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9 reinventing dirty Work Immigrant Women in Nursing Homes lucy t. fisher and miliann kang Paula, a fifty-nine-year-old widow who emigrated from the Philippines in the mid-1980s, has worked at the same nursing home in California for sixteen years. When asked to describe her work as a certified nursing assistant, she joked that she refers to herself not as a CNA but as a “PAW—professional ass washer.” While she highlighted the dirtiness of the job, she also regarded it as caring, skillful work, and she took pride in performing it. She elaborated: “Giving a bath like that, cutting their nails. Everything, do everything. . . . CNA is a big responsibility . Not in bed making—it’s easy to do the bed. If you’re taking care of people, you have a big responsibility, because their life depends on you. It’s hard. Like those who are working in the office [can] just leave the papers. . . . But I’m not considering this a hard job because it depends upon your technique and routine. . . . Of course, if you’re very picky, you cannot be successful CNA. You have to be practical. . . . I supported my niece for nursing school. . . . Now she can find work anywhere—Saudi, Canada, Australia—anywhere. I’m proud of her.” Paula’s description revealed the multiple and contradictory dimensions of a CNA’s job. On the one hand, it is low-status, poorly paid, and physically demanding “dirty work” that requires attention to intimate parts of the human body. On the other hand, the fact that others “depend on you” for their lives, and that the job is a “big responsibility” can lend it meaning and importance. As Paula asserted, not everyone can be a CNA, as the job necessitates developing “technique and routine ” that encompass a range of physical, emotional, and communication skills learned only through experience. Furthermore, this job allowed her to support herself and her extended family; in addition to putting her niece through nursing school, she sponsored visas for family members and regularly sent money back home to the Philippines. ImmIGrANt WomeN IN NUrsING homes · 165 Immigrant women like Paula, who make up a large part of the CNA workforce , accommodate themselves to the various demands of low-wage, low-status service jobs by engaging in “boundary making” (Lamont 2000, 3), processes that circumscribe and redefine the performance of “dirty work” (Stacey 2005). This study builds on these concepts and expands them based on distinct processes related to the provision of long-term care in nursing homes. According to Lamont, boundary making refers to material and symbolic processes in which providers of low-wage work impose limitations on its performance while redefining the work as skillful and important. For CNAs, boundary making also includes negotiating the interface between hands-on work in long-term-care institutions and their own social worlds, especially reformulating the stigmatization of this work as unskilled and low status. While these processes can give CNAs and other service workers some control over both the material and symbolic aspects of the work, boundary making also has significant structural limitations. CNAs’ ability to create better working conditions and higher status for this job is limited by the institutions that employ them, their status as immigrant women performing low-wage work, and the downgraded status of both elderly people and elder care in the United States. Drawing on the literature on care work, nursing, and the body, we define dirty work as physical labor that involves cleaning and caring for the human body, its products, and its environs, particularly where doing so involves handling body parts or products that are intimate, messy, or possibly contaminated. Several aspects of the CNA job contribute to its characterization as dirty work: contact with the human body and detritus; sexualization of interactions involving intimate physical contact with patients; and dealing with dead or dying patients. This work also involves extensive emotional labor (Hochschild 1983) and body labor (Kang 2010), in which the management of feelings and bodies is an essential part of performing service work. By recognizing the embodied and emotional dimensions of their work as requiring important skills, CNAs reinvent dirty work as having greater dignity. Like Stacey’s (2005, 849) study of home-care work, which found that aides derive a “sense of pride that comes from doing ‘dirty work,’” our study shows that CNAs find meaning through their mastery of work that others shun. However, this work is performed under less-than...

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