When an attending doctor recently took me aside after a particularly hard clinical case with a first-year resident, she made pains to point out to me that the resident felt she wasn’t being treated fairly by nurses, because she was a woman. The physician went on to describe the difficulty of being a woman in a professional world where male colleagues are taken more seriously and treated with more respect, regardless of knowledge. My first sentiment was one of sympathy because of course I understood what it feels like to be dismissed, talked over, and minimized in the clinical setting. But immediately I was struck by a deep and unsettling irony.
Nursing is one of the most female-dominated professions in health care, particularly in the area of obstetrics where I work. For generations, nurses have carried the emotional and physical work of medicine, yet remain on the lowest rung of its hierarchy, systematically undervalued, regardless of education, experience, or even simple competence. When female physicians, who continue to struggle for legitimacy in a male-coded profession, enter a workforce led by women who have been systematically undervalued, the result can be a quiet but painful collision.
The paradox of gendered hierarchies
Medicine and nursing were never created as equals. The early 20th-century hospital formalized a gendered division of labor: the male physician as authority, the female nurse as assistant. Even as both professions diversified, the architecture of power remained.
While today women make up approximately 40 percent of physicians in the U.S. workforce and more than 85 percent of registered nurses, gender parity hasn’t erased the hierarchy; it has complicated it. In obstetrics, the imbalance is more stark; women represent the majority of the discipline, with 62 percent of physicians in the specialty and over 95 percent of the nursing workforce. This female-centric gender dominance is unlike any other labor force in the world. Even so, female residents report being interrupted, doubted, or undermined by attendings and patients alike. Nurses, in turn, are often expected to defer to those same residents, even when the nurse’s clinical experience and expertise far exceed the training doctor’s. Likely this is because both groups struggle under the assumption that their value must be constantly and demonstrably proven.
In the clinical environment, when frustration has no safe immediate outlet, it tends to flow outward. In nursing, this well-studied phenomenon is deemed horizontal violence: the aggression or blame that moves laterally among colleagues rather than toward the systems that create the inequity. In hospital culture, this can manifest as curt exchanges, exclusion from decision-making, or subtle undermining under the guise of informing or teaching. Residents often internalize the same hierarchies that marginalize them. Struggling for authority in a profession that rewards masculine norms of confidence and control, they may unconsciously project their insecurity onto nurses. The nurse, positioned as both subordinate and female peer, becomes an all-too accessible target.
This dynamic frequently surfaces in times of high-stress or clinical uncertainty. When outcomes are questioned, blame is more likely to fall to the nurse who holds less institutional power, not less knowledge. I’ve seen nurses with 20 years of obstetric experience, advanced degrees, or exceptional clinical skill corrected by residents who have yet to manage their first uncomplicated birth or postpartum hemorrhage. The friction isn’t about ego; it’s about being seen. Expertise without authority is, or at the very least feels, invisible.
Internalized oppression & the cost of habitus
Decades ago, feminist and race-theorist Audre Lorde warned against replicating patriarchal power structures, as internalized oppression leads the marginalized to replicate structures of domination among themselves. The enduring medical model is a microcosm of a society that demonstrates authority over certain people.
French sociologist Pierre Bourdieu wrote at length about how structured social places (fields) create their own rules and forms of capital. In hospitals, doctors hold capital in the form of prestige, authority, and legitimacy, while nurses hold embodied, practical knowledge, and emotional labor. The hierarchy persists because our field legitimizes certain forms of knowledge: medical “objective” over embodied “subjective.” Female residents absorb this hierarchy as they gain knowledge within the framework and, perhaps unknowingly, reinforce structures of dominance that preceded them. This replicated habitus creates a feedback loop, producing stress and fear, which is displaced laterally (resident to nurse, nurse to resident) until everyone feels diminished.
Toward gender parity: a model for medical collectivism
When respect erodes, so does communication. In medicine, communication is paramount to keeping patients safe. I am one of many experienced nurses increasingly hesitant to speak up in expectation of dismissal, as residents often resist input that challenges their perceived authority. The result of a muted nurse with experiential knowledge (which is inarguably salient for medicine to work) isn’t just emotional fatigue; it’s risk to patients. Many studies have shown that poor interprofessional collaboration is a leading factor in sentinel events.
Beyond patient outcomes, the emotional toll is profound. Nurses feel unseen despite their experience. Residents feel unsupported despite their education. Both leave strained interactions questioning their competence. This is not a problem of individual attitude but of institutional design: one that rewards hierarchy over collaboration, and credential over experience. If we are serious about equity, we need to closely examine the history behind these struggles and the structures that uphold inequity. Gender parity means little if we reproduce the same patterns we have historically struggled under in medicine.
A key element to change should include building structured interprofessional dialogue (not just teamwork rhetoric) facilitated spaces where nurses and residents take notice of how hierarchy shapes their daily interactions. Joint debriefs, not just after complex cases but after all clinical procedures, can clarify clinical reasoning while giving space to appreciate and acknowledge one another’s expertise. Mentorship programs pairing experienced nurses with early-career residents would be a useful model to cultivate mutual respect rather than defensiveness. Hospitals should also examine how institutional language and practice reinforce inequity: policies that describe nurses as support or ancillary staff, EHR systems that bury nursing assessments and notes beneath physicians’, and entrenched deferential expectations send a quiet but enduring message about whose knowledge counts.
Ultimately, what both nurses and residents want is the same: to be trusted, respected, and heard. But that cannot happen until we acknowledge that the culture of medicine (even when tipping toward a future dominated by female providers) still maintains the architecture of patriarchy.
Redefining essential knowledge
When the attending doctor told me how the resident felt unfairly treated, I paused, nodded, and said, “It’s hard to be undermined and have your expertise devalued.” What I wanted to add was “welcome to the culture of medicine” because in this environment, we are all devalued. But our shared frustration should not make us adversaries, rather allies in dismantling the structures that pit us against one another.
Respect in health care will never come from hierarchy; it will come from humanity: from seeing each other not as chiefs and interns, attending physicians and staff nurses, or health care providers and their ancillary staff, but as colleagues bearing different kinds of knowledge, all of it essential.
Jennifer Carraher is an advanced practice nurse.
