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


We must address this growing public health crisis.


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This editorial was supposed to be about the war in Ukraine. I was going to talk about the carnage happening there. The hospitals being bombed, the maternity wards, the schools. The sacrifice of the health care workers. Then Uvalde happened. Carnage came home to us-again-just 10 days after the massacre in Buffalo, New York.

Figure. This is abou... - Click to enlarge in new windowFigure. This is about our duty to protect the health and well-being of all.

We are not at war. There are no bombings from above, no tanks rolling through our streets. Soldiers aren't committing war crimes, shooting civilians in the head, their hands tied behind their backs. Instead, we have teenagers with military-style assault rifles walking into schools and slaughtering children. We have carnage at concerts, churches, mosques, grocery stores, movie theaters, nightclubs, and on the subway. We are not safe anywhere.


Gun violence is the scourge of this country. According to a 2019 report from the School of Nursing and Health Professions at the University of San Francisco (USF), the firearm homicide rate in the United States is 25 times higher than that of any other high-income country. And it's 36 times higher in high gun ownership states. The United States ranks eighth among 64 high-income countries for homicides by firearms, according to the Institute for Health Metrics and Evaluation. And the USF report notes that 97% of children ages four years or younger, and 92% ages five to 14, who are killed by guns in all high-income countries are killed in the United States.


And it's getting worse. U.S. firearm homicides increased by nearly 35% from 2019 to 2020, according to the Centers for Disease Control and Prevention. According to the Violence Project, which tracks mass shootings, these shootings have increased steadily since 1966 and the increase is accelerating. In 2020, gun violence surpassed motor vehicle accidents as the leading cause of death for children and adolescents ages one to 19 years.


This is a public health crisis. The American Nurses Association and National Nurses United have both declared gun violence a public health emergency and adamantly support legislation to enact universal background checks and a ban on assault rifles. The six deadliest shootings in the United States since 2009 were committed with assault weapons or high-capacity magazines.


Mass shootings aren't the only legacy of a culture steeped in gun violence. We are in the midst of a mental health crisis-suicide rates are climbing. Most suicide attempts are not fatal-unless that attempt is with a gun. According to a population-based study in the December 17, 2019, Annals of Internal Medicine, the overall case fatality rate for suicide attempts is 8.5%; when a gun is used, it's 90%. In 2019, firearms were the method used in over half of deaths by suicide. And that was before the pandemic brought on a tsunami of mental health issues and a surge in gun purchases-a lethal combination.


But enough statistics. Let us look into the faces of each of those numbers: each child whose last thoughts were of terror; each person who impulsively reached for a gun in a moment of despair; each child who found a loaded gun in a bedroom drawer; each misguided teenager who will never have a chance at redemption. Let us look at the anguished faces of families in waiting rooms, the fathers collapsing outside the trauma room door, the mothers saying goodbye in blood-stained clothes.


And then let's talk about the evidence. Research consistently finds that in states with universal background checks fewer children die from firearms. Studies-notably a 2016 study in the Lancet-also find that ammunition background checks and requiring identification for firearm purchases would substantially reduce firearm deaths.


Let's talk outside of politics. As nurses who believe caring for others is the foundation of our profession-this is about our duty to protect the health and well-being of all. At the time of this writing, a landmark bipartisan anti-gun violence bill has passed in the Senate and the House and was quickly signed into law by President Biden. This bill is a good start and will save lives, but more is needed.


In some places, violence comes from outside, as in Ukraine. In other places, violence comes from within, as in the United States. No matter where the violence happens, nurses are on the front lines, caring for the wounded, the scarred, the bereaved. But we know that prevention is the goal. Let's talk. We must do something.