1. Fulton, Janet S. PhD, RN, ACNS-BC, ANEF, FCNS, FAAN

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The National Association of Clinical Nurse Specialists recently invited members to participate as volunteers in service to the organization's committees. Why participate? Participation facilitates individual professional development, fosters networking with colleagues, offers new challenges and opportunities, and most importantly, preserves and shapes the future of nursing and the clinical nurse specialist (CNS) role. Participating in nursing organizations is a professional citizenship responsibility.


Professional citizenship is not discussed often, at least not in nursing circles. The 2004 Statement on Clinical Nurse Specialist Practice and Education1 listed professional citizenship as an essential characteristic of a CNS but provided little guidance beyond stating that a CNS has a responsibility for contributing to local, state, and national healthcare policy. A more expanded view suggests that citizenship means having membership in a community with rights to participation. For the ancient Greeks, polis citizenship was deeply connected to an individual's life wherein the destiny of an individual was strongly linked to the destiny of the community. More to the point, President Theodore Roosevelt said that the first requisite of a good citizen is to pull your own weight. No freeloaders. Good citizenship requires contributing to the well-being of the community. Failure to participate because of inconvenience is poor citizenship.


Guideposts for professional citizenship may be sparse; however, the notion of citizenship and civic participation in democracy has deep roots in nursing. Calls for nurses to be great citizens can be found in the landmark work of Peplau2 in her descriptions of interpersonal relations as the foundation of nursing practice. For Peplau, participation in a democratic society was an obligation in the cause of citizenship-an imperative to develop science, advance practice, and position nursing as a force in the larger society. Engaged citizenship in a democracy, noted Peplau, was linked to greater independence, collaborative participation, and authentic control over healthcare decisions.3 Other authors have argued that professional nursing values linked to social responsibility and can be found in many historic works including Florence Nightingale, Margaret Sanger, Lavinia Lloyd Dock, and Lillian Wald.4 Analysis of Dock's contributions suggested that her work included efforts toward creating a "new ideal" for society and democracy.4 Indeed, our foremothers called for nurses to aid in the promotion of a democratic society.


Professional citizenship is conferred to those who are members of the profession. Joel5 noted that like society at large, the nursing profession is dependent on great citizens. The future of a profession will not take care of itself; full participation by its members is required. Participation is a professional responsibility that comes with rights and privileges by virtue of being a member of the profession. Referencing the work of Alexis de Tocqueville, a French diplomat, political scientist, and historian, Joel proposed that nursing has 2 types of members: inhabitants and citizens. Inhabitants are complacent toward the future, accept things are they are, often live in discontent, and believe that someone is acting on their behalf. Citizens, on the other hand, step up and create a preferred future. In the absence of an engaged citizenry, the outcome is ominous. The inhabitants sit in judgment of the citizens. When the inhabitants outnumber the citizens, the future is not sustainable. Our profession is not guaranteed and complacency risks marginalization and extinction in the larger democracy. Nonparticipation is lethal. Each of us must pull our weight.


Nurses have been reluctant to engage in professional citizenship. Some commonly observed and documented reasons for nonparticipation are misalignment of personal values with organizational mission, fear of criticism or retribution by peers or employers, unfamiliarity with democratic principles and structures, limited understanding of the political process, and a sense of apathy and powerlessness. Fear, ignorance, and apathy are not the attributes of a professional.


And then there is the money. Many nurses are reluctant to pay dues to a professional organization, ignoring the historic hard work and heavy lifting of those who, through their good citizenship, helped ensure the reasonable wages and benefits most nurses enjoy. There are exceptions, of course, but for most nurses, professional membership dues are a teeny, tiny fraction of an annual salary.


Clinical nurse specialists, this is a call to professional citizenship! After investing time and treasure in obtaining academic degrees to advance your career, make a commitment, engage, volunteer, and yes, pay dues. The destiny of each CNS is tied to the destiny of the community of CNSs. Be an active citizen, not an inhabitant of the profession. The future is not guaranteed.




1. National Association of Clinical Nurse Specialists. Statement on clinical nurse specialist practice and education. Harrisburg, PA: National Association of Clinical Nurse Specialists; 2004. [Context Link]


2. Peplau HE. Interpersonal Relations in Nursing: Offering a Conceptual Frame of Reference for Psychodynamic Nursing. New York: G.P. Putnam's Sons; 1952. [Context Link]


3. D'Antonio PD, Beeber L, Sills G, Naegle M. The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nurs Inq. 2014;21(4):311-317. [Context Link]


4. Mill J, Astle BJ, Ogilvie L, Gastaldo D. Linking global citizenship, undergraduate nursing education, and professional nursing: curricular innovation in the 21st century. Adv Nurs Sci. 2010;33(3):E1-E11. [Context Link]


5. Joel LA. On citizenship in a great profession. Am J Nurs. 1998;98(4):7. [Context Link]