CONTEMPORARY NURSING PRACTICE
The practice of nursing occurs in organizations
that are generally bureaucratic or systematic in na-
ture. Although there has been much discussion
about the end of bureaucracy to better cope with
twenty-first-century innovation and worklife
(Pinchot & Pinchot, 1994), bureaucracy remains a
valuable tool to identify and understand the funda-
mentally different principles that undergird coor-
dinated and relational organizational systems.
Organizational culture has a rich heritage and has
been studied both formally and informally since
the 1930s in the United States (O’Grady & Malloch,
2003; Smircich, 1985). Informal organization or the
integration of codes of conduct encompassing
commitment, identity, character, coherence, and a
sense of community was considered essential to the
successful functioning or the administering of
power and authority in the formal organization.
Political, economic, legal, and technical systems
comprise the formal organization. What distin-
guishes organizations as culture from other para-
digms, such as organizations as machines, brains,
or other images (Morgan, 1997), is its foundation
in anthropology or the study of how people act in
communities or formalized structures and the sig-
nificance or meaning of work life (Ciulla, 2000;
Louis, 1985). Organizational cultures, therefore, are
viewed as social constructions, symbolically
formed and reproduced through interaction
(Smircich, 1985). The beliefs about work emerge in
organizational mission and policy statements. A
nation’s prevailing tenets and expectations about
the nature of work, leisure, and employment
are pivotal to the work life of people; hence, there is
an interplay between the macrocosm of a na-
tional/global culture and the microcosm of specific
organizations (Eisenberg & Goodall, 1993). In re-
cent years, economics has been a potent contestant
in macro- and microcultures. There is an ever
greater concentration of economic and political
power in a handful of corporations, which separate
their interests (usually profit-driven) from the in-
terests of human beings, which are life-centered
(Korten, 1995; Schroeder, 2003; Turkel & Ray,
2000).
Health care and its activities are tightly inter-
woven into the social and economic fabric of na-
tions. As organizations were affected by issues
of cost and profit, health-care systems underwent
immense change, particularly in the United States.
Confidence in major health-care institutions and
their leaders fell so low as to put the legitimacy of
executives at risk. Old rules of loyalty and commit-
ment to employees, investment in the worker, fair-
ness in pay, and the need to provide good benefits
were in jeopardy. Health-care systems fell victim to
the corporatization of the human enterprise.
Consequently, the conflict between health care as a
business and caring as a human need resulted in a
crisis in nursing and health-care organizations
(Page, 2004).
The actual work of nurses, while undervalued in
terms of both cost and worth (Turkel & Ray, 2000,
2001), currently is being evaluated in terms of is-
sues of patient safety (Page, 2004). Nursing educa-
tion is highlighted as a bridge to quality (Long,
2003). Since the Institute of Medicine report (Page,
2004), a resurgence of interest is taking place in the
meaningfulness of work, particularly in many hos-
pitals. The language of trust and morally worthy
work (Cuilla, 2000; Ray, Turkel, & Marino, 2002) is
replacing the language of downsizing, restructur-
ing, mergers, and acquisitions. Cuilla (2000) stated
that “[t]he most meaningful jobs are those in which
people directly help others or create products that
make life better for people” (p. 225). Although the
traditional work of nurses is defined as directly
helping others, contemporary nurses’ work is also
defined by and in the organizational context—
legal, ethical, economics, technological, and politi-
cal. Urging nurses, physicians, and administrators
to find cohesion among organizational phenomena
and body, mind, and spirit integration for the sake
of the patient calls for the reinvention of work (Fox,
1994). Incorporating business principles and the
“work of the soul” or relational self-organization
(Ray, Turkel, & Marino, 2002) means leading in a
new way (O’Grady & Malloch, 2003). It is a witness
to the power and depth of reseeing the good of
nursing, searching for meaning in life, and finding
new meaning in the complexities of work itself.
Organizational Cultures as
Transformational Bureaucracies
The transformation of nurses toward relational
self-organization is a new pursuit for the profes-
sion. Identifying professional nurse caring work as
having value and an expression of one’s soul or
one’s creative self at work replaces the notion of
nursing as performing machinelike tasks.362 SECTION IV Nursing Theory: Illustrating Processes of Development