Chancers, pests and poor wee souls: problems of legitimation in psychiatric nursing

This paper explores the relationship between psychiatric nurses and 'problem' patients as a means of commenting on the occupation of psychiatric nursing. Proceeding from a detailed examination of the case of one particularly problematic female patient, and drawing on a body of observational and interview data relating mainly, though not exclusively, to nursing activity on two very different psychiatric wards, we argue that what is critical in determining nurses' categorization of some patients as 'problems' is not so much the level or nature of patients' demands, as much previous work has suggested, but rather the patient's willingness to legitimate the nurses' therapeutic aspirations. Possessing neither readily identifiable technical skills nor unambiguous authority, the psychiatric nurse must look to her dealings with patients to sustain a viable professional identity. 'Problem' patients are those who call attention to the fragility of nursing authority by rejecting, implicitly or explicitly, the special services that the psychiatric nurse stands ready to provide.