Q&A with Author Sarah DiGregorio on Taking Care: The Story of Nursing and Its Power to Change Our World

Genevieve Carlton, Ph.D.
Updated November 14, 2023
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    As nurses today strike and protest for better wages and safer working conditions, Sarah DiGregorio explores a time when nurses were figures of authority.
    Team of doctors and nurses walking down a hospital hallway togetherCredit: Getty Images

    We sat down with journalist and critically acclaimed author Sarah DiGregorio to discuss the history and evolution of nursing in her new book, “Taking Care: The Story of Nursing and Its Power to Change Our World.”

    Portrait of Sarah DiGregorio

    Sarah DiGregorio

    Sarah DiGregorio is a journalist and critically acclaimed author of, “Early: An Intimate History of Premature Birth and What It Teaches Us About Being Human and Taking Care: The Story of Nursing and its Power to Change Our World.” DiGregorio has written for the New York Times, the Washington Post, the Wall Street Journal, Slate, and Insider, among others. She has been a keynote speaker for many universities, corporations, and professional organizations. She lives in Brooklyn, New York with her daughter and husband.

    Q&A with Sarah DiGregorio

    NurseJournal (NJ): In capturing the long history of nursing, you use a broad definition of “nurse.” So what defines a nurse?

    Sarah DiGregio (SD): There have always been skilled and organized practitioners who have focused on maximizing people’s health and well-being in a holistic context. Nurses think about patients not just as different organ systems but as full people. What kind of housing they have, what kind of food and water they have access to, what their community is like. Nurses think about health and wellness in a very relational way.

    Is this person a hands-on practitioner? Are they thinking about someone’s well-being in their full context? Are they engaged in the community and thinking about the way that the community can create health or ill health? Today, medicine is one tool of nursing, but it is only one tool — it’s not the focus of nursing. Medicine is very concerned with the processes of disease, the functions of the body, and alleviating illness, whereas nursing is always thinking about prevention and advocacy for public health.

    NJ: In “Taking Care,” you trace how nursing has played a key role in establishing and developing societies throughout history. You also point out how nursing skills have been written out of history. Why has the foundational role of nurses been ignored?

    SD: The earliest kinds of nursing were done in the home, in very domestic settings. Recording these kinds of stories and telling those stories for posterity doesn’t always serve the victors. For instance, the Roman Empire depended on nurses. The Romans knew that if they didn’t have healthy troops, they would never be able to maintain these far-flung outposts — but nursing is like an invisible hand in these stories.

    In the United States, nursing was practiced by enslaved people who brought their own expertise from their own healing traditions. Enslaved people were often forced to work as a nurse, but they also chose to nurse, often within their own communities. The majority of babies born in slave states, both Black and white, were delivered by African-American midwives, and this persisted until the beginning of the 20th century.

    Why has nursing been written out of history? It’s a combination of factors. Nursing is done in the home. It’s not a story of domination or power. And it was often done by women and enslaved people whose stories were written out of history on purpose.

    NJ: Prior to the past few hundred years, nurses were respected authority figures. Yet modern healthcare places nurses in a subordinate role to physicians. From your perspective, what changed?

    SD: I would suggest that we need to go back to the establishment of the first medical schools in Europe. When medical schools were established in the Middle Ages, for the most part women were not able to go to medical school with the notable exception of the University of Salerno. Before this, there were apprenticeships, there were guilds, there was a healthcare system and a healthcare economy. People learned by doing — there was a lot of empirical knowledge passed down in oral traditions.

    But then medical schools were established. Suddenly, there was this new kind of practitioner. They were exclusively men. They had to have the status that was necessary to go to these schools. These new practitioners had to invent a difference for themselves because they didn’t have more practical knowledge for actually alleviating suffering and helping people.

    The faculty at medical schools embarked on a centuries-long quest to establish why they were better. We went to medical school, we are licensed as physicians, we are educated as physicians — and you’re not. It became illegal to practice medicine without a license, but you could only get a license by going to medical school, and only men of a certain status could go to medical school.

    Jacoba Felicie was a very well-established physician in 14th-century Paris. She was charged with practicing medicine without a license, and she was convicted even though her patients testified that she cured them. But she had broken the law because she didn’t have a license.

    The idea of a physician as a high-status man who has gone to medical school became the lynchpin in this new hierarchy. Physicians use language about patient safety and quackery to justify the hierarchy. You can trace that language straight through to the present when the AMA says that nurse practitioners are dangerous for patients.

    But this new healthcare hierarchy that privileged male physicians had a problem––there were all these other practitioners who had lots of experience, but also, there weren’t enough physicians. Gendering the medical schools and gendering the idea of expertise created a hierarchy that said women could practice healthcare, but they couldn’t give medicines. That evolved into a subordinate female role.

    NJ: Florence Nightingale is often the defining figure in nursing history. For many nursing students, Nightingale might be the only historical figure mentioned in textbooks and lectures. Why is that a problem?

    SD: It’s a problem because it’s not true. It’s not true that she founded nursing; It’s not even true that she founded modern nursing. And when we say it’s true, we imply that nurses are one kind of person and nursing is one kind of practice. That has served to keep many people out of nursing, and it has served to keep nursing disproportionately white. It has served the modern healthcare hierarchy.

    I do not think it’s an accident that Florence Nightingale became the archetypal nurse. When she hired nurses for the Crimean War in 1853, she hired only white women. Mary Seacole, a Jamaican-Scottish woman, tried to join the group and was rejected specifically because of her race.

    Nightingale made nursing, which could have been subversive to the social order, quite palatable to those in power. She made sure that the version of nursing that she put forth was one that reinforced social norms instead of disrupting them. And it’s a problem because nursing has come from everywhere. It’s been done by everyone. And if we say nursing is only done by nice white ladies who should keep their heads down and stay out of politics––first of all, it’s not true. Second of all, it robs nursing of its true power.

    NJ: Misogyny, racism, and marginalization are central threads in the history of nursing. How can learning about the history of nursing help better prepare today’s nursing students for the challenges of 21st-century nursing?

    SD: It’s important for nursing students to know that nursing has been foundational to the establishment of human societies all around the world. Nursing has come from so many different places — nursing has been a fundamental human endeavor. It’s important that nurses understand that nursing is not small. Nursing is just as fundamental to the way that human society functions as art and literature, as medicine. It’s fundamental to how we organize ourselves, and it’s fundamental to how our society functions.

    Nurses from marginalized groups and men face a sense that they don’t belong in nursing. That’s not true. Looking at history can absolutely tell us that nursing doesn’t belong to any one group.

    There’s a lot of vested interest in nurses not recognizing their own power. Understanding history can help nurses recognize their power. History can let them know that if someone says, “There’s only one way to be a nurse, you have to graduate from nursing school and then you go work on the med-surg unit and that’s how you become a nurse.” That’s one way to become a nurse, but actually, there are so many ways to become a nurse, and there are so many ways that nursing knowledge and nursing expertise can work in the world and can make the world better.

    Nurses should understand that they are part of that tradition. Nursing knowledge and expertise are relevant in so many settings. Broadening the lens in this kaleidoscopic way might give nurses a better sense of their own power.

    NJ: “Taking Care” tackles important topics like the role of nurses in climate change, reproductive access, and treating substance use disorders. Based on your research, what do you think is missing from nursing education today?

    SD: I would suggest that this idea is prevalent in nursing education: you have to go work on the medical-surgical floor, or you have to work in a hospital to be a real nurse. I think that it would be useful for nurses to know more about how they can use their nursing skills and expertise in other settings.

    Hospitals are not set up often to fully recognize or value nursing expertise and nursing practice. Hospitals can be a really terrible place for nurses to work, even though we very much need nurses and hospitals. I think it would be good for nursing students to know that there are other ways of being a nurse. Being a nurse is about maximizing people’s health and well-being, thinking about prevention, advocating for people and for populations, and helping people have health literacy. There are so many ways that that skill set can work in the world.

    A lot of times nurses do quit. They walk away from nursing because hospitals can be very abusive places to work. I would hope that we can open up more avenues for nurses to work in the world and that nursing schools could be a part of that.

    NJ: You note that as many as 57% of newly graduated nurses quit their jobs within the first two years. What are some of the systemic problems that nurses face in the American healthcare system?

    SD: When this has been studied, a very large proportion of nurses quit because of burnout. When researchers investigate what people really mean by burnout, it means a lack of support from leadership. It means a lack of safe staffing, so not having enough nurses — having to take care of so many patients that you don’t feel that your care is safe.

    Often nurses quit early in their careers because the workplace conditions can be unbearable and there is a disconnect in terms of what they thought that they were going to be doing and what they actually find themselves doing. So many people go into nursing because they’re interested in science and also they want to help people. They want to alleviate suffering. They want to maximize well-being. They want to have meaningful connections with their patients.

    And a lot of times, the reality is that the way that hospitals are set up in terms of staffing, that is not possible. Sometimes this is called moral injury, when nurses are asked to do their jobs in a way that they don’t feel is congruent with their values. If I have seven patients and I know I can’t safely take care of seven patients with the conditions that they have, it ends up feeling like you’re actually hurting patients instead of helping patients. That’s something that causes nurses to quit.

    NJ: So many of the challenges facing nurses today, from poor working conditions to low wages, have long historical roots, as in your example of early 20th-century nurses who essentially worked in hospitals for free. How can nurses today take on these ingrained problems?

    SD: The best way that I know of is unionization. Certainly, there are other ways, but the way that has been most effective in nursing is unionization. Nurses are a very big group of people––they are certainly not homogeneous, they have differing political backgrounds and beliefs. Also, there has been often historically and currently a demand on nurses that they “stay out of politics,” “stay above it, just focus on patient care.” Engaging in organizing, activism, and any kind of political activity is somehow not befitting of a nurse.

    Those pressures on nurses have served the interests of corporations that run hospitals to make a profit. When nurses do organize and unionize and fight to have workplace conditions that most benefit patients, they are incredibly powerful. The truth is that none of it could run without nurses. If every nurse walked off the job right now, the entire country would fall apart. There are 5 million registered nurses in this country. Nurses are the largest group of healthcare professionals. They provide the vast majority of patient care, and they are not valued in hospitals the way that they should be.

    The California Nurses Association was responsible for lobbying for the only comprehensive staffing legislation in the country — that was brought about by unions. There’s a lot of research that shows that staffing laws actually save lives. You’re more likely to survive or have a good outcome if your nurse has time to take care of you. So it’s not just about nurses, it’s about everybody.

    More nurses have joined unions since the pandemic. Maybe it pushed some nurses towards the fight because it became incredibly clear that they would have to fight but it also pushed nurses to quit.

    NJ: The COVID-19 pandemic has had an enormous impact on the healthcare system and nurses. What lessons did the pandemic impart for nurses in the future?

    SD: I’m in New York, and I remember very clearly when we all came out to bang pots and to clap for the nurses and physicians and everyone else working in our hospitals. It was such a bleak moment. There was nobody on the streets, there were constant sirens. I live down the street from a crematorium, and it was billowing smoke night and day.

    There was something so comforting about the ritual of coming together to say there are people out there who are trying to keep our neighbors alive. And at the same time, of course, that was not what nurses needed. What they needed was adequate protective equipment. They needed adequate staffing. They needed for their lives to be valued, and that wasn’t what they got.

    The pandemic for nurses may have just reinforced the idea that people don’t know what they do. We put them on a pedestal, but we don’t really give them what they need to do their jobs well or even to stay alive.

    I don’t know if the pandemic had a lesson to teach nurses; I think nurses got through it––or many of them got through it––because of their skills and because of camaraderie among nurses and other healthcare staff.

    When it came right down to it, when there wasn’t enough PPE, hospitals only sent nurses into the room. Housekeeping didn’t go in, physicians often didn’t go in, unless there was a procedure that was medically necessary where the physician had to be in the room. Nobody went in but the nurses. It was quite clear that nursing care was the only care that was non-negotiable in hospitals. I think nurses knew that already.

    I was hoping that there was a lesson for the public. We all have emotions for nurses, we are primed to appreciate them, and we know how important they are. The disconnect is really understanding what they do and what they need in order to do the work that keeps us all healthy. I always wonder if this is a missed opportunity — or maybe it’s still an opportunity — for nurses and the public to come together and understand each other better. Nurses talk to other nurses, and the public gets information from the media. And the media does not quote nurses as experts. A study showed that nurses were quoted as experts in healthcare articles 2% of the time.

    So the public is clearly primed to feel grateful for nurses and yet we are living in an information vacuum about nurses. Nurses are saying we don’t need appreciation, we need good working conditions so that we can continue to serve our communities. I think there’s an opportunity there because our interests align– the question is how to get there.

    NJ: “Taking Care” investigates the tension between nursing as a caring profession and the power of nurses when they take action. What do you hope nurses and nursing students take away from your book?

    SD: I hope that they take away that it’s not a tension. In fact, the power is the caring. Our communities have to function, and we need caring work for our communities to function. If we don’t have it, our communities will not function.

    I would like to reimagine caring work as the most powerful work. It is the most complex work. There is nothing more complicated than human beings. I hope that what nurses and nursing students can take from the book is actually doubling down on the caring. The caring does not mean that you need to walk away from fights or express your own power. In fact, the caring is what demands that you take action.

    Page last reviewed on November 4, 2023