Access and delivery of Canadian health care is expected to be enhanced through telenursing, a growing nursing specialty. Using institutional ethnography, I describe how telenursing work is socially organized within protocols, contracts, quotas, and time. My core argument, supported by evidence, is that nurses’ work is too firmly tied to protocols that involve nurses in highly standardized and routinized activities. These are textually mediated work processes that cover over and squeeze out skilled nursing judgment. The research establishes a critical analysis uncovering nurses' troubling capture within ‘conceptual practices of power’ (Smith 1990) –taken-for-granted (supposedly competent) practices that overrule their capacity for skillful, compassionate interactions with callers. The findings have troubling implications for nurses and for the discipline of nursing. Moreover, in relation to the careful and prudent use of health resources, I show how organizing nurses' work this way is a serious waste of an important resource.