1. Moffa, Christine M. MS, RN


Finding our voices.


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I used to say that I hated writing, but that's not completely true. I hated having to sit down and express my thoughts in a clever, organized way that other people would be judging. In elementary school, I hated tests with essay questions. That little blue book would sit empty on my desk while I looked around at a roomful of students scribbling fearlessly; I was so jealous. What could they possibly have to say on the assigned topic? Finally some kind of survival instinct would take over, and slowly, painfully, I'd start to write. By the end I'd have eked out enough to get by. In high school and college it was more of the same; and when I went back to graduate school after 10 years as a working nurse, it was even worse. It made me so uncomfortable to sit at the keyboard that I usually waited until the night before a paper was due, then sat up typing and cursing myself until the following morning, handing in whatever scraps I could piece together. The whole time I'd have to keep talking myself out of quitting. Eventually, with enough experience, writing got easier, and I graduated with a master's degree in nursing education. You might ask: why go through all of this? Well, to quote a line from the Oscar-winning film The King's Speech, "Because I have a voice!"

Figure. Christine M.... - Click to enlarge in new windowFigure. Christine M. Moffa

I think many nurses have similar experiences with writing (I occasionally still do). It's difficult to find your voice when it's competing with an internal editor and external authority figures. Historically, nurses have been encouraged to keep quiet; when nurses do speak up, it's often only to echo an approved sentiment that's already out there. I can recall times when I saw clinical practices that were less than ideal (see my blog post on decreasing interruptions:, or felt I was being treated unfairly by a physician or a supervisor, but didn't feel safe enough to speak up. That's why it's so important that we take advantage of the perfect climate for change that's upon us now.


For one, there's the Institute of Medicine's 2010 report, The Future of Nursing: Leading Change, Advancing Health (, which AJN has covered in the journal and on our blog, Off the Charts. Some nurses have been quick to dismiss the report, either because they feel its message isn't new and hasn't led to change or because they believe it only applies to nurses in academia, not to those in the "trenches." But they're wrong. According to the report's third "key message," the nursing profession needs to develop leaders across the health care system "from the bedside to the boardroom." And in order to have an impact on health care, "nurses must see policy as something they can shape rather than something that happens to them. Nurses should have a voice in health policy decision making and be engaged in implementation efforts related to health care reform." We do need to use our voices; after all, others are using theirs. Shortly after the report came out, physician groups like the American Medical Association and the American College of Physicians put out statements challenging its recommendations.


Now, more than ever before, we each have countless opportunities to offer our own thoughts and opinions. If writing an article seems too daunting, start smaller. Social media are readily available to anyone with a computer or a cell phone. (If you aren't familiar with Facebook, Twitter, or LinkedIn, see this month's iNurse column for an introduction.) Getting involved can be as simple as posting a status update on your Facebook page, commenting on someone else's status, or joining a Twitter conversation. Do you read any blogs? Most blogs, including ours (, encourage reader comments. If you're ready to try something bigger, take a look at our Cultivating Quality department, which profiles quality improvement (QI) projects. Does your hospital have an interesting QI project going on? Why not write it up, so that others can benefit from your hard work?


It would be great if everyone participated. The sound of 3 million nurses having a conversation: who can ignore that? Give it a try today; your profession and your patients are relying on you.