Standpoint Epistemology Beyond Risjord

Mark Risjord brought standpoint epistemology to nursing. He did not invent it. The tradition he was drawing on is older, more extensive, and more politically pointed than the version that ended up in BSN curricula.

Issue 001 of this publication argued that nurses occupy a distinct epistemic standpoint and that the dual-trained clinician occupies a third. The argument relied on Risjord. The argument was correct as far as Risjord went. This essay is about how far Risjord went and where the tradition continues.

This is the most academic piece in the year-one arc of this publication, and it is written primarily for readers who came to clinical practice through doctoral training in nursing, philosophy of science, or adjacent fields. The compressed version for clinical readers: the standpoint argument is not a metaphor and it is not a soft humanities frame. It is a forty-year argument in feminist and anti-racist philosophy of science with empirical methodological consequences for how clinical research should be conducted and how clinical knowledge should be produced. Risjord introduced the tip of it to nursing. The rest of it is still available.

What Risjord Did

Mark Risjord is a philosopher of science at Emory University. His 2010 book Nursing Knowledge: Science, Practice, and Philosophy applied tools from contemporary philosophy of science to questions about what nursing knows and how it knows it. The argument that mattered for nursing's intellectual self-understanding was that nursing has a distinctive epistemic standpoint shaped by its specific position in clinical structures, and that this standpoint generates knowledge that is not derivative of medical knowledge.

The argument worked because Risjord did the philosophical work carefully. He grounded the nursing standpoint in the broader feminist standpoint epistemology tradition — Nancy Hartsock, Dorothy Smith, Sandra Harding — and then made the case that nursing's structural position has the features that tradition identifies as epistemically generative: presence at sites of embodied vulnerability, work within hierarchical institutions, and the production of practical knowledge under conditions of constrained authority.

Risjord did the introductory work. He did not write the comprehensive treatment, and the parts of the standpoint tradition he did not develop in depth are the parts that have the most to offer nursing's continuing intellectual project.

Donna Haraway: Situated Knowledges

Donna Haraway is a philosopher of science and feminist theorist whose 1988 essay Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective is one of the foundational documents of late-twentieth-century philosophy of science.

The essay's central move is the critique of what Haraway calls the god trick — the conceit that scientific knowledge is produced from a view from nowhere, by a knower without a body, without a position, without an interest. The god trick is the epistemological self-image of mainstream biomedical science. Haraway's argument is that the god trick is not just philosophically untenable. It is empirically wrong. All knowledge is produced from a position. All knowers have bodies. All inquiries have interests. The pretense that they do not is a political move that hides the conditions of production of the knowledge.

The constructive move Haraway makes is that objectivity is recovered, not through the impossible god trick, but through accountable partial perspective. The knower who acknowledges where they are standing produces knowledge whose limits and conditions are visible and can be reasoned about. The knower who denies they are standing anywhere produces knowledge whose limits are invisible and whose conditions cannot be examined.

For nursing this matters. Nursing has been historically denied epistemic authority by a clinical hierarchy that claimed the god trick for medicine. The nurse stood at the bedside; the physician stood above the diagnostic conclusion; the diagnostic conclusion was framed as the truth without acknowledgment that it too was a partial perspective from a particular standing place. Haraway's framework dismantles this asymmetry not by claiming nursing's perspective is better, but by showing that medicine's perspective is also situated, also partial, also accountable to the conditions of its production. The asymmetry was never between situated and objective. The asymmetry was between two situated perspectives, one of which had been allowed to call itself objective.

A nursing research program that took situated knowledges seriously would design studies that surface the standing place of the investigator, that name the patient's standing place as data, and that treat the production of clinical knowledge as a collaborative achievement between situated knowers rather than as the recovery of facts from a neutral background. Some of this is happening. Most of it is not.

Patricia Hill Collins: The Matrix of Domination

Patricia Hill Collins is a Black feminist sociologist whose 1990 book Black Feminist Thought, expanded across subsequent editions, is the foundational text of Black feminist epistemology. Her contribution to standpoint theory is the recognition that standpoints are not single.

Collins introduces the matrix of domination — the interlocking systems of race, gender, class, sexuality, and nation through which any individual's standpoint is constituted. A standpoint is not produced by membership in one category. It is produced by simultaneous location within multiple categories, each of which shapes what the knower can see, what the knower is structurally positioned to know, and what the knower is structurally positioned to miss.

This extension matters for nursing because nursing has never been epistemically monolithic. A Black nurse-midwife working at an FQHC has a different standpoint than a white BSN-prepared nurse at an academic medical center. A Diné nurse at an Indian Health Service facility has a different standpoint than both. The standpoint each of them brings to clinical practice is shaped by their intersectional location within the matrix of domination, not just by their professional training. Collins's framework refuses the move that would collapse all nurses into a single standpoint and lets the actual epistemic diversity of the profession come into view.

Collins also names the outsider-within position — the standpoint of someone whose location places them inside an institution they were not built to include. The Black scholar in white-dominated academia. The Indigenous physician in settler-dominated medical training. The nurse in physician-dominated clinical hierarchy. The outsider-within sees both the inside operations of the institution and the perspective of those the institution was not built for. The position produces knowledge unavailable from either of the more straightforward locations.

Nursing's intellectual project has not yet fully taken up Collins. It should. The matrix-of-domination framework gives the nursing standpoint argument the tools to engage with race, with class, with immigration status, with colonial history, in ways the Risjord-level account does not.

What Nursing Inherits

The tradition Risjord borrowed from is alive and continuing. Haraway and Collins are two threads. The full intellectual genealogy includes Sandra Harding's strong objectivity, Alison Wylie's standpoint as methodological tool, Dorothy Smith's institutional ethnography, and more recent work on decolonial epistemology that extends standpoint theory into questions about whose knowledge counts as knowledge at all.

For nursing, the inheritance has three concrete implications.

The first is methodological. Nursing research that takes situated knowledges and intersectional standpoint seriously will not look like the nursing research that has dominated the discipline for forty years. It will produce different studies, different methods, different criteria for what counts as a meaningful result. The shift is already underway in some corners of the discipline. The full implications have not been worked out.

The second is curricular. The BSN curriculum touches the standpoint tradition through the nursing theorists named in earlier issues of this publication. The PhD curriculum touches it more deeply but unevenly. A nursing doctoral program that took Haraway, Collins, Harding, and Wylie as core readings would produce graduates with a different epistemic toolkit than the average current program does.

The third is structural. The clinical workforce that takes the situated and intersectional standpoint seriously will engage differently with patients, with colleagues, and with the medical hierarchy it operates within. The third-standpoint argument of Issue 001 of this publication assumed a relatively flat treatment of the nursing standpoint. The Collins framework requires that flatness to be replaced with a more textured account of which nursing standpoint and which nurse. The dual-trained clinician's position is not a single third standpoint. It is a position within an intersectional field that the standpoint tradition gives the tools to map.

Risjord opened the door. The hallway is long. The next steps are available, intellectually rigorous, and have been waiting for nursing to walk further into them for at least three decades.

About the author

Peter Schindler, MD, PhD is an Assistant Professor of Medicine and Associate Program Director of the Community Health Center Family Medicine Residency Program at the University of Nebraska Medical Center. He practices at Winnebago Comprehensive Health System, OneWorld Community Health Center, and Nebraska Medicine. He completed a Primary Care Research Fellowship at McGill University and holds a BSN from the University of Wisconsin-Oshkosh, an MS and PhD in nursing from Emory University's Laney Graduate School, a Diploma in Tropical Medicine from the Liverpool School of Tropical Medicine, and an MD from the Medical College of Wisconsin-Green Bay. He is board certified by the American Board of Family Medicine. The Interprofessional publishes new essays every week at the intersection of medicine, nursing, and the clinical knowledge that lives between them.

Disclaimer. The views in The Interprofessional are Peter Schindler's own and do not represent the official positions of the University of Nebraska Medical Center, Winnebago Comprehensive Health System, OneWorld Community Health Center, Nebraska Medicine, or any other affiliated institution.