Nursing’s Problem With Fake Kindness

As we suggested in the previous section, there are field-level sociological factors which likely affect both the effectiveness and prevalence of fake kindness and we believe a lot of health and social professions are particularly propitious to it. Our focus here, however, will mostly be on nursing as it is a profession with a somewhat perplexing relation with the concept of caring [17] as well as pervasive issues with bullying and horizontal violence [18-20]. Those two characteristics of nursing have been extensively discussed but are generally conceived as unrelated. By contrast – and in line with similar arguments proposed by Walker [21] as “the tyranny of niceness ” and by Burton [22] as “the caring tax ” – we think that understanding fake kindness as a form of symbolic violence might provide insights into how the discipline’s obsession with the concept of caring and its extensive problems with bullying actually connect.
Nursing is a profoundly gendered and hierarchical profession. In Anglo-Saxon countries, the roots of present-day nursing are linked to the sexist and racist values of Victorian Britain. Those roots also connect to the historic – and gendered – subordination of nursing to medicine in “modern” hospitals [23, 24]. Despite the discipline’s rebranding efforts, today’s nursing still bears the marks of those influences [24, 25]. In academia, propriety and weaponized civility often continue to take precedence over independent thought and critique: “The fiefdoms of the elite are critique-free zones, virtually devoid of any spirit of inquiry, ethos of debate or culture of scholarship ” [26]. In that context, our understanding is that “professional propriety” expectations are often used as tools to sustain traditional hierarchy and disciplinary power. The same can be said of the discipline’s quasi deification of Florence Nightingale. Nightingale believed a nurse must develop the proper moral standing to be considered good, which would imbue her with the power to police and discipline. Women from the middle and upper classes were hired as a disciplinary tool for their supposed superior moral influence that was thought to mould new nurses into the characteristics of the ideal nurse: quiet, obedient, and nurturing [27].
In that context, the discipline’s definition of caring has, over decades of endless debates, evolved into a fully normative concept that describes everything nursing-related that is good and desirable. The corollary of this definition being that the notion is also tautological: criticizing the concept of caring is uncaring and therefore unworthy of a good nurse [28]. The overlaps in the concepts of caring and kindness are also hard to miss. For example, caring is generally framed around selflessness and sacrifice [28, 29]. In the same way, caring often prescribes specific behaviours or even scripts that nurses must adhere to be considered ”good” nurses and that overlap to a large extent with what we described as behavioural kindness.
But, notwithstanding its reincarnation as a moral virtue, to this day caring remains foundational to nursing as an academic discipline. Some of nursing’s most revered and cited scholars, such as Jean Watson, are theorists of caring. There are entire scientific journals dedicated to the topic, like the International Journal for Human Caring . And, at least in North America, caring plays a central role in curriculum content and structure. It is likely that no other profession is trained in programs putting such a strong emphasis on moral values and proper behaviour [8, 29]. And while we agree that the image and place of nursing have been deeply shaped by external social forces, the discipline itself has continued to perpetuate the virtue script: nurses are good women who are honest, kind, caring, compassionate and self-sacrificial. For example, recruitment campaigns have attempted to attract women into the profession by promoting traditional stereotypes of nurses as ’women born to be good’ [30]. In the same way, in 2021, the Canadian Nursing Association’s national nursing week theme was ”We answer the call ” [31] reinforcing the belief that nursing is first and foremost a vocation.
According to the framework we developed in the previous sections, the emphasis nursing puts on caring as a behavioural and moral compass has implications in the way it shapes the sociological field in which nurses work. Among other things, this emphasis will increase the symbolic value associated with behavioural kindness to a level that is somewhat unique. In other words, nowhere will it pay more to behave in ways that align with behavioural kindness than it does in nursing. This isn’t a bad thing in itself. It would actually be good if there were no dissociation between behavioural and teleological kindness. But this characteristic of nursing also frames the profession as a specific social field in which both the prevalence and effectiveness of fake kindness as a form of symbolic violence will be extremely high.
This being said, we see no reason to believe there is more symbolic violence exerted in nursing than in any other social field. However, we do think that nursing’s professional and disciplinary enthusiasm for caring will shape the form that symbolic violence, and more generally power struggles, will take. Instead of transparent displays of domination and direct confrontation, power struggle will be played in the register of fake kindness. Burton [22] aptly summarizes this when she writes: “This sensibility is sanctified in our culture in the notion that a good woman does not contradict and a nice woman does what she is told”. Something that will allow those nurses in dominant social positions to assert their dominance without having to fear the pushback that only a “nasty”, “bad” and “uncaring” nurse would offer. In that sense, the discipline’s requirements for propriety, professionalism and civility – generally all bundled into, and implied by, the caring ethos – are the mainstay upon which the effectiveness of fake kindness rests.