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The cost of caring

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Image: Facebook/Nurses Education Montreal

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Quebec's latest austerity measures uniquely disempower women nurses. By living as women and working as nurses, women nurses are facing particular challenges in the face of the latest wave of austerity measures.

In the name of attaining a zero-deficit budget, a systemic reorganization of health-care services is currently taking place; one that contributes to the economic, social and political incapacitation of nurses. This reorganization includes increasing the number of patients per nurse, restructuring services and teams of employees, increasing the number of insecure part-time positions without benefits, and the redefinitions of jobs.  Such large-scale transformations generate significant stress among nurses due to increased workload, unclear job descriptions and decreased job security. 

Austerity generates significant psychological distress among nurses by giving rise to an understaffed workforce required to care for an increasingly ill population. This distress, known as "compassion fatigue," is an increasingly prevalent phenomenon in the context of budget cuts to healthcare services in Quebec.  

From the start of their education and throughout their careers nurses are continually reminded of the professional moral obligation to care and be caring. Such expectations come from nurses themselves, their professional order and society at large. It should be noted that not only is compassion fatigue normalized as an occupational hazard, it is held as a yardstick for nursing professionalism. To quote a piece in the British Journal of Nursing: "compassion fatigue only happens to nurses who do their jobs well." 

Through decentralization of health-care services, austerity also disempowers women as wage earners. While issues surrounding healthcare reforms are predominant in current discussions of austerity, budget cuts to health and social services and their decentralization have been the order of the day in Quebec since the early 1990s.

This decentralization has involved re-conceptualizing health and social services as domestic responsibilities to be carried out within the family, with institutions acting as secondary players or backups. Moving services rarely translates into additional homecare services or improved care, as is often promised by politicians. Governments are offloading the cost of healthcare services onto households who have to perform them for free.

Since women are the primary caregivers for family members in the home, shifts of services place disproportionately greater demands on women. Decentralization of health care requires women to stop or substantially reduce their participation in the workforce and community organizations in order to answer for the increased demands to care for family members in the home. This directly disempowers women by compromising their financial security and earning power.

Budget cuts also disempower women by limiting their access to healthcare services. According to a publication from Réseau national sur la santé des femmes et l'environnement, women in Quebec make more use of healthcare services not only because of the demands on women's bodies by reproductive labour but also because more women live in poverty. Cuts to healthcare create barriers to accessing abortion services, delay early detection of breast cancer and significantly reduce pre- and post-natal care programs. These compounding factors function to compromise women's health.

Austerity's disempowerment of women is exacerbated by many women's unconscious internalization of the concept of woman as maternal, nurturing caregiver. Internalization of social expectations of what one's personal morality should be leads many women to unquestioningly accept the caregiving responsibilities offloaded onto them by austerity because it is the "right thing to do." Assuming the social role of woman requires prescription to a women's morality, and compels women to accept these responsibilities without complaint.

Austerity increases the likelihood of compassion fatigue by working in conjunction with women nurses' internalized conceptions of their moral obligations as women and as nurses. Not only does a woman nurse have to care because she is a woman and therefore essentially nurturing and maternal, she must do so out of professional ethical obligation.

Expectations surrounding the nursing identity combined with a shift of complex care into the home under austerity means that the woman nurse will no longer be able to leave her professional ethical duty and identity at the hospital.

The intersection of women's moral obligations and nurses' professional ethical duties compels women nurses to care for and care about others regardless of the detriment to their own psychological health. This functions to solidify the existing expectations that nurses put the needs of others before their own, both as professionals and as women; women who must always and without fail continue to care.

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