1. Rosa, William E. PhD, AGPCNP-BC, FCCM, FAANP, FAAN


A call for a vision of interconnectedness.


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In her bestselling book, The Blue Sweater, entrepreneur and social justice advocate Jacqueline Novogratz tells the story of a blue sweater given to her as a gift in her younger years. By adolescence, she had donated the sweater after outgrowing it. Ten years later, working in Rwanda, East Africa, she passed a young boy in the street and noticed he was wearing the same blue sweater. She did not speak the local language and the boy did not know English, and so she gently approached him and turned over the collar-there in the back of the sweater was her name. Novogratz has used that story for years as an analogy for our shared and vulnerable humanity, a reminder that each of our choices in life can affect people worldwide we may never meet.

Figure. William E. R... - Click to enlarge in new windowFigure. William E. Rosa

Not long after reading The Blue Sweater, I moved to Rwanda as part of a major health care capacity-building initiative. Over the year I lived and worked in East Africa, I repeatedly learned that all of us in the global village are much more alike than different in our values, ethics, and hopes.


Novogratz's story has meaning for the nursing profession like never before. We-as nurses and citizens of the world-are living in both unprecedented and uncertain times. In the United States, we continue to confront injustice and inequity related to a history of structural racism, gender inequality, and fear of "the other." On a planetary level, we face a loss of biodiversity, ecosystem degradation, and the worsening sequelae of the climate crisis. At a time when we require unity and oneness for survival, the dramas of the media and political foolishness appear to exacerbate our social, economic, and cultural divides.


I believe, like many others, that nurses hold a covenant with society to promote health and well-being and protect the dignity of humanity at all costs. This social contract calls for an ethic of global citizenship. There are many definitions of global citizenship. However, in my mind, it means that we can no longer afford to think about the world in terms of you and I, but rather in terms of us.


This notion of global citizenship depends on respect, altruism, and inclusion. It doesn't require packing up and moving to a foreign nation; rather, it encourages nurses in every setting to critically reflect on how we see and engage the world, acknowledging biases, surrendering outdated ways of thinking and doing, and remaining curious about others and their stories. It starts right here and now with knowing that what we do and don't do has real-time implications for our patients, neighbors, and communities.


Jogerst and colleagues (Annals of Global Health, 2015) identified 13 competencies for the global citizen across eight domains. For example, in the domain of social and environmental determinants of health, nurses should be able to describe how different cultural contexts influence perceptions of health and disease. In another domain-capacity strengthening-nurses can collaborate with communities to identify strategies that reduce health disparities and adopt methods emphasizing sustainability in partnerships.


But we can go further. Planetary citizenship is a more inclusive notion than global citizenship. It incorporates the idea that human health and well-being are integrally tied to those of other animal species and the environment at large. If humanity is to survive, we will have to redefine the meaning of health at a planetary level and work to support the systems that sustain us all. We must think beyond clinically based parameters of health. Cholesterol levels mean little to civilizations that, quite literally, face extinction because of sea level rise, weather emergencies, and lack of access to clean water. Planetary citizenship invites us to consider our interconnectedness as humans living on one intensely rich and vibrant planet.


The World Health Organization has declared 2020 as the International Year of the Nurse and the Midwife. Four million nurses in the United States are joining with more than 16 million nurse and midwife colleagues worldwide to celebrate and honor our legacy of service. As nurses continue to promote health for every human, let us not forget the tenets of global and planetary citizenship that will ensure well-being for all life throughout our precious world.