Contributors*:
Danielle Walker MSN, PMHNP-BC @danielletanika
Robin Cogan, MEd, RN, NCSN, FAAN @RobinCogan
Rae Walker PhD RN FAAN @UMassWalker
Jess Dillard-Wright, PhD, MA, RN, CNM @midwifingtherevolution
Jane Hopkins-Walsh MSN, PNP-BC @_radicalnursing

Once again, the world looks on as the United States wrings its hands, inert in the face of white supremacist gun violence and mass death. The thoughts and prayers offered by politicians are doing what they always do: nothing, because these events are not accompanied by action and policy. We see the same old tired platitudes that are never backed up with political will, the same admonitions to avoid politicizing gun violence and death–as if these things are not political in the first place–when civic urgency for gun policy reform swells. In 2020, firearms deaths supplanted motor vehicle accidents as the leading cause of death for Americans ages 1 to 19, according to an analysis of Centers for Disease Control and Prevention data published recently in the New England Journal of Medicine.

Gun violence is devastating. Lives are abruptly, unexpectedly ended or wholly-transformed on impact. In the wake of the direct impact to the injured and slain, gun violence traumatizes families and communities. This is particularly stark in the aftermath of mass shootings like the recent events in Buffalo, Uvalde, Tulsa, Philadelphia; undoubtedly more mass shootings will unfold in the interval between our writing, Nursology.net’s publication, and your reading of this piece. In these moments, mental health becomes a central topic, often cited as a contributory to the commission of mass shootings. However,  there are far-reaching mental health implications for those  who have experienced or witnessed gun violence and mass shootings. Exposure to these devastating violent events increases the chances of PTSD, depression, anxiety, and substance abuse. The impact is not equitable across demographics, with those of low socioeconomic status and non-white people being more likely to have adverse mental health outcomes (Lowe & Galea, 2017). In a country where rates of mental illness are high, access to mental healthcare is low, and mental health care outcomes are poor, we cannot afford to add to this by inaction on gun regulations.

Like reproductive rights, United States gun legislation varies considerably by state. What is consistent, however, is that that rates of gun deaths–murder, suicide, and accidental deaths– are increasing, with 2020 marking an all time high: a salient concern for nurses working in all healthcare settings. Positions on gun policy generally break along partisan lines, though some policies like universal background checks garner broad bipartisan support. The profound and worsening disconnect between popular support for gun reform and meaningful policy change at the Federal level can be largely understood as a product of oligarchy at the intersections of whiteness, settler-colonialism and capitalism, generating profound inequities in power over policy-making at the highest levels of our government. Gun technology and its culture is deeply rooted in origins and founding of the United States, including the genocide of Indigenous communities and maintenance of a political economy founded on chattel slavery and subjugation of the Global South.

Guns are also big business, estimated in 2018 as bringing in about $28B in annual revenue through gun and ammunition sales to domestic customers and governmental entities like the department of defense–a number that has only grown in recent years as sales of personal firearms including assault-style and militaristic weapons has continued to increase. The business of protecting Americans (or their property) from guns–whether through school shooter drills, school security, backpack inserts, friable bullets, insurance, or other technological innovations and services–is even bigger. Research published by political scientists Martin Gilens and Benjamin Page, analyzing 1,779 U.S. policy outcomes over the course of 20 years, found that, “economic elites and organized groups representing business interests have substantial independent impacts on U.S. government policy, while mass-based interest groups and average citizens have little or no independent influence.” This points to the imperative to not only legislate gun control but to transform campaign finance regulations to curb the disproportionate influence afforded so-called corporate citizens, an influence that swamps what influence is possible for individual and grassroots voters to muster in a late-stage capitalist political economy. 

So, how do we locate hope in times like this? Hope is a practice, not a feeling. In her book, We Do This ‘Til We Free Us, prison abolitionist Mariame Kaba teaches us that “Hope is not optimism; hope isn’t an emotion” (Kaba, 2021, p 16). In this practice of hope, it is imperative that we recognize that we do not have to accept reality as it currently is as a foregone conclusion. Gun violence, terror, oppression–these are not compulsory and these things could be different. What that requires is imagination, a radical one (Haiven & Khasnabish, 2014). Radical imagination demands that we understand hope is a project, “hope is a discipline” (Kaba, 2021, p. 26). Taking up Kaba’s line of thought means we are then charged with resistance and action as a process of hope. We can imagine an alternative, we can see what other nations do to protect people, and we must think, organize and act as if this is possible.

Our title includes the phrase, “the point is to change it,” taken from political philosopher Karl Marx’s (1888) Theses on Feuerbach. The entire thesis reads “Philosophers have hitherto only interpreted the world in various ways; the point is to change it,” imploring philosophers to attend to the material and embodied realities of the world around them, inspiring them to political action as they come to know the world and its injustices. Nursing interprets — and co-creates — the world in various ways, but as a practice discipline, we have a commitment and an obligation to recognize where things need changing and then make those changes happen. This is our praxis of hope. Our only hope, particularly if we accept, as philosopher Leonard Harris (2020) posits, the only moral arc is the one we create.

What we have outlined here are the environment-health connections, connections that link gun violence to nursing, to nurses, to nursing theory that cannot be separated from the structural forces of politics, capitalism, history, white supremacy. Theory–including nursing theory– is praxis, action; not abstract but a move to change in the world. Nursing theory is inherently political because theory (and theorizers) are linked to time and space, and both must be contextualized as such to address the material realities of human and nonhuman experience, such as wealth inequities, climate change, species extinction, war, oppression, white supremacy, and gun violence, among others.

Transformation, co-creation, and worldbuilding are well within the purview of nursing. Nursing theory is replete with concepts like health, environment, care, caring, wellbeing and wellbecoming (Roy, 2019; Smith, 2019). These notions are directly linked to an imperative to address threats to health and wellness, inclusive of gun violence and its political economies as well as other oppressive and structural threats. This means that addressing gun violence is central to nursing’s “central unifying focus” and the mandate of the discipline (Willis et al., 2008, p. e28). This requires us to see the connections, to act on them. We can reimagine nursing theory as resistance and hope if we chose to think of theory as liberation (hooks, 1991).

We conclude with speculation and with possible actions. Imagine a movement propelled by the massive political capital of nursing–there are more than 100 professional nursing organizations, representing more than 4 million practicing nurses. The irony of nursing organizations promoting advocacy as an ethical standard of practice (Matthews, 2012) rings hollow as many will not take meaningful political action under the umbrella of remaining apolitical.

Abolitionist organizer Mariame Kaba writes that “your timeline is not the timeline on which movements occur… We are not even close to being around to see the end of it” (Kaba, 2021 p. 27). Kaba’s writing compels us to act, understanding that although we, as community members and nurses, are living a tiny part of this big story, taking the long view means taking a stand in the world. This means building different kinds of presents and futures, collectively and with an eye for justice and safety for all people. Below, we list suggestions for nurses to move from theory to action to end gun violence. We invite ongoing engagement and discussion.

10 ACTIONS

1. Recognize interconnections between gun violence and other forms of violence that shape our society, as all oppression is connected.
2. Show up for and develop deeper relationships with organizers and activists in movements to address racial justice issues such as the school-to-prison pipeline, family policing system, continued expansion of the carceral state into schools and other spaces of our communities, state-sanctioned violence and police brutality particularly against communities of color.
3. Connect disability justice issues like the urgent need to create more safe and accessible spaces for learning and working.
4. Engage LGBTQ+ justice issues like trans panic defenses and violence against queer and trans individuals.
5. Seek understanding of the intersections of violence and reproductive justice, including the disproportionate rates of domestic violence and especially gun violence perpetuated against pregnant and birthing persons.
6. Conceptualize climate justice issues – like the exacerbating effects of a worsening climate and its associated harms, such as pandemics – and how they compromise health and safety..
7. Follow coauthor PhD Candidate Danielle Walker and her work with colleagues at the RACISM-BASED VIOLENCE INJURY PREVENTION LAB at Boston College School of Social Work. @RBVIP_lab on Twitter
8. Stay up to date on current actions, policies and news by following coauthor Relentless School Nurse coautor Robin Cogan – on Twitter @RobinCogan and her blog here;
9. Register to vote and confirm your voter status. Volunteer to Power the Polls and protect the right to vote. Engage with your elected officials at local, state and federal levels to demand and support legislation to end gun violence.
10. Join ongoing actions, like the ones from Healthcare Workers Against Gun Violence.Sign up here to join the actions. Follow @ThisIsOurLane and use #NursesForGunSafety, #DoctorsForGunSafety, and #ThisIsOurLane on Twitter to harness the power of social media and stay connected. The point is to change it.

References

Haiven, M., & Khasnabish, A. (2014). The Radical Imagination. Fernwood Publishing.

Harris, L. (2020). A Philosophy of Struggle: The Leonard Harris Reader (L. A. M. III, Ed.). Bloomsbury Academic.

hooks,  bell. (1991). Theory as Liberatory Practice. Yale Journal of Law and Feminism, 4, 1.

Lowe, S. R., & Galea, S. (2017). The Mental Health Consequences of Mass Shootings. Trauma, Violence & Abuse, 18(1), 62–82.

Marx, K. (1888). Theses on Feuerbach. https://www.marxists.org/archive/marx/works/1845/theses/theses.htm

Matthews, J., (January 31, 2012) “Role of Professional Organizations in Advocating for the                   Nursing Profession” OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 1, Manuscript 3.

Roy, C. (2019). Nursing Knowledge in the 21st Century: Domain-Derived and Basic Science Practice-Shaped. Advances in Nursing Science, 42(1), 28–42. https://doi.org/10.1097/ANS.0000000000000240

Smith, M. C. (2019). Regenerating Nursing’s Disciplinary Perspective. Advances in Nursing Science, 42(1), 3–16. https://doi.org/10.1097/ANS.0000000000000241

Willis, D. G., Grace, P. J., & Roy, C. (2008). A Central Unifying Focus for the Discipline: Facilitating Humanization, Meaning, Choice, Quality of Life, and Healing in Living and Dying. Advances in Nursing Science, 31(1), E28–E40. https://doi.org/10.1097/01.ANS.0000311534.04059.d9

*About the authors:

In the spirit of community building, we reject the competitive idea of first authorship. This post is the result of collaborative thinking and writing and, to that end, we embrace and assert coequal authorship. As authors, nurses and citizens, we have disparate connections to gun violence, through combinations of clinical care, scholarship, activism, and lived experience. Some of us have experienced gun violence first hand. Some of us have deep personal connections to mass shooting events. Individually, we have cared for people harmed by gun violence in emergency, critical care, and primary care settings. Collectively, our work strives to center students, individuals, families and communities disproportionately impacted by gun violence, including state-sanctioned police gun violence.