Embracing the Politics of Nursing, Constructing Nurse Consciousness

Florence Nightingale is often hailed as the founding heroine of professional nursing. In many respects, perhaps she is. Her Notes on Nursing was a call to arms of sorts, the watershed that cantilevered the domestic work of women into a respectable profession (1860/2012). Nightingale violated cultural norm after cultural norm of her day in pursuit of building a profession that embodied the potential she saw in nursing. At the same time, her admonition to stay above the fray directed nurses to stay out of the woman suffrage cause (check out the concluding paragraphs of Notes!). There is a wide array of interpretations of Nightingale’s political position, but here, I would point out that even this controversy bestows nursing with a conflicted legacy of apoliticism, a hegemony that starts at the very beginning of our professional identity.

This is not to deny, dismiss or denigrate the work of Florence Nightingale. Her work was critical to the professionalization of the field (Thorne, 2014). But often we throw the angel of the hospital – the lady with the lamp – up as an angelic emblem of neutrality. This belies her own justice focus and obscures an undercurrent of justice long present in nursing (Andrist, 2006; Thorne, 2014).  And, because nursing began in some respects as an outgrowth of the domestic responsibilities of women, nurses are often equated with mothers, with peace, with love, with nurturing (Andrist, 2006). This roots our narratives and tropes of nursing in the domestic sphere, a cult of true womanhood (Andrist, 2006). Part of an oppressed group (Roberts, 2006).

As part of an oppressed group, voices of nurses are often silenced, even sometimes silenced before they have spoken. Socialized into silence (Andrist, 2006; Roberts, 2006). We bear the evidence of oppressed group tendencies: lateral violence, demeaning one another, even bullying those in our charge. But as part of an oppressed class, with scrupulous attention to identity and position, nurses can achieve epistemic privilege and even liberation if we work at it (Harding, 2004; Risjord, 2010; Roberts, 2006). We can and we must embrace the nursing standpoint as vector along which to organize. As we do this, we must attend to intersectionality, recognizing that race and gender and other aspects of identity interact in complex and unique ways in order that we might avoid replicating the problems of white supremacy in liberal feminism (Crenshaw, 1989). Oppression forms what Patricia Hill Collins (2009) calls a “matrix of domination,” acknowledging the interconnectedness of privilege and social groupings. This points to the complexities of the problems we as nurses face in doing the work of advocating for ourselves, for the patients for whom we care, for justice, for equity. We can and we must work to ensure that our profession reflects the needs, priorities, and diversity of those for whom we care at the same time we work to make our profession itself more diverse, just, and equitable.

Nursing has a radical ethos. An emancipatory impulse. An imperative for liberation (Thorne, 2014). And has since the beginning. Nursing is inherently political and complex. Thumbing through the annals of nursing history, we can see this: abolitionist Sojourner Truth, anarchist Emma Goldman, contraceptive reformer Margaret Sanger, first wave feminist Lavinia Dock (Andrist, 2006). We take care of who needs taking care of. We are in the business of getting stuff done, one of our finer points, if you ask me. But because we are always quick with a workaround or a creative solution, the practical problems our profession confront can be difficult to demonstrate. This, I think, is how we have found ourselves mired in a healthcare system in the United States that fails to care for all comers in an equitable and just way. I cannot stand by quietly as women die from preventable complications of childbirth, especially when African American women are sacrificed at three to four time the rate of white women, clearly illustrating structural racism in healthcare. I will no longer tolerate the euphemistic language of “health disparities” when these outcome differences are driven by structural and institutional racism. I cannot participate in a healthcare system that prioritizes the almighty dollar over the lives and wellbeing of people. I have to nurse outloud and, to me, that means embracing and embodying nursing as social justice (Thorne, 2014). If we don’t stand up, speak out, and precipitate change, we are complicit with injustice. This is to to say nursing is perfect – it’s not – and we have much work to do to end racism in the profession. We have to start somewhere.

All this is amounts to manifesta of sorts. A starting point. The impetus for action. Vanessa shared, in her first blog post, the origin narratives for this conversation. Peggy Chinn, inimitable and larger than life, brought together this unlikely and incredible group of nurse-activists, setting the stage for continued action. This continued action is explained in the Manifesta for the Radical Southern Nurses Collective that will be shared next week.

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Jess Dillard-Wright is a radical nurse, midwife, nurse educator, and PhD student living in the South.

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References

Andrist, L. (2006). The history of the relationship between feminism and nursing. In L. Andrist, P. Nicholas, & K. Wolf (Eds.), A History of Nursing Ideas (pp. 5-22). Boston, MA: Jones and Bartlett Publishers.

Collins, P. H. (2009). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.).. New York, NY: Routledge.

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. The University of Chicago Legal Forum, 140, 139-167.

Harding, S. (2004). Introduction: Standpoint theory as a site of political, philosophical, and scientific debate. In S. Harding (Ed.), Feminist standpoint reader: Intellectual and political controversies (pp. 1-17). New York, NY: Routledge.

Nightingale, F. (2012). Notes on nursing: What it is and what it is not. [Kindle iPad version]. Start Publishing. (Original text published in 1860).

Risjord, M. W. (2010). Nursing knowledge: Science, practice, and philosophy: Ames, IA: Blackwell Publisher.

Roberts, S. (2006). Oppressed group behavior. In L. Anderist, P. Nicholas, & K. Wolf (Eds.), A History of nursing ideas (pp. 23-33). Boston, MA: Jones and Bartlett Publishing.

Thorne, S. (2016). Nursing as social justice. Philosophies and Practices of Emancipatory Nursing. P. Kagan, M. Smith, & P. Chinn (Eds.), pp. 79-90.