It would seem that 2016, would be a great time for nurses to celebrate. After all, the nursing profession is golden as deemed by the recent Gallup poll results which found nurses to be the most trusted profession for an amazing 14 years in a row. In fact, over the last 17 years the only time nurses didn’t rank number 1 was when firemen received the prestigious award after the 911 disaster.
This merit, voted on by the American public, is a lot to be proud of when you consider that nurses had some tough competition. The highest rating for honesty and ethical standards, was won by nurses over twenty other esteemed vocations including doctors, judges, teachers, safety officers, military and clergy!
So what gives? Are nurses to blame for the bad news in healthcare? How can we fault the angels of mercy for what is happening in America? My answer, after 25 years of bedside nursing and being a healthcare crusader is this: While nurses aren’t the cause of our failing healthcare system, we ARE guilty of not using our influence to impact the changes necessary to make our healthcare system great. Great would be fantastic, let’s start with adequate. Because let’s face it, what’s so great about being #1 in a system that causes more than 75% of the bankruptcies in the United States? What’s so great about an organization that tells the American people to use the emergency room for primary medical attention? What’s so great about a structure that pays the most money per capita for healthcare, yet loses more lives to diabetes, cancer and heart disease than any other industrialized country?

To me, this award is like getting the Titanic award. Our levels of morbid obesity, unchecked mental illness and deaths due to medical errors are disasters that should make a nurse’s head explode. Instead of celebrating, we should be outraged enough to want to revamp the system to give the safe, unparalleled care that the American people deserve.

Let’s look at three ways nurses can use their influence to change America’s healthcare delivery.
1. Nurses need to demand compensation and recognition for what they do. One of the most daunting tasks of the Affordable Care Act (ACA) is the lack of providers available to actually care for the sick let alone educate the public on lifestyle changes known to prevent debilitating and costly illnesses. Utilizing public health nurses and home health nurses to prevent and treat obesity, diabetes and tobacco use can save hundreds of millions of dollars a year. According to the Partnership to Fight Chronic Disease, these conditions cost more than a trillion dollars per year, and if there is no changes, this number could balloon to nearly 6 trillion dollars by the year 2050. Preventable and highly manageable diseases account for 75 cents of every dollar we spend on healthcare in the United States., every day, every year. Even more daunting, chronic disease costs consume 90 cents of every dollar spent on Medicare and Medicaid. In contrast, we spend less than 5 cents on prevention. There are over 3 million nurses in the United States, the largest number of medically trained and licensed personnel available, yet nurses are finding it difficult to find work. Let’s insist that more nurses be employed by public health.
2. End violence in the workplace: Yes, patients are more violent toward nurses but I’m talking about the unspoken violence of bullying. The hazing of new nurses and lack of teamwork among healthcare workers causes a huge turn-over rate in nursing. The RN Work Project, a Robert Wood Johnson Foundation-funded study of new RNs and the only longitudinal study of RNs in the United States, showed that of newly licensed hospital-based nurses 43% leave their first jobs within 3 years of employment. Turn-over is costly. The recession has slowed resignation rates from 46 % to 43% since 2008, but nursing is still a profession that is known for “eating its young.” A much needed revamping in the mentorship and training of new of nurses could change this culture by re-setting its priorities by utilizing more on-the-job teachers and nurse apprentice programs.
3. Finally, the most influential duty that nurses, the most ethical and trusted professionals, must do to improve healthcare is to stand up and say “NO!” to unsafe patient care assignments. In some states, like California, there are nurse-ratio laws that mandate no more than 1:1 or 1:2 critically ill patients per nurse but in other hospitals across the country one nurse may have 4 or even 5 critically ill patients to juggle. Yet, hospitals across the nation are betting that fear of losing their job will more often, than not, dictate a nurse’s behavior to accept an unsafe patient assignment. With more than 100,000 injuries or deaths per year caused by hospital errors there is nothing ethical about accepting assignments that a nurse knowingly cannot handle.

Nurses need to adhere to the Florence Nightingale oath to do no harm. I agree with RN, Cynda Hylton Rushton, Professor of Clinical Ethics at Johns Hopkins University when she said: ”Many of our challenges facing our healthcare system is related to the overall task of balancing quality and safety with efficiency.” Nurses have known for decades that the business of providing healthcare cannot be run like an assembly line. The value of medicine is not in its size, as in the Titanic, but in the outcomes of a healthy nation. RNs at the bedside save lives and whistle-blower protections must be upheld to protect nurses who tell on employers who knowingly place patients in harm’s way.

Being a nurse is a calling ruled by a higher law. Nurses care even when you don't care about yourself. As elections draw near, look to the nurses who endorse the candidates who challenge price gouging by pharmaceutical, insurance and hospital corporations. 
It’s no wonder nurses were voted the most ethical and trustworthy profession because we have to be. Patients, their families, and the public are counting on our values of caring, compassion and community.