer and sociologist of medicine whose explores the relationship between the organization of medical work and the reproduction of racial, economic, and gender inequality. The empirical terrain of these explorations ranges from professional negotiations between medicine and nursing to organizational shifts in older adult care.