Opinion Paper: Revisiting Speaking Truth to Power

By Canales, Mary K. PhD, RN

           Author Information Advances in Nursing Science 48(4):p 331-334, October/December 2025. | DOI: 10.1097/ANS.0000000000000593

Free

I  just hope that the coalition of forces that put on the march [on  Washington] can be kept together for the more difficult struggles that  lie ahead.

—Bayard Rustin1 

IN THE United States, there are many “difficult  struggles that lie ahead” for nurses and the communities they serve  including, but not limited to, massive financial and labor cuts to  federal research, public health, and science agencies; reductions in  funding for government health insurance and food support programs for  the poor and working classes; and elimination of environmental and  climate change initiatives designed to improve air and water quality.2 Revisiting Falk-Rafael’s3Advances in Nursing Science article amidst today’s chaotic time provides an opportunity to rethink  critical caring as the theoretical framework for nurses’ political  engagement and consider grassroots democracy (GD) as a more relevant  alternative.

Through primarily a public health lens, Falk-Rafael3(p.212) positions speaking truth to power as a “moral imperative” with multiple  obligatory reasons supporting nurses need to be politically motivated  and engaged to address the social determinants of health, especially the  significant economic inequities that disproportionately affect the  poor. Although I agree that “political activism/advocacy is rarely a  salient feature of nursing practice,” I question if nurses agree with  her conclusion that they are “ideally situated and morally obligated” to  engage in sociopolitical advocacy.3(p.212) Take for example H.R. 1, the Reconciliation Bill, recently passed by the U.S. Congress.4 Alongside the American Medical Association prediction that the bill will exacerbate existing wealth and health inequities,5 the American Nurses Association outlined the devastating effects  Medicaid cuts will have particularly on rural and underserved areas.6 Yet 2 of 3 elected nurses in the House of Representatives voted in favor of its passage.7 Were these nurse legislators, who were “ideally situated” not also  “morally obligated” to adhere to their “social contract” with society  and vote against such draconian legislation? When ideology trumps  morality among nurses best positioned to enact positive changes for the  population, how does the average nurse respond to the profession’s  continued appeal to nurses’ moral obligation as the rationale for  engaging in political activism, which Falk-Rafael3 dated to Nightingale’s time?

In the United States, the first Code of Ethics  approved by the ANA in 1950 strongly supported active political  engagement, stating that “the nurse recognizes and performs the duties  of citizenship”, including voting and holding elected office and claimed  that it is “inherent” within the Code that the nurse “subscribes to  democratic values.”8(p.1247) This language was subsequently eliminated from future codes until the  most recent 2025 version, which now states, “nurses have a role at every  level of the democratic process,” including but not limited to  “informed voting in local and national elections; running for office;  combating voter suppression.”9 Although these latest pronouncements are to be commended, the question  remains: will the 2025 Code have any more effect on overcoming barriers  to nurses’ political engagement than efforts of early nurse leaders, the  1950 ANA Code of Ethics, or Falk-Rafael’s appeal to a higher moral  calling to improve U.S. population health outcomes?

Recent systematic reviews of nurses’ political participation indicate that barriers persist. For example, Woodward et al’s10 review suggested that significant obstacles to individual nurses’  political participation could be addressed through increasing personal  interest in political knowledge and information and membership in  professional organizations, yet Han and colleagues11 reported that individual barriers such as nurses’ lack of political  interest combined with organizational challenges, especially poor  working environments – high stress, shift work, long hours, insufficient  staffing levels – and perceptions that nursing organizations’ lack  political power, continue to limit nurses’ political engagement.

Falk-Rafael3 offered critical caring as a framework for addressing nurses’ lack of  political engagement, linking such engagement to nurses’ better selves –  their moral social contract with the populations they serve. Although  calling upon nurses’ better selves is admirable, their continued limited  action in the political arena combined with professional nursing  organizations stepping back from their own political activity, suggests a  new framework is needed.  

In 1942, when Bayard Rustin initially employed the phrase, speaking truth to power,  he did so within the context of war, believing that pacifism and  non-violence were the “creative methods” to deal with conflict.1(p.4) Rustin’s leadership during the civil rights movement culminated with  his key role organizing the 1963 March on Washington for Jobs and  Freedom, an event that began mobilizing the country to address  segregation, economic inequality, and voting rights.1 In the context of the many struggles the country faces today, such a  movement is once again needed. It is time to shift away from critical  caring, a values-based, virtue-laden approach, and toward a  people-centered movement, like the civil rights movement of Rustin’s  time. I believe that grassroots democracy (GD) employing community  organizing and social mobilization strategies offers nurses another  avenue for becoming politically involved.

Rustin wanted to transform the March on  Washington’s success into a long-term movement, writing that the  coalition of forces represents “a new entity commonly called ‘the big  tent’” that could sustain lasting change.1(p.277) This “big tent” is central to GD, which focuses “on core democratic  themes such as equality, participation, and consensus at the  community/organization level.”12(p.3056) GD “as an alternative pathway to political change… emphasizes informal  and decentralized structures” with community organizing a key strategy.12(p.3060) GD movements often have “structures of cooperation or affinity groups”,  that support new kinds of relationships among activists, providing a  safe space within an often-contentious political environment.12(p.3061) Central to successful GD movements, elements of which may resonate with  nurses, are “mutual trust, respect, and care within the activist  group.”,12(p.3061) Rather than care being the theoretical framework for action as Falk-Rafael3 promoted, care is one of many elements supporting activist efforts, including relationship building.

Through GD and its accompanying strategies of  community organizing and social movements, there are many opportunities  for nurses to become engaged with, and part of local, regional, and  national mobilization efforts. I strongly believe that an increase in  political engagement will only be realized when nurses shift away from a  reliance on official, monetized professional nursing organizations and  instead, become part of communities that are member-driven, from the  grassroots up rather than from professional leadership down. Considering  the workplace constraints previously identified, nurses often see  political activism as one more task in a long list of duties they are  already asked to do. Fortunately, GD provides a wide array of options as  time and ability allows. The following three examples of member-driven  organizations exemplify Rustin’s “creative methods”,1(p.4) whose volunteers are dedicated to mobilizing various communities to  address the many health-related challenges facing the United States.

The Relentless School Nurse aka Robin Cogan  demonstrates the influence one volunteer nurse can have through  individual activism that engages nurses and other health professionals  at local, regional, and national levels.13 Through a weekly blog, with over 13 000 free subscribers, a Facebook  presence, with almost 7000 followers, and podcasts, videos, and articles  available on the website, The Relentless School Nurse advocates for  children and families, nurses and other health providers, and the public  by providing evidence-based information and avenues for addressing  pressing issues. For example, The Relentless School Nurse recently  called nurses to “stand-up” to save the Nurses’ Health Study (NHS), “the  foundation of women’s health research” for 50 years, from proposed  funding elimination.14 Information is provided about the NHS, specific action steps, including  how to contact NHS study leaders and federal legislators, and ways to  mobilize public support. From reading a weekly blog, to contacting a  legislator, to becoming the next Relentless XXX Nurse – you fill in the  blank – nurses can be part of GD efforts.

Another avenue for involvement is joining a  member-driven, in-kind national nursing organization dedicated to  shaping health policy through political engagement. Nurses for America  (NFA) began as a grassroots nursing organization to support the 2020  democratic presidential candidate (2025).15 Its mandate has broadened, with the development of a newsletter and  social media presence to educate nurse members about national health  care issues; a committee focused on endorsing state and national  candidates supportive of a comprehensive health care for all agenda; and  partnerships with other organizations to harness increased political  power.15 The organization is free to join, relies on volunteers for all its  activities, and provides many opportunities for nurses to participate.  Through NFA, nurses engage with other nurses committed to health policy  and election reforms while also collaborating with other  multidisciplinary grassroots health organizations such as Defend Public  Health (DPH).16

DPH was “born” in late 2024 when “hundreds of  health care providers, scientists, advocates, and allies responded” to a  call-out on social media posted by a group of alarmed public health  researchers concerned about further erosion of the public health system  under the new administration.16 DPH exemplifies the new networks forming “to bridge agendas, pressure  institutions, and build advocacy power in support of public health.”17(p.108) Like NFA, DPH is volunteer-driven with a coordinating committee that  supports over 4000 members across the country dedicated to protecting  the health of all, supporting proven, science-based public health  policies, and responding collectively to nominations of anti-science  officials.16 Through an active social media presence, publication of editorials and  articles in legacy media, general and topic-specific online meetings,  and communication trainings for members, nurse members can connect with  scientists and practitioners who are action-oriented and committed to  preventing “the destruction of the world’s most successful health policy  and medical research apparatus.”16 DPH is an example of how GD supports activism during times of duress;  with speed, efficiency, trust in volunteer organizers, and community  building across disciplines, a new entity grounded in the present and  positioned for the future was created.

These GD examples highlight a few of the many  opportunities available for nurses to engage in the health policy arena,  gain political knowledge, apply their organizing skills in a new  context, and live the values of mutual trust, respect, and care that  ground many nurses’ actions. While Falk-Rafael3 encouraged nurses to speak truth to power from a critical caring  perspective, today’s political divisiveness and increasing violence  calls nurses to return to the phrase’s original context, engaging in  peaceful, non-violent movements as part of “the coalition of forces,”1(p.272) committed to Rustin’s goal of achieving social change through  democratic processes. There is space for every nurse in the big tent of  grassroots democracy.

link to this article and references: https://journals.lww.com/advancesinnursingscience/fulltext/2025/10000/opinion_paper__revisiting_speaking_truth_to_power_.8.aspx