The legacy of midwifery and public health nursing all-star, Mary Breckinridge, solidified my decision to attend Frontier Nursing University’s nurse practitioner program. Her development and implementation of a nursing-led program to care for rural and underserved communities in rural Kentucky, based on her research of public and community health programs in Scotland, England, and France, was the first of its kind in the United States. That strong history, comprised of epic portrayals of nurses on horseback intrepidly crossing raging rivers to provide care, combined with the university’s present-day emphasis on cultural humility, health equity, and social justice as praxis for practice, clicked with me. However, in reading Mary Breckinridge’s memoir, Wide Neighborhoods, detailing the formation of the Frontier Nursing Service, I grew concerned about her views on race, class, and eugenics.
While searching for a theory or concept to help me understand how to approach this duality in Breckinridge’s legacy, the American Nurses Association (ANA) text, Code of Ethics with Interpretative Statements, provides the imperative for caring and advocating at the patient and population levels. However, it does not explain the how or the process of doing this work. The ANA’s position statements on issues of social justice illustrate how far we have come as a profession. We know Breckinridge’s portrayal of some patients and communities would not stand unchallenged today, and yet, a full 360-degree view of her legacy remains elusive.
Social movements, like Black Lives Matter and #Metoo, have given some of us a new way to understand and examine the behaviors of institutions, such as law enforcement, and those with power, privilege, and access. Just as concepts to explain nursing as a profession, a science, and a discipline (Butts and Rich, 2018, p.67) vary, social justice can be also viewed as an approach and a philosophy to reimagine and repurpose societal norms and institutions, so they are more inclusive and less oppressive. Social justice is about emancipation from oppression. If we, as Radical Nurses, are to embrace social justice and reshape our curriculum and institutions, there is a responsibility to also critically examine our nursing foremothers to put social justice principles in practice.
Robin Walter, PhD, RN, CNE, wrote in Advances in Nursing Science, about emancipatory nursing praxis as a framework that prompts nurses not only to engage in social justice on an intellectual level, but to intervene (2017). Intervention can mean activism. Activism can be perceived as antithetical to nursing and nurses, a profession and discipline that some may perceive as nonpolitical. However, critical reflection of historical figures like Breckinridge can be done with thoughtfulness and compassion.
“Conformity, blind cooperation, and the lack of the questioning of established policies are never avenues to progress or to the attainment of freedom” (Wolf, 1975, as cited in Kagan, 2006).
As nursing embraces social justice as a theory, framework, and practice, we must also reckon with our own legacy of oppression. This process will be dynamic and continuous; we can utilize nursing theory to guide us in this journey. Collective discussion on this topic may prove incendiary at worst or uncomfortable as best. I propose using nursing philosopher’s, Charlene Wheeler and Peggy Chinn (1984), process of “Peace and Power” to guide critical reflection; nurse philosopher and activist, Jo Ann Ashley’s role as a nursing whistle-blower can be employed as justification to engage in this essential process (Kagan, 2006). Radical Nurses have an opportunity, and an imperative, to speak out about the complexity of our own professional, historical figures.
Vanessa Shields-Haas is a radical nurse and co-founder of http://www.radicalnurses.com. She advocates for harm reduction approaches to care and reproductive freedom for women in the deep South.
Click here to learn more about Peace & Power.
American Nurses Association. (2016). The nurse’s role in ethics and human rights: protecting and promoting individual worth, dignity, and human rights in practice setting [Position statement]. Retrieved from https://www.nursingworld.org/~4af078/globalassets/docs/ana/ethics/ethics-and-human-rights-protecting-and-promoting-final-formatted-20161130.pdfc
American Nurses Association. (2015) Code of ethics for nurses with interpretive statements. Silver Spring, MD: America Nurses Association. Retrieved from https://www.nursingworld.org/coe-view-only
Breckinridge, M. (1952). Wide neighborhoods. Lexington, KY: The University Press of Kentucky.
Butts, J.B. & Rich, K. (2018). The philosophies and theories for advanced nursing practice: third edition. Burlington, MA: Jones & Bartlett Learning.
Chinn, P., & Falk-Rafael, A. (2014). Peace and power: a theory of emancipatory group process. Journal of Nursing Scholarship, 47(1), 62-69. https://doi-org.frontier.idm.oclc.org/10.1111/jnu.12101
Kagan, P. (2006). Jo Ann Ashley 30 Years Later: Legacy for Practice. Nursing Science Quarterly 19(4), 317-327.
Walter, R. (2017) Emancipatory nursing praxis. Advances in Nursing Science, 40(3), 225-243. doi: 10.1097/ANS.0000000000000157
Ashley, J.A. in Wolf, K.A. (Ed.). (1977). Jo Ann Ashley: Selected readings (pp.35-52). New York: National League for Nursing Press. (Original work published in 1975).