Marilyn Anne Ray Theory of Bureaucratic Caring Summary

Marilyn Anne Ray Theory of Bureaucratic Caring Summary

  • Born in Hamilton, Ontario, Canada.
  • Graduated from St. Joseph Hospital School of Nursing in 1958.
  • Worked at the University of California as well as in Los Angeles Medical Center where she was assigned in obstetrics and gynecology, emergency department and cardiac and critical care.
  • Studied BSN and MSN in maternal-child nursing at University of Colorado School of Nursing in 1965.
  • Was influenced by Dr. Madeleine Leininger whom she met at University of Colorado.
  • Graduated as a flight nurse from the School of Aerospace Medicine and worked as an aero-medical evacuation nurse in 1960s and served in the US Air Force for 30 years in different positions and eventually promoted as a colonel.
  • Received several commendation medals for nursing education and research during her service in the Air Force.
  • Had her first faculty positions at University of California San Francisco and the University of San Francisco.
  • Completed her Master of Arts in Cultural Anthropology in McMaster University in Ontario where she also joined the nursing academe.
  • Attended the first transcultural nursing doctoral program at University of Utah as she was invited by Dr. Leininger; her dissertation for her doctoral studies was where the Theory of Bureaucratic Caring emerged.
  • Was appointed as the Christinne E. Lynn Eminent Scholar at Florida Atlantic University in 1989 to 1994.
  • Received the Distinguished Alumna Award from University of Utah College of Nursing in 2007(Alligood, 2014).

Theory of Bureaucratic Caring

The theory was generated from qualitative research involving health professionals and patients in the hospital setting. The theory implies that there is a dialectical relationship (thesis, antithesis, synthesis) between the human (person & nurse) dimension of spiritual-ethical caring and the structural (nursing, environment) dimensions of the bureaucracy or organizational culture (technological, economic, political, legal and social).  
The Model is holographic, illuminating the holistic nature of caring & synthesis of the humanistic systems and technological, economic, political, and legal systems.

Major Concepts:

  • Caring
  • Spiritual-Ethical Caring
  • Educational
  • Physical
  • Socio-cultural
  • Legal
  • Technological
  • Economic
  • Political 

Major Assumptions

  • Nursing/Caring
  • Person/Cultural Being
  • Health
  • Environment/Culture of Organization 

Caring – Is defined as a complex, transcultural, relational process, grounded in an ethical, spiritual context. Caring is inevitable within a culture or society, such as, personal culture, hospital organizational culture, and society culture.

Spiritual-ethical caring – This pertains a holistic integration of the body, mind and spirit. Spiritual-ethical caring for nursing focuses on the facilitation of alternatives for the good of others can or should be attained.

Education – Education both formal and informal programs make use of audiovisual media to disseminate information, and also other forms of teaching and relaying information are factors related to defining care.

Physical – This factor is related to the physical state of being, which includes, biological and psychological patterns. The reason is that, both the human mind and body are interrelated, showing a pattern that influences the other.

Socio-cultural – Social and cultural aspects are factors related to ethnicity and structures of the family; intimacy with friends and family; communication; interaction and support with a social group, community and society.

Legal – Definition of caring in terms of legal factors are responsibility and accountability; rules and principles as guidance of one’s behavior, such as policies and procedures; informed consent; rights to privacy; malpractice and liability issues; client, family, and professional rights; and the practice of defensive medicine and nursing.

Technological – Factors relating to technology such as non-human resources, like the use of machines to sustain physiological well-being of the patient, diagnostic investigations, pharmaceutical agents, and also the knowledge and skills required to operate the resources.

Economic – Related factors of the definition of caring include money, budget, insurance systems, limitations, and guidelines imposed by managed care. Caring as an interpersonal resource should be considered like goods, money, and services.

Political – How nursing is viewed within a healthcare administration is influenced by political and the power structure. This included the communication patterns, decision making within the organization, role gender stratification among nurses, physicians, and administrators; union activities including negotiation and confrontation; government and insurance company influences; uses of power, prestige, and privilege are, in general, competition for scares human and material resources.

Strengths and Weaknesses

One of the major strengths in Ray’s Theory of Bureaucratic Nursing is that its assumptions can be highly applicable in the modern nursing profession. With the fast advances in technology and healthcare, Nursing today has been more elaborate. There have been several fields such as oncology nursing, infection control nursing, gerontologic nursing and many more. Nurses have also assumed administrative positions such as nurse supervisors and chief nurse. These different fields if nursing may affect the nurse’s interaction and view on patient care. Ray’s theory suggests that caring in nursing is contextual and is influenced by the organizational structure. For instance, a staff nurse who is primary involved in direct nursing care may have a different caring approach to a patient as compared to his chief nurse who is more concerned in the nursing system in the hospital.

Also, the Bureaucratic Theory has never lost the heart of the profession. Ray states that care for a patient may be affected by political, legal, economic, educational, physiologic, socio-cultural and technological factors. But these factors are influenced by spiritual-ethical caring. In this theory, the nurses, especially those in the administrative position serve two masters. First is the patient, second is the organization the nurse is working for. As part of the administrator, the nurse is responsible to make decisions that will be beneficial for the organization (this is the politics, legal and economics factors). But, as a nurse, whose primary role in patient-care, she is also in the position to make decisions to ensure that quality of care is given to the patient.

However, one limitation is that the theory is focused on nursing in the hospital. the organization mentioned in the theory pertains to a hospital administration. Hence, this theory is less flexible and may not be applicable to other fields of nursing like public health.


Marilyn Ray’s theory on bureaucratic caring provides direction and guidance for nurses to understand the way caring is lived and expressed throughout the hospital organization. This theory guides an understanding of how nursing can be practiced in the contemporary setting. In bureaucratic nursing, nursing care has been associated with the dominant culture of an organization thereof care varies on the organizational values, beliefs, and goals. Bureaucratic caring shows that caring and management can exist side by side as administrators view nursing care as an investment or a resource of the organization. The theory serves as a synthesis of the ideas revolving around organizational decisions (from careful consideration of corporate needs) in light of the basic humanistic care needs. Nurses and other healthcare professionals struggle with the paradox of serving the corporate needs of the bureaucracy while serving the caring needs of human beings. Marilyn Ray further illustrated in her theory the issues within the organization today that in some way affect the delivery of quality nursing care and these include economic constraints, the nursing shortage, complex patient, increased workloads, and technological advancement.


Alligood, M. (2014). Nursing Theorists and their Work. (8thed). Missouri, MO: Elsevier, Inc.

Davidson, A., Ray, M.,&Turkel, M. (2011). Nursing, Caring and Complexity Science: For Human-environment Well-being. New York, NY: Springer

Constantino, E. (2013). Marilyn Anne Ray’s Theory of Bureaucratic Caring. Retrieved from

Davidson, A., Ray, M., &Turkel, M. (2011). Nursing, Caring and Complexity Science: For Human-Environment Well-being. New York: Springer.

Marilyn Anne Ray (n.d.). In Prabook. Retrieved from

Ray, M. (2010a). Transcultural Caring Dynamics in Nursing and Health Care. Philadelphia: F.A. Davis.

Turkerl, M. (2007). Dr. Marilyn Ray’s Theory of Bureaucratic Caring. [PDF version]. Retrieve from


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