But realizing—in action—
who we are, what we stand for, the values we believe in—
these are the real challenges that remain before us.
Peggy L. Chinn, RN, PhD, FAAN (2019, p. 10)
In my first editorial as Editor-in-Chief of JANAC, I discussed my definition of nursing, which was based on change and how nurses help people deal with change. It was no grand theory, and I am sure it lacked many of the components required of a creditable definition for nursing. Despite that, it was my personal philosophy and a construct I thought would work well in the context of providing nursing care and advocacy for—and with—people/communities living with and affected by HIV. Nursing has certainly changed in the ensuing 12 years, and I am thinking of those changes as I write this, my last editorial for JANAC.
But first, I need to say that editing JANAC has been one of the most amazing gifts that I have ever been granted. I have served as your editor with joy, and I am confident that Michael Relf, your new Editor-in-Chief, will serve you with equal passion.
Peggy Chinn, who I quoted above, is an amazing nurse leader. One of the many privileges of my career has been learning from her as a member of the International Academy of Nursing Editors (better known as INANE). I heard Dr. Chinn discuss nursing at the last INANE meeting from a perspective that I had often imagined was possible but never quite believed would come to pass. In her comments, Chinn encouraged editors of nursing journals to publish articles that (a) include diverse forms of nursing knowledge, (b) are guided by nursing theory, (c) reflect the discipline of nursing, and (d) acknowledge that evidence is not the only—or even the most—important way of knowing (P. L. Chinn, personal communication, August 1, 2019). In some ways, these are old concepts, things we have heard before, but in many other ways, they are radical ideas that will demand a paradigm shift to accomplish.
I encourage you to read Chinn's (2019) recent keynote address at Case Western Reserve University. In that speech, Chinn discussed problems that were of concern to her and other nurse leaders. The two that made me stop to consider my own values were interprofessional (which she called interdisciplinary) care and internalized nursogyny, both of which impact nurses in HIV care.
As you know, ANAC has moved toward an identity as an interprofessional organization, and JANAC has endorsed this action through the publication of interprofessional articles, the addition of interprofessional editorial board members, and accepting reviewers and authors from a variety of professions. It took a long time for me to come to the conclusion that this was an appropriate step for the journal and the organization. I was persuaded because interprofessional care makes sense for nurses, who have long espoused the need for teams to bring together knowledge and skills to provide the best patient care. Despite that, I have always feared the loss of nurse power (which is already limited) through such a change, and it turns out that I was not the only one. As Chinn (2019) stated, an interprofessional approach often “creates an opportunity for certain disciplines to achieve their own interests and exploit the talents of others” (p. 19), a point that has been my personal experience. Chinn (2019) further stated:
… interdisciplinary teamwork has all too often betrayed us and we have all too often remained silent and vulnerable … we find ourselves erased, serving the interests of other disciplines (sometimes not even realizing it), with our own interests as nurses ignored or placed at the bottom of the barrel. … when our interests are not part of the team objectives, then we are serving their interests, not ours. (pp. 19-20)
All of this is not to say that nurses are bound to lose as a profession in interprofessional teams, but that nurses must speak up and stand for nurse knowledge, skill, practice, and theory.
Nurses in HIV care will recognize this concept because we battle a related concept—internalized stigma—every day. Internalized nursogyny is the way that we, as nurses, discount ourselves, allow our contributions to be dismissed, and willingly accept the role of nurses as second-line health care professionals, as handmaidens, and as those who take orders and do not think for themselves. Chinn (2019) claimed that nursogyny
… comes in part from the historical trauma of nurses' exploitation as students and even further back to the killing of women as healers. Like internalized misogyny, homophobia, racism and other socially constructed prisons that exist only in stereotypes and prejudices embedded in societal norms, nursogyny is alive and well. (p. 20)
Chinn (2019) further asserted that nursogyny is not of our own making but is made worse by our compliance and internalization of a socially constructed myth, which we need to change.
Be a Nurse
I have had a long and privileged career in nursing. I have been a nurse in clinical, research, education, and management positions and have been frustrated in all of those roles because I was a nurse. But I have also grown and known and been enlightened because I was a nurse. Nursing has been a great career, providing opportunities that I could never have imagined in 1968 when I started nursing school. As I leave JANAC, I encourage you to support your profession, nursing contributions to global health, and everyone in need of nursing care, which is everyone. I urge you to:
- Be proud of who you are and what you do. You are unique in nursing and you are a member of the largest health care profession on earth. And you, as nurses in HIV care, have blessed an entire generation with your gifts; your care has—and continues to—matter.
- Be a real nurse advocate. We should advocate for ourselves the same way we advocate for patients. How? Look for nurse leaders, researchers, theorists, educators, and clinicians to emulate and to serve as mentors (even if they are far away and only available in the pages of a journal or textbook). Remember that your base is nursing and go there first. Start with nursing theories to inform your research, use nursing research to support your clinical practice, teach nursing principles, and cite the nursing literature. Other professionals can add to our knowledge, but their interpretations do not acknowledge nursing. It is your job to appreciate knowledge from other fields and to understand it from a nursing perspective.
- Celebrate the Year of the Nurse and Midwife. The World Health Organization Executive Board has designated 2020 (the 200th anniversary of Florence Nightingale's birth) as the Year of the Nurse and Midwife, a global celebration of who we are (International Council of Nurses, 2019). Do not miss opportunities to talk about nurses, who they are, what they do, how they make differences around the world, and why you do what you do. Talk to nurses to share ideas and develop working groups to move the profession forward. Go to the international HIV conference in San Francisco/Oakland and make noise. Go to your own organization and make noise. Keep your focus on the tenets of nursing and stay true to your profession.
- Demand the respect you deserve. Give the care your patients deserve. Stand up for what is right.