Contraintes vécues, idéal normatif et actions déployées en vue de transformer
 l’exercice de la profession infirmière en centre hospitalier : une étude exploratoire auprès d’infirmières québécoises politiquement engagées

Socioeconomic developments in the past few decades have led to profound changes in Quebec’s relations with its healthcare professionals. In the 1990s, private capital accumulation was sanctioned as a political philosophy borrowed from the realm of business emerged in the public service. Since then, the governance paradigm has taken hold in hospitals, where 65% of Quebec’s nurses practise. Researchers have investigated the constraints and harms nurses have suffered as a result of health-system restructuring, but only a few have turned their attention to the power relations or power structures (including structures of domination) in which nurses’ experience is rooted.  The aim of this study is to explore the lived experiences of politically engaged staff nurses working in a hospital centre; to portray the social order that exists there; to describe the way in which the nurses would ideally like to practise; and to record their ideas and the action they have taken individually and collectively for fostering change in the social order and the practice of nursing. Epistemologically, this qualitative study is based on a view of reality as complex, mutable, and dependent on individual perception, which suggests a comprehensive, contextualized approach to human action and politics and, hence, to the consideration of the political views of the participating nurses.  The linkage between lived experience, normative ideals and political action is explored from a dialectical, praxeological, postmodernist perspective derived from critical theory which constitutes a reflection not only on what is but also on what ought to be. Such a reflection may, under certain conditions, lead to transformative action. The notions of power, power relations, resistance, and emancipation lie at the very heart of our analytical approach.  The results of the study indicate a gradual deprofessionalization and increasing technicization of nursing. Our findings point, too, to an intensifying drift towards authoritarianism in hospitals with the adoption of the semantic register of the market economy along with the notions of efficiency, performance and optimization. Viewed as little more than high-performance robots, staff nurses find themselves excluded from decision-making processes. They have thus been deprived of the freedom to express opinions about or criticize decisions taken by the top ranks of the hospital power hierarchy (rather than by the nurses themselves) regarding the way nursing is practised. Disciplinary power in hospitals, exerted through technological policies such as constant surveillance, reprisals and fear, the technicization of care, and mandatory overtime contribute to the staff nurses’ subjectification. Their clinical judgment has been devalued, their group solidarity undermined, and their union organization brought to heel. They have thus been diverted from demanding the realization of their rights and their ideals of emancipation and been reduced to the role of subordinates. Accordingly, although the nurse participants want to take action in the hospital to humanize care and achieve professional self-determination, the practical purpose of much of the action we recorded was, rather, their own protection and survival in a dehumanizing hospital system. There are, nonetheless, staff nurses who raise conscientious objections, resort to individual or collective non-cooperation or engage in acts of civil disobedience with the aim of establishing a new power relationship, one that must necessarily be put in place for their demands, which would otherwise be ignored in this system of hospital governance, to be taken seriously.  Unless the antagonistic exercise of power in this system of hospital governance is thwarted by the exercise of equal or greater power on the part of nurses working collectively, they will continue to be subjected to its political philosophy and objectives. Their collective action must focus on the radical renewal of hospital democracy, which, as a new power relationship is established, will enable staff nurses to fully participate in discussions of the orientation of their practice.

Keyphrases: Praxis, Conditions of practice, Hospital centre, Neoliberal governance, Political action, Political power, Postmodernism, Power relations, Praxis, Staff nurses