Nurses Declaration of Solidarity and Resistance


The 2017 U.S. Executive Branch is taking steps that will have an effect on the health and well-being of all who reside within the borders of the United States, and of all people worldwide.  At this moment in history, we call upon nurses to stand together, act to resist that which harms health and well-being, protect those who are harmed, and build coalitions that move toward the ideals we seek.  We stand on a long legacy of political activism by nurses that arises from our moral imperative to actively promote public policy to assure social/health equity. Our actions are grounded in the premise that health and well-being depends on healthy environments and  just communities. We pledge to join with others to engage in determined action to protect health and justice for all, regardless of age, social/economic circumstance, religion, skin color, race, sexual orientation or gender identity.

1. We believe that health and well-being of mind, body and spirit is a fundamental human right.

As nurses, we are committed to provide care for all people – care that promotes and supports high level wellness, prevention and treatment of injury and disease, and restoration of health when it is compromised.  

2. We believe the integrity of our environment is integral to human health and well-being.

We oppose all actions that contribute to damage and erosion of the earth’s ecosystem and the physical structures which we inhabit. We will promote, protect, and support actions toward healthy and sustainable structural and natural environments for all the earth’s inhabitants.   

3. We believe that all people deserve access to affordable quality care.

As nurses, we are committed to caring for all patients and families, regardless of economic status, sexual orientation/gender Identities, current immigration status, age, ability to pay, or spiritual/religious beliefs/practices (or lack thereof).

4. We oppose all forms of oppression and discrimination.

We commit to protect and care for those whose safety and well-being is threatened based on gender, race, ethnicity, nationality, sexual identity, physical ability, economic status, or any other attribute seen as “difference.”  We will take public stands opposing any attempt to weaken public policies and programs designed to protect health and well-being of those who are disadvantaged. We will fight for policies and programs that assure equality and justice.

5. We oppose intimidation and violence in our homes and communities.

We will act to protect any who are victims of intimidation and violence, particularly those who are vulnerable because of skin color, race, sexual orientation, gender identity or religion.  As nurses, we nurture peaceful resolution of conflict and support those who step up to intervene peacefully in situations of threat and danger.

6. We believe that the health of women must be protected.

We will act to assure that all women receive the full range of care that assures their right to control their own reproductive choices as well as all women’s healthcare services needed to maintain their own health and the health of their families.

7. We trust scientific knowledge that supports a wholistic approach to nursing care

We examine all sources of evidence to inform the choices we make in caring for those we serve. We can assure the public that we practice from a firm foundation of sound and reliable scientific evidence. We will take all steps needed to inform the public of the science that supports our practices.

We invite all nurses, and our colleagues who support our values, to join us in declaring these  values and actions by signing this declaration. You can add your signature to this document here.  We invite you to use this declaration as you wish, and revise to suit your own purposes.  Let us know of your actions, follow #nursesresist, and join our Facebook group.

Contributing authors:

Carey S. Clark, PhD, RN, AHN-BC
Peggy Chinn, RN, PhD, FAAN
Elizabeth Berrey, PhD, RN
Lisa Sundean, RN, MS, PhD Candidate
Adeline Falk-Rafael, PhD, FAAN
Leslie Nicoll, PhD, PhD, MBA, RN, FAAN
Sue Hagedorn, RN, PhD, FAAN

Thank you to the Cambridge Health Alliance for inspiration!

If you would like to co-sign your name to this declaration, please provide your information using this formThe list of co-signatories will be updated as frequently as possible.

SEE THE DECLARATION AND LIST OF SIGNATORIES HERE

Making a list – of ways to support health, equality and justice for all


A couple of days ago I received an email from Elizabeth Berrey, who is one of this project’s leaders, in response to my post of November 15, “Grieving for my country.” Her message inspired me to think quite specifically about the list of things that I will do over the coming months to participate in action to resist the dangers that are becoming more and more clear in the US and world-wide, threatening the health and well-being of world citizens everywhere.  After all, his is the time of year that our children are making lists in anticipation of the December holidays,  At the same time, the notion of “lists” in and of itself raises a specter of danger for many – for example, there is now a website recruiting names of “liberal professors” (see report here and here).

So let’s be clear – making a list of ways we can act and be involved can serve to inspire others, particularly those who are tempted to give up in despair given what is happening around us.  But the list must also lead to action – and this is what is so inspiring about Elizabeth’s message.  We may not agree about the specific ways to act, and we can certainly have a discussion about the race, class and economic implications of any action we choose to raise awareness in the quest for finding the best and most effective avenues.  But unless we act, and support those who are choosing different paths than our own, we in fact support the forces of injustice.

Elizabeth has given me permission to post her message here – so here it is, lightly edited, in the hope that the actions she is taking will inspire you to go beyond a mere list – to find your own ways to get involved!

Hi Peggy,
I have now read your post & sent it to my kids, some nurses, & other non-nurses.  I especially like that youEB-Photo-250 said that we must be ready at a moment’s notice. I also read the replies to date. Thx so much for clarifying to the person who wrote that we should stand with Trump & give him a chance.
I have been wearing, & will continue to wear, my safety pin – a large one in the top hole of my left ear. I brought safety pins to our NMOLOC  (New Mexico Old Lesbians Organizing for Change) Gathering this month, & explained what it means to the old Lesbians gathered. Our Unitarian church handed them out the 2 Sundays after the elections, with explanations for the whole congregation & especially the children.
As I think that I told you, I am working here in NM to get our state legislatures to sign onto the National Popular Vote Interstate Compact. Nurses across the country could do this, too! They could certainly activate their nursing associations to lobby their state legislators to sign onto this compact. This is the 2nd time that the electoral college has overturned the majority vote in this country since the turn of this century, for heavenssakes! As someone on the Laurence O’Donnell show said a couple of wks ago, “What we call the popular vote here in the US is called the vote in the rest of the world!”
We are organizing our NMOLOC chapter to show up in Santa Fe for the Million Women March (our state’s version). We’ll have our old Lesbian banner, of course!
We are planning training in resistance in our NMOLOC chapter for the coming yr — reminding us all of what we learned, and practiced, so many yrs ago. As you say, we must be ready!

Sociopolitical Knowing: Connecting with hearts, minds, guts, and groins


[Edited 8/6/16] At a time when many are celebrating the official nomination of Hillary Rodham Clinton I am also acutely aware that many are not. While there are many valid concerns that have been raised, what troubles me most is to hear the contempt and disbelief that anyone could support Trump. It concerns me because it reflects a de-humanizing and de-valuing of many in the white working class.

We expect that our students and coworkers will be sensitive to the values and personal goals our patients and their families. We expect nurses to be non-judgemental towards patients who are living in poverty, suffering from addictions, or making decisions that do not seem based in upper-middle class norms and values. Can we also expect nurses to develop an understanding of how to be respectful and understand what is important to people with different political views. 

Sociopolitical Knowing is a core strength of professional nursing. Conceptualized by Jill White in 1995, sociopolitical knowing occurs on two levels:

1) the sociopolitical context of the persons (nurse and patient), and 2) the sociopolitical context of nursing as a practice profession, including both society’s understanding of nursing and nursing’s understanding of society and its politics. [emphasis added]

To start the dialogue, I am circling back to the Spiral Dynamics model that was used to organize the sociopolitical context of nursing in the published Results from the Nurse Manifest 2003 Study: Nurses’ Perspectives on Nursing.

Trump_&_Clinton.jpg

Basics principles of leadership and motivation according to Spiral Dynamics:

  1. identify the specific needs and capacities of individuals and groups, and
  2. calibrate the precise developmental messages that fit each unique situation.

Sociopolitical knowing requires an understanding of how to connect with and motivate people where they are. It means developing an understanding of what messages will be most effective in “pushing someone’s buttons” or eliciting a strong emotional response. The table below highlights the most prevalent value memes in modern society – defined through worldview, core values, and value-based reasons for violence and war. 

spiral dynamics.JPG

How Trump connects: From sexual innuendos and vulgar speech to stoking conspiracy theories and racist viewpoints, Trump often makes his connection with people’s minds, guts, and testicles. He has effectively tapped into pent-up frustrations and fears, justifying aggression and intolerance to make America “great again” (red and orange) and “safe again” (blue and green). 

How Clinton connects: From It Takes a Village to Hard Choices, Clinton has a long history of speaking to people’s hearts, minds, and ovaries. She has effectively tapped into national pride and hope, focusing on accomplishments that make America “great right now” (red and orange) and safer through unity and tolerance (blue and green). 

Both campaigns employ messaging that is strategically targeted at different audiences. The point of this blog entry was not to start a political debate — this is not the place for that. Rather, I am hoping to start a conversation about understanding how we might apply sociopolitical knowing to strengthen our ability to communicate with others. I hope that through application of sociopolitical knowing we can better connect with different communities about the work of nursing, and issues that impact the patient populations and communities we serve.

Please help build the dialogue around sociopolitical knowing, through comments here, and conversations with your coworkers, family, and friends. 

References for further reading:

Beck, D. E. Human Capacities in the Integral Age: How Value Systems Shape Organizational Productivity, National Prosperity and Global Transformation

Charen, M. What Hillbilly Elegy Reveals About Trump and America: A harrowing portrait of the plight of the white working class. National Review, July 28, 2016.

Harryman, W. Is Hillary Clinton the First Integral Politician? Integral Options Cafe, November 6, 2005.

Jarrín, O. F. Results from the Nurse Manifest 2003 Study: Nurses’ Perspectives on Nursing. Advances in Nursing Science, 29(2), E74-E85.

Pew Research Center. Few Clinton, Trump Supporters Have Close Friends on the Other Side. August 3, 2016.

Schwartzbach, S. M. Drowned: Nurses Under Water. The Nurse Sonja. July 27, 2016.

Vance, J. D. Hillbilly Elegy: A Memoir of a Family and Culture in Crisis. 2016; HarperCollins: New York, NY. 

White, J. Patterns of knowing: review, critique, and update. ANS Adv Nurs Sci. 1995 Jun;17(4):73-86.

Expressing Gratitude For Our Global and Local Nursing Leaders


I have been fortunate to have been supported and influenced by many of nurses’ contemporary leaders: I studied with Dr. Jean Watson prior to completing my dissertation by taking 6 units of doctoral level electives with her at UCHS. I had contacted Dr. Watson during my Masters studies, and I was amazed at how approachable she was via email. Watson’s Theory of Human Caring has influenced and directed my work in a way that is immeasurable on many levels; being with her and spending a week in sacred center, studying emerging sacred-caring science concepts brought me to a new vision of how nursing education can and should be practiced.

 

I also stumbled upon the work of Dr. Peggy Chinn and the nurse manifest project during my early doctoral studies, and soon found myself embraced by the NurseManifest community. I was blessed to have been part of the first Nurse Manifest research project team, and the experience of presenting our findings together was monumental in my life as an emerging nursing scholar.

 

While Dr. Watson and Dr. Chinn epitomize the amazing academic and scholarly accomplishments of Nurses’ Living Legends, they both also remain approachable, kind, caring, and generous. They reflect back to us a deep love for nursing, coupled with calls toward caring and a level of social justice activism that is highly needed in our process of supporting both local and global healing. There are many other nurses whom I might call “global nursing leaders” who share in this attitude, commitment, and consciousness toward change.

 

I am also frequently touched by the leadership capacity of my nursing students; the willingness to change their lives, spread their wings, and find ways to bring caring, holism, and healing to the “local” bedside in environments where these concepts often remain fringe in the face of allopathic approaches. The many global nursing leaders inspire nursing students, and the continuum to me is clear; students and nurses need these leaders to raise our consciousness, build our confidence, and lead us into our own leadership capacity at the local level. We need global leaders to shine a light on our professional paths and support our deepening understanding of both self as nurse and our profession’s capacity to create nursing qua nursing as the norm.

 

I am honored to be working with my RN-BSN students this fall in their leadership coursework. We will look at Chinn’s Peace and power work and also explore leadership through holistic concepts. We will examine burnout and how we can recover or support others in their recovery through self-care. In analyzing our workplaces, we will explore Sharon Salzberg’s (a registered nurse and globally known meditation teacher) Real happiness at work: Meditations for accomplishment, achievement, and peace as a supportive tool for self-exploration around workplace issues.

 

Many nursing students struggle to perceive themselves as “local nurse leaders”, and I strive to support them to tap into their own leadership capacities, to create the types of healthcare workplaces where they can thrive and support the healing of their patients through integrative modalities and caring consciousness. I do believe one way to provide this platform for students’ emerging leadership is to create a caring environment for students, to support their own healing processes, and to role model shared leadership processes and self-care-healing for, and with, students. In this way, I humbly express my deepest gratitude for those global nursing leaders who have shone their light on my own professional and healing path when it was often far from clear where I was headed.

The Prison System and Social Justice


I recently came across an article in the New Yorker entitled Madness by Eyal Press. The full article can be viewed here: http://www.newyorker.com/magazine/2016/05/02/the-torturing-of-mentally-ill-prisoners. The article looks at one Florida prison, where mentally ill patients have suffered horrible mistreatment by the prison system. Our largest provider of healthcare for the mentally ill in the United States is the prison system, and yet our leading mental health researchers and providers tend to shy away from or ignore this enormous vulnerable population.

I will warn you that you may find aspects of the Madness article disturbing, and it leads us as nurses to consider many social justice issues, including the right to adequate care, proper diagnosing, safety, and support for health and healing. As the United States has the highest incarcerated population of any country, nurses need to consider how we as a society and a culture care for and treat our very vulnerable mentally ill population. The challenges of advocating for these prisoners and one’s own potential vulnerability when working in this system are clearly highlighted in the Eyal Press article. Until we recognize the mentally ill incarcerated population as traumatized human beings in need of deep caring and support as they proceed along their own healing journey, true transformation of our systems toward ones that can offer rehabilitation and reduce recidivism may remain elusive.

I also found this article to be heart wrenching on a personal level. My brother died in prison at the age of 45, and the unit where he died is indeed either this particular unit as described in the Madness article, or one very similar to it in Florida.

My brother Bryan was a star elite athlete in his youth, holding a national age-group track record set at the Junior Olympics when he was around 15 years old. After sweeping many state championships in high school track, he received an athletic scholarship to a school in the midwest, and while he had been a “difficult hyperactive child” deeper signs of his mental illness began to emerge. He ran up huge gambling and credit care debts, and one Christmas he returned home from school having lost about 25 pounds with no good explanation for why this had occurred.

When he was about 25 years old and had finished college, Bryan had a full psychotic breakdown. He spent several months in a psychiatric facility as they strived to diagnosis and stabilize him. My brother was bipolar with schizoaffective disorder, and sometimes his life was relatively calm, like when he married his first wife and they dreamed many dreams together….other times not so much, like when in the midst of another psychotic break he held a knife to his first wife’s throat; or the time he totaled his own car using his own hands and a crowbar; or when he was found running naked on the Nike compound in Oregon.

In 2008 Bryan went off his medications for unknown reasons. He became incredibly manic, delusional, and he was certainly having hallucinations. He left his wife and young daughter and moved into a shelter setting, which he was kicked out of due to fighting with others. Simplifying the story a bit, I will just say that he was found tampering with his estranged wife’s car at her place of work and the police were called; a high speed chase ensued and my brother was charged with aggravated battery with a deadly weapon (I believe he struck one of the officers with something once his car was forced to a stop), aggravated fleeing and eluding police, and resisting an officer with violence. About two months after his arrest, upon the advice of his free public attorney, my brother took a plea deal and he was sentenced to 3 years in the Florida State Prison System. I believe his mental illness, which he had been struggling with for over 20 years, was never clearly considered in the charges or in his placement. The copy of his charges is here: https://bailbondcity.com/fldoc-inmate-CARROLL/130350 .

As sometimes happens within families of those suffering from mental illness, my brother and I had been estranged on and off for most of our adult lives. My brother would sometimes become violent, threatening, and manipulative when he was off his medication, and I desired a peaceful life for me and my young family. Our childhoods were traumatic, and while I can’t speak for my brother, my adverse childhood experiences were a “5”/ 10, which indicates trauma to the point of potentially having adverse effects on health and low stress resilience. I am certain that my brother also had a high ACES score, and that his mental health issues were compounded by our traumatic youth and family life. [If you want to learn more about how adverse childhood experiences impact one’s health, I have presentation that covers that here, slide 16 begins the information around the ACEs concepts: https://voicethread.com/myvoice/#thread/4492225/22882928/24864974   }.

Due to our previous estrangement and my own challenges with balancing caring for a newborn baby and toddler, and working as an adjunct nurse faculty for several different schools, I did not reach out to my brother prior to his incarceration or during that time, though we had been in touch on and off for the three years prior, when our mother had passed away suddenly from a massive MI. So, my father and stepmother kept me informed of Bryan’s prison life and while they did not visit him, they often scanned and forwarded his letters to me. It was clear to me that during his less than one year in prison, he declined rapidly; he claimed to be taken off all of his medications and we know he was transferred to a psychiatric unit (either the same one in this article or another one like it). In the two months prior to his death, he mentioned several times that he was dying or he was going to die, that things were very bad in prison. I encouraged my stepmother and father to reach out to him and the system, which they did not do, and I found that since I was not on Bryan’s “list” I had no rights around communication with him and within the system.

Via an email on the morning of March 28, 2009, I found out that Bryan had died in prison. The official county coroner’s autopsy stated that at the age of 45 Bryan had died of “moderate heart disease”, though it contrarily also noted no signs of stroke or MI. As his sister, I had no rights to request or pay for a second independent autopsy, and my family refused to have one performed, instead opting for an immediate cremation. Over the 7 years since his death, I know I have been suffering from complicated grief; I have felt powerless to create change in the prison system and sometimes I have felt scared to use my voice to call for change and for social justice in the way we manage the health of our growing prison population. I have felt fearful of being stigmatized and ashamed for having a relative who was incarcerated.

However, when I think of the many social justice issues the Madness article brings up, I begin to feel angry; and that anger is now motivating me to speak out and find ways to support the creation of healing within our justice systems.

I know that part of my own healing journey involves moving beyond telling my brother’s story, and beginning to move toward taking action in supporting an end to the injustices our incarcerated vulnerable populations suffer. I recently have been in connection with a beautiful resource at the Maine Prison Hospice Project (http://mainehospicecouncil.org/?q=content/hospice-corrections-partnership-maine-state-prison ), and I hope to help support their research efforts around the benefits of prisoners being of service during and after their incarceration period. I hope to someday serve as an example of how nurses on their own healing path strive to heal in conjunction with others; with those whom we serve. Imagine what we can do when we truly believe we are all on this path together, as interconnected unitary human beings; then the movement toward social justice becomes a part of our calling on this life’s journey.