nursingforsocialjustice

I had an experience today that left me pretty unsettled. I feel so unsettled that right now it’s the middle of the night and I cannot sleep because my brain cannot stop trying to process the information I was exposed to today. I am struggling with how it matches with my nursing framework and my perspectives on nursing care. I am also struggling with my knowledge that, as nurses, we provide round the clock care to people in the inpatient setting; we enter into relationships with people in a way that no other health care worker does because we are there in the day and also in the middle of the night, when people are recovering but also when people are suffering and when people are dying…we have the privilege of entering into these special caring relationships with people and I think maybe we need to start doing a better job of communicating to the rest of the world that this is not just part of our job, this is the core, the heart of our job. I think that we also need to do a better job communicating to the rest of the world that relational practice is something that is deeply embedded in nursing care, that the tasks that we do are integrated into the critical thinking that we do and the care that we give.

I entered the day feeling hopeful, with the expectation that I would feel inspired and recharged by the end of the day. At the end of the day I felt disempowered, devalued, lonelier, and extremely confused about the what i experienced. I am still trying to figure out if this is because of my stuff or because there were some stuff that was missed.

I completed understood what the content of the day was supposed to deliver. I feel like what happened throughout the day was that a bunch of people in a room agreed that we are all incredibly reflexive in our work and that we are all on the same page and have great understanding of how we fit within the team and now we shall move forward to save people and save the world because of this. I think that what I felt at the end of the day was reinforcement that my role is less understood, that I feel awful because I feel misunderstood as a nurse and that I feel that more than ever my voice and opinions need to be silenced. I felt like an outsider on my team, I felt alienated. I also felt like a lot of the discussion about where we are coming from in terms of ethical practice and reflective practice as well as reflexive practice does not match up with what we are actually doing. These are some questions that I walked away from the experience with:

How does life experience qualify someone to do a job? I am not sure if this is because I am thinking about it too logically or not abstractly enough or what but I got really confused about discussion that seemed to imply that experience in someone equated to qualification to do a job. Am I just being too logical about this? I started to think, I drive a care everyday, I have lots of experience driving a car but that does not qualify me to design cars. I have children, I teach them stuff, but that does not qualify me to be a grade school teacher. I watch a lot of television, I love television, but that does not qualify me to make television shows. So I don’t understand really how that line can be drawn between having experience with mental health challenges or substance use issues, or poverty, or health challenges as a means of qualifying someone to work in a particular area…unless the goal is peer support…and to think that being a peer support person is an inherent quality completely devalues the role of someone in peer support. I get it, I understand that our personal experiences, our lived experiences help us build empathy and compassion and make sense of the world, and maybe I totally missed something because I was so fixated on misunderstanding, but my personal experience does not qualify my to be a nurse…it does not qualify my to work ethically and responsibly with people…

Is it okay to be poor? Is it okay to be homeless? I feel like we automatically make the assumption that someone wants housing. I feel like we are into what the research says when it supports our opinion, but not so much when it comes down to things like providing evidence that what we are doing in particular is good in terms of ethical principles. What does coercion mean and how does this fit into the job that I do given the (seemingly?) conflicting principle of autonomy? I feel like some reality checking needs to be made about the number of times that a shared space is entered with the paid worker thinking this is what you need and this is what we will accomplish rather than asking the question, what do you need? You have been referred to us, this is what we do, what do you want help with? I feel like there needs to be better understanding of the fact that psychiatry is the only area of health care where is is still perfectly acceptable to force decisions on people because we are making the assumption that our informed decision is better than any informed decision that someone with severe and persistent mental health issues can make. I feel like there needs to be a larger discussion about how our values and beliefs get mapped onto the people that we are providing care to. And I feel like the most confusing thing of all to me is that I left with the unsettling feeling that because people share life circumstances then they are approaching the decision making process from the same place as the service user. I think that every day it is important, multiple times a day to think about what my personal values are as a health care professional, as a woman, as a mother, as a nurse, as someone who is the product of my parents, and my education and my geographical location and so on and so forth are influencing my thought process and then how this may completely differ from that of the person I am providing care to. Is it weird that we call people “service” users? Is it weird that we adopted a language of customer service? The language that resonates with me, from my nursing perspective is the person that I am providing care to. Is it weird that this is the language of nursing?

I felt completely devalued when the job is I do is described as “hanging out” and I also felt extremely confused about what the mandate of the program is and my purpose in the program. I also felt confused about how the ethical principle of justice fit into this equation because resources are scarce and I am not confident that this is being taken into consideration. I get it, I get that we are trying to move away from stigmatizing language, but does that confuse what are job actually is?

I also left the situation questioning the degree to which professional boundaries are maintained, only because the language that was used seemed indicative more of social relationships rather than therapeutic ones. I also left the conversation thinking about how the trauma I experience as a caregiver was invalidated because I am paid to do the job. I understand, it is a job that is chosen but that does not mean that we are not entering into shared space with someone in a relational practice where I am changed by the situation as much as someone who is dying in front of me is. I completely understand, I am the health care professional and that there should be capacity to ensure that I am psychologically safe. I think I perhaps missed part of the full message, but I left feeling like the notion that compartmentalization of the tragedies and trauma that we experienced should be reinforced and the bad feelings that we get should be ignored. Logically I know that this could not have been the message that was trying to be reinforced but emotionally that is the message I walked away from the experience with.

I do not understand how scarce resources are being allocated in an ethical way when my job, as someone with specialized education and also with a substantial wage difference, is allocated to do the same tasks as everyone else on the team. I get it, I get that we are trying to flatten the hierarchy, but this seems to be at the expense of allocating those scarce resources. I walked away wanting to know what a mental health outreach team would look like if it was completely staff with experienced nurses mostly or only. I felt lonelier on my team walking away from the day than I did walking in, and I do not know who I am safe to talk to about this.

I feel like the ball got rolling and the momentum is being built but that the groundwork was laid in order to make sure that the purpose and mandate of the work  and how it fits into the continuum of care was understood and now its just a jumbled mess of trying to find small successes that help make sense of where efforts are going.

I feel like the day was to reinforce that we are the good guy and that we are fighting the good fight rather than asking questions about what is the good fight? I feel like the day ended with more reinforcement of us versus them in terms of health care services, with us thinking that we are more right rather than better understanding that these are the constraints that we are working within and that on both sides the goal is common. And maybe the whole purpose of the day was to challenge us to think about what questions we walked away from the discussion with and to leave us with unsettling feelings but I really walked away from the conversation feeling misunderstood as a nurse and feeling like my role within the team is viewed in a stereotypical way, that is, I give a needle, I take a blood pressure, I dress a wound, and the more important pieces of the core of what nursing is to me, what mental health nursing is to me, are stripped away.

I get it. I get why there is discussion that the Housing First model, as it is conceptualized and as it actually is may not be a realistic goal. I get that from a funding perspective, from a allocation of resources perspective, it seems like too much is being spent on a handful of people when many, many more need the service, and won’t get the service because so much time is spent on preventing crisis in the handful of people.

I feel sad that nurses are not fighting the good fight in the acute care system, the places where they experience social injustice in their own profession everyday…I feel like as nurses we are oppressed and that we have to be willing to put ourselves out there to change the system.

Peace

Michelle D.