Bureaucracy, considered by some as a machine-
like metaphor, plays a significant role in the mean-
ings and symbols of organizations (Ray, 1981,
1989). Weber (1999) actually predicted that the fu-
ture belonged to the bureaucracy and not to the
working class. Weber, who saw bureaucracy as an
efficient and superior form of organizational
arrangement, predicted that bureaucratization of
enterprise would dominate the world (Bell, 1974;
Weber, 1999). This, of course, is witnessed by the
current globalization of commerce. Recent acquisi-
tions and mergers of industrial firms and even
health-care systems, especially in the United States,
are larger and hold more power than some world
governments. The concept of bureaucratization is
thus a worldwide phenomenon (Ray, 1989).
Although considered less effective than other forms
of organization, Britain and Cohen (1980) stated
that, “Like it or not, humankind is being driven to
a bureaucratized world whose forms and functions,
whose authority and power must be understood if
they are ever to be even partially controlled” (p. 27).
The characteristics of bureaucracies are as
follows:
- A division of labor
- A hierarchy of offices
- A set of general rules that govern performances
- A separation of the personal from the official
- A selection of personnel on the basis of techni-
cal qualifications - Equal treatment of all employees or standards of
fairness - Employment viewed as a career by participants
- Protection of dismissal by tenure (Eisenberg &
Goodall, 1993).
Bureaucracy, while condemned by some as asso-
ciated with red tape and inflexibility, continues to
provide the most reasonable way in which to view
systems and facilitate the preservation of organiza-
tions. In the past two decades, there has been a call
for decentralization and the “flattening” of organi-
zational structures—to become less bureaucratic
and more participative or heterarchical (O’Grady &
Malloch, 2003). Many firms have begun to hold to
new principles that honor creativity and imagina-
tion (Morgan, 1997). Even nursing has advanced in
a more collaborative or decentralized manner by its
focus on patient-centered nursing and more decen-
tralized control from administration (Long, 2003;
Nyberg, 1998). But creative views still need to be
marked with understanding of bureaucracy as eco-
nomics sweeps the globe. Leadership models, which
are fundamentally hierarchical because of the need
for order, continue to head the short-lived partici-
pative movement toward decentralization. Power is
still in the hands of a few as global economics and
the market rule (Korten, 1995). As a result, the con-
cept of bureaucracy does not seem as bad as was
once thought. It can be considered as much less
radical than the business paradigm that focuses on
competition and response to market forces, subse-
quently eradicating standards of fairness for
human beings in the workplace.
Caring as the Unifying Focus of Nursing
Caring in nursing brings things into being. It is hu-
mane and rational. As such, caring is considered by
many nurse scholars to be the essence of nursing
(Boykin & Schoenhofer, 2001; Leininger, 1981,
1991, 1997; Morse, Solberg, Neander, Bottorff, &
Johnson, 1990; Ray, 1989, 1994a, 1994b; Swanson,
1991; Watson, 1985, 1988, 1997). Although not uni-
formly accepted, Newman, Sime, and Corcoran-
Perry (1991; Newman, 1992) characterized the
social mandate of the discipline of nursing as
caring in the human health experience. Caring thus
is an influential concept, and the expression “car-
ing” in the human health experience emphasizes the
social mandate to which nursing has responded
throughout its history and encompasses the scope
of the discipline (Roach, 2002). Caring, however, is
manifested in different and complex ways in the
nursing discipline and profession (Morse et al.,
1990; Newman, 1992). Various paradigms that en-
fold the care and caring ideal exist in nursing. The
totality (Fawcett, 1993), the simultaneity (Parse,
1987), and the unitary-transformative (Newman,
1992) paradigms have been the prevailing world-
views in nursing and have directed nursing theories.
The totality paradigm demonstrates that nursing,
person, society, environment, and health character-
ize the nature of nursing. The simultaneity para-
digm illuminates the human-environment integral
nature of nursing. The unitary-transformative
paradigm states that what constitutes nursing’s
reality is the view that the human being is unitary
and evolving as a self-organizing field embedded in
a larger self-organizing field identified by pattern
and interaction with the larger whole. Health is
considered expanded consciousness, and caring in
the human health experience is the focus of theCHAPTER 23 Marilyn Anne Ray’s Theory of Bureaucratic Caring 363