Nurses’ Letter of Declaration Against the Russian War in Ukraine


Contributors: Marsha Fowler,
Deborah Kenny & Elizabeth Peter

Introduction

Soon after Russia invaded Ukraine, it became apparent that immediate action is needed, as innocent lives continue to be lost. We nurses are in a perfect position to do so. Nurses have a large, trusted, and strong voice to advocate for the Ukrainian people and issue a call to action for legislators to put an end to these amoral acts. Sometimes during war, civilian collateral damage is unfortunate and inevitable, but Russia’s targeting of healthcare facilities, churches, schools, and other non-military objectives clearly represents war crimes. To assist all nurses in this advocacy, Dr. Marsha Fowler (US) crafted the attached letter with further input from Dr. Deborah Kenny (US).

Please download and distribute widely the attached letter via your professional social networks and organizational channels. Send to your state Congressional representatives or other leaders representing your individual country. Please tailor for your own country as necessary. Distribute it to nursing students to show them how to advocate through policy action. Together nurses can have a tangible and significant impact on the global health and wellbeing of all individuals. Nurses can be a compelling force for good in the world. Call upon your respective nations governments to take swift and decisive action to end these war crimes against humanity.

US nurses: We encourage each nurse to contact your own Congressional legislators (or legislative body members) and the White House. Congressional members can be found through https://www.congress.gov/members.  Additionally, nurses can flood the White House switchboard at (202) 456-1414. It is staffed by live volunteers who tally calls. Call the White House to express your concern and you may use the letter as a template.

Download Letter in PDF format
Download Letter in Word format

Letter

Attn: President Biden, Vice President Harris, Sec. Blinken, Speaker Pelosi, Majority Leader Schumer, Congress, Chairman Milley, Secretary–General Guterres, President von der Leyen, President Roberta Metsola, Director–General Ghebreyesus:

We write to express our profound concern regarding the unjustified, unprovoked, and illegal invasion of Ukraine. Those who sign below represent nurse-leaders, many specializing in bioethics and, as such, we hold dear human life, health, well-being, human solidarity, dignity, freedom, and social justice as core values of our profession. These core values of the nursing profession, affirmed by the fields of bioethics, ethics, and social ethics, are themselves desecrated in Russia’s military invasion of Ukraine. Our concerns and requests are several:

We call upon the United States and the UN and its member nations to hold President Vladimir V. Putin of Russia accountable for multiple and egregious violations of the Hague Regulations of 1907, the Geneva Conventions of 1949 and its associated Additional Protocols, and the Rome Statute of the International Criminal Court.

Under Mr. Putin’s command, the Russian military have committed numerous violations of these regulations, conventions, protocols, and statutes. In particular, we draw your attention to violations of Geneva Conventions that specifically require:

  • respect for “hospital and safety zones and localities so organized as to protect from the effects of war, wounded, sick and aged persons, children under fifteen, expectant mothers and mothers of children under seven.”
  • respect for neutralized zones
  • protection of civilian hospitals
  • that “Persons regularly and solely engaged in the operation and administration of civilian hospitals, including the personnel engaged in the search for, removal and transporting of and caring for wounded and sick civilians, the infirm and maternity cases, shall be respected and protected.
  • that “Convoys of vehicles or hospital trains on land or specially provided vessels on sea, conveying wounded and sick civilians, the infirm and maternity cases, shall be respected and protected in the same manner as the hospitals provided for…”

Moreover, we express our outrage at the multiple violations of virtually every regulation under Article 51 of the Additional Protocol of the Geneva Conventions on the Protection of the Civilian Population. These have been made visible to the public through multinational war correspondents. The Hague and Geneva Law identify many of these violations as war crimes, e.g., the illegal use of thermobaric blast weapons against civilians and civilian sites.

We call upon the United States and the UN and its member nations to investigate, document, retain evidence, and try Mr. Putin for the commission of war crimes, genocide, crimes of aggression, and crimes against humanity, consistent with the evidence that is obtained, including but not limited to:

  • Intentionally directing attacks against the civilian population as such or against individual civilians not taking direct part in hostilities;
  • Intentionally directing attacks against civilian objects, that is, objects which are not military objectives;
  • Intentionally launching an attack in the knowledge that such attack will cause incidental loss of life or injury to civilians or damage to civilian objects or widespread, long-term and severe damage to the natural environment which would be clearly excessive in relation to the concrete and direct overall military advantage anticipated;
  • Attacking or bombarding, by whatever means, towns, villages, dwellings or buildings which are undefended and which are not military objectives;
  • Making improper use of a flag of truce, of the flag or of the military insignia and uniform of the enemy
  • Intentionally directing attacks against buildings dedicated to religion, education, art, science or charitable purposes, historic monuments, hospitals and places where the sick and wounded are collected, provided they are not military objectives;
  • Pillaging a town or place, even when taken by assault;
  • Employing weapons, projectiles and material and methods of warfare which are of a nature to cause superfluous injury or unnecessary suffering or which are inherently indiscriminate in violation of the international law of armed conflict. (From: Article 8 of the Rome Statute of the International Criminal Court)

While sanctions do not stop material aggression, harm, and damage to life, infrastructure, and environment, we call upon the United States and the UN and its member nations to place, consistently tighten, and maintain sanctions against Mr. Putin and his government so that he is economically and forcibly constrained in his action.

Mr. Putin has waged an unprovoked and unjustified war on a sovereign, democratic nation and has indicated his intent to carry through to the end his invasion until he achieves the full surrender, submission, and subjugation of the Ukrainian people. He has thus indicated that he will not negotiate withdrawal, rendering diplomatic solutions null. He has also indicated that sanctions will not affect his plans for Ukraine. Past statements have indicated his general contempt for Ukrainians and that Ukraine has no right to exist as a country. His invasion and wanton killing in Ukraine are genocidal. And, there is no indication that he will stop with Ukraine, following as it does his military actions in Syria, Chechnya, Georgia, Crimea—including the razing of Grozny.

We call upon the United States and the UN and its member nations, to intervene with increased humanitarian aid both, for the Ukrainian nation and its refugees, and to increase aid to refugee-receiving nations and conflict adjacent nations.

In addition to increased governmental aid, we ask that a central website be established for Americans (and in other nations) with links to authenticated governmental or non-governmental organizations, where donations can be specified for and directed toward aid to Ukrainians and/or Ukraine resistance and Ukrainian refugees.

We call upon the United States and the UN and its member nations, to markedly increase aid to the Ukrainian citizenry to increase their capacity for resistance to Russian invasion.

We support increasing the supply of rations/food, protective gear, field first aid and medical supplies, communications equipment, and those supplies necessary to support the resistance of the Ukrainian people. In addition, we also support the provision of arms, weapons, munitions, armored vehicles, armored fighting vehicles, planes, surveillance equipment, drones, classified surveillance information, cybersecurity expertise, and more.

We call upon the United States and the UN and its member nations, to provide for the medical and nursing needs of the Ukrainian populace, and nurses (and physicians) giving care under wartime conditions.

This war follows upon the heels of the Covid pandemic which had already strained medical and nursing resources in Ukraine. We ask our nation and the UN and its member nations to increase its provision of medical and nursing resources including but not limited to clothing, birthing kits, hygiene kits; cleaning, disinfecting, and sterilizing supplies and equipment; medical and surgical supplies and instruments; head lamps; tourniquets, bandages, and wound care kits; nutrition support for infants, children, and adults; blankets, towels, diapers, isolettes, bassinets, medications, antibiotics, and infusions; disposable scrubs; ambulances, and stretchers. In addition, nurses and physicians are living in hospitals in Ukraine and need personal support with food, warm clothing, ground cold-barrier foam for sleeping, blankets, clothing, and personal care items.

We call upon the United States and the UN and its member nations, to provide the necessities and comforts for the particularly vulnerable in Ukrainian society.

Many of the women, children and elderly persons have had to take cover in underground stations, basements, subway tunnels, and bunkers. We ask that our nation coordinate with NGOs and the International Red Cross to increase the donation of such things as clothing, shoes/boots and socks, blankets, ground-insulating foam rolls, food; child education and amusement kits and comfort toys; hygiene kits; feminine hygiene supplies, reading materials, communications tools; candles and flashlights and batteries, head lamps; supportive religious items; warm clothing, and other necessities.

We call upon the United States and the UN and its member nations to create collaborative and coordinated structures that can support the work of volunteer nurses and midwives who enter conflict zones to ameliorate the excess demands that fall upon the nursing and midwifery work of nationals in conflict zones.

The world is never free of war. War places even greater demands upon both military and civilian nurses and midwives. We call for the creation of an international structure and system of coordination and support for nurse and midwife volunteers who are willing to serve in conflict zones. The remarkable Médecins Sans Frontières, is a model that could be extended to an international cooperative and collaborative system of organizations and agencies, that are materially supplied by their nations of origin or international donations.

We are, collectively, horrified both at the invasion and the conduct of this war. As Mr. Putin appears to accept no diplomatic solution other than utter surrender and accession of the Ukrainian nation and its people into Russia, we ask our nation, and the UN and its member states, to do all in their power to force an end to this war, to maintain the sovereignty of the Ukrainian nation and its populace, to aid the Ukrainian resistance, to bring aid to the people of Ukraine and its refugees, to aid refugee–receiving nations, and to harden other nations against Russian expansionism, invasion and cyberattack.

In affirmation of the dignity of human life; the value of health, well-being, respect, and freedom; the hallowed nature of the natural environment, and our commitment to justice and peace as nurses and bioethicists, we humbly submit these requests and urge stringent intervention to halt this unjustified war, to punish war crimes, and to restore Ukraine and the Ukrainian people to sovereign status.

Sincerely,

“Overdue Reckoning on Racism in Nursing” – Taking an August Break!


Our organizing team for this project has decided to take a break from our usual monthly schedule for the month of August – but we will be back in September! Remember to follow this blog to get email notifications of our blog posts – we will announce each new event well in advance!

The Last Saturday “BILNOC” gathering in July is (of course) happening before our August break!

Then …. no gatherings in August. But never fear – members of the organizing team are going on a virtual retreat in August with the intention to revisit and renew our commitments, and return to this work with new vigor! We believe that this project is vital for the future of nursing, and that our approach to addressing racism is both unique and necessary. We believe that until the voices of nurses of color are at the center, racism in nursing will persist.

So watch this blog – we will post here the specific plan for September and going forward! We WILL go forward .. our commitment to this work is unrelenting!

If you have ideas for the future of this project, please let us know! Use our contact form here – https://nursemanifest.com/contact-us/. We are eager to hear from you!

Nurses’ Concerns with COVID19: Update April 1, 2020


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. 

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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.

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(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.

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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

Namaste

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Nurses’ Concerns COVID 19: Update March 26, 2020


Yesterday, I received an email from Governor Cuomo asking about my availability to be part of the surge, where they are training and employing nurses to be on the front line of care during this pandemic. I am assuming I received it as I am newly licensed in NY state for my job.

Today, I learned from a nurse colleague of this story of an assistant nurse manager dying of COVID19. He had been treating COVID19 patients, was hospitalized March 17, and passed away Tuesday. Kious Jordan Kelly, RN, may he rest in peace, was only 48 years old. It was reported that he had asthma.

Unfortunately, he worked at one of the hospitals, Mount Sinai West Hospital, where nurses were reportedly short on PPE and using trash bags for PPE.

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The nurses were also posting that they were out of masks and they were reusing disposable ones, along with reusing face guards that are simply wiped and reused. Some nurses are stating that the hospital should be held responsible for Nurse Kelly’s death, as they failed to provide him with proper PPE. Despite the pictorial evidence, Mt Sinai denies that the staff doesn’t have proper PPE.

I am seeing a bit of a shift in social media, where nurses are starting to resign or refuse to work due to lack of PPE. Nurses, in general, appear to be more accepting of the idea that some nurses have decided that it’s not worth the personal risk. I think we have to consider that the amount of stress and anxiety this pandemic has caused can also decrease immunity and stress resilience. We need to take care of each other.

Meanwhile, many states are calling for new grad RNs who may not even be licensed yet to be trained and allowed to work in these settings. We all know that ER and ICU type nursing skills that COVID19 patients require are not created overnight: it takes many nurses years of learning and growing toward expertise to be truly effective in these settings. This brings to mind questionable standards of care; as the population in need grows, we will lack the ability to provide skilled care that is needed. Some hospitals are trying to do rapid ICU classes, in literally 2-3 days, attempting to train nurses with some experience to become ICU prepared. I don’t know if that is really effective or possible, and I also don’t have other solutions to offer. I’d love to hear your thoughts on this.

Lastly, I leave you with this great link to the New England Journal where Dr’s Ranney, Griffith, and Jha discuss much of what I have also written about around the Defense Production Act. We need the President to actually enact so ventilators and PPE can be manufactured and distributed here. https://www.nejm.org/doi/full/10.1056/NEJMp2006141

Please, take action: contact your congressional members and the white house and demand that action be taken. https://www.usa.gov/elected-officials

Nurses’ Concerns with COVID19 Update: March 21, 2020


This will be a quick update to implore nurses to not use cloth masks and not call for the creation of more cloth masks. The evidence shows that they are ineffective, do not create a barrier for transmission, and may in some ways increase transmission.

We all learned in nursing school that once the mask becomes damp it’s not effective. Cloth masks will become damp within minutes and we have no evidence around if adding in a filter or other materials sandwiched between layers of cloth will help. Add to this that one then has a wet, potentially contaminated cloth mask that should likely be disposed of, but at the very least needs laundering, and it becomes clear that cloth masks are not the answer. They may indeed be harmful.

In my humble opinion: The CDC stating that bandanas, scarfs and cloth masks could be helpful when they are actually potentially harmful is reprehensible.

Please review the BMJ Open article entitled:

A cluster randomised trial of cloth masks compared with medical masks in healthcare workers.

https://bmjopen.bmj.com/content/5/4/e006577?fbclid=IwAR2bng1KIAtVW3PjBns3usq_3tOmQG2wvYxWiSxJXdITf4uqvIuB-tMcHy4

While the ANA has called out the CDC on their call for non-evidence based protocols and statements and addressed the white house, nurses are going to have to act locally.

At the very least please contact your representatives and demand access to proper PPE, increases in manufacturing, the federal government taking more responsibility for ensuring our safety.

How can we organize ourselves around advocating for proper PPE?