A Call to Action Beyond Thoughts and Prayers : Nursing Education Perspectives

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DEPARTMENTS: Message From the NLN Chair

A Call to Action Beyond Thoughts and Prayers

Poindexter, Kathleen

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Nursing Education Perspectives 44(3):p 137-138, 5/6 2023. | DOI: 10.1097/01.NEP.0000000000001131
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America has the highest rate of gun-related deaths globally compared to similar high-income countries, and the numbers continue to escalate. This is a public health crisis that has moved far beyond “thoughts and prayers” and demands a call to action.

I never thought I would be writing about safety on our college campuses, support for students after a traumatic event, or the numbers of mass shootings in America. Then, again, do any of us really think our college will experience the horrific terror and profound range of emotions that surround being a site of a mass shooting? Despite taking part in emergency drills and internalizing the “run, fight, hide” response, nothing prepared me for the aftermath of the shooting event that occurred on my home campus, Michigan State University (MSU), last February. My heart aches for the innocent people whose lives were forever altered by this senseless act of violence. My hope is that none of you ever experience a similar incident.

The escalating number of mass shootings in America presents a different picture, and the stark reality of this growing crisis shows that no one is immune. The number of mass shootings (four or more persons shot in a single spree, which may include the shooter) in America from January 1, 2023, to March 1, 2023, averaged 1.73 shootings per day, 179 killed, and 398 wounded (Mass Shooting Tracker, 2023). Nationally, we averaged 649 mass shootings per year between 2020 and 2022, and 44,000 gun-related deaths in 2022 (Gun Violence Archive, https://www.gunviolencearchive.org/past-tolls). In 2022, 43,450 children experienced 46 school shootings (K-12) that killed 34 students and adults (Cox & Rich, 2023). Firearms are the leading cause of death in children (Kaiser Family Foundation, 2022). America has the highest rate of gun-related deaths globally compared to similar high-income countries, and the numbers continue to escalate.

This is a public health crisis that has moved far beyond “thoughts and prayers” and demands a call to action. Unfortunately, in America, there is a pattern of response after mass shooting events. It involves media attention, calls for action, marches, and passionate calls for gun reform laws, followed by failed votes in Congress and subsequent inaction. Has the time arrived when a bipartisan approach can agree on legislation to break this cycle?

It was naïve of me to believe we would somehow be exempt from such a tragedy. The senseless act of violence that took the lives of three of our students and wounded five others was unthinkable. Sadly, this was not the first mass shooting experienced by several MSU students. A number of students survived the Oxford High School shooting in Michigan 15 months earlier, and one was a child at Sandy Hook Elementary in 2012. Students are in school to learn, and they should not have to stay strong, shelter in place for hours, work through the loss of friends, or worry about their safety in a classroom or library. Many of the students interviewed after the event said they simply followed the protocols to stay alive that they had been taught in grade school. Barricading doors, blocking out windows, shutting off lights, hiding, and staying quiet are all components of K-12 school drills that now are as common as fire drills. I worry, are acts of gun violence becoming so familiar and expected that we, as a nation, are becoming complacent?

The growing number of databases with statistics on gun-related deaths and injuries do not tell the complete story. First, there is no unified definition of mass shootings and school shootings, resulting in discrepancies in reported data that enable some to question the validity of the reports. If anything, the numbers of active shooter events are believed to be underreported, especially when school shootings take place off school grounds or there are fewer than four victims (Riedman, 2022). Second, the data exclude the vast numbers of silent, invisible victims who are severely traumatized or injured from secondary trauma as a result of experiencing the shooting. These include other students, family members, friends, and caregivers as secondary trauma. Those who witness the shootings, lose friends, or spend hours in lockdown experience trauma that can be long term and complex.

Although the response is unique to each person, nine out of 10 survivors report experiencing trauma that frequently affects their well-being and/or functioning (Everytown Research & Policy, 2022a). Children and teens who experienced frightening circumstances, such as school shooter drills and lockdowns, are at risk for worsening academic and social progression, depression, anxiety, and posttraumatic symptoms. I can certainly attest to the range of responses across students. Some report difficulty studying, labile emotions, fear of returning to campus, trouble sleeping, anxiety, and/or depression (Everytown Research & Policy, 2022c). Others prefer to return to their friends, structured classroom schedules, and normal routines. One student shared: “COVID-19 took away my high school years, and one person is not going to take away my college years.”

Despite growing numbers of gun-related deaths and injuries, funding for research on gun control was severely restricted in the United States after the passage of the Dickey Amendment in 1996 (Everytown Research & Policy, 2022b). The amendment prevented the Centers for Disease Control and Prevention from using federal funding for gun control advocacy. In 2011, Congress voted to extend these restrictions to the National Institutes of Health. It took until 2020 for Congress to act and appropriate $25 million in funding for research related to the causes and impacts of gun violence (Barna, 2020). The research hiatus delayed studies into predictors of gun violence and policies and practices that might have prevented thousands of gun-related tragedies. Guns are the vehicle used in shooting incidents; the problem of violence is deeply woven into the fabric of our society. Regulating the method is only one element of addressing this epidemic in America.

As nurse educators and academic leaders, it is our responsibility to ensure the safety of our students and campus communities during these unsettling times. As nurses and health care leaders, we have a responsibility to address public health priorities by advocating for funding research on prevention, safer gun regulations, early intervention programs, access to mental health care, and the implementation of safe community action plans (Fernandez-Pena, 2021). Perhaps a short-term solution to this deeply rooted social problem is to promote a sustained sense of intolerance to complacency and inaction.

A long-term solution will require a multifaceted approach that includes examining risk factors for gun violence; funding research on evidence-based primary, secondary, and tertiary prevention and treatment plans; and informing policy recommendations. Implications for practice could include evidence-based prevention and intervention efforts to reduce gun-related deaths and injuries. Findings could inform policies related to gun ownership, registration, and sales. Research on the impact of exposing children to active shooter drills is important to develop best practices without further traumatizing the children. Additional research is required to develop standards and recommendations for posttraumatic care for victims of gun violence. I can share by experience that there is no playbook and there are no best practice recommendations to help a community heal from a tragic event.

The incident on our campus has reminded me to be more aware of my surroundings and mentally prepare an action plan to best guide students in the event of an emergency. There is a renewed sense of urgency to actively advocate for safer gun laws; research funding to support studies on prevention, detection, and early treatment programs; and access to mental health care. I am grateful for the coordinated communication of our 911 operators, the swift action of our MSU police, the professional care provided by first responders, and the health care teams at Sparrow Health System. Coordinated efforts across hundreds of responders and thousands of community members would not have occurred without a disaster management plan in place managed by members centrally located in the MSU emergency command center. I am also grateful for the overwhelming support provided by my NLN colleagues and appreciate the donation to offset the cost of care for the victims of this tragedy.

Nurses everywhere — please join together in advocating for safer schools, research on gun prevention, policy and clinical practice guidelines, and support for all victims traumatized by gun violence. Daily, 120 people are killed with guns in America. This is the equivalent of a 737/700 plane crashing daily. Are we ready for bipartisan action?



Barna M. (2020). Federal funding for gun violence prevention research sparks hopes: Priorities, direction being explored. The Nation’s Health, 50(3), 114. https://www.thenationshealth.org/content/50/3/1.2
Cox J. W., Rich S. (2023, February 14). After Parkland: School shootings affect soaring number of kids. Washington Post. https://www.washingtonpost.com/dc-md-va/2023/02/14/school-shootings-parkland-5th-anniversary/
Everytown Research & Policy. (2022a). When the shooting stops: The impact of gun violence on survivors in America. https://everytownresearch.org/report/the-impact-of-gun-violence-on-survivors-in-america/
Everytown Research & Policy. (2022b). Why funding gun violence research matters. https://everytownresearch.org/report/why-funding-gun-violence-research-matters/
Everytown Research & Policy. (2022c). The impact of gun violence on survivors in America. https://everytownresearch.org/report/the-impact-of-gun-violence-on-survivors-in-america/
Fernandez-Pena J. R. (2021). Ending gun violence epidemic requires public health strategies. The Nation’s Health, 51(6), 3. https://www.thenationshealth.org/content/51/6/3.1
Kaiser Family Foundation. (2022). Firearms are the leading cause of death for children in the United States but rank no higher than fifth in other industrialized nations. https://www.kff.org/private-insurance/press-release/firearms-are-the-leading-cause-of-death-for-children-in-the-united-states-but-rank-no-higher-than-fifth-in-other-industrialized-nations/
Mass Shootinf Tracker. (2023). Mass shootings in 2023. https://massshootingtracker.site/data/?year=2023
Riedman D. (2022). K-12 school shooting database. https://k12ssdb.org/all-shootings
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