To propose that the budgeting of time is one of the most essential tasks
of a nursing administrator may seem outrageously naïve in a time
when organizations seem to be interested only in bottom-line figures.
Ironically, however, the time allocation strategy offered here supports
the goal of cost containment. Studies have shown that caring behaviors
of nurses (Duffy, 1991) and nursing staff attitudes (Cassarea et al.,
1986) are directly related to patient satisfaction. Benner and Wrubel
(1989) also found that caring is integral to expert practice. As a
result, and from the standpoint of quality of care as revenue producing,
this strategy of allowing time for dialogue and reflection has merit.
From the viewpoint of the Nursing as Caring theory, the nurse
administrators' beliefs about person would require that new ways
of being with the nursed are created and supported. The nursing
administrator models a way of being with others that portrays respect
for person as caring. Through modeling, others grow in their competency
to know and express caring. Of course creating and sustaining
environments that nurture and value the practice and study of nursing
remains the challenge facing nurses caught in the maze of various
organizational structures. Systems tend to perpetuate existing ways of
being even though their members may repeatedly question the legitimacy
of actions flowing from these structures. It is our belief that
nursing can create a culture that values caring within systems and
organizations. Systems and organizations can be reshaped and transformed
through living out the assumptions and values inherent within nursing as
caring.
Assumptions on which Nursing as Caring is built serve as stabilizers for
the organization. These assumptions directly influence the climate of
the organization and serve as the organizational pillars. The climate of
organizations is determined by beliefs and values of persons within it.
An organization grounded in the assumptions of person as described in
Chapter 1 would not support arbitrary and capricious decision making
in which the input of all persons has not been discerned. Mission
statements, goals, objectives, standards of practice, policies and
procedures emerge from assumptions, beliefs, and values that emphasize
one's humanness. If one accepts the assumption that persons are
caring by virtue of their humanness, then it follows that cultures are
comprised of caring persons. Respect for person as person is engendered
within this context. There is a desire to know and support the living of
caring; to support each other in being who we are as caring persons in
the moment. Therefore, assumptions of Nursing as Caring ground not only
the theory but may likewise influence the ontology of the organization
itself.
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