Abstract
Catheters, Slurs, and Pickup Lines: Professional Intimacy in Hospital Nursing by Lisa C. Ruchti is an insightful, well-written, and well-organized book that discusses how framing nursing as professional labor has been an important part of a long battle that nurses have fought to be taken seriously in the medical industry. Ruchti suggests that a dichotomy of professionalism and care persists in part because intimacy, as part of bedside care, seems unprofessional. In this book, Ruchti uncovers how professionally intimate care work fits into the larger system of commercialized and commodified intimacies and demonstrates how nurses, administrators, and patients idealize care, which only serves to reinforce the misunderstanding of this labor.
The book is based on eight hundred hours of ethnographic observations in a Magnet hospital with a diverse nursing staff. Ruchti interviewed and observed forty-five nurses over an eight-month period, in addition to ten administrators and three nursing professors, on the meaning of intimacy in nursing and whether they thought “being caring” could be taught in nursing school. The findings from her interview with the hospital president mirrored what she observed at the hospital: no one identified the meaning or acknowledged the practice of intimate labor. Because the word intimacy was essentially absent from hospital institutional culture, the intimate aspects of nurses’ care work were invisible. Ruchti’s study successfully marked the professionally intimate labor of nurses that is invisible, naturalized, and taken-for-granted, but which contributes greatly to quality healthcare and to hospital profit.
Ruchti deftly applies intersectionality theory to explain how nursing has been traditionally considered women’s work, particularly white women’s work, and the importance of the Florence Nightingale image at the intersection of race (whiteness), nationality (English-speaking) and gender (femininity). The findings of the study clearly highlight how the intersectional approach defines professional intimacy in terms that incorporate intersections of gender, race, and nationality to recognize the diverse work experiences of nurses and the diverse meanings of quality healthcare. She used intersectionality as a methodological and theoretical approach to show how the intersection of race and gender informed the process of professionally intimate care and the work experience for women-of-color nurses and male nurses. Ruchti aptly points out that inequalities in nursing result from various combinations of controlling images (“mammy”) about gender, race, and nationality and that it is important to be clear about which identities are functioning and which are not when using intersectionality to study inequalities.
The book begins by employing Arlie Hochschild’s concept of emotional labor and Vivian Zelizer’s concepts of body labor and intimacy to reveal the connections between micro-level interactions such as those between nurses and patients and macro-level processes such as the relationship between the nursing shortage and the global economy. The book is organized into five chapters, the conclusion and appendices A, B and C. It is well-written and meticulously researched but the organization leads to a bit of redundancy between theories and concepts in the introduction and other chapters. Chapter One discusses the sociological perspective of intimacy in care as it occurs in nursing. Chapter Two draws on sociology of gender and intimacy theories, theories of whiteness and femininity to explain nurses’ care work. The intersectional theory is used to distinguish between personal identity and identities as social constructs and to connect the salient intersections of gender, race, and nationality in the study. In Chapter Three, Ruchti discusses how nurses build, negotiate, and sustain what she calls intimate trust with their patients.
Chapter Four explains how Ruchti’s concept of intimate conflict led to relaxed boundaries and a sense of entitlement and sometimes encouraged patients to express anger and sexual desire toward nurses. Chapter Five discusses how nurses managed and negotiated boundaries with patients and family members during intimate conflict. Ruchti also introduces her concept of collective intimacy as an alternative strategy for nurses to deal with patient conflict as a team. In the conclusion, she discusses theoretical and practical strategies for nurses and hospital administrators to improve professional intimacy in health care. Her study revealed that nurses professionally and intimately negotiated a cycle of trust, conflict, and renewed trust with their patients to ensure quality care.
One important criticism of Catheters, Slurs, and Pickup Lines is the lack of context in discussing professionally intimate care work in sexualized interactions which nurses had to negotiate in order to give their patients care. The analysis of sexualized interactions from patients based on literatures on commercialized and commodified intimacies as part of the labor process marginalized professional intimacy in nursing care work and overemphasized professional intimacy as sexual. An in-depth analysis of hospital policy and administration responses to verbal, physical, and sexual harm from patients would have prevented a highly distorted and unrealistic perspective of the profession that is typically seen on popular TV sitcoms. It is important that studies of professional intimacy in nursing present an accurate portrayal of the crucial role nurses assume as frontline providers for the care and health of the public at a time when healthcare resources are increasingly limited.
Ruchti’s book is largely sociological and is suitable for undergraduate audiences. In addition, graduate courses in women’s and gender studies, work and occupations, social inequality, sex, and gender would benefit from the inclusion of this book as a supplementary text, primarily for its excellent synthesis of important literatures in these areas. The book should be of significant use to anyone interested in patient and quality healthcare, the nursing profession, the growing diversity in nursing, and implications for the nursing shortage.