Nursing as total institution

Abstract

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.

Dangerous and Unprofessional Content: Anarchist Dreams for Alternate Nursing Futures

“…Professionalized nursing is a total institution [11,12]. Without nurses' continued compliance with the carceral logics of the neoliberal and racial capitalist order, healthcare-a powerful tool of oppression and control-would cease to function.…”

“…Nurses are made, ready to be both governed and to govern. Control over nurse identity and the power to define who nurses are and what nurses do are central to the intersection of power, agency, governance, and oppression [11,12].…”

Another nursing is possible: Ethics, political economies, and possibility in an uncertain world

“…We can build alternatives invested in mutual aid and kinship, rooted in community and connection informed by traditions of abolition. The specter of these possibilities represent matters of life and death, clear and immediate, a reality we refuse at our own risk as our health care colleagues and friends and patients die, subject to the necropolitical economies of health care under capitalism (Dillard‐Wright & Jenkins, 2023). And dreaming could lead us to tell different stories.…”