Nursing in the 21st Century: A New Call to Action - June 14, 2003

Associate Dean Nyamathi, Chancellor Carnesale, Dean Cowan, distinguished faculty, and above all, honored graduates, families, and friends. It is a very special privilege for me to address you on this, your day.

The occasion is made poignant by my memories of a UCLA graduation seven years ago, which I attended as a proud parent -- beaming as my daughter Lisa received her PhD in psychology and addressed the graduates. This was just a few short years before she engaged in the battle of her life against cancer.

I am overwhelmed and humbled to receive the UCLA Medal. Twenty years ago, this school nurse from Santa Barbara never would have believed that one day I would be honored by one of the world's pre-eminent academic institutions with an award given to such distinguished luminaries as former Presidents Jimmy Carter and Bill Clinton, Israeli Prime Minister Shimon Peres, and actor Laurence Olivier. I will do everything I can to live up to the honor you are bestowing on me here today.

And I am so pleased to receive this award as we gather here today to honor the new nurses graduating. This year the UCLA medal is given to a nurse, one of your own—and so I accept it in your name and in honor of our profession.

This is your day and I want to speak to you about the career you have chosen.

First of all -- Congratulations! You did it! You have all worked hard to get here and you, your families, and your teachers deserve to be proud of your accomplishments.

Today marks a significant achievement in your lives, and for our health care system. Some of you will now join the health care workforce for the first time, some will be rejoining it, and others will continue their education. But all of you will continue to make the delivery of health care your priority and I hope your life's work. It is a serious and honorable responsibility. But I want to give you an added charge.

I have always said that nursing is not just a job, but a calling. You have all answered that call, but it needs more than your best work at the bedside of a patient. Because of your training, your expertise, and your compassion you will be looked to for advice and strength. You will be trusted. And you must live up to the responsibility of that trust. So I call upon you to look beyond the day-to-day health care needs—the details that will fill your lives, and look for opportunities to make broader impact on both our life's work and our society.

Recently I had the privilege of traveling to South Africa. For decades, the vast majority of people in that nation were deprived of basic rights. The Apartheid system denied them legitimacy as human beings and standing in the eyes of their government. They were prevented from playing any role in deciding how their society would address the issues that deeply affected their lives.

As they looked at the obstacles they faced, at the challenges they wanted to overcome, and as they thought of possible solutions, they were blocked from exploring them with their country. This went on for generations until the end of apartheid in 1991.

Now South Africa is struggling to deal with the consequences of the decades of brutal division and suppression of its populace. They are rebuilding all the institutions of their nation. Their economy is in poor shape. Their health care system is struggling to keep up with the country's needs. And because of our nursing shortage many of their best-trained nurses are being lured to U.S. hospitals. And like many African nations, the AIDS epidemic is wreaking havoc on their society.

I remember when they held their first free elections. The news was filled with images of men and women standing for hours in lines that seemed to go on for miles, just to vote. And when I went there recently I was struck by the commitment I saw. The unstoppable drive to work together to solve their problems and overcome their challenges.

For so long these people had been denied any chance to take control of their lives. Now they will not allow anything to stop them. They will stand up and participate in their society. They will vote. They will volunteer. They will work together to address challenges. They will never again allow the problems of their lives to be resolved without their input.

Their commitment to their nation is something we here in America should look to as a shining example. In this country we do not face the problems as they do in South Africa. We are not building a nation all over again. But despite our wealth and history of stability, we face serious challenges of our own.

Make no mistake; our country is facing a health care crisis. We have been limping along for years, addressing individual problems in our creaking health care system in a piecemeal way. But we are now facing a confluence of events that threaten to deny millions of Americans access to critical health care.

For the last three years our economy has been struggling. Unemployment is at a nine year high. And States are facing the worst fiscal crises in years. On their own these are serious problems. Taken together they mean frightening things for health care in the United States. And there are other problems we must confront.

After years of Congressional debate, millions of American seniors are still without prescription drug coverage. Our parents and grandparents have spent their lives taking care of us. Now many of them are being denied access to the most advanced treatments because they cannot afford them.

But they are not the only ones who are without essential health care. Recent surveys have indicated that somewhere between 30 and 70 million Americans have gone without health insurance for a part of a year. The struggling economy and high unemployment is only going to make it harder for people to afford health insurance. We have programs like Medicaid to help deal with this problem, but many states, including California, are looking at making cuts in Medicaid to balance their budgets.

As you all know, the uninsured don't get access to everyday health care. When they get sick, they try to muddle through until their condition gets so bad they cannot ignore it. At that point they go to an emergency room. The care they get is more expensive and less effective than earlier treatments could be. This drives up the cost of health care for everyone and puts an enormous burden on hospitals, emergency rooms, and their staffs—not to mention the uninsured themselves.

These costs add to the problems our health care facilities already face. In the face of rising health care costs, insurance companies and HMOs are tightening their belts and cutting payments to hospitals and other health care institutions. Medicare, Medicaid, and the states are also cutting payments to these facilities as part of efforts to balance their budgets.

Many hospitals are finding it more difficult to stay open with these cuts. Trauma centers have to close their doors because they don't have enough funding, leaving communities with nowhere to turn for emergency care. Nursing homes are unable to provide care for our parents and grandparents with such limited resources. And state agencies and local health care providers are struggling to improve their ability to respond to terrorism even as their budgets are being pared back.

In short, our entire health care infrastructure is in danger because of insufficient attention and misplaced priorities, misdirected resources, and inefficient delivery system.

Finally, and most relevant to you all today, is the danger of a growing nursing shortage. Nurses are the backbone of the public health infrastructure -- we are the first line of defense in health care.

And today the nursing community is facing a dire situation. With an aging nursing workforce approaching retirement, and a dwindling supply of new nurses, we are facing an incredible shortfall of well-trained, experienced nurses. To make matters worse, this shortage will peak just as the baby boom generation begins to retire and require a greater amount of care.

We are truly at a crossroads.

Since September 11, 2001, we have been reminded of just how important our first responders are, including nurses. And as our nation prepares itself for a world of new challenges and threats we have to strengthen our health system by making sure there are enough nurses to make the system work.