The Battle Line Between Formulaic Caring and Authentic Caring

Why a battle line?

Because nurses are battling for their souls,

in response to the current battle cry for formulaic caring,

in the race for higher patient satisfaction scores.

The pressures from evidenced based practice (EBP) standards and technologies are bad enough, but the added insult of formulaic caring programs without attention to authentic caring is what makes the message from nurse leaders bitter.

Formulaic Caring –

Formulaic caring is characterized by the classic nurse-patient relationship where the nurse is consistently kind, responsive, concerned, encouraging, reassuring, caring.

These skills are learned through nursing schools and then through organizational education programs.

The organizational programs are designed to instill organizational vision, improve work conditions and processes, engage nurses in decision-making, enhance nurse sensitivity within the complex clinical environments, and achieve consistent caring behaviors. No doubt, they have transformed care and raised nurse and patient satisfaction levels throughout hundreds of hospitals and clinical settings.   images-34

The problem is that most programs exist in an organizational vacuum. There is little or no recognition of authentic caring – the need for, research of, or the development of authentic caring. (Sadly, the DAISY Award program tries to fill the vacuum.)

These programs too often communicate that caring needs to come from committees and leadership. This leaves a taste of an institutional caring. The notion that caring can be scripted, mandated, and accountability mechanisms need to be applied cuts to the core of nurses’ souls.

This vacuum is evident in nursing leadership literature. The intentions of many of the programs presented are attempts to raise patient satisfaction scores.

Authentic Caring –

Authentic caring is characterized by a deeper connection between the nurse and patient. Here nurses are authentically present with their wholeness and caring consciousness, which exhibit their understanding of the meaning of the illness or event to patients, creating a caring moment. Each patient feels un-judged, acceptance and trust.

This caring consciousness is at the energetic core of the nurse-patient relationship. These connections:

  • Originate within the nurse
  • Spark from a connection between the nurse and other
  • Are nurtured by the nurse’s internal resources
  • Can only be sustained by the nurse

This connection restores both patient and nurse and potentiates learning and healing.                                                            (Halldorsdottir, 1991;Watson, 2012)

Authentic caring requires development of each nurse’s personal and aesthetic nursing knowledge. Widespread cultivation of these forms of knowing creates a significant challenge. It is understood that “personal nursing knowledge is the most problematic to master and to teach” (Carper, 1978), Personal knowing is sourced within each nurse and depends on the nurses’ desire to develop his/her mindsets about caring processes and skills.

The challenges of widespread, ongoing cultivation of authentic caring are obvious, but the need for it cannot be ignored.  

What has escalated this tension to a tipping point now?

  • Pressures of EBP standards and technologies reaching record limits for bedside nurses and frontline nurse leaders, with no end in sight
  • Growing recognition that it is nursing care that most impacts the patients’ care experiences and raises patient satisfaction scores. This puts the spotlight directly on nurses for not only the scores, but for reimbursement
  • Society’s needs shifting from all things science and technology to wellness; bringing mindbodyheartspirit needs, desires and expectations into healthcare
  • Nurse burnout, compassion fatigue, attrition rates increasing at a time when healthcare and nursing reform and societal caring consciousness are turning in the direction of nursing’s domain
  • The narrowing of nurse leaders’ bandwidth already consumed by all of the above.

Watson advised that healthcare change would happen when nursing and the people it serves are aligned (1999).


  • 1. Halldorsdottir, S. (1991). Five basic modes of being with another. In D.A. Gaut & M Leininger (Eds.), Caring: The compassionate healer. New York: National League for Nursing Press.    2. Watson, J. (2012). Human caring science; A Theory of nursing (2nd ed). USA: Jones & Bartlett Learning.      3. Carper, B. A. (1978) Fundamental patterns of knowing in nursing. ANS, 1(1), 13-24.           4. Watson, J. (1999). Postmodern nursing and beyond. Edinburgh: Churchill Livingstone.

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