For this week’s reflection on our “Overdue Reckoning on Racism in Nursing,” watch this conversation between Jemele Hill (staff writer at The Atlantic) and Ibram X. Kendi about his book “How to Be an Antiracist.” This conversation was recorded at the 2019 Aspen Ideas Festival, and touches on so many fundamental ideas that are at the heart of what we are doing in our “overdue reckoning.” At the close of this conversation, Dr. Kendi speaks to the importance of caring for ourselves as we engage in anti-racism activism!
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.
Ongoing Issues: By now, most of us know the obvious: nurses and other healthcare professionals do not have the PPE that they need to practice safely. Nurses are testing positive for COVID19. The Defense Production Act has not been activated to produce more PPE and ventilators, and nurses and other providers are even fired for speaking out about it or organizing ways to access more PPE (Doctors and Nurses Fired for Speaking Out ).
Nurses’ Skill Level: Nurses are worried about being asked to do work they aren’t prepared to do. A former student of mine, who has been in more of an administrative role, is extremely concerned with being asked to go back into a hands-on medical surgical or even ICU in a supportive role. Practicing beyond one’s skill level or expertise is just one area of concern that is likely to grow as more nurses become ill, or refuse to work, or are otherwise unable to work.
Volunteer calls: From California to NYC to Maine, nurses are being asked to submit their names to volunteer to work. Most of these nurses will be paid, and it is an effort to organize our resources.
Nurses on the Front Line: The stories I am hearing from nurses are war-time hell-like, maybe even worse then you have heard of if you don’t have direct contact with nurses on the front line.
An example is a story a friend of mine posted from his friend in NYC: in the ER, there may be 7-10 COVID+ vented patients waiting for ICU placement. Some patients are lying on the floor in the ER because there are no beds. People are being taken to rooms on the floors and passing away before they even get seen by a nurse on that floor. Medications like propofol, ketamine, versed, and fentanyl are being run without pumps because there are no more pumps. Supplies are running out. Med Surg nurses are being forced to run drips and vents that they have not been trained on.
Pay Issues: In Utah, nurses and doctors are being asked to take pay cuts, and there is concern that this will create a great deficit of providers in this state when professionals go elsewhere to work (Utah’s largest medical provider announces pay cuts). Meanwhile, note this lovely NYC serene skyline shot, with pay that must recognize the obvious inherent hazard pay for these positions.
(nurses recruitment add, contact information removed)
Populations and Outcomes:
Much preventative and maintenance care for those with chronic and even acute illnesses is now taking a back seat. A positive note is that telemedicine and telehealth are being used much more widely, and this may have a favorable effect on how we care for populations in the future.
Dr. Chinn forwarded a first-hand account to me of a nurse who is working in Brooklyn. She is concerned about how this illness is impacting Latinx populations, as they are often members of “essential worker” populations, and they also live in large households. This nurse states that these patients are at higher risk for death, and often experience death with less dignity. She also sees all staff getting sick, from direct care providers to janitors, and patient care technicians.
Anecdotally, in one social media group, I heard the nurses estimating that survival rate once a patient is ventilated is only around 14-20%. This is devastating to be surrounded around so much futile care and facilitating so much end of life care without perhaps the time and space it requires to do this well. (Edited: national statistics show a recovery rate of about 50% post ventilator initiation).
Heartbreak: I am hearing heartbreaking stories of nurses sending off their children to grandparents or ex-spouses, so they won’t be exposed in the household should the nurse become sick themselves or accidentally contaminate the household. Nurses who can’t hug or hold their loved ones are aching inside every day. Nurses dying. Nurses looking around at their colleagues and they might wonder, who will be the next to not be at work, which one of us might end up in the ICU? Nurses may know that much of the care they are providing is futile or palliative, which creates moral distress. I am very concerned when I hear of nurses working multiple shifts, with one nurse posting that she had worked 13 shifts in a row, another posting about minimal sleep, and losing 10 pounds already. They don’t have time to eat and when they go shopping, the stores are lacking in supplies. There is no question in my mind that nurses are being put at greater risk not only due to exposure, but also due to physical, mental, emotional, and spiritual stressors.
Post-Traumatic Stress: We could say nurses are stressed, or maybe we should just be truthful and say that nurses are being traumatized. I have great fears of nurses leaving the profession after this, and I also have great fears about the health of the population in general. I am fearful for those on the front lines without access to proper PPE. This sort of chaos we are experiencing may lead to positive change eventually, but for now, it’s extremely uncomfortable, painful, confusing, infuriating, and even disorienting.
We need to take good care of ourselves and take good care of one another.
I am reaching out with loving-kindness to all nurses:
May all nurses be safe
May all nurses be at ease
May all nurses be loved
May all nurses know personal healing
Robin Cogan sent along this article that was just published in the Philadelphia Inquirer about the art activism initiative she is involved in with Camden high school students. It is called #NoMoreEmptyDesks
Robin was featured on our “Inspirations for Activism Part II” series in September, and this project was also featured on NurseManifest in November! But media attention to this project, and the purpose it serves, is growing, and shows the power of one nurse to create change!
Inspiration for Activism
- A group of nurses, mostly from Toronto, ON who organized to become a distinct and unified nursing voice to speak out on social issues that
- Lobbied professional nursing organizations to take action on a range of issues, such as multilateral nuclear disarmament and child poverty
- Formed coalitions with like-minded non-nursing activist organizations advocating for women’s health, gender equality, peace
- Demonstrated support for controversial issues, e.g. abortion rights, needle-exchange programs
- Engaged in civil disobedience to shut down, temporarily at least, an “arms fair” protest the selling of arms to brutal dictatorships
- Took positions opposed to violence against women, economic globalization, racism
- Exposed nursing workplace issues, such as nursing cutbacks, preferential treatment of physicians over nurses, and racism
- Published a newsletter initially, then later a magazine sold in news outlets across the country – “Towards Justice in Health”
Free download through April, 2018 – article providing a critical review of “Towards Justice in Health” magazine – Falk-Rafael, A. R., & Bradley, P. A. (2014). “Towards justice in health”: an exemplar of speaking truth to power. ANS. Advances in Nursing Science, 37(3), 224–234. https://doi.org/10.1097/ANS.0000000000000034