Joel, Lucille A. EdD, RN, FAAN
Lucille A. Joel, AJN Editor-at Large, is a professor in the College of Nursing, Rutgers, The State University of New Jersey, and past president of the American Nurses Association. She represents North America on the board of the International Council of Nurses.
Figure 1 Every President searches for drama to spice his inaugural address. Second-term Presidents are further motivated to establish an agenda that will secure their place in history. Bill Clinton is no exception. But his challenge is particularly formidable given the absence of any overriding international or domestic crisis. Even controversy is hard to find in the wake of a political campaign that was largely won without confrontation and dominated by a successful strategy of keeping the President above the fray.
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The fact that there are no hot issues creates the illusion of security and satisfaction. Instead, today's issues are more obscure but just as real as war or depression. They strike at the heart of the American spirit and threaten the stability of day-to-day life. These insidious and mounting discontents about life in general are especially dangerous because as our tolerance builds, we forget the quality that life can hold. To address these issues is to admit our own participation in creating the problems that confront this nation.
And so this leaves us with the toughest of times-no substantial external threats, just deterioration from within. Health care conforms well to this paradigm. State and federal programs are expanding to cover more lives, yet there is less consumer and employee satisfaction, eroding quality of care, and even questions about safety at the point of service.
But time and politics are on Bill Clinton's side. A second and final term offers the opportunity to do what is right as well as what is political. And just being there at the end of a century opens the mind to broader, bolder, and more incisive thinking from both leaders and followers. So the President has a window of opportunity, and he should maximize it with a clear yet elegant message that builds on the American experience. Anticipate the third millennium, throw down the gauntlet to the people and expect them to rise to the occasion. With the best of leaders, after the work is done, the people say, "We did it ourselves!" A comparison can be made to the restructuring of health care systems: Successful reorganization calls for competent and sensitive leadership and the hands-on involvement of those who will personally have to live with the change.
Hope is in short supply for many Americans. Their vision of the future is warped by low-paying, monotonous, dead-end jobs. Job insecurity among nurses has robbed many of us of the thrill that we once found in practice. Crime, violence, abuse, and addictions have become so commonplace that we assume they belong in our society.
But focusing on the negative invites a minimalist attitude. Fewer dollars for public entitlement programs may create hardship but it may also prompt more personal responsibility, exorcising the generational effects of increasing dependency on government. The return of volunteerism has been born of necessity but finds its roots in humanism. The net result could be neighbor helping neighbor, neighbor knowing neighbor, and reinvestment in community. In similar fashion, a declining job market in hospital nursing will force us to move back into the community and develop exciting new markets.
The more confounding question is how extensively government should be involved in domestic social welfare. And does more government necessarily have to mean more bureaucracy? Who among us deserves the protection of public assistance? We must be assured that debate and subsequent decision-making will proceed forthrightly, not as a back-door and punitive response to other problems, such as immigration. And the frustration of less-than-universal health care still gnaws at our collective conscience, and must be kept alive.
Are we unknowingly creating an underclass whose most common quality is hopelessness? Is labor capable of redefining the job and remodeling the workplace while preserving the spirit of the worker? What is the proper niche for American business and industry in the international marketplace? How can we passionately lobby for educational opportunities yet tolerate functional illiteracy among so many Americans? Do nonprofit hospitals, bred in gentler times, have the backbone to make cost-efficiency a priority while maintaining quality care? Do tax incentives for big business and the rich really promote economic growth? How do we take back our streets and protect Americans from violence? Just what international problems should be brought home to this country?
You will read these comments when the 53rd inaugural address by an American President is history. They will be either an anticlimax or an indictment of what was said. As the President invites us to follow him across that bridge into the 21st century, we must realize that it is a bridge over troubled waters.
© Lippincott-Raven Publishers.