A critique does not consist in saying that things aren’t good the way they are. It consists in seeing on just what type of assumptions, of familiar notions, of established and unexamined ways of thinking the accepted practices are based… To do criticism is to make harder those acts which are now too easy.

― Michel Foucault

I’ve been thinking about what it means for nurses to be politically engaged. Nurses witness at close hand the inadequacies of the health system and the impacts of the social determinants of health and issues to do with differential quality and access.Yet few nurses see it as their role to challenge the political decisions that contribute to inequalities in health.

Amélie Perron’s Nursing as ‘disobedient’ practice: care of the nurse’s self, parrhesia, and the dismantling of a baseless paradox invites nurses to move beyond the valorising of the liberal autonomous individual of the therapeutic relationship to greater political consciousness and action.  However, political engagement including: “building political awareness, engaging in political discussions and action, presenting and speaking of themselves as political agents, and importantly, tying this political consciousness and involvement to their nursing identity” are seen as taking nurses away from care. However, I believe that it is nursing’s social mandate and professional responsibility to challenge structural constraints and social policies rather than passively accepting them. Contributing to much of this lack of movement is the ways in which much of nurses’ professional autonomy and agency are  constrained by administrivia and regulation within highly monitored health care organizations. The reductionism that this kind of surveilling invites means that there is a focus on the micro at the expense of the meso and the macro, so much that  the ‘bigger picture’ of nursing and health care are lost, let alone one’s role in the sociopolitical arena.

What I love about Perron’s paper is that she concludes this:

nurses are not faced with choosing either caring for their patients or engaging with politics. Instead, I assert that engaging with one automatically binds nurses to the other and vice versa. I base my discussion on the assumption that such dichotomy is meaningless and that engaging with issues of relationships firmly grounds nursing in the realm of politics. I argue that this portrayal of the nurse–patient relationship as a private and apolitical phenomenon could well (and, in fact, does) distract nurses from the bigger picture of nursing and health care, the broader context within which nurses practice their profession and which shapes and governs the ways and the extent to which nurses can do so. It also creates the illusion that the world ‘out there’ is a minefield of political games, while the safe, private, and seemingly more predictable one-on-one relationship with a patient is neutral and devoid of political content and processes. In fact, it seems to be a common saying among nurses that ‘I don’t want to be involved in politics, I just want to care for my patients’, as though the worlds of ‘politics’ and ‘patient care’ are separate and actually possible to disentangle

I am noticing a lot of discomfort around political consciousness and action, in the context of Gaza and Israel, Syria, austerity, global exploitation of resources, climate change and more. I think it is difficult to positively and constructively engage with politics.

Importantly, I think understanding (and distinguishing) the links between oppressive structures and individual experiences is critical. These structures can be patriarchy, capitalism, racism, compulsory heterosexuality, ableism, the nation state etc etc. Therefore, I can like Australians but critique the Australian Government’s stance on asylum seekers, I can have friends who are Jewish but feel devastated at the bombing of Gaza and the heavy handed tactics of the Israeli state; I can like men but despair of misogyny and sexism in the media and the lack of acknowledgement of women’s affective labour; I can like shopping for trinkets but critique the exploitation of labour eg in Qatar and ask what the true cost of my trinket is; I can enjoy romantic comedies but also ask questions about why they are only ever about white men and white women; I can appreciate my remarkable standard of living (not just money, but clean air, facilities etc) but critique why there is an uneven distribution of the world’s wealth and resources; I can love the birds in my garden but be concerned about how the indigenous custodians of the land came to be displaced and how I got to be living on it; I can enjoy flying and travelling on dual carriageways and also critique the valuing of work at the expense of community, I can be concerned about the impact on the environment of dredging the Great Barrier Reef.

I call for our politics to extend beyond the micro-level of interpersonal relationships to consider the meso-level of institutions and nations and the macro-level of international relations. We need it now more than we’ve ever needed it. 

The reluctance of nurses to politically engage could be addressed in undergraduate nursing education, where tools for engaging in politics or broader socio-political health promotion roles or health policy analysis (see Dean Whitehead’s work) could be emphasised. Such preparation would assist nurses to integrate the political, social, economic and environmental into their practice using frameworks such as cultural safety so that health for all would be achievable.

Postscript
As I was writing this, word came out that academic Steven Salaita who had been actively tweeting his opposition to the bombing of Gaza by Israel had had a job offer rescinded. It does concern me that blogging about the need to be concerned with the political can result in job loss (or withdrawal). David Palumbo Liu notes:

But above and beyond this academic exercise, do we really want our tweets or other social media communications used against us in ideological witch hunts? Do we want to allow a cloud of suspicion to hang over our heads? Do we want to constantly be checking ourselves as we voice our opinions on social media, and worry that by advocating a certain political position our employment might be jeopardized? By not protesting this instance, we are opening ourselves up to a world in which these kinds of denials of employment will be acceptable. What use, then, will social media be but to be a platform for the most mild forms of expression and banality with regard to controversial subjects?

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