Contributor – Rachell Nguyen
Equal strength being pulled from both sides
Neither willing to concede to the other
Pulling with all the will-power in the world
Swearing to not give in to one another.
Such as the concepts of rules and empathy,
The fall of one breaks life’s tranquility,
No rules brings chaos, no love conveys spite,
All order loses its stability.
As humans, we follow regulations,
To protect the institution as a whole.
But without the humanity to protect the individuals,
Systems become sanctuaries without soul.
With this constant fight, have we really gotten far,
Or will we forever pull in the game of Tug of War?
“Have you done your mandatories?”
“Not yet.”
“Well, why not? If you don’t do them by this date, you may get reprimanded.”
“I was prioritizing my patients, and it has been a busy shift.”
Or how about this…
“Has the consent been signed?”
“Not yet. The patient has further questions that the provider can only answer.”
“Well, this delays our throughput and will affect our numbers.”
How many nurses have had similar conversations? I am sure we all have. Although situations may have differed, we all faced that tension: protocol versus compassionate care.
As I have transitioned from being a clinician to education and leadership, this stark contrast has become more apparent. Nurses with good intentions are stuck in the gray zone between rigid protocols and the humanism of patients… and themselves. Recently, though, I witnessed this dilemma on a more personal level, and, honestly, it felt like a stab in the heart. The system I worked hard for seemed to betray me behind my back. I saw that very imbalance in action… truly, when rigidity triumphs over humanity, it causes moral injury.
That “Tug of War” resonates with many individuals and is an important factor affecting nurses’ well-being. When that tension is balanced, there is the “yin and yang,” the equilibrium that balances the scale. However, when one side tries to overpower the other, the ground rumbles in disorganization. I have noted that, over time, rigid institutional protocols and technology… are slowly overshadowing humanistic care, one of nursing’s core components. If we allow this pattern to continue, we will lose that precious art side of our discipline.
Theoretical Grounding: Watson and Ray
This tension has been at the forefront of nursing thought, and two theorists helped me name what I was witnessing. Jean Watson’s Caring Science reminds us that nursing is, at its core, a moral and relational act. It is not simply a set of tasks to complete, but a way of being with another human being, honoring their dignity, their fear, their story. Watson’s Caritas Processes ask us to show up fully present, not just clinically competent (Watson, 1985).
Marilyn Anne Ray’s Bureaucratic Caring Theory adds a harder truth: that caring does not exist in a vacuum. It lives inside systems, shaped by policy, economics, and institutional structures that can either nurture or quietly suffocate it. Ray doesn’t ask us to reject the system. She asks us to see it clearly (Ray, 2018).
Together, these theories illuminate the tug-of-war. When systems forget they exist for people, caring becomes collateral damage.
Way Forward
I know that, realistically, there is no clear-cut solution. Rules exist for reasons. Protocols save lives. What I am not asking is to choose empathy over order, but rather, refuse to let one erase the other.
The way forward is not a policy. It is an orientation. It is the nurse who pauses before escalating throughput concerns and asks, “What does this patient actually need right now?” It is the leader who protects space for those conversations instead of burying them in compliance checklists. It is all of us reclaiming caring not as a soft add-on, but as the very foundation of why we entered this work.
We will always feel the rope in our hands (I know I do!).
The tension is not the enemy; losing our grip on one side is. So, the question is not whether we play Tug of War, but “Are we strong enough to hold both sides?” I ask my fellow nurses, “How are you holding the rope today? How will you keep the delicate equilibrium between the art and science of nursing?
When protocols and caring are not held in balance, nursing risks losing its moral and human foundation.
References
Ray, M. (2018). Theory of bureaucratic caring. In M. J. Smith & P. Liehr (Eds.), Middle range theory for nursing (4th ed., pp. 107–117). Springer Publishing Company.
Watson, J. (1985). Nursing: Human science and human care. Appleton-Century-Crofts.
About Rachell Nguyen
I am a nursing professional development specialist and a board-certified family nurse practitioner with 20 years of clinical experience in various healthcare settings, including academic medical centers, community clinics, and specialty practices. My professional focus is on evidence-based practice (EBP), research, nursing practice, nurse empowerment and advocacy, and the management of chronic diseases, particularly diabetes, in underserved populations. I teach and facilitate system-wide nursing programs on EBP, research, and practice. My academic background includes a Doctor of Nursing Practice and ongoing Doctor of Philosophy studies in nursing. I am dedicated to advancing nursing practice through clinical inquiry, mentorship, empowerment, and interdisciplinary collaboration.