Ruchti, Lisa C. Catheters, Slurs, and Pickup Lines: Professional Intimacy in Hospital Nursing . Philadelpia : Temple University Press , 2012 , $24.95/£15.05 (pbk) x+ 215 pp. ISBN 978-1-4399-0753-5

The author positions her work by telling us that ‘(T)he primary goal for this book is to mark the professionally intimate labor of nurses that is invisible, naturalized and taken for granted yet contributes greatly to quality health care and to hospital profit’ (p.8). I noted that rarely does one see a work in which nursing care is overtly linked to hospital profit!

Ruchti, who is not a nurse, took on a difficult assignment in studying nurses and nursing work in the practice setting in the United States. The book arises from her graduate research candidature, which was situated theoretically, and in design, within the disciplines of sociology, auto-ethnography and feminism. Her intent was to analyse the nursing work (places) through these disciplinary and theoretical lenses, which she does well. Studying nursing work in its practice environments, however, seems to have left Ruchti with many questions and observations she could not resolve; but the analyses she makes of some of the ‘darker’ side of nursing work are frankly and fearlessly reported.

This is a courageous book, derived from her doctoral study, about sensitive and sexualised issues that are inherent in nurses’ work and workplaces. At face value, the work appears to be relatively indicative of what occurs in the US, particularly, questions of ‘color’ and other forms of social differentiation in the healthcare workplace. However, as you read through the work, particularly in the latter part, she focuses her research on sexual harassment and abuse from patients towards their nurses. These are two very ‘hot’ issues in healthcare work, but about which little research exists.

There are two striking features of this book. First, it focuses much attention on race/colour and ethnicity in the nursing workforce/workplace in the US. The author returns many times to issues of race and colour and how they play out in workforce stratification and harassment of staff by patients. Here, Ruchti relies on Grenshaw’s (1989) construct of ‘intersectionality’ to explain the unique combination of sexism and racism experienced by nurses of colour. She goes further, however, in drawing attention to the many ways in which race, colour and ethnicity are problematic features of the nursing workforce in the US. Second, despite her research, Ruchti’s quest to understand intimacy in nursing practice seems to have left her with some unresolved questions, in part, because she writes in a way that suggests she is sceptical or disbelieving of what her informants were telling her.

The author returns repeatedly to the question of intimacy; and although it is a central theme of the work and a component of the book’s title, Ruchti did not seem able to reach a position where this concept fitted her framing of nursing work. She calls intimacy ‘the elephant in the room’ (p.49) but it takes some time for her to come to the view that this did not really matter (p.80) in the wider scope of nursing and patients’ experiences. I was particularly impressed with her analysis of the way that patients can, at times, treat nurses as servants. This aspect of nursing work is generally only discussed among nurses – and in very discrete ways. It is refreshing to see an author report this aspect of nurse’s work, and she describes it as ‘service’, for example, meeting the needs of patients’ relatives.

Ruchti gets to the core of nursing in many ways, particularly her recognition that ‘nursing is both invisible and socially constructed’. What emerges from her conversations with informants is that they recognise that the patient may experience some aspects of nursing care to be intimate, but this term is not one that nurses themselves see as necessarily descriptive of their work. Nor does she come to a comfortable understanding of why nurses do not necessarily perceive sexualised behaviour of patients as harassment. To Ruchti, harassers are those who use their power to get what they want – and she persists in her view that harassment is an issue in nursing despite much data from her informants that questions this position – arguing that ‘we still need a language to describe intimacy’ (p.49). Ruchti uses the term ‘intimate conflict’ to describe an aspect of nursing work that is seldom written about, and is not a key focus of undergraduate nursing school; however, it is a central feature of the workplace, which she enunciates fearlessly.

Overall, this book is a good read, and a brave and insightful analysis of race and the discrimination that accompanies nursing work in some contexts. For those of us who are nurses, it is also instructive to take note of how our work is perceived and theorised by ‘outsiders’. While I can’t say I enjoyed the work, given its findings, I certainly found it a compelling and instructive read.