I'm so looking forward to beginning a shiny new year. Although I'm usually a “glass half-full” person, I found it increasingly difficult to stay positive during the last months of 2012.
For one thing, severe fall weather in the New York City metropolitan area, where I live, caused extensive damage and numerous fatalities. This year's storms, first Hurricane Sandy and then an unnamed nor'easter, were far more destructive than last year's Hurricane Irene, which caused over $15 billion in damages; at this writing, it's estimated that losses from Sandy could reach $50 billion. During Sandy, we witnessed the unprecedented evacuation of six New York City hospitals, as well as hospitals in several low-lying New Jersey towns; many nursing homes were also evacuated. It's amazing that no lives were lost during the evacuations, thanks to the herculean efforts of hundreds of health care professionals, first responders, and the National Guard. But weeks after the two storms, several facilities (including Bellevue Hospital Center, which has one of the busiest EDs in the nation) remain closed for repairs, their staff and patients scattered to other New York City hospitals.
For another, the presidential campaign seemed to go on forever. I'm thankful that the election is finally over. While the big picture hasn't changed—both the president and the congressional balance of power remain the same—I'm hoping the rancor and partisanship that have come to characterize our legislative procedures will lessen and we can move on to address the significant challenges we face. Perhaps the extremists on both sides of the aisle can be reined in by party leaders, so that the moderates can work together toward meaningful governance.
It's true that in some ways, 2012 was a good year for nursing. Thanks to the dynamic recommendations of the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, and to a well-crafted implementation initiative, the Campaign for Action (http://campaignforaction.org), we now have tangible evidence that legislators and health care stakeholders are finally “getting” what nursing can do. New rules from the Centers Medicare and Medicaid Services will allow payment for transitional care management by “qualified nonphysician practitioners,” care coordination by RNs, and anesthesia and pain management services by certified registered nurse anesthetists where permitted by states. While nursing organizations were working on these matters before the IOM report came out, the ensuing media campaign and publicity undoubtedly helped garner support from some who had previously withheld it.
But I'm disheartened by the ongoing divisiveness within our profession, which prevents nurses from uniting into one strong organization. Last October, the New York State Nurses Association (NYSNA), which had been suspended from the American Nurses Association (ANA) on December 15, 2011, for dual unionism, voted to disaffiliate from the ANA. Claiming 37,000 members, NYSNA had been the largest constituent state member of the ANA. Its disaffiliation is a significant loss: the ANA will lose dues revenue, and nursing loses yet another opportunity to come together as a profession. There are an estimated 3.1 million RNs in this country, yet only a small proportion of them belong to the ANA or indeed to any professional association.
And why is this important? There are professional issues that go beyond union objectives—such as those regarding standards of practice, credentialing, and shaping national health policy—and which should matter to all nurses. Make no mistake: I'm not anti-union or anti-workers’ rights. Nurses need safe workplaces, appropriate patient assignments, and protection against mandatory overtime, and unions have achieved many of these gains. But nursing is not just a job, and we must think and act as professionals if we're to move forward. Practice and roles and work settings are changing, and it will take all of us—staff nurses, managers, administrators, and educators—working together to make sure nursing is an integral part of a new health system.
On this page two years ago, I wrote, “If ever there was a time for nursing groups to put aside parochial concerns and speak with one voice, that time is now.” I'm still hoping.