The Lichen Praxis: Co-culture of care culture

Created by
Melisse Watson, RPN
Fellow, Caring Cultures 2025

Published
February 6, 2026

Introduction

The Lichen Praxis (2026) is a living archive and call to practice to care workers and care receivers alike based on the learnings and impacts gathered from its sister project, Nursing Wounds (2024). This collection of wounds and remedies offers a how-to in creating healthier and more atypical community environments that subvert traditional systems of exploitation and care labour devaluation. 

Lichen: a symbiosis of several bacteria and mycelial species forming a new organism with a high degree of variability, adaptability, and resilience.
Praxis: practice as distinguished from theory – the practical application of theory/ideas.
Co-culture: a cell culture in the same medium containing two or more types of cell.

The Lichen Praxis is a co-culture grown from the knowledge and experiences of seven nurses spanning the Greater Toronto Area. Through shared practice, interviews and the cultivation of mycelium and bacteria – The Lichen Praxis’ sister project, Nursing Wounds, set out to understand and reflect the wounds and desires for change that nurses were fighting against and towards. Through the cultivation of specimens on petri dishes, a new language organically took shape – expressing the complexities of this work, while shifting perceptions of our practice/praxis, and advocating through interaction with the true nature and reality of health care. While bacteria grows to shape the strains and wounds these seven individuals are subject to, the mycelium grows from the desires and instincts towards healing and creating healthier systems, communities and self care.

The Lichen Praxis is a reflection of this work and growth. As the dishes have long since gone dormant, the work continues and shifts every day. This co-culture offers the beginning of an archive, to capture this knowledge in this moment, from nurses who practiced through the COVID-19 pandemic, and continue to manage through personal, political and systemic barriers on a daily basis. Where Nursing Wounds pulled back the curtain, The Lichen Praxis leaves a reminder of what we caught a glimpse of. Here are the learnings, and the tools – for change

Each of these findings were provided by one or more of the nurses interviewed through the Nursing Wounds project, and summarized/characterized by the author. Nurses have not been identified via quotes as to protect their identities and praxis.

Key wounds

Over-worked

Across contexts and work environments a theme is clear – staffing ratios are too high. One nurse to six, seven, eight or more patients in some contexts. “There are days I spend max two out of twelve hours with a patient across the day because otherwise I can’t get my work done”. The system does not support presence – it supports procedure. Documentation surpassing dedication. The ratio of greater risk to higher reward only benefits the institution. Budgets are tight, after all. And it is the patient that is squeezed for time. We do our best. We blunt the risk as best we can. But we all deserve better healthcare.

Undersupported

The space we access the greatest support as nurses is each other. With a glance, a sigh, a conversation in a lunch room with poor ventilation and single pane windows. We laugh as we express our stresses for the day – “I can’t believe we are short staffed again”. Our time off has been denied – our sick day vilified; another devaluation of care itself. We work through what we can hardly stomach. Can we not afford each other grace? The reality is there are days we are not kind, patients and staff alike – we are sick and strained – each muttering, “I can only imagine how difficult they have it.” We understand that today we are care providers, tomorrow we may be bedridden ourselves. We understand we are all a part of larger impacted communities that share each hospital/long term care/community care bed – who is hearing our concerns? Willing to make change? We, as patients and care providers, are holding up the same building – carrying the same weight.

Degree of responsibility

“When I first began nursing eleven years ago it was nothing like this, now the degree of responsibility is very different”. We are marked by a time of deep responsibility, our actions and inaction as nurses and health care providers have large consequences and deep impacts on human life. Accountability and competency is critical in our praxis, and it is a difficult space to admit we are flawed and too, human. I wonder, what has changed? Responsibility increases with morbidity, and our beds are always occupied. “Patients are younger, sicker – illness that you usually see in older populations,” one nurse reflects; “I wonder if this is another effect of long Covid, I notice a trend.” If we cannot pause to improve our praxis in line with the changes in our world that demand it, how might we work together to rebuild the boat while continuing to mobilize it?

Traumatized

“Sometimes, I think, we gravitate towards the kind of nursing that wounds us the least. That’s how some of us end up working with kids, others, mental health or emergency. We’ve just been impacted differently.” Taumatized uniquely as we all have been. We compartmentalize as best we can, leave most at work and carry membranes of the rest. It is hard not to wonder where someone ended up, it’s hard not to remember the many families that have or have not shown up. There are some units we try to switch with each other – because sometimes for some people it is difficult to wake up ready to preserve life, to find out you are assigned to help it end. What is in place to keep our praxis from unravelling – after all we all have treated those who were nurses “way back when…”.

No heroes, no kings

“They call us heroes, but they don’t treat us like it…”. It is dangerous and a misunderstanding to view nurses as heroes. It is the other side of the same coin that villainized disability – and both devalue care. Each removes the self-responsibility and self-identity that we all have to be care providers and care receivers – it denies our humanity. We are the same as you. Believing we are not may be comforting – believing we are a stone above may be necessary for society to find comfort in our fragility, our capacity for illness and disability and mortality. The problem with heroism is the displacement of responsibility for our own actions – allowing you to believe nurses are not flawed does us both a disservice. Capitalism and colonialism have led you to believe that Disability and illness are flaws – the antithesis to valuable – the atypical to healthy/normal. When in truth, we wouldn’t be here without bacteria and atypicality. Caring does not require heroes, nor villains – it requires honesty, a commitment to a culture of care and re-evaluating how we choose to treat each other.

Co-culture of capitalism

Capitalism and colonialism have led you to believe that Disability and illness are the villains. That atypicality is an unwanted deviation from an expected normalcy. That our relationship to bacteria is only through the medication/probiotic yogurt we consume to control it. That our relationship to illness is that of a temporary and inconvenient devaluation from our usual efficient and healthy status. “I’m still nervous to go back to my doctor three years later because I was treated differently when I mentioned I was a nurse…”. “I finally went to the doctor after ignoring something chronic because I was used to it… only to find out it’s more serious than I wanted to acknowledge”. “I finally broke down at work, crying. It was too much. They still wouldn’t let me go home without a replacement”. If we are not careful we will be collaborators in the aspects of capitalism that thrives off our inhumanity/saviour complex. If we are not careful we will continue to accept the villains capitalism has carved out for us to hate (ourselves). If we are not careful most of us will continue to believe our value is our labour and our fault if we cannot keep up. In scorning illness, and Disability, and atypicality, and bacteria and “unhealthy”, we will chronically hurt ourselves and grow accustomed to the discomfort. Diversity creates fortitude, resilience, collaboration, rest, while colonialism continues to eradicate balanced ecosystems in the name of control, extraction and profit. The singularity of monocultures are dangerously unable to adapt or recover. We, unfortunately, create this co-culture.

Key remedies

Self and community care

We all deserve better healthcare. We are not disposable. We are not more or less deserving of care. This includes the kind of care we offer ourselves. This may be a moment to take a breath, a trip to the washroom, a step outside for a moment, however brief. Rest is often a privileged opportunity, with intersections of race, class, location, safety, gender and ability all being factors in the availability of non-concequential rest. This is a space where community is important. A community can be a support in a moment, or a built network of generally reliable social infrastructure that allows for a person to reach in to ask for aid and a lean-to to reduce the impact of that break or moment of reprise from negatively impacting one’s life. The reality that rest can be consequential is not a reality that anyone should want, ideally, but we must build solutions inside of current paradigms that shift us toward new futures as we dismantle the current conditions creating such states of overwork and overwhelm to our bodies and our communities.

Systemic support

We are holding up the same building – supporting the same weight. We require health care systems to adapt to the needs of the populations we serve and exist within. This includes nurses being able to have a sustainable work load that fluctuates when the acuity of our patients shift. This requires management that is responsive, not only communicative – but actionary towards change. This requires executives to relinquish their personal profits to ensure the front line has the support it needs to provide quality care. This requires unions that push further than expected – right to the brink – we’ve given up our right to strike, but we are as essential as our labour, and we can’t forget that. We all are in service to care, first, whether or not systems have our backs. Our practice requires we look towards you, our patients – because we honor the humanity we share. We will continue to cultivate collaboration and pull back the curtain on our flaws and our contributions to a healthcare system that does not value the sick.

Degree of treatment

How can we mobilize to create change in the ways we all are treated, nurses and patients alike? “If there is one thing I would want my patients to know, it’s that I’m here for you”. Tell us when we could do better to meet you where you’re at and we will do our best to improve our practice. I’ll make that commitment to you, can you make the same for me? You have power – advocate for the treatment you and your family members need if the system is falling short. Speak to your nurses, with their humanity in mind. We are not supposed to tell you we are short staffed, or tired, or having a difficult day. We are not supposed to be honest about how we are because we are expected to not need to receive care while in our role. We as nurses understand the power dynamic, and we try to balance that power with responsibility, flexibility and tolerance. We do experience racism, sexism, and violence on a daily basis, and there needs to be a degree of treatment that we can all expect in each of our contexts. It is our responsibility to not treat you the way you treat us – we must do our best to provide a high standard of care regardless. We all sometimes have a hard time remembering each other’s humanity, or recognizing the realities and reactions that are possible in the relationship between power and vulnerability. We can all find dignity in treatment. We can all be more careful.

Recovery

Recovery is the tender that keeps the injury from soaking through the thread. We need to tend to our wounds. We need to pause with externalizing our care and remember that it’s not our tolerance that makes us stronger, but our ability to be soft and flexible. Realistically, we may not in the moment be able to stop – we can’t turn off as nurses on the job, or as parents to children, or any other responsibility we have taken on. We do, though, deserve to take a moment to check in with ourselves or with someone else we trust, so that the wound doesn’t get infected. We can sometimes offer to take more of the load when we are able, and see a friend, colleague, or stranger struggling. We can ask for help when we feel overwhelmed, overstimulated, strained or injured. It is not a reflection of worth or deservingness, to receive and offer care. It is a shifting of culture, it is the recovery stage of trauma, it is the gauze on the injury, it is the rest that grace for ourselves and others requires. Sometimes it is a privilege to rest. But in all cases it is necessary – and those of us in positions to carry more of the weight, I urge you to – because it helps you practice humility and create greater sustainability for everyone.

New perspectives

We each have the opportunity to identify with being a care provider and a care recipient. The question we need to begin with is how do we each view and value each of those roles? How do we view our ability to provide and receive care? What do those answers bring up for us emotionally? Is it easier to view/value ourselves as one over the other? We can’t shame ourselves into trying to care more – we have to address the shame. Or guilt, or fear, or indifference, or apathy, or reluctance to the thought of caring for ourselves and others.

How we perceive requiring care and our ability to provide care really is a reflection of how our societies have supported and suggested the value of that work and collaboration. And unfortunately, it has not been held very highly. Both offering and receiving care is emotional and requires vulnerability, humility, patience, the ability to listen, and many more skills that are grown in practice. It is the practice that restores communities. “I don’t like having patients that are unsatisfied with the care offered at the end of the day… it keeps me up at night – I take time to reflect on how it could be different.” We can reflect on our impact, even when we have reasons and good intentions that could defend ourselves – we can ask others what they need and where we missed the mark. “Have you spoken to (patient name)? He’s got an incredible story… I’m late on my meds now but it was really great to get to speak with him more.” We can push against the system when the walls of production come in too close for us to form connections. It is critical in shifting and resisting the pressure to individualize when we have so many more models of collaboration to learn from. Shifting the community perception that care work is restricted to role, and receiving care is restricted to weakness or a decrease in value – to an understanding that we all have the capacity and opportunity to build a more resilient and structurally sound co-culture with care as the mycelium that holds it together.

Co-culture of care

We create co-culture. And we have been overworking ourselves. What if we reframed our understanding of normal? What if variation was expected and celebrated? I learn how to be a better nurse every day by witnessing my colleagues in their practice, in discussing the unique ways we address challenging situations, in sharing knowledge and asking for support from one another – this behaviour happens naturally in a very unnatural environment because the constraints on individual time, capacity and physical ability push us towards collaboration as the only answer to collectively making it through a twelve hour shift while holding an extreme degree of responsibility. When I consider why collaboration isn’t the natural reaction to strain in other environments, I notice the difference is competition. Scarcity. Not everyone will benefit, because there is not enough to benefit everyone – so competition must outweigh collaboration. Interesting. Can we sustain that kind of belief? If we, the reader, have been the ones to win that bet over and over, what has the cost of that culture truly been? Who are we willing to beat? We can build our capacity – there are resources that we can cultivate abundantly – care that we can create together that gestures towards needs equitably. That regenerates and lends to taking turns in this work so that we aren’t burning out or running out or falling out of value when we are disabled, or ill, or tired, or overwhelmed. A culture of care challenges our commodification for capital – and if it is possible, what do we have to lose?

The Lichen Praxis collects the beginning of this research and the next stage of archival is the creation of an oracle card deck for change. This set of oracle cards challenges each viewer to consider which wounds and remedies restore balance, which remedies compliment each other when used together, and which wounds create collapse if compounded without resolve. It asks the viewer to reflect on their own perceptions, participations and capacity for change – and the hope is that care givers and receivers (whichever role we have in this moment and context), feel inspired to participate in recovery and co-creating a culture of care.