Enough is enough- taking back our profession

[forrester]

the nursing declaration of independence

the unanimous declaration of the 3.1 million nurses in the united states of america

when in the course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of healthcare, the separate and equal station to which the laws of nature, ethical imperatives, and public responsibility entitle them, a decent respect to the opinions of humankind requires that they should declare the causes which impel them to the separation.

we hold these truths to be self-evident, that all nurses are created equal, that they are endowed by their history and mission with certain unalienable rights and responsibilities, that among these are the right and responsibility to advocate for their patients, the right and responsibility to advocate for a fair and effective health care delivery system, and the right to protect their own self interests so as to guarantee their ability to fulfill their ethical obligations -- that to secure these rights, organizations and administrations have been instituted in nursing, deriving their just powers from the consent of the governed, that whenever any form of organization or administration becomes destructive of these ends, it is the right of the nurses to alter or to abolish it, and to institute new organizations and administrations, laying their foundation on such principles, and organizing their powers in such form, as to them shall seem most likely to effect their mission, professionalism, and ethical integrity. prudence, indeed, will dictate that successful organizations and administrations long established should not be changed for light and transient causes; and accordingly all experience hath shown, that professions are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. but when a long train of abuses and usurpations, pursuing invariably the same object, evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such domination, and to provide new sentries for their future security. such has been the patient sufferance of professional practicing nurses; and such is now the necessity which constrains them to alter their former systems of medical, organizational, and administrative domination. the history of the present healthcare industry is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute tyranny over nursing and patient care. to prove this, let facts be submitted to a candid world.

oraganized medicine has continued to obstruct and prevent the independent practice of nurse practitioners, in spite of over 40 years of studies which have well documented their safe and effective practice.

facility administrators have repeatedly maintained a rigid, militaristic practice environment which devalues nurses and, by patient load and a variety of intimidation factors worked to prevent nurses from fulfilling their ethical responsibilities.

nursing organizations, particularly the american nurses association, have failed to actualize a political strategy to successfully counter these oppositional forces, to the detriment of both nursing and the american public.

organized medicine has successfully controlled, and gained disproportionate influence in the political processes so as to enact laws which protect their self interest over the interest of the american public, as well as the interests of professional nursing.

administrative systems in healthcare have repeatedly ignored nursing research in opening up the doors of access to primary health services and public education, basing their decisions on profitability instead of population benefit.

nursing organizations such as the american organization of nurse executives, have aligned themselves with the american hospital association, and have historically and systematically worked to thwart the efforts of bedside nurses who have attempted to address working conditions through collective bargaining.

organized medicine, pharmaceutical companies, insurance companies, and the american hospital association have exerted undue political influence to control and dominate the political dialogue so as to limit choices and possible solutions to the healthcare crisis in the united states.

organized medicine has manipulated their public image to project themselves as the only authoritative voice in healthcare.

administrative systems have colluded to keep nursing salaries low, actively worked to fracture and keep the profession of nursing from any type of organization, and created working conditions which abuse and devalue the work of nursing.

in every stage of these oppressions we have petitioned for redress in the most humble terms: our repeated petitions have been answered only by repeated injury. a "prince", whose character is thus marked by every act which may defined a tyrant, is unfit to be the ruler of a free profession, or the sole decider of systemic reform.

nor have we been wanting in attentions to our medical and administrative partners. we have warned them from time to time, either indirectly in opinion surveys or directly in correspondence, of attempts by their organizations to extend an unwarrantable jurisdiction over us. we have reminded them of the circumstances of our history and ethical responsibilities here. we have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. they too have been deaf to the voice of justice and of consanguinity. we must, therefore, acquiesce in the necessity, which denounces our separation, and hold them, as we hold the political processes, enemies in war, in peace, friends.

we, therefore, the representatives of the profession of nursing in general congress, assembled, appealing to the supreme judge of the world for the rectitude of our intentions, do, in the name, and by authority of the good people of these united states, solemnly publish and declare, that these publicly recognized professionals are, and of right ought to be, free and independent practitioners; that they are absolved from all rigid and subordinate allegiance to organized medicine, select professional organizations, and the administrative powers in facilities, and that all political connection between them and the profession of nursing, is and ought to be totally dissolved; and that as a free and independent profession, they have full power to levy war against those who would compromise patient care, conclude peace with those who support the ethical obligations of nursing, contract alliances as deemed most appropriate to further the aims of nursing to establish a fair and equitable healthcare delivery system, establish commerce, and to do all other acts and things which independent professions may of right do. and for the support of this declaration, with a firm reliance on the protection of divine providence, we mutually pledge to each other our lives, our fortunes, and our sacred honor.

john silver

[merlee]

Yeah, that.

[CoolhandHutch, MSN, RN]

I have my pitchfork and torch, where we headed?

[DixieRedHead, ASN, RN]

Can you say this in a short version so I can understand it. I can read all the words but somehow I don't get what we are to be free from, and free for.

[pink_shoes99]

I agree with Dixie.

[Isitpossible, LPN, LVN]

How do we get to the independence that you speak of ???????????

[Thedreamer]

I think the gist of this was, "I like turtles."

[Bortaz, MSN, RN]

Are you a pirate, or a fishmonger?

[llg, PhD, RN]

Actually, what it says is that the OP doesn't like working for an employer and wants to be an independent practitioner. I say, "If that is what he/she wants to do, then he/she should go for it." It's possible. If you don't want to work for an employer, set up your own business and be an independent practitioner.

Now ... I strongly suspect that the OP intended the piece to say more than that ... something along the lines of nurses using their influence to exercise more political power within their current organizational cultures. But that's not what the document in the OP actually says.

[GilaRRT]

Readers Digest version:

Mean doctors are holding back nurse practitioners and we best do something about it.

[forrester]

We have NP's being blocked from independent practice and prescription authority in far too many states.

We still have political and structural subordination in the health care facilities, which impacts things like pay, staffing ratios, and even the priorities of the facilities.

Our nursing organizations have become mired in rhetoric and unable to really accomplish anything politically.

The NNU is the only nursing organizaiton growing in numbers, political power, and social activism.

We have CNO's hired by the CEO's, which subjugates nursing interests like safe patient care and advocacy, to the interests of the administrators.

I think every nurse should read up on Lillian Wald and see her vision of what nursing led healthcare can look like.

As to some of the comments so far:

I agree, the BSN "requirement" is not needed. I worked for many years with my ADN and no one ever asked me about my degree. Competence is the issue, although I do believe in scope of practice limitations for the LPN's, and I too have worked with many excellent ones.

I am not a dis-satisfied employee somewhere. Many, many nurses do not have the luxury of simply becoming "independent". It is nursing itself which needs to be liberated.

[brandy1017, ASN, RN]

Sounds like you missed your calling, you were meant to be a lawyer not a nurse. Too long winded legalese to sift through.

I thought medicare already reimburses nurse practioners, but at 1/2 the rate of a doctor. Don't know how you can run a successful private practice on that type of reimbursement, given that most family practice and internal med doctors are being bought out by the hospital systems now as they can no longer make a decent living with falling reimbursements and rising costs of overhead, etc.