Scatter my ashes here...

Scatter my ashes here...
scatter my ashes in the desert...

Sunday, May 6, 2018

Nurses Week Takeaways from DC Part I: Politics and Nursing

It’s Nurses’ Week again.

I'm going to write two posts of Takeaways from the Nurses Take DC rally in Washington in April. There's so much I want to say, I can't fit it in a single post.

For the first post, I want to go back to Pam Robbins’ presentation in DC, Ascend to Political Nurse Advocacy, because she pointed out so many important considerations for engaging all nurses in our cause. I am paraphrasing many of the statements she made and adding my interpretations here.

I’ve talked about some of these points in my book, Navigating the C, in regard to my experiences in healthcare, in an oncology nursing context, but it applies universally to all nurses, and all of healthcare. In my second post of Takeaways, I am going to incorporate some of what I said in my book along with the points I made in my speech in DC.

First, FEAR
Pam talked about fear being the biggest thing that holds nurses back. Part of it is the antiquated, unenlightened approach to thinking about gender and the roles we have associated with gender in the past. It’s time to discard those ways of thinking and be people. Yes, we have differences and that makes things interesting, but we are all first human beings.

Nurses MUST stop being martyrs and stop shortchanging ourselves with self-deprecation. If we want to be leaders we must overcome these fears, placing more value and believing in ourselves. Too many nurses are terrified they will lose their jobs for speaking up.

And I can tell you from personal experience, they will do everything they can, no matter how ridiculous and petty, to get rid of you do if you do. But if we don’t speak up, it means our patients’ safety is forever compromised. We cannot afford to risk their lives.

Nurses need to articulate our value to the public by getting out there, speaking to journalists, being interviewed, being visible on social media. We need to speak up in our professional organizations, who should also be involved in such matters, as unhappy nurses will not be as productive or influential in their careers.

Every professional specialty organization, such as AACN, ENA, ONS, AORN and so on, needs to take a stand WITH their nurses, instead of siding with those who will take advantage of nurses. The power gradient against nurses increases when our professional organizations do things that don’t truly help us. They may talk a good game but it is important for nurses to look closely at the policies they come up with.

That is why Nurses Take DC has offered similar but better legislation that works in nurses’ best interest. Working nurses should be in control, have more control, and right now, many professional organizations do not want to yield that. They mostly support industry interests and will back the administration’s interest over staff nurses. All you have to do is attend a nursing conference and you will see the disproportionate influence of pharmaceutical and hospital industry funding.

The fear extends beyond the workplace to participating and speaking within these organizations, too. Recently, I found it interesting that when I posted my reply to a post about the nursing shortage on the discussion forum of my professional organization, I only received one public reply. But I received several private replies from people, which tells me the level of fear is pervasive, to the point of not wanting to speak out even on these specialized forums.

If you’re one of the many (maybe majority still?) of nurses who say, I can’t lose my job, my livelihood depends on it, I have a family, a mortgage, my kids, or I’m a single parent, here is what YOU need to do.

  • In the workplace, form a coalition of nurses so you stand together when you approach management with an issue. Don’t leave each other alone- have each other’s backs.
  • You don’t have to necessarily be vocal in your workplace, either- you can be a nurse constituent and contact your legislators with your concern. Your employer won’t know about that.
  • There’s Flo’s Whistle, and anonymous reporting tool for unsafe staffing conditions in an easy to use app.
  • You can also become active in contributing and leading as a nurse in your community.

Here are some other practical interpretations I got from Pam’s presentation at Nurses Take DC.

Nursing Culture and Education
We need to start educating nursing students in both policy and taking political action. That is a tall order and a giant shift in the nursing school curriculum. Unfortunately, the abusive culture of nursing often starts in nursing school. Instructors exert their control over students and show them the ropes of the eat their young culture. Nurses need leadership skills and we need to start learning these early on in our careers.

Nurses can be, and have been, awful to each other. Nurses get so little recognition and expressions of appreciation. When there’s so little to go around, they fight over it, like a scarce resource, like dogs fighting over a bone. They feel constantly abused and taken for granted, and this feels like another reminder of just how insignificant they feel. It sounds like middle school all over again, and in many ways, it is. Stop it. Don’t be nasty. Grow up, act like mature adults. This applies just as much, if not more, to management. Leaders need to set examples, not be part of the problem.

Public Perception
Nurses need to learn how to stand up for themselves, to have a voice in their workplaces and in their communities, to be visible, audible, and persistent. The public does not have a realistic perception of what nurses do, how important we are, and our potential for stepping up our influence in public policy.

The Robert Wood Johnson Foundation published a report in 2010 based on Gallup opinion leaders polls conducted in 2009. Pam discussed some of the findings:

  • While opinion leaders nurses are the most trusted profession, the same opinion leaders perceive nurses as having little influence over healthcare reform in the near future.
  • Nurses are not perceived as important decision makers or revenue generators, and that we do not have a single (unified) voice on national issues.
  • The public views nurses as functional doers rather than thoughtful strategists. We need leadership skills, and we need to start early.

Paternalism in Healthcare
Healthcare is not all about medicine and physicians. Nurses are the ones who keep patients safe and alive, during times when the doctor is not there, which is over 99% of the time. Really. If the doctor is there for 5 minutes a day when the patient is in the hospital, that’s only about 0.3% of the time! So nurses are watching you 99.7% of the time. And nurses check the doctor’s written orders to make sure that everything is appropriate and safe for the patient, and we correct them if they are wrong!

I really think we need to start changing the language around healthcare workplace relationships between physicians and nurses- doctors writing “orders” still sounds so paternalistic, as if they are ordering us around, like we are their handmaidens.

Doctors write a medical treatment plan, and nurses have a nursing care plan, so it should be referred to as something more egalitarian, that can be established mutually in the interest of the patient’s safety. They can’t exist without each other, and they are important, I would even say that without nursing care, patients would be in trouble if they only had the medical treatment. Because nursing care will keep you going even in the absence of medical treatment.

In our politically divisive times, we also need to make the case that this is not about being pro-union or anti-union, Republican or Democrat, red/blue or purple state- but it’s about issues that affect everyone.

One thing that I add is that nurses wouldn’t think of refusing care to someone because they believe differently or have a different political affiliation, we accept everyone as our patients and give them equal care. This issue is beyond political divisions. Every single person is a potential patient.

And every one of us are, also.

Apathy and Democracy are Incompatible
We live in a democracy, but few of us take full advantage of the power it affords us. As citizens, we have the right to vote and make our voices heard, yet only a small percentage of the voting-eligible public votes! Only a miniscule proportion ever get involved in the legislative process.

If you saw something being done to your patient that would cause them harm, you wouldn’t hesitate to stop it and speak up on behalf of the patient. But when it comes to our country, and public health, safety, and well-being, few nurses use their advocacy skills.

If nurses would think of our country as their patient, insist on only the highest quality care being given, and protect the public from harm, we would make great strides.

Takeaways-What we need to do
1. Lose your fear. It’s power in numbers, and by banding together, you can help each other deliver a stronger message. When a colleague expresses a need to change things, don’t treat them as if they were radioactive. Instead, get behind them, support them, and bring others on board.

2. Don’t downplay the achievements of your colleagues, don’t put them or yourself down. When someone is recognized for an achievement, it’s common for backstabbing, envy, and resentment to well up among those who feel even more diminished if one of their colleagues is being publicly honored. When we raise the profile of nursing through one of our colleagues’ work, we lift all nurses’ profiles.

3. Stop making it about political affiliations. This is about everyone, we are all potential patients. This is about the public’s best interest, all of us.

4. Nursing education must start preparing nurses with skills on political advocacy, negotiation, and articulating the value of our profession to the public. If we can get the public to understand what we do, and articulate that clearly, we can show that healthcare is not all about medicine and physicians, the holistic approach to nursing care is what moves patients away from illness and toward wellness.

5. Research by nurses should hold equal status to medical research. You can give all the medicine you want, but unless there is someone there to make sure they are being cared for safely and that medicine is administered properly, all the medicine in the world won’t save a life. It’s not all about medicine and physicians. Nurses are the ones who keep patients safe and alive, during the times when the doctor is not there (which is most of the time).

6. Look at the different nurse staffing bills in front of Congress. Both the ANA and Nurses Take DC bills are based on evidence, but unless you have regulation with staffing ratios in writing that holds the employers accountable, you have nothing. We must hold our employers, as well as our professional organizations, to account and transparency.

While they are similar in many ways, note the ANA’s bills (S. 2446 and H.R. 5052) do not include a mandate for employers to commit to a staffing plan for their employees, in writing. The Nurses Take DC bills (S. 1063 and H.R. 2392) do have such a mandate, with proposed ratios in different clinical areas. Employers would not be able to avoid the staffing plan mandate. This protects both nurses and patients.

For more information about the Nurses Take DC movement, visit

The next post will be about takeaways from my speech at Nurses Take DC.

photo credit: Andrew Lopez

(Note: a variation of this post was recently published in Oncology Nursing News)

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