“Nurses’ talk about powerlessness and victimhood: slavery and jouissance”
Nurses are in distress, in the grip of a deep depression with far-reaching effects on the health service and nursing. The austerity measures underway in Ireland suggest the Government is aiming to take upto 35% of funding from the health services by 2014. This is an extraordinary measure and probably unprecedented in developed countries. A complete recruitment ban coupled with a drive for early retirement has left some services so understaffed that specialist nurses are being asked to return to the wards.
Places are being closed down. The fate of nurses is bound up with that of helpless, vulnerable patients . No one knows how nursing will look in 2014. What kind of hope can our middle and senior nurse managers glean for the future? Its nurse against nurse. Nurses are stabbing each other in the back. Where are the leaders to help us? Economic forces and the dominance of the medical establishment are overpowering nurses whose efforts and self-sacrifice go unrecognized by senior management and increasingly even by patients and their families. Through their dedication to their patients and their strong moral sense of duty nurses are exploited. Nurses are the slaves.
Wait a minute. This collection of phrases from nurses themselves is beginning to sound familiar. Reassuringly familiar. Familiarly reassuring. Haven’t we heard this before? Its not good but at least its not unfamiliar.
This morning I want to make this argument. Here’s a simple map of where I hope to go:
1 Nurses often express outrage
2 The context of nursing is widespread unrealistic expectation and fantasy
3 One way nurses avoid challenging the fantasy is by becoming a slave (and externalizing the disjunction between fantasy and reality)
4 Being a slave has payback
5 Health systems rely on nurses’ passivity for continued functioning
6 An alternative is to move away from a professional fantasy world
1 Nurses expressing outrage
I want to start by sharing with you something puzzling and paradoxical that has struck me in my research with nurses. In focus groups or interviews with nurses, over about 20 years and across continents nurses regularly talk in highly negative ways about nursing work yet this negativity is expressed with, or seems to produce, a high degree of energy and a kind of, well, a kind of self-destructive enjoyment. Let me give you an example. Here is just one of many I could chose, taken from an on-going PhD study with nurses in London by my colleague Chrysi Leliopoulou. These are experienced, senior nurses:
Nurse 1: …we’re…er… risking so much litigation. I mean the medical profession has always been very… powerful
Nurse 2: How many mistakes do doctors make and they never get any sanction or…or…
Nurse 1: No never sanction
Moderator: Yes.
Nurse 1: Nurses don’t have that at all. Nurses stab each other in the back.
Nurse 3: Also, we put up with a lot of these things that nurses go without breaks, they stay late and other professionals wouldn’t do that, you won’t get a secretary working through their coffee break.
Moderator: Why do we do it though?
Nurse 3: Because we’re conscientious….
Nurse 2: [I’m] Just thinking that we’re painting a really bad picture of nursing and it’s obviously something that’s making us stay in nursing.
Moderator: What is it? What is it keeping you going?
Nurse 2: It’s rewarding and… I think sometimes it’s quite a privilege to have been that intimate with a patient.
Nurse 1: You don’t always. Not necessarily. You can’t do anything else, I’m too old now.
Moderator: Really, you could change.
Nurse 1: But there’s always… Burn out. That is the danger of what we’re doing. We’re over-working, we’re at risk… we’re risking our health. We’re risking to burn out. And then our profession with… we’ve… we’ve lost it.
I am sure that most people here will recognise this kind of talk.
Recently I have begun to ask what light psychoanalytic explanations can shed on this strange observation and to ask what kind of unconscious factors might be at work in nurses’ words in this research. I am going to draw, this morning, on some of the ideas of Jacques Lacan and Slavoj Žižek, as well as the father of psychoanalysis, Sigmund Freud. In particular I plan to focus on a kind of enjoyment (Lacan’s word is jouissance) experienced by nurses in expressing and repeating a position of powerlessness and as ‘slave’ in healthcare systems. In the process I also offer some speculative explanations for the high-profile failures of nursing care that we have seen in the media with seemingly increasing frequency….
More to come