Patterns of Care, Status Differentiation, and the Reproduction of Inequality in Hospital Nursing

Feminist scholars have established care work as a key site for intersecting systems of power. The naturalization of feminized caring legitimates the institutionalized coercion and exploitation of care work, inflecting a matrix of inequalities built up around these relations of caring labor. However, there has been little systematic analysis of the mechanisms of social reproduction through caring labor in a medical setting. This project, based on three years of IRB-approved ethnography of RNs and CNAs at work in a California hospital, addresses this gap. It analyzes the social processes in the social construction of care, illustrating how RNs created and used culture to mitigate coercion, exploitation, and subordination. Specifically, they used semiotic codes—and their respective sets of daily practices—to define what counted as “care” in particular contexts. They also delegated tasks linked with servitude to CNAs through rituals of subordination. These processes enabled RNs to assert professional power, but they also linked status differentiation to empathy/disempathy, facilitated affective structures and subjectivities of disempathy, and reproduced racialized relations of domination between themselves and the CNAs. Thus, mechanisms of empathy/disempathy reproduced inequality. This analysis identifies the limitations of professional nursing power based on the ideological dichotomization of emotional and technical dimensions of medical work and highlights how this ideology—and the structure of feelings that animate it—obscures the actual role of empathy as medical work. This research leads to the formulation of a general theory of empathy/disempathy as a mechanism that contributes to inequality. The argument is that structures of domination, coercion, and exploitation devalue and constrain care throughout the social formation. Institutions that order these power relations are organized through affective structures—and their corresponding ideologies and subjectivities—that link status differentiation to empathy/disempathy. Mechanisms of empathy/disempathy rearticulate the ideological interpellation of subjects by shaping “subject-centric” perceptions of power and determining the processes through which people produce and use culture to rationalize it. On one hand, hegemonic structures of feeling constrain capacities to care and facilitate subjectivities of disempathy. These subjectivities refract experiences of agency through disempathy, power, and status. On the other hand, another category of subjectivity, which I call double-agency, constructs experiences of agency through capacities for empathy— and estrangement from those very capacities. Consequently, processes of empathy/disempathy function as a mechanism in the social reproduction of inequality