Nurses must meet the complex and diverse needs of the people they care for—washing, dressing, meal times, medication, counselling, liaising with social services—at the expense of lunch breaks and evenings. Feelings of guilt and panic pervade the working day. If you leave exactly when your shift ends, you feel you are failing your patients. If you stay late, you are effectively working for free and affirming the expectation that you should work for free, making it harder for your colleagues to leave on time. You are trapped between two kinds of compassion: your compassion for your patients, and your compassion for your co-workers.
Reports of neglect and abuse in hospitals and care homes appear with alarming regularity. Received narratives blame “burn-out”: understaffing, low wages and squeezed margins transform overworked and overstressed carers into monsters. The proposed solution is extra vigilance and “Compassion Training.” Shifting the question of working practices and worker wellbeing onto the terrain of compassion is a sleight of hand. It implies that care workers should police themselves and their colleagues rather than fight collectively for better pay and conditions. By this account, compassion flows in one direction only, from nurse to patient, and never between nurses, or from the nurse to her or his own family and friends.
Those who are challenging or aggressive can struggle to find people to meet their care needs. They might be left in pain, or go hungry, because they cannot make themselves sufficiently likable. Because they cannot form the kinds of relationships within which caring labor is dispensed (e.g. marriages, friendships, families). Whilst nurses are paid to form these relationships with everyone and anyone, in the context of over-stretched health care systems, it is inevitable that the most challenging, least likeable patients will lose out. This is one of the unintended implications of advising nurses to pretend that patients are people they love. It is hard to love people who are abusive or ungrateful or racist. Compassion is in permanent crisis: love and guilt cannot ensure that everyone in society is adequately cared for.
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