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We Have Never Been Nurses

Nursing in the Anthropocene, Undoing the Capitalocene

Dillard-Wright, Jessica MA, MSN, RN, CNM; Walsh, Jane Hopkins MSN, PNP-BC, RN; Brown, Brandon Blaine MSN, RN-BC, CNL

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doi: 10.1097/ANS.0000000000000313
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Abstract

Right now, the Earth is full of refugees, human and not, without refuge.

Donna Haraway, 2015

THE FIRST 50 years of nursing theory, knowledge, and practice were heavily influenced by positivism, vestiges of which remain in our ongoing romance with metaparadigms, grand theories, and situation-specific theories.1 The reductive impulse of positivist approaches to epistemology paired with the neoliberal turn in health care has had very specific consequences for the discipline of nursing, especially in the United States. These consequences include technological optimism, capitalist health care systems, empirical teleology, structural inequality, and wholesale embrace of the commodification of nursing work. This ultimately impedes the discipline of nursing from fulfilling its full emancipatory potential, leading us to question whether, under the circumstances, we have ever been nurses.2–5 The fervent confidence in our special United States blend of science and capitalism, however, has reached its breaking point. We face mass extinctions globally connected to planetary climate change and, as nurses, we need different analytics to address the dystopian present that is unfurling in the context of the health crises that a cataclysmic future brings.6

The call for this epistemological and ontological transformation in nursing is foun-ded on the consequences of what we as nurses observe around us as the climate crisis accelerates and inequity is further reinforced. This crisis is anything but abstract: climate change is real and clearly affects global populations in uneven and unjust ways. Climate-related crises, including unrelenting heat in the summer and poor air quality due to uncontrolled wildfires, disproportionately harm those living in poverty in the United States. Unjustly affected by climate-related health problems, impoverished people experience further systemic inequities as they are frequently shut out of accessing health care in a structure that is designed to extract profits. Nurses have and will continue to have an up close view of the human cost of climate change if we are willing to see it.

Public health nurses in the United States bear witness to climate crises while managing emergency shelters for medically fragile evacuees fleeing inland to avoid the raging hurricanes in the Eastern United States, and nurses are responsible for evacuating hospitals filled with critically ill patients. Emergency room nurses see it too, while caring for climate migrants from the global South who are unable (or are afraid) to access preventive health care, presenting instead only when their otherwise-manageable condition becomes critical. Activist nurses volunteering in immigrant detention centers on the Southern United States borders report centers that are filled with environmental refugees motivated to leave their homes to access the immense resources of the global north from which they are otherwise sequestered. Moral questions confront us as asylum-seeking children and families endure detention, exacerbating an already-precarious flight from their climate-ravaged countries where people are dying from natural disasters, folks are malnourished from crop failures, and migration is driving families apart. We are teetering on a precipice, abutting, maybe breaking through the boundaries of normal nursing science, where new problems cannot be solved using nursing's established tools and frameworks.7

In the face of unprecedented political polarity, high-stakes standoffs in matters around climate, and segments of the US populace unwilling to accept scientific consensus, we run the risk of being like “those mechanical toys that endlessly make the same gesture when everything else has changed around them” as nursing clings to outmoded ways of thinking, being, and doing.8(p225) Contemporary challenges require us to look outside our current disciplinary skill set to find new ways of conceptualizing our possibilities. We must outline novel strategies for talking and thinking about the problems we face and develop interventions for addressing the uncertain future of attending to the job of caring for people who are living and dying on a deteriorating planet. To begin developing these tools, we propose a posthuman turn in nursing, illuminating the wires that connect us across space, time, and species. The tension uncovered in the search for these interwoven threads prompts us to wonder whether we have ever truly been nurses, a question we will revisit as we unpack the influences of human activity and capitalism on the planet and in nursing.

In our pursuit of the question of whether we have ever been nurses, we first position ourselves as scholars, considering our own posthuman turn in order to orient ourselves in the milieux and trace filaments of posthumanism that allow us to envision a speculative emancipatory praxis for the discipline. To accomplish this turn, we embrace rhizomatic thinking, an approach drawn from the poststructuralist work of Deleuze and Guattari,9 a nature-inspired entry to nonhierarchical, open-ended epistemology that makes space for ideas that come from inside and outside the discipline, encouraging us to interrogate the received wisdom of nursing. We then introduce the concept of the Anthropocene, the geological era in which human influence is indelibly and indisputably inscribed on our global terrain.10,11 For nursing, thinking about the Anthropocene requires that we examine the hazards of downstream thinking and advancing the argument for structural, upstream solutions.12 We then turn to a critique of the Anthropocene and the central role that capitalism has played in global transformation, prompting some to refer to the age as the “Capitalocene.”13 This capitalist transformation challenges the very essence of our nursing identity as we ask the question of whether we have ever been nurses. We will further examine these concepts as our argument unfolds. The article ends without finality, introducing briefly Haraway's 2015 conception of the Chthulucene, a dystopian vision of a posthuman future with space to think outside the Anthropos, an endeavor we hope to continue in future conversations.14

Statement of Significance

What is known or assumed to be true about this topic:

Posthumanism, poststructuralism, and new materialism are philosophical constructs that are increasingly well developed outside of nursing. The speculative qualities of this theoretical work link the development of new ways of tackling contemporary challenges to nursing care for humans living and dying on a deteriorating planet.

What this article adds:

This article adds a robust discussion of theoretical concepts from poststructuralist, posthuman, and new materialist thoughts including neoliberalism, the concept of the Anthropocene and its corollary the Capitalocene, as well as the theoretical proposition of the Chthulucene, necropolitics, and rhizomatic thinking. We link these concepts to material practices in nursing, making the case for nursing engagement in antiracist, justice-oriented, decolonizing praxis, and thought.

OUR POSTHUMAN TURN

As a nurse activist-scholar compost pile (with liberties from and thanks to Donna Haraway15), we envision a radical future for nursing theory that embraces critical use of self to enhance equity and justice in nursing praxis, liberates nursing from the pernicious influences of positivism and neoliberalism, and recognizes the reciprocal interdependence of all planetary life and nonlife. To accomplish this requires a turn toward posthumanism, decentering human primacy to recognize the continuity between nature and culture rather than its binary divisions.16 The fixed, hierarchical arrangement of theory we have inherited—metaparadigm, grand theories, middle-range theories, practice theories—limits our thinking, imposing boundaries and enforcing a proscriptive order that constrains our creativity.17–19 The rigidity of this kind of empirical approach in nurse theorizing encourages gatekeeping, policing what counts as nursing knowledge according to a narrowly prescribed range of orderly, well-behaved, and uncritical ideas. And while we recognize the political salience of adopting a “big science” approach as nursing strove to shore up professional legitimacy in the mid-twentieth century, the combined forces of enshrined patriarchy, neoliberal academe, and big money funding agencies reinforce a narrowly defined range of nursing science, reinscribing hegemony and replicating existing structures of power and knowledge.19,20

The hierarchical approach to nursing theory fragments and isolates knowledge production, prioritizing those knowledges that are congruent with positivist, empirical approaches that in turn reinscribe the binaries that have come to define modernity. This both contributes to the reductive framing of complex wholes and enforces ignorance of those forms of knowledge that take other approaches.19 In developing nonhierarchical alternatives, we wish to plant a rhizome, the seed of an idea that grows in all planes without a distinct beginning, prescribed directionality, or linear telos.9 The impulse is rooted in what we see, along with Cowling et al,21 as the emancipatory but as yet unachieved potential of nursing. Dismantling the boundaries and limitations of our nursing thought is necessary in the face of the undeniable planetary struggles staring down life on Earth. These struggles include widespread structural inequalities, overtly racist ideologies, disturbingly patriarchal politics, and catastrophic climatic challenges to individual and community health and well-being. To make this posthuman turn does not require a rupture as much as an awakening, similar to what Paulo Freire calls concientisación.22,23 The turn we propose links the materialist perspectives of scholars like Freire and Latour to the critiques of postmodernism and poststructuralism, mobilizing these ideas in ways that are useful and necessary for making a material difference in the world. This inevitably leads to new disciplinary concepts for a radical and emancipatory future. We envision this turn as an imperative for a practice discipline like nursing.

This posthuman turn also requires that we, as nurses, confront our history head-on. Siobhan Nelson and Suzanne Gordon24 examined the consequences of nursing's history of a historicity, identifying a tendency in nursing to break with the past to forge boldly into the future. Relying on a “rhetoric of rupture” erases the historical philosophies, narratives, and practices that shape our present, leading to the perception that nursing is without roots, floating unanchored in the tempest of health care.24 This divorce from our historical narratives also removes us from our past professional ideology, knowledge, and praxis, creating the illusion that each successive generation of nurses must reinvent themselves, in theory and in practice, leaving behind the arcane and archaic behaviors of past nurses, cast aside as silly and irrelevant.24 Alienation from our history keeps us subjugated, vulnerable to the same troubles, toils, and snares we have fought time and time again.25,26

Failure to critically examine nursing's past also elides aspects of nursing that are questionable or problematic, which are conveniently relegated to footnotes. Florence Nightingale's primacy in nursing history as the founder of modern nursing refracts, distorts, and reassembles nursing history. Nightingale's place has long been heralded, while the story of Mary Seacole, a Jamaican-born nurse entrepreneur who served in the Crimean War, remains largely subaltern in nursing history.18 The narrative of modern and professional nursing also erases a long tradition of nursing prior to Nightingale's interventions, dismissing the role women healers and midwives played in communities for much of human history.27 Maintaining this race-less, class-less pristine state has the effect of exculpating nurses from reckoning with the baked-in white, able, cisgender, heteropatriarchal normativity that we both benefit from and actively perpetuate, in spite of our best intentions.25,28

Instead of a clean break and starting from scratch, we urge nurses to assemble the tools at their disposal to reflect and reconsider their personal and professional positionality in the context of the world around us. This mandates that we deeply invest in excavating the trends, patterns, and processes that shape where we are today, not all of them nice or feel-good. In this way, we can think of historiography—the stories we tell about nursing, how we think about the nursing past in our nursing present—as a form of nursing philosophy, in the manner advocated by Foth et al.28 How we read and understand our past comes to inform our understanding of our present and may help us avoid repeating past blunders. We are connected by “tentacular appendages,” root-like tendrils, linking us with the past, embracing the chaos of the present and future, binding us to one another.15 This notion harkens to Deleuze and Guattari's9 rhizomatic thinking, an epistemological process that grows in all directions without singular origin or direction, a seed that connects us all.17

LOCATING OURSELVES IN THE TROUBLE

Before going on to talk about our ideas, proposals, and the refuge we hope to build, it is necessary to position ourselves. Our way of being in the world spans broad swaths of human experience personally and professionally, and our understanding of the way this influences our scholarship is only ever partial. We recognize the profound privilege in our positionality and the ways this shapes our ideas and actions. We recognize the limitations this may impose on our thinking as we actively seek to locate and account for positional shortcomings in the way we tell this story. We are able, white, cisgender, nurse-activist doctoral students living in the United States. We bring with us queer identities. We bring with us the survival of sexual violence. We bring mental illness and family histories of addiction. We also bring internalized white supremacy, ableism, complicity in capitalist regimes, and internalized misogyny. Even in this chaotic and dystopian miasma, there is potential.

In our passion for racial, social, and climate justice in all its manifold forms, we acknowledge that we are the benefactors of the work of Black, Brown, Indigenous, and Asian individuals and peoples, both materially29,30 and intellectually (eg, Carmichael31; Collins32; Owens and Fett33; bell hooks34; Lorde35; Mbembe30; Ross36; Tuck and Yang37; and so many more). It is vitally important that we recognize and amplify diverse, subaltern, and historically suppressed influences as we imagine making kin, resisting imperialist impulses, and developing praxis and knowledge in partnership with—rather than in place of—communities.38 Making kin is a process of denaturing the boundaries that divide, building interconnections anew, a strategy that, with intentionality and commitment, will help us breakdown binaries and eliminate the hegemonic structures of oppression that characterize our present.14,15,34 This is an activist modality, one that we see as a question of life and death as the future unfolds.34

This article marks a starting point (one of a rhizomatic many) for our conversation about what comes after the Anthropocene because it demonstrates the potential of creative, speculative theorizing and philosophizing in nursing. As we do so, however, we draw your attention here to the inherent perils we pose as white colonizers on this path of speculative theorizing, with Audre Lorde's35 admonition that “the master's tools will never dismantle the master's house” ringing in our ears. We recognize the potential risks in these posthumanist modalities to replicate the oppressions imposed on indigenous people and indigenous ways of knowing, eliding indigenous wisdoms that surpass hegemonic consciousness.38 We acknowledge that indigenous cultures often resist anthropocentrism; many posthuman constructs and values, however, appropriate indigenous worldviews.38 In recognizing the risk of appropriating indigenous knowledge practices, we wish to honor indigenous ways of knowing, building along with them where fitting.38

Despite our best intentions, we, as nurses, still fall well short of Freire's ideal conceptualization of conscientization,23 the reflexive and honest assessment of the bare violences of imperialism, colonialism, and racism, both current and historical, that makes liberation possible. Our collective professional failure to acknowledge this specific history of the past and the present in our theoretical and practical work limits our full emancipatory potential, begging the question of whether we have ever been nurses.39 Institutionally and professionally enforced ignorance of the historical legacies to which we are heirs perpetuates our settler-colonizer status as nurses.19,37 We recognize that we speak from a position of privilege and power, as benefactors and perpetrators of settler-colonialism. We as individuals, as nurses, as a health care system, and as a nation-state engage in activities that continually reify settler-colonialism. We must actively choose decolonization if we are committed to staying with the trouble and undoing the mess.13–15,29 Consider first, the Anthropocene.

NEGOTIATING THE ANTHROPOCENE

We live in a complex, multidirectional, and life-threatening epoch that geologists have unofficially styled the Anthropocene.10 The term “Anthropocene” was coined in 2000 by Paul Crutzen to describe the current geological era in which we find ourselves.11 Unlike previous geological periods that have built the foundation of life on this planet, the Anthropocene is uniquely centered around Anthropos, the Greek word for human.40 The significance of this characterization has taken root and crept quietly into philosophy, ecology, and other disciplines. This disciplinary translocation has inspired heated debate on the significance, substance, and the specifics of the Anthropocene. The point in time when this began, the so-called “Golden Spike” of the Anthropocene, its origin myth, has many possible locales.29 The hallmark, if there is one, of the Anthropocene is that humans have become an autopoietic force, living matter that has shaped, built, and conquered all corners of Earth in ways that affect all wayfarers who call this planet home.10,15,40

We must critically interrogate the origin stories of the Anthropocene if we wish to undermine the implicit white, cisgender, ableist, heteropatriarchal, and colonial narratives it constructs.29 Some scholars locate the beginning of the Anthropocene age in the mid-15th century, known as the Black Metamorphosis, when Africans were first enslaved, pressed into work on Portuguese sugar plantations, marking the start of the sugar-slave complex.29 Others see the 1610 Columbian “exchange” of flora and fauna and European invasion of the Americas as a critical origin moment. Another possible, if limited, origin myth locates the start of the Anthropocene with the genesis of empirical science in the 18th century as wealthy white men asserted their dominion over nature through settler science, the beginning of the extraction modalities that have come to shape modernity.29,30

Proposing an alternative, Bottery41 described the Anthropocene as beginning in the first half of the 20th century, when the widespread use of fossil fuels ascended to primacy in driving the global economy. Yusoff29 critiqued romanticized, Eurocentric foundations for the Anthropocene, asserting that these iterations erase the historical context of capitalist and racialized oppressions that characterize the Anthropocene. Seeing only the glorious economic growth of the Anthropocene belies centuries of systemic racism, irrespective of its origin, “incubated through the regulatory structure of geologic relations.”29(p2) There is scholarly debate (and there is considerable debate) over the Golden Spike that historical time point for the start of the Anthropocene reveals its significance, but at the same time disguises the systemic violence of its construction. The Anthropos seized agency to write the origin story of the Anthropocene, but the question remains, who gets counted as Anthropos?29,30 Wherever we plant the Golden Spike, we must consider those who are forced to bear the perils of the Anthropocene. Those nonwhite humans whose lands have been taken, stolen, colonized, and coopted for use by capitalist forces under the guise of white human exceptionalism are rendered inhuman, and their flesh is converted to commodity in exchange for gold, tea, spices, cotton, and sugarcane.29,30

Under the auspices of the Anthropocene, settler-colonizers exercise sovereignty over resources of this Earth, the other, and the nonhuman or what Mbembe calls a “category of nonfellows.”30(p17) This sovereignty, in Mbembe's estimation, constitutes a necropolitics, the capacity “to dictate who may live and who may die,”42(p11) which pervades the hubris of the Anthropocene. In this consideration of power over who lives and who dies, we locate a link to nursing, a discipline charged with the care and keeping of those in various kinds of transitions of living and dying, the workforce of necropolitics. Necropolitics is akin to biopower, a poststructuralist concept derived from the work of historian and philosopher Michel Foucault and introduced in nursing by Jane Georges. Biopower is a construct that speaks to the power to manage bodies, individually and in aggregate; necropolitics represents the converse.43–46 But while nurses deal in life and death all the time in individual ways, we do not often think of our power in the context of this or any other colonialist narrative. This important telling of the Anthropocene story, with the tentacles of racialized historical reference linking the past to the present, critically shapes and informs what comes next to serve as a blanket of power. The framing of the origin story is what reifies white supremacy while expunging the record of violence required to attain this dominance.29

Our current situation, it is clear, does not come without histories. These histories are plural but told from the privileged and violent perspectives of white colonists, sanitized of racialized, gendered, colonial, and geological narratives of those people who bore and bear the historical pain and scars.29 To remediate this, we intend to “stay with the trouble.”14 The admonition to stay with the trouble implores us to be aware of not only of the present in all of its inequities but histories that have shaped the world around us.14 Staying with the trouble proposes to us a new mode of thinking that allows us as change agents to recognize our relational place among the living and nonliving, the human and the nonhuman. Staying with the trouble implores us to generate the potential of thinking together as collectives through an interrelated and tentacular approach.14 It is through this enduring process of “sympoietic thinking” that our consciousness begins to evolve and we become tentacular beings with the realization that every single thing touches some other thing.15 Ultimately, this connectivity prompts us as humans to recognize the kinship that we share with the other, because “it matters which beings recognize beings.”15(p96)

The fact of the matter is that we are not living in an era of bygone colonialism, not even in nursing. The world is facing a global nursing shortage but supply and demand are uneven geographically.47 To meet the needs of the United States health care workforce, for example, nurses may be contracted from developing nations like the Philippines.47 While this may represent economic opportunity and mobility for the contracted nurses, it also closely resembles what Tuck and Yang call external colonialism, wherein resources—including human ones—are extracted, consolidating resources for the dominant force, in this case, the US health care system.37 This is a singular example from nursing, but other exemplars abound: migrant workers also shore up our agrarian economies and keep hotels, restaurants, and construction sites staffed, often without the benefit of US citizenship rights, or even being considered human.48 Colonization, as critical race and indigenous studies scholar Eve Tuck reminds us, is not a past gone by, “merely the unfortunate sins of our forefathers,”49(p411) rather, a material and present reality. This reality is plagued by the narrative of individual responsibility that dislocates the climate, workforce, race, gender, extraction, and all other challenges from the structures that shape them.12,28,29 Subsequently, we must consider the trouble with downstream solutions.

The problem with downstream solutions

When considering the problems of the Anthropocene, we must awaken to the fact that downstream solutions never create substantive, enduring solutions. Worse still, downstream solutions frequently camouflage deeply entrenched dysfunction, delegate the burden of problem-solving to individuals, and obscure the malfeasance of corporations and governments. This is the trouble with the neoliberalism of our era, where discourses are nimbly deployed to dissemble unpleasant realities and contextualize individual actors as the only agents at work.28 Downstream foci tend to emphasize individual remedies that ultimately have the effect of making more robust problem-solving seem either unnecessary or overwhelming.12

Attending to considerations of climate and environment in nursing, Leffers and Butterfield declared that “the nursing profession has not reached full capacity to address the health impacts of climate change because of lack of knowledge and appropriate education and training to achieve greater nurse participation in upstream and downstream strategies for climate change.”50(p211) And while there have been calls in nursing to address the consequences of climate change, these calls are disjointed, inchoate, and ineffective, typically calling for piecemeal, local solutions to problems that are much larger than an individual nurse's capacity to address. Situated among these downstream solutions is the call to advance disaster education in nursing curricula throughout the United States. Williams and Downes,51 for example, have called for the creation of disaster response curricula within nursing education to address the effects of climate change. Similarly, George et al52 call for the development of adaptive strategies to help mitigate the risk of respiratory complications of climate change. These strategies involve downstream solutions that include educating patients on the indicators of poor air quality and assisting patients in identifying the best time to be outdoors.52 These are akin to all other downstream resolutions, resolutions that dislocate the onus of solution for structural problems of society to individual behaviors. These downstream solutions include “stop the bleed kits,” which will never solve gun violence; soup kitchens that will never solve food insecurity; and symptom science, which will never improve structural health inequalities, to name a low-hanging few. While we do not dispute the value of these downstream interventions and understand the imperative for individuals to act in the moment, responding to material crises, nurses must not stop there. We must seek out remedies that address the root problems.

Our US health care system deals with patients as individuals, which onetime Student Nonviolent Coordinating Committee leader and Black Panther Stokely Carmichael would see as a cop-out, recognizing the structural limits that institutions impose on the behaviors and choices of individuals and families navigating their environments.31 Reproductive Justice advocates, too, insist that we consider the community and context of reproductive families when we act to improve health outcomes (see, eg, Ross36 and the collected works of the Combahee River Collective). The language of health disparities reinforces this individuation, making poor health the problem of the individual rather than tracing the faults and fissures to the structural root of the problem. When social determinants of health language are employed, problems are often misattributed to the group of individuals affected rather than the structures that order them which reinforces an “individual responsibility” narrative of health and illness.53 To escape these confines, we must think more broadly about the legal, economic, social, cultural, historical, and political structures, systems, and institutions that create and enforce inequality.

Looking upstream

To avoid the pitfalls of downstream solutions, we must forgo the temptation to affix superficial redress to structural challenges and call the problem solved. Addressing the perils of our epoch requires major shifts in economic, climate, and health care policies at the community, state, national, and global levels. Metzl and Hansen54 recognize this in their conceptual framework for structural competency. Indeed, cultivating structural equity requires that nurses adopt what Kagan et al characterize as upstream thinking, an examination of the “causes of causes” through a critical deconstruction of the structural inequities of society.55(p6) But the US-based health care “system” is a fragmented patchwork of structures, predicated on a for-profit business model.56 The provision of care in our current capitalist enclosure of the health care will always be limited by shareholder profit margins, mandating that we nurse institutions rather than people. Under the current regime, call for health care as a service for all is delimited by considerations of the bottom line. As long as the case for universal health care is linked to privatized profit, widespread systemic change toward socially just health care instead of medical care is unlikely.

We actively advocate for the abolition of the US health care system as we know it, recognizing that an incremental approach can never and will never result in equity. As we deconstruct the current system for a fresh start, we recognize some merit in bringing a chair to the policy table, gathering data to demonstrate that nursing care, with communities, alongside and informed by our patients, can improve health outcomes. But even this is a Band-Aid. The rhetoric of cost-savings will never and can never resolve inequality, even under nurse-led systems, because the problems of racism, gender essentialism, heteropatriarchy, ableism, and other forms of inequity are rooted in the extraction of capital, which invariably reinforces hegemonic dialectics of power. Focusing on this kind of downstream rationale can never solve upstream problems. Worse still, it expends resources, creates the illusion of doing something, and ultimately making it possible for the same old behavior to continue.57

Antiracist praxis is a starting point for eliminating racism in the health and medical systems. Changing the attitudes of the people who provide care, nurses and physicians, is a fundamental prerequisite for building structures in health care that are “responsive to structural racism's contemporary influence on health, health inequities, and research.”58(p30) Reflective practice, active antiracism work, and community-based participatory approaches to care are foundational for upstream solutions, though they are not innately upstream solutions in and of themselves.33,58 These kinds of community-engaged approaches reorient the foci of health care, emphasizing people rather than profit. This paradigm is exciting but not new: the Black Panther's political platform included provisions for community-based health care free for those in need while Reproductive Justice activists actively work toward building the necessary conditions for members of Black communities to raise the families they wish to have safely and with the resources necessary for a secure, safe, healthy life.36,59 These approaches all share 2 things: first, they decenter the individual as the primary unit of activism and focus on the community; second, they were developed, articulated, and implemented by activists, providers, and scholars of color rooted in the communities they aim to center.

Community and global perspectives are the obligate headwaters for thinking in nursing.12 The work we do at the hospital bedside is invariably influenced by the material realities folks experience in their day-to-day lives. Our challenges as nurses working in an unjust world do not originate at the individual level, though their consequences are borne out on and through individuals. The global sociocultural and political atmosphere is abject, even dire, characterized by attacks of freedom of expression and rejection of scientific thought and policy predicated on isolationism, nativism, white supremacy, and patriarchy. Surging involvement in far-right extremist groups has wrought mass killings aimed at racial and sexual minorities and overt racist aggression toward refugees and migrants (see, eg, Butt and Khalid60; see also hate groups and hate crime statistics at the Southern Poverty Law Center61). However, we cannot lose sight of the trajectory that brought us here. This did not begin overnight. We have been working toward our current catastrophe for decades if not centuries.

We cannot hope to understand our contemporary political milieux unless we engage with the challenges of the climate crisis.62 And this is more complex and challenging than simply acknowledging changing weather patterns. To understand the mass global movements of people as refugees, we must recognize the human, economic, political, social, and ecological impact of climate injustice, which brings with it extremes of poverty, violence, and hunger. These consequences are the overwhelming effects of neoliberalism and late-stage capitalism. We are not looking upstream far enough in nursing unless the conversation involves considerations of the climate crisis and its attendant political constellation. Our discipline, complicit in our own practices of normative whiteness, compulsory heterosexuality, and exacting femininity, is overdue for an interrogation of the extractive, colonial practices in which we engage. The resources we consume, the waste we produce, and the people for whom we care (or not) are imbricated in the rhizomatic connections that link the living and nonliving, shaping the future of our planet.

EFFECTS OF THE CAPITALOCENE

Maybe the seeds of the Capitalocene were sown at the dawn of the Anthropocene, tho-ugh where it all starts largely depends on who is telling the story and to what ends, as outlined previously. Insofar as the Anthropocene is a function of white settler colonialism, white geology, and white extractive economies, as Yusoff explained, the Anthropocene has always been a Capitalocene.29 The narrators of the Anthropocene are remiss in failing to account for the effects of extraction and imposition of inhumanity on Black and Brown bodies, centering whiteness while obscuring the racialization of the extraction throughout history. “The Anthropocene,” Yusoff wrote, “might seem to offer a dystopic future that laments the end of the world, but imperialism and ongoing (settler) colonialism have been endings worlds for as long as they have been in existence.”29(pxiii) The Capitalocene, then, is the characterization of the Anthropocene in which racialized modalities of capitalism, replete with its hungry, consumptive extraction apparatuses, consume resources, human and not, in the name of advancing the bottom line.13,29 The Capitalocene is what the Anthropocene becomes, doused in the accelerant of industrial capitalism and set aflame.

Perhaps the Anthropocene has always been the Capitalocene: some humans have always worked to extract, commodify, and capitalize. Indeed, the scarcity of natural resources has been discussed since at least the industrial revolution. In the 1960s, scarcity was linked explicitly to economic growth, technology, labor, and output.63 Natural resources were useless according to capitalist narratives until extracted.63 This kind of scarcity drives competition for resources, which are depleted through use, which further reinforces a cycle of competition, greed, and extraction, an endless recursion of consumption that will one day lead to complete exhaustion. The advantage of the language of Capitalocene here, as environmental historian Jason Moore contended, is the central recognition that capitalism is not simply a world economy, limited to markets and money. Rather, capitalism forges a world-ecology,13(p10) natural and human resources extracted and reshaped to capitalistic ends. This underscores the multispecies reality of late-stage capitalism and makes space for the “relation of capital, power, and nature as an organic whole” in ways the Anthropocene in its optimistic human-centeredness cannot.13(p81) This means that the question of Anthropocene or Capitalocene is not one of rhetoric but rather of recognition, of relations, and of realities. This links us to Haraway's question about whether we have ever been human, to Latour's contention in the face of postmodern quandaries regarding binaries that we have never been modern, and to our query into if we have ever been nurses.

Recognizing the power relations implicit in capitalism, the frame of the Capitalocene makes space for analytical and material complexity. In so doing, the concept of Capitalocene resists the reductive impulse of teleological inevitability in the Anthropocene.13 Rather than the “backdrop against which the drama of life unfolded,”13(p19) the environment becomes central in world-making, agentic.13,64 And it unfolds unevenly because, within the Anthropocene and Capitalocene, not all humans are afforded humanity.29,30 Not all resources are inanimate.29,30 The Earth is capable of readjustment, of agency, and of accommodation but we would be mistaken to presume that the Earth needs humans.15,30,64,65 This hubris contributes a sense of [white] human exceptionalism that, paired with optimism, intoxicates us into believing that more innovation, more invention, and more extraction can lead us out of catastrophe.

The Capitalocene in all its grim glory, however, does need humans. Humans are as colonists, the drivers, an idea that brings us to the present. Just how does this Capitalocene present concern to nurses and nursing? Nursing as a modern profession is and has always been subject to capitalist enclosure, particularly when we tell the stories of origins that frame the birth of nursing as synonymous with hospital nursing, Nightingale leading the charge.2,5,13,66 Our professional endeavors have never been free from the crucible of capitalism, subject to ever-increasing exogenous pressures of the insurance industry, the tyranny of evidence-based practice, and the health care system's bottom line.

And as with telling the stories of nursing, it matters what stories we tell. We are apt to think of Nightingale when we think of nursing: the Lady with the Lamp. We are less likely to call out the normative whiteness of nursing and the gendered tropes that this particular image imposes. So fiercely protective are we of our nursing legacy that we deny the contributions of figures like Seacole, even as these individuals may have complex relations to nursing.18 We valorize Nightingale in ways that make even talking about other possible narratives in the origins of modern nursing inflammatory (see, eg, McDonald67). We subsume the respectability politics of nursing, opting to engage in a euphemistic discourse of civility and incivility rather than risking open discussion of conflict or problems. Scholars (ourselves included) are discouraged from talking openly about racism, for example, because it is deemed provocative or runs the risk of making people uncomfortable.68

What about the role of capitalism in the discipline-ecology of nursing? This has led to nursing's complicity in capitalist apparatuses beyond the health care enclosure like the prison-industrial complex, where incarcerated individuals are treated with cruelty, as in the recent case of a woman forced to birth unattended, against her will, abetted by the inaction of jailhouse nurses.69 Prison surveillance cameras captured the birth of her baby, documenting the jail nurse's inattention, reflecting the alienating priorities of the penal institution rather than the needs of a would-be patient.69 As this surveillance footage circulated on major news networks and the Internet, questions of nursing's complicity in unjust and unethical practices emerged, underscoring the power of surveillance technology in capitalist structures. The dissemination of this footage also raised other questions about the amplification of trauma, as the video spreads beyond the control of the individuals filmed, without regard to those whose trauma is broadcast. These are big stories, stories worth telling, origins and all. The banality of the Capitalocene, though, is the pervasive acceptance of for-profit health care and nursing as a commodity in the United States. The widespread grip of these ideas makes it difficult for nurses to envision another way. This leads us to the question of whether we have ever really been nurses.

Neoliberal inculcation of nursing (or Have we ever been nurses?)

This question evolved from an assertion first advanced by philosopher of science Bruno Latour, who asserted that “we have never been modern,” a declaration that interrogates the paradox of postmodernity.39(p11) In the face of questions about postmodernity, Latour contended that the boundary between humans and nature at the root of modernity has never been and can never be firm, decentering the binaries that characterize modern thought.39 In this meditation, Latour occupied himself with the untidy constructedness of reality, scientific facts, and science itself, seeking out the fissures that theoretically form boundaries.8,39 How, in the face of boundaries that are at best provisional, can we assert that, as humans, we have ever been modern? Nothing—no thing—is purely scientific or purely ideological or purely, distinctly separate. Modernity has no stable definition, which makes defining postmodernity more unstable still.39 Amidst his revelations, Latour calls us back to material realities, calling for a return to a new materialism that links thought to action and society to nature, rather than treating them as separate.8,70 This aligns with a call to posthumanism, as posthuman realities seek to undo binary thinking and decenter humanity.16

Latour's meditation on the realities of premodernity, modernity, and postmodernity is not simply a clever device.8,39 Nor is the question of whether we have ever been nurses. If modernity has no stable definition, neither does nursing. As Latour notes, “we are going to have to slow down, reorient, and regulate the proliferation of monsters by representing their existence officially.”39(p12) Namely, we posit that, as nurses, we have never really been nurses because we have never been autonomous professionals, free from the influences of patriarchy, colonialism, capitalism, and racism, the so-called doctor-nurse game, no matter the “progress” we make. We are not and perhaps cannot be separated from the capitalist health care ecosystem that incubates us. Asking whether we have ever been nurses asks us to question the illusion of nursing as we currently define it (as caring, as ethical, as the most trusted) while pairing it with the more nuanced realities of nursing as commodity, as extractive apparatus, as governmentality, and as complicit in white supremacist patriarchy.3,4,71 We take this approach to mine the vast cavern of possibility.

One of the key forces that limits nursing from recognizing its full potential is the health care–industrial complex as it is configured in the United States. While we take Martin Lipscomb's critique of the profligate simplification of the concept of neoliberalism in nursing seriously,72 we still find it irrefutable that the capitalist enclosure of health care as we know it in the United States has traveled far down the path of neoliberalization.4,66 Lipscomb's focus on hermeneutics and the competing constructions of neoliberalism is itself a diversion, failing to attend to the protracted violence and the extreme and [in]human cost of extractive modalities across the globe.73 This kind of critique diverts our attention from the violent and uneven inequities perpetuated by neoliberalism.74 Neoliberalism is predicated on extraction wrought through central principles of decentralization, individualization, and privatization, ultimately benefiting an elite few at the expense of the majority.75,76 In terms of ethos, neoliberalism is a political and economic ideology that advances the agenda that freedom and liberation are best upheld through free markets and entrepreneurialism.77 State protections are only necessary insofar as they guarantee profits, secure property rights, and maximize market place transactions.78 Implicit in this individualist market orientation is the disintegration of welfare-focused social programming. The discourse of neoliberalism is so deeply entrenched that it has become difficult to discern, having penetrated so deeply as to be thought common sense.78 That neoliberalism is obscure works to perpetuate neoliberal discourse and the agents that wield it. This quality makes neoliberalism hard to see, hard to believe, hard to undo, and hard to imagine any other way forward.79 This position, of course, is precarious for nurses and for health care as well.

We as nurses and nursing are actively engaged in propping up the health care–industrial complex, a so-called system in the United States that contributes to inequality and prioritizes the profit of the few over the needs of the many.4 Remaking nursing for the future means thinking about the world around us in different ways. It means thinking about nursing and about patients in new ways. It means thinking about structures and systems in new ways. Remaking nursing for what comes next is first a mandate to decenter hegemony in meaningful ways, disrupting the arboristic unidirectional and teleological thinking of the received view in favor of cultivating rhizomatic approaches that grow in all directions simultaneously, without beginning or end.9,17 What could nursing look like when the Capitalocene falls down? Envisioning the end of capitalism means developing kinship relationships with patients and colleagues, demolishing the structures that reify inequality in health care and society more broadly, acknowledging the global and universe patterning world ecologies that influence our posthuman future, and it means staying with the trouble. This gives us ideas for thinking about the posthuman future, which Haraway calls the Chthulucene.14

WHERE DO WE GO FROM HERE?

The Chthulucene promises nothing beyond compost, hybridization, and quandary. The Chthulucene is Donna Haraway's vision for a post-Anthropos future, dystopian, and utopian all at once.15 Embracing the Chthulucene means dismantling the hubris of overbearing technological optimism and acknowledging the dark chaos that characterizes our nursing past, present, and future, unmooring ourselves from both the Anthropocene and the Capitalocene.15 This embrace requires that we critique our disciplinary norms to identify and dismantle the pernicious influences that constrain us, including our own racist, sexist, ableist, and elitist tendencies as a profession. Focusing on upstream causality to build structural equity is a critical priority, digging into the root of problems rather than applying a superficial veneer in the form of downstream solutions. With this comes the mandate to first imagine and then create a postcapitalist health care future, recognizing that we are all in this earthly game together, human, animal, plant, soil, and we all need care and keeping. It also demands a speculative approach to prognosticating what the next fifty—hundred—thousand years might look like for the discipline.

We have introduced many concepts here: the Anthropocene, the Capitalocene, and the Chthulucene, as well as posthumanism, rhizomatic thought, and new materialism. And, as promised, we have raised many questions without clear resolution. We recognize that this article is one entry point of many, offers no firm conclusions, and has no end. Instead, we envision this as a starting place, a node in the rhizome, for ongoing discussion of these issues. If we are ever to be nurses and indeed, if we are to have a future in which to nurse, we have to embrace a posthuman Chthulucene. What will this look like for nursing? We envision a compost pile of nursing philosophy, theory, practice, research, and policy commingled to nurture the rhizome we have planted, decomposing boundaries to connect anew. We believe that, with the right nurturing, what can emerge is just episteme, liberatory pedagogy, rhizomatic thinking, and more equitable approaches to nursing care as we promote posthumanization in living and dying on a deteriorating planet.80 This vision leaves us with many more questions than it does answer, more fears than comforts, and a clear recognition that we must stay with the trouble. There is much work to be done.

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Keywords:

Anthropocene; antiracism; Capitalocene; climate justice; emancipatory nursing; necropolitics; neoliberalism; new materialism; postcolonialism; posthumanism

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