1. Kennedy, Maureen Shawn MA, RN, FAAN


Major changes in policy, attitudes, and events leave many reeling.


Article Content

Each January, we look back over the previous year at the major events that have affected health, health care, and nursing. We usually hone in on one central issue, but as evidenced by the collage on our cover, this year there were several major stories that seemed equally appalling in one way or another.

Figure. Maureen Shaw... - Click to enlarge in new window Maureen Shawn Kennedy

The cover images represent five stories that our editorial board and staff felt dominated the headlines: the increasing number of deaths from the opioid epidemic; environmental disasters such as fires, floods, and hurricanes; the political battle over how to deliver health care to U.S. citizens; the continuing nightmare of mass killings and Congress' refusal to enact effective gun laws; and the manhandling of a nurse for protecting the rights of a patient. (For more on these topics and others, see "The Year in Review," In the News.)


But these are just a few of the reasons 2017 may go down as one of the most tumultuous years in recent memory. In pursuing its commitment to undo a health care law that increased access to care for millions, as well as to roll back protections and funding in the financial, research, education, environmental, and humanitarian sectors, the Trump administration has put in motion changes that have had or will have negative repercussions for every U.S. citizen.


Many people have put their future on hold. I know of people who decided not to retire because they worry that cuts in Medicare will restrict their ability to afford the care they need; young couples who are putting off starting a family because of the uncertainty of affordable health insurance; and hospital administrators who won't make needed changes because they fear further decreases in federal and state reimbursements. In September, we reported on hospital closures in rural areas, and in December, our lead news story was on the disappearance of maternity services in rural America. In October, we reported on a health care analysis by the Commonwealth Fund of 11 developed countries, in which "the United States scored lowest overall and also for access, equity, and health care outcomes."


Last March, I wrote an editorial urging nurses to pay attention to the new administration's policies concerning health care, and explained AJN's role "to provide nurses with evidence-based clinical content, but also to inform on the broader policy issues, examine how they may influence the public's health, and raise the alert when policies may be detrimental to our ability to meet the needs of a changing society." I was taken to task by some readers for writing about "political matters." To quote one reader who posted on our Facebook page:


"I was considering taking a subscription to AJN, but after reading that editorial I will not be getting said subscription and will not support your magazine[horizontal ellipsis]. I don't want any political views, I want straightforward FACTUAL information about disease processes, treatments, and medication. Leave your political views and discussions to your cocktail and dinner parties."


Politics, which is commonly defined as " the art or science concerned with guiding or influencing governmental policy," is everyone's responsibility. Should we as health care professionals not advocate for policies that promote health, prevent disease, and provide for the needs of vulnerable populations? Should we only be concerned with the disease processes, treatments, and medications of the patient in the bed in front of us, or should we think about the lack of access to preventive care that likely got him there? And when this patient goes home and is unable to afford medications or proper diet or transportation to medical appointments, is that not part of our concern when planning for discharge? It's not about taking a political stance-it's about fulfilling our professional duty to promote health.


In a June op-ed in the New York Times, physician and author Danielle Ofri wrote, " Advocating for patients is as much a part of medical care as the medical care itself. Diagnosing the problem and prescribing the treatment helps only if the patient can actually get the care." Exactly.