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.

To give voice to the lived experiences of nurses and law enforcement officers who interact with one another in an acute care hospital setting, while gaining an understanding of individual perspectives and unique experiences, as well as how they interpret these experiences. This qualitative study used interpretative phenomenological analysis (IPA) to strive to meet the study objectives. There is a paucity of literature on the topic of nurse and law enforcement interaction in the hospital setting. Overwhelmingly, participants described a contentious dynamic between nurses and law enforcement officers in the hospital, wrought with argument, stress, and a feeling of coming from "different worlds." The influence of gender was apparent to the female-identified participants, and gender constructs and therefore gender role conflict were critical points of contention. In exploring how nurses and law enforcement officers think about and describe their experiences, nurses and hospital systems may develop a deeper understanding and appreciation of barriers to care for incarcerated patients and of the challenging experiences nurses face in caring for these patients. The nurses' expressed feelings of intimidation, stress, and impaired self-efficacy in this dynamic underscore the need for institutional support and prioritization of caring practices, and identification of the ways in which carceral practices impair care, as well as nurses' safety.

Aim

Through a review of philosophical and theoretical constructs, this paper offers insight and guidance as to ways in which nurse leaders may operationalize advocacy and an adherence to nursing's core ethical values.

Background

The US health care system works in opposition to core nursing values. Nurse leaders are obliged to advocate for the preservation of ethical care delivery.

Evaluation

This paper draws upon the philosophies of Fromm, Foucault, and Deleuze and Guattari to critically review the functions of nurse leaders within a capitalist paradigm.

Key issue

Key emergent issues in the paper include health care and capitalism and the nurse leader's obligations towards advocacy.

Conclusion

The nurse leader acts as parrhèsia in viewing truth telling as a duty critical to improving the lives of patients. Ramifications of the decisions by those in power have even greater impact in institutions that serve those with little to no political agency.

Implications for nursing management

The nurse leader has a freedom and platform that their patients do not and must take the courageous risk of choosing to speak. This paper serves as a call to action for nurse leaders to urgently address the current state of US health outcomes.

In the field of nursing, narratives of professional identity have been, and remain, closely tied to the shape(s) of the discipline. How we conceptualize our nursing-selves, individually and collectively, is intimately related to how nurses see themselves and their practices, how we compare, contrast, and relate our discipline to related professions, and with the widespread, but imprecise popular culture narratives regarding the form and function of nursing. As we argue here, reimagining nursing identity/identities is essential to radical change for patients, communities, and ourselves. Refocusing, or perhaps replacing altogether, the conceptual lenses through which we see ourselves, and those through which others see us, reaffirms our role in shaping the nursing identity which emerges from complex current, as well as historical, social, and cultural relations. Despite its relatively recent rise to prominence in academia and popular politics, the concept of identity has a long history in the Western philosophical tradition (Appiah, 2010; Lewis, 1966; Ricoeur, 1991; Sayers, 1999). A discussion of its intellectual genealogy elucidates how we can use the concept as a tool in pursuit of nursing’s radical reimagination.

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.