Journal of Nursing Management, 2005, 13, 282285
Commentary. The social construction of `woman's work: nursing
labour and status
In this paper it will be suggested that the historical
social construction and devaluation of what is perceived
as womens work has provided a legacy that has
resulted in low levels of status being associated with
nursing. The historical shift of control of matters con-
cerned with birth, death, health and illness, from
women to men, will be considered. This will be situated
within the context of the rise of scientific positivism and
the emergence of professional practice. It will be pro-
posed that nursing work became situated at the lower
end of a hierarchy, within which status associated with
nursing was primarily attached to the perceived virtues
of duty and vocation, which became principle incentives
for people to enter and remain in nursing. It will be
suggested that such perceived virtues no longer accrue
status within contemporary western society. This has
led to an anxiety within nursing to endeavour to secure
status primarily through assimilating to, and advoca-
ting, scientific rationale and professional recognition.
The limitations of this shift in nursing focus will be
explored and a re-valuation of work concerned with
birth, death, health and illness will be proposed as a
means of re-conceptualizing status within nursing and
caring labour.
The social construction of femininity, coupled with
aspects of the biological realities of reproduction, have
provided the historical context in which women main-
tained control over activities associated with birth,
death, health and illness. This included responsibilities
around childbirth and delivery, child rearing, nurturing,
family nutrition, family hygiene, care and treatment of
the sick, and care of dying. The past three centuries
have witnessed the development and growth of scientific
positivism, which has become the dominant school of
thought within academic institutions. The application
of this scientific approach to human experiences con-
cerned with bodily functions has led to a shift in control
over these matters from women to men. This gender
shift has developed through a complex mixture of pol-
itics, scientific advancement, professional closure and
gender biases in academic institutions (Kelleher et al.
1994). Although other approaches have emerged,
282
including social approaches and humanistic models, the
scientific biomedical model has achieved the status of a
concerted singular point of reference from which other
approaches, theories and practices concerning birth,
death, health and illness are conceptualized. The defi-
ning features of this scientific approach have been des-
cribed as biomedical, reductionist, mechanistic and
allopathic (Naidoo 1994), wherein the body is con-
ceptualized as an entity which is made up of small parts.
If something is wrong with the body, treatment consists
of applying a force or intervention which seeks to cor-
rect this dysfunction, which usually takes the form of
pharmacological drugs or some form of surgery. There
have been significant scientific breakthroughs eman-
ating from the bio-medical school of thought that have
unarguably enhanced human existence, for example
anaesthesia, antisepsis and antibiotics. However, pro-
fessional closure around this bio-medical approach has
ensured that this school of thought has become the
predominant paradigm utilized to understand and
respond to a diversity of human experiences that are
beyond the flesh (Hugman 1991). Non-medical
approaches such as nursing are consequently concep-
tualized in relational terms to the medical paradigm,
thus reducing nursing practice to a concept of other or
a form of deviation from the accepted singular bio-
medical scientific ideal.
From the mid-1800s onwards, this medicalization of
health became increasingly formalized across the west-
ern world, endorsed by legislation and controlled by
occupational closure (Turner 1987, 1996). This has led
to the medical profession developing a legal monopoly
over the control of caring interventions and the health
policy in which it is situated (Foucault 1973, Illich
1976, Coe 1978). It is within this context that nursing,
which remained female dominated, became occupa-
tionally situated at the lower end of a hierarchy of
control of care. This was arguably reinforced by the
work of Florence Nightingale who, influenced by the
British public health reform movement, successfully
applied emerging understandings of hygiene and infec-
tion control to nursing care during the Crimean War.
2005 Blackwell Publishing Ltd

While Nightingales achievements were significant, she
would appear to have developed, refined and reinforced a
system in which the content and process of nursing care
labour was directed by doctors, who predominantly
operated from an emerging scientific medical paradigm.
Within this system of care-giving, status within nursing
became attached to an ethos which rotated around
principles of duty, order and obedience. Such perceived
virtues within nursing remained principle aspects of
prestige within nursing for more than a century after their
generation. These socially constructed status indicators
provided for ease of recruitment and retention of nurses
to care giving milieus which were highly controlled and
structured around medical scientific rationale.
The later part of the 20th century has seen a pro-
motion of individual freedom. Key moments of this
change have been the spread of various forms of west-
ern democratic capitalism governance, the rise of
globalization with its associated rapid movement of
people, capital and ideas, the emergence of postmodern
schools of thought, the feminist movement and the
general rejection of grand narratives as providing uni-
versal understandings of social life. Within this con-
temporary social setting, concepts of duty, order and
obedience have decreased in social status and have been
replaced with status associated with autonomy, per-
ceived development progression and individual com-
mercial success. It would appear that this has provided
the social context in which nursing has rejected the
status associated with vocation, duty and obedience and
has developed an anxiety to achieve occupational status
by pursuing strategies of professionalism and practice
based on scientific truths.
With todays rapid and unprecedented changes, a
new urgency has been added to the critical need
for a body of scientific knowledge specific to
nursing (Smith 1981, p. 1).
Nursing science has come of age. The multiple
publications of conceptual systems and theories in
nursing, have demonstrated advance in the scien-
tific movement in nursing (King 1995, p. 39).
The application of scientific positivism to nurse
practice has led to the emerging prominence of what is
referred to as evidence-based practice (Pepper 1989).
This form of practice proposes a high degree of
accountability, as nursing interventions are based on
outcomes that have survived extensive scientific en-
quiry. The integration of such scientific rationality in
nursing education, management and practice has
increasingly established an orthodoxy within which
2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 282285
Social construction of woman's work
care-giving is conceptualized in terms of its scientific
legitimacy. The regularization of nursing interventions
within this scientific school of thought endeavours to
achieve consistency in nursing care, thus ensuring that
each patient can expect a similar nursing intervention
from any registered professional nurse. Ease of
cooperation between the various professions that utilize
the scientific approach is also considered by many to be
advantageous as it ensures a cohesive programme of
care delivery to patients. However, there have been
significant critical observations of this approach to
nursing care (Freshwater & Rolfe 2004).
There has been an increasing emphasis on research as
a prerequisite for the recognition of nursing as a legit-
imate profession within the professional community.
The development of nurse theory provided the intel-
lectual mechanisms that have enabled this research
movement while simultaneously playing a significant
role in the realization of a professional status in nursing.
Advocates of the nursing process and nursing models
are incorporating a hidden agenda that of profes-
sionalizing the nurse (Smith 1985, p. 70). This agenda
of status through professionalizing nursing based on
scientific research has been powerful within nurse the-
ory, nurse management, nurse education and nurse
practice. A consideration of the qualities and short-
comings of professionalism appears to be engaged as a
sideline academic issue in nursing and unfortunately the
articulation of any potential limitations of profession-
alism in nursing is often reacted to with charges of
heresy from ones peers. This has resulted in many
nurses navely pursuing a professional ethos in the
absence of a critical exploration of what the nature of
nursing will be if this ethos is realized.
The classical professional model has several key
characteristics: a claim over a monopoly of knowledge,
a self-regulated and controlled registration of entry, a
legally backed monopoly of practice and autonomy. In
pursuing this ethos, Davis argued that nurses are
embracing the classic way of being professional
all-knowing distant and detached (Davis 1996, p. 46)
an ethos which appears to be distinctly incongruous
and inappropriate to the act of caring which lies at the
core of nursing. There would appear to be major
limitations in claiming a monopoly of intellectual
property over insights into birth, death, health and
illness, which inform the knowledge base for caring
(Porter 1990, 1992). A legally enforced professional
closure around such insights would seem to be a dis-
empowering process within society, a process which
solely serves the purpose of establishing and reprodu-
283
D. Brennan
cing power. The exerting of power over patients is
diametrically opposed to the philosophies from which
most nursing theory claims to emanate from. Criticism
of professionalism has led some nurse theorists to
question the presumptions that professionalism is a
desirable and worthy model for nurses to pursue,
proposing that, an advancement into old profession-
alism is an advance into a cul de sac (Davis 1995,
p. 152).
The question we must ask is not is nursing a
profession? but should nursing want to be a
profession, and if so, what do we mean by it?
What are we hoping to achieve and is this the best
way to go about it? (Salvage 1985, p. 92).
Nursing has inherited a legacy of positivism,
which promotes objectivity and reductionism and
which excludes subjective meaning and the per-
sonal from the research process. In part this has
been due to the powerful influence of medical
hegemony, which has defined the nature of legit-
imate knowledge (Playle 1995, p. 979).
This process of application of scientific positivism,
emanating from the medical model to nursing theory,
has been described as a process of medical imperialism
(Barker et al. 1989). In recognition of such criticism,
some nurse theorists have searched for methods of
verifying nursing knowledge, without blindly pursuing
the dominant perspective of scientific positivism (Rolfe
2000). It would appear that the transcending of fixed
binary understandings of nursing labour requires an
exploration and problematization of models of singu-
larity and conceptualized other. Such an exploration
can provide a philosophical context that advocates an
equality of diversity, wherein nursing can be considered
beyond relationality to medical positivism.
Aspects of feminist theory provide philosophical
understanding that lend themselves to such a re-con-
textualization of nursing. Drawing on Hegel (1967) and
Sartre (1956), de Beauvoir (1974) provided an existen-
tialist consideration of womans oppression, centrally
proposing that woman is oppressed by virtue of oth-
erness. de Beauvoir proposed that for woman to become
self she must, like man, transcend the definitions, labels
and essences limiting her existence. Adopting a post-
modernist stance, Irigaray (1995) critiqued and further
developed de Beauvoirs work, proposing a decon-
struction of the acceptance of the concept of sameness
which underlies the definition of what is other.
In her study of Western philosophy and psycho-
analysis, Irigary found sameness everywhere: in
284
thinkers as various as Plato, Rene Descartes,
G.W.F. Hegel, Friedrich Nietzsce, Sigmund Freud,
and Jacques Lacan (Tong 1989, p. 277).
Irigaray adds de Beauvoir to this list and links her
view of sameness to that of Sigmund Freud, like de
Beauvoir, he (Freud) does not recognize the other as
other: and, albeit in different ways, they both propose
that man remain the singular model of the subject,
which women must try to equal (Irigaray 1995, p. 11).
Hence Irigaray problematizes the legitimacy of accept-
ing a singular model from which the other is concep-
tualized. She proposes that the other is full in its own
right and not reducible to a notion of an accepted col-
lective sameness.
This notion involves for Irigaray both the des-
cription and denunciation of the false universal
which is inherent in the phallocentric posture: one
which posits the masculine as a self-regulating
rational agency and the feminine Other as a site
of devaluation (Jagger & Young 1998, p. 299).
Here the model of one is replaced by a model of
many, which are not placed in a hierarchical relation-
ship, each being fully respected for their wholeness.
Irigarays philosophical paradigm provides a context in
which nursing may be conceptualized without reference
to its relationship to medicine. Hence nursing can be
considered as a full and legitimate response to birth,
death, health and illness, not limited by or endeavour-
ing to control the diversity of other approaches to such
human experiences. The adoption of this approach
offers nurses the opportunity to define their practice and
knowledge while not reducing nursing insights into a
process of comparison or contrast to other perspectives.
Within such a context, respect, remuneration and status
in nursing are not derived from the creation of a pro-
fessional monopoly over knowledge and practice but
are earned through the positive contribution that nur-
sing can make to a persons, familys and communitys
experience of birth, death, health and illness.
It would appear that caring labour continues to be
devalued within contemporary society. This challenges
the achievement and retention of status within nursing,
which can result in difficulties in the recruitment of
nurses and the retention of high quality nurses within
sites of caring. Several strategies have been adopted by
nurses in the pursuit of occupational status. Unfortu-
nately, the popular contemporary strategy appears to be
one which advocates an exit from nursing care. This can
be observed by nurses realization of status through
moving away from undervalued areas of care such as
2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 282285

hygiene and nutrition, and simultaneously migrating
towards labour which attracts status such as advanced
nurse practice, particularly that practice which is per-
ceived as clinically advanced and based on scientific
evidence. There are several key limitations to such a
strategy. Initially, this places nurses in direct competi-
tion with medics, whose educational focus is located in
scientific clinical practice, not in caring as is the case
with nursing. Resulting competitiveness for excellence
in scientific evidence-based clinical practice provides
nurses with a setting in which to reconfirm a position at
a lower point in a hierarchy of clinical achievement.
Furthermore, this strategy of professional/scientific
assimilation appears to signal a devaluation of nursing
care from within nursing itself. Hence, nurses appear to
accept the legitimacy and rationale of low status
attached to their caring labour, particularly intimate
aspects of care, and so seek to affirm their status
through occupational distancing from such labour.
An alternative strategy could be pursued within nur-
sing. This is one where nursing care is valued for its
historical, enduring and ongoing caring contribution to
positive experiences of birth, death, health and illness.
However, this would appear to be unattainable until the
core caring aspects of nursing are re-valued by nurses as
the pinnacle of achievement and status within nursing
itself. Until then it would appear that academics (like
myself), those who pursue nursing management, and
those who advance their practice through specialized
scientific clinical expertise, will continue to accrue
greater status and remuneration than nurses who nurse.
References
Barker P., Baldwin S. & Ulas M. (1989) Medical expansionism:
some implications for psychiatric nurse practice. Nurse Edu-
cation Today 9, 192202.
de Beauvoir S. (1974) The Second Sex. Vintage Books, New York.
Coe R.M. (1978) The Sociology of Medicine, 2nd edn. McGraw-
Hill, New York.
Davis C. (1995) Gender and the Professional Predicament in
Nursing. Open University Press, Buckingham.
Davis C. (1996) Cloaked in a tattered illusion. Nursing Times 92
(45), 4446.
Foucault M. (1973) The Birth of the Clinic. Tavistock, Great
Britain.
Freshwater D. & Rolfe G. (2004) Deconstructing Evidence-based
Practice. Routledge, London.
2005 Blackwell Publishing Ltd, Journal of Nursing Management, 13, 282285
Social construction of woman's work
Hegel G.W.F. (1967) The Phenomenology of Mind. Harper and
Row, New York.
Hugman R. (1991) Power in Caring Professions. The Macmillan
Press Ltd, London.
Illich I. (1976) Limits to Medicine, Medical Nemesis: The
Expropriation of Health. Marion Boyars Publishers Ltd, Lon-
don.
Irigaray L. (1995) The question of other. In Another Look,
Another Woman: Retranslations of French Feminism, Number
87, Yale French Studies (L. Huffer ed.), pp. 719. Yale Uni-
versity, Yale.
Jagger A.M. & Young I.M. (1998) A Companion To Feminist
Philosophy. Blackwell Publishers Inc., MA.
Kelleher D., Gabe J. & Williams G. (1994) Understanding med-
ical dominance in the modern world. In Challenging Medicine
(J. Gabe, D. Kelleher & G. Williams eds), pp. 2842. Rout-
ledge, London.
King I.M. (1995) Forward. In Foundations of Nursing Theory:
Contributions of 12 Key Theorists (C.M. McQuiston & A.A.
Webb eds), pp. 3940. Sage Publications, CA.
Naidoo J. (1994) Health Promotion: Foundations for Practice.
Bailliere Tindall, London.
Pepper L.S. (1989) Conceptual Basis of Professional Nursing, 2nd
edn. Lippincott Company, Philadelphia, PA.
Playle J.F. (1995) Humanism and positivism in nursing: contra-
dictions and conflicts. Journal of Advanced Nursing 22(5),
979984.
Porter S. (1990) Vain aspirations. Nursing Times 86 (11), 4647.
Porter S. (1992) The poverty of professionalization: a critical
analysis of strategies for the occupational advancement of
nursing. Journal of Advanced Nursing 17(6), 720726.
Rolfe G. (2000) Research, Truth and Authority: Postmodern
Perspectives on Nursing. Macmillan, Basingstoke.
Salvage J. (1985) The Politics of Nursing. Heinemann, London.
Sartre J.P. (1956) Being and Nothingness. Philosophical Library,
New York.
Smith J.P. (1981) Nursing Science in Nursing Practice. Butter-
worths & Co., UK.
Smith L. (1985) Issues raised by the use of models in psychiatry.
Nurse Education Today 6(2), 6975.
Tong R. (1989) Feminist Thought: A Comprehensive Introduct-
ion. Westview Inc., USA.
Turner B.S. (1987) Medical Power and Social Knowledge. Sage,
London.
Turner B.S. (1996) The Body and Society: Explorations in Social
Theory. Sage, London.
DAMIEN BRENNAN
Lecturer
School of Nursing and Midwifery
Trinity College
Dublin
Ireland
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