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As nurses, we reach for meaningful expressions of our values, too often
finding overwhelming constraint and resistance, sometimes within ourselves
and sometimes imposed from without. We are calling for a movement
to awaken those precious and powerful ideals that are rooted in nursing’s
worldwide historical traditions. We call forth the written and spoken
voice of nursing to be claimed and reclaimed. We seek to inspire the
fullest expression of the heart of nursing through individual and
collective acts. We believe there are profound possibilities in claiming
our individual and professional sovereignty.
We believe that it is possible to find connection in the midst of alienation, to find inspiration in the midst of cynicism, to find nourishment and meaning in the midst of spiritual impoverishment, to find hope in the midst of despair, to find wholeness in the midst of fragmentation, to find peace in the midst of violence, to find enrichment in the midst of economic idolatry, and to find sovereignty in the midst of constraints. Our communities, our patients, share this hope.
The situation we find ourselves in has been created from an array of forces. While economic issues have helped create a situation in which nurses cannot practice nursing, we, as nurses, have participated by remaining silent. Our professional sovereignty is threatened. The health of global humankind is at risk. It is now time to ask ourselves, who benefits from the situation as it now exists? As long as we know that the current situation inhibits the fullest expression of nursing's highest values, and that people who need our care are not receiving the best we can offer, we know that we, and those we serve, are not benefiting. If nurses are to significantly contribute to a mission of caring for people and communities, we must find our voice, acting now to create situations in which our values come to the center and from which we can realize our best intentions.
Now, seeking meaningful avenues for action, we choose to identify ourselves with the heritage and future of nurses. From nursing history we have learned the fullness of our own potential as nurses, the strength of nurses, the effect of nurses in communities and to individuals. We have seen our own common self interest, and common oppression. Having found these authentic bonds as nurses, we realize we can rely on each other as we seek conscience-based action to shape a new future for nursing and for health care.
We do not seek to define what is "radical," "revolutionary," "moral," or "reform" -- we seek to call forth what is good for nurses and nursing, and what is good for the health of people worldwide. We are not questioning, challenging, or critiquing existing organizations. nor are we calling for the creation of a new organization. Rather, we are calling for nurses to join together with other nurses, in whatever way they can, to act consciously and with conscience.
We call forth in all nurses the possibilities inherent in discovering one’s own truth and living fully as a person and nurse from this truth. We call forth a willingness to reach for making a critical difference toward betterment of humankind. We call forth the power to act forcefully out of conscience to shape a future that is consistent with our values. We call forth the reawakening of our personal and professional sovereignty to determine our own destinies and to act individually and collectively to transcend the forces that would constrain us.
We call forth the passion of practicing nursing from this state of sovereignty and rightfully claim governance of our discipline. We call forth a repudiation of patterns that we create, or that are imposed upon us, that inhibit the full expression of our beings as nurses and persons. We call forth the opening of our hearts to reveal the prospects for action that carry us beyond the negative forces of passivity, contempt, frustration, cynicism, and despair; forces that keep us from living our wholeness and creating a world of peace and healing.
We offer the following ideals and principles upon which this call to action is based.
- Our concern covers the world and we seek to embrace a global perspective. We can no longer consider our values and actions out of the context of all beings.
- Historically, although organizations serve useful purposes to society and to disciplines, fundamental societal change does not occur through organizations. Organizations serve to mobilize resources and people and codify actions aimed at disciplinary concerns. However, they rarely create the daily experiential responses that are necessary to change the world.
- Organizations are not changing because people in organizations are not changing. We seek to inspire and excite the desire for claiming personal and professional sovereignty. We are seeking no less than fundamental change in a movement that awakens us to the possibilities for transformation of individual and collective consciousness and to that which restrains us. This is the meaning of realizing sovereignty.
- We are opposed to colonization; that is, we do not wish to impose our views onto others. Rather, we are calling for nurses who share our concerns to join in collective consciousness-raising and action based on chosen values.
- We are opposed to all forms of oppression, including that based on gender, race, ethnicity, nationality, sexual identity, physical abilities, economic status, or any other attribute seen as "difference".
- We welcome all who are attracted to this process and yearn for change that will come from engagement with others. We do not wish to distinguish those who join in this journey by educational or social background, chosen work role, or specialization.
- We believe that nurses are particularly attuned to the needs for social justice throughout the world, given their connection to humans in times of personal change and challenge. It is because we cannot practice the art of nursing that we act. While we may have grown silent, our patients believe in us. We must listen. We must speak.
- The concept of wholeness is something we fully embrace. Our notion of wholeness involves a commitment to the inherent oneness of all beings. We seek to recognize, appreciate, celebrate, and exploit this individual and universal wholeness in order to create health.
- It is our firm conviction that there is a body of knowledge that is specific, if not unique, to nursing’s concerns and interests. We think that this knowledge is grounded in appreciation of wholeness, concern for human well being, and ways in which we accommodate healing through the art and science of nursing. We value theoretical and practical plurality with the centrality of nursing knowledge at the forefront of practice and knowledge development.
- We advocate for a critical formulation of the educational enterprise of nursing that places a greater emphasis on personal and professional sovereignty and that nurtures the development of action generated from reflection, contemplation, and recognition of values. We believe that it is time to attend to inherent wholeness and natural healing tendencies that are often educated out of nurses as students.
- Nursing practice is guided by conscience, competence, connection with individuals and communities, and a belief in all beings’ essential worth. We own our power to transform.
- Our goals are no less than revolutionary changes, which will improve the lives of patients and families, communities and organizations, nurses and administrators, students and faculty. We believe in approaches to such changes that involve an awakening to potential power and an enactment of that power infused in our daily lives. We understand that a movement of this magnitude requires a shift in many traditional power relationships and the creation of new ways of relating to one another.
- We believe that our journeys to enact this manifesto will certainly require a reuniting of the inner and outer life, accepting our wholeness and owning our freedom – a wholeness and freedom that will strengthen our outer capacity to love and serve. "If we understand our common work as fundamentally unifying the inner life of mind and spirit and the outer life of service, we must inhabit and do our work with a deeper vision that focuses our attention on the world that is nearest to us, the world within our own hearts. Within the world of being, we discover, again and again, that our common work is to support each other in the deepest, most sacred part of our own selves. This work of being leads us repeatedly into the world of action and service, where our energies can contribute to those cultural trends that are renewing the relationship between the interior and exterior dimensions of life" (Rob Lehman, The Institute Report, Fetzer Institute, 1998). We believe in the possibilities for fundamental change and nourishing a "community of consciousness" that enlivens all the work of nursing.
We are inspired by the many events, people, and expressions of nursing that surround us. We hear nursing students yearning to heal; we hear nurses despair in the midst of too many patients and too little time; we hear patients remembering the meaning of nursing.
We are inspired by widespread public dismay and despair about the conditions that prevent nurses from practicing fully and about the fragmentation and dehumanization of health care. The public is demanding accountability for quality and respect in health care; we are inspired to act.
Nurses are telling stories about their frustrations in not being able to practice nursing consistent with the values that they hold most precious. There is acknowledgment of and discontent with the social inequities that are foundational to our most persistent health problems. We are inspired to shift these realities to overcome these frustrations.
There are indications that nurses seek ways to practice their ideal vision and values, seeking autonomy and control, in spite of restraints imposed by systems of health care and perceived economic contingencies. There is a clear rediscovery of natural ways of healing and a movement toward innovation in holistic healing modalities. We are inspired to make these values more real.
The historical evidence is overwhelming that movements grow out of dissatisfactions with injustices and inequities. Likewise, we are inspired to act, and feel an urgency to act, based on a long list of concerns that we have detailed below. We have phrased our concerns in such a way that we hope suggests and inspires what could be, rather than simply what is. We caution everyone, ourselves included, that to focus on these concerns would drag us back into a mire of despair and frustration. Therefore, we ask that as we consider these concerns, we do so holding to a beacon of hope and conviction that, through our transformative expressions of personal and professional sovereignty, we can move toward new realities.
These are the concerns that cause us to pause, reflect, and call for change:
- The clinicalization of human experience that is instrumental in denying important facets of human life, and not fully accounting for the essence and wholeness of human experience
- Overemphasis on clinical specialization while sacrificing our attention on the healing potentials within wholeness.
- Client interventions shaped by economics rather than need that arise from a society consumed with economic and material idolatry.
- Distorted priorities in our educational and health care systems that place nursing’s attention on outcomes and economics at the expense of human needs, experiences, and quality of life.
- General subjugation of spiritual consciousness to the economics of health care.
- Persistent racism, sexism, classism, heterosexism, and hosts of other "isms" that prevail in nursing and health care, undermining our sensitivities to the fundamental humanness and value of all people everywhere.
- Over-reliance on physical/material conceptions of human health and illness, rather than a perspective accounting for the whole of experience.
- The idol of the current health care system symbolized by achieving measurable outcomes in an economically feasible manner in the shortest amount of time, at the expense and depletion of even more valuable resources such as caring, understanding, real human connections, and spiritual and physical renewal.
- Depletion, rather than integration, of the sacredness of nursing practices and rituals within the technology and artistry of nursing care and nursing research.
- The long-standing ideology (acquired consciousness) of nurses being subservient to other interests, and not encouraged to be deeply committed to their own healing work.
- Loss of soul in nursing care and in nursing science.
- Educating for compliance rather than creativity.
- Practicing in ways whereby we lose touch with the real needs of our patients and communities.
- Putting a heavier emphasis on testing and evaluation, rather than on teaching and development, that often results in the worship of grades, standardized test scores, and merit scores, outside the context of other features of nursing care.
- Disrespecting nursing practice and nurses who practice.
- Dogmas associated with what forms of knowledge are most relevant to nursing and what warrants financial support for expanding the discipline’s knowledge.
- The tendency to treat one another with cynicism, suspicion, and contempt because of differences in educational preparation, roles, views, theoretical orientations, political ideologies, and specializations, rather than bringing to our interactions a generosity of spirit that honors the dignity and worth of all.
- The creation of environments for learning and healing which are not based on what we know is best for learning and healing, but rather on what is most practical and cost-effective for the institution.
- The gradual divorce of nursing from nature and its potentials for enhancing the quality of lives and promotion of healing.
- The parallel shifts in nursing and medicine that have enabled nurses to abandon nursing to practice medicine, and have enabled physicians to practice nursing while maintaining their medical practice.
- An overemphasis on diagnosis and treatment of disease and a lessening of attention on experiential features of health and illness.
- Denigration of nursing theory and all forms of what we know as nursing that provides distinction to a discipline.
- Limited definitions and manifestations of what constitutes "legitimate nursing."
- Disembodied physiology in which nurses perceive human physiology as a mechanistic process that is distinct from the rest of human experience.
- Denial of the relevance of the uniqueness, essence, and wholeness of human experience.
- Unconscious use and abuse of data to serve one’s own ends and self-interests.
- Limited and constricting ways in which performance is judged for students, educators, and practitioners, not accounting for the richness and variety of human expressions of nursing
- Lack of a full and clear
voice for nurses in the systems and arenas that influence health care.
We believe in a world in which:
- Nurses practice healing with transformative results.
- Nurses support, mentor, and nurture one another through participation in learning, researching, and practicing.
- Nurses act from our most fundamental values.
- Nurses control our own work lives.
- Nurses are strong and creative in the face of adversity.
- Nurses are powerful as healers and as participants in caring and healing processes.
Ours is a call to conscience and action that grows from the awareness of this conscience. We prefer not to prescribe what is necessary for such a movement. We offer suggestions for individual and collective ways to encourage sharing, changing, reflection and action. We are willing to provide resources and to tell the stories associated with this movement if you heed our call. Most importantly, we provide a place from which to begin to tell our stories and listen to other nurses.
The processes for group interaction that
are described in Peace
and Power: Building Communities for the Future (Jones and Barlett) illustrate values-based action in the contexts
of group processes. The actions are not prescriptions, but rather
suggestions for individuals and groups to consider as they begin to
develop habits of cooperation, nurturance, respect, and wholeness.
Participatory, cooperative, feminist, activist,
and appreciative methods are ways in which to do research that returns
to "subjects" the legitimacy of their own knowing and the
capability to produce and use their particular ways of knowing as
a guide in their own action. These emancipatory research methods are
founded on the beliefs that humans long for wholeness; wholeness requires
connection; connection demands participation; participation leads
to empathy; empathy implies responsibility; and humans cannot experience
wholeness or freedom without responsibility. Participatory research
provokes, envisions and values differences. These are research projects
that are founded on critical assumptions that re-orient the research
enterprise toward participation and action. Research must be meaningful
to those it is intended to serve, and the best way to create this
meaning is through involving participants as co-researchers. Research,
to be of social relevance, needs to be oriented toward action in practice.
Participatory and activist research is expressed through mutual engagement
among individuals throughout the research process from the identification
of issues, concerns, and problems to plans for action and researching
that action to implementation to evaluation of the research endeavor.
Hearing the stories of patients
and acting WITH them to change the structural and personal obstacles
to health is a way to begin to practice nursing as we envision it.
The act of listening to and being in presence with patients can provide
a strong foundation for change. Listening individually, asking how
we can partner with patients, is an act of courage. Growing our awareness
to a community of patients, holding living room and coffee shop conversations
about together changing health care, is a revolution. It will provide
a vision of what can be in practice and in partnership.
and town meetings would provide an opportunity to invite members to
come and discuss the issues and concerns and reflect on possibilities
for action. The community could be defined as any group of individuals
you think might have similar concerns and interests. These would be
open meetings structured according to the intentions of the participants
and conveners. Citizen salons are smaller forums for discussion and
dialogue held in individual’s homes. These are usually invitational
and involve a specifically defined topic for the focus of the group.
With any of the meetings, the goals would be conscious raising and
exploration of possible strategies for action consistent with conscious
intentions. A good resource for citizen salon information is the book,
The Healing of America by Marianne Williamson.
These are experiential group encounters designed
by participants to nurture personal and professional sovereignty.
The experience is very thoughtfully designed and planned to draw everyone’s
focus and attention on that which can shift our abilities to act powerfully
in the world. One such design can be focused on acknowledging the
barriers that exist to nurses claiming and acting from a place of
personal and professional sovereignty. The meeting room can be designed
to provide barrier and resistance "stations." Each participant
visits each station and declares what they wish to seek. For instance,
one might say, "I wish to practice nursing spending more time with
patients and less time with paper work." The station attendants
make declarative statements about why this is impossible saying aloud
all the reasons for not accepting the desired possibility. "You
are crazy. We have to document all our actions. There is not enough
time." The participant
keeps stating their desire only to hear reasons to abandon their desire.
Once the participant feels brave enough to claim his or her personal
and professional sovereignty, he or she enters the center of the room
and declares loudly, "I claim my personal and professional sovereignty
to practice nursing as I see fit with my patients." The act of
claiming one’s sovereignty is celebrated with verbal acknowledgments
and rituals. Participants are free to design these group encounters
in ways that support and nurture this public proclamation of sovereignty.
ways to get in touch with what matters most to them. This can be done
by solitude, meditation, reflection, making crafts, playing music
and spending time in nature or any method that allows for delving
into the inner world that is often abandoned due to external constraints.
Another way to think about this is to find that which is most sacred
to you, that which is your truth and passion. The next step is to
contemplate ways to express yourself more fully from this sacred space.
For instance, you may journal about your reflections and allow yourself
to discover new ways of acting in your work and personal life, nurturing
the spirit within. The goal is to manifest love in our lives.
This is totally individual.
It might be creating a garden for meditation or building an altar
with things that represent your values and commitments. It might involve
journaling or relaxation exercises and practices. It may include walks
and experiences in nature. It may be individual or include others.
You define what "inspirits" you
and create rituals that manifest this "inspiritedness."
Making personal and social change fuels the soul. What
in your community or personal life is calling for you to speak and
act? Anything, from turning off the TV for a month or learning photography
to starting a tutoring program for at-risk kids or speaking out at
your local school board meeting, constitutes change. The power of
making change is profound. The process of change provides opportunities
to question our values, define and refine our priorities, act consciously,
and feel our personal and/or collective power. It is that power from
which we act that can be translated into resonating change.
These are task-oriented projects that
people come together to accomplish, bringing their shared values as
a foundation for both the processes and the products that they envision.
Such groups can use some of the suggestions in Peace and Power to
identify and define what they plan to accomplish, as well as how they
are going to accomplish it. Such projects bring into focus the difficulties
involved in working together in a different way, in the context of
a group that has mutually made a commitment to learn the new ways.
This kind of group can also nurture the vision of what is possible
in the world.
Seek to tell your story about your experiences of nursing with other nurses. Seek to hear their stories. You could do this through face-to-face encounters or through cyperspace Share stories of nursing, struggles and challenges, but also of courage and accomplishment. Also re-tell and re-story the lines of the story to create the desired future you would like to have. We invite you to share your stories through this website. We appeal to you to seek out the stories of two other nurses and share them on the website if they agree. This is an act done to make visible what is invisible to others and to raise consciousness for change.
We welcome you to join us in envisioning, shaping, and manifesting a future that reflects the deepest passions, beliefs, and values that come from our roots in nursing – a future that is deliberately and consciously formed. If you wish to lend your endorsement of this document, or add a dimension to it, or post your own manifesto here, please contact us.
This manifesto was initiated as a combined effort of Sue Hagedorn, Peggy
Chinn and Richard Cowling. We all come from white, essentially middle-class
backgrounds. We grew up in diverse areas of the United States (New
York, Hawaii, Virginia). We all have relatively privileged backgrounds
that included opportunities for education, travel, and cultural experiences
(camps, concerts, etc.). However, early in our lives, we all followed
personal and political paths that challenged the status quo (much
to the chagrin of our families and friends). While some of our personal
paths have not seemed particularly "political" on the surface,
they all reflect a deep and abiding yearning for peace and justice
in the world, and for the values of caring and nurturing that we perceive
to be at the heart of nursing. We came together in preparing the early
text for this manifesto informed by our individual awarenesses of
the deeply political nature of our personal choices.
The Nursing Manifesto by Cowling, Richard; Chinn, Peggy; Hagedorn, Susan is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
The correct APA (5th edition) citation should read:
Cowling, R., Chinn, P.L., & Hagedorn, S. (2000). The Nurse Manifesto.
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