Perforated body work: the case of tele-nursing

Abstract

This article extends an understanding of how the embodied nature of work, in this case nursing work, is reformed by workplace technologies. It outlines how technological advancements helped to partially restore the physical and psychological perforations inflicted on those performing nursing work. However, the transitions to remote nursing analysed here also undermined the prospects for future professional advancement. By analysing how technologies can disrupt embodied practices within the occupational field of nursing, the article provides both an empirical and a theoretical contribution to existing research on embodiment and work.

Keywords

embodiment healthcare rationalization injury nursing telework women work and family

Introduction

Telework has been analysed from numerous angles over the past few decades, resulting in several dedicated special issues in work and management related journals (Journal of Management Studies, 2001; Journal of Organizational Behavior, 2002 and New Technology and Employment, 2003). These, and other collected works (Deery and Kinnie, 2004; Holman et al., 2007), have highlighted the deepening heterogeneity and segmentation of call centre work, which challenge the deterministic and optimistic/dystopic binaries often accompanying research into telework (Castells, 1996; Howcroft and Taylor, 2014; Stanworth, 1998).

The degree of technological ‘disruption’ and organizational rationalization taking place within the public healthcare sector (Brannon, 1996; Cooke, 2006; Hood, 1995) has resulted in occupations such as nursing attracting particular attention from telework scholars. To date, tele-nursing research has provided important insights into how telework fragments labour processes that expose nurses, and other health professionals, to more detailed workplace monitoring than was experienced previously (Burton and Van den Broek, 2009; Smith et al., 2008; Valsecchi et al., 2012; Wise et al., 2007). The introduction of computer algorithms led to more detailed analyses of how performance management systems eroded worker control and any hope of developing mutual trust relations between employees and their firms (Prichard et al., 2014). As telework shifted into more skilled occupational and industrial sectors, further research questions unravelled the impending tensions developing around the professional and occupational identities of workers vis a vis their organizational identities (Fältholm and Jansson, 2008; Russell, 2012; Russell et al., 2016; Van den Broek, 2004). This migration of telework into more complex work settings raised particular concerns about the way knowledge might, or might not be, transferred between colleagues and clients and/or patients (Van den Broek, 2008). Technological advancements in nursing also led to warnings about assumed repercussions in the area of humane care of patients (Barnard and Sandelowski, 2001).

As noted above, much research into tele-nursing has focused on the labour process and the management implications of new technologies in nursing practice. Here the augmentation of work processes, increased management control and reduced nurse autonomy have extended an understanding of workplace change within the nursing profession. However, despite the fact that this type of care work relies on close interaction with colleagues and patients (Gimlin, 2007; Wolkowitz, 2002, 2006), analysis into the body work–technology nexus in this occupation is largely absent from the existing literature. This article contributes to the sociology of work and embodiment by analysing how technology reshapes the embodied capabilities of nursing work. It posits two central questions, including: how and why nurses appropriate technology to alter the embodied aspects of their work and how these transitions altered the way participants envisaged their career opportunities. In order to understand how technologies redefine the nature and experience of nurses’ embodied work, the next section presents literature investigating the nexus between the body, work and technology. This is followed by a more detailed analysis of tele-nursing work as a context to the following sections that set out the perimeters of the research study on nurses working in a privately run Australian health call centre.

The nexus between the body, work and technology

Several research strands have developed around the inter-relationship between the body and work. One clear area of research explored the way that workers modify their own bodily attributes to suit organizational demands in order to conform to firm expectations and corporate branding (Bolton, 2000; Hancock and Tyler, 2000; Harquail, 2006; Shilling, 1993; Warhurst et al., 2012; Wolkowitz, 2006). The emotion management literature also directed attention to how workers attempt to manage their own emotions at work. Hochschild’s notion of surface and deep acting provided a valuable analytical tool to identify how workers shape outward displays that could lead to both positive and negative outcomes for workers and their workplaces (Ashforth and Humphrey, 1993; Hochschild, 1983; Hughes, 1971; Nguyen et al., 2016). Related research highlighted the impact of those who work directly on other peoples’ bodies, in what is often labelled ‘dirty’ work that is physically, socially or morally tainted (Simpson et al., 2012; Tracy and Scott, 2006; Wolkowitz et al., 2013).

By drawing on a number of theoretical and empirical approaches, these discussions highlight the diverse implications for many employees who perform bodywork. Yet there could be further investigations into how the workplace can be ‘written on’ (Gimlin, 2007: 363) or indeed ‘rubbed off’ the body. In many occupations, embodied attributes, which can include injury and fatigue, might limit the professional opportunities that present themselves as careers advance. For example, drawing on Bourdieu’s concepts of habitus and cultural capital, Wainwright and Turner’s research on ballet dancers (2006) shows how the ‘lived experience’ of ex-dancers was a major factor prematurely limiting work and careers. Given the physical demands of professional dancing, ageing and injury represented deeply poignant ‘epiphanies’ that led dancers to reflect on how their embodied habitus impacted adversely on their career. Equally, Wacquant’s (1995) research on boxers and Tulle’s (2008) research on elite athletes and the athletic habitus reinforced how bodily ‘competence’ or bodily capital represented an important, yet unpredictable and often finite, variable shaping occupations and careers.

Understanding the social relations around body work is relevant to occupations such as nursing where workers directly labour on the bodies of others (Twigg et al., 2011; Wolkowitz, 2002). For example, Lawler (1991) conceptualized the nursing body as a ‘lived body’ that was imbued with positive attributes based on quality patient care (Gimlin, 2007: 360). Such expectations about levels of care remain despite the rationalization taking place within and around the healthcare sector. For example, since the 1980s, highly restructured and rationalized hospital systems have reshaped nursing practice and underscored intensified working conditions that have eroded the potential health and well-being of nurses and the quality of care they are able to provide to patients (Baines and Van den Broek, 2016; Bolton, 2004). Nurse Managers working in public healthcare systems in Australia further report that rationalization of the healthcare sector has eroded the ability to manage nursing services and provide professional and clinical leadership, which has seriously diminished worker satisfaction, motivation and commitment (Newman and Lawler, 2009).

As outlined earlier, the nursing labour process requires considerable physical and emotional effort and despite the introduction of safety equipment and mechanical lifts to improve the working conditions of nurses, the job remains for many ‘pure hard slog’ (Bogossian et al., 2014) both physically and psychologically. These factors give added imperative to focus on the changing body/work nexus to understand more fully how nursing bodies are formed, and potentially deformed, over the course of a working life.

This article analyses the body work–technology nexus of nurses who have transitioned from ward to tele-nursing positions in a privately run telehealth service in Australia. Analysing participants’ motivations for retraining into tele-nursing work, the article identifies how remote-nursing technologies presented nurses with opportunities to ‘rub off’ or significantly reduce the physical and psychological damage they faced in ward-nursing roles. As elaborated below, while such respite was welcome, tele-nursing work was also perceived by many to negatively impact on potential career advancement. In order to analyse how technologies augmented the nature and experience of nurses’ embodied work, the next section describes tele-nursing work in more detail as a context to the following sections, setting out the data collection methods and the findings that emerged from the data collection process.

Tele-nursing technologies and healthcare rationalization

Nursing is particularly well suited to explore the embodied aspects of work due to the ‘cost containment’ drivers that have developed within and around the healthcare sector and the demographic profile of those doing the work (Brannon, 1994; Hood, 1995). For example, nurse training and education has shifted its focus away from hospital/clinical settings, into tertiary university campuses that have arguably led to an increased professionalization of the occupation (Kessler et al., 2015). Such professionalization has, however, been undermined by increasingly rationalized and overstretched healthcare systems that lock nurses into tight levels of accountability and measurable output (Adams et al., 2000; Cooke, 2006, 2012; Spitzer et al., 2006; Walby and Greenwell, 1994).

Nursing work and the nursing labour process in particular is physically and psychologically complex (Bolton, 2000; Gray, 2009; Lawler, 2006) because it involves the care of critically ill patients, often in very emotionally charged environments. Healthcare workplaces have benefited from improved mechanization to assist in patient care; however, ward nursing remains physically taxing due to shift work schedules and the potential for patient assaults and horizontal bullying (Duffy, 1995; Holmes et al., 2012; Hutchinson and Jackson, 2015; Kennedy, 2005). Within the National Health Service (NHS) in the United Kingdom, for example, levels of occupational stress are higher than in other similar professional areas, with 28 per cent of nurses suffering at least minor mental health problems, compared to 18 per cent in the general employed population. Similar to other groups, health workers face a high risk of gender-based violence in the workplace, with almost one-quarter of all violent incidents reported at work emerging from the health sector (Cruz and Klinger, 2011). According to Cruz and Klinger, violence towards nurses is inflicted by co-workers, who are the main perpetrators of psychological abuse, or by patients who are the main perpetrators of physical abuse (2011: 20).

One aspect of nursing that has not changed significantly is the gender and age profile of the nursing profession. In most OECD countries, including Australia, over 90 per cent of the nursing workforce is female and the median age of nurses is approximately 44 years of age, with over 38 per cent over the age of 50 (Australian Institute of Health and Welfare (AIHW), 2012; World Health Organization, 2006). The work intensification and emotional burnout from organizational and occupational hazards detailed above, which many claim are under-reported (Adams et al., 2000; Bone, 2002; Cruz and Klinger, 2011; Kennedy, 2005), may go some way to explaining why more than 20,000 registered nurses and midwives in countries like Australia have chosen to pursue employment outside the nursing and midwifery industry (AIHW, 2012).

One option for nurses adversely affected by the physical and psychological demands of ward nursing, who wish to remain within the nursing profession, is to shift sideways into remote-nursing services. Call, or contact, centres that deliver health advice have been operational in various forms internationally since the 1930s; however, they have become firmly established across healthcare systems in most OECD countries since the 1970s and 1980s. Precise numbers of tele-nurses are difficult to establish internationally, though telephone triage and home care health services represent one of the fastest growing applications in the healthcare area (Collin-Jacques and Smith, 2005; Wahlberg and Wredling, 1999; Wheeler and Siebelt, 1997).

These services, dispensed through telecommunications technology, respond to patient (or caller) symptoms via decision support system technologies and clinical information systems either deployed from individual nurses’ homes or through privately or publically run tele-nursing centres and mobile units. The actual work involves nurses providing telephone triage to callers to the ‘right care at the right place and at the right time’. According to industry sources, services are designed to address structural problems in the healthcare system, including difficulties accessing Emergency Departments; limited access to rural and after-hours services; and the need to overcome staffing problems (internal company document). As with other call centres, the technology in healthcare call centres relies on automatic call distribution systems and expert software that structure the speed and type of interactions between nurses and callers. While nurses can use their professional knowledge and expertise to work around established software protocols, they are rarely involved in the actual design of medical software, rather reacting and working within the confines of the technologies they use (Collin-Jacques and Smith, 2005; Larsen, 2005; Van den Broek, 2008).¹

The embodied skills required of this work differ immensely from ward nursing in the sense that tele-nursing care relies on verbal interactions with callers. Unlike ward nursing, where care is both physical and psychological, tele-nursing requires no bending and lifting of patients and no threat of physical violence. As such, what tele-nursing bodies can ‘be’ and ‘do’ represents different ‘assets for everyday work’ as compared to ward nursing (Rankin and Campbell, 2009; Waite, 2006: 24). As indicated below, over time the challenging physical and psychological aspects of ward nursing can result in broken and injured bodies that make the work increasingly difficult to perform. The option of removing yourself physically (away from ward settings) can therefore represent a desirable and/or necessary career decision.

The following sections analyse how nurses care for, and seek to protect, their own bodies over the span of their careers. As nursing practice is increasingly performed ‘on screen, instead of “behind the screens”’ (Lawler, 2006; Sandelowski, 2002: 64), it is important to understand how nurse participants relied on embedded telework technologies to steer new career directions that helped to reform many of the embodied aspects of their work.

Research context and methods

Overview of data collection

Once the occupational salience of the project was established, it then became apparent that the most appropriate method to understand how tele-nurses ‘lived’ their work was through qualitative case study research. As such, the author secured participation with one of the largest privately run tele-nursing firms that had established operations in Australia in the 1990s. Interviews were undertaken with three managers, including: human resource; operations; and a line manager working at the case site. Managerial personnel subsequently provided contact details for research participants employed within the firm to make contact with the researchers. Twenty research participants identified their willingness to participate.² Background interviews were also undertaken with two representatives of the government health sector and four representatives of nursing unions and professional associations.

Open-ended interviews

Interviews were undertaken with nurse participants in the office-based urban locations of this firm as well as in home-based settings in various regional areas of two Australian states of New South Wales and Victoria. As Table 1 indicates, 14 of these research participants worked in such home-based arrangements and six were based in the firm’s two main urban locations. Visits to respondents’ homes revealed that nurses were supplied with an integrated computer and phone system by the firm that was set up in a specially designated room or, on occasions, in the lounge or bedroom of the research participant’s house. Some nurses also had their personal computer set up alongside the company computer so they could multitask personal and work-related activities.

Table 1.

Nurse participants.

Tele-nurse (pseudonyms)	Gender	Age (approx.)	Location of work
Alice	Female	35	Office
April	Female	50	Home
Belle	Female	50	Home
Beth	Female	50	Office
Betty	Female	50	Home
Deb	Female	58	Home
Jane	Female	50	Office
June	Female	50	Home
Kandice	Female	30	Office
Kelly	Female	50	Home
Kieran	Female	40	Home
Kim	Female	40	Office
Mary	Female	50	Home
Nancy	Female	60	Home
Pam	Female	50	Home
Ruth	Female	50	Home
Sharon	Female	50	Home
Sue	Female	50	Home
Susan	Female	50	Home
Wanda	Female	30	Office

All of the research participants were registered nurses and most participants had many years of ward-nursing experience in a variety of specialities, particularly emergency departments, due to the firm’s preference for this nursing speciality. Participants’ ages ranged between 30 and 60 years; although reflecting international age averages, just over 80 per cent of those interviewed were over the age of 40 and all of the research participants were female.

The interview process itself was open-ended in the sense that questions reflected broad topics related to work and career. For example, as schedule one notes, initial questions identified why participants entered the nursing profession and why they transitioned into tele-nursing. This provided opportunities for research participants to reflect on pivotal events and personal and professional junctures throughout their nursing career (O’Neil and Bilimoria, 2005). Such a broad approach also led to research participants recalling where they had worked in the past and how they lived their career over time. Most interviews lasted from between one and a half to two hours. All interviews were transcribed verbatim and each of the respondents was then allocated a pseudonym to ensure confidentiality according to ethics protocols. See Appendix 1 for interview schedule.

Data analysis

After the interviewing process had concluded, an iterative approach was used to analyse the data. This method incorporated a systematic, but flexible, way to approach the collection and analysis of the data that helped to develop theories that were ‘grounded’ in the data. It also helped to draw comparisons between data and facilitated a better understanding of why research participants had gravitated towards tele-nursing (Charmaz, 2006: 2; Eisenhardt and Graebner, 2007). For example, initial interview questions asked respondents about the tele-nursing labour process; however, as the project advanced it became apparent that research participants were more concerned to relate their experiences of previous employment in ward nursing. Here their rejection of the physical and psychological strain of ward nursing was continually recalled as the reason they transitioned into their current tele-nursing role. Therefore, initial questions about the tele-nursing labour process, including the nature of the work (i.e. the use of algorithms and schedule guidelines; collegial, team and patient interactions) and the location of the workplace (i.e. dispersed and isolated from organizations) became more focused around categories that captured broader interactions between the body and work, including psychological and physical injury, and the perceived renewal that tele-nursing offered vis a vis ward nursing. These findings led the research to develop new conceptual categories related to the body and work that helped to dig deeper into why a tele-nursing career was pursued.

While recognizing the researcher’s role in co-constructing the content and emphasis of this research (Patton, 2005), there was a conscious attempt to capture, as accurately as possible, research participants’ responses to minimize these subjectivities. There was also a need for conceptual development with the relevant literature in the field to contextualize the emerging categorizations related to the body and work (Charmaz, 2006; Strauss and Corbin, 1994). Further to these aims, participants’ responses were integrated with published material on relationships between the body and work within the context of rationalization within the health sector (Brannon, 1994; Holmes et al., 2012; Reverby, 1987).

Two strong themes emerged from the research data. The first theme, labelled the perforated body, reflected how respondents had accumulated small injuries or punctures that served to weaken their ability to remain in a ward-nursing role. The second theme elaborated on how remote work offered research participants the opportunity to repair injured bodies while at the same time facilitating greater integration with personal obligations. These positive aspects of telework were labelled regenerative possibilities because they provided opportunities for nurses to improve physical and psychological health that extended their nursing careers. There were also drawbacks related to the belief that tele-nursing eroded the potential for future professional advancement. This ‘satisficing’ decision to move to telework because it was ‘good enough’ rather than optimal was based on relative comparisons between this and ward nursing and the gendered nature of household obligations (Corby and Stanworth, 2009; Scholarios and Taylor, 2010). Indeed, these two themes reflect the degree to which research participants negotiated around significant disruptions and limitations within both their professional and their personal lives that resulted from the embodied nature of nursing work, and the technological opportunities that a tele-nursing career could provide.

Findings

All service jobs require workers to make an emotional investment that can lead to exhaustion and burnout, including professional service work that involves the repetition of physically demanding tasks. As mentioned above, research into the embodied aspects of professional dancers and boxers reveals the centrality of embodied attributes, including physical health or stamina, in remaining and succeeding in an industry and/or occupation (Wacquant, 1995; Wainwright and Turner, 2006).

Research participants in this study also articulated the physical and psychological features of nursing practice as an on-going project for which they had initially had a deep enthusiasm. As careers progressed, the accumulated demands of ward-nursing work led participants to articulate that their work, careers and their bodies had become ‘perforated’ over time. Just as a line of small holes helps to tear a piece of paper, so too the accumulation of small injuries these nurses faced in ward nursing weakened their ability to remain in the profession. As indicated in the next two sections, the accumulation of these small punctures prompted participants to access healthcare technologies that transformed the labour process of nursing work and removed them physically from the hospital ward environment. As such, tele-nursing technologies allowed nurses to accommodate their shifting physical and psychological capabilities that fundamentally altered the embodied characteristics of their work. These developments in turn reshaped the personal and professional opportunities of the nurses participating in the research.

The perforated body: ward nursing, injury and fatigue

When reflecting on their careers, research participants articulated how their bodies had accumulated physical (injury, etc.) and psychological (emotional burnout, etc.) damage that undermined their ability and desire to remain in ward nursing. The nursing labour process was a major factor, as retold by Pam’s recollection of an event where a patient had:

fallen out of bed at five o’clock in the morning and his leg was entwined in the bedrails and his bone was poking out. In their wisdom they’d welded the actual bedrails onto the bed where they are meant to be detachable for that very reason. So we had to hold him off the ground and because the lifting machine didn’t reach the ground, I had to hold him up off the ground for an hour while they disentangled his leg. This gave me an injury for a year when I went on work cover.

Kelly recalled various patient attacks she had endured while ward nursing, including being physically bashed and assaulted. These work-related incidents, although slightly different for each woman, were common. Deb related:

I actually took a patient to court because I was just fed up with being seen as a target, and won the case. She [the patient] spent five days in gaol. Kicked in the chest. I’ve had it all … those assaults don’t count for the thousands of times you have been verbally abused, shouted at, sworn at, spat at. It adds up.

Kelly was now relieved that she no longer was required to ‘pin someone down and put shackles on them’ in her new tele-nursing role. Tele-nursing gave many participants the capacity to ‘turn off’ some of the challenges outlined above.

This accumulative perforation to research participants’ physical well-being was underscored by the psychological demands of patients as well as colleagues. Raising the issue of collegial relations, Nancy reflected: ‘We’ve all had the horizontal violence that’s quite common between nurses in hospitals’. Many stated that they ‘never really liked being based in wards because there is so much politics and horizontal violence’. Pam said: ‘We’re bitchy to each other, it’s horrible, it’s terrible. We don’t look after each other and we’re carers!’.

There was a common perception that:

a lot of people go to [tele-nursing] because they’re injured or wounded in some way. It’s either physically or emotionally. But, quite often, people end up at [tele-nursing organization] that, in my experience anyway, it’s because there’s something not quite right. (Nancy)

The impact of ward-nursing work weighed more heavily over time. One participant felt that nursing was a:

young women’s game … You get to a point where you just get sick of the bed pans, the blood, the guts, the gore … you are just surrounded by death and disease all the time and its not much fun. It’s really exhausting. (Wanda)

All research participants articulated the temporal nature and limited time that they could withstand the physical and psychological cost associated with ward-based nursing:

I’m 58 years old. This is my retirement job. I’ll stay here until they kick me out or my hearing goes or my sight goes. This job, we can work at this for quite a long time. There’s no retirement age for this one. (Deb)

Turning their gaze to their current roles, participants viewed tele-nursing as ‘clean’ work (Wanda) that involved less confrontational patient relations. As Jane noted: ‘No-one is slogging me around the head here and no-one is abusing me or swearing at me’. The remote relationship also reduced the prospect of negative collegial relations as well as exposure to the acuity of patients that presented at hospital wards as compared to those that ring up health lines to seek advice (Kandice).

The physically and psychologically demanding nature of ward nursing goes a long way to explain research participants’ transition into alternative nursing practice such as telework. Here the transition reflected a ‘satisficed choice’ (Corby and Stanworth, 2009; Scholarios and Taylor, 2010) borne from the embodied pressures of ward nursing. Particularly for more experienced research participants, these perforations prompted decisions to either leave the profession, or make sideways shifts into some kind of alternative nursing role:

I knew that I never really wanted to go into management side of it. I’d had opportunities over the years and just thought no, I didn’t want to. I preferred to work in a clinical context. So when I was reading about tele-nursing, I just thought that would be really ideal for me, because I thought then I could still use my nursing skills, but not have to worry about the fact that the feet were falling to pieces. (Nancy)

While many respondents articulated that they were drawn into the profession through a desire to care for the physical and psychological well-being of patients, the subsequent perforations that ward nursing presented to their own bodies over time meant that this pursuit became unsustainable.

Tele-nursing as a regenerative opportunity

The shift into tele-nursing and the physical separation from the patient required research participants to develop new communication skills and technological competencies. Some research participants lamented the increased accountability and adherence to pre-determined algorithms and occasional caller abuse as unappealing aspects of tele-nursing work, though these were counter-balanced with other benefits. April was happy to dispense with ‘the sights and the smells of nursing’ while others felt they had achieved a more manageable emotional obligation to remote patients compared to those they cared for in hospital wards:

If you are busy it can be very stressful as well because you can see they are distraught. You can see how unhappy they are every time you wander past doing something for someone else, whereas with this you are focused on the one person and the one time. Also, on a ward if you have got someone who is troublesome you have to deal with them for eight hours and that can really be a struggle. (Wanda)

As such, there were trade-offs, yet transitions to telework did offer opportunities that would have otherwise been unavailable:

I don’t think I would still be nursing if I didn’t get this job. I would have changed careers completely. I don’t think I could do it anymore physically because I’ve got a bad back from lifting patients for however many years. (April)

The generative possibilities of telework also related to personal, rather than professional, factors based on individual life cycles and familial obligations. Relocating themselves within their home provided research participants increased autonomy over work schedules that allowed them to develop ‘a much better lifestyle than you would working in a hospital’ (Beth).

Telework offered increased personal autonomy and greater flexibility to tailor shift patterns to personal commitments and unpaid bodywork. For example, Kim’s transition to tele-nursing was based on the birth of her child at the age of 44. Tele-nursing allowed her the ability to: ‘go home … to pick up shifts and being able to work around the baby’. Many recognized the opportunities for greater levels of personal satisfaction than they could have achieved in previous ward-nursing roles. As one tele-nursing manager suggested: ‘the people who are most happy and enthusiastic in the role are people with children at school because it’s so flexible; or it’s the older population who have got the nurses’ back’ (Beth).

This spillover between work and home raises various complex issues that cannot be elaborated here (Hyman et al., 2005), suffice to say that telework provided participants a greater ability to cope with the inevitable conflict that develops between personal and professional goals. There were also some clear professional drawbacks. Sue saw tele-nursing as a slow-moving dead end:

I don’t think there are a great deal of career opportunities and if I wanted career opportunities, I wouldn’t have chosen [tele-nursing organization] at home. But I honestly think that this suits me because of my time in life. If I’d just finished my nursing or my midwifery, this wouldn’t be for me because I’d feel I was stagnating and I’d just be marking time until I found something else … I’m marking time until the cardboard box. (Sue)

As such, the regenerative possibilities that came with tele-nursing were accompanied by some strongly articulated professional costs. Tele-nursing transitions were variously described by the research participants in this study as a ‘career diversion’ (Sharon), a ‘sideway shift’ (Wanda), or a ‘flick in the history of my nursing career’ (Jane) and a ‘lifestyle job’ (April), or even a ‘no-think job’ (Pam). These perceptions highlight how embodied work such as this required considerable compromise and readjustment over time.

Finally, the significant restructuring and rationalization of the public healthcare systems represented a major factor in the withdrawal of nurses from ward nursing. Austerity drives significantly eroded working conditions and job content to the point where many nurses working in the sector felt a greater sense of job insecurity, loss of autonomy and limited support structures (Baines and Van den Broek, 2016; Zeytinoglu et al., 2011). Moreover, the deterioration, particularly the increasing injury and exhaustion of ward nursing, provided these research participants with stark ‘satisficed choices’ about what nursing work was able to be performed and what alternative employment could be envisaged.

Therefore, notwithstanding the potential damage inflicted by patients/colleagues, rationalization within the broader healthcare and hospital system reinforced the erosion of nurse morale, which was in part symptomatic of a stretched health and hospital system. Research participants felt that they had ‘no real say in anything anymore. You are always short-staffed and underfunded, and the morale is terrible and people just take it out on each other’ (Wanda). Others felt that while they were ‘very professional and take great pride in our knowledge and being able to help people, it’s generally almost always undermined by management and lack of staff resources’ (Kelly). Sinking organizational support merely exacerbated the accumulation of small injuries or perforations on the body, which began to indicate ‘best before’ dates.

The way workers, in this case nurses, interpret both their personal and professional situation, will impact on how the work environment becomes embodied (Wainwright and Calnan, 2002). However, for the respondents in this study, intolerable working conditions led nurses to pursue tele-nursing opportunities that provided them the ability to ‘rub off’, or at the very least ameliorate, the physical and psychological injury that they had experienced as ward nurses. One nurse, who felt she was speaking for many others like her, suggested that: ‘A lot of nurses, once they get out of the hospital, they are not going back there’ (Jane).

Summary and conclusion

Research into embodied work and bodywork (Gimlin, 2007; Mavin and Grandy, 2013; Shilling, 2004; Skeggs, 2004; Turner, 2008; Wolkowitz, 2006) has provided important insights into how workers are shaped, and shape, the work they perform (Hancock and Tyler, 2000; Harquail, 2006; Hochschild, 1983). The research shows that physical and psychological attributes also influence the dynamic between the personal and professional opportunities and constraints that all workers face. Apart from some notable exceptions (Tulle, 2008; Wacquant, 1995; Wainwright and Turner, 2006) there has been little attention and empirical investigation into how the workplace can be ‘written on’ (Gimlin, 2007) and ‘rubbed off’ the body. Therefore, while Waite (2006) suggests that our bodies represent ‘assets for everyday work’ (p. 24), these assets are neither stable nor infinite. Daily work routines can, over time, damage both the physical and psychological capabilities of many workers, particularly those employed in the nursing profession where the combination of healthcare rationalization and daily work routines contribute to exhaustion and burnout (Bogossian et al., 2014).

This research initially sought to analyse the daily work routines of tele-nurses employed in a privately run national health call centre. During the process of interviewing, however, research participants articulated strong views about their previous work as ward nurses. It became clear that remote technologies allowed nurses the ability to remove themselves from the physical and psychological violence and poor work environment of ward nursing (Duffy, 1995; Farrell et al., 2006; Hegney et al., 2003). As the research shows, reforms in the public provision of health services exacerbated many of the negative embodied aspects of the nursing labour process, including increased work intensification and considerable levels of occupational stress that prioritized organizational and bureaucratic accountabilities over patient and collegial relations (Baines and Van den Broek, 2016; Brannon, 1994). Paradoxically, this rationalization process also underscored the expansion of virtual nursing services via the creation of nurse-led call centres established throughout Australia. For many of the research participants, transitions into tele-nurisng were double-edged. While the shift did offer opportunities to partially restore physical and psychological well-being and to maintain more integrated relations between work and family, it also reduced the potential for career advancement for many research participants.

By identifying and reflecting on the transitions that many workers make over the life cycle of their careers, ranging from mid to the later stages of working life, it is clear that career ‘choices’ are often based on the embodied demands and requirements imposed by the work they undertake (Gimlin, 2007). It is also clear that technology can play an important part in (re)forming the embodied demands of our work that can have both positive and negative consequences. The implications of this are particularly relevant for the nursing profession. Firstly, the sector employs, and will continue to employ, a considerable number of women who have important embodied knowledge, experience and skills. Secondly, given the average age of nurses and the ageing patient population in countries like Australia and the UK, the demand for nurses and other professional care workers will result in greater pressure being applied on those in the industry to stretch their careers even further than they are doing at present.

From an individual standpoint, understanding these external pressures and recognizing how the embodied nature of nursing work interacts with workplace technologies will sharpen an understanding of what enables and sustains care work in ways that are often unavoidable and unpredictable. Further research could elaborate on why some individuals may be better equipped to overcome these professional and personal challenges than others. More particularly, a research agenda more attuned to the embodied nature of work, technology and employment is imperative to sustaining the health and well-being of those who work in this, and other, vital caring professions.

Footnotes

Appendix

Appendix 1.

Interview Schedule.

Tele-nurses
Could you describe what got you interested in nursing?
Could you describe a typical day as a tele-nurse?
What are the most important skills that you have to use in your current job?
How do you feel about using the software guidelines (algorithms)?
Describe how your patient care might be different from other nurse settings?
How would you describe your collegial/teamwork relationships?
How would you describe your relationship with your supervisor (i.e. frequency of interaction, type of interaction; feedback, etc.)?
How would you describe your career opportunities in tele-nursing?
What are your personal circumstances?
Do you have anything you would like to talk about that we haven’t already discussed?

Acknowledgements

I would like to acknowledge the editor and the anonymous referees of WES for their detailed comments on earlier drafts of this article.

Funding

The author received no financial support for the research, authorship and/or publication of this article.

Notes

Diane van den Broek is Associate Professor in the Discipline of Work and Organisational Studies at the University of Sydney Business School and is Co-Convenor of the Migrants@Work Research Group. Diane undertakes research into skilled mobility and migrant work; workplace diversity and inclusion; and lookism, identity and aesthetic labour and telework. Her work has appeared in national and international peer review journals.

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