The image of the hospital is presented to the public as a place of healing. Though the oft‐criticized total institutions of the past have been notably dismantled, the totalizing practices therein are now operationalized in the health care system. Through the lens of Erving Goffman, this article offers ways in which health care institutions operationalize totalizing practices, contributing to the mortification of patients and nurses alike in service to the bureaucratic machine. This article examines the ways in which totalizing practices (...) may disrupt the agency of both patients and nurses alike. (shrink)

Healthcare under the auspices of late‐stage capitalism is a total institution that mortifies nurses and patients alike, demanding conformity, obedience, perfection. This capture, which resembles Deleuze's enclosure, entangles nurses in carceral systems and gives way to a postenclosure society, an institution without walls. These societies of control constitute another sort of total institution, more covert and insidious for their invisibility (Deleuze, 1992). While Delezue (1992) named physical technologies like electronic identification badges as key to understanding these societies of control, the (...) political economy of late‐stage capitalism functions as a total institution with no cohesive, centralized, connected material apparatus required. In this manuscript, we outline the ways in which the healthcare industrial complex demands nurse conformity and how that, in turn, operationalizes nurses in service to the institution. This foundation leads to the assertion that nursing must foster a radical imagination for itself, unbound by reality as it presently exists, in order that we might conjure more just, equitable futures for caregivers and care receivers alike. To tease out what a radical imagination might look like, we dwell in paradox: getting folks the care they need in capitalist healthcare systems; engaging nursing's deep history to inspire alternative understandings for the future of the discipline; and how nursing might divest from extractive institutional structures. This paper is a jumping‐off place to interrogate the ways institutions telescope and where nursing fits into the arrangement. (shrink)

This paper begins with the lived accounts of emergency and critical care medical interventions in which an unhoused person is brought to the emergency department in cardiac arrest. The case is a dramatised representation of the extent to which biopolitical forces via reduction to bare life through biopolitical and necropolitical operations are prominent influences in nursing and medical care. This paper draws on the scholarship of Michel Foucault, Giorgio Agamben, and Achille Mbembe to offer a theoretical analysis of the power (...) dynamics that influence the health care and death care of patients who are caught in the auspices of a neoliberal capitalist healthcare apparatus. This paper offers analysis of the overt displays of biopower over those individuals cast aside as generally unworthy of access to healthcare in a postcolonial capitalist system, in addition to the ways in which humans are reduced to ‘bare life’ in their dying days. We analyse this case study through Agamben's description of thanatopolitics, a ‘regime of death’, and the technologies that accompany the dying process, particularly in that of the homo sacer. Additionally, this paper illustrates the ways in which necropolitics and biopower are integral to understanding how the most advanced and expensive medical interventions make visible the political values of the healthcare system and how nurses and healthcare functions in these deathworlds. The purpose of this paper is to develop a greater understanding of biopolitical and necropolitical operations in acute and critical care environments, and to offer guidance to nurses in these spaces as they work to uphold ethical duties in a system that increasingly dehumanises. (shrink)

This paper opens with first‐hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients (...) who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to “bare life” under the political pretext of an emergency or “state of exception” (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal “will” exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state. (shrink)

Professionalized nursing and anarchism could not be more at odds. And yet, if nursing wishes to have a future in the precarious times in which we live and die, the discipline must take on the lessons that anarchism has on offer. Part love note to a problematic profession we love and hate, part fever dream of what could be, we set out to think about what nursing and care might look like after it all falls down, because it is all (...) falling down. Drawing on alternate histories, alternate visions of nursing history, we imagine what nursing values would look like, embracing anarchist principles. We consider examples of community survival, mutual aid, and militant joy as strategies to achieve what nursing could be if nurses put an end to their cop shit, shrugging off their shroud of white cisheteropatriarchal femininity that manifests as professionalism and civility. We conclude with a call to action and a plan for skill-building because this can all be different. (shrink)