Abstract
Catheters, Slurs and Pickup Lines is a compelling ethnography that skillfully explores the work of professional intimacy in hospital nursing. Drawing from 800 hours of ethnographic observation over an eight-month period and over 55 interviews with a diverse group of nurses, hospital administrators, and nursing professors, Ruchti ably achieves her stated goal: “to mark the professionally intimate labor of nurses that is invisible, naturalized, and taken for granted” (p. 8). The book is a major contribution to the newly burgeoning scholarship on care work, and Ruchti’s findings pose numerous questions to anyone interested in bringing recognition to professionally intimate labor. For example, should it be considered valid labor with measurable outcomes? How does gender operate as a social construct in the provision of intimate care, and how do race, ethnicity, sexuality, and other statuses intersect with gender to influence perceptions of intimate labor? Why aren’t nurses taught more about intimate care, not only how to provide it, but also how to respond to intimate conflict?
Ruchti uses narrative detail to great effect, and the book opens with the story of Anna, a new Latina nurse who experiences sexual innuendo, as well as racist and sexist slurs, from a white, male patient who is scared, in pain, and in need of Anna’s catheterization procedure. Anna is suddenly faced with a range of issues to navigate: calming her patient, establishing trust, deciding whether or not to continue her work in an emotionally charged and hostile environment, assessing whether to confide in a peer or report to a supervisor, and worrying about how the patient’s behavior would reflect on her abilities and professionalism. In some ways, the book is organized around the challenges apparent in this scenario.
In chapter one, Ruchti explores how the invisibility of intimacy is achieved, in part, by viewing care as “natural.” For male nurses, gay nurses, and/or nurses of color, the challenge of care is complicated by assumptions about care as best embodied by straight, white women. Furthermore, if care is perceived as “natural,” then providers might not be considered professionals. Chapter two is theory heaven for those interested in the sociology of gender and intimacy theories, including theories of emotional labor, body labor, and intimacy. One major strength of the book is Ruchti’s detailed historical overview of intersectionality as theory and method. She articulates how an intersectional approach informs her conceptual strategies, research design, and data analysis. In true feminist fashion, intersectionality is used to help produce knowledge for both sociology and women’s studies, as a means to “analyze the impact of multiple identities in social interaction, ideologies, and institutions” (p. 61). Examples from the data—like when a white, male patient tells a Black, female nurse that she reminds him of his mammy—are used to illustrate how separating social constructs of race, gender, sexuality, and identity is problematic because people do not live these experiences separately.
Chapters three through five are data gold mines for qualitative researchers interested in how intimate trust is negotiated between nurses and patients (chapter 3), how intimate conflict unfolds with patients in the context of commercialized intimacy (chapter four), and how nurses were more likely to use individualized strategies for trust building and conflict negotiation, rather than collective strategies with institutional support (chapter five).
In Ruchti’s vision, administrators will begin to recognize professionally intimate labor “as something to be articulated, taught, and formally counted as nurses’ work” (pp. 20-21). After all, hospital profits are connected to quality of care even though nurses do intimacy not for profit but to perform their jobs effectively. But implementation is a tough nut to crack; Ruchti tackles it by suggesting best practices for recognizing the social and economic value of care. Besides professional training in intimacy and support from nurse supervisors, institutional support could also take the form of time. Nurses overburdened with too many patients and too many bureaucratic responsibilities cannot be available for professional intimacy. Reorganizing space (e.g., private nursing stations) and reconfiguring duties (e.g., dictating charts) are steps in the right direction.
Anyone teaching qualitative methods, whether at undergraduate or graduate levels, will want to have this book on hand. In addition, faculty members who mentor students interested in conducting qualitative research using an intersectional approach will appreciate the roadmap for research design and analysis. In Appendix A, Ruchti describes why her research is feminist; she also reveals many tricks of the trade in this type of work, from designing a pilot study, to choosing a research site, gaining entrée, developing rapport, and protecting participants. Finally, this book is a must-have for those of us teaching and researching in medical worlds. Our students will gain valuable insight into the day-to-day work of caring for patients, and our research will benefit from consideration of the many lessons contained in this richly documented exploration of professional intimacy.