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.

Generally, organizational structures reflect bureaucratic values. Structures imply ways of being with and relating to people. The process of relating is typically illustrated in a hierarchical fashion. The concept of hierarchy carries with it the notion that there is a "top" and a "bottom." Competition, levels, and positions of power are implicit. In climbing the rungs of a bureaucratic ladder, it is difficult for the employee to be authentic and valued as a unique person with special ideas because the risks of such valuing are often too great for the bureaucracy to bear. Competition too remains the driving force of most organizations.

Within an organization, however, we can imagine each person's hands as clinging to the rungs of the bureaucratic ladder. Taken further, this image would clearly portray persons who are not and can not be open to receive and know other. Because of the vertical axis of the bureaucratic hierarchy, persons, more often than not, are viewed as objects. The ladder positions people so that they are either looking up or down but rarely eye-to-eye. Obviously, the hierarchical model does not support the idea of each person as important in and to him or herself.

By contrast, and from the assumptions posited in Nursing as Caring, the model for being in relationships resembles a dance of caring persons (Boykin, 1990). The same persons are present in this circle that were in the hierarchical structure described above. The difference between the two models is the philosophical way of being with other. Because the nature of relating in the circle is grounded in a respect for and valuing of each person, the way of being is diametrically opposed to traditional patterns of relating in organizations. Leaving the security provided by known hierarchical structures, however, requires courage, trust, and humility. Building on the assumptions of this theory, one can infer that the basic dance of all persons in relationships is to know self and other as caring person. Each person is encouraged and supported in a culture that values person-as-person, person as caring.

The image of a dancing circle is also used to describe being for and being with the nursed. In the circle, all persons are committed to knowing self and other as living and growing in caring. Each dancer makes a distinct contribution because of the role assumed. The dancers in the circle do not necessarily connect by holding hands although they may. Each dancer moves within this dance as called forth by the nature of the nursing situation. The nursed calls for services of particular dancers at various points in time. Each person is in this circle because of their unique contribution to the person being cared for ... nurses, administrators, human resources, etc. These roles would not exist if it were not for the nursed. There is always room for another person to join the dance. Rather than the vertical view described earlier, this model fosters knowing other. Eye-to-eye contact assists one to know and appreciate each other as caring persons. Each person is viewed as special and caring. No one person's role is more or less important than the other's. Each role is essential in contributing to the process of living grounded in caring. As each person authentically expresses their commitment in being there for and with the nursed, caring relationships are lived. When the focus in any health care institution fails to be the person cared-for, purpose, roles, and responsibilities become depersonalized and bureaucratic rather than person-centered and caring.

Personal knowing--knowing of self and other--is integral to the connectedness of persons in this dance. The nursing administrator interfaces with persons of many disciplines as well as with the nursed. With each interaction, the nurse administrator is honest and authentic in encouraging others to know and live out who they are. Each encounter with another is an opportunity for knowing other as caring person. From an organizational standpoint the nursing administrator assists in creating a community that appreciates, nurtures, and supports each person as they live and grow in caring moment to moment. The nursing administrator assists nurses to hear and understand the unique calls for nursing and supports and sustains their nurturing response.

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