title: Economism, efficiency, and the moral ecology of good nursing practice.
abstract: The free-market rhetoric dominating health-policy discussions today frames health-care goods and services as commodities that consumers will or will not buy at a given price. Health-care systems are being redesigned and hospitals restructured with a view to increased efficiency and productivity. Drawing on the experiences of clinical nurses in the United States, this paper shows how the application of economism to nursing may severely disrupt the ecology of good practice, leading to difficulties in meeting minimal standards of nursing care and severely constraining the acts of compassion called for by the human experiences of illness, loss, and death. Concerns about moral responsibility and conflicts between institutional and nursing goals are described. Increasing mistrust of health-care systems on the part of practitioners, patients, and families suggests that it is time to attend closely to the moral ecology of caring practices.
authors.affiliation: Institute on Aging, Department of Physiological Nursing, University of California, San Francisco, USA. sweiss@ioaging.org
authors.forename: Sara M
authors.initials: SM
authors.lastname: Weiss
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Malone
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Merighi
authors.forename: Patricia
authors.initials: P
authors.lastname: Benner
mesh_terms: D004471:Economics, Nursing / Q000639:trends*; D004526:Efficiency; D004993:Ethics, Nursing; D009014:Morals; D009723:Nurse-Patient Relations; D009729:Nursing / Q000592:standards*