Reciprocity in Caring Labor: Nurses’ Work in Residential Aged Care in Australia

Abstract

Feminist economists identify reciprocity as a motivation for both paid and unpaid caring work. In general, reciprocity describes people responding to each other in similar ways, either benevolently or harmfully. The quality of care is potentially increased when care relationships are motivated by positive and generalized forms of reciprocity and decreased with negative forms of reciprocity. This study draws on nursing literature and two qualitative studies in Australian residential aged care facilities, conducted in 2002–3 and 2009, to identify a new form called “professional reciprocity.” This form of reciprocity involves deliberate and skilled relational work by nurses to facilitate mutual and interdependent exchanges with care recipients that are beneficial to both care recipients and nurses. This study argues that professional reciprocity, as a skill that can be taught, is important for achieving quality care and workers’ job satisfaction.

Keywords:

• Caring labor
• reciprocity
• rapport
• aged care
• nurses’ work
• quality of care

Keywords:

• B54
• D64
• I11

Acknowledgements

The authors thank Diane Elson for a fruitful discussion and useful suggestions in the early stages of this article. Siobhan Austen and Therese Jefferson provided useful feedback and suggestions. The second project in this research was funded by a short-term scholarship from the South Australian and Northern Territory Dementia Study Training Centre.

Notes

Nancy Folbre and Tom Weisskopf (1998) identify six motives for caring labor: altruism, a sense of responsibility, intrinsic enjoyment, an informal expectation of reciprocity, a well-defined, contracted reward, and coercion.

The feminist-economic twofold conceptualization of care aligns with work in other disciplines. For example, see earlier work by political scientist Joan C. Tronto, who argues that care is “both a practice and a disposition” (1993: 105).

The communicative side of care is comprised of emotional labor, and whether it is commodifiable is a paradoxical issue. Arlie Russell Hochschild differentiates between emotional labor, which is sold for a wage and has exchange value, and emotion work, which refers to the same acts done in private where they have use value (1983: 7). Although Himmelweit maintains this distinction in discussing caring labor (1999: 36), it has not been upheld across the feminist economics literature: some authors use labor in relation to paid caring services while still acknowledging the non-commodified element in caring work (Nelson 1999; Gabrielle Meagher and Julie A. Nelson 2004; Nancy Folbre 2006). The nursing literature discusses nurses as being both “emotional jugglers” who present a variety of “faces” (Sharon C. Bolton 2001: 97), as well as people who offer emotion work as a “gift” in the form of authentic caring behavior (Sharon C. Bolton 2000: 582).

Elster (1998), in his critique of individual self-interest as the universal motivation, argues that some people look at what others are doing and follow the majority. But under the norm of fairness, he says, “one should do one's share but only if others are doing theirs” (1998: 72). England and Folbre (2003) draw on a review of experimental evidence by economists Bowles and Gintis (2000) to make the point that people will sacrifice income to punish others who do not conform to norms of fairness and reciprocity. In an experimental game known as the Ultimatum Game, the split of money offered by Player A needs to be egalitarian, or Player B will turn it down despite the personal cost involved. The rules of the game specify that if Player A's offer is rejected, all money must be returned to the experimenter, and both Player A and B receive nothing. The results of the game show that on many occasions Player B punishes Player A for not making a fair offer, perceived as less than an even split in the case of windfall gains (Folbre 2009: 315).

All personal information that would allow the identification of any person(s) described in the article has been removed.

Non-numerical, Unstructured Data; Indexing, Searching and Theorizing (NUD*IST ) version N6 was used for the 2002–3 study and NVivo 7 for the 2009 study. Both software packages are supplied by QSR International.

We recorded and transcribed the interviews verbatim, and we analyzed the data using software for qualitative research that works with text by supporting the process of coding data into an index system, searching text for patterns for coding, and supporting the researcher in theorizing from the data with the flexibility to allow changes to be made as data accumulates and early ideas change (Lyn Richards 1998). Initially, we coded the data by topic to analyze dimensions or patterns. They were then “coded on” into more specific categories (Lyn Richards 2005: 97–8). In this way, it was possible to determine whether the relationships the nurses discussed involved reciprocity and, if so, what form it took.

Neoclassical economist Heyes (2005) has argued against paying nurses well. His rationale is that “increasing the wage will, other things being equal, reduce the proportion of applicants (and hence employees) who have a vocation. It corresponds to the notion that high wages might attract the ‘wrong sort’ of person” (564). Heyes’ argument has been critiqued by Julie A. Nelson and Nancy Folbre, who argue that “high pay can attract opportunists in any job” and that there is no reason to expect this to be worse in nursing, where wage levels are moderate (2006: 130). Nancy Folbre (2006) argues further that Heyes does not apply the same reasoning to surgeons or chief executive officers, overlooks the reality of a current nursing shortage in both the US and the UK, and that adverse selection models in general ignore the impact of pay and working conditions on employee morale and retention.