Getting Ours? “Girlbossing” and the Ethics of Nurse Reimbursement Models

TL;DR

This paper examines how nurse reimbursement models under capitalism can perpetuate harm and obscure systemic issues in healthcare.

Contribution

The paper introduces a critical analysis of nurse reimbursement models through the lens of 'missing care' and racial capitalism.

Findings

Professionalization processes help nurses cope with moral injury caused by harmful reimbursement models.

Capitalist imperatives shape healthcare outcomes and data practices, often at the expense of ethical care.

Racial capitalism limits the development of ethical alternatives that prioritize well-being over profit.

Abstract

This article politicizes a reimbursement model proposed by some professional nursing associations that aim to better align the price of nursing labor (nurses’ pay) to the value of nursing and make nurses’ contributions more visible.

Using the concept of “missing care,” the critique reveals how professionalization directs attention to individual-level interactions between care seekers and practitioners while obscuring from view the harm inflicted by social institutions and structures constitutive of a capitalist political economy and the related carceral state.

Direct reimbursement models render practitioners complicit in the harms perpetrated and perpetuated by the health care industrial complex while professionalization processes are deployed to reduce cognitive dissonance (and moral injury) produced by combining harm with nursing’s normative principles.

We describe and trace the complementary capitalist imperatives of extraction-based profit maximization and efficiency through the health care industrial complex to demonstrate how formative those imperatives are of the health care system, care-seekers’ outcomes, nurses’ experiences, nonconsensual modes of data collection, and surveillance.

The naturalization of racial capitalism and the precarity and violence it entails foreclose the creation of ethical alternatives that prioritize well-being instead of the pursuit of profit that could bring the provision of and payment for care closer to the normative principles held by practitioners.