To understand fulfillment, we must confront the moral conditions of work. Nurses operate within systems and structures that impose constraints on our moral agency. These conditions—scarcity of resources, institutional demands and unchangeable systemic pressures—shape nurses’ work in ways that can feel dehumanizing. Yet, within these constraints, nurses can find and create meaning. This ability to navigate moral challenges and still derive fulfillment from our work speaks to the profound strength of our profession. Irvine Sue & Bill Gross School of Nursing, the headline statistics reinforced the conviction that U.S. healthcare needs to be more dynamic, inclusive and responsive in a diverse society. “We all benefit from a holistic model that cares for the whole person and focuses on the disparities in healthcare,” says Leanne Burke, a midwife, associate clinical professor of nursing and director of teaching, excellence and innovation at the school. She points out that at UCI Medical Center, nurses and other caregivers now focus on providing a continuum of care that considers patient experience before, during and after pregnancy. With relevance to the current crisis, that patient-centered approach is critical to improving the American way of birth.
The Hidden Nature of Fulfillment
Why, then, is fulfillment so rarely discussed? Perhaps it is because fulfillment resists measurement and easy definition. Unlike burnout, which is visible and urgent, fulfillment is subtle and grows in spaces where intention meets meaning. It is cultivated in the tension between action and reflection, in the quiet acknowledgment of purpose amid hardship.
The moral conditions of work, as contemporary philosopher Joanne B. Ciulla reminds us in her 2019 essay of the same name*, are not entirely within the worker’s control. For nurses, these conditions include the emotional labor of caring for patients, the ethical dilemmas of limited resources, and the systemic inequities we often witness but cannot change. Fulfillment, then, is not the absence of these struggles but their integration into a broader sense of purpose. It is the ability to hold onto the meaning of care, even when faced with the realities of what cannot be fixed or undone.
The Dual Nature of Nursing
Nursing is both profoundly practical and deeply spiritual. It requires scientific precision and technical expertise while demanding an artful attentiveness to the humanity of others. This duality places nursing firmly within the realm of the humanities, even if it is not always recognized as such. Figures like Florence Nightingale, Mary Seacole, Walt Whitman and Ludwig Wittgenstein—all of whom worked as nurses—exemplify how nursing transcends the clinical and enters the realm of moral and spiritual endeavor.
Each of these figures worked within moral conditions they could not entirely reshape. Nightingale, despite her undeniable impact, faced societal barriers to women’s leadership. Seacole challenged racial exclusion while providing care during war. Whitman bore witness to suffering that no amount of care could alleviate and, like Whitman, Wittgenstein sought grounding in the quiet, unassuming acts of care amid the chaos of war. Their fulfillment arose not from erasing these constraints but from finding meaning in their responses to them.
Fulfillment Amid Paradox
The same conditions that make nursing fulfilling—emotional engagement, ethical commitment, and attentiveness to others’ needs—can also make it depleting. Nurses face an ongoing tension between our desire to care and the structural limitations that constrain our ability to do so. Yet, despite this paradox, fulfillment emerges—not as the absence of suffering but as the presence of purpose. Work’s moral conditions are inescapable but not insurmountable.
Fulfillment in nursing is found in small but profound moments: the reassurance in a patient’s eyes, the connection formed with a family in crisis, or the knowledge that one’s care eased another’s pain. These moments, fleeting yet significant, anchor us as nurses to our purpose. They are reminders that even in the face of systemic challenges, our work matters.
Reclaiming Fulfillment
As educators, leaders and clinicians, we must nurture the vision of the profession as a humanist endeavor. While we equip students with scientific knowledge and clinical skills, we must also guide them to reflect on the deeper questions of care: What does it mean to be present with another’s suffering? How does nursing shape our own humanity? And how do we find fulfillment in a profession that often exposes us to the limits of what we can control?
Fulfillment in nursing is not an unattainable ideal. It is found in the everyday acts of nursing care, the steady commitment to serve, and the recognition that our work contributes to something larger than ourselves. While the moral conditions of work cannot always be changed, they can be navigated with integrity and purpose. In doing so, we nurses rediscover the enchantment of our calling: the awe of human fortitude, the wonder of connection and the beauty of care’s sacredness.
In these moments, we find not only the meaning of nursing but the meaning of what it is to be human.
*“The Moral Conditions of Work” by Joanne B. Ciulla, published in The Oxford Handbook of Meaningful Work, ed. Ruth Yeoman, Catherine Bailey, Adrian Madden and Marc Thompson (Oxford University Press, 2019).
