As the efforts to roll back the U.S. Affordable Care Act has progressed, what has emerged even further is the resistance from “we the people” – resistance that has, in no uncertain terms, changed the conversation. So even though we hear, every day, another jaw-dropping bit of news that threatens democracy world-wide, it is vitally important that we shift our gaze and energy to continuing whatever actions we can do to sustain our public voices. As Bernie Sanders stated in a recent interview with The Guardian –
“This is what they [the people] should do,” he says, pumping out the Bern. “They should take a deep reflection about the history of this country, understand that absolutely these are very difficult and frightening times. But also understand that in moments of crisis, what has happened, time and time again, is that people have stood up and fought back. So despair is absolutely not an option.”” (source)
Our “Declaration of Solidarity and Resistance” continues to draw supporters – not only from nurses but from many others who join us in declaring the values that motivate our actions – actions that are not only important as acts of resistance to the current political trends to damage health and well-being, but actions to affirmatively promote and protect health and well-being for those we serve. Our Declaration informs our deep reflection – reflection on the historical stand that nurses have taken for decades, and reflection on the political courage to step forward to act – to resist, and to build a future based on these values!
We welcome your stories, photos, videos – anything that you can share that shows what you are doing! If you are sending a postcard to the White House on March 15th, send us a photo of your card! If you are attending a rally, send us a photo or a video! Write about your reflections, and ways that you are shifting away from despair! We want to hear from YOU!
A few weeks ago (I know, don’t tell me it feels like months!), when the 45’s “Muslim Ban” was in full swing, Pamela Cipriano, the current President of the American Nurses Association, issued a statement that reads as follows:
“Nursing is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice. The ANA Code of Ethics for Nurses with Interpretive Statements establishes the ethical standard for the profession in its fervent call for all nurses and nursing organizations to advocate for the protection of human rights and social justice.Therefore, ANA opposes any action that erodes the human rights of people, and strives to protect and preserve the rights of vulnerable groups such as the poor, homeless, elderly, mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.This underlying principle must be considered in light of the current Administration’s efforts to halt refugee admissions for 120 days and block citizens of seven Muslim-majority countries from entering the United States for 90 days.Any actions taken that are intended to increase the safety of our country must be clearly defined and not jeopardize human rights nor unfairly target religious groups.” (http://nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2017-NR/ANAPresidentResponds-ImmigrationEO.html).
Social Media Reaction
I happened to read this on facebook, so of course I was very excited to see a nursing leader take a public stand. As I moved onto the comments section, I was concerned by what I saw, as it seems about 50% of the nurses commenting were concerned about the political nature of Dr. Cipriano’s statement, and comments were made that nurses should not be making political statements, that ANA should not be taking political stances, and that there is no room for politics in nursing.
We still have a lot of work to do in educating nurses, both in the academic and professional settings. We need to ensure that nurses understand their ethical obligation to act as advocates for populations; and that this obligation extends beyond the bedside and workplace setting and out into the wider arena of politics.
Ethics and Political Action, Advocacy, and Activism
The Code of Ethics for Nurses With Interpretive Statements (American Nurses Association, 2015: http://nursingworld.org/DocumentVault/Ethics-1/Code-of-Ethics-for-Nurses.html) guides us in our nursing practice. In particular, nurses should be aware of the implications around the following provisions (emphasis added with italics):
- Provision 7: The nurse in all roles and settings advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
- Provision 8: The nurse collaborates with other health professional and the public to protect human rights, promote health diplomacy, and reduce health disparities.
- Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
All nurses can access this document for free online at the above link, and I would recommend particular attention be paid to provision 9.3 (integrating social justice, p. 53) and 9.4 (social justice in nursing and health policy, pg. 53-54).
I particular like how the ANA code provides a context for nurses to realize that our work does not stop at the bedside; we care for and advocate for those who do not have a strong voice, those who need support in attaining the best pathways toward good health and healing, and we care for and advocate for populations and the planet.
In this sense, when we made aware of political issues like the possible repeal of the Affordable Care Act, it becomes clear that we are ethically obligated to take action to ensure that vulnerable populations do not lose access to their healthcare, and that we be part of the conversation as new processes and policies emerge via federal and/or state mandates regarding healthcare insurance. This area may seem obvious, but we are also ethically obligated to take action when we see the health of specific populations and the health of the planet at risk.
One example of this might be the “extreme vetting process”, which is targeting refugees from specific war torn areas such as Syria. The atrocity of human destruction in Syria and the need for refugee re-settlement is one that nurses should be concerned about; the damage that is done to human life and the degradation of the environment and the planet in Syria is a global concern, and a nursing concern. Nurses should therefore be fulfilling our ethical obligation by questioning the new extreme vetting process and supporting a call to assist Syrian refugees. A war torn vulnerable human population requires social justice action.
I am sure there will be more examples that require nurses to fulfill our ethical obligations in the forthcoming days and weeks as we look at this administration’s stances around the environment, healthcare, and even education (yes, our children are a vulnerable population away, one that needs a strong voice in support of the best educational practices).
So what can we as individual nurses do?
Make an action plan around a singular or perhaps a few areas of political concern. Keep in mind, your actions do not need to be huge or time consuming; calling, emailing, or writing your representative on a regular basis can take just a few minutes of your time, and it can be of great impact. Don’t forget to mention you are a nurse, and always strive to share personal stories around your topic of choice. Align yourself with other like-minded nurses, and take steps to balance your work-family-advocacy-self-care efforts. Rejuvenate yourself, and find communities that you align with.
The reason why we became nurses may vary to some degree, but most of us felt a calling toward healing, toward caring, toward supporting people and populations in maximizing their health. And the world needs nurses right now to fulfill their ethical obligations in the political arena.
As a nursing student in the largest French-language faculty of nursing in the world, I have the privilege to rub shoulders with budding scholars from all over the world. Today, I’d like to publish a text written by my friend and colleague, Houssem Eddine Ben Ahmed. It is a timely piece that helps remind nurses of our social contract, a concept that can help anchor us in these politically charged times. He is a PhD student in nursing, passionate about the application of Caring. He believes Caring, embodied in a educated and competent nursing workforce, is a question for public health as well as nursing. Here is his piece on Caring and learning processes:
It’s with great pleasure that I send you my brief description about my own experience of professional caring in nursing education. I’m currently a PhD student in Canada, but I was born and raised in Tunisia, where I also entered the academic world. Nursing education is quite different there, and graduate programs are not yet available for nurses. Consequently, I did my Master’s degree in Public Health, where I was able to bridge my nursing knowledge to broader issues. This is what led me to pursue doctoral studies where I could explore the relationship between nursing students and their educators.
I have learnt from my personal and professional experience how caring is important in many aspects of our lives. There is a professional type of caring that can be developed between two persons (nurse-patient or educator-student). This relationship needs time and can be nurtured and reinforced to promote the development of a caring towards others, outside the initial professional relationship. In the personal realm, there is also one’s innate behavior of caring. I want to distinguish between these two categories of caring because many nurses and educators think it’s impossible to change one’s attitude in our modern (and often cold and uncaring) society. By this distinction, I want to clarify that we, as a nurse scholars who are interested in caring, should work to integrate the professional caring in our science. As a PhD student interested in professional caring in nursing, I’m exploring the professional caring relationship between nursing students and their educators because I strongly believe that for caring to be expressed in all the different domains of nursing (practice, theory, research and policy), we must improve our reflection on, and attention to, the idea of caring in the learning process.
In the course of my first year in my PhD program, I developed a deeper understanding about the difference between a caring and non-caring educator and how this can affect learning processes. I realized how it’s important to function within a safe environment of teaching-learning and how professional caring can have a positive influence on me as a student and on my learning and professional processes. Through my doctoral project, I hope to develop pedagogical knowledge that will help all nurses with a teaching role (educators, directors, nursing scholars) understand that caring is also taught through the relationship we develop with our students. We need to focus more on developing professional caring in our profession to prepare the next generation of nurses to fulfill their social mandate. Patients and families need caring and competent nurses, and our students need educators that embody this concept to learn the scope depth of what caring is all about.
Houssem Eddine Ben Ahmed
Ph.D. student in Nursing Science
Université de Montréal
This morning I heard from a nurse in Seattle asking this question in response to our advocacy alert inviting comments on the proposed rules weakening the Affordable Care Act – “How can I be sure that my writing, calling and speaking up against these changes to ACA don’t actually encourage them to cut more? They seem to take our protests as success on their parts.” This is a terrific question, and it is one that plagues all of us from time to time! Here is my response – and I invite everyone to add your comments to this post – to help all of us focus on our determination to resist!
It is true that we really cannot know, at least not right away, whether or not anything we do will make a difference. But it is also true that a common initial reaction, by anyone, to opposition is to dig in further and make a “show” of being emboldened – and for the politicians, this is exactly what they will do for the first few signs of opposition. What they cannot withstand is a continued, large-scale show of opposition because at that point, it threatens their security. Those who are elected officials begin to realize they cannot survive with large scale opposition. Those who are appointed officials are also threatened, because our opposition threatens the elected administration that has put them in place. It may be true that they will ignore our opposition to all actions that threaten the health of the American people, but we will be on record for standing on the side of the people, and as our opposition persists, and grows, if anything will make a difference, this will.
There is another piece to this – there are things that people do that indeed do help them – which is to keep repeating what they say, even if we say “don’t” – when we say “don’t take away our healthcare” we are actually calling forth the image of what we want them not to do – to take it away. When we repeat their tweets and their promises to repeal, we are actually emboldening them. And so it is important to focus on what they do, not what they say. We will be posting suggestions for positive action regularly on the NurseManifest website, and also sending advocacy alerts like this one! (note: we are sending email advocacy alerts to all who signed the Declaration of Solidarity and Resistance and included your email)
This question also inspired me to re-visit my post earlier this month – Guidelines for Resistance – guidelines that we are using as we offer suggestions for action. Here again is the list of guidelines (tweaked a bit) – to help sort out, as best we can, what actions can be effective.
2. Remember this is a regime – he’s not acting alone; he has put in place many who have no interest in serving the needs of people for health and safety.
3. Do not argue with those who support the new administration –it doesn’t work;
4. Focus on his/their policies and actions, not his orange-ness, mental state, or wealth;
5. Keep your message positive; they want the country to be angry and fearful because this is the soil from which their darkest policies will grow.
6. No more helpless/hopeless talk
7. Support artists and the arts – pay attention to the comedians especially
8. Be careful not to spread fake news. Think like a scientist. Check it.
9. Take care of yourselves; and