We all know one or more Filipino nurses – so sharing this important information.
Teddie Potter PhD, RN, FAAN
School of Nursing University of Minnesota
Throughout the history of professional nursing, nurses have designed new care delivery models and transformative interventions in response to unmet needs and population health and public health challenges. These changes required disruptive thinking and bold courage in the face of broken systems, ineffective policies, and powerful naysayers. Climate change may be a modern example of a major public health crisis yet the challenges to mounting an effective response are similar. This is the story of Nurses Drawdown, a global, nurse-led movement to improve the health of humans and the planet.
Honoring the Ancestors of this Movement
Around the globe, the earliest experts in planetary health were, and continue to be, indigenous people. Their values and patterns of decision-making acknowledge the deep interconnection of human health and the health of the biosphere.
Many early nursing leaders shared a similar awareness that we ignore the environment at our peril. The ideas of Florence Nightingale, Lillian Wald, and Mamie Odessa Hale offer inspiration to transformative leaders today. Florence Nightingale is considered the founder of modern professional nursing; her astute observations and applied statistics established nursing as a science-based profession. Nightingale was an expert systems thinker who connected the health of humans to the quality of the environment. Like Florence, nurses today must recognize that nursing care is delivered in the context of nature.
Lillian Wald, the founder of public health and school nursing, faced the daunting task of addressing the health needs of resource-poor immigrants in New York City (Wald, 1915). She went to the people and lived among them. Her willingness to participate in health initiatives alongside those she served offers a lesson for transformative leaders today. Nurses can inspire people to take action on climate change by first making changes in their own lives.
Mamie Odessa Hale was another historical change agent. Hale was an African American Nurse Midwife practicing in an era of deep racial segregation. She taught community midwives simple practices based on the best science of the time thereby improving birth outcomes for African Americans (Hale, 1948). The story of Mamie Odessa Hale encourages today’s nurses to realize that simple science-based interventions, taught with respect and empathy, can transform the health of individuals and whole communities.
These early nursing leaders laid the foundation for today’s global movement to address climate change. They are a part of the Nurses Drawdown story.
The Seeds of a Movement
In September 2014, I took a long bus trip across the nation to attend the People’s Climate March in New York City. Over half a million people from all demographics and all walks of life came together to send a strong message that the United States must take climate change seriously and meaningfully contribute to global negotiations.
Like my fellow travelers from Minnesota, I wore a bright orange t-shirt. The only indication that I was a nurse was the sign I created that said, “Minnesota Nurses for a Healthy Future.” As the march moved through the streets of Manhattan, I was shocked how frequently observers standing along the route commented to one another, “The nurses are here!” Some even asked to take their picture with me so they could send it out on social media with the message that nurses had shown up to address climate change. I remember thinking, “What is this?” The people were not shouting, “The engineers are here!” or “The teachers are here!” There is something about nurses taking on climate change that inspired hope.
Fast forward to 2018 when I adopted the book Drawdown: The Most Comprehensive Plan Ever Proposed to Reverse Global Warning (Hawken, 2017) for “The Global Climate Challenge: Creating an Empowered Movement for Change,” a course that I teach at the University of Minnesota. Climate change is an urgent public health crisis; therefore, I teach that our solutions must be effective and have significant impact. Project Drawdown (2020)provides the solutions; could nurses provide the inspiration to scale them?
I contacted Project Drawdown and presented the argument that as the largest global health profession and the most trusted profession, nurses may be able to effectively and broadly scale Project Drawdown’s science-based solutions to climate change. Nursing’s long history of innovative leadership to improve the health of individuals, families, and communities can be relied on to improve the health of humans and the health of the planet. So, a partnership was formed between Project Drawdown and the Alliance of Nurses for Healthy Environments (ANHE).
ANHE (2019), the leading professional organization for nurses working to promote a healthier environment, coordinates the Nursing Collaborative on Climate Change and Health, a broad network of professional organizations committed to planetary health. Katie Huffling and Cara Cook from ANHE and I assembled a leadership team to plan and initiate Nurses Drawdown. It was very important that we include nurses across the globe, nurses from a wide variety of practice settings, and different demographics including nursing students.
The vision for Nurses Drawdown is “to improve the health of individuals, communities, and the planet through commitment to and action on the Nurses Drawdown solutions.” The mission is, “Nurses, the most numerous and most trusted health profession in the world, have the power to significantly impact climate change. By embracing and teaching the evidence-based solutions of Nurse’s Drawdown, nurses around the world will help to decrease greenhouse gas emissions and create a healthier future for humans and the rest of the planet.”
To this end, the Nurses Drawdown leadership team elected to scale Project Drawdown solutions that have the co-benefits of improving human health and the health of the planet. We selected five themes, reflecting an alignment between core nursing expertise and effective evidence-based solutions. These include:
- FOOD: Committing to eat a more plant-based diet, using clean burning cookstoves, and reducing food waste
- MOBILITY: Promoting walkable cities, including improving bike infrastructure and using mass transit
- GENDER EQUITY: Educating girls and improving access to family planning
- ENERGY: Increasing the efficiency of buildings and transitioning to clean energy sources
- NATURE-BASED SOLUTIONS: Planting trees and protecting forests
An Invitation to Join the Movement
Throughout history, professional nurses have been at the forefront of change. Whether it was alleviating mass suffering related to conditions of war, addressing severe economic disparities that impact health, or responding to new and emerging infectious diseases, nurses’ orientation toward systems thinking and prevention have made them the ideal leaders for innovating and mobilizing effective solutions.
We invite you to continue this tradition by joining Nurses Drawdown at nursesdrawdown.org. Under the Take Action tab, you will find practical solutions to apply in both your personal and professional life. You will also be inspired by the stories of nurses around the globe who are taking action to promote a healthier future for generations to come.
Many will remember 2020 as the year of the pandemic. Let them also remember 2020 as both the Year of the Nurse and Midwife (World Health Organization, n.d.), and the year that nurses around the globe activated to address climate change. The nurses are here!
Alliance of Nurses for Healthy Environments [ANHE]. (2019). Alliance of Nurses for Healthy Environments. https://envirn.org/nursing-collaborative/
Hale, M. O. (1948). Arkansas midwives have all-day graduation exercises. The Child, 13(4): 53–54.
Hawken, P. (2017). Drawdown: The most comprehensive plan ever proposed to reverse global warning. New York, NY: Penguin.
Project Drawdown. (2020). Drawdown 2020. https://www.drawdown.org/
Wald, L. (1915). The house on Henry Street. New York: Henry Holt.
World Health Organization. (n.d.). Year of the nurse and midwife 2020.https://www.who.int/campaigns/year-of-the-nurse-and-the-midwife-2020
About Teddie M. Potter, PhD, RN, FAAN
- Clinical Professor, School of Nursing- University of Minnesota
- Specialty coordinator of the Doctor of Nursing Practice in Health Innovation and Leadership
- Director of Planetary Health
Dr. Potter is deeply committed to climate change education including co-founding Health Professionals for a Healthy Climate, membership in the Alliance of Nurses for Healthy Environments, and membership on the American Academy of Nursing Environment and Public Health Expert Panel. She is a member of the Coordinating Committee of Columbia University’s Global Consortium on Climate and Health Education and a Fellow in the Institute on the Environment at the University of Minnesota. She chairs Clinicians for Planetary Health (C4PH) and is a member of the Steering Committee of the Planetary Health Alliance at Harvard.
At the University of Minnesota, Dr. Potter designed and co-teaches an interdisciplinary course titled “The Global Climate Challenge: Creating an Empowered Movement for Change”. In addition, she co-leads a Health Sciences initiative titled, “Climate Change and Health: An Interprofessional Response”. In 2019, Dr. Potter was appointed the first Director of Planetary Health for the School of Nursing.
by Guest Contributor Kathleen M. Clark, DNP, RN
Edited by Kaija Freborg, DNP, BSN
Racism is a public health issue and has been the root cause of health disparities for Black, Indigenous, and Persons of Color (BIPOC) in our country for over 400 years. The recent killing of George Floyd has brought this emergent issue to the forefront of our nation’s attention as we bear witness to a man struggling to breath against a knee of a police officer. An incident that took 8 minutes and 46 seconds, which may be the same amount of time it takes for you to read this blog, sent people around the world into a rage demanding justice. In the words of James Baldwin, “Not everything that is faced can be changed, but nothing can be changed until it is faced.”1(p0) And in my view, facing George Floyd’s death will change the world– we have a responsibility to make sure that it does.
The reflections I offer in this blog are rooted in the epicenter of the unrest, the city of Minneapolis, amidst the worst pandemic in modern day history. As a nurse, representing a profession repeatedly cited as the most trusted profession, my worldview is influenced by the patients I serve, those experiencing homelessness in Minneapolis. In this setting, as I direct the Augsburg Central Health Commons, a nurse-led drop-in center serving those unhoused or marginally housed, I have witnessed the implications of health issues for these individuals. One of those individuals was George Floyd. While I knew him in a limited capacity, his membership in the community has amplified the emotions and passions felt by others to take action in response to his death. Poverty and police brutality, both longstanding issues in the black community of Minneapolis steeped in institutional and structural racism, ultimately led to George Floyd’s murder; his arrest was allegedly over a counterfeit $20 dollar bill. Stories like this are but one of the many stories I have collected as a nurse engaging in civic agency. I teach in the graduate nursing programs at Augsburg University, which focus on transcultural nursing and social justice praxis. Here are some of my reflections and experiences.
During the height of our state’s peak of COVID-19, the video capturing George Floyd’s wrongful death spread through social media sites. The anger at yet another killing of a black man by the hands of systemic racism in our policing systems could no longer be silenced as Minnesota has been the home of first Jamar Clark, followed by Philando Castile, and now George Floyd. Peaceful protesting resulted in nights of looting and rioting where buildings were burned, stores were raided, and the Minneapolis 3rd Police Precinct was taken over by demonstrators. After each night of protests, the early morning hours revealed not only the visible social carnage but also the anger, fear, despair and loss felt throughout the community.
One of those mornings I was providing care at the Health Commons, counseling people who had known George and mourned the destruction of their community. Despite all of this loss, they still felt compelled to support the riots because otherwise there would be no systematic change without it. Following the Health Commons, I was to bring food to the encampments that afternoon through local volunteer efforts to address the lack of food and water that existed for those living on the streets due to the restrictions of COVID-19. I was assigned to distribute food to the largest encampment in the Minneapolis area, referred to as the Sabo Encampment. Accessing the encampment itself was deemed difficult as the typical path to access it was located in the parking lot where a Cub Foods grocery store and Target had been set on fire the night before. After discovering a way to the area, I found myself in the middle of what I fail yet to understand. The police were dismantling the tents of the residence in the name of public safety. According to these officers, the residents of the encampment were the root cause of the rioting, and the encampment served as a public health concern due to the drug use and human feces discovered onsite. Thus, amongst the back-drop of charred rubble and buildings still in flames, surrounded by a group of activists from Native Against Heroine and Cop Watch groups, I made my way into the encampment to bring the food and water. Realizing how many people were now displaced by a pandemic and now race riots, with no place to go, I left that moment in a flood of emotions, tears pouring down my face. How could I possibly leave these people in this moment, knowing that they did not cause this unrest, had no place to stay, and were likely to endure more violence? I felt paralyzed.
As the days of unrest and destruction continued, those who were displaced bore the burden of violence from tear gas used and rubber bullets fired. That following Saturday night the National Guard entered the streets of Minneapolis on the Governor’s order to address the civil unrest. News stations across the nation captured tensions rising between demonstrators and the National Guard. Word spread that those causing much of the unrest were not local residents, but instead they were flooding in from other states, seeking to escalate the situation to a civil war. Those residing in those neighborhoods found themselves at a loss, not sure of where to turn to ensure personal safety, as vans of white supremacists dropped off people in alleys, explosives were placed in people’s yards, and the National Guard was firing rounds of paint pellets at people on their own porches.
Many residents shared stories of forming neighborhood watch groups during the unrest in response to 911 calls for help were no longer an option, as the system was overwhelmed. Lee George stated, “Last Saturday we were told by City Councilwoman Alondra Cano during a gathering in Powderhorn Park, that if something happens tonight, if your buildings are burning, if you have armed men in your neighborhood, you are on your own.” People organized a 24 hour watch system, prepared buckets of water, and connected hoses to spigots (for possible fires or if the water supply became compromised), packed a bag for an emergent exit if needed, and identified those who had certain skills such as medical training. Not only was the community mobilizing to protect one another, they found themselves caring for peaceful protesters caught in the crossfire or displaced after curfew. These actions demonstrated acts of solidarity in the community, as neighbors demanded justice for George Floyd.
A group of volunteers, who had been organizing efforts to address the health and safety issues in communities of homeless people during the pandemic, found themselves needing to mobilize in new ways due to the civic unrest. Inspired by the organization theory of mutual aid, they formed a human shield as best possible; volunteers, service workers, and nurses fought to secure safety for the unsheltered. After negotiating with a nearby hotel, the unsheltered were welcomed to stay at what was temporarily named the Sanctuary Hotel. The plan was that these individuals would be allowed to stay until the night time violence ended. That next morning (Sunday), I was able to help provide care to those staying in the hotel and in a nearby encampment. Most people were exhausted from the endless chaos and trauma they found themselves in. A few individuals suffered from eye irritants, wounds from rubber bullets, or falls while attempting to flee. Not one person told me they were actually part of the protesting, but instead they were caught in the crossfire because that is where they had currently called home. The owners of the hotel decided to allow the unsheltered guests stay longer, while a nearby foundation offered funds to cover the cost of the hotel. The members of the volunteer group, where there is no one leader named, spread the word that additional volunteers would be needed to maintain the hotel for the guests. Thus, endless volunteers helped to coordinate on site collecting donations, distributing food, cleaning rooms, washing clothes, providing medical attention, and operating the front desk. I have never witnessed a group acting in solidarity, without hierarchies or self-interests dictating the next moves. People came from outside communities to provide assistance and formed trusting relationships in real-time. While the hotel had to end the stay for the residence 10 days later, being part of this experience with this group re-invigorated my hope as a nurse in the way we can co-create community in the future.
While still enduring this pandemic, Minneapolis communities continue to organize in unity as well as protest for justice in the wake of George Floyd’s death. While I have endless stories to offer from my nursing practice, these ones surfaced as vital in demonstrating the capacity to act, to create solutions in community that are potentially life-saving. Nurses have power and this privilege can be used to support and create change in communities where we are called to care. I have been transformed by the destruction, fear, and pain that has been embodied in structural racism in Minneapolis for more than 100 years, but I’ve also been transformed by the kindness, goodwill, and brave actions of people – many of them nurses – demanding justice for George Floyd.
1Li C. Kinfolk. Confronting History: James Baldwin. 2017. https://kinfolk.com/confronting-history-james-baldwin/#:~:text=But%20nothing%20can%20be%20changed,wrote%20the%20late%20James%20Baldwin.
About Katie Clark
Kathleen ‘Katie’ Clark is an Assistant Professor of Nursing at Augsburg University and is the Director of the Health Commons. She has taught at Augsburg University since 2009 where her primary responsibilities are in the graduate program in courses focused on transcultural nursing, social justice, and civic agency. She also practiced for over eight years in an in-patient hospital in both oncology-hematology and medical intensive care. She has a Masters of Arts in Nursing degree focused on transcultural care and a Doctor of Nursing Practice in transcultural leadership, both from Augsburg University. Katie has been involved in the homeless community of Minneapolis for over 15 years and has traveled to over twenty countries. She lives with her husband and three children in Stillwater, Minnesota.
About Kaija Freborg
Kaija Freborg is the Director of the BSN program at Augsburg University and has been teaching as an assistant professor in the undergraduate and the graduate nursing programs since 2011. Her focus in teaching includes transcultural nursing practice as well as addressing social and racial justice issues in healthcare. She obtained a Doctor of Nursing Practice degree in Transcultural Nursing Leadership in 2011 at Augsburg before teaching at her alma mater. Currently her scholarly interest in whiteness studies has her engaging in anti-racist activism work both in nursing education and locally; her aspirations include disrupting and dismantling white supremacy within white nursing education spaces. Previously Kaija had worked at Children’s Hospitals and Clinics in Minneapolis, in both pediatrics and neonatal care, for over 15 years.
The COVID19 pandemic continues to be quite an issue in New York, with over 14,000 deaths reported. I found this link to the New York Times to be helpful in assessing where we are with official numbers of reported testing and deaths (NYTimes CVOID19), though in many states we know that testing remains very limited and accuracy of tests is still only at about 67-70%.
PPE: Nurses are still without proper PPE. While the federal government claims to have distributed millions of masks and gowns, frontline workers are still faced with shortages and putting themselves at risk. Now we are seeing surges in the cost of PPE, with costs going up over 1000%, according to a report published last week by the Society for Healthcare Organization Procurement Professionals. Competitive bidding for these supplies both internationally and within our own county has compounded the issue, and if we had federal government oversight and processes in place, it is likely these issues could be addressed in ways that would help to prevent price inflation ( CNN review of the inflation of PPE cost).
This video that appeared on CBS’s 60 minutes made it clear that nuses like New York nurse Kelley Cabrera are beginning to speak out. Nurse Cabrera works at Jacobi medical center in the Bronx. She makes the point that when nurses are required to reuse N95masks for up to 5 days, they are literally being provided with medical waste to be used as PPE. Nurse Kelley Cabrera 60 minute’s interview
Nurses Stories: Meanwhile, I have heard the stories of nurses continuing to work without proper PPE and we reultantly have high numbers of nurses testing positive in areas like Ohio.
Nurses have started to reject the idea that they be considered to be angels or heroes. They didn’t become nurses to die, and they don’t want to be martyrs. While the 7 pm clapping and cheering ritual in New York City seems to have built a community spirit, some nurses experience this differently. One New York City nurse wrote: ” I ask that you do not pity me, that you do not call me a hero. I do not wish to be made into a martyr….Clap for me and other healthcare workers at seven o’clock if it makes this pandemic feel more bearable. I concede, your cheers help us trudge on. Just know that cheers and hollering don’t change the outcome. This is my fervent plea – that we change what we can after all this is over”.
Fallen Nurses: The loss of nurses becomes hard to track as the numbers increase. NYSNA has set up a memoriam page: Fallen Nurses Memoriam
A 28-year-old pregnant nurse in the UK passed away on 4/12, RIP nurse Mary Agyeiwaa Agyapong. Her father passed away two weeks before she died. Mary’s baby daughter was delivered via cesarean section before Mary died.
Many other nurses and hospital staff in the UK have also died (daily mail review of nurse and staff COVID19 deaths).
Two nurses in Palmetto, Florida have also died from work related exposure to COVID19. Nurse Danielle Dicensio leaves behind a 4 year old son and hubsand. Nurse Earl Bailey also worked at the same hospital, Plametto General Hospital, and he passed away from CVOID19 a few weeks ago. Both nurses complained about not having access to proper PPE, which the hospital denies (two nurses die of COVID19 ).
A colleague of Nurse Cabrera’s (mentioned above), Freda Orcan, who worked at Jacobihospital in the Bronx passed away March 28.
ANA’s response to COVID19:
The Ameican Nurses Association has issued a statement that nurses should be reporting when then experience retaliation around their raising concerns regarding their personal safety in the workplace, as these are OSHA violations (OSHA and retaliation issues). While hundreds of complaints have been filed, it’s difficult to determine specifically how OSHA is responding to reports made. There is a plethora of information on their website regarding COVID19 issues (https://www.osha.gov/SLTC/covid-19/),
The ANA has created a page of resouces for nurses (ANA COVID19 page). There have developed a corona virus response fund for nurses. There is also a section about ethical guidelines for nurses that may help some in their decision making process and calls forward the bigger ethical issues that nurses are facing, and links that show all of the steps that ANA is taking in advocating for nurses.
The latest ANA/ AHA/AMA letter witten calls for the government to address the issue of minorities and the disparities they experience with receiving adequate care for their COVID19 issues. (ANA letter to the Secretary, US Department of Health and Human Services). The letter in part reads:
“As organizations that are deeply committed to equity in health status and health care, we have long recognized differences in the incidence and prevalence of certain chronic conditions, such as diabetes, asthma, and hypertension — conditions that are now known to exacerbate symptoms of COVID-19. We also recognize that other factors, including but not limited to socioeconomic status, bias and mistrust of America’s health care system, may be resulting in higher rates of infection in communities of color. Lack of access to timely testing and treatment will inevitably lead to worse outcomes for these patients.
As America’s hospitals and health systems, physicians and nurses continue to battle COVID-19, we need the federal government to identify areas where disparities exist and help us immediately address these gaps.”
While ANA has been interacting at the national level, my perception from the nurses directly working with patients on the frontlines is that they feel under-represented and that ANA is not providing them with the voice they need. One time letters to federal authorities seem to make little measurable immediate impact. around what matters for nurses being able to practice safely. They also feel that many of the practicing nurses don’t belong to ANA exactly for this reason: that there is somehow a gap between the reality of nursing practice and the work and publications of the ANA. The crisis is far from over.
May all nurses and all beings know some peace and ease.
At this point, things are so disheartening for so many people. The range of nurses’ stories is so wide and varied, from OR nurses being essentially laid off due to no elective surgeries happening, to nurses being offered a lot of money to come to New York City to work.
New York State has taken the unprecedented step of merging all of its 200 hospitals into one system (New York State hospital system consolidation ).
There’s a lot of death. One nurse told a story of how she had 10 patients in one shift and 7 of them died. In some hospitals, there is a different kind of rapid response team called, specifically for CVOID19 patients, and they are being called sometimes just minutes apart on different units throughout the hospital.
Also, nurses are working with their colleagues who end up being patients in their same units; one nurse told of their nursing supervisor being hospitalized in their own ICU, and they conjectured the supervisor most likely would pass away there.
There’s a lot of understaffing and over-working, including on the medical-surgical units. Part of this is because nurses themselves are becoming ill and unable to come to work.
Some nurses are actually more frightened to work in the medical-surgical units because they have a lack of PPE, and all patients are presumed to be COVID19 negative. Of course, when tests come back days later, the nurses discover that they worked with these COVID19 positive patients without proper PPE. There are also many issues around HIPPA and staff not being able to find out the COVID19 status of the patients they worked with previously.
Another nurse relayed this story: he works twelve-hour shifts on a medical-surgical floor, and their usual patient load now runs from 12-15 patients, the only real charting they really do is vital signs and meds. This is possible because NYC has suspended a lot of normal operations when it comes to providing care as per the governor’s laws:
“A massive section of regulations on the “minimum standards” governing hospitals — dealing with everything from patients’ rights to the maintaining of records — has been suspended ‘to the extent necessary to maintain the public health with respect to treatment or containment of individuals with or suspected to have COVID-19’.” (read about all of the laws suspended) .
This nurse cries after every shift, and he stated his tears are so different from before, in part due to his utter exhaustion. His family and friends want him to quit, they are worried about his health, but he stated he can’t quit now, they need him too much.
Nurses are asking about ramifications of quitting their jobs; some claim that they have been threatened that they will be reported to their board of nursing for disciplinary action (this is not the reportable offense of walking out and abandoning patients, rather for resigning their position). While these threats are likely idle, some nurses are still fearful of losing their licenses.
One nurse states that she works in a COVID19 only ICU unit. She says it’s mostly completely staffed by RNs: they have no NPs, PAs, Residents, Techs, or Housekeepers. Nurses and ICU Attending and Intensivists care for the patients. Med Surg nurses act as techs and assist the ICU nurses.
Recruiting: There is still a lot of recruiting going to bring nurses to NYC. One new graduate nurse (recently licensed, with no work experience) posted on social media about being offered to be “trained” to work in the ICU in NYC. All of her travel and lodging would be covered. She would be required to work 21 days, 12-hour shifts, with no days off. The majority of the experienced nurses tried to set her straight about why this was a really bad idea, but we have no idea if she proceeded or not.
It’s not just NYC: We now have a 54-year-old nurse in Michigan who died, Lisa Ewald.
Unfortunately, nurse Ewald may have had some issues with initially being tested by her workplace, Herny Ford Health System in Detroit, Michigan. She was likely exposed on March 24, received her positive test on March 30, and passed away on April 3. She died alone in her home. (Lisa Ewald’s story).
Rest in Peace Nurse Ewald.
Meanwhile, more than 700 Henry Ford employees have tested positive for COVID19; 500 of the positive tests are nurses. (Henry Ford COVID19)
The field of nursing will be forever changed by this.