Nursing elective: balancing caregiving in oppressive systems

This course was developed when health care reform was being birthed in local hospitals under the slogan "Patient First." Architects of the change promised to involve nursing in all decisions. In the end, nursing leaders and advocates were terminated or squeezed out of the organizations. No one there now speaks for nurses at an executive level. Returning registered nurses experience this lack of voice in their organizations and come to class feeling powerless to stop the emergence of unsafe or fraudulent practices in health care (i.e. use of unlicensed assistants, altering of diagnostic codes to lengthen stays, etc.). Nurses want to take action but lack the political knowledge and skills to know where to start. Developing and implementing a course in oppression in nursing challenged this author to face the ways nursing education continues to oppress students and prepares them to blend into the status quo. Students graduate to practice in systems consumed with restructuring health care, lowering patient costs, and providing the least amount of qualified staff. Learning about oppression and how to withstand domination of one's nursing practice in deviant health care systems is not part of the regular language of teaching. The course was an attempt to flush out, articulate, and confront the meta-world of the curriculum that silently instructs students to accept oppressive practices in the workplace. The course labeled the beast and served as a catalyst for many interesting discussions. Oppression and tactics to counter oppression must be actively taught to our students. Oppressed nurses equal oppressed nursing care. Based on my learning and a critical eye to the scary realities of practice, this course marks for me my intent to support Jane Hardens (1996) call to teach for peaceful revolution.