1. Kennedy, Maureen Shawn MA, RN, FAAN


A review of a year some labeled 'toxic.'


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Last January, when we published our annual review of the top stories of 2017 that influenced nurses, nursing, and the people in our care, five stories surfaced as the most compelling. One, the misguided arrest of Utah nurse Alex Wubbels, was settled with Wubbels being vindicated and many hospitals revisiting policies to protect nurses' and patients' rights. The other four items-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; and the continuing nightmare of mass killings and Congress' refusal to enact effective gun laws-persisted throughout this past year (see In the News for more analysis):

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

* According to the Centers for Disease Control and Prevention, as of April 2018 drug overdoses had claimed approximately 68,255 lives-essentially unchanged from April 2017.


* California has had its worst fire season to date, and Hurricanes Florence and Michael ravaged the Southeast. And in November the federal government released a report detailing the devastating economic and human consequences of climate change.


* Congress continued to erode access to health care for many Americans through weakening the Affordable Care Act (ACA). Programs to help eligible people enroll in Medicaid and federal marketplace coverage were defunded; states were given permission to offer plans that do not comply with the ACA, which will ultimately raise premiums for those who choose ACA-compliant plans; and states can now enact a work requirement as a criterion for Medicaid eligibility.


* And although incidents of gun violence have decreased somewhat-from 15,650 deaths and 346 mass shootings in 2017 to 13,151 deaths and 320 mass shootings in 2018 (as of November 25)-these numbers demand action.



As critical as these issues are and continue to be, they were overshadowed in the spring when the federal government instituted a policy of separating children from parents apprehended crossing the U.S.-Mexico border. This action sparked such a backlash that President Trump issued an executive order rescinding the policy. At one point, according to a July government report, there were over 2,500 children between the ages of five and 17 awaiting reunification with a parent or other family member. While most have now been reunited, one wonders how the effect of months of separation will play out for these children in years to come: research has shown that severe stress in early childhood, especially in the absence of adult support, exerts physical changes on the brain (see AJN Reports for details). On the cover of this issue is one of the many heart-wrenching images of children who are placed in holding centers around the country. And as I write this at year-end, hundreds of Central American asylum seekers are amassing at the U.S.-Mexican border seeking entry, potentially creating another humanitarian crisis.


It's no wonder that in November the Oxford Dictionaries announced that its pick for the 2018 word of the year was toxic, meaning "poisoned or imbued with poison." It was chosen for its frequent use as a descriptor for widely discussed issues during the year, and was habitually used alongside words such as chemicals, masculinity, environment, relationship, culture, and air. Oxford made its choice based on a word "judged to reflect the ethos, mood, or preoccupations of the passing year, and have lasting potential as a term of cultural significance." While it may seem an appropriate choice, it is a sad commentary on the times.


However, as we begin 2019, I believe there is cause for optimism. Perhaps the midterm elections, which put an unprecedented number of women-including two nurses-in key positions in state government and Congress and restored us to a two-party Congress, will spur a different dialogue on these important issues. Perhaps the addition of young and diverse legislators will serve as a reminder to Congress that it represents all the people. Perhaps political debate can return to respectful discourse, with positions grounded in evidence and with the goal of bettering the health and welfare of everyone. We can only hope.