Community Nursing in a Climate of Economic Rationalism: The Need to Value an Ethic of Care

Abstract

For almost 25 years generalist community nurses have provided professional services and developed many innovative programs in response to the needs of Victorian communities. They have established a Primary Health Care role in the co-ordination and management of preventative and therapeutic programs, as well as undertaking their more traditional duties of support and nursing care. At the present time there is unprecedented change occurring in both the structure and practice of community nursing, due, in large part, to measures aimed at achieving economic goals and reducing the high cost of illness care. These changes are creating ethical dilemmas for generalist community nurses who believe that the social costs of economic management might, in the long term, outweigh the gains. At a time of growing socio-dislocation when the community is exhibiting symptoms of alienation, experienced generalist community nurses are needed more than ever to provide a voice for those whose needs are not being met. The dilemma for nurses is how to provide the services that the community needs, cope with increasing and more complex caseloads, meet the demands of the bureaucracy, and become involved in the politics of decision making to influence health policy. The ethical stance of generalist community nurses and the rational stance of politico-economic decision makers are explored, and it is suggested that it is vital for nurses to value their professional ethics and to reaffirm their role if they are to survive the next 25 years.