!Becoming a nurse --- agk's diary 3 February 2023 @ 17:47 UTC --- written on GPD Win 1 via PuTTY on couch while baby naps --- I passed the national licensure exam. I'm a regist- ered nurse in my country. For a month I've been orienting on the floor at the psychiatric hospital where I work. In a few days I'm off orientation, in charge of my petty kingdom and subjects. Becom- ing a nurse is mostly disappointing. Ms. Anna, former fighter. In my old role in this hospital I tended rebellious souls with knowing kindness, care, consistency, and the structure they craved from adults. I made human-sized spaces for them in the restrictive, capricious, neglectful total institution of industrial psychiatry. I challenged them to structure their own time, snatch fun from the jaws of boredom, encounter the unfamiliar and be astonished, get something worth- while from the worst of times, equip to go home with something they needed when they came in. Hosp- itals are evils of healthcare financing & liability structures. I fought the evils as much as I could. Now I impose the evil. Not alone, of course: there are the big structures. Our call center coaches in people who don't meet admission criteria. They get cash bonuses for conversion rate metrics. Then there's me. We're under a consent order for inappr- opriate admissions, and I can see a third of our patients have been tricked into our hospital, but I can't undo their admission, so I'm the next liar they meet on their journey. I pump 'em out of the psych factory. Call center fills the bed before it's cold. I'm up front admit- ting another. I make her strip for skin assessment, dump her on the unit, don't talk to her again 'cept at med pass. Never as a person, always a bundle of risks: "You hearing things I can't hear? When was the last time you pooped? Any pain? Wanna kill yourself? Lemme see under your tongue. Okay send the next one." f6k is right, morning time snatched alone from the jaws of the day is one of life's pleasures. Not wanting to go to work, form people into psychiatric subjects, I sat on the floor some mornings. To ward off myself I read Foucault on the psychiatric power and Orr on biopsychiatric governance.[^1] Orr quotes the founding director of the National Institute of Mental Health (1949): "The guiding philosophy which permeates the activities of the NIMH is is that prevention of mental illness, and the production of positive mental health, is an attainable goal.... Since this must be done as rapidly and economically as possible, techniques for a mass approach to the problem must be devel- oped." Orr notes: "The industrial production and consump- tion of psychopharmaceutical drugs appear to have delivered on the NIMH's mid-20th-century goal of efficient, cost-effective techniques for a mass approach to mental health." When other nurses call inpatient psych a factory, their critique's defensible. A teen got dumped by his first girlfriend, or lives in the middle of no- where with no friends, or saw her dad kill her mom, or gets bullied at school and idolizes the 1999 Columbine school shooters, or can't sit still in boring or confusing understaffed classrooms, or has been through 10 foster homes and lots of abuse, or was smoking weed and sending naked selfies to adult men. We have a "mass approach to the problem." One of the most galling parts of my new role is the status and pay attached to it. One of my classmates was a practical nurse, works in the same cancer ctr but now as a RN. She's furious: "I do the same job but get paid $15 more per hour for it." I actually do an easier job, I feel, than I did before, and certainly one with less social utility. My family's income, $12,000 last year, will be over $60,000 this year. I don't have or want the tastes that go with this income. I want to give it back and keep our public Medicaid health insurance. But now we make enough to be worth robbing, so no more Medicaid for us. The professional and managerial classes, long the target of my ire and impassioned critique, is now us. No longer dignified poor, we now have the new trap of predatory precarity confronting us.[^2] Ethically, morally, we must evade that trap some- how, as we shouldered through and escaped traps we faced when poor. We mustn't resort to denial of our place in the world through romantic overidenti- fication with our poor past, neighbors, patients. And as a nurse, I have particular pitfalls. Almost every nurse is bitter, all about different things. When during orientation I managed my time, carved out 10 minutes to talk a sobbing teen out of a corner, give her care and perspective like I used to, most every orienting nurse trained her bitter- ness on me: "You're a nurse now. We don't have time for things like that. We don't even have time for [legally-mandated] breaks." I feel the bitterness infect my thoughts: ("yeah but you have time to shop on your phone while your patients suffer"). I have to push it away. As charge nurse, I'll make time. I'll impose evil with one hand because it's my job. Like Nietzche's ascetic priest I'll take the evils away with my other hand on days I can, when I have a med nurse, no morning admissions or discharges. I'll get good and fast at what's required so I can do what my human heart demands. I'll train new techs in some of what I used to do, teach 'em to frame their work with a social model of distress recovery to counter my medical model. In a dream, afoot I approached six people by the rutted red-dirt forest service road in deep green woods. - - - 1: Michel Foucault (1973-74), Psychiatric power. In Rabinow, ed., Ethics: subjectivity and truth. Jackie Orr (2010), Biopsychiatry and the inform- atics of diagnosis: governing mentalities. In Clarke et al, eds., Biomedicalization: techno- science, health, and illness in the U.S. 2: Steve Randy Waldman (2019-08-20), Predatory pre- carity. Interfluidity blog.