screens’ where women conceal their work, themselves, and their significance (Lawler 1991) and images of emotional labour being no more than women’s natural work, therefore unskilled and unvalued within the heroic stance of medicine (James 1989), are powerful signs of this oppression.
No easy task. Those in authority have vested interests to maintain the status quo, to keep people in their place rather than in the place they need to be in tune with realising their vision. Hence being in place becomes a contested arena. As Mayeroff (1971, p. 68) notes:
I am in‐place because of the way I relate to others. And place must be continually renewed and reaffirmed; it is not assured once and for all, for it is our response to the need of others to grow which gives us place.
Fear is a powerful deterrent for being different. It suppresses practitioners from voicing their opinions and asserting autonomy. Yet how comfortable are people in their illusions of truth? Is it better to conform than rock the boat? Is it better to sacrifice the ideal for a quiet life and patronage of more powerful others? Better to keep your head down than have it shot off above the parapet for daring to speak up?
Nurses are taught to ‘know their place’ within the order of things. It is natural for dominant professions such as medicine to reinforce subordinate behaviour in other healthcare professions, such as nursing (Oakley 1984). In other words, doctors are always motivated to maintain the status quo and resist rivalry for power. Nurses rationalise their compliance with medical domination because of the need to be valued. Chapman (1983) suggested that doctors reinforce nurses’ subordination through humiliation techniques that become a normative pattern of relating. Hence it becomes difficult for nurses to claim autonomy to move into the right place to practice desirably, kept in place by both managers and doctors. It is also the same with students and teachers. Even in Universities, teachers traditionally set the agenda and control the classroom. Students learn to be ‘good’ otherwise sanctions will ensue. Of course, some students like practitioners rebel against stifling authority. They are labelled ‘trouble makers’. They often quit rather than lead unsatisfactory lives.
Embodiment
Practitioners are socialised into a culture determined by tradition and authority. This becomes their normal framework for viewing practice. It is what it is whether you like it or not. For an easy life the practitioner conforms to ‘fit‐in’ to be recognised as a ‘good team player’. Because normal ways are embodied they are not normally scrutinised for their appropriateness. Hence we tend to go about practice in the same old way with minor tweaks here and there as authority demands. Reflection confronts this. It demands the practitioner to ‘wake up’ to their embodied practice. Some practitioners will simply reflect along the surface of their practice, and nothing significant will change. Practitioners can passively accept the ‘normal’ as their truth. Yet to passively accept suggests they have become aware of the contextual nature of their practice.
Empowerment
Understanding inevitably changes practitioners. However, acting on understanding may be difficult as noted above or because of a lack of commitment. It may be better to swim in the shallow waves than drown in the rip currents of critical reflection? Yet, once practitioners become aware of realising desirable practice, they are likely to become restless knowing that there are more effective and satisfactory ways to practice.
Shifting barriers that seemingly constrain realising desirable practice can feel like hitting your head against a brick wall – what I term ‘the hard wall of reality’. It can be painful and frustrating and consequently feel it’s not worth tackling. As Smyth (1987, p. 40) notes ‘most of us, unless we feel uncomfortable, shaken, or forced to look at ourselves, are unlikely to change. It is far easier to accept our current conditions and adopt the least line of resistance’. Lieberman (1989, p. 88 – cited by Day 1993) notes that ‘working in bureaucratic settings has taught everyone to be compliant, to be rule‐governed, not to ask questions, seek alternatives or deal with competing values’.
Practitioners need to feel empowered to act. Empowerment is enhanced when practitioners are committed to and take responsibility for their practice, have strong values, and understand why things are as they are. Practitioners may sense they lack agency to formulate and attain their goals. They depict their lives as out of their control, shaped by events beyond their control. Others’ actions determine life outcomes, and the accomplishment or failure to achieve life goals depends on factors they are unable to change. They may view themselves as victims of circumstance. To view self as a victim is to experience a loss of personhood and to project the blame for this loss onto others rather than take responsibility for self. Victims are oriented towards avoiding negative possibilities than to actualising positive possibilities. Bruner (1994, p. 41) notes that persons construct a victimic self by:
Reference to memories of how they responded to the agency of somebody else who had the power to impose his or her will upon them, directly or indirectly by controlling the circumstances in which they are compelled to live.
In theory, reflection would enhance the core ingredients of personal agency, self‐determination, self‐legislation, meaningfulness, purposefulness, confidence, active‐striving, playfulness, and responsibility (Cochran and Laub 1994 cited in Polkingthorne 1996). These qualities are essential to a sense of empowerment. ‘I am not a victim! I have agency! I can assert myself!’ Not easy for the individual working within organisations. Collective action may be necessary to bring about deeper shifts in tradition and authority. And yet it does happen and quite dramatically.
Finding Voice
The idea of asserting self and empowerment can be viewed as ‘finding voice’ based on ‘Women’s ways of knowing’ (Belenky et al. 1986). This is particularly apposite for professions that are predominantly women, such as nursing, although equally valid for men. Their typology of voice moves through a number of levels from silence, the most impoverished level of voice, through the received voice, the subjective voice, the procedural voices, to the constructed and assertive voice.
The Silent Voice
So many practitioners’ voices are silent or suppressed. Perhaps you can remember being silenced, not so much by others but by yourself. Imagine the practitioner’s reflection – ‘I wish I had said something but…’.
Is it a fear of repercussion, humiliation, or a sense of subordination? Either way it is a reflection of knowing your place is to be silent. Cumberlege (DHSS 1986) observed at meetings concerned with the discussion of her report on community nursing that doctors sat in the front rows and asked all the questions, whilst nurses sat in the back rows and kept silent. She commented how nurses needed to find a voice so they could be heard, otherwise, they would have no future in planning healthcare services. Her comment reflects how nurses have been socialised into a subordinate and powerless workforce through educational processes and dominant patterns of relationships with more powerful groups (Buckenham and McGrath 1983).
Writing ‘I wish I has said something but…’ opens the voice if just on paper. It begs the questions ‘what did I want to say?’ and why didn’t I say it?’
The Received Voice
As a student nurse, I remember sitting passively in the classroom being filled with facts. Often the teacher would write them on the board for the students to copy. Such facts were authoritative to be reproduced as rationale for action. I have no sense of being enabled to develop critical thinking skills, and even if I had, the all‐knowing authorities within clinical
