Surprisingly, for all the differences between themselves and other types of care providers, hospital nurses reveal many of the same tensions in their caring work. Nurses differ from the majority of care workers in belonging to a profession: with government backing, nurses exercise at least a modicum of collective control over recruitment, training, licensing, rights, duties, and compensation within their areas of competence. Like their fellow health profes- sionals—pharmacists, psychologists, and physicians—they collectively guard the boundaries between their specialty and adjacent caregiving fields.
Nurses divide into a variety of ranks and specialties: administrators, practical nurses, aides, nursing students, members of surgical teams, and more. The mainstay registered nurses qualify for their jobs through substantial college educations. Compared with other care workers (excluding physicians, of course), RNs receive relatively good pay. Indeed, in the contemporary United States intense competition for their services often includes a signing bonus. Nurses’ technical and emotional caring services are multiple: they range from storage and administration of medicines to monitoring of life-sustaining machines, checking of vital signs, provision of bodily care, answering questions from patients and their families, advising and psychological counseling, and administering hospital wards from day to day—and night to night. As Daniel Chambliss found in his extensive field research within medical institutions, such multitasking requires efficient organization:
The staff nurse dispenses hundreds of pills a day to dozens of patients, starts and maintains intravenous lines, gives bed baths, documents on paper virtually everything she does, monitors temperatures, blood pressures, and urine “outputs,” delivers food trays, and responds more or less to all the miscellaneous patient and family requests. . . . Simply getting through an eight-hour shift without mistakenly giving Mrs. Jones the pills for Ms. Smith, or forgetting to check Mr. Martin’s IV line, or not helping Miss Garcia eat her lunch is challenge enough.
And these are the everyday, non-emergency tasks. (Chambliss 1996: 34-35)
As distinguished from physicians, most nurses spend a great deal of their time providing bodily and emotional care. In that regard, they resemble many other caregivers, for example those we have already encountered within households. As Chambliss notes, “Close patient contact, with all five senses, is nursing’s specialty. .. . Nurses are constantly talking with, listening to, and touching their patients in intimate ways; the prototypical, universal dirty work of nursing is ‘wiping bottoms’ ” (64). Physicians do, of course, as Chambliss mentions, “perform major procedures (inserting tubes into the chest for bronchoscopies): but most of what is said and physically done to patients is said and done by bedside nurses” (64).
As in other varieties of paid care, nurses often find themselves pulled in three directions: toward their formal professional responsibilities, toward their personal advantage, and toward concern for their patients’ welfare. Forty-year-old Karen Mitchell, a nurse at Mercy Hospital in suburban Minneapolis, specializes in tending patients who fall somewhere between intensive care and general medicine. According to a New York Times reporter, for Mitchell,
the concerns of making money and the concerns of healing have never been easy companions. .. . Which is why Mitchell sometimes takes it upon herself to sacrifice one for the other. It’s her small act of rebellion, a quiet vote cast for the future. Every once in a while, when Mitchell encounters a patient like Mr. Beaudry—a strong soul having a moment of true vulnerability—she will unclip the hospital phone from her hip and pull out its batteries. And then closing the door, she sits down beside her patient, just to be near. (Corbett 2003)
Nurses occupy conflicting positions. On one side, their daily attentions sustain lives and produce much of the healing that actually occurs in medical care. On the other, they lack the physician’s authority to prescribe drugs, make significant changes in treatment, call for tests, transfer patients, and to make diagnoses, but still often take the blame when things go wrong. From the perspective of supervising physicians, nurses succeed when they perform their technical duties well, enforce the treatment regime, keep records adequately, respond effectively to life-threatening emergencies, and keep patients from complaining. But to accomplish these objectives, nurses establish close relations with their charges. Not only do they provide intimate bodily and emotional attention, but also they deploy the skilled practices of personal intimacy—joking, cajoling, consoling, and sympathetic listening. Yet they bear greater organizational responsibility for their patients’ welfare than do the nurse’s aides, attendants, food servers, and cleaners who also sometimes establish personal relations with patients. It is a taxing job, as conversations in the nurses’ lounge always reveal.