It is neither original nor particularly insightful to point out that the 2020 International Year of the Nurse and Midwife has not unfolded as expected. Months of carefully planned celebrations of the work and worth of nurses and midwifes has confronted and collapsed in the face of new rules about social distancing, quarantines, and voluntary (and, internationally, sometimes mandatory) self-isolation. It is a cruel irony that a deadly, world-wide coronavirus pandemic has brought attention to the real work and worth of nurses in ways no media campaigns and public relations initiatives ever could. Images are now seared in our minds of nurses and midwives rushing into potentially deadly sites, with or without enough personal protective equipment. We now have images of nurses and midwives as celebrated heroes, as impassioned advocates, as skilled clinicians, and, we must never forget, as tragic victims of a virus we have yet to understand.
As is inevitable for all journals, the themes and timelines for every issue has to be established well in advance of publication dates. OJIN: The Online Journal of Issues in Nursing had planned this topic when we first thought we might use history tell the stories of how we came to a celebration of the 2020 International Year of the Nurse and Midwife. But one must read these stories now in an entirely different context. And, as our brave, new context clearly demonstrates, that history has never been more important. The most obvious referents have been to the flu pandemic of 1918-1919, responsible for an estimated 50 million deaths worldwide. I have written and spoken about the historical implications of this pandemic. About how the discipline frequently described as the scourge of nurses training schools was also a way of transforming young women (almost all nurses in the early 20th century were white women) into resilient and courageous clinicians who would care for patients suffering from poorly understood bacterial “germ diseases” – all the while knowing those germs could also kill them. And about how the unending need for more and more nurses during times of pandemics, epidemics, and war led to increasing opportunities, in particular for nurses of color and men.
One simply cannot read the articles published in this OJIN topic without thinking about what they might say about our current pandemic (even as we should always recognize they were not written for this purpose). The first two articles deal with war and leadership. Matthews and colleagues, Florence Nightingale” Visionary Role of Clinical Nurse Specialists, deals with role leadership in war. Arthur’s, Edith Cavell: The Other Nightingale, speaks to moral leadership. There is now no other way to state this: we are at war with the coronavirus. The analyses of these two different nursing leaders suggest we look to these examples of how we can muster resources, challenge conventional wisdom, build networks of support, and develop our own (popular or unpopular) sense of moral clarity about the roles we are now called to play.
In the article, Voices Echoing Forward: One Institution’s Efforts to Preserve Nursing History, Larkin et al. describe how nurses at the Massachusetts General Hospital, with its own long and storied history, created the structure and the processes to preserve its own nursing history. They began this planning long before the hospital assumed its central role in Boston’s coronavirus outbreak. But it has left them particularly will situated to capture the incredible stories of how its nurses, clinicians, students, patients, and families actually confronted the coronavirus pandemic. I do not think these will all be only stories of heroes and heroics. We know from the past how responses are messy, uncertain, conflictual, and sometimes problematic. Nurses have more responsibilities that just to patients: how do they balance other responsibilities to themselves and their families? We now have a repository.
Some of these stories involve fundamental ethical decisions. As Fowler, one on the founders of modern nursing ethics’, recounts in Toward Reclaiming our Ethical Heritage: Nursing Ethics before Bioethics, the ethics behind choices nurses make, as individuals and as a discipline, has its own history. I found her argument compelling that we not discount late 19th and early 20th century ethical directives as mere “etiquette.” During periods where “rules” of conduct were interpreted by a larger public as signifying one’s moral character, these “rules” helped establish the authority and legitimacy of practitioners of a new discipline.
The final articles bring us to the international stage, where nursing has had a historical impact, and which reflects the reality of the coronavirus pandemic. Ferguson and Benton, in The Contribution of American Nursing to the Evolution of the International Council of Nurses, reminds us of the leadership roles that nurses from the United States have played in the formation and the power of this organization. And, as we know, the ICN has played an instrumental role in the World Health Organization’s designation of 2020 as the International Year of the Nurse and Midwife. I am not sure such American leadership ever foresaw this legacy.
Similarly, Peters et al. use, The Influence of Anglo-American Teaching Systems in Brazil: Contributions by the Parsons Mission (1921-1925), to track the spread of one particular western tradition of nursing education to the southern hemisphere. Of note, arguments about the need for this move did not occur in a vacuum: the Anglo-American system of nursing education had strong philanthropic backing. Yet, as Julita Villaruel Sotejo argued in Capucao’s, Beyond Western Expectations Philippine Nurse Leaders Anastacia Giron-Tupas and Julita Villaruel Sotejo, 1910-1950, this kind of importation of a training model also existed within a complicated world of colonialism, exportation of nursing talent, and inherent racism. As we think of the global scale of this particular pandemic these articles encourage us to question: What are the dominant nodes of knowledge? How do these intersect with local, indigenous nodes? And, most importantly, how can we shed our own culture’s biases, preferences, and all too often assumptions of “best” to meet the needs of our global population?
As I write this introduction, I have learned that the ICN has now called for the planned celebration of International Nurses Day during this Year of the Nurse and Midwife to be not only a celebration but also a call to action: to not just recognize the crucial role that nurses play in society, but also to ensure nurses’ health and safety at work and to improve their pay and working conditions. We, of course, join this call. The articles in this OJIN topic show how, why, and what worked as we follow in the footsteps of our forerunners, seeking to construct a better future.
The journal editors invite you to share your responses to this OJIN topic by sending a Letter to the Editor or by submitting a manuscript that will further the discussion initiated by these introductory articles.
Patricia D’Antonio, PhD, RN, FAAN
Dr. D’Antonio is the Carol Ware Professor of Mental Health Nursing and Director of the Barbara Bates Center for the Study of the History of Nursing at the University of Pennsylvania School of Nursing in Philadelphia, PA.