Nursing Students or Student Nurses: What’s in a Name

Recently, Jane Dickinson drew attention to the power of the language we use in her blogs examining language and health and in her argument to replace words that shame. It reminded me of another instance of language use that I believe to be inherently harmful – referring to nursing students as student nurses. This practice has been so widely used for so long that I can imagine many gasps and reactions, such as, “Well, that’s what they are; what else should we call them?” Why not nursing students? Is there a difference? I would argue there is a great difference.

I cannot think of one other group of students, health or otherwise, that is referred to with a similar moniker. We do not speak of student doctors, student lawyers, student engineers, for example. They are medical students, law students, engineering students. The lack of parallelism is the first indication that we should examine this practice.

When I “trained” to be a Registered Nurse in a hospital in the early 1960s, student nurses made up a large proportion of the hospital’s workforce. Student nurses were identified by their caps, first having none in the first 6 months, then after the capping ceremony, a white cap. Second year students were identified with a light blue ribbon on their caps, third year meant a dark blue ribbon, until finally Registered Nurses wore the coveted black ribbon. The uniforms likewise differentiated students from Registered Nurses, with graduate nurses wearing all white and students being required to wear a blue dress, with highly starched white bib and apron – all exactly 14” from the floor, regardless of the student’s height (so in class pictures the skirts were exactly at the same length) – along with plastic collar and cuffs. Although I describe the practice of one particular hospital, similar practice were common elsewhere. Student nurses were a category of hospital worker and were, as such, as easily identifiable as housekeeping staff, candy stripers, or Registered Nurses.

I say all of this to make the point that not only did the label “student nurse” make her (with very few males at that time) identifiable, but also indicated something about her place in the organization and the expectations that organization had of her. (I will continue to refer to “her” because, although our class was unusual in that we had 2 males in our class, their uniform was white, like male Registered Nurses wore. It did not change throughout the 3-year program, and neither male students nor male Registered Nurses wore a cap or any other ranking symbol.)

The term student nurse comes from a time when nursing students were expected to be not only subservient (if a physican entered the nursing office, a student nurse who was sitting and charting, for example, was expected to rise and give the physician her seat), but also loyal, innocent and pure. The Florence Nightingale pledge, recited at graduation by the graduating classes of the time, included the promise to “pass my life in purity.”  In the first year after my graduation, I was employed as a Registered Nurse  at a secular  hospital (I ‘trained’ in a Catholic hospital) in a different Canadian province.) Yet the Director of Nursing forbade the graduating class that year from taking the pledge because she didn’t believe they had lived their lives in purity. She enjoyed the power to be able to do that!

This combination of an aura of innocence/ purity with the expectation that student nurses provided intimate care to males made “student nurses” highly desirable as dates.  Even during my student nurse years, engineering students from the local university would come to hospital schools of nursing to find dates for their dances.  Unfortunately, this also applied to nurses generally – the saying “if you can’t get a date, get a nurse” was common for years after I graduated in 1964. The frequent representation of nurses as sex objects, well documented by such authors as Kalisch and Kalisch extended to student nurses as well.

Despite the fact that nursing education has changed dramatically in the last 50 years, the term “student nurse,” with all its connotations, persists.  When I was teaching, I challenged students to refer to themselves as nursing students instead.  In class discussions on the topic, despite students’ general agreement that the connotation of “student nurse” was very different from that of nursing student, very few took up that challenge and subsequently submitted assignments in which they referred to themselves as student nurses. Some told me they were required to designate their status as S.N. when signing their charting.

I was interested in whether or not a Google images search for nursing student yielded any different result than search for student nurse images. The screen shots of the first screen that came up with each search are below.  Without a careful analysis, some differences are immediately apparent.  The top one is the screenshot of student nurse images; the second a screenshot of nursing student images.  


While both screenshots include some images that appear unrelated, in the top one they are images of children. There are no images of nurses practicing, and the screenshot includes images of the back of a nurse’s capped head, and the nurse as a romantic figure (Cherry Ames). The somewhat self-deprecating text message reads “ Student Nurse Diagnosis: Stress R/T: knowledge deficit, impaired memory, sleep deprivation, unbalanced nutrition, interrupted family process, lack of social interaction, disturbed energy field.”

Note the general increase in diversity and portrayal of adult nurses providing care in the second picture. The unrelated shots appear to depict Go-Kart racing. The text image, giving the same stress diagnosis, makes its point without self-degradation: “Diagnosis: Just a tad stressed r/t complete academic overload, depleted resources, little or no life.

It seems to me that the collages support the argument that the term student nurse has a different connotation than nursing student and its removal from our lexicon is long overdue. Some time ago I wrote a blog about nurses soaring like eagles. It is a parable about an eagle that finds itself in a chicken yard and starts to act like a chicken, rather than fulfilling its destiny and potential as an eagle.  I believe that by referring to nursing students as student nurses we are unwittingly reinforcing the many messages that the term connotes and are hindering their ability to soar like eagles.


Reclaiming Holistic Nursing

Jane Dickinson’s wonderful post of February 24th, “Replacing words that shame and blame in nursing care” touched on one of my own favorite topics – the words we use!  Our language is steeped in euphemisms – particularly where medicine and health are concerned.  Years ago Jo Ann Ashley often pointed out ways that the term “health care system” is a misnomer – it should be call “Sickness” or “disease” care system.  Even our conception of “prevention” is distorted, in that very little actual prevention happens. holisticLens Mostly, the activites that this term refers to is “disease detection” – not prevention.  With the exception of the development and use of vaccines, very little prevention happens.  Early detection of disease is a good thing, of course, and can “prevent” progression of disease to an advanced stage, but this is not prevention.

The term “holistic” is particularly important to consider where nursing is concerned.  Wholism (my preferred spelling) is, in my view, is one of the foundational values that distinguishes nursing as a discipline.  From this point of the view, the term “holistic nursing” could be seen as redundant. However, now the term “holistic nursing” is taken to refer to a nursing speciality that draws on complementary or alternative healing modalities.  We do need a term to refer to this particular focus, but it seems to me that even someone whose practice includes a complementary modality does not necessarily mean that it is wholistic, in terms of the extent the nurse takes into account not only the whole person, but the family, envieonment and social determinants of health.  Given the nature of the modalities we refer to as “complimentary” or even “holistic,” it is likely that the practice is indeed more “wholistic” than many medicalized specialties, but it is still too easy, in many of the contexts in which nurses work, to be overly focused on a part, not the whole.

I would be very interested in your thoughts and ideas on this!  Reaching for that which is “whole” is not easy, and is made more difficult in the contexts of specialization, and our language is a barrier as well. So share you thoughts and insights here – let’s have a discussion!

Replacing words that shame and blame in nursing care

The last time I wrote about language and health, specifically diabetes, I mentioned several words that impart judgment, shame and blame. People with diabetes live with and manage a demanding and challenging disease. When we use words like non-compliant or poorly controlled we are not taking into consideration all the factors that could be at play. Can the person afford insulin? Are they experiencing food insecurity? Did they ever receive diabetes education? What is their level of health literacy?

Two weeks ago I gave a talk about the messages we send to children and adolescents at diabetes camp. I discussed how we can send messages of judgment, or messages of strength and hope, simply based on the words we choose. Empowering campers is the work of diabetes camp professionals and volunteers. For nurses outside of the camp setting, the focus is also on empowering people – in hospitals, clinics, home care, public health, academics, etc.

At the end of my presentation, there was some discussion. The people in the room who live with diabetes strongly agreed with my suggestions about language and messaging. However, two people (who happen to be health care professionals) raised the point that “there are times when it’s necessary to use words like uncontrolled, good and bad.” They argued that doing otherwise is not giving good care. One of them also shared that she thought my talk was judgmental. At the break another participant came up to me and said she agrees that these words are not “PC.”

My first response to these comments was concern. I am clearly not using effective messaging about messaging if this is how people respond! Then after thinking about this feedback for several days I realized that it was very important for me to hear these points. This is how I can do a better job explaining what I’m trying to say. If I come across as judging people for using certain words, that absolutely defeats my purpose. If I come across as not giving good care by avoiding certain words, that’s not my intent either. And if we are simply thinking of the words we use in health care as “PC” or “not PC,” then we are not looking at the underlying problem. And isn’t that what we learned back in nursing school? (Look at the underlying problem, don’t just treat the symptoms.)

So my approach to all this is to go back to the problem, which is using language that is not appropriate for chronic care. Patients in 2016 are demanding holistic, person-centered care – and language is part of that care. Words create a context for people, and through that context people create meaning. So if they hear words that make them feel judged, they are likely to translate that into “I’m a bad person.” If they hear poorly controlled they may feel they are a failure.

Some ways we can change the messages we send to people include using words that put the person first: woman who has diabetes, people living with diabetes, or child with diabetes, instead of diabetic. We can use words that build on people’s strengths, rather than their weaknesses: takes her medication about half the time, rather than she’s non-compliant. And we can use words that focus on physiology, rather than judgment: blood glucose levels in the target range, elevated A1C, glycemic variability, glycemic stability, or blood glucose management, instead of any version of control.

When a patient has blood glucose levels that are clearly not in a safe or healthy range, we can start by asking questions. How do they feel about it? Find out what they know or don’t know. What are their resources? Ask if it’s ok to make some suggestions or share some guidance. Acknowledge that it’s hard and scary. This is how we can give good care and empower people. It doesn’t require judgment or judgmental words to help people make changes.

By focusing on sending messages that are person-centered and strengths-based, words that are consistent with those approaches will naturally follow. We can’t change the history of health care, or the words that went with it. But we can change the messages we send going forward.

Language and Nursing Care

In 1993, I gave an inservice for nurses on a School-Age Pediatrics Unit. The purpose of my talk was to discuss the importance of putting patients first by avoiding calling them by their diagnoses. We discussed how “diabetic” and “asthmatic” and “leukemic” and “sickler” are labels, and that there is so much more to each child than a disease or medical condition. I was saddened last year when I came across my notes from this talk and realized that things haven’t changed enough. We have not eliminated the words in health care that can hurt people, and maybe even lead to negative health outcomes.

I am a nurse and certified diabetes educator. I have been working with people who have diabetes for 20 years. I’ve lived with diabetes myself for almost 40 years, which is certainly one of the reasons I take language seriously – I know how it makes me feel. I remember my pediatric nursing courses, where we learned to avoid words that were potentially frightening to children, such as “stretcher” and “shot.”  Instead we were taught to use “gurney” and “injection.” I also remember a friend who was infuriated when the family physician called his baby “failure to thrive.” “No one is going to call my son a failure,” he fumed, not understanding what the term meant.

In diabetes care there are many words that imply judgment, shame and blame. Words such as “compliance,” “control,” “test,” “good,” and “bad.” And the list goes on – I have heard people with diabetes referred to as “recalcitrant,” “non-compliant,” and even “neurotic.” Nurses discuss patients through both speaking and writing. They sometimes use these words directly with patients, and often with each other. I believe that people with diabetes can sense when a health care professional deems them “non-compliant” or “poorly controlled,” even if they refrain from saying those words to their faces.

Where do those words come from? Why would people who choose a helping, serving career such as nursing, use words that could hurt people? It started with the acute care model, on which our health care system was founded. People came to health care professionals for help and were told what to do to “get better.” Taking medication for an infection, or changing a bandage, is very different from managing the daily tasks of a chronic disease. Since health care professionals don’t go home with their patients and help them manage their disease day in and day out, it truly is self-care or self-management. And it’s hard to deny that our health belongs to us. Therefore, words like “compliance” and “adherence” don’t belong in chronic care. Those words mean doing what someone else wants. People with diabetes make choices every day, and those choices determine how they take care of themselves, how they feel, and their health outcomes.

Another judgmental word is “control.” “Glycemic control” is so ingrained in our diabetes terminology that very likely most people don’t realize how often they say it and read it. But how much control does the person with diabetes actually have? Despite modern advances in technology and medications, it is not physically possible to keep blood glucose levels in the normal range all the time for those with diabetes. With much effort it is possible to manage diabetes, but perfection cannot be achieved. Using words like “control” makes it appear that control is possible and those with diabetes are not doing a good enough job.

Diabetes is a demanding disease with an emotional toll. Many, if not most people with diabetes experience some level of diabetes distress due to the stresses of diabetes. These stresses include the daily tasks of poking fingers, taking medications, scheduling and attending health care visits, and thinking about every morsel of food they eat. Add to that the constant questions and concerns from family and friends and society in general. Having to endure judgmental words from health care professionals on top of all that could really be the last straw. What if our words lead to further burnout or discouragement? Better yet, what if changing our words could empower people with diabetes to take better care of themselves?

Nursing is known as the caring profession because we truly care about people and their health. It’s time to match our words with what we do and what we stand for. Becoming aware of the words we use is the first step. Let’s really pay attention to the words we speak, read and hear in practice and in everyday life, and think about how they could be affecting people’s health. Stay tuned for a future blog post with ideas for words that empower people. And please feel free to add your own experiences with language in nursing care.

The Emancipatory Praxis of Integral Nursing

This blog will discuss my doctoral research, which was a critical narrative inquiry that sought to identify patterns in the stories of 10 nurses working in an American Nurse Wendy4Credentialing Center (ANCC) Magnet re-designated Oncology unit. Critical narrative inquiry is a research method developed by Dr. Suzie Kim (2010).  Critical narrative inquiry reflects upon societal-contextual experience and prescribed power relationships to identify, transform and transcend oppression. It deconstructs normative hegemony (the way things are or expected to be vs. the way things could be) by analyzing language, communication patterns and symbolic meanings in experience (Dunphey & Longo, 2007).

The method has 3 phases: 1) the nurses tell a story that exemplifies their experience of a theory guided practice; 2) the stories are recorded and transcribed, then critically read and reflected upon by the participants and researcher with the purpose of identifying salient patterns that emerge as facilitators or barriers to their theory guided practice; and 3) the nurses identify opportunities for transformative learning and emancipatory praxis.

During the process of the study I used Dr. Peggy Chinn’s Peace and Power model (2008) to share power with the nurses and optimize emancipatory knowledge acquisition by hearing their voices. I asked them what was important to them in their practice and in their experiences. Our research sessions were a dialogue between colleagues and I was careful to value their voice and power throughout the study and publication.

The purpose of the research was to:

  • Examine the impact of Human Caring theory guided practice upon nursing qua Nursing.
  • Learn about nurses’ educational preparation in theory guided practice and integral nursing.
  • Examine the relationship between nurses knowledge, caring and power in the Magnet environment.
  • Identify patterns that facilitate and create barriers to nursing qua nursing.

What we learned from the research was:

  • Nurses are transformative change agents who advocate for their patients, even against normative views and authoritarian power if it is in the best interest of their patients and families.
  • Nurses have a language and culture of rich values enacted through careful and meaningful comportment via her/his self-agency that protects and preserves the integral health of those in their care, community and environments.
  • Environments are affected by nurse’s behaviors and actions; external environments are carefully created to enhance patient’s internal environments via; lighting, ambient temperature, music, positioning, cultural, spiritual and religious acts, healing intention, touch, voice and presence.

These findings support Jarrin’s (2012) work where she describes nursing as “Situated Wendy1caring shaped by internal and external environments. These environments include: the individual nurse’s state of mind, intention and personal nursing philosophy, their scope, role, level of skill, training and experience societal and professional norms, values, and worldview social, political, and economic systems embedded in education and practice environments” (p. 14).

This research further supports Kagan, Smith, Cowling and Chinn’s (2009) work that rally’s nurses together for social justice and to protect and support professional values that empower nurses at all levels. The nurses in my study identified that working with nurses who value and support each other; while valuing and seeing the big picture or true meaning of protecting, advocating for and enhancing the patient and families integral health experience, creates optimal work and patient care environments.

Emancipatory praxis requires a convergence of multiple patterns of knowing, doing and being; where the nurse can sense and see patterns that are emerging; and imagine what can become for self, colleagues and those in their care. The knowledge, caring and power dialect is a rich area of inquiry for nurses to conduct further research.


Dunphey, L. & Longo, J. (2007). Reflections on postmodernism, critical social theory and feminist approaches: The mind of the postmodern. In P. L. Munhall (Ed.) Nursing research: A qualitative perspective (4th ed., pp. 127-142). Sudbury, MA: Jones and Bartlett.

Jarrin, O.F. (2012). Redefining the metalanguage of nursing science: Contemporary underpinnings for innovation in research, education and practice. Advances in Nursing Science, 35(1), 14-24.doi10.1097/ANS.obo13e3182433b89.

Kagan, P. N., Smith, M.C., Cowling, W.R., & Chinn, P.L. (2009). A Nursing Manifesto: An emancipatory call for knowledge development, conscience, and praxis. Nursing Philosophy, 11, 67-84.

Kim, H.S. (2010). The nature of theoretical thinking in nursing (3rd ed.). New York: Springer.

Marks, L.W. (2013). The Emancipatory Praxis of Integral Nursing: The Impact of Human Caring Theory Guided Practice Upon Nursing Qua Nursing in an American Nurses Credentialing Center Magnet® Re-desginated Healthcare System. Retrieved October 21, 2014 from