Reflections on Nurses Declaration of Solidarity and Resistance


It has been nine months since we posted the Nurses Declaration of Solidarity and Resistance, calling for nurses to join together in expressing the values on which we will act in the face of potential US government policies and actions harming health and well-being of people and the environment.  We now have over 2,000 co-signers – a modest but important expression of concern and determination to act to protect and promote health.  We have heard from many NurseManifest readers with comments, some raising concerns and issues with bits and pieces of our Declaration, but many giving “voice” to their own renewed dedication to exercise the rights of citizenship on behalf of these values.

Now, nine months later, it is clear that we had a sound basis for sounding the alarm regarding the new administration’s intentions.  At the same time, the underlying belief in the power of people to resist is also well-founded. The efforts to dismantle and undermine the US Affordable Care Act have not abated, and some of these efforts are beyond our reach, but the remarkable resistance expressed by people across the nation has been loud and clear, and largely effective.  Indeed, there is no thoughtful person who claims that the ACA is as it should be, but the steps that it provided toward  more equitable care for all have embedded in the heart and mind of our nation that we can do better than we have in the past, and that it is worth striving toward an even better way.

Yes there are many reasons to still despair. Serious, deeply embedded social and political problems like the challenges of healthcare, protection of the environment, and protections against economic insecurity seem intractable.  But as we support one another in raising our voices and lending our energies to work toward the ideals we seek, we will continue to see a way forward to do what we believe is right and good.

So today, I call upon all who read this blog, to reflect on the values that are embedded in the Declaration, and in the Nursing Manifesto, and renew your focus on values that guide your intentions and that energize your actions!  Share with us here things that have inspired you over the past few months, and that have made it possible to act on the values you hold dear!

To Men in Nursing: Consider Your Privilege


I want to talk about men in nursing and privilege. I expect it will be a difficult, nuanced dialogue, but it’s an important one, and one particularly relevant to nursing, a profession so entwined with the ideals of egalitarianism, advocacy and feminism.

Before I begin, I want to clarify: I do not want to challenge the presence of men in our profession, their growth in numbers, their competency, or their intentions. I do want to challenge men in our profession to challenge themselves to analyze their privilege, and I want to challenge men in our profession who have already done this work to challenge others to do the same. Specifically, I want to challenge male nursing groups, particularly NYC Men in Nursing and the American Association of Men in Nursing, that provide networking and career opportunities for their mostly male members. Broadly, I want to challenge all male nurses who use their privilege, inadvertently or purposefully, to get higher positions and higher pay.

I identify as an intersectional feminist. Intersectionality is a term used by modern feminists to define the multiple identities that are subject to systems of oppression. An intersectional feminist holds that arguing against sexism is logically and ethically invalid if you do not also rally against racism, classism, homophobia, transphobia, queerphobia, ableism, ageism and religious discrimination in our society. Intersectional feminists work hard to examine their own identities of privilege (I, for example, am white, able-bodied, cisgendered and educated) and how they have benefitted us, and work to dismantle the systems that bolster that privilege. Intersectional feminists “call people in” instead of calling them out.

I often discuss experiences of discrimination in the workplace with other non-male identifying feminists, and through these conversations, I learned I am very lucky to be a nurse. Compared to tech or the restaurant service industry, for example, nursing is a feminist dreamland. Most men I have met in nursing have been respectful and compassionate. Disappointingly, however, only a few have demonstrated a deep understanding of the privilege they enjoy, both in our profession and society at large, due to their gender. Male nurses have great capacity to be intersectional feminists, but because they do not bear the brunt of gender inequality, it takes more work for them to recognize it than it does for women, and because it’s hard to say no to a leg up, it takes more self-sacrifice to shun its benefits.

As an intersectional feminist, I empathize with the position of men as a minority in an industry. They comprise only about 10% of nurses. Male nurses have historically been made fun of for being feminine (I’ve seen the movie Meet the Parents), which I’m sure can be hard for some men. Male-identifying nurses who are gay or queer suffer homophobia in the workplace. Our black male nurses come from identities that have higher rates of imprisonment, police brutality and death by homicide. Men are also more likely to be mistaken for doctors, according to one male classmate of mine, for whom I played my well-worn miniature violin. Seriously, though, I empathize with all of this and readily acknowledge that some identities men have (race, disability, sexuality) put them at higher risk for discrimination than some women. I even empathize with the doctor comment, but mostly just because I am proud to be a nurse. 

But we must remember, a minority population is not always a victimized one. Male nurses are more likely to hold advanced practice positions, and they earn more money than female nurses in comparable positions with comparable accreditation and experience. Men are less likely to be the recipient of sexual harassment from a patient or coworker. Men are less likely to be demeaned and ignored as professionals by MDs and other team members. Men are promoted faster and more often. Ultimately, the privilege men, particularly white men, still have within our profession is difficult to reconcile, and to me, despite my empathy, trumps their minority status.

As a student at NYU, the most active group at my school was Men Entering Nursing. Despite their good intentions, I could not shake my philosophical argument with the group. I keep coming back to one analogy:

Imagine that we had a student interest group for white students. Imagine that the group for white students became the most active group in the school. The group hosted events with all white presenters. The professor leading the group was friendly and available and helped you find jobs and study for tests. The group had a strong affiliation with the citywide white group, which provided excellent career guidance and networking opportunities. Of course, non-white students would be allowed as well, if they wanted to join the group and enjoy its networking and academic benefits. Some non-white students even sat on the e-board, but most avoided joining because they had enough on their plate trying to address non-white issues. To top it all off, one month after the election of Donald Trump, all the white students in the school (even if they weren’t Whites in Nursing members) were asked to gather after the last exam before graduation in their scrubs and take a group photo, and no one questioned it at all.

Even if white people only comprised 10% of the student and professional population, this would be inappropriate. I am a white person, and I would do everything I could to reduce this group’s influence at the university, or I would try to funnel the momentum of the group toward events and dialogue focused on privilege analysis. This is what I suggest men in nursing do in the future. 

This is my perspective, but I am open to others. I am open to being called wrong and being corrected. I am open to dialogue. Please share your ideas.

Jillian Primiano, RN, BSN, recently graduated from NYU Rory Meyers College of Nursing, where as a student, she worked with the Hartford Institute of Geriatric Nursing to develop education for geriatric care providers and improve health outcomes for older adults. Before earning her nursing degree, she studied History and Journalism at Boston University with a focus on Cold War anti-war activism, feminism and the Civil Rights Movement. After her first stint in college, she spent three years teaching English, American Studies and International Relations at An Giang University in Vietnam’s Mekong Delta, where she learned about her privilege in ways she could never have imagined.

Nurses Take DC for Safe Nurse:Patient Ratios on May 5!


For a number of years, nurses have marched on DC to call for changes in nursing and healthcare that the conditions under which nurses care for patients.  This year the specific issue is safe nurse:patient ratios, calling for passage of bills that are already in both the House and the Senate that set national standards for nurse:patient ratios.  This event promises to be an invigorating event with inspiring speakers and the opportunity to be part of a strong, non-partisan event focusing on issues of great concern for all nurses.  The march also coincides with the following week designated as “nurses week” – a U.S. tradition highlighting tokenism at its best (full disclosure – my personal opinion!).  The march has the potential to energize nurses across the country to bring the activism home, and during nurses week take local action calling for safe ratios at home – in place of roses!

For more information, visit the Nurses Take DC website.  You can also follow the Nurses Take DC Facebook page, or follow #NursesTakeDC on Twitter.

What is “best nursing care?” Deconstructing the business model driving healthcare


The current feature on the AJN blog “Off the Charts” is a post titled “The Limitations of Rating Nursing Care by Customer Surveys.”  Since I have, for many long years, decried the practice of basing the evaluation of nursing care on patient satisfaction surveys, I jumped at the opportunity to read this post!  Of course we need and want to know how patients perceive the care we provide, but how we obtain this information, and what we do with this, is a key factor.  Since this approach derives fundamentally from the corporate business model, and is now practiced in the context of this model, the substance, use and outcomes of this practice are deeply flawed when examined from a NurseManifest perspective.  The example the author, Juliana Paradisi gives as an example of her best safe and compassionate nursing care involves a woman in extreme distress who “fired” her as her nurse –  a situation in which she could not break through the barriers inherent in the patient’s distress, but provided a level of care that was exemplary.

Even though the overarching business model that governs healthcare now is probably not going to go away soon (Ha!) – we can raise awareness of the limitations that this imposes on our practice, select specific actions to take to place these practices into context, and work to achieve whatever changes we can make.  We can start with addressing the question: “What is best nursing care” from the perspective of the values in the Nursing Manifesto.  There is no single answer to this question – but there are insights to be gained by thinking, talking and writing the ideas that arise from it. Once we have expressed our ideas, we can examine new and better ways to document our care, and continue to address the limitations of the existing practices that fail to document and support our best practices.

We welcome your ideas here – and stories about the times you provided what you think is the best nursing care!

off the charts

The Power of Ten!


Sigma Theta Tau has now published the 2nd Edition of the book “The Power of Ten,” a book of essays by nursing leaders that address ten top issues for nurses to rally around for the next few years.  These issues were identified prior to the results of the 2016 election, and now they are issues of increasing importance!  The essays provide ideas and inspiration for actions to strengthen nursing’s focus and activism.  The issues are:

  1. Educational Reform
  2. Academic Progression
  3. Diversity
  4. Interprofessional collaboration
  5. Systems thinking
  6. Voice of Nursing
  7. Global Stewardship
  8. Practice authority
  9. Delivery of care
  10. Professional handoff

This is an important resource for all nurses who are determined to act on the fundamental values of nursing.  The essays are a follow-up to the 2012 “Future of Nursing” report; the issues dovetail with the four recommendations of the report, and sine a light on the actions that nurses can take now to bring a culture of health to the center in shaping the future of nursing and healthcare.  The essays are short and to the point, and there are inspirational quotes from nursing leaders throughout that point the way forward.

Check it out! The book is available in several different formats directly from Sigma Theta Tau or from Amazon.  All proceeds from the book are being donated in equal parts to the American Red Cross nursing programs and the American Nurses Foundation.