A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper)

August 31, 2026September 12, 2026 / renataem5f99684f1a / Leave a comment

Renata E. Mares MIPH, BScN, BA Kin

Aug 22, 2026

Please use this document in any way that you wish. You can freely use this document (with citation; see our creative commons license in the footer of this and all pages on this site) The format for citing the document is shown at the end of the table of contents. If you wish to have other ideas integrated into this document, or included on this web site, please contact us or the author directly renata@adaptablefolks.com

1.     Introduction
2.     Planetary Health is Nursing Work
3.     Commercial Determinants of Harms and Health: Get Political
4.     Nursing Is Not a Buffer for System Failure
5.     Against the Medical-Industrial Complex
6.     Our Commitment
7.     A Call to Conscience and Action
8.     About the Author
9. Reference list (see image)

Citation: Mares, R. E. (2026). A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation (green paper). https://nursemanifest.com/2026/08/31/a-nursing-manifesto-for-2030-human-care-against-extraction-and-exploitation-green-paper/

Foreword

I came across this incredible blog post about A Nursing Manifesto 2000 written by three incredible nurses and academics: Richard Cowling, Peggy Chinn, Sue Hagedorn in 2000 and I thought to develop a parallel manifesto which brings together some of the books I have been reading over the past 5 years post-pandemic and some which reaches further back to the 80s 90s, 2000s, till present time.

The world have shifted quite a bit since this manifesto was developed and shared. In and of itself, it reads like something to aspire to. Maybe when I started my nursing career as a new graduate back in 2008, it would have been something to aspire to in my own work, career, research and teaching. But now I find some pretty troubling things not only missing from this manifesto as historical accounts, including the troublesome origins of the nursing and medical profession / culture, but it needs to be updated for the year 2030 and beyond.

But first, take some time to read and get familiar with A Nursing Manifesto 2000: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/

Below is the introduction to A Nursing Manifesto: A Call to Conscience and Action written in 2000. I am sharing here just the initial Introduction, but please do have a read of the entire manifesto as it discusses the ideals and principles, inspiration, concerns, vision and suggestions for actions. It also describes the authors and their positionality and about the art contained within this blog.

A Nursing Manifesto: A Call to Conscience and Action (2000)

by Richard Cowling, Peggy Chinn, Sue Hagedorn

Introduction (excerpt)

“As nurses, we reach for meaningful expressions of our values, too often finding overwhelming constraint and resistance, sometimes within ourselves and sometimes imposed from without. We are calling for a movement to awaken those precious and powerful ideals that are rooted in nursing’s worldwide historical traditions. We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty” … link to full manifesto here: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/#intro

My initial thoughts on this this first paragraph would be:

Awakening the so called ‘precious and powerful ideals’ is definitely a good thing, but how does nursing as a profession and value-based career wrestle with the monolith it has created the lack of diversity over the course of centuries
Rooted in nursing’s worldwide historical traditions: would these discuss how Nightingale-like nursing is rooted in supporting war and military efforts? Would these traditions address the issues of explicitly racism, sexism, and harmful medical cultural administrative practice over the course of the centuries? Our current professional associations are build as empires where lack of diverse leadership opportunities persist and patriarchal hierarchies are celebrated as excellence.
Attrition in nursing and healthcare is at crisis levels, yet no one talks explicitly about trauma and cPTSD experienced not from patients, toxic teams, but administrative and regulatory practices. Anyone care to elaborate here?

As I was reading this incredible manifesto and remembering back to the year 2000, I started to draw both parallels and the need to advance these exact thoughts to the years 2030 and beyond. At first I had the idea of taking each section and paragraph and write my thoughts in support and opposition. But then I thought, why not take all that I have read and know and develop something totally new yet complementary. Building upon my elders’ work.

Believe it or not, I have a fear of writing my own voice and ideas down. I don’t want to hurt feelings and I do get intimidated by folks who are much more qualified than myself, and therefore, I have the feeling that maybe I should not share what I have to say. I am now slowly building back my lost confidence and also recognizing that part of nuanced and critical thinking is (sometimes) getting things wrong, and sometimes right but too soon. So, I want to share both what I might be thinking that is wrong and also my worries about the nursing profession that I love so much. After nearly 20 years in this profession across specialties like orthopedic/trauma, medical/surgical units, mental health, public and community health, policy and education, I feel that I did my authentic best in trying to build the new and not getting lost in the challenges of the past. However, burnout happens to all of us, some more resilient than others. I am accepting that I might have pushed too hard for change and lacked the skills of relationship building. My past of being a refugee and immigrant female child who grew up in post-Communist Romania and Hungary could add to some of these reasons. The urgency to alleviate struggles for others was a real cause and drive for me. I never understood how a bunch of smart people could just sit around the table and talk about action, while people were struggling. Access to healthcare is access to people’s tax dollars. Talking was seemingly a waste of time from my perspective, as an early career public health nurse. I was searching to find people who felt the same urgency (or at least understood my motivations) as I did to act and help get folks out of poverty, get access to health and social services, and not just talk about it in meetings.

I may have been naïve and rushed. I was give the privilege of a profession to do good and alleviate harms. However, without trusted relationships, money doesn’t flow and people remain in poverty, in struggles that are the result of structures and systems I wanted to adapt. Some lessons we learn the hard way. I am now re-learning to build the confidence to talk, share ideas, and build relationship among people who are looking to advance the only huma-centered profession still remains. (I might be biased in this view) Is the last human job a nurse? Or so I assume in this manifesto. Or maybe the last human jobs are human-collaborations across sectors. Yes, that sounds more like it. But first we need to pivot (yes, just like that couch on a Friends episode from Feb 1999) and pay those human-collaboration jobs a fair wage.

Therefore, I am using my LinkedIn platform to share my ideas of A Nursing Manifesto for 2030: Human Care Against Extraction and Exploitation – a draft (2026) paralleling what has been written in 2000 and adding in some of my ideas from the list of resources that I will share at the very end of this writing. It might give future nurses in undergraduate and graduate studies something to ponder beyond the status quo of the nursing/ healthcare profession and education. We need to get out of ‘our’ status quo cultural box.

As always, I am open to discussions and opposing views that are shared respectfully.

1. INTRODUCTION

‘We’ are nurses (diverse with complex/ adaptive skills professionals) at a time when care is being remade by machines, markets, and systems that measure human worth in data points, risk scores, productivity targets, and billing codes.

We do not reject technology.

We reject technology without accountability.

Artificial intelligence, automation, surveillance, and predictive systems have entered hospitals, homes, clinics, long-term care, and public health. They promise efficiency while too often deepening abandonment. They sort people by profitability, automate denials, intensify workloads, erase human judgment, and place the burdens of flawed systems on those already made vulnerable by racism, colonialism, poverty, disability, gender oppression, and displacement.

We have seen what happens when an algorithm is treated as neutral while it inherits the inequities of the world that trained it. We have seen staffing systems call exhaustion as ‘optimization’. We have seen virtual care become a substitute for accessible, relational care. We have seen automation used not to relieve nurses of harmful labour, but to eliminate jobs, deskill practice, and demand that fewer workers do more with less.

This is not innovation.

It is extraction.

We are nurses practicing amid converging emergencies: widening inequality, climate breakdown, poisoned water, forced displacement, worsening chronic illness, automated exclusion, and healthcare systems increasingly governed by commercial interests rather than public need.

We affirm that health is inseparable from the conditions in which people are born, grow, work, live, age, and die. Health begins with breathable air, safe homes, nourishing food, clean water, meaningful connection, cultural continuity, freedom from violence, and a stable living planet. No hospital, algorithm, drug, or procedure can compensate for a society that systematically destroys these foundations.

The medical-industrial complex has transformed illness into revenue, crisis into market opportunity, and health into a commodity distributed according to wealth, insurance status, postal code, citizenship, and institutional power. It profits from endless treatment while neglecting clean air, safe housing, food security, living wages, disability justice, mental health, reproductive freedom, and the conditions that allow people to live well before they become patients.

We reject the fiction that health care exists apart from the world. The same systems that commodify illness extract from workers, communities, lands, and waters. The medical-industrial complex profits from treatment while underinvesting in prevention; corporations profit from pollution while public systems absorb the resulting disease; technology firms market “innovation” while shifting social, environmental, and clinical risks onto patients, caregivers, and frontline workers.

This is not an accident. It is a political choice.

We refuse to accept a healthcare system that calls itself advanced while people wait in pain, workers burn out and become patients themselves (Chapman, 2023), communities are poisoned, and the planet warms. (Check out the underlying drivers of planetary harms by Planetary Health Alliance website: culture, values, behaviour, consumption, population size/demographic changes, technology) https://planetaryhealthalliance.org/what-is-planetary-health/

Nursing must be more than the human face placed on an inhumane system. Our role is not to make austerity appear compassionate, to absorb the moral injury created by unsafe conditions, or to quietly compensate for decisions made by executives, insurers, technology firms, regulators and governments far from the bedside.

Our ethical obligation is to care and to confront what makes care impossible.

2. Planetary Health is Nursing Work

Planetary health is not an optional specialty or a future concern. It is present in every heat-related illness, asthma exacerbation, contaminated water supply, food insecurity assessment, infectious-disease outbreak, wildfire evacuation, pregnancy complication, mental-health crisis, and preventable death.

We recognize the health of people as inseparable from the health of lands, waters, ecosystems, and climate. Indigenous peoples have long carried knowledge of these relationships and of stewardship, reciprocity, and collective responsibility. Nursing must listen, learn, and act without appropriating that knowledge or repeating colonial systems of control.

We will advocate for health systems that reduce rather than export harm: low-carbon care, ethical procurement, less waste, resilient infrastructure, safe transportation, sustainable food systems, and emergency planning led with (not imposed upon) affected communities.

Clean water is a health right, not a commercial asset. Water insecurity, contamination, privatization, boil-water advisories, drought, flooding, and inadequate sanitation are nursing concerns because they produce infection, chronic disease, reproductive harm, trauma, displacement, and death. We will name water injustice as a clinical and public-health emergency, especially where it follows colonial dispossession, industrial pollution, and neglect of rural, remote, and Indigenous communities.

3. Commercial Determinants of Harm and Health: Get Political

We confront the commercial determinants of health: the corporate practices that shape exposure to harm, access to care, public policy, and the very definition of health.

Industries profit when people consume products that damage their bodies or environment, including tobacco and nicotine corporations, alcohol producers, ultra-processed food companies, fossil-fuel industries, extractive mining interests, pharmaceutical monopolies, private equity firms, surveillance platforms, and vendors of unaccountable health technology, and digital-addictive designs and digital-afterlife industries. Their influence reaches advertising, research, regulation, education, political lobbying, clinical guidelines, and data infrastructure.

We reject the normalization of harm as “consumer choice” when choices are engineered through marketing, pricing, scarcity, misinformation, racism, design inequity and unequal power.

We also recognize that commercial power can shape health positively only when it is democratically governed, transparent, and subordinated to the public good. Products, technologies, and services must be assessed not simply by revenue or technical novelty, but by their effects on equity, ecological sustainability, worker safety, community control, and long-term health. (my favourite slogan: war brings neither peace nor climate justice, defund military spending).

4. Nursing Is Not a Buffer for System Failure

Nursing is not low-paid emotional labour designed to absorb the failures of health and social systems. It is not a flexible reserve workforce to be stretched during crises, disciplined through precarity, or replaced by automation when budgets demand it.

Nursing knowledge is scientific, relational, ethical, political, and ecological. Nurses assess changing conditions, interpret uncertainty, build trust, notice patterns others miss, coordinate care across fragmented systems, protect rights, respond to suffering, and advocate for structural change. This expertise cannot be reduced to tasks, scripts, dashboards, or a layer of “human oversight” added after an algorithm has already shaped a person’s options.

We reject the use of artificial intelligence and automation to intensify work, monitor workers, remove professional judgment, automate benefit or treatment denials, or redirect accountability away from corporations and institutions. A nurse must never be expected to legitimize a harmful system simply because a person remains nominally “in the loop.”

Technology must serve care, not govern it. Any system used in health care must be transparent, independently audited, accessible, privacy-protective, environmentally accountable, and open to challenge by patients, families, nurses, and communities. It must be assessed for bias, labour impacts, energy and water use, supply-chain harms, and effects on access, not only for accuracy or cost savings.

5. Against the Medical-Industrial Complex

The medical-industrial complex converts suffering into revenue. It treats health as a market, patients as customers, records as assets, and workers as costs to be minimized. It normalizes private equity, monopolies, predatory pricing, medical debt, pharmaceutical profiteering, commercialization of data, and the outsourcing of public responsibilities to corporations.

We refuse a health system that boasts of technological progress while people cannot obtain primary care, medication, safe housing, home care, reproductive services, mental-health support, palliative care, or culturally safe care.

We oppose austerity disguised as efficiency. We oppose privatization disguised as innovation. We oppose surveillance disguised as safety. We oppose extraction disguised as care.

A just health system must be universal, public, adequately funded, community-rooted, culturally safe, accessible, and accountable to the people it serves. It must invest upstream: in income security, public housing, education, food sovereignty, disability justice, harm reduction, clean water, healthy ecosystems, and meaningful public-health capacity.

6. Our Commitment

We therefore commit ourselves to:

Defend human dignity over speed, profit, automation, and institutional convenience.
Defend health as a collective right and reject its treatment as a commodity.
Identify and confront commercial practices that produce illness, environmental destruction, inequity, and barriers to care.
Follow the leadership of communities most affected by environmental injustice, commercial exploitation, and institutional neglect.
Insist that every artificial intelligence system used in health care be transparent, independently audited, explainable, contestable, and governed with meaningful public and worker participation.
Refuse algorithms that reproduce discrimination or replace clinical judgment, informed consent, and relationships of trust. Stand against racism, colonialism, ableism, sexism, homophobia, transphobia, class exploitation, and xenophobia in health systems and society.
Demand that technology reduce harmful work and expand access to care, not intensify surveillance, cut staffing, deskill nursing, or deny services. My post on nursing profession and branding https://www.linkedin.com/feed/update/urn:li:activity:7496682545108025345/
Organize for safe staffing, fair wages (like programmers and coders once were paid), public health infrastructure, union rights, and workplaces where nurses can speak honestly without retaliation (regulatory harms have still not been addressed explicitly and attrition continues to crisis levels). My post on trauma: https://www.linkedin.com/feed/update/urn:li:activity:7496346149822287873/ ; my post on regulatory harms https://www.linkedin.com/feed/update/urn:li:activity:7496353936921071616/
Treat climate disruption as a health emergency created by unequal systems of extraction, and advocate for care that protects communities and the living world.
Stand with patients and communities against medical debt, privatization (yes Canada, you too), predatory pharmaceutical practices, corporate consolidation, and the commodification of suffering (CDoH, 2022). post on global power demand by 2030 https://www.linkedin.com/feed/update/urn:li:share:7255265303691997184/
Advocate for public, universal health systems free from corporate capture and private-profit priorities.
Center the knowledge and leadership of Indigenous peoples, Black communities, disabled people, migrants, low-income communities, and all those harmed first and worst by unequal systems. (Can we please collect wealth tax, and stat? Harrington, 2025)
Protect the right of every person to understand, question, and refuse the technologies affecting their body, records, treatment, and future. (Once people lose mental capacity, at any age, what happens to their digital footprint and logins. Read up on digital-afterlife industry) my post: https://www.linkedin.com/feed/update/urn:li:activity:7496323674120048640/
Practice solidarity across professions, sectors, and borders, because no individual nurse can solve harms produced by structural power.
Protect clean water, sanitation, healthy ecosystems, and climate stability as indispensable conditions of health.
Treat nursing expertise as essential to governance, policy, technology design, climate adaptation, public health, and community-led care, not as inexpensive labour or an afterthought in executive decisions.
Build care systems based on solidarity, reciprocity, prevention, justice, and ecological repair.

7. A Call to Conscience and Action

In 2030, conscience requires more than compassion.

It requires courage. Not only to speak for/with patients, families and communities, but to speak against professional toxic culture, leadership, and stagnant professional envelopment. It requires collective action against the systems that manufacture illness and call the consequences unavoidable.

It requires us to ask not only, “Can this technology be used?” but “Who does it serve? Who exposed to/ bears its risks? Who profits? What forms of care, labour, and life does it displace?” Who is left waiting, excluded, displaced, or silenced?

I have held a role as a nurse informatics, merging duplicate files because IBM refused to adapt their infrastructure. Are informatics professionals seen as human-in-the-loop or human-exploited-in-the-loop?

It requires us to understand that a healthy society cannot be built on exhausted workers, disposable patients, automated exclusion, or a damaged planet. We CAN however, pivot workforce roles and pay people to do human jobs, like witnessing and delivering care where it’s needed. (Pugh, 2026)

Care cannot be ethical if it relies on ecological destruction. Innovation cannot be just if it is built on surveillance, dispossession, or underpaid labour. Health cannot exist where water is unsafe, homes are unaffordable, ecosystems are collapsing, and human needs are subordinated to corporate return.

We will not be reduced to exhausted labour, automated compliance, or human cover for decisions made by machines and markets.

We call on nurses to reclaim our collective (yet, diverse) voice. We call on health workers to organize. We call on institutions to place care above revenue (wealth tax helps here). We call on governments to regulate health technologies in the public interest and to fund universal, accessible, community-rooted health care.

We call on the public to reject a future in which the right to health is determined by an algorithm or a balance sheet.

Care is not a product. Health is not a privilege. People are not (just) data to be extracted and sold.

The planet is not expendable.

We will not be silent witnesses to systems that harm in the name of progress.

We will practice, organize, resist, and build a future in which care remains human, collective, just, and sustainable.

We are nurses. We are advocates, clinicians, educators, organizers, researchers, knowledge holders, and defenders of the conditions required for life.

We will care for people and we will fight for the world in which people can be well.

8. About the Author

The Nursing Manifesto 2030 builds upon and expands The Nursing Manifesto 2000, the pioneering work of Richard Cowling, Sue Hagedorn, and Peggy Chinn. In the age of AI, provenance is one of the most important forms of acknowledgement, demonstrating that ideas and thoughts never simply appear, but are cultivated, grazed, turned over, and digested with time, patience, and communal support. The original authors all came from white, middle-class backgrounds and grew up in diverse regions of the United States (New York, Hawaii, Virginia), with relatively privileged access to education, travel, and cultural experiences. Yet early in their lives, each followed personal and political paths that challenged the status quo, often to the chagrin of family and friends. Though not always overtly “political” on the surface, their journeys reflected a deep yearning for peace, justice, and the caring, nurturing values they perceived to be at the heart of nursing. They came together to prepare the text for A Nursing Manifesto 2000, informed by their shared awareness of the deeply political nature of personal choices.

Renata E. Mares, author of The Nursing Manifesto 2030: Human Care Against Extraction and Exploitation (green paper), brings both continuity and distinct difference to this legacy. Born in 1984 in Oradea, Romania, a region marked by Hungarian legacies and Romanian cultural tensions since the 1920s (Treaty of Trianon), she became a refugee at age four when her family fled the communist regime in 1988. She grew up in post-communist Hungary (schooling) and Romania (summer vacations), experiences that shaped her social justice and ethical compass, and led her to challenge oppressive and racist systems throughout her nursing career. Her father and brother spend fiver years (1990-95) in Rochester, New York in hopes for her mother and herself to follow but at that time families could not easily join. Her family immigrated to Guelph, Ontario, Canada in 1996 and has called this place home even across her decades of travel and nursing. Since nursing school in Canada (2003–2008) and continuing through diverse roles in ortho-trauma, med-surg, rehabilitation, mental health, long-term care, public health, outbreak management, policy consulting, education, and global humanitarian work (2009–2019), she has consistently challenged the status quo, even when it meant alienating friends, colleagues, and family. Today, she firmly believes nursing remains the most human-centered profession, uniquely positioned to challenge profiteering practices, build regulatory and safety guardrails through healthy public policy, and resist automation of human-care work. Grateful to the original manifesto authors for helping her articulate the political nature of her own choices, she writes in hopes that reflection, awareness, and philosophy will offer others the same healing she has found through two decades of honest practice in nursing and across the health system.

9. References

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Alison Pugh. The Last Human Job. 2026. https://press.princeton.edu/books/hardcover/9780691240817/the-last-human-job?srsltid=AfmBOoq_JMH6DnzyIEP2cMrGLQaAsBUtcxJWMy439dXRkiXxKJRId0CX.

Arthur Allen. Vaccine: The Controversial Story Of Medicines Greatest Lifesaver. WW Norton, 2008.

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Bartlett, Cheryl, Murdena Marshall, and Albert Marshall. “Two-Eyed Seeing and Other Lessons Learned within a Co-Learning Journey of Bringing Together Indigenous and Mainstream Knowledges and Ways of Knowing.” Journal of Environmental Studies and Sciences 2, no. 4 (2012): 331–40. https://doi.org/10.1007/s13412-012-0086-8.

Bessel van der Kolk. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Penguin Books Canada Limited, 2015.

Brian Evergreen. Autonomous Transformation: Creating a More Human Future in the Era of Artificial Intelligence. 2023. https://www.amazon.ca/Autonomous-Transformation-Creating-Artificial-Intelligence/dp/1119985293.

Brooke Harrington. Offshore: Stealth Wealth and the New Colonialism. 2025. https://www.penguinrandomhouse.ca/books/773970/offshore-by-brooke-harrington/9781324110323.

Cory Doctorow. The Reverse Centaur’s Guide to Life After AI. 2026. https://www.versobooks.com/en-ca/products/3584-the-reverse-centaur-s-guide-to-life-after-ai.

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Richard Cowling, Peggy Chinn, and Sue Hagedorn. “A Nursing Manifesto: A Call to Conscience and Action.” NurseManifest, 2000. https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/.

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Robin Wall Kimmerer. Braiding Sweetgrass: Indigenous Wisdom, Scientific Knowledge and the Teachings of Plants. 2015. https://www.amazon.ca/Braiding-Sweetgrass-Indigenous-Scientific-Knowledge/dp/1571313567.

Shoshana Zuboff. The Age of Surveillance Capitalism. 2019. https://www.hachettebookgroup.com/titles/shoshana-zuboff/the-age-of-surveillance-capitalism/9781610395694/?lens=publicaffairs.

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Tina D. Purnat, Tim Nguyen, and Sylvie Briand, eds. Managing Infodemics in the 21st Century: Addressing New Public Health Challenges in the Information Ecosystem. Springer, 2023. http://www.ncbi.nlm.nih.gov/books/NBK609023/.

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Vanessa Machado de Oliveira. Outgrowing Modernity. 2025. https://www.penguinrandomhouse.ca/books/783178/outgrowing-modernity-by-vanessa-machado-de-oliveira/9798889842507.

“What Is Planetary Health?” Planetary Health Alliance, September 5, 2017. https://planetaryhealthalliance.org/what-is-planetary-health/.

(Potential) Rescheduling of Cannabis in the US: Policy, Process, and Patients

December 29, 2025 / drcareyclark / 3 Comments

Cannabis has been a DEA Schedule I drug since the initiation of the Controlled Substances Act (CSA) in 1970. Schedule I drugs are those classified as having a high potential for abuse and no known medical benefit. Cannabis has remained a schedule I drug despite the National Academies of Science, Engineering, and Medicines (2017) publication entitled The Health Effects of Cannabis and Cannabinoids, where NASEM concluded that there is substantial evidence for cannabis effectiveness in treating chronic pain, chemotherapy induced nausea and vomiting, and multiple sclerosis spasticity; moderate evidence around cannabis improving sleep with short term outcomes related to sleep apnea, fibromyalgia, chronic pain, and multiple sclerosis; and limited evidence around cannabis’s effectiveness with anxiety, PTSD, Tourette’s, IBS, TBI outcomes, dementia, glaucoma, and other neurodegenerative diseases.

Because cannabis has remained a Schedule I drug, research has been greatly hampered, and the NASEM (2017) report called for the development of a national cannabis research agenda focusing on clinical and observational research, health policy and health economics research, and public health and public safety research.

The NASEM report can be accessed here: https://www.ncbi.nlm.nih.gov/books/NBK423845/

Additionally, in 2003, the federal government issued a patent on cannabinoids related to the drug’s ability to help with healing from brain trauma and age-related brain changes.

There is a lot of excitement in the medical cannabis world around the potential rescheduling of cannabis related to the US president’s December 18, 2025, executive order 14370 to reschedule cannabis. However, in 2024, the U.S. Department of Justice initiated a rulemaking process to begin the rescheduling process, and President Biden issued an executive order in 2022 directing the Department of Health and Human Services and the Department of Justice to review the rescheduling of cannabis. The DHHS in 2023 recommended that cannabis be moved to Schedule III, and in May 2024, the Attorney General signed off on a proposed rule to reschedule cannabis, which was also published in the Federal Register. This can be accessed here: https://www.federalregister.gov/documents/2024/05/21/2024-11137/schedules-of-controlled-substances-rescheduling-of-marijuana

However, an administrative law hearing is needed to formalize the process, and it has been stalled over the past year due to lawsuits alleging bias and procedural misconduct in the rescheduling process. Lawsuits include those from Doctors for Drug Policy Reform that allege they were excluded from the list of 25 designated hearing participants due to supporting rescheduling, Panacea Plant Sciences has sued the federal government because small cannabis businesses have been excluded from the hearings, Attorney Matt Zorn has claimed in a law suit that collusive communications occurred between the DEA and the anti-cannabis group Smart Approaches to Marijuana (focuses on the Freedom of Information Act), and a group of pro-rescheduling entities has been granted an interlocutory appeal based on the DEA being a proponent of the proposed rule. The interlocutory appeal has indefinitely stayed the rescheduling hearing process. Essentially, all of these lawsuits are focused on the concern that the DEA has stacked the witness selection process to ensure that cannabis remains a Schedule I drug in direct opposition to the DHHS recommendation that cannabis be rescheduled to Schedule III. The DEA and the DHHS have historically had differing views of DEA/ CSA scheduling. The current 2025 executive order does not address this issue; it does not provide a defined means to bypass the existing legal process, and the CSA of 1970 does not permit a President to unilaterally reschedule a drug.

The only other approaches toward timely rescheduling of cannabis include an act of congress, which may be required to address the issues of banking concerns, research processes, and address the current conflicts between federal and state laws regarding cannabis. Additionally, Attorney General Bondi could expedite the process by bypassing the notice-and-comment process.

There is a clear need for more medical cannabis research, and moving the drug to a schedule III would bypass researchers’ requirement to have a Schedule I license and the requirement to only access cannabis from a handful of government cannabis sources that may not provide access to quality cannabis products. Rules will need to be changed, and funding for cannabis research as a national public health agenda item will be initiated, with the goal of USFDA treatments being developed. By rescheduling, the reduced stigma associated with the prohibition of the cannabis plant may help to encourage academics, pharmaceutical companies, and cannabis businesses to engage in more cannabis research. Still, again, Congress will likely need to clarify or revise previous laws. For instance, Biden’s 2022 Medical Marijuana and Cannabidiol Research Act has not led to greater cannabis research because of the lack of access to the product, high costs associated with the security of cannabis products, lack of funding sources for research, and issues with federal law prohibiting the transfer of cannabis across state lines.

Additionally, implications around what rescheduling means for cannabis producers, medical cannabis patients, and healthcare providers remain unclear. Cannabis being rescheduled does not change the federal legality of cannabis. It would still be a federally controlled substance, and currently, whether or not patients will be able to have cannabinoid therapeutics covered by insurance remains in question. While dronabinol, a synthetic THC medicine, is a Schedule III drug, it is only approved for CINV when other methods have failed, and loss of appetite and weight loss with anorexia and cachexia. It is not a first-line treatment for any health condition, although prescribing in pediatric settings appears to have increased over the years. Additionally, dronabinol may not be as therapeutically effective as whole-plant cannabis due to its lack of various cannabinoids, terpenes, and flavonoids that are found in whole-plant cannabis and may support optimal functioning of the body’s master regulator, the endocannabinoid system.

While this process of rescheduling cannabis to Schedule III comes with a great deal of uncertainty and legal concerns, it is part of the process of ending the prohibition era of cannabis and entering into an era of cannabis regulation. Ideally, the patients who could benefit from access to cannabis and cannabinoid therapeutics are always at the forefront of benefits in the political process. Patients’ access to safe, tested, effective cannabinoid therapeutics remains a social justice issue, a research priority, and an advocacy concern for nurses. Nurses are ethically obligated to support patients’ autonomous right to access cannabinoids and to ensure that beneficence and nonmaleficence are upheld.

Resources

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana. (2017). An evidence review and research agenda. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research.National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK423845/

https://alaskapublic.org/news/economy/2025-12-26/marijuana-rescheduling-would-bring-some-immediate-changes-but-others-will-take-time

https://mjbizdaily.com/news/great-leaps-in-cannabis-research-expected-after-marijuana-rescheduling/613762/

https://www.nbcnews.com/health/health-news/medical-marijuana-research-open-floodgates-cannabis-reclassification-rcna249811

Nurses’ Concerns COVID19: Update March 29, 2020

March 29, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN

There is so much going on that it’s really hard to summarize all of the issues. I welcome dialog and discussion of your concerns and what you are seeing and hearing about.

Nurses’ Shifting Thinking About Duty To Provide Services

I am seeing a shift in thinking with more nurses being willing to leave their jobs as they are not adequately protected: working without adequate PPE creates harm to self, others, and community. An emergency room doctor was fired for speaking out about his hospital’s response (US NEWS report). So these actions are not without their cost.

We are also seeing more and more healthcare workers testing positive for COVID19. What stands out to me is the over 160 healthcare workers in Boston have tested positive for COVID19 in these early days. (Boston Hospital Workers test positive) and 12 nurses in Chicago have tested positive for COVID19 Chicago nurses test positive for COVID19.

Nurses who are staying in the direct care workforce are often very frightened: they are staying because if they quit, they won’t’ get unemployment, they are fearful that they won’t find another job because they left their current job abruptly, they are the sole or majority breadwinners in their families, and they are afraid of losing their healthcare benefits. Some nurses may still feel the deep roots of historically being linked to self-sacrificing, or with links to nursing’s history of religious or military duty (I do anecdotally feel like I am seeing less of this as the pandemic crisis grows).

New Grad Nurses as a Resource: Dr. Chinn pointed out to me that one area that is not getting enough attention is the idea of new grad nurses being allowed to or recruited into practice early, perhaps even before sitting for NCLEX or even finishing their final exams. An example: A CNO in a large New Jersey medical facility is begging a Nursing Program Director to send her senior nursing students to the clinical site, the NLN is okay with this, but how can she, in good conscience, allow her students to be there without proper PPE? Her students who work as techs at this facility also convey the dire conditions in the facility. Also, her faculty, like most nursing faculty, is older (in this case, age 59 on average) with underlying health conditions, which creates a greater risk for them as well.

My ethical perspective answer to this is that unless adequate supervision and proper PPE can be assured, the students should not be allowed into theses settings, as they will ensure harm to self and others, and we must abide by our ethical responsibility to practice beneficence and nonmaleficence. In my own setting as a director of an RN-BSN nursing program, we decided to remove all of our students from all clinical settings, even though we had students who wanted to stay in these community settings, the risks do not outweigh the benefits.

I also think of the challenges of being a new grad nurse: there is so much to learn and process and in a crisis situation will this even be possible? Will we ultimately end up losing a large number of these new grad nurses to post-traumatic stress and illness? This seems to me to really be lacking an ethic of care toward a very vulnerable population, our new grad nurses.

Is Nursing Political?

I was reminded this week that nursing is of course political. I found an interesting posting about how very political Florence Nightingale was. Cynthia Sim Walter (March 22, 2020, facebook) stated that during the Crimean War, Florence was first known as the Lady with a Hammer; she fought for her nurses to have what they needed to provide proper care, and she beat down military storerooms with a hammer. I loved this quote: “Military leaders loathed her and feared her. She drank brandy with the soldiers, did statistics for fun, and had no respect for the politics of men,” (I did not fact check this).

Florence took physical action when nobody else would and her actions were a political act of rebellion to save lives in dire times.

Let’s Reuse Our Masks? Here’s some data

This is heartbreaking when our leading facilities are looking for ways to somehow sterilize single-use masks. Here is something floating around on social media, put out by Stanford.

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The full report can be read here. It sums up two important things, that autoclave may be effective (the mask will not have the same integrity, particularly over time; please see stats above). Also with the plastic face shields over other masks, we have no efficacy data around their effectiveness (Stanford Report).

We still need PPE to be well stocked so we can be more assured that we are well protected. We still need to be demanding that.

New Resources and Webinars:

To share more current information, the American Journal of Nursing has joined with Johns Hopkins and others to share ideas around keeping nurses safe. Here’s the link with all the info. https://nurses.wikiwisdomforum.com/

The Schwartz Center for Compassionate Healthcare is offering a webinar on Tuesday, April 7, 1-2 pm EDT, entitled: Leading with Compassion: Supporting Healthcare Workers in Crisis. Register Schwartz Compassion Center Webinar

Be well.

Nurses’ Concerns with COVID19: March 20, 2020

March 20, 2020March 21, 2020 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 7 Comments

Like many of you reading this, I have a range of emotions and feelings as the pandemic of COVID19 grows in the USA: anxiety, fear, and anger. Today (and for the last several days), I am angry about the lack of Personal Protective Equipment (PPE) available for nurses who are being called to care for those who are most ill and the most contagious. The following is my attempt to express my personal concerns and align them with nursing’s guiding ethical principles.

There may be flaws in my thinking and I am open to respectful dialog about these issues. I understand that emotions are running high and that we may not agree, but we can and should have civil discussions and dialogs.

Lack of Personal Protective Equipment. On February 7, 2020, the World Health Organization warned of a shortage of Personal Protective Equipment in China and beyond. As that was 6 weeks ago, there has been time to ramp up the production of PPE. Meanwhile, state’s governors from Maine to Wisconsin to Florida and Washingon are asking to access the federal stockpiles for access to PPE:

https://www.penbaypilot.com/article/governor-mills-urges-federal-government-vice-president-release-personal-protection-eq/131972

https://www.nbc15.com/cw/content/news/Evers-asks-federal-govt-for-much-needed-supplies-from–568975621.html

https://www.propublica.org/article/heres-why-florida-got-all-the-emergency-medical-supplies-it-requested-while-other-states-did-not

https://www.doh.wa.gov/Newsroom/Articles/ID/1117/Addressing-shortages-of-Personal-Protective-Equipment-PPE

Nurses Quitting: A few days ago, one of my Facebook friends quit her job because she was no longer being provided the proper PPE, She was not directly caring for COVID19 patients, but she needs proper PPE to keep herself and her patients safe during the provision of care, and her quitting her job got me thinking, considering ethical issues, advocacy, the role of the nurse, and so on. I respect her decision, and I hope this post makes it clear that during these frightening and murky times, the decisions we make as nurses are going to be hard ones.

I want to say, from an ethical perspective, it is perfectly acceptable for nurses to quit their jobs and/or refuse to work without proper PPE. Refer to my previous post of the ANA calling for the CDC to provide evidence when they make guidelines, and consider the recent use of bandanas and reuse of face masks protocol from the CDC: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html. This flies in the face of everything we know about the transmission of viruses.

Ethical Principles: The overarching ethical principles at play here that help to guide nurses’ decision making are beneficence (doing the good thing, moral obligation to do the right thing, what is best for the patient) and nonmaleficence (do no harm to patients). When we work without proper PPE, there is a very real risk that not only might we harm ourselves, we potentially spread pathogens to patients. When we don’t have proper PPE, our stress, fear, and anxiety can be magnified and potentially may harm patients.

Additionally, The code of ethics for nurses (https://www.nursingworld.org/coe-view-only) requires a lot of us. To begin with, we must be deeply familiar with The code and how it guides our decision-making processes. The following are some excerpts from The code that guide our decision making at this time:

The code: 3.5 Protection of Patient Health and Safety by Acting on Questionable Practice

This concept is all about the reporting of inappropriate and questionable practices. We may become stymied when even our boards of nurses are aware of dangerous and non-evidence-based practices, but they may see no way around them. We can report the issues, but when the governing bodies we report to are not holding up our own ethical standards, the field is put at greater risk for collapse (from infection spreading and/ or providers quitting).

Even as standards are relaxed, entities such as the Oregon Board of Nursing should be taking more responsible action and not placing nurses and patients at risk. The following is a statement by the Oregon Board of Nursing that states that nurses cannot refuse assignments because of sub-par PPE that does not align with CDC or WHO regulations. In other words, in this case, the BON is either not considering the greater harm for both patients and nurses by not recognizing the greater ethical concerns and personal risks nurses are being asked to take, or they simply see no other solutions. The paragraphs about the social contract and evidence-based approaches contradict the highlighted area regarding changes in PPE approaches and the right to refuse assignments.

Regardless of what our boards of nursing state, Provision 4 makes it clear that we are ultimately responsible for our own practice: “The nurse has authority, accountability, and responsibility for nursing practice; makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care”. Specifically, Provision 4.1 states that “Nurses bear primary responsibility for the nursing care that their patients and clients receive” and “Nurses must always comply with and adhere to state nurse practice acts, regulations, standards of care, and ANA’s Code…”. This does lead to interesting paradoxical issues with the Oregon Board of Nursing, as one could view this as a regulation, but it contradicts further statements in The code, including:

Provision 4.3: “Nurses are always accountable for their judgment, decisions, and actions: however in some circumstances, responsibility may be borne by both the nurse and the institution. Nurses accept or reject specific role demands and assignments based on their education, knowledge, competence, and experience, as well as their assessment of the level of risk for patient safety. Nurses in administration, education, policy, and research also have obligations to the recipients of nursing care” and “Nurses must bring forward difficult issues related to patient care and/or institutional constraints upon ethical practice for discussion and review”.

Most importantly, The code calls for us to take good care of ourselves so that we can take care of others. We see this shown in Provision 5, particularly:

Provision 5.2 Promotion of Personal Health, Safety, and Well-Being

“…nurses have a duty to take the same care for their own health and safety. Nurses should model the same health maintenance and health promotion that they teach and research, obtain health care when needed, and avoid taking unnecessary risks to health or safety in the course of their professional and personal activities.” The sticking point here is arguing whether or not the risks of not wearing proper PPE, which include risks of death for oneself or other patients who have not yet been exposed, is necessary or not. From my perspective, I can see where working without proper PPE could be too large of a risk to oneself and the communities served.

And I get concerned when nurses seem to think it’s only about them be willing to take on the personal risk for themselves, forgetting about how they may also become the vector.

One last ethical issue, we have to do our own self-care during these challenging times. As nurses, we are required to take care of ourselves. Provision 5.2 continues: “Fatigue and compassion fatigue affect a nurse’s professional performance and personal life. To mitigate these effects, nurses should eat a healthy diet, exercise, get sufficient rest, maintain family and personal relationships, engage in adequate leisure and recreational activities, and attend to spiritual or religious needs…it is the responsibility of nurses leaders to foster this balance within organizations”

Now onto a round-up of current COVID19 issues for nurses as I am seeing on social media:

Masks: Some nurses are being told to store their 1 daily mask in a paper bag and remove/ doff between patients, and replace/don the old mask for new patients. Of course, the bag and the mask would all be potentially contaminated; the bag actually creates a source of contamination and risks for greater transmission. I also heard rumors on social media of nurses being told to share masks, and I am hoping this is simply just false information, as I couldn’t verify that claim. I did hear that eye shields were being shared. I have confirmed that nurses who are normally required to wear masks because they have not been vaccinated for the flu are now being told to not wear masks because there is a shortage of masks. I have also confirmed that having a doctor’s note regarding why one must wear a mask (verification that they are immunocompromised) may work in some settings to either ensure masks are available to the person or excuse them from work.

We are vulnerable: Nurses are humans and many of us are vulnerable, whether that means we have chronic health conditions and co-morbidities, or we are at risk because of age.

The average of RN’s in the USA is 50, perhaps increasing risks related to the virus (https://alliedstaffingnetwork.com/americas-nurses-are-aging/ ),
Indeed it has been documented that healthcare workers may fair worse when they contract COVID19, which in part may be related to stress or multiple exposures to the virus. The healthcare system was already strained before the pandemic started, and as nurses also become ill, the system will become even more strained (https://www.businessinsider.com/nurses-are-understaffed-and-frustrated-as-they-battle-coronavirus-2020-3 ).
We are already feeling the “psychic” shock of this pandemic, and showing signs of potential PTSD ( https://www.washingtonpost.com/outlook/2020/03/18/doctors-nurses-are-already-feeling-psychic-shock-treating-coronavirus/?fbclid=IwAR3yUXxn6VrwckM1p3FX1pAeBMARQ8hlxCMaUm_kr81b2xZB6aHLr2UBV9k ). I am seeing growing division of nurses on social media pages regarding many of these topics.
I heard rumors that as many as 1/2 of the positive COVID19 cases in the state of Pennslyvania were healthcare providers. I couldn’t verify this fully, though there are positive healthcare providers (https://6abc.com/6026148/), and on this date, at least 10 of the 44 cases recently identified in PA are healthcare providers (https://patch.com/pennsylvania/chestnuthill/20-44-coronavirus-cases-philadelphia-are-healthcare-workers?fbclid=IwAR1o0fR0kLQA4aat1-qr1LU0UyxrWz3Gy_nVecEB3_QXgXc9c0cMghZCnAs ).
We, of course, know that healthcare providers are at greater risk, and likely more so with poor PPE (https://www.washingtonpost.com/health/covid-19-hits-doctors-nurses-emts-threatening-health-system/2020/03/17/f21147e8-67aa-11ea-b313-df458622c2cc_story.html ).
We are worried about our families, and this may mean distancing ourselves from them (https://www.advisory.com/daily-briefing/2020/03/18/doctor-fears) or choosing to protect the frail in our family instead of working. I have heard of nurses and doctors renting airb-n-b rooms to be away from their families in order to protect them from contamination.
We are being denied sick leave after exposure or told to use PTO or go without pay. Or we are being told to work post-exposure, or work with flu and cold-like symptoms if no fever is present.
For nurses who are willing and able to work, many believe they should be getting hazard pay for the risks they are willing to take.

Nurses are also fighting amongst themselves about whether it is okay to quit the workplace now. We have to recognize that these are complex decisions; nurses are real people who have their own health issues. Getting angry about people not willing to take the risk is not productive in both the short and long term.

It’s okay to choose your life and your well-being over the “duty” or social contract to work. It’s okay to make those tough decisions, like quitting your job, and, for some folks, they may be willing to risk their license by refusing assignments where they can’t keep themselves or their patients safe, even if their board of nursing disagrees.

Many nurses will carry on, work hard, provide excellent care, and do their best.

It’s also okay to feel vulnerable and scared in these uncertain times and to question your decisions and the decisions of administrators, regulators, and leaders.

It’s okay to organize and advocate for our needs, whatever that looks like.

Always remember, you have ethics on your side.

Drug Wars, Drug Addiction, and Social Justice Issues

July 10, 2017December 22, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I have been reading Johann Hari’s Chasing the scream: The first and last days of the war on drugs.

This book provides a very detailed account of how we came to be an anti-drug \ and pro-prohibition nation that lead the way toward making criminals out of people who struggle with use of substances and millionaires out of people/ cartels who sell drugs on the black market to drink ayahuasca in the Andes. I have found the book in some aspects hard to read because the political manipulation of our global population and the injustices that have arisen from this global movement. I get angry about what has happened as I read and I have to step away for awhile.

Some key points from this text for nurses to consider:

The dominant medical establishment (in particularly the AMA) was initially very against “drug” prohibition, but key vocal players were forced into silence by the government.
Overall, 90% of people use substances we call “illicit drugs” without having addiction issues, yet we continue to think that people need to be cautious with drug use. For instance, many (not all) soldiers used heroin in Vietnam to get through the hellish experiences, yet many (not all) had no issues with heroin addiction when they returned stateside.
There is a clear connection between lack of social support, childhood abuse, and adverse childhood experiences (ACEs: see the CDc website for more info on this) with addiction. We need to be compassionate toward those who are suffering, because these childhood experiences literally changed how their brains function, making them very vulnerable toward addiction. Adverse childhood events impact young people across the socio-economic spectrum, and many people who came from “good families” have also experienced a lot of childhood trauma.
When it comes to death and illness, our two leading “drug use issues” are likely nicotine and alcohol, both legal, and both toxic and deadly. Yet, we simply put warning labels on these drugs and let folks self-determine their fate. Why are these drugs okay, but others are not? Because they are socially acceptable? Because they are “cheap”?

When we think of the opiate crisis, one of the biggest issues of course is people not having safe and affordable access to opiate medications: when people are cut off from safe supplies (ie, their pain prescriptions which the medical establishment has endorsed and prescribed, with potentially some of the cost covered by their medical insurance ), they may turn toward heroin and other “street” opiate medications. These drugs are expensive, sometimes hard to find, and in many ways they force or perhaps support people to live a life of crime in order to maintain their habits, if people have gone that far they must get help. And people overdose because they have no idea what is in the products they are obtaining.

Maybe, we have created an addiction monster in our society.

However, Portugal has found a way out of the addiction monster’s clutches. In 2001, with a growing heroin addiction problem, Portugal decriminalized all drugs and began to consider addiction to be a public and personal health issue. Drug addiction was viewed for what it is: a chronic, debilitating illness. People caught with a 10 day supply of any drug are referred to a sociologist who helps to determine their treatment options. And what Portugal has realized is that not only is this a more humane approach, it is also far less expensive to provide adequate medical care and treatment to addicts versus incarcerating them. Portugal has experienced a 75% drop in addicted persons from the 1990’s, and their addiction rates are 5 times lower than the rest of the EU. Meanwhile, drug related HIV infections have dropped by 95%, and the stigma around addiction has lessened dramatically.

http://www.npr.org/sections/parallels/2017/04/18/524380027/in-portugal-drug-use-is-treated-as-a-medical-issue-not-a-crime

As nurses, we are concerned about social justice issues and public health issues. I would posit that nurses and politically active nursing organizations should be taking action around the opiate crisis in several ways:

Calling for safe injection sites and distribution of clean needles (or needle exchange centers) and free condoms.
Looking at prevention and early identification of at risk persons (both ending early childhood trauma through supporting parents at risk for enacting trauma and assessing for early childhood trauma both across the lifespan and across all populations to determine risks for addiction).
Supporting harm reduction techniques.
Supporting a view of addiction as a public health issue, and a chronic disease issue.
Considering a call toward decriminalization of drugs and ending incarceration for addicts (the Portugal Model).
Acting compassionately toward all addicts (even the “drug seeking” ones).
For emergencies, call medicaltransport.co.

If you are interested in this topic, I do recommend reading Chasing the scream. This text provides great historical insight into how we came to where we are at with the global “war on drugs” and the escalating issue of for-profit prisons.

We have become the nation with the greatest number of incarcerated individuals (not %, but sheer number!): though we only have 5% of the world’s population, we incarcerate 25% of the world’s total prison population (this link looks at the complexity of these numbers and supports the idea of the truth that in the land of the free, we incarcerate a much higher percentage of people due to lack of alternative ways to provide help https://www.washingtonpost.com/news/fact-checker/wp/2015/07/07/yes-u-s-locks-people-up-at-a-higher-rate-than-any-other-country/?utm_term=.1ca70c3620af).

Columbia University’s CASA group has released multiple reports that link drug addiction issues to crime, incarceration, and repeat offenses. Sadly, while 65% of our prison population qualify for addiction treatment, only 11% actually receive treatment. Meanwhile, the majority of violent crimes are committed by those suffering from addiction. https://www.centeronaddiction.org/newsroom/press-releases/2010-behind-bars-II

Poverty, race, and income inequality also play a role in both addiction and incarceration, and as nurses, we are ethically obligated to advocate for change in healthcare and system wide policies that impact vulnerable populations. Raising awareness is a first step, but perhaps nursing organizations need to also start taking stances and lobbying for more humane treatment of those who struggle with addiction.