Implication

Caring From A Distance: Implications of Dr. Marilyn Ray’s Theory of Bureaucratic Caring in Nursing Administration

Dr. Marilyn Ray has defined nursing as first and foremost a profession rooted in caring. In general, caring in Nursing is identified with the ability of Nurses to administer skills, use knowledge and build relationships to foster the wellness of patients. This almost always involves direct interaction with the patient. However, as the nurse’s career progresses through the organizational ladder, he/she finds that there is less time spent with the patient and more time allotted to administrative work. In the changing and challenging roles of nurses today, is there a way to show caring without being directly involved in patient care?

Dr. Ray’s Bureaucratic Caring Theory provides us with an answer to this query and it is a resounding YES. She provides us with a framework to be able to give care whatever the nurse’s role may be in the organization – staff nurse, midlevel manager, head nurse, or director. It shows that it is quite possible to

The Nurse Manager is in a position to affect the patient’s spiritual-ethical being by empowering the nurses that care for them, fostering positive relationships with the health care team, support staff, administrators and influence them to work together to deliver quality care.

The Nurse Manager as a Culture Changer

The Theory of Bureaucratic Nursing states that caring is largely influenced by the organizational culture and the type of care given in the unit.

Culture is the unit’s way of life. It is how they do things in the unit and is an accumulation of experience, training, beliefs, values, resources and roles. A unit that is used to giving mediocre care or has poor relations with other units will remain that way until the unit’s culture is changed. Conversely, a unit that is rooted in quality will always give quality care even with faced with challenges.

A Nurse Manager can positively affect the culture by setting clear goals, sticking to standards of care and fostering good communication in and around the unit. When the staffs are given standards to follow, they are more likely to give the level of care required and beyond. Empowering nurses by telling them how largely they can influence patient outcome and supporting that by providing the training and resources necessary can dramatically change a unit’s negative culture. For example, a nurse who used to call the Pain Control Nurse every time the patient demonstrates pain can be empowered to relieve the patient’s pain using non-medical means after undergoing Pain Control training. This will lead to better job satisfaction (from positive feedback from the patient), a mutually respecting relationship with the Pain Control Unit (because their time is respected) and better care for the patient. By influencing a unit’s culture, the level and kind of care the nurses give towards patients, co-workers and the institution can be transformed.

The Nurse Manager as a Patient Advocate

From womb to tomb, most people from developed countries will visit a health care facility at least once in their lifetime which makes healthcare a very profitable business. Gone are the days when people can just walk into the emergency room to receive care without being asked what type of insurance they have or how they plan to pay for their stay. Dr. Ray’s theory proposes that nurses take a proactive role in ensuring that caring will always come before making a profit.

Nurse Managers, especially those who have entire units under their care have the opportunity to act as patient advocates by reviewing and negotiating better rates of procedures and services. In this role, Nurses would have to learn how to assert and present themselves to hospital administration and speak in behalf of the patient while keeping the interests of the company at heart. It may involve doing research, learning the way the hospital operates and interacting with different professions such as Accountants, Architects, Doctors, Executives and Engineers.

The Nurse Manager as a Bridge Between Staff and the Administration

There is a known gap between the staff and the managers of any organization. Dr. Ray has postulated that it is the Nurse Manager’s role to bridge this gap by opening a line of communication and acting as advocates for each side. During huddles, it is imperative for the manager to relay the administration’s plans for the staff and the hospital. This will ensure that everybody is on the same page and make it easier to reach company’s goals.

On the other hand, the Nurse Manager must also relay concerns about the staffing, schedule, lack of equipment to the hospital administrators in behalf of the staff. According to Dr. Ray’s research, hospital administration has recognized the need to support a good nursing program because the patient’s level of satisfaction is largely dependent on the nurse’s quality of care.  When the patients are satisfied with the level of care they receive, they are more likely to come back to the hospital again. This illustrates the influence caring has on hospital economics. She encourages nursing leaders to take a stand against corporate leaders and not allow them to dictate their move. It is their job to ensure that the nursing department is respected and established in any institution.

For example, a Nurse Manager can assert the need to hire clerks to take care of the paperwork that are often done by the nurses.  The Nurse Manager’s initiative shows that she cares for the staff nurses by reducing their workload. By doing so, the nurses are able to give better care and spend more time with their patients. Increasing the quality of care will encourage the patients to patronize the institution.

Nurses have many roles to fill and these three examples show that wherever they may be in the organization, they have numerous opportunities to give care. Caring is contagious in any organization and nursing leaders have the opportunity to make changes in and around her that will resonate in all directions - like dropping a stone in a quiet pond.

Nurse Managers can utilize Dr. Marilyn Ray’s theory to care for patients, the staff and the institution both directly and indirectly. It provides a guide for nurses as they move up the corporate ladder enabling them to be true to their nature as caregivers.