Epilogue
Nursing, gender, aporia
Kim Walker
Nursing (Applied Research), St Vincent's Private Hospital, Australian Catholic University, Darlinghurst NSW
PP: 163 - 165
Article Text
As my co-editor Paula McGee (2009) rightly notes, this collection of papers on gender and nursing was difficult to assemble. Despite the fact that our call for abstracts was catholic in its scope and had to be extended a number of times to increase the possibility that papers would eventually amass to form a special issue of Contemporary Nurse, alas this was not to transpire; both Paula and I pondered and vexed over this problem during the many, many months of this collection's gestation. To be honest neither of us could muster a plausible theory as to why the issue of nursing and gender failed to grab the individual and collective imaginations of our colleagues.
This failure to arouse significant interest is certainly perplexing as Paula (2009) also rightly notes in her considered and comprehensive prologue. Gender is undoubtedly still a pressing and perennial one for nurses in terms of the gender divide that separates men's and women's health issues into quite disparate and sometimes contradictory spheres of concern and eventual resolution. The tensions between men's and women's health status and the ways in which we respond to these were evident in this collection and amplified by the various reports and literature cited by Paula but, clearly, gender as an underpinning narrative to the larger story of how health and sickness are conceived, planned for, managed and evaluated is perhaps not the priority some of us would like to imagine it should be.
What, then, might this mean for nurses themselves in what is a profoundly gendered profession? Given that we have only one paper (Brown 2009) on this topic perhaps this too, is not as relevant today as I recall it was in the late 80s through the late 90s. During this decade a reasonably vibrant corpus of feminist and postmodern nursing scholarship was finding its way into print exploring concerns about the gendered nature of nursing and the issues this invoked.
In closing this small collection I indulge in some reflections on nursing and gender from my own perspective as a man and as one for whom nursing and gender has always created in me a sense that 'I'm stuck, I cannot get out, I'm helpless' (after Aristotle in Derrida, 1993, p.13). This is not suggesting that I am a victim of some sort of existential anguish; rather, it is to say that it's all about power, as Foucault (1980) would say. And if that is the case, then everything is dangerous and there is always something to be done (as he would also say!).
In a still deeply patriarchal healthcare system, where mostly male medicos and executives continue to call the shots and nurses struggle to be heard at the decision making tables, if they are even invited to them, nursing - as a profession comprised almost exclusively of women - has much work to do. By this I mean that still far too many asymmetries of knowledge and power operate to render nurses' voices and actions as less authoritative and compelling than those of doctors and health administrators; our future potential as a profession still hinges far too acutely on the desires and wishes of these omnipotent 'others' than I and many of my colleagues consider necessary or appropriate. And for those who think that several decades of feminist thought and activism has changed all this; think again. Almost daily I read in the press of situations where women generally struggle to gain recognition and rewards commensurate with their male counterparts (eg far too few female professors in the academy; far too few female politicians in the parliaments; far too few female CEOs of major corporations; far too few female surgeons - the list is longer than I have space for).
Therefore, I take it as axiomatic that the profession's profoundly feminised culture and the effects this perpetuates on nurses and non nurses alike is and always has been one of its deep and abiding aporia. As Murray (2009, p.11) explains:
The term 'aporia' comes from the ancient Greek aporos and literally means 'without passage' or 'impasse' ... If we arrive at an aporia, it means we are in doubt we are perplexed, we are confused about how (best) to proceed. There is seemingly no exit, an intrinsic undecidability. An aporia is a contradiction, a puzzle or a paradox.
The paradox of gender for nursing is bound up in the construction 'always and already', of nursing as essentially women's work (see Walker & Holmes 2008). The long history of nursing took a decisive turn in about 1861 when Nightingale (1969, p.iv) made indelible the link between maternity, femininity and nursing with her decree that:
Every woman ... has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid; in other words, every woman is a nurse.
This almost strident proclamation of the role of women as carers ex officio, reflecting the 'order of things' that was unquestioned in a patriarchal Victorian society, trapped women in a mire from which they will forever struggle to escape. It necessarily relegated men to the periphery of caring and nursing work because it was unimaginable then that men might be fit, let alone have the desire, to be a nurse, hence my expression earlier of 'feeling stuck, trapped, helpless' in my life as a nurse; someone who wants nurses to be able to exercise power/knowledge with the same effects as doctors.
Even today, men continue to live with the legacy of this deeply gendered assumption. As Brown, 2009 (citing McDougall, 1997, p.812) points out in this collection 'nursing, and more particularly, femininity 'with its stress on dealing with dependency, acknowledging emotions and intimacy and nurturing others - comes to represent qualities that are feared in masculinity''. Brown (2009) then highlights the perplexity and confusion the aporia of nursing presents us with because 'men's involvement in nursing itself is formulated as some kind of wound, as if the proximity of men to caring or femininity would activate a fear response or a psychodynamic process of 'denial'. However, as Brown (2009) further develops in his paper, the extension of this idea of a certain fear, or what he terms 'masculine misery', then allows a man in nursing to claim a perverse, if not bizarre sort of 'oppression'.
The paradox in this, as is well reported here and elsewhere, is that men enjoy enormous privilege and authority in nursing as they take up higher qualifications to advance their careers, rise up the ranks in education, management and clinical roles and take home more money; furthermore they achieve these goals in a shorter time than their female counterparts to boot (and my own trajectory as a man in nursing absolutely exemplifies this truth!). And this 'truth' merely mirrors the image I described a couple of paragraphs earlier whereby men patently enjoy the privileges their gender uncritically affords them at the expense of any similar privileges women might want to enjoy in the academy, the corporation, the parliaments and so on.
So how do we move beyond such paralysing constructions of nursing and gender for men and women alike? Is our long and convoluted history as a profession forever to be immured within the logic of a gender argument that says nursing should only be thought of as a feminised profession, in the sense that it is subordinated and marginalised in the great hierarchy of importance and authority, and feminine, in the sense that it is naturally and only women's work?
I think the nub of the problem, once again, lies in the fact that, whether we like it or not, human beings are in thrall to power. So, while in healthcare the gendered relation nurses enjoy continue to perpetuate a certain 'order of things', little is likely to change because too many have too much to lose. Our male medical colleagues thoroughly enjoy the status and privileges their masculinity affords them so there is no reason for them to think that they want the gendered order to change. Similarly, I suggest that the mostly female profession of nursing is equally in thrall. Notions of subordination are, perhaps, not as troublesome to many because they reinforce women's perceptions of themselves as 'just a nurse' and 'just a woman' because history and the traditions it has imposed on them individual and collective understandings about 'the order of things'.
While all this may sound like too bleak a picture of our current reality, reflect on why, after 150 years, men in nursing still comprise only 10% of the nursing population. If successive waves of feminism have truly changed the gendered realities of the world, then why would this situation still exist? Why is it that nurses and doctors still routinely play the nurse/doctor game so aptly described and defined by Stein (1967) over forty years ago if, indeed, power relations between the two professions were not more symmetrical and less fraught with the degree of peril that the game is designed to palliate? It seems to me that we often want to believe that things are better than they sometimes are and avoid asking the difficult questions for fear we might get equally troublesome answers that belie our Pollyannaesque stance.
Therefore, the issue of gender does I believe, warrant closer attention and perhaps that is a good place to exit this epilogue. For it seems to me that gender and nursing can and will be an issue for the profession only if we have a collective will to make it so. As Paula and some of the papers in this collection have intimated, gender undeniably remains an issue for the ways in which health is perceived and then managed by nurses. The more intimate, for want of a better word, issue of nursing as a profession and its many, if rather subtle, gendered complexities has surfaced in the past as I discussed above but currently seems not to be so important. For this writer however, while the larger world in which nurses live and work continues to treat them as less than full citizens of the world, then in our microcosm of healthcare, there is still much to be done to rectify the asymmetries of power and knowledge and the terms and conditions they instantiate, for those of us who are 'just a nurse'.
In closing, I hope those who read this modest gathering of writings find something in them to extend their understandings of nursing, gender and the issues and concerns they pose for the ways in which we are and can be nurses in our contemporary moment. For it is only by reflecting critically on our lived experiences of the world, that we can be opened to the possibility of transforming it. Carpe diem!
References
Brown B (2009) Men in nursing: Re-evaluating masculinities, re-evaluating gender. Contemporary Nurse 33(2): 120-129.
Derrida J (1993) Aporias. Stanford CA: Stanford University Press.
Foucault M (1980) Power/knowledge: Selected interviews and other writing 1972-1977. In C Gordon (Ed) New York: Pantheon.
McDougall G (1997) Caring: A masculine perspective. Journal of Advanced Nursing 25: 809-813.
McGee P (2009) Who says we're all equal? Gender as an issue for nurses and nursing care. Contemporary Nurse 33(2): 98-102.
Murray SJ (2009) Aporia: Towards an ethic of critique. Aporia 1(1): 8-14.
Nightingale F (1969) Notes of nursing: On what it is and what it is not. New York: Dover.
Stein L (1967) The doctor-nurse game. Archives of General Psychiatry 16(6): 699-703.
Walker K and Holmes C (2008) The 'order of things': Tracing a history of the present through a re-reading of the past in nursing education. Contemporary Nurse 30(2): 106-118.
eContent Home
