The Dour-Faced Nurse's Approval

 is considered a story Curiosity item.

Item description
"It is hard-earned."

Obtaining
 can be obtained by doing the Offer the services of the Brisk Campaigner, Offer the services of the Haunted Doctor , or (successfully) Offer your services actions in The Charitable Hospital.

Usage
 is required to begin The Pilgrimage to Amaradri in Varchas.