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

houssemeddinebenahmed@hotmail.fr

As difficult as it is for me to believe, I only became aware of this slogan early in the 1990s, when I was already in my late 40s! At that time graduate work led me to the exploration of oppressed group theories and specifically feminist theories under that broader umbrella. At that time, and for some time afterward, I associated the “Personal is Political”, correctly or not, with the feminist movement and most specifically with women’s reproductive rights. It was then and certainly is now true on a much broader basis.

“Political” seems to have such a negative connotation for so many people who immediately associate it with partisanship, which in itself implies having to “choose sides” or offending friends and should therefore be avoided at all costs. I so often have heard the disclaimer, “I’m not political” when discussing an issue; I’ve seen Facebook friends offer an apology for posting something that others might construe as political (and making excuses that it is worth reading in spite of seeming political) and for announcing they are blocking political posts. And yet, politics can simply refer to relationships within a group and/or activities to gain advantage and/or power within that group, e.g., office politics . Students in my leadership class were challenged to embrace political activism as necessary to the pursuit of social justice. When they protested that they were “not political” I reminded them that if they had ever negotiated for extensions or marks on assignments, they were being political!!!

But in its larger sense, i.e, activities related to governance of a specific political entity, such as a town, city, state, country, etc., the personal most certainly must be political; democracy requires it. The freedoms we so easily take for granted – to speak out, to meet, to worship as we choose, etc. have been enshrined in constitutions and charters but are threatened by complacency and/or ignorance. Timothy Snyder, a Yale professor argues that Americans have a year or less to defend American democracy. In a lengthy interview, but one well worth the read, he draws comparisons between Europe in the 1930s and the current time in the U.S. and urges that we learn from history. He makes the point that regardless of the differences between the personalities that may be involved, the conditions and even more importantly the warning signs were there then as they are now -that a change in regime was the intent of those seeking power. And by change of regime, he means a change from democracy to an authoritarian state.

For the last number of years, I have travelled to Europe at least once a year, usually on a tour. I love the educational nature of the tours and through them have learned much about European history . Speaking with people who have lived through the Nazi and/or Communist regimes or both, I’ve come to appreciate more fully the cost at which their current freedom has come. Their personal certainly was political. My own parents escaped the Soviet Union a year after Stalin came to power. Many of us have similar stories and for me, it would be a dishonor to the sacrifices they made to dissociate from the political because it has become distasteful!

Last year, the tour I took was to England. It was in September, a few months before the American presidential election and a few months after the Brexit vote. I was very aware of being the only Canadian on the tour and wondered if the upcoming election would become a topic of conversation, which, of course, it did! I tried to simply listen but at one point a fellow passenger asked me what I thought. I replied that my fear was that if a certain candidate were elected, it would be the last American election. I was quickly reassured that was not possible because the Constitution and institutions put in place by the Founding Fathers were in essence a guarantee of continued democracy. I hope she’s right; yet recent assaults on the press and judiciary suggest otherwise.

The interview with Dr. Snyder referred to above was in response to his Facebook post on “20 Lessons from the 20^th Century”). Those lessons contain many political actions that are not visible to others, such as not obeying in advance, believing in truth, and investigating. Others, like “standing out” are more visible, may be more uncomfortable, but are equally important to protecting our freedoms and democracy. He warns that even worse than taking freedom for granted is learning to take unfreedom for granted without realizing that it is our choice and our actions which can make the difference.