untitled

have not been established among executives, nurs-
ing leaders, and members of the nursing staff (Ray,
Turkel, & Marino, 2002). As a result of this lack of
trust within the organization, many nurses ques-
tion both their own loyalty to the organization and
if executive decisions are motivated by political
considerations rather than a concern for the prac-
tice environment.
A grounded theory study conducted by Ray,
Turkel, and Marino (2002) identified losing trust
as a care category. Consequences of losing trust in
the organization included nurses becoming disil-
lusioned with nursing practice and experiencing
decreased loyalty to the organization. Strategies for
rebuilding the loss of trust in order to transform
nursing within organizations included respecting
the nursing staff, communicating with the nurs-
ing staff, maintaining visibility, and engaging in
participative decision making. Administrators need
to focus on rebuilding in order to create a better
working environment for the nursing staff. Regis-
tered nurses view the rebuilding of trust as the key
component to the recruitment and retention of
nursing staff.

The foundation for professional caring is the

blending of the humanistic and empirical as-

pects of care. In today’s environment, the

nurse needs to integrate caring, knowledge,

and skills all at once. Given political and eco-

nomic constraints, the art of caring cannot

occur in isolation from meeting the physical

needs of patients. When caring is defined

solely as science or as art, it is not adequate to

reflect the reality of current practice.

Nurses must be able to understand and ar-

ticulate the politics and the economics of

nursing practice and health care. Classes that

examine the environment of practice gener-

ally, and the politics and the economics of

health care in relation to caring, must be in-

tegrated into staff-development curricula.

Nurses need to search continually for differ-

ent approaches to professional practice that

will incorporate caring in an increasingly

technical and cost-driven environment.

Doing more with less no longer works; nurses

376 SECTION IV Nursing Theory: Illustrating Processes of Development

must move outside of the box to create inno-

vative practice models based on nursing

theory.

Administrative nursing research needs to

continue to study the relationship among

staff nursing caring, patient outcomes, and

organizational economic outcomes. Further

research is required to firmly establish the

nurse-patient relationship as an economic re-

source in the new paradigm of evidence-

based practice of health-care delivery (1999).

Findings from these research studies will

continue to validate the Theory of Bureau-

cratic Caring as a middle-range holographic

practice theory.

Nurses need repeated exposure to the eco-

nomics and costs associated with health care.

Lack of knowledge in this area means others

outside of nursing will continue to make the

political and economic decisions concerning

the practice of nursing. Having an in-depth

knowledge of the economics of health care

will allow nurses to challenge and change the

system. A new theory-based model can be

created for nursing practice that supports

human caring in relation to the organiza-

tion’s economic and political values. The

political and economic dimensions of bu-

reaucratic caring serve as a philosophical/

theoretical framework to guide both contem-

porary and futuristic research and theory-

based nursing practice.

Having an in-depth knowledge of the

economics of health care will allow nurses

to challenge and change the system.

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Bassingthwaighte, J., Liebovitch, L., & West, B. (1994).Fractal

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Battista, J. (1982). The holographic model, holistic paradigm, in-

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