To Challenge and to Cooperate

Most readers of this blog are already aware of the IOM/Robert Wood Johnson report on the Future of Nursing that was issued in October of 2010.  You may recall my post about the report last June – in fact, there were 16 replies to that post – a record for this fledgling blog!  The replies were thoughtful and brought to the fore exactly what is most badly   needed in nursing – challenges about not only the report, but the assumptions underlying it.  So I would like for us to focus once again on this initiative, not simply because of the terrific discussion it raised on this blog, but because it is generating a substantial degree of action.  Part of the action component is built into the funding plan that accompanied the original report, which actually strengthen the possibility that something will come of it!  But of course the action components need to be watched closely.  The challenge for me, and I suspect for many others who entered the discussion in June, has to do with a fundamental question: “Who benefits?”

During the August conference of INANE (International Academy of Nursing Journal Editors) in San Francisco, the 130+ nursing journal editors and publishers heard a presentation by Susan Hassmiller, the Senior Advisor for Nursing for the Center to Champion Nursing in America.  In response to her presentation, the group decided to initiate a coordinated effort across as many nursing journals as possible, to further the possibilities for the achievement of the report’s recommendations.  So far, the INANE web site has a listing of editorials and resources that have appeared in various nursing journals over the past year or so; in the spring of 2012, many of the journals will carry focused messages about the report, articles, and other content that provides evidence and resources for their readers in moving forward.  I would encourage folks to browse this list … it is impressive, and many of the editorials are well worth looking up and reading.  Also, if you want to see Susan Hassmiller’s presentation from the INANE conference, you can find it here (scroll down to the Friday 8:00 session).

So my question for readers of the Nurse Manifest blog: can we both challenge and cooperate?  I fully agree with many of the challenges that came forward in our discussion in June, including skepticism about the source of the report, and the fact that the report’s recommendations are in fact what we might call “lame.”  However, the cold hard truth is that the recommendations of the report, which of course should already be reality, are far from real.  If we were to achieve the report recommendations as reality, do we not have a better outlook for achieving not only the fundamental goal of better health care and better nursing care, but also the ideal of seeing nursing at the center of health care policy-making.  If we simply sit on the sidelines and challenge the report, then we isolate ourselves from the places where mainstream change might be possible.  If we simply cooperate with the report without questioning some of the assumptions and directions, then we ourselves may all too easily be drawn into an abyss of the status quo.  So bottom line, to me, there is no simple way forward.  But I favor moving forward, challenging ideas and actions where possible to be heard, and with as much cooperation as possible with those who follow a more mainstream path than many of us follow!

8 thoughts on “To Challenge and to Cooperate

  1. Peggy,
    I agree! We need to challenge AND cooperate. The question is which comes first? I say cooperate at least a little to get our feet in the door, then offer some convincing reasons for the challenge. In the end, it’s all about the people who benefit from care, so we need to focus everything we do (and say and write) on that end. The means to better patient care may look like some of the things they suggest, and may not look like others. I read a very interesting article the other day about the importance, in education, of teaching students to ask the questions (not just come up with answers). I think we need to know what the questions are in this (and every) situation, so we can then find the answers. You have raised a very important question. Thanks for sharing all these resources that I don’t have time to check out – UGH. I’m glad you’ve restarted the conversation – this is what Nurse Manifest is all about.


  2. Hello Jane & Peggy!

    As you point out, how the Future of Nursing manifests for us as nurses depends partly upon our involvement in creating it. This might start with understanding and communicating our role and value to the health of those we serve, and to the healthcare system and policymakers. If nursing can see itself as a leader, to the public and all members of the healthcare team, in translating health and care to the people in a culturally congruent and integral manner; then we may see our future manifest as we dream it to be. How do we get our words and actions into the venues that can shape health policy and ecomonics? Publications, marketting, lobbying, speaking up and out of our usual venues so that those that have the power to help us achieve our dreams of the future can give us the support we need to advance the profession.
    Best to all, Wendy


  3. A better healthcare system for patients and nurses, and the importance of nurses/healthcare workers being at the center of policy-making are central themes of a new Hollywood movie, Puncture.
    Puncture is the first feature film that dramatizes the serious medical, social and legal issues that helped usher in the US Needlestick Safety & Prevention Act 2000:
    Movie Puncture Exposes Hep B&C, Hiv Dangers In Needlestick Injuries For
    Nurses, Healthcare Workers
    Now the public will understand the dangers and barriers to safety innovations inherent in the work place and the ongoing need for healthcare system and policy reforms. Help spread word of mouth on Puncture.


  4. I think it would be great if we could engage first and then challenge some of the mandates. I suppose part of the question for me remains how do we come together to engage with the IOM? I would think the IOM is aware of some of the professional issues we face, but I would also want their support and brain-power around solving some of those issues; perhaps they have some fresh perspectives.

    I think we also need better ways to dialogue amongst the professionals; the INANE conference sounds simply awesome, as a way to bring together leaders and begin to focus on the topics at hand. What are the ANA, NLN/ NLNAC, CCNE, etc doing to help address the future of nursing?

    For instance, the ANA seems to mostly just applaud the report:

    IOM Future of Nursing Report

    A new report from The Institute of Medicine (IOM) calls on nurses to take a greater role in America’s increasingly complex health care system. The American Nurses Association (ANA) highly commends the IOM for its newly released report on the nursing profession and acknowledges the need for nurses to take a leadership role in all settings to meet the demands of our changing health care system. The report is the result of the Initiative on the Future of Nursing, sponsored by the Robert Wood Johnson Foundation (RWJF).

    ANA was gratified to find that many of the elements and recommendations of the IOM Report on the Future of Nursing are reflected in our ongoing work to advance the nursing profession. We are in complete agreement with the four “key messages” of the report. ANA and the ANA constituent state nurses associations have engaged in a wide range of activities over time that support the evidence-based recommendations of the IOM. (see document below)

    In a July 2011 speech to the National Association of School Nurses, American Nurses Association President Karen Daley describes the challenges and opportunities created by recommendations in the Institute of Medicine’s Future of Nursing report. Links to video clips from the speech are available below.
    (retrieved September 23, 2011 from


    • Excellent question, Carey, about what is actually happening. The web site that has the most information on this so far is The ANA is not prominent but then for an organization like ANA to mobilize around anything is like moving an elephant! The folks who are involved in the “Campaign for Action” seem to be working more through the state organizations and state boards, and grassroots level by organizing action coalitions and things like “awareness” meetings. So I would encourage folks to sign up for their email updates and volunteer to get involved at some level in your state, and once you are plugged in to what they are doing, let your voice be heard. One aspect of Susan Hassmiller’s response at the nursing editor’s meeting that raised a huge red flag for me, and that they definitely need to be working on someone asked her what the campaign is doing to address the fact that new graduates are not able to find jobs her answer was pretty lame, but she acknowledged that this is a huge problem that needs to be addressed. I think they don’t really know what to do about this and how to address it yet but I believe that with more and more folks expressing concern and a bit of willingness to work on an issue like this, something more could happen! I am signing up for the emails will keep folks posted if I learn new stuff! And others who sign up, do the same!! Peggy

      Peggy Chinn New My Blog!: Nurse Manifest Blog:


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