The nurses who speak through these quotations all agree that caring is, and always has been, the cornerstone and the quintessence of their profession. It is the key concept of nursing, the vital theme around which the whole field turns. Coded into the notion of caring are the characteristic forms of knowledge and skill, practice, and ritual, the fundamental attitudes and values, beliefs and symbols that define the work that nurses do, its goals, its meaning, and its distinctive culture.

Over time, the world in which nurses work has undergone fundamental alterations that have diminished the paramountcy of caring, making it more difficult to sustain on a consistent and continuing basis. Changes in illness patterns, the increasing dominance of technology in medical care, the growth of bureaucratic medicine, and the preoccupation with cost containment in recent years all act to constrain and thwart nurses from meeting what they regard as their foremost and unique obligation to patients.