In my over 45 years of nursing primarily in intensive care units, and head of several important nursing committees, this is my take. There are too many nurses who work just for a salary, do NOT speak up about anything, and go on their merry way. It was not this way many years ago but with the advent of 12 hour shifts, many nurses work for more than 1 employer and there are many nurses from other cultures where speaking up is not allowed. Plus, even in management you can see that the important nursing exec jobs have been diminished in power, so even if you have a voice it is not carried through to the few in power to do anything about it. Of course, communication is the most important tool we have but too few use it, most (the every growing senior managers) still do NOT understand what nurses do nor do they ask.