1. Roush, Karen MSN, RN, FNP-BC


Where is nursing's voice?


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We spend our working lives confronting suffering with knowledge and skill. We care deeply. Yet there remains a fundamental failure within nursing practice. It's the reason we face a never-ending onslaught of sick and wounded patients. This failure is an inattention to social justice.

Figure. Karen Roush... - Click to enlarge in new windowFigure. Karen Roush

Social and economic factors create serious disparities in health and quality of life. The infant mortality rate among blacks in the United States is twice the national average: 14.1 versus 6.9 deaths per 1,000 births, according to the Centers for Disease Control and Prevention. One in four American women, it's estimated, will experience intimate partner violence during her life. The World Health Organization reports that a girl born in Sierra Leone can expect to live 36 years, compared to the 84 years for a girl born in France.


How many times will we patch up an abused woman and send her back for more before we address the underlying oppression and acceptance of gender-based violence? How many prescriptions for inhalers will we write before we demand environmental changes or traffic rerouting around schools in poor neighborhoods? Do we ignore the social context and say it's not our responsibility? And if not ours-we, who see care as central to our purpose-then whose?


There are some who argue that social justice is political, that nursing should be apolitical. This is naive and shortsighted. As part of a world that must negotiate the distribution of limited resources-from medications to supplies to clinicians-nursing is political. As part of a world where class, gender, and race create disparities in care; where childbirth is a life-threatening condition for millions of women and a generation of children has been orphaned by AIDS; where at every moment violence disrupts and destroys lives-in our workplaces and communities, in war and genocide-nursing is political.


We don't provide care in a vacuum. We can't hide behind patient charts. Social justice is a nursing responsibility. The International Council of Nurses, the American Association of Colleges of Nursing, and the American Nurses Association all note the importance of addressing patients' social as well as health needs.


Nursing is difficult. The demands upon us grow greater and patient care grows more complex. But this doesn't excuse us from our duty to pay attention, act, and demand justice. In his 1980 classic work, Basic Rights: Subsistence, Affluence, and U.S. Foreign Policy, Henry Shue outlined basic human rights-liberty, security, and subsistence-that "are everyone's minimum reasonable demands upon the rest of humanity," yet they don't exist for too many. It's not enough to simply acknowledge these; we must act to ensure them-in the way we educate new nurses, in outreach activities, in involvement with policy development, in what we choose to research and how we conduct this research, and through advocacy at the individual, local, and global levels.


Ignorance is no excuse. Nurses must take responsibility for being informed-not just about the latest drug or evidence-based treatment, but about human rights violations, the reality of hunger and abuse, the dichotomy of oppression and privilege in our own backyards. We must develop a critical social consciousness, one that questions existing social norms and challenges the unjust conditions underlying so much of the pathology we see.


Nurses have a long and honorable history of fighting for vulnerable populations, from Florence Nightingale's work on the Poor Laws reforms to the more recent work of Dr. Ruth Watson Lubic, who founded the Family Health and Birth Center in Washington, DC. But we need to be more insistent in our demand for justice for all. According to the National Sample Survey of Registered Nurses, there are over 3 million RNs in the United States alone. Imagine the roar if even half of us raised our voices.