Lately, I (Dorolen) have been wrestling with how to reconcile feminist critiques of nursing-which point out how nurses have been vulnerable to exploitation-with the highly esteemed Christian ethic of agape love, which manifests itself in nursing as selfless altruism. I began grappling with this question while studying the self-expressed identity of Canadian nurses who began practicing in the 1930s to 1950s (Wolfs, 2011). These nurses struggled to reconcile shifting societal and professional expectations of nurses with personal ideals of selflessness.

In the 1940s, the Canadian nursing occupational identity, like nursing in other developed countries, began to shift from "physician's handmaiden" and "ministering angel" toward a more professional image embodying expertise and independence. While the hospital employers and the public continued to value selfless service, the nursing profession distanced itself from the feminine domestic roles it had historically embraced. In an attempt to gain the professional respectability more typically afforded their male counterparts, nurses increasingly emphasized university education, clinical expertise, and autonomy. Yet, in an era when feminist discourse chastised those women who sustained a sexist image, the nurses I studied took pride in portraying themselves as selfless servants to their patients and communities. Even in retrospect (they were interviewed after retirement), these nurses did not question the value of selflessness to nursing. I should not have been surprised, as it has been argued that selflessness is key to nursing (Cusveller, 2011). In light of this I wonder how can nurses give compassionate, caring service-a traditionally Christian attribute-while being independent and without being harmed by exploitation?

It is intriguing that, even though the nurses reported militant working conditions, none described these as exploitative. Their recollections are permeated not only with expressions of self-conscious distancing from the image of "physician's handmaiden" and stories highlighting their education, expertise, and assertiveness, but also with the tremendous satisfaction they gained from serving their patients. They communicated that they chose to serve others. And in doing so they felt a sense of receiving something in return. Giving to patients was imbued with a sense of contributing to the wider community. Giving of themselves gave meaning to their work.

We can look to our faith for direction on how to avoid harm in the midst of selflessness. Jesus reminded his followers that we are to love our neighbors as we love ourselves (Matthew 22:40). Taking care of ourselves is important. The love given to a neighbor should not harm the one who loves. Berry (1988) argues that we harm ourselves when we believe that, "If I don't do it, it won't get done," and "Everyone else's needs take priority over mine." Although noble and gracious on the surface, these beliefs trap one into feeling both grandiose-he or she alone is responsible for others-and worthless, since one's own personal needs do not merit concern. In reality, this thinking does not recognize God's overarching power to work in ways outside of us. Distinguishing self-sacrifice (good-for-others-rather-than-me) from selflessness (good-for-others-and-good-for-me) is one way to guide us in what is harmful and what is altruistic.

I think that selflessness can edify us. When we love/serve others, we also are loving and serving Christ, who in turn loves/serves us in a win-win-win cycle of mutual contribution and benefit. Stackhouse (2008) calls this shalom. Perhaps framing caregiving as a "win-win-win" shalom style of caregiving will satisfy feminist, nursing, and Christian ideals by valuing empowered lives, finding meaning in caregiving, and striving for blessing and peace for all.