How often – and how well – do nursing programs teach lessons about the impact that climate exerts on health? And as more of us are exposed to and sickened by toxins, polluted air, unsafe drinking water, and a lack of access to basic health care – not to mention the economic, geographic and social effects of rising tides, stronger storms and predictably unpredictable weather – should climate lessons be mandatory for clinicians?
“In public and environmental health,” University of VirginiaMSN student Amelia Kirby, BSN, RN explained, “that Venn diagram, that overlay, is really close.”
Kirby began her professional life working in nonprofits before heading to nursing school in spring 2020, just as COVID struck. Two years later, Kirby – who on May 22 earns a master’s in nursing through the UVA’s Clinical Nurse Leader program – says it couldn’t have happened any other way. And the environmental causes she embraced since childhood continue to flavor her nursing and determination to do good for both the planet and its human residents.
“I thought entering health care would be the end [of my environmentalism], but it’s turned out to be quite the opposite,” Kirby said. “There are a lot of people in nursing and medicine who care really deeply about the planet, and they’re motivated to change things. It’s very buoying to see how many people are interested in this.”
A climate and health conference in early 2021 first brought Kirby into contact with UVA nursing professors Tracy Kelly, Emma Mitchell and Kathryn Reid, champions of the Nurses’ Climate Challenge, which offers tools, resources and support for faculty committed to teaching climate and health lessons in their courses.
As Kirby’s environmentally minded connections multiplied, so did her ideas and determination to act. Over the last year, she led in developing a Planetary Health Report Card tool for measuring nursing schools’ planetary awareness. The work has presented speaking opportunities at conferences, and landed a national award and other applause from national nursing and environmental groups.
The first Planetary Health Report Card tool was created in 2019 by a group of University of California, San Francisco medical students to assess across five metrics about the climate consciousness of medical programs.
Following a similar model, Kirby, fellow clinical nurse leader student Alyssa Dimatulac, and a team of nursing students from the University of Minnesota, the University of Brighton, the University of Lancaster, and Germany’s Esslinger Science and Health College compiled their own tool to assess nursing programs’ environmental mindedness across curricula (how well and how often nursing courses embed topics of climate’s impact on health), day-to-day sustainability practices, student support, community impacts and interdisciplinary research. She hopes the tool ultimately becomes a commonplace way for prospective students to assess programs that align with their personal values.
The American Nurses Association’s (ANA) Board of Director’s decision to rescind the 1985 Presidential Endorsement process and replace it with a Presidential Engagement Policy received mixed reviews from the nursing community. Some nurses were appalled that a leading nursing organization would fail to endorse a more suitable candidate during this presidential election. For some, this was particularly disturbing given President Trump’s handling of the pandemic and his ongoing bashing of key experts and agencies who have ably provided science-based guidance to protect the public’s health for decades. As nurses who are committed to advancing the public’s health, I can understand why some nurses were disappointed with ANA’s decision. After all, there is growing consensus that our nation deserves a better and more trustworthy leadership. Further, there is ample evidence that the nation’s health is at stake.
However, it is not surprising that some organizations would shy away from endorsing political candidates. While the ANA represents hundreds of nurses across the country, they do not speak for ALL nurses. In fact, because of its diverse membership, it is inevitable that political affiliations and political perspectives would be diverse as well. Thus, the ability to make an endorsement that reflects the perspectives of such a diverse membership would be problematic, to say the least. Given that voting is also a personal responsibility, the ball will always be in our courts to evaluate presidential hopefuls as individual voters with or without an organization’s endorsement.
In response to this disappointment, a group of nurse leaders moved quickly to organize a “Nurses for Biden-Harris” campaign urging the profession and public to vote for Vice President Joe Biden and Senator Kamala Harris. These organizers believe that a Biden Harris agenda would be more responsive to addressing one of the nation’s most pressing needs, equitable and accessible health care.
“We urge Americans to vote for Joe Biden and Kamala Harris.” “The health and wellbeing of our nation are at stake,” were some of the sentiments put forth by this group. As nurses, we have a personal and professional responsibility to vote on behalf of the health and well-being of those we love and serve. I believe that regardless of the ANA’s position, nurses must and will vote for what is best for health care, the profession, and society as a whole.
Nurse of the Week Marie Manthey is a very busy 85-year-old nurse, entrepreneur, advocate, and activist in the anti-racism movement. After the American Academy of Nursing presented her with a Living Legends award in 2015 for her pioneering work in developing the Primary Nursing model, she did not retire to rest on her laurels. Manthey continues to host her Nursing Salons (regular gatherings in which nurses meet to share conversations and support), works with the company she founded and is still an active advocate for nurses suffering from substance use disorder.
Marie Manthey, at a U Minnesota celebration of the Marie Manthey Professorship.
Manthey is also a leader among nurses in the anti-racism movement. After the summer wave of anti-racism protests, she met with DailyNurse to talk about what it means to take action against racism, her journey as a White ally, and her latest Creative Nursing article, which takes a look at trailblazing Black nurse Frances McHie (pronounced “mic-hye”) and the struggle to overcome racism at the University of Minnesota School of Nursing.
DailyNurse: How did you first hear about Frances McHie?
Marie Manthey: “The school of nursing at University of Minnesota has long had a group of very strong volunteers who have a very extensive collection and data [on the history of the nursing school]. So this group of alumni volunteers—who care passionately and energetically about the history of the school of nursing—are responsible for managing historical documents.
And in that documentation area, we found that our first African-American student, Frances McHie, had only been admitted by demand of the legislature. (We recently celebrated the centennial of her admission, which was attended by some of her descendants).”
DN: How did you become involved in the anti-racism movement?
MM: “My awareness began when, 4 or 5 years ago, the Dean of the University of Minnesota School of Nursing, Connie Delaney—who is a phenomenally transformative leader—brought in a speaker to talk about white privilege. That was the first time I had heard that term. She also brought in a university-wide task force on diversity and equity, and I attended some of their open discussions about what is happening to African-American students in our school today.
The next step for me, was I became friends with an African-American person. Her name is Tammy, and she’s a nurse in an administrative position at a local hospital. Well, we met at a statewide leadership meeting, where we made a commitment to develop our relationship and became friends. Tammy started to come to the nursing “salons” I had formed earlier—where we would have dinner, and talk, where the question would be asked, “what’s on your mind about nursing?” and at the end of the evening we would go around and respond to the question “what’s on your mind about nursing now?” After Tammy joined us, we often found ourselves discussing issues affecting nurses of color, and Tammy went on to open a Black nursing salon. We held the first one at my house, and mine was the only white face there. That was part of my leap to a different level of understanding because I listened to what these nurses were talking about. And as I’m listening to them, I’m hearing about what systemic racism really looks like! I had not understood it before; I thought it was about the way we individually deal with racism.
[At the Black Nurses’ Salon] I began to understand what the system has done. It was a big breakthrough. I could finally see where I was in the system as a nursing leader. I could see where some of the decisions I made that involved a person of color versus a White person going for a promotion or better hours, and my decision would sometimes be ‘well, it would work out better if we give this to a White person; she’ll get along better.’ And I didn’t see that until I heard these nurses talk about what it’s like to apply for better hours or something, and despite equal education, equal experience, the white nurse will get it. Also, until now, I didn’t really understand White privilege. Now—at the age of 85—I finally get how being born white has affected everything from my thought processes to my life experiences. It’s very clear to me that action is the only solution.
Tammy and I are going to start another Salon on diversity in nursing with an equal number of nurses of color and nurses who are white. To get us talking to each other.”
DN: It’s complicated. On one hand, it’s not the job of Black people to tell Whites, “this is what you need to do to stop being racist,” but at the same time, we can only learn by communicating in an open, willing dialogue.
MM: “I had to learn how to listen without judgment. At the Black Nurses Salon, I went in ready to just accept what everyone was saying without deciding whether I agreed with everything that was being said.”
DN: One of the biggest obstacles we face is that we are living in an age of “I’m not a racist” racism.
MM: “That’s very true. I discuss that in some detail in a piece I wrote on my journey toward becoming an anti-racist. I went from proudly saying, “I’m not racist!” to actually taking on responsibility for taking steps to dismantle systemic racism and acknowledging that my people with my skin color have been building this system for 400 years At the salons, I began to accept responsibility for what happened. I didn’t ask for it or personally cause it to happen, but it was part of my culture. People of color certainly didn’t ask for it either…..and both of us have experienced the impact of systemic racism.
After taking responsibility, I began to understand that the only solution—I’m a big follower of Nelson Mandela and the idea of reconciliation; it’s a big part of my value system—is reparations. I don’t necessarily mean financial, but the way I am in my world, how I present myself, how accept what other people are saying to me.”
DN: That brings us to the Frances McHie nursing school scholarship, which is a form of reparation, right?
Frances McHie Rains (1911-2006)
MM: “Yes. When the idea of a scholarship in Frances McHie’s name came up, we found a relative of hers who was a nephew and began putting some flesh on the idea. And with his help, we established the Frances McHie Scholarship for nurses of color [at the University of Minnesota School of Nursing]. That was an action step following a public apology to the McHie family. Dean Connie Delaney made a public statement reflecting that the Frances McHie scholarship was a step in reparations and in accepting the school’s responsibility for racism.”
DN: What other actions are nursing schools taking to reduce the effects of systemic racism?
MM: “Some are changing admissions criteria from a hard GPA requirement, and are taking a person’s story into account as well. I think that’s a good idea. There’s no doubt that people of color don’t have equal opportunities. I have a book that was published in 1933, [Carter G. Woodson’s] The Mis-Education of the Negro. It tells the story of how Jim Crow schools started. It says they were teaching them at a lower level, and that’s been carried on through the years.”
DN: What sorts of things can individuals do to fight racism, on an immediate level?
MM: “We can look at big-picture issues—who we elect as our representatives, our senators, etcetera, but we also have to work on a personal level. We need to make deliberate, conscious, intentional choices about the way we live our lives. What is my circle of responsibility and control, and how do I want to be in those areas? I have to look at the way I interact with my children, my friends, my family, my associates, and ask “what are the things that I can influence?” For me writing—for instance, the article [on Frances McHie] and my personal story about my journey—can help me to influence others to work toward change. I just feel that that is what I need to be doing at this point in my life. This is a personal choice we make: are we going to continue to be the way we’ve been, or are we prepared to step into an area where we can’t predict what people’s reactions will be?”
DN: Are more people sincerely examining their own views and trying to move forward?
MM: “I feel very hopeful because so many people are having these conversations. I have these conversations with a lot of my friends. A lot of [other White people] are talking to me about racism. And my company is creating a task force; we are engaged in looking at everything we do.
I’m also the chairman of the board of Directors of the Nurses Peer Support Network, which helps nurses who have been struggling with addiction and are trying to regain their licenses. I’ve been asking people, “can you help me find African-Americans or other people of color for our board?” We recently added our first Black board member, and we have two more we are considering for our [organization. And I think that I’m not the only person who is doing this. Best Buy is looking for enough people of color and women to make up 30% of their new hires. A number of companies are taking action, and I think that’s a hopeful sign.”
Marie Manthey is the author of the award-winning book, The Practice of Primary Nursing, and is a co-founder of the journal Creative Nursing. Manthey’s recent article on Frances McHie—the nurse, activist, and entrepreneur who broke the color barrier at the University of Minnesota School of Nursing—is available here.
The Year of the Nurse and Midwife hasn’t really turned out the way any nurse I know (including myself) would have imagined.
You thought the NCLEX was hard? What about the gripping fear that comes from realizing the way you’re being asked to use your N95 would’ve resulted in you failing out of nursing school clinicals? Or the horror you feel about being unable to give patients what they most need: a loved one to hold onto as they transition out of this life? Or the overwhelming anxiety that you might carry an infectious and potentially deadly disease home to your spouse, your children, or your aging parents?
Turns out COVID-19 is the pop quiz none of us ever wanted to take.
While we love the free pizzas, the 7 p.m. applause and the increased visibility, we nurses also see what so many outside of our profession don’t. Nurses witness firsthand the unacceptable toll this pandemic has taken on health care workers, with more than 900 dead in the United States so far—and even more horrifying, COVID’s toll on health care workers of color, who make up 62 percent of that fatality list.
We know that while the data collected are woefully inadequate so far, this disease is having a heartbreakingly disproportionate impact on our patients who are Black, Indigenous, and people of color.
Beth Toner, RN, MJ, MSN
Those of us who chose this profession to make a difference in others’ lives are willing to work hard to ease the suffering of others. We know our patients. We know they are far more than the condition that landed them in our care. It is food insecurity, inadequate housing, low wages, and unreliable (or no) transportation that have as much effect on people’s health as the medication they take and the health care they receive.
Yet this pandemic has shown us just how fragile this system we call health care is. How can we take care of patients if we can’t even take proper care of ourselves?
Here’s the good news: There’s never been a better time for nurses to make themselves heard and push hard for the changes we have been calling for since, well, forever. The National Academy of Medicine is hard at work on the next Future of Nursing report and it will focus on how nurses can be supported as they address the problems in communities that prevent so many from living their healthiest lives.
A new report from the WikiWisdom Forum—which spent nearly six months listening to nurses across the nation discuss the heartbreaking conditions on the COVID front lines—has made recommendations on how to avoid a similar tragedy in the next pandemic, which will surely come. The report calls for everyone—policy makers, the public, and nurses themselves—to listen, protect and support nurses.
I’ve heard similar themes from the nurses who playing starring roles on SHIFT Talk, a new podcast supported by the Robert Wood Johnson Foundation, that addresses bullying, PTSD and preceptorship in our profession. The host and guests tackle tough topics and point out that the pandemic has only made worse the problems nurses have been facing for a long time.
But again, there are a few bright spots. Nurses are so resilient. Not only will we get through this, we will, I believe, get through this stronger. We have solutions to the problems the nation’s health care system faces. We know what we, and our patients, need.
It’s time to speak up boldly. It’s time to fight the injustices so many of our patients—and so many of us—face. It’s time to stare down systemic racism within our profession. It’s time to bring a variety of voices to the table. It’s time to make the shift and make this a Year of the Nurse we will remember for all the right reasons.
Over the past month, a growing number of nursing associations have been calling upon members of the profession to take action against racism.
The first official remarks appeared the day after George Floyd’s death. On May 31, the Minnesota Nurses Association issued a press release stating that “nurses continue to see the devastating effects of systematic racism and oppression targeting people of color in our communities. We demand justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them.”
The Board of Directors of the New York State Nurses Association declared, “As nurses, we mourn for the hundreds of Black men and women killed by the police every year, like Breonna Taylor, an EMT studying to be a nurse in Louisville, Kentucky.” The NYSNA called upon nurses to “fight against the bigotry, intolerance, and hate fueling current politics and feeding an armed white supremacist movement that threatens our democracy.”
This is “a pivotal moment,” according to ANA President Ernest J. Grant. In a June 1 statement, he urged US nurses “to use our voices to call for change. To remain silent is to be complicit.”
Calling racism “a public health crisis,” the Washington State Nurses Association said, “Racism has a 400 year history in America – and the hand of racism rests heavily on the health care system and public health. We know that people of color face systemic barriers to accessing health care and being listened to or heard. It is the reason African American women face higher rates of maternal death and why the burden of the coronavirus pandemic is falling more heavily on people of color. It is why African Americans have the highest death rate and shortest survival of any racial and ethnic group in the US for most cancers. It is why African Americans are almost twice as likely to die from a firearm than their white counterparts. And, it is why we as nurses must look racism in the face and call it what it is.”
The Oregon Nurses Association commented, “As nurses, it is our duty and our calling to protect and serve the health and well-being of the entire community. That duty extends particularly to people of color who are especially vulnerable in this healthcare system.” In an interview with Austin station KXAN, Dr. Cindy Zolnierek, CEO of the Texas Nurses Association, echoed Grant’s statement, saying, “This is core to our ethics. It’s human rights so we cannot stand on the sidelines. To be silent is to be complicit. So, we have a role in this. We have a role to play in advancing human rights – in advancing health care.”
The Kentucky Nurses Association released a seven-point action plan to combat racism both in the profession and in the culture at large. The plan includes goals such as “training for nurses regarding racial disparities,” promoting the “recruitment of African American nurses and other nurses of color to serve on boards and commissions and leadership positions within our organization as well as others that focus on health,” and the addition of “cultural competency training, bias training and disparity education in every Kentucky nursing school curriculum.”
The Massachusetts Nurses Association also spoke out: “As nurses and healing professionals… we recognize institutional racism and the systematic oppression of communities of color as both a crisis in public health and a pervasive obstacle to achieving the goals of our work in both nursing practice and in the labor movement.”
