Nursing and Advocacy and Voting

Thank you University of Washington Continuing Nursing Education for the opportunity to share my ZOOM videotaped thoughts on all things nursing advocacy, activism, civic engagement and voting. And I meant what I said towards the end of my remarks: my nursing students give me great hope for our collective future. Most of them already understand the importance of this, are doing this work, and are keen to hone their advocacy, activism, and civic engagement skills. I’d also add here that we need to stand up against voter suppression and intimidation.

Stay strong and vote!

Past Presidents of the ANA Endorse Biden-Harris

Note: The following is a letter from eight past presidents of the American Nurses Association in support and endorsement of Biden-Harris in the 2020 election. It was shared with me today by past ANA president, Virginia Trotter Betts who asked that I share it widely. Nurses, nursing students, and everyone whose lives have been/are/will be impacted by a nurse need to read this. And vote for Biden-Harris in the November election.

Open Letter from American Nurses Association Past Presidents as signed below

The 2020 presidential election will be one of the most consequential decisions our nation has ever faced. Over the course of more than four decades, we, the undersigned past presidents of the American Nurses Association (ANA), led the nation’s nurses without deference to specialty or affiliation on matters of policy and politics. Instead, our work was grounded in the tenets of the ANA’s Code of Ethics for Nurses and the principles of its Social Policy Statement, venerated guideposts that establish nurses’ professional values and direct their practice, embodied in a commitment to serve all society. Our body of work compels us to speak out and express our support for the presidential candidate who we believe will best serve the people of this nation—Joe Biden.

We believe that Americans have a choice on the ballot this year between a candidate who will be inclusive and restore a moral compass with empathy for human beings or a candidate who has sewn chaos and division while showing no compassion for the American people. The Trump administration has us literally fighting for our lives as we face down the Coronavirus pandemic while sparring over our economic futures; access to affordable and equitable health care; racial equality; social justice; and immigration policy.

From bedsides to boardrooms, professional nurses across this country have always served the healthcare needs of our people. We know firsthand the value, knowledge, and skills nurses bring to the care of others. Perhaps more than at any other time over the past century, the COVID-19 pandemic has brought into focus the essential nature of nurses’ contributions to the health promotion, illness prevention, and compassionate healing of all people in need. It has also laid bare the lack of a coordinated national response to COVID-19, which has failed nurses and all Americans. A failure to promote and enforce life-saving coronavirus mitigation strategies through organized, consistent, and evidence-based guidelines and the silencing or denigrating of scientific and medical experts and institutions has denied critical public health safeguards for us all.

Utilizing nursing’s core principles, the eight of us have analyzed the positions of each party’s presidential candidate. Without question, the Democratic Party platform aligns best with nurses’ ethical values and numerous ANA positions on important issues such as promoting public health, healthcare access, ensuring racial equality and social justice, ending the epidemic of gun violence, providing humane treatment for those seeking refuge from danger, and securing a clean energy future, among others.

The choice is clear. As national nurse leaders, we strongly support Vice President Joe Biden for President. He will safeguard the future and health of our nation. Join us in support of the Biden-Harris ticket!

Signed, Past Presidents of the American Nurses Association in Support of Biden-Harris

Pamela Cipriano, RN, 2014-2018 Virginia
Karen Daley, RN, 2010-2014 Massachusetts

Rebecca Patton, RN, 2006-2010 Ohio
Barbara Blakeney, RN, 2002-2006 Massachusetts

Mary Foley, RN, 1999-2002 California
Virginia Trotter Betts, RN, 1992-1996 Tennessee

Eunice Cole, RN, 1982-1986, California
Barbara Nichols, RN, 1978-1982 Wisconsin

Nurses: Please Vote

Nurses in the United States: Please do not sit this election out. Do your duty as an American citizen and as a nurse. Make informed decisions about candidates and issues and cast your ballot (just once, that is—don’t listen to our current president, silly man that he is, only vote once, whether it is by mail or in person or via e-mail for oversees folks). Voting is always important and is a sacred civic duty. This year, it is especially crucial for the health and future of our country. And do whatever you can to encourage and enable other people to vote, including your patients and your community members.

If you happen to be a nurse educator as I am, remember that you can and should provide course content on the importance of political knowledge and advocacy for nursing. It seems to be a common misperception among nurse educators that political content is somehow a no-no and that it can get them in trouble with their employers. Providing non-partisan information on being an informed voter is never a no-no. And, our nursing students need to be exposed to nursing faculty and other mentors who are politically engaged—including nurses who run for political office at the local, state, and national levels. A great non-partisan resource is the All In Campus Democracy Challenge. Check to see if your college/university has signed on to this challenge and what resources and activities you can tap into.

In just a few weeks, I will cast my ballot here in Seattle, King County, Washington. I am proud of our state and county for ensuring that our elections are safe and open to every eligible voter, no matter their race/ethnicity, country of origin, language, able-ness, and political affiliation. I am proud to be part of the grassroots Nurses for Biden-Harris group, working to promote information on the reasons why nurses should strongly consider voting for the Biden-Harris ticket: compassion, faith, resilience, empathy, kindness, humility, joy, respect, inclusion, and dignity. Those are the core values of Joe Biden and Kamala Harris. They also happen to be core values and part of the Nursing Code of Ethics of the American Nursing Association.

Racism and Nursing

Bandaging a patient’s hand, Cross-Over Clinic, 1986. Richmond Times-Dispatch

Ibram Kendi writes, “We are surrounded by racial inequity, as visible as the law, as hidden as our private thoughts. The question for each of us is: What side of history will we stand on?” (How to Be an Antiracist, p. 22).

In preparing to teach population health nursing and health policy and politics again this coming academic year, I am working with the good folks at StoryCenter to develop media literacy content utilizing digital storytelling videos. And, since our University of Washington Health Sciences Common book will be Kendi’s How to Be and Antiracist (not to mention the current moment in terms of racism in our country), I plan to use digital storytelling focusing on racism and bias in nursing and health care.

Nurstory, working with StoryCenter, has some excellent digital storytelling videos by nurses across the country, including nurses with the Nurse Family Partnership. Dr. Raeanne Leblanc and her colleagues at University of Massachusetts, Amherst, completed a Nurstory project on social justice. My plan is to work with our students on the use and making of digital stories related to racism and bias. Since I believe that I should practice what I preach (or teach in this case), I recently made a digital storytelling video on my experience of racism in various aspects of nursing, including nurse education. Titled “Relics,” here it is:

Relics, Josephine Ensign, August 2020

Good Riddance Lost Cause

My hometown of Richmond, Virginia is a city anchored to its past by bronze and marble Confederate shrines of memory. I was born in Retreat for the Sick Hospital, Richmond’s oldest hospital opened in 1877 by Civil War nurse Annabella Ravenscroft Jenkins. The hospital was around the corner from the towering memorial to Jefferson Davis—a memorial topped by Vindicatrix, the symbol of virtuous white womanhood—a woman literally on a marble pedestal.

My paternal great-great grandmother from a Georgia cotton and slave-owning plantation was a first cousin of Varina Davis, First Lady of the Confederate States of America. I was raised on Richmond’s eastern edge, on the relic-strewn Civil War land of Cold Harbor. I am a product of Virginia public schools: Battlefield Park Elementary School, Stonewall Jackson Middle School, and Lee-Davis High School. I went to high school with the son of the Grand Dragon of the Ku Klux Klan who threatened me with physical violence if I did not stop campaigning for Jimmy Carter. The high school’s song was the “Rebel Yell” and then, as now, it is called the “home of the Confederates.”

During my nursing education at the Medical College of Virginia in Richmond, I mostly cared for homeless and impoverished (and oftentimes imprisoned, shackled to their beds) African-American patients in the ‘old hospital,’ formerly the ‘Negro-only hospital.’ The new MCV hospital curled around the White House of the Confederacy like a lover. In nursing school, we were taught that the profound racial health disparities in our country were caused by inherent biological differences of African-Americans, rendering them more susceptible to disease. Therefore, it was implied, we could do nothing to change these health disparities. Racism and its health effects were never discussed.

Starting in 1986, as a newly-minted nurse practitioner, I ran a health care for the homeless clinic in the Richmond Street Center. My first HIV/AIDS patient was an African-American man who became so ill that I drove him to MCV Hospital where, after a protracted and painful month, he died. His hospital chart listed me as next of kin and I was asked to attend a hospital ethics meeting to decide whether to remove him from life support. I was not there when he died but I attended his graveside funeral in the Potters Field area in the city-owned Oakwood Cemetery. Even then, I was aware of the moral pitfalls of white supremacy masquerading as white savior.

For the past three decades, I have lived and worked in the younger and more progressive city of Seattle. It took this geographical cure, living away from and looking back at my upbringing in the American South to understand the insidious and caustic effects of the South’s sense of history and of place, including the rigid roles of race, class and gender. These insidious and caustic effects are on me as an individual, and on my family, community, and country.

But my smugness and sense of living in a morally superior region of our country has long since been tempered by experience. Deeply entrenched racism is not just a relic of the American South. It should not have taken the killing of George Floyd by a police officer in Minneapolis to have reminded us of that fact.

I teach public health at a school of nursing founded by Seattle public health nurses and stemming from their response to the 1918 influenza pandemic, a time eerily reminiscent of our current COVID-19 pandemic, including its disproportionate burden on communities of color. Elizabeth Soule, our school’s first dean and dubbed the “Mother of Nursing in the Pacific Northwest,” banned admission of African-American students until her retirement in 1950. My students have pointed out that several of our required medical-surgical nursing textbooks continue to erroneously perpetuate a biological basis of African-American health inequities. Our students of color continue to encounter white patients who refuse to be cared for by them. Our hospitals and our school continue to support these patients’ wishes, reinforcing institutional racism.

It heartens me to know that protestors tore down the Monument Avenue statue of my relative, Jefferson Davis, in early June. As of this writing, Vindicatrix remains high on her pedestal but the city plans to remove her and all other Lost Cause statues. This, and the activism of my nursing students, give me hope that there will be meaningful dismantling of the systemic racism running through our monuments, schools, healthcare institutions, and professions.

Note: As of today, Vindicatrix has been removed. Good riddance.

Protect and Support DACA

In this time of justifiable anger, protest, and civil unrest, let us not forget other ways that the rights of persons of color are being undermined in our country. DACA: Deferred Action for Childhood Arrivals is an Obama-era program that gives temporary legal status and work permits to undocumented immigrants who came to our country as children. The vast majority of DACA recipients are young people of color and many of them work as nurses and other essential workers. (see “Washington’s DACA recipients on the coronavirus frontline await Supreme Court ruling” Nina Shapiro, The Seattle Times, May 31, 2020)

The Trump administration, big on building walls and racial/ethnic/political divisions in our country, has been trying to dismantle DACA. The NAACP is a staunch supporter of DACA. The Supreme Court is set to rule on a major DACA case any day now. In fact, they were expected to release their ruling today but likely delayed it in case their ruling fuels further protests.

At least one of my nursing students this year is a DACA recipient. It has been an honor to be one of her teachers. With her permission (and her group members’ permission), I share this powerful digital storytelling/health policy video: “Barriers to Health Care for DACA Recipients: Yohannah’s Story.”

COVID-19 Health Inequities

So proud of our University of Washington nursing students for using their talents and experiences to speak out on important health policy current event issues. This is just one of the student group digital storytelling health policy videos they produced for my spring quarter 2020 healthcare systems course. They consented to me sharing it. I will share additional health policy student-produced videos in future posts. This one is especially relevant to the current outcry across our country about racism, hate crimes, and police violence against black and brown people.

Views from Seattle-King County, COVID-19 Outbreak

Week #2 of the Seattle area COVID-19 outbreak with its dark cloud hanging over the city, the nation, and the world, here is what I know to be true:

  1. Know and follow credible, scientifically evidence-based public health recommendations such as washing your hands with soap and water for at least 20 seconds–or using alcohol-based hand sanitizer (if you are lucky enough to have bought some before every store sold out) and practice sensible social distancing…
  2. Nicely but firmly correct any misinformation and bigotry that comes your way.
  3. Only share information that is from verifiably credible, scientifically evidence-based public health experts. For me here in Seattle that includes Public Health–Seattle & King County and Washington State Department of Health.
  4. Avoid engaging in stupid, fruitless, politically or ideologically-charged arguments (repeat #2 above and this could be a positive way to practice a different kind of social distancing).
  5. Don’t just sit there (unless, of course, you are sick)–do something positive! Support our heroic front-line public health and health care workers like nurses, physicians, medics, and cleaning staff who are working around the clock to care for individuals, families, communities, and entire populations affected by this pandemic. Support our elderly, medically-vulnerable, and people experiencing homelessness. If you are able, volunteer to assist in these efforts.
  6. Remember to get outside or somewhere close to nature to smell the flowers.
  7. Be kind.
Burke-Gilman Trail near Children’s Hospital, Seattle

Nursing in the Time of Pandemics

Having come of age and been a nursing student during the early days of the HIV/AIDS pandemic, I have been feeling many moments of deja vu over the past month with the world-wide spread of the novel coronavirus and the accompanying COVID-19 illnesses. It is, of course, more than a distant global health issue now since I live, work, and teach nursing in Seattle-King County–site of the first death of a patient with COVID-19 and where experts now estimate at least 1,500 people are already infected. The two high-risk groups for severe complications and deaths from COVID-19 are healthcare providers and older people who have underlying chronic illnesses. I fall into one and a half of those categories, so I am concerned on a personal level.

But I am concerned on a larger level because I teach hundreds of nursing students and feel an urgent responsibility to help prepare and equip them to deal with this public health emergency. And not just the practical training and adequate access to the necessary medical supplies–on the use of personal protective equipment like face masks and goggles. But also the emotional and ethical preparation and support for processing a rapidly evolving, complicated pandemic. Acknowledgement that fear and anxiety are part of this but that we have a personal and professional duty to care for people despite that fear and without bias. I like the public health messaging that has gone out from our Public Health-Seattle & King County people: “Viruses Don’t Discriminate and Neither Should We.” Yet it goes beyond that, to an acknowledgement of weaknesses of our healthcare and public health system and resolve to do better, to learn from our mistakes–including from our mistakes in how we handled the HIV/AIDS pandemic. We cannot allow shallow, partisan politics, malicious misinformation, undermining of evidence-based public health interventions, and bigotry to fuel the spread of this virus.

Dorothea Dix and the Trade in Lunacy

Dorothea Dix, Harvard University Houghton Library

Dorothea Dix was a leading US and international mental health reformer. She knew how to wield her quill pen and do her own reporting to advocate for positive changes. We still have a lot to learn from her.

Starting in 1830 with her investigative reporting on the deplorable conditions of inmates at a Cambridge, Massachusetts jail, Dorothea Dix quickly spread her mental health advocacy efforts with inspections of prisons and insane asylums throughout Massachusetts and other states, then internationally to England and Scotland (petitioning Queen Victoria for reforms), France, Italy (petitioning Pope Pius IX), and Turkey (trying unsuccessfully to meet with and petition Florence Nightingale at the end of the Crimean War).

After Dix’s controversial stint as Superintendent of Women Nurses for the Union Army during the American Civil War, she again took up her mental health reform efforts extending them to the Far West, visiting California, up through Oregon, to Washington Territory. Remarking on the natural beauty of Washington, including snow-capped Mt. Rainier, she described in a letter to her British Quaker reform friends, the Rathbones of Liverpool, that she was favorably impressed by the Pacific Northwest’s “humane and liberal” prisons and insane asylums. She attributed their excellence to how newly settled the area was, a newness that allowed for more progressive thinking than in either European or the American East Coast cities.

Dix was involved with political debates raging in England and Scotland where local parishes used the contract system, paying for their insane poor to live and work in private, for-profit insane asylums. Many of the asylum proprietors cut costs and increased their profits by shackling patients inside unheated rooms and depriving them of food and medical care. Known as the “trade in lunacy,” once the truths of the trade were uncovered, the practice was a source of widespread moral outrage and calls for reform.

In America, there were claims that treatment of insane incurable paupers in state-run insane asylums was a more humane approach. Proponents claimed it would save money in the long run, given economies of scale and since patients could avoid being sent to higher-cost jails and prisons.
Early reports from institutions such as the Worcester Insane Asylum claimed high success rates of “curing” patients of their insanity, by citing high patient discharge rates. What they failed to mention were the equally high rates of readmission of these patients to the same or similar institutions within short periods of time. Once forced to face these statistics, proponents of insane asylums, including Dorothea Dix, began to point to “seasonable care,” meaning that successful treatment and cure rates occurred when patients were identified early in their illness and were provided with appropriate treatment at insane asylums. Early in their illness was typically defined as treatment within the first year of onset of their symptoms.

Public and private debates in America were raging as to whether paupers–insane or not–brought on their own plights through immoral acts such as intemperance, specifically in terms of alcohol consumption, and the duty of the state to care for such people. Calvinist work ethics and conceptions of sin and salvation colored these debates. Women with children “out of wedlock” and prostitutes were labeled as sinners and as undeserving poor. Leading reformers such as Dorothea Dix declared that the duty of society was the same whether insanity or destitution resulted from “a life of sin or pure misfortune.”

Sources:

Dorothea Lynde Dix, Asylum, Prison, and Poorhouse: The Writings and Reform Work of Dorothea Dix in Illinois (Carbondale, Ill.: Southern Illinois University Press, 1999).

Thomas J. Brown, Dorothea Dix: New England Reformer, Harvard Historical Studies ; v. 127 (Cambridge, Mass.: Harvard University Press, 1998).
Dix, Asylum, Prison, and Poorhouse.

Legislative Assembly of the Territory of Washington, “An Act Relating to the Support of the Poor.”

Tamonud Modak, Siddharth Sarkar, and Rajesh Sagar, “Dorothea Dix: A Proponent of Humane Treatment of Mentally Ill,” Journal of Mental Health and Human Behaviour 21, no. 1 (2016): 69, https://doi.org/10.4103/0971-8990.182088.

Dorothea Dix, “‘I Tell What I Have Seen’—The Reports of Asylum Reformer Dorothea Dix,” American Journal of Public Health 96, no. 4 (April 1, 2006): 622–24, https://doi.org/10.2105/AJPH.96.4.622.

Dorothea Lynde Dix, The Lady and the President: The Letters of Dorothea Dix & Millard Fillmore (Lexington: University Press of Kentucky, 1975).