Dear Senator – an idea for an invitation!


We recently received a message from Suzanne Fontanesi in Baltimore, sharing a letter she is sending to her Senator asking them to shadow a nurse to inform their health care debate by seeing reality up close and personal. She has given us permission to post the letter here so that other nurses can follow through with their senators as well!

Dear Senator _______,

I am a nurse writing to you on behalf of tens of thousands of my fellow nurses, who are deeply concerned about the possibility of Americans losing health care coverage. Before the Senate votes to repeal and/or replace of the Affordable Care Act, Congress members should be very clear eyed about who will be impacted, and how that impact will shape lives.

Nurses are ranked as the most trusted professionals in the nation. Members of Congress are ranked among the least trusted. In the eyes of the American public, nurses have distinguished themselves as moral, responsible and compassionate professionals. One important practice among nurses is that of ”shadowing”. Before committing to a workplace, a nurse spends time observing at close hand, the minute to minute reality of the people they will be serving.

Senators have great responsibility and many demands on their time, which function to keep them at a distance from many of the realities of daily life for the average American, not to mention the most vulnerable.

On behalf of the American people, I am inviting every United States Senator to spend a full work day shadowing a nurse, prior to voting on the repeal of the ACA. I ask them to observe a full work day, not as honored guests, but as quiet and anonymous observers in settings where nurses are caring for vulnerable Americans. Go with an open mind and ask questions.

I am requesting that you pause and take in the reality with your own eyes, ears and noses. Then, you may more legitimately resume the debate that will shape the lives of the most vulnerable millions of Americans. Regardless of party affiliation or political ideology, each Senator will bring relevant, firsthand information to the conversation.
Among 100 Senators, you will have collectively taken in the reality at schools, nursing homes, hospital emergency rooms, community mental health clinics, churches, drug treatment centers, and homeless shelters. Only then can you look us in the eyes and say that you understand our lives.

Please share this request with your fellow Senators. I will be happy to facilitate a shadow day for you or any of your colleagues.

Thank you for your consideration,

Your name
Your contact information

The Ethics of Nurses Being “Political”


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.

Image result for image facebook

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. Image result for picture nurse political

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. Image result for picture nurse political

 

Caring in the learning process; insights from a worldly PhD student in Canada


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

Do our actions make a difference?


#NursesResist
#ProtectHealth

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.

1. Don’t use the name of the new President, and do not repeat his tweets, even in protest or in the negative (see the example below).
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
10. Resist!
One shining example of why #1 on this list is so important.  A few days ago DJT tweeted that the media is the enemy of the people – and in response, some in the media started the hashtag #NotTheEnemy.”  This hashtag simply brings to mind the image of the media as the enemy, and reinforces the damaging image in the initial tweet.  George Lakoff (the originator of the list above) called the media out on this and encouraged everyone to stop using the “enemy” hashtag and imagery – to use instead #ProtectTheTruth.  Even these very little things are vastly important!  So share your ideas and inspirations here – let’s keep the resistance going – and grow it!

One thing you can do – now


#NursesResist

All the talk about repealing the U.S. Affordable Care Act (ACA) is scary stuff for those of us who are concerned about those who would be harmed immeasurably if this were to happen.  Of course this is a U.S.-specific problem, but all countries face ongoing threats that weaken healthcare systems worldwide (for example, the U.K. “Brexit” initiative is a significant threat for their National Health Service). Here in the U.S. we are at least a bit encouraged by the signs that repealing our fledgling ACA may not be easy – that the voices of the people letting MoCs s (members of Congress) know that this is not a good idea – may be getting through.  However, as Rachel Maddow has been advising us for weeks now – watch what they DO, not what the say. In fact one of the most damaging things we can do is to repeat over and over what they say, which only reinforces their message.

So fortunately, we have folks stepping up to help us watch what they do, and giving us leads about what we can do about it.  When, just a few days ago, Tom Price, avid opponent of the ACA, became Secretary of Health and Human Services, put up a proposal to make it harder and more expensive to get coverage under the ACA, and also supporting DJT’s speakupexecutive order that gives insurers freedom to deny and limit benefits for those who already have it – most of the public had no way to know that this was happening.  The brand new DCReport.org, established by David Cay Johnston, is filling this void.  Read the report on the new ACA proposal here – Administration Moves To Block Access To Health Insurance.  Here is the action box that accompanies this report:

Citizens have until March 7 to weigh in on the new rule. Use the rule-making code CMS-9929-P in any correspondence.

Write: Centers for Medicare & Medicaid Services / Department of Health & Human Services / Attention: CMS-9929-P / P.O. Box 8016 / Baltimore, MD 21244-8016. The phone number is 410-786-7195.

You can also comment online. This link will take you to the text of the proposed rule. There is a comment button on the right.

Of course this is not a dramatic, showy kind of action, and it certainly will not remove the threat that our country is facing. But if nobody speaks up now, then this administration will be further emboldened to continue down a damaging path.  We can at least put them on alert by sending strong and clear messages that they do not have a mandate to continue.

We will continue to alert all NurseManifesters of actions we can take related to health and healthcare – but to stay alert for any issues that concerns you, follow DCReport.org, and other trusted news sources that help guide your own actions.

#ProtectTheTruth
#HealthForAll
#FreePress
#MakeJournalismGreatAgain