The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published (...) between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems. (shrink)

The aim of this paper is to summarize key psychoanalytic concepts first developed by Sigmund Freud and apply them to a critical exploration of three terms that are central to nursing's self‐image—empathy, caring, and compassion. Looking to Menzies‐Lyth's work, I suggest that the nurse's strong identification as a carer can be understood as a fantasy of being the one who is cared for; critiques by Freud and others of empathy point to the possibility of it being, in reality, a form (...) of projective identification; reading Lacan and Žižek, I propose that repeated research into caring and repeated complaint about barriers to caring can be understood as manifestations of the death drive first posited by Freud. I conclude that psychoanalytic insights suggest that caring roles can raise profoundly ambivalent issues for those who care but they can also point the way to freedom from painful and self‐destructive symptoms inherent in such work. (shrink)

This chapter explores a potential analogy between mereological principles and laws of nature. Against a backdrop of what Marmodoro has termed ‘power structuralism’ (and a rejection of a Humean worldview), the connection between parthood and modality may be richer than has hitherto been considered. Mereological principles delineate possibilities for parts and wholes, and putting powers at the centre of a discussion about parthood can furnish a novel conception of mereological laws, much as dispositionalism has done so for natural laws; namely, (...) these principles express connections between fundamental dispositional properties. By extending dispositionalism to comprehend mereology in this way, we can help fulfil its promise to provide a foundational, naturalistic metaphysics, as foundational mereological debates then begin to mirror those relating to dispositionalist views of laws of nature: we may treat natural and mereological laws in tandem, as holding either necessarily or contingently, with associated strategies for dealing with supposed counterexamples to one’s preferred set of mereological principles. We can thus bring new life to the debate over whether questions of composition admit of contingent or only necessary answers. (shrink)

The aim of this paper is to re‐examine nursing work from a Marxist perspective by means of a critique of two key concepts within nursing: autonomy and caring. Although Marx wrote over 150 years ago, many see continuing relevance to his theories. His concepts of capital, ideology and class antagonism are employed in this paper. Nursing's historical insertion into the developing hospital system is seen in terms of a loss of autonomy covered over by the development of cults of loyalty (...) toward those institutions, while the concept of emotional labour is used to re‐examine nursing's high valuing of “caring” and to understand it as potentially exploitative of nurses. Raising awareness of this alternative way of understanding nursing work can become a first step toward change. (shrink)

Nursing has a gendered and religious history where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealized notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing's professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 (...) and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis, we focus on the nurses' apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as ‘slaves’ or ‘martyrs’ in the health care system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse's role. We argue that a remnant of a quasi‐religious ethic within the profession makes it acceptable for nurses to talk about self‐sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in, a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions. (shrink)

Postmodernism has been criticized as failing to offer, on the one hand, authoritative explanations for social phenomena that might provide a scientific basis for policy formation or, on the other, the philosophical justification for emancipatory work – its radical scepticism about claims to knowledge leaving its advocates, including many nurses, with little scope to transform oppressive social and political regimes. Various approaches to this important problem have been offered, both philosophical and mediodological. Some critical theorists have rejected certain aspects of (...) postmodernism as dangerous and distracting. Some more accommodating solutions are troubled by unacknowledged inconsistencies. Others embrace post‐modernism's unavoidable ambiguity (towards the Enlightenment for instance) with a lighter heart. In this paper I will review some of the criticism of postmodernism and some proposed solutions to these problems. Using recent research into the impact of managerialism on nursing within the UK National Health Service as an example and drawing on deconstructive literary theory, I conclude by accepting a rhetorical agonistics of undecidability. I take postmodernism as a mandate for causing trouble for those groups who are currently having their say and whose version of truth and rationality has achieved domination over others. I do not take postmodernism as a place from which to champion the cause or privilege the view of any particular group. (shrink)

The oil crisis, risk and evidence‐based practice Evidence‐based practice has risen to prominence over the last 20 years. Different professions have taken it up in different ways and for different purposes. It has been seen as holding both threats and advantages to professionalising endeavours and professional identity. It has engendered controversy but some criticisms of it have been unconvincing. It is possible to account for its rise as a response to tightening financial constraints on state spending in the west, as (...) a sign of a culture increasingly concerned with risk, distrust of professionals and experts, as well as a way for professionals themselves to maintain control over their activity in the face of growing managerialism. This paper reviews the literature of some of the movement's proponents as well as criticism from various professional groups. It concludes that more useful than either arguing for or against it, is to understand the policy background and sociological reasons for its emergence and spread. (shrink)

Sider (2001) and Hawley (2001) argue that, in order to account for the mere possibility of change, temporal parts must be as fine-grained as possible change, and hence as fine-grained as time. However, when dealing with metaphysical possibility, the fine-grainedness of actual time and the fine-grainedness of possible change can come apart. Once this is taken into account, we see that, on certain assumptions about the actual microstructure of time, the modal arguments of Sider and Hawley lead to the problematic (...) claim that temporal parts are more fine-grained than time. The utility of a temporal parts theory thus seems to be sensitive to metaphysically contingent facts concerning the microstructure of time. (shrink)

It is well established that nursing practice produces considerable anxiety, and it can also give rise to envy and jealousy. While envy in nursing was identified in the literature more than 50 years ago, there remains a paucity of articles addressing either envy or jealousy for nurses. In a recent research study on current experiences of clinical practice, we analysed a fragment of nurses’ speech via Klein's theory of jealousy. The results revealed that the nurses expressed jealousy at the privilege (...) afforded to doctors. We argue that it is important to acknowledge jealousy in nursing practice because it has the potential for ‘spoiling’ effective care delivery and as such, can have detrimental ramifications in the health system. Also, jealousy may keep the nurse from fully focusing on their nursing practice in that it divides the nurse's attention and so limits the nurse's treatment of the patient. Nurses’ jealousy of doctors is a taboo topic in nursing, and yet it warrants serious consideration due to the potential deleterious consequences that can arise when this dynamic is present. (shrink)

I will adapt part of an argument in Prosser to the case of persistence, to conclude that our experience does not favour any particular theory of persistence—our immediate experience cannot rightly be considered as evidence in this context. Even if it does in fact seem that objects persist by enduring, this cannot be because they do in fact endure; and if things do in fact persist by perduring, this should not be considered to be in spite of appearances. Thus any (...) explanation for why objects are represented in experience as enduring will be one that is independent of the truth of endurantism. (shrink)

The present paper proposes a route to modal claims that allows us to infer to certain possibilities even if they are sensorily unimaginable and beyond the evidential capacity of stipulative imagining. After a brief introduction, Sect. 2 discusses imaginative resistance to help carve a niche for the kinds of inferences about which this essay is chiefly concerned. Section 3 provides three classic examples, along with a discussion of their similarities and differences. Section 4 recasts the notion of potential explanation in (...) Lipton’s (Inference to the best explanation, Routledge, Abingdon, 2004) in order to accommodate inferences to possibility claims; Sect. 5 then attempts to characterise a principle underlying such inferences. Section 6 concludes by discussing how the proposal relates to other modal epistemologies, with emphasis on the potential of such inferences to produce genuinely new ideas. (shrink)

It is well established, following Menzies' work, that nursing practice produces considerable anxiety. Like Menzies, we bring a psychoanalytic perspective to a theorization of anxiety in nursing and do so in order to consider nursing practice in the light of psychoanalytic theory, although from a Lacanian perspective. We also draw on Bataille's notion of ‘surplus’. These concepts provide the theoretical framework for a study investigating how some clinical nurses are able to remain in clinical practice rather than leave the profession (...) or seek work at a distance from the bedside. We conducted focus groups and present here an analysis of two fragments of nurses' speech. We found the nurses responded from one of two positions. In the first position, the nurses focus on doctors, complain about the surplus afforded them, and call for it to be eliminated. In this way, the nursing group is similar to other groups, considered by Bataille, who also attempt to get rid of a surplus. However, in the second position, the nurses stay with the surplus, tolerating it as they nurse the patient. This latter position is one where the nurse practises with a focus on the patient rather than being distracted by their dispute over the doctor's privilege. The importance of this paper is in its illustration of two distinct positions from which the nurse can practise: one that is not optimal because the nurse is distracted and the other that is more focused on practice, and thus the nurse is in a position to provide the best care possible to patients. (shrink)

Modern British nursing developed from the mid‐nineteenth century and was seen as a morally purifying activity and as a potential force for social cohesion. It was also considered an activity fit for women. However, it embodied a fundamental tension within Victorian sensibility between a kind of rationalistic utilitarianism and a faith in transcendent values. This paper explores this tension and suggests that it can be detected in current debates about practice and evidence in nursing in the contemporary context of a (...) rise of managerialism in public services. (shrink)

The present work explores various ways in which contingent evidence can impact metaphysics, while advocating that, just as a scientific realist allows for ampliative inferences to the unobservable, ampliative inferences from possible evidence can warrant possibility claims that lie beyond the reach of sensorial imagination. In slogan form: possible evidence is a guide to possibility. Drawing on Shoemaker’s (1969) argument for the possibility of time without change, I advocate the following principle: If there is a possible world at which the (...) observable facts make it objectively reasonable to conclude that p, then we should conclude that p is possibly true. This provides a route to contingentism in metaphysics, for, if one considers that there are worlds in which the observable facts make it objectively reasonable to conclude that p, and worlds in which the observable facts make it objectively reasonable to conclude that not-p, then my principle tells us that we should conclude that possibly-p and possibly not-p, i.e. that p is contingent. This contingency in what is reasonable to conclude, I suggest, occurs most saliently in debates where evidence of phenomenal experience and empirical science are marshalled to support one theory over another. I also explore some consequences of taking possible evidence to be a guide to possibility in this way, among them being an interesting modal analogue of the lottery paradox. (shrink)