All regulatory work benefits from the sunlight of public scrutiny. Such accountability can be messy, inefficient, inconvenient, even irritating, but that is how a healthy democracy functions. The public pays attention, gets involved, shares and debates ideas, and builds consensus. Citizens oversee regulators and keep them honest. Who else will? Wise citizens know that we cannot afford to give regulators unfettered power and secrecy. Without sunlight, rot and corruption are inevitable.
“No one pretends that democracy is perfect or all-wise… democracy is the worst form of government, except for all those other forms that have been tried…” – Winston Churchill
Without our diligent participation, democracy withers and we pay a stiff price. Germans paid such a price when they freely gave Adolph Hitler unfettered power. I wonder how many Germans had said “I don’t do politics. They’re all the same anyway…” Imagine their regret!
Americans, when they pay any attention at all to government, focus on the big jobs like President or Governor. We don’t pay much attention to details like regulatory boards as they muddle along, anonymous and unsupervised. People trust or distrust all government as a whole, usually without sweating the tedious details. Yet the details matter!
As an example, let’s discuss the state Board of Nursing in Arizona. Who pays them any attention? Very few people, of course. AZBON has no system to monitor and address abuses in this crucial system. AZBON offers anonymity to those who file complaints against nurses; it publishes lists of all accused nurses. Employers can, and apparently often do, fire nurses interfering with their unethical and/or illegal activities, then file complaints against their licenses. Such nurses wait months, unable to work while their licenses remain in public doubt. About 1000 nurses each year wait more than 7 months for a decision, unemployed. It would be hard to design a more effective way for regulators to aid and abet corruption and crime. It turns BON’s function on its head, arguably protecting abusers better than the abused. Power without justice and accountability amounts to tyranny or organized crime.
For perspective, consider California’s BON. In 2009, accused nurses waited over 3 years on average for a BON decision. When it became public, the Governor fired half the board. “FredAguiar, Secretary of the State and Consumer Services Agency, said in an interview that the new board would be asked immediately to come up with a plan to eliminate the case backlog. ‘This plan needs to include how many more investigators are needed, how much that will cost. . . . I want to know now.’ ” Sometimes, public scrutiny leads to positive action. It certainly improves the odds. California’s BON performed worse than Arizona’s, by one measure at least, yet California responded to public criticism. Arizona has done the opposite: it has done nothing.
What is a nurse’s proper place in society? Arizona seems to demand silent obedience regardless of the public welfare. What do others think? Consider two opinions from 1860:
“No man, not even a doctor, ever gives any other definition of what a nurse should be than this – ‘devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.” Florence Nightingale, Notes on Nursing
“Let us have faith that right makes might, and in that faith, let us, to the end, dare to do our duty as we understand it” – Abraham Lincoln
Have much have we nurses moved forward since then? Do we settle for “devoted and obedient,” silently resigned to corrupt and abusive regulation? Do we instead openly advocate for patient safety, stand for our professional ethics and our future? Dare we take such risks? Many Americans once felt that abolitionists were too strident, too impatient, too arrogant and controversial, too noisy, irritating, and disruptive. People commonly made the same complaints about those pushing for women’s right to vote, or civil rights, or any number of just causes. Today, are we the unstoppable advocates Nightingale and Lincoln sought? Or will we passively wait, like respectable serfs, for others to decide our fate?
“The nurse’s primary commitment is to the patient, whether an individual, family, group, or community… The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient… participates in establishing, maintaining, and improving healthcare environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action… The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.” – American Nurses Association, Code of Ethics for Nurses with Interpretive Statements, © 2001 By American Nurses Association. Reprinted with Permission. All rights reserved.
Words and ideas are important, but people often abuse them. They offer empty, pleasing sounds signifying nothing but hypocrisy and rationalization, an empty sense of self-righteousness, and an excuse for inaction. What would Lincoln’s legacy be today, if he had merely “applauded” efforts to end slavery? Would anyone remember Nighingale if she’d done what she was told and skipped nursing altogether? What would the world be like today, if they’d both taken the easy way out?
The time for apathy, hopelessness, and blind deference to authority has long passed. Our professional duty, our nurse ancestors, and our interests all demand action. Unless we publicly lead, we surrender nursing and health care leadership to whomever else steps into the vacuüm. Who will answer the call? We each have no choice but to choose.
You choose YES for nursing, or by default, you vote NO.
You cannot avoid taking a side, for or against nursing.
To avoid choosing is actually to make a clear vote, “NO,” against yourself and your profession.
The choice is clear, and the time is now. Choose well.