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.