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Gaut D.A. (1981) Conceptual analysis of caring: research method. In
Caring, An Essential Human Need: Proceedings of Three National
Caring Conferences (Leininger M. ed.), Charles B. Slack,
Thorofare, NJ, pp. 17–20.
Hutchinson S.A. (1984) Creating meaning out of horror. Nursing
Outlook 32(2), 86–90.
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Of Three National Caring Conferences. Charles B. Slack,
Thorofare, NJ, pp. 3–16, 133–144.
Mallison M.B. (1988) Ordered to care. American Journal of Nursing
88(4), 425.
Maslach C. (1982) Burnout: The Costs of Caring. Prentice Hall,
Englewood Cliffs, NJ.
JAN 30th ANNIVERSARY EDITORIAL
Can an ethic of caring be maintained?
30th Anniversary Invited Editorial reflecting on
Law Harrison L. (1990) Maintaining the ethic of
caring in nursing. Journal of Advanced Nursing
15, 125–127
In her 1990 Guest Editorial for JAN, Lynda Law Harrison raised
the question: ‘Can an ethic of caring in nursing be maintained?’
This is a provocative question to ponder once again as we move
into a new era which witnesses the unravelling of timeless ethics
and values that guide and sustain nursing as a moral endeavour
which assures its universal professional covenant with the public.
The current socio-political, medical-economic polemics of health
(read sickness) care are arguably turning nursing away from
human caring and its bedrock ethic of caring.
The demands of modern medicine have turned nursing more
towards technical-industrial, quantitatively time-bound, prod-
uct-line, institutional demands of the job. Such westernized
clinical views of humanity and compassionate, ethical, human
caring services, leave little room for nurses to attend to the work
that they love. The work nurses love, that calls them into nursing
in the first place, is often the caring–healing relationships, the
values, and the sense of purpose and meaning attached to the
human dimensions of nursing. This deeper humanitarian, caring
science endeavour and the work of caring–healing relationships,
is grounded in the timeless ethic and ethos that guides the

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30th anniversary editorial
Ray M. (1981) A philosophical analysis of caring within nursing. In
Caring, An Essential Human Need: Proceedings of Three National
Caring Conferences (Leininger M. ed.), Charles B. Slack,
Thorofare, NJ, pp. 25–36.
Ray M. (1987) Health care economics and caring in nursing: why the
moral conflict must be resolved. Family and Community Health
10(1), 35–43.
Reverby S. (1987) A caring dilemma: womanhood and nursing in
historical perspective. Nursing Research 36, 5–11.
Service R. (1988) Caring for the caregivers. RN 51(5), 7.
Slevin A.P. & Harter M. (1987) The teaching of caring: a survey
report. Nurse Educator 12(6), 23.
Watson J. (1988) Addendum to Krysl’s existential moments of
caring: facets of nursing and social support. Advances in Nursing
Science 10(2), 17.
personal and professional life of nursing. Yet, this is the very
ethic which has been and continues to be eroded by the dominant
technical, medicalized, clinicalized, professionalized view of
humans and nurses themselves. Ironically however, just as we
can currently identify the dissonance between the caring ethic of
nursing and the focus of the dominant system, we witness
collapse and chaos from within, nationally and internationally.
Harrison’s (1990) JAN Editorial invites a revisit as we enter a
new era of conflict with respect to ethics and values, and what is
truly important in sustaining hospitals as well as the humanity of
practitioners and patients alike. The concluding challenge of that
editorial, 15 years ago, was to acknowledge that: ‘Nurse
practitioners, administrators, educators, researchers and theo-
rists must continue to work together to ensure that the ethic of
caring remains an essential unique focus of our profession’ (p.
126). I could not agree more with Harrison’s conclusion, but
with an updated view for this new century.
Since that editorial was published, some disturbing, yet
paradoxical, dynamics are increasingly evident in the world of
hospital nursing: for example, the growing shortage of nurses,
exceeding any past shortages in Western countries, including
shortage of nursing faculty; the rising tension between corporate
models vs. professional models of health services; the institu-
tional-scientific management tactics, driven by costs and econo-
mic gains; the continuing widespread stories of dispirited nurses;
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30th anniversary editorial
the breakdown of professional institutional standards for main-
taining healthy and viable nurse-working conditions; and, in
some instances, last-resort approaches towards quotas and
nurse–patient ratios have now been selectively legislated. These
growing dynamics within and without the profession, guided
largely by economic imperatives, have hardened and short-
changed the ethic of caring. Nurses and nursing are detoured
from the human caring mission towards demands to do more and
more, but with less and less time and appreciation.
At a deeper level, we have to acknowledge the dissonance
between the disciplinary-ethical-moral foundation of human
caring as ontology, and epistemology, as well as a philosophy
and model of science that guides informed caring practices.
Parker (2004) does not hesitate to name this dissonance by
reminding us that every epistemology becomes an ethic. Thus, if
nursing does not maintain its caring ethic, it and we suffer
harmful consequences, which as Palmer puts it, can result in
ethical formation or ethical deformation (italics added). Thus,
critical issues and consequences are evident if we do not and
cannot maintain the caring ethic in nursing, and if we are to
sustain humanity itself.
But do not despair! In the midst of all the difficulties of this
era, consistent with chaos and complexity theory, a new order
and pattern of hope and change seems to be emerging underneath
the chaos at the surface. Perhaps because of, or in spite of, the
tense dynamics and value-conflicts and growing dissonance,
there is evidence of an ethic of caring re-emerging; indeed, having
to be emerge, if the profession of nursing and the systems that
require nursing care are to survive.
To put things in another perspective regarding the broader
standing of nursing in the world, once again, in the 2005 Gallup
poll in USA, the public placed the nursing profession on top, with
respect to honesty and ethics, above other major professions
(http://www.gallop.com). This acknowledgement is a reinforce-
ment of the importance of sustaining the caring ethic if we are to
maintain our covenant with the public.
The tension in the dominant approaches to hospitals and
medical treatment is in stark contrast to the public’s accelerating
interest, if not demand, for professional integrity, honesty and
ethics, along with complementary-alternative medicine and an
increasing awareness of the relationship between spirituality and
health (Watson 2006). A new model of expectation is now
emerging from the professions and the public alike, inviting a
new order to emerge. What is bringing me hope, is that I am
currently witnessing an increasing number of hospitals, nursing
and hospital executives giving greater and greater attention,
dignity, voice, recognition and action towards transforming
nursing from inside out. These transformation efforts are
resulting in nursing returning to its timeless ethic and practices
of human caring, in that these ethical, theory-guided professional
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practice models seek to make explicit the caring relationships,
the knowledge, values, philosophy, theory and therapeutics that
guide advanced professional practice. These developments are
transforming the practitioners as well as conventional
systems (Watson 2006). For more information and selected
examples of these progressive organizations and their caring-
guided projects, visit the Watson website (http://www.uchsc.edu/
nursing/caring).
Thus, what is emerging under the chaos is an internal shift
whereby individual nurses, nurse leaders and the profession of
nursing are together bringing forth its timeless paradigm of
caring as a hopeful ethic for this time of erosion and despair.
There appears to be a momentum to develop theory-guided
practice models in the midst of current hospital reorganizations.
This turn is consistent with the widely-heralded American Nurses
Credentialing Center Magnet Hospital initiative in USA, inviting
hospitals and nursing administrators and leaders to achieve
national Magnet recognition (http://ana.org/ancc/magnet/
index.html). This development, if done with integrity and
authenticity for deep change, is heartening. It gives nursing a
professional pride and theoretical model to excel in its most
cherished human caring practices, guided by an underlying
caring ethic. It also promotes clinical research, and nurses as
clinical scholars and knowledge workers, which the system
requires for its ethic and integrity as well as its commitment and
accountability to its public.
The 1990 JAN editorial by Harrison identified steps that
administrators in healthcare organizations can take to minimize
institutional barriers to caring, by ‘implementing policies that
reflect respect and care for nurses’ (p. 126). Further, these
policies would involve nurses in decision-making so that they
could determine how to implement caring; could establish
programmes that facilitate nurses meeting their personal, as well
as professional responsibilities. Administrators need to support
education and therapeutic communication of caring which have
‘significant economic benefits for healthcare organizations’
(p. 126). It seems that with the current turn towards having to
maintain the caring ethic in nursing, as well as new views from
informed nurse administrators and leaders and visionaries, we
see Harrison’s challenges being met within a new context for
change.
In conclusion, the challenges of Harrison remain, but with the
need for renewed attention and articulation. Some of the work by
Nyberg (1998) a nurse administrator and leader of one of the
original Magnet hospitals in the USA, provided an early voice for
some responsibilities of the Nurse Administrator within a Caring
Model which are congruent with Harrison. However, these
responsibilities have expanded, and have increasing importance
if nursing is to sustain its caring ethic. They include some of the
following (Watson 2006, p. 54):

• Understanding and communicating caring as philosophy and
ethic for organizational processes, structures and relationships;
• Developing skills of caring behaviours, caring presence in
formal–informal relationships with individuals and groups;
• Being alert and responsive to situation for modelling, creating,
and articulating theoretical–philosophical–ethics of caring
with staff and colleagues;
• Providing leadership in implementing and evaluating experi-
mental-demonstration models of caring–healing theory-guided
practices;
• Promoting and supporting research on caring and healing/
health outcomes;
• Exploring relationships between and among data which
document connections between caring theory-guided practice
models, nurse retention, patient–nurse satisfaction, healing
outcomes and costs;
• Serving as stewards of caring-economics-costs, by incorpor-
ating caring as a valuable economic resource and caring as the
foundational ethical variable in cost–benefit ratios.
Finally, nursing and medical systems are in a new era of having
to reconstruct new models that are based on hope and possibil-
ities that transcend old paradigm thinking – thinking that is still
lingering from an industrial-product-line mindset, silent with
respect to the human spirit as the source for change. However, as
nursing matures, and as it realigns its responsibilities and ethical
JAN 30th ANNIVERSARY EDITORIAL
More than a makeover is needed to improve nursing’s image
30th Anniversary Invited Editorial reflecting on
Law Harrison L. (1990) Maintaining the ethic of
caring in nursing. Journal of Advanced Nursing
15, 125–127
Does the public image of nursing reflect a profession that has lost
its ethic of caring? Harrison detected signs of this in the United
States of America (USA) in 1990, as reflected in her JAN
editorial, and a similar case can be made today in the United
Kingdom (UK). Television soap operas portray the seamy (and
steamy) side of hospital life; documentaries with titles like
Undercover Angels use hidden cameras to expose nursing

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30th anniversary editorial
caring covenant directly with the public, it stands as a beacon of
light for a new ethic and ethos that transcends all that has come
before and informs the healthcare system at large as well as
society as a whole. So, in addressing the rhetorical question: ‘Can
an ethic of caring be maintained?’, my response – knowing what
we know now – is: ‘How can the discipline and profession of
nursing, in good faith to itself and its public, bear to NOT
maintain and act on an ethic of caring?’
Jean Watson PhD RN AHC-BC FAAN
Distinguished Professor of Nursing,
Murchinson – Scoville Chair in Human Caring,
University of Colorado Denver and Health Sciences Center,
Denver, Colorado, USA.
E-mail: jean.watson@uchsc.edu
References
Harrison L.L. (1990) Guest Editorial. Maintaining the ethic of caring
in nursing. Journal of Advanced Nursing 15, 125–127.
Nyberg J. (1998) Caring in Nursing Administration. University Press
of Colorado, Boulder, Colorado.
Parker P. (2004) The Violence of Our Knowledge: Toward a
Spirituality of Higher Education. 21st Century Learning
Initiatives. Fetzer Institute, Michigan.
Watson J. (2006) Caring theory as ethical guide to administrative and
clinical practices. Nursing Administrative Quarterly 30(1), 48–55.
malpractice; and anecdotes recycled as news items feature
supposedly uncaring nurses much like those Harrison described.
Such is the deluge of media information, misinformation and
opinion that the public image of nursing is hard to pin down. In
the intervening years, digital technology and the globalization of
mass communication have changed the media beyond recogni-
tion. There is so much data from so many sources. It would be a
Herculean task to replicate the studies pioneered by Kalisch and
Kalisch, who analysed representative samples of media portray-
als of nursing in the USA (for example, in Kalisch et al. 1983).
I argued in 1985 in my book The Politics of Nursing (Salvage
1985) that it was time to drop the tired and demeaning
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