“The Body of Tasks: Foucault’s Disciplinary Power in Nursing” - Student Essay - 3rd Runner Up
Micah Rojo, BSN, RN, Duke Divinity School, Durham, NC
Consider a patient in respiratory distress whose oxygen saturation begins to drop. The doctor orders the nurse to complete several tasks: put the patient on a partial rebreather mask, draw labs, take vitals, etc... The nurse understands that these tasks will be done successfully if they are done safely and efficiently. If not done safely, the patient may suffer an infection or other complication. If not done efficiently, the nurse will fall behind and the patient’s condition may worsen as a result.
If the nurse treats safety and efficiency as the ultimate ends of nursing, however, then the nurse’s imagination has become severely limited. The embodied experience of the patient is then devalued or even removed from the vision of the nurse. When safety becomes the ultimate end, the nurse will view the patient as a potential for error, and when efficiency is overvalued, the patient becomes an obstacle in the way of the next task. As a practicing nurse, I recognize these patterns in myself. The patient described above was my patient, and she begged me, between her desperate gasps for breath, to call her daughter to let her know what was happening. I responded with annoyance and censure. I could have asked a nurse down the hall to call the daughter while I was busy, but all I could think about was being safe and efficient. Holding safety and efficiency too highly made my care surprisingly cold and callous.
This presentation argues, through the Foucauldian concept of disciplinary power, that the nurse is shaped to understand the ends of nursing to be safety and efficiency, ends which inevitably turn the patient into a body of tasks and the nurse into a machine that completes those tasks. The argument of disciplinary power in nursing is made by analyzing how the nurse is individualized through isolated responsibility and how nursing movements are controlled through evidence-based practice. It then looks at how the Electronic Medical Record functions as a form of continuous observation which regulates and documents the nurse’s every action, how the guidelines surrounding shift change report function as a form of normalizing judgment that determines what we value in our patient care, and finally how the National Council Licensure Examination (NCLEX) is a form of examination which shapes how nurses are educated while also turning them into objects of knowledge. The presentation then ends by making clear its intentions: the first is to be an alarm bell, informing nurses of the hospital machinery that must be resisted and the second is to be a call to arms, asking for a specific type of nursing scholarship that may inform our practices of resistance.
If the nurse treats safety and efficiency as the ultimate ends of nursing, however, then the nurse’s imagination has become severely limited. The embodied experience of the patient is then devalued or even removed from the vision of the nurse. When safety becomes the ultimate end, the nurse will view the patient as a potential for error, and when efficiency is overvalued, the patient becomes an obstacle in the way of the next task. As a practicing nurse, I recognize these patterns in myself. The patient described above was my patient, and she begged me, between her desperate gasps for breath, to call her daughter to let her know what was happening. I responded with annoyance and censure. I could have asked a nurse down the hall to call the daughter while I was busy, but all I could think about was being safe and efficient. Holding safety and efficiency too highly made my care surprisingly cold and callous.
This presentation argues, through the Foucauldian concept of disciplinary power, that the nurse is shaped to understand the ends of nursing to be safety and efficiency, ends which inevitably turn the patient into a body of tasks and the nurse into a machine that completes those tasks. The argument of disciplinary power in nursing is made by analyzing how the nurse is individualized through isolated responsibility and how nursing movements are controlled through evidence-based practice. It then looks at how the Electronic Medical Record functions as a form of continuous observation which regulates and documents the nurse’s every action, how the guidelines surrounding shift change report function as a form of normalizing judgment that determines what we value in our patient care, and finally how the National Council Licensure Examination (NCLEX) is a form of examination which shapes how nurses are educated while also turning them into objects of knowledge. The presentation then ends by making clear its intentions: the first is to be an alarm bell, informing nurses of the hospital machinery that must be resisted and the second is to be a call to arms, asking for a specific type of nursing scholarship that may inform our practices of resistance.