Thoughts on Bureaucracy
By
Marilyn A. Ray, RN, PhD, CTN-A
Professor Emeritus
The Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, Florida
THE MEANING OF BUREAUCRACY AND THE THEORY OF BUREAUCRATIC CARING
Bureaucracy has multiple meanings, often associated with diverse metaphors. Bureaucracies are
represented as complex systems with political, legal, economic and technological dimensions. They are
socio-cultural entities. Often they are viewed as negative, however, "T[t]he study of bureaucracies is, in
effect, the study of the most salient [most important] and powerful organizations of the contemporary
world. How bureaucracies react to their own problems and or ours determine how we live--indeed
whether we live at all. Like it or not, humankind is being driven into a bureaucratized world whose forms
and functions, whose authority and power, must be understood if they are ever to be even partially
controlled" (Britan & Cohen, 1980, p. 27). Researchers and planners must establish which aspects of
bureaucratic growth benefit a particular organization or population as a whole. Leaders have to an
understanding of components of bureaucracy which are dynamic, creative or emergent based upon
choices made in networks of relationships and thus become essential [such as caring, compassion,
resilience, courage](Bar Yam, 2004; Davidson, Ray & Turkel, 2011).
Weber (Boone & Bowen, 1980. Britan & Cohen, 1980, Leavitt, 2005)), a famous sociologist and
economist, and considered one of the great thinkers of the meaning of bureaucracy illuminated its
meaning. The term is used by sociologists, anthropologist, and organizational theorists or professionals to
identify a group of workers (for example, in government service or in complex organizations) who are
considered the bureaucracy or bureaucrats. Bureaucracy generally outlines a set of principles that impact
both the private and public sectors of a nation. Weber (Boone & Bowen, 1980) identified six major
principles. They are as follows:
1. A formal hierarchical structure where at each level in an organization, controls are in place for the
purposes of central planning and often centralized decision-making. There are leaders and leaders imply
followers. "Leaders plus followers means hierarchy-not the old rigid hierarchy to be sure [in the
contemporary era], but hierarchy nonetheless" (Leavitt, 2005, p. 141). At the same time in hierarchies,
decision-making occurs at different levels related to professional and non-professional roles but they are
always obligated to uphold the rules and regulations of the central authority.
In a hospital organization, there is a President or Chief Executive Officer of Director in Charge with
executive staff, such as, as Chief Operating Office, Chief Financial Officer, Vice Presidents or Directors
of Nursing, Medicine, Ancillary Personnel, Materials' Management, Human Resources, Volunteers and so
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forth. In nursing there are registered nursing administrators or directors, such as, vice-presidents, nurse
executives, nurse managers, charge nurses, clinical nurse leaders, clinical nurse specialists, nurse
practitioners, staff nurses, practical nurses, certified technical nurses, or registered nursing assistants,
technicians, and orderlies. Other supportive personnel, include but are not limited to, Respiratory
Therapists, Occupational Health Professionals, Patient Representatives, Social Workers, and Physical
Therapists. Hospitals have different names for different roles but professionals are usually classified
according their role in care of the patient or in relation to the administration. Care or caring values or
virtues are or become dominant based upon different roles (Ray, 1981, 1984, 2010a; Ray & Turkel,
2015).
Complex hospital organizations or systems, such as the military health care or the Veterans'
Administration system, or any large scale health care system are now influenced by health care law, such
as, in the United States, the Patient Protection and Affordable Care Act (PPACA)(www.hhs.gov/Public
Law 111-148, March 23, 2010).
Complex Organizational dynamics are not always a direct outcome of the formal organization or the
hierarchical structure but a result of complex issues related to, for example in hospitals or other health
care organizations, constantly shifting economics, physician authority and perceived control, social and
relational caring patterns, cultural and transcultural understanding, and other factors outside the
organization's control, such as, in hospitals or other health care systems, the patient's right to make his or
her own decisions related to health, healing and well-being, pharmacological interventions and changes,
and the changes in health care related to government health care or interventions, and health insurance
issues.
Despite the movement over recent decades toward The end of bureaucracy and the rise of the intelligent
organization (E. & G. Pinchot, 1994), decentralization, or the development of flat" structures or systems,
hierarchies are here to stay and we, as professionals, must learn to manage these complex systems more
humanely, effectively and efficiently with caring, human and cultural rights, and (such as, through
boundary-crossing leadership, patient centered and relational caring, the understanding of Ray's Theory of
Bureaucratic Caring, leading and caring for people on the front-lines of care, shared governance, and cocreation of community with communitarian ethics and transcultural caring) (Allen, 2013; Davidson, Ray
& Turkel, 2011; Eggenberger, 2011; Leavitt, 2005; Ray, 1981, 1984, 1989, 2010a, b, c; 2011; Ray &
Turkel, 2013; 2014, 2015; Sherman, 2014).
2. Management by rules which have been made by external organizations (such as, in nursing, the
American Nurses Association Code of Ethics with Interpretive Statements, 2015), National Institutes of
Health, Institute of Medicine directives, Quality and Safety Education for Nurses (www.quen.org/about
qsen/contact-us/, government organizations AHRQ quality Indicators Tool Kit
(www.ahrq.gov.professional systems/hospitals/), other regulatory organizations, insurance companies,
and internal regulations, rules and policies.
3. Organization by functional specialty which, in nursing, professionals are organized by types of work,
skills, competencies, roles, unit organizations and particularly registration such as, in nursing, licensed
registered nurses, nurse practitioners, clinical nurse specialists according to diverse certifications, such as
critical care, oncology, holistic nursing, transcultural nursing and so forth.
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4. For-Profit or not-for-profit or public organizations which, in for profit organizations serves the
stockholders and stakeholders, such as the board of directors, or whatever agency is empowered as a
regulatory board. In not-for-profit systems, it can be the government, the military health care system e.g.
TriCare, the Veterans'Administration, religious organizations or voluntary organizations.
5. Equal treatment of employees means that there is a quest to treat all employees equally in their
performance of their professional roles and, in essence, not be influenced by individual differences. In
health care situations, patients rights must be protected, e.g. HIPAA federal privacy rules and regulations
under the Health Insurance Portability and Accountability Act (HIPAA)(www.hhs.gov.; HIPAA Public
Law 104-191, 110, stat. 1936, August 21, 1996). And in the contemporary situation, individual
differences based upon need is usually taken into consideration (such as, attention to cultural or religious
diversity). Under equal treatment for all, the potential of impersonalization of individuals exists based on
certain issues or problems arising in complex systems. In situations where there is substance abuse or
legal issues, rules and professional regulations are initiated and laws are in effect. In contemporary
hospitals, there is a Human Resources Department that has been created to both support or oppose
employees if rules are not followed.
6. Employment based on professional or technical qualifications gives the rights to an arbitrator of the
acquisition of legal counsel if there is a dispute.
In summary, the characteristics of bureaucracies are as follows:
a: a fixed division of labor,
b: a hierarchy of offices, (leaders who enact political, legal, economic, technological components of
complex systems, social-cultural)
c: a set of rules that govern performances,
d: a separation of the personal from the official,
e: a selection of personnel on the basis of technical or professional qualifications,
f: equal treatment of all employees or standards of fairness,
g: employment viewed as a career by participants, and
h: protection of dismissal by permanent status or tenure (in Ray, 1989, 2001, 2010a, b; Ray & Turkel,
2012, 2013, 2014, 2015; Coffman, 2014).
Bureaucracy, while condemned by some or associated with "red tape" and inflexibility continues to
provide the most reasonable way in which to view complex systems/organizations/governments and
facilitate reasonably their preservation or change. Organizations are recognizing creativity and
imagination as well as how stress impacts systems and incorporate research or in some organizations, the
institution of Heart Math®, or Caritas Processes (body, mind and spirit), or the Theory of Bureaucratic
Caring (Davidson, Ray & Turkel, 2011; Ray & Turkel, 2015; Watson, 2008) to deal with complex issues
or problems that need to be solved to improve the quality of care and caring.
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The Theory of Bureaucratic Caring
The theory of Bureaucratic Caring originated as a grounded theory from a qualitative study of caring
using ethnography, phenomenology, and grounded theory methods in a complex organizational culture
and was published first as a dissertation (Ray, 1981) and appeared in the literature in 1989 and in
subsequent publications from that time (Coffman, 2007, 2010, 2014; Ray, 2001, 2005, 2010a, b; Ray &
Turkel, 2010, 2012, 2014, 2015). In the qualitative research within the hospital institutional context, the
research revealed that nurses and other professionals struggled with the paradox of serving the
bureaucracy and serving human beings, especially patients through human caring experience (feeling),
knowledge and action. The discovery of the Theory of Bureaucratic Caring resulted in both a
substantive theory and a formal theory. The substantive theory emerged as Differential Caring, and the
formal theory was a synthesis, the Theory of Bureaucratic Caring. Differential Caring showed that
caring in the complex organization of the hospital was complex and differentiated itself in terms of
meaning by its context and roles. In other words, there were dominant caring characteristics related to
different areas of practice or units in the hospital wherein professionals worked and patients resided.
Differential Caring Theory showed that the different units promoted different caring models/modalities
based on their unit and organizational goals, values and different care needs, such as critical care units,
cardiac and step-down units, oncology unit, medical-surgical nursing care units, pediatric nursing care
unit, emergency, operating and recovery rooms, as well as different departments, such as the budget and
finance, admissions, materials' management, supportive units, such as physical therapy, occupational
therapy departments, and so forth.
The formal Theory of Bureaucratic Caring symbolized a dynamic structure of caring that was
synthesized (using Hegel's philosophy of thesis, antithesis, synthesis) from a dialectic between the thesis
(notion of caring as humanistic, social, educational, ethical and religious/spiritual (elements of humanism
and caring), and the antithesis (opposite) of caring as economic, political, legal, and technological
(elements of bureaucracy) into a new synthesis--the Theory of Bureaucratic Caring (Ray, 1989). The
research revealed that the economic, political, legal and technological dimensions were dominant caring
characteristics in relation to the humanistic, social and ethical/spiritual dimensions (there was an interplay
between and among the dimensions highlighting spiritual-ethical caring and the system dimensions as
holographic--the whole is in the part and the part is in the whole, thus, everything is an unbroken whole as
Bohm (2002) stated). The theory revealed that nursing and caring are not only transpersonal but also,
contextual, in other words, influenced by the social structure of the complex organizations (the value
system of a bureaucracy and humanistic caring). Interactions and symbolic meaning systems are formed
and reproduced from the construction of or dominant values held within nursing and indeed, other
professions, including patients, and the organization. This research responds to the fact that "we are the
organization", we are the language and action/s of the organization. Nurses must see "caring" in a new
way; a change of heart, that does not repel or keep at bay the organization but incorporates the
bureaucratic elements and thus, co-creates a complex system, such as a hospital or health care system, and
indeed a family system if in community health, as a living organization. By understanding and
incorporating the Theory of Bureaucratic Caring, they bring caring into being--what makes a human
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community and organizations possible and what is edifying to our spiritual well-being and intellectual
lives (Ray, 2005).
Significant References in Conjunction with the Theory of Bureaucratic Caring
Bar-Yam, Y. (2004). Making things work: Solving complex problems in a complex world. Boston:
NECSI, Knowledge Press.
Britan, G. & Cohen, R. (1980). Hierarchy & society: Anthropological perspectives on bureaucracy.
Philadelphia: Institute for the Study of Human Issues.
Bohm, D. (2002). Wholeness and the implicate order. London: Routledge.
Coffman, S. (2014). Marilyn Anne Ray's theory of bureaucratic caring. In M. Alligood (Ed.), Nursing
theorists and their work (8th ed.)(pp. 98-119). St. Louis: Elsevier.
Davidson, A. & Ray, M. & Turkel, M. (Eds.) (2011). Nursing, caring and complexity science: For
human-environment well-being. New York: Springer Publishing Company. (2011 American
Journal of Nursing Book of Year Award for Professional Development and Issues)
Leavitt, H. (2005). Top down: Why hierarchies are here to stay and how to manage them more
effectively. Boston: Harvard Business School Press.
Nirenberg, J. (1993). The living organization. San Diego: Pfeiffer Publishing Company.
Pinchot, G. & E. (1994). The end of bureaucracy & the rise of the intelligent organization. San Francisco:
Berrett-Koehler Publishers.
Ray, M. (in press). Transcultural caring dynamics in nursing and health care (2nd ed.). Philadelphia:
F. A. Davis Company. (Released in October 2015)
Ray, M. & Turkel, M. (2015). Marilyn Anne Ray's theory of bureaucratic caing. In M. Smith & M. Parker
(Eds.), Nursing theories and nursing practice (4th ed)(pp. 461-482). Philadelphia: F. A. Davis
Company.
Ray, M. (2010a). A study of caring within an institutional culture: The discovery of the Theory of
Bureaucratic Caring. Saarbrüken, Germany: Lambert Academic Publishing.
Ray, M. (2010b). Transcultural caring dynamics in nursing and health care. Philadelphia: F. A. Davis
Company.
Ray, M. (1997b). The ethical theory of existential authenticity: The lived experience of the art of caring
in nursing administration. Canadian Journal of Nursing Research, 29(1), 111-126.
Ray, M. (1989). The theory of bureaucratic caring for nursing practice in the organizational culture.
Nursing Administration Quarterly, 13(2), 31-42.
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Watson, J. (2008). The philosophy and science of caring (Rev. ed.). Boulder: University Press of
Colorado.
Weber, M. Legitimate authority and bureaucracy. In L. Boone & D. Bowen (Eds.). The great writings in
management and organizational behavior. (pp. 5-21). Tulsa, OK: PenWell Publishing Company.
CHAPTERS AND ARTICLES
Ray, M. (2015). Rootedness in holistic nursing: The ontologic mystery and structure of caring.
Beginnings, 35(2), 12-14.
Ray, M. & Turkel, M. (2015). The theory of bureaucratic caring. In M. Smith & M. Parker (Eds.),
Nursing theory and nursing practice (4th ed.)(pp. 461-482). Philadelphia: FA
Davis
Company.
Ray, M. & Turkel. M. (2014) Caring as emancipatory nursing praxis: The theory of Relational Caring
Complexity. Advances in Nursing Science, 37(2), 137-146.
Ray, M. (2013). Adventures in qualitative research: Trustworthiness toward evidence-based practice:
Complexity sciences, human sciences and relational caring complexity. Philippine Journal of
Nursing.
Ray, M., Morris, E. & McFarland, M. (2013). Leininger's Ethnonursing Method. In C. Beck (Ed.), The
Routledge international handbook of qualitative research. New York: Routledge.
Ray, M. (2013). The theory of bureaucratic caring. In M. Smith, M. Turkel & Z. Wolf (Eds.), Caring
classics in nursing. (pp. 309-320). New York: Springer Publishing Company.
Ray, M. (2013). Caring inquiry: The esthetic process in the way of compassion. In M. Smith, M. Turkel
& Z Wolf (Eds.), Caring in nursing classics: An essential resource (pp. 339-345). New York:
Springer Publishing Company.
Ray, M. (2012). Transcultural nursing scholars' corner. Journal of Transcultural Nursing, 23(4), 412.
Ray, M. & Turkel, M. (2012). A transtheoretical evolution of caring science within complex systems.
International Journal for Human Caring., 16(2), 28-49. (Includes Patient and Professional
questionnaires)
Turkel, M., Ray, M. & Kornblatt, L. (2012). Instead of reconceptualizing the nursing process, let’s
rename it. Nursing Science Quarterly, 25(2), 194-198.
Ray, M. & Turkel, M. (2011). Prologue. In A. Davidson, M. Ray & M. Turkel (Eds.), Nursing, caring,
and complexity science: For human-environment well-being (pp. xxiii-xxxvii). New York:
Springer Publishing Company.
Ray, M., Turkel, M. & Cohn, J. (2011). Relational caring complexity: The study of caring and
complexity in healthcare hospital organizations. In Davidson, A. & Ray, M. & Turkel, M. (Eds.)
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(2011). Nursing, caring, and complexity science: For human-environment well-being (pp. 95117). New York: Springer Publishing Company.
Ray, M. (2011). Complex caring dynamics: A unifying model of nursing inquiry. In Davidson, A. & Ray,
M. & Turkel, M. (Eds.) (2011). Nursing, caring, and complexity science: For humanenvironment well-being (pp. 31-52). New York: Springer Publishing Company.
Campling, A., Ray, M., & Lopez-Devine, J. (2011). Implementing change in nursing informatics
practice. In A. Davidson, M. Ray & M. Turkel (Eds.), Nursing, caring, and complexity science:
For human-environment well-being (pp. 329-329). New York: Springer Publishing Company.
Ray, M. & Turkel, M. (2011). Complexity science. In H. Feldman (Ed.), Nursing leadership: A concise
encyclopedia (2nd ed.). New York: Springer Publishing Company.
Ray, M. (2010). Creating caring organizations and cultures through communitarian ethics. World
Universities Forum Journal, 3(5), 41-52.
Ray, M. (2010). Transcultural caring dynamics in nursing and health care: A framework for
transcultural caring analysis: In M. Douglas & D. Pacquaio (Eds.). Core curriculum for
transcultural nursing and health care. Thousand Oaks, CA: Sage.
Ray, M. (2010). Grounded theory method for the study of transcultural nursing. In M.
Douglas & D.
Pacquaio (Eds.). Core curriculum for transcultural nursing and health care. Thousand Oaks,
CA: Sage.
Ray, M. (2010). Phenomenological-hermeneutical research method for the study of transcultural nursing.
In M. Douglas & D. Pacquaio (Eds.), Core curriculum for transcultural nursing and health care.
Thousand Oaks, CA: Sage.
Ray, M. (2010). Critical theory for transcultural nursing research. In M. Douglas & D.
Pacquaio (Eds.). Core curriculum for transcultural nursing and health care.
Thousand Oaks, CA: Sage.
Ray, M. & Turkel, M. (2010). The theory of bureaucratic caring. In M. Smith & M. Parker (Eds.),
Nursing theory and nursing practice (3rd ed.). Philadelphia: F.A.Davis Company.
Ray, M. & Turkel, M. (2009b). Caring for not so picture perfect patients”: Ethical caring in the moral
community of nursing. In R. Locsin & M. Purnell (Eds.), A contemporary nursing process:
The (un)bearable weight of knowing in nursing (pp. 225-249). New York: Springer Publishing
Company.
Ray, M. & Turkel, C. (2009a). Relational caring questionnaires. In J. Watson (Ed.), Assessing and
measuring caring in nursing and health sciences (pp. 209-218). New York: Springer Publishing
Company.
[Professional and Patient Questionnaires are posted on the Watson Caring Science Institute of
the Springer Publishing Company website; also, in Article: A transtheoretical evolution of caring
science within complex systems. International Journal for Human Caring, 2012,]
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Ray, M. (2008). Caring scholar response to: “Achieving compassionate excellence: A cooperative
accelerated BSN program. International Journal for Human Caring, 12(2), 39-41.
Ray, M. (2007). Technological caring as a dynamic of complexity in nursing practice. In A. Barnard &
R. Locsin (Eds.). Perspectives on technology and nursing practice. United Kingdom: Palgrave
MacMillan.
Ray, M. (2006). The theory of bureaucratic caring. In M. Parker (Ed.), Nursing theories and nursing
practice (pp. 360-368). Philadelphia, Pa: F. A. Davis Company.
Ray, M., Turkel, M. & Marino, F. (2002). The transformative process for nursing
in workforce redevelopment. Nursing Administration Quarterly, 26(2), 114.
Turkel, M. & Ray, M. (2004). Creating a caring practice environment through self-renewal. Nursing
Administration Quarterly, 28(4), 249-254).
Turkel, M. & Ray, M. (2003). A process model for policy analysis within the context of political caring.
International Journal for Human Caring, 7(3), 17-25.
Ray, M. (2001). The theory of bureaucratic caring. In M. Parker (Ed.), Nursing theories and
nursing practice. Philadelphia, Pa: F. A. Davis Company.
Turkel, M. & Ray, M. (2001). Relational complexity: From grounded theory to
instrument development and theoretical testing. Nursing Science Quarterly, 14(4), 281-287.
Turkel, M. & Ray, M. (2000). Relational complexity: A theory of the nurse-patient
relationship within an economic context. Nursing Science Quarterly, 13(4), 307-313.
Ray, M. (1999), Critical theory as a framework to enhance nursing science. In E. Polifroni & M. Welch
(Eds.). Philosophy of science in nursing (pp. 382-386). Philadelphia: Lippincott.
Ray, M. (1989). The theory of bureaucratic caring for nursing practice in the
organizational culture. Nursing Administration Quarterly, 13(2), 31-42.
Ray, M. (1998a). Complexity and nursing science. Nursing Science Quarterly, 11, 9193.
Ray, M. (1998b). A phenomenologic study of the interface of caring and technology: A new reflective
ethics in intermediate care. Holistic Nursing Practice, 12(4), 71- 79).
Ray, M. (1997b). The ethical theory of existential authenticity: The lived experience of the art of caring
in nursing administration. Canadian Journal of Nursing Research, 29(1), 111-126.
Ray, M. (1991). Critical theory as a framework to enhance nursing science. Nursing Science Quarterly,
5(3), 98-101.
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Ray, M. (1989). A theory of bureaucratic caring for nursing practice in the organizational culture: Nursing
Administration Quarterly, 13(2), 31-42. (Also translated and published in the Japanese Journal of
Nursing Research.)
Ray, M. (1987a). Technological caring: A new model in critical care. Dimensions in Critical Care, 6(3),
166-173.
Ray, M. (1987b). Health care economics and human caring: Why the moral conflict must be resolved.
Family and Community Health 10(1), 35-43.
Ray, M. (1984). The development of a nursing classification system of caring. In M. Leininger (Ed.),
Care, the essence of nursing and health (pp. 93-112). Thorofare, NJ: Charles B. Slack.
Ray, M. (1981). A study of caring within the institutional culture. Doctor of Philosophy Dissertation,
University of Utah, Salt Lake City.
Bureaucratic Caring Theory of Marilyn Anne Ray Written by Other Authors (2006-2012)
Coffman, S. (2014). Marilyn Anne Ray’s Theory of bureaucratic caring. In M. Alligood (Ed.), Nursing
theorists and their work (8th ed.) St. Louis: Mosby/Elsevier.
Coffman, S. (2010). Marilyn Anne Ray’s Theory of bureaucratic caring. In M. Alligood (Ed.), Nursing
theorists and their work (7th ed.) St. Louis: Mosby/Elsevier.
Coffman, S. (2006). Marilyn Anne Ray’s Theory of bureaucratic caring. In A. Marriner Tomey and M.
Alligood (Eds.), Nursing theorist and their work (6th ed.)(pp. 116-139). St. Louis:
Mosby/Elsevier.
Gibson, S. (2008). Legal caring: Preventing retraumatization of abused children through the caring
nursing interview using Roach’s six Cs. International Association for Human Caring, 12(4), 32- 37.
Turkel, M. (2007). Dr. Marilyn Ray’s theory of bureaucratic caring. International Journal for Human
Caring, 11(4), 57-74.
Turkel, M. (2006). Applicability of bureaucratic caring theory to contemporary nursing practice: The
political and economic dimensions. In M. Parker (Ed.), Nursing theories and nursing practice
(pp. 433-444). Philadelphia, PA: F. A. Davis Company.
Other References for this treatise:
Allen, S. (2013). An Ethnonursing Study of the Cultural Meanings and Practices of Clinical Nurse
Council Leaders in Shared Governance, University of Cincinnati College of Nursing, Cincinnati,
Ohio.
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Boone, L. & Bowen, D. (Eds.)(1980). The great writings in management and organizational behavior.
Tulsa, OK: PennWell Publishing Company.
Britan, G. & Cohen R. (Eds.)(1980). Hierarchy and society. Philadelphia: Institute for the Study of
Human Issues.
Eggenberger, T. (2011). Holding the frontline: The experience of being a charge nurses in an acute care
setting. PhD Dissertation, The Christine E. Lynn College of Nursing, Florida Atlantic University
Boca Raton, Florida.
Leavitt, H. (2005). Top down: Why hierarchies are here to stay and how to manage them more
effectively. Cambridge: Harvard Business School Press. Francisco: Barrett-Koehler Publishers.
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