Duty to Care : Clinical Nurse Specialist

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Duty to Care

Fulton, Janet S. PhD, RN, ACNS-BC, ANEF, FCNS, FAAN

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Clinical Nurse Specialist 37(2):p 49-50, 3/4 2023. | DOI: 10.1097/NUR.0000000000000737
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The front page of the newspaper featured an article about Xylazine, an animal tranquilizer that is mixed with fentanyl and sold as a street drug. Xylazine, known to cause painful injection site wounds and possibly limb amputation, is not an opioid and therefore resistant to standard opioid overdose treatments. A new threat to an already devastating epidemic of substance abuse disorder. The paper’s magazine insert included an expose on a physician whose practice is dedicated to persons living on the streets of a major American city. What began as a short-term grant-funded project has become a permanent effort to address an ever-growing unsheltered population. Also included in the news of the day was an article discussing the increasing concerns over negative health outcomes related to abortion restrictions. Another article explored the loss of high-tech workers in some states as growing anti-LGBT legislative efforts are causing members of this community and their families to relocate for fear of violence. And, newly reported, gun violence now extends to a 6-year-old shooting his first-grade teacher in the classroom. Point made; the news can be distressing.

The Future of Nursing 2020-20301 report identified addressing the social determinants of health (SDOH) as a top priority for the next decade, noting that nurses at all levels, no matter the setting, have a duty and responsibility to work with others to address SDOH in pursuit of health equity. SDOH has now crept into our vocabulary if not yet fully formed in our daily activities. The newly revised American Association of Colleges of Nursing Essentials: Core Competencies for Professional Nursing Education2 requires SDOH content be included in nursing curricula. Defined as personal, social, economic, and environmental factors that impact health conditions, SDOH are variables in the environment where people are born, live, learn, work, play, worship, and age that affect health, functioning, and quality of life. Different strategies have been proposed for teaching about the influence of SDOH on health such as immersion practicum experiences, simulation exercises, and clinical projects. Researchers are being called upon to provide scientific evidence of the influence of SDOH based on rigorous, systematic analysis.

Newspaper reports are neither clinical nor scientific; they are the raw data of SDOH. News reports about patterns of substance abuse, homelessness, access to care, intimidation, threats, and acts of violence are ways for nurses to gain information about both longstanding and emerging SDOH variables influencing the health of individuals, families, groups, and communities. A colleague noted she unsubscribed to newspapers because, in her opinion, the news is awful, and reports can be wrong. Yes, many problems require large scale solutions, and yes, reports are sometimes inaccurate. However, news reports are not experimental designs, they are a heads-up about the goings on in a community. And the community is bigger than what each of us can individually experience.

In the keynote address for the 2022 Sigma International Research Congress, Dr. Calvin Moorley, London South Bank University, reminded the audience of the great, global diversity of human experience and our duty as nurses to care regardless of a person’s individual characteristics or circumstances. The duty to care is the essence of a nurse’s responsibility to our fellow humans. Our common bond is our humanity. Indeed, the American Nurses Association defines the scope of nursing practice as the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.3

Our duty to care begins with being informed about the world we live in. Being able to address the impact of SDOH on our patients, our fellow humans, is strengthened by awareness of the social, economic, and environmental factors that influence their health – substance abuse, homelessness, limited access to care, violence. As advanced practice nurses, clinical nurse specialists should be leading efforts in identifying groups at risk, advancing advocacy, and collaborating for innovative interventions. It all starts with information. Read the newspaper. Question what you read and read multiple sources. The problems described in news stories reflect the experiences of people in our communities. These experiences are manifest in our healthcare settings as fellow humans present with disease, wounds, worries, and chronic conditions. Nurses have a duty to care, which includes being informed about contemporary issues underpinning social determinants of health. Read about it in the newspaper.


1. National Academies of Sciences, Engineering, and Medicine. The future of nursing 2020-2030: Charting a path to achieve health equity. Washington, DC: The National Academies Press; 2021. https://doi.org/10.17226/25982.
2. American Association of Colleges of Nursing Essentials. (2021). Core competencies for professional nursing education. Accessed January 10, 2023 at: https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Essentials-2021.pdf
3. American Nurses Association. Nursing: Scope and Standards of Practice. 4th ed. Springfield, MD: American Nurses Association; 2021.
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