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A Nursing Manifesto: A Call to Conscience and Action
Citation Information
Credits
and perspectives from which this document emerged
This document is intended to raise awareness, to inspire
action, and to open for discussion issues that are vital to health care around
the globe. Click on the links above to see writings inspired by this call.
Please use this document in any way that you wish. You
can freely copy and paste sections of the document, use portions for your own
manifesto or other writings, or send to anyone who might be interested. If
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A
Nursing Manifesto: A
Call to Conscience
and Action
Introduction
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.
Return to Table of Contents
Ideals and Principles
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. |
Return to Table of Contents
Inspirations and Concerns
Background:
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. There is 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. 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.
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.
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.
Return to Table of Contents
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. |
Return to Table of
Contents
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.
Return to Table of Contents
Some suggestions we offer are:
| Peace and Power
Processes. 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. |
Return to Table of Contents
| Participatory Research.
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. |
Return to Table of Contents
| Patient and Nurse
Collaboration. 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. |
Return to Table of Contents
| Community Meetings,
Town Meetings, and Citizen Salons. Community 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. |
Return to Table of Contents
| Sovereignty Circles.
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. |
Return to Table of Contents
| Finding Your Heart
Space and Living From That Space. Nurses find 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. |
Return to Table of Contents
| Practice Rituals That
Nurture the Spirit. 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." |
Return to Table of Contents
| Make Change. 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. |
Return to Table of Contents
| Deliberate Hope
Projects. 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. |
Return to Table of Contents
| Storytelling. 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. |
Return to Table of
Contents
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 send an e-mail message to peggy.chinn@uconn.edu
Credits:
This manifesto was initiated as a combined effort
of Sue Hagedorn (Sue.Hagedorn@UCHSC.edu
), Peggy Chinn (peggy.chinn@uconn.edu)
and Richard Cowling (wcowling@hsc.vcu.edu).
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.
Citation:
This document is not copyrighted; please use and distribute
freely. However, to assist in letting people know about
this resource, we request that you cite this document in any
published work. The correct APA (5th edition) citation
should read:
Cowling, R., Chinn, P.L., & Hagedorn, S. (2000).
The Nurse Manifesto.
Retrieved [your date] from http://nursemanifest.com.
Return to Table of Contents
Page updated:
June 09, 2003
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