What is “best nursing care?” Deconstructing the business model driving healthcare


The current feature on the AJN blog “Off the Charts” is a post titled “The Limitations of Rating Nursing Care by Customer Surveys.”  Since I have, for many long years, decried the practice of basing the evaluation of nursing care on patient satisfaction surveys, I jumped at the opportunity to read this post!  Of course we need and want to know how patients perceive the care we provide, but how we obtain this information, and what we do with this, is a key factor.  Since this approach derives fundamentally from the corporate business model, and is now practiced in the context of this model, the substance, use and outcomes of this practice are deeply flawed when examined from a NurseManifest perspective.  The example the author, Juliana Paradisi gives as an example of her best safe and compassionate nursing care involves a woman in extreme distress who “fired” her as her nurse –  a situation in which she could not break through the barriers inherent in the patient’s distress, but provided a level of care that was exemplary.

Even though the overarching business model that governs healthcare now is probably not going to go away soon (Ha!) – we can raise awareness of the limitations that this imposes on our practice, select specific actions to take to place these practices into context, and work to achieve whatever changes we can make.  We can start with addressing the question: “What is best nursing care” from the perspective of the values in the Nursing Manifesto.  There is no single answer to this question – but there are insights to be gained by thinking, talking and writing the ideas that arise from it. Once we have expressed our ideas, we can examine new and better ways to document our care, and continue to address the limitations of the existing practices that fail to document and support our best practices.

We welcome your ideas here – and stories about the times you provided what you think is the best nursing care!

off the charts

The Power of Ten!


Sigma Theta Tau has now published the 2nd Edition of the book “The Power of Ten,” a book of essays by nursing leaders that address ten top issues for nurses to rally around for the next few years.  These issues were identified prior to the results of the 2016 election, and now they are issues of increasing importance!  The essays provide ideas and inspiration for actions to strengthen nursing’s focus and activism.  The issues are:

  1. Educational Reform
  2. Academic Progression
  3. Diversity
  4. Interprofessional collaboration
  5. Systems thinking
  6. Voice of Nursing
  7. Global Stewardship
  8. Practice authority
  9. Delivery of care
  10. Professional handoff

This is an important resource for all nurses who are determined to act on the fundamental values of nursing.  The essays are a follow-up to the 2012 “Future of Nursing” report; the issues dovetail with the four recommendations of the report, and sine a light on the actions that nurses can take now to bring a culture of health to the center in shaping the future of nursing and healthcare.  The essays are short and to the point, and there are inspirational quotes from nursing leaders throughout that point the way forward.

Check it out! The book is available in several different formats directly from Sigma Theta Tau or from Amazon.  All proceeds from the book are being donated in equal parts to the American Red Cross nursing programs and the American Nurses Foundation.

Despair is not an option!


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!

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