Caring nurses: the dilemma of balancing costs and quality

This paper explores the tensions visible in the rhetoric and practice of today's health care system. This system is becoming dominated by the views of economic rationalists where decisions are based on principles more frequently associated with private enterprise. One could argue that health care should be managed as a business, however, the ethics which guide such a business must be examined closely to ensure the integrity of the caring which is implicit in much of the practice in health care. Individuals in today's society value humanistic functions more than ever before. The caring function of nursing is perhaps the most significant determinant of the quality of care received from a patient's perspective, and one to which there is little cost attached in dollar terms. While it is difficult to measure and cost the caring that nurses provide, it must be done to ensure that these qualities are maintained and enhanced. More importantly, strategies must be developed to provide cost-effective quality indicators of the caring function implicit in the nurse's role. (This is an abridged version of a paper delivered at the Nursing Economic$ International Symposium 1993 in Hobart, Tamsania.)