Jess Dillard-Wright

With this paper, I will interrogate some of the implications of nursing's dominant historiography, the history written by and about nursing, and its implications for nursing ethics as a praxis, invoking feminist philosopher Donna Haraway's mantra that ‘it matters what stories make worlds, what worlds make stories.’ First, I will describe what I have come to understand as the nursing imaginary, a shared consciousness constructed both by nurses from within and by those outside the discipline from without. This imaginary is fashioned in part by the histories nursing produces about the discipline, our historical ontology, which is demonstrative of our disciplinary values and the ethics we practice today. I assert that how we choose to constitute ourselves as a discipline is itself an ethical endeavour, bound up with how we choose to be and what we allow as knowledge in nursing. To animate this discussion, I will outline the received historiography of nursing and dwell in the possibilities of thinking about Kaiserswerth, the training school that prepared Nightingale for her exploits in Crimea and beyond. I will briefly consider the normative values that arise from this received history and consider the possibilities that these normative values foreclose upon. I then shift the frame and ask what might be possible if we centred Kaiserswerth's contested legacy as a training school for formerly incarcerated women, letting go of the sanitary and sanitised visions of nursing as Victorian angels in the hospital. Much energy over the past 250 years has been invested in the professionalisation and legitimation of nursing, predicated (at least in our shared imaginary) on the interventions of Florence Nightingale, but this is one possibility of many. I conclude with a speculative dream of the terrain opens up for nursing if we shed this politics and ethos of respectability and professionalism and instead embrace community, abolition and mutual aid as organising values for the discipline.

ABSTRACT This is a tribute to Sam Porter's 2019 paper, ‘Why Nurses Should be Marxists’ in honour of the 25th anniversary of the journal Nursing Philosophy. In that paper, Porter made the case that nurses should be Marxist. While Porter was clear that Marxism could not solve all of nursing's problems, he made the case that it was an important start. I thought I would take up Porter's call to Marxism, to engage with it seriously, to offer up some extensions, to call folks to action. With this paper, in homage to Porter and also all the dreamers, movers, actors, organisers, and carers, I want to offer up the imperative to speak and act up in the face of rising authoritarianism and its threats to health, wellbeing, and liberation for us all. I get there by first outlining Porter's (2019), argument about why nurses should be Marxists. I then add the prefigurative potentials of anarchism as a praxis for nursing. From here, I go on to make the case that, whether communist or anarchist or abolitionist, nursing must be radical should we wish to survive our fascist present. After outlining the current order of things, I move to thinking about what might be possible, a speculative exercise in dreaming pushing off from current events. Possibility gives way to making things different, some provisional moves to build the futures we dream of in the face of perilous presents.

Critical posthumanism as a philosophical, antifascist nonhierarchical imagination for nursing offers a liberatory passageway forward amidst environmental collapse, an epic pandemic, global authoritarianism, extreme health and wealth disparities, over‐reliance on technology and empirics, and unjust societal systems based in whiteness. Drawing upon philosophical and theoretical works from Black and Indigenous scholars, Haraway's idea of the Chthulucene, Deleuze and Guattari's rhizomatic thought, and Kaba's abolitionist organizing among others, we as activist nurse scholars continue the speculative discussion outlined in prior papers. Here we further imagine how we can engage a radical philosophical mission of care for all beings human and non, walking and working alongside the people and communities nurses accompany, connected as we are on this dystopian celestial orb. Discussion is centred on critical analyses of traditional justice framing in nursing, and on the praxis possibilities found within rhizomatic thought, making kin, and just episteme while knitting filaments of nursing theory and history, humming song lyrics from collective memory, and critically dismantling received wisdoms to stumble toward a more emancipatory present future.

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.

In the crucible of the pandemic, it has never before been clearer that, to ensure the relevance and even the survival of the discipline, nursing must cultivate a radical imagination. In the paper that follows, I trace the imperative for conjuring a radical imagination for nursing. In this fever dream for nursing futures, built on speculative visions of what could be, I draw on anarchist, abolitionist, posthuman, Black feminist, new materialist and other big ideas to plant seeds of generative insurrection and creative resistance. In thinking through a radical imagination, I unpack the significance of reparatory history for nursing, a discipline founded on normative whiteness. From there, I consider what it would take to shift the capitalist frame of healthcare to one of mutual aid, which requires the deep work of abolition. With a radical imagination that breaks down the enclosures that contain us through reparatory history, mutual aid and abolition, kinship becomes urgently possible.

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness.

This paper explores how contemporary US healthcare, shaped by neoliberal biopolitics and thanatopolitics, functions as a death-making institution that commodifies care while systematically disposing of certain lives, reflecting an ethics not of care but of capital. Drawing from critical theory, historical analysis, and lived experience, we examine how death is deeply embedded in the structures of power and capitalism. Through the lens of haunting and organized forgetting, we analyze how institutions sanitize death, muting human loss into metrics and decontextualized data points, while erasing the tragedies of systemic violence. We argue that nurses, who are situated in physical and spiritual proximity to death, are uniquely positioned to act as witnesses, truth-tellers, and conjurers of the dead. Rather than comply with the institutional imperative to forget, we advocate for a practice of conjuring; calling forth the ghosts of those lost to violence of medical neglect, structural racism, and economic abandonment as a form of parrhesia: dangerous, necessary truth-telling. We explore how organized forgetting rewrites radical histories into palatable myths, disciplining contemporary activism and muting its transformative potential. We turn to examples like the Marys of ACT UP, whose embodied activism illustrates the power of public grief and haunting to incite justice. Inspired by theorists such as Foucault, Giroux, Derrida, and Ahmed, we locate in mourning a form of resistance, in memory a political act, and in storytelling a path to rehumanization. Ultimately, we argue that to conjure our dead is not only to remember them but to be transformed by them, allowing their voices to shape our ethical responsibilities, professional identities, and collective futures. In being possessed by our dead, we foreclose upon the institutional disavowal of suffering and reclaim a politics rooted in compassionate reckoning and the belief that another world is possible.

This is a tribute to Sam Porter's 2019 paper, ‘Why Nurses Should be Marxists’ in honour of the 25th anniversary of the journal Nursing Philosophy. In that paper, Porter made the case that nurses should be Marxist. While Porter was clear that Marxism could not solve all of nursing's problems, he made the case that it was an important start. I thought I would take up Porter's call to Marxism, to engage with it seriously, to offer up some extensions, to call folks to action. With this paper, in homage to Porter and also all the dreamers, movers, actors, organisers, and carers, I want to offer up the imperative to speak and act up in the face of rising authoritarianism and its threats to health, wellbeing, and liberation for us all. I get there by first outlining Porter's (2019), argument about why nurses should be Marxists. I then add the prefigurative potentials of anarchism as a praxis for nursing. From here, I go on to make the case that, whether communist or anarchist or abolitionist, nursing must be radical should we wish to survive our fascist present. After outlining the current order of things, I move to thinking about what might be possible, a speculative exercise in dreaming pushing off from current events. Possibility gives way to making things different, some provisional moves to build the futures we dream of in the face of perilous presents.

Background: Advocacy and activism are dynamic terms representing a spectrum of political action, aiming to achieve social or political change. The extent to which nursing advocacy and activism are legitimate nursing roles has been debated for around 50 years. Nursing regulatory documents, such as codes of conduct and professional standards, may provide direction to nurses on how they should act in the context of advocacy and activism. Aim: To explore what regulatory documents say about advocacy and activism, either explicitly or implicitly, and how they shape advocacy and activism. Research design: We used a Reflexive Qualitative Document Analysis approach with a Critical Feminist lens to analyse contemporary nursing regulatory documents from the USA, UK and Australia. Ethical considerations: This article has no human participants, and informed consent was not required. Findings: We identified eight nursing regulatory documents from the American Nurses Association, Nursing and Midwifery Council and Nursing and Midwifery Board of Australia. We constructed two major themes that reveal how nursing advocacy and activism are conceived and shaped in regulatory documents. Theme 1, Ideological arena describes the gendered and neoliberal subtexts influencing advocacy and activism. Theme 2, A five-pointed star, describes the shape of advocacy and activism in the regulatory documents. Conclusions: Regulatory documents from the USA, UK and Australia support diplomatic nursing advocacy and activism for people, equity, ourselves (nurses), the profession and systems change. However, more oppositional and disruptive advocacy and activism are potentially constrained by gendered and neoliberal subtexts that depoliticise nurses’ roles.

During the COVIDicine, many nurses awoke to the ways that the Healthcare‐Industrial Complex (HIC) dictates the care we are able to provide. Using the Foucauldian concepts of pastoral power and governmentality, we explore the ways that nurses participate in upholding power structures within the HIC and reproducing them in our work, contributing to a carceral culture based on hierarchy and power dynamics. We also explore the ways nurses are both agentic in this system and subject to it, reluctant to make waves and lose our place within a system that can offer nurses safety and security in, and most importantly, a paycheck. This paper articulates a prefigurative anarchist approach to nursing praxis. Through the writing of Emma Goldman, we locate a historically founded philosophical basis for practical tactics that nurses can use to actualise this praxis. Both individually and as a collective, nurses can assert their own ethic and power through direct action, micro‐insurgency and solidarity to build the world we know can be. Our only limitation is our imagination.

Political action has a long history in the health workforce. There are multiple historical examples, from civil disobedience to marches and even sabotage that can be attributed to health workers. Such actions remain a feature of the healthcare community to this day; their status with professional and regulatory bodies is far less clear, however. This has created uncertainty for those undertaking such action, particularly those who are engaged in what could be termed ‘contentious’ forms of action. This study explored how advocacy and activism were presented in nursing and medical codes of ethics, comparing disciplinary and temporo‐spatial differences to understand how such action may be promoted or constrained by codes. The data for this study comes from 217 codes of ethics. Because of the size of the corpus and to facilitate analysis, natural language processing was utilised, which allowed for an automated exploration of the data and for comparisons to be drawn between groups. This was complemented by a manual search and contextualisation of the data. While there were noticeable differences between medical and nursing codes, overall, advocacy, activism and even politics were rarely discussed explicitly in most codes. When such action was spoken about, this was often vague and imprecise with codes speaking of ‘political action’ and ‘advocacy’ in general terms. While some codes were far more forthright in what they meant about advocacy or broader political action (i.e., Nursing codes in Denmark, Norway, Canada) more forceful language that spoke in specific terms or in terms of oppositional or specific actions (e.g., civil disobedience or marches) was almost completely avoided. These results are discussed in relation to the broader literature on codes and the normative questions they raise, namely whether such action should be included in codes of ethics at all.

Overtaxed by the realities laid bare in the pandemic, nursing has imminent decisions to make. The exigencies of pandemic times overextend a health care infrastructure already groaning under the weight of inequitable distribution of resources and care commodified for profit. We can choose to prioritise different values. Invoking philosopher of science Isbelle Stengers's manifesto for slow science, this is not the only nursing that is possible. With this paper, I pick up threads of nursing's historical ontology, drawing previous scholarship on the historical narratives nurses use to understand themselves. Peeling back nursing's myth to alternate points of origin allows me to consider alternate lines of flight, a speculative adventure in paths not taken but paths that exist nonetheless. I go on to examine what a collective ethic of nursing could be, when we make space for these alternate histories, considering the confluences and conflicts that enable nurses to care and those that inhibit them from doing so. The imperative for this lies in the central importance of the reproductive labour of nursing health care, which leads me to a critique of nursing's capitulation to the pressures of late stage capitalism. This is a problem with ethical and ontological implications both for nursing, and also for those who require nursing care, an imperative to think about the kinds of present/futures for health, care, and health care we might cocreate in collaboration and solidarity with the communities in which nurses are imbricated, shedding the trappings of neoliberalism. There is significant power in the vision and praxis of 28 million nurses and midwives worldwide. Our ethics can guide our imagination which can in turn create possibility. This kind of endeavour—that of dreams and imagination—leads us to what could be, if only we leap.

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.

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.

The Vitruvian Man is a metaphor for the “ideal man” by feminist posthuman philosopher Rosi Braidotti (2013) as a proxy for eurocentric humanist ideals. The first half of this paper extends Braidotti's concept by thinking about the metaphor of the “ideal nurse” (Vitruvian nurse) and how this metaphor contributes to racism, oppression, and burnout in nursing and might restrict the professionalization of nursing. The Vitruvian nurse is an idealized and perfected form of a nurse with self‐sacrificial language (re)producing self‐sacrificing expectations. The second half of this paper looks at how regulatory frameworks (using the example of UK's Nursing and Midwifery Council Code of Conduct) institutionalize the conditions of possibility through collective imaginations. The domineering expectations found within the Vitruvian nurse metaphor and further codified by regulatory frameworks give rise to boredom and burnout. The paper ends by suggesting possible ways to diffract regulatory frameworks to practice with affirmative ethics and reduce feelings of self‐sacrifice and exhaustion among nurses.

With this paper, we walk out some central ideas about posthumanisms and the ways in which nursing is already deeply entangled with them. At the same time, we point to ways in which nursing might benefit from further entanglement with other ideas emerging from posthumanisms. We first offer up a brief history of posthumanisms, following multiple roots to several points of formation. We then turn to key flavors of posthuman thought to differentiate between them and clarify our collective understanding and use of the terms. This includes considerations of the threads of transhumanism, critical posthumanism, feminist new materialism, and the speculative, affirmative ethics that arise from critical posthumanism and feminist new materialism. These ideas are fruitful for nursing, and already in action in many cases, which is the matter we occupy ourselves with in the final third of the paper. We consider the ways nursing is already posthuman—sometimes even critically so—and the speculative worldbuilding of nursing as praxis. We conclude with visions for a critical posthumanist nursing that attends to humans and other/more/nonhumans, situated and material and embodied and connected, in relation.

Resistance is a concept understudied in the context of health and healthcare. This is in part because visible forms of social protest are sometimes understood as incongruent with professional identity, leading healthcare workers to separate their visible actions from their working life. Resistance takes many forms, however, and focusing exclusively on the visible means more subtle forms of everyday resistance are likely to be missed. The overarching aim of this study was to explore how resistance was enacted within the workplace amongst a sample of twelve healthcare workers, based in the United Kingdom; exploring the forms that such action took and how this intersected with health and healthcare. In depth-interviews were conducted and results were analysed utilizing Lilja’s framework (2022). Our findings suggest that resistance took a number of forms, from more direct confrontational acts, to those which sought to avoid power or which sought to create alternative or prefigurative practices or norms. These findings speak to the complexities, ambiguities, and contradictions of resistance, as carried out by healthcare workers in the workplace. While many acts had clear political motives, with issues like climate change in mind for example, participants also described how the act of providing care itself could be an act of resistance. While saying something about our participants, this also said something about the healthcare systems in which they worked. These findings also raise a range of normative issues. Perhaps needless to say, there appears to be substantial scope to expand and interrogate our findings and apply the idea of resistance to health and healthcare.

Stimulated by our conversations at the 2018 International Philosophy of Nursing Society Conference and our shared interests, the coauthors present an argument for augmenting the broader discussion of “missed care” with our synthesized concept called structural missingness. We take the problem of missed care to be largely grounded on a particular economic construction of the healthcare system within an era of what some are calling the Capitalocene, capturing the pervasive influence of capitalism on nature, humanity and the world order. Our perspective is that of the United States, however, extrapolations can be made to the social and healthcare systems in other countries. We are concerned with the underlying conditions that structurally reify inequality and ultimately undermine nursing practice. To situate the discussion, we briefly review existing literature on the contextualization of missed care. We understand contemporary circumstances of missed care as a function of the neoliberalization of healthcare, including the idea of nursing as a commodity. From this, we discuss the implications of missed care, which forms the basis of our critique. Synthesizing the term “structural missingness, we locate a moral imperative in the professional and disciplinary commitments of nursing to consider who and what have been left out. This moral imperative for the nursing profession, along with other social and health related professions, underscores our obligation to be involved in uncovering inequities and conceptualizing upstream solutions for structural missingness.

Critical posthumanism as a philosophical, antifascist nonhierarchical imagination for nursing offers a liberatory passageway forward amidst environmental collapse, an epic pandemic, global authoritarianism, extreme health and wealth disparities, over‐reliance on technology and empirics, and unjust societal systems based in whiteness. Drawing upon philosophical and theoretical works from Black and Indigenous scholars, Haraway's idea of the Chthulucene, Deleuze and Guattari's rhizomatic thought, and Kaba's abolitionist organizing among others, we as activist nurse scholars continue the speculative discussion outlined in prior papers. Here we further imagine how we can engage a radical philosophical mission of care for all beings human and non, walking and working alongside the people and communities nurses accompany, connected as we are on this dystopian celestial orb. Discussion is centred on critical analyses of traditional justice framing in nursing, and on the praxis possibilities found within rhizomatic thought, making kin, and just episteme while knitting filaments of nursing theory and history, humming song lyrics from collective memory, and critically dismantling received wisdoms to stumble toward a more emancipatory present future.

Drawing from a keynote panel held at the hybrid 25th International Philosophy of Nursing Conference, this discussion paper examines the question of epistemic silence in nursing from five different perspectives. Contributors include US‐based scholar Claire Valderama‐Wallace, who meditated on ecosystems of settler colonial logics of nursing; American scholar Lucinda Canty discussed the epistemic silencing of nurses of colour; Canadian scholar Amelie Perron interrogated the use of disobedience and parrhesia in and for nursing; Canada‐based scholar Ismalia De Sousa considered what nursing protects in its silences; and Australian scholar Janice Gullick spoke to trans invisibility in nursing.

The specific arrangements of power/knowledge that characterize nurse interactions with the electronic health record form a panopticon. As health care moves into the 21st century, sophisticated technologies like the electronic health record shape the terrain of professional possibilities. The longer it is in use, the more it is possible to excavate the inherent disciplinary function of electronic health record. A panopticon is a generalizable, replicable apparatus of power that cultivates discipline when similar behaviours are desired from a group of people. This paper traces the arrangements of power/knowledge that characterize nurse interactions with the electronic health record rooted in a trauma critical care setting. Examining the apparatuses of power/knowledge enforced through panopticism in nursing makes the invisible visible. This in turn enables nurses to address the intended and unintended consequences of the electronic health record. If nurses are to effectively shape the direction of their own futures and the future of health care, nurses will need to unpack the invisible techniques of power such as the electronic health record as a panopticon. In the process of building a visible identity, contextualizing nursing knowledge to better care for patients on the one hand and understand the relationships of power that limit us on the other, nurses are neither apolitical nor powerless. Considering the dialectic of power/knowledge in the healthcare setting helps to illuminate spaces to recharacterize nursing, reveal the contributions and knowledge of nurses, and consolidate the professional power of nurses to affect meaningful change and self‐governance in the healthcare setting.

In the crucible of the pandemic, it has never before been clearer that, to ensure the relevance and even the survival of the discipline, nursing must cultivate a radical imagination. In the paper that follows, I trace the imperative for conjuring a radical imagination for nursing. In this fever dream for nursing futures, built on speculative visions of what could be, I draw on anarchist, abolitionist, posthuman, Black feminist, new materialist and other big ideas to plant seeds of generative insurrection and creative resistance. In thinking through a radical imagination, I unpack the significance of reparatory history for nursing, a discipline founded on normative whiteness. From there, I consider what it would take to shift the capitalist frame of healthcare to one of mutual aid, which requires the deep work of abolition. With a radical imagination that breaks down the enclosures that contain us through reparatory history, mutual aid and abolition, kinship becomes urgently possible.