!Becoming a nurse
---
agk's diary
3 February 2023 @ 17:47 UTC
---
written on GPD Win 1 via PuTTY
on couch while baby naps
---
I passed the national licensure exam. I'm a regist-
ered nurse in my country. For a month I've been
orienting on the floor at the psychiatric hospital
where I work. In a few days I'm off orientation,
in charge of my petty kingdom and subjects. Becom-
ing a nurse is mostly disappointing.
Ms. Anna, former fighter. In my old role in this
hospital I tended rebellious souls with knowing
kindness, care, consistency, and the structure they
craved from adults. I made human-sized spaces for
them in the restrictive, capricious, neglectful
total institution of industrial psychiatry.
I challenged them to structure their own time,
snatch fun from the jaws of boredom, encounter the
unfamiliar and be astonished, get something worth-
while from the worst of times, equip to go home
with something they needed when they came in. Hosp-
itals are evils of healthcare financing & liability
structures. I fought the evils as much as I could.
Now I impose the evil. Not alone, of course: there
are the big structures. Our call center coaches in
people who don't meet admission criteria. They get
cash bonuses for conversion rate metrics. Then
there's me. We're under a consent order for inappr-
opriate admissions, and I can see a third of our
patients have been tricked into our hospital, but I
can't undo their admission, so I'm the next liar
they meet on their journey.
I pump 'em out of the psych factory. Call center
fills the bed before it's cold. I'm up front admit-
ting another. I make her strip for skin assessment,
dump her on the unit, don't talk to her again 'cept
at med pass. Never as a person, always a bundle of
risks: "You hearing things I can't hear? When was
the last time you pooped? Any pain? Wanna kill
yourself? Lemme see under your tongue. Okay send
the next one."
f6k is right, morning time snatched alone from the
jaws of the day is one of life's pleasures. Not
wanting to go to work, form people into psychiatric
subjects, I sat on the floor some mornings. To ward
off myself I read Foucault on the psychiatric power
and Orr on biopsychiatric governance.[^1]
Orr quotes the founding director of the National
Institute of Mental Health (1949): "The guiding
philosophy which permeates the activities of the
NIMH is is that prevention of mental illness, and
the production of positive mental health, is an
attainable goal.... Since this must be done as
rapidly and economically as possible, techniques
for a mass approach to the problem must be devel-
oped."
Orr notes: "The industrial production and consump-
tion of psychopharmaceutical drugs appear to have
delivered on the NIMH's mid-20th-century goal of
efficient, cost-effective techniques for a mass
approach to mental health."
When other nurses call inpatient psych a factory,
their critique's defensible. A teen got dumped by
his first girlfriend, or lives in the middle of no-
where with no friends, or saw her dad kill her mom,
or gets bullied at school and idolizes the 1999
Columbine school shooters, or can't sit still in
boring or confusing understaffed classrooms, or has
been through 10 foster homes and lots of abuse, or
was smoking weed and sending naked selfies to adult
men. We have a "mass approach to the problem."
One of the most galling parts of my new role is the
status and pay attached to it. One of my classmates
was a practical nurse, works in the same cancer ctr
but now as a RN. She's furious: "I do the same job
but get paid $15 more per hour for it." I actually
do an easier job, I feel, than I did before, and
certainly one with less social utility. My family's
income, $12,000 last year, will be over $60,000
this year.
I don't have or want the tastes that go with this
income. I want to give it back and keep our public
Medicaid health insurance. But now we make enough
to be worth robbing, so no more Medicaid for us.
The professional and managerial classes, long the
target of my ire and impassioned critique, is now
us. No longer dignified poor, we now have the new
trap of predatory precarity confronting us.[^2]
Ethically, morally, we must evade that trap some-
how, as we shouldered through and escaped traps we
faced when poor. We mustn't resort to denial of
our place in the world through romantic overidenti-
fication with our poor past, neighbors, patients.
And as a nurse, I have particular pitfalls. Almost
every nurse is bitter, all about different things.
When during orientation I managed my time, carved
out 10 minutes to talk a sobbing teen out of a
corner, give her care and perspective like I used
to, most every orienting nurse trained her bitter-
ness on me: "You're a nurse now. We don't have time
for things like that. We don't even have time for
[legally-mandated] breaks." I feel the bitterness
infect my thoughts: ("yeah but you have time to
shop on your phone while your patients suffer"). I
have to push it away.
As charge nurse, I'll make time. I'll impose evil
with one hand because it's my job. Like Nietzche's
ascetic priest I'll take the evils away with my
other hand on days I can, when I have a med nurse,
no morning admissions or discharges. I'll get good
and fast at what's required so I can do what my
human heart demands. I'll train new techs in some
of what I used to do, teach 'em to frame their
work with a social model of distress recovery to
counter my medical model.
In a dream, afoot I approached six people by the
rutted red-dirt forest service road in deep green
woods.
- - -
1: Michel Foucault (1973-74), Psychiatric power. In
Rabinow, ed., Ethics: subjectivity and truth.
Jackie Orr (2010), Biopsychiatry and the inform-
atics of diagnosis: governing mentalities. In
Clarke et al, eds., Biomedicalization: techno-
science, health, and illness in the U.S.
2: Steve Randy Waldman (2019-08-20), Predatory pre-
carity. Interfluidity blog.
