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


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

Alicia Wanless. The Information Animal: Humans, Technology and the Competition for Reality. 2025. https://academic.oup.com/book/61821.

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.

“Automating Inequality.” Virginia Eubanks, August 19, 2017. https://virginia-eubanks.com/automating-inequality/.

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.

Costanza-Chock, Sasha. Design Justice: Community-Led Practices to Build the Worlds We Need. Information Policy, edited by Sandra Braman. MIT Press, 2020. https://mitpress.mit.edu/9780262043458/design-justice/.

Daniel Susskind. “A World Without Work.” Accessed August 22, 2026. https://www.danielsusskind.com/a-world-without-work.

David Graeber and David Wengrow. The Dawn of Everything. 2023. https://www.penguinrandomhouse.ca/books/616885/the-dawn-of-everything-by-david-graeber-and-david-wengrow/9780771049842.

Emily M. Bender and Alex Hanna. The AI Con: How to Fight Big Tech’s Hype and Create the Future We Want. 2025. https://thecon.ai/.

Gabor Maté. When the Body Says No: The Cost of Hidden Stress. 2004. https://drgabormate.com/book/when-the-body-says-no/.

Gary Slutkin. The End of Violence. 2026. https://www.hachettebookgroup.com/titles/dr-gary-slutkin-md/the-end-of-violence/9780316520119/.

Gregory P. Marchildon. Tommy Douglas and the Quest for Medicare in Canada. 2024. https://utppublishing.com/doi/book/10.3138/9781487560430.

Haun Saussy, ed. Partner to the Poor: A Paul Farmer Reader. 1st ed. University of California Press, 2010. https://www.jstor.org/stable/10.1525/j.ctt1ppcmr.

“Invisible Women | Caroline Criado Perez.” Accessed August 22, 2026. https://carolinecriadoperez.com/book/invisible-women/.

John Ralston Saul. On Equilibrium. 2001. https://www.amazon.ca/Equilibrium-John-Ralston-Saul/dp/0140288031.

Karen Hao. Empire of AI. Penguin Random House Canada. 2025. https://www.penguinrandomhouse.ca/books/743569/empire-of-ai-by-karen-hao/9780593657508.

Leanne Betasamosake Simpson. Theory of Water: Nishnaabe Maps to the Times Ahead. 2026. https://www.leannesimpson.ca/portfolio-books/theory-of-water.

Linda McQuaig and Neil Brooks. Cancelling Billionaires Before They Cancel Us. 2026. https://www.dundurn.com/books_/t22117/a9781459754836-cancelling-billionaires-before-they-cancel-us.

Maude Barlow. Profit Is Not the Cure by Maude Barlow | Penguin Random House Canada. 2011. https://www.penguinrandomhouse.ca/books/8670/profit-is-not-the-cure-by-maude-barlow/9781551995267.

Maude Barlow and Tony Clarke. Blue Gold : The Battle Against Corporate Theft of World’s Water. 2003. https://www.penguinrandomhouse.ca/books/8669/blue-gold-by-maude-barlow-and-tony-clarke/9780771010866.

Mehra, Natalie, and John Cartwright. “Profit Is Not the Cure.” The Council of Canadians, April 12, 2024. https://canadians.org/analysis/profit-is-not-the-cure/.

Nason Maani, Mark Petticrew, and Sandro Galea. The Commercial Determinants of Health. Oxford University Press, 2022. https://academic.oup.com/book/44473.

Noral Loreto. Corporate Control. 2025. https://www.dundurn.com/books_/t22117/a9781459753136-corporate-control.

Paul Farmer. AIDS and Accusation: Haiti and the Geography of Blame. 2nd ed. University of California Press, 2006. https://www.jstor.org/stable/10.1525/j.ctt1pp3p4.

Paulo Freire. Pedagogy of the Oppressed. 50th ed. 2018. https://www.bloomsbury.com/ca/pedagogy-of-the-oppressed-9781501314162/.

Renee DiResta. Invisible Rulers. 2024. https://www.hachettebookgroup.com/titles/renee-diresta/invisible-rulers/9781541703377/?lens=publicaffairs.

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/.

Robert Chapman. Empire of Normality. 2023. https://www.plutobooks.com/product/empire-of-normality/.

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.

Tim Ingold. Anthropology: Why It Matters. 2018. https://www.wiley.com/en-us/anthropology-why-it-matters-p-9781509519804.

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/.

Vanessa de Oliveira Andreotti and Rene Suša. “Meta-Relationality Institute & Clearing the Field Series.” Meta-Relationality Institute, July 25, 2025. https://metarelationality.institute/about/.

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/.

Standing Up For Access to Vaccines in the United States


Written by Carey S. Cadieux, PhD, RN, AHN-BC, RYT, FAAN

As many of us struggle with the threats to public health under the current adminsitration, we may feel unempowered and discouraged. It’s important as patient and population advocates, and as the largest number of healthcare care providers, that we take steps toward finding small ways we can make a difference. Sharing our knowledge and calling for what is right for the health of the American people is something we can do in our everyday lives.

I have been greatly concerned about access to vaccines. For about a week in my state of New York, I haven’t been able to access a COVID vaccine as a prescription is required. For a number of reasons I couln’t obtain a prescription even though I have qualifying factors and I was about to travel to another state to obtain care until the Governor Hochul of New York wrote an executive order that ensures that all the people of New York State can receive a COVID vaccines without a prescription. Her executive order ensures that for the next 30 days, all NEw Yorkers can access a COVID vaccine, and the legislature will be charged with creating an official long term legislative move that will ensure access to all vaccines remain in place for New Yorkers. Ideally her actions alongside those of the governors of Massachusetts, California, and New Mexico will be replicated by other states.

Meanwhile, we have an opportunity to make our voices heard to the Avdisory Committee on Immunization Practices (ACIP) and the CDC prior to their next meeting in 7 days time. Until Spetember 13 @11:59 pm EDT, you can send a comment to the committee expressing your concerns the ACIP will be discusisng revisions to vaccines that can be adminstered to children and the vaccine schedule that dictates how ACA insurance is used (or not) to pay for vaccines. Their recommendations will also apply to the Vaccines for Children program, which has been highly successful at ensuring children have access to vaccines.

The call for comments can be read here: file:///Users/careycadieux/Downloads/CDC-2025-0454-0001_content%20(1).pdf

Your own comments with a 500 word maximum can be made here: https://www.regulations.gov/document/CDC-2025-0454-0001/comment

It’s important to consider what you want the ACIP to hear; while personal stories may be moving, it’s also appropriate that we include data and factual information in our comments. Start by letting the committee know you are an RN and why you are writing the comment. Include some links to articles or websites to support your ideas. Tell them what you want them to do. Remain professional. Include stats if you find them. Also, my entry is approaching the 5k word limit, but even just a few hundred works can have an impact.

You have the power!

Here is an example I submitted today (at the time of this blog posting it is still awaiting approval).

As a registered nurse with a PhD, an interest in public health, a fellow of the American Nurses Association Advocacy Institute, a Fellow of the American Academy of Nursing, and a background in public policy, I am deeply concerned about the current state of the CDC’s vaccine stance and the next steps for the ACIP. The recent proposal to limit access to the hepatitis B, MMRV, RSV, and COVID vaccines could end up being disastrous for the United States citizens. This is likely to end up costing the country and its citizens greatly on many levels. The ACIP vote, scheduled for September 2025, will, in great part, determine the future of our nation’s health. 

There is a significant public health concern that people, particularly children, should be vaccinated, and that the vaccines be covered by marketplace/ACA insurance, as well as the Vaccines for Children Program. A study performed by the National Institutes of Health with scientists from Henry Ford Health found that the some of the most impactful risk factors for the spread of COVID-19 in households include obesity and children as vectors (Siebold et al., 2022). 

Our public health system needs to vaccinate people to reach and/or maintain herd immunity for many preventable diseases. Herd immunity refers to the evidence-based concept where enough people are vaccinated to prevent the rapid spread of infectious agents. According to the Cleveland Clinic (2022), achieving herd immunity from COVID-19 required vaccination levels of up to 85% of the population, which we failed to achieve; hence, COVID-19 is now considered to be an endemic disease. Restricting access to vaccines contradicts the well-established scientific evidence that vaccines protect populations from infectious diseases, decrease overall healthcare costs, and safeguard vulnerable populations (Ashby & Best, 2021). 

The ACIP must also consider the cost of ongoing vaccine hesitancy and the lack of public health system support for accessing vaccines. A Kaiser Family Foundation study estimated that the cost of 690,000 vaccine-preventable COVID-19 hospitalizations in June-November 2021 was $13.8 billion (Kaiser Family Foundation, 2021). The CDC’s own research has found that the Vaccines for Children Program is effective. From 1994 to 2023, this program prevented 508 million lifetime cases of illness and 32 million hospitalizations, while also saving $540 billion in direct medical costs and $2.7 trillion in societal costs (Zhou et al., 2024). 

Additionally, vaccine-preventable diseases (VPD) in people over age 50 are not just costly; VPD hospitalized patients incurred worse clinical outcomes, greater loss of independence, and increased mortality and morbidity versus control groups (Hartman et al., 2024). The indirect costs of low vaccination rates include lost productivity, increased public health costs, diversion of public health resources, and higher insurance premiums. At a time when societal and US debts are rising at an alarming rate, not supporting access to free vaccines on a clearly defined and evidence-based schedule is an ingredient of a recipe that results in US economic failure.

Instead of focusing on restricting vaccines, the CDC and the ACIP should be focusing on overcoming vaccine hesitancy so that adults and children can be properly vaccinated according to an evidence-based schedule. In the best interest of the health of the US citizens, the proliferation of fear around vaccines needs to come to a halt, and the polarization of vaccine acceptance needs to be rebuked. The CDC needs to overcome vaccine hesitancy by supporting doctors, nurses, and pharmacists in their efforts to educate people about the acceptance of vaccines and their effectiveness at maintaining both individual health and the health of the population. The APIC, by supporting an evidence-based CDC vaccination schedule and a regulatory system that encourages vaccination for children and adults, could address the main components of vaccine hesitancy: lack of confidence in vaccines, complacency, and lack of vaccine access/ convenience (Gregory et al., 2023). The ACIP and CDC should not be creating road blocks around the people’s access to life saving vaccines. 

When considering the moral and ethical implications of vaccine programs and mandates, governments must always prioritize maximizing public benefit and minimizing public harm (Jalilian et al., 2023). The unintended consequences of the ACIP not fully supporting an evidence-based vaccination schedule from the CDC, include increased costs to the system, further division of the US population around this issue, and growing vaccine hesitancy. 

I urge the ACIP to vote in favor of evidence-based decisions regarding vaccine effectiveness and ensuring availability to all people in the population. You are charged with minimizing harm, overcoming vaccine hesitancy, enhancing access to vaccines, and reducing overall costs to the US government and the American people. 

References:

Ashby, B. & Best, B. (2021). Herd immunity. Current Biology, 31(4), R174-R177. https://doi.org/10.1016/j.cub.2021.01.006

Cleaveland Clinic. (2022). Herd immunityhttps://my.clevelandclinic.org/health/articles/22599-herd-immunity

Gregory, P., Gill, M., Datta, D., & Austin, Z. (2023). A typology of vaccine hesitancies: Results from a study of community pharmacists administering COVID-19 vaccinations during the pandemic. Research in Social and Administrative Pharmacy, 19(2), 332-342. https://doi.org/10.1016/j.sapharm.2022.09.016

Hartmann, M., Servotte, N., Aris, E., Doherty, T.M., Salem, A., & Beck, E. (2024). Burden of vaccine-preventable diseases in adults (50+) in the United States: a retrospective claims analysis. BMC Public Health 24, 2960. https://doi.org/10.1186/s12889-024-20145-0

Jalilian, H., Amraei, M., Javanshir, E., Jamebozorgi, K., & Faraji-Khiavi, F. (2023). Ethical considerations of the vaccine development process and vaccination: A scoping review. BMC Health Services Research23(1), 255. https://doi.org/10.1186/s12913-023-09237-6

Kaiser Family Foundation. (2021). Unvaccinated COVID patients cost the US health system billions of dollars. https://www.kff.org/covid-19/unvaccinated-covid-patients-cost-the-u-s-health-system-billions-of-dollars/


Seibold, M. A., Moore, C. M., Everman, J. L., Williams, B. J. M., Nolin, J. D., Fairbanks-Mahnke, A., Plender, E. G., Patel, B. B., Arbes, S. J., Bacharier, L. B., Bendixsen, C. G., Calatroni, A., Camargo, C. A., Jr, Dupont, W. D., Furuta, G. T., Gebretsadik, T., Gruchalla, R. S., Gupta, R. S., Khurana Hershey, G. K., Murrison, L. B., … HEROS study team. (2022). Risk factors for SARS-CoV-2 infection and transmission in households with children with asthma and allergy: A prospective surveillance study. The Journal of Allergy and Clinical Immunology150(2), 302–311. https://doi.org/10.1016/j.jaci.2022.05.0

Zhou, F., Jatalaoui, T.C., Leidner, A.J., Carter, R.J., Dong. X., Santoli, J., Stokely, J.M., Daskalakis, D.C., & Peacock, G. (2024). Health and economic benefits of routine childhood immunizations in the era of Vaccines for Children Program- United States, 1994-2023. MMWR Morbidity & Mortality Weekly Report, 73, 682-685. https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a2.htm

Nurses’ Concerns with COVID19: Update May 2, 2020


I find that nothing is more powerful than hearing the stories of our nurses during this pandemic crisis. This website has some of these powerful stories from nurses around the globe, sharing their experiences of caring for COVID19 patients: Nursespeak.com

PPE: Nurses continue to lack Personal Protective Equipment: A recent survey showed that 75% of staff in home-care settings are lacking in PPE. Home Care Survey. 86% of healthcare systems are also concerned with having adequate PPE available: PPE shortages

Political unrest emerges even as nurses remain on the front lines of providing care for patients during the pandemic. Nurses rose to the occasion to stand their ground in the face of protestors. Nurses Urge Protestors to Stay Homeimage.png

National Nurses United organized a nation-wide May-Day protest about lack of PPE: https://www.cbsnews.com/news/may-day-protest-nurses-ppe/

image.png Nurses also took  action by protesting outside of the Whitehouse on April 21 and reading aloud the names of nurses who died from contracting COVID19 in the workplace: Nurses Whitehouse Protest

And nurses are still speaking up, even if it puts their jobs at risk: Hospitals fire and suspend staff for speaking out

 

Nurses deaths: The virus continues to take its toll on nurses and other professionals. Issues around post-trauma recovery are now coming to light. Healthcare workers may be feeling hopeless or helpless or suffering clear PTSD symptoms. Sadly we have lost some professionals to suicide: NYPost tragic deaths.

If you need help please reach out. National Suicide Prevention Lifeline: 1-800-273-8255

A Missouri nurse, Celia Yap Banago, who raised concern about lack of PPE died of COVID19. Nurse Banago had worked as a nurse for 40 years and was literally days away from retirement.Nurse Banago

image.png

New York State Nurses Association houses a memoriam page to nurses lost to COVID 19. NYSNA memoriam page The retired executive director of the National Student Nurses Association is counted in the losses: Rest in Peace Robert V. Piemonte, EdD, RN, FAAN. image.png

To all of the nurses taking action, thank you for stepping up.

Nurses’ Concerns with COVID19: Update April 7, 2020


At this point, things are so disheartening for so many people. The range of nurses’ stories is so wide and varied, from OR nurses being essentially laid off due to no elective surgeries happening, to nurses being offered a lot of money to come to New York City to work.

New York State has taken the unprecedented step of merging all of its 200 hospitals into one system (New York State hospital system consolidation ). 

There’s a lot of death. One nurse told a story of how she had 10 patients in one shift and 7  of them died. In some hospitals, there is a different kind of rapid response team called, specifically for CVOID19 patients, and they are being called sometimes just minutes apart on different units throughout the hospital.

Also, nurses are working with their colleagues who end up being patients in their same units; one nurse told of their nursing supervisor being hospitalized in their own ICU, and they conjectured the supervisor most likely would pass away there.

There’s a lot of understaffing and over-working, including on the medical-surgical units. Part of this is because nurses themselves are becoming ill and unable to come to work.

image.png

Some nurses are actually more frightened to work in the medical-surgical units because they have a lack of PPE, and all patients are presumed to be COVID19 negative. Of course, when tests come back days later, the nurses discover that they worked with these COVID19 positive patients without proper PPE. There are also many issues around HIPPA and staff not being able to find out the COVID19 status of the patients they worked with previously.

Another nurse relayed this story: he works twelve-hour shifts on a medical-surgical floor, and their usual patient load now runs from 12-15 patients, the only real charting they really do is vital signs and meds. This is possible because NYC has suspended a lot of normal operations when it comes to providing care as per the governor’s laws:

“A massive section of regulations on the “minimum standards” governing hospitals — dealing with everything from patients’ rights to the maintaining of records — has been suspended ‘to the extent necessary to maintain the public health with respect to treatment or containment of individuals with or suspected to have COVID-19’.” (read about all of the laws suspended) .

This nurse cries after every shift, and he stated his tears are so different from before, in part due to his utter exhaustion. His family and friends want him to quit, they are worried about his health, but he stated he can’t quit now, they need him too much.

Nurses are asking about ramifications of quitting their jobs; some claim that they have been threatened that they will be reported to their board of nursing for disciplinary action (this is not the reportable offense of walking out and abandoning patients, rather for resigning their position). While these threats are likely idle, some nurses are still fearful of losing their licenses.

One nurse states that she works in a COVID19 only ICU unit. She says it’s mostly completely staffed by RNs: they have no NPs, PAs, Residents, Techs, or Housekeepers. Nurses and ICU Attending and Intensivists care for the patients. Med Surg nurses act as techs and assist the ICU nurses.

Recruiting: There is still a lot of recruiting going to bring nurses to NYC. One new graduate nurse (recently licensed, with no work experience) posted on social media about being offered to be “trained” to work in the ICU in NYC. All of her travel and lodging would be covered. She would be required to work 21 days, 12-hour shifts, with no days off.  The majority of the experienced nurses tried to set her straight about why this was a really bad idea, but we have no idea if she proceeded or not.

It’s not just NYC: We now have a 54-year-old nurse in Michigan who died, Lisa Ewald.

image.png

Unfortunately, nurse Ewald may have had some issues with initially being tested by her workplace, Herny Ford Health System in Detroit, Michigan. She was likely exposed on March 24, received her positive test on March 30, and passed away on April 3. She died alone in her home. (Lisa Ewald’s story).

Rest in Peace Nurse Ewald.

Meanwhile, more than 700 Henry Ford employees have tested positive for COVID19; 500 of the positive tests are nurses. (Henry Ford COVID19)

The field of nursing will be forever changed by this.

Nurses’ Concerns with COVID19: Update April 1, 2020


Ongoing Issues: By now, most of us know the obvious: nurses and other healthcare professionals do not have the PPE that they need to practice safely. Nurses are testing positive for COVID19. The Defense Production Act has not been activated to produce more PPE and ventilators, and nurses and other providers are even fired for speaking out about it or organizing ways to access more PPE (Doctors and Nurses Fired for Speaking Out ).

Nurses’ Skill Level: Nurses are worried about being asked to do work they aren’t prepared to do. A former student of mine, who has been in more of an administrative role, is extremely concerned with being asked to go back into a hands-on medical surgical or even ICU in a supportive role. Practicing beyond one’s skill level or expertise is just one area of concern that is likely to grow as more nurses become ill, or refuse to work, or are otherwise unable to work. 

 image.png

Volunteer calls: From California to NYC to Maine, nurses are being asked to submit their names to volunteer to work. Most of these nurses will be paid, and it is an effort to organize our resources.

Nurses on the Front Line: The stories I am hearing from nurses are war-time hell-like, maybe even worse then you have heard of if you don’t have direct contact with nurses on the front line.

An example is a story a friend of mine posted from his friend in NYC: in the ER, there may be 7-10 COVID+ vented patients waiting for ICU placement. Some patients are lying on the floor in the ER because there are no beds. People are being taken to rooms on the floors and passing away before they even get seen by a nurse on that floor. Medications like propofol, ketamine, versed, and fentanyl are being run without pumps because there are no more pumps. Supplies are running out. Med Surg nurses are being forced to run drips and vents that they have not been trained on.

Pay Issues: In Utah, nurses and doctors are being asked to take pay cuts, and there is concern that this will create a great deficit of providers in this state when professionals go elsewhere to work (Utah’s largest medical provider announces pay cuts). Meanwhile, note this lovely NYC serene skyline shot, with pay that must recognize the obvious inherent hazard pay for these positions.

image

(nurses recruitment add, contact information removed)

Populations and Outcomes:

Much preventative and maintenance care for those with chronic and even acute illnesses is now taking a back seat. A positive note is that telemedicine and telehealth are being used much more widely, and this may have a favorable effect on how we care for populations in the future.

Dr. Chinn forwarded a first-hand account to me of a nurse who is working in Brooklyn. She is concerned about how this illness is impacting Latinx populations, as they are often members of “essential worker” populations, and they also live in large households. This nurse states that these patients are at higher risk for death, and often experience death with less dignity. She also sees all staff getting sick, from direct care providers to janitors, and patient care technicians.

Anecdotally, in one social media group, I heard the nurses estimating that survival rate once a patient is ventilated is only around 14-20%. This is devastating to be surrounded around so much futile care and facilitating so much end of life care without perhaps the time and space it requires to do this well. (Edited: national statistics show a recovery rate of about 50% post ventilator initiation).

Heartbreak:  I am hearing heartbreaking stories of nurses sending off their children to grandparents or ex-spouses, so they won’t be exposed in the household should the nurse become sick themselves or accidentally contaminate the household. Nurses who can’t hug or hold their loved ones are aching inside every day. Nurses dying. Nurses looking around at their colleagues and they might wonder, who will be the next to not be at work, which one of us might end up in the ICU? Nurses may know that much of the care they are providing is futile or palliative, which creates moral distress. I am very concerned when I hear of nurses working multiple shifts, with one nurse posting that she had worked 13 shifts in a row, another posting about minimal sleep, and losing 10 pounds already. They don’t have time to eat and when they go shopping, the stores are lacking in supplies. There is no question in my mind that nurses are being put at greater risk not only due to exposure, but also due to physical, mental, emotional, and spiritual stressors.

image.png

Post-Traumatic Stress: We could say nurses are stressed, or maybe we should just be truthful and say that nurses are being traumatized. I have great fears of nurses leaving the profession after this, and I also have great fears about the health of the population in general. I am fearful for those on the front lines without access to proper PPE. This sort of chaos we are experiencing may lead to positive change eventually, but for now, it’s extremely uncomfortable, painful, confusing, infuriating, and even disorienting.

We need to take good care of ourselves and take good care of one another.

I am reaching out with loving-kindness to all nurses:

May all nurses be safe

May all nurses be at ease

May all nurses be loved

May all nurses know personal healing

Namaste

image.png