Catheters, Slurs, and Pickup Lines: Professional Intimacy in Hospital Nursing

1. Invisible Intimacy in Nursing

N o administrator at the hospital could articulate the process of care—for example, how nurses specifically made patients feel safe or responded to their needs across many different contexts. This did not mean that hospital leaders did not value care. The hospital demonstrated the priority it placed on care through its mission, its value statements, and its Magnet status. While all three of these acknowledged care in various ways, none of them included topics related to professional intimacy. For example, my interview with the hospital president revealed that, although he valued nurses, he could not say how care happened and could not acknowledge the expertise needed to negotiate intimacy. He said, “I don’t know how they do it. I am just grateful they do!” On the surface, the president’s sentiments seem to express his appreciation for nurses and even, perhaps, his support of their work. On a deeper level, these sentiments mask the actual work he appreciates. The hospital president expressed gratitude for the nurses’ ability to handle intimate care but for what exact skills, he did not know. He values care but does so in a way that mythologizes it and hides intimate labor practices. These findings from my interview with the hospital president mirror what I observed at the hospital, where staff and administration alike effused about the importance of care but no one identified its meaning or acknowledged the practice of intimate labor. Consider this statement that describes the hospital’s work culture: “Mutual respect and care are the underpinnings Invisible Intimacy in Nursing 1 24 chapter 1 of our culture. They create a work environment where everyone feels valued and appreciated, where employees look forward to going to work every day.”1 What does it mean for “mutual respect and care” to facilitate “a work environment where everyone feels valued and appreciated”? Mutual respect and care are the subjects of this sentence, but respect and care do not just happen. Framing care this way makes the intimate aspects of nurses’ care work invisible . The statement expresses what I witnessed as genuinely held values at the hospital, but it fails to recognize how this environment is achieved on any practical level. The hospital also demonstrated its commitment to care by including in its nursing literature statements such as “______ Hospital always cares for you” and “The staff are true professionals who sincerely care about the patients and each other.” Here nurses are identified as professional, but care is broadly described as a value or a feeling one may experience upon entering the hospital doors. Instead of marking intimate labor as distinct from other forms of care, these statements conflate various types of care: medical care, technical care, care coordination (care plans), personal care, and of course, care as a way of being—a way of being “nice.” To be taken seriously by the medical profession, nurses emphasized measurable outcomes of their labor, such as technical and medical care. They partitioned care as a value separate from professional labor. They found care difficult to describe and also used it as a lump-sum term to refer to various aspects of nursing. Consider the following quotation from a nurse administrator when I asked her to define different aspects of care: I think it would be very difficult, and the reason I say that is, oh, the technical would outweigh the professional. But not really, because really , what’s happening at the same time is that the nurse is thinking, and that’s the distinction of a professional—is thinking while performing the technical. So, I might be giving a patient a medication, and there’s the technical part, the robot part when I go over and get the medication and I look at the record of how much I should give, and I walk it to the patient’s room. But the professional side, of evaluating the patient’s allergies, what are the other medications that the patient’s on, what has the response to the medication been, and then if I think they’re going to go home on it, teaching them about this at the same time that I’m administering it. It’s difficult to separate it out. It is important to note that this administrator began her response by saying it would be difficult to define different aspects of care. She was not alone. Inv IsIble IntImacy In nursIng 25...