In the 1990s, just around the time of the Swedish financial crisis, researchers noted a growing public and political interest in the nursing profession. “One had to look back to the days of Nightingale to find a corresponding attention directed at the care work performed by nurses”, according to a Lund University dissertation published in 1992. Why was there, in the tumultuous years of the early 1990s, such a sudden interest in nursing – an occupation usually taken for granted? The answer could be that nurses enter the spotlight whenever there is a major crisis, only to recede into the margins of public and political consciousness during times of equilibrium.
Sweden in the 1990s witnessed a major shift of resources from social reproduction commons to sectors of accumulation, as well as the ascendance of logics of private capital within the public sector. This would lead to a structural under-investment in healthcare, as well as a “renegotiation of working conditions” negatively impacting female-dominated public sector- and welfare state workers. At the same time, public sector restructuring opened up new career paths for nurses. NPM’s focus on managerialism meant that nurses and not only physicians could become managers, because management was seen as a general skill instead of as an expression of professional hierarchies. In line with neoliberal ideology, NPM also centered on the individual, which in the healthcare system translated into patient-centered care. Nurses were no longer supposed to simply care for patients; they were the ones who would aid in empowering them.
The crisis of the 1990s brought a lot of attention to nursing in Sweden, but only for a brief period of time. Soon, researchers would conclude that nurses again felt invisible and under-appreciated. Their working conditions became increasingly complex, contradictory and intense, but their wages remained low, as did their status within the healthcare system and in society in general. While new career paths had opened up for some nurses, others were stuck in repetitive, physically draining and emotionally demanding positions. Their dissatisfaction grew, and a decade into the new millennia, Sweden started to witness new forms of labor protest: nurses organizing mass-resignations, die-ins in front of hospitals, and so-called salary protests wherein nurses promised each other not to accept job offers if the offered monthly salary was below SEK24k.
The Corona pandemic seems to be part of this pattern. After years of unsuccessful demands for recognition, sustainable working conditions, and higher salaries, the complex and highly challenging covid-19 care interventions delivered by nurses, especially in intensive care, brought a renewed interest in nurses’ and other care workers’ essential contributions to public health. As in Italy and many other countries, public initiatives and politicians’ praise meant that at the height of the pandemic, nurses were applauded and given free lunches – literally; people would applaud and companies provided complimentary lunch boxes. Nurses’ were invited to share their stories in newspaper articles and radio shows.
But the attention was not matched by actual contributions to sustain nurses in their day to day, night to night work situations. Instead, as soon as the hospitalization rates and death rates slowed, nurses’ in major hospitals were given news of significant cut backs or even given notice.
How do we account for this pattern? Most would probably agree with the statement that nurses are important, essential even, to the health and well-being of all people; at some point in our life, we will depend on a nurse. But oftentimes, nurses’ efforts are taken for granted – and sometimes, their work is thought of as expressions of women’s natural abilities, rather than hard-earned skills. At the level of economic policy, their labor is conceptualized as a cost best reduced. With the help of feminist philosopher Nancy Fraser we can think of this contradiction between nurses being revered and nurses being disregarded as a contradiction between capital and care, or between accumulation and reproduction. Capitalism is dependent on social reproduction – all those activities, paid and unpaid, that sustain life. However, the sphere of social reproduction has for long been severely under-invested and under-emphasized. We are facing, according to Fraser, a crisis of care, expressed in lack of time, resources and capabilities needed for people to recover and care for each other. Since the 1990s, neoliberal dominance has meant that institutions of social reproduction such as hospitals, elder care homes, schools and childcare arrangements should not cost, it should simply function, or even generate revenue for private shareholders. But when social reproduction is systematically undermined, it is also harder for people to function in the productive sphere and in society as a whole. In fact – a society that undermines social reproduction undermines the entire economic sphere, very much including private enterprising. The crisis of care is built on the contradiction within the capitalist system, wherein “capitalism’s orientation to unlimited accumulation tends to destabilize the very processes of social reproduction on which it relies”, as Fraser puts it.
The concept of contradiction has been important for researchers in understanding situations, processes or events wherein seemingly opposed forces are present. The Covid-19 pandemic highlights precisely such a contradiction: nurses are essential, but treated as if they are dispensable. But in the theoretical tradition in which the concept of contradiction has been developed, it is also a hopeful concept; it is what leads to change. Hopefully, what the pandemic may shine a light on, is care workers’ significance to a sustainable society, and their vital role in keeping people healthy and able. Whenever we face incompatible accounts of nurses and nursing as both oh so important and oh so difficult to properly fund, we should identify this as a contradiction and a crisis – and proceed to protest, to create change. Nurses are indispensable, and our society’s resources should be at their disposal.