David Pereira

Abstract Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or 'stressors', have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of 'stress'. It is argued that the notion of 'stress' and the domination of the questionnaire have produced a narrow reading of the topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of 'anxiety' and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of 'anxiety' is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety.

This paper reports on the findings of a study that considered how anxiety might function to organise nurses’ practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change‐of‐shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety.

The nurses’ relationship to knowledge has been theorised in a variety of different ways, not the least being in relation to medical dominance. In this study, the authors report on one of the findings of a case study into nurses’ anxiety informed by psychoanalytic theory. They argue that the nurse’s subjection to the knowledge of the other health professional, inclusive of the doctor, can be a transference arising in the context of anxiety for the nurse. Grasped by anxiety, the nurse finds their own knowledge insufficient and in this moment can operate a transference to their non‐nursing colleague, who obligingly, responds. This transference is not present in the change‐of‐shift handover report though, when the other’s knowledge is suspect, even open to derision. Thus, this reference to the knowledge of the other is not consistently present in nursing and can be seen to be just one way that nurses organise themselves in relation to anxiety. Therefore, those wanting to break down the medical dominance of the nursing profession might consider other ways nurses might organise themselves in relation to anxiety, so that the political dominance of the other is not reinforced via transference to that other.